[Congressional Record Volume 140, Number 79 (Tuesday, June 21, 1994)]
[House]
[Page H]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: June 21, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
                 THE CONTEXT OF THE HEALTH CARE DEBATE

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
February 11, 1994, and June 10, 1994, the Chair recognizes the 
gentleman from Oregon [Mr. Wyden] for 60 minutes.
  Mr. WYDEN. Mr. Speaker, I think it is particularly important to try 
to set in some context the health care debate as we are facing it in 
the remaining weeks, particularly before the August recess. I think it 
would be fair to say, and I think Members of Congress on both sides of 
the aisle would agree that there is substantial confusion with respect 
to the health care issue. Certainly since the President gave his very 
eloquent address here in this Chamber, we have seen very powerful, very 
influential, very well-funded interest groups spend substantial sums of 
money to try to protect their interests, to try to make sure that the 
debate in effect goes their way, and I think the public is confused.
  Mr. Speaker, I think it is important to set out a few facts, and one 
of them, Mr. Speaker, I think deals with why there is an immediate need 
for action on health care and action in this session of Congress.
  Mr. Speaker, we know that our country does have superior health care 
in many respects. There are many things that are right about American 
health care, but the fact of the matter is that there are many things 
that we can do far better.
  The infant mortality rate would be just one example. The infant 
mortality rate for our country ties us for 21st out of 25 
industrialized nations. That means that in terms of the industrialized 
world, we are not up in front. We have a lot to do.
  Specifically, that means that in our country there are 9 children out 
of every 1,000 that are born who die before their first birthday. At 
least half of the American infants who die could be saved with simple 
prenatal care for low-income mothers, care that they cannot get without 
health insurance coverage.
  Eight out of ten uninsured Americans are part of working families. 
Mr. Speaker, it is a myth to say that those who are uninsured by and 
large want to be uninsured, or are just home and taking it easy. Most 
of them are part of working America. They get up in the morning, they 
go to work, they try to play by the rules, and yet they have not been 
able to afford health care.
  We have almost 2 million Americans who lose their health insurance 
coverage each month. Eighty-one million Americans have pre-existing 
conditions, such as asthma and diabetes and high blood pressure, and 
health insurance companies in our country routinely use these kinds of 
conditions as a rationale to jack up insurance premiums or to deny our 
citizens access to insurance altogether.
  More than 100 million Americans have so-called lifetime limits on the 
amount their health insurance policies will pay out. Chronic disease 
and illness does not respect these limits, and neither should the U.S. 
Congress.

                              {time}  1810

  It seems to me that when our constituents ask why is it so important 
that Congress act and that Congress act now on the health care issue, 
these are the kinds of considerations we should point to.
  Let us talk about why it is not right for so many young people to not 
get a fair chance in life, why the infant mortality rate is so high in 
our country, why so many of our citizens are victimized when the 
insurance companies cherrypick and take the healthy people and send 
those who are ill off to some underfunded government program.
  Those are the kinds of things that I think we ought to be focusing on 
as we go into this period before the August recess when it is so 
important that Congress act.
  Mr. Speaker, let me also talk for a moment about some of the serious 
consequences in terms of the way health care is funded today. To a 
great extent today in America, our system of financing health care has 
a real strain of socialism, a redistributive kind of function that just 
is not right. What we have in America is those who do get their 
coverage through their place of employment in effect subsidize those 
who do not. In my home State of Oregon, what we find is the employers 
who cover their people usually offer preventive care, some outpatient 
health services, perhaps a catastrophic health care benefit. It is not 
a Mercedes, it is not a Cadillac, it is just the basics of American 
health care. But very often, those hardworking Oregon small businesses, 
and they usually are small because in my State the vast majority of 
businesses are small, they have to subsidize the companies that are not 
offering coverage to their workers. And not only do they have to 
subsidize the coverage, but they have to subsidize the coverage at the 
most expensive end, because we find in our country that the workers, of 
course, the businesses that do not cover their folks, those workers get 
sick, no question about that, they cannot defy human nature, they end 
up going to the hospital emergency room and then those costs, and I 
want to emphasize this word, those costs are socialized, they are 
socialized throughout the community and the employers who cover their 
people have to pick up the expenses.
  So I happen to think that we ought to deal with this cost shift. The 
Congressional Budget Office has estimated that about $25 billion in 
health costs are shifted onto persons with private insurance each year.
  In 1991, hospitals were left with an estimated $10.8 billion in 
unpaid bills from uninsured patients. That was up from $3.5 billion in 
1981. So I think we ought to deal with this matter of the cost shift. 
For those who want yet another example from the real world, the 
National Association of Manufacturers has asserted that in 1991 its 
members were billed an extra $11 billion to recoup costs not covered by 
the government or the uninsured.
  So my own sense, Mr. Speaker, is that everybody has got to be part of 
the solution. We ought to say that individuals in our country ought to 
have to pay something as a portion of the cost of health care. There 
needs to be individual accountability, and I have long said that I 
personally would favor the idea of an individual making a copayment 
every single time they go to a medical provider's office.
  Individual responsibility, individual accountability ought to be 
right at the heart of financing health care.
  But I also think that employers ought to have a role in financing 
health care as well, because if we do not have such a system the 
employers who cover their people subsidize the ones that do not, and 
they have to, in effect, pay the most expensive end of the health care 
system, and that is the cost of these emergency room bills.
  So I think that we ought to recognize in our country, particularly if 
we want to be fair to our businesses and our businesses that are trying 
to compete in tough global markets, that we ought to stipulate that we 
are going to seriously deal with this problem of cost shifting. It is a 
problem that is growing in our country, and it is particularly 
inequitable to the small businesses across our country, such as the 
ones I have talked to in my home State who struggle, and yet valiantly 
are able to cover a significant portion of their workers' health costs 
and yet those Oregon small businesses are subsidizing some of their 
competitors, and that is not right.
  Mr. Speaker, let me try now to touch on one of the other issues that 
is so important to the citizens of our country, and that is the 
elderly. We are finding that Medicare, which of course is a program 
that is of extraordinary importance to seniors, has left many of our 
seniors now paying more out of pocket for their medical bills than they 
did when Medicare began. We are finding many seniors for example having 
to pay more than a thousand dollars a year out of pocket for their 
prescription drugs. That seems particularly unfair, given the fact that 
taxpayers and seniors do much of the heavy lifting with their tax 
dollars to get these drugs, particularly cancer drugs, to market.

  So I would hope that as we look to these last few weeks before the 
recess that we particularly take steps to try to address the concerns 
of seniors and fill in some of the gaps in Medicare.
  In this regard, another important step that could be taken is to 
begin a serious, long-term care policy for our country and to build it 
around home health care. In my own State of Oregon I had a lot of 
familiarity with this program back in the days when I was co-director 
of the Oregon Gray Panthers. We have started a home care program which 
has significantly reduced the number of older people in nursing homes 
and also made seniors happier and more comfortable with the prospect of 
being in their community.
  To his credit the President in his health reform bill tries to start 
a long-term care policy for our country, beginning with home health 
care, and in my view the President deserves great credit for having 
launched this long overdue effort.
  Finally, it seems to me in the Medicare area there must be an effort 
to try to make sure that the payments that seniors rely on for their 
health care services are based on what they need and not on where they 
live.
  Recently the General Accounting Office sent to me a shocking report 
demonstrating enormous differences between regions of the country as to 
what Medicare will pay for a particular health service.
  For example, there is a 180 percent differential between what 
Medicare will pay for mammography services of course being of great 
importance to older women in our country, and there is a great 
difference between what Medicare will pay between Southern California 
and Northern California, even with the same carrier.
  So I would hope as we look to health reform that some uniform 
national standards be defined with respect to Medicare payments for our 
senior citizens, and I would point out that ensuring that there are 
some uniform payments standards would also be fair to our physicians, 
because they should not have to have the uncertainty that we now have 
with respect to Medicare payments when they see older people.
  Mr. Speaker, finally, as we look to these last few weeks we should 
recognize that health care is really the premier domestic issue of our 
day and the test of our ability to govern.

                              {time}  1820

  One-seventh of our economy, almost $1 trillion, is devoted to health 
care.
  I would say that on a personal basis, this is the most important 
issue to the American people, because we know that if our families and 
their loved ones do not have their health, virtually nothing else 
matters. So this is an issue that we cannot allow to fall by the 
wayside.
  There is a very serious problem with the American health care system 
today despite the many positive attributes of American health care, and 
that is why I outlined the issues with respect to infant mortality and 
life expectancy and the many challenges.
  We have to make sure, particularly, that our young people get a fair 
start, and there is a problem with financing, Mr. Speaker, because 
right now we do have the employers who cover their workers. In many 
instances, facing great difficulty in doing so, those employers have to 
subsidize the employers who do not cover their workers, and that is not 
right from the standpoint of making sure that all businesses face the 
same kind of competitive consideration.
  Finally, it seems to me that we ought to make sure that we go to bat 
for our seniors, and to his credit, President Clinton starts a long-
term-care policy for our country. He also initiates a number of 
positive changes in terms of nursing home insurance. I, the gentlewoman 
from Illinois [Mrs. Collins], Senator Pryor and others have worked on 
this.
  There is a great deal of bipartisan support for this, and this 
measure should be enacted also.
  Finally it seems to me we ought to deal with the shocking General 
Accounting Office report that I mentioned that shows enormous 
disparities as to what Medicare pays for the various regions of our 
country for essential health services, and to me those issues, 
addressing the need for health care reform, because so many Americans 
go without every day, recognizing that the financing of American health 
care must be fair, and that all of us, individuals, businesses, and 
government, should contribute, and then, finally, making sure that our 
seniors get a fair shake and we address the problem that I outlined 
where many seniors are paying more out of pocket for their Medicare 
than when the program began.
  These ought to be issues that come before the Congress before we go 
home for the August recess.
  I think Members of both sides of the aisle can come to an agreement 
on many of these key kinds of issues. I am certainly anxious to work 
with my colleagues on a bipartisan basis toward that end.
  I now yield to the gentleman from California [Mr. Fazio], who has 
done yeoman work on the health issue for many years, and I appreciate 
his participation.
  Mr. FAZIO. I thank my colleague from Oregon for yielding.
  Of course, Oregon is a State that has really been on the cutting edge 
of health care reform, and I guess it is no surprise its delegation, 
particularly the gentleman from Portland, the gentleman from Oregon 
[Mr. Wyden], has been in the forefront of efforts to bring health 
reform to the Nation.
  I think I am most anxious to hear more voices raised similar to yours 
in behalf of universal coverage. I think for many Americans the 
assumption is when we deal with health care reform here in Washington 
that is automatic, that is guaranteed. In fact, I think many people 
thought with the announcement of the President's plan that we were well 
on our way to enacting the kinds of comprehensive health care plan that 
sure that all Americans were covered.
  I guess I was struck by one of the news reports last night where a 
women shown caring for her husband who had recently had a stroke was 
asking, in fact, are they going to blow it, are they somehow going to 
fail to bring us what we have been waiting for so long, what we have 
come to expect, and that is a health care plan that will cover all 
Americans at affordable rates, private insurance, important to point 
out, but insurance that still cannot be taken away, insurance that 
cannot have a cap that can be exceeded, insurance that will have the 
kind of internal reforms that are needed to make sure that people can 
move from job to job, and in fact can be employable.
  But the issue of universal coverage, I think, has been sometimes 
misdescribed. I do not think it is simply that many of us who are 
anxious to see these reforms brought about feel it is appropriate, 
equitable, fair to cover everyone. I think that is a given. We 
understand that people who work hard every day and not people on 
welfare who have access to Medicaid, but people who work hard every day 
really do deserve to be able to bring home to their families the 
security that a health care plan provides.
  But it is not just the question of equity and fairness. It is 
essential, if we are to get health care costs under control, that we 
have a comprehensive system that rewards the insurer, the provider for 
keeping people healthy. We have got to have a systematic approach to 
health care reform in this country.
  For too many years we have had people falling through the cracks only 
to become the burden that government and the private insurance payers 
have to carry, sometimes because of their unfortunate circumstances, 
sometimes because of their own decision not to have coverage even when 
it might have been available or affordable which, of course, is not 
always the case. But as a result, we have a system that tends to, I 
think, drive costs higher, and all Americans benefit when a systematic 
approach is put together, when we finally have a health care system 
that includes everyone and provides the burden of responsibility for 
both the employer, as in the President's plan, and the individual, the 
beneficiary, who will be contributing to that plan so that it is 
affordable.
  So often when people fail to have, for example, prenatal care, and 
there are some 5 million women who have health care policies without 
that benefit, but so often when people fail to have that kind of basic 
protection and they end up giving birth to low-birth-weight babies, all 
of us, insurance payers as well as taxpayers, many of us twofold, end 
up paying the additional cost of, say, bringing a low-birth-weight baby 
to viability.
  So for the lack of $500 to $1,500, we will end up spending $500,000 
because we are not simply going to let a low-birth-weight baby die. We 
are going to employ every possible avenue to save that child and make 
it viable, but it seems that we have, therefore, our priorities 
backward. We have our economies in the wrong place. We are being, in 
effect, penny-wise and pound-foolish.
  There are many, many people who think, as young individuals, they 
want to maximize their income and perhaps avoid contributing anything 
to their own health care costs. It would be wrong to assume that they 
will not have health care costs, and when they become expensive, some 
would call them catastrophic, they certainly fall on all of us once 
again.
  We have certainly begun to understand in this Congress cost-shifting, 
that is to say, when one level of Government reduces its expenditures 
say for reimbursement in Medicare, we find other levels of Government, 
the State perhaps, certainly local Governments that run county 
hospitals have to increase their spending, because there is no 
alternative to providing ultimate care to people in their most acute 
need.

  What we have often failed to see as we cost-shift around between the 
public sector and private sector or between public sectors is that we 
really have not solved the problem of cost containment. We have simply 
aired our dirty linen. We have shifted the burden to some other element 
of our society, some other source of payment. That is one of the 
reasons why so many of our hospitals are struggling.
  So what we have got to do with universal coverage is to bring people 
into a health care system that really does provide for the first time 
the sort of protection that everyone in our society needs from the 
every escalating costs of health care, and that, I think, is far more 
important than any number of individuals or families that may for any 
given period of time be without care, because we all understand that 
while it is important as a question of equity, it is even more perhaps 
important to the total health care bill that is running far in excess 
of inflation in most years, and certainly in far greater numbers as a 
percentage of our economy than the countries we compete with.
  We have got a problem that needs to be resolved. And so I want to 
congratulate the gentleman's reference to universal coverage, to 
comprehensive benefits for people that are available to everybody, but 
I think you cannot underscore too many times the broader contribution 
this makes to all of those people who currently have a package of 
health benefits and a tax bill that they have to make payments on.

                              {time}  1830

  I was listening to the news this morning about workers who are about 
to go on strike because in fact their health benefit package was being 
whittled back once again. This was in a defense contractor's situation, 
an industry that we all know has been under real stress.
  People are willing to consider going out on a picket line over a 
decline in their benefit package, or perhaps an increase in what it 
would cost them to maintain their benefits.
  So we see that even those people who in relatively well-paid 
industries, even those families that have had a very, very solid 
package of health care benefits, are coming under the stress of these 
costs that are rising, that are driving employers to take extraordinary 
measures to try to shift the burden that they are assuming to others. 
So no one is really immune. In the short run you may compare yourselves 
to others, your neighbors in the community, and feel well off and 
wonder what is in it for you. But in fact, all of us are showing signs 
of having a hard time bearing up under the costs of the health care 
system currently in place.
  Of course it was this President who had the courage to lead us into 
this very, very complex political problem. I am convinced it is this 
Congress that will ultimately find our way to a solution, one that I 
think needs to cover all Americans at some point, hopefully sooner 
rather than later, because if we fail the working Americans, those 
people who are currently unable to get coverage any other way than 
through their work, if we fail to help those who are not getting health 
care today, to make it more affordable to the middle class, we will 
have another layer of cynicism added onto the American public. These 
are the people who are the ones, who are the people who pay the 
freight, who follow the rules, who are there every year to make their 
contribution to Government, and certainly when they go out into the 
marketplace to purchase insurance, they have to pay far more than many 
of their neighbors who work for corporations or for the government or 
some other employer that makes a major contribution. These are the 
people we cannot fail to take care of. If we neglect them, we are 
neglecting Americans in every district of this country, Republican and 
Democratic alike, middle-class people who deserve to have 
their problems attended to, who have, I think, been for too long the 
hidden victims of the health care system that we have in this country, 
which tends to ration care based on where you work and how much you 
make.

  So once again I want to associate myself with the effort of the 
gentleman from Oregon [Mr. Wyden], who has once more laid out the 
reasons for this very difficult, but very fundamental, change we are 
trying to make in the way the American health care system works.
  Mr. WYDEN. I thank my colleague, the gentleman from California. 
Particularly I want to underscore the point he is making with respect 
to universal coverage.
  Mr. Speaker, there is a myth, I think, afoot in some quarters that 
people who are uncovered, by and large, do not want to be covered; they 
are sort of sitting at home in their hammocks, having a soda or 
something like that.
  What we have found is that the vast majority of uninsured citizens 
are working people, they are working in businesses, as the gentleman 
has stated, they play by the rules, and they are struggling to get 
ahead, and very often their businesses are dying to cover them but they 
have just not been able to afford it.
  So I think the gentleman's point about the need for universal 
coverage is critical.
  We also ought to know there has been some talk, for example, about 
just going forward with various kinds of reform in the marketplace and 
just leaving it at that. I think these marketplace reforms are very 
good, the insurance reforms, having uniform billing, changes in the 
deductibility laws so that sole employers get the same tax break that 
big employers do. Those are valuable benefits.
  We absolutely ought to have them in any health care bill. But if we 
do, what will happen is that the system, particularly employers, will 
start wringing out some of the extra costs and then those who are 
uninsured will be in even worse shape because our employers, as the 
gentleman has noted, are already having to write off considerable 
costs.
  So I think the gentleman has given us a very fitting way to close.
  What this debate is all about is making sure that we get all 
Americans under the tent, that all Americans have access to decent, 
affordable health services on a date certain. It seems to me we should 
not go into the next century without Americans having that kind of 
coverage. And I want to commend my friend and colleague for all the 
good work that he has done on this issue for these many years.

  Mr. Speaker, if the gentleman desires any additional time, I would be 
happy to yield it to him.
  Mr. FAZIO. I thank the gentleman. I just wanted to indicate that in 
my discussions with my constituents in the small business community, I 
see a great deal of concern about the affordability. The average small 
business today is paying 35 percent, on average, more than the large 
corporation to provide coverage for their workers. I found a real 
anxiety, an angst on the part of many of the people who run these 
businesses because they really would rather provide health coverage to 
their families and workers than the worker's compensation which most 
States require them to provide. In fact I think there has been some 
misuse of worker's compensation because of the absence of health 
benefits for many, particularly low-income workers.
  What these people are telling me is that they would much rather 
provide 24-hour care to people and let them have less money spent on 
the argument over whether it was a job-related illness or not, and put 
our resources into holding down costs and at the same time providing 
basic benefits to everyone, including the families of these workers.
  But, of course, that would take us to the point of responsibility for 
trying to integrate worker's comp and the normal health care system. 
This is something I think this Congress needs to look at.
  I have been told in my State of California that business could save 
$1 billion a year with this sort of integration. Our insurance 
commissioner John Garanendi, talked about the 24-hour care and the fact 
that it probably could reduce the combined package of worker's comp and 
health care that is currently paid for by some average small business, 
by one-third. This, I think, is one of the areas we could go to help 
keep faith with the small business community that wants to provide 
coverage, that will help us without creating new bureaucracies, and 
move toward a comprehensive coverage for all Americans.
  We have obviously talked about doing away with the inequitable 25-
percent deductible for the sole proprietor the gentleman has mentioned. 
Everyone should have this health care deducted. I think we all 
understand that small businesses with low-income workers are to need 
some subsidy to get started. If we can only provide that subsidy and at 
the same time the advantage of the lower rates which I think we 
certainly would expect these pooling arrangements to provide, then I 
think we have come a long way toward meeting the legitimate concerns 
about small business, concerns that caused us to think twice because we 
do not want to put people out of work at the same time we provide 
comprehensive health benefits for everyone.

  Mr. WYDEN. The point the gentleman makes with respect to small 
businesses is critically important. All of the bills that are moving 
through the pipeline employ the idea of a kind of voluntary alliance. 
Some of the defenders of the status quo, when there was debate about 
how to get purchasing power for the little guy--because that is what 
this is all about--you can call them alliances, co-ops, anything you 
want, but the idea is to get purchasing power for the little guy so he 
or she is in a position to bargain with doctors, with hospitals, with 
insurers.
  To his credit, the President has been very flexible in terms of 
working with the committees--I sit on the Health Committee, and the 
gentleman is on the Appropriations Committee--in terms of trying to 
look at this alliance approach to try to address those kinds of cost 
considerations.
  I think now there is growing bipartisan support for some kind of 
effort to allow these small businesses to pool their bargaining power 
and be in a good package.
  Mr. FAZIO. Regrettably, we have talked about individual access to 
health care. I say regrettably because it is a misnomer, I believe. 
Somebody said to me just the other day, ``I have access to every 
restaurant in my home town, but I cannot order from the menus of many 
of them because of the prices.'' I think that is why I am a little bit 
concerned about people going down that blind alley in this debate. we 
are going to somehow conclude if we would all just take individual 
responsibility, we would have universal coverage.

                              {time}  1840

  We have a law in my State that requires everyone to have a certain 
amount of auto insurance, and yet I have not met anybody who has had an 
accident with anybody who is not an uninsured driver in a long time.
  It simply does not get the job done, and yet at the same time, while 
access has not guaranteed that people get care when it is needed and at 
the most affordable cost, we have also concluded, it seems, that it is 
a bit of a misnomer to say that simply be mandating something actually 
accomplishes it.
  We need to avoid creation of new bureaucracies; everyone understands 
that. So we need to build on the existing system which has provided 
health care for 9 out of 10 Americans and their families, and I hope 
that we have gotten beyond the rhetoric, beyond the quick 30-second 
spots and other things that attempt to describe what we are doing here, 
which is expand an existing system as some sort of socialized medicine.
  And yet I am so astounded by people who tend to believe the worst 
about anything that is proposed by our Government. We, in fact, in 
Government have to act to reform the insurance system to figure out 
ways to contain costs, to do all the things that people really want to 
do. It takes an act of Congress and a signature of this President. It 
seems to me we are well on our way to making that kind of progress and 
accomplishing our goal.
  But we have still got to fight through these rhetorical hurdles which 
are constantly thrown up that are really designed to divert people's 
attention, and to try to confuse them and create anxiety over the 
direction we are going. There will be more choice for many people in 
terms of where they can go for a doctor, for a health provider of any 
sort.
  So, Mr. Speaker, I am hopeful that efforts like the gentleman's this 
evening are really going a long way in trying to inform the public 
about what the real choices are and, hopefully, to disabuse and end the 
confusion of those who have been carried away by other efforts that 
have been made to kind of stop this in its tracks and to prevent this 
sort of progress that most Americans truly want to make in this area.
  Mr. WYDEN. I think that last point is particularly important because 
I think some of these well-funded interest groups that obviously have a 
financial stake in protecting the status quo have, in effect, climbed 
into our television sets over the last 6 to 8 months and said the 
Western civilization is going to end, and the Federal Government is 
going to come to town, tear up the sidewalks and take over the 
communities, and as the gentleman has correctly pointed out, what 
health reform is all about: It is building on what we have today, 
keeping in place the many positive aspects of health reform, filling in 
the gaps to make sure all our citizens are covered, dealing with the 
inequities of cost shifting, and I think the gentleman's point is 
particularly valuable, and I appreciate it.
  Mr. FAZIO. One of the ironies of this whole debate is that within 2 
years, looking backward, we had no consensus on the insurance reforms 
that today are said to be of consensus view on this floor. People are 
now coming forward saying, ``Well, let's just fix the health insurance 
system. We have heard all the complaints, and we are ready to go. Let's 
find a consensus on that issue.''
  Well, first of all, Mr. Speaker, that is a consensus of very brief 
duration. The consensus with the insurance industry has occurred as a 
result of the very serious debate and desire to move forward that has 
occurred under the leadership of President Clinton and Mrs. Clinton.

  But even more so, to simply add to all our costs, to fix the 
inequities in the health insurance system that condemn some families 
with a very sick child or parent to huge debts for as long as the eye 
can see is really not to solve the problem alone because cost 
containment, of course, is further away if we simply add to the costs 
of everyone to work out the inequities in the health insurance system.
  We not only have to do that, but we have to hold out not just the 
promise, but the reality, of cost containment for people because it 
defies logic to say that we can bear up the costs of catastrophic 
health incidents that affect some families and not pay more to resolve 
those issues.
  So, back to the original point: We need a system of health care. We 
need to reduce costs and burdens on middle class families or we will 
not have the wherewithal to solve the inequities in the existing health 
insurance system, let alone find ways to cover people who are without 
insurance.
  So the ultimate need here is not just to tinker with the existing 
system. We have been doing that. Maybe we have advanced the cause in a 
bipartisan sense on insurance reform. But we owe the public a lot more 
than simply doing that and leaving town, indicating that we think we 
really have accomplished the central purpose for which this whole 
debate has been focused.
  Mr. WYDEN. I think also the point that the gentleman makes on the 
cost containment issue is so critically important for the 80 percent 
plus of America that is covered.
  Mr. FAZIO. And happy with their health plan.
  Mr. WYDEN. Happy with their coverage and, frankly, at this point kind 
of scared because of all of these commercials.
  Now to the extent we can have managed competition, standardized 
coverage, these plans having to compete for the business of our 
consumers and our patients on the basis of price, and service, and 
quality, that heightened competition can be of real benefit to the 80 
percent who are covered.
  I would also say that I think that we will be exploring some cost 
containment approaches that are not going to involve some kind of 
Federal micromanagement or run-from-Washington kind of approach.
  One idea that has been presented to me of late is that plans, to the 
extent that they are required to stay within certain cost limits, if 
they did not stay within those limits, they simply would have their 
enrollment frozen. They would not be able to take additional people 
until their costs went down below any kind of reasonable cost 
containment.
  That does not strike me as some kind of huge federal micromanagement 
approach, the cost. That is something, again in the private sector, it 
would take place in the local communities across the country. It would 
not be something that would be run from Washington, DC, and frankly 
some of these special interest groups that created this image, that the 
idea is that, as my colleagues knows, all the health care would be run 
by Washington, DC, and their doctors would wear a white coat that says 
``commissar'' on it, and part of this would be part of just one Federal 
bureaucracy, and I think the gentleman really has, I think, hammered 
home the point that this is still going to be health care in the 
private sector. It is going to be built on the system we have today, 
and I appreciate it.
  Mr. FAZIO. If the gentleman would yield, I think I am referring to 
the most recent Harry and Louise ads where I see the specter of 
rationing raised and, as the gentleman knows, the fear of somehow, with 
cost containment, or some other limitation on what can be spent on 
health care, that we are going to be rationing care. I find that really 
a misnomer and a real effort to divert people's attention from the real 
problems.
  I was talking with Budget Director Panetta today about the irony of 
having some people here on the House floor voting to place caps on 
entitlements and at the same time their unwillingness, their inability, 
to support any efforts to contain health care costs, when in fact we 
know here at the Federal level 80 percent of our problem with 
entitlements in terms of future-year budget deficits is directly 
related to our cost of health care, the cost of Medicare and Medicaid, 
and other health activities which have been growing and impacting us 
just as they have the private sector businessman and individual payer.
  So, Mr. Speaker, there is a little inconsistency here. On the one 
hand the same voices that say we have got to contain entitlements and 
we have got to hold down on Federal spending are saying essentially 
that when you try to do this with any sort of certainty or surety at 
all, we are ending up rationing care, creating fear among the public 
that somehow there will be an inadequate amount of money to go around 
to provide the kind of commitment to care that everyone thinks they 
have purchased with their health insurance. It is a little 
inconsistent. In fact some might say hypocritical. These are some of 
the same people who criticize for cutting Medicare too much when in 
fact in some cases they opposed its creation and now are foursquare for 
it.

                              {time}  1850

  Mr. WYDEN. What is interesting about that is some of the folks who 
are taking that approach on entitlement programs are the leading 
advocates for a very modest bill that would just have a handful of 
changes in insurance costs.
  That kind of approach ironically will produce bigger bills for the 
folks who are covered today. Because if all we do is have some 
insurance changes and folks who are facing serious health problems are 
put into the pool with those who are healthy, absent any overall 
reform, the only thing that is really accomplished is the 80 percent 
who are relatively healthy get bigger bills.
  Mr. FAZIO. That is right.
  I do appreciate the gentleman's contribution this evening. I do hope 
that over the next several weeks, we will be able to assure that woman 
I saw on the news last night who was wondering whether once again we 
were going to blow it here in Washington and somehow overlook the 
tremendous desire the public has to solve these problems and move 
forward. It is so easy today in this atmosphere to frighten people into 
neutrality or worse. It is very hard to galvanize a majority to move 
toward change. But I think we have the leadership in the White House 
that we need and I think there is a sufficient understanding in the 
Congress now of this issue that we will understand if we fall short and 
hopefully step up to the challenge.

  It is individuals like the gentleman from Oregon who provided us that 
leadership within the House of Representatives, in our caucus, and I am 
happy to be associated with the gentleman's remarks this evening.
  Mr. WYDEN. I thank my colleagues.
  I would also note, the gentleman from California is well known for 
his political involvements in many areas, and I think it would be fair 
to say that the vast majority of what we have discussed on this floor 
over the last 30 minutes is part of an approach that can win strong 
bipartisan support. I have heard again and again, the public has said 
they want to see real health reform and not a lot of partisan sniping. 
I think as someone who also is very significant in political 
obligations, it is very constructive to hear the gentleman focus as he 
has this evening on the kinds of health reforms that can win a broad 
base of support in this Congress from Members on both sides of the 
aisle. I think it is an ideal way to sum up.

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