[Congressional Record Volume 140, Number 51 (Tuesday, May 3, 1994)]
[Senate]
[Page S]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
HEALTH CARE REFORM
Mr. DASCHLE. Mr. President, I did not have the opportunity to listen
to all of the remarks made by those who have preceded me in the Chamber
this morning. I did hear the comments made by the Senator from Georgia
just now, and I certainly share his view that the decisions we make on
health care this year will be the most important, will be perhaps the
most critical we will make in this Congress, perhaps this decade, just
possibly in the careers of those who serve here today.
I disagree strongly with some of the characterizations made by the
Senators from Texas and Georgia with regard to the plan proposed by the
administration. It is clearly a difficult and complex issue, and it is
easy to see why the American people can be confused with the
allegations and the charges made with regard to the implications of the
President's plan. Once again I heard a couple of those this morning.
Reference was made to heavy fines imposed upon those who are not
participating within the system, that fraudulently violate some of the
tenets, some of the principles laid out in this particular bill.
We have been told on numerous occasions, Mr. President, that fraud is
a very serious problem in health care today. It may be responsible for
$70 billion in the costs incurred by Americans as we pay for health
care. In an effort to deal as directly and as successfully with fraud
as we possibly can, fines are going to be imposed upon those who
fraudulently abuse the system. That is what we are talking about here--
fines imposed upon those who fraudulently and in some cases criminally
and very detrimentally affect the well-being, the welfare of our health
system and the people it serves.
Reference was also made to choice. There are a lot of accusations
about whether we improve or diminish the availability of choice for all
Americans as they consider their options in health reform. But one does
not have to take the word of the advocates of the Clinton health bill
as we look at whether choice is enhanced or not. One only has to look
at the independent analysis that has been done by the Congressional
Budget Office cited by the Senator from Texas, by a number of other
analysts both in and out of Government with regard to what this bill
does for choice.
Ask those today who have a preexisting condition how much choice they
have. Ask those who are locked into a place of employment because their
employer only provides them one plan how much choice they have. Ask
those who are paying thousands and thousands of extra dollars every
year because it is the only plan they are entitled to how much choice
they have.
Millions of Americans, Mr. President, have no choice whatsoever. And
in an effort to give them more choice, to give them a vehicle with
which they can pool their resources to maximize choice, just as Members
of Congress have today, this plan addresses the needs that they have
for amplifying choice and providing more opportunities to get that
plan, to acquire that plan which makes the most sense for themselves
and their families.
So let there be no doubt choice is dramatically improved as a result
of the health reform proposal made by the administration and, frankly,
some of the other plans that are before us right now.
It is an important decision, and perhaps it is upon that agreement
that we can go forth with the expectation that at some point this year
this Congress will pass a comprehensive health care reform bill.
Shared Employer Responsibility
The opponents of the President's Health Security Act have recently
seized upon a Chamber of Commerce survey of its members to trumpet the
small business community's opposition to the proposition that
businesses be asked to share the cost of their workers' health
insurance premiums.
I have no doubt that this survey provides some measurement of the
business community's concern regarding health care reform. It is
understandable because change is often frightening and this change will
affect every American. But I also think it is important to point out
that any public opinion survey on this issue cannot help but be
affected by the volumes of misinformation that have permeated this
debate. Some opponents of health reform have deliberately misled the
American public on the real impact of the President's plan. Even the
Wall Street Journal, not regarded as a great ally of this
administration, says that ``fear-mongering is rampant''--that is a
quote, Mr. President. According to the Wall Street Journal, ``fear
mongering is rampant'' in the fight against health care reform and
refers to some of these efforts as ``alarmist propaganda.''
That is the Wall Street Journal's analysis of what we have heard so
far from many of the opponents in the debate.
We cannot allow ourselves to be scared away from tackling health care
reform by the propaganda of a few well-funded vested interests. The
issue is far too important for that, and we know this.
We owe it to ourselves, and to our constituents, to look at the facts
to best understand the real effect that competing health reform plans
will have on our health care system, and the real effect they will have
on business, and the effect it will have on business.
For example, what many of the small business owners who responded to
the chamber survey may not know is that 2 months ago the Congressional
Budget Office [CBO] that we have quoted this morning, released an
analysis of how the President's Health Security Act would affect
families, businesses, and the economy.
The results were overwhelmingly positive, especially for business,
remarkably especially for business.
CBO concluded that, ``businesses' costs for health care would be
substantially reduced overall,'' and that their savings would reach $90
billion when the plan was fully implemented. Workers wages would rise
as a result, with no net effect on employment.
We have heard all of the claims about job loss. The Congressional
Budget Office said not only will there not be job loss, but that we
will actually save $90 billion for business each and every year when
this plan is fully implemented.
In other words, CBO is arguing that health reform would be a major
benefit to businesses: most would save significantly on health expenses
and increase their workers' wages, even if they are required to
contribute to their employees' premiums.
Given CBO's analysis, many observers of the health reform debate may
find it perplexing that earlier this year a number of major business
groups decided to oppose the Clinton plan--interestingly long before
the chamber conducted its membership survey.
While the more cynical might respond that this is not so surprising
given that major business organizations have opposed virtually every
major social change in this century, I think a brief critique of the
chamber survey might provide more insight into its results.
the chamber survey asks the wrong questions
While the chamber survey helps to gauge this fear, it does not
measure the benefits to business of the President's reform proposal or
the need for it.
A more helpful survey would ask the 60-plus percent of all small
businesses that currently do offer insurance for their workers how much
their premiums have risen over the last several years because the
current system does not control health costs.
A more helpful survey would ask how these businesses feel about
paying $10 billion to subsidize the health costs of their competitors
who don't cover their workers.
A more helpful survey would ask the 40 percent of small businesses
that don't offer insurance why they do not, and if they would like to
offer coverage, with some assurance their premiums will be controlled.
A more helpful survey would ask for opinions from the thousands of
businesses that fail each year because of high health care costs.
A more helpful survey would ask the workers at small firms what it
feels like to be uninsured, and what kind of impact this has had on
themselves and their families.
A more helpful survey would ask how many businesses had to drop
coverage, or were denied coverage, due to a worker's preexisting
condition, and how many workers lost coverage when they changed jobs,
moved or were laid off.
Unfortunately, the chamber survey does not ask or answer any of these
important questions. Instead, it paints with broad brush strokes a
picture of steadfast opposition to any mandate of any kind.
Yet the question remains: How can we get to universal coverage, which
virtually all experts in business and government agree is necessary to
contain costs, without some type of a requirement?
The answer, of course, is through a broad-based tax we could
accomplish the same thing. I suspect that most of the Nation's small
businesses would be even less enthused about that option.
the case for shared responsibility
So, if we conclude that some sort of mandate is necessary to gain
universal coverage, we must decide whether or not we want an individual
mandate--essentially placing the entire burden of health insurance on
families--building upon the current tradition, building upon the
practices that have been in place now for generations.
Many have concluded that the shared responsibility option makes the
most sense.
It makes the most sense because it builds upon our current health
care system. Today, the vast majority of the insured have coverage
through the workplace. Building upon this strong base represents the
least radical and most prudent means to gain universal coverage--
guaranteed private health insurance for everyone.
And those who follow the poll's data will surely want to note that
the public supports the employer-based approach overwhelmingly.
According to a Washington Post survey, 73 percent of Americans support
an employer requirement for full-time workers and 69 percent for part-
time employees.
A Wall Street Journal poll found 65 percent of Americans support
shared responsibility for small firms, small businesses.
Most people support shared responsibility because the employer-based
system has worked well for decades and Americans know and support it.
Why not build on a system that works, rather than start a completely
new one that shifts cost entirely to families?
shared responsibility will help small business
While some opponents of health reform cling to the status quo and
view change as a threat especially to small business, I believe that
comprehensive reform will actually help small businesses thrive.
In fact, shared responsibility has the real potential to improve the
economy by increasing employment and decreasing business costs.
Coupling strong cost containment with a requirement that employers
share responsibility for health coverage will not result in job loss.
According to the nonpartisan Employee Benefits Research Institute,
implementation of the Health Security Act could result in a net gain of
up to 660,000 jobs.
Through shared responsibility, we can guarantee health insurance
coverage for all Americans and we can help small businesses remain
competitive.
Through shared responsibility, we can protect small businesses from
double digit health inflation and give them benefits that cannot be
taken away at the whim of an insurance company.
Through shared responsibility, we can create an environment in which
business owners and workers no longer make employment decisions based
upon who does or does not offer insurance coverage.
Through shared responsibility, we can level the playing field so that
those firms that offer coverage no longer subsidize those that do not.
Through shared responsibility, we can guarantee health insurance
coverage for all Americans, including business owners, workers,
children, and the elderly.
conclusion
As we acknowledge the misconceptions that surround the employer
mandate proposal, we should take care not to be cowed by some business
opposition to this linchpin of reform. Instead, let us commit ourselves
to assuaging these fears by telling small business owners the truth:
shared responsibility will result in a better health care system,
healthier workers, and a stronger economy.
Our broken health care system is unsustainable, and businesses look
to Congress and the President for some leadership in solving the many
problems that perplex us today. They do not want a handout. They want
some help--rules that level the playing field, encourage personal
responsibility, and provide them and their workers with health
security.
Let us make sure that small businesses, the backbone of our economy
and the engine of its growth, can thrive without the burden of worrying
about their own or their employees' coverage.
Let us utilize fair, shared responsibility between employers and
employees as a means to fix our broken health care system.
And let us do it this year. Let us do it constructively.
Let us do it without delay.
Mr. President, is it my understanding that I control the time.
The PRESIDENT pro tempore. The Senator is correct.
Mr. DASCHLE. There are no speakers on my side wishing to be
recognized.
opposition to employer mandates
Mr. PRESSLER. Mr. President, I am honored to join several of my
Senate colleagues today in expressing opposition to the inclusion of an
employer mandate in any health care reform bill adopted by Congress. In
short, an employer mandate would cost jobs and reduce wages.
My opposition to an employer mandate does not mean I do not support
efforts to reform our health care system. We must take steps to reduce
medical costs and to make insurance affordable and available to
everyone. However, an employer mandate is not the best solution.
The National Federation of Independent Business [NFIB] recently
studied the impact of the employer mandate as proposed by the Clinton
administration. That study reveals the following: 850,000 U.S. jobs
would be lost; 1,700 jobs in my home State of South Dakota would be
lost; some 23,000,000 U.S. jobs would be negatively impacted with an
average annual wage loss of $1,200 each; and the cost of the subsidy to
smaller firms would be $81 billion during the first year.
As ranking member of the Senate Small Business Committee, I am
concerned about the impact of escalating health costs on small
businesses. Between 1980 and 1990, employer health costs nearly
tripled. The primary reason many employers do not provide medical
benefits to their employees is excessive cost. The primary goal of
health care reform should be determining how we can best reduce
insurance costs, not the imposition of another mandate.
Last year, other members of the Senate Small Business Committee and I
met with First Lady Hillary Rodham Clinton to discuss the issue of
health care reform. She and the President should be commended for
bringing this issue to the forefront of national attention. Although I
agree with their goals, I do not support their proposed solution, which
seems to change virtually daily.
At our meeting, I presented to the First Lady a letter signed by 40
Republican Senators. The letter expressed our opposition to an employer
mandate. Mr. President, I ask unanimous consent to submit this letter
for printing in the Record.
Our message was clear then and it remains the same today. We oppose
the Government mandating health insurance cost on all employers. That
is not the best solution.
Since the President introduced his health care reform plan--the
Health Security Act--over 19,000 South Dakotans have contacted me to
express opposition to the President's proposal. Many of them agree than
an insurance mandate on employers who cost jobs and reduce wages.
However, all these folks agree that we need to make some changes in our
health care system.
We need to make significant changes. However, we do not need to
overhaul the entire system. I like to use this analogy in explaining my
views on health care reform. If a farmer has 10 tractors and 2 of them
need overhauling, he will overhaul the 2 and maybe just tune up the 8
others. This how we should proceed on health care reform.
Reform should include the following:
Every American should have access to health insurance;
Insurance coverage should remain with the individual at all times--
that is, it should be portable;
There should be no denial of coverage for what is called a
preexisting condition;
We should encourage individuals and groups to form voluntary
purchasing pools;
We must reform our malpractice laws, including limiting damages
awarded in lawsuits, encouraging arbitration, and establishing standard
medical practice guidelines;
We must reduce paperwork;
We must reduce Federal regulation;
We must make changes in our antitrust laws;
We must eliminate waste and fraud; and
We must provide financial assistance to help the very poor purchase
insurance.
Mr. President, health care reform is long overdue. But in the process
of fine tuning the current health care and insurance system, let us
avoid imposing a Big Government solution that would cost many jobs and
create many other problems. As others have said, let us fix what needs
to be repaired and no more.
There being no objection, the letter was ordered to be printed in the
Record, as follows:
U.S. Senate,
Washington, DC, August 3, 1993.
The President,
The White House,
Washington, DC.
Dear Mr. President: We share your concern about the rapidly
escalating cost of health care and the large number of
Americans without health insurance. With health costs
increasing ten percent a year and millions of Americans
uninsured, corrective action must be taken now.
Many of us have been working to devise a proposal for
comprehensive health care reform. It is essential to preserve
the best elements of our existing system, while minimizing
costs, and ensuring adequate health care for our nation.
We are strongly opposed to an employer mandate to pay for
health care reform. Whether it is a wage based premium,
payroll tax or any other carefully crafted euphemism for
taxes, job loss among small businesses will be unavoidable
and significant.
Small businesses create the vast majority of new jobs in
our country each year. Indeed, under-capitalized small
businesses are often the first step to realizing the American
dream of entrepreneurship. While we strongly support health
care reform, small businesses and family farms cannot be
sacrificed in the process.
Health care reform must include provisions to help
employers provide health benefits. However, new health care
taxes will cost jobs and slow the economic growth of our
country.
We look forward to working with you and other members of
Congress in an effort to adopt a health care reform package
yet this year.
Sincerely,
Bob Dole, John H. Chafee, Larry Pressler, Don Nickles,
Thad Cochran, Strom Thurmond, Dirk Kempthorne, Larry E.
Craig, Al D'Amato, Lauch Faircloth, Frank H. Murkowski,
Slade Gorton, Kit Bond,
Phil Gramm, Trent Lott, Al Simpson, Jesse Helms, Bob
Smith, Orrin G. Hatch, Robert F. Bennett, Dave
Durenberger, Chuck Grassley, Mitch McConnell, Hank
Brown, Jack Danforth, Conrad Burns, Connie Mack,
John Warner, Dick Lugar, Mark Hatfield, John McCain,
Arlen Specter, Nancy Landon Kassebaum, Kay Bailey
Hutchison, Daniel Coats, Malcolm Wallop, Paul
Coverdell, Judd Gregg, Bill Cohen, Pete V. Domenici,
Ted Stevens.
Order of Procedure
Mrs. KASSEBAUM. Mr. President, I wonder if I might ask unanimous
consent to speak for a few moments on a subject other than health care
without the time being taken from the control of the Democratic side of
the aisle.
Mr. DASCHLE. I have no objection.
The PRESIDENT pro tempore. How many minutes would the Senator
require?
Mrs. KASSEBAUM. Five minutes.
The PRESIDENT pro tempore. Is there objection? Hearing no objection,
the Senator from Kansas is recognized for 5 minutes which will not be
charged against the time under control.
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