[Congressional Record Volume 140, Number 72 (Friday, June 10, 1994)]
[Senate]
[Page S]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: June 10, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
                       VERMONT'S HEALTH CARE PLAN

  Mr. DOLE. Madam President, I would like to bring to the attention of 
my colleagues a rather compelling article in today's New York Times--
``Vermont Shows How Health Care Can Fail.''
  What struck me about this article is that a State, like Vermont, with 
relatively low medical costs, few illegal aliens, an uninsured 
population of about 11\1/2\ percent, compared to 15 percent nationwide, 
and generous social welfare benefits--qualities conducive to 
comprehensive health care reform--could not enact such legislation.
  Vermont is also unique in that it is the only State whose Governor--
Howard Dean--is a physician. I have had the pleasure of meeting with 
Governor Dean and was impressed with his knowledge of health care. But, 
despite his expertise, the plan collapsed.
  Madam President, it was not the fault of the Governor. And, it was 
not the fault of Democrats, or the fault of Republicans, that health 
care reform did not pass in Vermont. It was due to the very nature of 
the legislation that was being considered, the enormity of its costs, 
and its lack of public support.
  What Vermont tried to pass is very similar to the President's plan 
and to democratic bills currently before the Congress--the plan had 
mandatory alliances, global budgets, employer mandates, and a one-size-
fits-all basic benefit package--the very same elements that are cause 
for concern for many Americans and for many of our colleagues--on both 
sides of the aisle.
  One of the most compelling parts of this article, Madam President, 
was the statement made by the majority leader of the State Senate. In 
essence, he said the plan lost support in the end because officials 
refused to discuss the unpleasant financing details in the beginning.
  I think this may be the very same trap we may be heading for here. I 
am hopeful that there will be enough of us to put together a 
reasonable, sensible, bipartisan package. Maybe this is not an example 
of what would happen here, but it seems to me that if you do not have 
the public's support, as we learned here on catastrophic coverage a few 
years ago, if it is not there when you act, it is not going to be there 
after something passes.
  What this experience tells me, and what I hear from constituents in 
Kansas, is: Go slow and get it right. Congress comes back every year, 
and every year there is going to be somebody here--100 Senators--and 
they are going to be dealing with the issues of the day. We can do some 
this year and some next year.
  The Finance Committee has a reputation of being a consensus 
committee, not a partisan committee. I think if anybody would go back 
and look at all the measures going through the Finance Committee--
health care or anything else--you will find that in nearly every case 
it was either a unanimous voice vote, or 16-4, or something like that 
maybe, on amendments. Rarely on final passage have we had a strict 
party-line vote. So there is still some hope.
  Yesterday, the chairman of the Finance Committee, Senator Moynihan, 
gave us a nine-page document, and we are in the process of examining 
that. It seems to me that, just on first blush, it is about $190 
billion in new taxes, and a lot of mandates, and a lot of people are 
going to be denied the right to self insure.
  There are problems, but as the chairman pointed out, I think it is a 
place to start, and we will see what happens in the next several weeks.
  I ask unanimous consent that a New York Times article be printed in 
the Record.
  There being no objection, the article was ordered to be printed in 
the Record, as follows:

                Vermont Shows How a Health Bill Can Fail

                            (By Robert Pear)

       Montpelier, Vt., June 4.--For years, Vermont set an example 
     to the nation, showing how to regulate health insurance to 
     control prices and expand coverage. Now it offers a different 
     lesson, showing the perils of trying to enact a health care 
     overhaul that is both ambitious and complex.
       Gov. Howard Dean, a doctor who is vice chairman of the 
     National Governors' Association and who will soon be the 
     group's chairman, listed health care as his top priority in 
     January. He asked the General Assembly to pass legislation 
     very similar to that proposed by President Clinton. But the 
     Governor's plan collapsed last month, spurned by liberal 
     Democrats who said it did too little and by Republicans who 
     said it did too much.
       ``We tried to do too much too quickly,'' said State 
     Representative Sean P. Campbell of Saxtons River, a Democrat 
     who is the majority leader of the House and chairman of a 
     special committee that drafted a health care bill. ``It was 
     too big. We couldn't swallow it. We ended up spitting it 
     out.''
       Over and over, when Vermont residents describe their 
     experience, they liken it to the national struggle over 
     health care. They wonder how Congress can pass comprehensive 
     legislation if it has proved impossible in a state like this, 
     where the politics are much less complicated, the lobbying is 
     more restrained and the Governor has a high approval rating 
     as well as a large store of political capital.
       State Senator Matt Krauss of Barre, a moderate Republican, 
     said: ``Early this year there was a great expectation that we 
     would pass a comprehensive health care bill. But the more the 
     public learned about the details and the cost, the more 
     nervous they became. The general public soured on health care 
     reform. In the month before our vote in the Senate Finance 
     Committee, it became clear that the bloom had gone off the 
     rose.
       ``Our mind-set was that we were going to revamp the health 
     care system from top to bottom,'' Mr. Krauss continued. ``In 
     retrospect, that was a bad mistake. We should have been more 
     realistic and targeted. We should have taken health care 
     reform in small, modest doses, in doable increments. By 
     trying to tackle everything, we ended up accomplishing 
     nothing.''
       Like the President's plan, Governor Dean's proposal would 
     have required employers to help pay health insurance premiums 
     for their employees. As in the Clinton plan, most people 
     would have obtained coverage through a purchasing pool, or 
     alliance, and the government would have set an annual budget 
     for all health spending.
       A compromise bill that included new taxes to finance 
     coverage for the uninsured died in the Senate Finance 
     Committee. The vote was 7 to 0 against the bill, with four 
     Republicans joining three Democratic backers of a Canadian-
     style system in which the government pays for the health care 
     of its citizens.
       One of those Democrats, State Senator Elizabeth M. Ready of 
     Bristol, said she still supported ``single payer'' approach, 
     financed with tax revenue. ``I'm not wavering in that,'' she 
     said. ``It's clear and true vision.''
       But she has concluded that ``We must take small, deliberate 
     steps, an evolutionary rather than a revolutionary approach, 
     because we're not going to get the whole enchilada.''
       In an interview, Governor Dean, a Democrat, asserted that 
     ``an unholy alliance of the far left and the far right killed 
     a bill that would have guaranteed health insurance to 
     everybody in the state.''
       Vermont has 15 hospitals, 1,000 practicing doctors, 
     comparatively low medical costs, two major private health 
     insurers, 68,500 uninsured people (out of a population of 
     576,000) and a history of bipartisan cooperation by 
     conscientious public officials. The state takes pride in its 
     quality of life and in its comparatively generous social 
     welfare benefits.
       Vermont residents are widely conversant with the 
     complexities of overhauling health care, having studied the 
     issue for four years. Vermont was among a half-dozen states 
     that could not wait for the Federal Government to act on 
     health care; it passed its own laws in 1991 and 1992. These 
     measures require insurers to sell coverage at standard rates 
     to people regardless of their medical histories, and they set 
     annual spending goals for each hospital.
       State Senator John Carroll of Norwich, a Republican who is 
     majority leader of the Senate, supported that legislation. 
     This year he was ready to vote for new taxes to finance 
     coverage of the uninsured, and he supported a plan requiring 
     employers to contribute to the cost of coverage for their 
     employees--two ideas opposed by many Republicans in Congress.
       Mr. Carroll says the health care plan died here mainly 
     because public officials delayed discussing unpleasant 
     financial questions.
       ``The most important questions about health care reform are 
     financial: How much does it cost, and who pays?'' said Mr. 
     Carroll. ``There was a persistent tendency to put off those 
     questions to the end. It was a fatal mistake. Those are the 
     toughest questions, and we should have confronted them at the 
     beginning.''
       Analyzing what they describe as their ``health care 
     meltdown,'' many Vermonters agree with State Senator Althea 
     Kroger of Essex Junction, a Democrat and assistant minority 
     leader of the Senate, who said: ``We underestimated the 
     complexity of the issue. We underestimated the opposition.''
       And many are asking, in the words of Norman E. Wright, 
     president of the Vermont Hospital Association, ``Did we have 
     a dream bigger than our ability to perform?''
       State Senator Peter E. Shumlin of Putney, a Democrat, said: 
     ``This is as much our fault as the special interests. We all 
     collectively share the blame for telling voters this would be 
     simple, easy, painless and free.''
       On the other hand, Governor Dean said that Vermont's 
     failure showed the need for Federal action. ``We really need 
     a Federal framework,'' he said in the interview. The Federal 
     Government, he said, should define a standard set of health 
     benefits for all Americans and should prescribe some method 
     of financing, whether through premiums or taxes, but should 
     let states decide the best way of delivering health care.
       Moderate Republicans, an endangered species in Washington, 
     have dominated the Republican Party in Vermont. Likewise, the 
     left wing of the Democratic Party is more influential here 
     than in Washington. Nevertheless, Mr. Dean sees many 
     similarities between Montpelier and Washington. Negative 
     advertising frightened many consumers. Here, as in Congress, 
     there was intense pressure to make the benefits package more 
     generous and therefore more expensive.
       Asked why health legislation has died this year, State 
     Representative Robert J. Harris of Windsor, a Democrat, said, 
     ``The cost, pure and simple.''
       The Vermont House seriously considered raising income and 
     payroll taxes to help pay for health care. Local newspapers 
     published tables showing that state income taxes would double 
     for many people. ``It scared the daylights out of the 
     public,'' Governor Dean said.
       People generally did not realize that the new taxes would 
     replace premiums they were already paying for health 
     insurance. House members, deluged with complaints, beat a 
     hasty retreat. The bill that was eventually passed by the 
     House did not specify a level of benefits or a means to pay 
     for them; it called for a study of those questions.
       ``The opponents of health care reform were much more 
     motivated than the supporters,'' the Governor said. 
     ``Businesses that favored health care reform sat on their 
     hands.''
       On the other hand, Mr. Dean said, many advocates of a 
     single payer health system used what he called ``slash and 
     burn tactics'' to block a compromise.
       ``They were incredibly inflexible,'' he said. ``They were 
     more interested in ideological purity than in actually 
     providing health care to the uninsured.''
       Alan Hark, a lobbyist for the Vermont Low-Income Advocacy 
     Council, said some single payer advocates ``did a disservice 
     to their constituents, especially those who are uninsured, 
     because they were so rigid and inflexible.''
       State Senator Cheryl P. Rivers of Bethel, a leader of the 
     liberal Democrats, rejected such criticism but acknowledged 
     that ``we formed an alliance with the most conservative 
     Republicans who didn't want anything.''
       ``Instead of standing up to the special interests and 
     getting efficiencies from the health care system, the Senate 
     bill would have required middle-class people and small 
     businesses to pay for health care reform,'' she said. ``It 
     would have taxed the benefits of people already insured, and 
     it would have created a new welfare-like program for the 
     uninsured.''


                        waiting for a consensus

       When a bill dies, legislators often say they ran out of 
     time. But State Senator Jan Backus of Brattleboro, a Democrat 
     who is chairwoman of the Senate Committee on Health and 
     Welfare, said that ``in some ways, we had too much time''--
     people found more to dislike as they studied the legislation 
     more closely.
       It became evident, as Senator Ready said, that ``we as 
     Vermonters, we as a nation, have not come to a consensus on 
     what to cover or how to pay for it.''
       Some Republicans said that rather than devising its own 
     health insurance scheme, Vermont should wait to see what 
     Congress does.
       But as the legislature crawled toward adjournment, State 
     Representative Margaret F. Martin of Middlebury, a Democrat 
     who heads the House Committee on Health and Welfare said: 
     ``I'm battered and bruised and very, very disappointed. What 
     happened here is, I fear, what will happen nationally.''

                          ____________________