[Congressional Record Volume 140, Number 110 (Wednesday, August 10, 1994)]
[House]
[Page H]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: August 10, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
                   HEALTH CARE: START OVER NEXT YEAR

  (Mr. DOOLITTLE asked and was given permission to address the House 
for 1 minute and to revise and extend his remarks, and include 
extraneous matter.)
  Mr. DOOLITTLE. Mr. Speaker, it is not just the Republicans who do not 
like the Democrats' socialistic health care bills. Liberal Democrat 
columnist Robert Samuelson in today's Washington Post has written a 
column called ``Health Care: Start Over Next Year. They don't know what 
they're doing up there.''
  Here is what he says:

       Among other things, the Democratic health care plans 
     contain a large--and unjustified--multi-billion-dollar tax on 
     younger workers. You wonder whether most members of Congress 
     know this or even care. The whole health care debate is now 
     completely out of control. The desperate effort to craft 
     something that can be advertised as ``universal coverage'' 
     means that Congress literally no longer knows what it's 
     doing. Anything resembling the Democrats' bills, if enacted, 
     would produce massive unintended side effects.
       Apparently, most Americans grasp this. In a Newsweek poll 
     last week, respondents were asked whether Congress ought to 
     ``pass reform this year'' or ``start over next year.'' By 
     a two-to-one margin (65-31 percent) they said ``start 
     over'' * * *
       Republicans * * * are now correct that a bad bill would be 
     worse than none.

  Mr. Speaker, the full text of the column by Robert Samuelson is as 
follows:

 Health Care: Start Over Next Year--They Don't Know What They're Doing 
                                up There

                        (By Robert J. Samuelson)

       Among other things, the Democratic health care plans 
     contain a large--and unjustified--multi-billion dollar tax on 
     younger workers. You wonder whether most members of Congress 
     know this or even care. The whole health care debate is now 
     completely out of control. The desperate effort to craft 
     something that can be advertised as ``universal coverage'' 
     means that Congress literally no longer knows what it's 
     doing. Anything resembling the Democrats' bills, if enacted, 
     would produce massive unintended side effects.
       Apparently, most Americans grasp this. In a Newsweek poll 
     last week, respondents were asked whether Congress ought to 
     ``pass reform this year'' or ``start over next year.'' By a 
     two-to-one margin (65-31 percent), they said ``start over.'' 
     They sense that the versions of health reform crafted by 
     House and Senate leaders are hodgepodges of conflicting 
     provisions whose only purpose is to win passage. But what is 
     clear to ordinary Americans is denied in Washington. In the 
     capital, the fiction is that legislators know what they're 
     doing and are debating rational alternatives.
       ``I think you're going to see a very good, erudite back-
     and-forth,'' says House majority leader Richard Gephardt, 
     sponsor of the House bill. Well, it won't be ``erudite'' if 
     members of Congress don't understand the consequences of 
     their actions.
       Gephardt's plan, for instance, would create a new Medicare 
     Part C program for the unemployed, workers in small companies 
     and many existing Medicaid recipients. The Congressional 
     Budget Office estimates that the program might enroll 90 
     million people. But the projection could easily err by 
     millions in either direction. More important, Medicare Part C 
     emphasizes ``fee for service'' medicine (patients selecting 
     individual doctors), while the rest of the bill emphasizes 
     ``managed competition'' (reliance on health maintenance 
     organizations and similar plans).
       In a single stoke, the bill would separate the under-65 
     population into two groups, mainly based on income and size 
     of employer. Each group would be crudely steered toward a 
     different type of medicine. In practice, this division may 
     not be politically acceptable or economically workable. Many 
     Americans may find one type of medicine more appealing than 
     the other and resent being excluded. Or the artificial 
     segmenting of the medical market may raise costs for both 
     ``managed competition'' and ``fee for service.'' Gephardt 
     doesn't know; no one does.
       Now, consider the tax on young workers. It arises from 
     ``community rating.'' As people age, their health costs and 
     insurance premiums rise. But ``community rating'' requires 
     that everyone pay the same rate. This provision is included 
     in the House bill, and in a modified version, in the Senate 
     bill. The effect would be to raise insurance for younger 
     workers (say those below 45); the amounts are hard to 
     estimate, but a good guess is at least $300 to $500 a 
     worker. If employers have to pay higher insurance, they 
     will pay lower salaries. The invisible tax on young 
     workers might total $15 billion to $25 billion annually.
       Is this fair? No. If enacted, it would compound the 
     existing bias against the young. Already, one-third of the 
     federal budget goes to the elderly; the young are taxed to 
     support the old. How much farther is this to go? Or is it a 
     cynical reaction to voting patterns (the young vote less than 
     the middle-aged or old)?
       Questions like these swirl around both Gephardt's plan and 
     Senate majority leader George Mitchell's. It is hard even to 
     describe Mitchell's plan. He says it's voluntary and lacks a 
     ``mandate.'' Wrong. It's true that it doesn't mandate 
     companies to buy insurance for workers. But it does mandate a 
     standard benefit package for firms--the vast majority--that 
     offer insurance. Because the mandated benefits are above 
     average, this would probably raise health spending. Companies 
     below the new standard would increase benefits; those above 
     would have trouble lowering them.
       Next, Mitchell hopes to achieve 95 percent insurance 
     coverage by offering subsidies for low-income workers to buy 
     it. But there's a ``fail-safe'' mechanism to limit subsidies 
     if the budget costs exceed projected costs. However, if 95 
     percent coverage doesn't occur by 2000, Congress could 
     require employers to pay 50 percent of their workers' 
     insurance. But this would apply only to firms with more than 
     25 workers. Got it? Neither Mitchell nor anyone else knows 
     whether this would reach 95 percent coverage.
       These plans are confusing because the health debate evaded 
     the basic tension between expanding health services 
     (``universal coverage'' etc.) and controlling health 
     spending. It's hard to do both at the same time. The plans' 
     complexities--as with the original Clinton plan's--aim to 
     disguise this conflict. Republicans haven't been especially 
     constructive in this debate because they haven't faced up to 
     it either. But they are now correct that a bad bill would be 
     worse than none.
       Chaos is now the most important (and largely unreported) 
     reality about the health care debate. Dozens of provisions in 
     these bill would have huge unappreciated consequences. John 
     Sheils of Lewin-VHI, a health consulting firm, says premiums 
     for small businesses in the Mitchell bill could be 25 percent 
     higher than for big companies. The CBO agrees a gap exists 
     but puts it lower. Who's right? Do most members of Congress 
     understand the gap? Probably not. Still, the pretense in 
     Washington is that Congress is making conscious choices.
       The pretense is sustained because in Washington politics is 
     sport, especially at the climax of a legislative battle. All 
     attention fixes on who wins and loses--and the deals that 
     enliven the game. Rhetorical blasts are taken for reality; 
     political reporters know little of how legislation would work 
     and care less. This often leads to bad laws, and in health 
     care, the potential for blunders is huge because Congress is 
     tinkering with one-seventh of the economy and most aspects of 
     medicine.
       In May, Robert Reischauer, head of the CBO, warned that 
     trying to find a compromise by combining provisions from 
     different bills might make the health system worse. He 
     compared it to building an auto engine with incompatible 
     parts: ``You can't say I want a piston from Ford, a fuel pump 
     from Toyota * * * and expect the engine to run.'' Well, 
     that's precisely what's happened. The contraption is no 
     longer even a car made with incompatible parts. It's now part 
     car, part tractor and part rollerblades. It's a clunker. Most 
     Americans seem to understand this. Will Congress?

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