[Congressional Record Volume 140, Number 95 (Wednesday, July 20, 1994)]
[Extensions of Remarks]
[Page E]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: July 20, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
                           HEALTH CARE REFORM

                                 ______


                          HON. LEE H. HAMILTON

                               of indiana

                    in the house of representatives

                        Wednesday, July 20, 1994

  Mr. HAMILTON. Mr. Speaker, I would like to insert my Washington 
Report for Wednesday, July 20, 1994 into the Congressional Record.

                           Health Care Reform

       Many Hoosiers have asked me about the status of health care 
     reform and how possible changes would affect them and their 
     families. The health care debate can be confusing, and it is 
     not yet clear what reforms will pass Congress this year.
       The President has not been able to rally a majority in 
     Congress behind his reform proposal, and a wide variety of 
     plans are before Congress. Nearly all share two primary 
     goals: to expand coverage, or to obtain universal coverage, 
     while containing costs. Today, over 38 million Americans lack 
     medical coverage and health care costs continue to rise at 
     two or three times the rate of overall inflation.
       Reaching a consensus on health care reform will not be 
     easy. Americans want to reform the health care system but do 
     not share a vision of what the system should be or how to 
     achieve it. The major interested parties in health care 
     reform--consumers, doctors, hospitals, employers, insurance 
     companies, and taxpayers--all can have different views 
     concerning health care, and reform hinges on balancing these 
     often competing interests.
       Reform Proposals.--If Congress is to reach a consensus 
     concerning health care reform, it must agree on a number of 
     issues.
       Benefits Package.--A basic benefits package would provide 
     preventive care, coverage for catastrophic illness, and some 
     coverage of extended care and prescription drugs. The package 
     could be taken from job to job, but consumers may have to pay 
     a higher share of the cost to make them more aware of medical 
     expenses so they consume health care more prudently. 
     Obviously, the more generous the benefits the greater the 
     cost. I think the benefit package should provide basic 
     benefits, not Cadillac coverage. It is better to add benefits 
     later if funding is available than the other way around.
       Choice--Americans strongly favor being able to choose their 
     own doctor or hospital. I agree, and Congress is not expected 
     to support reforms which would eliminate this choice.
       Education/Information--Health care reform almost certainly 
     will emphasize better education and information. Consumers 
     and health plans, for example, will be making more 
     comparisons of the cost and quality of care.
       Universal Coverage--Expanded or universal coverage is a 
     goal of health care reform, but it will be phased in 
     gradually. Congress is not seriously considering a single-
     payer plan similar to Canada's, and support for employer or 
     individual mandates is still short of majority in the House 
     or Senate. Rather than mandate health insurance, it is more 
     likely Congress will expand the pool of Americans who can 
     obtain health coverage by implementing insurance reforms, tax 
     incentives to encourage businesses to provide medical 
     coverage, and government assistance to those who cannot 
     afford coverage.
       Insurance Reform--Possible reforms include insurance for 
     those with pre-existing conditions, guaranteed renewability 
     or portability, movement towards standard insurance premiums 
     (with variations for factors such as age or location), 
     consumer protection, standardized forms to reduce paperwork, 
     and allowing small businesses and individuals to join 
     together to buy group insurance at lower rates.
       Malpractice Reform--Malpractice reform would reduce 
     insurance costs and limit defensive medicine. Indiana is a 
     leader in malpractice reform. Congress is considering 
     national regulations.
       Anti-trust Reform--Anti-trust reforms would allow hospitals 
     and doctors--especially in rural areas--to work together to 
     better make use of limited resources. Such reform, for 
     example, could make it easier for nearby hospitals to 
     coordinate the purchase of expensive diagnostic equipment.
       Taxes--Congress is not expected to support a broad-based 
     tax increase to pay for reform, and we probably will not tax 
     employer-paid health insurance. Self-employed persons could 
     receive a 100% tax deduction for health care expenses, just 
     as employers now do. Taxes on tobacco products probably will 
     increase.
       Cost-control--Congress is unlikely to support direct cost 
     control. Instead, it will attempt to increase competition 
     among health care providers in order to restrain cost 
     increases.
       Trigger--A ``trigger'' device would activate in several 
     years if reform goals such as increased coverage or cost 
     control are not met. A ``hard trigger'' would, at a future 
     date, either implement additional reforms or force Congress 
     to vote on specific measures designed to achieve the unmet 
     goals. A ``soft trigger'' would require Congress to consider 
     how to achieve the unmet goals. Congress is more likely to 
     adopt a soft rather than a hard trigger.
       Scope of Reform--As Congress considers health care reform, 
     one important debate is between universal coverage and a more 
     modest, incremental approach. I come down on the side of 
     incremental reform.
       First, I am concerned about whether Washington successfully 
     can reform the health care system. It would be extremely 
     difficult to restructure in a few months the $1 trillion 
     health care system developed over decades.
       Second, managing a new health care system could be very 
     difficult for the government. The government already is 
     straining to deal with its current responsibilities, and 
     there is an enormous amount of public distrust of government. 
     If we put into place a health care system the government 
     cannot handle, it could have severe consequences on our 
     entire government system.
       Third, while I see strong support for health care reform, I 
     do not see a consensus for any single comprehensive reform 
     proposal. Hoosiers are becoming more cautious as they learn 
     more about health care reform. Our health care system has 
     many strengths, and it makes sense to preserve what works 
     well and build on it.
       But this is not an argument for doing nothing. Enacting no 
     health care reform can cause harm as well. As health costs 
     continue to rise, fewer people can afford health insurance 
     and more companies will drop medical coverage as part of 
     their benefits. Also, larger companies are using their clout 
     with health care providers to demand lower costs. These costs 
     do not disappear, and smaller employers are being forced to 
     pay more as expenses are shifted onto them.
       I think Congress and the President should proceed with 
     reforms which have strong public support, such as insurance 
     reform, reducing red tape, and promoting managed care. What 
     we should not do is try to reform the entire health care 
     system in one year.

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