[Congressional Record Volume 140, Number 42 (Monday, April 18, 1994)]
[Senate]
[Page S]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: April 18, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
                    TWO SUBJECTS OF UPCOMING DEBATE


                           health care reform

  Mr. KINGSTON. Mr. Speaker, what I wanted to talk about are two of the 
subjects that we will be debating in the course of this spring. The 
first one, of course, is health care reform; the second one, gun 
control.
  I wanted to talk first about health care and specifically about an 
article I read and, unfortunately, I am not exactly sure which 
publication it was in, but I believe it was the New York Times. It was 
about the Columbia Health Corp., which is the largest hospital company 
in the United States, has a net worth of about $267 million, and has a 
game plan to double in size over the next 5 years.
  Currently, Columbia Health Corp., owns 195 hospitals across the 
country, and that is up from about 22 when the company was founded in 
1988. They have all kinds of plans to grow. But the question about how 
they are going to grow, I think, is interesting and something that 
probably we should consider as we debate health care. And that is that 
what they plan to do is, because of the volume, get discounts from the 
suppliers when they buy things and have lower overhead and use this to 
basically negotiate better provider contracts.
  Now, as we all know, health care is shifting from a cost-plus based 
reimbursement system. The way the cost-plus arrangement traditionally 
was is that the more services a doctor or a hospital performed, the 
more they got paid for it. So if you went in for a broken arm and they 
could x ray it three different ways, put on two different kinds of 
bandages, maybe test your blood, each procedure you got billed for.
  And Medicare has changed that because of a lot of their 
reimbursements. But now managed health care is changing that as well. A 
long of insurance plans, HMO's and PPO's, are doing the same sort of 
thing.
  So now we are seeing hospital and provider groups seeing how they can 
cut some of the expenses out. One example that this article showed that 
Columbia was using is, instead of testing a patient's blood after and 
operation, the blood gases, every 15 minutes, what would happen if you 
let it go for 30 or maybe 20 minutes. They were not saying there was an 
absolute but just stretching it out a little bit more.
  There was a savings there, and there is a savings to be realized.
  Obviously, early release of patients is going to save a lot of money, 
and they encourage their doctors in their provider networks to get 
folks out of the hospitals a lot faster. So that is another method that 
they are using.
  Then one that I thought was real interesting, when you look at the 
economies of scale, and I thought this was particularly interesting 
because one of the proposals that we are talking about is allowing the 
formation of purchasing groups. And we are debating if that should be 
voluntary or mandatory. But in any case, listen to this.
  Prior to Columbia's merge with the Hospital Corporation of America, 
they were purchasing a volume of x-ray film. That level now is about 
$30 million worth of x ray film each year. As a result of such a 
volume, they actually pay 40 percent less now than they did prior to 
the merger with HCA. I thought that was very indicative of what we are 
looking at in terms of potential health care savings, because $30 
million by one corporation which, incidentally, only owns 3 percent of 
the for-profit hospitals in America, which for-profit hospitals, I 
believe, only constitute about 13 to 14 percent of the total hospital 
marketplace, the total delivery system for health care. So that shows 
what a relatively small player can do. Think what we can do as we merge 
together.
  Another thing that they are practicing is somewhat controversial, and 
that is the cookbook type medicine where computer programs are getting 
doctors, nurses, and everyone else along the provider line to go and 
prescribe certain after-treatment therapy or certain treatment, 
depending on the ailment, by a computer program rather than ``It is all 
in my head and I know what to do next.'' That structured application of 
medicine sometimes is called a cookbook form. I do not think that is 
always the case. Sometimes that is a good description, but it is not 
necessarily a derogatory term.
  I think that is interesting. But to give you an idea what all this 
has meant to Columbia is that last year for the county contract in Lee 
County, FL, for the county employees, they underbid their closest 
competitors 38 to 58 percent providing health care services. I think 
there is a lesson out there, Mr. Speaker. I think this says something 
about the volume argument, something about purchasing groups, 
something that I would hope would be voluntary purchasing groups.

  But it also shows you that reform is happening right now in the 
private sector. As I talked to hospitals and physicians around the 
country, I always ask, are you doing things differently this year than 
you did last year or 2 years ago. Every time the answer is yes. And if 
you say 5 years ago, you are talking ancient history.
  So I think that the lesson of Columbia Health Corp. is that reform is 
going on. It is going on in the private sector right now. The sabre 
rattling by the administration and by Congress is very helpful in this. 
It is a catalyst to the private initiatives.
  What I would hate to see us do in Congress is come in with a cookie-
cutter approach on health care reform which would stifle initiatives. 
Certainly, Columbia is going to have its detractors, as does anyone 
else. But there are some positive things that are going on. I wanted to 
bring that to the attention of the Members here.


                              gun control

  Mr. Speaker, rather than continue talking about health care, I want 
to talk about gun control. I do not want to talk about all of gun 
control, because there are so many different aspects. And there is so 
much emotion. But I think because there is emotion, it is important for 
Members of Congress to look at gun control not based on philosophical 
bias but based on empirical data and objectivity.
  Yet, I realize this is one of those issues that whenever you talk 
about it, you will have people already bristling, Where is he going 
with this?
  Here is where I am going. I am going to talk about an article that 
was in the March Journal of Medicine, which is the publication of the 
Georgia Association of Medicine. In it they took to task some of the 
articles that have been printed by the CDC and the New England Journal 
of Medicine. They have done a good job, because they have referenced 
everything that they have put in there. They back it up.
  The article that I am going to talk about was written by a lawyer 
named David B. Kopel. I hope I pronounced it correctly.
  The name of the article is, ``The Lure Of Foreign Gun laws.''

                              {time}  1850

  In it he talks about countries that have strict gun control laws and 
what it has meant in terms of the crime rate. The first example he uses 
is in Japan.
  In Japan, and incidentally, Mr. Speaker, anyone who wants a copy of 
this, please call my office, because I will be happy to share it. This 
magazine has more objective data on gun control than any publication I 
have seen.
  It talks about Japan. Japan has strict gun control laws which 
actually go back to 1588, when the Emperor put a nationwide ban of 
swords and went through the samurai and the shoguns, I guess, and 
basically disarmed the peasants, and went up from the aristocracy from 
there. Today you cannot own a gun or a rifle in Japan. You can own a 
shotgun, only through very rigorous licensing laws.
  Is it a safe country? It certainly is a safe country. They have a 
very low crime rate. What does that mean? Maybe if we look at it at 
first glance, get rid of the guns and you get rid of the crime problem, 
if you only look at the law and the crime rate.
  Let us look at Switzerland, as Mr. Kopel did. In Switzerland, it 
actually has a lower murder rate than Japan. They have strict gun 
control laws, but in a completely different way. Every male in 
Switzerland has to join the militia. If you are between the age of 20 
and 50 and you are male, you are a member of the militia. You spend 3 
or 4 weeks per year training, and as part of your duty in the militia 
you are given a fully automatic assault rifle which you take home. You 
do not leave that at the National Guard armory for weekend duties. You 
do not pick it up for your 3 weeks of summer training. You take that 
home to suburban Zurich or wherever you live, and you keep it at home. 
Every male must be proficient in marksmanship. Every male between the 
ages of 20 and 50 will get tested on marksmanship.
  In a country which is about two-thirds the size of West Virginia, 
there are over 3,000 shooting ranges. Ammunition, while we have one 
proposal right now to tax it, is subsidized in Switzerland. To get a 
handgun or rifle there is a very easy permitting process. Just about 
any adult can get one. You can even get an antitank gun, antiaircraft 
gun, and you can buy some types of cannons. This is just the folks on 
the street.
  I said earlier, Switzerland has a lower murder rate than Japan, which 
has a lot smaller murder rate than America. Are the Swiss just great 
people? Are they more responsible than Americans? Are they safer?
  Are they smarter? What is it about them that is different than us?
  I would submit that they are not more responsible, they are not 
safer, and they are not smarter, but what they do have in Switzerland, 
and they also have in Japan, is a strong family structure, tightly knit 
communities, and good relationships from generation to generation.
  In short, in these two countries culturally young people are 
socialized into noncriminal behavior. That is so important, because as 
we look at the murder rates in America, and we have some of the 
diagrams and graphs in here, and I do not know that we will have time 
to get into them, but it does show that the homicide rates in America, 
the correlation is that it is still going up in the inner city, where 
you do not have the strong family structure and the tightly knit 
communities, and that is such an integral part of crime control and 
criminal justice reform that we as a Congress would be negligent if we 
do not put these folks into it.
  If we just superficially kid ourselves and say we are going to get 
rid of the guns, we are going to get rid of the problems, the 
statistics do not show that at all. They show it to be a cultural 
socializing process which we are not doing a good job at in America, 
particularly in the inner cities, where we have the highest murder 
rates.
  In Britain, they have very tough gun control laws. They have had 
those, I think, for about 30 or 40 years right now. Mr. Koppel says 
yet, despite that, in a country where only 4 percent of the households 
legally have guns, their murder rates are higher now than they were 
before the strict gun control laws went into effect.
  Let us talk about Jamaica, because one of the things we hear so often 
from second amendment proponents is that you are not necessarily owning 
a gun to defend yourself against a burglar, but you are doing it to 
defend yourselves against the government.
  In 1974 Jamaica enacted very strict gun control laws, which include 
house-to-house searches randomly, secret trials, detention 
incommunicado, mandatory life sentences for possession of a single 
bullet, very strict gun control laws.
  What happened? Violent crime dropped significantly for about 6 
months, but then, within a year, it went back up to the level it was 
before the gun control laws, and in fact has been increasing since.
  What is the most significant is that one-third of the murders in 
Jamaica were perpetrated by the police. Think about that in terms of 
the second amendment people who are saying, ``You have to worry about 
the government, not just the burglar,'' because what human rights 
groups are saying is that the police, what they would do is shoot their 
enemies, because their enemies were not armed, and then they would 
later go back and report that the citizen, the private citizen, had 
started it, and that he was killed in a shoot-out and the police shot 
him in self-defense. Of course, there were no witnesses.
  Could government potentially be the enemy? Ask one-third of the 
people murdered in Jamaica and they would tell you absolutely yes, if 
they were around to say so, but they are not.
  Think about what we are saying, Mr. Speaker. Why is it that police 
can have guns but you and I and the average American citizen cannot? 
Are they going to be that much safer, allowing police to have them and 
disarming ourselves? I do not think that is the case.
  I trust my fellow Americans, as I know you do and most Members of 
Congress do, but I trust them to use their judgment.
  This article, as I said, I can give any Member of Congress or anyone 
else a copy, but the publication itself is so full of statistics and 
facts and nonemotional discussion of the gun control issue that I think 
it ought to be required reading, particularly as we go into this 
debate.
  Is this by a group that is an NRA-backed group? Certainly not. This 
group, if anything, is a more progun control group, but they have come 
to the conclusion that you cannot argue with the fact that the 
statistics do not merit outlawing guns. You are not going to get the 
achieved results. What you will do is have an argument that takes the 
emphasis off using the death penalty, off mandatory sentencing, off 
truth in sentencing, and so forth, but that is where we need to change. 
We do not need to take the guns.
  Mr. Speaker, I am going to conclude with that for the time being. I 
look forward to discussing this magazine with Members of the House. I 
look forward to citing some of the graphs that are in here. There is 
just tons of good information. I appreciate the opportunity to address 
the House tonight.

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