[Congressional Record Volume 140, Number 112 (Friday, August 12, 1994)]
[Extensions of Remarks]
[Page E]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: August 12, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
                  SINGLE PAYER WILL WORK FOR EVERYONE

                                 ______


                           HON. JIM McDERMOTT

                             of washington

                    in the house of representatives

                        Friday, August 12, 1994

  Mr. McDERMOTT. Mr. Speaker, Jack Gordon, a retired Florida banker, 
who is today president of the Hospice Foundation of America, recently 
asked an interesting question in a Miami Herald oped article. He wrote, 
``Doesn't it make sense that if Medicare works for our parents and 
grandparents--and maybe some of us--it would work for everyone? And if 
it is good enough for them, why isn't it good enough for everyone 
else?''
  Mr. Gordon advocates the single payer approach after studying health 
care matters for 20 years as a member of the Florida State Senate, 
including time as majority leader of that body and as chairman of 
appropriations and other committees with health care oversight. He is a 
serious student of health policy having served also for 5 years as 
director of the public policy institute of Florida International 
University.
  He notes that the market economy does not work in health care 
delivery, that the American people understand the Medicare approach, 
that $120 billion can be saved annually in administrative costs, and 
that paying for it is not complicated or confusing with the single 
payer approach.
  I am inserting his short article in the Record and urge all of my 
fellow colleagues to read it seriously and with an open mind. They 
will, I hope, arrive at the conclusion that single payer indeed will 
work for everyone and that it is good enough for us all.

                 [From the Miami Herald, July 28, 1994]

               Expand Medicare Benefits To Cover Everyone

       The delusion of ``managed competition'' in the current 
     health care debate is based on an erroneous assumption that a 
     market economy is at work in health care delivery. It 
     presupposes (1) competition sets market prices, (2) willing 
     buyers deal with willing sellers, and (3) none are under any 
     constraints.
       Health care, however, has no independent buyers. If you are 
     sick, you need care. Indeed, if you don't get it, you may 
     die. Beyond that it is the supplier of health services, your 
     doctor, who creates the demand as well as supplies the 
     services.
       The doctor says, ``Go to the hospital,'' and only to one 
     where he has staff privileges. Then you become the passive 
     user of ancillary services--laboratories, X-rays, anesthesia, 
     drugs--all requisitioned by the doctor. Neither he nor you 
     are in any position to shop around for alternatives. There 
     isn't any true market.
       What happens in the real world of competition among 
     insurance company plans (or health maintenance organizations) 
     is that services are often limited in order to lower costs--
     hardly a benefit to the patient. Managed care is a delusion 
     ultimately fed by the greed of the large insurance companies. 
     It means a system driven by the profit motive, and excludes 
     your doctor as the basic determiner of necessary services. He 
     is replaced by private enterprise bureauctats--as real as the 
     government kind but less likely to be held to any standard of 
     public responsibility.
       The obvious solution that is largely overlooked in this 
     increasingly stalemated health care debate is to build on an 
     existing system that is known to everyone and that works 
     reasonably well: Expand Medicare to cover everyone
       This approach, partly included in the U.S. House Ways and 
     Means Committee bill, is understood by most Americans, unlike 
     other proposals. It preserves a personal choice of physician, 
     an advantage that doctors are increasingly recognizing. And 
     Medicare provides an administrative role for large or small 
     insurance companies as contract administrators of its 70 
     regional districts at a cost of about 2 percent of 
     expenditures. In contrast, private plans and HMO 
     administrative costs range from 15 to 25 percent.
       Cost control can be achieved by imposing a fee schedule on 
     all providers. And instead of a government bureaucracy to 
     enforce the fee schedule, why not make the provider liable 
     for triple damages and attorneys' fees for excess charges? 
     This might even be a trade-off to the legal profession for 
     limiting malpractice claims.
       Projecting from a study reported in 1991 in the New England 
     Journal of Medicine of all 6,400 Medicare hospitals, a fee 
     schedule and the attendant reduced administrative costs would 
     produce an annual savings of some $120 billion. That would go 
     a long way toward providing coverage for the currently 
     uninsured.
       Paying for the expanded Medicare system is not that 
     complicated, either. It requires two simple trade-offs: an 
     increase in the corporate income tax equal to the amount that 
     employers are now contributing to their employees' health 
     care, and an increase in either Social Security or personal 
     income tax to equal the amount that individuals are currently 
     paying for coverage.
       This plan would save businesses the high cost of 
     administering their own health plans and obviously would save 
     the cost of private insurance. It would also preserve the 
     privacy of employees, whose medical history would no longer 
     be available to their employer.
       We don't have to look to Canada or some other foreign 
     country to find a workable single-payer system, because we 
     already have one that can be easily expanded to include all. 
     Doesn't it make sense that if Medicare works for our parents 
     or grandparents (and maybe some of us), it would work for 
     everyone? And if it is good enough for them, why isn't it 
     good enough for everyone else?

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