[Congressional Record Volume 140, Number 113 (Saturday, August 13, 1994)]
[House]
[Page H]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: August 13, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
                          HEALTH SECURITY ACT

  The ACTING PRESIDENT pro tempore. Under the previous order, the 
Senate will now resume consideration of S. 2351, which the clerk will 
report.
  The legislative clerk read as follows:

       A bill (S. 2351) to achieve universal health insurance 
     coverage, and for other purposes.

  The Senate resumed consideration of the bill.

       Pending:
       Mitchell amendment No. 2560, in the nature of a substitute.
       Dodd amendment No. 2561 (to amendment No. 2560), to promote 
     early and effective health care services for pregnant women 
     and children.

  The ACTING PRESIDENT pro tempore. The time until 5 p.m. shall be for 
debate only, to be equally divided and controlled by the managers of 
the bill or their designees. Who seeks recognition?
  Mr. PACKWOOD. Mr. President, I suggest the absence of a quorum.
  The ACTING PRESIDENT pro tempore. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. PACKWOOD. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.
  Mr. PACKWOOD. Mr. President, I yield such time as the Senator from 
Maine may need.
  Mr. COHEN. Mr. President, I thank the Senator from Oregon. Mr. 
President, as the debate on health care reform rages on and Republicans 
are buffeted with charges of being obstructionists and incrementalists, 
I am filled with a sense of deja vu--perhaps in Yogi Berra's words, 
``deja vu all over again.''
  I must say I was disappointed, but not surprised, to see a story in 
the Washington Post that was headlined, ``Senate Republicans Impede 
Health Care Legislation.''
  Mr. President, why did not the headline read: ``Senate Republicans 
Halt Rush to Premature Amendments"?
  The story also said that we spent 4 days on this legislation before 
the first amendment was introduced. We spent portions of 4 days. If you 
total up the hours spent, it might total one entire day.
  As I understand it, only nine Republican Senators have had an 
opportunity to speak on this legislation--only nine of us. Yet, we are 
now accused of impeding progress on health care legislation.
  Mr. President, this is legislation which we are told has been in the 
waiting now for some 40 or 50 years. It seems to me that taking several 
days to at least allow the Members to make opening statements on 
legislation that they and their constituents are deeply concerned about 
is not asking too much.
  It should not be reported that we are being obstructionists just 
because we want to give Members the opportunity to speak, not to delay, 
but to at least express their opinions. Just because we want to have 
the opportunity to speak, we should not be labeled as obstructionists 
or incrementalists or accused of impeding health care legislation.
  Mr. President, back in the summer of 1990, in response to what was 
then an emerging issue of increasing national concern, Senator Dole 
charged Senator John Chafee with the job of forming a Republican task 
force to develop a comprehensive proposal for national health care 
reform.
  Over the next 3 consecutive years we met regularly--every single 
Thursday morning for an hour, an hour and a half, and sometimes even 2 
hours--to define, discuss, and debate the problems plaguing our health 
care system. Sometimes we brought in experts to at least try to 
enlighten us about complex technical issues, such as risk adjustment. 
But more often than not, we talked among ourselves, discussing a 
multitude of issues raised by our constituents, and even about our own 
personal experiences with the health care system.
  The problems were clear. Health care spending, which this year is 
expected to top some trillion dollars, was at an all-time high and 
rising daily, placing a strain on families and employers and 
governments alike. As health care costs skyrocketed, more and more 
Americans were being priced out of the market, leaving some 37 million 
or more Americans at any given time with no health care coverage 
whatsoever, and many more living in terror that they would lose their 
coverage if they became ill or changed jobs.
  We all found it both ironic and tragic that under our current system, 
the very people who need health care coverage and treatment the most 
are the ones who cannot get coverage simply because they are already 
sick or suffering from a preexisting condition. We agreed unanimously 
that health care insurance should be portable; that insurers should be 
prohibited from denying, canceling, or limiting coverage on the basis 
of a person's health status.
  We agreed that, rather than competing on the basis of their ability 
to attract the healthiest customers, insurers ought, instead, to be 
competing on the basis of price, quality, and service. We agreed that 
insurance market reforms--guaranteed eligibility and renewability, 
portability and limitations preexisting condition exclusions, should 
all be a part of any health care reform proposals.
  We reached agreement on several other key components that we believed 
a bipartisan majority in Congress could agree upon; namely, access to 
health care for all Americans; subsidies for low-income individuals and 
families; full tax deductibility for the self-employed; encouragement 
of managed care and cost containment to make coverage more affordable; 
administrative reforms to reduce costs and paperwork and to make the 
system more efficient; malpractice reforms to reduce the costly 
practice of defensive medicine; expanded access to care in rural areas 
and incentives to encourage more physicians to enter primary care; 
stronger efforts to combat fraud and abuse which robs our health care 
system of as much as $100 billion a year; and, finally, greater 
emphasis on primary and defensive care.
  These principles were part of my own legislation, which I offered 
back in 1990--4 years ago. It is a 76-page document. This bill which I 
introduced emerged as the major campaign issue in 1990 when I was 
running for reelection. My opponent, who favored a single-payer plan 
based on the Canadian system, said my approach was too complicated. 
This 76-page document was too complicated. We needed a simple system 
like the single-payer system. So it was dismissed as being too long, 
too involved, too convoluted and complicated. Most of the principles I 
just mentioned, that we have bipartisan support upon, were contained in 
this legislation, but it was dismissed.
  Now, we have a new document which is not just 1410 pages. I checked 
this morning. It has been amended for the second time and is now 1,443 
pages.
  Mr. President, I mentioned a moment ago that we incorporated 
provisions dealing with health care fraud. Over a year ago, I first 
introduced my health care fraud bill. As I recall, it was in May of 
last year. Nothing was done until November, when we passed an amendment 
to the crime bill, trying to come to grips with health care fraud, 
which, according to GAO, is costing us $100 billion a year. But even 
though the we passed it on our version of the crime bill, the House 
objected and dropped it in conference.
  Maybe that was a wise thing to do in view of what happened with the 
crime bill. They said, ``Let us save it for the health care debate.'' 
So we have saved it for a year and a half now. We may not finish this 
debate this year. Hopefully, we will. But we have already lost an 
opportunity to get some of that $100 billion a year that we are losing. 
We are losing $275 million a day--$275 million a day--to fraud, $11.5 
million every hour to fraud. Yet, we have delayed almost 2 years now 
from taking any action to deal with it.
  Mr. President, the key principles agreed to in the Republican health 
care task force were also contained in the bill submitted by Senator 
Chafee on behalf of some 20 of us who supported his efforts.
  They are also contained in many of the Democratic proposals. Indeed, 
they are even contained in the latest version of the majority leader's 
amendment. Many of these principles were incorporated into Senator 
Lloyd Bentsen's proposal that was passed in the Senate--but later 
dropped in conference--as part of the 1992 tax bill.
  So we had broad bipartisan support for those new initiatives.
  In the fall of 1992, Senator Dole, Senator Chafee, I, and several 
others, approached the majority with a list of what we called 11 points 
of commonality between Republican and Democratic proposals. We met with 
the majority leader's task force on more than one occasion to press for 
these reforms on which there was broad-based bipartisan agreement. 
These were significant steps that we believed could and should be taken 
immediately to slow the growth of health care costs and increase access 
to quality health care for millions of Americans.
  We were rebuffed. We were told that reforms were not comprehensive 
enough and that anything short of comprehensive reform would not do.
  Mr. President, let me say, very frankly, it was a stall. It was a 
stonewall. I believe it was a political tactic to delay any reforms 
until the elections were over in November. That is what happened. The 
Democratic majority wanted a perfect issue and not an imperfect 
solution, and it was a perfect political issue at that time. The point 
is, we had broad-based agreement and we could have passed something.
  So here we are, 2 years later, still talking about the same 
principles on which we know there is broad-based bipartisan agreement: 
portability, no preexisting condition exclusions, affordable coverage, 
expanded access, emphasis on prevention, cost containment, 
administrative simplification, and stronger efforts to combat fraud and 
abuse.
  We agree on those provisions, and they are part of the Dole- Packwood 
bill. They are also part of the Mitchell bill.
  The problem is the majority leader's bill goes far beyond these areas 
of agreement and would drastically alter the delivery of health care in 
this country.
  I have listened to the debate, and I must tell you I have been moved 
by the recitation of the tragic stories that have affected and have 
afflicted so many thousands and perhaps millions of Americans who lack 
adequate health insurance coverage under the current system. I cannot 
agree more that we must do everything we can to correct this situation 
for the families who are suffering on a daily basis.
  But what is most tragic of all is that most of the situations that 
have been so poignantly described in this Chamber during the portions 
of the past 4 days that have been devoted to the health care debate 
would have been helped immediately by the proposals set forth by 
Senator Chafee, myself, and others.
  Mr. President, health care reform has often been compared to two 
other major social reforms of the 20th century--the creation of Social 
Security in 1935 and then Medicare some 30 years later. However 
controversial they may have been at the time, both of these major 
proposals were ultimately passed. The House passed the Social Security 
Act by a vote of 371 to 33, the Senate by a vote of 77 to 6. The margin 
on the Medicare bill was somewhat narrower but still conclusive--68 to 
21 in the Senate, and 307 to 116 in the House. As controversial as they 
were, these two measures enjoyed broad bipartisan support.
  We are told that the President of the United States is now pursuing a 
51-vote strategy. Let me suggest that it may--and I will talk about 
this at length in a moment--it may be in the political interest of the 
President to pursue that strategy. I think it is bad for the country. 
Let me just suggest why.
  If we are to pursue a 51-vote strategy in this Chamber, or 52 votes 
or perhaps even 1 or 2 more, I can assure you that the very next thing 
that is going to happen after the election in the fall is that the 
reforms we pass now will begin to unravel.
  In the fall elections, we on the Republican side expect to gain 
several more votes. It may be one; it may be two. Conceivably it could 
be 10. I do not want to alarm the chairman of the Finance Committee--
let me compromise--let me say that we expect that anywhere from one to 
five may come to our side.
  In any event, whatever the margin of increase, I can almost assure 
you that, from the day we come back into session next January, an 
effort will be made to undo legislation that passed by a 51-vote 
strategy. And the President will sit in the White House and he will 
exercise his veto, and, depending upon how many Members are added to 
this side of the aisle, he may be successful. He will spend the next 2 
years of his administration vetoing legislation.
  In the meantime, the country will be in a state of complete 
turbulence. Our constituents will want to know: Are we in? Are we out? 
Do we have a plan or not? Is it HIPC or non-HIPC? Is it voluntary or 
involuntary? What should we plan on?
  I can guarantee you the effort will be made on this side to undo 
something that passes by that narrow a margin. That is not good for the 
country.
  We need not do that. We have an opportunity to put together something 
that many of us, if not most of us, can support.
  But if you are just looking to have 51 votes, and that is it, on a 
straight, narrow party line vote, you will get a short-term political 
victory, perhaps--and I am not even sure it will work in the short term 
to the President's advantage. It may be that it only causes more 
turbulence in the country prior to November, and it will not redound to 
his benefit or to anyone else's in this Chamber.
  Mr. President, I have a profound sense of apprehension about any 
strategy that seeks to ram something this important through on a party 
line basis because there are people of good will on both sides. There 
are many good things in the Mitchell amendment, and there are many good 
things in the Dole-Packwood proposal as well.
  The decisions we make in the coming weeks will have profound 
consequences for every single American and will control the future 
direction of one-seventh of our Nation's economy. We should not even 
begin to contemplate enacting such sweeping reforms unless they have 
broad based and bipartisan support.
  To date, much of the discussion of Senator Mitchell's plan has 
focused on the issues of universal coverage, mandates, and the search 
for the ever-elusive perfect trigger--what some have called the 
Goldilocks trigger, one that is not too hard and one that is not too 
soft.
  Mr. President, Gertrude Stein once said, ``A rose is a rose is a 
rose.''
  An employer mandate is still the equivalent of a tax on jobs, with a 
trigger or without. Whether you call it a mandate, it is a tax by any 
other name.
  Employers are not going to bear the cost of that insurance--workers 
will, in the form of lower wages, lost benefits, and lost jobs. And 
CBO's analysis confirms that fact.
  The trigger does nothing to change the essential problems with 
mandates. It just delays their impact until after the turn of the 
century. It is a slow-burning fuse that will trigger long-term damage 
and the loss of thousands of jobs.
  Further, all of the focus on mandates and triggers has clouded the 
much more important issues that have to be decided with regard to what 
we are proposing to do with the health care system in the interim.
  Even without the mandate, there is considerable new regulation in the 
majority leader's bill. This regulation will not only undermine the 
most effective and time-proven cost containment mechanism--
competition--but it is going to add significantly to the costs of 
running a small business.
  I am not sure those of us in this body appreciate the regulatory 
burdens that small businesses already face. I have the benefit of a 
private adviser on these matters. He is my father. He is 85 years old. 
He works 18 hours a day, 6 days a week. He has no pension plan. He has 
no investments, no stocks, no bonds. He just has to keep working to 
support himself and my mother and other members of the family. I know 
what he has to go through to make ends meet. And he could not do it, he 
could not stay in business if we imposed a mandate, as the Gephardt 
bill will do, upon him. It may be the majority leader's amendment's 
exclusion of employers with 25 or fewer workers will exempt him or 
others similarly situated.
  But once you have a mandate in place, it is only a question of time 
until it starts to be applied along the line. We will have to deal with 
the arguments that a small business exemption allows employers with 
less than 25 workers to cost shift. One can see inevitably that the 
handwriting on the wall is not forgery. It will ultimately be applied 
down the line to every single employer.
  Another person whose counsel I have taken and would urge others to 
take on this matter is, surprisingly, that of former Senator George 
McGovern.
  Two years ago, Senator McGovern had printed in the Wall Street 
Journal what amounted to a mea culpa. He regretted that he never really 
understood the struggles of running a small business until after he 
left public service and opened a small inn in Connecticut.
  He wished he had this experience before he entered the Senate. He 
said that he would have been a better Senator and a better Presidential 
contender. He said he would have been more sensitive to the impact 
Government mandates and regulations have on small businesses, driving 
up operating costs and even--as in his case--forcing many of them into 
bankruptcy.
  Mr. President, I ask unanimous consent to have printed at the end of 
my remarks the article written by Senator McGovern for the Record.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.
  (See exhibit 1.)
  Mr. COHEN. Mr. President, as CBO has repeatedly testified and 
reported to us, no one really knows what the impact of the regulations 
contained in this amendment are going to be--no one, not the Members of 
this Chamber, not the other Chamber, not the country, not CBO. No one 
knows the impact of these regulations, and we ought to proceed with 
some caution.

  I recall a few years ago when Congress instituted a tax on luxury 
boats.
  The chairman of the Finance Committee is nodding.
  It was perceived by many simply as a way of squeezing revenue from 
the rich and the famous. Instead they stopped buying large boats and 
the workers suffered. We aimed at the wallets of the rich and we hit 
the blue-collar, middle-class workers in the neck. We put them out of 
work. We put them out of work because we were trying to tax the rich. 
``Let's get the rich,'' we said, and we hit the people right in the 
middle.
  And this legislation runs the risk of hitting those same people right 
in the middle by putting them out of work as well.
  This is a very good example of how Congress often does not appreciate 
the ultimate consequences of its actions. We ought to keep this in mind 
as we continue to debate health care legislation.
  One of the clear messages that I have received from my constituents 
is they are concerned about choice, about any plan that takes too much 
of the decision-making authority about health care out of their hands 
and puts it into the hands of the Government regulators or bureaucrats.
  The majority leader's legislation creates dozens and dozens of new 
Federal and State bureaucracies that would have unprecedented authority 
to regulate the way health care is bought, sold and, to a certain 
extent, even practiced in this country.
  We have a powerful new National Health Board that would be making 
decisions on what medical care is necessary and appropriate--decisions 
that one would think should be between the patient and his or her 
physician. A National Council on Graduate Medical Education will set 
quotas and tell medical students what specialties they can practice. 
And there is a strange system of mandatory voluntary purchasing 
cooperatives that is going to herd all employees of businesses that 
have less than 500 workers into large collectives and destroy their 
employers' ability to control their costs.
  All of this focus has dismissed concerns about costs.
  Mr. MOYNIHAN. Will the Senator yield?
  Mr. COHEN. I am almost finished. At the end, I will yield.
  Now, a key element of cost containment has to be more competition. 
The more regulated the health care industry becomes, the less 
competition can occur and the more costs are going to increase.
  One of the best ways to control health care costs is to give 
consumers incentives to choose efficient, cost-conscious plans. 
However, the majority leader's legislation would impose a complex and 
convoluted tax on plans whose premiums are growing--no matter how low 
those premiums might be.
  This would lock in existing price differences, penalize plans that 
have been efficient, and reward plans that are not. It is little more 
than a backdoor approach to price controls.
  Finally, I am concerned that the so-called fail-safe mechanism in 
this bill--which is intended to ensure that health care reform does not 
add to the deficit--is too weak. It is almost certain that the spending 
associated with the new entitlements and subsidies in the bill are 
going to exceed all expectations and further fuel the deficit that 
threatens to cripple the economy right now.
  And I might point out that when Medicare was first adopted, it was 
projected to cost, I believe, $500 to $600 million. Lyndon Johnson 
said, ``That is something that we can afford,'' and we passed it. The 
cost of Medicare now runs--correct me, Mr. Chairman, if I am wrong--as 
high as $150 billion per year.
  So again we have to exercise some caution when we are projecting what 
ultimately will be the impact of legislation that we are proposing.
  A few days ago, I had lunch with my oldest son, who was recently 
married. He said to me during lunch, ``I hope that Congress will pass 
something by the end of the year.'' He will soon be off to graduate 
school at Dartmouth. He said it would be helpful, he thought, to have a 
health care bill that we could pass this year.
  I assured him that I hoped it was possible. I would like to see 
legislation passed. But he, like most of my constituents, has no idea 
what devils lurk in the details of this massive amendment. He has no 
concept. And, indeed, the Members of this Senate still have limited 
knowledge and comprehension of what is in here.
  There is a group of us meeting as I speak, 15--I think yesterday it 
reached as high as 17--Members of the Senate who are sitting down, 
going through this bill page by page, line by line, all individuals who 
are highly intelligent, who have studied this for several years, and 
who are confused about the implications of what is contained here.
  We are working today. We will start again on Monday. We will continue 
to work through all next week so we can at least make some constructive 
proposals in terms of how we think this legislation can be improved.
  I also pointed out to my son that the proposal that President Clinton 
now supports--namely, the majority leader's proposal; and the bill that 
Mrs. Clinton now opposes, namely the majority leader's proposal--is 
likely to raise the insurance rates that he and others in his age group 
will pay in order to reduce the costs to older citizens.
  Frankly, he was stunned. He was absolutely stunned. He had no idea 
that pure or flat community rating would cause such an increase in his 
own insurance rates, which he cannot even afford now.
  There are other provisions in this bill which are likely to stun the 
American people upon their full disclosure. And, Mr. President, at a 
future time, I will have more extensive comments to make when we debate 
these specific provisions of the majority leader's bill.
  I would like, in the meantime, to add my own comments of praise to 
those of Senator Chafee for the majority leader, and commend him for 
modifying the President's proposal in an effort to seek compromise.
  The next few weeks give us a very narrow window of opportunity to 
enact meaningful health care reform legislation. I suggest that the 
principles--the key principles outlined at the beginning of my 
statement--could form the basis of a centrist reform bill that relies 
upon competition rather than Government regulation to control costs, 
expand choice, and to ensure that everyone has access to the health 
care they need.
  I believe it is the kind of proposal that would attract the broad-
based, bipartisan support that is necessary for health care reform to 
succeed, and it would take us in the direction I believe the American 
people want to go.
  I resist the notion that has been articulated by the White House that 
it is the majority leader's bill or nothing. If that is the case, we 
may very well end up with nothing. I have been encouraged by my 
colleague from Maine and his statement that his proposal is the just 
the beginning and that he welcomes constructive proposals to improve 
it. And that is the attitude with which I have spent the last 3 years, 
nearly 4 years, of my own life in this body, working to improve our 
current system.
  Finally, Mr. President, let me say that President Clinton and Mrs. 
Clinton have, I think, justifiably complained about the negativity that 
seems to be pervasive in our society. I think that they have been, in 
many instances, unfairly criticized. I think that they have taken a lot 
of unneeded, unwarranted, unjustified assaults. This is something that 
all of us should struggle to overcome and try to do our best to 
eliminate from our proceedings.
  But it also works in the same fashion for them. They cannot, in turn, 
point to individual Members of the Senate, Senator Dole in particular, 
and try to demonize him, saying: ``There; the Republican leader is 
seeking to delay, to impede, to destroy.''
  Senator Dole, not alone in this Chamber, but perhaps more than any 
other individual, has suffered pain during his lifetime. He knows what 
health care means and what not having it means. He can tell you--and he 
will not tell you--from family history what it means to go without 
insurance, to go out and have to raise money to pay for treatment that 
is not available without it.
  So I do not think anyone is in a position to be too pious and point 
their finger at Senator Dole or anyone else in this Chamber in an 
attempt to undermine their motive or cast aspersions upon their 
character.
  What we need to do is to continue a debate which is healthy, 
constructive, positive, and has respect for all the Members in this 
Chamber.
  There are others who also suffered war wounds and other types of pain 
during their lifetime. And no one, be it in this Chamber, the other 
Chamber, or in the White House, ought to be pointing fingers at those 
who are seeking to come up with the best possible proposal for the 
American people.
  Mr. President, I hope there will be a cease-fire, a white flag 
raised, no more ad hominem attacks on individual Members. I think there 
is good will in this Chamber and that we can work together to come up 
with something that the majority can support and the majority of the 
people of this country will rally behind.
  I yield the floor.

                               Exhibit 1

               [From the Wall Street Journal, June 1992]

           A Politician's Dream Is a Businessman's Nightmare

                          (By George McGovern)

       Wisdom too often never comes, and so one ought not to 
     reject it merely because it comes late.--Justice Felix 
     Frankfurter
       It's been 11 years since I left the U.S. Senate, after 
     serving 24 years in high public office. After leaving a 
     career in politics, I devoted much of my time to public 
     lectures that took me into every state in the union and much 
     of Europe, Asia, the Middle East and Latin America.
       In 1988, I invested most of the earnings from this lecture 
     circuit acquiring the leasehold on Connecticut's Stratford 
     Inn. Hotels, inns, and restaurants have always held a special 
     fascination for me. The Stratford Inn promised the 
     realization of a longtime dream to own a combination hotel, 
     restaurant and public conference facility--complete with an 
     experienced manager and staff.
       In retrospect, I wish I had known more about the hazards 
     and difficulties of such a business, especially during a 
     recession of the kind that hit New England just as I was 
     acquiring the inn's 43-year leasehold. I also wish that 
     during the years I was in public office, I had had this 
     firsthand experience about the difficulties business people 
     face every day. That knowledge would have made me a better 
     U.S. senator and a more understanding presidential contender.
       Today we are much closer to a general acknowledgment that 
     government must encourage business to expand and grow. Bill 
     Clinton, Paul Tsongas, Bob Kerrey and others have, I believe, 
     changed the debate of our party. We intuitively know that to 
     create job opportunities we need entrepreneurs who will risk 
     their capital against an expected payoff. Too often, however, 
     public policy does not consider whether we are choking off 
     those opportunities.
       My own business perspective has been limited to that small 
     hotel and restaurant in Stratford, Conn., with an especially 
     difficult lease and a severe recession. But my business 
     associates and I also lived with federal, state and local 
     rules that were all passed with the objective of helping 
     employees, protecting the environment, raising tax dollars 
     for schools, protecting our customers from fire hazards, etc. 
     While I never have doubted the worthiness of any of these 
     goals, the concept that most often eludes legislators is: 
     ``Can we make consumers pay the higher prices for the 
     increased operating costs that accompany public regulation 
     and government reporting requirements with reams of red 
     tape.'' It is a simple concern that is nonetheless often 
     ignored by legislators.
       For example, the papers today are filled with stories about 
     businesses dropping health coverage for employees. We 
     provided a substantial package for our staff at the Stratford 
     Inn. However, were we operating today, those costs would 
     exceed $150,000 a year for health care on top of salaries and 
     other benefits. There would have been no reasonable way for 
     us to absorb or pass on these costs.
       Some of the escalation in the cost of health care is 
     attributed to patients suing doctors. While one cannot assess 
     the merit of all these claims, I've also witnessed firsthand 
     the explosion in blame-shifting and scapegoating for every 
     negative experience in life.
       Today, despite bankruptcy, we are still dealing with 
     litigation from individuals who fell in or near our 
     restaurant. Despite these injuries, not every misstep is the 
     fault of someone else. Not every such incident should be 
     viewed as a lawsuit instead of an unfortunate accident. And 
     while the business owner may prevail in the end, the endless 
     exposure to frivolous claims and high legal fees is 
     frightening.
       Our Connecticut hotel, along with many others, went 
     bankrupt for a variety of reasons, the general economy in the 
     Northeast being a significant cause. But that reason masks 
     the variety of other challenges we faced that drive operating 
     costs and financing charges beyond what a small business can 
     handle.
       It is clear that some businesses have products that can be 
     priced at almost any level. The price of raw materials (e.g., 
     steel and glass) and life-saving drugs and medical care are 
     not easily substituted by consumers. It is only competition 
     or anti-trust that tempers price increases. Consumers may 
     delay purchases, but they have little choice when faced with 
     higher prices.
       In services, however, consumers do have a choice when faced 
     with higher prices. You may have to stay in a hotel while on 
     vacation, but you can stay fewer days. You can eat in 
     restaurants fewer times per month, or forgo a number of 
     services from car washes to shoeshines. Every such decision 
     eventually results in job losses for someone. And often these 
     are the people without the skills to help themselves--the 
     people I've spent a lifetime trying to help.
       In short, ``one-size-fits-all'' rules for business ignore 
     the reality of the marketplace. And setting thresholds for 
     regulatory guidelines at artificial levels--e.g., 50 
     employees or more, $500,000 in sales--takes no account of 
     other realities, such as profit margins, labor intensive vs. 
     capital intensive businesses, and local market economics.
       The problem we face as legislators is: Where do we set the 
     bar so that it is not too high to clear? I don't have the 
     answer. I do know that we need to start raising these 
     questions more often.

  The PRESIDING OFFICER (Mr. Mathews). The Senator from New York.
  Mr. MOYNIHAN. Mr. President, could I congratulate and thank the 
Senator from Maine for his remarks and tell him that there is much more 
I agree with than disagree? But the central point of what he has said 
is how much in common we have on both sides of the aisle. I would 
remind him that the Committee on Finance reported a bipartisan bill and 
that bipartisanship is still here. On the front page of the New York 
Times--that is my hometown--Mr. Adam Clymer this morning reports, 
``Mitchell Sees Room for Dealing on Rival Health Care Proposals.'' 
``Big Gain Toward a Compromise in the Senate.''

       Mr. Mitchell, the majority leader, said today that issues 
     raised by bipartisan moderates led by Senator John H. Chafee 
     appeared to be negotiable.

  And of course they are.
  I think we all need to ask ourselves about this particular form of 
ineffectiveness, of almost an entropic decline in our capacity to 
produce results, whether it is institutional, systemic--I do not know. 
Twenty-five years ago a Republican President--we can say that now--
proposed a guaranteed income, which twice passed the U.S. House of 
Representatives and died in the Senate from those who said it was too 
much and those who said it was too little and those who made the 
calculation that, my goodness, if a Republican will do this, think what 
the next Democrat will do.
  That same Republican President proposed universal health care and 
employer mandate. And I am standing 3 feet from the Republican manager 
of the bill here, Senator Packwood, who introduced it. And again the 
calculation was made. Some thought it was too much. But on our side, 
some said not enough, we can get more. Think; if that man would give us 
this, think of how much more we can get. And we got nothing. That is 
the record. We got nothing. It is a quarter century of impasse.
  And I think it is only in the spirit of which he speaks that we will 
move on. Because we are not getting better in some respects. I have 
frequently spoken of the extraordinary advances in medicine--medical 
technology, medical science--that we have seen in the last 30 years. 
But on the subject of infant mortality, in 1960 the United States was 
11th among 23 OECD countries in infant mortality, and 30 years go by 
and we are 21st. We have not been looking to our affairs very 
competently. And we continually miss these opportunities.
  There is an element of the neurotic in this, an element of the 
individual who repeatedly states one desire and behaves in a way that 
thwarts that desire. It is a very common neurotic pattern. I do not 
have to tell a person of the insight into these matters of the Senator 
from Maine, but I thank him for his address.
  Mr. COHEN. Will the Senator yield at this point?
  Mr. MOYNIHAN. I yield the floor.
  Mr. COHEN. Mr. President, I go back to what I think will be the 
problem. Articles have been written about ``demosclerosis.'' That our 
democracy has become----
  Mr. MOYNIHAN. Demosclerosis.
  Mr. COHEN. Filled with special interest groups that are highly 
organized; that they will prevent not only attempts to adopt new 
legislation but prevent any modification of existing legislation. We 
are suffering from a sclerotic condition.
  One of the reasons I feel so strongly about not pursuing this 51-vote 
strategy, or narrow, partisan strategy, is that what will take place in 
the country, if the country sees that we are divided virtually on party 
lines with some minor exceptions, they will then be divided along party 
lines as well. Our division will be replicated and reflected out in the 
country. And they, in turn, will mobilize forces to change what we have 
done. That will continue. I am persuaded that will continue into the 
future.
  If we really want to do something constructive for the country, if we 
reach broad-based bipartisan support, we send the signal to the country 
that we are united. If the country and the groups that are out there 
feel we are divided, as we are today--publicly at least--in terms of 
these issues they will seek to exploit that. And, year after year, 
President Clinton--he will not enjoy the next 2 years, I can assure 
you. He will not enjoy the next 2 years. We will not enjoy the next 2 
years. And the country will be in a state of confusion.
  I am pleading for both sides to try to find some appropriate middle 
ground. I am part of the Chafee mainstream group. I have been so. I 
continue to work in that fashion. I just hope we can stop the attacks. 
Frankly, I think by going to the amendment--I understand what the 
strategy is: Let us go to the amendments. Let us get some momentum 
going, pass some amendments, and give at least the perception that we 
are doing something constructive, rolling along. And that will give the 
House the incentive to go ahead.
  We are in a situation where we, for the first time, are proceeding on 
a major tax bill in front of the House because they do not want to go 
first now, something extraordinary in our history.
  I understand the tactics involved. But I plead with my colleagues on 
the other side, do not believe Members over here are seeking to stall 
and delay for the purpose of stalling and delaying. There are people 
over here who have been working on this for years, who would like the 
opportunity to speak. I have waited 4 years to speak--what was it, 25 
minutes? I only consumed 25 minutes. I wanted to make that speech 
before we got to the amendment stage. There are others who feel equally 
strongly.
  So I just resent the notion that somehow the headline story is Senate 
Republicans impede progress on health care legislation. We are not 
seeking to impede. We would like an opportunity to explain our 
positions to our constituents, to inform them of what we believe to be 
some of the deficiencies in the proposals, to let them know that a 
number of us over here, and I would say Senator Dole is in this 
category--he has encouraged us to see if we can come up with some 
constructive solutions.
  So it ought not to be labeled obstructionist once again, and pure 
negativity on the part of the Republican Party. I think we are working 
to see if we can do something that is in the best interests of the 
country.
  Mr. KENNEDY. Will the Senator yield for a question?
  The PRESIDING OFFICER. Who yields time?
  Mr. MOYNIHAN. Let me, when Senator Kennedy speaks, yield our time.
  Mr. KENNEDY. I was listening--and I see others who want to address 
it. But as we are moving through the course of the debate, I think it 
is important that we try to find out, as we use these terms, how they 
are related to the legislation that is at hand. I know there was some 
question in the presentation of the Senator about the allocations of 
various residency programs. Of course the Senator understands that the 
American taxpayers pay for better than half of all the residencies, 
unlike the law schools where individuals pay or the law schools pay.
  So there are those, of whom I am one, who think since the American 
taxpayer is paying half or even more in many situations across the 
country, that the idea that the public should have some interest in the 
percent of residencies in different kinds of areas is not all that 
radical. Particularly when the AAMC, which is the principal instrument 
for the medical colleges, supported various--this proposal.
  I was wondering, since the Senator mentioned this in what I perceived 
as somewhat of a derogatory way about the Federal Government making 
decisions about who are going to be doctors and specialists, what does 
the Senator--what is the Senator's alternative?
  Mr. COHEN. I ask whether or not the Senator from Massachusetts thinks 
it is in the best interests of the people of the State of New York to 
tell the State of New York how many orthopedic surgeons it might plan 
on?
  Mr. KENNEDY. Of course that is not in the bill. That is not in the 
bill, in terms of allocating any kind of formula to any particular 
medical school. I know there have been those who have been out here for 
the past days who suggested that, but that is not the bill.
  The other point I would make to the Senator and that is on the 
preexisting conditions. I was just looking through the Dole legislation 
on preexisting. We are all against preexisting conditions as well. It 
is in the Mitchell bill. Those provisions are illustrated in the Dole 
proposal on page 80 where it talks about the preexisting.

  I do not question in my own mind that the Senator wants to eliminate 
preexisting conditions. We have been listening to debate on both sides 
saying how we all want to eliminate preexisting conditions. Of course, 
the Dole provision does not provide that. If you have any kind of 
serious illness, serious sickness, if you have diabetes, if you have 
cancer, if you have been diagnosed in those particular ways, you are 
excluded under the Dole proposal.
  I am just wondering, as the Senator and the chairman of the Finance 
Committee has pointed out, in a spirit of comity, if the Senator's 
position would be whatever we pass will truly eliminate all preexisting 
conditions, in whatever will be coming through hopefully--prayerfully. 
I think, quite frankly, there are some provisions in terms of the 
complete elimination of the preexisting under the Mitchell proposal 
that might be adjusted to change as well.
  But just in terms of where the Senator from Maine is coming out, do I 
understand he would be for the complete elimination of the preexisting 
condition and would like to see that changed in the Dole bill or 
perhaps modified in the Mitchell bill?
  Mr. COHEN. I believe that there is quite a similarity between the 
Mitchell proposal and the Dole proposal, as far as preexisting 
condition. My own view--I go back to my personal view--is, I favor the 
elimination of preexisting conditions with perhaps some timeframe to 
make sure people do not wait until they actually get sick before 
seeking coverage. I think you will find broad-based support in the 
Chafee proposal, and I think the Dole proposal is not that far away 
from the Mitchell proposal on preexisting.
  Mr. KENNEDY. There are other Senators waiting.
  If you have heart disease today, if you have cancer today, if you 
have diabetes, juvenile diabetes, under the Dole proposal they are not 
considered to be eligible, under the language that is printed in there. 
I will join with the Senator in working to make sure, however, that as 
we come through this process that we do it.
  I certainly know that the Senator--I have talked to him about health 
care policy on a number of occasions--his own position is the 
elimination certainly, and mine. And it is one, I think, as we go 
through this discussion and debate, it is important because I think 
that is one of the very, very important key items in terms of any 
health care policy reform: The elimination of that preexisting 
condition. We can talk about it. The real question, as has been pointed 
out by our colleagues, is whether the language conforms.
  Mr. COHEN. May I say in response, that is one of the benefits of 
taking our time and going through the legislation so we are all sure 
exactly where the Mitchell bill is, where the Dole bill is, where the 
Chafee proposal may take us. That is the benefit of having this kind of 
debate without characterizing it as being obstructionist or anyone 
trying to engage in a filibuster. I have not heard anyone--virtually no 
one--on this side talk about a filibuster. We want to discuss this 
measure at length because it is not altogether clear what the 
distinctions are between the legislative proposals.
  I might say, Mr. President, if I can just complete my remarks, it 
seems to me there is a philosophical approach that is quite different 
in how we have approached it and how those on your side have approached 
it.
  I believe Senator Mitchell takes the position, and that is reflected 
by the majority and Democratic side, that you must have universal 
coverage in order to reduce costs. Those on this side take the approach 
that we must reduce costs in order to get universal coverage. 
Hopefully, these two positions will move closer together. But those are 
the basic philosophical differences that divide us right now. I believe 
there is a middle course we can pursue to achieve our goal.
  Mr. KENNEDY. If I can ask one final question. When you talk about the 
cost provisions in the Dole bill, as the Senators----
  The PRESIDING OFFICER. Who yields time?
  Mr. MOYNIHAN. I yield as much time as the Senator needs.
  Mr. KENNEDY. There are other Senators here.
  In looking through this--and I think this is another element in terms 
of the limitations on costs--I had a good deal of difficulty in 
identifying on page 82--it basically talks about rating limitations for 
community-rated plans. There is no limit on how much insurance 
companies can charge.
  We have seen since 1986 that there has been a 117 percent increase in 
premiums with only a 24 percent increase in wages. We have seen the 
flow lines. Perhaps the Senator--maybe others on that side--as we go 
through the day can address that issue. I think it would be helpful. I 
think we are getting into the substance of preexisting conditions, the 
children's issues, how are we going to get a handle on costs.
  I, quite frankly, think we are going to have to address the issues, 
at least for me perhaps, even more effectively than we have in the 
Mitchell bill. In looking through that, I do find that it is difficult 
to see where the costs would really be restrained in the Dole proposal.
  Mr. MOYNIHAN addressed the Chair.
  The PRESIDING OFFICER. The Senator from New York.
  Mr. MOYNIHAN. Mr. President, I want to associate myself with the 
Senator from Maine with respect to what is in this bill.
  Several days ago, a week ago, I offered the thought that it would be 
most unwise for the Federal Government to start lowering the number of 
medical graduates who were taking their residency in our hospitals. It 
would reduce the supply of doctors. It was agreed that this was not to 
be done, as I understood.
  Yet, I open to page 483, ``Health Professions Workforce and Public 
Health Initiatives, Workforce Priorities Under Federal Payments.''
  We turn here, Mr. President, and we find that we apparently have 
established a National Council on Graduate Medical Education. It says--
the Senator from Maine might want to hear this--on page 491:

       Annual Authorization of Number of Positions.--In the case 
     of each medical speciality, the National Council shall * * * 
     designate for academic year 1998-1999 and each subsequent 
     academic year the number of individuals nationwide who are 
     authorized to be enrolled in eligible programs in each 
     medical speciality. * * *
       (b)(1) Requirement Across Specialities.--
       (B) Reduction.--For each of the academic years * * * total 
     determined * * * shall be reduced by a percentage determined 
     by the National Council.

  If I may say, Mr. President, this is not my understanding of how 
science proceeds. I claim no special knowledge of this at all. But I 
have been a member of the President's Science Advisory Council. I have 
been a vice president elected to the American Association for the 
Advancement of Science, the largest organization of its kind in the 
world.
  I feel scientists would recoil at the notion that work which is, by 
definition, unpredictable and follows extraordinary paths, collapses 
one discipline into another and then expands in five more--that sort of 
creative process--for the Government to reach out and require, but most 
importantly, to reduce.
  Do we want fewer doctors in order that there be better health? This 
has never been debated, never been explained. It just keeps coming out 
in this legislation. There is a staff member somewhere who wants this. 
And no matter what we do, we keep getting it.
  This is hubristic. This invites the wrath of the gods. This invites 
the death, the closing of a great moment of medical discovery, 
unprecedented on Earth. In the history of medicine, no such thing as 
happened in the advances in the last 30 years made in the United 
States. This is, if I may say--and I do not wish to introduce first 
amendment problems to this debate--but this is a sin against the Holy 
Ghost.
  Mr. COHEN. If the Senator will yield----
  Mr. MOYNIHAN. I have said all I have to say. I have to go back in the 
back room and read this again.
  Mr. COHEN. I am told that the members of the Finance Committee, the 
so-called mainstream group that reported out the bill in the Finance 
Committee, when they saw the actual language of the bill, were stunned; 
that they found there were measures put in the bill that the committee 
reported out that there was complete disagreement upon. And the 
attitude was, well--staff's attitude was, well, since you did not 
discuss it, we had no prohibition against putting it in. We had members 
coming out and saying, well, I supported that bill--what I thought was 
the bill--but I do not support this legislation any longer; that is not 
what we thought we had agreed upon. Am I incorrect in that?
  Mr. MOYNIHAN. I must say there is a staffer somewhere--not on the 
Finance Committee staff--who does dearly love quotas for thoracic 
surgeons. How he got that way, or she got that way, I do not know. But 
we are on the verge of adopting them and we will not know we have done 
so.
  Mr. ROCKEFELLER addressed the Chair.
  Mr. MOYNIHAN. Mr. President, I yield the floor. I see the Senator 
from South Dakota was going to speak but the Senator from West Virginia 
wants to speak on this point.
  The PRESIDING OFFICER. The Senator from West Virginia.
  Mr. ROCKEFELLER. I thank the distinguished Presiding Officer.
  I thought the Senator from Maine just at the very end of his remarks 
brought up an extremely important point, and I think it is in fact the 
core of this whole debate. That is, he said that what the Democrats 
appear to want to do is to do universal coverage in order that you can 
reduce cost, and what the Republicans want to do, to the extent that 
there are differences, what the Republicans want to do is reduce cost 
and then proceed to universal coverage.
  That takes me back to precisely the first subject that was discussed 
and debated in the Pepper Commission. Senator David Durenberger was a 
member of that Commission. Senator Edward Kennedy was a member of that 
commission. Bob Kerrey was not a member but attended all of the 
Commission meetings.
  And that is the core of the debate. We debated that on our very first 
series of meetings. They always began at 8 o'clock in the morning. What 
we decided was that you cannot pick one core or pick the other core, 
you have to do both at the same time to achieve both or other; that if 
you do not go for universal coverage in the Mitchell plan, it is not an 
immediate reach--it is a step-by-step reach--that you can by definition 
not control costs.
  On the other hand, if you just simply control costs, or in the Dole 
plan, for example, as you cut from Medicaid and Medicare and things of 
that sort and do not return those into programs for seniors but for 
subsidies for the poor, that is not going to get you universal 
coverage.
  We decided on a bipartisan basis--there was not a single dissenting 
vote in the group--at the beginning of the Pepper Commission, as we set 
our basic philosophy, we agreed that we had to do both. We had to work 
for universal coverage, which we achieved in our plan, and cost 
containment, which in my judgment we achieved but achieved 
insufficiently in our plan.
  I agree with the Senator. I think that is fundamental, and I would 
lay down that stipulation as a major source of meritorious, substantive 
debate in these next several weeks. We have to do both, Mr. President. 
We have to both work toward universal coverage and we have to control 
cost if we are going to make the American health care system work.
  I thank the Chair.
  The PRESIDING OFFICER (Mrs. Murray). Who yields time?
  Mr. MOYNIHAN. Madam President, the distinguished Senator from South 
Dakota, the chairman of the Democratic Policy Committee, is on the 
floor equipped with diagrams, and I yield him such time as he may 
require.
  Mr. PACKWOOD. Madam President, would the Senator yield for a 
unanimous consent request?
  Mr. DASCHLE. I would be happy to yield.
  Mr. PACKWOOD. I ask unanimous consent that Peter J. Levin, a fellow 
on health care on Senator Mack's staff, be granted floor privileges 
during the consideration of S. 2357, the Health Security Act.
  The PRESIDING OFFICER. Is there objection? The Chair hears none, and 
it is so ordered.
  Mr. PACKWOOD. I thank my friend from South Dakota.
  The PRESIDING OFFICER. The Senator from South Dakota.
  Mr. DASCHLE. Mr. President, I, too, want to express my strong 
agreement with some of the points raised by the Senator from Maine just 
a moment ago.
  He, like many of us, has expressed an interest in bipartisanship and 
trying to reach agreement on many of these difficult points. He 
indicated he, too, was concerned about the 
mischaracterization of much of what is being proposed here. 
He expressed his concern about impugning motives on the Republican 
leader, and I share that concern.
  Like the Senator from Maine, I have immense respect for the 
Republican leader, as I know he has respect for the Democratic majority 
leader. Yet, I hear many remarks made on both sides of the aisle that 
mischaracterize his proposal and use hyperbole to make points.
  Last night, as we ended the debate, there were many references made 
to the Mitchell bill. In fact, if they were just references, I would 
not be troubled. But many opponents of the Mitchell bill raised what 
they characterized as three versions of a Mitchell bill. They want us 
to believe that, somehow, the majority leader, using all of his 
imagination and legislative prowess, has come up with not one but three 
versions of his own bill.
  That troubles me, frankly, because it is this type of 
mischaracterization, as the Senator from Maine correctly stated, that 
undermines our ability to have a substantive discussion of the real 
issues. Obviously, as concerned as I am with complexity and the need 
for a better understanding of what it is we are talking about, I asked 
the majority leader what was the basis for the changes made. His answer 
was surprising.
  All of the changes in the version being characterized as a completely 
new bill are on one page. This is it. These are all the changes in the 
Mitchell bill--one page.
  This legislation is a melding of the Labor Committee and Finance 
Committee bills. We have known that from the beginning. So no one 
should be misled into thinking we are redrafting the entire health care 
reform proposal and coming up with new versions daily.
  The Republican manager of the bill, our colleague from Oregon, is 
probably as experienced a legislator as we have in the Senate. He has 
had to manage bills. He, like all of us, understands that as you 
develop legislation, there are technical corrections and other changes 
that must be made. He has had to do that himself on countless 
occasions. And so it makes a nice prop, but in my view it is a 
mischaracterization of what is going on here. And as the Senator from 
Maine so ably stated it, it does not serve the Senate or serve those 
who may be trying to understand this debate to imply that we have 
completely different versions coming out each day.
  I think what is really important to the American people, what is 
important to this country, what is important to this body, is simply to 
try to do what we know has to be done. That is what we are here for, to 
address our health care problems.
  I know, as the Senator from Maine also suggested, there are 
differences in philosophy. He cited one that I think is a very 
fundamental difference, though I do not think that it is necessarily a 
partisan difference.
  I have a mentor who is no longer with us, who used to admonish the 
partisanship that often comes in heated debate and cautioned me on many 
occasions early in my public career not to view debates as Republican 
and Democrat, but as constructive and destructive. Oftentimes the 
debate becomes destructive for short-term political gain when, through 
constructive analysis and constructive debate, we can better realize 
our common goals.
  One of those constructive debates that I hope will occur is how we do 
achieve the goals that we say we all want. We talk about universal 
coverage, and we talk about effective cost containment. And as the 
Senator from Maine implied, there are those who believe that you cannot 
achieve universal coverage until you have effectively controlled costs.
  I believe, Mr. President, it is just the opposite; that until we 
include everybody in the system, we cannot effectively control costs. 
So many of the experts who came before the Finance Committee reiterated 
that point and elaborated on why it is important. All one has to do is 
think of an emergency room today. What happens when a person is not 
covered today? What happens is that person comes into an emergency room 
for what may be a bottle of aspirin costing somewhere between $2 or $3 
in a pharmacy. But that trip to the emergency room for a bottle of 
aspirin for a young child with a fever costs $75. That is the kind of 
proliferation in costs that we are trying to deal with.
  If that person walking into an emergency room had comprehensive 
insurance coverage, they would not have had to go to the emergency 
room. They would have been able to go to the pharmacy and get whatever 
pain relief may be required without exponentially increasing the cost 
of that one visit. That is how universal coverage affects cost 
containment. That is what we are talking about.
  If people cannot get primary and preventive care, their costs are 
much higher in the long run. But it is not just running up the costs in 
a linear fashion. You also cost shift those costs. There are 
administrative costs involved in trying to figure out who is going to 
pay. Will it be the Government? Will it be the insurance companies? 
Will it be the hospital absorbing those costs? Somebody must cover 
those costs. That cost shift is what we are talking about.
  Madam President, we will have many opportunities to debate these very 
consequential points. But I hope that, as the Senator from Maine 
suggested, we can do it with civility, that we can do it without 
impugning motives of those who may disagree with us.
  As we have indicated, there is a profound admiration for many of 
those on the other side of the aisle who have studied this issue and 
who have come to different conclusions than some of us have on 
important points.
  I hope that, as we try to resolve those differences, we can do so 
keeping in mind the best interests of this country and the credibility 
of the Senate.
  Mr. REID. Will the Senator yield?
  Mr. DASCHLE. I am happy to yield to the Senator from Nevada.
  Mr. REID. I note the Senator indicated that the cost of emergency 
room treatment for someone needing aspirin is $75. I would say to my 
friend from South Dakota that may be the case in South Dakota, but in 
Las Vegas or Reno that same treatment would be closer to $300. That is 
going to the emergency room in Las Vegas, especially Las Vegas, and in 
Reno to a lesser degree. And the emergency rooms are filled with people 
who have no other place to go for health care. It may be a bad sore 
throat or a broken leg. But the fact is most of the people are there as 
a result of not of an emergency, not because of a motorcycle accident, 
but because they are sick and have no other place to go.
  Mr. DASCHLE. The Senator makes a very important point. Obviously, the 
costs vary as you cross the country. Emergency room care is high-
technology care involving extraordinarily high costs. In concentrated 
areas like Las Vegas, they are even higher than they are in rural 
settings like we have in South Dakota. So $75 may actually be the 
minimum charge for that kind of care. You could spend as much as $1,000 
or $2,000 for emergency care, hundreds of times more than care provided 
in a traditional outpatient settings.
  So I think the Senator makes a very important point. I was 
conservative with my $75 estimate. It could be much more.
  Mr. REID. I would also say to my friend from South Dakota that I have 
followed this debate very closely. During the first days that we were 
working on this, our friends from the other side of the aisle rose and 
spoke on the Mitchell bill in a negative fashion.
  Now, with the other bill that has been introduced, and we have stood 
to critique that bill, suddenly, it is no longer the way to do business 
here. We should not look at what is inside the Dole bill. Let us not 
look at the fact that it does not do anything for small business. Let 
us not look at the fact that it really is not a universal coverage 
bill. Let us not look at the fact that it does nothing for children or 
pregnant women.
  I say to my friend from South Dakota that I think that is a 
responsibility we have, not in a mean-spirited fashion, but in an 
effort to find out what is in the Dole bill. I think we have a 
responsibility to do that, especially in light of the fact that the 
majority leader took considerable time before his bill was introduced. 
He took what he felt was the best out of finance bill, what he felt was 
best out of the education and labor bill, the best that he found in 
other plans that have been proposed by the mainstream group and others.
  So, I think during the next few days and weeks, if it is necessary, 
we have to take a look at the bill that is being talked about as being 
the bill that is going to take care of health care in this country, and 
that is, namely, the bill offered by the distinguished minority leader. 
Does the Senator from South Dakota agree that we should take a look at 
that?
  Mr. DASCHLE. Absolutely. I think the Senator from Nevada again makes 
another point that we ought to recognize. The purpose of this debate is 
to analyze the different approaches pending before the Senate so that 
we can come to some conclusions about which is the most appropriate 
course of action. I think that is the whole purpose of having a good, 
healthy debate about the different options available to us. We hope to 
do that again in a civil way, in a way that recognizes differences in 
philosophy and approach, but also recognizes the consequences of making 
the most appropriate decision.
  The reason I have always felt the majority leader's bill was so 
critical to us is that, frankly, it does what we have said all along 
must be done if we are going to achieve meaningful reform and provide 
health care for all Americans. At the end of this process, we must 
accomplish our primary goals--offering greater choice, controlling 
costs, putting emphasis as the Dodd amendment does, on good primary and 
preventive care, especially for pregnant mothers and children, and 
providing opportunities for higher quality care.
  In South Dakota these are all very serious concerns. How do we 
achieve good quality? How do we achieve meaningful cost containment? 
How do we achieve greater emphasis on primary and preventive care? How 
do we get universal coverage? The Mitchell bill makes a substantial 
contribution to that goal by melding the Labor and Finance Committee 
bills, which have been developed over many, many months.
  Mr. KENNEDY. Will the Senator yield for a question? As the Senator 
mentioned, the melding together of the two different committee bills--
is the Senator familiar with the fact that actually in the Labor 
Committee we had 51 hearings on health care since the introduction of 
the President's bill and a markup, and Finance held 30 hearings from 
September to June 1994. So those are 81 days of hearings with good 
representation of the Senate on that which has been included.
  Mr. DASCHLE. I think the Senator is absolutely right. There has been 
an incredible amount of debate and analyses in both the Labor Committee 
and the Finance Committee. I know the Senator from West Virginia has 
held many hearings in the Veterans' Committee to explore how veterans 
would fare under health reform.
  We have listened to witnesses from across the country--frankly, from 
all over the world; we have had people from other countries who have 
come to Washington to share their concerns and their experience with 
us.
  Our colleague from Oregon has been a significant participant in those 
hearings. I do not know that he has missed a hearing. That demonstrates 
the kind of interest, the kind of thoughtful study that has gone into 
the process so far.

  Mr. KENNEDY. Can I ask a question in one other area of public policy?
  Mr. DASCHLE. Yes.
  Mr. KENNEDY. I know the Senator has been interested in this. We were 
talking earlier today about the difference between the Mitchell bill 
and the Dole bill and how it treats preexisting conditions. I would 
just like to ask whether my understanding of the difference between the 
two bills is accurate--which is enormously important to families all 
over this country. There are about 44 million Americans who have some 
disability, and the 87 million American families have been touched by 
it. As I understand it--and correct me if I am wrong--under the Dole 
provision, if you are treated for an illness or a sickness anytime 
prior to the 3 months before you have an application or get your 
insurance, then the preexisting condition will not be treated for the 
next 6 months, will be excluded. As I understand it, that is the 
position of the Dole bill.
  On the other hand, on the Mitchell bill, you have what is called the 
amnesty provision, so that anyone who has a preexisting condition can 
be covered. During the first enrollment time, the exclusion of 
preexisting conditions is waived, if it is the first time. Second, if 
that individual is receiving any kind of subsidy, which means that they 
are moderate-income working families, then that exclusion of 
preexisting conditions is waived, and the bottom line is that by the 
year 2000 all of it is eliminated, all preexisting conditions, as 
barring participation in the insurance program.
  I am just asking the Senator if that is his understanding, because as 
we were talking before during the course of the debate, we are finding 
out many people are using these words: ``We are for universality, cost 
containment, elimination of preexisting condition,'' but when it comes 
down to it, we are going to find out what is going to be in the 
different legislations. On the one hand, under Mitchell, by the year 
2000, preexisting conditions are eliminated; and, second, if you have 
the subsidy, the preexisting condition is effectively eliminated. 
Third, for the first-time enrollment period, after this bill goes into 
law, it is a clean deck, an amnesty. You have those three protections 
for individuals.
  I daresay I am sure the Senator would wish, as I do, that the day the 
bill is passed, we would have what exists in the Mitchell bill for the 
year 2000. Nonetheless, we are making a commitment to all Americans 
that may have heart disease, cancer, diabetes, juvenile diabetes, or 
may have had any range of health care needs, that those preexisting 
conditions are going to be out. On the other hand, I have difficulty in 
finding in the Dole bill any of these kinds of protections. And the one 
that I have stated--that is, if you have been treated for the 3 months 
prior to the time you are in, you are excluded for any kind of 
additional treatment for 6 months. Generally speaking, that is a time 
when you need help the most, because you have lost your job, because 
you are not able to perform your work, and you are going to be hard 
pressed.
  That is something that I just ask the Senator, whether he agrees with 
me, and if that is his understanding of the difference; and second, if 
he agrees with me that it is a major, major difference between the 
approach of the majority leader and the minority leader.
  Mr. DASCHLE. Madam President, I think the Senator characterized the 
bills accurately. In fact, I think that is exactly why we have the 
situation we have now with regard to the two bills. There have been 
many references made to the length of this bill--1,400 pages. Some 
reference was made to the fact that the Dole bill is a lot smaller. 
Well, it is half the size because it does half as much.
  One of the most important things that it leaves out, in my view, is 
the very issue that the Senator from Massachusetts raises. If there is 
anybody who ought to be concerned about what we do in health reform, it 
ought to be those today with preexisting conditions. Most are hard-
working American people, and they are the ones who would give almost 
anything to have greater access to doctors, hospitals, and insurance 
plans, but they are locked out and they and often their children have 
no access to health insurance.
  So what happens, obviously is that the costs go up for them, for the 
system, for everybody involved. That is really one of the most 
important distinctions I would draw between the two bills.
  We have to be able to say at the end of the day that we have 
addressed the concerns of all Americans with preexisting conditions. We 
cannot leave them out. The majority leader's bill does address their 
concerns, and I think that is one of the most important differences 
that ought to be recognized in this debate.
  I yield to the Senator from Nevada.
  Mr. REID. Senator Dole's plan limits but does not eliminate 
preexisting conditions. Under the Dole plan, insurance companies would 
still be able to deny coverage for preexisting conditions for up to 1 
year. That is section 21-111 of his bill. While most universal coverage 
plans use preexisting condition limitations as a necessary transition 
to them before universal coverage is reached, the Dole bill never 
achieves universal coverage. It never even comes close. Thus, there is 
no reason to believe the exclusion in the Dole bill, as indicated by 
the Senator from Massachusetts, will ever go away.
  If I could ask the Senator from Massachusetts--if I can get the 
attention of the Senator from Massachusetts. We talk about preexisting 
conditions, and I think the American public thinks of someone in very, 
very bad shape, almost ready to die, like a heart attack or having 
cancer. But the fact of the matter is--I am asking the Senator if he 
agrees--preexisting conditions could be a skin problem. Someone may 
have had a skin cancer on their face, or they could have orthopedic 
problems and they are denied coverage.
  Is the Senator familiar with cases like that?
  Mr. KENNEDY. The Senator is absolutely correct. In so many of these 
instances, as we have heard in the course of those hearings, you have 
individuals who may have had a heart attack. And I can think of one 
woman in Belchertown, MA, Kathy Wojnar, who had worked in a vineyard in 
California, had a heart attack, then moved back to Massachusetts. She 
wants to work, but she not only cannot get work, but she cannot get any 
health insurance, either--and she would be glad to participate and glad 
to pay, and she has a pretty good prognosis. All of us would hope for 
her for the future. But she has worked all of her life, and she wants 
to work. She told us that she cannot get a job, because no one will 
hire her with her health condition.
  Those are real-life stories. It is not only her circumstances, but 
scores of others, as the Senator has described.
  Mr. DASCHLE. That is the point I think we need to constantly keep in 
mind. There are human faces behind all of this, and human experiences 
that go beyond statistics and reports and testimony.
  Obviously, the Senator from Nevada is as sensitive as anybody in the 
Chamber to those faces and to the extraordinary implications of failure 
to act.
  Madam President, I know that our time in this round is drawing near. 
I know the Senator from Illinois has a very important matter to which 
she must attend, and we have agreed here on the floor that she could 
utilize the remainder of our time in this round subject, of course, to 
the managers' agreement.
  Mr. MOYNIHAN. So everyone will be clear, we do not have rounds. We 
just have 7 hours, equally divided. We would like to alternate, as we 
would do normally. But the Senator from Indiana graciously suggested 
that the Senator from Illinois might want to speak now as she has a 
very pleasant family duty to attend.
  So I yield to the Senator such time as she may desire.
  Ms. MOSELEY-BRAUN. Madam President, I thank very much the Senator 
from New York, the Senator from South Dakota, and Senator Packwood, for 
their courtesy.
  I mentioned earlier that the Senator from New York was kind enough 2 
days ago to mention my son's 17th birthday, and it was the first time 
in 17 years that I was not with him on his birthday because we were 
here, engaged in this historic debate.
  Madam President, I would like to share a story with you briefly, as I 
talk about health care reform in a context that to me makes all the 
difference and why this is so important. When I decided to run for the 
U.S. Senate, I had a conversation with my son Mathew, who was then 15, 
who said to me: ``You know, Mom, your generation has left this world 
worse off than you found it.''
  That was like a body blow to me at the time. Of course, I disputed 
him about that. I said to him: ``You are wrong. My generation does this 
and this.''
  For everything I had to say to him, he had a response as I guess one 
would expect from a 15-year-old who knows everything.
  In any event, when I got here I made a point to take a look at some 
long-term issues that Mathew referenced in our conversation over dinner 
that night.
  So following last year's budget debate, I asked and was appointed to 
serve on the President's Bipartisan Commission on Entitlement and Tax 
Reform. Just last week, that Commission issued its findings on the 
long-term trends this country is facing. Let me just talk about a 
couple of those findings in the context of health care reform.
  Finding No. 1 states, that by the year 2012, ``unless appropriate 
policy changes are made in the interim, projected policy outlays for 
entitlements and interest on the national debt will consume all tax 
revenues collected by the Federal Government'' all by the year 2012.
  It goes on to say that, by the year 2030, ``unless appropriate policy 
changes are made in the interim, projected spending for Medicare, 
Medicaid, Social Security, and Federal employee retirement programs 
alone will consume all tax revenues collected by the Federal 
Government.''
  That finding also estimates that ``if all other Federal programs 
(except interest on the national debt) grow no faster than the economy, 
total Federal outlays would exceed 37 percent of the economy. Today, 
outlays are 22 percent of the economy, and revenues are 19 percent.''
  Finding No. 4--and this is important with regard to this debate--goes 
into the trends in health care expenses. It states that ``the growth of 
public and private health care costs poses an immediate problem that 
must be addressed.''
  It goes on to state that ``Federal health care spending has been 
increasing at annual rates averaging 10 percent or more during the last 
5 years, far in excess of overall economic growth. Private sector 
health costs have increased comparably.''
  Now, Madam President, I would like at some later point in this debate 
to go further in detail about why health care costs are rising so high 
and why they are so far outstripping the growth in our economy.
  We have a chart which shows even if we control health care inflation, 
Federal health care spending doubles by the year 2030.
  There are other charts in this regard--and again I will, at another 
time when there is more time, discuss the cost implications of the 
rising explosion in health care spending, address them.
  However, Madam President, there has been a lot of discussion in the 
context of the health care reform debate about partisanship. I have to 
tell you that the findings of the Entitlement Commission are entirely 
bipartisan. The Commission's membership includes 12 Members of the 
Senate, 6 Democrats and 6 Republicans, and 10 Members of the House of 
Representatives, 5 Democrats and 5 Republicans. All but one of these 
Members voted for the findings I just quoted to you, because they are 
facts that we absolutely have to face up to.
  It seems to me that in this debate that is the most important thing 
that we can do, to face up to the economic facts. The Entitlement 
Commission was formed because Congress and the President recognized 
that the current trends are not sustainable, and the only way to 
address those trends in a way that avoids imposing real pain on large 
numbers of real people is to act now.
  Without action on comprehensive health care reform, without action to 
restrain the growth of private health care costs as well as public 
health care costs, the American people, including 85 percent of the 
American people who have health insurance now, face a future of less 
and less access to medical care, of higher and higher costs out of 
their own pocket, and of greater and greater risk of losing their 
health insurance altogether.
  Madam President, let us make no mistake about the importance of this 
debate. Inaction will not protect Americans access to high-quality, 
affordable health care. In fact, just the opposite is true. Inaction 
will virtually guarantee that the access of most, if not all, Americans 
to high quality, affordable health care will be eroded and ultimately 
lost.
  Again, I call you back to the conversation with Matthew. His 
perception at the time was actually supported by the findings of the 
Entitlement Commission, and that is why it is absolutely imperative 
that we move and do something specific about this issue now.
  So, Madam President, if we are to keep a health care system of which 
we are justifiably proud, and I think it is fair to say that America 
has the greatest health care system in the world, if you can afford it 
and access it, if we are to keep a good quality health care system, if 
we are to keep health care affordable and available for the 85 percent 
of our population who now has insurance, and if we are to deal with the 
15 percent of our population who does not now have insurance, if we are 
to reduce that figure, even if we simply want to keep it from growing 
dramatically, we must face our health care problems and face the long-
term health care costs trends, we must act.
  I would be the last one to say that the Mitchell bill represents the 
be all and the end all in terms of an answer to these cost trend 
problems. It is not. The cost controls in the bill can and need to be 
strengthened, in my opinion. The Mitchell bill, however, does represent 
a solid start in the right direction to put us on the road to achieving 
the goals that the Entitlement Commission spoke of. We need to work on 
it in a bipartisan way. We need to work with colleagues on both sides 
of the aisle to achieve the goals that are so important to rein in the 
growth in costs in health care and to preserve the kind of quality 
system that I believe we have.
  We are right now in the midst of a historic debate, and I know 
everyone who has spoken to this issue has talked about that. Many 
believed that this time would not come. I listened to conversations and 
debate referencing all the years of trial and error in this regard.
  Just in this session of the Congress, the Finance and Labor 
Committees of the Senate have held over 100 hearings on health care 
reform and, as Senator Mitchell said the other day, President Truman 
proposed reform in 1940's, President Nixon proposed reform in the 
1970's, and 50 years is not rushing anything. I agree it is an enormous 
task and a complicated one, but quite frankly that is what we were 
elected to do, to tackle enormous problems and to answer complicated 
questions.
  We hear continually from people back home that they are happy with 
the health care and they are afraid of reform. They do not know what 
all this means. I would submit that quite frankly what we are dealing 
with in that regard is what I call the 1,000 points of fright. There 
has been an awful lot of misinformation out there about what is going 
on, and frankly, it stands to reason that you will have misinformation 
where there is complication. You always have people putting out road 
blocks and diversions and side tracks when you are on the road to 
genuine change.
  But let me say this: I believe that we can achieve that change. I 
believe that that change is imminent if we work together in the best 
interest of the country to preserve a quality health care system and to 
address the long-term trends that the Entitlement Commission spoke of.
  Madam President, from the beginning of this debate, I have referenced 
what I call the four cornerstones of reform, and those four 
cornerstones of reforms are universal coverage, which is so important I 
believe, cost containment, maintaining the quality of care, and 
retaining freedom of choice for the American people in terms of the 
health care delivery and the providers of health care.
  I believe we can achieve those four cornerstones if we approach this 
debate in a bipartisan way, if we approach this debate with the view to 
the long-term trend, as well as a view to all that affects us not only 
in the global macroeconomic sense because it has this kind of 
implication, but also in the personal sense, how it affects people 
where they live, what actually is going on in the world of people who 
need health care.
  I recently received a letter, Madam President, from a constituent 
that described her family's experience in obtaining insurance. The 
Pascals are self-employed people and they have three healthy children. 
Over the past 8 years they have been forced to change insurance 
carriers six times. The first company increased the rates on their 
individual family policy by 600 percent in a 5-year period.
  Finding the cost of that plan prohibitive, the Pascals joined a group 
plan in order to lower their costs. Unfortunately, the group was 
dropped because one of the members of that group got sick. The family 
then moved back to an individual policy, but due to a 65-percent rate 
increase after the first year, they could not afford that any longer 
either. So in desperation they settled on a catastrophic coverage plan 
that has no preventive care in it, that requires a $5,000 deductible 
and that limits the providers they can go to.
  So now the Pascals find themselves in the situation where they can no 
longer take their children to the pediatrician.
  And that, it seems to me, is outrageous. This family has done 
everything right, they have even managed not to get sick, but 
affordable, comprehensive health care coverage is still beyond their 
reach.
  Clearly, our system should not work this way, not for the self-
employed and not for the employed with employer provided coverage.
  Statistics indicate however that over half of employed Americans who 
receive coverage from their employer have had their health benefits cut 
back or had their employee contributions increased during the last 2 
years.
  No wonder, Madam President, a recent poll said that 60 percent of the 
American people were still worried about losing their current coverage.
  Madam President, I used the Pascals as an example. I am sure we will 
hear and have heard many, many more individual stories. But the fact of 
the matter is that this system really is broke. It is not working for 
ordinary people. It is not working for working people.
  It is something of an anomaly that we now have a system in which the 
very wealthy can have health coverage, the very poor can have health 
coverage, and everybody in the middle is worried about it, either they 
cannot access it or afford it because they are self-employed or in job 
lock because they cannot leave because of a preexisting condition or, 
alternatively, the cost of the health care that the employers are 
providing is going up and up and up, millions of Americans like the 
Pascal family cannot afford insurance. Our Government cannot afford it. 
Our Nation cannot afford it. We absolutely have to have an imperative 
to change.
  Last year, our country spent $1 out of every $7 on health care. That 
amounts to about 14.3 percent of our GDP and a total of $898 billion. 
And we know, again, health care costs are rising at twice the rate of 
inflation still. Medicare and Medicaid take up almost a quarter of the 
entire Federal budget.
  And so, we are looking at these escalating costs and wondering what, 
if anything, we can do.
  I believe that we have now a window of opportunity to begin to 
correct the situation and fix this problem.
  As I see it, we now have two options: One is to use the Mitchell bill 
as a base for building health security for the American people. The 
other is to use the Dole plan as the basis.
  But in any event, we have to, I think, achieve the four cornerstones 
and we have to build on this bill, or a compromise of the two or a 
variation of the two, we have to build on what we have introduced here 
to come up with a plan that gives us universal coverage, that really, 
genuinely puts us on the road to universal coverage. Because, quite 
frankly, without it, we will continue with the cost shifting that has 
escalated the cost of health care in this country.
  We have to maintain choice. We have to maintain high-quality care and 
we have to achieve cost containment. I hope the cost containment 
imperative of this issue does not get lost in the debate, because that, 
after all, has implications for the Matthew Brauns, Madam President, 
for your children, and for these pages sitting here. If they are going 
to have health care, we have an obligation to fix this 
nonfunctioning system.
  Madam President, I believe the Mitchell bill puts us on the road 
toward universal coverage. According to CBO, it will reach 95 percent 
by 1997. And the employer mandate, of course, will result in universal 
coverage by the year 2002.
  I do not think, frankly, the Dole bill achieves that to the same 
extent. I believe the Mitchell bill, based on my initial reading of it, 
significantly improves and expands coverage for millions of Americans. 
All children and pregnant women up to 300 percent of the poverty level 
will be covered. And that is $44,000, Madam President. That is a pretty 
elastic range.
  Preexisting condition exclusions will be eliminated under the 
Mitchell bill. Coverage will be portable. In other words, a person can 
move from job to job and still not lose coverage.
  Insurance discrimination based on age and geographic location will be 
eliminated. I do not believe, again, that Dole bill achieves that.
  But I was delighted to hear my colleagues on the other side talking 
about wanting to work together to try to fine tune and do these things 
in a bipartisan way to achieve a bipartisan consensus on this issue.
  The Mitchell bill also guarantees choice, which was one of my other 
cornerstones of reform. Every American will have a choice of at least 
three private insurance plans--fee for service, HMO, or point of 
service.
  The Federal Employee Health Benefits Program, available now to 
Congress and to most Federal employees, will be available to many more 
Americans.
  The Mitchell bill--and I think this is important, Madam President-- 
will also maintain the high quality of care that we have in this 
country. Funds will be made available through assessment on premiums 
for graduate medical education, for biomedical research and for health 
care services research.
  A National Quality Council will be established to keep the goals of 
high quality in place.
  Consumer information and advocacy centers will be created to give 
people information about health care services and to hear grievances.
  Query: Where do you go for a grievance about the way your insurance 
company treats you today or the health care services that you receive 
today? That is a step forward in regard to quality.
  And the health plans must ensure that enrollees have access to 
specialty care, which is so important when it is your kid who needs 
something special that is not within the range of the generally 
provided services, when your kid has a special condition. That is so 
important.
  The Mitchell plan, I believe, also has included cost containment 
measures.
  Again, I would like to work with the chairman of the Finance 
Committee and others. We are going to have to strengthen cost 
containment. I think that is something that has to come out of this 
debate and I think will come out of this debate.
  Madam President, I know everybody wants to speak on this issue. I 
have been saying for months that the Senate was going to act as a 
committee of the whole with regard to this important issue and I am 
sure that that is correct.
  The chairman of the Finance Committee has been more than gracious 
with me. I have more to say. In fact, I have several pages more to 
stay, but I will not say it right now. I will wait until another more 
appropriate time in this debate. We will come back and I am sure I will 
have other opportunities.
  But I wanted to thank my colleagues for this opportunity today to say 
that we owe it to the Mathews of the world to address this issue as 
Americans--not as Republicans, not as Democrats, not squabbling over 
ever dot and tittle of every line, although the dot and tittles have to 
be worked out, because, after all, the devil is in the details, is it 
not?
  But the fact is, we have an obligation as Americans to fix this 
nonfunctioning health care system, to provide coverage to 
every American, to maintain the high quality of health care that we 
have in this country, to maintain the opportunity for people to choose, 
and to get the cost containment that will preserve the future for these 
young people.
  Madam President, I am just so delighted at all the hard work that has 
gone into this debate. I very much look forward to working with my 
colleagues in a bipartisan fashion to achieve the goals of this bill.
  My assistant just passed me a note which said, ``You forgot to speak 
about the Dodd amendment,'' which I have more pages on. I will defer 
until Monday to speak to the Dodd amendment specifically. I will 
support it. I hope Dodd will add me as a cosponsor of the amendment. I 
think it is the right direction.
  Again, I congratulate my colleagues and thank them for the 
opportunity to have a few words about this issue.
  The PRESIDING OFFICER. Who yields time?
  Mr. MOYNIHAN. Madam President, may I simply use this quick occasion 
to thank the Senator from Illinois for her able and thoughtful remarks 
and for the emphasis on a bipartisan approach. That is how we are going 
to get something that we are not only going to enact but is going to 
stay enacted.
  It was a wonderful note on which to get off to that birthday 
celebration.
  I thank the Senator very much.
  Madam President, before I yield the floor, I would like to thank the 
Senator from Indiana for his courtesy.
  The PRESIDING OFFICER. Who yields time?
  Mr. PACKWOOD. I yield such time as the Senator from Indiana may 
consume.
  The PRESIDING OFFICER. The Senator from Indiana is recognized.
  Mr. COATS. Madam President, I thank the Senator from New York for his 
kind remarks, as well as the assistance that I have received over the 
last several weeks in trying to understand the health care legislation 
from the Senator from Oregon.
  Madam President, not to be the skunk that spoiled the picnic in this 
wonderful spirit of bipartisanship this morning--the rhetoric obviously 
cooled down from where we were last evening.
  Let me just comment briefly, before I give my statement, on some of 
the discourse that has taken place here this morning, because it does 
relate to the discussion that took place last evening relative to the 
implication and expressed charge that Republicans were attempting to 
deny the supporters of the Mitchell plan from moving forward with their 
bill when I think it is clear that what we are attempting to do is 
trying to understand the nature and the complexity of the bill that is 
before us and seeking time to understand what all of this means. Just 
this morning we have had two differences of opinion relative to what 
the legislation seeks to propose. One of the Senators from the other 
side of the aisle indicated that there were no specific quotas as to 
medical specialties. That was corrected by the Senator from New York 
when he pointed to page 491 of the bill that is now before us, the 
Mitchell III bill, which specifically states, in section 3013, under 
title I: ``Annual Authorization of Number of Specialty Positions.'' 
Line 16 begins: ``In the case of each medical specialty, the national 
council shall''--not may--``the national council shall designate for 
academic years 1998-1999, and each subsequent academic year, the number 
of individuals nationwide who are authorized to be enrolled in eligible 
programs in each medical specialty.''

  It then continues on for 16 pages describing how this is going to be 
applied and setting out specific percentages.
  Beginning in 1998 and 1999 it says: The percentage of the graduating 
class that completes the eligibility programs in primary care shall not 
be less than 39 percent; in 1999-2000, 44 percent; then in 2000-2001, 
49 percent; then academic year 2001-2002, 55 percent.
  It is interesting to note there is a requirement in here for a study 
of the impact of this, but that study is not due until January 1, 2005. 
So the decision, obviously, has been made without the understanding of 
Senators, as was indicated on the floor by the Senator from New York. 
The decision has been made to go forward with a quota system 
designating which specialties are eligible under this program. And then 
after it is implemented, we will have a study back to us in the year 
2005.
  It is this type of confusion, it is this type of mandate that exists 
throughout this entire 1,433-page piece of legislation that is 
precisely why many of us believe that we need to take our time, to 
analyze what is here, to analyze what it is this bill seeks to 
accomplish and what implications it is going to have, not only on our 
health care system but our economy as a whole and on all 250 million 
Americans that will be subjected to the provisions of this act.
  We have struggled this week to understand what this bill purports to 
accomplish. We were delivered a copy of the original Mitchell bill. In 
fact, many outside organizations delivered pieces of paper to our 
office asking Members to pledge to read the entire bill before they 
vote on it. They said it is not fair to impose on all of us as 
Americans a new health care system unless you, the Representatives and 
Senators, understand what is in it and read it. I signed that pledge 
and I began reading the original Mitchell bill, only to be surprised 
that a second bill was then brought before us. I was part way through a 
massive tome, weighing 14 pounds, trying to understand the complexity 
of it and cross-referencing all the sections and then I was suddenly 
given a new 14-pound bill, ``By the way we have made some changes.''
  The Senator from North Dakota said, ``Those changes just fall on one 
page. It is unfair to imply that the Mitchell II bill, which is of the 
same size, is a completely new bill.'' In that respect he is correct, 
partially correct, because it is not a completely new bill. But that 
so-called ``one page of changes'' simply lists the titles that are 
changed and the sections that are changed. I point out that the changes 
are comprehensive, and take extensive cross-referencing and 
understanding to see what changes have been made.
  In title I alone, 33 sections were changed. That means we have to 
check every one of those sections to see what the change is.
  In title II, six sections were changed as well as subtitle D.
  In title III, 27 sections were changed as well as subpart B of part 3 
of subtitle D, and on and on it goes. The entire subtitle A changed of 
title VIII, subtitle B of title IX, and of title XI it says: ``all.'' 
So in title XI it is all changed. Which means we have to discard title 
XI in the original bill, pick up title XI in the second bill and 
attempt to understand the difference.
  This relates back to the question of the quotas under medical 
specialties, because it says here in title III that section 3012 is 
changed. Section 3012 is what I just quoted from; 3012 and 3013 is all 
part of subpart B, Authorized Positions in Specialty Training.
  So this is the difficulty that we face. That is why we simply are 
asking for time to review and analyze the bill and understand the bill 
and understand its implications. What we learned this morning is that 
the floor manager of the Mitchell bill, the chairman of the Finance 
Committee, arguably the individual in this Senate body who knows more 
about health care than any of the rest of us, was astonished to find 
that this bill, indeed, despite what he thought were the Finance 
Committee recommendations to the staff, that this bill indeed includes 
a 16-page section authorizing specialties.
  If that is a discovery to the chairman of the Finance Committee, who 
knows more about health care than anybody else in this body, you can 
imagine what that says to a relatively new Member of Congress who does 
not serve on that committee relative to what may or may not be in this 
bill. I think that is all the more reason why Members need to read and 
understand and staff needs to analyze exactly what it is we have before 
us in this legislation and why there should not be a rush to finish or 
move legislation in this body. We are up against a time pressure. 
Members have had to cancel plans with their families, cancel plans with 
their children who will be going back to school very shortly. The 
thought is we need to move ahead and get this thing out of here, we 
will put the finishing touches on it later, so we get at least some 
semblance of a break.
  But we are dealing here with perhaps the most important piece of 
legislation that this body may have ever dealt with. It certainly has 
more implications for our economy and obviously more implications for 
our health care system--which encompasses one-seventh of that economy--
than any other piece of legislation that we have ever faced. That is 
why we feel it is important to take some time to understand what it is 
we are dealing with and make sure we have a right to be heard, each and 
every Senator, on our sentiments regarding this bill.
  I would also like to correct another misimpression that has been 
left. That is that the only Members of the Senate or of Congress who 
have a vision of health care for America--or who care about this 
issue--are supporters of the Mitchell bill or the Kennedy bill or the 
Clinton bill. The Republicans simply want to stop all changes, stop all 
reform. They are just simply naysayers who have no health care thoughts 
of their own. I think that implication is wrong.
  As the Senator from Maine [Mr. Cohen], eloquently outlined this 
morning, he has been a proponent of health care reform for a number of 
years, even devised his own plan--even submitted his own legislation--
and has been actively working, as many of us have, for a number of 
years to try to grasp what is going on in health care, to try to 
understand what changes need to be made and should be made to make it a 
more efficient system and more accessible to all Americans; and try to 
bring about those reforms which will preserve what is arguably and, I 
think, demonstrably the most effective health care system in the world, 
that provides more quality care to more people than any other system; 
to retain the benefits of that system, to retain what is good about 
that system and make reforms and fix those areas that are wrong.

  Republicans have offered a variety of plans. Senator Nickles offered 
a comprehensive plan. Senator Gramm has offered a plan which I 
collaborated on and which incorporated the concept of medical savings 
accounts--which I will talk about in a moment--which I think truly goes 
to cost containment and may be perhaps the only concept that truly 
affects, in the longrun, effective cost containment.
  We have had the Lott-Michel bill. We have had a number of other 
proposals floating around here from Republicans who are sincerely 
interested in making changes. Senator Chafee has spent years working 
with a group in proposing legislation. Senator Packwood and Senator 
Dole now have a plan on the floor before us.
  So the implication that Republicans do not care, that Republicans 
just simply want to say no to anything, that we are just simply out to 
submarine and torpedo the President, no matter what is proposed for 
health care, that implication is wrong. I think those who have followed 
the issue know that it is wrong.
  When I came to the Senate in 1989 and tried to evaluate the issues 
that we would be dealing with during my time here, at the top of the 
list was health care reform. I told my staff: ``This is going to be a 
major--if not the major--domestic issue of the nineties that the Senate 
will have to grasp and have to deal with, and I don't feel I am 
prepared to deal with that. I think I need to do a lot of homework and 
we, as a staff, need to do a lot of homework.'' I employed people who 
had an understanding and knowledge of the health care system, and they 
have worked diligently to try to incorporate ideas and gather 
information and bring me up to speed on what is happening in health 
care.
  I have traveled the State of Indiana visiting hospitals and emergency 
rooms and outpatient clinics, visiting community health centers and 
migrant health centers, talking with doctors and nurses and physical 
therapists, and ambulance drivers and patients and recipients of health 
care. I have visited nursing homes. I have held town forums and health 
care meetings, I have brought in experts, all in an attempt to 
understand this massive health care system that exists in the United 
States, and understand what might be right with it and what might be 
wrong with it.
  Out of that effort, we produced a piece called ``A Hoosier Model for 
Health Care Reform.'' This was published in 1990. It conceptually 
discusses what this Senator believes are the major problems in health 
care, and proposes solutions to those problems. It is a model based on 
my experience in Indiana and based on the experience of a number of 
health care providers and consumers in Indiana.
  I will just read the table of contents to show how it addresses what 
I think are some of the concerns that have been raised here:

       The Coats health care plan confronts the fear of rising 
     costs; section 2, How the Coats plan confronts the fear of 
     rising costs; 3, How the Coats plan confronts the fear of 
     losing coverage; 4, Supplements to the Coats plan, women, 
     children, seniors and fighting disease.

  It incorporates the models of the medical savings account, which I 
referenced just a few moments ago, as a cost containment measure and an 
innovative way of providing health care incentives for individuals to 
become actual consumers of health care.
  So that it is not a third party making a decision about who pays the 
bill and how much that bill will be, but the actual beneficiary of the 
health care is an active participant in determining the cost of health 
care.
  It is interesting that in this country, we shop, we are consumers for 
just about every product and every service in America. We would not 
think of going to the car lot to buy a new car without checking down 
the street or across town with a competitor to see if we could get a 
better deal. We would not think of buying a television simply by 
picking up the phone and saying, ``Just send me a 35-inch, I don't care 
what it costs.''
  But in health care, the question is not is there a more cost-
effective way I can receive the benefits of health care; is there an 
alternative treatment that will not cost as much; can I get the same 
drug or the same diagnostic procedure or the same treatment somewhere 
else for a better price? Those questions are never asked.
  The only question asked is: Is it covered by my insurance? And if the 
answer is yes, it is covered by my insurance, then we do not care who 
provides it or how much it costs.
  The medical savings account is a way of putting that decision in the 
hands of an individual. I will just give one brief example of how it 
works.
  A woman in Indianapolis called me and said, ``I finally understand 
the genius of the medical savings account.'' She said, ``I have reached 
the age where it is important that I get an annual mammography, a 
mammogram.'' She said, ``I called up the local hospital and said I 
would like to schedule a mammogram, how much does it cost?''
  They said, ``$250.''
  She said, ``Wow, that seems like an awful lot of money.'' She said, 
``Do you guys ever have sales?''
  And they said, ``Well, no, we don't have sales, but we offer, in the 
week preceding Mother's Day every year as a special attraction to women 
to encourage them to get a mammogram, we offer it for $50 during that 
week before Mother's Day.''
  She said, ``Sign me up.'' She said, ``It suddenly dawned on me that 
if someone else is paying the bill, I don't care whether I get it in 
March or May, or whether it costs $50 or $250. But if I am paying the 
bill and I stand to benefit and save by getting the same procedure for 
a better price, then I'm going to look and shop for that procedure at 
an effective price.'' She said, ``I would have saved $200 had I been a 
consumer under a medical savings account.''
  Medical savings account simply says that as an employer or 
individual, you can choose to go outside of employment and protect 
yourself with a catastrophic policy, protect yourself from the excess 
medical costs that can take away a lifetime of savings or run someone 
into bankruptcy.
  So you buy a policy that covers all expenses over $3,000, and you 
take the $3,000 that you normally would have put into purchasing an 
insurance policy and you put it in an account in your name, just like 
an IRA, except this is an MSA, medical savings account, instead of an 
individual retirement account.
  That medical savings account is in your name and your family's name, 
and it can be used for the first $3,000 of medical expenses. To the 
extent you do not spend it on medical expenses that year, that savings 
rolls over tax free and accumulates toward retirement. It can be used 
then to purchase a long-term care policy, it can be used to supplement 
Medicare or a number of other medical purposes.
  To the extent that you use all that $3,000, you kick into the 
catastrophic coverage policy and that covers all your extra expenses. 
So the employee or the individual is not out any more money. They 
simply are spending it in a different way. But the difference is that 
they have a personal incentive to be cost conscious in terms of 
purchase of health care. It is the only way that I have discovered that 
truly will affect human behavior which will truly affect health care 
costs.
  Right now about 10 percent of Americans, I think, eat shredded wheat 
without sugar on it in the morning, or some kind of fiber cereal which 
tastes like oats that you give to the horses. They choke it down every 
morning because it is good for their health. The rest of us are into 
all this sugar stuff that dominates the shelves, and so forth. Ten 
percent of us, I think for altruistic reasons, say I am going to do 
what is good for my health--eat right, exercise, so forth.
  I met with one of the Nation's leading cardiologists. He said, ``You 
know, Senator, 90 percent of the patients that come into my office are 
there because of bad choices that they have made. They are either 
overweight or underexercised, or they smoke too much or they drink too 
much or they engage in behavior that ends up giving them heart 
problems.'' Ninety percent.
  As I said, about 10 percent of us will do those things necessary to 
substantially reduce the risk. Some of this is obviously genetic and 
some of it is just a fact of life with which we need to live. But most 
of us will not exercise the discipline because there is no financial 
incentive to do so.
  But it is amazing how Americans respond to financial incentives. It 
is amazing how we can change behavior when it affects our pocketbook, 
when it affects the amount of disposable income we have.
  A medical savings account provides that incentive. It seems to me, if 
we truly are going to get at health care costs in this country, we have 
to provide a means, a way for people to become consumers of health 
care.
  Now, is this the answer to all the health care cost problems? No. It 
is simply one of the answers because this is an incredibly complex 
problem. I tried to outline some of that in this proposal that I issued 
in 1990. But it at least ought to be incorporated as an option, an 
option for employers and an option for individuals. I am pleased that I 
brought this idea to Washington. It was incorporated--it is the heart 
of the Gramm health care plan. It was incorporated in the Nickles plan. 
It was incorporated now in the Dole-Packwood plan as an option, as a 
way to help reduce health care costs and give us a more sensible health 
care spending provision in this legislation.
  Unfortunately, it was not incorporated in any of the Democrat plans. 
It is not part of the Mitchell plan. It is not in the Gephardt plan. It 
was not in the President's plan. It was not in the Kennedy plan.
  In fact, I may be mistaken there. I think we did incorporate it in 
the Kennedy plan in committee, but it is not part of the plan that is 
before us.
  I also outlined in here the Indiana experience with medical 
malpractice. I do not know what the total figure is. Many estimate it 
at $25 to $30 billion a year of unnecessary medical expenses because 
doctors are ordering tests and conducting procedures and increasing and 
inflating their charges solely because it is--not because it is in the 
best interests of the patient but because their lawyer comes into the 
office and says, ``Unless you do this you are going to find yourself in 
court.''
  Exercising your best medical judgment today is not enough. This is a 
litigious society. And there is a substantial portion of the legal 
profession that makes their living on filing lawsuits and settling them 
out of court, and you are a prime target because you are in a high-
income area.
  There are all kinds of gray areas in terms of judgment, in terms of 
diagnosis and treatment. The medical practice is not an exact science. 
It is still an art. Even though much of it is a science, it is still an 
art in terms of establishing the correct diagnosis and prescribing the 
right treatment. Obviously, human beings are involved and mistakes are 
made. Those mistakes ought to be paid for and ought to be covered.
  What we have found in the malpractice area today is that about 70-
some percent of the awards are not going to the patient who is injured 
but they are going to lawyers or going to the courts. So Indiana, more 
than 20 years ago, under our then Governor, Dr. Otis Bowen, who later 
became Secretary of Health and Human Services, implemented liability 
reform, and it is a model. Is it a perfect model? Probably not. Can it 
be improved on? I am sure it can, on a Federal basis. But that model 
ought to be incorporated because we are expending billions and 
billions, tens of billions of dollars on health care costs that are 
unnecessary simply because doctors are practicing defensive medicine, 
because they fear that they will end up in court under a lawsuit that 
in many cases are not suits that are grounded in negligence that ought 
to result in needed payments to individuals.
  I can talk at length. When we get to that section of the bill, I 
will. I do not mean to take up time on it.
  So the question before us is not whether or not Republicans care or 
Republicans have ideas or Republicans think there should not be 
solutions to health care. We have proposed solutions, and many of them 
I think are innovative solutions and we are disappointed they are not a 
part of the legislation before us.
  But what divides us here, the real issue, is simply this: Can we find 
solutions to the problems that plague America's health care delivery 
system today without fundamentally changing the basic nature of a 
health care system which is, I believe, unarguably the best system in 
the world and that has provided the best quality care to citizens of 
any country anywhere in the world? I do not know of any Members of 
Congress that get on a plane and go to Canada or Sweden or anywhere 
else in the world for heart surgery or for specialized treatment, or 
for medical care.
  (Mr. WELLSTONE assumed the chair.)
  Mr. KENNEDY. Will the Senator yield on that point?
  Mr. COATS. I would like to finish my statement, and when I finish my 
statement I will be happy to yield to the Senator from Massachusetts.
  But I know that there are thousands and tens of thousands of people 
from around the world, who, if they could afford it, would get on a 
plane and come to the United States. I have a good friend who is a 
Congressman from up-state New York, from Buffalo, just across the line 
from Canada. He said, ``Our number one industry in Buffalo is the 
provision of health care services by Americans for Canadians. They 
stream across the border because they do not want to wait for 
procedures and because they believe that the health care system in the 
United States gives them a better quality.''
  The basic nature of our system is that we as Americans have the 
freedom to choose our own doctors, choose our own facilities, choose 
drugs and methods of treatment. That would be limited under a 
Government-directed and Government-controlled program. We want to 
retain the freedom to say, ``Doctor, I just don't feel confident that I 
want to pursue the course you have prescribed. I think I will get a 
second opinion. I think I will search out treatment somewhere else.''
  I was driving home the other day, and I heard an advertisement from 
Johns Hopkins, I think, arguably one of the better, if not one of the 
best, providers of health care in the Nation and maybe in the world. 
They were saying if you live in McLean or if you live in Springfield or 
if you live in Oxon Hill or if you live in Bethesda, or any of the 
Washington areas, or you live in Washington, DC, why not consider Johns 
Hopkins as the place to get your medical coverage? Why not consider 
Johns Hopkins Hospital and Johns Hopkins medical facilities as a place 
to provide even your primary care? Give us a chance.
  That is a freedom that Americans want to retain, the right to seek 
out a second opinion, the right to go to Massachusetts Hospital or 
Johns Hopkins or the Mayo Clinic or the Cleveland Clinic or the 
Bluffton Clinic in Indiana, if they think that they can find a doctor 
or find a treatment that is going to be better in accord with their 
concerns about their health care.
  I think our system, without a doubt, offers the technological 
innovations that not only improve the quality of our care, but also 
help curb health care costs that is unparalleled anywhere in the world. 
We lead the world in technological innovation. It is one of the things 
that has driven up our costs, but it has also driven down costs. We 
need to understand that the innovations that have taken place in health 
care have been dramatic in terms of reducing costs.
  Medical innovation in the United States is a product of the system 
that we have. I know that the drafters of the Mitchell proposal are 
well intended, but I can guarantee you under that system many of the 
decisions in terms of how dollars are directed for medical research and 
drug research are going to be politically decided and not decided on 
the basis of market needs and not decided on the basis of medical 
needs, because it is an inevitable consequence of a Government 
involvement, whether it is State or Federal, that the political process 
will rear its ugly head and make decisions as to how money is directed.
  We do that in every other program we are involved in, whether it is 
building a road or funding a college or equipping a military facility. 
Hundreds of millions, if not billions of dollars are directed by a 
political decision based on who sits on what committee, based on who 
can form a coalition, based on what interest group has the most 
influence, and oftentimes those decisions are not the correct 
decisions. The market has a way of sorting that out in a way that the 
political process never can.
  I spent a day out at NIH not too long ago, and I discussed the 
funding that goes into medical research. I was told confidentially and 
privately, because they do not want to ruffle any feathers here on 
Capitol Hill, that hundreds of millions of dollars are misdirected into 
research projects that are overlapping and duplicative because Congress 
has dictated that that is where the money ought to be spent, and that 
is driven by interest groups pounding on our door; the ones that pound 
hardest and the ones that form the biggest coalitions and the ones that 
somehow tug our emotions the most are the ones that get the money.
  They said we just are begging, we are crying out--we have areas where 
we think we are on the verge of breakthroughs that will make 
substantial, dramatic improvements in the health care of Americans. We 
cannot direct money there because it is directed to another area on the 
basis of a political decision, and our hands are tied.
  That is going to be multiplied by who knows what factor, if we move 
further from a market-directed system to a Government-directed system? 
Just in drug therapy alone, we have had some dramatic breakthroughs in 
the last several years. Today, we are treating patients at costs one-
tenth the cost of what the procedure was previously.
  In asthma, a study in the use of an anti-asthma drug showed that it 
reduced trips to the emergency room by 96 percent, and hospital 
admissions were reduced by 62 percent, saving up to $2,250 per patient. 
The annual cost of this asthma medicine is $431.
  Patients suffering from osteomyelitis, a bone infection, were often 
hospitalized in the past in order to receive intravenous antibiotic 
treatments that lasted several weeks. Now we have a new generation of 
antibiotics that can treat these people at home. A documented study 
shows that we have saved $6,000 per patient with this.
  Bone marrow transplants, cancer, diabetes, depression, heart 
conditions, on and on it goes--gall bladder. Today we do laparoscopy. 
Who would not accept laparoscopy treatment to remove a gallstone or to 
remove a gall bladder rather than the open chest surgery that was 
formerly necessary, that kept patients hospitalized for a minimum of 6 
days, that required a lengthy time of recovery? Today they go in with a 
little tube with a miniature TV camera in it, making an incision 
smaller than a pencil--a couple of incisions, one in the arm, and one 
in the chest.
  Who would not rather sit in a bathtub and have ultrasound dissolve a 
kidney stone than to go through surgery or the extraordinarily painful 
process of passing a kidney stone? One of my staff members has had 
kidney stone problems, and he said it is an inconceivable difference 
between what he used to go through with a kidney stone, facing surgery 
to remove that stone or facing the excruciating pain of trying to pass 
that stone. And today he goes and sits in a bathtub for an hour, and 
they turn it on. It vibrates a little bit, and the stone is dissolved.
  That is innovation that we do not want to stifle. That is innovation 
that can truly affect the health care costs. Is it the total answer? 
No. But it is a part of the answer that we do not want to stifle. I am 
afraid that we will stifle that for the reasons that I have stated.
  Mr. President, I was reading the other day in the Washington Post--
and there were three articles in that paper. I was fascinated by their 
relationship one to the other, even though it was not intended. The 
first article is on welfare reform. It described, ``Mr. Clinton's $9.3 
billion plan to reform the welfare bureaucracy . . . having now 
admitted welfare's utter failure . . .''
  From HHS Secretary Donna Shalala, ``There is no magic solution to the 
complex problem of chronic welfare dependency.''
  The article described, `` . . . because of the difficulties of 
changing such an enormous bureaucracy.''
  The ``bureaucracy'' under the Mitchell health care plan, the Gephardt 
plan, the Clinton plan, whatever emerges from all of this, the 
bureaucracy will make the welfare but bureaucracy welcome. It will 
dwarf the bureaucracy that currently exists in the welfare system. Yet, 
the Secretary of HHS said, ``We cannot change that system because of 
the bureaucracy.'' It is so massive they cannot change it.
  The second article describes the problems being faced by European 
governments, and said it finally recognizes that social welfare 
spending and government-run enterprises do not work.
  I quote:

       Western European countries are beginning to reshape 
     longstanding economic policy such as cradle-to-grave welfare 
     benefits, and government ownership of businesses presaging 
     far-reaching changes in the way Europeans work and live. The 
     largest economies in Europe are facing unacceptable levels of 
     government debt.

       It says * * * unacceptable levels of high unemployment * * 
     * eleven percent of the European union work force 
     unemployment * * * forecast growing difficult in exporting 
     their once prized goods. As a result, governments from Spain 
     to Scandinavia are inching the way from the social democratic 
     policies that have nourished their people and inspired 
     generations of liberal politicians around the world.

  Is it not ironic that at a time when Western Europe and socialized 
medicine and socialized government programs have created unacceptable 
unemployment in Europe which has created unacceptable costs of goods 
which are no longer competitive around the world, and when an abysmal 
future faces those countries which have engaged in what we are about to 
attempt? Is it not ironic that at a time when they have now concluded 
that has been a failure we are rushing to duplicate what they have 
done?
  The third article in the Post that day describes the new U.S. 
Government bureaucracy that would be created under Mr. Mitchell's plan 
to nationalize one-seventh of the American economy. Why is it that when 
all the world's nations, except maybe a couple of exceptions, are 
dismantling their government-run industries and social welfare 
bureaucracies in favor of private enterprise when we have recognized 
that social welfare programs have led not to prosperity but to 
dependency?
  Why is it that we are now undertaking to enact into law a bill that 
represents the largest Government entitlement program ever devised?
  Perhaps, Mr. President, the thing that concerns me the most is not 
necessarily just the details of this bill but the incredible 
establishment of bureaucracy that results in implementing the details 
of this bill. My staff, along with Senator Gregg's staff, spent an 
extraordinary amount of time putting together a booklet entitled, ``A 
Primer to Clinton-Mitchell Health Care Bill, New Bureaucracies, New 
Mandates, and New Federal Powers.'' I did not number the pages--I 
should have. There are 81 pages. It is a very, very small print 
booklet. There is no political propaganda in here. It just simply lists 
item by item the bureaucracies, mandates, and new Federal powers that 
exist under the bill before us--81 pages, each one itemized and 
referenced to a section.
  So Members can look at this, and then look in the bill and say there 
it is. There is no commentary in here.
  What we found so far are 50 brand-new bureaucracies, 33 powers that 
run to the National Health Benefits Board, 177 new statements of 
responsibilities.
  The Secretary of Health and Human Services will have under this bill 
815 new powers and duties. How many offices is that? How many 
individuals, how many outside consultants, how many staff members, how 
many telephones, how many clerks, and how many lawyers will be needed 
at HHS to carry out the 815 new powers and duties granted under this 
legislation?
  I have handed these out to Members. I ask them do not just take my 
word for it. This is not a Republican up here just throwing out some 
nice political rhetoric. Take the book, check the reference, look in 
the bill, read about it, and try to understand and grasp the 
implications of what this would do.
  The Secretary of Labor gets 83 new powers, all listed in here. And 
just today, I have been handed a piece, and I guess I will have to add 
this. I do not know if I will bring out a coach, too. Maybe we will 
bring out an addenda sheet of the 49 new responsibilities that will 
flow to the employer or a plan sponsor--49 new responsibilities. I will 
get this printed up and have it available for Members on Monday, with 
reference to the section number so that you can check it out for 
yourself. Forty-nine new responsibilities that every employer and every 
plan sponsor in America will have to comply with. Who knows how much 
that is going to cost and how many new staff positions that will cost. 
We may see an explosion of employment under this bill, and it will all 
be Government employment. Maybe that is one of the intended 
consequences, I am not sure.
  The Washington Post said--and it is not a publication, you know, that 
is necessarily a tool of the Republican Party. The Washington Post 
said, ``The Mitchell bill would create dozens of new Federal and State 
agencies that would have the untested authority to centralize, 
reorganize, monitor and enforce the way medical care is being bought, 
sold, and to a lesser extent practiced in this country. The Mitchell 
bill substitutes Government bureaucracy for private.''
  Let me repeat that. The Washington Post concludes, ``The Mitchell 
bill substitutes Government bureaucracy for private. It challenges 
States and Federal agencies to set up new agencies with complex 
responsibilities never before performed on the same scale by public or 
private enterprise. It would require States to enforce complex new 
insurance industry laws. It obligates States to verify that plans have 
had the ability to care for patients in the way the law requires, and 
forces the States to monitor the transfer of billions of dollars in 
insurance premiums paid by employers and individuals to private 
insurers.''
  A wise man once said, ``All futures have one virtue: They never look 
the way that you imagine them.'' If the bill before us today passes, I 
do not believe that any of us can imagine what the future will be under 
this bill, and that is the problem. I do not believe it is a future 
imagined by the American people, and I believe that is why they are, in 
overwhelming numbers, calling our offices and writing to us and 
stopping us at the airport and stopping us on the streets at home and 
saying, ``Do not pass that Government bill.''
  They do not know the details. We do not know the details. They do not 
know them for sure, but they have an inherent distrust in the ability 
of Government to deliver a service efficiently or cost effectively, and 
they have an inherent understanding that politics will so complicate 
and so misdirect resources under this bill, that it will become a 
political nightmare. They simply have lost confidence in the ability of 
this institution and in the ability of Government to provide services, 
particularly when it concerns the thing that is the very closest to 
them--that is, their health and the health of their loves ones. It is 
one thing for us to argue whether a road should be built north of the 
city or south of the city, or in Indiana or Ohio; it is another thing 
to argue whether or not a Government clerk, or bureaucrat, or Member of 
Congress, or a national health board, is going to decide the health 
future for your loved ones, your spouse and your children, and whether 
we are going to layer a bureaucracy on the health care system that we 
have never seen the likes of in this country.
  Mr. President, several months ago, Mrs. Clinton came before the 
Congress in a joint meeting with the Finance Committee and Labor 
Committee. It was held over in the Russell Building in that big caucus 
room over there, a scene of the McCarthy hearings and Watergate 
hearings, and a scene of some very important battles. The room was 
filled, and cameras were there, and the press was there. Mrs. Clinton 
was introducing her bill and touting its virtues.
  It occurred to me, as my time to question was coming, that rather 
than getting into arguing the details of the bill, we ought to at least 
question the underlying assumptions, the pillars that were the basis 
for the bill itself. So I raised those questions with her. I said, 
``Mrs. Clinton, first of all, I understand the prodigious amount of 
work that you have engaged in while putting this bill together, and 
your interest in health care.'' I said, ``But it seems to me that it is 
based on faulty assumptions.'' I said, ``Let me just raise four 
assumptions with you briefly, and you tell me where I am wrong.'' I 
said, ``Assumption No. 1, to me, is that the bill is based on the fact 
that the Government can deliver services more efficiently than the 
private sector.'' I said, ``Without going into all the details and the 
long list of examples as to why I do not think that is correct, if you 
have a package and it absolutely, positively has to be delivered where 
you want it by the next morning, do you take it to the post office, or 
UPS, or Federal Express, a private carrier? If it absolutely has to be 
there for the sale of a house, or the closing of the contract, or the 
signing of the legal document, or the birthday gift--absolutely has to 
be there--what do you instinctively do? Do you say I better not take it 
to the post office? Why? It is a Government-run monopoly, an entity 
that does not have a very good history of delivering the mail on 
time.''
  We learned the other day that there are truckloads of mail that have 
been sitting outside post offices for weeks and months that have not 
been delivered, and there is a huge post office scandal. I said, ``It 
seems to me that the underlying assumption that Government can deliver 
more effectively than the private sector is just not based on 
experience.''
  The second assumption is that the Government is more cost-effective 
than the private sector. I said, ``It seems like we cannot pick up the 
paper in the morning without reading about a new misuse or 
misapplication of funds, or cost overruns that occur.''
  Senator Glenn held a hearing in July highlighting some of the 
Government's inefficiencies. To quote from part of that:

       The Office of Personnel Management found that it needed to 
     make a $54 billion adjustment to its retirement insurance 
     account.

  The Internal Revenue Service testified that, well, yes, it might be 
able to collect $29 billion more in taxes that are owed, but it cannot 
be sure because the question is, ``Why do you not go out and collect 
it?'' They said, ``We are not sure that money is owed, but we think it 
is 29 million dollars.'' The State Department cannot account for $250 
million it paid out.
  The Customs Service says it could not account for 10 tons of illegal 
confiscated drugs.
  The defenders of the Clinton-Mitchell plan say, well, you are 
comparing the post office to health care, and that is like comparing 
apples to oranges. Let us compare apples to apples. We recently passed 
and supported a vaccine for children program. The Government is going 
to buy one-third of the Nation's vaccine supply, package it, house it, 
and distribute it, starting this October. It is a well-intended 
program.
  The GAO just gave us a report on the progress of that program. Here 
are the three findings:
  The program is way behind in letting purchase contracts.
  Two, GAO is unprepared to evaluate whether the system could 
efficiently process orders from the 70,000 doctors and clinics that are 
supposed to receive the vaccines.
  Three, they are unprepared to adequately test whether the packaging 
and delivery system would retain vaccine potency. Vaccines require 
strict temperature controls.

       Our review indicates that it is unlikely that the 
     Government can fully implement the vaccine for children 
     program by October 1, 1994, and raises questions about 
     whether the vaccine for children program, when fully 
     implemented, can be expected to substantially raise vaccine 
     rates.

  If we cannot run a vaccine-for-children program, how are we going to 
run health care for everything else?
  Mr. President, the third assumption that I raised with Mrs. Clinton 
was: You know, the problem with this is that when you turn things over 
to Government, politics gets involved instead of the disciplines of the 
market where, if you do not make a profit, you are out of business and 
the shareholders are after your neck at the next shareholder business 
meeting or the stock plummets. Instead of the discipline of the 
marketplace, the Government does not have a competitor, the Government 
does not have to make a profit, and the political process always 
intervenes.
  Already, we have seen the interest groups lining up. We have an 
amendment on the floor now that says--and it is a well-intended 
amendment, and I take nothing away from its sponsor, who has 
passionately defended and promoted the rights of children in a whole 
number of areas, and he cares deeply about that. But already on a 
political basis we are trying to make decisions that, well, this ought 
to be included. There are probably 100 areas, 100 items, maybe more, 
that Members feel just as passionately about for different reasons that 
they want carved especially in the program, and the decision is going 
to be made here on the Senate floor rather than in the national health 
boards or in a commission. It certainly will not be made in the 
marketplace.
  This is not to say that there should not be some of those provisions. 
This is not to say there should not be a vaccine-for-children program. 
The question is how can we do this without skewing how the money is 
allocated, how the resources are allocated? How can we as political 
entities whose future depends on saying yes and whose career is thought 
to be terminated when we say no, how can we resist the temptation that 
we have not resisted, in my experience in Congress, to say, well, maybe 
we can work that into the next bill. You make a good case. You have an 
important lobby. That is a touching story. I will talk to the chairman 
of the Finance Committee to get it in the next tax bill.
  Already the litany has started. The Labor Committee added $32 billion 
of benefits to the President's plan, and when the House Labor Committee 
took it up, they added benefits. They got a lot of pressure from the 
dental people, I guess, and they added more. They said they could not 
draw the line at 18, they had to make dental benefits available to 
everybody. Some others wanted additional programs for women and 
children. The mental abuse people are lining up saying, ``What do you 
mean, 30 days? We need 60 days.'' When they get 60 days, they say they 
need 90 days of coverage. On and on it goes.
  Whatever interest group is not covered right now I guarantee you, if 
they are not meeting today, they met yesterday, and they are devising 
their strategy to come and put pressure on us to add benefits and make 
decisions. We are not the best people to make those decisions. We do 
not have the expertise. We are politicians.
  Everything in us says yes, and we will pay for it later, and if it 
does not fit, that is OK. You can walk out the door happy. Everything 
in us says, oh, if we say ``no'' we are going to have to look for 
another line of work.
  So, I told Mrs. Clinton. I said, it just seems to me that the 
assumption that we can do this outside of politics undermining your 
best attempts, undermining the attempts of people who wrote this bill, 
I just do not think that is within our experience nor see how we can do 
it.
  Her answer to that was kind of disturbing because she said, 
``Senator, I don't challenge what you have just said in terms of our 
experience, but I think this time we are going to do it differently.''
  I just do not believe that is the case.
  I know Members are wondering when I am going to quit, and I am just 
about done. The question, I think, now is, Where do we go from here?
  I believe a sensible health care reform bill could be put together on 
a bipartisan basis in this Chamber in a very short amount of time. We 
start talking about when Senator Bentsen introduced a bill a few years 
ago. We talked back and forth. I believe there was majority support for 
that. It will not solve all the problems, but it will be a huge step 
forward. It would give us time to analyze progress. It would give us 
the ability to pay for that progress. It would give us the ability to 
make changes next year or the following year if we have information 
back that there is more we could do.
  But the President has stated, he has drawn the line in the sand, 
drawn a couple lines. I was in the Chamber when he said, ``See this 
veto pen. Nothing that is less than 100 percent coverage will get my 
signature.'' And that line is now 95 percent. But just the other day he 
said, ``Anything less than the Mitchell bill is totally unacceptable.''
  Well, we are starting to look at the Mitchell bill, and we already 
found out that, distressingly, in just one area it is going to set up a 
Government agency to tell us how many doctors we need in what 
specialty. Even the chairman of the Finance Committee finds that 
appalling and unworkable.
  Any time we suggest anything less than what the President has 
outlined, we get nothing but resistance from the White House. So I have 
concluded that a sensible bill is not going to pass here this year. A 
bill that is achievable is not going to pass here this year.
  I think that only leaves us with one option, and that option is to 
kill the President's bill, to send a message to the White House, ``Mr. 
President, the American people, as expressed through their 
representatives in this Congress are not going to support your concept 
of health care for America.''
  Until the President gets that message and understands that message, 
we are not going to make any progress, because he is going to continue 
to insist that the leadership of the House and the leadership of the 
Senate pass what he wants. But what he wants has been rejected by the 
American people. I do not know how many times we have to say this. This 
thing has been killed six times. Maybe it is like a cat; it has nine 
lives. We have to kill it three more times. This proposal out of the 
White House has been dead more times, or thought to be dead more times, 
than we can count. Yet it keeps trying to resurrect itself.
  The President has to understand that his vision of health care for 
America is not America's vision of health care for America, and unless 
he understands that, we will not be able to make any changes or any 
reforms in health care. We will not be able to make any progress.
  So I have concluded we have to defeat the Mitchell bill. We have to 
defeat what essentially is the President's proposal. We have to defeat 
the Gephardt bill. And we have to send that message, and then and only 
then can we begin to put together the needed reforms that will truly 
preserve what is right about our health care system and make changes in 
those areas that do not work right.
  The American people have said they do not want or they do not trust 
Government to take over the health care system of this country, which 
is one-seventh of our economy. They do not want or trust Government to 
make decisions about issues that are the most personal issues in their 
lives. That is the health of themselves and their spouses and their 
loved ones and their children.
  They do not want most of the critical decisions regarding their 
health care settled on a political basis.
  This is the fundamental issue: Do we as a people want Government-run 
health care? The American people are saying no. They do not know the 
details, but their instincts are correct. And those instincts are 
shaped by experience, time after time after time, with Government-run 
programs.
  That message has to penetrate the White House and only when it does, 
only then can we begin the process of real health care reform.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from New York.
  Mr. MOYNIHAN. Mr. President, before the Senator from Indiana leaves 
the floor, could I, with great respect, suggest that either I misspoke 
or was misunderstood, and that is probably both as it frequently 
happens.
  I mentioned surprise to find in Senator Mitchell's bill provisions 
that indicate that the Federal Government will designate the number of 
specialists that will be trained for specific specialties and then will 
reduce the number of residents, and so forth. I said there must be some 
staffer who wants that because we had thought it was being taken out of 
the majority leader's bill. It never was in the Finance Committee bill, 
and the Finance Committee staff did not add it, as I am sure Senator 
Packwood will agree.
  Mr. COATS. I did not believe it was the Finance Committee.
  Mr. MOYNIHAN. They were much concerned.
  Mr. COATS. It was distressing. It was on someone else's staff.
  Mr. MOYNIHAN. I wonder if the Senator might consider revising his 
remarks in that regard.
  Mr. COATS. Mr. President, I am happy to revise the remarks, based on 
the statement made by the Senator from New York, implicating a member 
of the Finance Committee staff as being responsible for the quota 
system set up for medical specialties under section 3012. Apparently 
that was inserted by either staff of another Senator or some other 
staffer but not a member of the Finance Committee or the Finance 
Committee staff.
  Mr. MOYNIHAN. That is right. I appreciate the courtesy.
  Mr. President, this question of Government-run medicine, we are going 
to hear a lot about that.
  May I just offer the thought in a bipartisan spirit--and I was happy 
to hear the Senator from Indiana speak of a bipartisan spirit; happy to 
hear him speak of Bluffton, where my grandfather, who dug pipelines 
from Jamestown, NY, around central New York, ended up.
  Medicine, by the oldest experience of the Western civilization, is a 
socialized activity. Individual doctors, no; but hospitals, yes.
  There are some for-profit hospitals in the country. Perhaps 15 
percent of the patients are in them. But it is not a profitable 
activity. It is, by definition, socialized.
  The largest activities, say, in my city of New York, the main 
hospitals are religious-supported hospitals. They are Catholic, they 
are Protestant; Columbia Presbyterian, St. Luke's, Mount Sinai, 
Montefiore, the latter being associated with a Jewish charity; as a 
Presbyterian charity; as a Catholic charity.
  The Shriners run extraordinary burn centers around the country. There 
are Masons. And there is never a bill.
  We have the hospital systems we have because of generosity from the 
charitable, the sharing concerns of Americans, not as an enterprise. 
And I hope we keep that in mind.
  I quote my Republican friend, who accompanied the President to the 
Middle West yesterday, the mayor of New York, who said in a letter to 
the House, ``America is debating universal health care. New York has 
given universal health care for most of the century.''
  It is a question of how much more, than whether. And I think we will 
see that.
  I take the Senator's point about the vaccination program we 
authorized in the last budget. And Senator Packwood and I realize that 
it is the responsibility of the Finance Committee. It has not gone 
well. We will have to hold a hearing, and we hope we can do better. But 
we have had free vaccinations provided by the city of New York in New 
York since 1890. And it has not turned us into a hopelessly communal 
society.
  Mr. PACKWOOD. Will the Senator yield?
  Mr. MOYNIHAN. I yield the floor.
  Mr. PACKWOOD. I do not want him to yield the floor.
  The PRESIDING OFFICER. Who yields time?
  Mr. PACKWOOD. I yield myself a couple of minutes.
  We have reached the level of vaccinations that we had hoped to reach 
in the legislation that we passed. It is not only in the city of New 
York, but we have found this in any number of towns in major 
metropolitan areas where we have tried and tried and tried to vaccinate 
everybody. The problem is not the lack of vaccine. The problem is 
getting people to wherever your communal vaccination facility is to do 
it. And the cost has not been the deterring factor. We do not know why 
they will not. But it is not a question of the vaccine, which was free.
  I thank the Chair.
  Mr. MOYNIHAN. Mr. President, I make that point. The determinants of 
health increasingly in the modern world has to do with personal 
behavior and community behavior.
  The change in infant mortality in the world is really striking. How 
much better things are than they were.
  I look at Portugal. In 1960, it had an infant mortality rate of 77.5 
per thousand. One child in 13 died before reaching one year of age. It 
is now down to 11 per thousand or one child in 99.
  The United States, which was never that good--it helps to be born in 
Iceland if you want to prosper as a child--but we were 11th among the 
23 OECD countries in 1960. We are now 21st. Not because we have 
forgotten medicine; medicine roars forward. But, community behavior is 
less than it obviously once was.
  Mr. President, I see my friend from Massachusetts and I yield to him 
for such time as he may desire.
  Mr. KENNEDY. I thank Senator Moynihan.
  We are going to get back very quickly to the Dodd amendment on 
children, and also the comparisons between the Mitchell program and the 
Dole program, not only on children but on working families and seniors.
  But I wanted to just take a moment, before yielding to the Senator--
--
  Mr. REID. Will the Senator from Massachusetts allow me to ask him a 
question?
  Mr. KENNEDY. I will be glad to. Could I just make one brief comment 
on a matter that I brought up earlier, and then I will yield for a 
question.
  That is, we are hearing on the floor now about how we continue to 
study the different proposals and find new insights.
  I must say that I share that experience, just in the past few hours 
in further study of the Dole proposal. Earlier I had spelled out the 
difference on one very key element of the Mitchell proposal and the 
Dole proposal on the exclusion of treatments for preexisting 
conditions, which is an absolutely essential part of the different 
proposals.
  I mentioned in the comparison, when I was exchanging comments with 
the Senator from South Dakota [Mr. Daschle] about how the Dole proposal 
provides that if you are diagnosed or being treated during the 3 months 
prior to the time of the enrollment, you are therefore excluded, or you 
are limited in terms of any kind of help and assistance or medical 
attention for 6 months.
  So I looked over on page 81 and found this 3-month period where you 
would be treated and the limitation of 6 months.
  On the next page, it says, ``Special rules for individuals.'' So in 
the case of an individual who is not enrolling as a member of a group 
but as an individual, 3 months in paragraph 1(a) is deemed a reference 
to 6 months. So it is not 3 months, it is 6 months. And in paragraph 
(b), any reference to 6 months is deemed a reference to 12 months.
  So, I agree that 12 months without medical treatment is absolutely 
devastating for any individuals who are trying to get attention for a 
medical condition.
  But then if you just read further, because we talked about an amnesty 
provision, which was included in the leader's provision, and also the 
first open enrollment where they can enter into a program without any 
exclusion of coverage.
  And now we have heard our friend from Indiana talk about the 
bureaucracy in the administration of the leader's proposal.
  Listen to this. Under the Dole proposal, there is also an amnesty 
provision, but in general this subsection shall not apply during an 
initial enrollment period described generally, but the participating 
State may establish a limit on the number of new enrollees a health 
plan must accept during the period described based on the plan's share 
of the applicable community-rated or experienced-rated population.
  Now you talk about a bureaucracy. Here the Dole bill says they are 
going to give it to the State to develop some kind of agency when they 
are having this limited amnesty period, and then the State is going to 
decide--on the basis of what? Capacity--who is going to get in and who 
is going to be left out.
  You talk about playing God. You talk about the Mitchell proposal, 
trying to include people and having administrative procedures to 
include people--here, under the Dole proposal they are creating a new 
State agency to keep people out; to keep people out.
  This is wise, to try to get through exactly what is the bureaucracy 
in the two proposals.
  Mr. DASCHLE. Will the Senator yield on that point just for a 
clarification? As I understand it, if that interpretation is correct, 
then you would have a State governmental agency deciding the 
eligibility for insurance for every individual with a preexisting 
condition? You could have someone in North Dakota who has a preexisting 
condition who would be eligible for care, but a person in South Dakota 
with the same preexisting condition where Government says you are not 
allowed any access to that insurance? Is that what that provision says?
  Mr. KENNEDY. It is stated. The Senator is exactly correct. The 
participating State may establish a limit on the number of new 
enrollees a health plan must accept. So they decide who they are going 
to accept. There is no consistency in terms of trying to make sure you 
are making a commitment to those individuals, our fellow citizens who 
have a disability, and say they are part of this whole process; they 
are part of the whole process. Here it says the State will establish an 
agency. The State will decide who will come in and who will be left 
out.
  I think the Senator's interpretation is correct.
  Mr. REID. Mr. President, will the Senator yield?
  Mr. KENNEDY. I will yield for a question and then yield whatever 
time, yield the floor.
  Mr. REID. Mr. President, through you to my friend from Massachusetts, 
you will recall the junior Senator from Indiana said, and this is not 
an exact quote: I am not prepared to go forward on health care 
legislation. I ask my friend from Massachusetts, is it not true that we 
have been talking about health care, universal health care, for over 50 
years in this country?
  Mr. KENNEDY. The Senator is absolutely correct.
  Mr. REID. Is it not true we have gone through about six Presidents, 
talking health care?
  Mr. KENNEDY. Certainly Teddy Roosevelt, Franklin Roosevelt, Harry 
Truman, President Nixon----
  Mr. REID. It is also my understanding the Education and Labor 
Committee and the Finance Committee have held more than 60 hearings on 
the legislation, the one reported out by the Finance Committee, the 
bill reported out by the Education and Labor Committee--much of which 
has been melded into the Mitchell plan? Over 60 hearings; is that 
right?
  Mr. KENNEDY. Over 80 would be more accurate.
  Mr. REID. And hundreds of witnesses, is that true?
  Mr. KENNEDY. The Senator is correct.
  Mr. REID. I am wondering, do you think the Senator from Massachusetts 
is ready to go forward with this legislation?
  Mr. KENNEDY. I think the American people are ready to go. They are 
ready for the Congress to finally address the more important issues of 
our time.
  Mr. REID. I would say to my friend from Massachusetts, talking, for 
example, about preexisting disabilities, preexisting conditions, in the 
small State of Nevada--and it is a small State--we have about 360,000 
people with preexisting conditions. Now, under the Dole plan, as has 
been explained by the Senator from Massachusetts and the Senator from 
South Dakota, most of them are still out of luck; is that not right? 
Under the Dole plan, preexisting conditions--in the small State of 
Nevada we now have about 360,000 people with preexisting conditions. 
They would still basically be out of luck; is that not right?
  Mr. KENNEDY. Certainly they would be out of luck if they have been 
getting any kind of treatment for 6 months prior to the time--they 
would be out of luck for the next year for any other kind--any kind of 
treatment and assistance. If you look at the nature of these kinds of 
diseases--cancer, heart disease, diabetes, HIV, the whole range of 
different kinds of diseases--that is the time when people really need 
the help and assistance. In effect, they would be excluded.
  Mr. REID. I hope later on in this debate, we will have an opportunity 
to talk about some of the other things that need to be addressed, like 
helping the small business people in this country; like helping women 
who need prenatal care. I hope we will have the opportunity during this 
debate to indicate now is the time to go forward with health care 
legislation for the people of the State of Nevada, the people of the 
State of Massachusetts, and throughout the United States.
  Mr. KENNEDY. I thank my colleague. We are back, hopefully, to the 
excellent amendment of the Senator from Connecticut.
  I think for----
  Mr. COATS. Mr. President, may I ask the Senator from Massachusetts to 
yield to me just to respond in 30 seconds to the Senator from Nevada?
  Mr. KENNEDY. For 30 seconds.
  Mr. COATS. I thank the Senator.
  Perhaps the Senator from Nevada was not here when I spoke last 
evening. Or maybe he did not hear my entire statement today. If he 
misinterpreted my statement or if I misstated in my statement, I 
apologize for misstating it.
  This Senator said--meant to say--I am not prepared to go forward with 
the Mitchell bill or even the Dole bill. I have not had time to analyze 
it all. I doubt if any Member here has. Certainly, I am prepared, as I 
indicated in my statement--I closed with it--to go forward with 
meaningful, sensible health reform legislation. I am not prepared. I do 
not fully understand--even the Finance Committee chairman said he did 
not realize the section was in the bill. I do not think any of us have 
had the chance to fully analyze the situation to the point where we can 
just do the bill now and get out of here and go home. That is what I 
meant to say.
  But I say to the Senator from the State of Nevada, the premise of the 
Senator's statement, if it was based on my statement, I think the 
Senator was wrong.
  Mr. KENNEDY. I see the Republican leader. I was wondering if there 
had been any decisions on the resolution of the two amendments that 
were going to be voted on--hopefully voted on--on Monday at 5 o'clock. 
I think the majority leader had indicated he was hopeful of being able 
to get some kind of response on that request.
  Mr. DOLE. I will be meeting with Senator Mitchell at 1:45 on another 
matter, and I will be happy----
  Mr. KENNEDY. Fine. I thank the Senator. I yield the floor.
  The PRESIDING OFFICER. Who yields time?
  Mr. MOYNIHAN. I yield the Senator from Connecticut as much time as he 
desires or may require.
  Mr. DODD. Mr. President, what is the pending business?
  The PRESIDING OFFICER. The Dodd amendment No. 2561.
  Mr. DODD. Mr. President, I am glad to hear that. To paraphrase Daniel 
Webster: It is a small amendment, Mr. President, but there are those of 
us who love it. It is only two pages long. I proposed it last night at 
5 o'clock. I gather we are not going to be able to vote on it until 
maybe Monday or Tuesday. But I just wanted to bring us back a little 
bit to the subject matter before this body, which I introduced going on 
24 hours ago. It is not a difficult amendment to read.
  I understand the overall bills are longer but this amendment is just 
two pages and pretty straightforward as to what it does. I am 
disappointed we cannot get a vote on it sooner. I just hope we will get 
a vote at some point.
  Just to reemphasize the point that was being made by the Senator from 
Nevada a moment ago--I hear some people saying how we need a lot more 
time on this issue before we go forward.
  I sit on the Labor and Human Resources Committee. We had 51 hearings 
on this subject matter in just that committee alone. There were some 30 
or 35 different hearings, as I recall, in the Finance Committee. 
Roughly 40 Members of this body serve either on the Labor and Human 
Resources Committee or the Finance Committee.
  If you add the Veterans' Affairs Committee and the Governmental 
Affairs Committee, each of which had hearings on this subject matter--
and then you consider all of the network programming, all of the 
stories, the opinion page pieces done on this, the American public is 
now familiar with a language that I think a year and a half or so ago 
they would have been totally unfamiliar with; things like preexisting 
conditions, portability, and the various kinds of plans.
  I just want to make the point here that we have had an endless amount 
of information made available to us. The subject matter of our 
discussion here should now be tremendously familiar to Members. We must 
not miss this opportunity. I hear some Members talking about not being 
ready to proceed. It reminds me of students the night before a school 
paper is due who have not done their homework. So, a student shows up 
the next day and says the dog ate his paper and he is very sorry he 
could not get it done. Or another student takes an incomplete at the 
end of the semester because he or she did not study.
  We cannot take an incomplete on health care. We cannot just quit and 
go home. Congresses exist for a finite period: 2 years. We are coming 
toward the end of this 103d Congress after a significant amount of work 
on health care--including hearing from hundreds of witnesses in 
countless numbers of hearings.
  So while I am certainly patient about people wanting to study and 
read a bit more, I think this may not pass the smell test, as they say. 
What we may be really looking at is just some good old-fashioned foot 
dragging.
  So I am hopeful that we might get a vote on my two-page amendment at 
some point because it is pretty straightforward. It deals with 
children. It requires private insurance policies to cover pregnant 
women and children. I will go over it in a minute. That is all it is. 
It is not a Government program. It does not create some fancy new 
bureaucracy. It moves the date up for coverage for kids from 1997 to 
1995. This should not be heavy lifting in terms of getting us to vote 
on this. People around here who think we need to study, study, and 
study some more are not convincing this Senator, and I believe other 
people, about why that is necessary.
  So, let me come back again, if I can, to the subject matter before us 
because I think a critical point needs to be made over and over and 
over and over again.
  If you are a family living on public assistance today in 1994, your 
family gets health care. What we are talking about when we talk about 
those who are not covered are families who are working. They get up 
every morning and go out the door and hold down a job and try to 
provide for themselves and their families. They are the ones that are 
being excluded from basic health care coverage in too high numbers. So 
we are trying to do what we can to see that they get drawn into the 
process. That is what this is really all about. Because people talk 
about this program as some sort of a giveaway, I would just like to 
share with you some testimony I heard when chairing a hearing before 
the Children's Subcommittee. My colleague from Indiana serves as the 
ranking minority member of that subcommittee.
  Lynn Morrison testified before our subcommittee last November. Let me 
read a little of her testimony if I can, because we need to put a human 
face on the numbers and charts we have before us. While Lynn is only 
one woman, she speaks, I think, for literally hundreds of thousands in 
this country:

       My name is Lynn Morrison. I want you to know that I'm an 
     average working person. I've worked since I was 14 years of 
     age. But when I was pregnant with Desiree and needed help in 
     getting health insurance, I couldn't get it.
       I'm here today to tell my story so that maybe other women 
     won't have to go through what I did. Others won't have to be 
     afraid when they can't get in to see a doctor before they 
     deliver. Others won't get late prenatal care like I did and 
     risk having a problem.
       This year money was tight, even though we were both 
     working. We had just bought our first home and had a monthly 
     mortgage to pay. My husband and I had not planned this 
     pregnancy. This was not the best time to have a baby. But my 
     husband and I were delighted to bring a new baby into the 
     world, to care for her and to give Rachel a new sister.
       When I learned I was pregnant, I had just changed jobs to 
     be closer to Rachel's kindergarten. I left my job at a 
     pediatrician's office because it was a 1\1/2\-hour commute 
     and I had difficulty getting Rachel to and from school. I 
     like my new job, but they don't offer their employees health 
     insurance.
       At first, I was not really worried because Rachel is school 
     age and a pretty healthy child. I was feeling fine and 
     healthy, too. When I learned I was pregnant, I tried to get 
     on my husband's health insurance plan through his work. We 
     learned they had been taking out monthly payments from his 
     paycheck as if he had a family plan, but I was never 
     enrolled. When he tried to enroll me with the health 
     insurance company after I was pregnant, I was denied because 
     my pregnancy was considered a ``preexisting condition.''
       I really wanted this baby to have a good start. I was a 
     little nervous. I was 32 years old.

  She goes on to say:

       Soon after that the welfare office--

  She went and applied for welfare. I am leaving some of this out.

     told me that my income and my husband's income combined would 
     be too high to be Medicaid eligible. So I tried to find a 
     doctor who would see me without insurance. I found one clinic 
     who would see me, but they wanted $250 to $350 for my first 
     visit and hundreds of dollars for blood tests. We just didn't 
     have it. I was very scared. We were stressed and my husband 
     felt terrible that he couldn't take care of my health needs. 
     I was exhausted from the whole ordeal.
       About this time, I was changing from sad and scared for my 
     baby to mad. No one would see me. I thought, I've worked all 
     my life and for what? No one will insure you if you need it, 
     not even if you're pregnant. I have been putting money into 
     the system for 18 years, and isn't it ironic that I can't get 
     any health care when people who have not worked all their 
     lives get Government help? My baby has a right to medical 
     care. I don't understand why I can't get it just because I 
     change jobs and we don't meet certain criteria.
       I took the initiative and got on the phone and called 
     around to find help. No one would help me. Before I had the 
     baby, I went into premature labor twice and was hospitalized. 
     I felt scared, but with the help of wonderful doctors--

  Which she talked about, her baby was born healthy.

       We are very lucky our baby doesn't have health problems. 
     Everybody should be able to get health care if they need it. 
     All this not only put our baby at risk, but we were afraid of 
     losing our home and marriage. Because there is no guaranteed 
     health coverage today, I couldn't get prenatal care until the 
     fifth month of my pregnancy. I hope you hear my story and 
     understand every American should have health care coverage, 
     whether they change jobs, get sick, or have a baby.

  I took the time to read that because I think as we go through this 
bill, we get up and read sections, subsections, talking a lingo and 
language that would glaze the eyes of an accountant, an actuary. 
Legislative language is difficult stuff to understand, to go through. 
We need to talk in terms of real people. Lynn is a real person and 
there are many, many more like her out there who are worried. This 
amendment tries to address her kind of situation.
  (Mrs. FEINSTEIN assumed the chair.)
  Mrs. MURRAY. Madam President, will the Senator from Connecticut yield 
for a question?
  Mr. DODD. I will be glad to.
  Mrs. MURRAY. I was startled, as I think most people were, when you 
read the story and talked about a woman who said pregnancy was a 
preexisting condition. I have had doctors tell me any woman over 16 has 
a preexisting condition. I think when we talk about that, we forget 
when a lot of women go to a doctor, try to find a new insurance plan, 
that preexisting condition is something they thought was just part of 
their life. I think it is imperative we remember that during this 
debate.
  I want to ask the Senator from Connecticut, I have heard from my own 
ob/gyn that many times he has young women, or women in their twenties 
sitting out in a car and they are in their ninth month of pregnancy; 
they are in labor and they sit out in their car and in the hospital 
parking lot until the very last second to go in to deliver because 
their health care coverage would not cover pregnancy.
  Is this something that you heard in your committee hearings?
  Mr. DODD. I thank the Senator for her question.
  Madam President, I will tell you, this is something we heard over and 
over again--the nightmarish stories that people go through. Again, each 
of us ought to be doing everything we possibly can and not just because 
we are a civil society and because we care about people, but must also 
I point out that there are some real dollar savings involved here. We 
are constantly talking about the fiscal implications, as we should, of 
the various health care proposals. But let me just share, if I may, the 
incredible dangers of having a low birthweight baby if you have no pre-
natal health care.
  Each year, there are some 250,000 babies born to women who do not 
receive the necessary kind of prenatal care before the sixth month of 
pregnancy. These babies are twice as likely to be born with a low birth 
weight. More than 90,000 infants were born to mothers who did not see a 
health care provider during their pregnancy at all. These babies are 
three times more likely to be born with a low birth weight than those 
mothers who received the appropriate prenatal care.
  What does that mean in terms of dollars and cents? Usually, you are 
looking at a child that ends up in a hospital--and I am sure many of my 
colleagues have been to these infant intensive care units. It is 
remarkable what they can do from a technology standpoint, but do not 
kid yourself, their work is very expensive. It is not uncommon for the 
cost to be $150,000 to keep one of those infants alive in one of those 
incubators. I am just stunned by the capabilities that we have in this 
area. It is wonderful. But it costs a tremendous amount.
  Mrs. MURRAY. Madam President, will the Senator yield for a question?
  Mr. DODD. I will be glad to yield.
  Mrs. MURRAY. The Senator mentioned the tremendous cost of low 
birthweight babies and mothers who have not had good prenatal care. As 
a former preschool teacher, my experience was that the young kids when 
they got to be 3, 4, and 5 and were in my preschool class were the ones 
that were further behind, took longer to learn, and were much more 
difficult. Do those costs reflect further in life as these low 
birthweight babies grow up?
  Mr. DODD. It does. As the Senator has correctly pointed out, there 
are costs when that child enters school without the kind of learning 
capacity that they should have and a variety of other problems. The 
following numbers were developed by the Carnegie Foundation, the March 
of Dimes, and others. Every time a low birthweight delivery is 
prevented, it saves between $20,000 and $50,000. Every time a low 
birthweight delivery is prevented, it saves approximately $150,000 or 
more on neonatal intensive care costs per child.
  Mr. REID. Will the Senator yield?
  Mr. DODD. I would be glad to.
  Mr. REID. I had two gentlemen from Nevada come to my office who were 
neonatalogists. They indicated--and I think it is a confirmation--I 
would like the Senator to respond--of what he is telling us here--it is 
not unusual in their facility to have women come who have never ever 
seen a doctor, and they are there for delivery, and that they do not 
have babies that cost $150,000; they have million-dollar babies. By the 
time the baby gets out of a hospital the first time, the hospital bill 
is $1 million. Has the Senator heard of cases of that nature?
  Mr. DODD. Certainly. In years back, those children would have died. 
And today, because of our commitment to research and technology, we can 
now save those lives. But they are tremendously costly. And again, you 
will hear over and over about the low cost and savings from prevention. 
I called Travelers Insurance Co., by the way, and asked about my 
amendment and said, ``How much will this cost?'' It is 9 cents a day to 
cover children's care. That is 9 cents a day in premium costs.
  By the way, my insurance companies do not oppose this amendment. We 
hear about the insurance industry and some of the things that are said 
about them, but I want my colleagues to know that they are behind this 
and believe it is an acceptable step. Many of them have it already in 
their plans. A lot of the HMO's have it in their plans and insist upon 
it. Some 20 States require it. So this amendment would just insist that 
any private insurance plan cover it as well.
  Mr. REID. Will the Senator yield for one final question?
  The Senator from Washington stated the problems that women have can 
be preexisting conditions. To indicate that this is not just a fallacy, 
I have an organization, a nonprofit organization in the State of Nevada 
that wrote me a letter--I talked about it once a couple months ago on 
the floor--the National Association of Latin Americans. They have 23 
employees. They had health insurance, and the reason they were able to 
maintain employees is they had health insurance. The average wage was 
$4.50. They were glad to work; they had health insurance. They were 
unable to find someone that would renew or write a new policy because 
they had preexisting conditions that had developed during the year. Two 
of the conditions were pregnancies. One of the conditions was diabetes. 
They were canceled.
  Is this what the Senator from Connecticut is talking about?
  Mr. DODD. Exactly. Those are exactly the kinds of conditions and 
problems that people face. And I would like to, Madam President, if I 
could draw the attention of my colleagues to this chart or graph here. 
There are a lot of numbers and language here but let me briefly try to 
explain the comparison between the Mitchell plan and the Dole plan when 
it comes to children and how they are affected. We are talking about 
the children of working people here now.
  These numbers here on the side of this chart are income levels 
starting at $14,000 going up to $44,000, which is 300 percent of 
poverty.
  Under the Mitchell plan, the amount of premium you would pay for 
children is zero through 150 percent of poverty.
  I would point out that under the Dole plan, the cost of a family 
policy does not cost you anything at $14,000, but when you jump up to 
$22,000, 150 percent of poverty, you don't do very well. Under the 
Mitchell plan, there is no cost. Under the Dole plan, you pay $5,883, 
in excess of 26 percent of that family's income.
  Mr. PACKWOOD. Will the Senator yield for a question?
  Mr. DODD. I will in a second. Let me finish the graph. You go to 
$29,000, $36,000, $44,000. These are working people. We have made a 
significant effort in the Mitchell plan to assist those families, 
particularly at that level.
  The highest cost a family at the $44,000 level for these children is 
a little in excess of $1,700 a year--4 percent of that family's income.
  One of the things we want to try to do here is not bankrupt people 
who are out there earning a living, trying to provide for their 
children's needs. And health care is costly. And so the Mitchell plan 
makes a significant effort to assist those working families with 
children and see that they get the kind of support and backing that 
they need.
  With all due respect--as I said last evening--and I will repeat it 
here now because I do not want to hear it said later, there have been 
very few people in this Chamber who have fought harder and cared as 
much about kids as Bob Dole of Kansas. Food stamps, WIC programs, he 
has been there.
  Now, my reference here is the----
  Mr. PACKWOOD. Will the Senator yield?
  Mr. DODD. In a second I will. There is a significant difference and 
people ought to take note, a significant difference. If you are in that 
$22,000, $29,000, $36,000 range, under Mitchell you are paying less 
than 1 percent at $29,000, 2.7 percent of your income at $36,000, 4 
percent of your income at $44,000. Under the Dole proposal, at $22,000, 
you pay 26 percent, at $29,000 you pay almost 20 percent, at $36,000, 
you pay almost 16 percent, and at $44,000, you spend 13 percent of your 
income for coverage.
  Mr. PACKWOOD. I do have a question.
  Mr. DODD. One quick question.
  Mr. PACKWOOD. Yes. What benefit package is the Senator using to 
estimate the Dole-Packwood bill?
  Mr. DODD. The Dole bill only covers the family policy. It does not 
pick up children separately. So there is a distinction. But this is how 
families are affected across the board.
  Mr. PACKWOOD. Where does the Senator----
  Mr. DODD. Let me finish. Then I will yield to my colleague.
  Mr. PACKWOOD. Where does the Senator----
  Mr. DODD. I will yield. Let me answer the question. The Mitchell plan 
provides for children specifically whereas the Dole proposal covers the 
family. The coverage and the cost is the same. That is why we have this 
amendment.
  Mr. MURRAY. Will the Senator yield?
  Mr. DODD. I will be glad to yield.
  Mr. PACKWOOD. My question is where did the Senator get----
  The PRESIDING OFFICER. The Senator from Connecticut has the floor. He 
has yielded to the Senator from Washington.
  Mrs. MURRAY. I thank the Chair, and I thank my colleague from 
Connecticut.
  They probably heard me when I made my opening remarks the other day 
talk about a young child who I had in my preschool class who was unruly 
and disruptive, and after observing him I noticed he could not hear, he 
had ear infections. And I went to his mother and suggested she take him 
into the physician and help him. It did not occur, and after 3 weeks I 
went back to her and I said, ``Have you taken him in?'' And she looked 
at me in tears and said, ``We don't have any health care insurance.''
  Now, there is a child who remained a problem in my classroom simply 
because of ear infections. His family did not have coverage. I would 
guess their income was probably in the $22,000 range. Under the 
Mitchell plan, what would be the premium she would have to pay?
  Mr. DODD. As it is written now--it may be changed if people want to 
knock it out or modify it--but right now under the Mitchell plan, that 
family is protected up to 150 percent of poverty so that they would not 
have a premium cost for those children.
  We understand the value of that. If their income falls into the 
$30,000 range, they participate and pay something. We are trying to 
help out working families in this area so that that woman----
  Mrs. MURRAY. That child would then have gone into the doctor, had his 
ear infections fixed, and been back and been a nondisruptive member of 
the class.
  Mr. DODD. That is absolutely correct. The Senator made a point. 
Again, in stating the statistics, Madam President, there are 
implications here--Lord knows, there are implications. We know now that 
a dollar invested in prenatal care can save on the average $3 to $4.
  So the investment, in the case of a pregnant woman, with the kind of 
care that we can provide today, does a tremendous amount to save costs 
when you face the problems that these infants incur with low 
birthweights. Now, I would say my colleague from Oregon is absolutely 
correct, in my view, regarding vaccines. My State of Connecticut has a 
free vaccine program, and I have gone out day after day, in area after 
area, Hartford, Bridgeport, New Haven, with clowns and food and 
gimmicks and everything else to get people to come out and take 
advantage of it. And they do not.
  We have a hard time with that. We have to think of more creative ways 
of doing it. But, nonetheless, it is critically important that these 
children get some assistance.
  So this amendment that is the pending business, Madam President, does 
not create a bureaucracy. Very simply, it requires every private 
insurance policy in the country to include preventive services for 
children and pregnant women in their basic benefits package by next 
summer.
  Let me conclude on this note. I see other colleagues want to address 
these issues. I come from Connecticut. I come from the insurance 
capital of this country. I have 55,000 constituents who work in the 
industry. I also have 23,000 constituents who lose their health 
insurance every month. Most of them get it back before the year is out. 
But God forbid something happens to them during that year.
  I would not be standing here supporting a program that would destroy 
the private industry involved in health care. They have done a very 
good job, in my view. I know other colleagues may have a different 
point of view. But I believe they have done well. This bill builds on 
the existing program. It does not tear it down. This amendment 
specifically builds on the existing program. That is why I think it is 
important and why I believe it can make such a difference in these 
young children's lives and their families' lives.
  Mr. KENNEDY. Will the Senator yield just on the question about the 
estimates? As I understand--I would be interested if he agrees--the 
benefits packages estimate is from the CBO for Mitchell, and both the 
Mitchell and Dole are estimated equal to Blue Cross standard under the 
Federal Employees Health Benefits Program. As I understand it, the Dole 
probably is actually higher because the community rating pool is 
smaller. It is outlined on pages 86 and 87. But as I understand, that 
is how the estimate came. Am I correct?
  Mr. DODD. The Senator from Massachusetts is absolutely correct. We 
are talking about the children's features. In the Mitchell bill, we go 
beyond 150 percent of poverty and try to do something for those 
families.
  Under the Dole proposal, there is an effort, and 100 percent and up 
to, I guess, 150 percent. It stops at 150 percent.
  Mr. KENNEDY. Nothing above 150.
  Mr. DODD. That is correct.
  Mr. KENNEDY. There is no program in there for children?
  Mr. DODD. That is correct. That is why, under the Dole proposal, at 
150 percent of poverty--in excess of $22,000 a year--you are going to 
be in the same category as the person making $44,000 a year when it 
comes to children. In fairness to Senator Dole, up to 150 percent the 
plans both help families. I happen to believe if you are making 200 
percent in excess of poverty or 300 percent, you are not a wealthy 
American. You are a middle-income family trying to hold it together, 
pay mortgages or rents, clothes, God knows what else. These are not 
affluent Americans. To suggest that those families can afford 26 
percent of their gross income for health care premiums is excessive, in 
my view. Maybe others do not think it is, but I think it is. That is 
why the Mitchell proposal is so much better.
  Mr. KENNEDY. If I could just ask the Senator about this chart over 
here. The Senator has addressed the questions about what is happening 
under the Mitchell program, as I understand it, which has the unique 
program which is directed toward children. The Senator's amendment 
addresses this concept and accentuates the benefits of it at an earlier 
period of time. As I understand it, it has the support of many within 
the industry as compared to the Dole proposal.
  The only question I would like to ask is whether the Senator agrees 
that we are basically talking about families of working men and women. 
The Senator has pointed out correctly that those are the most needy 
children of working families. The poorest are covered by Medicaid.
  But does the Senator agree with me that there is a parallel in the 
difference between the Mitchell program and the Dole program, not just 
in terms of children, but also for working families; that the effort of 
the Mitchell program was to again try to get a very, very affordable 
program for children, which are the ones that have been left behind in 
the special interests?
  But does the Senator not agree with me that, if you look further down 
the road in terms of the Mitchell plan and the Dole plan with regard to 
working families, you see that dramatic difference again reflected in 
the amounts that would be required in terms of payment? Under the 
Mitchell program, we still try to keep that figure down. Here you see 4 
percent, 6 percent, 8 percent, and 10 percent. Under the Dole program, 
it goes 12 percent and 26 percent. At $22,000 for a family of four, it 
is 26 percent, and, particularly since you are talking about the 
voluntary program, it is going to be virtually prohibitive and really 
not a program at all.
  Mr. DODD. The Senator is absolutely correct. As I pointed out last 
evening, of the 37 million Americans who have no health insurance 
today, 12 million are children. They represent roughly 25 percent of 
the population of the country, yet closer to 36 percent of the 
uninsured. Eighty-two percent of the adult population are working 
Americans. If you are on public assistance, you get health care today 
in America.
  As I pointed out last evening, if you are incarcerated in America 
today, you get health care. But if you are working, it is difficult. 
Most of the uninsured are working.
  I do not have the chart with me, but let me make one last point which 
I think ought to startle people because of where the trend lines are 
going. In 1987, 64 to 65 percent of the children of working families, 
working either full time or part time, had employment related health 
care coverage. In 1992, that number is now around 59 percent. The 
number of children who are receiving insurance in families where there 
are full-time jobs or significant part-time work is declining. The 
trend lines are moving in the direction where fewer and fewer children 
are getting covered because of the tremendous costs.
  So while you can say, ``Well, Senator, look, 60 percent are still 
covered,'' you are right. But it is down from 65 percent of just a few 
years ago and heading in the wrong direction. So while that may be OK 
for you today, I just caution you. If you think the status quo is doing 
nothing, folding up our tent, going home, taking the incomplete, in 
effect, because we did not want to sit around and address these hard 
questions, you are going to be in potentially greater difficulty as a 
working family out there in meeting the health care needs of your 
children. That is statistically the case as you watch those numbers 
move in the wrong direction, I think, by everyone's estimate.
  Mr. REID. Will the Senator yield for a question?
  Mr. DODD. I yielded to my colleague from Minnesota.
  Mr. WELLSTONE. I yield.
  Mr. REID. Just a brief question: The State of Nevada has the highest 
teenage pregnancy rate in the United States. In addition to that, 
almost 50 percent of the teenaged mothers have never had prenatal care; 
zero. Would the underlying bill and the amendment suggested by my 
friend from Connecticut help the young women in the State of Nevada?
  Mr. DODD. I say to my colleague, absolutely. What we are doing here 
is requiring the private carriers to have this kind of service, to make 
it available in July 1995. It does not seem like much to many people. 
But 18 months could make a big difference to these families.
  Of course, under the Mitchell proposal, the subsidies go up to 300 
percent of poverty. I am presuming that by and large, these teenaged 
mothers come from poorer families, and are poorer, obviously, given 
their age and their inability to earn higher incomes. They are going to 
be particularly assisted in this process, and they should be able to 
get help.
  The Senator from Oregon brings up the point that we have to get them 
there, too.
  So I think it is a critically important question.
  Mr. WELLSTONE. Will the Senator yield? First of all, would the 
Senator agree with me? I have a chart. Actually, when you look at those 
Americans that are without insurance, a disproportionate number of 
them, in fact, are working middle-income families.
  Mr. DODD. The Senator is absolutely correct. I am stunned that people 
do not see that. The notion out there, I think, is that the uninsured 
are all on public assistance, that these are welfare recipients who do 
not want to work and are just living off everybody else's labor. I am 
just amazed by this, because the fact is that 82 percent of those 
without health coverage are working Americans. They may be holding a 
low-wage or low-salary job but they are working. In a sense, we are 
trying to amend the welfare laws in this country. If you have kids, you 
would almost have to be out of your mind to get off welfare and take a 
$6 an hour job with no health care coverage.
  We are trying to get people off welfare and into private sector jobs. 
What is the inducement if you go out there and take that job and you 
lose the health care coverage you get as a welfare mother? What is the 
inducement? You can almost argue that you are being irresponsible to 
your children if you go off welfare and lose all health protection for 
them.
  We are trying to get people off of welfare without losing health 
coverage. That is the biggest incentive to decrease welfare dependency 
I know of. You talk to welfare recipients and they are scared about not 
having health care coverage for their kids. It is going to be hard to 
make any progress towards getting people off welfare if we do not 
provide a good health care system for those kids.
  Mr. WELLSTONE. What the Senator is saying is that you actually can 
have a true welfare reform bill where women or men--usually women are 
the single parents--are able to work and support their children--
although I believe he is saying being at home with the children is very 
important work. But unless we do something about health care reform to 
make sure they do not lose their Medicaid on AFDC. Is that what the 
Senator is saying?
  Mr. DODD. The Senator is correct. I feel so strongly about it because 
we do not value enough those people who say: Look, I am going to try 
and do this on my own. I do not want to ask for anybody's help. I am 
going to take that job and try to provide for my family. They are going 
out that door and they do not get many good jobs, high-paying jobs, and 
they place their families at risk as a result. If you really claim to 
care about people and want to see them working, we must have health 
care.
  I have always said the best social program designed by anybody 
anywhere is a job--a good old 9-to-5 or 8-to-4 job. Nothing does more 
for families, for one's sense of self esteem and self worth, then to be 
able to contribute to your family, your neighborhoods and community 
through a job. So if we are to try to get people to work, we have to do 
something on the health care issue.
  We have about 20 legislative days left in this Congress. After all 
the work, hearings, discussion and debate, we are down to 20 days, and 
I am hearing people say, ``I have not heard enough yet. I need to 
examine a bit more.'' Our various committees have held at least 80 
hearings with hundreds of witnesses. Most of us in this body have 
attended hearings. In my case I participated in 10 days of markups in 
the Labor and Human Resources Committee as well, and I know there was a 
similar mark-up in the Finance Committee. The Presiding Officer may 
know, or my other colleagues may know exactly how much time was spent.
  My Lord, my friends, what is the real situation here? We do not spend 
this much time on other complicated matters around here. To have 
somebody say, ``I am sorry, I do not quite get it'', is ridiculous. 
When I go home, the people in my State get it. They understand it. They 
want preexisting conditions eliminated; they want portability, and they 
want to see kids get covered in this country.
  This is not magic. This is not that difficult. This is about rolling 
up our sleeves, deciding to work together and getting the job done. We 
have about 3 weeks left to do the job. The American public, I think, 
expects us to try. We may fail in the end, but let us not fail by 
filibuster. Let us try and get it done and try and work together. This 
tactic of 30, 40, 60 hours of general debate is not fooling anybody. 
This is the tactic of digging in your heels, slowing down the process, 
hoping the calendar runs out, hoping we go home, and hoping the 
American people lose.
  I yield the floor.
  Several Senators addressed the Chair.
  The PRESIDING OFFICER. The Senator from Utah [Mr. Bennett] is 
recognized.
  Mr. BENNETT. I yield such time as he may require to my friend, 
Senator Shelby.
  Mr. SHELBY. Madam President, ``Who shall check the Parliament?'' Yes, 
who shall check the Parliament? John Stuart Mill asked this question 
over a century ago, and it is appropriate today.
  Mill subsequently notes that:

       An assembly, if the cry of the moment goes with it, however 
     hastily raised or artificially stirred up, thinks itself and 
     is thought by everybody to be completely exculpated, however 
     disastrous may be the consequences. Besides, an assembly 
     never personally experiences the inconveniences of its bad 
     measures until they have reached the dimensions of national 
     evils.

  Those were the words of John Stuart Mill.
  Madam President, Mill frames for us the fundamental question that the 
Senate confronts at this very moment: Will we, in haste, and in the 
heat of battle, lose our measured and our judicious temperament? Will 
we, with no sense of culpability and responsibility for our rash 
actions, pass bad measures that will become national evils for present 
and future generations?--to paraphrase Mill.
  Madam President, in the Federalist Papers, No. 62, Madison informs us 
that the Senate's constitutional necessity is marked by ``the 
propensity of all single and numerous assemblies to yield to the 
impulse of sudden and violent passions.'' Madison reminds us that the 
Senate ``must be, in all cases, a salutary check on the Government.''
  In the United States, it is the Senate that must watch the 
Parliament.
  The American people are anxiously waiting to see if the Senate--this 
Senate--fulfills its constitutional role and checks the popular 
passions that have been unleashed in the rush to pass health care 
reform.
  This health care debate is one of the most critical moments in the 
economic and social history of modern America. This Senate, Madam 
President, will decide whether or not we will have the most massive 
expansion of Federal power and spending commitments since the Great 
Society programs--a decision that will decide the future of every 
American's health care, the tax and financial burdens on our children 
and grandchildren, and the fundamental role of Government in the free 
market.
  The private sector in Europe has created no net new jobs in 20 years 
as a result of high burdens on employers, big government, and untenable 
social spending commitments. Furthermore, Western Europe suffers from 
structural 11 percent unemployment compared to under 7 percent in the 
United States. As a result, the leaders of the European Community 
agreed in 1993 that lower labor taxes were needed to enhance 
competitiveness.
  Yet, Madam President, while Europe struggles to throw off the yoke of 
these big government burdens, this Congress is preparing to put another 
burden on private employers in the form of insurance mandates, 
increased taxes on the American people, expanding Federal spending by 
over a trillion dollars in the next decade and, yes, and give the 
Government the major role in managing 14 percent of our economy through 
so-called health care reform.
  Throughout the world, governments are slimming down and loosening the 
shackles on private enterprise. Yet, like a dinosaur, the United States 
trods down the well-worn path of bigger Government and higher taxes--a 
path that is less and less attractive to the other advanced industrial 
societies in the world.
  A recent poll taken in my home State of Alabama found that 57 percent 
of Alabamians believe that Congress should take more time to study the 
health care issue, rather than acting immediately to pass legislation.
  This number reflects the belief expressed by 46 percent of the poll's 
participants that the net effect of health care reform on an 
individual's personal health care coverage will be negative. Only 12 
percent of the poll's participants felt that their health care would 
improve under this type of legislation that is before the Senate today.
  Madam President, there is deep anxiety in my State, and I believe 
across the country, that in order to meet an artificial deadline set by 
the date of congressional adjournment, Congress will pass an ill-
conceived, politically compromised piece of legislation--
legislation that imposes substantial new tax and fiscal burdens on the 
American taxpayers and makes our current health care system, a system 
that provides the highest quality health care in the world, 
substantially worse.

  One-seventh of our economy is tied to our health care system. It 
would be irresponsible for this Congress to pass legislation making 
sweeping changes in our system without due consideration and 
examination of the consequences.
  Few Senators have had a chance to adequately review the contents or 
to consider the consequences of the voluminous document that we are now 
considering. Only since last week have we seen the bill language of the 
pending measure. Even more astounding, we are now looking at our third 
revision of that bill during the past week.
  This is no way to reorganize one-seventh of our economy. It would 
take years to adequately assess the impact of this plan on every 
American's health care and his or her pocketbook.
  At present, all we have is a scant two dozen pages of analysis from 
the Congressional Budget Office, an analysis that the office itself 
admits is hardly reliable.
  The rush to pass health care reform has failed to take a hard look at 
the new fiscal commitments that will be made as a part of reform, or to 
adequately discuss what has become the second major raid on the 
American taxpayers in this Congress.
  I did not support the massive tax increases passed by this Congress 
last year. I worked actively to defeat that measure and I will oppose 
the new taxing and spending binge by a taxaholic Congress called for by 
the pending health care reform bills before the Senate.
  The Mitchell bill would put the burden of nearly $300 billion in new 
taxes over the next decade on the back of the American taxpayer. Most 
of these taxes will be raised through the taxation of every working 
American's health benefits.
  The 103d Congress has already raised more taxes than any Congress in 
history. Passage of the Mitchell bill will only ensure that this legacy 
will not be easily undone or overcome by future Congresses.
  I am opposed to employer mandates in any form. I am opposed to price 
controls. And I am concerned about the impact of so-called reform on 
the quality of our health care in America. However, the fiscal issues 
involved in health care reform remain my overriding concern here today.
  The Mitchell bill, this so-called moderate bill, will make almost 
half of the American people dependent upon the Federal Government for 
their health care. Through the year 2004, the subsidies for expanded 
coverage will cost the taxpayer over $1 trillion--$1 trillion in new 
spending, with or without employer mandates.
  The Mitchell bill proposes to pay for part of this massive new 
entitlement by putting four separate taxes on the working American's 
health benefits taxes that Senator Gramm, and others, and I will 
attempt to eliminate from this bill.
  One tax would put a 35-percent assessment on any benefits that an 
employer provides to an employee over a Government-determined minimum 
level. Can you imagine?
  A second tax would levy a 25-percent assessment on health care 
premiums that exceed 2 percent real growth each year.
  The third tax is a 1.75-percent excise tax on every health care 
premium in the country.
  The final health benefit tax is a very cleverly concealed provision 
that would prevent insurers from offering discounts--can you believe 
it--for a healthy lifestyle and good health.
  This tax would instead require these plans to make payments to 
underwrite high-risk individuals.
  I am going to discuss these taxes at length in the future.
  But I want to state here and now that the American people did not 
count on health care reform being financed on the backs of their hard 
won and well-deserved benefits.
  The high-growth plan tax is not only a tax on quality health 
benefits, but is also intended as a form of price control that would 
result in rationing of health care services offered by health plans.
  However, despite the cynical intention for the tax to reduce the 
American worker's health benefits to one-size-fits-all health plans 
that provide fewer benefits for the same amount of money, the tax will 
not control costs.
  According to the CBO, this tax would provide little incentive for 
cost containment. Instead, the tax is a monster $70 billion revenue 
raiser that will increase the cost of the working American's health 
care premiums.
  The Mitchell bill also contains a 1.75-percent excise tax on every 
health care premium in the country. Like all consumption-based taxes, 
this tax is a substantial revenue raiser, and it will grow.
  However, like all sales and excise taxes, the working people of 
America will feel the pain of the tax in far greater proportion than 
will the well-to-do. Is taxing the middle class's health benefits to 
pay for bigger Government health care reform? I say no, Madam 
President.
  This is the Congress that promised to make the wealthy pay their fair 
share. Yet, once again it is the middle class who must pay the bills 
for the Federal Government's unchecked growth.
  Furthermore, Madam President, the taxes on excess health benefits 
strike at the heart of our fundamental freedoms and the American 
spirit. I could never support a measure that would limit any American 
worker or employer to a Government-defined health plan if they desired 
to purchase better for themselves or their family.
  The right of any American citizen to improve his or her circumstances 
is as fundamental as the right to free speech or trial by jury. This 
tax would not do that. It is not right.
  Madam President, Congress can take a few simple steps to reform our 
insurance market, reduce administrative costs, and make insurance more 
affordable to small businesses this year without giving the Government 
control over our Nation's health care system or levying new burdens on 
an overtaxed economy.
  A vote for a bad health care bill is not a vote for reform. Health 
care reform should not become an excuse for expanding the size and 
power of the Federal Government.
  Consequently, I will vote and work against any measure that levies 
new taxes on the American people, makes unrealistic fiscal commitments 
for future Congresses to meet, imposes job killing mandates on small 
business, or threatens to reduce the quality of a health care system 
that works well for 85 percent of the American people.
  I believe Congress must do health care reform the right way or should 
wait until the next Congress. The stakes are too high to do otherwise.
  Madam President, I believe the Mitchell bill is unwise, unworkable, 
and unwanted by the overwhelming majority of the American people. I 
urge my colleagues to oppose the Mitchell proposal.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Nevada is recognized.
  Mr. REID. Madam President, I say in brief response to my friend from 
Alabama health care this year is going up over $100 billion. We have to 
do something about that cost of health care. Also the 17 percent of the 
people who have no health insurance are not the only ones who suffer. 
There are many people who have insurance who we call underinsured. It 
is a problem we must address.
  I yield now 1 minute to the Senator from Virginia.
  The PRESIDING OFFICER. The Senator from Virginia is recognized.
  Mr. ROBB. Madam President, I thank the Senator from Nevada and the 
Senator from Minnesota, who has kindly permitted me to go one place 
ahead of him.
  Madam President, I rise today to support the amendment offered by my 
colleague from Connecticut, Senator Dodd, which requires that new 
health insurance policies or renewals include clinical preventative 
benefits--without copayments--for pregnant women and children.
  This is a very important amendment, because it goes right to the 
heart of what we're trying to do in this health care debate: spend 
health care dollars wisely and rationally, and expand access to health 
care to those who really need it.
  I would argue strongly that spending money on preventive care for 
pregnant women is a good economic deal. I would rather pay for prenatal 
and postnatal care any day than pay the hundreds of thousands of 
dollars it can take to care for a child in a neonatal intensive care 
unit--and I have visited many of them.
  Ensuring that children get adequate preventive care, immunizations, 
et cetera, should reflect what we stand for as a Nation.
  Some of my colleagues have spent a great deal of time talking about 
Lyndon Johnson and his commitment to provide health care to poor 
Americans through Medicaid and to our Nation's senior citizens through 
Medicare. I can tell you, firsthand, that Lyndon Johnson was a 
magnificently generous human being who personally felt the pain and 
suffering of the people around him. He truly felt injustice. He felt 
inequities. He was a large man who believed that wrongs could be 
righted if you had a good product to sell and you worked hard enough.
  His oldest daughter, to my own good fortune, is the same way.
  As Governor, I established the Southern Governor's Commission on 
Infant Mortality--and I appointed my wife, Lynda, to serve on 
commission representing the Commonwealth of Virginia.
  During the last decade, Lynda has traveled throughout Virginia, 
throughout the South, and throughout the Nation--later as a member of 
the congressionally mandated National Commission to Prevent Infant 
Mortality--working to make people understand that providing preventive 
health care to pregnant women is just plain the right thing to do from 
an economic standpoint, from a moral standpoint, and from an ethical 
standpoint.
  I thank the Senator from Nevada for yielding the time and especially 
the Senator from Minnesota who will now be recognized.
  The PRESIDING OFFICER. Who yields time?
  Mr. REID. Madam President, I yield 20 minutes to the Senator from 
Minnesota.
  The PRESIDING OFFICER. The Senator from Minnesota is recognized for 
20 minutes.
  Mr. WELLSTONE. Madam President, I wrote a piece for the Minnesota 
Star Tribune a couple of weeks ago. I would like to read from the 
beginning, because it sets the tone and framework for my remarks on the 
floor of the Senate today, which are a little bit different from 
everybody else's.
  I quote from the piece:

       Citizens beware. Health care that is always there is out, 
     and triggers are in. All of you who worry about losing your 
     coverage, who have no coverage, who are not covered for the 
     conditions you most need insurance for, who pay too much for 
     too little, are in danger of being told to just sit tight, 
     all because several health care proposals circulating in 
     Washington are generating a lot more attention than they 
     deserve.

  Madam President, let me start out with the obvious, because I think 
it has been lost in some of the debate. The obvious point is that the 
Mitchell bill, which represents a lot of hard work on the part of the 
majority leader, nevertheless leaves out some 14 million Americans for 
a very long period of time. It is not a universal coverage bill.
  Most people who are following this debate and who think about their 
own lives understand that when 14 million people are left out, that 
could very well be them.
  Madam President, it is very interesting to me that, as we think about 
a hard trigger in 2002--if that in fact becomes necessary--that here in 
the U.S. Senate we are not waiting until 2002 for all of us to be 
covered.
  And one more time, I do not think the Mitchell plan meets the 
standard set by so many of the speeches I have heard and so much of the 
rhetoric that I have heard that we ought to pass a reform bill that 
gives everyone as good a health care plan as we have for ourselves and 
our children.
  Madam President, there is another issue--and this is far less a 
criticism of the majority leader's plan and far more a criticism of 
some of the alternatives or lack of alternatives we have heard from 
some other colleagues. I heard the Senator from South Dakota say he 
believes universal coverage is so important to cost containment. I 
heartily agree with his analysis.
  Let me take it one step further. If we do not have universal coverage 
and we move to community rating, which we should do, the premiums for 
younger people go up, and then they do not participate because they do 
not have to. And then, in the language of actuaries, what that leads to 
is a death spiral where, in fact, people's premiums then go up for more 
people, and then more people drop out. It just simply is unworkable.
  Madam President, earlier today we were talking about the Dodd 
amendment. I asked the Senator from Connecticut--and I appreciate his 
fine work--whether or not one of the most important aspects of his 
amendment was to go beyond very low-income people and get some early 
childhood care or prenatal care to a wider range of women and to their 
children; and was it not true that, among the 40 million people who 
have no health insurance, many of them were moderate income, working 
families? He said, yes. And I agree with him. That is why his amendment 
is so important.
  But the fact of the matter is, whereas the President promised 
affordable health care, the majority leader's bill still leaves all too 
many families--when we get beyond this care and these services for 
women and children, but other services people need and other health 
care they need--still paying up to 20 percent or more of their family 
income just for health insurance premiums.
  In other words, if you do not have employers paying their fair 
share--and please remember, colleagues, our employer pays 72 percent--
then you have to go to subsidies. But if you want to keep the cost of 
subsidies down and only cover low-income or low- and moderate-income 
people, a lot of working and middle-income families do not receive any 
subsidy or any support. Thus, whether it be pretrigger or even 
posttrigger, you could still have families paying--and they do pay--20 
percent or more of their annual income on premiums. And that is too 
much for middle-income people. As a matter of fact, I think we pay 
about 3 percent of our income, as Senators, for our plan. That is quite 
a difference, Madam President.
  Third of all, there is another weakness in the majority leader's 
plan, for all the positive effort that he has made, and that has to do 
with low-income families and low-income people.
  Madam President, I just would tell you that if we are going to 
continue to have a $10 copay in fee-for-service health plans, whether 
it be for Medicaid recipients or whether it be for low-income people, 
in the State of Minnesota and in many States with rural communities 
where we do not have HMO's, $10 will be too much.
  We are all trying to emphasize family doctors and nurse practitioners 
and preventive health care. But if your child has a sore throat and you 
can't afford the $10, you will not go. It will not be universal 
coverage if it is not affordable. People simply will not go. And if we 
are talking about low-income families and children, I will just tell 
you that $10 copay is too much.
  Finally, I worry to no end--and I wish this was more a part of the 
discussion--about two provisions in the majority leader's bill that I 
really think have to be dealt with in amendments.
  Two points, Madam President: We set up commissions. We set up a 
National Health Benefits Board and we also set up a National Health 
Care Cost and Coverage Commission.
  There is no requirement for consumer representation on these Boards. 
I will have an amendment saying we ought to make sure consumers are 
represented on these boards.
  But what bothers me the most is the fail-safe mechanism that says 
that if we do not contain costs--and I am not at all sure we will be 
able to--automatically the National Health Care Cost and Coverage 
Commission will cut subsidies.
  Well, if you are going to cut subsidies, you are going to cut 
subsidies for low- and moderate-income people. Are we going to 
privatize Medicaid, take low- and moderate-income off the coverage they 
have and offer them coverage in the private sector, only to find that 
if there is no cost containment, we are cutting their subsidies?
  Why don't we really guarantee cost containment? What happened to 
insurance premiums caps? What happened to finding ways to overhaul 
health care costs? What happened to making cuts in our administrative 
load? Why would we want poor people to be the ones to be the first to 
be cut?
  Another amendment is in order to strengthen that provision.
  Madam President, the majority leader has really made an effort to 
bring a bill to the floor and I applaud him for that.
  But then I see some of these other efforts.
  Yesterday, we had the Boren-Nunn-Domenici-Bennett bill introduced. 
And I just would have to say--and maybe later on this will be a point 
of debate--there is no universal coverage in this proposal. It would 
cover only 90 percent of Americans. We are talking about leaving 24 
million men, women, and children without protection. That is what CBO 
is going to say. That is what CBO has said about similar proposals.
  I could raise questions about cost containment. I could raise 
questions about the comprehensive benefits. Where are the long-term 
benefits, where are the prescription drug benefits that are in the 
majority leader's bill?
  Finally, just to signal what I think is going to be a very important 
debate, this proposal does not give States the option of implementing a 
single-payer program. Madam President, quite frankly, this is a little 
bit perplexing to me, because a good conservative principle--one, by 
the way, which I have shared almost all my adult life--is a critique of 
overly centralized and bureaucratized public policy. I have always felt 
conservatives have been right about that.
  Decentralize health care. After we talk about some basic national 
goals and standards, let us let States decide on how they might finance 
and implement reform. Let the creativity and the development and the 
bargaining and the financing be at the State level.
  Utah may not want to go single payer. In that case, Utah should not. 
But maybe Minnesota should. Or maybe Vermont would. Or maybe California 
might. And maybe Florida would do everything within managed 
competition. States are already laboratories of reform. Why would 
anybody be afraid of letting a State have an option to implement a 
single payer plan?
  Then I read the New York Times today and I got the sense that the 
majority leader's bill--which does not have universal coverage, which 
does not include the same benefits that we have, which does not call 
for employers to contribute 70-some percent, all of which is what we 
have as Senators--may yet be even further weakened. Now there are all 
sorts of other discussions about how to water down the bill and weaken 
the bill. While at the same time, over and over and over again, the 
vast majority of people in the country say they are for universal 
coverage. The vast majority of people in the country say they are for 
employers paying their fair share.
  Madam President, these pieces of legislation are alternatives which 
further weaken the majority leader's bill, which is already quite weak 
in present form. I myself have made no decision whether I can support 
this bill in present form, much less if it is weakened. I think then 
support would be very problematical.
  It will do nothing about the trends. In 1980, 24.2 million Americans 
were uninsured; 1992, 38.9 million. We cannot be talking about 
legislation that keeps things as they are or weakens the proposal given 
the kind of trends we see within our country.
  (Mr. PRYOR assumed the chair.)
  Mr. WELLSTONE. By way of conclusion, let me go to point A and point 
B. Today I sent a letter to the majority leader, with Senator Simon, 
Senator Feingold, Senator Moseley-Braun, Senator Metzenbaum, and 
Senator Harkin. I will just read a paragraph.

       As we continue to support your efforts to achieve 
     affordable health care coverage for every American, we want 
     you to know that we are gravely concerned about several 
     aspects of the bill you have introduced. Further movement 
     away from the goals of universal, affordable coverage would 
     cause us to question even more seriously our ability to 
     support the bill.

  Mr. President, I want to make it clear that we meant those words and 
will be meeting with the majority leader at 11 a.m. on Monday. I will 
not read from the rest of this letter, but I will tell you, Mr. 
President, that for myself--and I think I speak for some of my 
colleagues, although they have very important amendments as well--we 
are ready to come to the floor with amendments to strengthen this bill. 
I want to give some examples.
  There is no reason why we cannot achieve universal coverage for 
everyone sooner by having an earlier timeline for insurance reforms 
triggering an employer mandate by 1999 if necessary. We would like to 
find a way to get to this commitment we made earlier.
  No. 2, Mr. President, we ought to improve the contribution that 
employers make. If in our case our employer contributes 72 percent of 
the premium, then we should have an amendment that says that as a 
matter of fact in this health care reform plan that should be exactly 
the way we move to financing. The same quality plan, as good as what we 
have. By the way, another amendment on my part will be a vote on the 
sense of the Senate that the final plan should provide people with as 
good health care as what we in the U.S. Congress have. That should be a 
yardstick.
  Mr. President, there ought to be effective cost control measures. But 
if we do not stay within budget, we should not automatically trigger 
cuts in coverage for poor people. We ought to trigger a cap on 
insurance company premiums. I guess the insurance companies have a 
little more power than low-income people. Maybe that is what is going 
on. But I assure you, I will have an amendment on the floor that will 
do that.
  If we are talking about employer mandates and about universal 
coverage, then I would make another proposal. It would seem to me that 
we might also think about what happens if matters get worse. So we will 
have an amendment to say that if coverage goes below 1994 level, we 
will have an automatic trigger for an employer mandate. What if only 80 
percent are covered as opposed to 83 percent in 1994? Then we ought not 
to be talking about year 2002, we ought to be triggering employers 
paying their fair share earlier.
  We have to talk about some kind of maintenance of effort. There are 
many, many people in this country that worry about a trigger that leads 
to 50-50 coverage when their employers are contributing 80 percent. 
What are we going to do to prevent employers from ratcheting down 
coverage they now provide? We need to come to the floor with an 
amendment that makes sure that does not happen to so many middle-income 
and working-income people, the very people we have been talking about 
all morning.
  There is no reason why we should not have disclosure of CEO salaries 
as a condition of tax deduction, or to get subsidies.
  Let me also say that there are a whole range of other amendments 
which I think will strengthen this, including making sure that 
consumers have representation on health care boards. If we are going to 
set up these boards and they are going to deal with cost containment 
and they are going to deal with benefits, then we absolutely ought to 
make sure that consumers have representation. I think of amendments 
that will strengthen the long-term care. I think of amendments that are 
important in mental health substance abuse. I look forward to 
introducing one with my colleague, Senator Domenici.
  But I want to say today on the floor of the Senate that we have now 
reached the point where the majority leader has brought out a bill. It 
has some fundamental weaknesses. He believes it is a first step. I hope 
it will be a first step. Right now I am not sure. But what I do know is 
that some of these alternative efforts just simply weaken it and water 
it down to the point where, I guess, all of us can have a fancy name 
and an acronym and say we have done something great. But certainly it 
does not live up to the commitment we began with which is: We ought to 
make sure that each and every citizen, each and every man, woman, and 
child can afford humane, decent health care for themselves, their loved 
ones and their children.
  We ought to make sure that the health care plan that we pass is as 
good as the plan we have. We are all covered. Another amendment I am 
considering with Senator Simon says if we are going to have 95 percent 
covered, then we ought to have an amendment to figure out which five 
Senators will go without coverage.
  We are going to see that health care for everyone is as good as what 
we have in the Congress. Everyone is covered here, there are no 
exceptions for preexisting conditions, our employers contribute over 70 
percent of the premium, and it is a good comprehensive package of 
benefits--though it could be improved. I think that is the standard. 
Over the next couple of weeks to come, we will have the amendments to 
strengthen it. If this bill gets further weakened, if this reform 
effort is hijacked, then there are some of us in the Senate who I think 
are going to fight as hard as we know how to.
  Certainly I view this meeting with the majority leader on Monday as 
being important. It is quite one thing to present your very best as a 
reform effort and say it is a step forward. It is quite one thing to 
say, do not make the perfect the enemy of the good. I agree. It is 
quite another thing to get to the point where you have a piece of 
legislation that is so weakened, so watered down, so hijacked, so 
blocked by all those huge interests that have poured all that money 
into Senators and Representatives with all their power and clout with 
the people who need this reform the most left out. It seems like the 
people who need the change do not have the power, and the people who 
have the power do not want the change.
  Whether we reach that point--and I think we are close to it--I think 
there are a number of us in the Senate who will draw the line in the 
sand on that.
  I yield the remainder of my time.
  The PRESIDING OFFICER. The Senator from Utah.
  Mr. BENNETT. Mr. President, I yield myself such time as I may 
require.
  Mr. President, I say to my friend from Minnesota, whose enthusiasm is 
one of the refreshing things about this place, that he need have no 
fear about voting for the Mitchell plan. Because I am convinced if the 
Mitchell plan passes, it will be such a disaster, bureaucratically and 
administratively, that his opportunity to take the opening to offer 
single payer will be hastened by the failure of the Mitchell plan. And 
there are some of us, frankly, who would prefer single payer to the 
disaster of the Mitchell plan. I say that as one who is opposed to 
single payer, but who, upon examining the Mitchell plan, says 
administratively single payer makes more sense.
  Mr. WELLSTONE. Will the Senator yield for a moment?
  Mr. BENNETT. I will be happy to yield.
  Mr. WELLSTONE. I thank him for his remarks. I obviously do not agree 
with his analysis of the Mitchell plan, at least within the Senator's 
framework. We will not go into it now. But I am very interested in the 
second point he made. If that is the case--and I know the Senator from 
Utah to have tremendous intellectual integrity--then I am hoping that I 
will be able to enlist the Senator's support for at least some language 
that will enable the States to have flexibility to go forward with 
their different approaches.
  In other words, that was one of the things, as I mentioned in my 
earlier remarks, which surprised me about the bill. And Senator 
Domenici, who is one of my best friends here, brought out language that 
would preclude States from being able to do that.
  Why not let the States have an opportunity, and if it does not work, 
it does not work, but let the people and their representatives decide.
  Mr. BENNETT. Mr. President, there are some reasons why we adopted the 
position we have, in our view. But I would be more than happy to sit 
down with my friend from Minnesota and go through that, because the 
main point I intend to make in this discussion that is coming up is 
that the notion that we are facing a window of opportunity here that 
will close within the next 20 days if we do not take it is a notion 
that is completely unacceptable to me.
  I believe we will meet next year, we will meet the year after. I 
think we will be discussing this over a period of time, and what I am 
going to ask for is an intelligent, staged reform that does not rush to 
judgment or, in my view of the Mitchell bill, rush to disaster in the 
desire to meet an artificial deadline.
  I would be happy to visit with my friend from Minnesota to talk about 
the place where a single-payer thing might be of some appropriateness, 
but do it in something other than the kind of frenzy that has been 
built up around this debate today.
  Mr. President, I remember as a freshman Senator some months ago 
walking onto the floor and falling in step with the distinguished 
chairman of the Finance Committee, Senator Moynihan. I first met 
Senator Moynihan when we served together in the Nixon administration. 
Maybe neither one of us want to admit that now. But he served as 
domestic counselor to President Nixon, and I was in the Department of 
Transportation as the head of congressional relations. Ever since that 
time, I have had great respect for his intellect and his intellectual 
honesty.
  As we stepped onto the floor of the Senate, I said to him, ``Senator, 
are we going to get health care this year? Are we going to be able to 
pass something?'' And he said, ``Yes, I think so.''
  Then with his well-known understanding of history, he gave me the 
following history lesson:
  He said, ``Harry Truman tried to do it in the 1940's and the 
Republicans said no and we didn't get anything.''
  He said, ``Richard Nixon tried to do it in the late 1960's and the 
Democrats said no and we didn't get anything. But now,'' he said, 
``both the Republicans and the Democrats are agreeing that we have to 
do something about the health care system, and I think we will get a 
bill.''
  That is what he was saying, and I was agreeing with him roughly a 
year, 14, 15 months ago.
  Now, where are we today? I turn to the current issue of Newsweek 
under the head, ``National Affairs,'' and read this headline: ``Will 
Reform Bankrupt Us?''

       Health care: 65 percent of Americans say Congress should 
     start over. Newsweek's economics columnist argues that 
     they're right.

  How did we get here, from a circumstance where a Republican and a 
Democrat could walk onto the floor of the Senate agreeing with each 
other that we are going to get a bill, to the point where a national 
publication says 65 percent of the Americans say we should wait and 
start over next year and they argue very persuasively, in my view, that 
the 65 percent of Americans are right.
  What has gone wrong with the process? Have we not discussed this 
enough? Oh, Heaven knows we have discussed it enough. We heard on the 
floor of the Senate about the 80 hearings that have been held in the 
two committees, and that is just in the Senate. We talked about it on 
the House side. We spent time on the floor. Yes, we talked it through 
enough. What is left to discuss?
  Well, I suggest that we have talked and we have talked and we have 
talked about the wrong things. We missed some very fundamental points 
that need to be addressed before we are going to come up with the 
answer to this. I would like to outline some of those.
  No. 1: We have not talked at all, except in a glancing occasional 
reference, about better health. We have spent all our time talking 
about health care, but we have not talked at all about providing 
information or motivation for people to stay well in the first place. 
Of course, the best cost containment of all in the health care debate 
is going to be better health on the part of individual Americans. This 
is not a matter of universal coverage; it is a matter of education and 
motivation.
  We do it in other kinds of insurance. I see the ads, so do you, for 
auto insurance: ``Nonsmokers discount,'' we see. There is a clear 
economic incentive for somebody to do something intelligent about their 
own health and stop smoking.
  When I go down for a life insurance physical, the first question I am 
asked: ``Do you smoke? Do you drink? Do you engage in--'' and they have 
a list of other high-risk activities. And when I say, ``No, I don't 
smoke; no, I don't drink,'' so on, ``No, I don't engage in some of 
these other things,'' they say, ``Well, you will get a better rate.''
  When we stand on the floor and talk inevitably and incessantly about 
health care for all Americans that cannot be taken away, we wipe aside 
the notion that there might be some kind of incentive that could be 
built into our system that says that people who take better care of 
themselves should get a better deal when it comes to paying for health 
care than people who do not. That has not been part of the debate, and 
that is one of the reasons why we have gone astray in all the talk we 
have had and missed the point.
  If I may quote from the Newsweek article with respect to this issue 
about better health, Mr. Samuelson says:

       We are slowly surrendering our economy to health care--for 
     surprisingly modest gains in our health--and what we needed 
     was a debate that confronted these relentless pressures. 
     ``The cost-control imperative has been lost,'' says John 
     Inglehart, editor of the respected journal Health Affairs. 
     Some day there may be frightful economic consequences. 
     Business groups already say the costs of Government-dictated 
     benefits will destroy jobs. Those would mount if health 
     spending climbs and the costs are imposed on businesses by 
     fiat or payroll taxes. Europe's experience is sobering. Since 
     1974, its unemployment has risen from 3 to 11 percent and 
     private job growth has been meager.

  His first point, we have seen all this increase in health spending, 
but we have gotten very little benefit and results.
  Here is the same article:

       Economist Charles Phelps of the University of Rochester 
     studied the connection between higher health spending and 
     Nations' improved health. The connection was ``tenuous.'' The 
     biggest health gains come from higher incomes--

  If you earn more, presumably you take better care of yourself, not 
from health care.

     higher incomes, better education and inexpensive measures: 
     Vaccinations, antibiotics against infections. Among 
     individuals, diet and personal behavior (smoking, drinking, 
     drug use) often explain who's healthy and who isn't. Even in 
     societies such as England and Sweden, where everyone has 
     insurance, the poor aren't as healthy as the middle classes.

  You have not eliminated the disparity in health by eliminating the 
disparity in health coverage, and that is something I think we should 
have been talking about.
  I keep hearing from my constituents: ``As you address health care, 
Senator, address the issue of high-risk behavior and do something to 
see to it that there is some kind of economic incentive for people to 
take better care of themselves.'' But there is nothing in any of these 
bills, there has been nothing in any of the hearings that has addressed 
that issue.
  No. 2: In all of the hearings we have had and all the discussions we 
have had, we have not, in my view, had a serious discussion of the 
importance of why market forces do not really work in health care.
  I have already given a speech on this. I will not repeat it all. But 
let me summarize it.
  First, the basic principle. When it comes to allocating scarce 
resources, market forces are always more efficient and fairer than 
Government's. That is a truth that has been established since the days 
of the ancient Egyptians and Romans, and on through the Renaissance and 
all through the Industrial Age.
  Write it down. You can take it to the bank. When it comes to 
allocating scarce resources, market forces are always more efficient 
and fairer than Government's. So we are talking about allocating health 
resources and market forces do not work. Why do they not work? For one 
very fundamental reason. The customer has no power in the health care 
debate. The customer does not control what will happen. Who does? The 
insurance company. The insurance company is the controller, not the 
person who is consuming the health care.
  I had that brought home to me very vividly during the campaign. I 
went to a hospital in Ogden, UT, the standard campaign circumstance. I 
was going through talking to people. I sat down in the board room with 
the administrators of the hospital, and we began talking about some of 
their problems.
  They were commenting that the equipment in their hospital--I do now 
know whether it was an MRI machine, but let us take that as an example 
because everybody is talking about too many MRI's in the United States. 
This piece of equipment in their hospital was utilized about 20 percent 
of the time.
  Well, being a businessman, I immediately said to myself the market is 
telling you something, hospital administrator. The market is telling 
you there is no more demand than 20 percent for that machine. You ought 
to do something to make a deal with the hospital down the street so 
that you could say, well, we are going to refer everybody who needs an 
MRI to the hospital down the street, and we will get full utilization 
of this machine.
  My mind is saying we have to do something in Congress about the 
antitrust laws so the two hospitals can do that; they can talk to each 
other.
  ``No, no,'' they said. ``Mr. Bennett, you do not understand. We have 
this MRI in this hospital because the market insists on it.''
  And I say, ``Now, wait a minute. You do not understand. With a 20 
percent utilization, the market is sending you a message.''
  They said, ``No. You do not understand. We have to have it in order 
to meet the market.''
  We stood there and argued back and forth fruitlessly for 4 or 5 
minutes until suddenly they enlightened me as to what they were talking 
about when they said the ``market.'' They said, ``If we do not have an 
MRI machine in our hospital, insurance companies will not allow any of 
the people that they insure to come to our hospital.''
  I said, ``Oh, wait a minute. You are telling me then that the market 
is the insurance company, not the sick person.''
  They looked at me like I was the dumbest guy in the block. ``Of 
course, the market is the insurance company. You think we exist to 
serve sick people? We exist to serve insurance companies who send us 
sick people. And the insurance companies say we will not send anybody 
to your hospital unless you have an MRI, so we have to go out and buy 
an MRI, even if we do not get enough utilization for it and we have to 
cost shift.''
  The light began to go on in my head. Market forces do not work in 
health care because the consumer is not the customer, and we need to do 
something about that. But we have not had that point raised in any of 
these hearings. We have not talked about it in these hearings.
  So someone else is making the economic decision for me as the 
consumer. And who is the someone else? Ultimately, it is the employer. 
Now, I have been an employer. I have been the CEO of a company. I have 
made the decision. I have had everybody come in. They make the 
presentation to me. I am the CEO. I get to decide. The insurance 
companies are coming to me. The self-insurance regulators are coming to 
me. The HMO's are coming to me: We want to sell your employees this 
thing. But really they want to sell me. I make the decision for all my 
employees.
  What kind of market force is that, if one of my employees wants 
something other than I decide he or she should have?
  We perpetuate this in this whole debate. We have never challenged 
that. We have gone willy-nilly from the notion that the employer should 
decide what people should have, to the idea that the Government should 
replace the employer deciding what people should have. And never in the 
debate have we raised the issue that maybe the people should decide 
what the people should have, at which point you begin to get market 
forces coming into the circumstance.
  All that these various bills we have before us do is substitute the 
Government for the employer and leave the underlying problem still in 
place. We are never going to get true cost containment until we do 
something about that No. 3.
  Never have I heard in all these hearings anybody challenge the 
absurdity of the notion of first-dollar coverage. Once again, let us 
look at insurance outside of health care and see how absurd this notion 
is.
  Auto insurance. We all have auto insurance. Talk about mandates. We 
are mandated to have auto insurance in my State, and I assume every 
other State. I cannot get a driver's license; I cannot get a license 
for my car renewed if I do not have auto insurance. It is checked every 
year when I go in to get it renewed. There is a very firm mandate.
  But my auto insurance does not provide first-dollar coverage. It 
would be absurd for me to think of it. What would it cost for an auto 
insurance plan that says we will cover through our insurance coverage 
the cost of changing the oil in your car. It cost me about, if I go to 
one of these Jiffy Lubes, $19.95 to change the oil and the oil filter 
in my car.
  Suppose, along with the cost of changing the oil and the oil filter, 
I had to pay the cost of filling out an insurance form and sending it 
to a third party to scrutinize it to see whether it came under the 
terms of my policy, and then the insurance company would pay for 
changing the oil.
  I rather suspect, based on various studies that have been made in the 
health insurance industry, that the cost of handling that insurance 
claim would be around $20. So what does that mean for the cost of 
changing my oil? Instead of $20, it is going to be $40. What kind of 
premium am I going to have to pay for that policy in order to have the 
insurance company pay for the changing of the oil?
  Very quickly, I can put a pencil to it and say it is a whole lot 
cheaper for me to have an auto insurance policy that pays for 
catastrophic events like if I run into somebody in an intersection and 
get sued. But, frankly, I will pay for changing the oil myself.
  The same thing in homeowner's insurance. What kind of homeowner's 
insurance policy would we have if the policy covered the cost of mowing 
the lawn? It is so absurd nobody even thinks about it. And yet in 
health care we have it in our heads that somehow, if the insurance is 
not there to pay for changing the oil in the car, or is not there to 
pay for the cost of mowing the lawn, then we are not covered.
  It is the absurdity of the notion of first-dollar coverage that is 
driving the cost of medical insurance right through the roof. We need 
to change our thinking and start saying the insurance principle should 
be what it has always been in everything else, which is insurance 
covers catastrophic events and it is not there to pay for a $15, $20 
office visit by adding a $15, $20 claim cost on top of the office 
visit.
  No. 4--and it comes out of No. 3--the myth of other people's money. I 
have heard this on the floor today, and this again is something we have 
not talked about in this whole debate. The idea that you are paying for 
your health care with somebody else's money, the employer must pay for 
my coverage, somebody else's money, is nonsense. Actually, it is all 
your money.
  We have had percentages kicked around. The original bill that we were 
thinking about that has been the subject of hearings says that 80 
percent of the costs will be paid by the employer. We are going to have 
a mandate that says every employer has to pay 80 percent of the cost. 
No. There is a flashback against that. So along comes Senator Mitchell. 
He says: I recognize that I cannot get an 80-percent mandate. I will go 
for a 50-percent mandate. So the employer will only pay 50 percent.
  I am sure my friend from Minnesota would complain about that and say 
it ought to go back up to 80 percent. We just heard him say the Federal 
Government pays 79 percent of ours. Why should not every employer pay 
79 or 80 percent? I would say to my friend from Minnesota, if he were 
here, that the Federal Government does not pay 79 percent. Employers do 
not pay 80 percent. I pay 100 percent. Every dime that goes for my 
health care is a form of compensation to me, and in the private sector 
particularly it represents a lowering of my taxable income by virtue of 
an employer decision to put the money in health care benefits instead 
of in my paycheck.
  There is no such thing as other people's money here. It is the 
employee's money in every case. Again, I have been an employer. I know 
how it works. I explain to my employees, you may think you have a 
$20,000 a year job, but it is a $30,000 a year job because that is what 
it is costing me as your employer. I have to pay $30,000 to keep you 
working for me. I put $20,000 of that on your W-2 form that you take 
home at the end of the year that you pay taxes on. I put the other 
$10,000 into a variety of benefits for you. But they are still going to 
be part of the cost of having you on my payroll.
  Indeed, we have heard some of the ads that have been running during 
this debate that make reference to that. Somebody says, ``Hey, I want 
those benefits. I gave up wage increases to get those benefits.'' You 
have heard that on some of the commercials. That employee is beginning 
to understand that those are his dollars, not the employer's dollars. 
One hundred percent of the cost of health care falls upon the employee, 
because the employee is earning enough money for the employer to pay 
that $30,000 that I referred to in the example, not just the $20,000 he 
takes home.
  So when Senators stand up on this floor and say, ``If the Senate of 
the United States does not pass this health care legislation, I will 
move to take away their benefits,'' all he is really saying is, ``I 
will move to cut their salary, cut their compensation, by the amount 
those benefits represent in dollars.''
  What will I do if that passes? I will do the same thing every other 
Member of this body will do. Having taken about a $300 a month salary 
cut, I will take the money that is left and go out and buy myself some 
coverage someplace else. The Government does not give me benefits. The 
Government spends my money for benefits which the Government has 
decided I need.
  So, as I say, these two come out of each other, the myth of other 
people's money and the earlier point about the lack of market forces 
operating in health care.
  So, Mr. President, I suggest these four things have been missing in 
this debate in spite of the debate's length and complexity:
  No. 1, we have not discussed the impact of this whole thing on 
people's health, and what it will do to make them healthy.
  We have, No. 2, not discussed the failure of true market forces to 
work.
  No. 3, we have not discussed the impact of the absurdity of the 
notion of first-dollar coverage on health care.
  And, No. 4, we have not discussed the impact of the myth of other 
people's money.
  I think we need to do that if we are truly going to restructure the 
health care system around sound principles.
  The end result of all of this, our failure to discuss these 
underlying points, is summarized again in Newsweek. I go back to the 
article and give you a few observations.

       President Clinton is right about the historic opportunity, 
     and he blew it. Somewhere along the way, health care took a 
     decisive turn towards fantasy.
  I agree with that completely.

       If Congress passes sweeping health reform, as they urge, we 
     will have compounded all our long-term budget and economic 
     problems by force-feeding the monster of health care 
     spending.

  I agree with that completely.
  We are headed in the wrong direction. We need to stop and start over 
again. We are left with a legislative mishmash of ideas cobbled 
together in the majority leader's office in the last few weeks, put 
into legislative language that has now been revised twice. So that we 
have three sets of ideas before us, under an enormous time pressure, 
pushed onto the floor with an artificial deadline, with no report 
language, no opportunity for a careful analysis of all of it, no chance 
to run some of these things by real-life scenarios before we have to 
vote.
  And in the pressure cooker of floor debate, with the threat of a 
cloture vote designed to embarrass people politically hanging over us, 
we are told to legislate the most far-reaching piece of social 
engineering ever proposed since the Great Depression.
  Mr. President, that kind of demand upon the Senate is irresponsible; 
it is dangerous and it is unnecessary. I say it is irresponsible 
because we are left with a bill that few, if any, have read--I tried, 
only to have to stop when the next version comes out and start all over 
again--a bill few understand, and no staff has really been able to 
summarize it or synthesize it to my satisfaction.
  With respect to ``one-seventh'' of the economy, that statement has 
been made. I put it into chart form. For the sake of helping us 
understand just how big it is, we show here on the top line, the red 
line, the total U.S. health industry economic activity, which is $942 
billion. That is a big number, by anybody's imagination.
  But let us put it in some kind of context. How big is that? Is it 
bigger than a bread box, to go back to a phrase that comes out of my 
youth, on television? It is bigger than the entire economy of Great 
Britain? This first yellow line shows the entire economy of the United 
Kingdom. Do you think that people in the Parliament would be 
restructuring their entire economy in a single bill in a single 
Congress, and be considered responsible? No. They would go about 
something like that very carefully.
  Canada, here is the entire size of the Canadian economy. We are 
talking about nearly twice as much money as the entire Canadian GDP; 
Spain, The Netherlands, Australia, Belgium, Sweden, Austria, so on and 
so forth, all the way down. There are only five nations that have GDP's 
larger than the amount of money that we are talking about. They are 
Italy, France, Germany, Japan, and of course, the United States, 
because this represents one-seventh of our GDP. So our total GDP would 
be seven times bigger than this.
  This illustrates the size of the stakes that we are playing with 
here. It is irresponsible, as I say, to be dealing with something that 
big in the manner in which we are.
  I said that the bill was complicated. The bill is huge. It is almost 
impossible for anybody to understand it, including the staffs.
  There is one group that probably understands it about as well as 
anybody, and are forced to by virtue of their profession and 
assignment; I am talking about the Congressional Budget Office. The 
Congressional Budget Office, after looking at how we would restructure 
$942 billion worth of economic activity, has this to say:

       For the proposed system to function effectively, new data 
     would have to be collected, new procedures and administrative 
     mechanisms developed, and new institutions and administrative 
     capabilities created.

  That is a pretty daunting task all by itself.

       In preparing the quantitative estimates presented in this 
     assessment, the Congressional Budget Office has assumed--

  They have not determined, they have assumed.

     not only that all those things could be done, but also that 
     they could be accomplished in the timeframe laid out in the 
     proposal.

  Those are two rather significant assumptions. And then in what I 
consider one of the great understatements in the document, they say:

       There is a significant chance that the substantial ranges 
     required by this proposal could not be achieved as assumed.

  We are fooling around with something bigger than the entire GDP of 
Great Britain, and there is a significant chance that the underlying 
assumptions could not be reached.
  What are the implications of this kind of haste to judgment, having, 
as I said, ignored some of the other things that are outside our normal 
view of the way this matter should be discussed? I think it is 
dangerous for us to proceed, because the first indications we have of 
what will happen can be very, very serious.
  Going back to the Congressional Budget Office, it says:

       The subsidies for people who are temporarily unemployed 
     would be particularly hard to administrate and monitor. It 
     would be difficult, for example, to determine whether people 
     had left their jobs voluntarily or involuntarily, or whether 
     they would receive employer contributions for health 
     insurance through an employed spouse. Moreover, because of 
     the way these subsidies would be structured, significant 
     horizontal inequities could result. That is, families with 
     similar income could receive quite different subsidy amounts.
       Senator Mitchell's proposal, like many other reform bills, 
     would encourage a reallocation of workers among firms in ways 
     that would increase its budgetary costs. In addition to 
     raising the Government's costs, the reallocation of workers 
     could reduce the efficiency of the labor market.

  Again, the ripple effect of bad decisions as it goes through the 
entire economy.

       The imposition of the mandate would raise the cost of 
     employing workers at firms that do not currently provide 
     insurance. Economic theory and empirical research both imply 
     that most of this increased cost would be passed back to 
     workers, over time, in the form of lower take-home wages. 
     Such shifting would not be possible, however, for workers 
     whose wages were close to the federally regulated minimum 
     wage. Therefore, the net cost of employing those workers 
     would be raised by the mandate, and some of them would lose 
     their jobs.

  Let me pause with a definition that does not come out of Webster's. I 
take full responsibility and blame for it. But I say here that my 
definition of a mandate that forces people to spend money is that it is 
``a tax.'' If you mandate something that causes people to increase 
their costs, it has exactly the same impact on the business as if you 
had raised their taxes. And we are talking about a whole bunch of 
mandates here. ``Oh, no,'' we are told, ``the Mitchell bill does not 
have any mandates.'' Oh, yes, it does.
  The Mitchell mandates. Who gets hit? Or if I apply my definition, who 
gets taxed? There is a mandate on future Congresses. This bill tells 
future Congresses what they must do if certain things do not happen.
  There is clearly a mandate on States. Clearly, there are requirements 
that the States are going to have to spend money--mandates on doctors, 
health care providers, big businesses, small businesses, independent 
contractors, individuals.
  If the trigger kicks in, clearly there will be mandates all the way 
through. Who pays? Well, of course, as I said earlier, ultimately the 
individual pays all of these costs in the form of higher taxes, lower 
wages, fewer jobs, lower quality, and less choice.
  The Mitchell mandates are clearly in the bill.
  What will happen if the Mitchell bill passes? In my view, there are a 
number of things that can be fairly safely postulated. Number one--and 
we have talked about it--costs will rise.
  If I may turn to an article that appeared in the Wall Street Journal, 
written by Martin Feldstein, former Chairman of the President's Council 
of Economic Advisers, currently a professor of economics at Harvard. He 
is talking about mandates in much the same way I am. This an article 
entitled ``The Hidden $100 Billion Dollar Tax Increase.'' I will repeat 
that: ``The Hidden $100 Billion Tax Increase.''
  Professor Feldstein says:

       President Clinton is increasing the pressure on Congress to 
     enact a massive and irreversible entitlement program to 
     subsidize health insurance and redistribute income. The cost 
     for this largest-ever welfare expansion would top $100 
     billion a year at today's prices. That is equivalent to 
     raising personal taxes across the board by nearly 20 percent.
       Amazingly, the Senate Democratic leadership has managed to 
     conceal this massive tax increase from the public. The 
     legislative wrangling and public discussion have virtually 
     ignored the cost of financing this spending explosion. 
     Members of the business community have been so eager to avoid 
     employer mandates that they have not considered the tax 
     consequences of the pending legislation, and members of the 
     general public have been so concerned about preserving their 
     ability to choose their own doctors that they have not 
     focused on what these plans would mean for their individual 
     wallets.
       In short, buried in the CBO numbers is the projection that 
     the Senate Finance Committee plan would have a $63 billion 
     annual cost, at 1994 price levels, and that all but what the 
     CBO estimates to be $14 billion in cigarette levies would be 
     obtained by hidden taxes in the form of cost shifting through 
     health care providers and insurance companies. It's 
     remarkable that the same politicians who have produced this 
     $49 billion in hidden cost shifting have the audacity to say 
     that the public should support their plan in order to 
     eliminate the much more limited cost shifting that occurs 
     under the existing system as hospitals pass on the cost of 
     free care.
       Indeed to the extent hospitals are already giving free 
     care, the increase in formal insurance coverage gives that 
     much less to the currently uninsured and confirms that most 
     of the plan's cost is to achieve income redistribution, not 
     expanded health insurance. Costs will rise, and the historic 
     driving force primarily responsible for people being 
     uninsured is high costs.

  There are those who suggest, even if the press reports can be 
believed from Mrs. Clinton herself, that one of the main consequences 
of passing the Mitchell bill will be to increase the number of the 
uninsured. I think the fact that the costs will rise is a driving force 
behind that belief.
  People in America are not stupid. They can figure out how to game a 
system. It is very clear that they will start to game this system. They 
will split into several companies with under 25 employees in each 
company. They will hire more temps. That is already happening. We see 
that phenomenon, clearly, through the economy. And it is cheaper for an 
employer to pay overtime than it is to pay benefits to a second 
employee when the benefits have been mandated at such a high level. We 
are seeing that happen in the economy now.
  The community rating experience in New York shows that the number of 
uninsured raises and does not fall under the community rating system 
unless, once again, there is a very heavy-handed force that comes in 
and the Government gets involved more and more and more.
  The net effect is that the number of uninsured will go up rather than 
come down. In my view, it is an absolute certainty that the Mitchell 
bill will fail to decrease the percentage of the uninsured so that we 
are certain that if we pass the Mitchell bill we are legislating for 
the Congress in the year 2002.
  The trigger is not a hard trigger. It is not a soft trigger. It is, 
in fact, a certainty. The Mitchell bill will not work, and the trigger 
called for in the Mitchell bill will take place. That is inevitable.
  So we find ourselves in the circumstance of being arrogant enough to 
say that this Congress, in the name of going through a window of 
opportunity that we are told will not reappear for another 30 years, 
has the wisdom to shape the form of health insurance and health 
coverage for this country 8 years from now, and that intervening 
Congresses will be frozen out of doing anything about it.
  Well, the absurdity of this is what is causing the rising chorus of 
dissatisfaction within this Congress, House and Senate. We are getting 
new bills introduced all the time. I just agreed to go on one, along 
with my friend, Senator Domenici, on the Republican side; and it will 
be sponsored on the Democratic side by Senator Nunn and Senator Boren. 
It will be along the lines of the bipartisan effort that is being 
introduced in the House. We will have formal introduction of it 
sometime early next week.
  There is rising dissatisfaction with the options in front of us, a 
sense that somehow Mr. Samuelson is right. We have missed a historic 
opportunity. The debate has taken a decisive turn toward fantasy, and 
we probably ought to start over again next year.
  I will say that I do not think we should despair of doing anything in 
this Congress. I would not be, along with the three Senators I have 
mentioned, sponsoring a new bill at this late point if I felt that way. 
We can do something this year. We can do something meaningful this 
year. We should just make sure we do not do something dangerous or 
irresponsible this year.
  My friend from Minnesota gets all upset because the bill we are 
sponsoring does not provide universal coverage, and I say to him that 
he is absolutely right, and it is not designed to. But it is offered on 
the assumption that the Congress will meet next January. It is offered 
on the assumption that the Finance Committee will still be in business 
next year and can address the issues that I have talked about in 
something less than the pressure cooker we are in--can go back to the 
fundamentals that have been overlooked, that I mentioned in the 
beginning of my statement, and try to sift through those. And, in the 
meantime, we will have at least this year taken some steps to solve the 
problems we all agree should be solved.
  I reject the notion that seems to underlie most of this debate that 
says if we do not do it in this Congress, we will not get another shot 
for 30 years. I had that exchange with Dr. Uwe Reinhardt when he 
appeared before the Joint Economic Committee and said, ``Why can't we 
do it intelligently, one step at a time, and do what we now know we 
have to do and tackle some of the structural things next year?'' He 
said, in effect, ``Senator, that is clearly the right way to do it. But 
those of us who are junkies on this issue say that we get one 
opportunity every 30 years, and this is our only opportunity.''
  I said, ``That is stupid,'' and he looked at me and he said: ``Are 
you willing to commit to addressing this next year?'' And I said, ``Not 
only next year, but the year after and the year after, and however long 
it takes to try to get this thing solved.''
  He kind of blinked a little and said, ``Well, if the Congress really 
would do that, maybe we do not have to do it all this fall.''
  So that is my plea. Let us abandon the imagery that comes out of the 
space program of a window of opportunity. In the space program--you 
will recall that is where the phrase came from--there is a window of 
opportunity in space when the weather and the placing of the moon and 
other things relating to a launch opens up, and it is open for a matter 
of a few hours, and then the moon moves on or the weather rolls in and 
the window closes. And the people at the Johnson Space Center in 
Houston realize it is going to be x number of months before they get 
another window. That is where the phrase comes from, and that is the 
imagery we have been going on that has been driving the debate.
  Let us set that imagery aside and replace it with the understanding 
that President Clinton has, instead of pointing out a window of 
opportunity, given us an open door to walk out of the past, into an 
open, sunlit circumstance, where we can view all our options and make 
intelligent decisions, and the window will not close once. We are 
through that door, on the other side, committed to the idea of doing 
the right thing for health care. We can do it intelligently, gathering 
the data, waiting until we see what the data tells us before we take 
the next step, then watching to see what happens, and moving 
intelligently and soundly in the direction of solving this problem 
ultimately for all of our citizens.
  Am I committed to the idea of universal coverage? If you will let me 
define what universal coverage is, I will tell you absolutely I am 
committed to the idea of universal coverage. Am I agreeing with the 
idea that we are rich enough to provide the proper kind of health care 
for every American? Absolutely, I agree with that. But I do not want to 
do it under an artificial deadline, working with a legislative mishmash 
that has been put together in a political atmosphere of debate that has 
ignored some of the very basic concepts that I have been talking about.
  Back to my imagery. President Clinton has opened the door. I give him 
full credit for that. I always have. He has had the courage to take on 
an issue that many of his predecessors ducked. But we are walking into 
that sunlight on the other side of the door with blinders on, blinders 
that come out of the paradigm, if you will, that we have lived on this 
side of the wall, and we need to take the blinders off and look around. 
And we are not going to be able to do it in the present legislative 
circumstance.
  That is why I say the folks in Newsweek have it right. Sixty-five 
percent of Americans have it right. We should not rush to judgment on 
this.
  I conclude by quoting once again from the Samuelson argument. He 
says:

       What we have had this year was the chance to begin 
     grappling with the basic questions. We squandered it. The 
     Clintons imagined that health care will secure their place in 
     history, and in a peculiar way, they may be right. History is 
     written with hindsight, and when it is, it may judge them 
     harshly, not simply because they led us in the wrong 
     direction, but because all the evidence needed to go in the 
     right direction was obvious, and they chose to ignore it.

  Mr. President, I yield the floor.
  The PRESIDING OFFICER (Mr. Daschle.) The Senator from New York.
  Mr. MOYNIHAN. Mr. President, may I once again take this opportunity, 
as I have not had it sufficiently, to thank the Senator from Utah for 
his very thoughtful, important statement. And that statement we have 
been hearing from both sides of the aisle today. Universal coverage is 
a goal that this country can achieve and ought to commit to, and will, 
I think, do both.
  That was a very fine statement.
  Mr. BENNETT. Mr. President, may I thank my friend from New York for 
his kind remarks, and in the spirit of what he has just said, remind 
him of my opening statement. I do not think he was here when I made my 
opening statement. I quoted him, I hope correctly, at a time when he 
and I walked onto the Senate floor and I asked him, as a freshman at 
the feet of the experienced legislator, ``Are we going to have health 
care this year?'' And he said to me--he may well have forgotten, and he 
may now wish to repudiate the notion--but he said to me: ``Harry Truman 
tried it in the 1940's, and the Republicans said `No.' Richard Nixon 
tried it in the late 1960's, and the Democrats said `No.' Now we have 
both Republicans and Democrats agreeing that it ought to be done, and I 
think we will get a bill.''
  If we can go back to the spirit of the Senator's comment to me there, 
I think we can get a bill, and certainly over time we can solve the 
problem.
  I think it is very significant that every single Republican Member of 
this body has signed on to some kind of bill calling for basic 
restructuring of the health care system, and certainly the same is true 
on the Democratic side. That is a matrix that has not existed in 
previous growing seasons, and I hope we do not lose it this time.
  Mr. MOYNIHAN. I thank the Senator.
  And that is the extraordinary central fact of this debate.
  Mr. President, the fact that this debate is taking place, the fact 
that we are here on the floor speaking about universal coverage with 
such a wide convergence of views on that essential principle, is owing, 
in more than any one thing, to the extraordinary efforts of the Senator 
from Pennsylvania.
  He raised this issue in the most dramatic way almost 4 years ago in 
his State in that election. His success rang a bell that is still 
echoing across this Nation.
  He has to leave for Pennsylvania, so his good friend and mine, the 
Senator from Michigan, has agreed to step aside for a moment.
  I ask unanimous consent that the Senator from Pennsylvania be 
recognized for 15 minutes, followed by the Senator from Michigan.
  But, once again, I state my great gratitude. We are indebted to you, 
sir.
  The PRESIDING OFFICER. The Senator from Pennsylvania is recognized.
  Did the Senator from New York yield to the Senator from Pennsylvania?
  Mr. MOYNIHAN. I do so.
  Mr. LEVIN. If the Senator from Pennsylvania will yield, was the 
unanimous consent of the Senator from New York granted that after the 
Senator from Pennsylvania is finished, that I then be recognized for 15 
minutes?
  The PRESIDING OFFICER. Is there objection? Hearing none, it is so 
ordered.
  Mr. WOFFORD. I thank the Chair.
  Mr. President, for the last couple of hours, I have been talking to 
100 or more people from around Pennsylvania. And there was a great 
contrast between the clarity with which they saw some of these issues 
and the lack of clarity and confusion that we have had during part of 
this debate.
  But I want to thank the Senator from Utah for the spirit in which he 
ended and he began his remarks. I take issue with some of the points in 
between, but we must find a way not to lose this opportunity. And it is 
not going to be all done this year. We will be back next year and the 
year after that.
  One of the things I do agree with him on is that we should not focus 
entirely on an action or a trigger that takes place in the year 2000 
and moves into the next century. I certainly do not think any of us 
should be proud that we are seeking to stretch it out, delay it, move 
beyond the next century. I hope very much, in addition to whatever 
happens in the year 2000, to see how far we have come on the way to 
universal coverage; that every year, once we have set up a health 
insurance structure charting the way to universal coverage, that every 
year we have an annual checkup in which we see how far we have gone and 
how far we have fallen short.
  A doctor does not say, ``Let's try aspirin, or this little medicine 
for a while and come back in 6 years.'' A doctor says, ``Call me in the 
morning.''
  I think our national health commission, as soon as it comes into 
being, should report every year on how far we have moved toward 
coverage or slipped back, whether more employers are contributing or 
less, whether the burden is being shifted more onto the backs of 
families and individuals and working people--an annual checkup. And I 
hope the Senator from Utah will join me and our Presiding Officer and 
others of us who want to see that there is an annual checkup and a 
report to the Congress and the people so we can take action sooner 
rather than later.
  I hope that on every key element of this bill we strive for the 
principle of sooner rather than later. For example, we should look at 
every element that takes no additional cost but could go into place 
now--the ending of the preexisting condition rule that excludes people 
when they change jobs, when they move; a condition my wife has that 
made her scared that if I lost my job we could not get health 
insurance, really scared at a time before she was old enough to qualify 
for Medicare. That rule ought to go on day one. It ought to go next 
year. That insecurity should be lifted. The shadow of death should be 
lifted from the people who have a preexisting condition.
  And Senator Dodd's amendment that is before us now, for children 
first, for something that, in basic private health insurance plans, 
preventive care for children and for pregnant women, comes into place 
sooner, not later; not the year 2000. Sooner rather than later.
  But there have been so many myths and misrepresentations and my 
friends from Pennsylvania were seeing through them so clearly just a 
little while ago. A lot of them came from Washington, PA. And the 
contrast between how they understood it from Washington, PA and how 
some of my colleagues here understand it in Washington, DC was very 
stark and disappointing.
  There were some of them that go back to Harry Truman, too. There was 
a man that was at Keesler Field, MS, in the Army Air Corps in World War 
II when I was there. He was out there telling me that he, like I, was 
there cheering Harry Truman on when he started the battle for universal 
health insurance.
  Some of us in that crowd remember the studies and the hearings and 
the proposals and the care that went into trying to craft a good plan 
then, and the special interests and the fog of confusion that was laid 
down that beat Harry Truman.
  There were a lot of people there that remember when President Nixon, 
aided by the Senator from New York--then not a Senator from New York--
when the chairman of the Finance Committee, in a previous incarnation, 
helped President Nixon present a plan to us, a careful, thought-out 
plan, and we did not take that opportunity. A terrible lost opportunity 
then.
  Others have heard the Senator from Massachusetts, the chairman of the 
Labor and Human Resources Committee, over the years, over decades, 
conduct hearings, present plans.
  The Senator from West Virginia, Senator Rockefeller, has been part of 
some of the most remarkable hearings as part of the Pepper Commission. 
A mountain of studies have piled up. And my friends from Washington, 
PA, know in their bones it is not more study that we need.
  I have been in the Senate for 3 years. From the day I got here, I 
have been part of efforts--some of which I have pressed for and some of 
which my colleagues, who have been in this battle before I got here, 
were already planning--week after week, hearings, careful proposals, 
homework. In the Labor Committee, 151 hearings. In the Finance 
Committee, I think it is 32 hearings; the Veterans' Committee, and 
other hearings just in this body alone.
  We are talking about the bill that has been crafted by the majority 
leader--the bill that drew on the careful work of the Finance Committee 
and the Labor Committee and blended those proposals together in a bill 
that is before us--as too complicated, too long, too heavy a document.
  Well, I once on this floor assembled all of the NAFTA documents. I 
think there were five, it may have been six, volumes. They piled up 
this high. This Congress knew how to act on that. I did not go along 
with the way they acted. I opposed it. But it was not too complicated 
to pass that NAFTA bill. And now we hear this is too complicated.
  Well, my friends from Pennsylvania, they have a very simple test. I 
agree with them. But it is a test that came out of the people of 
Pennsylvania. And that is, what is good for Congress ought to be good 
for the American people.
  They do not understand why a Congress that has arranged for itself 
guaranteed health insurance--cannot be canceled, no preexisting 
conditions, comprehensive benefits, a choice of private plans, not 
Government-run plans, but Blue Cross-Blue Shield, HMO's, your own 
plans, choose your own doctor--why Congress can arrange that for 
themselves and for 9 million Federal employees and their families, with 
their employer contributing three-quarters of the premiums, why it 
cannot now move forward, after all this work in this Congress, to take 
the great step forward in arranging that kind of a private health 
insurance for the American people.
  I think the people in Pennsylvania, through this confusing debate, 
have gotten the point. This is not new Government-run medicine. It is 
private health insurance. They have seen the charts that have been put 
up. I do not know what that chart really is about, but a far more 
complicated chart would be the chart of our present health insurance 
system. The doctor from Iowa has charted what the experience is for 
him. My wife tells me all the time what the paperwork and bureaucracy 
and back and forth and claims forms, the burden she carries as a 
patient, is like for her.
  One day I was a billing clerk in Jefferson University Hospital. I do 
workdays in other kinds of work, closer to what people in Washington, 
PA, do than what we do in Washington, DC. One of those workdays was in 
a hospital. First, I was an admissions clerk. I have seen admissions in 
a lot of hospitals, and there is this appalling experience of following 
somebody in a stretcher into the operating room saying, ``How are you 
going to pay for it? What's your Social Security number?'' Filling out 
the beginning of the forms.
  And then I spent some hours as a billing clerk with the piles of 
bills, 9 months old, inch-and-a-half files, not just going back and 
forth with the Government, but with Blue Cross-Blue Shield, Aetna, 
Prudential, private insurance, dealing with 1,250 different plans and 
all the different forms. How in the world can the billing clerks figure 
out how to translate the doctor's notes into a bill? They do not 
succeed. The plans send it back saying, ``You did not fill it out 
right, our categories are different from the Blue Cross or Medicare 
plan.''
  All those different forms. If we cannot have a simple claims form, 
simple standard system, simple information system--it does not have to 
be Government run. We put an amendment in the Labor Committee and the 
Finance Committee, that I pressed for and sponsored, which drew on the 
work from Senator Bond on the other side of the aisle and Senator 
Riegle on this side, that says the private sector can do the 
information system with standard measures.
  Finally, I want to say the people in Pennsylvania see through to the 
central point. If Members of Congress can arrange it for themselves but 
do not believe it is time to have it for the American people, then get 
off the Government trough, get off the present plan that enables them 
to be shielded from the experience that the American people have, cease 
enjoying this Federal benefit plan with guaranteed insurance.
  If they want to study it more--if they succeed in persuading us not 
to act now--if they want to study it more, then study it on a level 
playing field with those American people whose employer does not 
contribute and see what it is like to get health insurance in the 
private market.
  I say practice what you preach. If you really believe that should not 
be what is possible for the American people, then do not require it of 
your employer, the taxpayers of the United States. And if you want more 
study, then study it while you feel some of the heat and some of the 
hurt that the American people are feeling while we delay.
  They know, the people I have just been meeting with, just like 
justice delayed is justice denied, health care reform delayed is health 
care denied.
  Mr. MOYNIHAN. Mr. President, may I congratulate the Senator from 
Pennsylvania once again. As I keep track, every day of this debate he 
has stood up, added to the debate, and concluded with that point: 
Health care delayed is health care denied. It is unmistakable fact. We 
are deeply in his debt for keeping it before our eyes.
  Mr. President, I yield to the Senator from Michigan.
  The PRESIDING OFFICER. The Senator from Michigan is recognized.
  Mr. LEVIN. Mr. President, first, let me add my voice of thanks to the 
Senator from Pennsylvania in what he has done for this Nation, bringing 
this issue so dramatically to the Congress as he has in recent years. 
His being on the floor so constantly and his raising the issue of the 
importance, of the time urgency of this issue is a little bit 
reminiscent of a Senator from Wisconsin who used to be on the floor, I 
think, every day on the Genocide Convention, for year after year.
  Mr. MOYNIHAN. Senator Proxmire.
  Mr. LEVIN. Decade after decade, until finally this Senate ratified 
the Genocide Treaty.
  We see in the Senator from Pennsylvania the same kind of tenacity. We 
are going to get universal health care or he will be up here every 
single day of his career here reminding us that we have that 
obligation.
  Congress is famous for not being able to act quickly and 
expeditiously to meet some of the important problems of the day. But I 
have to tell you, when it comes to health care I think we are setting a 
new world's record. This is 50 years. We are told we are rushing to 
judgment? Fifty years ago, almost, Harry Truman sent messages to the 
Congress--I have them here and I am going to read from them in a 
minute--urging the Congress to adopt universal health care. We have 
been told how many hundreds of hearings we have had in our various 
committees, and we have, under the chairmanship of Senator Moynihan--I 
do not know how many hearings the Finance Committee has had. I do not 
know how many hearings Senator Kennedy's committee had. Together they 
total over 100 in the last 2 years alone.
  But this goes back for decades. This is an all-time record we are 
setting here for nonaction if we delay this again.
  Harry Truman sent up a message to the Congress in 1945. It was called 
Special Message To The Congress Recommending a Comprehensive Health 
Program. It was a Special message to the Congress, November 19, 1945, 
espousing the right to adequate medical care and saying the following:

       Millions of our citizens do not now have a full measure of 
     opportunity to achieve and enjoy good health. Millions do not 
     now have protection or security against the economic effects 
     of sickness. The time has arrived for action to help them 
     attain that opportunity and that protection.

  ``The time has arrived for action,'' that is 1945. He went on to say 
in his message:

       We should resolve now that the health of this Nation is a 
     national concern; that financial barriers in the way of 
     attaining health shall be removed; that the health of all 
     [all--all] its citizens deserves the help of all the Nation.

  That message went on to say:

       The American people are the most insurance minded people in 
     the world. They will not be frightened off from health 
     insurance because some people have misnamed it socialized 
     medicine.

  This is President Truman speaking:

       I repeat, what I am recommending is not socialized 
     medicine.

  He went on to tell the Congress.

       Socialized medicine means that all doctors work as 
     employees of Government. The American people want no such 
     system. No such system is here proposed.

  He could be writing in 1994.

       Under the Plan I suggest, [President Truman said] our 
     people would continue to get medical and hospital services 
     just as they do now on the basis of their own voluntary 
     decisions and choices. Our doctors and hospitals would 
     continue to deal with disease with the same professional 
     freedom as now. There would, however, be this all important 
     difference. Whether or not patients get the services they 
     need would not depend on how much they can afford to pay at 
     the time.
       I am in favor [he wrote] of the broadest possible coverage 
     for this insurance system. I believe that all persons who 
     work for a living, and their dependents, should be covered by 
     such an insurance plan.

  He wrote another message to the Congress. That was not the only 
message that President Truman sent to Congress. He kept trying and 
trying, too, just like Harris Wofford.

       The truth is [Harry Truman wrote] that all except the rich 
     may at some time be struck by illness which requires care and 
     services they cannot afford. Countless families who are 
     entirely self-supporting in every other respect cannot meet 
     the expense of serious illness.
       Although the individual or even small groups of individuals 
     cannot successfully or economically plan to meet the cost of 
     illness, large groups of people can do so.

  And the President wrote to Congress back then, in May 1947 when this 
message was sent:
       If the financial risk of illness is spread among all our 
     people, no one person is overburdened. More important, if the 
     cost is spread in this manner, more persons can see their 
     doctors and will see them earlier. This goal can be reached 
     only--

  President Truman wrote--

     only through a national medical insurance program under which 
     all people who are covered by an insurance fund are entitled 
     to necessary medical, hospital and related services.

  Fifty years later almost, we are moving in the wrong direction. We 
are actually seeing more and more people who are becoming uninsured. We 
are actually losing about one-half million people a year now from 
insurance coverage. So that about every 2 years, a million more 
Americans are losing health insurance. These are people who change jobs 
or now become ill or have someone in their family who has become ill, 
who are dropped from insurance, who become unemployed and, as has been 
pointed out so many times on this floor and it is so poignant and so 
dramatic, the great bulk of our uninsured 40 million Americans are 
working people.
  If you are on welfare in America, you are insured. You have health 
insurance if you are on welfare. If you work in America--if you work in 
America--you may or may not have health insurance. There is something 
wrong with that system, and we have to change it.
  We actually now have about 17 percent of Americans, most of them 
working, who do not have health coverage, and about 6 million children 
without health coverage. Fourteen years ago that figure was only 12 
percent. So that in the last 14 years, the number of uninsured 
Americans, the vast majority of whom are working people, has grown from 
12 percent of our population to 17 percent of our population
  Under the existing rules, many people lose insurance when they become 
sick. They lose insurance when they change jobs. They lose insurance if 
a family member becomes ill or if a family member loses a job. Forty-
six Americans lose health insurance every minute in America.
  At the same time this is happening, and partly because of it, health 
care costs rise at the rate of 10 percent per year, way above the rate 
of inflation; $1 of every $7 of our economy goes to health care. The 
average family spent more than $5,000 on health care in 1993, three 
times what they spent in 1980, and the situation worsens.
  Without reform of our health care system, the Commerce Department 
estimates that by the end of the century the average family will be 
spending $10,000 each year.
  As we debate details--and details are important and they are worth 
debating--but as we debate the details of the various plans before us--
so far the Mitchell plan and the Dole plan basically--we should remain 
focused on the principal goal, which is that every American be 
guaranteed health care that is affordable, health insurance which is 
portable from job to job and which they cannot lose. Every major 
country in the world does that for its citizens. We are the only 
advanced nation in the world that does not provide guaranteed health 
care for every one of its citizens.
  Universal coverage is central to reform for many reasons.
  First, simple justice. Again, every free democratic nation provides 
its citizens with a right to basic health care, at a cost which he or 
she can afford. But second, without universal coverage, prices are 
going to continue to rise sharply and costs are going to continue to be 
shifted to those who have insurance in order to pay for services which 
must be provided to those who do not.
  Reforms like portability, allowing a worker to take his or her 
insurance from job to job, and the elimination of those restrictions 
relative to preexisting conditions, are not workable without universal 
health care. The closer and the faster we get to universal guaranteed 
health coverage, the faster we are going to eliminate the shifting of 
costs, this bizarre situation which we have in America, where half of 
the people typically who come to our emergency rooms do not have 
emergency problems. The reason they are going there is because they do 
not have health insurance.
  I have visited emergency rooms across the State of Michigan. I went 
to the emergency room in Hurley Medical Center, in Flint. They had 
52,000 emergency visits last year; 34,000 of them not emergency cases. 
Think of the waste, the sheer waste of the present system in that 
hospital--34,000 of the 52,000 visits in that hospital in Flint, MI, 
are nonemergency visits. And they go to the emergency room, using the 
most expensive equipment we have, some of the most expensive talent we 
have, and multiply that by hundreds of hospitals across this country.
  Naturally, two different surveys reached different conclusions. GAO 
says 43 percent of emergency room patients do not have urgent needs. 
That is a GAO study. That is across the Nation. Why? They do not have 
insurance. They go to the emergency room because they cannot go to a 
doctor, to a clinic, because they do not have insurance. So they go to 
emergency rooms and use those facilities.
  According to a more recent National Center for Health Statistics 
study in March 1994, 55 percent of the 90 million emergency room visits 
in this country were not urgent. That is the current system. We have to 
change it. We cannot change that without universal coverage.
  I have a lady whom we have been trying to help in my office, who was 
covered by three different insurance policies. She cannot get any of 
them to cover her bills because each of them points to the other 
insurance company as being the principal company responsible. They all 
admit one of them is going to have to pay, but they all deny coverage 
and say go somewhere else. And the other company says go somewhere 
else.
  This is a woman who had three policies covering and cannot get them 
to pay, and this is for a serious illness that she has.
  We think the Mitchell bill is thick, and it is. As complicated as it 
is, she has a box of bills and a box of paper relative to her problem. 
The paperwork involving her illness makes this look like a single sheet 
of paper, this Mitchell bill. That is the current system where she is 
played like a ping-pong ball from company to company, each one 
acknowledging, ``Yeah, she's covered by someone but not us.''
  That is eliminated under the Mitchell bill. That cannot happen under 
the Mitchell bill. Those companies have to pay and then argue among 
themselves who it is who is ultimately responsible, and not force 
citizens of this country to be inundated, swamped with paper in the 
mail, which is meaningless paper and the ultimate in waste.
  How many folks go to a hospital and then open up the mail weeks later 
and get a ton of paper that says, ``This is not a bill.'' Most of the 
new people that we hire in the health field are clerical people, now in 
America, not providing nursing care, medical care and health care, but 
typing out forms.
  One insurance provider in my home State has 300 different varieties 
of policies. That is just one provider--300 versions of a health care 
policy. That is the current system.
  Mr. President, let me close with some numbers that relate to my home 
State of Michigan. We have about 900,000 people in Michigan that do not 
have health coverage. Over 700,000 of them are working people. About 
74,000 people in Michigan are losing their insurance each month. Those 
are the figures, the unacceptable figures, in my home State of 
Michigan.
  I received a letter the other day from a man named Bill Carr who 
lives in the western part of the State. It is addressed to me. It is 
regarding, in his words, a hurting Michigan family.

       Dear Senator Levin: A year ago, I lost my job. For 45 years 
     I worked and paid my dues. Through a quirk of time at the age 
     of 55, there was no work, no unemployment, no place to live, 
     and no medical insurance. During the next 365 days, my wife 
     and I lived a tenuous life. We lived in fear that one of us 
     would get sick, or worse, hospitalized, or God only knows 
     what. We went to County Services for the Unemployed and the 
     Underemployed. They put us on a rating schedule. In other 
     words, we paid according to our income. My wife did become 
     ill. The county treated her but did not know what was the 
     problem, and she ended up going to a hospital. I explained to 
     the hospital I was unemployed, and asked for treatment for my 
     wife. The hospital refused to even talk to a doctor and 
     turned us away.
       Today, we still have no insurance, even though I have been 
     working for 30 days. My wife is still ill, and still has not 
     been treated. We are in fear of cancer, but will not know 
     until 60 more days when our insurance kicks in and I can take 
     her to a hospital.

  That is the status quo. It is typical of too many letters that come 
into every one of our offices. Here is a man who, in his own words, 
represents a hurting Michigan family; in his own words, a man who paid 
his dues, who is now 55 years old and has lost his job. He then was 
reemployed, but now is without insurance and they are afraid that his 
wife has cancer. But they have to wait 60 more days. Only then will 
insurance kick in and he can take her to a hospital.
  That should not happen in America. We are better than that. We are 
strong enough, we are rich enough, we are decent enough so that need 
never happen in America.
  And Harry Truman, back in 1947, asked the Congress to end that kind 
of shame. He closed one of his messages to the Congress asking for 
universal health care with the following words:

       The total health program which I have proposed is crucial 
     to our national welfare. The heart of that program is 
     national health insurance. Until it is part of our national 
     fabric, we shall be wasting our most precious national 
     resource and shall be perpetuating unnecessary misery and 
     human suffering. I urge the Congress to give immediate 
     attention to the development and enactment of national health 
     insurance.

  So President Truman wrote in 1947. It has been true ever since. We 
should not delay another year, because that will lead to another decade 
and to another five decades before we end the shame of this kind of a 
letter, where a person cannot find out if he or she has cancer because 
they do not have insurance.
  I yield the floor.

                          ____________________