[Congressional Record Volume 140, Number 88 (Monday, July 11, 1994)]
[House]
[Page H]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: July 11, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
                           HEALTH CARE REFORM

  Mr. BOND. Mr. President, a Boy Scout leader approached an elderly 
lady who had just been helped across the street by one of his Scouts, 
so the story goes. When the Scout leader inquired if the Scout had 
rendered good and courteous service, the lady replied: ``He was very 
nice, but I did not want to cross the street.''
  In the battle over health care reform, I have been an advocate of 
achieving universal coverage by requiring every citizen to take 
responsibility for their health care coverage, either obtained at work, 
through a Government program, or by the individual's purchase of a 
health care policy assisted by tax credits and/or deductions. In fact, 
an individual requirement lies at the heart of the Clinton health 
reform package. Every individual would have to have health care 
coverage for which the individual would be responsible for at least a 
portion, or the individual, if not employed, would have to purchase the 
health care policy themselves.
  The so-called employer mandate alone in the Clinton plan does not 
achieve universal coverage without the requirement that the individual 
participate and, if self-employed, buy that coverage for himself or 
herself and the family.
  The employer mandate is simply a thinly disguised way of hiding 
health care costs by imposing what amounts to a payroll tax on 
employees, and that, in my view, would significantly curtail job 
creation and cost millions of jobs.
  As I have traveled around my State of Missouri in recent weeks, I 
have heard more and more people telling me that while they want to fix 
what is wrong with health care, they also do not want to be told by 
Government that they have to purchase a certain package of health care 
insurance. In effect, they are saying that we do not want to cross that 
street, as the lady told the Scoutmaster.
  There are three basic reasons why universal health care coverage, or 
significantly increased health care coverage, is very desirable.
  First, much human suffering could be alleviated, lost time avoided 
and health care costs reduced if everyone received regular, primary, 
and preventive health care. When people do not have health care, they 
too often wait until late stages of an illness to seek health care, 
often in an expensive emergency room and have to have much more costly 
treatments which may or may not be effective.
  Much of that problem can be solved by eliminating the tax inequities 
which discourage and penalize farmers, ranchers, other self-employed 
people and employees who do not receive health care coverage at work 
from obtaining their own coverage.
  In addition, under the Chafee health plan, the HEART proposal which I 
helped draft, and most of the other plans, low-income individuals would 
be provided with subsidies to enable them to purchase health care 
coverage.
  A recent study by Lewin-VHI suggested that a system of tax equality 
and low-income assistance could achieve coverage for significantly over 
90 percent of Americans even without a mandate. For those initially who 
do not choose to receive health care, education, effective public 
advocacy and economic incentives can significantly raise the level of 
coverage under a voluntary system.
  The second problem with a lack of universal coverage when it is 
accompanied by insurance market reform, such as most plans now before 
us include, is what is referred to as adverse risk selection. Most 
proposals before Congress would eliminate the ability of health care 
insurers or other providers to refuse to cover preexisting illnesses 
and to discriminate against those who are sick. If a person could wait 
until he was very sick to purchase insurance on his way to the 
hospital, then the cost of insurance could be driven further out of 
reach of many citizens who would be faced with the high premiums for 
health insurance policies purchased only by sick people.
  This adverse risk selection can be dealt with by limiting the 
coverage of preexisting conditions to allow insurance companies to 
impose a waiting period to cover preexisting illnesses for people who 
have chosen not to purchase insurance. Under that provision, there 
would be less an incentive to delay the purchase of insurance until 
illness strikes.
  A third frequently cited problem with a lack of universal coverage is 
the phenomenon of cost shifting. When a hospital, a physician or other 
health care provider provides basic care to people who cannot or will 
not pay, these costs have to be shifted onto the bills of the middle-
class patients and others who pay their bills personally or through 
health insurance.
  Some estimates indicate that as high as 30 percent of health 
insurance premiums or other health care charges on paying customers are 
imposed to pay for the uncompensated care given to those who have 
inadequate coverage or no coverage at all.
  One of the greatest villains in this piece is the Federal Government. 
Under pressure from Congress to save on health care costs, arbitrary 
price controls have been placed on the amount reimbursed for patients 
under Medicare and Medicaid. We do that when we ratchet down the 
payments made for Medicare and Medicaid patients.

  As a result of the underpayment by the Federal Government, ratcheting 
down the reimbursement for Medicare and Medicaid, which amounts to 
about $15 billion a year in cost shifting and the uncompensated care 
that must be provided by the health care system, charges for private 
patients are about 130 percent of their costs in most areas of the 
country.
  It seems to me that if the Federal Government makes fully deductible 
the cost of a reasonable health insurance policy, provides a 100-
percent subsidy for health care premiums for those at the poverty level 
and below, and declining subsidies with those just above the poverty 
level, the health care consumers and providers would be in a better 
position to protect themselves against uncompensated care. If an 
impoverished patient seeks health care and has no coverage, then the 
health care provider could require that he or she apply for the 
subsidies available to participate in a health care program. For those 
who have ample resources but have not chosen to purchase health care, 
the health care provider could insist prior to providing such care, 
other than an emergency setting, that the patient must make 
arrangements to pay for the health care charges. Under a system with 
full tax deductibility plus subsidies, the likelihood of uncompensated 
care and its amount should be substantially reduced.
  Apparently my colleagues in this body and in the House are hearing 
similar complaints from constituents who do not want to be faced with a 
Government directive saying that they must purchase health care. That 
is why the Senate Finance Committee has come forward with a bipartisan 
compromise that provides for Federal assistance but no requirement that 
people purchase health care policies. It seems to me that there are not 
the votes to impose individual mandates in this body, as I have talked 
with colleagues and I have listened to their comments on the floor.
  Another way, of course, to provide universal coverage is to have the 
Government provide health care for everybody. I do not believe that 
there is anywhere near a majority for that, and even that Government-
provided health care does not ensure that it will be utilized by those 
who need it.
  We have seen the shocking statistics of the large number of children 
under 2 in this country who have not had their recommended 
immunizations. In my State in our two largest cities, only 50 percent 
and 30 percent of infants have been fully immunized. Thus, 50 percent 
and 70 percent of infants have not been fully immunized, even though 
vaccines are widely available through Medicaid and public health 
departments for parents who could not afford to buy them. The failure 
to obtain immunizations strongly indicates that these infants are also 
not receiving the vitally important well-baby preventive care that 
should be among the highest priority preventive programs that we have.
  A pediatrician who practices in rural Missouri tells me that his 
office must triple book Medicaid patients. That is, book three Medicaid 
patients for children at each given hour because roughly two out of the 
three Medicaid-recipient parents who make appointments do not show up.
  Senator Dale Bumpers of Arkansas introduced an amendment to cut 
welfare payments--AFDC--to parents who fail to immunize their children. 
Although the amendment was overwhelmingly adopted in this body, it 
never made it out of the House-Senate conference.
  A bipartisan welfare reform measure, S. 2009, which I have introduced 
with Senator Tom Harkin, would require AFDC recipients to sign family 
responsibility agreements obligating them to obtain health care 
including immunizations for their children. Failure to sign the 
agreement or to comply with its provisions would lead to a reduction 
and ultimately termination of AFDC payments.
  In my view, we can correct many of the things that are wrong in 
health care without damaging the health care system, as I believe the 
Clinton plan or the plan reported out of the Senate Labor Committee 
would do. I believe that a significant majority in this body can be 
mustered for a health care proposal that does take the necessary steps 
of reforming the insurance market, providing for fair tax treatment, 
offering subsidies for low-income people, setting standards for 
electronic filing, processing of health care claims to reduce 
administrative costs, lessening the cost of malpractice litigation, and 
reducing defensive medicine.
  If we are willing to recognize the realities of health care and 
listen to the people we represent, I am convinced Congress can pass 
health care reform that will remedy the flaws in the current system. 
This can be done without destroying the benefits we receive from having 
a high-quality health care system that is run by the private sector.
  I look forward to working with my colleagues in this body and, we 
hope, ultimately in the House, to achieve a workable compromise that 
achieves what is needed in health care and does not fix that which is 
not broken.
  I thank the Chair.

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