[Congressional Record Volume 140, Number 74 (Tuesday, June 14, 1994)]
[House]
[Page H]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: June 14, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
                INSURANCE REFORM AND UNIVERSAL COVERAGE

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
February 11, 1994, and June 10, 1994, the gentleman from Washington 
[Mr. McDermott] is recognized for 30 minutes as the designee of the 
majority leader.
  Mr. McDERMOTT. Madam Speaker, as you know, I have made an effort to 
talk to my colleagues almost every week about key issues in health care 
reform and to explain how these issues will affect the American people 
directly--in plain terms that everyone can understand.
  I have spoken previously on why every American needs universal health 
insurance, not just the uninsured. And I have spoken on why system-wide 
managed care is the wrong approach to health care reform. I will speak 
on both of those issues again.
  Tonight I want to talk about a proposed compromise in health care 
reform that is being widely discussed in the media--because I believe 
that the American people are being very much misled on the workability 
of this compromise.
  This compromise is like ``the emperor's new clothes.'' There are a 
lot of people admiring the silk, but in reality, there is nothing 
there.
  I am talking about the idea of just doing, quote, ``insurance 
reform'' and dealing with universal coverage later.
  Well, there is one problem with that. Insurance reform only works if 
you have universal coverage guaranteed. If you do insurance reform 
without universal coverage, the result is that the price of insurance 
premiums go up, period. Employers stop offering insurance because the 
price is too high, and people lose insurance rather than gaining it.
  This is not just theory. It has happened in the real world. In New 
York State, in an attempt to improve access to coverage by the middle 
class employed, instituted community rating and eliminated the 
preexisting condition exclusion. In other words, it became illegal to 
exclude people from insurance if they already had a physical problem or 
illness. But New York did not require universal coverage.
  And what was the result? Insurance premium prices escalated, 
employers dropped insurance, and after the insurance reform, they have 
more uninsured people in New York than they did before insurance 
reform.
  Why? Because all the young healthy people left the insurance pools 
when community rating came in. This made the insurance pools even more 
expensive, causing a death spiral of higher premiums, people unable to 
afford insurance unless they know they will use it, and ever-worsening 
insurance pools which in turn become more expensive.
  The only way to prevent this is to do universal coverage first or 
simultaneously with insurance reform. Then the insurance pools stay 
mainly healthy and insurance premiums have at least some possibly of 
becoming affordable.
  Insurance reform without universal coverage is a sham! It will give 
Americans the illusion that we have done something for them on health 
care reform, when in fact we will have made matters worse.
  What could be worse than enacting reform that will cause people to 
lose their health insurance coverage? And that's exactly what insurance 
reform without universal coverage will do. Mr. Speaker, I urge my 
colleagues to reject out of hand such proposals. The American people 
will figure this out in a very short amount of time and they will come 
looking--with great justification--for the culprits who did it.
  There is another concept being floated as a potential compromise that 
is equally ludicrous. In fact, I saw the distinquished Senate minority 
leader, Mr. Dole, advocating this in a television commercial on health 
care reform.
  And that is the notion of giving Americans, quote, ``portability'' 
without universal coverage. Now, I've been working on health care 
reform for 30 years and I cannot for the life of me figure out what 
portability without universal coverage is.
  Portability means that you can take your health insurance with you 
wherever you go no matter how your employment or personal situation 
changes.
  How can you do that if there is no universal coverage? What is the 
vehicle, the mechanism of portability? What are they saying? That if 
you lose your job or move, they'll let you buy your own insurance at 
full price in the individual market? Most Americans have the right to 
do that now. They don't need a new law to do that. The reason they 
don't do it is because they can't afford to do it.
  You don't have portability if you leave a job that has insurance and 
your next employer doesn't offer it.
  You don't have portability if you get divorced and are no longer on 
your spouse's insurance policy and have to pay for insurance yourself.
  You don't have portability if your spouse dies.
  You don't have portability if you move or change jobs or lose a 
spouse that carried insurance when family health policies today cost 
$5,000 to $6,000 a year.
  If you don't have a system that guarantees you coverage and a way to 
pay for it, you don't have portability, period.
  Now, it's time to stop throwing words at the American people and 
pretending that words are solutions.
  The American people are not fools and they know that some shortcuts 
are more trouble than they are worth. We can't take shortcuts on health 
care reform.
  We can't take shortcuts--not because it would be immoral or inhumane 
or undemocratic. We can't take shortcuts because they simply won't 
work. We must have universal coverage because you can't get insurance 
reform or portability or cost-containment without it. Health care 
reform without universal coverage simply is not worth doing. In fact, 
it will probably make matters worse.
  Mr. Speaker, I am concerned that we are conveying the impression that 
health care reform is just too hard to do. This is unworthy of the 
American people.
  When we look around the world and the events of the last few years, 
we see historical developments of almost biblical proportions. The 
Berlin wall has come down and Russia is a struggling democracy.
  Unbelievably, South Africa has ended apartheid and has completed its 
first nationwide democratic election.
  Our fellow industrialized countries are climbing--and scaling--the 
Mount Everests of political challenges. Compared to the challenges 
these nations have embraced, the difficulty of reforming our health 
care system so that we can finally get everyone into the system is so 
small. It is not Mount Everest. It is not even a hill.
  We are the greatest Nation in the history of the world. We are the 
richest and we are the most democratic.
  To say that we cannot do something as relatively simple as get all 
our citizens in the largest health care system in the world in less 
time than it took for de Klerk to end apartheid or Gorbachev to bring 
down the Berlin wall is unworthy of the American people.
  Since when are the American people so weak or so small that we cannot 
meet our own challenges?
  We have witnessed ordinary people around the world in the 
transformations of recent years and weeks rise to the stature of 
giants. The American people are every bit their match and we should 
never concede otherwise.
  Universal coverage is the house of health care reform. We all know 
that it is better to own your own home than to rent an apartment. But 
what usually keeps people from buying their own homes? The downpayment.
  We have to come up with a downpayment--the way to get into the 
house--or, as a nation, we will just have to keep on renting this 
inadequate and over-priced apartment.
  An apartment that is too small, that doesn't suit our needs, that 
drains our resources and keeps us from ever being able to afford the 
house.
  So how do we get into the house? There is no question that the 
cheapest, the quickest, the most efficient way to get into the health 
care house is through single-payer reform.
  This is the way every other country in the industrialized world got 
into the house, and they are living there much more comfortably than we 
are in our poor apartment.
  Single-payer is the way to absolutely guarantee 100 percent universal 
coverage within 1 year. Even Senator Durenberger, who is not a single-
payer supporter, acknowledged that only single-payer could achieve full 
universal coverage with every ``i'' dotted and every ``t'' crossed.
  Only single-payer guarantees unrestricted free choice of provider and 
eliminates insurance company interference in the physician-patient 
relationship. Only single-payer guarantees that you can have a lifetime 
relationship with your doctor if that is your choice.
  Only single-payer provides complete benefits including preventive 
care, all outpatient and hospital services, prescription drugs, 
children's dental care, mental health services, and comprehensive long-
term care. It takes care of the coverage part of universal coverage.
  How is single-payer able to do all this? Very simply.
  If Americans paid their health insurance premiums to a single 
national health security fund instead of to all their different 
insurance companies, and then that single national fund reimbursed 
health care providers directly for their services the way insurance 
companies do now, we would save enough money on insurance 
administration to pay for universal coverage and comprehensive benefits 
for all Americans.
  With single-payer, we get to universal coverage immediately. So don't 
let anyone tell you we have to phase it in over 5 years, or to the end 
of the century, or beyond.
  We don't need to wait that long. And remember, every year we postpone 
it, we lose money because we can't control costs. Every year it will 
cost more to fix the problem. Every year more people will lose their 
insurance and we will all have more to worry about.
  And every year universal coverage is delayed, the chances are greater 
that something will intervene in Congress to just keep on pushing it 
back. We will simply lose it.
  We can have universal coverage by 1997, and the American people 
should settle for no less.
  I urge all of you who want the guarantee of universal coverage for 
yourselves and for your families to insist on universal coverage by 
1997 so that we can finally move into the house that will give us 
security for the future.

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