[Congressional Record Volume 140, Number 22 (Thursday, March 3, 1994)]
[Senate]
[Page S]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: March 3, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
                    THE PRESIDENT'S HEALTH CARE PLAN

  Mr. GRAMM. Mr. President, I wanted to talk a little bit about health 
care and respond to something the President said yesterday about the 
declining popularity of his proposed health care plan. I will also talk 
about the meeting or retreat which Republicans begin this afternoon and 
will continue until tomorrow, in our effort to try to come up with a 
united position on health care reform.
  Let me first talk about the President's health care plan. I believe 
that support for the President's plan has declined every day since it 
was made public by him in a very excellent speech to a joint session of 
Congress. The President yesterday attributed that decline in support to 
special interests. I believe the decline in support is more basic than 
that. Not only has support for the plan declined every day since the 
public first heard about it, but the polls have consistently shown 
something that I think is very important, which is that the more people 
know about the President's plan, the more likely they are to oppose it.
  Let me just try to summarize what I think is right about the 
President's plan and what I think is wrong about it. What I think is 
right about the President's plan is that there are parts of America's 
health care system that are broken. We can fix the system and make it 
possible for people to change jobs without losing their health 
insurance. Every one of the proposals that has been made to reform 
health care, every single bill--those offered by Republicans; those 
offered by Democrats--has had a provision that would make it possible 
for people to change jobs without losing their health insurance.
  I believe the President is right that people should be able to buy 
health insurance that can never be taken away and cannot be canceled. I 
remember growing up in the fifties. My mama bought an insurance policy 
and paid on it 4 or 5 years. She had a major ailment, and the insurance 
company paid for the first episode of medical care and then immediately 
canceled. What good is health insurance if you do not have it when you 
need it? The good news is that while that happened a lot in the 
fifties, it rarely happens today. But the point is that it ought never 
happen. We can fix that.
  I believe the President is also right that we need to do something 
about excessive paperwork and we need to do something about the 
regulatory burden. But the paradox is that while the Government now 
pays 31 percent of the medical bills and generates two-thirds of the 
paperwork, the President would have us believe that if we turn the 
whole system over to the Government, somehow  the paperwork and 
regulatory burden will disappear. I do not think people believe that.

  We need medical liability reform. The President touches on it in his 
bill. I do not think it is a very dramatic change to limit contingency 
fees to 30 percent, every other health bill proposed has had a more 
comprehensive medical liability provision than the President's. But I 
agree with the President that there is a problem and in fact a crisis, 
depending on who you are and the status of your health care.
  I have never gotten into this silly debate about whether there is a 
problem or whether there is a crisis in health care. I think whether 
there is a problem or a crisis depends on who you are and what your 
circumstances are. Certainly, if you are in the process of changing 
jobs and you find out you or somebody else in your family is very sick 
and you have lost your health insurance in that transition, that is a 
crisis. If you are worried about paying the Nation's bills and you look 
at the exploding cost of Medicare and Medicaid, if it is not a crisis, 
it is close to it.
  There clearly are problems. The point is--and where I differ with the 
President--is that I believe we can fix what is wrong in the American 
medical care system without destroying what is right. If our objective 
is to try to help every American get health insurance, why would we 
want to destroy coverage for the 85 percent of all Americans who now 
have it in order to try to help the 15 percent who do not?
  I think where the President's plan gets off track--and where it has 
lost public support--is that while the President talks about access and 
talks about universal coverage, the reality is that only 19 pages of 
the President's plan have anything to do with universal coverage. The 
other 1,323 pages have to do with the Government taking over and 
running the health care system.
  I think where the American people have parted company with the 
President, and where Congress, Democrats and Republicans in Congress, 
are parting company with the President, is that we do not believe, and 
the American people do not believe, that having the Government take 
over and run the health care system is going to solve our problems. I 
believe the American people think that what we need to do is preserve 
the things about our health care system that we recognize as second to 
none: The quality, the access to the science and technology that have 
revolutionized American medicine and world medicine, and our right to 
choose. What we should do is change the system to help all Americans 
get and keep private health insurance; to make it possible for people 
who change jobs or who get sick to not lose their health insurance. But 
we should not force people out of the private sector into a Government 
health program.
  Here are the things that I think represent problems with the 
President's bill and, to some extent, with the Cooper bill; and it is 
because the American public is recognizing these problems that I 
believe we are going to be able to first build a consensus among 
Republicans and then, hopefully, sit down with Democrats to try to work 
out a bipartisan bill.
  I do not see a health care bill passing with 55 votes. I expect a 
health care bill to pass with 80 votes, and I expect it to pass with 40 
Republicans and 40 Democrats, because I think, in the final analysis, 
we are going to decide that we do not want the Government to take over 
and run the health care system; that we want to try to build on the 
strengths of the system and we want to try to fix the parts that are 
broken, but we do not want to tear down the whole health care system of 
the country and recreate it in the image of Government.
  Where I think the President gets off track is when he attempts to 
limit people's freedom. Under the President's plan, if you do not work 
for the Federal Government and you do not work for a company that has 
5,000 or more employees, your health insurance is going to be canceled. 
You are going to be forced to buy health care and health insurance 
through a Government-run cooperative that will be a monopoly buyer in 
your region.
  The American people have looked at this, and I think they have 
rightly been concerned about a seven-member board in Washington, DC, 
that is going to dictate the principles under which health care will be 
practiced nationwide. I do not think it is because the President would 
appoint this board. I would not be happy with this board if we had the 
seven wisest people on Earth as members of it. I would not be happy 
with it if a Republican appointed them. I do not think any seven people 
ought to have that much power.
  The idea that anyone would force people to give up their private 
health insurance I think is alien to the American character. I am 
against the President's plan not just because it will not work, but 
because it is at variance with the basic character of the American 
people to say to someone who has a good Blue Cross/Blue Shield or other 
insurance policy, who is happy with it, that they have to give up that 
policy and they have to then buy their health care and their health 
insurance through a Government-controlled agency, I think people reject 
that.
  I think they also reject the idea that the Government ought to tell 
us what kind of insurance we should have. If the Government wants to 
provide information, if the Government wants to help make us wiser 
purchasers of health care by sharing information with us, I think 
people are for that. But I do not believe that people think the Federal 
Government ought to be telling people what kind of health insurance 
they need.
  I think the American people believe that each family ought to have 
the freedom and flexibility to buy the coverage they want.
  It is not a good idea to force everyone, for example, into a system 
where they are covered for alcohol and drug rehabilitation. Those are 
real costs, but in many States those requirements have driven up the 
cost of health insurance by 12 to 14 percent. The fact that we ought to 
mandate, as the President does, that every American be covered for 
participation in encounter groups--I do not know what an encounter 
group is. It may well be that an encounter group is useful. The point 
is, to take just one scenario, if a healthy 26-year-old is married to a 
healthy 23-year-old and they have three little children and are not 
allowed to buy the insurance of their choice in case little Sarah has 
to have an appendectomy or in case Johnny falls down and breaks his 
arm, and they are forced into a plan with all this exotic coverage 
which costs them money and denies them access just does not make any 
sense.
  We Republicans are going to meet in Annapolis this afternoon to try 
to come together and support a unified set of principles and ultimately 
later to produce a bill. We are not going to produce a bill by the end 
of this meeting. I think we all know it.
  But I think what has happened as people reject the parts of the 
President's program that use the coercive power of Government to force 
people into the collectivization of health care purchases, is that the 
rejection of the President's plan has created the opportunity to bring 
both Republicans and Democrats together.
  One of the main things that Republicans differ from the President on 
is the role of Government. Should we have Government set up these 
alliances, and control the purchase of health care?
  The President's plan says if you work for a company that has 5,000 or 
fewer employees, your insurance is canceled and you have to buy health 
care through this Government agency. The Cooper plan says the cutoff 
point is 100 employees, that if you work for a company with 100 or 
fewer employees, your insurance is canceled and you are going to have 
to buy insurance and health care through these Government-run 
cooperatives.
  My answer is that the magic number is not 5,000, and it is not 100. 
The magic number is 1. I do not think we ought to deny one American 
freedom to choose his or her own health insurance. If our objective is 
to help everybody get health insurance, why should we want to cancel 
the health insurance policies of the people who have health insurance 
today? I think that makes absolutely no sense.
  So as we reject the idea that we should cancel people's health 
insurance and make them buy through mandatory Government programs, I 
think that is ultimately going to bring Democrats and Republicans 
closer together. I believe that the health care purchasing cooperative 
would be ineffective in any shape, form, or fashion, other than simply 
allowing free people through organizations or through businesses to 
pool voluntarily in an effort to reduce cost. But any element of 
mandated pooling, anything that takes away from people their right to 
choose, that I am against. I believe ultimately when we vote on the 
floor of the U.S. Senate on these mandatory health care purchasing 
collectives which will force people to cancel their insurance, force 
them to buy through Government, and when we look at the President's 
extraordinary provision which provides a $10,000  fine for anybody who 
tries to sell private health insurance in competition with the 
Government, that is not going to survive a debate or a vote on the 
floor of the Senate.

  So I think a consensus can be reached when Democrats and Republicans 
catch up with the American people, reject mandatory purchasing 
cooperatives, and reject the idea of Government deciding what kind of 
health insurance people should buy. When we focus on the parts of the 
system that are broken, when we provide a workable plan so people can 
keep bridge coverage when they lose their jobs and retain their 
insurance until they get a new job, when we change the system to make 
insurance permanent, when we deal with medical liability, when we force 
the Government to reduce paperwork, when we allow free individuals and 
institutions to voluntarily pool to buy health insurance, and when we 
reform Medicaid and use the savings to give refundable tax credits to 
working moderate income people so they can buy private health 
insurance, then I think we are going to find a consensus on those 
issues. I believe the American people support those reforms.
  So, the basic difference that exists among Republicans and among 
Democrats is really a difference about the role of Government.
  The President believes that we should tear down the current system 
and start over. I reject that. I cannot see destroying the greatest 
medical system in history to start over and rebuild it in the 
Government's image.
  What we need to do is take the parts of the system that are broken 
and fix them and we need an aggressive program to fix them. I do not 
defend the status quo. I did not create the status quo. There are many 
things about the status quo that I do not support, but I do not believe 
that we should be destroying the greatest medical care system in 
history with the idea that by having Government re-create it, that we 
will be improving it.
  Let me also say that when some of my colleagues longingly look toward 
Canada as being an ideal place where medical care is perfect, it 
strikes me as somewhat paradoxical that nobody that I have ever heard 
of in the United States of America went to Canada to get health care. 
Yet I see Canadians who either have the money or have political 
influence come to the United States every single day to get health 
care.
  So I would say, in conclusion, Mr. President, that I want to pass a 
health care bill this year. There is absolutely no reason that we 
cannot dramatically reform the health care system to fix the parts of 
the system that are broken, to make the system more cost conscious, to 
make it more competitive, to make it more efficient. But we are not 
going to find cost consciousness in Government, we are not going to 
find efficiency in Government. We are going to find it by promoting 
price competition, by making consumers more cost conscious and more 
responsible for their own individual actions.
  I am hopeful that Republicans in Annapolis today and tomorrow will 
come closer together, will agree to write a health care plan that 
builds on the principles we believe in--the right of people to choose, 
a belief that price competition promotes efficiency and economy. I am 
hopeful that as the American people, as they seem to be doing in their 
great wisdom, reject all the coercive Government bureaucracy in the 
President's program--that we can all come together, put together a 
bipartisan health care reform package, get 80 percent of the Senate to 
vote for it, and show the American people that we, in fact, can do the 
job they want us to do. I look forward to that.
  I thank the Chair for his indulgence, and I yield the floor.
  The PRESIDING OFFICER. The Senator from Texas has consumed 10 
generous minutes.
  Mr. GRAMM. Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. LEAHY. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. LEAHY. Mr. President, what is the parliamentary situation?
  The PRESIDING OFFICER. The Senate is currently in morning business.
  Mr. LEAHY. Is there a limitation of time Senators can be recognized?
  The PRESIDING OFFICER. There is 10-minute limitation.
  The Senator is recognized for 10 minutes.

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