[Congressional Record Volume 140, Number 108 (Monday, August 8, 1994)]
[Senate]
[Page S]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: August 8, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
                           HEALTH CARE REFORM

  Mr. REID. Mr. President, there has been a statement made earlier 
today that we should hold up on health care reform until another day. 
Mr. President, that has been going on for 50 years or more. We have 
talked about doing something on another day through six Presidents. It 
has been debated off and on for over 50 years. I think the American 
public feels that we do not need more time, but we need more action.
  What we lack in this body is the ability to go forward on a tough 
issue. The majority leader has decided that this is the time--after six 
Presidents and over 50 years--for us to make a decision on health care.
  Why is now the time to do something about health care? We have over 
40 million uninsured Americans. We have 2 million people that lose 
their health insurance every month, and of those people who lose it--
sometimes for a day, sometimes for 2 months--100,000 out of those 2 
million lose their health insurance permanently. The 40 million figure 
is going up and up and up.
  The overwhelming majority of people from the State of Nevada want 
universal coverage, and they want it now. The vast majority of the 
American public wants universal health care reform now, just like the 
people of Nevada.
  Around the first of July--I do not have the exact date--an ABC-
Washington Post poll reported that 78 percent of the American public 
wanted universal coverage. I believe, Mr. President, if we fail to act 
now, every American would remain at risk of having their insurance 
taken away. When I talk about the 40 million-plus uninsured, all the 
people from the State of Nevada and all of the people from the other 49 
States should understand that health care reform is more than reforming 
the health care for the uninsured. If it were only the uninsured, maybe 
we could put it off to another day. But it is not only the uninsured. 
It is people who have insurance that are losing their insurance. It is 
people who have insurance that are underinsured.
  Health care reform affects everyone. In the State of Nevada, we have 
had two special sessions of legislature that had to be called as a 
result of health care costs--no other reason, just health care costs.
  So I repeat, if we fail to act now, every American--not only the 
uninsured, but every American--will remain at risk of having their 
insurance taken away. Why? Let me give a few reasons. Mr. President, 
millions of Americans will continue to be denied coverage based on 
preexisting conditions. When we think about preexisting conditions, I 
think most of us think of someone that is handicapped in the sense that 
they are confined to a wheelchair and they are denied coverage because 
of preexisting illness. But, no, that is not the way it is. Insurance 
companies deny coverage to people that have had a heart attack in the 
past, people who are healthy now, people who may have some orthopedic 
ailment and may have had surgery on their knee, or may have had back 
problems. Preexisting conditions are just that. The insurance industry 
wants people in perfect health. A preexisting condition is anything 
they can find.
  I have used this example before, and I will use it again. What are 
preexisting conditions that we really can understand? It was brought 
vividly to my attention when I went to visit my ophthalmologist--as the 
Presiding Officer knows, I have not worn glasses for a long time, but I 
am wearing them now. As I was leaving his office--and this is someone 
that I had known for a long time--he said, ``Harry, I sure hope they do 
something about the health insurance problem.'' He said, ``I have 27 
employees, and I have health insurance for my employees. One of my 
employees recently got cancer, and they will not rewrite my policy. I 
am having one heck of a time trying to find another insurance company 
to rewrite a policy for my 27 employees because of this woman that got 
cancer.''
  That is what we are talking about. That woman not only cannot be part 
of a group policy, a small group policy, but I guarantee you she cannot 
get coverage on her own. That is impossible. So millions of Americans 
will be denied coverage based on preexisting conditions unless we do 
something about health care reform.
  We have also the problem of somebody who works for a company, they 
get sick, and they now have a preexisting condition; they are covered 
under the large policy that they have, but if they want to leave that 
job and go someplace else, very likely, they will not be able to get 
insurance.
  So this is a problem that is really spreading throughout our society. 
So preexisting conditions are important. We need portability with 
insurance policies, so that someone can leave a job and take their 
insurance with them, and not have to fight with an insurance company 
for coverage.
  Today millions of working Americans are, in effect, locked out of 
better jobs. They cannot leave because they have health insurance at 
one place and want to go someplace else. That is why I am saying this 
is only one example of how the health care crisis affects not only 
those that are uninsured, but those that are underinsured and those 
with preexisting conditions.
  Also, this health care debate deals with real people. It deals with 
people who cannot get insurance, who are a part of the 2 million people 
who may for a day or 2 months or 2 weeks have no insurance and during 
that period of time they are in an automobile accident or receive some 
type of injury. As a result of that, they have no insurance.
  Mr. President, the problem with our present health care system is 
that those who are not insured are paid for by those who are insured.
  If I came upon this Senate floor and said, ``I just came upon a great 
idea for health care; what we are going to do is say that everyone who 
has health insurance is going to pay for those who do not--that is our 
reform,'' everyone would say: ``What? Are you crazy? You are saying 
those of us who pay for our health insurance are going to pay for those 
who do not?'' ``Hey, that is what I want to do.'' You would say, ``No 
way.''
  Everyone should understand that is the system that is now in place in 
America. Those who have health insurance pay for those who do not. How? 
In the form of higher taxes for indigent care, in the way of higher 
insurance premiums, and in the way of higher hospital and doctor bills.
  It is not a very good system. If someone is up visiting the Capitol 
today and he or she has no health insurance, and they leave, and as 
they are leaving they are in an automobile accident or get sick in some 
way, they are immediately taken to one of the emergency rooms. It is 
the same in Las Vegas, Reno, and other cities in Nevada. They have no 
health insurance, so they are taken to an emergency room. The emergency 
room takes them in.
  The highest cost of care in the United States is in the emergency 
room. That is where all these uninsured get their health care. Who pays 
for that? We pay for it.
  We need health care reform for lots of reasons. I have mentioned a 
few of them.
  Small businesses will continue to see their premiums rise. Right now, 
it is about a little over half of those small businesses have health 
insurance for their employees. Those small business people who are 
gutsy enough to have health insurance for their employees pay 35 
percent more for the same coverage as does big business.
  But after having understood that, we should also understand that in 
addition to the 35 percent higher cost for their health insurance, 
their yearly increase is at a rate 50 percent higher than big business. 
Talk about not being competitive. For example, You have two people who 
are making widgets. They both have a small business. They have 30 
employees each. One has health insurance and one does not. It goes 
without question that the one who has health insurance is not as 
competitive as the one who has no health insurance. Why? Because of the 
cost that I have indicated. Not only did they pay for their health 
insurance but they pay more than big business for health insurance, and 
the yearly increase is even more.
  If we do not achieve universal health care reform, I repeat, we will 
be placing every American at risk. If we continue the status quo in 
which those with insurance pay for those without, we would be, in 
effect, doing the American public a tremendous disservice.
  Who is raising the hue and cry that we do nothing? Could it be the 
health insurance industry, which employs 2.4 million people, employs 
more people than work for the entire Federal Government? Do you think 
they want the status quo maintained? Of course they do.
  I heard this morning on the way to work that there is almost $50 
million that has been spent already, by those who want to maintain the 
status quo, in television advertisements, radio advertisements, and we 
are only seeing the beginning of the cost of these misleading status 
quo ads.
  Why would these entities want to change a system? This year the cost 
of health care in America is going up over $100 billion--not $100 
million, $100 billion. We will not have any better health care as a 
result of costs going up this year over $100 billion, not any better 
health care at all.
  Where is the money going? I submit, Mr. President, it is not all 
going to doctors and hospitals. Bureaucratic red-tape. How many doctors 
have told the Presiding Officer--how many physicians from Kentucky have 
said to the Presiding Officer, ``I as a physician would like to be able 
to practice medicine and not have to depend on some clerk to tell me 
whether I can do a medical procedure?'' I would bet the people have 
said that to the Presiding Officer. Physicians have said that to me, 
physicians from the State of Nevada. That is why the National College 
of Surgeons became desperate and supported the single-payer system. I 
asked my surgeons in the State of Nevada: ``Why did you do this?'' They 
said: ``Because we are tired of not being able to practice medicine the 
way we were taught to practice medicine. To do a surgical procedure, we 
have to jump through hoop after hoop after hoop of clerks telling us 
what to do.''
  So this system that is going to cost us $100 billion more this year 
is soon going to cost $1 trillion. That is, after next year it will be 
$1 trillion. That is how much we spend in health care in America.
  To people who are suggesting, let us not do health care reform, let 
us do a little bit here, let us do a little bit there, let us do some 
incremental reform, I say all that is going to do is drive up the cost 
of health care for middle-income families to pay in the way of higher 
taxes, higher hospital and doctor bills, and higher insurance premiums.
  A recent Lewin-VHI report on incremental reform reports:

       Our analysis shows that premiums are lower under universal 
     coverage than under insurance market reform linked to 
     subsidies. Further, we estimate that middle income families 
     that currently have insurance will pay more in general for 
     health care under partial reform than under reform that 
     includes universal coverage.

  The reason is because we will be picking up the tab for the millions 
of Americans who are left uninsured. It is no secret. Economists know 
what the problem is. This is what we call cost-shifting.
  Since 1986, the average cost of health insurance has increased by 117 
percent. We do not count 1986. We count 1987, 1988, 1989, 1990 1991, 
1992, and 1993. In those few years, the cost of health insurance has 
gone up by more than 100 percent. Over that same period of time almost 
8 million Americans have been added to the ranks of the uninsured.
  Who are these uninsured? In Nevada lots of them are children. In 
America, as in Nevada, over 60 percent of the uninsured are people who 
work every day. They are not derelicts. They are not bums. Over 60 
percent of them are people who work for a living.
  So, I look forward, Mr. President, to this debate. I publicly 
commend, I publicly applaud the majority leader for forcing the Senate 
to act on this measure. He is doing the right thing for the American 
public. He is doing the right thing for the people of the State of 
Nevada.
  This is an important issue that has been taken out of context by the 
television ads, the radio ads, and the mailings causing people to be 
afraid they are going to lose what they have.
  I believe any health care reform should not cause people who have 
health insurance to have less after we finish than they have now. But 
what it would do, I believe, is cut down on the bureaucracy, the red 
tape, fraud and abuse, and allow health care to be more cost effective 
than it is now.
  The frenzy that has been whipped up over this issue is simply a 
smokescreen. They set out to confuse the American public, and they have 
accomplished what they set out to do. They have confused the American 
public. But the American public will soon understand, as many of them 
do now, that it is a smokescreen, it is a feignt, it is a misleading 
tactic to divert their attention from the goal line. And what is the 
goal line? The goal line is to bring down the cost of health care for 
the American public.
  What we have been witnessing the last little bit and what we will 
probably see in the next few days is what has come to be known as 
gridlock, attempts to defeat what will be a winner for the middle 
class.
  The reason health care is so important, Mr. President, is that those 
people who are injured in accidents, those people who become ill, 
however that befalls them, it does not do it on the basis of their 
party affiliation, it does it whether you are a Democrat or Republican. 
And that is why I am so concerned that the direction of this health 
care debate has become partisan.
  I call upon my friends on the other side of the aisle to be 
courageous, to break from the pack, and be part of a debate that will 
allow us to accomplish something without partisan politics.
  We have a choice of preserving the status quo, in which every 
American is at risk and where those who have insurance pay for those 
who do not. Or we can take the courageous step of providing health 
security for all Americans and restoring fiscal soundness to 
skyrocketing health care expenditures.
  I also extend my appreciation to the senior Senator from Hawaii, the 
manager of this bill, for allowing me to go out of order and set the 
committee amendment aside.
  Mr. INOUYE addressed the Chair.
  The PRESIDING OFFICER. The Senator from Hawaii.

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