[Congressional Record Volume 140, Number 82 (Friday, June 24, 1994)]
[Senate]
[Page S]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: June 24, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
                              HEALTH CARE

  Mr. COATS. Mr. President, this morning's Washington Post feature 
story is headlined, ``Health Bill Cleared for Floor Votes.''

       In a victory for the President, the House Education and 
     Labor Committee approved a modified Clinton health bill 
     yesterday that provides health insurance for all Americans 
     and compels employers to pay 80 percent of the premiums for 
     their workers.
       ``Today . . . for the first time ever, a committee in each 
     House of Congress has reported a bill that guarantees 
     universal coverage,'' President Clinton said, referring to a 
     similar bill passed by the Senate Labor and Human Resources 
     Committee 3 weeks ago.

  Mr. President, at least according to the Washington Post, and at 
least according to the President of the United States and some others, 
the Clinton health plan is moving forward. Two committees now, one in 
the House and one in the Senate, have reported bills that are based on 
the same framework and very similar to what the President proposed in 
his Health Security Act. It was passed, admittedly, by two committees 
that are not deemed to have primary jurisdiction over health care, but 
it is touted on a front page article here today as a very important 
step forward for the President's health care bill.
  I serve on the Senate Labor and Human Resources Committee. We spent 
three weeks analyzing, debating, and finally passing that bill. I did 
not support the passage of that bill, but it was passed by a pretty 
much partly line vote, with one exception.
  I think it is fair to say that the bill that passed both the Senate 
Labor Committee and the House Education and Labor Committee represents 
the largest Government social experiment ever undertaken in this 
country. If passed and enacted into law, the President's plan, or 
something similar to the President's plan, will enact into law a 
sweeping new category of Government entitlements that far surpasses 
anything undertaken in the history of the United States.
  I think it is ironic that this health care debate comes at a time 
when most now agree that the last great social experiment--welfare--has 
been a dismal failure. After 30 years and hundreds of billions of 
dollars, if not trillions of dollars, of Government expenditures, after 
all the planning and expertise this Congress and this Government could 
muster, our welfare system is a monument to failure. It is proof that 
programs can mean well and fail utterly. It is evidence that our best 
intentions can be transformed into an assault on human dignity.
  Welfare, we were promised, will liberate us from want. Instead, we 
have seen children, so-called liberated children, ``liberated'' from 
the care of their parents; we have seen women ``liberated'' into 
dependence and destitution; whole communities ``liberated'' from order 
and hope.
  And now, just at this moment, just at the moment when the conclusion, 
I think, on an almost universal basis--liberals, conservatives, people 
in between--just at this moment when we are concluding that this last 
great Government social experiment, designed and offered with all kinds 
of compassion and all kinds of hope, just when this is now being 
declared a dismal, miserable failure, just at this moment we are told 
the Government must now extend its reach into the lives of every 
American, determining their health care needs, controlling their health 
care costs, and making their health care choices.
  We are sure that a health care utopia is just one law away, and the 
Washington Post this morning reports that that law is on a pretty fast 
track.
  I think the question we have to ask is, where does this confidence 
come from? Where does this confidence that Government can, through 
social engineering, plan and dictate and lay out the solution to a 
problem that exists, one that affects every individual in this country, 
one that affects one-seventh of our economy?
  Just a few weeks ago, I returned from a visit with members of the 
Armed Services Committee to Moscow. Our opening sessions were in a 
building that stands as a monument to the social, cultural, and 
economic failure that exists today in Russia.
  I asked, as we walked in, ``What building are we in?'' They said, 
``This is the Office of Central Planning.''
  This was the building, this was the office, where, for decades, 
Government centrally planned the lives of nearly 200 million Russians 
and centrally planned the lives of all those other hundreds of millions 
that came under the Soviet's sphere. What a dismal failure, that 
central planning; assembling the best minds of Government, assembling 
the best expertise they could, and saying: We can, by ourselves, within 
the confines of this building, make decisions for all of our people in 
a rational way that will provide an economic utopia. Instead, it has 
provided them economic failure.
  Now, the details of the health care debate are important, but I want 
to begin back at the beginning because I question the assumption that 
Government knows best. I question it on the basis of three decades of 
costly experience. I question it because there have been many, many 
casualties to our compassion.
  I could spend all afternoon here listing the problems I have with the 
Kennedy-Clinton health care bill. Instead, let me focus on a few key 
areas of concern.
  The first is the bureaucracy that this bill will create. When 
President Clinton first introduced his health care plan, he listed 
``simplification'' as one of his six goals. Despite that goal, it is 
clear that the President's Health Security Act, all 1,330 pages of fine 
print, and the Kennedy bill, which is essentially the Clinton Health 
Security Act with some modifications, both those efforts are 
bureaucratic nightmares.
  They are based on the assumption that Government is more efficient 
than the private sector. Yet, anyone who has dealt with any Government 
agency knows this assumption is false.
  One need only spend a short amount of time at the Department of Motor 
Vehicles or the Post Office to understand the absurdity of the 
assumption that Government can deliver services more efficiently and 
more effectively than the private sector.
  We were promised simplification by the President. Yet, the Clinton 
bill and the Kennedy bill create a national health care bureaucracy 
supported by 20 new Federal agencies and commissions--not 1, but 20.
  Let me detail some of these on this chart.
  New Federal bureaucracies, outlined under the Clinton health care 
plan and framework, adopted now by the Senate Labor Committee and by 
the House Education and Labor Committee include:
  A national health board with more than 240 new powers. I will outline 
some of them in a moment.
  It includes:
  A new National Center for Consumer Advocacy; a National Practitioner 
Data Bank; a Federal Aid Violation Reform Group; Home and Community-
Based Services for People with Disabilities; a Long-Term Care Advisory 
Committee; Long-Term Care Screening Councils; National Council on 
Graduate Medical Education; the National Council on Graduate Nurse 
Education; the National Institute on Health Care Workforce Development; 
Healthy Students/Healthy Schools Task Force; a National Quality 
Council; National Health Information System; National Privacy and 
Health Data Council; Commission on the Integration of Health Benefits; 
the Federal Mediation and Conciliation Service/Health Care Board of 
Inquiry; Federal Health Plan Review Board; the Advisory Commission on 
Regional Variations in Health Expenditures; Physicians Payment Review 
Commission; Prospective Payment Assessment Commission; and the National 
Transitional Health Insurance Risk Pool.
  These are the new Federal agencies and commissions that will be 
created under the Clinton health care--Clinton-Kennedy health care 
plan.
  Each one of those agencies will require a building here in 
Washington. Each one will require probably hundreds of employees. Each 
one will require a vast new bureaucratic set of decisionmaking that 
affects every aspect of our health care system.
  This is not the granddaddy of all the new boards. The granddaddy is 
the National Health Board. The National Health Board is a Board that is 
going to be an all-knowing, all-powerful nine-member Board whose 
collective wisdom is supposed to replace that of 250 million Americans, 
whose influence is being equated to that of the Supreme Court.
  The powers of this Board are so vast that it is not inconceivable 
that individuals would be seeking appointments to the National Health 
Board and turning down opportunities to serve on the Supreme Court. 
That may be an exaggeration, but when you look at the powers that flow 
to the nine-member National Health Board, they are staggering. We have 
gone through the bill and identified nearly 250 powers. I cannot get 
them all--I would have to stretch boards all the way across for anybody 
to read these. I put 140 of them on these two boards here.
  I will spare those watching and those listening from reading down 
through the powers of the new National Health Board. But I ask 
individuals to look at these. We had to put them in small print in 
order to get half--roughly three-fifths of them on the boards that are 
displayed here for the Senate Gallery in the Senate Chamber.
  Each one of these powers is going to require an office headed by a 
director who will hire staff who will hire outside consultants who will 
branch out and develop their own little bureaucracy in order to fulfill 
the decisions and the power making that the Board has.
  The National Board will determine what is medically necessary with 
respect to the comprehensive benefits package. I will talk about that 
in a moment. But for each medical service, and each prescription drug, 
and each procedure that is performed in a hospital and each procedure 
performed in a doctor's office that will have to be reimbursed--for 
every medical procedure this Board will have the power to determine 
whether or not it is medically necessary.
  How many individuals are going to have to be hired to determine 
whether or not a particular procedure is medically necessary? And how 
many exceptions will there be to the rule of individuals who submit a 
particular, unique case only to have the Board say we do not believe 
that is medically necessary. That is one result. The other will be a 
vast bureaucracy, paperwork procedure, investigative procedure to 
render a decision whether or not that exception ought to be granted.
  The National Board--instead of being a decision made between patient 
and doctor, the National Health Board will now determine what services 
and tests will be deemed medically necessary. The National Health Board 
will have the authority to expand or reduce the standard benefit 
package.
  Can you imagine the individuals lining up outside the National Health 
Board to plead their case that their particular service--which is not 
yet covered under the Government comprehensive benefits package, 
guaranteed rights package, and therefore reimbursed--ought to be 
included in the package? Can you imagine the political pressure on 
Members of Congress saying ``We are not in. Let us make our case.'' Can 
you imagine the response of Members of Congress? We will be standing 
here on the Senate floor arguing for including benefits that the 
National Health Board might not have considered or deemed medically 
necessary.
  The National Health Board will have the authority to terminate a 
noncomplying State system. We are going to have to review the systems 
for all 50 States to make sure they are in compliance. This means the 
National Health Board will direct the Secretary of Health and Human 
Services to take over a State health care system and it empowers the 
Secretary of the Treasury to impose a payroll tax on all workers and 
businesses in that State.
  In other words, if a State is deemed by the Secretary or by the Board 
to be noncomplying for one reason or another, not meeting the test, not 
meeting all the Federal qualifications, the Secretary of Health and 
Human Services has the power to take over the role of the State and the 
Secretary of the Treasury has the power to impose a tax on the workers 
and businesses in that State because the revenues did not match the 
expenditures.
  The National Health Board will establish by regulation additional 
classifications of so-called permanent resident aliens and prisoners. 
This will give the National Board the authority to define population 
classifications currently under the jurisdiction of the Attorney 
General.
  The National Health Board would establish such rules as may be 
necessary to carry out the act. Talk about a broad power, talk about a 
vague power--you have the power to establish such rules as may be 
necessary to carry out the act? This act governs one-seventh of the 
entire U.S. economy and this provision basically gives the National 
Health Board carte blanche to create any new rules it deems necessary 
to carry out the act or to manage one-seventh of the U.S. economy.
  I saw the results firsthand. We have witnessed the results through 
the media, of what central planning has done for the Soviet Union and 
former States of the Soviet Union. Now we are going to give a national 
board, a central planning agency here in Washington, the decisionmaking 
power to control one-seventh of our economy.
  I have just given 5 examples of the more than 250 examples of 
authority granted to the National Health Board under the Clinton plan 
and the Kennedy bill. The American people do want us to improve our 
current health care system. But what they do not want us to do is to 
improve it by supplanting it with a Government-run system.
  I mentioned earlier I would talk about the standard benefits package 
because another problem with the bills that passed both the Education 
and Labor Committee, and the Senate Committee, is that Federal 
bureaucrats or Members of Congress will be the ones to determine what 
fits in the ``one size fits all'' package of benefits.
  First of all, we are going to determine that a defined package of 
benefits is going to be available to all Americans regardless of 
whether or not they need them, regardless of age or family composition, 
illness, predisposition. ``One size package fits all'' and we are going 
to decide what fits in that one size package regardless of individual 
health care needs.
  If Congress were to legislate such a package, you can be sure that 
future Congresses will expand it. Congress does not have a happy 
history of knowing when to draw the line and knowing when to say no. We 
are very good at saying yes. We are very poor at saying no.
  Over the past year and a half or so all of us have been visited by 
representatives of various health provider groups. Each of them makes a 
very compelling case that their benefit must be included in the 
Government-mandated package. Some of them have been successful. The 
bill that was passed out of the Senate Committee expands the already 
generous package of benefits that the President proposed, which, as the 
Health and Human Services Secretary said, is a Fortune 500 company-plus 
package of benefits. It takes the very best insurance coverage in 
America and it adds to it. That is in the President's plan as described 
by his Health and Human Services Secretary. And then the plan that 
Senator Kennedy offered took that as its base and added a whole package 
of additional benefits.
  That package was calculated to cost an additional $32 billion over 
what the President's package has cost.
  Last month, the House Education and Labor Subcommittee approved an 
amendment to extend preventive and diagnostic dental coverage to adults 
on the date of enactment rather than waiting, as the President had 
proposed, until the year 2001. This benefit alone will add an 
additional $7 billion annually to the cost of the benefits package.
  The Senate package increased coverage for women, children, people 
with disabilities, low-income while substantially increasing benefits 
for mental health and substance abuse. Later in the day the House 
committee that added the dental benefits adopted an amendment to add 
coverage of smoking cessation classes for pregnant women. All 
Americans--male, female, pregnant or not--will pay for those classes. 
Are these benefits worthwhile? Yes, some of them are, maybe all of them 
are. But so are countless other benefits that are excluded currently 
from the bill. And the question is not whether or not a particular 
benefit is a valid benefit, even a medically necessary benefit or a 
worthwhile benefit. The question is whether or not that benefit should 
be included in the package, how much it is going to cost, who is going 
to pay for it, and who decides which benefits Americans are to receive?
  Under the Kennedy-Clinton bill, Congress and the National Health 
Board would decide which benefits Americans receive, which medical 
tests are appropriate, which treatments are medically necessary.
  Under our current health care system, for all its flaws--and I do not 
claim it to be perfect--these decisions are made by market forces. The 
field of medicine is always changing. New tests supersede old ones, new 
treatments render old treatments obsolete and the market responds to 
these innovations. But under the Clinton bill and under the Kennedy 
bill, innovation would respond not to the market, not to demand and 
supply but to the Congress and the National Health Board.
  Before a new test could become readily available to patients, a huge 
health care bureaucracy would have to meet to hammer out new rules and 
new regulations, advisory boards would convene, congressional 
committees would hold hearings and Federal departments and agencies 
would undertake studies. Meanwhile, the patient sits and waits and 
waits for the bureaucracy to approve a treatment on which his or her 
life may depend.
  Health reform will work only if it spurs innovation. Such innovation 
not only saves lives but it can actually reduce health care spending. 
Our market-based system has helped produced thousands of innovations 
that has improved health care quality while curbing health care costs.
  For example, a new drug called Capoten is now being used to treat 
patients with diabetic nephropathy. The use of the drug could reduce 
health care spending by $2.4 billion over 10 years by keeping these 
patients from needing dialysis.
  A sophisticated device known as the Pet scanner can cost several 
million dollars, but it provides physicians with information that can 
sometimes prevent open heart surgery which costs roughly $30,000 to 
$50,000 per surgery. And it could prevent a painful test for epilepsy 
that often costs more than $20,000 per test.
  The average cost of coronary artery surgery is $41,000, but the 
annual cost to treat coronary artery disease with drug therapy is only 
$1,000.
  These are decisions that the National Health Board and that Congress 
is going to have to decide. I suggest to you that that decision will 
not be made on a rational cost-benefit basis or what we can afford or 
what the need is. It will be made on a political basis. There will be 
constituencies advocating support for a particular test or a particular 
procedure over the other, and we will be arguing in this body, or the 
National Health Board will be under the pressure, to make 
determinations to satisfy political concerns rather than allowing the 
market to work as it should and as it must in order to provide us with 
these innovations and provide patients with a choice.
  Market-spur innovation: Bureaucracy strangles innovation in a web of 
redTape. The Kennedy-Clinton bill puts medical innovation and the 
quality of care that Americans have enjoyed for so long at the mercy of 
bureaucracy, and anyone who has had experience with the Federal 
bureaucracy understands what it is like to be at the mercy of the 
bureaucracy.
  Mr. President, let us talk a little bit about costs, because one of 
the concerns that we need to talk about and one of the greatest 
concerns with the Clinton-Kennedy bill is the fact that no one has any 
idea how much this is going to cost.
  Oh, it is wonderful to play Santa Claus. It is wonderful to go back 
home and say, ``You want these benefits? Sure, you can have these 
benefits; you're entitled to these benefits. These are great new ideas, 
new treatments. Let's include everybody.''
  It is tough to stand here and say, ``But how much does it cost and 
who is going to pay for it?''
  The fundamental question of the Clinton-Kennedy health care proposal 
is how much does it cost and who is going to pay for it. That question 
has not been answered by the White House, it has not been answered by 
Senator Kennedy, it has not been answered by the Congress which loves 
to give benefits but hates to tell anybody how much it costs.
  In that regard, I sat in the House Chamber the night the President 
said, and when we present our plan, we are going to present it with the 
costs as determined by the Congressional Budget Office, no more of this 
politically motivated and phony stuff coming out of the White House, we 
are not going to rely on the Office of Management and Budget, we are 
going to rely on the independent Congressional Budget Office.
  Some doubt the independence of the Congressional Budget Office, but 
the President said at the very least we are going to rely on that.
  Ordinarily, the Congressional Budget Office provides Congress with 
estimates of the costs of legislation before we vote on a bill. What 
household in America, what company in America would implement a new 
program without knowing how much it costs? It would be irresponsible.
  On May 13, however, I received a letter from the Director of the 
Congressional Budget Office, Robert Reischauer, indicating that the 
Congressional Budget Office has not made any prepared estimates of the 
cost of the bill which the Senate Labor Committee, Senator Kennedy's 
committee, was going to mark up. I have blown it up for those who are 
watching.
  May 13, 1994, written to me:

       Dear Senator: The Congressional Budget Office has received 
     your letter requesting CBO's estimates and analysis of the 
     chairman's health reform mark released by the Committee on 
     Labor and Human Resources on May 9. CBO does not have 
     detailed specifications or draft legislative language for the 
     proposal and has not prepared any cost estimate or analysis. 
     Therefore, please understand that we will be unable to answer 
     your inquiry within the time you requested.
                                                Robert Reischauer,
                                                         Director.

  With a copy to Senator Kennedy, who is chairman of that committee.
  Despite that, despite the Coats amendment which says we should not 
report out this bill and send it to the Senate floor until we at least 
know how much it is going to cost--how can we vote on a bill in good 
conscience and say, ``Move it along. We don't know how much it is going 
to cost. We'll worry about that later?'' Does that sound familiar? How 
many entitlements, how many benefits, how many programs has Congress 
enacted and said, ``We'll figure out the costs later; we'll pay it 
later.'' We now have a $4.6 trillion debt because we said we will not 
pay as we go, we will pay it later. It jeopardizes our economy and 
jeopardizes the future of every American, and it certainly imposes a 
debt load on the shoulder of our children and grandchildren that is 
unconscionable.
  Yet, here we go with the largest single expansion of Government in 
the history of this country and the Director of the Congressional 
Budget Office says, ``I can't tell you how much it costs,'' and our 
committee says, ``Well, we're going to go ahead anyway, we'll worry 
about the cost later.''
  We are told we have some of this information from the Congressional 
Research Service. So I wrote the Congressional Research Service: We 
have not had an opportunity to evaluate the bill, and we do not have 
the costs.
  Then we are told, well, look to the Office of Management and Budget. 
That is the group the President derided in his speech to the Congress 
and said you cannot trust those guys. But someone said they have the 
answers.
  So I wrote them and I got their letter back. They said:

        * * * we did not provide the staff with a full cost 
     analysis of all the features of the proposal.

  So the three entities in this city that are designed for the purpose 
of telling us how much something is going to cost all have said we do 
not know how much it is going to cost, we have not had time to study it 
so, consequently, we cannot begin to give you the results.
  What do the three letters mean? It means, once again, Congress is 
acting irresponsibly. They mean we are promising people benefits whose 
costs we do not know, benefits we plan to pay for with probably new 
taxes or with severe cuts in Medicare and Medicaid that I do not think 
this Congress is prepared to make or will make.
  Despite the fact that the chairman does not know how much the bill 
will cost, I was told in committee time and time again cost is a mere 
technical detail; we will worry about it sometime in the future.
  With the staggering deficits staring us in the face, with ballooning 
Federal programs, with decades of runaway entitlement spending as a 
guide, I am appalled that the Congress is proceeding so irresponsibly. 
We need to be honest with the American people about the costs of the 
promises that the Congress is making.
  If anyone doubts that Congress has acted irresponsibly, let me just 
give you the record on a few of our existing health care programs. 
Between 1984 and 1990, the Congress approved 24 new initiatives that 
substantially increased Medicaid spending. A study by the Health Care 
Finance Administration estimates that congressional expansion of the 
program--not health care inflation--accounted for more than half of the 
exploding Medicaid costs of the 1980's.
  Do you see the circular logic here? The President of the United 
States and the First Lady of the United States and the administration 
say we have to have health care reform written along our lines because 
the costs are exploding and we have to do this to control the costs. 
And yet the administration's own health care agency, the Health Care 
Finance Administration, says more than half of those exploding costs 
are because Congress has added benefits to the program.
  And so Government is adding benefits, on the one hand, which drive up 
the costs and, on the other hand, they are saying we have to hold down 
the costs when we are our own worst enemy.
  I doubt any more than a few Americans believe that Congress has a 
strong record for fiscal responsibility. And that skepticism is well 
placed. Even Senator Kerrey commented not too long ago, ``It's hard to 
make the case our Government can be trusted with a new entitlement 
program when we've let the old ones get so far out of control.''
  A perfect example is the Medicare Program. When Medicare was enacted 
in 1965, it was projected--someone stood up in Congress and said, 
should we not know how much this is going to cost the taxpayers? So 
they did a study, and they came back and reported the figures. It is in 
the Congressional Record; it was stated and printed. If Medicare was 
enacted in 1965, by 1990 it was going to cost the taxpayers $9 billion 
a year.
  Congress weighed those numbers and said, well, that is a lot of 
money, but that is way out in 1990; we will be able to afford it by 
then.
  What were the actual expenditures? The actual expenditures were $107 
billion in 1990--not the $9 billion Congress had projected. So even if 
these agencies gave us what they thought the health care plan would 
cost, does anyone think that after 5 years or 10 years or 20 years of 
Congress and the National Health Board capitulating to the demands of 
people and interest groups to expand we would be able to come in at the 
costs they suggested?
  Now, the ones they have preliminarily estimated are bad enough. The 
President vastly underestimated the impact on the deficit with his 
original program.
  But when we look at the examples of what has happened in the past, 
where a program that was estimated to cost $9 billion a year actually 
cost $107 billion, that ought to stagger us and give us more than 
pause. It ought to put a big red light up to say, wait a minute, do we 
really know what we are doing?
  Way back in 1936, when we started the Social Security Program, the 
Social Security Board said, ``12 years from now''--they actually 
printed this up and sent it out in a brochure to every American--``you 
and your employer will each pay 3 cents on each dollar you earn up to 
$3,000 a year.''
  And this is the kicker. ``That is the most you will ever have to 
pay,'' said the Social Security Board.
  Social Security was originally financed with a 1 percent payroll tax. 
The Government said 1 percent. That is all you have to pay. The Clinton 
administration on health care, small business individuals, just a 
small, little percent. Well, if what happened to Social Security will 
happen to health care, I think it is going to be a staggering cost 
because today a self-employed person pays 15 percent of payroll, not 
the 1 percent the Social Security Board said ``that is all you will 
ever have to pay.'' Today it is 15 percent. And while the Social 
Security Program began with only a payroll tax of 1 percent, Senator 
Kennedy in his bill is proposing over 19 new taxes and tax increases to 
finance his health care bill, and these new taxes add up to a heck of a 
lot more than 1 percent of payroll.
  I am putting up on the board now the new taxes under the plan passed 
by the Senate committee that the Washington Post this morning says is 
headed for a floor vote.
  The chart lists 19 new taxes. Let me just read a few of them: A tax 
on employers of up to 12 percent of payroll--not 1 percent, 12 percent; 
a tax on employees of up to 3.9 percent of payroll, a 2-percent payroll 
tax on small employers who do not participate in the program; a 2.5-
percent administrative expense allowance on premiums, a 1-percent 
surtax on all health care premiums, a $1.25 increase on cigarette 
taxes.
  These are just some of the 19 new taxes employed in the President's 
bill and the Kennedy bill. These taxes I suggest will decrease wages, 
eliminate jobs, and strangle research and development. But the one 
thing we know from experience is that they will not fully pay for the 
promised benefits, and this Congress will be back here saying, now, we 
just have to bump this up a couple percent, or we just have to add this 
because we are short.
  We do that on a regular basis here, and the American people are 
getting taxed to death. When you add up Federal and State and local and 
excise and personal property and sales tax and all the other taxes--
gasoline tax and airplane fuel tax and airport fees and all the other 
taxes--it is also said that individuals just pay a small percent of 
their income in taxes. The accumulated nature of taxes is such that we 
are now working well into May of every year just to cover taxes before 
we start earning anything for ourselves.
  This Congress is renowned for overpromising and underfunding 
programs. But Americans are tired of Congress making promises it cannot 
keep. The President tells us we are going to have a lavish package of 
benefits, but the taxes he has proposed will not be nearly enough to 
pay for them. And we do not even hear about how those benefits are 
going to be paid for. All we hear about is there is going to be an 
increase in cigarette taxes. So we are going to pay for new 
entitlements, we are going to pay for a comprehensive benefit package 
for every American, we are going to pay for a bureaucracy that--I 
cannot even post on the boards in small print because it will not fit--
we are going to pay for by just charging everybody a little bit more on 
their cigarettes.
  Madam President, let me talk just a minute about rationing. Rationing 
is not a word that we look upon kindly as an American public, but it is 
an underlying reality of the health care plan the President has 
proposed and the Senate has proposed through Senator Kennedy's bill. 
Every State-sponsored health cooperative will have a budget established 
in Washington that is maintained by putting caps on insurance premiums. 
Those premiums eventually set the price of everything else in the 
system from tongue depressors to brain surgery. When prices are kept 
artificially low to meet a federally mandated budget, demand for health 
services chases a dwindling supply. The results are shortages and those 
shortages result in a rationing of care.
  So we come to the reality of rationing, and rationing simply means 
that somebody loses. In England, for cost reasons, they deny kidney 
dialysis to anyone older than the age of 55. And so each year 1,500 
patients in Great Britain die from treatable kidney ailments. In 
Canada, medical treatment is rationed with long waits--4 months for 
bypass surgery, 4 years for a cornea transplant. And while Canada was 
celebrating the Christmas season, the nation's hospitals closed their 
doors due to a lack of funds because it was near the end of the year. 
The rationing that results from Government price controls creates a 
health system that works well for everyone except the sick.
  And so when rationing begins to occur, the inevitable pressure will 
come: Well, we cannot take this rationing; that is not what we are used 
to as Americans in health care, and so we are going to have to pick up 
some additional revenue and that means an increase in taxes.
  Let us talk about quality of care. Under the bills that are being 
proposed, Federal bureaucrats will decide whether expensive technology 
should be used on the elderly. How about on premature babies with a 
slim chance of recovery? Who is going to make that decision? Are 
Government agencies really prepared to draw ethical lines on who gets 
treatment?
  Under the administration's proposals, your choice of a doctor will be 
severely limited. More than likely, you will be forced into a managed-
care situation. Under the Kennedy bill if passed, Federal bureaucrats 
and numerous others will have broad access to your private medical 
records. Under that bill, Federal bureaucrats will determine how many 
specialists there will be and in what field doctors will practice. The 
bottom line is that the Kennedy bill will radically change the way 
Americans receive their health care.
  Mr. President, there is much more I could say about this. We have a 
massive notebook detailing page after page after page the proposals, 
the benefits, the costs, the bureaucracy, the new commissions, the new 
boards, the new responsibilities, the new powers.
  It goes on and on. I could spend the afternoon and the evening 
detailing the fine print. ``The Devil is in the details.'' It sounds 
wonderful for the President to stand up and say we want a simpler 
system, one that gives every American the right to medicine. The 
details are going to kill the health care system as we know it. They 
are going to deny choice. They are going to result in a massive new 
bureaucracy, expansive new taxes, and I think rationed care and the 
diminution of the quality of care that we have come to expect in this 
country.
  We have much to lose because we have a health care system that is the 
world's envy. It is not perfect, and it can be improved. We can improve 
our current system. But I do not have any faith that it can be replaced 
by the plans of a Government that has proven its incompetence in social 
engineering. People, real individuals, suffer from the Federal 
Government's good intentions.
  Humility learned from three decades of failed social experimentation 
is a demand of our recent history, and that is where our debate should 
begin. We can provide reforms to our health care system, reforms that 
we can agree on, reforms that can work in the marketplace, that can be 
implemented and tested and modified, if necessary. But we do not need 
to reinvent the whole system. We do not need a centrally planned system 
to fundamentally change the way health care is delivered to Americans.
  I cannot endorse a proposal that adds layers of bureaucratic 
Government rules and regulations, more taxes on American families and 
businesses, and particularly legislation that adds many new Federal 
entitlements without first understanding the cost.
  The President's proposal, as embodied in the Kennedy proposal, is 
ambitious but deeply flawed. It tries to swim against the tide of 
market forces, but the market is never cheated for long. Instead of 
price controls, rationing, and taxes, we need to examine reforms that 
use markets, not destroy them. That would be a healthier approach in 
every sense of the word.
  Much is at stake. We are coming to the decision point of the health 
care debate. The next few weeks will be times of making determinations 
that will affect the lives of every American citizen. Americans need to 
understand what is in this health care proposal. We need to understand 
what the Congress is doing and imposing on them. If we will listen, if 
we will provide them with the information and listen to their response, 
I am convinced we will reject a Government plan, a one-size-fits-all, a 
centrally directed plan devised by the White House that reinvents the 
entire health care system, saying that the whole thing is rotten; throw 
it out; start all over; Government can do it better.
  We will reject that approach, and we will proceed with sensible 
reforms that can bring more competition through the market, and provide 
and maintain the quality of health care for Americans that is the envy 
of the world.
  Mr. President, I yield the floor.
  Mr. HATCH addressed the Chair.
  The PRESIDING OFFICER (Mr. Mathews). The Senator from Utah.
  Mr. HATCH. Mr. President, I want to compliment my colleague from 
Indiana. I listened to much of what he has said. He has outlined, I 
think, some of the problems in the current health care debate as well 
as anyone, and I think the charts have really shown why what he is 
saying is so true. I think the American people are sick and tired of 
the prospects of Government-run health care.
  I want to compliment him because he played a very significant role in 
the Labor and Human Resources Committee, and I think certainly made a 
very cogent number of statements here today.
  (The remarks of Mr. Hatch pertaining to the introduction of S. 2240 
are located in today's Record under ``Statements on Introduced Bills 
and Joint Resolutions.'')
  Mr. HATCH. Mr. President, I notice my friend and colleague from 
Nebraska is about to speak.
  I yield the floor.

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