[Congressional Record Volume 140, Number 107 (Friday, August 5, 1994)]
[Senate]
[Page S]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: August 5, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
                         UNIVERSAL HEALTH CARE

  Mr. KERREY. Mr. President, President Clinton, Wednesday night at his 
press conference, said in a statement that was broadcast and 
distributed across the Nation that he urged the American people, and us 
on their behalf, to go with him down the road to universal health care.
  The route to be taken is either of the Democratic bills written by 
the Majority Leader Gephardt of the House or Majority Leader Mitchell 
of the Senate. My answer, despite my great passion to have every 
American secure in the knowledge they will receive high-quality health 
care and despite my great respect for the President and both majority 
leaders, is no. I do not want America to go down the road the President 
is asking us to travel.
  The road the President is asking us to travel takes us to a place 
where health care decisions will be increasingly centralized. The 
American public does not want that and their judgment is sound. They do 
not want political representatives or Government employees in 
Washington, DC, to make more of their health care decisions for them. 
They want them to make fewer.
  The road the President is asking us to travel takes us to a place 
where Federal spending on health care entitlements will have displaced 
even more of a dwindling pool of household savings. As one 
representative who has some knowledge of these predictions, I do not 
trust forecasts that our deficits will get smaller or remain the same.
  The air is full of promises to spend more. The winds carry a message 
to the people that our problem is we do not spend enough on health 
care, telling Americans they are victims of insidious individuals and 
institutions with malice in their hearts. Any campaign for universal 
coverage which proceeds upon these beliefs cannot be trusted to make 
the structure of America's fiscal house any stronger.
  The road the President is asking us to travel takes us to a place 
where an even larger percentage of the Federal budget and a larger 
percentage of total taxes will be devoted to spending on health care.
  Washington, DC, is already beginning to resemble an ATM machine where 
too many individuals and too many businesses come to get some extra 
cash. Worse, this emphasis on broadening and deepening the promise to 
pay somebody else's health care bills subordinates the promise of 
restraint or cost containment to the promise of free health care.
  The present system already penalizes States like Nebraska where 
frugality and efficiency are the order of the day. Any bill with new 
entitlements will create more demand, driving prices even higher, 
making matters worse for my State. It will also make matters worse by 
creating new Federal regulations driving Americans to Washington, DC, 
for permission to proceed in a wide range of currently unregulated 
health care activities.
  The majority leader has told me he is willing to make changes in this 
legislation. I believe him. I have great respect for his integrity and 
legislative ability. However, I want there to be no doubt that I will 
not vote for this bill as is. My vote is no.
  Tomorrow, America will celebrate, or curse, the 1-year anniversary of 
enactment of legislation which passed because I voted yes. I believed 
the road America would travel with that legislation would take us in 
the direction of improved consumer confidence, leading to sustained 
economic recovery, lower interest rates, increased housing starts, more 
American jobs and lower deficit spending.
  I voted ``yes'' because I believed the positives outweighed the 
negatives. The economy could withstand the blow of higher taxes and the 
weight of fiscal constraint imposed through tough spending caps. As it 
turned out, the economy not only survived, it has thrived.
  I almost voted no, Mr. President, for two reasons, both of which are 
relevant to my decision to inform the President and my Senate 
Democratic leader, George Mitchell, that I will not vote for his bill 
in its current form.
  First, it did not finish the job of eliminating our deficit. It did 
not put us on a course of paying off rather than continuing to 
accumulate debt.
  Second, the rhetoric which began with the lofty and powerful message 
of shared sacrifice, deteriorated into the harangue of the middle class 
as victims of the wealthy.
  This time I will not vote yes unless this bill is changed. Unless the 
road takes us where the power of decisionmaking shifts away from 
Washington, DC, I will vote ``no''. Unless the road takes us to where 
cost containment is our overriding purpose, I will not agree to get on 
board, Mr. President.
  This time I will only vote ``yes'' if the President follows his own 
stated desire to get a bipartisan bill. And there is a way. It is the 
so-called mainstream coalition which includes Senator Chafee, Senator 
Danforth, and Senator Durenberger, three of the Republican parties 
leading advocates of health care reform. The President should call them 
in and ask them what they want, support their requests as an amendment 
to the Mitchell bill.
  The coalition has great appreciation for the President's leadership. 
He will discover sincere gratitude for his service in the health care 
cause. He has driven this issue relentlessly and with a high sense of 
purpose. The President will also learn we are willing to fight so that 
every American has the help needed to pay the costs of health care. We 
want health care security to be universal.
  However, we believe that unless you deal with costs first you cannot 
get to health care security. It is the rising costs of care that are 
making Americans feel insecure. Further, we believe that demand for 
expensive care in an environment where someone else pays the bills is 
principally responsible for higher costs. In order to achieve 
universality, the price of health care must be affordable for all 
Americans. We cannot risk creating new entitlements which drive up 
costs for everyone.
  Government intervention to expand coverage is risky. Using history as 
a guide we should be very cautious to presume that government can get 
the job done. Every time we withdraw money from the non-health-care 
economy and drive it into the health care system, prices go up. Thus, 
as we collectively agree to pay someone's health care bills that 
agreement increases costs and makes it more unaffordable creating added 
pressure to pay more of someone's health care bills. It is a vicious 
cycle.
  Indeed, it is fair to say the unprecedented reduction of health care 
costs which has taken place in the marketplace the past 2 years is at 
least in part attributable to the fear of Government action. It is the 
action in the market which gives us a clue about what we should do with 
our health care laws. It is the marketplace's success at controlling 
costs and the Federal Government's failure which leads me to conclude 
that we should use the forces of the market to control costs instead of 
the dictates of the Government.
  The Mitchell bill has too many new Federal Government dictates. The 
majority leader has asked and next week we will supply him with 
suggested changes in his good faith effort to achieve consensus. Today, 
let me identify five areas of increased Federal decisionmaking:


                      federal oversight of states

  The Federal Government would set requirements which status must 
follow in the new system. States would submit an application to the 
Federal Government specifying how they will meet the requirements. If 
the State does not submit an application, or if the Federal Government 
does not approve the application, the Federal Government can step in 
and take over health care reform in the State, and charge a 15-percent 
tax on all insurance. After a State's application is approved, it is 
subject to the Uncle Sam's variation of the random drug test: It can 
audit a State's program at any time.


                     federal oversight of medicine

  The Federal Government would decide how many doctors will be trained 
each year and how many go into primary care and how many will be 
permitted to train in each specialty and where they will train.
  The National Health Board will set standards for what is medically 
necessary and appropriate treatment instead of doctors.
  The National Health Benefits Board and the National Health Care Cost 
and Coverage Commission are exempted from the Federal Advisory 
Committee Act. Translation: They do not have to allow the public into 
their meetings.


                 federal regulation of health spending

  The Federal Government would set the baseline for total health 
spending excluding Medicare and SSI based on 1994 spending for the 
standard benefit package. That number is trended forward in 1995 and 
1996 based on CBO estimates for health care growth in their 1993 
report. The Government then sets what the rate of growth will be 
beginning in 1997 and forward. Any plan that exceeds that will be taxed 
at 25 percent of the difference beginning in 1997. Big business and big 
unions are exempt from the tax until 1999.


                 federal regulation of health insurance

  These regulations have the net effect of eliminating the existence of 
hospital indemnity policies, cancer policies, and other types of 
supplemental policies.


                  federal regulation of small business

  No business with less than 500 employees would be permitted to self-
insure. All businesses of less than 500 would be required to join 
purchasing alliances.
  I do not want to travel down this road, and I do not believe the 
people I represent want to either. They and I do want health care 
reform. They know that much in our current system is broken and they 
want it fixed. They know health care is becoming unaffordable for many 
and they know the ice of medical indigency grows thinner under their 
feet.
  Increasingly, however, their mood is turning skeptical that we here 
in Washington, DC, know what we are doing. As they trust us less, they 
are less enthusiastic about any change we propose.
  The source of their skepticism is the hyper-inflated and 
unnecessarily exaggerated language of the partisans for or against 
change. The cure for this skepticism is not a hard line decision to 
support or oppose one bill or another. Instead the cure is a broad 
based bipartisan effort to write a new law. Either we quickly produce a 
bipartisan majority--as I believe the mainstream coalition could 
become--or we should just as quickly abandon all hope of doing the 
people's will.
  In conclusion, it will require States to come to Washington, DC, to 
get permission from a plan, and the Federal Government can take over 
the State's plan if they do not comply, giving the Federal Government 
the equivalent of a random drug test to come in and audit a State and 
take them over if they are not doing the right thing; increased 
regulation of business, Mr. President, increased regulation as well of 
the health care system and providers, increased opportunity for the 
Federal Government to make decisions about whether or not health care 
is going to be given.
  Mr. President there has been unprecedented change in the marketplace 
in the last 3 years, and this legislation ought to recognize that 
change, ought to give the President full credit for producing some of 
it and ought to enact legislation that gets cost control done by taking 
advantage of it.
  I yield the floor and I thank my friend from North Dakota.
  The ACTING PRESIDENT pro tempore. The Senator from North Dakota.

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