[Congressional Record Volume 140, Number 106 (Thursday, August 4, 1994)]
[House]
[Page H]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: August 4, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
            THOUGHTS ON THE VARIOUS HEALTH CARE ALTERNATIVES

  The SPEAKER pro tempore (Mr. Torres). Under the Speaker's previously 
announced policy of February 11, 1994 and June 10, 1994, the gentleman 
from Indiana [Mr. Buyer] is recognized for 60 minutes as the designee 
of the minority leader.
  Mr. BUYER. I thank the Speaker.
  This is a wonderful opportunity for me to address the House. Last 
week I took the House floor, along with my colleagues, to identify 
approaches to health care and spell out specifically why the approaches 
of some of those who are advocating the Gephardt bill, who want to lead 
this country to a complete Government takeover of health care, would 
lead to rationing and to poorer quality. I have to admit that having 
watched the President's press conference last night, I do have to speak 
of a tremendous disappointment, a disappointment in what the President 
had stated: ``Where is the Republican alternative?''
  The President must be ill-served by some members of his staff. 
Congressman Michel introduced his proposal in September of last year, 
nearly 3 months before we had legislative language of the President's 
proposal to even debate. It had 140 cosponsors, more than the 
President's plan of 103, more than the single-payer plan of 88 
cosponsors.
  So I would say that last night it might be that the President would 
rather play blame-game to hide the inadequacies and inefficiencies of 
his own legislative abilities to move forward his own plan. The botton 
line, Mr. President, for which you are not getting the message from the 
American people is they do not want a Government takeover of health 
care. In the debate, actually it really was not a debate, last week, 
just as tonight, the Democrats went first in a special order for 1 hour 
and we followed for another hour. Tonight they went for an hour and we 
followed for 1 hour.

                              {time}  1720

  Last week it was my good friend from South Carolina that said from 
the other side of the aisle, ``Let's not fool the American people.'' 
Boy, do I agree with that statement, ``Let's not fool the American 
people.''
  Those whom I respect in this debate are those who say what we need 
for America is a single-payer plan. I respect them because they do not 
finesse it, they do not wiggle it, they do not waggle it. They come 
right out and say, ``We think the government can run it better.'' They 
do not even finesse it. They are honest about it.
  The ones that the American people should be frightened of are those 
who finesse it, who wiggle it, and even spin it, saying, ``Well, we're 
going to look out after you, the small business people. We're going to 
look out after you, the middle class.''
  Well, I say to my colleagues, Whenever you put big government, big 
business and big labor bosses in the same room, middle class, look out, 
here it comes.
  What I would like to do here tonight, Mr. Speaker, is address what 
the President said he had not seen. Well, I say to the President, I 
know that those of you in the White House are watching. Listen to what 
we would like to propose. You know it's been out there a lot. Those of 
us who believe that you are about to lead America on the wrong path, we 
support substantive incremental reforms in the present health care 
system to preserve the quality and to also preserve the freedom of 
choice of alternative methods of treatment and medical facilities.
  What Congress can and should be doing to move a system that has 
coverage of Americans between debate it between 85 and 87 percent; if 
we want to move it forward to coverage of the 94 to 95 percent, there 
are things that we can do within the present medical system we have in 
this country without having Government intervention or government take 
over health care. The Congress can have insurance market reforms to 
address the affordability and preexisting conditions. We can move to 
greater risk pooling, to voluntary alliances. We can have the Medisave 
accounts. We can move with real tort reform and, that is, medical 
malpractice reform initiatives. We can move forward in issues of tax 
fairness. Those big-C corporations get to deduct 100 percent of their 
insurance premiums. Why not subchapter S corporations, sole 
proprietors, and partnerships? And also expanding the access into rural 
health care initiatives and also community health care hospitals and 
clinics?
  There are many things we can do. Let me first address insurance 
market reforms.
  I have to cite, if my colleagues recall, to win public support for 
the President for his health reform initiative he came here into the 
Congress, and he sought out and publicized health care horror stories 
of, quote, average Americans. Since announcing their plan last 
September the Clintons have invited carefully selected groups of 
citizens to share their heartrending stories at various forums and town 
meetings. They have depended heavily on the anecdotal evidence to 
persuade the Nation that there is truly the crisis of health care for 
which only government can provide the support and initiative. The 
Clintons' cases are intended to show the arbitrariness and inadequacies 
of the current system, but on further examination paint rather a 
different picture of our health care situation. I would like to share 
with my colleagues the case of the Andersons.
  The President claims that health-care reform is necessary because 
current medical costs are destroying the finances of many American 
families. To illustrate his point, he told the story of Richard 
Anderson in his first State of the Union Address. A few years ago 
Anderson was working as a parts salesman at a car dealership in Reno, 
NV, where he had health-insurance coverage for himself and his wife at 
a cost of just over $40 a month. Then, as the President described it, 
Anderson ``lost his job and, with it, his health insurance. Two weeks 
later, his wife Judy suffered a cerebral aneurysm. He rushed her to the 
hospital, where she stayed in intensive care for 21 days. The 
Anderson's bills were over $120,000. Although Judy recovered and 
Richard went back to work, the bills were too much for them, and they 
were literally forced into bankruptcy.''
  That is what the President told this body and the Nation.
  The actual course of events is considerably more complicated. First, 
despite being fired, Richard Anderson had the option of continuing his 
health insurance through COBRA. His wife was still employed, but they 
decided that they could not afford the investment of $240 a month even 
temporarily while he looked for another job. Even without insurance, 
the Andersons agree that Judy got excellent care during her emergency. 
Moreover, they weren't exactly forced into bankruptcy.
  A closer look at the hospital, they maintain a fund to reimburse 
hardship patients. Families earning up to 150 percent of the poverty 
line can apply for a total remittance of their debt. Families earning a 
bit more, up to 175 percent of the poverty line, can apply for a 50-
percent reduction in the bill and set up a long-term repayment plan for 
the rest. According to hospital records the Andersons were sent two 
applications for the fund, but they failed to use them. They chose 
bankruptcy instead because it was the least costly of their options and 
was an added benefit because it also wiped out their consumer debts 
with J.C. Penney's and Mastercard.
  The reason I took the time to go into this is because, as my 
colleagues know, we can do all kinds of things in here in the Congress, 
but, as my colleagues know, we cannot legislate personal 
responsibility. If the government wants to come in and take over health 
care, we cannot legislate personal responsibility. But I tell my 
colleagues what we can do though.
  When we get out there and ask about universal coverage, people have 
terrific concerns about the issues of portability and preexisting 
conditions. We can address that without government taking over health 
care.
  I would like to yield to a gentleman who is with us who has a 
district that is 30 miles from Chicago's Loop in western Du Page County 
in the 14th District of Illinois which also contains the Fox River 
Valley with the industrial cities of Elgin and Aurora. He is the leader 
of the Republican health care task force, and I am pleased to welcome 
him to this special order, the gentleman from Illinois [Mr. Hastert].
  Mr. HASTERT. Mr. Speaker, I appreciate the gentleman from Indiana 
[Mr. Buyer] having this order. I think it is certainly timely, and it 
is timely to really look at these issues in depth and try to lay them 
out because what the American people really want are some choices, and 
I have to hand it to the gentleman from Indiana. Not only has he been a 
leader here on the House floor in trying to get these issues out, but I 
had the privilege of traveling through his district and talking to some 
of his folks about health care concerns, and he certainly has been in 
touch with his district, and the people who make the economic wheels 
turn in that district, and the people, just common folk, who need 
health insurance and certainly want to see it change.

  I see one of the things that we want to talk about here tonight is we 
think there needs to be some change in health care. As a matter of 
fact, Republicans about 3 years ago looked at the situation, and we saw 
rising health care costs, and we saw folks that did not have 
portability because they could not move from job to job and make sure 
that they had health insurance, and we saw the problem with preexisting 
conditions.
  I say, if your daughter has juvenile diabetes, and you lost your job, 
or you wanted to go to a better hospital, you were tied to the job you 
were at because you probably couldn't get insurance at the next stop.
  Mr. Speaker, we felt those were real problems and started to try to 
find ways to solve those problems. I started working on health care in 
this Congress long before we ever knew that Bill Clinton was going to 
be President. But I have to hand it to the President. He has escalated 
the discussion and the debate, and it is to the point now where we 
really have to come down and make tough decisions, and most people in 
this country want to make sure that they can maintain the choice that 
they have in health care and they can maintain the quality that they 
have in health care, and I say to my colleagues, they just don't have 
the confidence that Government could take over their health care 
programs, the Government could take over their health care policies and 
that government could take over the health care delivery system and 
folks would still get the quality and the choice that they have today.
  As a matter of fact, Mr. Speaker, I have had a couple folks tell me 
that they are afraid that they are going to get health care quality 
which has the expediency and efficiency of the Post Office and the 
compassion of the IRS, and I think maybe that is what happens when 
Government takes over a huge delivery system that people have to depend 
on.

                              {time}  1730

  So, what are we going to do? What are our options.
  One of the things when we lay out parameters of health care, we want 
to ensure access to health care for every American. I think we share 
that goal with the President. We want to contain costs. We have to do 
that, because we cannot afford, for our public debt and the Government 
financing, to see costs go up and escalate up and out.
  It was interesting to hear the gentleman from West Virginia in the 
previous special order talk about when we brought Medicaid in in 1965, 
and the prediction was in 1965 that the cost of Medicaid to the Federal 
Government in 1997 would be $9 billion. I tell you, folks, that cost 
has escalated, because in 1997 we think that costs will be closer to 
$121 billion when you start to look at all the medical costs that the 
Federal Government has to pick up and the private sector has to pick 
up. That is a huge expansion.
  So what we do now in what seems to be minuscule proportions ends up a 
huge burden on our next generation, on our children's backs and our 
grandchildren's backs. So we have to be very careful of what we do.
  But even more important, on the local and more timely basis, is how 
do we start to change the health care system so it helps small 
businesses, so it helps people that do not have insurance today, so it 
helps those people who have shouldered that burden of carrying their 
own insurance, picking up the cost of their insurance, and not having 
that provided necessarily by the place where they work.
  Who are the people? We have heard that number, 37 million people, not 
being covered by health care. I think that is a number that has been 
put out by HCVA. We see that number thrown out there all the time. But 
we first have to ask, who are they? You really start to see who they 
are.
  First of all, a big group of those people are people who own their 
own businesses. They are mom and pop barbers, truck drivers, farmers, 
beauticians, real estate agents, entrepreneurs. And when they go to the 
market to buy insurance as one or two people, they may have to pay 
$5,000, $7,000, $10,000 for health care. And when they have to do it, 
and they are earning $25,000 or $30,000 or $35,000 in a partnership or 
proprietorship business at the corner donut shop, all of a sudden they 
cannot afford health care.
  We have to let those people pool with other groups like themselves so 
they have a group to go to the market so they can buy good, low cost 
health insurance. That makes sense. It is a common sense approach.
  Who is another group of those people? They are folks under 26 years 
of age. When you talk to a young person under 26 years of age, just out 
of college or just out on their own trying to make their own way, a lot 
of those folks do not think they are going to die, let alone get sick. 
So how do you start? They need good, low cost catastrophic insurance. 
They need to be able to extend their folks' health care policy as a 
rider to stay on the policy, and not go out there without insurance.
  The other group are people who work for a living. That is about 10 to 
11 million people. They fall through the cracks. They are not covered 
by Medicare or Medicaid. What they do is they earn a living. They are 
under 100 percent of poverty, and not covered by insurance. Yet, they 
are folks who go to the hospital, wait until they are very sick to get 
care, and the emergency room costs and the costs of health care for 
those folks are very, very expensive.

  So when they cannot pay, hospitals charge everybody else about 140 to 
160 percent of the real cost of services to cross-subsidize or cost-
shift for this 10 or 11 million people who have had a hard time paying 
for insurance, still need health care, providers give them health care, 
and then cost-shift to pay for it. So we need to address the needs of 
those people.
  So I think when we start to calculate how do you do these things, one 
of the things we probably ought to do is reform Medicaid by giving 
Medicaid recipients the same choices as other Americans. We can 
privatize those billions of dollars that we send out to States into 
health care providers and huge bureaucracies and say let us let the 
private sector start to deal with this. Let us let the market bring 
down health care costs.
  Another thing we need to do is give those small business people a 
chance to have 100 percent deductibility. When they go out and buy 
their insurance, just like any other business, but they have zero 
deductibility, that is wrong. It is not fair. So when a barber or truck 
driver or shoe salesman that owns his own shop goes out to buy 
insurance, he ought to have deductibility.
  If that small business is a start-up business, and they have 
employees who have to buy their own insurance, they ought to get 100 
percent deductibility, too. But what we do not want to do is to put a 
huge government mandate on small businesses, the start-up businesses.
  In my district, and I think the gentleman from Indiana's district, 
they are very similar areas, we found that 70 percent of the new jobs 
created in the last year and a half are jobs that were created by small 
business, start up businesses, entrepreneurs starting up. When you 
start up with a business with a mom and pop organization or three or 
four people, and you are trying to make a payroll, maybe you cannot 
cover all those huge benefits. But shall we say we are going to put a 
mandate on those businesses, and say either you give health care or 
close down?
  In my district, we would lose thousands of jobs. In the State of 
Illinois, we would lose 142,000 jobs, mostly on the back of small 
business, if we put out a health care mandate on small businesses.
  Not only is that unfair, that is not smart. So we need to find the 
answers. I have always said, if we are going to pass health care in 
this country, Republicans cannot do it by themselves, and Democrats 
should not have to do it by themselves. We ought to do it on a 
bipartisan basis. We ought to bring the best ideas from both parties 
together. We ought to meet right over there in the middle aisle and 
come up with a good health care plan that we can present to the 
American people, that the American people can be proud of, and that 
represents mainstream America, not one end of the spectrum or the other 
end of the spectrum.
  So I really appreciate your taking on this special order tonight. I 
know that some of your colleagues are here and have done a lot of work 
on this issue as well. It is going to be an interesting couple of 
weeks. But I think what the American people ought to know, they ought 
to be able to read what those health care bills have in them, they 
ought to be able to digest what those health care bills have in them, 
and they ought to know how it affects them before they let their 
Congressmen and Senators know what kind of bills they want for their 
future and their children.
  So I thank the gentleman from Indiana immensely.
  Mr. BUYER. Reclaiming my time, I appreciate your comments. You could 
not be more right on point. I am a Member of the body who is expressing 
a disappointment that the Gephardt bill would be introduced to the 
body, knowing that it would not receive any votes from the Republican 
side.
  Why would you introduce a bill that is only going to deal with one 
side of the body? I think that that is wrong, that we should come 
together in a bipartisan fashion. And applaud your efforts to meet with 
those on the Rowland-Bilirakis and Cooper-Grandy to draft a bipartisan 
bill that will have a tremendous amount of substance for the 
incremental reforms to the President's system, without going out and 
having a complete brain transplant and revamp a whole new system.
  Something, Mr. Hastert, that you had mentioned about having these 
reforms to the private system without governmental controls, are you 
stating that a substitute bill that is being drafted right now is 
expanding insurance coverage without price controls or mandates and, if 
so, we are talking about moving access and moving coverage from 85 to 
around 91 percent? That is attainable, is it not, Mr. Hastert?
  Mr. HASTERT. I think we can do better than that. I can't give you 
exact details of the bill, because it is still being drafted and some 
things are still being negotiated. What we are trying to do is build a 
bill that does not have mandates in it, that lets business work its 
will, take care of its employees the best they can, give everybody a 
chance to get insurance who are not covered at their workplace, and at 
a low cost, a fair way to do it, those people who cannot afford 
insurance and are below 100 percent of poverty, to get some help on a 
free market way to do that, and then to move forward and say I think we 
can get by the year 2004, or sometime out there, up to a coverage of 95 
percent coverage.

                              {time}  1740

  I think that is fair to say. The Lewin Group, who does a lot of 
number crunching around this city, has said about the same thing. So I 
think we can achieve it. We are not there yet. But I hope we will be by 
the end of this week or the first of next week. And that bill comes 
out, the American people can take a look at it.
  Mr. BUYER. The Lewin-VHI agrees not only with what you said, but they 
agree with the CBO that three basic reforms would cover 91 percent of 
the population. That is insurance market reforms, the 100 percent 
deductibility for individuals and the self-employed, and then the low-
income premium subsidies, up to 200 percent of the poverty level. We 
are talking about doing much more than that, about the greater risk 
pooling and Medisave accounts, tort reform, the expansion of community 
health centers and rural health care initiatives and many other things. 
So I appreciate the gentleman's contribution.
  Let me, since we just mentioned Medisave accounts, let me yield to 
the gentleman who represents the 10th district of Ohio, an industrial 
base of sound minded people who are pragmatic and family-oriented, that 
is the gentleman from Ohio [Mr. Hoke].
  Mr. HOKE. I thank the gentleman for yielding time. I really thank the 
gentleman from Indiana very much for his leadership in putting together 
this special order. It is in fact something I really like to talk 
about, the medical savings accounts, because I think that of all of the 
different plans and ideas that have been presented to the U.S. Congress 
and presented to the American people, probably medical savings has the 
greatest promise for actually having a real impact on the way that 
medical health cared or medical services are delivered to the American 
people.
  I will tell you why. Because the thing that is driving this debate 
more than anything else is not quality; it is not access. In fact, it 
is cost. The reason for that is that we have gone from spending 5 
percent of our gross domestic product on health care in 1960 to 
spending 15 percent and more in 1994. In other words, we have tripled 
the amount of resources that are going to health care over the past 30 
years. Why is that? How is that possible?
  Because remember when we talk about health care and we talk about the 
problems with respect to health care, we are talking about a three-
legged stool. One has to do with access; one has to do with quality, 
and the third has to do with cost. In this country the debate does not 
really focus on quality. There is large agreement that we do deliver 
the best quality health care in the world. There is some debate about 
access. Even though it is true that nearly 86, 87 percent of the 
American people have health care coverage and, in fact, it is also true 
that everybody who presents to an emergency room must be cared for, 
because of legislation that was enacted by this Congress, nonetheless, 
not everybody has access, certainly to preventative care or to care 
with dignity in this country. There is a debate about that.
  But about which there is no question is the debate that goes on over 
cost. And the really insidious problem with respect to cost is that 
because costs have skyrocketed so much, it makes it impossible for, it 
squeezes out those people that are least able to afford health care 
from the system. So what is the solution? Is the solution more third-
party payment and more Government payment? Or is there a different 
solution?
  I would submit to you that the reason that we have skyrocketing costs 
with respect to health care is that we do not have a market for it. And 
the way that you best test that notion is by recognizing that none of 
us, none of us actually pay for our own health care. We do not pay for 
it ourselves personally. And becoming alienated from the function of 
actually buying the health care is at the nub of the problem. Who pays 
for the health care?
  Well, 90 percent of the health care in this country is paid for 
either by insurance companies or by the Government. In other words, we 
personally do not pay out of our own pockets. It is paid by third 
parties.
  What is the effect of that? The effect of that is that we have lost, 
in this case, 183 million drivers, those that are covered personally by 
private insurance, we have lost the power of 183 million drivers of 
price in this marketplace.
  And for those of you who think that perhaps this is not a perfect 
market, and we cannot apply market principles to health care, let me 
give you one example where it worked so very, very well, that health 
care costs are not covered by insurance. This is in the area of 
something that most of the people in this Chamber looking around are 
familiar with. It has to do with eye wear. It has to do with the 
correction of vision, clearly a health problem, and yet something that 
is not covered generally by insurance.
  It is something that we have to pay for out of our own pockets. What 
do we have in terms of the choices that are available for eye wear? We 
can go to optometrists. We can go to an ophthalmologist, or we can go 
to opticians. We can go to any mall in the country and get eye wear 
provided for us. And what has happened with respect to price? With 
respect to price, we have got an incredible record. Glasses have 
remained flat in inflation adjusted terms over the past 30 years and 
contact lenses have gone dramatically down in price over the past 30 
years.
  Mr. BUYER. In your discussions about bringing innovation into health 
care reform, in your discussion about the Medisave accounts, let us not 
forget that it was Pat Rooney of Indiana who runs the Golden Rule 
Insurance Co., that came up with this idea of injection of personal 
responsibility back into the health care equation.
  I agree with the gentleman from Ohio when he says that we are 
distancing ourselves from the responsibility when we just receive the 
bill and send it off to an insurance company and not worry about what 
the cost is.
  So right now that is what is happening. Employees elect a high-
deductible, low-cost policy. Employers deposit the funds into an 
account for employees to cover routine medical bills. That is what we 
want to do. That is the Medisave accounts. The Golden Rule Insurance 
Co., deposits $2,000 a year into a medical savings account for 
employees who choose a $3,000 family deductible. Employees at Golden 
Rule have an option of a traditional policy with a $500 deductible and 
a 20-percent copayment up to a maximum of $1,000.
  In 1993, 80 percent of the employees chose the medical savings 
account option. In 1994, the number is up to 90 percent who have chosen 
this Medisave account option. In 1993, the Golden Rule health costs 
were 40 percent lower than they otherwise would have been. Critics 
claim that medical savings accounts will not incentivize individuals to 
invest in preventive care. However, experience at Golden Rule shows 
just the opposite.
  Of those employees who use the medical savings account, 1 out of 
every 5 used their medical savings account for a medical service they 
would not have purchased under the traditional insurance plan.
  Mr. HOKE. I appreciate that. That is right. Mr. Rooney has shown a 
lot of leadership in this area. The Golden Rule Co., has used, and they 
have used medical savings accounts without having the tax advantages 
that would be a part of the plan that is in the Republican leader's 
health bill as well as in the Medisaver Patients Empowerment Act.
  I would like to just explain on a very graphic basis exactly how a 
medical savings account works. It is a fairly easy concept. Right now 
the average amount of money that is spent on the average family plan in 
the United States for medical insurance is $4,500, $4,500 on average. 
Some plans are a lot more expensive; some are less expensive. But if 
you have got $4,500, what a medical savings account plan does, what 
Medisave would do is take, of that $4,500, $1,500 to purchase a high 
deductible comprehensive health insurance policy. That is what we are 
trying to do with self-insurance. We are trying to eliminate the 
anxiety that comes from believing that we might get wiped out 
financially.
  So we take $1,500, buy a health insurance policy with a high-
deductible amount. The deductible amount in this case is $3,000, a 
$3,000 deductible. We take the cash, the $3,000 that is left over from 
the $4,500 after the $1,500 is spent on the catastrophic or the high 
deductible insurance policy, and we put that $3,000 into a medical 
savings account.
  From that medical savings account, each individual can draw down for 
whatever purchases, medical purchases he or she chooses for his or her 
family, and up to the amount of the $3,000 would come directly out of 
the savings account. Any money at the end of the year that is left over 
would belong to that individual. It does not go back to the company. It 
does not go to the insurance company. It does not go to the Government. 
It actually belongs to the individual. There is a tremendous financial 
incentive to make rational cost conscious choices.
  Mr. BUYER. I thank the gentleman for his contribution. Medical 
savings accounts, says a study by the Cato Institute, would lower the 
Nation's annual health care bill by $300 billion and reduce 
administrative costs by $33 billion.

                              {time}  1750

  That is a tremendous number.
  Where the Great and Little Miami Rivers drain south in Western Ohio 
sits the 8th district, represented by the gentleman by the name of John 
Boehner.
  I yield to the gentleman from Ohio [Mr. Boehner].
  Mr. BOEHNER. I would like to thank the gentleman from Indiana for 
yielding time, and I would like to thank him for his efforts in putting 
together this special order and for his leadership on this issue.
  Mr. Speaker, I come to the floor tonight to take part in this as a 
former small businessman, as a matter of fact, as someone who still 
owns part of a small business back in Ohio, in trying to look at what 
is going on here in Congress with regard to health care from the 
viewpoint of a small business person trying to succeed in America.
  If we begin to look at the Clinton bill, Clinton-Gephardt bill, the 
Clinton-Mitchell bill, you will see that the central pain feature to 
pay for those bills is the employer mandate. It has been estimated by a 
number of research firms that that employer mandate will cost 
Americans, 1 to 3 million Americans, their jobs.
  For those Americans who do not lose their jobs, they are going to see 
their wages reduced, their fringe benefits reduced, as a result of this 
requirement to make employers pay. Some 25 million American workers are 
estimated to be in this category that may see their wages not increase 
as fast as inflation, or their benefits reduced.
  Companies that can pass along this increasing cost are going to do 
that. What does that do? That is nothing more than a tax on consumers, 
because it causes consumers to go out and consume those goods and 
services the companies provide, and they are required to pay higher 
prices because of this mandate. It is nothing more than a tax on them 
because of it.
  Small businesses in America that currently do not offer health 
insurance would love to be able to do so today because it makes good 
business sense, and it makes good business sense today because if you 
want to be successful, we all know the key to a small business 
succeeding are the employees that they are able to keep on their 
payroll, because it is not the owner of the business that makes it 
successful, it is the employees that they have that make every company 
in America as successful as they are.
  If they could do it, they would, but the reason they are not is, very 
simply, there are a lot of marginal businesses in this country. Think 
about your local dry cleaner, think about the local grocery store 
owner, or maybe the local gas station, that is being hit not only with 
health care mandates and employer mandates, but being hit by the Clean 
Air Act and other laws and other agencies of the Federal Government 
forcing up their costs.
  To compound this problem, Mr. Speaker, or to solve this problem, I 
should say, what the Clinton folks and the Gephardt folks and the 
people over in the other body want to do is to offer subsidies to small 
employers, because they know if they have an employer mandate, it is 
going to have a devastating impact on employment in America, so they 
want to overcome this by giving subsidies to small employers.
  Where do these subsidies come from? They come from the taxpayers. 
Either we are going to raise taxes or we are going to cut spending, but 
when it is all said and done, it is going to come from taxpayers, many 
of whom are small business people in America.
  The second point I would make about subsidies is this promise: We are 
going to subsidize this. It is not going to really cost you very much. 
That is what we say, but what is going to happen next year when the 
budget crunch gets a little tougher? What is going to happen the year 
after?

  We all know what the history of promises from Congress are. We can 
all look 5 years down the road, 7 years down the road, and realize 
those subsidies are not going to be there and the employer is going to 
get stuck with the bill.
  The third point I make about subsidies is the fact that they are 
based on the size of a company. I do not know that it makes any sense 
to say that just because you have 10 employees, that you are more 
marginal than a company with 100 employees. You just may not be as 
large.
  In my company, we had five employees. We were very successful. 
However, there are a lot of companies much larger that were in a much 
more marginal situation.
  As we begin to look at the Clinton-Gephardt, Clinton-Mitchell plans, 
I think they have very serious problems from the viewpoint of a small 
business person. What is the alternative? I think the alternative, 
based on the Rowland-Bilirakis bill, would greatly assist small 
businesses in providing health insurance to their employees without 
mandates and without new taxes.
  We would do this in several ways. First, we would allow small 
businesses to more easily group for the purposes of self-insuring, 
pooling their resources, pooling their risk, in order to bring their 
costs down.
  If you are a small employer with 5 employees or 10, and you go to an 
insurance company and ask for a group policy, they laugh at you, 
because if you have anyone in that risk pool of 5 or 10 employees that 
has any kind of a health problem, it is going to put the rates out of 
reach for most employers. So by expanding the risk pool, we bring 
better rates to more employers. It is going to entice more employers to 
provide insurance for their employees.
  Second, Mr. Speaker, we deal with those with preexisting conditions 
through a modified community rating system. A lot of these employers 
have an employee or an employees spouse or child that has a preexisting 
condition that puts their costs out of control.
  If we solve the problem with preexisting conditions, as we do in the 
bipartisan approach, we, again, make it cheaper for small employers to 
find insurance for their employees.
  Third, we change the Tax Code, so that the self-employed who today 
can only deduct 25 percent of the cost of their health care insurance 
premiums would be able to deduct the full cost of those premiums. Why 
is this important? If you are a corporation of any sort, you are 
allowed to fully deduct the cost of health care for your employees and 
yourself. However, if you are a partnership, a sole proprietorship, if 
you are a farmer, you can only deduct 25 percent of those premiums. It 
is discriminatory.
  Therefore, if we put in 100 percent deductiblity for employers, it is 
going to entice more of those small employers to in fact be able to 
offer insurance to their employees. This type of approach, based on the 
market, based on having faith in the free enterprise system, we believe 
best delivers more health care to more Americans as opposed to the 
Clinton idea.
  We all know the Government is too big and spends too much. We all 
know clearly that, as we see in the Clinton bill that has been around 
for the last 9 months, we all know that is going to do nothing more 
than make Government bigger and make it more expensive.
  The American people are trusting us to do the right thing with their 
money. The American people have a certain cynicism about Government. 
They have heard about welfare, they have seen welfare not work. There 
has been a lot of promises given, but very little in the way of results 
that have been received by average Americans.
  Therefore, as we begin to debate the health care issue, we begin to 
move forward, I would urge my colleagues to do what the American people 
want. That is trust them and to put these decisions in their hands, and 
not in the hands of bigger and more expensive Government. I thank the 
gentleman from Indiana.
  Mr. BUYER, I thank the gentleman from Ohio for his contribution to 
this special order, from the perspective of a small businessman.
  We have discussed so far initiatives in which we seek in a bipartisan 
fashion substantive incremental reforms in our present system to 
contain costs, open up access in health care, we discussed insurance 
market reforms, medisave accounts, tax fairness.
  We also, let me talk for just a moment on greater risk pooling. What 
we seek across America are voluntary alliances. In northwest Indiana 
there is a health alliance. A group of employers in Lake, Porter, and 
LaPorte Counties in northwest Indiana have voluntarily joined together 
to gain market clout to buy health care coverage for their employees. 
Right now there are 340 employers who are in this alliance who enjoy 
savings of around 10 percent, which is extremely important. These 
employers are gaining access through innovation for occupational 
medicine programs and other medical programs. Employers in Porter 
County are already enjoying savings, like I said, of even 10 percent, 
50 percent on occupational health. One of the obstacles the alliance 
faces is the area of employers with employees with preexisting 
conditions.
  That is why what we seek to do here, in a bipartisan bill, would be 
to address the preexisting conditions and portability, so when we have 
businesses out there who want a risk pool and provide greater coverage 
for their employees, allow them to do that, and at the same time, let 
us stop this discriminatory practice that is going on and the cherry 
picking on portability and preexisting conditions.
  There are many of them across the country, from California to 
Cleveland, OH, and even Minnesota's Business Health Care Action Group, 
a purchasing group of 21 employers, reduced its members' insurance 
premiums by 10 percent.

                              {time}  1800

  There are many things that we can do rather than, as the gentleman 
from Ohio said, let government take over health care. Government is 
already becoming too big, too large and too intrusive in the daily 
lives of the American people.
  I would like now to yield to the gentleman who represents the Gold 
Rush counties in the foothills of the Sierras above Sacramento, CA. 
That district has truly produced a statesman with concerns for his 
constituents in California, and that is John Doolittle, to discuss 
universal coverage, what it really means.
  Mr. DOOLITTLE. I thank the gentleman for raising this very important 
special order and giving us the opportunity to comment on some of the 
fundamentals of health care reform.
  Earlier today I mentioned a quote by President Washington, and I 
would just like to reiterate what the gentleman from Ohio [Mr. Boehner] 
said: ``Government is too big and spends too much.''
  President Washington said it a little differently but basically the 
same way:

       Government is not reason, it is not eloquence, it is force, 
     and like fire it is a dangerous servant and a fearful master.

  We could substitute today perhaps for ``government'' the word 
``Washington.'' Washington is not just eloquence, it is not reason 
obviously by what we see going on in the Halls of Congress each day. It 
ultimately is backed up by force. Whatever we do to pass a law involves 
the use of force and here the Clinton administration is talking about 
doing something with force that could be very, very detrimental to 
every American. I would like to talk about that.
  I would like to also quote the junior Senator from West Virginia just 
to indicate that these people are serious when they talk about they 
know what is best for you and they are going to cram it down your 
throats whether you like it or not. Here is the quote:

       We are going to push through health care regardless of the 
     views of the American people.

  I would submit, Mr. Speaker, that is what is going on right now 
during the next 2 weeks.
  These health care bills are about 13,000 to 1,500 pages long. They 
are extremely complex. Yet we have not even seen, we cannot even read 
the bill that the House of Representatives is supposed to consider. 
Why? Because it has not been written yet. Why? Because they are doing 
horse trading in the so-called proverbial smoke-filled rooms looking 
for that 218 votes, the magic majority. You can imagine what kind of 
sausage will be crafted in that sort of circumstance. Yet this is a 
process that is going to impact \1/7\ of our national economy and will 
affect something that most of us hold near and dear, namely, our own 
health care and that of our family and friends and loved ones. That 
sets the stage by simply sharing the views of the junior Senator from 
West Virginia.
  In yesterday's Washington Post, Mr. Samuelson who I believe is a 
Democrat, a more liberal person, writing for the Washington Post, made 
this observation. I would like just to share it because it has been 
spoken of before here but we as a Nation need to recognize what is at 
stake and what the problem really is. Before you offer a cure as a 
physician to someone's ailment, you better have a proper diagnosis. I 
would submit that the Clinton administration has misdiagnosed what the 
problem is and they are about ready to prescribe a cure that, far from 
helping the patient, could kill the patient and certainly will make the 
patient much sicker. Here is the quote:

       Health spending is not at the edge of the entitlement 
     problem. It is the essence of the problem. Runaway health 
     spending is the central problem--and it will get worse with 
     time.

  My colleagues on the opposite side of the aisle talk about the 
Medicare program and how great it is. This is a program that has 
tremendous problems paying for itself. We have hiked the taxes at least 
twice since 1986 in order to deal with this problem and we still have 
not dealt with it and under the Clinton proposal, we are going to 
expand it a great deal more, because we are going to mandate costs, we 
are going to pass a law that says every employer has to provide health 
insurance and then we are going to put a program together that figures 
out how we are going to cut here and so forth in order to pay for this. 
Figure what this means.
  Steven Robinson in another article, I am just going to take it down 
briefly to what it means for the average individual.
  He explains that in order to deal with cost-shifting, which we 
presently have right now, Medicare reimbursement rates to doctors and 
hospitals are about 45 percent to 55 percent of their normal charges. 
So how do they make up for it? They charge everybody else with private 
insurance more. That raises everybody else's costs. In order to deal 
with that problem, universal health coverage has been proposed. That 
means we have got to deal with a way to help people afford the premiums 
for those who cannot afford it, and that costs a certain amount of 
money. It actually costs under our projections $22 billion. Then the 
increased utilization which results, because now these people who do 
not have health insurance wait, they ration themselves. They cannot 
afford it, so they do not go as often as they otherwise could. But all 
the studies show, and we have seen this with the entitlement programs 
we have now, once you create an entitlement, once something becomes 
free you use more of it. Therefore, the projected increases in 
utilization is $39 billion.
  As Mr. Robinson observes, what you end up doing in order to deal with 
saving, the cost of eliminating $29 billion in cost-shifting is going 
to be $59 billion in taxpayer money. It does not make sense. It is not 
businesslike.
  What does that mean for the average family? For every person in the 
country, it means an extra $316 per person to pay for this. Universal 
coverage will force the government to seek ways to contain costs. That 
means we are going to get price controls. It will also result in 
rationing when the price controls fail to do the job, and we have 
rationing now in the great Canada, which is always cited as the 
example.
  What the means for the average family is that we are going to tax 
them more, $316 per person. What are the statistics about taxes already 
in this country?
  The average family of 4 with a median income pays 24 percent of its 
total income to the U.S. Government in taxes. Now we are going to take 
$316 times 4 and add it on to the tax burden of the average family.
  Oh, yes, if I had time I would go in here and quote Mr. Samuelson 
further. When you really project out these costs, you heard the 
gentleman from Illinois [Mr. Hastert] explain what is happening to 
Medicare, the costs have increased manyfold. It is reasonable to 
project that that is what will happen here and the debt, which is $4.5 
trillion today, which is going to be $1 trillion more under President 
Clinton's 5-year deficit reduction plan, imagine what happens to the 
national debt when we to into this socialized health care that is being 
proposed.
  Let me just say that rather than going for increased government, 
which we know has failed in the Soviet Union and in Communist China and 
in Cuba and throughout the world, let us go for freedom. Let us take 
the view of George Washington and Thomas Jefferson, who is President 
Clinton's mentor, supposedly. Let us go for that government which 
governs least, governs best. If we want to help people with health 
care, do not mandate universal coverage but go with the suggestions 
that have been offered by the speakers here. Help people help 
themselves. Create the opportunity with lower taxes, with more economic 
growth, with more job creation for people to be able to afford health 
insurance. People want health insurance. The only reason they do not 
have it is because they cannot afford it. Let us go to Medisave 
accounts which address the heart of the issue, cost control and let us 
get away from governmental directives passed down from on high with all 
the insensitivity and inefficiency of government and let us go with 
something that we know works, that has been proven around the world 
that works.
  I thank the gentleman for the opportunity to offer those comments.
  Mr. Speaker, I include for the Record the newspaper articles referred 
to in my remarks, as follows:

                      Unspeakable Runaway Spending

                        (By Robert J. Samuelson)

       If you haven't heard, we now have a Bipartisan Commission 
     on Entitlement and Tax Reform. President Clinton created it 
     last year to find ways to cut budget deficits and spending on 
     entitlement programs, such as Social Security and Medicare. 
     It's a hard job, which would get harder if Congress passes 
     health insurance for the under-65 population. This would 
     instantly become the largest entitlement in U.S. history. So 
     far, the Entitlement Commission hasn't said ``boo'' about it.
       What ought to be said is simple: Hold on, let's not invent 
     new entitlements before controlling the old. But Sen. Bob 
     Kerrey, the commission's chairman, admits he's reluctant to 
     broach the health care issue because it might plunge the 
     commission into partisan paralysis. (Two-thirds of its 32 
     members are members of Congress.) This, he argues, would 
     sabotage any chance of consensus on what he sees as the 
     larger issue: how to accommodate the retirement of the ``baby 
     boom'' in the 21st century. By 2030, one American in five 
     will be over 65, up from one in eight now.
       Sounds reasonable. It isn't. The trouble with Kerrey's 
     logic is that the pressures of an aging population stem 
     mainly from rising health spending. Passage of new national 
     health insurance would almost certainly make matters worse. 
     It would probably increase spending while also changing the 
     political climate. If vast new coverage is voted for younger 
     Americans, older Americans will be even more reluctant--if 
     that is possible--to consider controlling their own health 
     care costs.
       The Entitlement Commission's projections show the 
     importance of health costs. Of course, an aging population 
     will raise Social Security spending. By 2030, it's expected 
     to hit 6.7 percent of our national income (gross domestic 
     product). Today, it's 4.8 percent. That's a hefty increase of 
     about two-fifths. Still, it could be tempered by raising, the 
     retirement age slightly (after all, we're living longer) and 
     trimming some benefits.
       The real spending explosion occurs in Medicare and 
     Medicaid. (Medicare provides general insurance for the over-
     65 population; Medicaid helps pay for the poor and for 
     nursing home care for the old.) Their spending, the 
     commission estimates, could rise from 3.8 percent of national 
     income in 1995 to 11 percent in 2030. That's tripling. The 
     huge increase reflects two pressures: Health costs are 
     growing faster than inflation, and the old need more care 
     than the young. Only the first can be changed.
       If it isn't, pressure for higher taxes or cutbacks in 
     spending would be huge. By 2030 projected Medicare and 
     Medicaid budgets would absorb more than half of all federal 
     taxes under current laws; Social Security would take another 
     large chunk. To run the rest of government would require at 
     least a 50 percent jump in taxes, assuming that other 
     programs remain at present levels.
       Projections so far into the future are obviously inexact, 
     but they do provide rough orders of magnitude. Health 
     spending is not at the edge of the entitlement problem. It is 
     the essence of the problem. What this suggests is that the 
     entire health care debate has been misdirected. Sure, 
     uncertain and incomplete insurance coverage are problems. But 
     they could be alleviated (though not eliminated) by some 
     fairly modest reforms. Runaway health spending is the central 
     problem--and it will get worse with time.
       Naturally, the health debate has all but ignored spending 
     control. ``Let's face it, you don't see any cost containment 
     buses rolling across the country,'' as Lawrence O'Donnell, 
     Jr., staff director of the Senate Finance Committee, told The 
     Post. The plan of the House Democratic leadership creates 
     huge new Medicare benefits and simply asserts that spending 
     will be held down. Just how is unclear. But even critics of 
     ``universal coverage'' have not truly addressed spending 
     control. This epitomizes entitlement politics. Everyone 
     emphasizes benefits and ``rights,'' and no one mentions 
     limits.
       An ``employer mandate''--the centerpiece of the Clinton 
     program and that of House Democrats--is the response of 
     politicians frustrated by high budget deficits and taxes from 
     providing new government benefits. The solution is simply to 
     order companies, via the ``mandate,'' to spend money on 
     government's behalf. Politically, this is appealing. In the 
     future, Congress could please selected constituencies 
     (advocates for children, cancer victims, alcoholics, etc.) by 
     quietly expanding the mandate without corresponding increases 
     in taxes or the budget deficit.
       No honest observer of Congress can expect this power to be 
     exercised with restraint. Every new benefit will seem 
     compelling; every possible restriction will seem cruel. The 
     mandate would represent a new category of entitlements worth 
     hundreds of billions of dollars. It's a second budget, 
     conveniently placed ``off budget.'' It is an evasion of 
     choice; to be sure, the choices are all hard. Medical 
     advances often carry steep price tags. Consider the use of 
     ``in vitro fertilization'' to induce pregnancy; a new study 
     finds that the cost of a successful birth ranges from $67,000 
     to $114,000. Any realistic effort to limit spending would 
     require restrictions on insurance coverage, cuts in federal 
     tax subsidies for insurance or strict government cost 
     controls.
       But hard choices will only become harder with time. If the 
     Entitlement Commission doesn't pronounce on this, what's it 
     supposed to do? To be fair, Kerrey has personally been 
     forthright in talking about the long-term problems of 
     government spending, including health care. The idea of a 
     commission was his, not Clinton's. And indeed, the Clintons 
     (husband and wife) have championed the ``something for 
     nothing'' rhetoric that defines the entitlement mentality. It 
     is an exercise in national make-believe, as a new Wall Street 
     Journal/NBC poll again shows.
       In the poll, 61 percent of respondents say they favor 
     cutting federal entitlement programs. But 66 percent of the 
     respondents also oppose cutting Social Security, Medicare and 
     Medicaid--the biggest entitlements. We are in a vicious 
     circle. Politicians won't discuss choices, because that would 
     offend public opinion. But the public hardly knows the 
     choices exist, because politicians won't discuss them. Does 
     anyone dare break the circle? Can anyone do so without 
     committing political suicide?
                                  ____


               [From the Washington Times, Mar. 3, 1994]

                    Republican Health Care Delusions

                        (By Steven M. Robinson)

       There may be no such thing as a free lunch, but apparently 
     dinner at the White House comes close enough to fool some 
     Republican senators.
       Last week, a number of Republican senators had dinner with 
     President Clinton. The topic of conversation was health care. 
     According to Sen. Bob Dole and Sen. Robert Packwood, there 
     was a tacit agreement with the president that the goal of 
     health care reform should be universal coverage. This week, 
     at the invitation of Sen. John Chafee, who was also at the 
     White House dinner, about 30 Republican senators, as well as 
     three Republican governors and a half dozen House 
     Republicans, are meeting in Annapolis to discuss health care. 
     Among the issues to be discussed will be universal coverage. 
     If the other Republicans in attendance agree with the 
     president's dinner guest, Americans may soon be stuck with 
     the bill for the most expensive free lunch in history.
       Most Republicans say that what they don't like about Mr. 
     Clinton's health care plan is all of the details. But, in 
     this case, the devil is not in the details, it is in the 
     destination. When it comes to universal coverage, all roads 
     lead to bigger government. Achieving universal coverage will 
     require government mandates on either employers or 
     individuals. Implementing a mandate will require the 
     government to make insurance ``affordable'' by providing low 
     income subsidies and imposing price controls. Low income 
     subsidies and price controls will lead to higher taxes, 
     bigger deficits and health care rationing. In other words, 
     all of the egregious details in the Clinton health plan are 
     the inevitable result of any plan that promises universal 
     coverage. That is why the goal of universal coverage must be 
     rejected.
       There are two arguments most often used to support the case 
     for universal coverage. First, it is suggested that we are 
     already paying for the uninsured through cost-shifting, so 
     universal coverage won't cost anything. Second, it is claimed 
     that the uninsured delay seeking health care until their 
     condition deteriorates into a more costly illness, therefore 
     universal coverage will reduce health care costs through 
     early detection and prevention. Both arguments are wrong.
       The cost of the health care of the uninsured in 1994 will 
     be about $47 billion. Assuming the entire cost of health care 
     for the uninsured (except for the $18 billion they pay out-
     of-pocket) is shifted to those with private insurance in the 
     form of higher taxes and premiums, the total amount of cost-
     shifting would be $174 per person. However, insuring the 
     uninsured would result in an increase in their utilization of 
     health care services. Since these services would be covered 
     by insurance, premiums would have to increase by at least $39 
     billion, or $194 per person.
       Since some of the uninsured could not afford these 
     premiums, government subsidies would have to be provided. If 
     the Clinton plan were in effect in 1994, subsidies for the 
     uninsured would be at least $20 billion. Thus, in addition to 
     the $194 in higher premiums, those with private insurance 
     would have to pay an additional $122 in higher taxes. Thus, 
     the cost of eliminating $29 billion in cost-shifting would be 
     $59 billion in higher taxes and premiums.
       Some Republicans think they could minimize the increase in 
     utilization and reduce the cost of premium subsidies by 
     mandating a less comprehensive insurance policy than Mr. 
     Clinton proposes. However, limiting coverage through higher 
     deductibles or the exclusion of some services would mean 
     continued cost-shifting. When the previously uninsured show 
     up at a hospital in need of urgent medical care, the hospital 
     is not going to tell them to come back when they have an 
     illness that is covered by their policy. There is not reason 
     to believe doctors and hospitals would not continue to 
     provide free care to the same extent they do today. This is 
     not to suggest that Republicans should oppose catastrophic 
     insurance and medical savings accounts for the insured. 
     Clearly, higher deductibles would reduce utilization relative 
     to first-dollar coverage. However, higher deductibles will 
     not reduce utilization relative to no coverage.
       For those serves that would be covered by a catastrophic or 
     other type of minimum benefit policy, costs would increase. 
     When a hospital provides services for free, it has every 
     incentive to economize, because it might not be able to pass 
     the cost on to its paying customers. But if both the patient 
     and the hospital know insurance is picking up the tab, the 
     patient will expect more and the hospital will be only too 
     happy to comply. Furthermore, the history of Medicare and 
     Medicaid shows that what begins as a minimum benefit will 
     inevitably become a much more generous benefit. In fact, 
     the threat to taxpayers' wallets from congressional 
     pandering is probably greater than the threat to 
     taxpayers' health from government rationing.
       The second argument in support of universal coverage is 
     based on the belief that the uninsured delay seeking health 
     care until their condition deteriorates into a more costly 
     illness. It is argued that universal coverage would allow the 
     uninsured to avoid illness through preventive care, or 
     receive care sooner, when it is less costly. While this 
     argument has great intuitive appeal, it is not supported by 
     the facts. The uninsured do not obtain a disproportionate 
     share of their health care from emergency rooms, nor do they 
     receive more expensive care. In fact, only 7 percent of 
     physician contacts by the uninsured occur in an emergency 
     room, and the average health care expense for the uninsured 
     is less than two-thirds of the amount for the insured. 
     Furthermore, numerous studies have shown that most preventive 
     services increase health care costs.
       Other countries with universal coverage have not made 
     health care affordable in the sense of providing services 
     more efficiently. Instead, doctors and hospitals have reduced 
     the quality and quantity of services in order to keep costs 
     within the limits set by their government. But, rather than 
     asking Americans to make these sacrifices, Mr. Clinton is 
     trying to sell universal coverage as a free lunch. 
     Republicans have an opportunity this week to tell the 
     president we're not buying.

  Mr. BUYER. Mr. Speaker, I appreciate the contributions of the 
gentleman from California. His concerns about the expanding of 
entitlements and creation of certain new groups of a broad new menu of 
health care benefits is extremely concerning to many of us which also 
means, let us not rush this. Let us not rush and cram a health care 
bill down the throats of America. Let us given an opportunity for 
everyone to study what in fact is in there. Give membership here within 
this body the opportunity to take these competing bills back home to 
our districts, an opportunity to be, yes, responsible and responsive to 
the people who sent us here.
  I appreciate the gentleman from California highlighting the concerns.

                              {time}  1810

  Mr. Speaker, right now I would like to yield for the moment to the 
gentleman representing the Clearwater and Tarpon areas, an old resort 
first settled by Greek sponge drivers in the early 20th century in 
Florida, Mike Bilirakis, a leader in this body for true health care 
reform without a government takeover.
  Mr. BILIRAKIS. I certainly thank the gentleman for yielding. In my 
office I was able to catch a part of this special order. I know many 
good points were made. I trust the point was made that every Member of 
this House of Representatives, particularly, I cannot speak for the 
other body, feels that there are problems out there as far as our 
health care situation is concerned, and that something has got to be 
done about it. So there is clearly a feeling of not wanting to be 
obstructionists, clearly a feeling of a bipartisan effort that has been 
mentioned by some others here today, and this is a perfect 
illustration. Ayes appear.
  I have a habit of holding many town meetings in my district. I 
represent an area in terms of age that is one of the older areas in the 
country. For a period of time, quite a period of time, no matter what 
the subject may have been, ordinarily I would have the public in my 
town meetings put up their hands and tell me there are problems with 
health care, and we have to have some sort of universal health care. 
They would talk about socialized medicine or something to that effect.
  What I am finding now and have been finding for the last year or year 
and a half is a complete change in attitudes. I think that is basically 
borne out by the polls. These completely nonpartisan polls that are 
taken by various newspapers, various members of the media are to the 
effect that the American people really are frightened, they are really 
frightened of what Congress may do to them. They are frightened about 
what Congress may shove down their throat. What the people are really 
saying to me now is 85 percent of us are basically happy with our 
health care, and we know there are 15 or 12 percent, whatever the 
proper figure might be out there that are really hurting. Why do we not 
just concentrate on the 12 percent or the 15 percent and leave us 
alone. Of course, others have said basically the same thing. The 
gentleman from Indiana [Mr. Buyer] has said what is the hurry up there, 
take it easy, haste makes waste, take your time. Yes, we want to see 
you do something, we want to see you do something right.

  Let me refer to last night's press conference. I know I heard one 
gentleman from Illinois [Mr. Hastert] commend the administration for 
bringing this really to the forefront, for bringing it to the high 
point in all of our thinking. Without that I doubt very much we would 
be at this point. But I certainly also commend the President on that 
particular point.
  But he had two unfortunate gentlemen there last night, and he used 
them as illustrations. One person was having a problem because of a 
lack of portability of insurance, and the other individual was having a 
problem because of preexisting conditions. The Rowland-Bilirakis plan, 
which is merely a consensus plan, was intended to take care of 
something like that. What we have received from the administration over 
this period of time is all or nothing. Let us not get out there and 
help the people now, and help cut costs now with malpractice reform, 
with streamlining the system, with antitrust reform and antifraud 
reforms, things of that nature, but let us sit back and take care of 
the entire thing first on an all-or-nothing type of approach.
  This is something, of course, that all of us feel very strongly that 
we have to take care now of what we can do now, help people now, save 
money now, and then we can address the rest. But in any case the 
Rowland-Bilirakis plan, which is merely a consensus bill, led to a 
bipartisan group consisting of five Democrats and five Republicans. We 
have been meeting an average of 5, 6, or 7 hours a day, well into the 
night. Tonight is really unusual. We met a couple of times earlier 
today to try to come up with some sort of a bipartisan effort. I would 
say that the cosponsors of the Rowland-Bilirakis bill as well as the 
Cooper-Grandy piece of legislation, which is the only other bipartisan 
bill today out to 52 Democrats. So we should have 52 Democrats out 
there that should be helpful.
  I know time is fleeting here, and I really do not have enough time to 
really go into what I want to say. But in any case, there are no 
obstructionists here. We believe very, very strongly in reforming 
health care, and we are all willing to give and take a little bit. We 
are going to get the job done.
  Mr. BUYER. I appreciate the gentleman's contribution and his 
leadership for this bipartisan solution is commendable, and his 
statesmanship.
  The only area we have not covered tonight, and I wish we had the time 
to get into it much more, is medical malpractice reforms.
  I think America should realize that great victories were had in the 
back rooms for trial lawyers in the Gephardt bill, and that is not 
good-sounding news that America should receive.
  In Indiana, 20 years ago, due to the strong leadership of our 
Governor at the time, Dr. Otis Bowen, medical malpractice reforms were 
put in place. The reforms included: caps on damages, sharp limits on 
contingency fees, and prohibitions on double recovery.
  Today, in Indiana an orthopedic surgeon pays on average $10,875 per 
year in malpractice insurance. In Michigan, an orthopedic surgeon pays 
$108,762, 10 times as much.
  All they had to do was just go a little bit to the north.
  We need some real medical malpractice reform initiatives, not the 
hoax that is contained in the Gephardt bill.
  Mr. Speaker, I yield to the gentleman from the 11th Congressional 
District of Michigan which includes one-half of Oakland County plus the 
suburbs of Redford Township and Livonia west of Detroit where people 
believe in the free market economics and oppose high taxes, and that is 
Joe Knollenberg.
  Mr. KNOLLENBERG. Mr. Speaker, I in fact want to enlarge on some of 
the things that were talked about here today. By the way, I do support 
the Bilirakis-Rowland bill. I think it is the move America wants to see 
done. If we look at the poll numbers, they tell us very, very clearly 
and glaringly that America does not want government-run health care. 
They want to fix what is wrong in what is right. That is precisely what 
the Bilirakis-Rowland bill does.
  Before I came in this afternoon I got a call in my office from one of 
my constituents. She is a young mother. Her son had to go in for his 
third operation. It was open heart surgery. While she was there she was 
telling my staff they talked to patients, talked to doctors, they 
talked to nurses that told her they were all concerned about 
government-run health care. They were concerned about, if you want to 
call it any other name, the Clinton-Gephardt health care plan, which is 
nothing more than a heavy dose of taxes, of spending and regulation.
  It is interesting that people across the country and in my district 
have concerns that even as we change the name of this bill from the 
Clinton bill to the Mitchell bill to the Gephardt bill, call it the 
Clinton-Gephardt bill if you will, people are concerned about 
government intrusion into their lives, and placing the government, a 
bureaucrat between themselves and their doctor.
  I just want to suggest in the very short time I have, because I know 
speakers that have come on before have covered the bases, and I know 
the gentleman from Indiana, Mr. Buyer, wants a minute to wrap up, but I 
would tell you not just the polls across the country, the polls in my 
district tell me 9 out of 10 people do not want government-run health 
care. They want private insurance, and we can do that with the 
Bilirakis-Rowland bill.
  Mr. BUYER. Reclaiming my time, I agree with the gentleman. Whatever 
you call this bill, on this side of the aisle it is still the Clinton 
plan, the Clinton plan, the Clinton plan. It does not have mandatory 
alliances, but it wants to lead to government takeover of health care.
  There is a real alternative. It is substantive, incremental reforms 
in the present system.

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