[Congressional Record Volume 140, Number 99 (Tuesday, July 26, 1994)]
[Senate]
[Page S]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: July 26, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
                           HEALTH CARE REFORM

  Mr. DURENBERGER. Mr. President, I know the hour is early and the 
Chamber itself is not full of our colleagues, but that is far from 
unusual at this time of the morning. I appreciate particularly your 
being here, Mr. President. And I appreciate also the special prayer of 
the Chaplain this morning for all of the people who bring the real 
sense of service to the tasks that they perform. They enjoy their work 
because they recognize that being a public servant is a very special 
vocation.
  That vocation is what brings me to the floor this morning. I want to 
talk about a commitment I made to my constituents in Minnesota quite a 
number of years ago. In fact, it was probably a commitment I made in 
action before I ever thought about running for the Senate. That was to 
do something about the high cost of health care in this country, the 
medicalization of the health care system which was driving the costs 
up, and the problems we were creating through a value system oriented 
toward high technology, medical exotica, and away from public health 
and community health.
  The kind of health care that is expressed more in real human 
relationships at the personal and community level--in a concern for the 
behavior of people, the raising of children, intelligent lifestyles, 
and proper health habits--is being destroyed by the medicalization of 
the system.
  We, in Minnesota and the upper Midwest, have a traditional ethic, a 
culture that leads us to be servants to others and to try to change 
systems when we see something going wrong, or something that could be 
done better. We are constantly trying to do that. And I offer my 
comments this morning in that spirit.
  As you listen to the health care reform debate, you are going to hear 
words like ``health insurance,'' ``purchasing cooperatives,'' or 
``health plan purchasing cooperatives.'' And for the Presiding Officer 
from North Dakota, for the Chaplain, who also has his roots both in 
North Dakota and in Minnesota, you will understand those are words with 
which you grew up. It is a way in which people, together, seek to 
resolve problems that are commonly experienced, where one alone cannot 
do it. It is a way in which people cooperate to solve their problems.
  Some of the rich traditions in health care in our part of the country 
go back to the cooperative movement in which people banded together to 
bring teachers to their community, to bring doctors to their community, 
to support a nurse who would travel around the community. So I am 
affected with a sense of deja vu when I hear us talk about health care 
reform in concepts like bringing back the cooperatives as a more 
appropriate way to buy health care than the way we do it now.
  That is our approach, and maybe it is a sign of the times. Maybe it 
is a sign that all the speeches about values and getting back to basics 
are finally beginning to pay off.
  One of the difficulties experienced by those of us who have been 
involved for any length of time in the health care reform debate is 
definition. My colleague from Rhode Island--who has now spent, I think, 
as of next month, 4 straight years on Thursday morning breakfast 
meetings trying to help us define the problem and to wrestle with some 
solutions--and I are blessed by having served for 16 years, in my case, 
and I think 18 years for Senator Chafee on the Senate Finance 
Committee. Currently that committee is chaired by our colleague, 
Senator Moynihan from New York. And during a whole series of hearings 
on health care reform in the last year or so, he has made almost a 
fetish of defining our terms: What do you mean by this word? What do 
you mean by that word?
  So again it is sort of surprising that we come to the floor today and 
we cannot even define ``health care reform.'' We cannot define 
``universal coverage.'' We have difficulty defining ``cost shifts.'' 
These terms which have been used in this debate continually as sort of 
a cause for which we are all fighting lack definition that can help 
bring us together on a solution.
  Yesterday's headline, for example, in the Washington Post, which 
everybody came back from a weekend and picked up, says ``White House 
Open to Delay of Reform.'' ``White House Open to Delay of Reform.'' And 
I thought, well, we are going to get August off. We do not have to do 
anything because we are not going to do reform.
  Well, if you read the article, it says that the deadline for 
universal coverage, that is, 100 percent of Americans enrolled in 
health plans with health security cards, has been delayed. I do not 
know delayed to what, but it used to be 1998 and now it is delayed to 
sometime in the future.
  But, Mr. President, that is not health care reform. That is not 
health care reform. That is expanding access to the system through a 
health plan or through health insurance to all Americans, but that is 
not reform. That is part of our equity job, as people in politics, to 
guarantee access to health care, but it has nothing to do with 
reforming health care.
  The dictionary definition of reform is, ``To make better by removing 
faults and defects.'' And during the course of our discussions today, 
tomorrow, or however long we are going to be permitted to do this in 
the morning, we are going to take on some of the faults and the defects 
in the current system. There are faults and defects in the coverage 
system in this country today, which we will talk about. For example, 
running a Canadian system in the middle of America for the elderly, the 
disabled, and low-income people while everybody else has the benefit of 
an American system. I think that is a fault in our current system. But 
that is not what they are talking about here when they talk about 
delaying health care reform. They are just talking about extending that 
system to all Americans. Reform of the health care system is going on 
right now. It is going on intensely in the State which the Presiding 
Officer represents. It is going on intensely in my State of Minnesota, 
his next-door neighbor. It is going on wherever you look.

  You cannot pick up a newspaper or listen to a radio or go into a 
doctor's office without hearing a lecture on either the benefits of or 
the evils of health care reform, because things are changing. It is 
going on all over America. It is going on in communities all over 
America. It is changing the way that we buy into the system. It is 
changing the way doctors, hospitals, nurses, and all kinds of people 
are providing health care. It is motivated by the fact that each of 
these people is trying to raise quality and lower costs.
  The ACTING PRESIDENT pro tempore. The Chair advises the Senator that 
he has consumed 5 minutes.
  Mr. DURENBERGER. Mr. President, I ask unanimous consent to continue 
for an additional 5 minutes.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.
  Mr. DURENBERGER. Mr. President, the reform that is taking place right 
now is real reform. But it lacks the benefits of guidance from the 
rules in the health care system. What is happening at the White House 
right now, as far as I can tell, is I think most of us get the doctors 
who just have been to see Ira Magaziner, now come up to talk and to 
suggest, or somebody else goes down there and gets a pitch, and then 
comes up to talk to us about health care reform.
  The problem seems to be that all of these people are confusing real 
reform with expanding coverage. And expanding coverage is a fine goal, 
but it does not change the system itself. It simply provides the 
dollars through revenues and savings to help buy health plans for more 
people.
  One of the shocking things that we do not hear much about was the CBO 
estimate on the Clinton health plan. In February, when Bob Reischauer 
came to the Finance Committee to report on the cost estimates for the 
Clinton health plan, which tries to combine system reform and coverage, 
he said that if everything goes perfectly well, by the year 2004, the 
medical costs and health care costs in this country will be 19 percent 
of our GDP; $2.7 trillion just in 1 year--19 percent of the GDP.
  So if you take the present system and you define health care reform 
as expanding coverage to everybody, what do you get? You may get 
coverage for everybody, but the cost is 19 percent of our GDP. Today, 
we cannot afford 14 percent of our GDP. It is 19 percent under a system 
that equates reform with coverage.
  System reform and coverage expansion, therefore, are two different 
goals. We can accelerate reform in the system now. We have to phase in 
coverage.
  I think that is what the administration meant by ``delay.'' Frankly, 
I think reform is the only way to get the coverage. Reform is how we 
get cost containment, and without cost containment we cannot afford 
coverage.
  One of the fallacious arguments made currently is that there is no 
cost containment in the moderate bill such as the mainstream proposal 
which was adopted by the Finance Committee.
  That is absolutely wrong.
  This kind of proposal is all about reform, and it is all about cost 
containment. All of the reforms which accelerate the role of the buyer 
in the system, insurance reform for small groups and individuals, group 
purchasing for everyone in these groups under 100, insurance products 
that can actually be compared for price and quality and value--all of 
that enhances the role of the buyer in the system.
  But for the producers of health care, there are provisions for 
integrated and efficient plans, information on quality and outcomes, 
preemption of anticompetitive rule, national rules by which local 
markets can operate, medical liability reform, and antitrust reform. 
How many of us in our communities have struggled with the doctors and 
hospitals trying to integrate their services to bring down costs? They 
cannot, because of the current state of antitrust law. That changes. 
How many people have read the stories about the costs of paperwork in 
the current system? Anything from $50 to $100 billion a year can be 
saved by administrative simplification. All of that is in here.
  You just walk through your own real life experiences with people in 
your communities, and you will find cost containment in this bill; 
changing the way people buy, the way they get in the system, what they 
buy, what that product looks like, the fact that they will have 
choices. Most people who work even for the largest companies do not 
have a choice of health plan. We offer them a choice of three health 
plans, and we require the employer not to unduly influence the choice 
of those plans by giving a larger contribution to one plan than to 
another. We require that every employer in America has to provide 
access to health plans, at least three, either through a co-op or 
through their own purchase for all of their employees. No one has that 
today. You are lucky, if you go to work, to see an insurance plan.
  In the future, people will be able to buy a health plan either on 
their own through an insurance agent or when they go to work, and even 
if their employer is not contributing 80, 70, or 60 percent of the 
premium, there will be a choice of three health plans there. The cost 
of getting those health plans is covered.
  So the bill itself, the system reform that is built into this, will 
make major contributions to cost containment.
  There is a third argument that I intend to deal with at greater 
length at another time. That is the fact that we have lost sight of the 
President's promise on January 25 in his State of the Union message--
when he said that every American ought to have the guarantee of a 
private health plan that cannot be taken away.
  Let me repeat what the President promised: A private health plan that 
cannot be taken away.
  If we could continue down that track, we would have real reform. But 
because this is Washington, we concentrate on guaranteeing, and we 
forget the word ``private'' as in private health plans. And we forget 
the fact that every older person in America, when he or she reaches 65, 
is forced to get out of an American health care system and get into a 
Canadian system, run by the Government. The same is true with the 
disabled and low-income people.
  The President said ``private health plan.'' Where is the endorsement 
that everybody in America can have the right to a private health plan 
that cannot be taken away? That would be real reform. So let us get on 
with that.
  Related to that is the argument about cost sharing.
  The ACTING PRESIDENT pro tempore. The Senator has consumed an 
additional 5 minutes.
  Mr. DURENBERGER. Mr. President, I ask unanimous consent to continue 
for 2 minutes, and then I will yield the floor to my colleague.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.
  Mr. DURENBERGER. Mr. President, I appreciate the tolerance of my 
colleagues from Nebraska and Rhode Island, in particular.
  But on the issue of cost shifting--and perhaps others will take this 
issue up, and I will discuss it myself later in the week. But one of 
the arguments that has been made for over a year as to why we have to 
have universal coverage is to stop cost shifting. The reality is that 
the real cost shift in this system is not from the uninsured.
  The real cost shifting occurs right here.
  It happens every year when we cut back on payments to doctors and 
hospitals under Medicare and Medicaid. And the difference between what 
we will pay in the Government system and what the doctors and hospitals 
actually need in Bismarck, ND, or Omaha, NE, is shifted onto private 
payers in the American system, which paralyzes.
  Today, we are paying 59 cents on the dollar of charges to doctors who 
serve Medicare patients, and about 70 cents on the dollar to hospitals. 
What happens to the difference? The difference is either made up by the 
doctor's office, if he can, by seeing a patient twice instead of once. 
That is why the costs continue to climb at 10 or 11 percent a year, or 
the difference gets shifted onto a private-paying patient. That is 
where the cost shift is.
  It is happening right here.
  Universal coverage is not going to solve that problem. Only a series 
of decisions will solve that problem, decisions to adequately fund 
Medicare and Medicaid--better yet, to allow people who are the 
beneficiaries of Medicare and Medicaid to buy private health plans and 
have us compensate those plans for their premiums.
  That would be real reform.
  Mr. President, I appreciate the opportunity that we are having this 
morning to discuss some of these issues, and I promise to be back at a 
future time before the debate begins in earnest in August to try to 
explain the commitment that many of us have made to doing real health 
care reform this year on our way to universal coverage.
  I yield the floor.
  Mr. KERREY addressed the Chair.
  The ACTING PRESIDENT pro tempore. The Chair recognizes the Senator 
from Nebraska [Mr. Kerrey].
  Mr. KERREY. Mr. President, I ask unanimous consent to speak for 15 
minutes.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.

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