[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.

                          ____________________