[Congressional Record Volume 140, Number 25 (Wednesday, March 9, 1994)]
[House]
[Page H]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]
[Congressional Record: March 9, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]
HEALTH CARE IN AMERICA
The SPEAKER pro tempore. Under the Speaker's announced policy of
February 11, 1994, the gentleman from Georgia [Mr. Kingston] is
recognized for 30 minutes.
Mr. KINGSTON. Mr. Speaker, I know that the gentleman from New York
[Mr. Solomon] is here and wants to talk about the budget. If the
gentleman is interested, I will have a few comments on health care, and
also we can tie it into the budget, because there are a number of
issues that I know will affect the folks of New York. If the gentleman
would like to mention anything about health care, I would be happy to
talk to you about it.
I think one of the things that is significant about the budget debate
and one of the things I appreciate the gentleman's leadership on, is
the fact that as we look at the budget, if we look at the revenues that
came into the coffers in 1980, I believe it was $517 billion, and in
1990 it was about $1 trillion.
The only problem is that during that period of time, our spending
outpaced our collections. So instead of balancing the budget with a
period of increased revenues, we continued at deficit levels, and, as a
result, we have I think as of February 9 a $4.51 trillion debt.
One of the things that I would like to do is, if we consider as one
of the proposals possibly a freeze, particularly in certain sections of
our budget, then we would have an opportunity to allow revenues to
catch up with spending. We could pay off the deficit as a result of
that, if not the first 2 or 3 years, certainly in the 4th or 5th year.
And then, along with that, what we could do is balance the budget, and
then pay down the debt, which right now is about 14 to 18 percent of
the total budget that we are spending. And it is very hard for Members
of Congress to go back and explain to people on Social Security or on
welfare or educators who are looking out for Head Start or other
programs that we do not have enough money, and yet 14 percent of what
our expenditures are are going just on interest on the national debt.
So I certainly appreciate the leadership of the people on the Budget
Committee, people like Mr. Kasich and Mr. Shays and Mr. Solomon in that
regard.
I want to talk a little bit about health care, because during the
last week there have been a number of polls that have come out about
the Clinton health care plan and about some of the various proposals.
I think one of the ones that was of interest is the fact that the
Washington Post had a poll that came out I think last Tuesday that said
8 out of 10 Americans are concerned that the quality of their health
care would be decreased under the Clinton program. Yet they were not
blaming that on the Clinton program per se; they were blaming that on
the bureaucracy that would be running the program.
One of the questions that I get at home in town meetings is, is this
nationalized health care? When I answer that question, I always say let
me just tell you what the National Health Care Board does, and then you
decide.
The National Health Care Board would be charged with a number of
things. But among them are developing and implementing a national
health insurance system; setting standards for doctors and health care
providers; prohibiting health care providers from performing certain
procedures not deemed necessary. That would be, of course, protocol
laws. Write and develop and approve language for insurance policies;
gather information and evaluate it; control health care costs; set
community rates on a national basis; have an oversight power for drug
pricing; set health care budgets in the form of insurance premium caps;
and the list goes on and on. And I have tried to document this as much
as possible.
Most of the power of the National Health Care Board is in section
1503, section 22, section 1911, section 1571, and section 1141. It
shows what the National Health Care Board does. And in the sense that
they would be running 14 percent of the GNP, then I think you could
certainly make the argument that the Government would become the sole
controller, or they would have the governing authority on almost all
health care matters.
The second question people ask me is how much would that bureaucracy
cost. And generally it is going to cost about $400 billion over a 5-
year period of time. The National Health Care Board alone would be
about $2 billion. This is all part of the program.
The bill is, 1342 pages long, so it is not something that we can
always predict in terms of cost. But people have asked what would the
cost be? Even if that is the case, is the Government that far off being
wrong now? One of the things that came out last week or the week before
was that the nonpartisan Congressional Budget Office said that the
Clinton health care plan would actually increase the deficit $74
billion rather than decrease it $50 billion, which is what the
President had said.
But look at the Government track record when it comes to evaluating
the cost of programs. If we go back to the 1960's, we find that in its
early days, Medicare actually ran 70 percent above the projected budget
for the first 5 years that it was in operation. And in countries such
as Canada and France and Germany, where you have socialized medicine
plans, there are constant budget crises. Canada, I believe in December,
came out in the Province of Ontario and said the hospitals had to cut
about $200 million from their budget and there they required hospital
staff to take 12 days of unpaid leave and closed down about 250
hospital beds since last year. That is just a small example.
Now, one of the things that also has come up in the last week was
this situation where the DNC has got a quote in an ad that Governor
Carroll Campbell is saying there is not a health care crisis, which is
too bad, because he never made that statement. He was saying there
certainly is a crisis. The crisis is more pronounced in some areas of
the economy and for some people than it is for others.
It is a complete misrepresentation of his words. But if we do dare to
examine who is the 37 million who are uninsured, we find that 70
percent of these 37 million are transient uninsured, and that they are
going in and out of the system as they are finding a new job or they
are temporarily out of work, and so forth.
Many of them are on COBRA. But that leaves about 11 million hardcore
uninsured. And those are the folks who are the working poor, the folks
with the high risk health problems like multiple sclerosis and cerebral
palsy and so forth, and these are the men and women we need to target
the first level of reforms at.
{time} 1950
I believe the Michel plan does that. The Michel plan, of which I am a
cosponsor, allows small businesses to form purchasing pools so that
they could have the economies of scale that large businesses have. It
allows greater tax deduction for unincorporated businesses. Currently
unincorporated businesses can only have a tax deduction of 25 percent
as opposed to incorporated businesses who have to have 100 percent. It
allows some of the malpractice reforms which would allow hospitals to
exchange lifesaving and premium dollar saving information back and
forth without being sued for antitrust.
It has malpractice reform. It has MediSave accounts and so forth.
I want to say that unfortunately this MediSave account is getting a
lot of undue criticism. I do not think anybody is saying the MediSave
account will completely reform medicine by itself, but the idea that
consumers drop off a cliff when it comes to health care, no one can
tell you if they break their arm, if it is going to cost $150, $400,
$600 and so forth. Yet would these same American consumers go to a
store, a retail store that did not have price tags on its goods? Never.
But when it comes to medicine, we do not seem to know what the costs of
goods and services are.
I believe if we had some disclosure of physician fees, along with
hospital fees for various services, and MediSave accounts that would
empower consumers rather empower the Government, we would have the
placement of a competitive market in the medical system which is
absolutely void of it right now.
The gentleman from California has joined us. I yield to him.
Mr. HUNTER. I want to thank my friend for yielding.
On the subject of the MediSave account, I think you have accurately
stated that it would be beneficial. We had a chance to have one
company, their name escapes me now, this has been several weeks ago,
but in fact several companies from the private sector came in and
testified to the Republican Task Force on Health Care and talked about
how their employees reacted to their MediSave accounts, where they gave
the employees catastrophic coverage at the top end, then they gave them
so much money. And if they did not spend the money on medical
procedures, they got to keep it.
They talked about the way the employees reacted to that, how that
trained them and disciplined them to be careful spenders of health care
dollars. And ultimately, the employees ended up saving money, enjoying
this choice.
This freedom that you have when you have a MediSave account, I think
that goes back to the basic bill.
The facts are that what we offer, as Republicans, I think puts more
trust in the American people than the package that is offered by the
Democrats.
Mr. KINGSTON. I want to throw something in. I was an economics major
in college. I did my senior year term paper on the Russian agriculture
system. I wish I could remember all the statistics, but the Government
collective farms, which basically the farmers of Russia had to give all
their food to the Government, they allowed the individual farmers to
keep or, excuse me, to use 25 percent of their land for their own food
production.
It turned out, on that 25 percent of the land that the farmers would
keep all their production on, that produced more crops than the entire
75 percent in the system that went to the Government. The point is that
if people are using their own money, they have a motive to keep
whatever is leftover for a college education, long-term health care,
they will be a lot more careful than what is happening right now, where
insurance companies are going in there and you have bureaucrats
spending their money.
American consumers know how to spend their money a heck of a lot
better than we do in Washington.
Mr. HUNTER. The gentleman is right on that accountability aspect.
I had a constituent of mine, a senior citizen come in to my office
months ago. She said, ``Congressman, I was told not to complain about
this because insurance is paying for it, but I just feel like it is my
duty to show you what is going on.''
She held up a little wrist brace, a little piece of plastic. She had
had a sprained wrist. She was given a wrist brace to immobilize that
wrist. It had two little elastic bands on it.
The bill to the insurance company was $550. She said, ``That is not
the kicker. Here is the kicker.''
She held up a little cheesecloth mitten that could not have cost more
than 5 cents or 6 cents to make. She showed me the bill. The bill on
that cheesecloth mitten was $120. She was told, do not worry about it.
The insurance is going to pay for it.
I am sure that even the insurance company is going to try to whittle
that bill down. They will not accept something that outrageous.
I felt, as the guy who used to have to defend the $600 hammer, as a
prodefense person, remember that in the mid-1980's, and the $300
military ashtray, that here we had the equivalent of a $600 hammer. But
it was the $600 medical hammer. The reason we had it was the same
reason that we had the $300 ashtray and the $600 hammer with respect to
the military establishment. That is, because there was no individual
directly responsible for paying that money.
This constituent of mine had enough of an ethic and a sense of
responsibility to come and complain about this and to fight it. But I
think the fact that you do not have accountability on many of the
things that are purchased in health care means that you have a lot of
overcharging going on. And you do reduce that in the MediSave accounts
when these families have a chance to save money, if they do not spend
it. I think it would be safe to say that if a family had a thousand
dollars in their MediSave account and they knew they were going to get
that at the end of the year, if they did not spend it, and one of their
kids got a wrist sprain in a football game that they would, and the
doctor put a little wrist brace on it and said, ``I'm going to charge
you $550 for it,'' I think you would hear the roof come off of that
doctor's office. Because it was their money, and they would not allow
that.
Mr. KINGSTON. They would know exactly how much that wrist brace was
going to cost them, also, because they would have information available
to them. And they would find out. They would have the motivation.
The beauty of the MediSave account is that it cuts out the middle
man, the big insurance companies and all the bureaucracies are out of
it. You go directly to the source. You make your purchase at the point
of purchase, and you pay for it. But I think it empowers consumers and
not the Government.
And finally, most important, it puts that free market mechanism to
work in medicine, which it is not allowed to do right now.
If the gentleman will allow us to move on, one of the things I wanted
to talk about also was the reform.
And so often in Washington we seem to be debating, do we want
McDermott, do we want Clinton, do we want Michel, do we want Armey, do
we want Cooper, Wellstone, Clinton.
We are looking at all these things. What about the local reforms that
are already going on? They are going on all over your great State of
California. I know they are going on all over Georgia.
I was at a retreat that a hospital had this weekend, and I went and
listened to some of the reforms they are doing. It is textbook example
of what can be done in medicine, if government stays out of it.
There are things that are making it more competitive, bringing down
the prices, and assuring the quality is still there, increasing
quality. And these reforms are going on now without Washington and
without the State legislature. And it makes me think that we need to
end this debate, include the efforts of local people and what they are
already doing before we go off and nothing happens to it in Washington
in this great body called the United States Congress.
Mr. HUNTER. I think the gentleman is right. I think in a way we are
making the same mistakes that a lot of very intelligent people made in
Moscow for many years. That was when a 5-year plan failed, and we know
it failed because a government does not make anything efficiently, and
government cannot direct costs to go down, and government cannot
mandate prosperity. But when a 5-year plan failed, the Kremlin would
stick another batch of bureaucrats into it. They would say, there are
not enough bureaucrats.
There is not enough control. There is not enough government
intervention in this particular enterprise.
And they would overload it even more, and it would fail quicker than
it had before. Any they never broke the code until we taught them that
socialism does not work.
I just hope that we remember that lesson that we taught the entire
world.
Mr. KINGSTON. I think that is a good point, because although people
are rejecting Washington driven alliances on a local basis, I am
finding that if it is a voluntary alliance and it is one that is
controlled locally by the private sector, then they are willing to take
a look at it. But they do not want us in Washington mandating a series
of licenses saying that this is the cooperative that you have to get
your health care from, you have to give up what you have now, and we
are going to set the price. We are going to take all the negotiation
out of it from you locally.
The Michel plan would allow this, because there is another difference
between it and the Clinton plan. It does not repeal the McCarran-
Ferguson Act. The Clinton plan repeals McCarran-Ferguson and says
basically that States can no longer regulate health care, that it will
be the domain of the U.S. Congress and the Federal Government. And in
doing so, it usurps the power of 50 States, but it takes away all this
local initiative, which is to me one of the biggest tragedies and one
of the things I have found, as a new Member of Congress, is that the
franchise or the franchises on brilliance are not issued in Washington,
DC. There are a lot of brains back home, a lot of thinking people who
can handle their problems just fine without us.
Mr. HUNTER. The gentleman is absolutely right. We have 435 Members of
the House and 100 Members of the other body.
{time} 2000
We cannot possibly be experts on everything, and there is no way that
Members of Congress can respond in a meaningful and thoughtful way to
the complaints and the ideas and the initiatives of all of these
constituents across this country, and the health care professionals,
and the patients, and the folks who are affected by health care if they
all come to Washington, DC., instead of going to their local bodies to
try to steer the right course. There is no way we can handle them. We
do not have a staff big enough to handle them.
So what it means is there is going to be a lot of hastily conceived
ideas that do not work in practice where we have not looked at the
great laboratories, which the States are in terms of making policy. And
we are going to make a lot of mistakes. Washington cannot solve this
problem.
Mr. KINGSTON. Another thing that is interesting about this health
care debate is last week I made a list of the various plans and the
numbers of cosponsors per plan. And it was amazing to me, I think the
two plans with the most cosponsors were the Clinton plan, I think with
101, and I do not want to say exactly, but I believe that was it, and
the Michel plan with 161. The other plans, some of them had 40, some of
them had 20, and some of them that get a lot of publicity do not have
very many cosponsors.
But last night, as you and I know, there was a tribute to
Representative Bob Michel, and over and over again we heard great words
about Bob Michel. And there was one thing that was just absolutely in
every sentence, and that was ``nonpartisan leader,'' a ``nonpartisan
guy,'' ``nonpartisan Republican,'' ``a bipartisan thinker,'' ``a
consensus builder.'' And so here is this guy who really does epitomize
the best of both parties in terms of bipartisan cooperation, and his
plan is not a Republican plan, it is a bipartisan plan. And we have
offered the bill to our Democrat colleagues and said please sign this
bill. It is a good bipartisan bill and we welcome your support, because
we want to target our reforms on the 10, 12 million uninsured, the core
uninsured right now. We want to give States flexibility, and we want to
empower consumers and not government, and we need your help.
Mr. HUNTER. The gentleman is exactly right. I was not at the tribute
to Bob Michel last night, but when the gentleman said nonpartisan,
bipartisan, he described Bob Michel, a guy whose first question is,
``How will this help America and how will it help Americans?''
I think it is interesting that he has more cosponsors on his plan
than the President of the United States has on his plan.
Mr. KINGSTON. I know the gentleman from New York wants to talk about
the budget, and we are going to yield the floor in a minute. But we
need to pound that nail very deep into the wood of thinking here,
because when we talk about it, here is a quote from Tip O'Neill who
called Bob Michel ``the finest Republican that ever walked the floors
of the House.'' There was a quote in the program from Speaker Foley,
saying that he had always worked with him in a bipartisan fashion, that
he was one of the finest Members of the House and they were very close
personal friends. We are not talking about a partisan guy. We are not
talking about a guy who is an in-your-face Republican in any way. We
are talking about a guy whose first concern, his first thought in
building a consensus, as the gentleman pointed out, is for what is best
for the United States of America. And if it was not best, then you can
be sure that Bob Michel would not lend his name to it.
Mr. HUNTER. The gentleman is absolutely right. From Bob Michel
carrying that BAR in World War II and just being concerned about those
five or six guys in his squad, to becoming a representative from
Peoria, IL, Bob Michel has always been concerned about his fellow
Americans. And he does not distinguish Democrat-Republican. I think the
fact that he has more people on his bill that the President indicates
also that Bob Michel has been listening to the American people, as have
the members of the Republican task force on health care who have done a
great job, the leadership task force, and I think there is a little
more of the American people's input into Bob Michael's bill and into
this process than there is in the other bill, in President Clinton's
bill.
Mr. SOLOMON. Mr. Speaker, will the gentleman yield?
Mr. KINGSTON. Absolutely, I yield to the gentleman from New York.
Mr. SOLOMON. Mr. Speaker, I am just so impressed with the special
order that is going on here because I represent an area in northern New
York, and we have snow up there, we are at 7 feet it seems like now.
I have a chain link fence around my property that is 7-feet tall, and
I have Siberian husky dogs out there that are looking over the fence,
the snow is so deep.
But the point is that it borders on Canada, and there was a wire
service story yesterday which indicated that their socialized medicine
program that they have in Canada is now bankrupt. It is bankrupt, yet
people cannot even get medical services there. And they flow across the
Canadian border in my district, and all across New York on the border,
and all across the rest of the country where they have to wait weeks
and months for very, very minor but serious operations.
The thing about Bob Michel's bill is, and you know his bill is
subject to change like all of the rest, but his bill does not fix what
is not broke. And the people in my area, senior citizens in particular
are scared to death. They are scared to death when they hear about this
single payer plan which is going to wipe out all of the other plans,
wipe out Medicare and Medicaid and all of the large corporate health
programs, all of the small business health programs, and they are just
scared to death. Bob Michel's bill does not touch Medicare. It deals
with those problems where for small businesses, under this plan small
businesses would be able to, without a mandate, have small group
insurance policies available to them. Do Members know how much of a
savings that is? In other words, if you have a policy that is worth
$5,000, costs you or your employee $5,000, just making a group
insurance policy available reduces that cost about 20 percent, and 20
percent off $5,000 is a lot of money. It is $1,000. Now you are down to
a cost of $4,000, and do you know, and you two probably do your own
income taxes like I know I do, but it is so frustrating to have to keep
track of all of your medical bills, and your insurance costs. And then
when you figure out the formula, and you go to take your deduction, you
do not save a doggone thing. If you could write off the total cost of
your insurance premium out of your pocket, and your deductible or your
out-of-pocket medical costs, and if you had a cost of $1,000, and you
were in a 25-percent tax bracket or a 30-percent tax bracket, you have
already reduced the cost of that premium by another $300 or $400.
Then if we could ever get through medical malpractice in this
Congress, think what that would do to lower the cost of insurance to
individuals.
You know, these are the things we ought to be doing. That is really
what Bob Michel's bill does, and that is why I admire the gentleman for
coming over here and talking about it.
Mr. KINGSTON. If the gentleman will yield, first of all let me say
No. 1, I am surprised that the gentleman has the ability, though I
should not be surprised because he is certainly one of the brightest
Members of Congress, to do your own taxes. But I think it is
interesting to point out that the tax simplification bill of 1986 was
491 pages long. This bill is 1,392 pages long, and I do not know too
many people who do their own taxes. We have tax simplification, and yet
many of the smartest business people I know right now have to go to an
accountant, and so do the slower ones, such as me.
So I certainly sympathize with all of them.
Mr. HUNTER. I just want to thank the gentleman for having this
special order and talking in a commonsense way about what we need in
health care. I think the American people have, and I think my friend
from New York knows this better than almost anybody because he has
talked about it a lot, the thing I think that makes Americans a little
different from Canadians, and Brits and Frenchmen, and Germans, and
people in other countries that have adopted one form or another of
socialized medicine, is that Americans have a little streak of
independence in them, and they have a wariness of government, of big
government. And I just hope that that commonsense instinct not to let
big government say, ``We are from the government and we are here to
help, and we are going to take over health care, we are going to make
it cheaper, we are going to command it to be more efficient,'' I think
the American people are a little more sophisticated than that, and a
little more independent. And a lot of the so-called policy wonks in
Washington, DC, these academics and others who have decided that the
American people are not smart enough to be trusted with their health
care, they have to have that handled for them, I think the American
people are going to surprise the Clinton administration with their
position on this bill.
You know, it is interesting. The polls I have seen show that as
people read the bill, and they are asked the basic question, ``Do you
like it more or do you like it less now that you know more about it?''
Most Americans polled say, ``We like it less,'' after they have read
it.
That indicates to me that this is not going to be quite as easy a
snow job as I think a lot of the folks thought it would be.
Mr. KINGSTON. Let me ask both gentlemen a question. And I am serious
about yielding the floor before the sunrises. The gentleman is from
California, and this gentleman from New York and I am from Georgia,
three different parts of the country. Ours incidentally has 80 degrees
this week, so leave your huskies up there, but you may come down. The
question that people are asking me is will I have to give up my current
policy which I am happy with under the Clinton plan? And I tell them
yes, and they are upset about that. How do the folks in California
react, and I want to ask about the folks in New York, how do they feel?
{time} 2010
Mr. HUNTER. Well, let me tell you, from the radio talk shows that I
have been on, once they learn that, and I have debated this with
Members of the other side of the aisle, and I cheated in the last
debate, I actually brought the Clinton bill to the debate with me and
read from it, and first, my opponent in the debate thought that that
could not possibly really be the Clinton bill, but I assured him that,
yes, it was.
When people realize this is mandatory, you give up some freedoms to
get this great security that the President talks about; the first
freedom is the freedom not to be in the plan. It says every American
shall be in the plan, and it also says every American shall contribute.
Now, as I recall, if you do not contribute, you get fined substantially
for not contributing.
So the first thing you give up is your right not to be in it, and,
you know, you mentioned, you were talking about the 37 million so-
called uninsured Americans and who they really are. A lot of those are
folks that make over $50,000 a year and just say, ``Thank you very
much, I will pay for my health care. I do not want to pay a middleman
in an insurance company to have health care.'' I think Americans ought
to have that right.
So there are a lot of freedoms that are given away, and I think
Americans are pretty wary right now of giving up freedoms.
Mr. KINGSTON. I would ask the gentleman from New York [Mr. Solomon],
is that how folks in New York feel?
Mr. SOLOMON. Listen, you would think the gentleman from California
[Mr. Hunter] represents my people up in northern New York up there.
Mr. HUNTER. I will in the springtime. Not the winter.
Mr. SOLOMON. He sounds just like Gerry Solomon.
I will tell you what people up there are alarmed about. They are
alarmed that some bureaucrat is going to be dictating to them who is
going to deliver the medical delivery care system to them. They are
terribly concerned about it. They are concerned that they are going to
have to pay more for less medical services, that we just cannot allow
to happen.
Mr. HUNTER. Let me just add one thing.
Incidentally, let me thank the gentleman from Georgia for making this
special order happen. His deliberate analysis of this health care bill
is real important.
One thing I would offer folks to think about in a commonsense way is
that we are going to have 300,000 new Government bureaucrats injected
into this, hired to manage health care. If we have a finite amount of
money available for health care in this country and we want to have as
much of it as possible being used to actually be used for treatment,
that interaction between doctors and patients, well, that means that
not only are we going to be continuing to pay the middlemen you talked
about, the insurance guy that used to have those guys in the middle,
you are going to be paying the lawyer cause the trial lawyers who own
the Clinton administration are going to be getting their cut of the
action, but now you are going to be paying 300,000 fine Federal
workers, and you are going to be using the same finite dollars, that
is, dollars that the American people earn to pay that.
The SPEAKER pro tempore (Mr. Strickland). Pursuant to the Speaker's
announced policy of February 11, 1994, the gentleman from New York [Mr.
Solomon] is recognized for 30 minutes as the minority leader's
designee.
____________________