[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]

 
                  HEALTH CARE AND NATIONAL UNIFORMITY

  Mr. DURENBERGER. Mr. President, I think we are waiting for a couple 
of our colleagues to come to the floor to speak on other matters. But I 
want to rise to thank my colleague from Nebraska, not only for that 
statement but to tell my colleagues that when he arrived here as a 
former Governor, I did not know what to expect.
  I was very surprised when, as a member of the Pepper Commission, 
Senator Kerrey took me aside--he was not a member--and asked: ``Do you 
suppose I could come to one of your meetings?'' I said, ``I don't know 
why not.'' He actually showed up and began coming to the meetings. 
While he could not participate as an active member, he attended those 
meetings, and he has since reflected not only the commitment that took 
him to those meetings but also a commitment to deal the imperative that 
the American people need some leadership from Washington, and the U.S. 
Senate in particular, to set a vision for the future of health care 
delivery and universal coverage.
  I am so grateful for the last number of months that we have been 
working together in a bipartisan fashion to craft a bill that reflects 
not only that vision and that goal but also a practical bipartisan, 
bicameral way to get there. I am so grateful to him for the leadership 
that he is providing on the other side of the aisle.
  Now that I have made reference to Governors, as I did in my earlier 
comments, another one of our colleagues who is a former Governor, our 
colleague from Florida, Senator Graham, spoke earlier this morning on 
the role of the States in health reform.
  As I indicated earlier, if there is a federalism issue around, this 
has to be it: How do you spend a trillion dollars out of the economy 
every year, and what is the role of Government in doing it?
  Senator Graham and I have spent a lot of time talking about issues of 
community health, public health, the way in which the medicalization of 
health care in this country is depriving Governors, depriving local 
communities, depriving families and people of the opportunities to do 
community-based health care the way we need to do it. However, I must 
say that I have a slightly different view than he has on the most 
appropriate role for State governments in helping all Americans gain 
access to medical services.
  I think there is a critical role within States and in communities to 
enhance public health, community health, environmental health, housing, 
nutrition, immunization--all of the basic health needs. But when it 
comes to access to medical services, people get their medical services 
in local communities; they do not get them in States. Medical markets 
and communities are not confined to State borders. Therefore, we 
desperately need national rules by which these medical markets are 
going to work in the future.
  If you look at where the anticompetitive, anticonsumer laws are in 
medicine today, they are all at the State level. Every one of them is 
at the State level because what has happened at the State level is that 
insurance companies, doctors--all kinds of medical professionals--have 
used State laws to protect their speciality from competition and to 
shield medicine from the consumer.
  Look at State-legislated mandates, for example. Every insurance plan 
sold in the State of Tennessee must include chiropractic or must 
include podiatry. Or, in my State, insurance plans must include 
coverage for hair loss and for facial reconstruction. You name a new 
medical speciality, you name a new service, and somehow or another the 
servers have found a way to enshrine their service and their speciality 
in our State medical practice acts, called licensure, and in our State 
legislation, called insurance.
  And when someone comes along and says, ``We are going to practice 
medicine differently by sharing the risk, by enhancing the quality of 
services, by giving consumers more information and more choices,'' then 
the fee-for-service indemnity system rises up and enacts laws that say 
you cannot do that.
  There is a current phenomenon called ``any willing provider,'' which 
means that an integrated health care system, a clinic, the Scott White 
Clinic in Texas, the Cleveland Clinic in Ohio, or wherever, cannot 
decide which doctors can associate with them and which cannot. ``Any 
willing provider'' says you have to take them all. If some doctor 
applies, you have to take him. This sort of thing has been enshrined in 
State legislation all over the country, and it has given us a $1 
trillion a year system, on the way to being a $2.2 trillion a year 
system.
  So, Mr. President, as we debate what is the solution to the reform 
that is before us, I suggest we take an example of one national law 
that has made it possible for employers and employees working together 
to bring down the costs of health care.
  That law is ERISA. We have the ERISA preemption rule which says that 
State legislation cannot impact employee benefit programs. So what has 
happened in health care is that all of these employers, rather than 
having to buy a $500 or $600 plan filled with all these State benefit 
mandates, filled with all of these contrivances from the medical 
industry, have said, ``We are not going to buy insurance; we are going 
to self-insure. Our company will take responsibility, will bear the 
financial risk of caring for our own employees.'' Then they go out and 
hire benefit administrators, third-party administrators, HMO's--
whatever the case may be--integrated systems, to change the way 
medicine is practiced, to improve the quality of access, to improve the 
services, to improve the prices for their employees.
  That is why we see private sector health spending in the chart I 
referred to earlier, that line decreasing--because we have one national 
rule that protects people who want to have better care for less money 
from burdensome State regulation.
  As we debate health care in the coming weeks, and begin to talk about 
why we need a uniform benefit set at the national level, why we need 
national antitrust rules, why we need national liability rules, that 
sort of thing. Remember, it is because people do not get their medicine 
in States, they get it in local communities and those communities 
overlap--Tennessee and Kentucky; North Dakota and Minnesota; South 
Dakota and Minnesota, and so on. So people buy their health care in 
communities, they do not buy it in States. We need national rules so 
these local markets can provide more and better health services for 
less money for all of our citizens.
  Mr. President, I yield the floor.
  Mr. KOHL addressed the Chair.
  The PRESIDING OFFICER (Mr. Mathews). The Senator from Wisconsin.

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