[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: UNIVERSAL COVERAGE VERSUS INCREMENTAL REFORM

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
February 11, 1994, and June 10, 1994, the gentlewoman from Connecticut 
[Ms. DeLauro] is recognized for 60 minutes as the designee of the 
majority leader.
  Ms. DeLAURO. Mr. Speaker, I want to say thank you to my colleagues 
who are joining me this evening for this special order with an 
opportunity to talk about health care.
  As we round the final curve and we head down the health care reform 
stretch, the homestretch, if you will, there are two reform proposals 
that are emerging from the pack: The first is health care reform. That 
includes universal coverage. Simply put, this means that every 
American--I repeat, every American--would be guaranteed private health 
insurance that can never be taken away for any reason.
  The second is what is being called incremental reform. This model 
would rely on various insurance reforms. This would mean that we make 
some changes in some of the insurance policies that exist today. For 
instance, ending preexisting condition exclusions, ending age 
discrimination, and making certain that health insurance is postable. 
These are all very laudable goals, goals which I support and my 
colleagues support. But this insurance reform only, or incremental 
reform, does not guarantee coverage to a single American. It does not 
guarantee coverage to a single American. It does not guarantee coverage 
to a single American, and that is where the plan falls short.

  The claim that insurance reforms alone will achieve the same kind of 
an end as comprehensive health insurance reform is just plain wrong. A 
study of both approaches for the Catholic Health Association which 
analyzed the impact of each approach on middle-class Americans shows 
the dangers of this incremental, or insurance reform, process only. The 
study was conducted by Lewin VHI, a respected independent, and I add 
independent, a nonpartisan health care consulting firm which has 
authored numerous studies regarding premium costs, insurance pools and 
managed care.
  The study shows that the middle class comes out a winner under 
universal coverage and a loser under this incremental or insurance 
reform only proposal. In fact, the average insured American family, 
those making between $30,000 and $39,999 per year, will see their 
yearly insurance costs under incremental reform by $344, that portion 
of the chart that is up here. I repeat. They will see yearly insurance 
costs increase under incremental reform by $344. Conversely, the same 
family would see their yearly health insurance costs decrease under a 
universal coverage plan where everyone is in the pool, everyone is 
being covered, they would see a decrease of $165.
  Moreover, under the incremental model, everybody pays more for health 
care. In fact, those who make less pay more. This is what the study 
found. I am not standing here making up these numbers and creating them 
out of whole cloth. This was a study again by an independent agency. 
The second chart displays what I am talking about.
  Those with incomes between $20,000 and $29,999 would pay $201 more a 
year for their health care, the red block of the chart here.
  Those with incomes between $30,000 and $39,999 would pay $344 more a 
year for health care as I mentioned before.
  Those with incomes between $40,000 and $49,999 would pay $137 more a 
year for health care. And those with incomes between $50,000 and 
$74,999 would pay $76 more a year for health care. Those who make less, 
at this end of the chart, wind up paying more for their health care.
  In contrast, this independent study found that under a plan that 
includes universal coverage, health care costs in fact would be reduced 
no matter what the income level. That is the blue portion of this 
chart, the blue blocks. Those with incomes between $20,000 and $29,999 
would pay $39 less a year for their health care; those with incomes 
between $30,000 and $39,999 would pay $165 less a year for their health 
care; those with incomes between $40,000 and $49,999 would pay $147 
less a year for health care; and those with incomes between $50,000 and 
$74,999 would pay $114 less a year for health care.
  Not only would the incremental or just the insurance reform proposal 
raise costs for working families but it would raise the total cost of 
the health care system as a whole. The problem with this model is that 
it enacts insurance reforms but does nothing about containing costs and 
it does not have any costs controls. In other words, it would open the 
system up to hundreds of thousands of Americans who are currently 
denied but contains no mechanism to offset the increased costs. The 
results would be disastrous for this country.
  We take a look at the next chart. It is a vicious, upward spiral of 
insurance premiums that would ensue should we pass a health care bill 
that dealt with insurance reforms only.
  Insurance reforms extend coverage, as I said, to the sick and older, 
higher users of health care services. Without universal coverage, 
everyone in the pool to ensure that low-risk individuals are included 
in these insurance pools, the average level of risk increases. Higher 
risk insurance pools result in premium increases for those who are 
currently insured, thereby causing a number of the healthy individuals 
who are in these pools and small businesses to drop out because the 
premiums are going up because we have taken in so many who are at high 
risk. Shrinking those insurance pools further increases the level of 
risk for those who remain in the pool which in turn again escalates the 
premium costs. Additional premium increases drive out more young and 
healthy people and small businesses. Once again we have got the high-
risk pools, resulting in an increased premium, causing again healthier 
individuals and those in small businesses to drop out and the cycle 
goes on and on and on, which we can see displayed in this chart.

                              {time}  1730

  By making health insurance available but not required, we can be 
assured that the only people who will have the incentive to purchase 
health insurance will be those who are ill and those who are elderly. 
That means that the pool of healthy young people paying into the system 
is depleted, and the people participating in the system are only those 
who are requiring the most expensive care.
  The result can only be skyrocketing premiums, as we have tried to 
point out here. Then who would pay the brunt of these increases? You 
guessed it: Working, middle-class families who continue to pick up the 
cost for everyone else who has been put into these pools.
  To find an example of how this cycle impacts working families we need 
only take a look to New York State which has attempted to enact 
insurance reform without going to universal coverage, again, getting 
everyone into this pool to be insured. What happened there confirms 
what the Lewin VHI study found, that the only way to control health 
care costs is through universal coverage.
  According to the New York Insurance Department, when New York 
instituted insurance reforms that opened its enrollment without 
universal coverage, premiums soared. Some premiums went up by more than 
100 percent. One hundred percent, incredible. Similar insurance reforms 
on a national level would truly devastate our working families.
  The most telling statistic from this Lewin VHI study may be the 
projected number of uninsured Americans under this incremental or 
insurance reform only compared to our current system, which is 
demonstrated in this chart. Current estimates put the uninsured 
population at around 37.2 million. If we enact insurance reform only 
without any universal coverage, the number of uninsured only drops to 
36.1 million. Even if we coupled with the insurance reform help or 
discounts or subsidies for working families at a particular wage scale, 
but do not include universal coverage, the number of uninsured remains 
high at 22.3 three million.
  These sad figures really only serve to confirm what President 
Clinton, what Majority Leader Richard Gephardt and other leaders in the 
health care reform debate have been saying all along. Universal 
coverage is the only way to get everyone covered and control costs at 
the same time. This is private, guaranteed health insurance for every 
single American that is affordable and that can never be taken away. It 
has got to be the foundation of any health care reform that this body 
passes. Anything less, and quite frankly, we have failed, and we will 
go back to the current system that we have today.
  My view, and I know the view of my colleagues here tonight is let us 
not fail the 40 million uninsured Americans. Let us not fail the 81 
million Americans with preexisting conditions. Let us not fail the 
millions of Americans who are one accident or one illness away from 
losing their health care. Let us not fail small business owners who are 
desperately trying to do the right thing, to cover their employees, 
even though the deck is stacked against them. Let us not fail our 
seniors forced to squander there retirement savings on prescription 
drug coverage. Let us not fail the working families of this country who 
will be the real victims if we enact soft-boiled reform.
  We have an opportunity in this body to pass health care reform that 
guarantees private health insurance to every single American. The 
American people deserve nothing less.
  I yield to the distinguished gentleman from Illinois [Mr. Durbin], 
who is the chairman of the Agriculture Subcommittee of the Committee on 
Appropriations, to join with us in this conversation tonight.
  Mr. DURBIN. Mr. Chairman, let me thank my colleague, the gentlewoman 
from Connecticut [Ms. DeLauro], for calling this special order. Let me 
speak for a few moments on the issue which she has raised, which I 
think is critically important information.
  First, as we used to say when I took debate in high school, let us 
define terms. A Member of Congress recently had a town meeting and a 
lady held up her hand and said, ``I am opposed to universal coverage.'' 
The Congressman said, ``Why''? She said, ``Because, Congressman, we 
can't afford to take care of the people in the United States, let alone 
everybody in the world.''
  Let me assure everyone listening that the universal coverage that we 
are discussing this evening refers strictly to the United States of 
America and to make sure that every person and every family has the 
peace of mind knowing that they have health care insurance.
  This debate has been going on for about 2 years. It would be an 
interesting book for someone to write and to plot the course of it and 
how it has changed, and to note the difference in approach between the 
two political parties in discussing universal care. It is almost as if 
we are reading different sections of the Bible or different sections of 
moral teaching. Some might say that the poor will always be with us, 
and Democrats have gotten carried away with this universal health care 
in the belief that we can somehow give this peace of mind to every 
American. Some others might take a look at the same book and say wait a 
minute, if I understood the Sermon on the Mount, we do have a 
responsibility to everyone, to make sure everybody and every brother 
and sister has that peace of mind in knowing that they have health 
insurance.
  But it turns out, as the gentlewoman from Connecticut has pointed 
out, what we are talking about here is not some moralistic debate as to 
how far our obligations go to our fellow man and woman, but we are 
talking about dollars and cents, and how to, on the most cost-effective 
basis, change America's health care system for the better. Myself and 
many others believe that universal health care is central to health 
care reform, not just because of some moral obligation, because 
economically we believe it is essential. I have felt this from the 
beginning. Now we have a study that has been referred to, the Lewin VHI 
study to the Catholic Health Association that analyzed this concept and 
said what if you did only part of this. What if you sat down, Congress, 
and just tried to take those pieces of the system that appear the most 
outrageous, and the most unfair, and change those alone. When it is all 
said and done, are we better off as a Nation or worse off? And you hear 
the argument yourself I think from time to time. Some of our neighbors 
will say why do they want to change the whole thing.

                              {time}  1740

  Why do they not just take care of the problems? And the problems they 
are referring to, as have been noted this evening, the fact that we are 
discriminated against if we have preexisting conditions. If you have 
had a back surgery, a heart problem, diabetes, cancer in your family, a 
child born to your family that has a difficulty, all of a sudden the 
insurance companies say, ``We may not want you.'' Your employer says, 
``You have become a big risk for us.'' That preexisting-condition 
exclusion worries every one of us.
  Each one of us is only an illness away from falling in that category, 
and 81 million Americans, a third of our population, are already there, 
already being discriminated against.
  So some of the folks who just want to do a little tinkering here and 
there say, ``Get rid of that preexisting-condition exclusion and you 
have done something good, Congress, and you can go home.'' What this 
study shows, and shows clearly, is that if you just do that and you do 
not address the underlying difficulty of getting every American 
insured, you create more problems than you solve, and that is the 
bottom line.
  The bottom line here is if people can wait until they get sick to buy 
insurance, enough healthy people will not be in the insurance pools to 
keep the premiums at a reasonable level.
  What the gentlewoman from Connecticut has said this evening in her 
special order and what has been said by the study is that if you take a 
look at really addressing health care reform, really bringing down 
costs and helping working families who are going to bear the brunt of 
paying these health insurance premiums, you have got to bring everybody 
in the tent. You have got to make sure every American has the peace of 
mind and assurance of health care protection. Then you can address the 
reforms. Then you can spread the risk.
  Mr. MILLER of California. Mr. Speaker, will the gentlewoman yield?
  Ms. DeLauro. I yield to the gentleman from California.
  Mr. MILLER of California. I just want to follow up on the gentleman's 
point.
  As I understand it, even if you do the insurance reforms that you 
outlined that almost all of our constituents support now, even many of 
the insurance companies have supported, because there are such 
outrageous exclusions of American families, even if you do that, you 
still have the problem that you have not done anything about making 
that insurance affordable or providing that coverage to those 
individuals.
  So the person who is working in one company today and that person is 
laid off or the job is terminated or they go to another employer on 
their own volition, if that employer is in fact not offering insurance, 
all you have is that you have the right to buy it, but not the question 
of whether or not you can afford it, and if you are a low-income person 
and your employer, under the proposals, some of the proposals, we have 
seen in the Senate and elsewhere, if your employer does not offer it, 
does not offer to help you with it, then you have no ability to get 
that insurance.
  So universal coverage is the key also for having access to that 
system after we reform it. Is that not correct?
  Mr. DURBIN. Absolutely. And the failure to include universal coverage 
means many of these reforms are going to backfire. Most of all, they 
backfire on working families. I think that is what the gentlewoman from 
Connecticut demonstrated in her charts. Working families pay more 
unless you take a look at the big picture. I think that is the critical 
point that is to be made.
  Mr. MILLER of California. The simple notion that insurance companies 
would no longer be allowed to prevent you from having insurance is sort 
of like going and getting fire insurance after your house is on fire. 
You are now sick. You were not able to or you were not responsible 
enough to provide for your insurance; now you are sick; now you can go 
and say, ``You must insure me,'' and those of us who have been paying 
for insurance over the years now have to pick up the cost of your 
irresponsibility because you have not contributed anything to the pot.
  Mr. DURBIN. Absolutely.
  In the State of New York, they tried to do it with insurance reform. 
They basically said, ``We are going to do away with preexisting 
conditions.'' What happened, or course, is a lot of people who had been 
out of the insurance pools were brought in. The insurance premiums went 
up, and as a result of those premiums going up, a lot of younger people 
who were healthy with low premiums said, ``Hold the phone. I cannot 
afford to pay these premiums.'' They dropped out. The families that 
were left in had higher premiums.
  You just do the reform without the overall, take a look at universal 
coverage, I think you lose the picture of what the ultimate goal is.
  Let me conclude by saying this: My point of view is this, it is not a 
question between the bleeding-heart liberals and the styptic-hearted 
conservatives. It goes down to basic economics. If you do not provide 
universal coverage and bring everybody in to share the risk, tinkering 
at the edges can make things worse than they are today.
  If Congress has any responsibility to the people, the millions who 
send us here to represent them, it is to do more than to put out a 
press release, pat ourselves on the back and go home. We have got to 
face the most fundamental challenge here to bring as many Americans as 
possible, moving us toward the universal coverage, under the tent, 
under that protection, and make sure that working families do not end 
up, because of some incremental reform, holding the bag.
  I thank the gentlewoman for this special order, because I think this 
is a critical point to be brought up in the closing weeks of this 
debate.
  Ms. DeLAURO. I thank the gentleman from Illinois and my colleague, 
the gentleman from California, first, the gentleman from Illinois for 
defining the issue of universal care, and second, the whole issue of 
preexisting condition.
  I am a survivor of cancer. I have a preexisting condition. If I did 
not have insurance and did not have it now, but was let into a pool 
that would then cover me, yes, in fact, if we only did that reform, 
others would pay for the high risk of my illness. That is not right. 
That is unfair. Everybody needs to be in so it is a shared cost, which 
is what this system was meant to be all along. So I thank you for 
talking about those two issues.
  Mr. Speaker, I yield to the gentlewoman from Utah [Ms. Shepherd] who 
is here to participate with us this evening.
  Ms. SHEPHERD. I thank the gentlewoman for yielding, and to my 
colleagues who have come before and explained so well why it is utterly 
and absolutely essential that every single American be covered in order 
for all of us to feel the security that we can be taken care of when we 
are sick, and that is a very basic need that we all have. It is as 
essential as having a roof over your head.
  If you are a mother, you need to know you can take your child to the 
doctor when the child is sick. If you are a child, you need to know 
that when your parents are sick and they need help, you can afford to 
get them that help.
  I am here really to talk about what universal coverage means to 
ordinary people who are citizens of America, who are watching this 
debate.
  For 2 years now, special-interest groups have been working to prevent 
the passage of health care reform. They have been spending a fortune on 
television, scaring people to death, making them believe that if we 
reform health care they will lose, when the truth is the American 
people will gain. But the special interests will lose, and in this 11th 
hour of the health care debate, I am here to urge the Members of the 
House of Representatives to listen to the people, to their 
constituents, and not to special interests.
  It has been hard to hear, because the noise has been so loud about 
who is really talking, and I finally, wringing my hands not knowing how 
I could hear what people wanted, made a program for myself where I got 
on a plane every single solitary weekend, went home, and every single 
Saturday got out and knocked on doors, door to door, 3 hours every 
Saturday this whole year, and I ask my constituents what they wanted. I 
was there to listen, not to tell them what it should be.
  The answer is absolutely clear to me. The constituents that come from 
the Second District in Salt Lake County, UT, want every American to 
have health care coverage, because they understand that that is the 
basic idea of shared risk, and that is the basic idea of insurance, and 
they know that if some people do not have it and they get sick, and 
that other people have to pay for it. And so they say they are willing 
to do their part if everyone else is willing to do their part as well.
  I would like to say to the Members of the House of Representatives 
that my constituents, and I believe theirs, are willing to do their 
fair share, and this is not the time to pander to Washington-based 
special interest groups, but it is the time for us to listen to our 
constituents. They understand that real health care reform guarantees 
health care coverage for everyone. They understand that if they now 
have insurance, they are paying for people who do not through cost 
shifts.
  They want us to address their problems responsibly. They do not want 
us to run and cower and shrink from making these tough decisions, 
because they know what we decide today is going to affect their lives 
tomorrow.
  Furthermore, they know, because they read the newspapers and they 
watch television, that incremental reform does not work.
  As my colleagues have already so credibly explained and with charts 
and with graphs and with data, we know what works. But if that is not 
enough, we can just look at the case of New York State. New York State 
has tried incremental reform. They did basic simple insurance reform.

                              {time}  1750

  And all they have gotten for their trouble is higher premiums for 
those people who have it and more people falling off insurance because 
they cannot afford it, and more and more debilitated families because 
they are being devastated by health care costs that they cannot afford 
and for which they are not covered.
  This Congress must not bow to the special interests' call that we 
ignore the will of our constituents. We must work together to provide 
our constituents with the security of reliable health care coverage.
  That is what we were sent here to do, and now is the time for us to 
get that job done.
  Mr. Speaker, I thank the gentlewoman from Connecticut [Ms.  DeLauro], 
for giving me this opportunity to join in her special order.
  Ms. DeLAURO. I thank the gentlewoman for her comments.
  There are just a few points here. I think the New York experience is 
really quite extraordinary. The premiums went up 100 percent, and that 
is incredible. We have data that tells us that this is not going to 
work and we have examples around the country where this is not working. 
If we want to apply this to the entire country, we are in for just some 
devastating effects.
  I also mention, the gentlewoman talked about the amount of money that 
the interest groups are using in order to really defeat health care or 
not make health care move forward or not change what we are doing and 
not change the system. I read that it is calculated that about $50 
million has been spent against health care reform, the largest 
expenditure of funds against any piece of legislation that has ever 
come before this body, before the Congress; $50 million to defeat 
health care.
  Now, that tells you something about the kind of money that is 
involved in this effort, and we should not be really following the 
special interests on this but following the dictates of the people, as 
the gentlewoman pointed out.
  Ms. SHEPHERD. It also tells us something about how much these special 
interests have to spend and how much they believe they will lose if we 
pass health care reform.
  We are trying to get more care to people, not more money to special 
interests. They have the reverse desire.
  Ms. DeLAURO. Amen.
  Again, I thank the gentlewoman from Utah [Ms. Shepherd].
  Mr. Speaker, I yield to the gentleman from Florida [Mr. Johnston]. 
The gentleman from Florida has spoken on, talked about, has his own 
legislation early on in health care, and as someone who has been 
leading the way in health care reform.
  I thank the gentleman from joining us this evening.
  Mr. JOHNSTON. of Florida. Mr. Speaker, I thank the gentlewoman from 
Connecticut and I appreciate the opportunity to speak on health care.
  Before coming to the Chamber, I had a conversation with one of my 
constituents from Palm Beach, FL, Mr. Feder, who is probably in his 
late seventies or early eighties. The only disagreement I have with the 
gentlewoman from Utah [Mr. Shepherd] and also the gentleman from 
Illinois [Mr. Durbin] is that this debate has not started in the last 2 
years, this debate has been going on for 60 years.
  Mr. Feder pointed out some of the rhetoric that was used back in 1935 
when Social Security was passed and in 1965 when Medicare was passed; 
same rhetoric today.
  If you go back in the Congressional Records of 1935 and 1965 when the 
prophets of doom and gloom got up and said that this is going to 
bankrupt the country, they are saying today that it is going to 
bankrupt the country, that this is socialized medicine. Well, it is 
not, it is not.
  Mr. Feder and I were talking about what a historic time it is to be 
in Congress and what a historic vote it is going to be. In this century 
we could probably bring it down to five votes: the declaration of war 
in 1917, the institution of Social Security in 1935, the declaration of 
war in 1941 in this Chamber, and Medicare, the fourth, and the fifth 
vote being this monumental vote dealing with universal health care.

  I am Harry, I am not the Harry of ``Louise and Harry.'' I want to 
assure you that. Do not, do not get caught up in the rhetoric of Louise 
and Harry. They are doom and gloom if there ever was one.
  I want to point out that what we are trying to do is to give to the 
American public, we in Congress, the same thing the American public 
have given to us in our health care. It is really simple. It is not 
complex at all. Yet they would make you think this is as big as a 
Sears, Roebuck catalog, the health care. It is not.
  It has become more so in the last several days with the new bill 
being presented by the gentleman from Missouri, our majority leaders, 
Richard Gephardt. We are cutting out a tremendous amount of 
bureaucracy. As the gentlewoman from Connecticut said and the 
gentlewoman from Utah, the costs involved in the delivery of health 
care in this country, $1 out of every $4 goes to administration. 
Talking about $250 billion; we are cutting that down substantially.
  We are encouraging, under this bill, in cost prevention, now, 
preventive medicine, something that you never had before. For every 
dollar we spend in prenatal care, we save $3 from that.
  In my hometown, in St. Mary's Hospital, there is a prenatal clinic 
that costs $1,500 to $2,500 per day to have a premature baby in that 
clinic.
  In France, when a woman goes in for her fourth prenatal checkup, they 
give her $1,000. True story. Why? Because she saves that much in having 
prenatal care, from what it would be.
  The other thing is by having universal health care, we are going to 
cut out the cost shifting that goes on. Any of you who have ever been 
to a hospital recently and read that hospital bill, that is the 
greatest piece of fiction since ``War and Peace.'' It really is.
  We are going to cut out the $10 and $12 and aspirin there. We were 
looking at, the other night, the incremental plans, probably talking 
about the Dole plan--and I remind you, Senator Dole in 1965 voted 
against Medicare. That is a matter of record.
  Now, the Congressman from Connecticut has gone through this very 
carefully and delineated that. Now let me bring it down to a local 
level.
  In Florida we have 2.6 million people who are uninsured, 591,000 
children are involved there. In my district, in Palm Beach, and I will 
repeat that, Palm Beach in Broward County, a very affluent area, we 
have 88,000 people who have no coverage whatsoever, 17,000 of those are 
children.
  Donna Shalala talked to us the other day, I say to the gentlewoman 
from Connecticut, and she will recall that Donna Shalala said if we 
have national health coverage in this country, approximately 1 million 
will come off the welfare rolls. Why? Because a woman, a single parent, 
woman or man, who has a child, who has an earache or a broken arm or 
something like that, literally cannot afford to go to work and lose her 
Medicaid benefits. If she does and it does not have health care 
benefits, she will literally go into bankruptcy.
  Let me briefly talk about the fiscal responsibility. This is a 
conservative bill, I might point out. When we passed this bill, when I 
got involved in health care 5 years ago, we were spending $500 billion 
a year in the delivery of health care in this country. Today we are 
spending $1 trillion. By the year 2000 we will spend 
$1,650,000,000,000. It is bleeding us to death.
  We are spending 14 percent of our gross national product and by the 
year 2000 we will be spending 18 percent of our GNP. Medicare goes up, 
it doubles, Medicaid goes up, it doubles.
  Employers, we are talking about employer mandates, their employees. 
By the year 2000 they will pay $303 billion. It will almost double 
there.
  Families today are spending 13 percent of their income, by the year 
2000 they will be spending 18.5 percent of their income just to be 
covered.
  Let me close by telling you what is going to happen to the Medicare 
recipients. Medicare recipients, everyone thinks they are getting a 
free ride in this country. Well, their premiums are, in large part, 
based on what the costs are. They are going to be paying one-fourth of 
the premium cost for part of their Medicare. That is going up at 10 
percent a year while the Social Security COLA's are going up only 2 
percent or 3 percent a year. We are trying to get that under control to 
make sure that Medicare costs are even with that, with cost of 
inflation.
  Finally, we are trying to increase in the Medicare benefits 
prescription drugs that the gentlewoman from Connecticut said, and home 
health care, which is the start, and a good start, for long-term care.
  I appreciate the opportunity to be here because of the importance to 
my district in Florida and also to the Members and the constituents in 
the entire State. I thank the gentlewoman.

                              {time}  1800

  Ms. DeLAURO. I thank the gentleman.
  I just want to mention to my colleague, or even ask my colleague:
  There has been so much misinformation that has been sent to seniors 
in particular, and I know that the gentleman represents a large number 
of our older Americans, and I would ask him if that is what he is 
hearing from some of his constituents who are older Americans. They are 
getting bombarded through the mail, through phone calls, with all kinds 
of misinformation about how they are going to be hurt by health care 
reform.
  Mr. JOHNSTON of Florida. The distortion of what we are trying to do 
here is obscene and immoral. It really is, because it is just the 
reverse.
  As I said, we are trying to get the American public what we have, and 
the senior citizen, we are trying to protect them, and prescription 
drugs, and their costs are going up twice of their premiums on Medicare 
than what they are getting. Their COLA's are wiped out before they even 
get the second COLA or the fourth COLA, so the gentlewoman is 
absolutely right, and I am asking them to stick with us and make sure 
they look at what we are trying to do before they make a judgment that 
we are doing wrong, because we are not. The same rhetoric in 1965 when 
they got their Medicare; same rhetoric in 1935 when they got the Social 
Security.
  Ms. DeLAURO. Mr. Speaker, I thank the gentleman.
  Just one other point, which is the welfare reform point, and what we 
want to do in this body, the President wants to do, a number of us want 
to, reform welfare which needs to be reformed, and we talk about having 
people go out and get a job, and we need to reward work. That is what 
welfare needs to be about. It has not been about that.
  On the other hand, as the gentleman pointed out, if we mandated 
someone to go get a job, and we said: ``You got to do it,'' and they 
go, and there is no health care benefits to take advantage of; when we 
think about the systems that we have created, oftentimes we think that 
they are in two different arenas, that they do not meld with each 
other. But, if we say to someone they need to get a job, and they go 
for a job, and now they get 100 percent of their health care covered, 
and they go to that job, and they do not have health care, where is the 
incentive? What have we done to make these two systems work together 
effectively so someone can work, get rewarded for that work, 
participate in paying for health care, as everyone should do in this 
country? It should not be a free ride for anyone.
  Mr. JOHNSTON of Florida. The gentlewoman from Connecticut is 
absolutely right. Welfare reform will never work unless we have 
universal coverage.
  I mean the statistics show that. People on welfare want to go back to 
work. But they cannot do it at the jeopardy of their family and their 
children and lose all their health benefits. Give them universal 
coverage, and, as I say, we will take a million people off of the 
welfare rolls tomorrow.
  Ms. DeLAURO. Amen. I thank the gentleman, and we know he is not the 
Harry of Harry and Louise.
  I would now like to recognize my colleague, the gentlewoman from 
California [Ms. Eshoo] who has been just an indefatigable participant 
in the health care debate in trying to get health care passed in this 
body.
  Ms. ESHOO. Mr. Speaker, I would like to thank the gentlewoman from 
Connecticut [Ms. DeLauro] who has been a great leader on this issue.
  Many evenings when I am working late in the office, Mr. Speaker, I 
still have my TV on, and who is on but the gentlewoman from Connecticut 
[Ms. DeLauro] being instructive and enlightening, obviously not only to 
her own constituents, but really to all of our constituents, and I 
thank her for that. This is so important, Mr. Speaker, to be 
educational this evening, and that is why I welcome it.
  Our colleague, the gentlewoman from Utah [Ms. Shepherd] spoke about 
the unprecedented amount of dollars, the most amount of dollars in the 
history of this Nation, that have been spent lobbying against providing 
health reform and universal coverage for every single American. That is 
a statement in and of itself, and so, even though we are up against 
costly special interests, I think that we need to educate and talk more 
about this idea that we want to make real of universal coverage.
  What does it mean? Very often my constituents have said, ``If you 
bring everyone in, isn't it going to cost more?'' It is almost 
counterintuitive, and yet we know, and the gentlewoman from Connecticut 
has done a superb job this evening with her charts, and graphs, and the 
quotes from the various studies about what universality will bring to 
every American.

  Some of our, perhaps, well-meaning colleagues are advocating what 
they call incremental health care reforms; in other words, small steps, 
baby steps, that then add up to something much farther down the road 
where they would reform the insurance market without having everyone 
participating in actually having health care coverage. Now an 
incremental or a small step approach may sound like a good idea, but in 
my view, and in many other professional views, make no mistake about 
it. It would be bad public policy. The supporters of this incremental 
approach want us to believe and the American people to believe that 
incremental means careful, that it means thoughtful, that it means 
cautious policy making, but in fact, when we take the veil away, when 
we remove the veil of this word ``incremental'' in not bringing 
everyone in under the tent, as the gentleman from Illinois [Mr. Durbin] 
said earlier, we find, and look at the findings of a recent study by 
Lewin-VHI, which is the largest nonpartisan--so for those who think we 
are making a partisan pitch here tonight, this is the largest 
nonpartisan health care research organization in our country, and the 
States that have implemented incremental reform, it becomes absolutely 
clear that this so-called reform is something that is half baked. It is 
incomplete policy making.
  Mr. Speaker, that is really what the report uncovers, and most 
important, it hurts the very people we are trying to help, and that is 
working, middle class Americans that either do not have health coverage 
now, and imagine working, paying taxes, playing by the rules and not 
having this. If I have it, and it works for me and my family, I ask, 
``Why shouldn't the families in my district have it?''
  Incidentally, I have a district, I represent a district, that many 
regard as extraordinarily wealthy, and there are many people in my 
district that are indeed wealthy and very blessed, but I also have and 
represent 88,000 working families, working families, not welfare 
recipients, but working families that do not have coverage at all 
today. They either cannot afford to buy it, or they have been knocked 
out of the market by these preexisting conditions.
  Mr. MILLER of California. Mr. Speaker, if the gentlewoman would yield 
on that point, I was reviewing the figures for my congressional 
district across the bay in the San Francisco Bay area from the 
gentlewoman's district, and I think the figures for my district were 
essentially the same, that there were about 85 percent of the families 
that did not have health care coverage insurance with members of 
working people--where people were working in the family, and I think 
about 20 percent of the uncovered individuals were children, and so 
what the gentlewoman is saying, even in her district, which I believe 
probably has a higher income per household than my district, that she 
has the same kind of situation where we have a substantial number of 
people in the district, tens of thousands of people in the district, 
that do not have that kind of coverage even though they are living in a 
household where somebody is working.
  Ms. ESHOO. I think what has become confused in the health care 
debate, and we have had a healthy one; anyone that says we need more 
time has not tuned into all the things that are going on in this 
country, including the Congress, but there are 13,000 children that are 
part of these families that have no health care coverage whatsoever.
  Again I think that there has been a confusion when we say people 
without health care coverage. Some might assume that we are only 
referring to the poor----
  Mr. MILLER of California. Mr. Speaker, if the gentlewoman would 
yield----
  Ms. ESHOO. Not that they should not be covered, and we want to bring 
them in and have them be part of all of this as well----
  Mr. MILLER of California. If the gentlewoman would yield, I see our 
colleague from West Virginia [Mr. Wise] on the floor who has raised 
this issue around employers, and small employers, and people providing 
and not providing health care coverage, and so what the situation is 
according to the Treasury Department, we have people in our district 
who are working every day, get up every morning, go to work, perform 
their functions, participate in the American economic system, except 
when they come home at night and they are all done with what they have 
provided their employer they do not have coverage.

                              {time}  1810

  So a person could work in my district, go to Pizza Hut, and they can 
work around hot ovens and wait on tables and clean up after people and 
provide the wherewithal for that Pizza Hut to make money, to make a 
profit as that company does, and yet they do not have it. And the 
person can go to work next door in a competing pizza parlor, and if 
that employer is responsible enough, that person can have coverage.
  So this is just the luck of the draw, apparently. Because we 
represent suburban districts where it is tough in the California 
economy, but essentially most people in our districts go to work every 
day, and yet they find themselves without coverage, simply through the 
luck of the draw of the job they went to.
  Mr. WISE. If the gentlewoman would yield, you are correct, and we 
will be talking about the employer mandate parts, shared 
responsibility, tomorrow. McDonald's, for instance, no insurance. 
Management personnel, yes. The folks that stand on their feet 8 to 10 
hours a day, do what society is asked, do not earn welfare, earn 
minimum wage or slightly better, serve the burgers, pizza, tacos, 
whatever, no insurance.
  The irony to that situation is it is bad business and economics. When 
they get their medical care, they will get it from the hospital at four 
times the cost, and we all as taxpayers will pay for it. So it is bad 
for the taxpayer, it is bad for the consumer. We save nothing by a 
lower price on a burger to the extent there would be an increase.
  Incidentally, the price of health care to most pizza parlors would be 
about the price of two or three extra pepperonis on the pizza. We save 
nothing as a consumer or a business person doing it that way.
  Mr. FARR of California. If the gentlewoman would yield, the 
Department of Treasury indicated in the district that I represent in 
California, which is typical of a lot of agricultural areas, rural 
areas, as well as a tourist economy, where you have a lot of small mom 
and pop businesses, we have 158,000 people that are uninsured. Now, 
that is about 20 percent of the entire region. That is almost what it 
is across this Nation. These are people that are not on the dole. They 
are working, 20 percent of them, or 80 percent of them, are working 
people without insurance.
  So what happens is, as was indicated here, that these people are in 
business where the competitor, who is providing insurance for their 
employees, is at an unequal level, unequal playing field. Indeed, I 
think when we talk about universal coverage, we talk about coverage for 
everyone.
  Mr. MILLER of California. What the gentleman is pointing out here is 
if you really want to look at one of the more effective groups that has 
been lobbying the Congress against universal coverage, against 
mandates, for some piecemeal, haphazard approach to insurance, it is 
really a group of employers who decided that they will, in an 
irresponsible fashion, not provide insurance to their employees, even 
though their competitor in the plumbing business, or in the tire 
changing business, or in the retail business, even though that 
individual, small business person, is providing insurance, they decided 
they simply will not do it. They simply will have people show up to 
cook their pizzas or sell retail goods or repair the appliances, and 
will simply not provide them with insurance.
  These people now have a national campaign to try and convince America 
that universal coverage is bad for America.
  What I do not understand is the place where we have universal 
coverage is among the elderly, and the elderly love it. You get 
coverage simply by the fact that you are 62 years old and under Social 
Security. And my mother, because of universal coverage, is able to go 
out when she is ill and choose her doctor, go to the doctor, the doctor 
can tell her if she needs to go to the hospital or have a test. She can 
do that, and it is taken care of.
  Who are these people who are trying to deny universal coverage to 
America when the largest class of people in the country, the elderly, 
have it, love it, would not give it up, and would throw all of us out 
of office if we tried to take it away? I don't understand this lobbying 
group that is being given such credibility.
  Ms. DeLAURO. The most incredible thing is that in fact it is a 
mandate on everyone else to pick up the tab for those who do not want 
to exercise responsibility and make it available. They are not going to 
pick up the entire tab. It is to allow there to be shared 
responsibility between employer and employee. Nobody is saying they are 
going to do the entire thing.
  Mr. MILLER of California. I think the gentlewoman is exactly right. 
This group that is lobbying us has decided that everybody else shall 
have to pay, and if they really get sick or their employees, they can 
go to the emergency room, the most expensive way to get medical care, 
and everybody else in society will pay, and won't, and they will pocket 
the differential.
  This is like the group of uninsured motorists lobbying America for 
their right not to have automobile insurance. In California a lot of 
people don't have automobile insurance, and people are upset because 
they are getting into wrecks with people without automobile insurance, 
and then they have to take it out of their insurance.
  What gives people the right to go around without insurance and, when 
you bump into them, they say, oh, you pay? This is the equivalency of 
an irresponsible motorist saying I am going to drive without insurance. 
If something happens, I will go to the county hospital, I will go to 
the emergency facility, and you will have to pay for your damaged car, 
for your medical care. I will go on my way. This is a group of small 
businessmen that the Congress is going to look up to and listen to when 
they lobby? It doesn't make any sense?
  Mr. FARR of California. Let me tell you another incident that 
happened in a town hall meeting, where a young woman came in with her 
two young children and indicated she was on welfare and would like to 
get off. Her youngest daughter has serious medical problems and has to 
be treated every week. She indicated to everybody in the room if she 
took the job offer, her young daughter wouldn't be able to get the 
medical insurance, and therefore she was in a dilemma as a parent. Does 
she provide for the one child by going to work and having a better 
income, and at the same time let the sick child suffer? She presented 
the dilemma to the audience. She said I am in a dilemma because of 
health care costs that I have to decide which child I want to give up. 
Nowhere in America should we have anyone faced with that kind of a 
problem.
  Mr. WISE. Last weekend I stopped at a fast food restaurant where I am 
sure the employees were not covered by insurance, it is a national 
franchise, and there on the counter top was a glass jar with a 13 year 
old's picture saying I have to have dialysis. This is what I need to 
save my life. Thank you for any support you can give.

  I checked with a Medicaid official, and it is the same situation. If 
that girl's parents are working, the chances are they are above the 
income level that qualifies for Medicaid, unless they spend down, 
unless they lose enough of their assets so that they then can qualify 
and trigger in. It is very likely they don't have insurance, so they 
are caught in this nether world that the gentleman so aptly describes. 
That is one of the things that universal coverage is all about.
  Ms. ESHOO. I would like to get back to what this Greek chorus that is 
chanting funereal sounds on the side of the stage, saying America's 
roof will fall in if in fact we have everyone under the tent. We are 
the United States of America, first of all, and we are so proud of 
that, and we salute the flag and say the United States of America, 
except for, and then fill in the blanks.
  The Lewin-VHI study that we have all quoted from this evening shows 
if we were to take this incremental reform that some espouse, it would 
force working families that make between $20,000 and $75,000 a year, 
which represents 60 percent of the families in our country, to spend 
more on health care. So as they keep saying that this is going to cost 
so much, just as those voices from the distant past when Social 
Security was debated, when Medicare was debated, they said the same old 
thing then, and they say that they are fiscal conservatives and that 
they are guarding the purse of the American people, they are not doing 
a darn thing for working middle class families. They are going to force 
them, by this incremental reform that they keep chanting about, into 
spending more for their premiums. And the study, this nonpartisan 
study, proves that out in its figures.
  So as we are seeking to continue to educate, both our constituents, 
frankly I think my constituents are the best educators in the world, 
because they keep stating over and over again what they want and how 
they think it should be done, and I really believe that the majority 
leader's bill that is emerging now really reflects what working 
families with the decent backbone in this country have stated over and 
over again they want. And it is not incremental. We know that that is 
going to cost more and do less. A universal approach where everyone is 
in, and, as I said earlier, to some seems counterintuitive, as you 
bring more in, some say it is going to cost more. No.

                             {time}   1820

  Just ask any major corporation in this country what they have been 
able to do by having more in their pool. Do you know what they have? 
They have market muscle. They can then go to the providers and say, we 
have 5,000 people here that we want to insure. Do you know what they 
get? They get lower costs because they have got the market muscle.
  If a 5,000 group can do it, look what we could do with everyone being 
brought into and under this tent with what we keep saying is universal 
coverage.
  Mr. MILLER of California. I think the whole point of universal 
coverage is built on the principles that we know is insurance in this 
country and basically throughout the rest of the world. That is that we 
are going to share the risk and that some of us are going to be 
healthier than others. Some of us are wealthier than others. Some of us 
will have a lot of children and some of us few children. Some of those 
children will grow to thrive and some will not. But we will pool the 
risk as a society.
  It is what bonds us together. It is what bonds us together as a 
nation, that we are prepared to share this risk, to drive down the 
costs so that most people can participate in this and when, 
unfortunatley, they need it, it will be there for them at that moment 
of need instead of walking around without the coverage and then 
throwing themselves onto either the public rolls, the taxpayers, or 
unreimbursed costs.
  Ms. DeLAURO. I would like to thank my colleagues for joining tonight. 
We will spend many more hours on this floor in the pursuit of this 
issue.
  I went to speak today at the Health Security Express, those folks who 
have come cross-country fighting every single day and talking about 
health care, making it real for people.
  As I left that hall today, a woman in a wheelchair stopped me and she 
said, ``I will fight as hard as I can.'' and I said to myself, we need 
to fight as hard as you are fighting.
  Second, there was a gentleman on that bus who lost his wife several 
days ago. She had stomach cancer. No health insurance. He got aboard 
that bus to come cross-country to talk to us about passing health care 
reform.
  That is the grit that is out there. We have to match that here in 
passing universal health care for every one in this Nation.

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