[Congressional Record Volume 140, Number 101 (Thursday, July 28, 1994)]
[House]
[Page H]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: July 28, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
                UNIVERSAL ACCESS AND UNIVERSAL COVERAGE

  The SPEAKER pro tempore (Mr. Engel). Under the Speaker's announced 
policy of February 11, 1994, and June 10, 1994, the gentlewoman from 
Oregon [Ms. Furse] is recognized for 60 minutes as the designee of the 
majority leader.
  Ms. FURSE. Mr. Speaker, I took out this special order tonight to 
return to the health care debate and to return it back to the American 
people. There really is only one special interest in this debate, and 
that should be the health of Americans. But unfortunately, a lot of 
other special interests have gotten involved.
  Special interests are spending millions of dollars to try to move the 
debate away from what I believe is the fundamental question, and that 
is what health care system can we design that meets the needs of the 
American people? Not what special interests can we keep in play, but 
how can we develop a health care system that actually meets our needs?
  Lately, seemingly everyone has a financial stake, in the billions, 
and their money is being used to sway the debate. Here in Congress, as 
we work on health care reform, our eyes must be on the needs of 
families and children. Unless we keep our eyes on this goal, we will 
lose an opportunity to establish for all Americans what they need, and 
that is a system that works, that makes sense, one that provides 
universal coverage so we end cost-shifting.
  I would like to say that universal access, which my colleagues spoke 
about, everyone, I believe, has access to every BMW dealer in the 
country but they do not have the opportunity to have the money to buy 
the car that they have access to.
  What we need is a health care system that says you have access and 
you have the opportunity to use it.
  So, universal coverage is very different from universal access.
  What I would like to do in this special order with other colleagues 
of mine is let everyone in this House know and let everyone in the 
country know that we really are willing and ready and able to vote for 
real health care reform.
  Now, I thought about how could we say what is real health care 
reform? We have heard so many 30-second spots, heard people taking out, 
hiring actors to tell us what is or is not health care reform.
  So I thought, instead of looking at those emotional 30-second sound 
bites, I would look at some statistics because I am a believer that in 
fact statistics can give us a good idea.
  So I thought it might be useful to look at statistics of other 
nations on health care and really what I want to say on health is there 
are certain statistics that everyone agrees show the health picture of 
a country. One of them is infant mortality and the other is longevity 
of women and men in a culture, in a country.
  I thought I would look and compare with our northern neighbor because 
that country, Canada, is very similar to us in a lot of our history and 
our geography--except that Canada has universal coverage and we do not.
  So I thought I would look at how much do we spend per capita and how 
much does Canada spend per capita on health care?
  In the United States we spend $2,867 per capita. Canada spends 
$1,915. So quite a lot less that Canada spends.
  Now, you would imagine that if you spent less, you were going to get 
worse health statistics. In fact, that is not what I found. What I 
found was that in Canada the life expectancy of men is 74 years and in 
the United States it is 71 years.
  So you live longer in Canada than you do here.
  Women is even more so: 80 years in Canada and 78.9 years in the 
United States, that women live.

                              {time}  1950

  So then I thought, well, I would look at the statistics around infant 
mortality because one of the things we know is that, if our children 
survive their first year, that is a sign that our health care is good, 
we have given good infant care, we have given prenatal care. So, I 
looked at, remembering that we spent much more in this country per 
capita, I looked at this comparison. In Canada the infant mortality 
rate is 6.28. That is 6.28 per 1,000 live births. In the United States 
it is 9.22. Far worse, 9.22 children in the United States die in that 
first year per 1,000 births compared to 6.28 in Canada.
  What was the difference? The difference was that Canadians have 
universal access to health care. So, certainly I believe that, if we 
were spending as much as we are now, we should have better statistics, 
and I think that that is part of the facts, rather than the special 
interests, that I would like to have us talk about tonight.
  I would like to yield time to my colleague, the gentlewoman from 
California [Ms. Woolsey] to talk about some of the issues that she has 
investigated and found out about this health care versus special 
interests.
  Ms. WOOLSEY. Mr. Speaker, I am glad to have the opportunity to speak 
about my special interests, and my special interest is the people of 
the Sixth District of California, Marin and Sonoma Counties. These are 
the people that hired me to come to Washington to work for them, and 
these are the people that I know want health care reform and want a 
health care reform plan in this Nation.
  Mr. Speaker, health care reform is of the utmost importance to the 
people I represent in Marin and Sonoma Counties. So, Mr. Speaker, I 
have been holding town meetings on health care all across my district, 
and hundreds of people have attended. I have also received thousands of 
letters and phone calls about health care reform from the people who 
are my special interests, the people I work for in the Sixth 
Congressional District.
  The residents of Sonoma and Marin have made it clear to me that they 
want guaranteed health care that can never be taken away. They want a 
health care reform plan that covers all Americans, regardless of 
employment, income, or marital status. They want a comprehensive 
benefit package, including a full range of reproductive benefits. 
Another thing that is very important to people in Sonoma and Marin 
Counties is the right to choose their health care providers, including 
alternative providers. Finally, they know that any health care reform 
plan must be affordable, and must be accountable to the public.
  Of all of the health care reform proposals currently under 
consideration, only one accomplishes all of these goals. And that is 
H.R. 1200, the American Health Security Act--the single-payer plan. I 
am a cosponsor with my colleague, the gentlewoman from Oregon [Ms. 
Furse] of the single payer plan because it will give the people in 
Marin and Sonoma everything they want in health care systems, and it 
saves money as well. The Congressional Budget Office has determined 
that a national single payer plan would reduce spending on health care 
by $114 billion annually by the year 2004. Mr. Speaker, no other 
proposal compares.
  I am proud that more than 1 million Californians have signed a 
petition to put single payer as an initiative on the ballot in 
California in November. If Congress does not pass a national single 
payer health plan this year, it is crucial that the final plan that 
Congress approves gives States the option to establish a single payer 
system. That way voters, such as my constituents in California, can 
vote to have a single payer plan in their State.
  Mr. Speaker, to ensure that the single payer plan can be successful, 
if it is voted in at a State level, the final health care plan must 
protect States that choose a single-payer system by forbidding 
businesses, regardless of their size or State boundaries, to opt out of 
the single-payer plan. Many American companies currently have locations 
in Canada, and are successfully providing their Canadian employees with 
health insurance under a single-payer system. American multistate 
employers must do the same within the United States.
  Mr. Speaker, the people of Sonoma and Marin want me to fight for the 
best possible health care system. Their hopes are high, and I do not 
want to disappoint them. I will continue to fight for health care 
reform that provides coverage to all Americans that can never be taken 
away while at the same time ensuring that States can choose to opt into 
a single-payer system without penalty.
  Ms. FURSE. Mr. Speaker, I began by talking about statistics, and 
statistics are useful, they are necessary for us, but they are dry, and 
what I think is important about our discussion on health care reform is 
that every single one of us knows somebody who has a problem in this 
health care system. That is the reason why my constituents all are 
decided that we do need change, we do need a new health care system.

  I would like to talk about a personal story. Many, many people in 
America are familiar with the issue of diabetes. Diabetes is a very 
serious health problem in our country. It affects 14 million people. 
One of those 14 million is my own very beloved daughter.
  Now anyone who has diabetes or knows someone who has diabetes is 
aware that it is very difficult to get an insurance company who will 
cover them. The problem is that they say, well, diabetes is a 
preexisting condition. Well, that is true, it is a preexisting 
condition. It is something that a person with diabetes cannot change. 
One cannot change it like they change the color of their hair, and, 
like my beloved daughter, they have to take good care of themselves, 
and she does. She takes tremendous care of herself, and what that means 
is she prevents much more serious disease, but if she cannot get health 
insurance, and there are many millions of diabetics who cannot, she 
cannot have that kind of health care that is ongoing, that prevents 
serious, serious injury.
  Now there is another person I would like to talk about. She is a 
constituent of mine. She is a new mother, and she has this beautiful 8-
month-old baby, and her husband is starting a new restaurant in Oregon, 
and he is working 15 hours a day. My colleagues know what it is like to 
start a new business, and they have very increasing costs at home, and 
so my constituent has decided that she has only one choice, and that is 
she has taken health care coverage, catastrophic health care coverage, 
for her baby and her baby alone. Neither she nor her husband can afford 
health care insurance. They have taken it on this precious child of 
theirs.
  Mr. Speaker, when my colleagues think about that child's health, they 
know that that child needs healthy parents to take care of that child 
if he should need them. Now, nobody, nobody, should be forced to choose 
between their child's health and their own. As parents, Mr. Speaker, we 
always choose our children first; of course we do. But what a terrible 
choice that is, and, as my colleagues know, it is a terrible choice 
economically.
  I hear people say, ``We can't afford health care coverage.'' Well, I 
would say to the gentleman who says we cannot afford it that we cannot 
afford not to have it, because when we provide universal coverage, it 
means that we do not have this terrible cost shifting, we do not have 
people going to emergency rooms for health care.
  We pay for it. Those of us who are fortunate enough to have 
insurance, we are paying doubly because we are paying very high costs. 
But we are also paying for very bad health care.
  Now I looked at the district that I represent, that I am so proud to 
represent. There are 11,000 uninsured children in my district.

                              {time}  2000

  Well, the State of Oregon decided to do something about that, and I 
am very proud of that. The State of Oregon, one of the very few States 
that decided to completely change and revise its health care system. We 
went on this unique journey, Mr. Speaker. We crafted a plan. What we 
did was have meetings with thousands of Oregonians who talked about 
their needs. We involved physicians, licensed providers, 
administrators, consumers, everybody. And, you know, that work has paid 
off. Last year, Secretary Shalala granted Oregon a waiver to move ahead 
with the Oregon plan. It is an inclusive plan, it is a plan that the 
people support, and it is proactive. And when Donna Shalala came to 
Oregon this year, she said Oregonians are the most health literate in 
the world, because she said we have dealt with this issue. We have put 
together a health care plan that cannot be taken away.
  So I believe, Mr. Speaker, that I have something to say about this 
issue. I believe that we can do it, we can provide that universal 
coverage, we can provide it, and we can tell the special interests that 
there is only one interest, and that is the American people.
  I want to say one thing about my Republican colleagues: That never, 
in the 2 years I have been here, have they produced a health care plan 
that has universal coverage. Even though the people have said that is 
what they want, not one House Republican, has authored, sponsored, or 
cosponsored a plan with universal coverage. It baffles me that they 
would do nothing to provide guaranteed health coverage for all 
Americans. It is the thing America looks for, it is the thing that the 
rest of the world in most industrial nations have, universal coverage. 
As my colleague` said, the fact that it can never be taken away from 
you, that it is comprehensive, and that you do not fear losing a job 
and losing your health insurance.
  I think in the next 2 weeks, Mr. Speaker, we will see the dialog. The 
dialog will be of Americans, not of special interests. We will have a 
health care plan that meets our needs.
  Mr. STARK. Mr. Speaker, the latest interest group to use their 
billion dollar budgets to defeat health reform is the American Hospital 
Association.
  With their ads--and their direct attempts at frightening senior 
citizens--the AHA is willing to risk defeating the President's goals of 
universal coverage and health care cost containment in the hope of 
filling their bedpans with billions more.
  The American Hospital Association's ads distort the Ways and Means 
health reform plan and are intended only to scare the American people. 
Despite all their claims, the truth is, if health reform is enacted, 
all Americans--including seniors, including hospitals, including 
workers--will be better off.
  The target of the AHA has been the Medicare program, and our attempts 
to bring costs under control.


          Reducing the Growth in Medicare is Not Unreasonable

  Without reform, Medicare spending is projected to grow from $206 
billion in 1996 to $307 billion by the Year 2000--a 10.5-percent 
average annual increase compared with 3-percent growth in general 
inflation. Even after adopting the Medicare growth reductions included 
in the Ways and Means bill, Medicare would increase during this same 
period from $202 billion to $271 billion--still a 7.6-percent increase 
each year. Further, AHA's claim that these reductions would leave 
Medicare paying only two-thirds the cost of treating Medicare patients 
assumes that hospitals do nothing to control their costs.


 Hospitals are Ignoring Revenue Gains Under The Bill That Would Offset 
                       Medicare Growth Reductions

  Hospitals will see significant new revenues under the Ways and Means 
bill. Hospitals loses from providing free care to the uninsured--about 
$14 billion a year--would be nearly eliminated, and $2.5 billion a year 
in new revenue would be provided to academic health centers. Another $1 
billion a year in capital financing assistance would be provided to 
hospitals in need of renovation. Combined--under the Ways and Means 
bill, these changes mean $12.5 billion more in revenue for hospitals.


  hospitals can absorb slower rates of growth without harming patient 
                                  care

  Despite the fact that almost 40 percent of hospital beds are empty, 
profit margins in the industry are at higher levels now than they have 
been over much of the last two decades. According to the AHA's own 
data, hospital profit margins were 5.5 percent in 1993, compared to 
less than 4 percent in the early 1980's, and less than 3 percent in the 
1970's. With these kinds of profits, hospitals can, and should slow 
their cost increases--without harming patients in any way.


        the medicare program will be strengthened under the bill

  In addition to ensuring the long-term viability of the program and 
reducing the need for future premium increases, the Ways and Means bill 
will improve the benefits available to every Medicare beneficiary. A 
new prescription drug benefit, improved coverage of mammography 
screenings, a cap on beneficiary out-of-pocket costs, and enhanced 
assistance to low-income beneficiaries will all be added.
  It is important that our debate and decisions be based on accurate 
information, and a good understanding of the reform plans before us. 
Ads like the AHA's only skew the facts and further complicate an 
already complicated process.


             hospitlas have been successful at this before

  Finally, sometimes it is helpful to have been around here awhile. The 
last time we took up the issue of health reform, it is useful to 
remember that the AHA was instrumental in its defeat.
  They had a different tactic at that time, but they were working for 
the same result.
  In 1979, the AHA, by saying that they could do it themselves, was 
successful in defeating legislation that would have guaranteed to the 
American public that health care costs would be brought under control.
  Today, in 1994, we in Congress are just proposing to do what the 
hospitals themselves offered to do in 1979--namely, slow the rate of 
growth in hospitals costs to a more reasonable level. It was Paul W. 
Earle, Executive Director of the AHA-sponsored ``Voluntary Cost 
Containment Effort'' who testified before a Congressional committee and 
made that promise to all of America.
  Achieving health reform in 1994 requires that we in Congress discard 
the double talk and put a plan that works before the American people.

                          ____________________