[Congressional Record Volume 140, Number 44 (Wednesday, April 20, 1994)]
[House]
[Page H]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: April 20, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
       THE BENEFITS OF A SINGLE-PAYER PLAN FOR HEALTH CARE REFORM

  The SPEAKER pro tempore. Under a previous order of the House, the 
gentleman from Washington [Mr. McDermott] is recognized for 5 minutes.
  Mr. McDERMOTT. Mr. Speaker, in the coming weeks, Members of Congress 
will face key votes on major issues in health care reform. I sit on the 
Ways and Means Committee, which, through its health subcommittee, was 
the first committee to act on health care reform.
  I want to share with you my thoughts on what has occurred in the Ways 
and Means Committee with respect to health care reform and how, as the 
coauthor of the single-payer proposal for health care reform in the 
House of Representatives, I intend to proceed in the coming weeks.
  I voted for the chairman's proposal in the Health Subcommittee after 
a great deal of debate. I did so for several reasons. The subcommittee 
vote was the first legislative action taken on health care reform and 
was widely regarded as the barometer for whether or not the reform 
process would continue. It was essential to keep health care reform 
moving for the single-payer plan that I advocate to go anywhere.
  However, a number of problems presented by the subcommittee mark must 
be overcome or I will vote ``no'' on reporting the bill out of the full 
committee.
  First, universal coverage was delayed to 1998. Universal coverage 
must be fully implemented no later than 1997. If pushed beyond that 
date, it will be undermined and further delayed in subsequent sessions 
of Congress. We simply will lose it.
  Second, the benefit package does not provide broad enough coverage to 
meet health insurance needs. Specifically, copayments and deductibles 
are high and there are no limits on out-of-pocket expenditures for 
health care. In other words, the patient can keep on paying 20 percent 
of medical bills forever no matter how big the bills get and out-of-
pocket losses never stop.
  This does not provide health security and does not solve the problem 
that plagues our economy; namely, people cannot leave their jobs 
because they are afraid of losing their insurance benefits. Without 
out-of-pocket limits on patient spending, this benefit package will not 
provide job mobility. In addition, long-term care is not addressed in 
any fashion.
  I view out-of-pocket limits and the provision of some long-term care 
as essential elements of the benefit package.
  The Ways and Means proposal does enable the uninsured and people who 
work for small businesses to get their health insurance through a new 
part of Medicare called Medicare Part C. Although Medicare C does 
provide better protection of free choice of provider than is provided 
in managed competition proposals, its high copayments create 
substantial barriers to non-HMO choices.
  Vigorous and affordable free choice of provider must be protected in 
the final bill. We cannot have a system where people are losing their 
doctors with every change in their health insurance arrangement.
  Single-payer clearly offers the best protection against losing your 
own doctor and the best protection against insurance company 
interference in patient/doctor treatment decisions, and it is the 
standard for which I intend to fight.
  Fourth, the scope of Medicare C is inadequate. I am unequivocally 
opposed to limiting Medicare C to employees of small businesses and the 
uninsured. This limitation will cause families to shuttle in and out of 
Medicare C as their job situations change, and they may lose their 
choice of provider in the process.
  Finally, financing health care reform through Medicare cuts is 
unacceptable. The attempt to realize savings in this way will severely 
threaten academic medical centers and urban hospitals, impair senior 
citizens' access to health care, and undermine the financial stability 
of our entire health care system.
  The goals of the single-payer advocates in health care reform are the 
goals of the American people: guaranteed health insurance for every 
American, lower costs, comprehensive benefits, and freedom to get and 
keep the provider that you think is best for your family. I do not 
intend to vote for anything that won't meet these goals.

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