[Congressional Record Volume 140, Number 101 (Thursday, July 28, 1994)]
[Senate]
[Page S]
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]

 
                THE GRINCH THAT STOLE HEALTH CARE REFORM

  Mr. KERREY. Mr. President, I have a title for this particular speech. 
It is entitled ``The Grinch That Stole Health Care Reform.'' I want to 
make it clear I do not have the Republican leader in mind this morning, 
unless of course he has filibuster in mind. I have in mind, instead, 
some rather difficult economic and political facts about health care 
and health care reform.
  The difficult economic fact is that we spend too much on health care 
not too little. And the more we spend the more difficult it becomes for 
lower income Americans to afford health care services. The difficult 
political fact is that our most significant Federal post World War II 
actions have had the unintended effect of adding to health care 
inflation. Thus, a great double barrelled paradox: Our demand for more 
and more expensive care and our effort to extend coverage have 
contributed to the numbers of Americans for whom being uninsured is a 
dangerous way of life.
  The Republican leader may still come grinch-like to this floor to 
delay action. However, he is not the chief villian here. The grinch I 
have in mind is all of us. Our collective appetite for health care 
services and our collective will to do good.
  Let me be clear. I want every American to know with certainty that 
they will get continuous, high quality health care as a birth right. 
There should be no doubt and no requirement of groveling to prove some 
special status other than being an American under color of law.
  There are tens of millions of Americans who are involuntarily 
uninsured and tens of millions more who wonder if they will be next. 
They ration the care they receive because they cannot afford to pay the 
bills. They deny themselves and their children good health. They do not 
enjoy the tremendous benefits of access to continuous health care. 
There is, as a consequence, a moral urgency to end this American fact 
of life.
  However, let me also be clear: Our capacity to afford high-quality 
care is directly proportional to our productivity. Saying that you have 
a right to care does not guarantee high quality. That we Americans are 
going to have to earn. If our non-health-care economy does not make 
productivity driven gains, our appetite for quality will not be 
satisfied. No Federal law can guarantee the quality of our care. Only 
our willingness to work and produce can accomplish this task.
  Further, good health is not just an issue of making certain that all 
Americans know they can get good care. While it is painfully obvious 
that accidents result in unavoidable and expensive tragedies which will 
require us to pass the collective hat, it is just as obvious that many 
of our costs are associated with self-inflicted abuse.
  The horror story of an American child born with high medical bills 
should be balanced with the horrible tragedy of a society where women 
afflicted with AIDS or addicted to cocaine bring babies into this 
already difficult world. Rather than encouraging the idea that we are 
all victims of a system which is unfair we should be encouraging the 
idea that we are responsible for correcting our destructive personal 
weaknesses.
  After making it clear that I believe health care should be a right, 
but that high quality care will have to be earned, let me throw one 
more bucket of cold water on our ardor for reform: Americans spend too 
much on health care. That is the problem. We spend too much because we 
spend too little time trying to understand how we could spend less. 
Except for those who have been given hospital, doctor, or pharmacy 
bills they cannot pay, most of us do not worry about how much we are 
spending because someone other than us pays the bills.
  Instead of insisting that we be given information about the price and 
quality of services and products, we have been insisting on getting 
more of the product which shelters us from worrying about such things: 
Insurance. The whole battle cry of the health care debate--universal 
coverage--is a request to be protected from the requirement of having 
to understand and pay the bills.
  Like the boys in the story Pinocchio who were enticed into having a 
good time at the fair, we have grown sick on the sweets and have become 
jackasses in our pursuit of better technology which can make us young 
again. While we have asked for more, more, more, we have simultaneously 
insisted that our Government erect a barrier between ourselves and the 
price of the goods.
  How have we done this? In many ways. The four horsemen of the health 
care cost apocalypse are four Federal laws which were enacted to do 
good things, as they unquestionably do. However, in addition to helping 
they each drive additional demand into the system and reduced personal 
accountability to cost.
  The four are tax treatment of employer provided health benefits, 
Medicaid, Medicare, and the dishonest budget methods used by the 
Federal Government. By treating health benefits as a fringe we 
encourage individuals to buy expensive plans which look less costly 
after taxes are paid. By collecting taxes and paying the bills for poor 
Americans on Medicaid and elderly Americans on Medicare we reduce 
misery, but we redistribute $280 billion into health care spending. 
Worse, because we allow the Federal Government to budget without 
balancing health spending with dedicated health revenues, citizens 
neither know what they are spending nor who is paying the bills.
  I do not believe there is a villain whose activities are singularly 
responsible for our rising health care costs. There is no doubt that 
greed causes us to spend more than we should. There is no doubt that 
money has corrupted the decisions that are made by some providers, some 
institutions, some lawyers, some businesses, some politicians, and some 
patients. However, I believe the principal problem is that we have been 
simultaneously asking for things that are in conflict with one another, 
and that the central argument of this debate will be whether or not we 
are going at last to trust that market forces can in fact produce 
sufficiency in health care, that market forces can in fact accomplish 
good things. That will be the central question that we need to answer.
  Unless you are honestly arguing that the Government should take over 
health care, and some are honestly doing this, then we must in the 
spirit of honest disclosure tell the American people that the most 
important change which must occur if we are going to make this work is 
to change our behavior. We must learn more, work harder, and lower our 
expectations of the perfect medical outcome.
  I sincerely believe if we reform the market correctly it can help 
provide citizens with the information they need to obtain high-quality 
care at a lower price. It will also provide incentives for health 
professionals to deliver care in a more efficient manner.
  By using market forces, we can create an equitable health care system 
which allows us to subsidize those individuals who need help paying the 
bills. To be clear again, I am an advocate of interfering with the 
market to help people who cannot afford to pay the bills. For most 
people in this country, health care is not a frill. It is a life-or-
death necessity.
  My hope is that in this debate, we will come and at the end of the 
day, we will enact legislation that will provide the security Americans 
are asking for, provide that security in an environment where we 
recognize honestly that the market has been doing an unprecedented job 
in the past 3 years and that we ought to use those market forces to do 
even more good in the future.
  I yield the floor.
  Mr. DURENBERGER addressed the Chair.
  The ACTING PRESIDENT pro tempore. The Senator from Minnesota.
  Mr. DURENBERGER. Mr. President, I ask unanimous consent that I may 
proceed for 5 minutes as in morning business.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.

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