[Congressional Record Volume 140, Number 112 (Friday, August 12, 1994)]
[Senate]
[Page S]
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]

 
                         PRIVILEGE OF THE FLOOR

  Mr. PACKWOOD. I ask unanimous consent that the privilege of the floor 
be granted to John Ratner, an employee of the General Accounting Office 
on Detail, Committee on Finance, during each day this bill or other 
health care reform is the pending business.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. PACKWOOD. Mr. President, let me tell you a bit what bothers us on 
our side. If you will notice, the House of Representatives the other 
day voted to apply all of the laws that apply to all other American 
citizens to the House of Representatives--the National Labor Relations 
Act, the Fair Labor Standards Act, and many others, including the 
Occupational Safety and Health Act, OSHA. Many or all of the pages that 
we have in the Senate, who do extraordinary work--and we work them long 
hours--are high school students, and they go to a special school here. 
But they would be very much like our young high school sons and 
daughters.
  What I think we are coming to, first, is this, Mr. President. There 
are four bills here. The top one is the finance bill we were first 
considering, and then the majority leader's first bill, his second 
bill, and third bill. I weighed this. If we adopt the Occupational 
Safety and Health Act for the Senate, the pages will not be allowed to 
pick up this stack. It is too heavy for them. We are being asked to 
consider this stack in a very short period of time.
  The majority leader was just on the floor saying there are minor 
changes, and that it is common and we do this all of the time. And we 
do make technical corrections all of the time. But I want to emphasize 
to the Senate the quantity of changes he was talking about. Between his 
first bill and his second bill--and we have his third bill tonight--he 
made amendments to every title of the bill. A title is the legal 
language we use in bills, like title 1, 2, and 3. He made changes to 
every title of the bill in 139 sections of the bill. Those are not 
minor, modest, minuscule changes.
  The Record will show that I asked yesterday whether or not it was 
true that a particular part of the bill that both the Chairman, Senator 
Moynihan, and I were interested in, was in or out of the second bill. I 
had heard it was out. This was a section that dealt in the law, not in 
the Finance Committee bill. It is the only bill that was introduced 
that did not have this section in it. We were going to tell every 
medical school in this country how many residents they could have. 
Residents are graduate medical students. We were going to tell them 
what kinds of residents they could have--surgeons, ophthalmologists, 
podiatrists, whatever. We were going to tell them on the theory that we 
knew better than they do. This is a section that offended very greatly 
the Chairman and I.
  I was assured by one of the Democratic Senators that in the new 
bill--it is no longer new; it is yesterday's--introduced by the 
majority leader that section was out; indeed, the section was out. Do 
you know what was in? A commission. And a commission was to determine 
how many residents and what kind of residents, and the word reduced--
and they shall determine to what extent the number of residents shall 
be reduced. Well, darn it, that answer misled me. I thought it was out 
of the bill. And I hope before we are done, this pernicious section is 
going to be out of any bill that we are considering.
  But how on Earth are we to know when we get, tonight, the leader's 
bill? We got this tonight. Some amendment has been offered to this, or 
something else, we are not yet sure, and the leader wants to vote on it 
tonight. That is our problem.
  There is one thing we do know about the leader's bill of yesterday. I 
do not know about it today. I do not have the CBO estimates yet. We 
know that the leader's bill, yesterday, would spend more money on 
health over the next decade than if we pass no bill at all. People have 
been talking about the waste, the excess, and ineptness of our present 
medical system. And if we did nothing, we would spend less money than 
if we passed the majority leader's bill intact. Maybe we want to spend 
more money. It is a fair argument. I would prefer not to. But it is a 
fair philosophical argument and, on balance, it divides, on average, 
Republicans from Democrats. On average, Democrats are more comfortable 
spending money, Republicans are not. Democrats are more comfortable 
with a centralized bureaucracy, Republicans are not. I am not saying 
every Democrat and Republican fall into those categories; I am just 
saying on average. You can tell it from the speeches. With a few 
exceptions, all of the Democratic opening statements have been horror 
stories of somebody who is sick or injured and had no insurance 
coverage. In essence, every one of their opening statements was that 
little Nellie is tied to the railroad tracks, and the train is coming 
down the track, and the train is going to cut off her legs and she does 
not have any insurance coverage; and the solution of the Democrats is 
to make sure she is insured. I think the solution of the Republicans 
would be to try to stop the train. And yet, we are not going to be 
allowed to stop the train if we pass the majority leader's bill.
  I am going to quote a few statistics, and it ought to bother 
everybody in this country, because it happens so slightly that we are 
unaware of it. In 1950, every Government in the United States--Federal 
Government, State government, local, cities, counties, fire districts, 
school districts, water districts--taxed 21 percent of all the money in 
this country, or $1 in $5. That was in 1950. All of those same 
governments, in 1950--all of them put together--spent about 23 percent 
of all the money we had. So we were taxing 21 percent and spending 23 
percent. We had a deficit, collectively, if you add all the governments 
together. The argument is, first off, that we should raise taxes to 
narrow the deficit. Well, over the last 40 years, that has not 
happened. As I said, in 1950, we taxed 21 percent, we spent 23 percent.
  Forty-four years later all of the same governments, all Federal 
Government, all the State governments, cities, counties, fire 
districts, water districts are taxing not 21 percent, $1 in $5 roughly. 
They are all collectively taxing 33 percent, $1 in $3. So the taxes 
have gone up rather significantly. Spending, however, for all of the 
governments is 36 percent.
  So in 1950, we taxed 21 percent; we spent 23 percent. In 1994, we 
taxed 33 percent; we spent 36 percent.
  We have raised the taxes. We have not narrowed the deficit. And the 
bill that we have before us raises an immense quantity of taxes and 
spends an immense quantity of money.
  As I have said, the bill we have before us will spend more money on 
health than if we pass no bill at all. But the question we ought to ask 
ourselves is, do we want to look in another 10 or 20 or 30 or 40 years 
like Sweden, because if we keep going the way we are going gradually we 
will end up taxing 40, 45, or 50 percent of all the money we have, and 
we will spend 2 or 3 percent more than we have. We will never balance 
the budget. We will just spend the money.
  The bill that we have before us, Mr. President, is an immense taxing 
and spending bill. And before we rush pell-mell into it, we would like 
a legitimate chance to know it and to talk about it and to present our 
arguments to the American public.
  We normally in the Senate have a recess schedule starting tonight. If 
we had the recess, we would be home, and we would be talking with our 
constituents about this bill. And we would be asking their opinion and 
their judgment.
  But the majority leader has said that we cannot go home. He has said 
we are going to stay here as long as it takes, as many days, weeks, and 
months, if necessary, for every Senator to be able to consider the bill 
amply. That is fine. But, Mr. President, there is one problem with 
that. We can consider it amply, but our constituents cannot, and the 
only chance we are going to have, because we cannot go home to educate 
them, is to attempt to educate them through debate on the Senate floor 
and through opening statements that are going to thoroughly dissect 
this bill.
  A few moments ago, I was called off the floor and interviewed by one 
of the better reporters who is covering this subject, and she indicated 
one of the Democratic Senators had gone up to the press gallery after I 
had indicated that we had many Senators who wanted to make opening 
statements and that some might be 4 or 5 hours long, not all, but two 
or three may be 4 or 5 hours long. Many of them will be an hour, some a 
half-hour, some an hour and a half.
  And that Senator accused us of using filibuster tactics. He called 
that a filibuster.
  I ask you if we cannot go home and talk to our constituents and if 
the only way we have where we otherwise would be a month at home 
talking to them, if the only way we have to get the point across that 
we feel so strongly about on this bill is to talk on the floor of the 
Senate, is that some kind of an immoral, unethical process? Is that a 
filibuster?
  And this was from a Senator who voted against allowing us to have a 
vote on product liability, who filibustered the bill so that we could 
not vote on it, then goes upstairs and says to the press that the 
Republicans are filibustering this when we cannot go home, and we have 
no other opportunity to bring this bill to the public's attention.
  Mr. President, we are going to bring this bill to the public's 
attention. It may take us days or weeks or months. General Grant said 
he was prepared to fight it out on this line if it takes all summer. I 
think we are prepared to equal General Grant.
  With that, I am prepared to yield such time as I have remaining of my 
half-hour section to the distinguished Senator from Texas.
  The PRESIDING OFFICER. The Senator from Texas is recognized.
  Mr. DASCHLE. Mr. President, a parliamentary inquiry.
  The PRESIDING OFFICER. The Senator will state it.
  Mr. DASCHLE. What is the current time allocation for the Senator from 
Oregon?
  The PRESIDING OFFICER. Under the previous order, each side is 
allocated 30 minutes. The Republican floor manager has 15 minutes and 5 
seconds under his control and, as I understand, he has yielded that 
time to the Senator from Texas.
  Mr. DASCHLE. I thank the Chair.
  The PRESIDING OFFICER. The Senator from Texas is recognized.
  Mrs. HUTCHISON. Thank you, Mr. President, and I thank the 
distinguished managers of the bill, Senator Moynihan and Senator 
Packwood, for allowing me this time. I do not intend to speak for 2 or 
3 hours I say to Senator Packwood. And unlike Senator Lott, it is not 
welling up in me and having to come out all at once tonight. But I have 
been watching the debate for the last week, and I did want to say a few 
things tonight before I do give my opening statement later in the next 
week or whenever my time comes.
  Mr. President, I did spend the last weekend at home going through 
Texas, walking through Dairy Queens, coffee shops, talking to people, 
not talking about health care in particular, but saying, ``What is on 
your mind?'' Not one person that I talked to did not blurt out 
something along the lines of, ``What are you people in Washington going 
to do with our health care system?'' That is a variation of everything 
I hear as I go through my State, just talking to people in the 
airports, walking down the street, walking into a building. It is the 
topic that people most fear, and it seems to me that the more they hear 
the more afraid they become, because they are being educated on all of 
the things that could change in the health care system as we know it.
  I would like to put in perspective what we are talking about here. 
Eighty-five percent of the people in our country have health care 
coverage. Most are satisfied with that coverage or, if they do not like 
it, at least they know that they are going to be covered and something 
catastrophic will not happen to them. Ninety-five percent is now 
considered universal coverage.
  So what are we going to do to bring the other 10 percent into the 
fold, because we do want them to be covered? We want them to know that 
something catastrophic will not happen to them when they do not have 
coverage.
  It seems to me that President Clinton and Senator Mitchell and the 
people who are supporting the kind of plan that will, in fact, throw 
out the system we have and replace it with something that is a massive 
Federal takeover of our system are asking a different question from 
what I think we should be asking.
  President Clinton is saying how can we bring the other 10 percent 
into the fold? That is the question. I think the question should be, 
how are we going to bring the other 10 percent into the fold without 
damaging the system that 85 percent of our people have and to make sure 
that the full 95 or 100 percent have a great quality health care system 
as we do in our country now?
  I think that should be the question. So if that is the question, I 
think you will come to a different answer from the Clinton-Mitchell 
type of approach.
  Senator Mitchell's plan has mandates. They do not come until after 
the year 2000, if we do not have the 95-percent coverage, but, 
nevertheless, the mandates are there. It is a 50-percent mandate for 
employers, but it includes individual mandates as well. So it is going 
to be mandates for all of the people in our country.
  It includes massive tax increases, the 1.75 percent tax on every 
premium, so if you are covered, you are going to pay that tax, and if 
you cover yourselves or your employees with a better plan, you are 
going to have a 25-percent excise tax.
  It seems to me that that is the wrong approach, having a massive tax 
increase if you are going to do better for your employees. We should be 
trying to encourage people to cover themselves fully, trying to 
encourage employers to do better, as best they can, for their 
employees.
  And there are so many things in there that I think we just do not 
know yet. That is why I have been uncomfortable with the bill that was 
introduced last week, taking it up immediately, 1,400 pages, because 
all of these new Federal programs and Federal agencies and commissions 
that are going to decide what all of us have in our cookie-cutter 
plans.
  But one thing did jump out at me, because I am very supportive of 
medical education, and that is that we are also talking about 
engineering our medical profession in these plans.
  What about the young man or woman who wants to go to medical school 
because his or her mother and father or mother or father were 
ophthalmologists and they want to go to medical school so they can come 
home and be in the family of ophthalmology? That is what they have 
grown up in, working in the summers when they were in high school. They 
know what ophthalmology is and they love it.
  So they go to medical school under one of these new plans and they 
graduate from medical school and they get ready to go into their 
ophthalmology specialty. And the agency that is in charge of saying how 
many specialties are available says, ``I'm sorry, but ophthalmology is 
filled. You are not going to be able to do that.''
  That is not what this country is looking for in health care reform. 
We are looking for keeping our choices, for our best young men and 
women to go into the medical profession knowing that they will be able 
to pick the specialty that they want or to be able to do a family 
practice, which is what we hope they will do, especially in our rural 
areas. But we do not want in this country to start engineering our 
medical practice, because that is going to take away from the quality 
that we have known in this country.
  It seems that we are patterning these new bills, the Clinton-
Mitchell-Gephardt type bills, after what we have seen in Canada. In 
fact, President Clinton said in the campaign that he was looking at the 
Canadian system as the model for his plan.
  But I wish you would talk to someone who has lived in Canada and 
lived under their health care system. If someone is well in the 
Canadian system, they do fine. But if you are sick in the Canadian 
system, you have a problem. There is rationed health care because there 
is a limit on what can be spent and that causes rationing. You wait 6 
months for heart bypass surgery; hope you have that luxury. A lot of 
people who can afford it will go to the United States to have surgery 
because they cannot wait 9 months for cataract surgery or 3 months for 
a mammogram.
  I read an article by a woman who had just had a baby in Canada. She 
said that she had thought she would have anesthesia. But there was only 
one anesthetist in the hospital there and the anesthetist was taken up 
with emergency surgery, and by the time he could get to her it was too 
late.
  That would not happen in America. No woman has a baby without 
anesthesia if she wants it, regardless of whether she can pay or not. 
That is because we have the quality of health care system that we do. I 
do not think we want to give up that quality for a system that is not 
working in Canada and we certainly do not want to put that kind of 
system in place in America where we do have the quality.
  So, Mr. President, I would just say that I think we do need to take 
our time. I do have some concerns, and I do want to more fully explore 
those concerns.
  But I think the people of this country deserve to be able to really 
know what is in this bill and what the effects are and have time to 
study it. I think they want to know what impact these bills are going 
to have on their quality of life. Because that is what this is. It is 
one-seventh of our economy. Millions of jobs in the health care 
industry are at stake here.
  But, most of all, it is a basic quality of life issue for every 
American, what we do. I do not think we have to do it in the next 2 
weeks, because if we make a mistake, it will be very difficult to 
reverse the mistake.
  You know, we passed a tax bill in this body last year, and I was 
against it. But I know that we will be able at some point in the future 
to repeal a bad tax. We have passed some regulations and mandates that 
I think are not going to work. We can repeal a bad regulation.
  But, Mr. President, when you overhaul the health care system, 
throwing out everything that we know today and putting in a whole new 
Government structure, we cannot reverse that. We cannot reverse it. And 
we must remember that. We are talking about something so important to 
so many families.
  The only responsible approach is to take it one step at a time. Let 
us improve the system as we know it. We can do that.
  There are some things that we need to do. We need more accessibility. 
The Mitchell plan provides that, so does the Dole plan. The Dole plan 
does it without mandates and taxes and without a massive Government 
bureaucracy. We need access, and we can do that. That will be a 
responsible thing for this Congress to do.
  And we can bring health care costs down with malpractice reform. The 
Dole plan is the only bill that has malpractice reform. I think that is 
the only way we are going to really bring the costs down. We can also 
do some of the things in the Mitchell-Clinton-Gephardt bills that take 
away some of the duplication of paperwork in our insurance forms. We 
need to do that. But we also need malpractice reform if we are going to 
bring the costs down so that we can keep the quality in our system.
  And we can make affordable access possible through voluntary pools. 
We do not have to have mandates for that. We can have voluntary pools 
with tax incentives to help people pay, along with subsidies for people 
who are at the poverty level or 150 percent of the poverty level.
  You know, I have seen so many of the President's press conferences 
and his town hall meetings. He has some tragic stories. Most of the 
people that are mentioned in the press conferences that do have needs 
that we must address would be covered in a plan like the Dole plan. We 
can bring those people into the system without hurting the system for 
the other 85 percent of our population. Let us do this responsibly.
  Mr. President, let us do this responsibly. Let us make sure that we 
take one responsible step at a time. We do not need a crisis, and we 
are going to make a crisis if we take an action that we have not 
experimented with, that we are not sure what the consequences will be.
  So, Mr. President, I thank you for recognizing me, and I thank the 
managers of the bill.
  I just hope that Americans will listen to the debate. I hope that we 
will be able to debate fully enough that they will have the education 
they need to make a choice. If they want this massive, new Federal 
bureaucracy taking over the health care system, do they want the new 
taxes?
  Let me just make one point before I close. And that is that we are 
told that there are people now not in the system and we pay for them 
anyway. And we can take those costs off by making sure that everyone is 
covered.
  I submit to you that it is just a matter of how we pay for the people 
who are not covered. I doubt that there is much difference between how 
we take care of people today through Medicaid, through county health 
clinics, through emergency facilities that are open to people who do 
not have coverage, versus the new taxes in the Mitchell-Clinton-
Gephardt bills that are used to pay for the people who are not covered, 
to pay for the subsidies for the people who are not covered. The 
subsidies in the Mitchell bill are estimated now to cost $1 trillion 
over the next 8 years--that is what I have seen in print.
  That is a cost that we must pay for. Someone is going to have to do 
it. It is going to be the people who are taxed on their premiums, 
especially if they decide to go the extra mile and pay 25-percent tax. 
There are taxes all through this bill. So that is how we are going to 
pay for the people who are not covered.
  We are doing that now. And people have a quality health care system 
to rely on. So let us try to help the people who do not have coverage. 
Let us try to bring them into the system, make sure they get the 
prenatal care, the preventive care, the care that will keep them from 
having the emergencies or the premature babies. We need to do that. Let 
us do it in a responsible way that brings everyone the quality that we 
have in our system. That is the responsible approach.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. Who seeks recognition?
  The Senator from New York is recognized.
  Mr. MOYNIHAN. Mr. President, I thank the Senator from Texas for her 
very thoughtful and carefully modulated remarks. I think on that happy 
note we conclude our debate for the day.
  There is just some concluding business for the Senate, I say to the 
Presiding Officer who has been waiting patiently, well passed the hour 
in which his watch was to have concluded.

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