[Congressional Record Volume 140, Number 100 (Wednesday, July 27, 1994)]
[Senate]
[Page S]
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]

 
                               QUORUM CALL

  Mr. MITCHELL. Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll
  The assistant legislative clerk proceeded to call the roll.
  The PRESIDING OFFICER. A quorum is not present.
  The clerk will call the roll.
  The assistant legislative clerk called the roll, and the following 
Senators entered the Chamber and answered to their names:

                             [Quorum No. 4]

     Jeffords
     Kassebaum
     Kennedy
     Kohl
     McCain
     Mitchell
     Pell

  The PRESIDING OFFICER. A quorum is not present.
  The clerk will call the names of the absent Senators.
  The assistant legislative clerk resumed the call of the roll.
  Mr. MITCHELL. Mr. President, I move to instruct the Sergeant at Arms 
to request the presence of absent Senators, and I ask for the yeas and 
nays.
  The PRESIDING OFFICER. Is there a sufficient second? There is a 
sufficient second.
  The yeas and nays were ordered.
  The PRESIDING OFFICER. The question is on agreeing to the motion of 
the Senator from Maine.
  The yeas and nays have been ordered. The clerk will call the roll.
  The legislative clerk called the roll.
  Mr. FORD. I announce that the Senator from Connecticut [Mr. Dodd] and 
the Senator from Iowa [Mr. Harkin] are necessarily absent.
  Mr. SIMPSON. I announce that the Senator from Idaho [Mr. Craig] is 
necessarily absent.
  The PRESIDING OFFICER. Are there any other Senators in the Chamber 
who desire to vote?
  The result was announced--yeas 77, nays 20, as follows:

                      [Rollcall Vote No. 234 Leg.]

                                YEAS--77

     Akaka
     Baucus
     Biden
     Bingaman
     Bond
     Boren
     Boxer
     Bradley
     Bryan
     Bumpers
     Burns
     Byrd
     Campbell
     Chafee
     Coats
     Cochran
     Cohen
     Conrad
     Coverdell
     Danforth
     Daschle
     DeConcini
     Dole
     Domenici
     Dorgan
     Durenberger
     Exon
     Feingold
     Feinstein
     Ford
     Glenn
     Gorton
     Graham
     Gregg
     Hatch
     Hatfield
     Heflin
     Hollings
     Hutchison
     Inouye
     Jeffords
     Johnston
     Kassebaum
     Kennedy
     Kerrey
     Kerry
     Kohl
     Lautenberg
     Leahy
     Levin
     Lieberman
     Lugar
     Mathews
     Metzenbaum
     Mikulski
     Mitchell
     Moynihan
     Murray
     Nunn
     Packwood
     Pell
     Pryor
     Reid
     Riegle
     Robb
     Rockefeller
     Roth
     Sarbanes
     Sasser
     Shelby
     Simon
     Simpson
     Stevens
     Thurmond
     Warner
     Wellstone
     Wofford

                                NAYS--20

     Bennett
     Breaux
     Brown
     D'Amato
     Faircloth
     Gramm
     Grassley
     Helms
     Kempthorne
     Lott
     Mack
     McCain
     McConnell
     Moseley-Braun
     Murkowski
     Nickles
     Pressler
     Smith
     Specter
     Wallop

                             NOT VOTING--3

     Craig
     Dodd
     Harkin
  So the motion was agreed to.
  The PRESIDING OFFICER. A quorum is present.
  Mr. MITCHELL. Mr. President, may we have order?
  The PRESIDING OFFICER. The Senate will be in order. We cannot proceed 
until the Senate is in order. Conversations will cease.
  The Chair recognizes the majority leader.
  Mr. MITCHELL. Mr. President, what is the pending question?
  The PRESIDING OFFICER. The pending question is the motion to proceed 
to S. 1513.
  Mr. HELMS. Mr. President, I cannot hear.
  The PRESIDING OFFICER. S. 1513.
  Mr. HELMS. I suggest the absence of a quorum until you can get order.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. HELMS. Mr. President, I ask unanimous consent that the order for 
the quorum call be dispensed with.
  The PRESIDING OFFICER. Is there objection? Without objection, it is 
so ordered.
  The PRESIDING OFFICER. The question is on the motion to proceed. Is 
there debate?
  Mr. GRAMM addressed the Chair.
  The PRESIDING OFFICER. The Chair recognizes the Senator from Texas 
[Mr. Gramm].
  Mr. GRAMM. Mr. President, we are in the process of debating a motion 
to proceed to a bill which, obviously, is an important bill. Clearly, 
it is a bill in which many Members of the Senate are interested. But it 
seems to me that there are a lot of other issues that are more 
important.
  When we have a great debate going on in the country on health care, 
when we have buses running up and down the road urging people to 
support the President's health care plan, and when people ask, ``Well, 
which health care plan?'' and supporters of the President's plan say, 
``Well, not the old health care plan, but a new health care plan''--yet 
there is no new health care plan--it seems to me, Mr. President, that 
we have reached the point where we are no longer talking about a health 
care debate; we are talking about an agenda. And the agenda, it seems 
to me, is to pass any health care bill rather than trying to deal with 
a specific set of problems.
  The point I wanted to make today, while everybody is deciding what 
they are going to do about the education bill, is the following: before 
we all get into a political debate, I think it is very important that 
we define what we are trying to do.
  I think it is very important that if the President, who has a bunch 
of people in my State today going in all kinds of directions but 
generally in circles, wants to ask people to vote for his new health 
care plan, even though the American people in overwhelming numbers have 
rejected the old health care plan, I think it is incumbent on the 
President to tell people what this new health care plan is. How does it 
treat working Americans? Does it force people to give up their health 
insurance and to buy health insurance through a Government-run 
cooperative? What does it do in terms of taxes? Does it tax health 
insurance benefits, as the Finance Committee bill does?
  As many of my colleagues are aware--and I am not sure all are--the 
Senate Finance Committee bill imposes two new taxes on health insurance 
benefits; one, an across-the-board tax that will tax every premium paid 
by every American for private health insurance, and then another tax, a 
25 percent tax, that will be imposed on the 40 percent of American 
families that have the best private health insurance.
  Mr. WALLOP. Will the Senator yield for a question?
  Mr. GRAMM. I will be happy to yield.
  Mr. WALLOP. I noted that the Senator referred to the Senate Finance 
Committee bill. Has that finally been reduced to print so that other 
people can see it, or are we still talking about this fantasy that was 
marked up in the Finance Committee and turned over to the staff to turn 
into bill language while we went on a holiday, and now that is not 
going to be any good because we are told that the majority leader and 
others are crafting a bill behind closed doors in secret? Has the 
Senator seen a plan, a bill from the Finance Committee?
  Mr. GRAMM. Well, the distinguished Senator is a member of the Finance 
Committee.
  Mr. WALLOP. That is why I asked, because I have not seen it.
  Mr. GRAMM. I do not have the privilege to serve on that committee, 
and therefore I did not have an opportunity to see if in fact there was 
real language. I had heard that there might be a bill, though according 
to press reports, it looks as if the committee just voted on concepts.
  My point is this: We cannot enact concepts. We have to debate what 
the President proposes. We have people running up and down the highway 
in buses saying, ``Vote for the President's health care plan,'' yet the 
President cannot tell us what the plan is. When the President has had a 
year and a half to convince the American people that his health care 
plan was good, he cannot claim he failed because he did not have a big 
megaphone. He has not failed because he is not a great salesman. He has 
not failed because the First Lady is not a great saleslady. He has 
failed because he has a bad product. He has failed because he has been 
unable to convince the 85 percent of Americans who have private health 
insurance that they should lose their health insurance and be forced to 
buy health care through a Government-run collective in order to help 
the 15 percent who do not have it.
  My point is this----
  Mr. WALLOP. Will the Senator yield for one last question?
  Mr. GRAMM. I will be happy to yield.
  Mr. WALLOP. If it does in the course of the day or sometime soon 
happen to befall to the Senator that he comes across the Senate Finance 
Committee plan in bill language, I would hope the Senator would share 
it with the rest of the Senate. We are going to be asked to go to 
debate next week and we have not the foggiest notion what we are going 
to debate, except the bill we are being asked to debate is being 
crafted behind closed doors.
  A seventh of the American economy is being crafted behind closed 
doors, in secret, and we are going to be asked to make decisions that 
affect the lives and times of individual Americans, groups of 
Americans, elderly Americans, young Americans, healthy and infirm, 
without having the foggiest notion what that is.
  The Finance Committee does not have a bill, and if the Senator comes 
across it, share it with the Nation, because most of us are going to 
want to have something upon which to run our debate.
  Mr. GRAMM. I would like to say, Mr. President----
  Mr. KENNEDY. Will the Senator yield for a question?
  Mr. GRAMM. I would be happy to yield.
  Mr. KENNEDY. Just as a point of information. We have this legislation 
that was reported out 16 to 1, bipartisan, and it is enormously 
important to the school children in this country. I see a number of my 
colleagues on the Judiciary Committee, of which I am a member, that are 
now in the process of marking up the crime bill, as well as on the 
Armed Services Committee, that are present here. They were interested 
in addressing the issues which, hopefully, we will have before the 
Senate.
  I am just wondering, inquiring of the Senator from Texas, whether he 
is going to permit us to get about the business which has been outlined 
by the majority leader, to permit us to begin the debate on the 
elementary and secondary education program which has bipartisan 
support.
  Just as a matter of inquiry, I am wondering whether the Senator is 
prepared to proceed.
  I would ask the majority leader and minority leader to designate some 
time, obviously, and, as he always has, to permit general comments on 
legislation and on the legislative agenda. But I am just wondering, 
since the principals are here, Senator Kassebaum and Senator Jeffords, 
who are cosponsors in support of the legislation, have not been able to 
speak to the legislation that we hope to address--Senator Pell and I 
have--just in the order of things I would like, as a point of 
information and courtesy to Members on both sides, to have some idea as 
to what the intentions of the Senator are.
  Mr. GRAMM. Let me say to the distinguished chairman, I do not have a 
dog in this fight. I had understood there was an objection to 
proceeding to the bill. We have had a real dearth of morning business. 
Since we have all these bus riders pushing the President's plan--I hope 
they are buying Texas gasoline--I am getting all kinds of calls from my 
State from people asking what I think of the President's new bill. And 
I simply wanted to take this opportunity, while I assumed others were 
working out your problem, to express my concern that I am being asked 
to engage in a debate on a bill that I have not had an opportunity to 
see, and no one else has had an opportunity to see.
  I was simply expressing, No. 1, frustration, and, number two, a 
growing conviction that what we have here is not a health care plan but 
an agenda. And the agenda is basically to try to pass any health bill 
because the President has gotten so far out on the limb on this issue. 
While it is clear that his initial idea has been rejected, rather than 
saying, well, maybe we ought to rethink this thing, maybe we ought to 
go back and look at some other ideas, and maybe we ought to come back 
next year and have a real debate on a real bill, what we are seeing is 
the promotion of an agenda.
  Now, that is the point I wanted to make. But I do not have a dog in 
the fight on this bill. I just assumed others were negotiating, and 
since we have not had any morning business, I was simply trying to take 
this time, assuming others were working out your problem. But I am not 
your problem.
  Mr. MITCHELL addressed the Chair.
  Mr. STEVENS. Will the Senator yield?
  The PRESIDING OFFICER. The Chair recognizes the majority leader.
  Mr. STEVENS. Does the Senator have the floor?
  Mr. MITCHELL. Mr. President, there are no other negotiations, so the 
Senator's assumption is incorrect. And if he is not trying to delay 
this bill, might I ask if he would permit us to have a vote on the 
motion to proceed, and I will then ask unanimous consent that he can 
speak for 10 minutes on whatever subject he wants.
  Mr. GRAMM. Mr. President, I do not object to a vote on the motion to 
proceed. I assumed that we had negotiations underway, and I simply was 
trying to speak on this subject.
  Did the Senator from Alaska want me to yield for a question?
  Mr. STEVENS. I would be pleased to be recognized in my own right 
before we are through.
  Mr. MITCHELL. The Senator has that right.
  Let me make clear, Mr. President, we are trying to begin debate on 
the elementary and secondary education bill. It was reported out of the 
committee by a vote of 16 to 1. I have given notice over several weeks 
of our intention to proceed to the bill.
  We are being prevented from doing so by Senators who have objected to 
our bringing the bill up. We now have a motion to proceed to that bill 
before the Senate. We will have a vote on it when Senators are prepared 
to do so. These talks merely delay the vote on it. Whether it is 
intentional or not, I do not know. That is the effect of the debate now 
going on.
  Senators do have a right to debate it, of course, if they wish to do 
so. That is their right. But what it does is it prevents us from 
proceeding to the bill. It also prevents us from acting on other cases. 
The Senate is spending hours in the morning doing nothing other than 
delaying something, and then we have to be here in the evening voting. 
And Senators ask, ``Why are we here in the evening?'' Well, we are here 
in the evening because we are prevented from proceeding to legislate in 
the morning.
  Certainly, Mr. President, the Senator from Alaska has the right, as 
does any Senator, to address the Senate on this matter.
  Everyone should understand that we are now having a delay because of 
an objection by our colleagues to proceeding to the elementary and 
secondary education bill. I hope we can get to the vote on the motion 
to proceed promptly.
  Mr. KENNEDY. Mr. President, I just remind our Members that even 
though there was an objection to proceeding, we were still moving the 
process ahead because we were addressing in the presentation the 
essential aspects of the bill.
  I see Senator Kassebaum and Senator Jeffords, who I know want to 
address this as well. So the process was basically moving ahead as the 
objection, whatever that is, was going to be evaluated by those who are 
going to object to making some decision with leadership as to the 
manner in which we proceed.
  So even though there has been some objection, we were at least moving 
the process of the debate and the discussion on this very, very 
important legislation.
  So to the extent that Members can permit that process of the 
statements and comments prior to the time that the leader puts the 
question, I hope that we can have as much cooperation on this as 
possible.
  I thank the Senator.
  Mr. STEVENS addressed the Chair.
  The PRESIDING OFFICER. The Senator from Alaska.
  Mr. STEVENS. Mr. President, I have not objected to taking up the 
education bill, and I do not intend to do so. I do want to make a 
comment.
  We had arranged for a series of special orders this morning to speak 
on other subjects. When I got home very late last night, I found a 
notice that it had been canceled. Some of us are very disturbed about 
the process on the health care bill. I am one. I have spent several 
days, as a matter of fact, going over some notes and looking into the 
history of the catastrophic insurance bill that was passed and then 
repealed. I was prepared to make those comments.
  I find, I think, on the part of some servants that we have here now, 
the fact that there is no regularity in really assigning the time for 
Senators to make short statements on subjects of great concern to us.
  My State is probably more adversely affected by any of these health 
care bills than any other State. It is one-fifth the size of this 
Union, with about one person per square mile. When you look at that, 
and realize that over the last 3 years, we had a series of meetings in 
my State, and after all those meetings people asked me, ``When you get 
the final version of the bill, will you come back and let us discuss 
that,'' that is the message I hope to present to the Senate when I get 
the time for a special order.
  I am not going to do it now. But I do think we have to have some 
similarity in terms of when we can make statements on matters of great 
concern to our States.
  Mr. WALLOP addressed the Chair.
  The PRESIDING OFFICER. The Senator from Wyoming.
  Mr. WALLOP. Mr. President, we are being asked to take up a bill with 
some 1,300 pages. The majority leader and the Senator from 
Massachusetts have just told us that this has been voted out, and has 
been--I think for 7 weeks--ready to go to the floor. That at least 
implies that Senators may have had a moment or two to look at it.
  But the health care bill is going to be this size, Mr. President. We 
have not gotten it yet, and we are going to be asked to cram that in 
before an August recess. And it is going to affect more American lives 
than this will, and for a longer future than this will.
  This is a very complex piece of legislation. I doubt that even its 
managers know each and every page of it. But at least it has been out 
for a time when people might have had an opportunity to examine it.
  But the health care bill is being drafted behind closed doors. And it 
is going to be this size, and we are going to be asked to make 
judgments on behalf of the American people in a collapsed period of 
time, when Senators are anxious to go out and campaign, especially on 
that side, because of the trouble that is abroad in the land.
  This is just not a very easy moment in time for us to understand why 
we are going to this when the health care bill continues to be promised 
and never shows up.
  I yield the floor.
  Mrs. KASSEBAUM. Mr. President, I would like to answer the Senator 
from Wyoming for a moment, if I may. It is daunting to look at this 
bill. But let me just say almost half of it is the proposed 
administration bill which has been crossed out. And of course, this is 
now the committee substitute. So it is not quite as long as it might 
look, and you would need to go to page 452 before we start with the 
legislation under consideration.
  Mr. WALLOP. The Senator makes my point; that I mean this is even 
shorter than the health care bill. We have 400 pages of it which are 
not relevant to us. But that still leaves 900 pages that are. I am 
saying that it has at least been around for 7 weeks, according to the 
majority leader. We would have at least less of an excuse for being 
daunted by it than we will by being daunted by a health care bill which 
is going to flop on our desks on Monday morning or Friday night, or 
some other day, and we will be asked to consider it. And it will have, 
I believe, far, far more effect on the lives of ordinary Americans, 
middle class and others, should that take place.
  Mrs. KASSEBAUM addressed the Chair.
  The PRESIDING OFFICER. The Senator from Kansas.
  Mrs. KASSEBAUM. Mr. President, all I would say to the Senator from 
Wyoming, and to others who are listening, is that the committee spent a 
lot of time looking at the reauthorization of the Elementary and 
Secondary Education Act, which has been in effect for some 30 years. I 
do not want to compare it to health care. That is not what I am engaged 
in at this moment.
  Mr. WALLOP. May I say I am not comparing it to health care. I am 
comparing it to the process by which we are about to proceed. I am not 
standing in the way. I am perfectly willing to let us go to a vote.
  But I will say, in answer to the Senator from Alaska, that one of the 
reasons these kinds of procedures are necessary is, frankly, because we 
were denied the opportunity to speak in normal routine morning business 
this morning, when that had been the view that some of us had before we 
went to bed last night.
  The PRESIDING OFFICER. Is there further debate?
  Mr. HELMS addressed the Chair.
  The PRESIDING OFFICER. The Senator from North Carolina.
  Mr. HELMS. I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Mr. HELMS. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. HELMS addressed the Chair.
  The PRESIDING OFFICER. The Senator from North Carolina.
  Mr. HELMS. Mr. President, I am going to make some remarks that I 
would have made this morning had there been a period for morning 
business. But I left here I believe when the distinguished manager of 
the preceding bill left. He and I were under the impression that there 
would be an opportunity to speak this morning. Then, when I checked the 
situation with respect to today's schedule, I found that there would be 
no time for morning business.
  (Mr. ROBB assumed the chair.)
  The majority leader is doing exactly what he said he would do for the 
record at the close of business yesterday. I am not concerned about 
that. But there were several of us who wished to talk about the health 
care matter. I had not proposed yesterday to speak long this morning, 
and I shall not. But I did want to make the point that in the debate 
thus far on health care reform, one solution has been given extremely 
short shrift. This is a solution that many businesses have already 
successfully used to keep their health care costs down and their 
employee satisfaction up. Of course, I am referring to giving 
individuals an incentive to spend health care dollars wisely. How is 
this being accomplished in many places across this country today? How 
do you accomplish it? You turn part of the savings over to the 
employees.
  I know personally of several private companies that have used cash 
incentives and medical savings accounts to cut their health care costs 
while keeping employees satisfied with their health care.
  One company that successfully has used this kind of incentive-based 
program cut its health care costs significantly. In 1992, Forbes 
magazine was spending $2.3 million a year for health care insurance 
from CIGNA. This averaged about $5,000 per employee. In an attempt to 
make employees more cost conscious, Malcolm Forbes, Jr.--better known 
to those of us who are his friends and claim him as our friend as Steve 
Forbes--decided to give his employees a bonus for not filing major 
medical and dental claims.
  Steve Forbes brought the choice to his employees. If, during the year 
an employee kept to a minimum the number of claims filed with the 
insurance company, Forbes would pay the employee a bonus of up to 
$1,200. Employees enthusiastically embraced this plan, and what do you 
know--insurance claims dropped dramatically. This year, while the 
premiums for other CIGNA clients rose between 21 and 25 percent Forbes' 
major medical premiums fell 17.6 percent.
  Back in April, I invited Steve Forbes to come to Charlotte, North 
Carolina and meet with about 400 businessmen at a luncheon. I asked him 
to discuss, among other things, that health care plan operated by his 
company. And I know of 350 or 400 businessmen who are solidly sold on 
this plan because they now know that the lesson learned from the Forbes 
example is that people can control their health spending if they get to 
keep the savings. It is pretty good discipline on the insurance 
companies as well. Of course, those who are really sick filed the 
necessary claims, and they received less of a bonus. Those who decide 
to pay out of pocket for routine health expenses rather than file 
claims--and that is a lot of paperwork--these people get the bonus at 
the end of the year that I referred to earlier.
  So one of the things that ought to be injected into this discussion 
about health care--instead of running all over the country in buses--is 
consideration to this kind of common sense solution. All I have heard 
is a series of invectives accusing those of us asking questions as 
being ``better off'' in health care. Well, I will say to Mrs. Clinton 
that we have the same health care that she and the President have. I do 
not believe she would turn any of hers down, and I have not heard of 
the President turning any of his down.
  But in the case of a Forbes company employee who regularly needs four 
different prescriptions filled, this has happened. As a result of 
Forbes' bonus program, this employee now has a reason to shop around 
for the best price for prescriptions. Before, he did not care. He did 
not give a hoot about how much a prescription cost because insurance 
paid for it. We all know that when insurance pays for every nickel and 
dime claim, we all pay in the form of higher insurance premiums--and 
lower wages, by the way.
  Forbes is not the only company to benefit from an incentive-based 
program. Dominion Resources, which is a public utility very much in the 
news these days, is a public utility holding company in Richmond, VA. 
That company has also developed an innovative method of reducing its 
health care expenses. This method is called a medical savings account.
  Here is how this MSA works: The employer--in this case Dominion 
Resources--buys its employees a health insurance policy with a high 
deductible.
  This kind of policy has two beneficial aspects:
  One is that it protects the insured against catastrophic health care 
expenses.
  Second, it has cheaper insurance premiums because of the higher 
deductible.
  The employer sets up a special account for each employee to pay for 
routine medical bills that the employee will now handle on his or her 
own. What the employee does not spend in this account, he or she gets 
to keep. This incentive encouraged 75 percent--three out of every 
four--of Dominion's employees to enroll in that high-deductible plan.
  Guess what? Since 1990, Dominion's health care costs have risen less 
than 1 percent per year.
  So, Mr. President, a lot of us are weary of hearing that the American 
people are not smart enough to spend their own money.
  These two examples out of many prove that the employees are smart 
when given an opportunity, when given a choice.
  It is tiresome to continue to hear this old ``Government knows best'' 
routine: We have to do this. We have to mandate that. We have to demand 
this. The President says that Government can make better health care 
decisions than the American people can, and I do not believe that.
  Americans do not need a Government commission to make health care 
choices for them. Individuals should be free to make their own health 
care decisions, and any legislation that is passed by this Senate jolly 
well better give the beneficiaries a choice instead of saying, ``You 
are mandated to do `x,' `y,' or `z'.''
  If we ensure freedom of choice, Americans can determine what is best 
for their families.
  Now, the Forbes case and the Dominion Resources case, as I say, are 
only two examples of private industry taking the bull by the horns and 
coming up with health care solutions that work. These incentive-based 
solutions work for the company and they work for the employees. Gerald 
Musgrave, an economist, had this comment.
   He said:

       We have thousands of years of experience with how people 
     handle their own money.

  Why not let Americans continue to handle their own health care 
dollars and help them realize their role in cost savings. Time and time 
again, Americans have shown that they do make cost-conscious health 
care decisions when given a financial incentive to do so.
  Mr. President, I ask unanimous consent that a recent Reader's Digest 
article further detailing both the Forbes and the Dominion Resources 
solutions to the high cost of health care be printed in the Record.
  There being no objection, the article was ordered to be printed in 
the Record, as follows:

                  Here's Health-Care Reform That Works

                         (By Rachel Wildavsky)

       Each year the typical American business spends a whopping 
     12 percent more than it spent the year before to buy health 
     insurance for its employees. No wonder employees--even those 
     who are now well covered--are nervous. Will I still be 
     covered in ten years? What happens if I lose my job?
       One result is ``job-lock''--employees who are not able to 
     quit because they fear becoming uninsured. Meanwhile, U.S. 
     businesses struggle under the insurance load, severely 
     handicapped in increasingly competitive world markets. 
     Employees are paid less, laid off or not hired in the first 
     place. The result? A loss of both jobs and opportunity for 
     millions.
       To many, rising health-care costs seem like an unstoppable 
     upward spiral. Provoked by these fears, the Clinton 
     Administration is drafting legislation to control costs 
     through radical changes in the system, despite evidence that 
     our health care remains the best and most versatile in the 
     world.
       Is such drastic change really necessary? Without any 
     changes in the law, some companies have stepped off the 
     health-care escalator, with no loss to their employees and 
     even with some employee gain. Before we let the government 
     take control of our health-care spending, we need to 
     understand the solid, easy concept that worked for these 
     businesses. If more broadly applied, the idea they used on a 
     small scale could help rescue American health care from 
     possibly dangerous ``reforms.'' In the process, it could save 
     big money and help expand health coverage to those now 
     without coverage.
       Cash Incentives.--At Forbes magazine, as at most 
     businesses, major-medical insurance premiums are based in 
     part on company claims submitted the year before. By the mid-
     1980s, a ``good'' year meant premiums rose only ten percent. 
     In 1990, a bad year, they were up 30 percent. By January 1992 
     Forbes was paying $2.3 million a year for health insurance--
     almost $5000 per employee. Even though employees chipped in 
     through payroll deductions, Malcolm S. Forbes, Jr., president 
     and editor-in-chief of the family-owned business magazine, 
     realized the situation couldn't continue.
       Forbes knew he had to persuade employees to be more cost-
     conscious. The problem was that they had no incentive to do 
     so. Like most Americans, their health care was paid for on a 
     ``use it or lose it'' basis. There was no reason for an 
     employee to make the effort to spend health-care dollars more 
     carefully. So, Forbes figured, why not give employees a bonus 
     for not filing major-medical and dental claims? Such a plan 
     would hurt no one--health insurance would still be there. 
     Sick employees could still use it, and he knew they should 
     and would. The only penalty would be not getting the bonus.
       In December 1991 Forbes offered its employees a deal: if, 
     during the year, an employee filed major-medical and dental 
     claims totaling less than $500, Forbes would pay that person 
     double the difference between $500 and what the individual 
     filed. Suppose an employee and his family had $900 in medical 
     expenses. If the employee filed them, the most the insurer 
     could reimburse him would be $900 minus his deductible and 
     co-payments (the portion of the bill the employee is 
     responsible for beyond the deductible). He would be our a few 
     hundred dollars, and since his claims were over $500, Forbes 
     would pay him nothing.
       However, if he filed no claims for those expenses, Forbes 
     would give him $1000. (Five hundred dollars minus zero, for 
     no claims, comes to $500; doubled, that $1000). This would 
     put the employee $100 ahead even after he paid his bills. To 
     hammer the incentive home, Forbes would pay whatever taxes 
     the employee owed on the bonus.
       In other ways, employee's costs rose. Deductibles, for 
     instance, came up from a maximum of $300 to one percent of 
     the employee's gross salary. Employees' contributions to 
     their premiums also rose slightly.
       Still, the staff at Forbes enthusiastically embraced the 
     plan, and claims plummeted. In 1991 the company's insurer, 
     CIGNA, reimbursed Forbes employees $1,427,895 for medical and 
     dental expenses. In 1992 it paid them just $1,041,907--a 
     reduction of $385,988 from the year before, or 23 percent 
     less per person covered. In addition, CIGNA estimates that 
     for each claims dollar, it spends eight cents on 
     ``administrative services.'' That means the insurer also 
     saved about $30,000 on 1992 paper work because Forbes 
     employees sent in fewer claims.
       Because CIGNA saved, Forbes saved. Last year the plan cost 
     the company about $125,000 in bonuses. But that was more than 
     made up for by a $200,000 rebate that CIGNA paid to the 
     magazine at the end of the year for saving it so much money. 
     And this year, while premiums for other CIGNA clients rose 
     between 21 and 25 percent, the magazine's major-medical 
     premiums fell 17.6 percent, and its dental premiums dropped 
     29.7 percent.
       Finally, because Forbes saved, its employees saved. For 
     1993 the magazine expanded its bonus program. Instead of 
     paying employees double the difference between $500 and the 
     claims they submit, Forbes will double the difference from 
     $600. This means the maximum bonus that employees can earn 
     will rise from $1,000 to $1,200.
       The success of the Forbes idea provides two important 
     lessons:
       1. People can control their own health spending if they get 
     to keep the savings. Susan Kern, an assistant in the 
     magazine's advertising department, regulated her health-care 
     spending last year, paying when she thought she could and 
     using insurance when she knew she couldn't.
       Hoping for the full $1,000 bonus, she started last year by 
     paying her own bills for a bout of bronchitis. In October, 
     though, she was hit with big medical expenses from a car 
     accident and used her insurance. While she received no bonus 
     this year, she hopes to earn one in the future.
       Executive vice president Leon Yablon regularly fills four 
     different prescriptions for himself and his wife. Now he has 
     a reason to check prices. ``Just last week, I filled 
     something for $29 that cost $45 at another pharmacy,'' he 
     says. ``Before, who cared?''
       2. Generous health insurance is not free. Without gold-
     plated policies, employers could pay workers more. Secretary 
     Donna Hampton has filed ``maybe one health-insurance claim'' 
     in her seven years with Forbes. Yet in that time, the company 
     has spent thousands per year to insure her. She would have 
     preferred the money--and with the bonus program, Hampton 
     received a $1,000 check last year.
       ``You tend not to think of the real dollar cost of 
     benefits,'' admits senior editor Bill Flanagan, another 
     recipient of a $1,000 bonus. ``But the more expensive health 
     insurance is for the company, the more expensive it is for 
     everybody.''
       Sharing the Wealth.--Other companies, too, are cutting 
     costs with the same concept: employees keep what they save on 
     health care.
       In 1991 Dominion Resources, a public-utility holding 
     company in Richmond, Va., announced that if its 1992 health-
     care expenses came in under budget, it would share the 
     surplus with employees who helped hold costs down. At year's 
     end, expenses were 31 percent under budget. Each employee 
     whose medical claims were below his deductible got a check 
     for $794.
       Another innovation helps keep Dominion's health-care 
     expenses low: incentives to employees to choose high 
     deductibles. Individuals with high deductibles handle 
     routine expenses on their own. For that reason, high-
     deductible policies are cheap to buy. But because 
     companies subsidize premiums, employees naturally prefer 
     low-deductible policies.
       Dominion solves this problem by offering three health plans 
     with deductibles ranging from $200 to $1500 for an individual 
     and $600 to $3000 for a family. Dominion contributes the same 
     amount toward each employee's premium, no matter which plan 
     he selects. Employees who choose more expensive low- and 
     middle-deductible plans must pay more to make up the 
     difference.
       Dominion offers a special feature to help employees see 
     that the money they save with high deductibles is their own. 
     Says vice president Ken Davis, ``We'll take what they save on 
     premiums and automatically deposit it in a savings account.'' 
     These incentives have helped encourage 75 percent of 
     Dominion's employees to enroll in the high-deductible plan. 
     And Dominion's health-care costs have risen less than one 
     percent per year since 1990.
       The Pittston Company of Stamford, Conn., goes even further 
     to ease the bite of high deductibles: it sweetens the pot. 
     Twice a year each employee gets a $500 check to help cover 
     the costs of medical bills. Whatever part of that check the 
     employee doesn't spend on health care, he pays taxes on and 
     keeps. If an employee's semi-annual expenses exceed $500, the 
     company's health insurance will pay the rest.
       President Gerald R. Spindler says it is too soon for the 
     self-insured company to know for sure that costs are down, 
     but the early results are ``encouraging.'' Employee-relations 
     director Ed Cox knows why. ``Before, people had no incentive 
     not to go to the doctor,'' he says. ``Now, if they don't, 
     they keep the money.''
       For four years Knox Semiconductor, Inc., of Rockport, 
     Maine, has had an insurance plan called ``Health Wealth,'' 
     which is marketed by Progress Sharing Co., an insurance 
     broker in Saco, Maine. Under the plan, Knox raised employees' 
     deductibles and co-payments, lowering its premium costs. It 
     then put the money saved into a mutual-fund account for each 
     employee. Employees--who make matching contributions--can use 
     the money in their accounts to pay for their deductibles and 
     co-payments. If they don't, they can pay taxes on the money 
     and keep it. Knox has had just one rate increase of six 
     percent in the past four years. The 32-employee firm has 
     saved over $100,000.
       Tax Relief.--Each of these employers saves money by letting 
     employees keep some of the health dollars they save. But, 
     limited by current law, employers will offer only enough cash 
     to affect relatively small medical expenses. Some lawmakers 
     hope to change U.S. tax law to make the concept go further. 
     The idea is called a medical IRA or a ``medical savings 
     account'' (MSA). Legislators have drafted a variety of MSA 
     bills. Here's how most would work:
       An employer would buy its employees a health-insurance 
     policy with a high deductible. The company would also set up 
     an account for each employee to pay for the medical bills 
     that he would now handle on his own. If the deductible was 
     $3000, the employer might put $3000 into each employee's 
     account every year. Advocates of MSAs say in most areas, 
     high-deductible policies are so cheap that employers could 
     easily fund employee accounts out of their premium savings, 
     sometimes even with money to spare.
       The money in each employee's account would belong to the 
     employee. If the person was healthy and didn't need to spend 
     it, he could keep it. Each year the employer would add more. 
     And because only about ten percent of American families spend 
     more than $3000 on health care each year, most accounts would 
     grow.
       So far, it sounds like what Pittston and Knox Semiconductor 
     have done. The crucial difference? MSAs would grow tax-free 
     from year to year, as long as they withdrew money only for 
     medical expenses. If an MSA-owner moved to another job, he 
     could take the account to this next position. If he lacked 
     insurance between jobs, he could draw on the account to pay 
     medical bills or to buy insurance.
       For catastrophic medical problems, patients will always 
     need insurance or Medicare. But MSA advocates say without 
     taxes and with their incentives to save, the accounts could 
     accumulate substantial cash. That would let patients use 
     cheap, catastrophe-only policies and pay most medical bills 
     the most efficient way: by themselves.
       When finally retired, the former employee could use the 
     money left in that account to supplement Medicare coverage, 
     either by buying more insurance or by paying medical bills 
     out-of-pocket. If he chose not to spend the money on health 
     care, he could use it--after finally paying taxes--for 
     whatever he wanted.
       The idea behind MSAs is the same as that behind the health 
     insurance plans at Forbes, Dominion Resources and other 
     companies: when possible, let employees keep the money they 
     choose not to spend on health care. ``If that were permitted, 
     people would spend more rationally,'' says economist Gerald 
     Musgrave of Economics America, a consulting firm based in Ann 
     Arbor, Mich. ``We have thousands of years of experience with 
     how people handle their own money.''
       Yet President Clinton's health-care plan probably won't 
     offer patients this choice or many others. The Clinton plan, 
     reported to cost at least $100 billion, would require all 
     Americans to have the same coverage whether they wanted to 
     pay for it or not.
       Some Americans already have the opportunity to make 
     rational health-care choices. If more had that chance, many 
     weaknesses of our current system would be improved without 
     risking what we cherish: high quality, choice and individual 
     control. The idea of a free marketplace in health care has 
     not failed; it has not fully been tried.

  Mr. HELMS. Mr. President, that concludes my remarks.
  I thank the Chair.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The absence of a quorum has been suggested, 
and the clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Mr. MITCHELL. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  Mr. HELMS. Mr. President, I object for the time being.
  The PRESIDING OFFICER. Objection is heard.
  The clerk will continue to call the roll.
  The bill clerk continued the call of the roll.
  Mr. MITCHELL. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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