[Congressional Record Volume 140, Number 105 (Wednesday, August 3, 1994)]
[House]
[Page H]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: August 3, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
                         HEALTH CARE REVISITED

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
February 11, 1994, and June 10, 1994, the gentleman from Colorado [Mr. 
Allard] is recognized for 30 minutes as the designee of the minority 
leader.
  Mr. ALLARD. Mr. Speaker, on Friday, the Democratic leadership 
announced its health care plan. Despite all the rhetoric about this 
plan not being the Clinton plan, the leadership plan is the Clinton 
plan's next of kin.
  Included in this plan is the job-killing employer mandate. Although 
some of my colleagues on the other side of the aisle would like to 
believe otherwise, this mandate will cost jobs. It will probably not 
greatly affect those with high-wage jobs who already have health 
insurance at their place of employment. But many minimum-wage workers 
will likely be laid off as their employers cannot offset the cost of 
health benefits with lower wages.
  Some Democrats might think that the subsidies included in the plan 
will be sufficient to save the low-wage jobs. But they were wrong. 
These subsidies do not absorb the entire cost of insuring those 
workers.
  Businesses cannot afford to be the vehicles for the Federal 
Government's social policies. Whether Washington likes it or not, 
businesses must make a profit in order to continue to exist. And more 
to the point, we must stop penalizing businesses. It is the businesses, 
and not the Government that have given the American people the highest 
standard of living in the world. And it is the businesses, not the 
Government that will continue to provide for the American people--if we 
will let them.
  Mr. Speaker, the small businesses of this Nation are already doing 
their fair share. Let us not make them do more than their fair share by 
imposing upon them these crippling mandates.
  And then there is the one-size-fits-all minimum benefits package. 
This is a diverse Nation which defies being characterized by a single 
medical benefit package. Mr. Speaker, the American people should be 
left with the freedom to design their health care as they see fit. 
Healthy people should be left with the option of selecting only a 
catastrophic insurance package, leaving them free to spend the rest of 
their income as they wish rather than forcing them to subsidize the 
health care of others. Or if, we are going to force them to pay for the 
health care of others, let's at least be honest with them.
  Along that same vein is the community rating concept. This requires 
insurers to charge everyone in a locality the same premiums regardless 
of age or health. Mr. Speaker, this is nothing but a tax on younger, 
healthier people. Many of the people who are in this group are now 
struggling to make ends meet since they lack the experience needed to 
obtain higher waged jobs. Many of the currently uninsured are in this 
group. They have made the rational decision that they are health enough 
that they do not need comprehensive medical insurance. Now, we are, 
proposing to force them to pay premiums for comprehensive insurance 
which they may not need and forcing them to forego future wage 
increases which they do need.
  Mr. Speaker, this is wrong. We should not be telling people how they 
will allocate their hard earned money. They know better than we do what 
their needs are and how best to provide for them. It is amazing to me 
how little attention community rating has received. By dictating that 
premiums must be the same for all individuals we penalize the young, 
and undercut incentives and rewards for remaining healthy.
  And finally, included in the Democrat leadership bill is a proposal 
that can truly be said not to have been in the Clinton health bill--
Medicare Part C. Mr. Speaker, it amazes me that Congress would advocate 
the expansion of an entitlement program which we have proven that we 
are incapable of controlling. When Medicare was created in 1965, the 
Government projected that it would cost between $9 billion and $12 
billion by 1990. It actually cost $107 billion, and now, only 4 years 
later, will cost $144 billion. Do we actually want to expand a program 
that has seen such astronomic growth? This is a recipe for a budgetary 
disaster.
  Mr. Speaker, many in this body have advocated that we move in the 
direction of the Canadian health care system, and indeed, the 
leadership bill does permit states to establish Canadian-style single 
payer systems. Supporters applaud the Canadian system's ability to 
provide comprehensive health benefits to all of its citizens, entitling 
rich and poor alike to anything from nutritional counseling to lung 
transplants. All of this care is delivered to patients with no 
deductibles, no copayments, and no insurance premiums, but instead is 
financed through general tax revenues. This plan appears to be a 
consumer's proverbial free lunch. But a closer look at this system 
reveals that it would be anything but a free lunch for the American 
people.
  Mr. Quesnelle, a Canadian citizen, paid nothing out-of-pocket for his 
triple bypass. And yet, he paid in other ways. Among other delays, Mr. 
Quesnelle had to wait an appalling 3 months for his operation, nearly 
heaving a second heart attack as he waited. Another Canadian citizen, 
Albert Palmer, had to wait 3 months for an operation to improve the 
blood supply to his feet. ``You don't want to wait when you're in pain, 
but there's no other choice,'' Mr. Palmer said of his ordeal.
  The Canadian Government may boast of providing comprehensive benefits 
to all, but, in practice, comprehensive benefits mean little if there 
are no doctors or technologies to provide the care. To curb costs, the 
Canadian Government restricts the number of specialists who are 
trained, compelling patients to wait weeks or months for all but the 
most urgent operations.
  A Toronto heart surgeon states that in theory, people who desperately 
need operations go to the top of the wait list, but, in practice, 
people die on the waiting lists. The Government limits the purchase of 
expensive new technologies, often forcing patients to undergo outdated 
and less effective treatments. The Government permits only a few 
hospitals to perform many specialized procedures, requiring patients to 
travel long distances in order to obtain care.
  As if the above scenario weren't dire enough, the Canadian system is 
presently facing a financial crisis. Canadian citizens are demanding 
ever more care, but are unwilling to pay the higher taxes needed to 
cover the costs. As the Canadian system is confronted with a flood of 
new expensive technologies and an aging, sicker population, many 
experts predict longer waits, increasingly outdated technology, and 
maybe even overt rationing. Rather than misleading the American people 
by asking them if they want a system like Canada's which provides 
universal coverage with no out-of-pocket costs, let's tell them the 
whole story and then let them choose. Let's ask them if they would be 
willing to wait 3 months for a triple bypass. Let us ask them if they 
would be willing to travel long distances in order to get the care they 
need.
  Mr. Speaker, the Clinton health plan and the Clinton-like Democratic 
leadership bills are both based on a fundamental belief in the ability 
of Government to solve the problems that face us. It goes against the 
belief in the individual that this Nation was built on. Let me repeat 
that. This Nation was built on a distrust in Government and a belief 
that individuals are capable of providing for their own needs. Therein 
lies the difference between the Democratic leadership bill which places 
its trust in the Government and its bureaucracies, and the bipartisan 
and republican alternatives which place their faith in the ability of 
the individual to judge what his health care needs are.
  Mr. Speaker, our health care system is in need of reform. But we must 
not turn our health care system over to the Government. Only a market-
based reform plan will give people access to affordable health care 
while maintaining our present high level of health care.
  Mr. Speaker, a lot of political rhetoric has gone into emphasizing 
the current employer-based health insurance system. The Democratic 
leadership seems to have failed to understand the fundamental reason 
why our system is the way it is. The current tax system has given an 
overwhelming incentive for a employer-based health insurance system 
since only employer-based health benefits are tax-deductible. The 
simple solution to this problem would seem to be to extend tax 
deductions to all health insurance premiums. However, by failing to 
extend full tax-deductibility for all health insurance premiums, the 
Democratic leadership has shown its desire to perpetuate the current 
employer-bases system. Why might this be? Perhaps the current system 
provides the easiest way to impose a hidden tax to finance this 
Government takeover of our health care system.
  Mr. Speaker, for some reason, the administration and some Members of 
Congress oppose responsible malpractice reform. This is in spite of the 
fact that the status quo is one of the major causes of preventable 
medical inflation. Fear of frivolous lawsuits inspires doctors to 
perform batteries of unneeded tests just to be on the safe side. The 
latitude given to juries to decide malpractice awards has caused 
malpractice insurance premiums to skyrocket. Case study after case 
study of the health care systems of other countries mention the 
relative infrequency of medical malpractice suits when compared to the 
United States.

  Mr. Speaker, we need a cap on non-economic damages that will permit 
victims of true medical negligence to receive their just compensation, 
but will prohibit juries from granting excessive awards. We also need 
to require plaintiffs to go through an alternative dispute resolution 
system before they can go to court. If the plaintiff rejects the 
decision, chooses to go to court, and fails to receive a higher award, 
he should pay the defendant's legal fees. These reforms would make 
plaintiffs think before pressing a malpractice suit, but would leave 
patients with the right to sue if they have truly been injured by a 
doctor's carelessness. If the Democratic leadership is serious about 
controlling costs, these reforms are not an option. Medical costs will 
continue to spiral out of control until we get a handle on this.
  Mr. Speaker, the greatest thing that we could do to regain control of 
health care costs would be to give medical savings accounts the same 
tax treatment that employer-based health insurance premiums now enjoy. 
This would allow patients to pay for their smaller medical bills with 
funds from their medical savings accounts while having a catastrophic 
health insurance policy to protect them from financial ruin should they 
get seriously ill.
  Despite the current tax disadvantage of medical savings accounts, 
companies that offer their employees this alternative have seen much 
lower employee health costs than companies that do not offer this 
option. The reason for this is simple. Under the current system, a 
consumer rarely asks up front how much a medical service will cost him. 
This is because insurance will pick up about 80 percent of the cost, 
while the patient will only have to pay about 20 percent out of his own 
pocket. Since he must directly pay for such a small portion of the 
cost, he has little reason to forego the procedure. On the other hand, 
if he decides not to purchase the care, the patient reaps only 20 
percent of the benefit for his actions. Other people who have the same 
insurer will reap the other 80 percent.
  Extending full tax-deductibility to medical savings accounts would 
correct this market distortion and thereby, control costs. Individuals 
would reap the full benefit and likewise bear the full costs for their 
actions. In addition, all medical decisions would be left to patients 
and their doctors rather than to a bunch of bureaucrats.
  Opponents of medical savings accounts do not think that individuals 
are capable of making their own health care decisions. The First Lady 
has said that under medical savings accounts, many people would save 
the money and fail to obtain necessary care ``unless they are required 
to be responsible.'' A Member of this body has been quoted as saying 
that individuals think they are ``invincible'' when they are well, but 
are ``absolutely irrational, brain-dead, sniveling, begging and 
fantasizing ills and pains'' when they are sick. According to these 
policymakers, then, our only remedy is to allow the Government to 
protect the American people from their own stupidity.
  Mr. Speaker, this is a blatant example of the arrogance which seems 
to pervade the Federal Government. Ordinary people are assumed to be 
too ignorant to run their own lives, so we, as elected officials, must 
deign to share our superior wisdom and make their decisions for them. 
This is the ultimate in what former British Prime Minister Margaret 
Thatcher has called the nanny state. Mr. Speaker, I think it is safe to 
say that our Founding Fathers would be thoroughly horrified by this 
contempt for individuals.
  There are several reforms that enjoy widespread support. Workers must 
be ensured that their health coverage will be portable and that they 
cannot be denied insurance due to pre-existing conditions. This would 
stop workers from feeling locked into an undesirable job because of 
insecurity over health benefits.
  In addition, small businesses must be allowed to pool so that they 
can negotiate better health insurance rates. The key word here is 
``allowed.''
  Mr. Speaker, we must not force businesses to pool. If businesses are 
allowed to pool and they judge that by so doing they will save money, 
they will decide on their own to pool. They will not need the 
Government to tell them what to do.
  I now turn to what I view as one of the most important aspects of 
this debate--the budget and tax impact of this massive new entitlement.
  It is frightening to consider the massive budget implications of 
creating another universal entitlement at a time when we have annual 
deficits in excess of $200 billion.
  That is why I set out from the beginning of this debate to ensure 
that the budget implications of the Clinton proposal are understood. It 
is critical that any Government-mandated health care plan be completely 
on-budget with all mandates scored as Federal taxes or receipts, and 
all related expenditures scored as outlays.
  This plan federalizes and socializes the health care of this Nation, 
and the budget should reflect that fact.
  Congressman Penny and I offered the health care on-budget language as 
legislation in the House earlier this year where it attracted over 140 
cosponsors. I offered the amendment in the House Budget Committee 
earlier this year. It was approved and included in the budget 
resolution. It was also included in the Senate budget resolution. 
Unfortunately, it was removed in conference. When the health reform 
bill comes to the floor I plan to once again offer the on-budget 
amendment.
  Earlier in the year, the Congressional Budget Office was asked to 
render a decision regarding the proper budget treatment of the Clinton 
health plan. The CBO stated that the Clinton plan should be scored 
completely on-budget. However, the CBO decision was advisory, and 
Congress must specify in the legislative language of health care reform 
what the budget treatment will be.
  In recent months, it appeared that Congress might be moving away from 
a plan that included mandates. However, it is now clear that the 
leadership intends to have the House vote on a plan very close to the 
Clinton plan. The budget treatment issue therefore remains central.
  Strong arguments remain for complete on-budget treatment of the 
Gephardt plan.
  As the original CBO recommendation stated:

       CBO bases this view [that payments to and from the 
     alliances should be on-budget] primarily on its judgment that 
     the Administration's proposal would establish a federal 
     entitlement to health benefits and that the mandatory 
     premiums used to finance the new entitlement would constitute 
     an exercise of sovereign power.

  While the mandatory alliances have been replaced with insurance 
pools, the Gephardt plan clearly establishes a Federal entitlement to 
health benefits, and relies on the sovereign power of the government to 
exact mandatory premiums to finance that entitlement.
  The Gephardt bill attempts to bring control of the entire health care 
system of this country under the thumb of the Federal Government. 
Businesses, alliances, insurance companies, States, and providers would 
all be acting as agents of the Federal Government. Those agents would 
be delegated the responsibility of delivering the universal health care 
entitlement. The CBO's original decision relied on the fact that the 
Clinton plan used agents to carry out the directives in that plan.
  Finally, the 1967 Report of the President's Commission on Budget 
Concepts, which remains today the only authoritative statement on 
federal budgetary accounting, recommends that:

       To work well, the governmental budget process should 
     encompass the full scope of the programs and transactions 
     that are within the Federal sector and not subject to the 
     economic disciplines of the marketplace . . . the budget 
     should, as a general rule, be comprehensive of the full range 
     of Federal activities.

  The health plan envisioned under the Gephardt bill would be within 
the Federal sector, and would not be subject to the disciplines of the 
marketplace.
  I will not let this issue be swept under the rug. The best medicine 
for America in the health care debate is honesty. Federal mandated 
premiums are tax increases, and the Federal budget must reflect that 
fact.
  Mandated premiums, lack of choice in plans and in doctors, potential 
rationing, and the massive budget implications, have all helped to 
discredit the Clinton plan. In fact, support for the plan has dropped 
dramatically as the American people have learned more about it.
  Despite this, the Democrat leadership intends to try and force-feed 
us the Clinton Plan. They intend to do this by cutting just enough 
deals to secure their usual one-vote victory.
  The Nation's health care is being drafted in a back room by the 
Democrat leadership with the help of lobbyists and every special 
interest under the sun.
  Remember last year's one-vote victory for the Clinton tax hike? The 
victory was assured only through special deals and the President's 
promises of pork-barrel spending.
  A tax bill is one thing, our health care is quite another. We must 
not turn the health of our children, our parents, our spouses, and all 
those we care for, over to a back room deal, where lobbyists slip in 
their favorite provisions only to be discovered months after the 
legislation has passed.
  This is not the way to reform our Nation's health care system. The 
American people deserve the right to have each of the major bills that 
Congress will vote on publicly available for at least 2 weeks before 
there is a vote.
  This is a democracy. Decisions in North Korea, Cuba, and China are 
made by elites in back rooms--that is not how we are supposed to make 
law in this country, particularly when the law will impact the lives 
and the health of every American.
  Mr. Speaker, it is my hope that we will reject the Clinton-Gephardt 
proposal. In its place we should approve a bipartisan plan which 
preserves our market-based system, and makes the incremental reforms 
that increase access to health care for all Americans without 
sacrificing our freedom and our values.

                          ____________________