[Congressional Record Volume 140, Number 34 (Wednesday, March 23, 1994)]
[Senate]
[Page S]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: March 23, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
     THE FAILING HEALTH OF OUR DEMOCRACY AND THE HEALTH CARE DEBATE

  Mr. WELLSTONE. Mr. President, in anticipation of the appointment of 
House-Senate conferees on campaign finance reform legislation, I wanted 
to speak for a few minutes about the need for real campaign reform, and 
I want to use health care-related political contributions as a case 
study.
  Senators toss around the word ``historic'' all the time when we 
discuss different issues and different votes. But the truth of the 
matter, Mr. President, is that it is very rare that we are dealing with 
legislation that is truly historic. It could be Social Security--that 
was truly historic--it could have been the National Labor Relations 
Act, or civil rights legislation, or the Medicare Act.
  Mr. President, I think we can talk about health care in exactly the 
same framework.
  This year, the Congress is debating a piece of legislation which will 
profoundly affect the lives of Americans, for good or ill, by the way 
we finance and deliver health care within our country. This is an 
opportunity of a generation for all of us who are here to pass 
significant health care reform that will make a positive difference in 
the lives of people.
  I did not rise on the floor today to debate the substance of 
different proposals. That is not my purpose. I am and will continue to 
be a very strong advocate of the single-payer system.
  Instead, I want to talk about a different issue: the failing health 
of our democracy and its relationship to the health care debate.
  What I am talking about are the huge amounts of money in campaign 
contributions, or being used to support media advertising campaigns, 
polling, political and marketing consultants, and all of the rest, 
which are financed by what we would call the medical-industrial 
complex: the insurance industry, drugmakers, HMO's, medical trade 
associations and other organizations as well.

  These forces, over the last five decades--over half a century--have 
been able to thwart reform. Tens of millions of dollars are being spent 
on these campaigns right now, and it is estimated that almost $100 
million will be spent on them by the time this bill becomes a law. When 
combined with the unprecedented campaign contributions going to Members 
of the Congress, the policy and the political impact is staggering.
  Soon the House and the Senate will appoint conferees on the campaign 
reform bill in order to work out the major differences between the two 
Houses on that bill. I hope that as we move forward on that process--
and this is why I rise to speak about this question today--we will use 
health care and the unholy mix of money and politics as it affects 
health care policy in the Congress, as an illustration of why it is so 
compelling and important that we move forward with campaign finance 
reform.
  I hope that reform will include a prohibition on soft money. I hope 
it will include tough new limits on what individuals can contribute to 
their own campaigns. I hope it will include the elimination of 
political action committees. I hope it will include much more stringent 
limitations on individual campaign contribution limits. I hope we will 
have tight new rules to close down the practice of lobbyists making 
political contributions to those whom they lobby. Finally, I hope we 
will open up this system so challengers will really have a level 
playing field by having some public financing, which was stricken from 
the Senate bill under the threat of a filibuster.
  But until we pass this campaign finance reform bill, we will continue 
to see the corrosive effect of this mix of money and politics, where 
large amounts of money are being poured into the Congress. Powerful 
economic interests are, I fear, dominating this debate. This is a once-
in-a-generation opportunity. Health care is an idea whose time has 
come, and come, and come again in this country, and always has been 
thwarted. This time we have to make sure it really is an idea whose 
time has come to stay.
  It is unclear who will benefit and who will bear the burdens of 
health care changes to be adopted in our country. But, while this is 
unclear, one thing is very clear. Members of Congress are already 
benefiting enormously from huge political contributions from health 
care sources that are truly unprecedented, I think, in the history of 
our country. If you want a historical perspective, I recommend my 
colleagues read Paul Starr's fine work, ``The Social Transformation of 
American Medicine.'' It was a Pulitzer Prize-winning work. He gives a 
detailed historical account of uniform efforts and of the special-
interest shoals on which they have often foundered.
  We could go back before World War I, where the American Association 
for Labor Legislation was pressing for universal health care coverage. 
That was defeated, though it was the beginning of that effort in 
Western Europe.
  Then, during the 1930's, Franklin Delano Roosevelt wanted to attach 
it to the Social Security Act, but that was defeated.
  Then Senator Wagner and Chairman John Dingell's father, 
Representative John Dingell, Sr., were once again interested in 
universal health care coverage, national health insurance reform. They 
worked on it. Harry Truman campaigned on it in 1948--it was an 
important part of his platform--but again it was fiercely contested by 
powerful interest groups. It was really quite amazing the effort, 
especially the $1.5 million American Medical Association effort to 
defeat the bill.
  We had red baiting and people were talking about socialized medicine 
and people were talking about a plot that was hatched in Moscow to 
bring down the Republic over health care reform. Once again this effort 
was defeated.
  Meanwhile, post-World War II, the rest of the industrialized world 
moved toward some form of social insurance health care policy. We did 
not. We went with market-based private insurance schemes. And now 
health care costs have driven through the roof, and what we have seen 
since is escalating costs and more and more insecurity.
  In 1964, Lyndon Baines Johnson won a landslide and his reform effort 
could not be stopped. He, with the support of the House of 
Representatives and the Senate, pushed through Medicaid and Medicare. 
Policymakers said they would fix all this in the next few years, 
content they had done their best in the short run. But the short run 
has now lasted over 30 years. That was an inadequate down payment on 
universal health care coverage. It is now time to redeem that promise 
of universal coverage.
  Now it is 30 years-plus later, and during the 1970's we saw a 
dramatic increase in prices, the escalation of costs, and once again we 
have seen millions and millions of people falling between the cracks: 
Not old enough for Medicare, not poor enough for Medicaid, and not 
financially secure enough to afford a decent health insurance plan.
  During the 1980's the idea of universal health care coverage was an 
anathema to the Reagan administration and the Bush administration. Thus 
we did not see much progress.
  Now it is 1994. Now we have a historic opportunity to pass 
historically significant reform. But once again, powerful interests are 
essentially trying to stop this reform, to thwart it. So now I speak 
about this with a sense of history. And although there are somewhat 
different players, basically we are again seeing efforts to use money 
to buy access. As a result, I think we have a huge problem, by any 
standard, for our representative democracy.
  Let me be a little more specific. In the 1992 Presidential and 
congressional elections, political contributions from the medical 
industry stood at $41 million. This reportedly included $16.4 million 
from doctors, $7.3 million from the insurance industry, $4 million from 
drug manufacturers, and almost $3 million from other providers. The 
rest came from HMO's, lobbyists, mental health professionals, medical 
suppliers and others.
  In 1993, for Congress alone, contributions increased by an estimated 
27 percent from these sources. And, as you might expect, many of these 
industries increased their contributions dramatically during the first 
10 months of last year--the latest period for which data have been 
analyzed. According to a recent Federal Election Commission analysis by 
Citizen Action, health-related large individual donor contributions 
increased by a remarkable 41 percent; 46 percent faster than the rate 
of increase from other interests. Doctors and other provider PAC's went 
up by 30 percent; hospital, nursing homes and HMO's increased their 
giving by 23 percent.
  I expect when the full 1993 contributions from the industry are 
analyzed, they will far exceed the amounts given in 1992.
  This is big bucks. It is big bucks with a purpose. And the purpose is 
to have a disproportionate amount of influence on this process and the 
final product. Most lobbyists and most analysts of these issues will 
all agree, if you talk to them, that the glut of spending on health 
care is unprecedented on a single issue in the Congress in such a brief 
timeframe.
  And if you think these figures for 1992 and 1993 spending levels are 
larger and really astounding, just wait and see what happens in 1994. 
The 1994 spending will eclipse all of what I have talked about. You 
will see huge amounts of money going into direct mail, going into 
television and radio, print media, and political contributions in the 
1994 elections.
  What are all these big contributions about? What are these 
contributors getting for their money? So far, what they are getting is 
the thing that they have been able to get from Congresses past: 
gridlock. For half a century, powerful interests have blocked reform, 
and I fear that could happen again.
  Let me just take a look at political action committee spending, as an 
example. Medical industry political action committee contributions 
increased by almost 2\1/2\ times during the 1980's, as people began to 
see the reform train move. The tentacles of the industry are long and 
powerful. In the Senate, 84 percent of health care PAC contributions 
went to incumbents during the 1992 elections. And the PAC money is just 
the tip of the iceberg.
  This chart is an overall summary of the 1992 health care industry 
contributions. Here we see the sources. What we see from 1990 to 1992 
is a 31-percent increase overall, $41.4 million; doctors, 1990 to 1992, 
$16.4 million, a 45-percent increase; insurance, 1990 to 1992, $7.3 
million, a 10-percent increase; pharmaceutical manufacturers, 1990 to 
1992, $4.0 million, a 20-percent increase; and other providers, 1990 to 
1992, $2.9 million, a 40-percent increase.
  Mr. President, this is just part of what is going on in terms of the 
dramatic increase in contributions. There are other ways that big-
ticket interests can influence this process. At the same time that I 
have been talking a little bit about political contributions, we ought 
to remember the amount of money that is going into the TV and radio ad 
campaigns right now. When the President and the First Lady did their 
spoof on the Harry and Louise ads the other night at the Gridiron 
dinner, they said their ad was brought to you by the ``Coalition to 
Scare the Pants Off You.''
  They were right on the mark. This year alone, the Health Insurance 
Association of America is reportedly going to be spending at least $10 
million just to discredit reform plans, be it the single-payer reform 
plan or the President's plan.
  It is not just the question of grassroots politics. This is not 
grassroots lobbying. This is astroturf lobbying. This is using big 
money to have leverage. It is interesting, in their lobbying package, 
according to a recent public relations industry newsletter, the HIAA 
advised their members that the first step in their lobbying campaign 
should be to identify big contributors to Senators and Representatives 
and then meet with those big contributors to make clear their interests 
in the debate.
  What we see here is the most telling and graphic example of this 
unholy alliance of money and politics and the way in which it affects 
the health care debate.
  Mr. President, I could go on for hours about this political 
advertising, but I will not. I will just simply say one thing: As a 
former political scientist, I have to tell you that I cannot see much 
that has been contributed to public dialog, to an honest debate of 
perspectives, issues, and choices facing our Nation on health care, by 
all this political advertising. I think the basic purpose of the 
political advertising is to make it all so complex for people, to plant 
doubts in people's minds and to scare people. And so we see very 
capital-intensive TV ads going on and on and on. It is an effort aimed 
at molding mass opinion, and preventing people from distinguishing 
clearly between their own interest and the special interests of 
doctors, HMO's, insurers, and drugmakers.
  Mr. President, this is a very serious issue for our democracy. I 
think this mix of money and politics in the health care debate puts the 
whole political system on trial. All the questions about who has power 
and who does not; who gets to the bargaining table and who does not; 
whose voice is heard and whose voice is ignored come into sharp focus.
  What is happening in the United States today is that a lot of people 
feel shut out. They do not feel their voice counts the same as the 
``heavy hitters.'' They feel there are certain people who have too much 
wealth, too many resources, and too much influence, and they have too 
little. They are convinced that the common good is giving way to 
special interests.
  I think it would be a huge mistake, if that is the way people in this 
country feel about this health care debate--that they somehow have been 
locked out, they somehow are out of the loop, that their voice really 
does not count; because in a representative democracy, their voice 
should count. One person, one vote: that should be our watchword here.
  And I point out that this level of health care spending is truly 
unique. In 1980, expenditures on Senate campaigns were $73 million. In 
1990, $173 million. The last election, $195 million. Or consider the 
average cost of a Senate campaign, another good barometer: $1.2 million 
in 1980; $3.3 million in 1990; and almost $3.7 million in 1992, and 
sure to rise substantially again this year if people continue to raise 
money at the pace they have during the past year.
  Let me point to another graph which illustrates the dramatic increase 
in spending over the last decade. This is just a line that you can look 
at from where we started to where we are right now; from about $200 
million in 1978 total to almost $700 million in 1992. That just 
illustrates the dramatic increase in spending for congressional races: 
$200 million to almost $700 million over this short period of time for 
congressional races.
  So I think--and I conclude my remarks today in the Senate this way--
that the time has come for us to try something new to break this 
special-interest gridlock that has captured the levers of powers, that 
I really worry about. For me, it is simple. I do not think that Members 
of the House of Representatives or Senators should be taking health 
care contributions from the health care industry broadly defined, from 
political action committees or in large contributions from individuals, 
for the duration of this health care reform debate.
  My concern is that if people do not believe in the process and they 
do not trust the process, they will never believe in the product of 
that process. And if they do not believe in the product, then they are 
not going to make the sacrifices that are required and we will not have 
the support we truly need.
  I know some of my colleagues and all House Members are involved in 
campaigns this year, and I say to my colleagues that surely I am not 
talking about people unilaterally disarming. But if any Representative 
or any Senator said to their competitors, ``Look, until this debate is 
over and until we pass the bill, I am going to voluntarily not accept 
any more contributions, and I would also challenge you not to do so,'' 
I think what you would see, given the mood in our country, is that 
challengers would agree to that. If they do not, then I would say that 
Senators and Representatives, of course, could go on and raise that 
money.
  But I honestly and truthfully believe that it would be so helpful and 
it would be so important to building good will, to having people trust 
in this process and really believe in what we do, if Members would 
voluntarily agree to forgo these contributions while this legislation 
is pending before the Congress and until we have a final vote.
  Once again, I really think that challengers would be willing to abide 
by the same agreement.
  Mr. President, we are all lucky to be in the Senate at a time when we 
really could do something historically significant. I really think that 
this is not just about health care, but about the political process, 
about accountability, about building trust in people and in the 
legislative process.
  I really believe if Senators and Representatives are willing to 
voluntarily forgo contributions, large individual contributions and PAC 
contributions from the health care industry broadly defined, and those 
who are running, their challengers, are willing to do the same, it 
would incur enormous good will on the part of people in this country 
and, quite frankly, I think it would lead to a better process and I 
think  it would lead to a process we can be proud of. And, most 
important of all, I think it would lead to real, significant health 
care reform.

  Mr. President, I yield back the remainder of my time, and I thank the 
Senator from Tennessee.

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