[Congressional Record Volume 140, Number 111 (Thursday, August 11, 1994)]
[House]
[Page H]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: August 11, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
         HEALTH CARE REFORM PLANS MUST BE THOROUGHLY UNDERSTOOD

  The SPEAKER pro tempore (Mr. Lehman). Under the Speaker's announced 
policy of February 11, 1994, and June 10, 1994, the gentleman from 
Michigan [Mr. Knollenberg] is recognized for 60 minutes.
  Mr. KNOLLENBERG. Mr. Speaker, this evening we are going to continue a 
matter that was brought up a couple of days ago in a special order 
regarding the process regarding what appears to be, and I just heard 
some comments from the other side as to the urgency that seems to 
prevail over there as to the fact that we have to do something now; we 
cannot wait; we cannot wait a week or 2 weeks or a month. We have got 
to do it now.
  Mr. Speaker, I would tell you that informed consent is something that 
I believe is very dear to the American people. It is something that 
everyone who makes a decision, whether it is an individual decision, 
and it is certainly an individual decision, they make it after doing 
some study, assessment, analysis. No one buys a home, for example, 
unless they spend some time checking things out, looking things over, 
and coming to some conclusions as to what they can afford, what is best 
for them, and what meets their purposes.
  Individuals make those decisions. Localities do. Cities, towns, 
whenever any issue comes before a city, wherever it might be across the 
country, they do not jump into it. If it is a matter of a bond issue or 
a rezoning, that is something that goes before the people, and the 
people are invited to take a look at the situation and make some 
judgments and, in effect, offer their opinions so the constituency is 
served. They get their day, so to speak, and everybody comes out with a 
reasoned decision, or at least it is a decision that is based upon some 
information that is provided from a number of sides.
  The Federal Government should be no different. It should be no 
different than what individuals go through in the reasoning process or 
what localities do.
  Frankly, this afternoon we saw an example perhaps that might fit. I 
do not want to talk about the crime bill. I do not want to talk about 
the rule except to say a rule, a crime rule, failed today, and it 
failed, I believe, in large part because a number of Members of 
Congress, and I am talking about both sides of the aisle, it was both 
Democrats and Republicans, felt there was too much they did not know 
about this bill, and for example, when a couple of things started 
trickling out like $10 million for a college down in Texas, that really 
does not fit into the purview of the crime bill. That becomes something 
else. That question was raised. There were many others.

  So I believe that we have to spend some time looking over what it is 
that we are making a decision on that affects one-seventh of our 
economy and affects every man, woman, and child in this country.
  So I do not believe that we should hurry up just for the sake of 
hurrying up. I believe we can do a better job if we stop, look, listen, 
assess, analyze, and come up with the best idea.
  I am glad to hear from the other side of the aisle that they 
recognize now there are some bills other than the Gephardt bill in the 
House and the Mitchell bill in the Senate. There is a bipartisan 
effort, and very honestly, it is truly bipartisan. It is one that 
embraces some concepts the American people have been telling us they 
want.
  As we look at poll results from around the country, we find that they 
do not want any kind of slam-dunk process. They want to be very careful 
about how we change this system. Reforms, yes, but not to completely 
turn it upside down and indicate to the American people that they do 
not care about what their thoughts are.
  I think we have a job here to be reflective of what the people in our 
own constituencies want. The overwhelming polling results tell us they 
want to go slow, ``Let us fix it right,'' and in that regard this 
evening, we are going to involve a number of people who have positions, 
who support certain bills, who have views about how this should be 
done.
  I want to turn to these people one by one. But first of all, I would 
like to have us welcome the gentleman from Arkansas [Mr. Hutchinson] 
who will talk to us about the process, reform, or anything that meets 
your approval.
  Mr. HUTCHINSON. I thank the gentleman for yielding. I thank the 
gentleman for organizing this special order this evening on this very, 
very important subject.
  As we enter into the debate on a social issue that will impact the 
lives of every American, every man, woman, and child in this country, 
what could be more important than taking time to discuss the pros and 
cons?
  I was delighted, as I am sure my colleagues were, today to see that 
the bipartisan negotiations that have been going on for weeks now, 
many, many hours in length, were rewarded, were fruitful in coming out 
and announcing today a bipartisan health care proposal.
  So we really have a debate now. We have a Clinton-Gephardt; we have a 
Clinton-Mitchell bill; and we have a health care reform bill with 
bipartisan support that deals with the health care crisis in this 
country from the standpoint of private sector reforms to expand 
coverage to more Americans than ever before and to begin to control the 
spiraling costs in health care.

                              {time}  2040

  I think there are a number of things out there in the public sector 
right now to assist us as we look at this health care debate.
  One of the books recently published, written by Dr. Jane Orient. She 
is an internist in Tucson, Arizona, and she heads the Association of 
American Physicians and Surgeons, with over 4,000 members nationwide. 
The title of her book is, a very timely book indeed, ``Your Doctor Is 
Not In.'' I think she provides us some important insights. Let me share 
a few of them.
  She says, first of all:

       The proposed remedies for the health care crisis are snake 
     oil, and you shouldn't swallow them. Further, the private 
     doctor is an endangered species. In the end, we will have a 
     herd--a nice, placid, socialized, tamed, cud-chewing herd. 
     Readers should care about the plight of doctors for one and 
     only one reasons; Some day they might need one.
       You may think you know what the Hippocratic Oath says, but 
     you probably don't, and you should learn about it before they 
     do away with it entirely.
       The Hippocratic Oath is built on physician autonomy. It 
     reads, ``I will prescribe regimen for the good of my patients 
     according to my ability and my judgment.''
       Further, do you want your doctor to place society or the 
     Department of Health and Human Services ahead of his being 
     independent?

  She says, further:

       Managed care is about preventing medical care in order to 
     make money for third-party payers or to save money for the 
     government. Behind the slick advertising, managed care is 
     little more than prepayment for rationed health care.'' 
     Rationed care is one of the most disastrous things that can 
     ever happen to the health care practice in this country.

  Then I conclude with her insight:

       There is no utopia. I will only maintain that a free market 
     in medicine is the best of the available alternatives and the 
     one that does the least harm.

  That is what doctors do, the least harm. That is what the Hippocratic 
Oath says. The way we do the least harm, although it is not perfect, is 
to maintain a free market in the health care system.
  Another recent book, a novel published entitled ``Fatal Cure,'' by 
Robin Cook, a best-selling novelist.
  He as a physician. As a doctor, imagines what will happen to the 
health care service industry in this country should we resort, should 
we go in these coming weeks, to Government-run health care system. I 
only share with the listeners this evening and with my colleagues a 
couple of paragraphs of the dialog that he imagines might take place 
some day.
  He says, ``Everyone knows that doctor/patient relationships are the 
cornerstone of medical care.'' One of the characters says, ``Maybe 
that's passe. The current reality is determined by a new army of 
medical bureaucrats being created by Government intervention. All of a 
sudden, economics and politics have reached the ascendancy in the 
medical arena. I am afraid the major concern is the bottom line on the 
balance sheet, not patient care.
  ``The problem is Washington. Every time the Government gets seriously 
involved in medical care, they seem to screw things up. They try to 
please everybody and end up pleasing no one.'' Dr. Cook is absolutely 
right. That would be the result of Government-run health care.
  In the Washington Post, not exactly an advocate of free-enterprise 
health care, certainly one that has espoused the Government-run health 
care in its editorial policies. Dana Priest, in a front-page story 
entitled ``Health Bill May Have No Substitute for Bureaucracy,'' he 
writes just recently,

       President Clinton and members of Congress last week hailed 
     the Senate Democratic leadership's health bill as a vast 
     improvement over the bureaucracy-laden 1,462-page plan 
     produced by the White House.
       But the 1,410-page bill proposed by Senate Majority Leader 
     George J. Mitchell (D-Maine) also would create dozens of new 
     federal and state agencies. They would have untested 
     authority to centralize, reorganize, monitor and enforce the 
     way medical care is bought, sold and, to a lesser extent, 
     practiced in this country.

  And indeed the Post is right. They would have untested authority to 
centralize, reorganize, monitor and enforce. I understand that the 
Clinton-Mitchell bill in the Senate has over 20 new Federal 
bureaucracies that will be created.
  Now, before I yield back to the gentleman, I want to share a letter--
I am from the State of Arkansas, I have served 8 years in the Arkansas 
Legislature with now-President Clinton, our President was then my 
Governor, our chief executive in the State of Arkansas.
  Many times during those 12 years that he was our Governor, the issue 
of abortion, and more specifically the issue of public funding of 
abortion, arose in various debates. In Arkansas, as it has been 
throughout our country, a major issue, and it continues to be a major 
bone of contention and a major issue in the health care debate. In 
every major Government-run health care plan that has been presented to 
this Congress, the provision for reproductive services or abortion 
services, if you will, has been included. That means that every 
American under a Government-run health care system would be subsidizing 
the practice of abortion regardless of what their moral conscience or 
religious convictions would be.
  September 26, 1986, Governor Clinton, then Governor, wrote in a 
letter to the Arkansas right-to-life people a letter in which he said, 
in part,

       Because many of the questions do concern the issue of 
     abortion, I would like for your members to be informed of my 
     position on the state's responsibility in that area. I am 
     opposed to abortion and to government funding of abortions. 
     We should not spend state funds on abortions because so many 
     people believe abortion is wrong.

  That was Governor Clinton who is now President of the United States 
saying he not only opposed abortion but he opposed public funding of 
abortion and believed it was wrong to require people who believe it is 
wrong to pay for abortions. And yet today he has included that, 
insisted on including that in every Government-run health care program 
that he has advocated and supported.
  Then I would conclude--and I am indebted to our colleague from the 
other side of the aisle, the gentleman from Minnesota, Tim Penny, 
Democrat, for his ``Dear Colleague'' letter in which he points out 
something that I think is vital in this debate in the coming weeks. He 
points out that major votes of the 20th century on large social policy 
changes have always been accorded overwhelming bipartisan support. He 
enumerates some of those: The Social Security Act of 1935, 96 percent 
of the Democrats supported that, 81 percent of the Republicans 
supported that, and it passed by a vote of 372 to 33. The development 
of the interstate highway system, Federal-Aid Highway Act of 1956, 
major policy change in our country, 93 percent of the Democrats 
supported it, 98 percent of the Republicans supported it, passed by a 
vote of 388 to 19.
  Now, the Civil Rights Act of 1964, what more significant social 
change has this Congress enacted than the Civil Rights Act of 1964? 
Sixty-one percent of the Democrats supported the civil rights bill, 80 
percent of the Republicans supported the Civil Rights Act, and it 
passed by a vote of 290 to 130.
  I could go on, the Clean Air Act, the Medicare Act, the Water 
Pollution Act, all of these passed by overwhelming bipartisan 
majorities.
  Here we are told that we must in the coming weeks, have a health care 
reform bill that is going to affect the lives of every American, the 
biggest social change in 50 years, and we are going to do it with the 
barest of majorities. It is going to be forced through in spite of 
overwhelming opposition not only by the Republican Party but, the polls 
indicate, by the American people.
  When the buscapade came to town, I saw the big banners on the side 
saying, ``Pass It Now.'' And I said to myself, ``Pass what now?'' At 
that point we did not even have a bill. No one had read a bill.
  Yet they say we have got to hurry it through, we have got to do it 
now. Yet the polls say 65 percent of the American people say they want 
to wait, they want to read it, want to study it, want to react to it, 
and that is the way major social change ought to take place.

                              {time}  2050

  It ought to take place with the American people aware of it, the 
American people supportive of it and with a large bipartisan majority 
supporting it in Congress. We do not have that, and that is why we 
ought to wait on health care reform.
  I thank the gentleman.
  Mr. KNOLLENBERG. Mr. Speaker, I thank the gentleman from Arkansas 
[Mr. Hutchinson] for his comments and his reference to the Government 
intrusion, the bureaucracy that appears to be a part of both the 
Gephardt bill; not just appears, is, and also the Mitchell bill.
  As my colleagues know, we did finally get, not the CBO figures in 
total, but we did get a preliminary analysis on the Mitchell bill, the 
one that is still forthcoming on the Gephardt bill, and there is 
something interesting in that analysis, and it is purely that. This is 
not the final product.
  But I want to just quote from a paragraph that has to do with the 
budgetary treatment of the mandate, and it says it is a mandate, and 
they are talking about this whole process of requiring people to buy 
insurance, that they must buy insurance. A mandate requiring that 
individuals purchase health insurance would be an unprecedented form of 
Federal action. The Government has never in history required 
individuals to purchase any goods or service as a condition of lawful 
residence in this country.
  So, as a part of that bill, in order to live in this country, just to 
live here, before you do anything else, before you make a wage, or buy 
a car, or buy a house, or whatever, before you do anything, you must 
buy something, and that something is insurance, and that is a part of 
the Gephardt bill. It is a part of the Mitchell bill. At least in this 
regard we are talking specifically now about the Mitchell bill.
  I want to go on to welcome the gentleman from the western part of 
Michigan who sits on the Committee on Public Works and Transportation 
and the Committee on Education and Labor, and that is the gentleman 
from Michigan [Mr. Hoekstra].
  Mr. HOEKSTRA. Mr. Speaker, I thank my colleague, the gentleman from 
Michigan [Mr. Knollenberg] for yielding. I would also like to clarify 
the comments of my colleague from Arkansas.
  I am sure that what my colleague meant, that we do not want to wait 
on health care and postpone it. We want to go through a deliberative 
process that can make this House proud of the work that we are doing 
and make the American people confident in the result that we are going 
to achieve. And we want to do it in a bipartisan way.
  Let me outline for my colleague here the process that we went through 
on the Clinton bill in the Committee on Education and Labor:
  We had 29 hearings. We had 8 weeks of markup. We had 4 weeks of 
markup in subcommittee. This is where Members can propose amendments. 
We discussed them. We debated them. And then we voted on them. We then 
had another 4 weeks of markup in full committee. In full committee we 
debated 99 amendments on the Clinton bill. Forty-four Democratic 
amendments were accepted, and 11 Republican amendments were accepted. 
So, we spent 8 weeks.
  Now what is the process that we are looking forward to on the next 
portion of the health care debate? What we are looking at is last 
night, August 10, we received nine bills. We received a Clinton-
Gephardt bill, we received a Mitchell bill, we received a bipartisan 
bill, we received a single payer bill and five other bills. In total 
nine bills were submitted.
  I have to give the Printing Office credit in that they were able to 
get them printed overnight so over the next few days we can read them, 
but now we have been told that the process that was outlined at the 
beginning of the week says, well, we know the work on the Committee on 
Education and Labor, and we only dealt with a portion of the 
jurisdiction of the bill. We know it took you 8 weeks. But we are going 
to give the full House 8 or 9 days to go through the process.
  I do not think that is a good way to legislate. Nine new bills and 8 
days to finish the work. No time to go back to our constituents.
  Some of our colleagues here earlier tonight are saying now that we 
have the bills we can learn them, we can read them, and understand 
then, and talk to our constituents about them. The question is: When 
are we going to go through that process? There is a better process.
  Today I went to the Committee on Rules. I asked them for an open 
rule, enough time to debate the issues, to propose amendments on all of 
the bills, asked them not to have a king-of-the-hill rule where the 
last bill that wins, even something that may only have 218 votes, is 
the law of the land, but the version that has the most votes becomes 
the law of the land. I do not know whether that will be the process 
that we go through or not.
  But let me go through the Clinton-Gephardt bill to take a look at why 
it is important for us to have this dialog in this debate--
  Mr. HUTCHINSON. If the gentleman would yield before you go into your 
analysis, let me pick up because you were clarifying my comments 
regarding whether we should wait or whether we should pass it now, and 
let me just expand that because I began my remarks by saying that today 
I was delighted that there was a bipartisan incremental approach, free 
market approach, to health care reform that was presently with the 
support of Republicans and Democrats. I think we need to do health care 
reform, but the polls indicate that the American people, if the choice 
is between radical, Government-run health care as presented in the 
Clinton-Gephardt, the Clinton-Mitchell and all the variety of bills 
thereof, if the choice is that or doing nothing, they would rather us 
wait and start over in the next Congress.
  And so what I support is a deliberative process, I support action, I 
support reform now, if it is the right kind of reform.
  The American people are saying, and I think we all agree, if the 
reform is the wrong kind of reform, it would be far better to wait than 
to make radical changes in the health care system without knowing what 
kind of impact that is going to have on the lives of individual 
Americans.
  Mr. HOEKSTRA. I agree with the gentleman. I think what the American 
people are afraid of is that we will go after health care, and we are 
going to do it in 8 days, and everybody knows, or should know, that 
this Congress is not good enough and is not smart enough to do health 
care reform or to reform 14 percent of our economy in 8 days. We may be 
good, although the American people would dispute that sometimes, or 
maybe frequently. There is no way that any group could restructure 14 
percent of the economy that quick.
  And the other thing is we, as freshman Republicans, we laid out 
another process. We said, ``Let's go through the bills this week. Let's 
allow the sponsors a day on the floor to go through their bill section 
by section to explain how it works. Let us go back home, not for 
vacation. Let us go back to our constituents to talk to the elderly, to 
talk to the uninsured, to talk to the small business person, to talk to 
the doctors, talk to the medical community, to get their input on these 
new versions.''
  We do not have that opportunity.
  We could go through that deliberative process, 8 or 9 days of debate 
on the floor, conference committee with the Senate, and still pass out 
a bill by October 7 rather than trying to cram one through the process 
by August 19.
  Here is why it is important. Paging through the Gephardt bill, and, 
just like the Democrats are going to page through the Michel bill and 
find sections that they do not understand, there is a mandate. 
Employers are required to contribute to health insurance. What is that 
going to mean to employment in my district? What is that going to mean 
to the average American? There are new taxes.
  This is small print. That is why the Clinton-Gephardt version is only 
250 pages. But I am going to have to bend over to read it because it is 
small print.
  Here in the text, 25 percent of the wages paid during such months by 
such employer to such employee. What does that mean? How is that going 
to affect employment?
  There is more taxes, small business subsidies. We hear so much, we 
are going to do this for small business. The subsidies phase out zero 
for calendar year 2005. What is that going to do to the engine of 
growth in this country where a lot of innovation has taken place? Small 
business is in trouble.
  Here we have standards for State managed competition programs. It is 
gobbledegook in here. I know what this language meant in the Committee 
on Education and Labor. It meant that our national health care program 
was going to be a continental United States program because the 
language in the Committee on Education and Labor, and I do not know if 
it is the same language exactly, but this type language in the 
Committee on Education and Labor exempted Hawaii.
  Here is one that I love. As I go back and I talk to the leading 
employers in my district, the people that have really aggressively 
contained costs, and, Tim, you have had the opportunity to talk to some 
of those people at those companies, they have effectively gotten health 
care under control, and what do they say? They talk about wellness, 
and, when they are talking about wellness, they tell the Secretary of 
Labor to put together a study on wellness and report back to the 
Congress in 2 years whether wellness programs are the right way to go.
  So, in 8 weeks, or excuse me, in 8 days, we are going to reform 
health care, 14 percent of the economy, and it is going to take us 2 
years to study whether wellness programs have any validity. There are 
new enforcement provisions about how we are going to pay for the bill 
or what types of programs we can put in place.

                              {time}  2300

  There are exemptions. Let me see if I cannot find the exemptions 
section. Who is exempted from this bill? What people do not have to 
participate?
  Well, we know that the Texas Frail and Elderly Demonstration Project 
does not have to participate. We know the HMO in Dayton does not have 
to participate. They may have a great program. They got an exemption. I 
do not know how they got an exemption. I wish I had an opportunity to 
exempt some of my people who thought that they had a good program. The 
Tennessee Primary Care Network has a Medicaid waiver. There is another 
one here for the Health Services Insurance Corporation of Milwaukee, 
Wisconsin. They have an exemption. The extension of the Minnesota 
Prepaid Medicaid Demonstration Project.
  Mr. Gephardt or the President did not call me and ask if I would like 
any people considered for exemptions. Those people are exempt.
  There is new amendments to criminal law, health care fraud, false 
representations, bribery and graft in connection with health care. 
Should we not spend more than eight days talking about those kinds of 
things?
  Health benefits may not be provided under a cafeteria plan. Another 
innovation in the free market, in the private sector, and what do we 
say? We may not have cafeteria plans. An employee cannot sit down with 
his spouse and say here are our needs as a family, or here are my needs 
as an individual for health care, so I am going to take dental, I am 
going to take some extra life insurance, I am going to take this and I 
am going to take that, and that is going to be my health care plan. The 
person next to him working on the other machine is saying my needs are 
different. Boy, am I glad that my employer has provided me with the 
choice. I am going to take eye coverage, and, rather than get this rich 
package, I think I will take $30 per week and a Medicaid cap.
  Cannot do it. That is the way I read it right now.
  Here is a really interesting one. Davis-Bacon, the place where we say 
prevailing wages, primarily on construction projects, Davis-Bacon is 
now part of a health reform bill.
  How in the world you are on public works with me, maybe you can tell 
me how Davis-Bacon would get into this type of a bill. Any ideas?
  Mr. HUTCHINSON. I wish I could give an answer for that. I cannot 
imagine how Davis-Bacon gets in some other bills. But how it would be 
included in a health care reform act is beyond me, and I think beyond 
the imagines of most Americans.
  Mr. HOEKSTRA. Does that mean the Gephardt bill is bad? I think we are 
concerned because it demonstrates government taking over health care. 
And we have a lot more faith in the free market system.
  Even to knowledgeably talk about mandates, taxes, state exemptions, 
wellness enforcement, criminal law, no cafeteria plans, Davis-Bacon, 
new fraud provisions, it takes a whole lot more than eight days to 
understand this, to get input from our constituents. That is one bill. 
There is eight other ones.
  Mr. HUTCHINSON. A thought struck me as you were presenting your 
analysis, a preliminary analysis, indeed, of the Gephardt bill. As you 
thumbed through it, I thought what an advantage you have to millions 
and millions of Americans who do not have a copy of that bill to thumb 
through and look at.
  For months I would go into book stores around the country, and the 
airport book stores as we fly through to our districts, and see the 
Health Security Act, the Clinton health care bill on the shelves, with 
analyses, explanations. But the Clinton Health Security Act has now 
been long dead. With eight days, we have been presented a new bill that 
is not on the book stores of America, that has not been analyzed that 
we have the advantage of analyzing for eight days, as little as time as 
that is. But the American people have not had. why not give them the 
time to study this bill? The Republican Conference is having task 
forces, study groups, to analyze, if need be 24 hours a day, that bill 
and other bills that come before us in the next eight days. What an 
impossible task to do justice to the American people to have eight days 
to study and analyze a great social change in our country.
  I thank the gentleman for yielding.
  Mr. HOEKSTRA. The biggest part we are going to miss, I agree. I do 
not think we will be able to fully understand this in eight days, but, 
more importantly, the American people will not have the opportunity to 
review it, to provide us input. My guess is when we actually start 
debating and discussing this bill on the floor of the House, it will be 
limited time, we will not have the same opportunity that we have in 
committee to make 99 amendments. There will probably be just a vote up 
or down on eight substitutes, and the last one will be the Clinton-
Gephardt bill. If it gets 218 votes, it passes, even though something 
like the Rowland-Bilirakis bill, the bipartisan bill--they keep calling 
it the Rowland bill, it is a bipartisan effort, 5 Democrats, 5 
Republicans put together a bill--no new taxes, significant reform, 
significant progress, that may end up being the solution. It will be 
buried somewhere in the process.
  I will yield back to the gentleman from Michigan and look forward to 
participating in the dialogue a little later.
  Mr. KNOLLENBERG. I thank the gentleman from the western side of 
Michigan, as opposed to the eastern side where I am from. I notice he 
talked at some length about the size of the Gephardt bill. And maybe 
you pointed out that there was 253 pages of fine print. I would like to 
suggest to you it is probably 253 pages, three columns. I do not know 
if this can be seen by the television camera, but it is smaller than 
most footnote text type.
  Mr. HOEKSTRA. If the gentleman will yield, maybe they can see the 
difference between how the Clinton-Gephardt is 250 pages, three 
columns, small print, and the traditional way we write bills, which is 
much larger text. My guess is that the Clinton-Gephardt bill, when it 
will be printed in bill form, will be close to 1,500 to 2,000 pages.

  Mr. HUTCHINSON. The same thing would be true with the Mitchell bill, 
I believe. Would you not say?
  Mr. HOEKSTRA. Yes.
  Mr. HUTCHINSON. Thank you.
  Mr. KNOLLENBERG. The interesting part, too, on that subject is the 
bipartisan bill that you spoke of really is less than--it is about one-
fourth the size, and I am going by, again, what was printed in the 
Congressional Record. I might mention that the Mitchell bill, which is 
another alternative, a substitute that will be offered, we have been 
told, has been about the same size as the bipartisan bill.
  So it seems to me that we have within our midst enough material to 
keep us going for weeks, if we are going to get through all of this 
newly laid upon us 253 pages, to soon climb to some 1,400/1,500 pages.
  I want to now go to the gentleman from Kentucky who is the newest 
Member of the freshman class. Before I do though, I want to cite that a 
lot of the information and a lot of the views that we have are based 
upon communicating with our own constituents. I know that Mr. 
Hutchinson has done it in Arkansas and Mr. Hoestra has in his part of 
the State. So have I.
  I have had some nine health care forums. Two of those were attended 
by over 500 people. I can tell you that those individuals that came, 
came with a mission. They wanted to hear. But they wanted to speak, and 
speak. And we gave them that opportunity. They told us what they 
wanted. It was not just in those settings, but particularly in those 
settings. It was also, from all the communications we have had, all the 
phone calls, cards and letters, and from my own particular district I 
know overwhelmingly they do not want government intrusion in their 
health care system. They like in a great majority of cases what they 
have. It can be improved, take care of the portability fashion, 
preexisting conditions, and some other matters, which the bipartisan 
bill does.
  I wanted to go to the gentleman from Kentucky [Mr. Lewis] to get some 
sense of his constituency, what he has gleaned from dealing with them 
in the short time he has been in Congress. So I welcome Mr. Lewis from 
the grand State of Kentucky.
  Mr. LEWIS. Thank you for yielding your time.
  Well, Kentucky is very much like what you are saying. Today we had 
calls in our district office all day long saying wait, wait, wait on 
the health care plan. Make sure you do it right. Don't hurry something 
through. And on August the 4, the Newsweek article showed that in an 
over two to one margin, Americans believe that it would be better for 
Congress to start over on health care rather than pass something 
quickly that could be hazardous to their health care.
  The American people want us to go slow, and they want us to do it 
right. And why do they want us to take our time and do something that 
is going to be beneficial and not hazardous?
  So what are the problems with the Mitchell-Gephardt-Clinton plan?

                              {time}  2110

  Well, mandates, employer mandates. It is going to cost them anywhere 
from 600,000 to 3.5 million jobs. Both the Mitchell bill and the 
Gephardt bill include these mandates, and you cannot have mandates 
without someone paying the price. And guess who pays the price? It is 
the middle class.
  Higher paid individuals will be able to still survive with these 
mandates, but the lower paid Americans are protected by the large 
government health care entitlement that will be created. So that leaves 
the middle class to take the brunt of these mandates.
  Another problem that they are having with the Gephardt-Mitchell plan 
is the threat of rationing. The Clinton-Mitchell-Gephardt plan can lead 
to rationing our health care services through those mandated cost 
controls.
  These bills sneak price controls in through the back door of these 
plans, and they are disguised as measures that will keep the cost of 
premiums down for Americans but, in effect, requiring the costs to be 
kept to a certain level, they will lead to rationing health care and 
benefits for the American people.
  The Mitchell bill will impose taxes on health care premiums that 
exceed rates set by the government. Obviously, health care providers 
are going to have to cut expenditures to meet these levels. As any 
business owner knows, cutting spending means cutting back on services 
and cutting back on services means cutting back on health care for the 
American people.
  Taxes, that is another thing that the American people are not liking 
about these bills. The Gephardt and Mitchell plan, they raise taxes on 
every American family and business owner in this country. These plans 
will initiate up to 20 new taxes on everything from retiree health care 
benefits to taxing ammunition.
  What is something from my district that the people do not want? Of 
course, I have an agricultural-based district, and tobacco is the 
number one crop. Well, these plans include a tax on tobacco. 
Specifically, a tax on a commodity that is singled out, singled out 
among all the others, this is the one that they are picking on. And 
with a huge tax, not a moderate tax, started out with a 75 cent tax 
with the Clinton bill, but now it is a 45 cent tax with these two 
bills.
  Well, our district cannot afford, our farmers in our district cannot 
afford taxes on tobacco. Tobacco is already taxed more than their fair 
share, and they are paying for a lot of programs that the government, I 
do not know what they would do to make up the money if tobacco is taxed 
out of existence. I think it would go back again to the middle class to 
make up the difference.
  Increased bureaucracy. The Gephardt and Mitchell plans impose more 
big government control over the lives of individuals and businesses. In 
fact, these plans create 20 new bureaucracies and these bureaucracies 
are charged with determining what health care coverage we can have. 
They will determine what medical procedures and what will be necessary. 
This could result in lower coverage and less choice for employers/
employees. By mandating what services must be provided, some employers 
will have no choice but to include the Federal plan.
  These new boards will have advisory power over a substantial part of 
the health care operations and it even goes as far as to regulate the 
number of specialities we have in schools, the medical schools. 
Further, the various board members will not be elected. They will be 
comprised of politically-appointed officials, and their meetings do not 
have to be open to the public. And these committees are exempt from the 
sunshine regulations provided under the Federal Advisory Committee Act.
  I think that the American people are saying, wait. I think they are 
saying, we want a plan that is going to work. And this bipartisan plan 
that has been introduced, I think, is a very good plan that we can look 
at and say, this might be what we need.
  But we need time to study it. We do not need to rush something 
through. Because when I go back to Kentucky, as the gentleman just said 
a little while ago, the folks in my district are lining up and they are 
talking to me about health care. They are lining up, just as the people 
in your district, and they are saying, why are you not waiting? Why are 
you not taking your time? Why can you not take time and have a national 
forum wherever everyone can see what is on the board and we can make 
educated decisions about what we want?
  Personally, I think what is happening here with the Gephardt-Mitchell 
plan is that it is a political thing. It is something that is trying to 
be rushed through. It is something that is supposed to make our 
colleagues across the aisle look better for some reason, if they can 
get a plan through. But we have got to start thinking about what is 
good for the American people, not what is politically beneficial, but 
what is going to be good down the road, years from now, when my 
children and my grandchildren are going to need health care.
  The people of this country do not want their coverage, their 
opportunities for health care coverage to be ruined. And the most 
common phrase I hear back in my home district is, do not fix what is 
not broken. So the people want us to make educated, thorough decisions 
about health care here in this House, and they want us to do it right. 
They do not want us to rush through and make some bad mistakes.
  Mr. KNOLLENBERG. I thank the gentleman from Kentucky. I think the 
gentleman is right in terms of the mandates which involve, of course, 
in the Gephardt bill, the Mitchell bill, new taxes, new mandates and 
tax caps, meaning that certain premium plans that are in force with 
various companies could not raise their benefit level above a certain 
point or it would be taxed. Of course, that one size fits all would be 
applied against some of the plans that are in existence around the 
country.

  Those people then would have to pay a tax on the excess.
  One nice part about the bipartisan effort that is being constructed 
and architected here in Congress is that it has none of that. It has no 
taxes. It has no mandates. And it has no tax caps. So the gentleman 
from Kentucky commented about tobacco.
  Well, there are any number of things they can tax. Of course, 
whatever moves or does not move could ultimately be the source or could 
be the target of the Federal Government in terms of taxing to raise 
that money.
  I would just cite one thing. These are the preliminary estimates of 
the Mitchell bill. This is not really official yet, but they are 
talking about the mandates that are a part of that bill.
  I wish I had something from the Gephardt bill, I would be talking 
about that.
  Mr. HOEKSTRA. Would the gentleman clarify exactly how much 
information we have on any of the nine bills about how much they will 
raise in new taxes and what the net result will be on the deficit for 
any of the nine bills?
  Mr. KNOLLENBERG. I can tell you one thing at the moment, I have the 
facts sheet on the Mitchell bill in terms of the mandate.
  Mr. HOEKSTRA. But we have nine different bills here in the House. 
What numbers do we have on any of those nine bills?
  Mr. KNOLLENBERG. The gentleman makes a point. I am talking about a 
bill that I will not even have to deal with. The reason I am is because 
we have nothing for the Gephardt bill. We have only facts and not 
really facts yet, they are just preliminary estimates of what the 
Mitchell bill's costs will be.
  Mr. HOEKSTRA. We will be debating these nine bills and there were 
colleagues on the floor for an hour before saying how great the 
Clinton-Gephardt bill was, how bad some of the other bills were. And we 
do not have any independent verification of what the numbers are yet.
  Mr. KNOLLENBERG. Let me give you one example: Mandates--with 
mandates--talking about the Mitchell bill again. I would love to talk 
about the Gephardt bill, but I have nothing to talk about.
  It states, for example, that 10 years from now in the year 2004, with 
mandates in place, we are still going to have $165 billion, $165 
billion in subsidies.
  Now, if you take the mandates out, it would be $194 billion. The 
point is, even with mandates in place, we are going to run up $164 
billion in deficits.

                              {time}  2120

  Now, how do you finance that? You could tax the tobacco of Kentucky, 
you could tax a lot of things. That is the problem with the Mitchell 
bill. I wish I could tell you what is totally wrong with the Gephardt 
bill, but I have to wait for those numbers. This is just preliminary.
  Mr. HUTCHINSON. Will the gentleman yield?
  Mr. KNOLLENBERG. I am glad to yield to the gentleman from Arkansas.
  Mr. HUTCHINSON. It is my understanding that the CBO came out with 
numbers on the Mitchell bill, but they have not yet produced numbers 
for this Congress in regard to the Gephardt--the Clinton-Gephardt bill, 
so the gentleman is exactly right. We do not have numbers on what the 
Clinton-Gephardt bill will do, how it will impact the deficit, how it 
will impact the pocketbooks of the American people.
  I might add also, in my initial analysis of the Gephardt bill, we 
have the Medicare Part C, which is established, which has been called 
the largest entitlement ever created in American social policy. It 
would bring over 90 million Americans under Government-run health care, 
direct Government-run health care, in Medicare Part C. That is rather 
incredible.
  In fact, Mr. Speaker, we just started a commission to study--I 
appreciate the gentleman from Kentucky [Mr. Lewis], whose first 
official act on this floor was walking over to this desk and signing a 
discharge petition for the A to Z, because of his personal concern 
about the deficit in this Nation, and the national debt.
  We have an entitlement commission that is supposed to come back and 
make recommendations, because we have entitlements now that are 
bankrupting the country and exploding in their costs, and yet we are 
getting ready, if we pass the Gephardt bill, to create the largest 
entitlement ever, at the very time we are now beginning to acknowledge 
what the entitlements are doing to our deficit situation.
  Mr. HOEKSTRA. Mr. Speaker, I think we have a preliminary report on 
the entitlement commission that says that by the year 2011, or 
something, all of the revenues that we collect in taxes will be used to 
pay for two things, entitlements, and interest on the debt, and that by 
now, if we create this whole new entitlement program, we are going to 
either be looking at one of two things, more debt, or higher taxes. I 
believe that was the preliminary report. I'm not sure.
  Mr. HUTCHINSON. Peter, if you will yield back, I think you are 
exactly right. I just think it is the highest of ironies that at the 
time we get this preliminary report, and there is general, broad 
acknowledgment that something has to be done on entitlement spending; 
that we are preparing now, or it is being proposed, it is being 
advocated, that we create the largest, the mother of all entitlements. 
I think that is a high irony.
  Mr. HOEKSTRA. And we will spend 8 days talking about it.
  Mr. HUTCHINSON. Eight days. I thank the gentleman.
  Mr. LEWIS of Kentucky. Will the gentleman yield?
  Mr. KNOLLENBERG. I am glad to yield to the gentleman from Kentucky.
  Mr. LEWIS of Kentucky. The Congressional Budget Office, have they 
come up with a figure on the Gephardt bill at all and what it is going 
to cost?
  Mr. KNOLLENBERG. It is my understanding, and I may have to yield to 
someone with more current knowledge, that they do not have those 
numbers, that is is forthcoming, we have been told. But at this point, 
and this is Thursday evening, we do not have them. I would yield to 
anybody who has better information.
  Mr. HUTCHINSON. You are exactly right, the numbers are not there. I 
have been told, Mr. Speaker, by those involved in the process more 
directly than myself, that it is physically impossible for all of those 
numbers to be produced for this Congress in the next 8 days, which in 
itself is a compelling argument for a more deliberative process, for 
more time to be taken so proper numbers can be presented to this 
Congress, so we will know exactly what we are voting on.
  The CBO, because of the number of bills that have been introduced, 
and the demands upon them, physically will not be able to give us the 
kind of accurate data we need to make an intelligent, deliberative 
decision on health care reform.
  Mr. KNOLLENBERG. If I could just interject, it is us, of course, that 
need information, but we have an obligation to funnel that back to our 
constituents, too, so they can make some judgments about this 
and provide us with input.

  I just wanted to relate a story that appeared on the AP wire this 
evening about calls from angry senior citizens who have been clogging 
the switchboards of AARP, the American Association of Retired Persons, 
after the group's board of directors--who are an inside-the-beltway 
kind of group, I guess they suffer from the same malaise as some other 
people, too--after the group's board of directors stated its support 
was going to be for the Democratic bills. Most of the callers were 
incensed that the AARP leadership made that decision without surveying 
the some 33 million AARP members.
  Mr. HOEKSTRA. Will the gentleman yield?
  Mr. KNOLLENBERG. Yes, Mr. Speaker.
  Mr. HOEKSTRA. It is interesting, regarding the callers, it may be 
unfair to attack the AARP here in Washington, because there would have 
been no way possible for AARP to poll its members, because the bill did 
not exist. The bill did not exist until 9 o'clock last night, so it is 
unfair of those callers to tell them to poll their members before they 
endorsed, because the bill did not exist.
  In reality what AARP did is they endorsed the bill based on an 
outline and some broad concepts, without understanding what is in this 
thing.
  Mr. KNOLLENBERG. The gentleman makes a valid point. It just 
illustrates the problem that all of us seem to have, not just the 
Members of Congress, but the people inside the beltway.
  Of course, it does, I think, frame properly the real difficulty we 
have here this evening in coming to grips with what is it, where is the 
bill.
  Mr. HUTCHINSON. If the gentleman will yield, in regard to the 
decision that the AARP made, I think that one of the--again, one of the 
ironic aspects of their decision to support a Government-run health 
care system, and in particular, the Clinton-Gephardt, Clinton-Mitchell 
bill, is that all of these health care plans depend very heavily on 
Medicare cuts in order to fund their particular health care plans.
  That may or may not be a wise decision, but it is something that 
needs to have a very close scrutiny. The hospitals in my State, the 
State of Arkansas, many of them, and I mean by that dozens of them, 
have communicated directly with me with this message: ``Please wait,'' 
because they are concerned about how drastic, radical Medicare cuts 
will affect rural hospitals in this country, who are so dependent upon 
Medicare reimbursement.
  So for AARP, which is supposed, of course, to have the interests of 
our senior citizens at heart, to endorse a bill that relies so strongly 
upon drastic Medicare cuts to fund the bill is, again, very ironic, and 
it needs to be looked at very, very closely, and the hospitals in the 
State of Arkansas have said ``Let us wait. Let us look at it closely. 
Don't do anything drastic. Don't do anything right away. Look at how 
this is going to impact rural health care.''
  I think they have made a wise decision in sending that message to 
Washington. I thank the gentleman for yielding.
  Mr. KNOLLENBERG. As we wind down here in the last couple of moments, 
if any of the gentlemen want to make some final comments, I yield to 
the gentleman from the gentleman from Kentucky.
  Mr. LEWIS of Kentucky. I have looked at some interesting statistics 
the other day in an investment paper, that 38 percent of the gross 
domestic product in this country is made up of Government.
  It said that if we go on, we are moving very close to that 50 percent 
mark where, if we pass a Mitchell or Gephardt bill, we would go over 
the 50 percent of our gross domestic product. That would take us past 
where Russia is right now. It would move us close to Sweden. It would 
take us over the edge. One-seventh of our economy would be made up of 
the health care plan.

  Mr. Speaker, we cannot continue on like this. We cannot continue on 
with more taxation. The 17 to 20, the taxes of the Mitchell-Gephardt 
plan, for the average family with local, State and Federal taxes, 40 
percent of their income, and when you include the hidden taxes, you are 
getting close to 50 percent.
  We are getting close to the point of putting the straw on that is 
going to break the camel's back, and I don't think the American people 
are wanting this. I don't think they are ready to go to a system that 
is going to be so overburdened by the Government in every area of their 
lives that they cannot have the freedom to make their own choices.
  Mr. KNOLLENBERG. I thank the gentleman.
  Mr. HOEKSTRA. Just a couple of final points, if the gentleman will 
continue to yield. When we are taking a look at the health care debate, 
we really do want health care reform, but we want a process that is 
going to enable creativity and innovation.
  We already see that some of the plans are doing away with wellness 
plans, where they are saying ``We are going to have to study them for 
two years.'' They are doing away with cafeteria-type plans. The States 
are the hotbed for innovation. They have been innovating on legal 
reforms, so what does the new Clinton-Gephardt bill do? It preempts all 
State laws on liability.
  What is the end result we want, Mr. Speaker? We want to go through a 
good process, one that we have gone through a deliberation, an 
opportunity to input, an opportunity to hear from our constituents. We 
want a plan that can get broad bipartisan support.
  I would love to pass a health care reform bill that has over 300 
votes. We want to build on what we have. Our health care system works 
for 85 percent of the American people. Let us build on what we have and 
let us start including the other 15 percent into that 85 percent.

                              {time}  2130

  If we go through that kind of process, if those are the principles 
that we use, we will end up with a result that is good for the American 
people and that they will be proud of.
  Mr. KNOLLENBERG. Mr. Speaker, I thank the gentleman. I think he is 
right on target in terms of suggesting that we not provide a 100-
percent solution for a 15-percent problem. Of course, that falls in 
line with the statement that we should fix what is wrong with what is 
right. Let us not throw the baby out with the bath water. We have got a 
great health care system here. It can be better, we can make it better. 
There is a bipartisan effort being made right now to do just that.
  Mr. Speaker, I would just like to close by saying the only partisan 
bill that I can recall in this Congress, in the 103d, was the budget 
bill. It was the only bill where there were Democrats and Republicans 
massed together. I believe in the health care debate, which is so 
important, to Republicans, to Democrats, to every man, woman, and child 
in this country, it should be a bipartisan effort that prevails and I 
believe we can get there and I believe the concepts that we have talked 
about this evening are what the American people want.

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