[Congressional Record Volume 140, Number 100 (Wednesday, July 27, 1994)]
[House]
[Page H]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: July 27, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]


                              {time}  1640
 
                    HOW TO WRITE A HEALTH CARE BILL

  The SPEAKER pro tempore (Mr. Hinchey). Under the Speaker's announced 
policy of February 11, 1994, and June 10, 1994, the gentleman from 
Georgia [Mr. Gingrich] is recognized for 60 minutes.
  Mr. GINGRICH. Mr. Speaker, let me just say I want to talk this 
afternoon about how to write a good health care bill. I was led to 
decide to give this outline of how to write a good health bill by 
spending some time this morning on ``Good Morning America'' and talking 
about what the Republican bills were trying to do and what their 
weaknesses were and what I thought the Clinton bill was trying to do 
and what its weaknesses were.
  What struck me was that by the simple act of being candid and saying 
look, the Republican bills do not do everything, they in fact are 
stronger on protecting the middle class and on protecting working 
Americans, they are weaker on reaching the marginal worker and do not 
do as much as does the Clinton bill; the Clinton bill is stronger on 
taking care of the marginal worker, but does more to take money away 
from Medicare and does more to limit the choices of working Americans 
who have good health insurance. Just by being candid about the fact 
there were upsides and downsides to both sets of bills, I got a very 
surprising reaction from people who said it was such a relief to not 
have somebody just saying mine is perfect and yours is terrible.
  On the way back from New York, I began to think about this nutty 
process we are in the middle of. Here we have an issue which is central 
to every American, life and death, coverage if you have a serious 
illness, the shape and nature of our health system, should we focus on 
preventive care and on wellness and on early detection or should we 
focus on acute care after you finally get very sick? Should we give the 
individual control and choice over their doctor, and if so, should they 
have to pay for that control; or should we insist that the individual 
go into something like a managed care system, whether it is government 
or private, and while they lose a certain amount of choice over their 
doctor or their hospital, they at the same time save a great deal of 
money?
  These are not small questions. Yet watching the last 2 or 3 weeks I 
think has been a very sad experience for all Americans because instead 
of calming down and settling down and trying to have a genuine effort 
between the leaderships of a bipartisan bill, to genuinely have Senator 
Dole and Senator Mitchell and Mr. Michel and Speaker Foley and the 
President, and Mr. Gephardt and myself, and folks sit in a room and say 
look, let us try to see how far we can carry America toward a better 
health system, and let us see how many things we can agree on that have 
a broad agreement where most people think there have to be changes, 
instead we are engaged in what is almost an ego game worthy of 
teenagers.
  There is a bus tour going across America. Who cares? What does a bus 
tour which can be bought and organized and paid for by any large group, 
whether it is the unions, or it is big business, or it is some 
ideological group, I mean putting a bus tour together today just means 
that you have some limited ability to organize, but it means nothing in 
terms of public policy.

                              {time}  1650

  Or we have speeches in which people stand on different platforms and 
yell at each other across the television sets, but in terms of public 
policy, none of that really matters. None of that is a good idea.
  Then we have the spectacle, and I guess I was led in part to talk 
about how to write a good health bill by learning yesterday the Senate 
Finance Committee bill, which I thought I saw being written on July 2, 
and I was at home for the July 4 break, and I took some time off and 
spent part of the afternoon watching on C-Span as the Senate Finance 
Committee marked up what I though was a bill, and they passed it out 
that Saturday afternoon. I now have discovered that bill does not 
exist, that although it is now 25 days later, that they still have not 
finished writing the bill, so the Congressional Budget Office cannot do 
its estimates because the bill which they passed over 3 weeks ago does 
not exist.
  Now what do we have? We have the spectacle of the Senate majority 
leader, who I am told has now dropped his Friday deadline for writing a 
bill to next Wednesday, although I am told the White House is telling 
the press they will have votes next Wednesday on a bill which he may 
not even introduce until Wednesday; I am told by the news media the 
Democratic majority leader, Mr. Gephardt, is working on some document, 
that there is a 7-page outline of general principles going around, the 
goal being to somehow magically write a bill, get it analyzed by 
experts, and bring it to the floor and get it to a fiscal passage vote 
in 2 weeks.

  Now, I just want to say to all of my colleagues, Republicans or 
Democrats, liberals or conservatives, this is a terrible way to run the 
most complex society in the world, and it makes no sense. I mean, what 
do we gain if the Gingrich bill passes by one vote or the Gephardt bill 
passes by one vote, but they are bad bills? Or they are bills that have 
such narrow support that they get repealed next year just as happened a 
couple of years ago when we passed the catastrophic health bill, and a 
year later we had to repeal it? What are we gaining?
  And in the process, look what is happening. The polling numbers 
indicate more and more Americans oppose any bill that has Clinton's 
name on it. The polling numbers indicate the country is more and more 
frightened the Congress will rush to do something dumb, and the 
spectacle seen around the world of the most complex government, and 
there is no government in the world which deliberately divides power 
the way we do, we have a President, and then we have a legislative 
branch, the legislative branch is divided into two parts, the House and 
Senate; the House is geographic, or is population-based, the Senate is 
based on States. So California has many, many Members in the House, but 
only two in the Senate. Wyoming has only one Member in the House, but 
has two in the Senate. Senators are elected for 6 years, and only a 
third are up, and House Members are elected every 2 years, and we only 
represent the Federal Government. There are State governments and local 
governments, and under our Constitution all other rights not expressly 
granted to the Government are retained by the citizens.
  We are the most complicated and difficult-to-lead society in the 
world. Our Founding Fathers deliberately decided they would keep power 
distributed so no dictator could force the system to work.
  For us to try to rush to write a complicated 1,200 or 1,500-page 
health bill and try to ram it through on a narrowly partisan vote with 
nobody in the country understanding the bill, no expert having read it, 
no public hearings, I think, would be tragic, and I think it would be 
bad government. I think it is bad policy. I think it is bad for 
America, and I think it is bad for the Congress, and I think all of us 
are at one level participating in pushing our way to a test of will 
where you are going to have a real effort to see who can win.
  I think it is silly. It is childish.
  Instead of having a duel between Senator Dole and Senator Mitchell or 
a duel between the Republican leadership in the House and the 
Democratic leadership in the House or a name-calling contest between 
the President and Mrs. Clinton and the Republican leaders around the 
country, it will be far better for us to take a deep breath, take a 
step back from the process and say to ourselves, what if we took 
seriously the health care of the American people, so seriously that we 
were willing to calm down, quit name-calling, and actually try to write 
a bill together.
  Now, there are a couple of simple principles. What if we were to 
write a bill that was focused on passing only things that had broad 
public support and broad public agreement? We would discover, for 
example, that malpractice reform, that is, lowering the number of 
lawsuits and lowering the amount of defensive medicine, something which 
one study indicates would save $76 billion over 5 years, that is pretty 
popular. Most Americans believe we have too many lawsuits, and they 
would like to see a less litigious system with fewer lawsuits. So we 
might include malpractice reform.
  There is overwhelming support for the idea that once you have health 
insurance you should never ever be kicked out because of a 
precondition, and the insurance companies agree this can be passed, and 
they can sustain this with almost no difficulty. So we could pass a law 
in the next few weeks that says that we will have no preconditions ever 
for people who already have insurance, so the day you get your first 
health insurance, the first time you go to work, from that day, the 
rest of your working career you can change jobs, you can take time off, 
whatever, you are in the system, and as long as you stay in the system, 
you can never be kicked out for precondition.
  That would meet the largest single fear of middle-aged working 
Americans.
  We also know that there is overwhelming support for the idea that 
small businesses and self-employed people and family farmers and 
unemployed people should get the very same tax break as the biggest 
corporations. Today, if you are a giant corporation and you buy health 
insurance, it is 100 percent tax deductible. If you are self-employed 
or unemployed or a family farm, it is zero tax deductible. Almost every 
American agrees that is unfair.

  We can find enough savings to be in a position to have the kind of 
approach that lets us take care of giving the same tax break, the same 
100-percent deductibility to small business, to the self-employed, to 
the unemployed, and to family farms that we give to big corporations. 
That would solve a big part of the problem. We can do that within the 
framework of a commonsense bill.
  There are other steps we could take. We could expand the number of 
community health centers so that we would be in a position to reach out 
to working Americans who are poor and get them an opportunity to have 
preventive care and to have inexpensive care without having to go to an 
emergency room. We could say to the States we think that people who are 
getting Medicaid ought to be in managed care where we begin to have 
preventive care and wellness programs and lower the cost of taking care 
of them.
  There are some estimates we could save as much as 20 percent of the 
cost of Medicaid by simply going to managed care for the poorest 
Americans and getting them into a system where there is, for example, 
prenatal care, where you have mammograms and check on people, and try 
to lower the cost.
  I am not trying to produce a long list. I am trying to give you a 
sense that there are very specific reforms that are very real, that are 
overwhelmingly supported by most Americans, and that could be passed 
this year without any damage to the system.
  We could sit down in a room, either at the White House or here at the 
Capitol, and I believe that you could have a genuine effort by Senator 
Dole and Senator Mitchell and Congressman Michel and Speaker Foley and 
by the President, and you could produce a bill that got 280 or 290 
votes in the House and got 60 or 70 votes in the Senate, and the 
American people would say:

       You know, it is really a positive thing to see our elected 
     officials put the country above party, to see our elected 
     officials put good legislation above scoring points, to see 
     our elected officials quit maneuvering and quit debating and 
     quit manipulating and actually work together constructively.

  Now, neither side would necessarily get everything it wants. Neither 
side would necessarily have all the breakthroughs. But, frankly, if the 
President, working with Republicans and Democrats alike, passed a good, 
solid, middle-of-the-road reform bill and he still wanted to fight for 
a bigger government Clinton-style plan in January, he could come back 
to the Congress, and in his State of the Union he could outline another 
set of reforms on top of the ones we passed, and we could start the 
process again next year.
  But what I think that I find so disturbing is the idea that on an 
issue which is not just about ideology or symbolism, it is literally 
about life and death, it is literally about 260 million Americans, it 
is literally about 14 percent of the largest economy in the world, 
about $1,300,000,000,000, on an issue of this importance, maybe the 
most important domestic issue of my adult lifetime, that we are being 
reduced to a series of petty partisan games. We are being reduced to 
politicians sort of yelling at each other on national TV. We are being 
reduced to symbols like a bus tour. We are being reduced to, I think, 
the most degrading and the most deficient process I have seen in a long 
time.

                              {time}  1700

  I mean every Member ought to just think about: What are your citizens 
back home watching? They are watching the news every day. They are 
seeing that there is no bill today, there is no Democratic leadership 
bill today, there is not going to be a Democratic leadership bill 
tomorrow. Yet we are going to rush without a single hearing, without 
any expert testimony, without anybody back home having a chance to tell 
us what is going on, we are going to rush to try to pass a bill of this 
size before August 12 or August 13? We must look, to any serious adult 
in this country, like we have just lost our minds, like it makes no 
sense at all.
  So I wanted to come to the floor and offer--this is just for myself, 
I have not cleared this with Mr. Michel, and certainly have not talked 
to Senator Dole about it, I am not even offering it as a Republican. I 
am just saying as somebody who had some time today to think about 
things, having thought about the reaction I got on ``Good Morning, 
America,'' by just being candid and open about the fact that the 
Republican bill is not perfect and the Democratic presidential bill is 
not perfect and we both have some strengths and they are different, and 
we both have some weaknesses, that the reaction, the way people thought 
it was so refreshing to have some elected officials say just, ``Hey, 
nobody is perfect, but let us try together.'' I wanted to come to the 
floor and in as open a way as I could say to the President and to Mrs. 
Clinton and to the Democratic leadership in the House and in the 
Senate: Why do we not slow the express down? Let us sit down and talk 
together, let us see if we cannot find a positive reform bill that an 
overwhelming number of Democrats and Republicans could sign onto 
together, that did no damage to the current system, that we could take 
together to the country and show people with great pride this would be 
better for America and we could explain what the good parts were and we 
could explain honestly what the costs were and maybe you would have a 
sense in the country that we have done something good for a change and 
maybe the Congress did deserve a little respect.
  And I think that that approach would be so much better than pork 
barrel and log rolling and back rooms and secret deals and the kind of 
chaos mentioned last Friday in the New York Times, where Members are 
getting goodies for companies and hospitals and people are being taken 
care of.

  I think we are about to head into 2 weeks that are going to look so 
demeaning and so tawdry and so negative from the standpoint of the 
average American that whether a bill passes or not this summer, the 
image of the Congress and the reputation of Congress will take another 
deep step down and people will be even more disgusted with the way 
politicians work in Washington.
  So I just wanted to come to the floor tonight and say I think we have 
a chance to do something right for America. I think all of us, 
Democrats and Republicans, ought to take a deep breath, step back, give 
up our pride of ownership in whatever we have done so far, talk 
together, find the pieces of a good bill that we can all agree on, pass 
them together.
  As a Republican, I am willing to have the President have a big bill-
signing ceremony, I am willing to have him get a boost in the polls 
because I think it is better for America if we actually pass a 
bipartisan bill rather than go through 2 months of just kicking and 
fighting and a kind of behavior that is going to lower the prestige of 
the country, lower the prestige of the Government and, frankly, produce 
a bill that is going to be a dumb bill.
  It is going to be very hard under these circumstances no matter who 
wins, it is going to be hard to write a good bill that we can be proud 
of in the long run.
  So I extend my hand. I am certainly prepared to sit down with the 
President or Mrs. Clinton and the Democratic leadership in the House 
and Senate to work together to try to do something good. And then, 
frankly, in January, if the people who believe in a single-payer 
system, if the people who believe in a big-government system want to 
come back and let us try again, and if they want to pursue their 
approach, fine. That is their right as Americans. We can have a debate 
over that in the fall. We will have passed a good first-step bill, we 
can debate the principles of future reform, the President can come to a 
State of the Union and announce next year where he wants to go.
  But to try to ram it through in the next few weeks in total 
ignorance, with no one really knowing what is in the bill and knowing 
what it means and knowing what it costs, that I believe is wrong for 
America, I think it is wrong for every Member of the House and Senate, 
and I hope we will not do it.
  So I hope the Democratic leadership and the President will take up 
this offer and I hope maybe as early as tomorrow we could sit down and 
work together to wrote a good health bill.

                          ____________________