[Congressional Record Volume 140, Number 114 (Monday, August 15, 1994)]
[House]
[Page H]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: August 15, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
                          HEALTH SECURITY ACT

  The Senate continued with the consideration of the bill.
  Mr. MOYNIHAN. Mr. President, I believe it is the case that there is 
no time agreement at this point, and the Chair will simply recognize 
Senators as they seek recognition.
  The PRESIDING OFFICER. The Senator is correct.
  Mr. MOYNIHAN. I yield the floor.
  Mr. PACKWOOD. Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. WOFFORD. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The Senator from Pennsylvania is recognized.
  Mr. WOFFORD. Mr. President, I, first, commend the majority leader for 
his plan that beginning tomorrow, if necessary, we remain in session 
night and day to get this work done. For the people who do not have 
health insurance, they do not get to sleep easily at night. The people 
who are in fear of losing health insurance if they change a job, if 
they have a preexisting condition, they do not get much sleep at night. 
I think it is fitting that we not sleep at the switch and that we go 
ahead, and now that this is within reach that we reach it and get it 
done.
  Mr. President, fortunately, there are Republicans and Democrats who 
are working together seriously on real health reform, but there are 
others who want only to block action. They seem to think it will help 
them politically. They do not put it that way. Instead, they say we 
must slow down because health care is too big to tackle for this 
Congress. Instead of acting, they say we ought to study some more. Call 
it what you want, but as Shakespeare and the Senator from Ohio would 
say a filibuster by any other name would still smell like gridlock.
  Mr. President, we have had 6 decades of studies, rivers and mountains 
of studies. We do not need more study about what is wrong with our 
health care system. We need the backbone to face up to the special 
interests and take action to protect middle-class families from a 
health care insurance system which is out of control from those 
insurance companies who are charging them more and giving them less.
  But if they want to study health care, let them study it firsthand, 
personally and directly what it is like to be a middle-class family 
caught up in the health insurance mess. Let them study what it is like 
when your employer cancels your insurance and you have to go out and 
buy it on the open market. Maybe then we would get action sooner rather 
than later.
  That is why I warned the Senate last week that if the defenders of 
the status quo succeed in delaying action on health care I will propose 
an amendment to disqualify every Member of Congress from the Federal 
Employees Health Plan until we pass a health care bill for the American 
people. So I am saying support the plan you live under or live under 
the plan you support.
  Americans deserve the same kind of guaranteed coverage and choice of 
affordable private health plans that Members of Congress have arranged 
for themselves. Why? Because taxpayers foot the bill for our health 
coverage and Members of Congress do not have Government-run health 
care. They have a range of private health insurance options. They do 
not have a one-size-fits-all system. They have a consumer-choice 
system, more choice than most Americans are getting today.
  The Mitchell bill will make the Federal Employees Health Plan that 
Congress enjoys available to other Americans and make it a model for 
reform, Private health insurance that cannot be taken away. No 
exclusions for preexisting conditions--you take it from job to job. 
Affordable premiums paid by a shared contribution from employer and 
employee. A choice of doctor and health plans.
  And what about the Dole bill?
  First, unlike the Mitchell bill, the Dole bill will not put us on the 
path to universal coverage. It does not even pretend to.
  Second, unlike the Mitchell bill, the Dole bill is a green light to 
employers to shift billions of dollars in costs onto the backs of 
working families.
  Third, unlike the Mitchell bill, the Dole bill will not protect 
millions of people from being denied coverage because of preexisting 
conditions.
  Fourth, unlike the Mitchell bill, the Dole bill will not guarantee 
that when you leave your job, you can keep your health insurance. It 
will let the insurance companies keep loopholes that they use to cancel 
coverage when people change jobs.
  Fifth, unlike the Mitchell bill, the Dole bill will not guarantee a 
choice of doctor and health plan.
  And sixth, unlike the Mitchell bill, the Dole bill will prevent most 
Americans from joining the Federal Employees Plan available to Members 
of Congress.
  Beyond those fatal weaknesses, the Dole bill is especially punishing 
to older citizens and their families.
  Unlike the Mitchell bill, the Dole bill would take billions of 
dollars in the Medicare program without investing any of this money, 
these savings, into protecting older Americans.
  Unlike the Mitchell bill, the Dole bill has no coverage for 
prescription drugs.
  Unlike the Mitchell bill, the Dole bill has no coverage for long-term 
care in the home and community.
  Unlike the Mitchell bill, the Dole bill will not do anything to 
change today's absurd system that forces an older person to give up 
their life savings--and often their dignity--in order to pay for 
nursing home care and qualify for Medicaid, because it does not include 
a voluntary, long-term nursing home insurance program.
  Unlike the Mitchell bill, the Dole bill will let insurance companies 
charge older citizens up to four times more than everyone else.
  Of course, Americans are skeptical about health reform and about 
almost everything else we do in this body. After the millions that 
special interests have spent to mislead and misinform, to spread fear 
and smear, it is no wonder people are concerned. But they are even more 
skeptical about those in the insurance industry, not all but far too 
many, who are blocking this bill and who seem to exist to charge ever 
higher premiums and cancel coverage just when people need it most.
  And they ought to be skeptical of any so-called reform which does not 
crack down on insurance company practices and policy loopholes that 
leave middle-class families out in the cold. If the Dole bill is so 
good, why do so many of those naysaying insurance industry forces like 
it so much?
  Americans want to see a reform that protects above all middle-class 
families from losing the insurance they have today and a reform that 
puts us on the road to universal private health insurance coverage.
  They want to have the kind of affordable coverage and choice of 
private health plans that Members of Congress have arranged for 
themselves. The Mitchell bill does that. The Dole bill does not.
  Mr. President, there is hope for a truly bipartisan effort that will 
go a long way toward real reform. But to those who simply want to 
protect the status quo, to scare people about change, to use every 
tactic in the book to bring this reform effort to a grinding halt, I 
say you are on the wrong side of history.
  People are tired of Washington's finger pointing and game playing. 
They do not want this Congress to squander this chance. They do not 
want special interests to hijack this reform. And they certainly do not 
want their health security held hostage to anybody's political agenda.
  So on, Mr. President, night and day, let us go on to succeed in 
winning the battle that Harry Truman started nearly 50 years ago.
  I yield the floor, Mr. President.
  Mr. DURENBERGER. Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk the call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. GORTON. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. DURENBERGER. Mr. President, I yield to the Senator from 
Washington State as much time as he may require.
  The PRESIDING OFFICER. The Chair would announce the time is not 
controlled, so the Senator can be recognized in his own right.
  The Senator from Washington is recognized.
  Mr. GORTON. Mr. President, the challenge before the Senate is whether 
we will approve changes that will be positive, acceptable, and 
affordable to the American people, or, on the other hand, are we going 
to pursue remedies that serve Big Government political agendas and 
endanger the very system of care on which we all depend for our 
families' health?
  This debate is historical because it is about nothing less than the 
role of Government in the most intimate decisions and fearful moments 
in our lives--the times at which we are in need of urgent medical care 
to heal ourselves and those we love.
  From the outset, this Senator admits to a presumption against 
Government expansion into areas in which market forces can operate more 
effectively and cost-efficiently. I am not against Government, but I 
believe that it should be limited, as the Framers intended, due to its 
often unaccountable, expensive, arrogant, and sometimes oppressive 
nature. Consistent with that belief, I am convinced that the Senate 
should restrain itself from arrogantly approving sweeping measures that 
will have unpredictable consequences. The Senate should limit itself to 
those measures we know are likely to improve the financing and delivery 
of health care. In short, we should fix only that which is broken.
  I should like to begin briefly by stating my health care reform 
objectives and those of the people of Washington State, followed by a 
discussion of the majority leader's proposal, and then other 
alternatives to reach appropriate objectives.
  I have been on an odyssey of sorts in looking for solutions to the 
high costs and market distortions of our current health care system. I 
have sought ways to achieve broad bipartisan reform that truly 
expresses the diverse concerns of the American people without 
jeopardizing the quality and choice that makes American medicine the 
best in the world. In pursuing these goals I have kept the physicians 
Hippocratic Oath in mind: First we must do no harm.
  I have cosponsored proposals ranging from the earlier Chafee plan to 
the present Dole-Packwood proposal. While I have disagreements with 
elements of both plans, each includes principles that I believe will 
bring improvements to our health care system. While there is 
considerable disagreement over how we get there, there are good reasons 
that call us to act responsibly.
  We need health care reform because the increasing costs of health 
care threaten to bankrupt both our Government and our families. Too 
often families facing catastrophic illnesses must first spend down by 
selling their assets to qualify for public assistance. Due to 
demographics and unrestrained entitlement spending, health care 
spending is likely to absorb an increasing proportion of State and 
national budgets until it makes up 20 percent of the gross national 
product within the next decade.
  We need reform because too many Americans today do not have health 
care coverage. Millions of hard-working Americans are without health 
care insurance and their health expenses are paid for indirectly 
through a wide range of cost shifting.
  Here are my objectives to meet the twin goals of affordability and 
access to health insurance:
  We must allow workers to take their health insurance with them when 
they switch jobs. Too many Americans are locked in jobs because of a 
fear of losing good health insurance coverage.
  We must protect small businesses from oppressive employer mandates, 
while we help them provide health insurance for their workers. Our 
current Tax Code includes absurd disincentives to the self-employed and 
small businesses that want to insure their employees. We can and should 
give them the same purchasing power as big corporations and provide 
meaningful incentives for them to cover their employees.
  We must have meaningful medical malpractice reform dedicated to 
protecting legitimate victims of negligence and our legion of dedicated 
doctors and other health care professionals rather than providing 
unlimited business to trial lawyers. The average doctor has a 37-
percent chance of being sued at sometime in his or her career. The odds 
are an incredible 52 percent for a surgeon and an even greater 78 
percent for an obstetrician. Defensive medicine, the wasteful 
procedures performed to protect physicians from lawsuit, cost a good 
$25 billion in 1991. Meanwhile, the Rand Corp. found that legal costs 
account for 38 percent of medical liability claims and only 43 cents of 
every $1 spent on litigation reaches the injured patient. We cannot 
pretend to tackle waste in our health care system without meaningful 
medical malpractice reform.
  We must promote individual responsibility for the health our people. 
While our system provides access to the world's finest health care when 
needed, the obligation to take care of oneself and to avoid preventable 
illnesses is vital to relieving the current stresses in our health care 
system. In all the talk of how the Government can help with health care 
security, we have forgotten the obvious fact that individuals are first 
and foremost responsible for avoiding their own preventable illnesses.
  Similarly, we must promote preventive care so that our current 
system, which focuses on healing the ills, will save money by 
preventing illness in the first place. We must support biomedical 
research and the innovations in biotechnology that are an important 
basis for preventive care as well as for dealing ever more effectively 
with serious illnesses and disabilities.
  We must insure quality and choice for families when they make their 
health care decisions. From every corner of the Earth, people come to 
the United States for the very best medicine and care the world has 
ever known. They come to train in our medical schools that provide the 
best education and residency programs. They come for miracles that 
occur on a daily basis, and must not be taken for granted.
  Most importantly, we must acknowledge that increased coverage will 
cost money. To some that may be stating the obvious. To this Senator, 
the obvious deserves equal time in this debate.
  Similarly, we must acknowledge that our health care system provides 
millions of good jobs for individuals who have dedicated their lives to 
the health of others. We cannot ignore the impact on these jobs that 
some health care reform proposals will have.
  In addition, we must acknowledge the reality that our system of 
financing and delivering health care is radically changing as we slowly 
contemplate our own perhaps less proposed relevant changes. This 
Senator is convinced that by the time a national health care reform 
program is enacted, we will need to alter it just to keep up with a 
much more responsive and efficient marketplace.
  Just look at health care inflation. While inflation was among the 
primary reasons for demanding the reform of our health care system less 
than a year ago, it is now hardly mentioned because health inflation is 
at its lowest point in 20 years. Some inside the beltway assert that it 
is only the threat of Government action that has restrained health care 
spending. While the threat of Government-run medicine has caused some 
health care stocks to plummet, it is primarily employers tightening 
their belt, negotiating with insurers, and eliminating waste that has 
slowed the increase in health care spending. Again, the marketplace has 
responded to inefficiencies and high costs much more quickly than the 
Government could imagine.
  A major source of innovation and efficiency in the marketplace is the 
right of companies to self-insure. Self-insurance is possible only 
because of the Employee Retirement Income Security Act, or ERISA, which 
gives self-insured employers the flexibility to negotiate plan design 
without the expensive and explosive mandated benefits required by State 
governments. As my senior colleague from Minnesota so eloquently has 
informed us, ERISA has provided a national uniform rule that permits 
true competition in the health insurance marketplace to occur. Self-
insurance and ERISA are not broken and therefore need not be fixed in 
health care reform.
  Another example of market ingenuity that must be preserved and 
promoted in health care reform are medical savings accounts or medical 
IRAs. Under this option, employers establish an account for their 
employees to which they contribute monthly amounts for employees to 
spend on medical costs or premiums for health plans of the employees', 
not the employers, choosing. This promotes consumer awareness, value, 
and responsibility while guaranteeing flexibility and lower 
administrative costs for the employer.
  Here is what we must avoid: Government run medicine that turns 
decisions between a physician and his or her patient over to Government 
bureaucrats rationing care under a global budget. The more obstacles 
you put in the way of a decision by a physician to determine the most 
appropriate care for his or her patient and the application of that 
care, the more you jeopardize the quality and add to the costs of the 
health care received. That is simply the reality of centralized 
medicine illustrated by literally thousands of Canadians who come south 
each week to the United States to pay out of their own pockets for 
health care when and how they want it. The fundamental goal for reform 
must be market-based or it will not have my support or the support of 
the American people.
  Most importantly, we must not punish those States that have moved 
forward with health care reform, that have imposed new taxes, new 
regulations, new bureaucracies, and new mandates. My State of 
Washington has enacted a comprehensive plan for which the details are 
still being worked out. Enormous change is underway that may be 
positive or negative depending on the substance and timing of Federal 
and State action. Careful consideration must be given to these States 
so that ultimately their citizens do not pay twice for health care 
reform.
  My goals are ambitious and my concerns are many. They are the product 
of an extensive listening process to the people of Washington State for 
the last 3 years. People, who, like the rest of the Nation want 
positive, affordable, and acceptable changes in our health care system. 
They, too, are skeptical that the current proposal by the majority 
leader will meet those goals and address those concerns.
  My first impression of the 1,400-plus page Mitchell health care 
proposal reminded me of Mark Twain's description of how Tom Sawyer felt 
when he first approached that ``thirty yards of board fence nine feet 
high.''

  Now, we all know how Tom finished the job. He convinced everyone who 
stopped by that this was the finest chore imaginable, almost a historic 
opportunity. Sooner or later, all the neighborhood kids were swapping 
their treasures just so they could have at that fence.
  The Senate has before us in the Mitchell bill an enormous board 
fence. The question is, in this case, do we have to whitewash the 
fence, or do we need to construct another fence altogether? After 
examining the costs, new bureaucracies, mandates, taxes, malpractice 
provisions, and regulations in this proposal, this Senator is convinced 
that reconstruction, not whitewash, is the only practical solution. 
This proposal is simply not affordable, constructive, or acceptable to 
the American people.
  The Congressional Budget Office, the umpire given the dubious task of 
judging the economic impact of the majority leader's health care plan, 
recently came to the same conclusion. It found that between 1997 and 
2004, the subsidy program to cover 26 million people in the Mitchell 
bill would exceed $1 trillion. The annual cost of this premium 
assistance would average $100 billion annually, or approximately $3,850 
per person currently without insurance. In only its second year of 
operation, this new entitlement program would the third largest Federal 
expenditure behind Social Security and Medicare.
  Assuming that these projections are correct is itself a risky 
venture. Keep in mind that actual costs for Medicare spending in 1962 
were 10 times higher than estimated. In any case, such an announcement 
came during the same week in which the Bipartisan Commission on 
Entitlement and Tax Reform announced its dire predictions of the future 
under our present spending habits, including the following:

       In 2012, unless appropriate policy changes are made in the 
     interim, projected outlays for entitlements and interest on 
     the national debt will consume all tax revenues collected by 
     the Federal government.

  Of course, that did not include any of the new entitlements in this 
bill.
  Yes, expanded coverage through subsidies will be expensive, but an 
even more important question is whether we would get our money's worth 
and a guarantee that this is not just another major expansion of 
government? We need to help make health insurance affordable to those 
in need, but another open-ended entitlement program is clearly not what 
the country needs or can afford. Difficult choices lie ahead, but the 
option of having the American taxpayer forking over more hard-earned 
pay is not an appropriate one. Everywhere but on Capitol Hill it is 
obvious that this option is not affordable. We can do better. CBO's 
analysis of the tax increases called for in the Mitchell plan raises 
serious doubts as to the plans level of acceptability to the American 
taxpayer. Of particular concern is the 25-percent excise tax on high-
growth premiums. CBO found that the tax:

       * * * would be difficult to implement. In addition, its 
     contribution to containing health care costs would be 
     limited, and it might be considered inequitable and an 
     impediment to expanding coverage.

  What CBO has found is simply common sense. Those plans which 
currently are efficient and carry low costs will be penalized 
significantly more than those plans that are wasteful and expensive. In 
an effort to protect constituencies with Cadillac health care plans and 
to avoid a blatant tax cap, the majority leader suggests we punish 
those who have succeeded in keeping their costs low. CBO concludes:

       Such an assessment would increase premiums, and higher 
     premiums would discourage participation in the voluntary 
     period.

  In other words, we may pay more and get neither cost control nor 
expanded coverage. That is not acceptable to the American people. These 
are tax increases which I believe to be unnecessary. And any tax 
increases certainly should have to be justified by achieving their 
intended ends.
  We have often heard proponents of employer mandates make the 
following argument: Since our current health care financing system is 
employer-based, why not take it one step further and demand that all 
employers pay for health insurance and then give it a nice term like 
``shared responsibility.'' They neglect the obvious and vital fact that 
employers offer voluntary employer-based system insurance to attract 
and keep employees. That is like ignoring the difference between a 
draft and a volunteer army. It is not subtle; it goes to the very 
difference between market forces and Government mandates.
  The results of our voluntary system have been impressive. In 1992, 
employers spent $252 billion for health benefits. Outlays for all 
health benefits have increased as a proportion of total compensation 
from 1 percent in 1960 to 7 percent in 1992. Even so, that is not good 
enough for advocates of employer mandates.
  The goal of universal coverage in the majority leader's proposal 
rests on the false security of an employer mandate that would kick in 8 
years from now and cover not only employees but their dependents as 
well. Although the mandate is claimed to be conditional on less than 95 
percent coverage, it is actually inevitable due to another mandate: the 
one-size-fit-all benefits package. By forcing conformity to essentially 
one product, those employers who could not afford that product would 
simply opt out--increasing the number of uninsured.
  The employer mandate does not affect the employer as one might 
imagine--it will be the employee who suffers. Even CBO agrees that:

       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.

  Moreover, the employee mandated share--50 percent--would amount to 
new payroll tax of up to 8 percent. How the individual mandate is 
enforced or monitored by the employer is a question the majority leader 
does not answer.
  One needs to look no further than my own State of Washington to see 
the impact that employer mandates and mandated benefits packages will 
have on the job force. There small businessmen and women are preparing 
for an estimated 70,000 lost jobs by the time the State health care 
reform is fully implemented in 1999. While proponents espouse subsidies 
as a relief for small business, the reality is that most entrepreneurs 
do not care for assistance, do not believe that the funds will be 
there, and would rather go broke before taking their own tax money from 
the Government.
  We must improve our current voluntary system by establishing 
purchasing cooperatives to ease the administrative and financial strain 
of finding health coverage for employees. Small businesses should have 
the same tax incentives to purchase health insurance as large 
corporations and be allowed to organize to their similar purchasing 
power. While some may argue that an employer mandate is a simple small 
step to universal coverage, this Senator simply does not accept the 
idea that we must trade jobs for health care reform.
  While the new taxes, mandates, and costs of the Mitchell plan render 
it neither affordable or acceptable to the American people, it is the 
exceptionally large new role of Government bureaucracies weaved 
throughout the entire measure that alarm me the most. In its report, 
CBO acknowledges that:

       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 
     mechanisms developed, and new institutions and administrative 
     capabilities created.

  While the majority leader claims that this bill is based on a private 
system of delivery, his proposal creates no fewer than 50 new 
bureaucracies, including a National Health Benefit Board, State Risk 
Adjustment Organizations, Health Plan Service Areas, Prescription Drug 
Payment Review Commission, National Council on Graduate Medical 
Education, National Advisory Board on Health Care Workforce 
Development, Healthy Students-Healthy Schools Interagency Task Force, 
United States-Mexico Boarder Health Commission, Health Information 
Advisory Committee, Mandatory State-based Alternative Dispute 
Resolution, Compliant Review Offices per each area, and the National 
Health Care Cost and Coverage Commission, just to name a few.
  Only after reviewing the duties and obligations of these new offices 
can one truly begin to understand the scope of radical change and 
expansion in the Government's role in health care we are contemplating. 
Some advocates of Government-run medicine believe that if you just 
``build it they will come''--that somehow if you build an 
infrastructure of bureaucracies you can address all the needs of the 
people more efficiently than they can themselves. This Field of Dreams, 
however, is clearly a nightmare that should never be built.
  CBO concludes with the following understatement:

       There is a significant chance that the substantial changes 
     required by his proposal--and by other systematic reform 
     proposals--could not be achieved as assumed.

  In other words, these enormous and expensive changes may not prove 
positive.
  As I have noted, this Senator is not anti-Government--I simply 
believe that Government must be limited and that empowered individuals 
can usher in positive change more readily than mandates and big 
Government. I subscribe to the theory Jefferson expressed when he 
wrote:

       I know no safe depository of the ultimate powers of society 
     but the people themselves; and if we think them not 
     enlightened enough to exercise their control with a wholesome 
     discretion, the remedy is not to take it from them, but to 
     inform their discretion.

  We can address the shortfalls of our current system without creating 
an unprecedented growth in Government to control more and more elements 
of our health care decisions.
  As I stated earlier, meaningful reforms in our medical malpractice 
system are a prerequisite for my support of any plan. The current 
medical malpractice system serves neither legitimate claimants or 
defendants well and is a source of unnecessary expense and waste in the 
health care industry. Only 43 cents of every dollar spent in medical 
malpractice litigation reaches injured patients, while the price of 
defensive medicine may well add as much as $25 billion to our national 
health care spending every year. Comprehensive medical malpractice 
reform could save as much as $35 billion over the next 5 years by 
curbing premium cost increases and many defensive medical practices.
  The rear of frivolous malpractice cases and real increases in 
malpractice insurance premiums is taking a toll. The Institute of 
Medicine concluded in 1989 that the traditional tort system is a slow 
and costly method of resolving obstetrical disputes and that it 
contributes to the disruption of the delivery of obstetrical care in 
this Nation, especially in rural areas. Almost one out of eight 
obstetrician/gynecologists has dropped obstetrical practice as a result 
of liability risks. One study found that increasing liability costs and 
threats have led 70 percent of physicians to order more consultation, 
66 percent to order more diagnostic tests, 54 percent to order more 
follow-up visits, and 28 percent to perform procedures they ordinarily 
would have delegated to other medical personnel. For health care 
providers, a frivolous or meritless malpractice claim can lead to 
personal and professional ruin.
  Considering that the Washington Post reported by last April 20 that 
the majority leader was inclined against including medical malpractice 
reform in health care reform, I was pleased to see a section dedicated 
to it in his proposal. Unfortunately, after I reviewed the sections--
providing open-ended litigation, and an entire new source of remedies--
I concluded that these provisions alone would be reason to oppose the 
entire measure.
  Instead of limiting the waste that zealous attorneys bring to our 
health care system, the Mitchell plan offers endless opportunities for 
trial lawyers to seek more causes of action and deeper pockets. He 
proposes State-mandated alternative dispute resolution mechanisms that 
have not been proven to save significant ligation costs, but do keep 
lawyers employed. He proposes certificates of merit that unfortunately 
are as easy to produce as an expert witness. He allows for periodic 
payments and studies on medical negligence, medical guidelines, and 
enterprise liability. Finally, the majority leader proposes limitations 
on attorney's fees at a level which regrettably only reflect the status 
quo.
  But an entire new section on remedies for claims disputes will bring 
a smile to every medical malpractice plaintiffs' lawyer in America. 
Under the majority leader's plan an entire new source and process for 
remedies is mandated on the States. Section 5502 dictates that each 
State:

       shall establish and maintain a complaint review office for 
     each community rating area established by such State.

  Throughout the remedies sections, the Mitchell bill ignores attempts 
to deter frivolous cases by providing for ``reasonable attorney's fees, 
reasonable expert witness fees, and other reasonable costs relating to 
such action.'' Section 5505 provides new civil money penalties 
available from the Department of Labor.
  On top of all that, complete judicial review in a court of law is 
available, as well as private rights of action, in case the responsible 
bureaucracies do not pursue certain claims. Essential community 
providers are provided civil and administrative causes of action for 
``failure of a health plan to fulfill a duty imposed on the plan.''
  In a bizarre attempt to blur the doctrine of separation of powers and 
preempt a court's discretionary powers, section 5540 provides that the 
U.S. District Court for the District of Columbia, which has original 
jurisdiction over constitutional challenges to the measure,

       may not grant any temporary order or preliminary injunction 
     restraining the enforcement, operation, or execution of this 
     Act or any provision of this Act.

  In addition to these measures, the Mitchell provisions relating to 
discrimination include some unprecedented litigation opportunities that 
may render the entire health care system unworkable. It is worth 
restating the entire section. Section 1602 provides that:

       The Secretary of Health and Human Services, and any State, 
     health plan, purchasing cooperative, employer, health program 
     or activity receiving Federal financial assistance, or other 
     entity subject to this Act, shall not directly or through 
     contractual arrangements--
       (1) deny or limit access to or the availability of health 
     care services, or otherwise discriminate in connection with 
     the provision of health care services; or (2) limit, 
     segregate, or classify an individual in any way which would 
     deprive or tend to deprive such individual of health care 
     services, or otherwise adversely affect his or her access to 
     health care services; on the basis of race, national origin, 
     sex, religion, language, income, age, sexual orientation, 
     disability, health status, or anticipated need for health 
     services.

  The section provides further that the section will apply, but is not 
limited to, the determination of the scope of services provided by a 
health care plan, and the provision of such services and determination 
of the site or location of health care facilities.
  This section would have two predictable effects that undermine the 
entire delivery of health care and many unpredictable ones that will be 
litigated endlessly. First, a provider would always be vulnerable to a 
lawsuit if it chose to deny care that it felt was inappropriate or 
decided on a course of treatment that was not preferred by the patient. 
The result is the formation of an even more costly health care system 
based entirely on defensive medicine.
  Second, for the first time, discrimination based on health status, 
anticipated need for health services, language, income, and sexual 
orientation would be actionable grounds for Federal civil rights 
claims.
  Instead, we should pursue caps on noneconomic damages at $250,000, 
several liability for noneconomic and punitive damages, periodic 
payments, the collateral sources rule, limits on contingent attorneys 
fees, statutes of limitation, and effective consumer protection. 
Instead of weakening the relationship between doctor and patient by 
encouraging malpractice claims, we should strengthen the relationship. 
Instead of leaving injured patients at the mercy of attorneys and the 
courts, we should provide mechanisms for quick and fair relief.
  The medical malpractice reform provision in the Mitchell bill provide 
clear examples of why the American people want us to proceed with 
caution in health care reform. They will make changes for the worse, 
cost more, and cripple a legal system already under strain from too 
much litigation.
  My greatest concern is that the Mitchell plan will leave the people 
of the State of Washington paying twice for health care reform either 
through the new taxes, mandates, regulations, or additional layers of 
bureaucracy. Of particular concern is the tax on growing health care 
premiums that punish States like Washington which now have lower health 
care costs than average that will inevitably rise under community 
rating. The 1.75-percent tax on all plans does not spare Washingtonians 
who have already paid taxes for health care reform. As our State plan 
is implemented, this Senator will insist that the cumulative Federal 
and State changes ultimately provide changes that are positive, 
acceptable, and affordable to the people of Washington State and do not 
charge them twice for the same services.
  Regrettably, all the whitewash in the world will not cover up the 
taxes, mandates, and bureaucracies. We need to build a different fence. 
Fortunately, there are other fences from which to choose.
  In the next 10 days, my colleagues from New Mexico, Georgia, and 
elsewhere intend to introduce a Bipartisan Health Care Reform Act 
similar to the Rowland-Bilirakis measure in the House of 
Representatives. Unlike other proposals, the American people can at the 
very least trust its title.
  This market-based, voluntary proposal builds on wide areas of 
agreement among members both Liberal and Conservative, Democrat and 
Republican. It focuses primarily on that which is broken in our health 
care system.
  Specifically, it includes health insurance reforms so that employees 
won't lose coverage when they switch jobs. It limits preexisting 
condition exclusions and provides additional safeguards against harmful 
insurance practices. Employers would be required to provide, but not 
pay for, at least two options--a standard coverage and one high-
deductible plan. Medical savings accounts would also be an option.
  Small employers would be enabled to gain the same purchasing power as 
large corporations for the purpose of purchasing affordable health 
insurance for their employees. Medical malpractice reform, 
clarification in antitrust laws, fraud and abuse control, and 
administrative simplification aim to lower wasteful health care 
spending. The cost of the plan is estimated to be approximately $140 
billion over 5 years, a fraction of the majority leader's proposal. 
Savings in Medicare and Medicaid are intended to make the plan budget 
neutral.
  Quality and choice are preserved under this measure. Employers will 
not lay off employees due to coercive mandates. It does not trade jobs 
for health care. It helps those in need get assistance through limited 
subsidies. The entire spending side of the proposal is subject to a 
fail-safe mechanism that ensures an affordable outcome. This is a bare-
bones, market approach for the 1990's--not a big government, taxpayer 
financed boondoggle of the 1960's.
  Will it solve all the problems in our health care system overnight? 
Probably not. It does not pretend to. Is it revolutionary or radical? 
No. It builds on the successes of American medicine. It recognizes that 
market forces in the health care industry are moving more rapidly than 
we can respond. It recognizes that open-ended entitlements and employer 
mandates are not the legacy we want to leave our children.
  I am anxious to see the cost estimates for this proposal from the 
Congressional Budget Office. Meanwhile, my impression is that it is the 
kind of health care reform that the American people will find to be 
positive, acceptable, and affordable. In fact, this proposal seems to 
build on the Better Access to Affordable Health Care Act of 1991 
introduced by then-Senator Bentsen and Representative Dan Rostenkowski, 
which I cosponsored in the Senate.
  The sponsors of the Bipartisan Health Care Reform Act truly reflect 
the concerns of the American people. They are fiscal conservatives 
devoted to improving the health security of American families. I trust 
their motives, commend their dedication for positive changes in health 
care, and look forward to hearing their arguments.
  While advocates of more radical health care reform have called 
for immediate and revolutionary changes in our health care system, this 
Senator advises his colleagues to take a different course. Now is not 
the time for hurried consideration or blind faith in complex redesigns 
of something as important as our health care system. Now is the time 
for humility, not hubris.

  As Adam Smith wrote in the Wealth of Nations:

       It is the highest impertinence and presumption, therefore, 
     in kings and ministers to pretend to watch over the economy 
     of private people, and to restrain their expense. They are 
     themselves always, and without exception, the greatest 
     spendthrifts in the society. Let them look well after the own 
     expense, and they may safely trust private people with 
     theirs.

  Now is the time to trust the American people, who are making it 
overwhelmingly clear that radical exchange in their health care system 
is not their desire. The cameras are on and they cannot be fooled. They 
know that ``shared responsibility'' means mandates. They know 
``contribution'' means ``tax.'' They know that a product of a 
conference committee that rejects the consensus of a Chamber should be 
rejected. More than ever, and some for the first time, are watching 
because they are rightly concerned that we will do the very harm they 
want us most desperately to avoid.
  Mr. President, I urge my colleagues once again to heed the words of 
my constituents for whom the future impact of some types of health care 
reform is happening now. Kim Ward, a small business owner in Kirkland, 
WA, offers the following advice:

       If there is one thing that I could pass along to the Senate 
     it would be--take your time. It is important that the things 
     Washington State is currently doing * * * be done prior to 
     passing any law. If Washington State had talked openly about 
     health care, its effect on business and their employees, the 
     outcome may have been different than the law passed. 
     Currently, everyone is trying to figure out how to fix the 
     current law.

  Mr. President, you and I both know that you can not fix comprehensive 
health care reform once it passes and impacts one-seventh of the 
Nation's economy. We have only one opportunity to do health care 
reform, and we must do it right or not at all. Right is more important 
than fast.
  Mr. President, most of this I wrote or thought about before the 
remarks by the majority leader early this evening. Those remarks and my 
own I think are even more relevant at this point. This Senator is 
absolutely convinced that the proposal before us, all 1,400 pages, can 
only be passed if the people of the United States do not know what is 
included in it. They do not want the radical changes and 
governmentalization of this proposal. They want it and its alternatives 
thoroughly discussed. They want it discussed in the light of day, not 
in the middle of the night. They want to be able to have an influence 
over the major elements in that debate on amendments, on proposed 
changes, on total and complete substitutes.
  Overwhelmingly, their advice to us is to make certain that we get it 
right the first time, not to pass something that we do not understand 
and they do not understand. If it takes another year to do it right, 
the American people want us to take another year. If we can take some 
steps forward now, if we can do some things to improve our health care 
system, they wish us to do it. But they do not wish the Senate of the 
United States, which alone of the bodies of our Government has the 
power, the authority, the right, and the duty to deliberate carefully, 
to pass this bill by the end of this week or the end of next week 
before the American people understand it at all. They want us to do 
this job right, and it is far more important to do it right than to do 
it fast.
  Mr. DURENBERGER addressed the Chair.
  The PRESIDING OFFICER (Mr. Robb). The Senator from Minnesota is 
recognized.
  Mr. DURENBERGER. Mr. President, before I yield the floor to the 
Senator from Texas, may I make an observation as follows? Other than as 
a very small child when my grandfather worked for the then Great 
Northern Railroad and used to take me on trips to the great Pacific 
Northwest, I think about 1984 was the very first time that I returned 
to Washington State. I was there at the invitation of the then junior 
Senator who just finished speaking. I was there to talk about health 
care, and I was there to listen on the issue of health care because he 
was persistent that I do. I was impressed by the time and quality of 
the people in the State of Washington to health care and health care 
reform, and especially the quality of the commitment of the Senator who 
has just finished speaking.
  I have not yet in this debate heard an explanation of what is at 
stake in health care reform that has been quite as complete, quite as 
thorough, and quite as on the point than the one we just heard.
  I have welcomed the work of our colleague from Washington in 
everything that we have done in health care reform. And as he has 
pointed out, he has been in the middle of the debate in an ideological 
or philosophical sense. He participated with us though the mainstream 
having worked with Senator Dole on his bill and now having expressed an 
interest in the similarities all of these bills have to what is in the 
House bill. I think out of that should come a message not only to the 
people of America but to the people of this Chamber as to where the 
consensus lies if we are to do health care reform this year.
  I would suggest that the majority leader, and others in a position to 
do so, could do worse than open up the Congressional Record tomorrow 
morning and read the statement by our colleague from Washington State, 
and take his advice. He has been sent here by the people of that State 
because they are trying to do reform in the State of Washington. I 
think they passed legislation, as he pointed out. But they, as the 
people in Minnesota, recognize that you cannot do this a State at a 
time. We need a set of national rules by which health care markets can 
work. As he has already pointed out, it is impossible to believe that 
we need this much ruling from the National Government.
  Mr. GORTON addressed the Chair.
  The PRESIDING OFFICER. The Senator from Washington.
  Mr. GORTON. Mr. President, I thank my dear friend and colleague from 
Minnesota for those kind remarks.
  As he knows, I have relied very greatly on him for advice during the 
course of not just this debate this year, but, as he knows, for the 
last 2, or 3, or 4 years during which we have tried to work on this 
issue. I suspect he shares the view that every time we work out a 
conflict and we have correctly answered one question, we find two or 
three other questions popping up. And the more we learn about this 
issue the more humility we have about it, and the more we want to make 
sure that we are absolutely right with every step that we take forward 
because we are dealing with perhaps the most profound of the concerns 
of each of our constituents.

  Mr. DURENBERGER. Mr. President, I yield such time as she may require 
to the Senator from Texas.
  The PRESIDING OFFICER. The Senator from Texas is recognized.
  Mrs. HUTCHISON. Thank you, Mr. President.
  Mr. President, the health care industry constitutes one-seventh of 
our Nation's economy. That cold fraction represents millions of jobs, 
and the livelihood of millions of families in our country. But even 
more sweeping is that every American's quality of life is at stake in 
this debate. The excellence and availability of health care determines 
the quality of American life.
  I have heard so many moving stories of people struggling with 
illness, and I want to mention some of them. A Florida man employed 
seven people in his furniture store. Over the last few years his health 
care premiums have increased dramatically. Last year, he learned that 
he could no longer insure all of his workers because two of his 
employees had become high risk due to their older age.
  A nurse here in Washington said that when a little boy asked her to 
sit with him during a chemotherapy session she had to leave that little 
boy alone to go to a mandatory class on how to fill out a form that had 
no direct bearing on the health of the children she was treating.
  An elderly couple in New Hampshire had to sell food out of their 
refrigerator to pay for their medicine. Another woman had to quit her 
job and go on public assistance in order to afford expensive treatment 
for her sick son.
  Another couple had a sick child, and their only source of insurance 
was one of their parent's employers, forcing the employer to either let 
that employee go or raise the insurance premiums on all 20 of that 
firm's employees by $200.
  Do these stories sound familiar? They are all true, and they are all 
tragic. And they have all been told by the President of the United 
States in an attempt to incite a revolution that would cause a radical 
change in American life. These stories are a legitimate cause of 
action. They call for responsible actions, not impetuous experimental 
upheaval.
  These sad stories should not be used to argue that a good but 
imperfect system should be destroyed. They should be used as an 
incentive to perfect the system.
  Let me put this in perspective. Eighty-five percent of the American 
people have health care coverage, and most are happy with it. Of those 
who are uninsured, almost half will be covered within four months, and 
every plan introduced in this Congress would allow them to have 
continuous coverage. President Clinton, Senator Mitchell, and 
Congressman Gephardt are asking the question, how can we bring the 
other seven or eight percent into the system? I think the better 
question would be how can we bring the other 7 or 8 percent into the 
system without harming the quality for the 85 percent now covered?
  These are two very different questions, and they produce very 
different answers, as you can see, when you compare the Mitchell plan 
to the Dole plan.
  The Clinton, Mitchell, and Gephardt plans have all a universal 
feature. They put universal coverage above everything, including 
quality of care. What will our universal coverage buy us under these 
systems? Is it the Canadian system, the system where you must wait 6 
months for a heart bypass operation, 9 months for cataract surgery, 3 
months for a mammogram?
  What about the woman who wrote of her experience having a baby in 
Canada? There was only one anesthetist in the hospital. Since there was 
an emergency surgery in progress, when she went into labor he was not 
available. By the time the emergency surgery was over, it was too late 
to help the woman having the baby.
  In America, any woman, regardless of coverage, can have anesthesia if 
she wants it when she is having a baby. That is because we have the 
best quality available.
  I experienced this firsthand when I was a volunteer, a Red Cross 
nurse's aid, at Ben Taub Hospital in Houston, TX. Ben Taub was the 
charity hospital. I worked in the labor room taking their blood 
pressure, holding their hands, trying to make the women in labor more 
comfortable before they received anesthesia and went into delivery. The 
care they got was excellent. And it made me proud that in America 
everyone would be treated so well.

  Mr. President, supporters of the Clinton-Mitchell plan say they want 
universal coverage. That is a noble goal and one that I share. But let 
us look at the method for achieving that goal.
  The most important feature is mandates--employer and individual. What 
is wrong with mandates? Well, for one thing, they do not work. The 
Government of Canada mandated universal coverage, but Canadians do not 
have it. The government of Hawaii mandated universal coverage, but 
Hawaiians do not have it. Now the Government of the United States is 
debating a mandate and even its biggest proponent, President Clinton, 
admitted recently that it will not provide universal coverage here 
either. So why would we tear down our system for a goal of universal 
coverage when we know it cannot be achieved?
  The President talked about employer mandates, to make everyone who is 
not an employer feel safe under the Clinton-Mitchell plan. But no one 
would be safe. An employer mandate is really a tax on employees. Many 
small business owners have told me that it will affect what they can 
pay in wages. The legacy of the Clinton-Mitchell plans would be more 
unemployment, less income, and less output.
  The American people know what is best for their own families. If we 
make health care coverage accessible, affordable, and portable, those 
who have coverage now can keep it, and more will be able to come into 
the system and buy it. The American people are sick and tired of having 
decisions made for them by the Federal Government.
  The individual mandates in this bill are onerous because the 
individual will be required to either contribute to an employer-offered 
standard benefit package, or individually purchase and fully pay for 
that standard package. The choice of what is best for you and your 
family will be taken away by this Government mandate.
  Why are the Clinton-Mitchell bills so unresponsive to our Nation's 
needs? I think the answer is that the administration has failed to 
target the problem in our system. A faulty diagnosis leads to a harmful 
cure. So what are the real problems? I believe the major one is 
underinsurance. Eight to 15 percent of Americans have no insurance. 
Many have partial insurance that excludes serious, often expensive, 
major ailments. Both of these groups face severe financial costs if 
their conditions get worse. That is the major problem: not enough 
insurance.
  There are other problems in our system: a malpractice explosion, too 
little prenatal and preventive care, and doctors and hospitals that are 
too far removed from rural Americans. We will be discussing these and 
others over the next couple of weeks, and I will support bills and 
amendments to address these problems. But the simple problem is access 
to care and access to insurance.
  Before we rush to recommend a cure, we should examine the healthy 
parts of our system and make sure we protect those healthy parts. The 
Hippocratic oath that doctors have taken for centuries says, ``primum, 
non nocere: first do no harm.'' So we need to look to our strengths and 
make sure to protect them.
  In spite of its flaws, our hope is to improve the system. The United 
States does have the greatest health care system in the world and the 
finest doctors in history. We have the most advanced medical 
technology, the best drugs, the most intense research, and the best 
medical training. People from every other nation on Earth come to 
America for serious medical treatment because they know it is the best.
  Our colleague from Georgia, Senator Paul Coverdell captured this 
truth a few months ago when he said, ``If you are a cancer survivor, it 
is because, by the grace of God, you live in the United States of 
America.''
  Many of our colleagues have related experiences with constituents 
during this debate and I had one, too, that illustrates this point. I 
was at a town hall meeting in Irving, TX, and a beautiful, poised young 
woman, who was the picture of health, revealed that she had just 
survived a colostomy, another grave ailment, and she must wear 
equipment 24 hours a day for the rest of her life. None of this was 
apparent. She looked like any other person in the room, except that she 
was drop-dead gorgeous. I asked her to come to the front of the room so 
everybody could look at her as a walking symbol of the health care 
system in America.
  Good quality also requires competition. That is the secret of our 
economy and why we are the strongest Nation on Earth. That is why we 
have been able to develop the best health care system in the world. 
Competition works throughout the system. Students compete to get into 
medical school, and the brightest are the only ones that get in. 
Medical schools compete for those students, and the results of this 
competition is outstanding medical training. Doctors compete for 
patients, hospitals and HMOs compete for doctors, and again the system 
rewards quality.
  This is not the first time that a nation built on competition has 
seen one segment of its society try to abolish competition. But it may 
be the most dangerous.
  Why do you think most companies now offer health insurance? It is not 
because of a Government mandate. Companies compete for workers. They 
offer health insurance because it is a good way to attract them. If it 
is customary for many Americans to purchase health care through their 
employers, it is not surprising that you will find that many uninsured 
people are among the unemployed. The latest estimates tell us that 58 
million people are uninsured for an average of less than one month in a 
year. Half of all uninsured spells last less than 6 months, and three 
quarters last for less than a year. So among the chronically uninsured 
are those who do not file income taxes and do not have mailing 
addresses. We all know that if they walk into an emergency room, they 
will get care. But as for insurance, no version of the Clinton bill 
will cover them, and everyone knows it.
  I represent a State that is largely rural. My constituents and their 
farms and ranches in the small towns across Texas are concerned that 
they have access to regular care without the burden of traveling to one 
of our large cities. The Mitchell bill has some good provisions aimed 
at helping rural Americans. But it also needs other parts to be added 
to really help rural America. The Mitchell bill lacks complete 
deductibility of insurance premiums for self-employed citizens. It 
lacks medical savings accounts which would help everyone, but 
especially those in rural areas. It hurts rural small businesses by 
outlawing their self insurance. It would punish good insurance plans 
that seek to expand into rural areas.
  The Mitchell bill also contains massive new taxes. There is a 1.75-
percent tax on every American health insurance plan. The Mitchell bill 
levies a 25-percent excise tax on high-growth plans.
  If you had any doubt about claims that the Mitchell bill would harm 
quality, lay them aside. It taxes quality. If the cost or value of a 
benefit plan exceeds the target growth rate, that plan will be taxed. 
So if you go beyond the Federal cookie-cutter benefit plan, a 
confiscatory 25-percent tax is levied. Studies show that taxing 
benefits does not control health care costs. It simply shifts more of 
the Nation's health care bill onto the middle class--the middle class. 
They seem to get it every time.

  Benefits have always been designed to attract employees. But the 
Mitchell bill says loudly to employers: Do not be generous with your 
employees or the Government will punish you. This is a step backward 
from health reform.
  Let us look at some projections about Clinton-style health care in 
the future. Last winter a staff report from the Joint Economic 
Committee projected that, in addition to the new taxes it would need 
now, it would run out of money so fast that Congress would face the 
following choices by the year 2000: Increase the deficit by $426 
billion, or a $3,500 tax on every family in America, or a 15-percent 
payroll tax on every business in America, or rationed health care.
  None of us wants to face that kind of choice, and we can stop that 
choice from happening today and this week and when we pass the bills 
that we are taking up right now and will be debating for the next few 
weeks.
  If you look at the taxes and mandates in this bill together, you will 
see the full burden of the Clinton-Mitchell health care plans on 
business. The Heritage Foundation found that in the first year of 
mandates, Texas companies alone would pay an additional $5.6 billion.
  I want to read a few letters from some small business people that 
wrote me about their concerns.
  Danco is a small air-conditioning and refrigeration business in Waco, 
TX, employing six people. Kim Obenoskey says:

       We have been in business for 10 years. Presently our third 
     largest expenditure following only the direct cost of labor 
     and materials is the cost of insurance. We do not offer 
     health insurance coverage to our employees because it is an 
     expensive cost that has escalated at unpredictable rates.
       What we do not need is mandates on employers. We spend 
     enormous amounts of money on government regulations at 
     present. This is money we could and would be compensating our 
     employees with.
       I do hope that Congress can see straight enough to know 
     that there to be a guide not a dictator. The human race is 
     not yet completely incapable of getting out of bed in the 
     morning without government to tell us which side is best 
     suited to our needs.

  CPI Systems in Houston, TX, R. Bailey--no relation--writes to me:

       As a small business owner, I do not want the federal 
     government to control or participate in any health care 
     program. Any program or re-vamp of the existing health care 
     system needs a deliberate view of all existing benefits. Not 
     just any cobbled up program to meet a calendar deadline.

  From S & S Enterprises in Hughes Springs, TX:

       Dear Senator: Regarding President Clinton's plan for health 
     care reform: I am convinced, as the owner of a small 
     business, that enactment of such legislation would seriously 
     cripple, if not kill, the operation of my business, thus 
     eliminating employment for myself and my ten (10) employees.

  I hope these figures and these letters put the problem into 
perspective, and by perspective I do not mean ignoring part of them. I 
share the goal of making insurance accessible to everyone. But there is 
a bill that will give access without harming our economy or our 
liberty, and that is the bill offered by the Republican leader.
  Mr. President, the Dole-Packwood bill will make insurance portable 
from one job to another. People would no longer need to fear changing 
jobs or losing their job since they could take their policy with them.
  Mr. President, the Dole bill, also called the American Option, will 
outlaw discrimination against the sick, the injured, and the dying--the 
very people who need health care and insurance the most. It will 
prohibit insurance companies from excluding preexisting conditions from 
their policies.
  The American Option will create medical savings accounts, similar to 
IRA accounts, so that people can save money tax free for their medical 
needs. Six States have changed their tax codes to accommodate medi-save 
accounts. They do not pretend to provide for catastrophes. But, by 
giving Americans the ability to save for their minor medical expenses, 
we can bring competition back into that system and bring down costs the 
real way. Medi-save accounts give patients the ability to use money 
that would otherwise be spent on insurance company overhead. The 
Clinton and Mitchell bills will not allow medi-save accounts.
  Time and time again, Mr. President, the Clinton administration has 
used horrible stories to sell its plan. Yet the stark truth is that the 
Dole plan would prevent those horrible stories, and the Clinton plan 
would bring new horrors down on the heads of the people he has brought 
into his press conferences and all other Americans as well.
  Our system is strong because we have good doctors. They are well 
trained, they can choose a specialty, and they can choose the type of 
practice in which they can excel, and they can offer their patients 
their best professional advice, plus the security of a stable doctor-
patient relationship.
  Americans take their liberty to choose doctors for granted. This 
relationship, and doctors' freedom to offer the treatment they think 
best, is as old as the medical profession, and quite frankly, it is 
what makes medicine a profession. Certainly, if patients have concerns 
about one type of treatment, they can raise them with their doctor and 
the two of them can discuss the options confidentially and agree on a 
choice.
  Mr. President, the Clinton and Mitchell bills insert the cold hand of 
Government into this private discussions and tell doctors and patients 
what sort of care will be covered and what sorts will not. There will 
be an engineering from Washington, DC, engineering of the type of care 
and which doctors can go into a specialty area. The National Health 
Care Cost and Coverage Commission, the National Health Benefits Board, 
the Commission on Workers Compensation Medical Services, and the 
National Council on Graduate Medical Education are just some of the new 
bureaucracies that Clinton and Mitchell will create.
  The administration said it was going to create new jobs in our 
country. Now we know what he meant--new Government jobs, new 
bureaucracies.
  These bureaucracies will be powerful, and the power that we will give 
them now resides in the American people. It will be a massive takeover 
of the free enterprise system and a transfer of personal liberty to Big 
Brother in Washington.
  When you turn to the Dole bill, you will find that it establishs no 
national health boards, no other Government agencies, because the Dole 
bill leaves those choices to doctors and patients. If we pass the 
Clinton-Mitchell type bills, we will have all of the new bureaucracies 
that I listed. If we pass the Dole bill, we will have none. A major 
problem in our system now is the growing crisis in medical liability. 
Medical malpractice suits have inflated the cost of health care 
delivery in the United States and it cuts access to patient care. Yet 
the only bill before us that seriously addresses this problem is the 
Dole-Packwood bill.
  On this issue, as on so many others, the States are ahead of 
Washington; 21 States now have some limit on damages, and 12 States 
have limits on attorneys' fees.
  The Dole bill caps noneconomic damages at $250,000. That is exactly 
the cap the State of California already has. But the Clinton and 
Mitchell bills not only fail to provide a Federal limit, but they also 
preempt the laws that are now in place in the State of California and 
every other State that has been able to rein in malpractice damages and 
the economic harm they cause.
  I would like to read a few letters from individuals that I have 
received against the Clinton plan.
  This is from Harry and Anita Kattegat from Grovetown, GA:

       By now I guess that you can imagine why we are so concerned 
     about the current Health Care Reform efforts. In its rush to 
     ``fix the system,'' Congress must consider the millions of 
     Americans who have insurance and how they will be affected by 
     some of the proposed changes. Let's focus on the people who 
     really don't have any health care, and not destroy or 
     downgrade what the large majority of Americans have.
       Keep government out of the health care system. We must 
     maintain ``Freedom of Choice'' and not resort to some form of 
     health care rationing.

  And from Jayne Hover, who signs it ``Jayne Hover, Citizen,'' from San 
Antonio, TX:

       The issue of health care has greatly disturbed me. I 
     totally agree that the current system is not efficient for 
     every individual. But I strongly disagree that the answer is 
     a federal system. To repeat what so many of you are saying on 
     this issue. * * * Show me even one area that the Federal 
     Government has taken over and done better than the private 
     sector.
       As you have expressed your frustration over not being in 
     closer contact with the people back here in Texas, I too am 
     frustrated that we, the American people, are not being 
     listened to in Washington, DC. I am amazed that folks who 
     have been placed in office, I believe, to express the wishes 
     of us who can't go to Washington would choose to not express 
     the wishes of their people whom they represent. . .It is 
     regrettable that such an attitude prevails in Washington, DC. 
     I am asking you as my representative. . .to please hear my 
     voice and do everything you can possibly do to stop the 
     health care profession from coming under the control of 
     Washington. The amazing thing to me is that I have heard 
     people say that they know the way things are now isn't 
     perfect, but not one person I speak to is in favor of the 
     federal government taking it over. Is anyone listening?! Just 
     because a system is faulty doesn't mean big government can 
     come in and make it better. We aren't asking Washington to do 
     that! Who is?! There are clinics all over the United States. 
     Walk into one and ask yourself if that's the way you want to 
     see a doctor in the future. Right now it's bad for some folks 
     (and that's not good), but if this program gets passed, we 
     will all have equal care--equally bad care!

  And this letter is from Austin, TX.

       Dear Senator Hutchison: I am writing to tell you I am 
     worried, no, more than worried, scared of what may happen to 
     us if this Clinton Health Plan (or one like it) should be 
     passed. . ..I am 68 years old, my husband is 70 years old. He 
     is retired military enlisted. I have many health problems, 
     but all are under control with medication and the supervision 
     of a good doctor. I had hoped to keep him until I die. If 
     this health plan should pass, I may not have that choice. . 
     ..
       I know your job is not easy and I do not presume to tell 
     you how to do it. I can only ask that you watch carefully 
     that they don't push something through in a hurry and we will 
     all suffer in the end.

  From Mrs. Dorothy Tillman.
  And this letter, from Hurst, TX, Natalie Cooper.

       Though I am just one of many residents in Texas, I ask that 
     you please consider my experience with our health care system 
     as you plan to influence its future. . ..
       I am a 23-year-old resident of Hurst who formerly pursued a 
     music education degree at Baylor University before becoming 
     seriously ill. I have been disabled for the last two years of 
     my life and ill for the last five. I firmly believe I would 
     not be on the road to recovery if I had been forced to 
     receive care under the proposed health plan. . . Instead, I 
     would be on the road to death, if not there already.
       I have been through a series of tests and diagnoses ranging 
     from multiple sclerosis to my illness being a figment of my 
     imagination. . ..
       Yes, my insurance, like so many others, was canceled. 
     Social Security denied me disability, and the medical costs 
     have consumed my husband's and my financial resources. Our 
     insurance system does need improvement, as does its 
     availability, but dooming our successful medical system to 
     one of socialistic demise is outrageous!
       The Clinton plan isn't about health care. It is about the 
     lifeblood of America--Freedom! To know that such atrocities 
     are even considered in this country is frightening beyond 
     that which words cannot describe.
  Mr. President, I would now like to address the charge of gridlock, 
which the President's supporters have frequently leveled against the 
Republican Members.
  A study of the debate during the writing of our Constitution makes 
clear that the reason the legislative branch of Government was created 
was to consider closely, and debate carefully, legislation that 
profoundly affects our Nation. We are supposed to weigh the values and 
interests of the people we represent and do what we think is best for 
them. We were not elected, and this Chamber was not constituted, to be 
a rubber stamp for the President, no matter how impassioned his 
challenges.
  A great legislator, Edmund Burke, said, ``Where the great interests 
of mankind are concerned through a long succession of generations, that 
succession ought to be admitted into some share in the councils which 
are so deeply to affect them.'' Think, therefore, of the generations 
after us who will build businesses and raise families in the Nation we 
leave them.
  If we think the Clinton-Mitchell plans are dangerous, and I do, then 
we are required by our oath of office not to pass such laws. If we 
think we have better ideas, and I think we do, then we must propose 
them.
  And if our proposal is not passed and we face a choice between 
passing no bill or passing a bad bill--I believe it is my duty to 
object to passing a bill that I think will hurt future Americans.
  If a good bill must wait until next month or next year, I will do 
everything I can to make sure that it waits.
  No amount of bullying from the President will persuade me to sell my 
constituents into a world of long lines, new taxes, and bureaucrats 
rationing treatment. The President can rail against us from a bus, but 
I will not abandon my countrymen's liberty to a National Health Board.
  Mr. President, the American people do not want a Government-defined 
standard benefits package. They want to choose their health care in the 
marketplace.
  Our forefathers who founded this Nation were independent and self-
sufficient. The Clinton-Mitchell plans would take away that individual 
choice and decision. While universal coverage is a worthy goal, it is 
also an impossible one. Hawaii and Canada have proven that. On the 
other hand, universal access is not impossible. Let us give the 
American people choices, not mandates. Let us give them the American 
option.
  Mr. President, a few weeks ago we learned that the Vice President of 
the United States holds dinners for Washington luminaries to discuss 
Metaphor. Not metaphor in the sense of a correlation between literature 
and life, but succumbing to the notion that theories of subatomic 
physics can explain human social interaction. I find this not just 
amusing, but also illuminating. It may be a Washington disease to try 
to explain human action in other terms, and I think it is a good bet 
that the designers of the Clinton plan have been dining with the Vice 
President.
  Mr. President, we are being asked to spend the next 2 weeks voting on 
a rapid series of detailed amendments to an enormous bill that will 
capture one seventh of our economy. We are taking up a plan that adds 
billions to the deficit, is anti-liberty, anti-small business and pro-
bureaucracy, and we are trying to whip it into a good reform in 2 
weeks.
  Mr. President, when you have a horse with four broken legs, you do 
not ride it. You put it out of its misery and find a different horse.
  I cannot stop this charge by myself. One of the oldest moral lessons 
in our civilization tells us always to act as though what we do makes a 
difference, even when we have no assurance that it will. That is why I 
stand here on the floor of the Senate opposing the efforts of the 
President of the United States.
  We owe it to our Nation to make another choice. And there are really 
two options before us. We could put the clever commercials off until 
next year, and then begin the debate anew with a clean start and plenty 
of time to deliberate and study what we have learned during this 
Congress. Waiting, and building on what we have learned, would be far 
better than hastily passing a bad bill.
  Or we can pass the bill offered by the Republican Leader. It is a 
good bill. It will provide access to affordable insurance for every 
American, rich or poor, young or old, sick or healthy. It contains 
sensible reforms and preserves liberty and quality. If its turns up a 
few weaknesses after a couple of years, we can address those with 
future legislation. But passing the Dole-Packwood bill will not put our 
growth and our security at risk. That is the choice I advocate today.
  If we approve the Clinton-Mitchell approach, we enter a nightmare 
system of Government coercion, rationed health care, new taxes 
totalling $100 billion dollars, special punishment of Americans who 
have made sacrifices for good health plans, intrusion into the doctor-
patient relationship, loss of jobs, reduction of wages, and harm to our 
Nation's fiscal, economic, and medical health--a harm, Mr. President, 
that can never be reversed.
  We can reverse bad tax increases and we can reverse bad regulations, 
but, Mr. President, how can we put a broken health care system back 
together when the quality is gone? It would be like patching a broken 
egg.
  President Clinton can go on television and tell truly sad stories 
from which he draws false conclusions. He can call those of us who 
oppose rationing, and mandates and new spending and new taxes and 
government control of health care, obstructionist. He can practice 
whatever desperate measures he wants to make radical changes in 
American life, but I will not yield.
  Henry Wadsworth Longfellow, our great American poet, said that ``We 
judge ourselves by what we feel capable of doing; others judge us by 
what we have done.'' I submit to my colleagues that we are capable of 
expanding access to health insurance for those who lack it, without 
consigning those who are insured to Governmental control, and without 
harming the quality of care, our economy, our liberty, our medical 
training, or research. If we pass constructive change like the Dole 
bill, then our grandchildren will look back on our choice with 
gratitude, and will be able to judge us by what we have done, and to 
believe that our course was wise.
  The PRESIDING OFFICER. The Chair recognizes the Senator from 
Minnesota, Senator Durenberger.
  Mr. DURENBERGER. Mr. President, I have a brief comment. Of course I 
do not know that I agree with my colleague from Texas about the 
possibility of putting health care reform off until next year. I hope 
we would do it this year. But I must say and must reinforce what she 
said about the importance of doing it right. I think that is the bottom 
line in her presentation.
  Not only are we talking about one-seventh of the economy, we are 
talking about a system in which 50 States--some part of 50 States have 
been sending us messages and signals for a long time about the need to 
do national reform so they in their communities can respond. I do not 
think we are going to change the system if we found we have made a 
mistake--we are not going to change it.
  The other thing I appreciate her reminding us of again, I just 
thought of this in the last 24 hours or so and was reminded of it an 
hour or 2 ago, this is not simple work we are doing. You do not just 
pick this thing up and pick through it and find your favorite solution. 
I recall President Clinton, when he came to office, promised he would 
do health care reform--would have a bill up here in 100 days. The bill 
did not get up here until almost 300 days after he made that statement. 
Why? Because he was lazy? No. Because he lacked commitment? No. Because 
it is a very, very complex issue. It is very difficult.
  So no one should be too surprised, even though we have sort of been 
at this issue in one way or another, that on the floor of the Senate, a 
lot of us on both sides of the aisle who have not been involved in one 
or the other committees, want to spend some time not only reading the 
bills but discussing some of the principles that are involved, because 
they are of such critical nature.
  So I compliment my colleague from Texas for that contribution and for 
all of the contributions which she has made and will continue to make 
to this effort.
  Several Senators addressed the Chair.
  The PRESIDING OFFICER. The Chair recognizes the Senator from South 
Dakota, Senator Daschle.
  Mr. DASCHLE. I will yield such time as he may consume to the Senator 
from Nebraska and then I will yield to the Senator from West Virginia.
  The PRESIDING OFFICER. The Chair recognizes the Senator from 
Nebraska, Senator Exon.
  Mr. EXON. Mr. President, before I make the remarks that I am about to 
make, I would like to repeat what I told the Senate Friday last when I 
discussed this matter. I said then, ``I come here with rancor to none, 
with accusations against none, with an understanding of the passion 
that grips Americans and Nebraskans on this health care issue, and with 
the understanding of the strongly-held views by my colleagues of all 
persuasions.''
  I go on to say that I rejected the President's bill some time ago. I 
was looking at the other bills that are before us. I hope we could 
reach compromise. I pleaded for debate that would be informative, as 
truthful as possible, and not to get off on tangents.
  I have been listening to the Senator from Texas. There are several 
things I think need correction. While I would say that there were many 
good remarks made by our colleague from Texas, in the remarks she has 
just finished, once again the Senator from Texas has been the typical 
case of several of the presentations made on that side of the aisle. 
They talk about mandates, mandates, automatic mandates, mandates. That 
is a scare tactic.
  The representation of the mandates in the Mitchell bill--that I have 
not agreed to support--but I am looking at that bill and others, trying 
to be objective. Let us, once again, set the record straight on what 
mandates are in the Mitchell bill. The Mitchell bill has no mandates in 
it at all. It simply says that if the bill does not reach the goal of 
95 percent coverage by the year 2002, then the board or commission 
would make recommendations to the Congress as to how we would reach 
that goal.
  The board or commission at that time would not be unlike the Base 
Closure Commission, which makes recommendations to the Congress, and we 
are all familiar with that. It is very similar in nature.
  It makes recommendations to the Congress to as to what we have to do, 
now that we have not met the 95-percent coverage that we hope we will 
meet at that particular time. It then goes on to say that if the board 
makes recommendations--and there is no assurance that the board would 
put mandates in there--to the Congress, and then if the Congress 
ignores the Board, takes no action whatsoever, then and only then would 
the mandates, that 50 percent of the cost by the employer and 50 
percent by the employee, only then it would kick in.
  I would simply emphasize once again that before mandates could go 
into effect there would be ample time, ample reason, every opportunity 
for either the House of Representatives or the U.S. Senate to step in 
at that time and say we are not going to have any mandates. So the 
mandates, way into the future on this bill, would only take over if the 
Congress of the United States fails to take action. But even at that 
time, I would point out that Senate and that House could overturn the 
mandates by a simple majority vote.
  So mandates have been blown all out of proportion, as if they were 
the same mandates in the original Clinton bill, which they are not.
  I also have heard some statement that we have a competitive system in 
the United States of America. We sure do. It is a competitive system. I 
agree, we deliver good health care to those who have coverage. But it 
is not good for all the citizens of the United States. Competitive 
system? It sure is. But I would simply say that too many people on both 
sides of the aisle are overlooking the fact that the Mitchell bill, the 
Dole bill, the Moynihan bill--and there are others--are trying as best 
they can to address the matter of costs. We have a competitive system 
but the costs are going right through the roof.
  Just one example of that. Certainly the people of the United States 
who pay premiums monthly for their health care recognize that they are 
reaching a point when they cannot afford to pay for what they have. 
Medicare and Medicaid cost the U.S. Government $9 billion in 1970; $137 
billion in 1990; and it is projected to go to $458 billion by the year 
2000. We have to do something.
  So let us continue to talk in a fashion that is reasonable, not 
making false claims and accusations as I indicated in my speech Friday, 
but to see if we cannot come to some kind of compromise and bring us 
all together.
  There were statements made about the Canadian plan. I am not a 
supporter of the Canadian plan, that is a one-payer, socialized system. 
But I have talked to many Canadians that like their plan very, very 
much. My wife, when we were in Canada one time, went to the hospital 
under the Canadian system. We were treated very well.
  The Canadian system is not as good as ours and the Canadians know 
that. They have never had as good a medical system in Canada as we have 
here, and we can be proud of that.
  But talk on the floor of the Senate that seems to try to relate 
whatever failures there are with the Canadian system--and there are 
some--as part and parcel of what we will have, the same coverage like 
that in America if we pass the Mitchell bill, is nonsense. There is no 
real resemblance between the Canadian plan and the Mitchell plan. They 
are totally different. And I think it is not fair, it is not proper to 
try to use those kinds of tactics and statements, because I think they 
tend to confuse the issue rather than address it squarely.
  I say again, in closing, that I am looking at all the plans. I think 
there are some good parts in all of the plans. I am not committed to 
vote for any one. I am going to see what amendments are put on to 
control the costs, above everything else. I cited the costs on Medicare 
and Medicaid. If those costs are high, what do you think has happened 
to the premium of Mr. and Mrs. John Q. Public?
  We are trying to address costs. I have not decided yet which one of 
the plans best controls costs, or would continue to provide the health 
care that we want and expect and are going to have in the United States 
of America.
  I simply say, Mr. President, that I hope that we can talk about these 
things objectively and fully understand some of the basic principles of 
the Mitchell plan and forget talking about mandates, automatic 
mandates. They are not in the bill, and we should have a clear 
understanding of that.
  I thank the Chair, I thank the Senator from South Dakota. I thank my 
friend from West Virginia for allowing me to go first.
  Mr. DASCHLE. Mr. President, let me thank the Senator from Nebraska 
for his clarification and for, once again, drawing attention to the 
fact that there has been a good deal of mischaracterization about the 
Mitchell bill and about many of the provisions in several of the bills 
that are currently pending before the Senate.
  Obviously, that is one of the purposes of this debate: To be able to 
sift through fact and fiction, to be able to lay straight the 
mischaracterizations, the misinformation, and he certainly has 
contributed to that this evening. I appreciate his contribution a good 
deal.
  At this time, I yield to the distinguished Senator from West Virginia 
such time as he may consume.
  The PRESIDING OFFICER. The Chair recognizes the Senator from West 
Virginia.
  Mr. ROCKEFELLER. Mr. President, I thank my very dear friend, the 
Senator from South Dakota, who is just pouring unlimited energy and 
integrity into this battle. I note, just before I make my remarks here, 
sort of a nice irony and circumstance, that the two gentlemen on the 
Republican side of the aisle who are here--Senator Durenberger and 
Senator Conrad Burns--are very, very dear friends of mine, people that 
over the years I have been able to work with very easily and very well 
on very important matters.
  That gives me comfort, Mr. President. It gives me hope and comfort as 
I look to these coming weeks because I can remember the Senator from 
Minnesota who I admire very, very much and who taught me everything I 
know about health care. I have worked with him on a number of things. I 
can remember one, wonderfully obscure but very important piece of 
information called the Resource Base Relative Value Scale. We were 
working on it together and our staffs were together, and we came to a 
critical point in the negotiations against those on the other side of 
this issue. We were seated in the Senate dining room, and we decided to 
do nothing.
  By the act of doing absolutely nothing at that particular moment, the 
other side caved in and we won. There have been many other examples--
working on the Pepper Commission with Senator Durenberger, exchanging 
ideas on many, many occasions with him. It has been an honor to work 
with him, a pleasure to work with him and a very constructive 
experience for this Senator to work with the senior Senator from 
Minnesota. I enjoy the fact very much that he is here. I would like to 
think of that as emblematic of what could take place.
  And I see Senator Burns, who is clearly fascinated by what I am 
saying because he is lost in his newspaper there, but he and I have 
worked together on the Commerce Committee on a number of occasions. We 
work together all the time on NASA matters, on technology matters. I 
remember one of the bills that was most crucial to Montana, to West 
Virginia and to the country called S. 4. It has to do with 
competitiveness technology--a whole lot of things. It is a very, very 
important bill, not very well known.
  The party Senator Burns represents was not necessarily in full 
agreement with parts of this bill. But the people who Senator Burns 
represents, he felt, could not get their just due unless this bill came 
to fruition. It was a remarkable experience just to watch him and to 
work with him as he just went ahead and did what he thought was right. 
We prevailed in the Senate. We worked together in the Senate on that, 
floor managed together in the Senate. It was another example of both 
parties working together and coming out with something that was 
constructive for Montana, for my State and for the country.
  I just take note of that, Mr. President, and I am very happy with 
that.
  Mr. President, I did some reflecting yesterday on what we have seen 
and heard--I guess particularly heard--over this past week. And I keep 
thinking about the millions and millions of Americans listening in, 
trying to figure out the accusations, the charts, the endless volleys 
of words that go back and forth like extended tennis rallies.
  Out of all of this, I think one very clear, very simple fact has 
emerged; and that is that the Senate is divided over health care 
reform. In many ways honestly divided.
  There is one group that wants to pass a bill to fix the wrongs of our 
health care system, and some of its Members have been here on the floor 
arguing for the majority leader's plan, the so-called Mitchell plan.
  Others, we hear, are still trying to sort through what is most 
important to them in defining a bill that is worth passing, that 
deserves their strong vote.
  And then I think there is clearly another group that feels very 
threatened by the very idea of a health care reform bill passing at 
all.
  I hope, Mr. President, and I pray that we will discover that this 
group represents only a fraction of the Senate, and I believe in the 
end it will. I am optimistic by nature. I need to be that way. I have 
to be that way. I want to be that way. I know from years of working 
with Senators, like Senator Durenberger and Senator Burns, on health 
care on both sides of the aisle, as well as the distinguished Senator 
from Nebraska, that there is a majority in this body whose hearts and 
heads are gravely concerned about real problems in health care facing 
our people.
  You cannot be in the profession that we are in, the craft that we 
practice and not run into serious situations where one is genuinely 
moved by family circumstances that you see, people who are caught 
without health insurance or who are caught where they are really 
hopeless against forces far larger than they are, which is why we are 
here.
  But, on the other hand, having reflected on this, there is really 
nothing very new about the fact, the very clear fact, that some 
Senators are determined to--and I emphasize some Senators, not all--
prevent the rest of this body from working out something to deal with a 
very major social problem.
  Most people, when they talk about the health care reform bill, refer 
to this as the most important piece of social legislation in the last 
30 or 40 years, 50 or 60 years. Social Security was tremendously 
important but, in a sense, it was an add-on. Medicare was tremendously 
important, but it was an add-on. This is reform. This asks a lot from 
each one of us and is complex by nature, contentious on the merits 
intellectually and very difficult.
  The Senate has had naysayers and delayers in the past on this floor 
trying to kill off virtually every major piece of legislation dealing 
with an important issue in the lives of Americans. There are some even 
on the Democratic side. You pore through the history books and 
Congressional Records and you will find relief in that the current 
situation is by no means unique. I think the stakes are higher, but the 
situation is not unique.
  Some or many Senators threw their verbal spears at Social Security, 
at New Deal programs, at Medicare, the civil rights bill. Senator Dole, 
on television yesterday, indicated that he voted against Medicare a 
number of years ago in 1965 and still had that same view: That Medicare 
was not the right way to go at it; there was a better way, in his 
judgment. People balked at civil rights bills and environmental 
protection bills. At the idea of guaranteeing a minimum wage--the 
concept of increasing the minimum wage can create an enormous firestorm 
in this Chamber--a safe workplace, reliable prescription drugs, 
creating the Food and Drug Administration, uncontaminated food, even 
toys. Toys that will not kill children still demand the attention of 
Government. You have to step in sometimes to protect consumers, which 
is in a sense what Government has to do. Government protects our people 
as a whole from foreign enemies, and we have to protect practices 
within our own society; we have to protect our consumers from events 
and practices which are not safe or proper.

  (Mr. AKAKA assumed the chair.)
  Mr. ROCKEFELLER. The list goes on and on. I confess I really hoped 
that it would be different this time, particularly on this subject. I 
care deeply about health care. I care passionately about health care. 
And here we are, talking about a problem that preys on and threatens 
Americans in every single State with no exception, and in many places 
with not much variation, in every part of town, among every age group, 
from birth through the very last days of life, among business owners, 
minimum wage workers. Any group that you can think of, they are 
afflicted, preyed upon, and unsuccessful in dealing with something 
called a health care problem.
  Now, what do all these people, all Americans have in common today? 
What they have in common is not being able to count on their health 
insurance when they need it. It is just as simple as that: Not being 
able to count on your health insurance when you need it, having the 
fear that the day the doctor says that you have a tumor, that you get 
pregnant, or that you need an operation is the day that the fine print 
in your insurance which you were given by your employer or which you 
negotiated but failed to read the fine print, that the fine print in 
your insurance plan takes over and, frankly, walks right over you--not 
being able to hold onto your health insurance when you change jobs or 
lose your job through no fault of your own. Perhaps your company is 
downsizing; you are out of a job, get wiped out of a job because of, 
perhaps, an unfair trade practice. These things happen, having to fear 
the day that you get the pink slip or the moving truck comes is the day 
that the footnote in your insurance plan takes over. And that little 
footnote says sorry, we do not have any need for you any longer.
  Mr. President, the point of the Mitchell plan before this body is to 
put a stop to this. It is the main point and thrust of that bill, 
together with working toward universal coverage.
  The only thing the Government is doing here is to say that health 
insurance should be there when you need it. And I think it seems not 
unreasonable for the Congress to insist on that, and insist on that in 
very clear terms. I think the American people expect that of us, and I 
think we should be expectant of ourselves to be able to deliver that to 
them.
  So let me tell you in just a word what is good and sensible and sound 
in Senator Mitchell's bill, and why this bill is the most reasonable 
and rational place to begin working on health care reform.
  Start with the fact that the Mitchell bill provides a path to 
universal coverage and pursues it in gradual and moderate steps.
  It allows, in a very definite timeframe and without burdens on 
business or Government takeovers, the market system to work. We want 
each and every American to count on reliable, effective, affordable 
health care coverage that can never be lost or never be taken away. 
Anyone fearing a massive overhaul by Government should listen up. There 
is no heavy Government hand at work here. There simply is not. And we 
will have a chance to discuss this as we get more into the debate.
  So far, most of the attack has come from the other side, and 
relatively little of the defense has come from this side. But the 
defense will come at the right time and in the right way.
  The Mitchell plan gives the health care market--the free market, the 
competitive market--the first chance to fix itself by allowing market 
forces and competition to keep prices down. The CBO believes that they 
can do that and at the same time achieve coverage for 95 percent of all 
Americans.
  It penalizes abusers of the system in order to help phase in benefits 
for children and pregnant women. The Senator from Minnesota will 
remember very well on the Pepper Commission back in the 1980's, that 
was one of our top priorities. And that is where we ought to start on 
health care reform, with pregnant women and children.
  It is absolutely amazing to me, astounding, stunning, unbelievable, 
that in America, not in every case but in most cases, if you are a 
young woman and you get married and you do not have health insurance 
and you become pregnant, you have a preexisting condition and most 
times you cannot get health insurance. If there is anything that 
requires health insurance it is being pregnant. But that is classified 
as a preexisting condition in most insurance policies and is an 
uninsurable event. In America, that is extraordinary, not something of 
which to be proud.
  The Mitchell bill's plan has a foundation that rests very firmly on 
preserving the strengths of our current system. It does not turn it 
upside down--no Government takeover--but preserves the strengths of a 
private guaranteed, job based insurance market, just the way it is 
today, the way people are fundamentally comfortable with it, and then 
easing in reforms to fix the faults.
  That is the major change between the Clinton bill and the Mitchell 
bill. The Clinton bill was much more aggressive. The Mitchell bill 
takes a more careful posture, trying to reach out to more people, to 
make itself more amenable, more comfortable, so people feel more free 
to embrace the idea as a plan that one can trust and put one's faith 
in.
  If there is one general guide to the Mitchell bill, it is consumer 
protection. And that is a very proper guide and a very proper role. I 
come back again to misleading fine print. There is a lot of it in the 
land, Mr. President. The Senator from Minnesota and I and Senator 
Danforth and others were very involved in reforming medigap, a $15-
billion industry at the time, a few years ago. The whole problem was 
that there was so much fine print, and people preyed on seniors, and 
people worked on commissions and so often seniors were buying much more 
insurance, medigap insurance, which in a sense fills in for what 
Medicare does not provide, and they were buying more than they needed.
  Salesmen would come to the door and make a persuasive case. The 
senior would not necessarily agree, and like most of us might not agree 
with the fine print. So they were paying too much for overlapping, and 
in some cases simply absent, benefits.
  So misleading fine print and deceptive practices are stopped cold by 
the Mitchell bill. ``No lifetime limits,'' People are going to have to 
be very familiar with that phrase: ``No lifetime limits.'' Most 
insurance policies these days have the amount of money that you can 
spend or your insurance policy will spend for you on your health care. 
But when that runs out, it stops. Well, we do not allow that in the 
Mitchell bill. ``No lifetime limits,'' an extraordinary combination of 
three words, and a very powerful phrase; no refusal for serious 
illness. If you get cancer, the insurance policy stays right there. 
Nothing changes. Not even for one moment do you fear that somebody will 
come in and raise your rates or take your insurance away. The thought 
will not even occur to Americans because nothing will happen. The 
insurance will stay there. It will remain there, no matter what the 
disease or what the problem.
  And for seniors, long-term care and prescription drugs is pretty 
basic stuff, but very, very important. Long-term care, particularly 
community and home-based care, is much less costly than hospital care, 
and much less costly than nursing home care. Sometimes hospital care is 
needed. Sometimes nursing home care is needed but very often it is not.
  Whenever you go into a nursing home--I know the Presiding Officer has 
been to many to visit his constituents and others--the rooms in the 
nursing home are always made to look much like the rooms at the home 
that the person left. Of course, the reason for that is the person 
would rather be home. So in the Mitchell bill, we emphasize home-based 
and community-based care; and, especially, Mr. President, to those 
people who work so hard is all of this significant, who play by the 
rules, who pay premiums but still get dunked--inexplicable to them--and 
cut off when they need insurance the most.
  We do not have to worry in Congress, do we? Our health care is paid 
for by a combination of ourselves and the American taxpayers. It is the 
same with Federal employees, and the same with the President. We have 
made that arrangement. We have made that arrangement for ourselves to 
take care of ourselves and our families. Then the American people would 
have the right to ask, ``Would it not be fair that we would get the 
same kind of arrangement that you, who work for us, and who receive our 
taxes so that you can have a salary; that we should have the same kind 
of arrangement?'' Well, I think that is fair. I think most Americans 
feel very, very strongly about that.
  For those families now struggling with the health care burdens, the 
Mitchell plan offers help to make ends meet. Rates cannot be 
arbitrarily jacked up. They can be now. An insurance company can 
unilaterally on its own decision simply take your rates and increase 
them by 20, 30, or 40 percent if you are a small business. They could 
do it because it is the end of a year, or they could do it because let 
us say one of the 10 people in that small business had come down with 
an illness and they wanted to minimize the risk, minimize the chance of 
losing profit. So they jack up the rates. That cannot happen under the 
Mitchell bill. Insurance will be affordable, and insurance will be 
dependable.
  All of this adds up to a bill that is good for the American people, 
that is moderate and sensible, and not intrusive, and not punitive in 
any way; using the system that we have, building upon it, and then 
fixing some of the flaws that exist. It will be a private system of 
guaranteed health insurance, and not Government health insurance. 
People will not pay their premiums to the Government. They will pay to 
a private health insurance company just as they do today.
  Still some are offering up Senator Dole's, what I would call 
tinkering proposal, as a better alternative. I do not see it that way. 
I do not see how others could see it that way. For starters, it does 
very little to protect consumers. Again, that is an area where 
Government has a legitimate right. We protect the country from foreign 
enemies. We ought to be able to protect consumers of health care on 
basic matters. There is very little of that in the Dole bill. All of 
those loopholes, all those restrictions that work against consumers, 
all of these things which I have mentioned which are eliminated in the 
Mitchell bill will remain under the Dole plan were it to be passed.
  There is no guarantee in that plan of decent coverage, and no 
assurance that coverage will remain portable. Remember I talked about 
jacking up rates. That can happen in the Dole plan. There is no 
preventive care coverage. It is gone with the Dole plan.
  I listened to Senator Dole and Senator Mitchell yesterday on a Sunday 
television program, and the final thing that Senator Mitchell said was 
that the thing which is closest to his heart, that he cares most about 
in health care, is primary care and preventive care. So it is carefully 
observed in his bill, and is widely ignored in Senator Dole's bill. If 
you fall seriously ill, and need your insurance, do not count on it 
under the Dole bill. Under the Dole plan, the fine print which today 
lets insurance companies cut and run stays in place.
  For seniors, the news is no better under the Dole plan. Medicare gets 
cut as it does under the Mitchell plan but you get nothing back for it; 
no new coverage. Under the Mitchell plan, of course, it is very 
different. In the Dole plan there are no prescription drug coverage. In 
the Mitchell plan there is prescription drug coverage. For seniors that 
is important. It is their major expense. There is no long-term care in 
the Dole plan. But there is in the Mitchell plan. For seniors, long-
term care is everything. It is everything, and for all of us parents, 
grandparents, and friends, long-term care is perhaps the most 
essential, sustaining continuing, agonizing part of health care.
  If you lose your job, or if you get too sick, or if you own your own 
business, or you just get old, I will tell you what Bob Dole's health 
plan says to you. It says basically that you are out of luck. Health 
care should not be a matter of luck. It should not be left to quick-fix 
half-measures. I am afraid the Dole plan is in that category. Think 
about this. In the United States today we make sure that the electric 
company and the gas company and the telephone company cannot just 
operate recklessly. They are subject to a public service commission, 
cable--something so American as cable. We make sure that utility rates 
cannot be raised suddenly without review by a public body. That is 
called consumer protection, which is widely understood and appreciated. 
And we make sure that service cannot be cut off arbitrarily, because in 
America people are not left sitting in the dark and the cold to freeze 
to death. We do not do that with our people with utility bills, and we 
should not do that with health care, which is at least, and probably 
substantially more over the long-term, important.

  Well, health care is just as essential. It should not be left to some 
inexact, ineffective certain rules. Consumers deserve as much 
protection and consideration when it comes to health care, and the 
Mitchell bill provides that consumer protection.
  The Mitchell plan, as I have indicated, is moderate and thoughtful 
and uses, in many ways, a rather light touch. It is sensible as an 
approach, seeks to be effective but not intrusive. I would hope that 
approach would be appreciated, and I would think that that approach 
would be applauded. It is pretty rare around here to take such a 
reasonable tack, and it should be, I think, appreciated.
  So, in conclusion, I just hope, Mr. President, on this evening that 
my colleagues can finally focus on the strengths, stop offering up 
lesser plans as equals, stop wasting time because time is now precious, 
and join me and many others in a determined effort to begin building on 
Senator Mitchell's plan to pass health care in this Congress.
  I thank the Chair and my friend from South Dakota.
  I yield the floor.
  Mr. DURENBERGER. Mr. President, I appreciate the opportunity to make 
a few remarks. Before I do--and I intend tonight to speak not only on 
the bill itself, but also the Dodd amendment, which I understand is the 
pending business.
  Let me acknowledge not only the respect I have for my colleague from 
West Virginia, but acknowledge how much pleasure it has been for me to 
serve with him in not only some of the projects he has already outlined 
but quite a variety of others which he has not. It only serves to 
underline, I think, the fact that the appearance of partisanship in the 
health care reform debate masks a tradition around here, as long as I 
have been here, of bipartisanship. I was pleased to hear him talk about 
the way we, together, used Medicare as a way to begin to reform the 
health care system in the 1980's.
  I, in particular, will never forget not the time we sat in the dining 
room doing nothing, but the time that the then-chairman of the Finance 
Committee, Lloyd Bentsen, said, ``I cannot get this RBRVS thing 
approved by the folks at Ways and Means, and I think I am inclined to 
just drop it.''
  Senator Rockefeller came to me and said, ``What do you think about 
that?''
  I said, ``That is not the right question, I am in the minority. What 
do you think?''
  He said, ``I think we ought to fight him.'' And we did and passed the 
bill. I must say the credit is to him.
  In addition to other things, he got Pete Stark and Henry Waxman, who 
were either not speaking to each other, or speaking in four-letter 
words, to come to my office one Saturday. I guess I was neutral ground, 
and we spent the better part of a Saturday hammering out the agreement 
which became the reform part of part B of Medicare. I will always be 
grateful to him for that experience, and others which I would love to 
share tonight, but I will save them perhaps for next month. I 
appreciate very much his comments.
  Before I begin my comments on the bill, on a related matter, the 
place I represent and the people I represent in Minnesota are always 
being very creative in one way or another, and they have made an 
incredible contribution to universal coverage and universal access. The 
latest is another accomplishment by the wonderful nuns who go by the 
name of Carondelet LifeCare Ministries of St. Paul.
  Sister Mary Madonna Ashton, who is a nun of the Carondelet Order and 
CEO of Carondelet LifeCare Ministries, has opened another free clinic, 
serving this time the uninsured and underinsured residents of the Twin 
Cities area around Wayzata, part of our community most people do not 
think about as uninsured and underinsured.
  I ask unanimous consent that an article that appeared in the 
Minneapolis Star Tribune, August 15, 1994, describing the launching of 
this clinic and putting it in the context of universal access in our 
community, together with comments by the CEO, Sister Mary Madonna 
Ashton about the need for universal coverage, which she has conveyed to 
me personally, and not all with which I agree, be printed in the 
Record.
  There being no objection, the article was ordered to be printed in 
the Record, as follows:

   A Small Step for Reforming Health Care--New Wayzata Clinic Gives 
                       Uninsured a Place to Turn

                          (By Dan Wascoe, Jr.)

       While Congress wrangles over whether to provide health 
     insurance and adequate health care to those without coverage, 
     a 10th free clinic serving uninsured and underinsured 
     residents of the Twin Cities area is about to open, this time 
     in Wayzata.
       The clinics' doctors and nurses are all volunteers. Office 
     space is donated. Patients need not pay a dime.
       The St. Mary's Clinics, most of them open one afternoon a 
     week, are sponsored by Carondelet LifeCare Ministries of St. 
     Paul.
       Since 1992, Carondelet has opened four clinics in 
     Minneapolis, four in St. Paul and one in Spring Lake Park. 
     Wayzata's will open Aug. 31 in the Interfaith Outreach and 
     Community Partners center.
       Why Wayzata, that tiny suburb on the shore of Lake 
     Minnetonka?
       ``It isn't all riches and boats,'' said Sister Mary Madonna 
     Ashton, the former Minnesota health commissioner who is 
     Carondelet LifeCare's chief executive.
       Cracks in the health insurance system appear everywhere, 
     she said.
       ``That's something that people need to learn,'' she said.
       The Wayzata clinic also will serve people in Hamel, Long 
     Lake, Medicine Lake, Medina, Minnetonka Beach, Orono, 
     Plymouth and neighboring communities.
       Not all patients are expected to be chronically poor; many 
     will be laid-off workers, employees of small businesses, 
     single mothers and children.
       The key is that they must not qualify for other health care 
     programs.
       St. Mary's Clinics are low-tech, low-budget operations. 
     They offer such basic services as throat cultures, pap 
     smears, ear checks, blood pressure readings, pregnancy tests 
     and general physicals.
       The doctors and nurses also have ties with specialists who 
     provide free care when the clinics make referrals. The 
     clinics also negotiate discounts for prescription drugs.
       Even so. ``Our Largest expense is medications, ``Ashton 
     said.
       Some services, including emergency care, family planning 
     and prenatal care, are not offered in order to keep the 
     clinics' malpractice insurance rates lower.
       Many clinics are located in churches, community centers and 
     office buildings. LaDonna Hoy, executive director of the 
     Interfaith center in Wayzata, said space normally used for 
     the center's transportation office, volunteer coordination 
     and newsletter production will be converted one afternoon a 
     week to an examination room, a waiting room and a place to 
     record weight and blood pressure.
       Ashton, who was state health commissioner from 1983 to 1991 
     under Gov. Rudy Perpich, said Carondelet will open six to 10 
     more clinics in the Twin Cities area in the next year or two.
       She and the state health department said they believe St. 
     Mary's Clinics are the only strictly free ones in the 
     metropolitan area. Others offer service on a sliding scale 
     based on patients' income.
       But she's less than confident that will happen, especially 
     in light of last week's decision to delay the start of the 
     health care debate in the House of Representatives. She's 
     also irked by talk that ``universal'' coverage, even if 
     passed by Congress, may mean 90 to 95 percent of the 
     population instead of everyone.
       She said she's ``terribly worried'' that those left 
     uncovered will be the very people whom St. Mary's Clinics are 
     trying to help.
       If health insurance reform doesn't cover low-paid 
     employees, temporary workers, the unemployed, employees of 
     small businesses, women and children who aren't on Medicaid, 
     then reform ``is not addressing the problem,'' she said.
       Even MinnesotaCare, the state-backed insurance plan that 
     helps some residents who can't afford insurance, doesn't yet 
     pay for dependents. And its premiums remain out of reach for 
     some Minnesotans, she said.
       Since the first clinic opened in 1992, Ashton said more 
     than 4,000 people have been served--an average of 9 to 10 
     patients per four-hour day.
       That's not much, compare to Ashton's estimate that 350,000 
     to 400,000 Minnesotans are without health insurance at any 
     time. But Hoy said the care is particularly important to 
     those who receive it.
       Because of contributed space and services, the clinics's 
     budget for next year will be only about $800,000, Ashton 
     said. The volunteers' time is worth about $500,000, she said. 
     The Sisters of St. Joseph provide about one-third of the 
     total budget. The rest comes from donations from 
     organizations such as United Health Care, the Phillips 
     Foundation, the Woman's Club of Minneapolis and the North 
     Suburban Hospital District.
       A federal program provides money for breast and cervical 
     cancer screening, and a state program underwrites pap smears, 
     mammograms and colposcopy for vaginal examinations. An 
     administrative staff of seven to eight employees in St. Paul 
     takes appointments and performs other duties.
       Pat Hein, the clinics' director of nursing, said St. Mary's 
     has negotiated discounts of up to 100 percent for inpatient 
     and outpatient care at five Twin Cities hospitals: St. 
     Joseph's, St. John's, Unity, Fairview Riverside and 
     Methodist. Negotiations are underway with North Memorial 
     Medical Center. In any case, the care is free to patients; 
     any hospital bills go to Carondelet, she said.
       Although only a small minority of patients require surgery, 
     ``those who need it get it,'' Hein said. The most severe 
     cases so far have been two patients who require mastectomies.
       William McGuire, chairman and chief executive of 
     Minnetonka-based United Health-Care Corp., said he strongly 
     endorses both the idea behind the clinics and their 
     performance. Although there's an abundance of hospital beds, 
     doctors and specialized services, ``we don't always have 
     appropriate distribution of these things,'' he said 
     ``Importantly, it is not being executed other than through an 
     organization like this.''
       Although Ashton would like to see the need for the clinics 
     fade away, McGuire doesn't consider that realistic. Providing 
     health services to specific uninsured groups will be 
     necessary regardless of political health care remedies, he 
     said. As evidence, he pointed to the founding of St. Mary's 
     Clinics ``in a state with one of the top two or three health 
     quality measurements, one of the lower per-capita health-care 
     costs,

                           *   *   *   *   *

  Mr. DURENBERGER. Mr. President, our colleague from Nebraska is not 
here, but while he was commenting on the statement by our colleague 
from Texas, he made quite a business out of saying there are no 
mandates in the Mitchell bill. Well, that just is not true. I am sure 
what he is talking about is the employer mandate to pay, although he 
was not that specific. I feel compelled--then, off the top of my head, 
without reading the Mitchell bill, remembering what is in the bill as I 
went through it--to say that he has to be talking only about this overt 
employer mandate to pay premiums, because in the Mitchell bill there 
are a lot of mandates.
  I was informed by one of my colleagues today that the word 
``shall''--as in such and such an agency shall--appears over 2,200 
times in the Mitchell bill--the latest version. To give you an idea of 
the mandates on employers and on working people, all employers in 
America, in groups of fewer than 500 employees, are mandated to join a 
cooperative. They are mandated to participate in community-rated risk 
pools. The employers are mandated to offer three plans, and they are 
mandated, if they make contributions, to make equal contributions to 
all three of the plans. They are mandated to offer the standard benefit 
package. For large employers, they are mandated to participate in the 
cost shift through risk adjustment. There is a specific provision in 
there that shifts risk from community pools onto large employers.
  Large employers are required also--mandated--to offer three plans. 
Large employers are also mandated to withhold premium payments.
  Having said all that and not having been totally complete in my 
description of mandates, I will add that mandates are not necessarily 
all bad. If a mandate means a national rule to which a market is going 
to have to adhere, then that is what we need. If mandates are a way to 
cost shift onto working people, or to cost shift onto businesses in 
implicit ways, then they are bad. That has been the consistent 
objection of everyone who has objected to employer mandates.
  I will speak at another time probably to the issue of cost shifting. 
But the reality is that the cost shifting of doctor and hospital bills 
in America is not coming so much from the uninsured, the businesses 
that do not insure their employees; it is coming from this place. The 
money that we do not commit to Medicare and Medicaid for the elderly, 
disabled, and low income, go to Hawaii in reduced payments to doctors 
and hospitals, come to Minnesota in reduced payments to doctors and 
hospitals. And that shift keeps getting wider and wider all the time. 
Today, I understand that on $1 of services at the hospital level, 
Medicare pays--the Government--only 71 cents, and for a billed dollar 
of doctor services only 59 cents. Where do you suppose the rest goes? 
The rest goes on someone else's bill in the private system, not in the 
Government system.
  An employer mandate is simply a way to say we cannot raise taxes, we 
cannot go deeper in debt. What we are going to do is guarantee 
everybody in America you can enroll in a health plan and the costs of 
that will be shifted onto all the working people in this country.
  Again, I will say I will have more to say on that subject another 
time, but just a reality. Every working person in America today is 
carrying the cost of his own in what he pays at work. He is bearing the 
cost not only of his own medical expenses but of one other family's 
medical expenses.
  Just keep that in mind. If you have a GDP today of 14 percent, those 
people are paying about effectively 28 percent into the system, and 
half of it is going for someone else's health care.
  At least, the Germans are honest about that. In Germany it cost 13 
percent, 6\1/2\ percent from the employer and 6\1/2\ percent from the 
employee, and they get 13 percent worth of service. The overall cost in 
Germany is about 7 percent of the GDP, but in America we are doubling 
the burden on every single working person.
  So those of us who have resisted the notion of a mandate that all 
employees have to pay are resisting the notion in this Congress, in 
this Senate we can continue to reduce our obligations to pay our bills 
in the Medicare and Medicaid system and cause all of those extra costs 
to be shifted onto working people. That has to stop.
  Mr. President, at this time, before I make any further comments, I 
yield such time as he may need to my colleague, Senator Conrad Burns 
from Montana.
  The PRESIDING OFFICER. The Chair recognizes the Senator from Montana, 
Senator Burns.
  Mr. BURNS. Mr. President, I thank my friend from Minnesota.
  Finally, the time has come when we finally get to see a piece of 
legislation on the floor and being talked about even though it has only 
been here since Friday at 5 o'clock.
  So, as we look at this, I was interested in some of the comments that 
were made earlier this evening as we started this debate tonight. 
Someone wanted to define gridlock awhile ago. Nobody has to define 
gridlock to us. We went through 4 years of it prior to January of 1993.
  If you want to talk about scare tactics, what about the scare tactics 
that everything is going to run out and if the Government does not act 
to do something this country is going to come crumbling down on top of 
itself?
  I do not think that is the case here in America. I think the American 
people are very inventive and have the ingenuity and the fortitude to 
take this country and go on.

  I am reminded of my parents who bought a farm in 1931. I do not think 
there was very many white clouds in 1931. Not very many in this body 
can remember those times. I read a lot about and heard a lot about it. 
I was born in 1935, and I know the last thing you wanted was kids. But 
nonetheless those were pretty dark times. They did not have a thing 
called national health insurance. In the depth of the Depression there 
were scare tactics.
  That this country would not survive without this Government acting I 
think is a little far-fetched. In other words, what are we going to do? 
Are we going to create the problem and then going to be the knight in 
shining armor to ride in and take care of it? But I am afraid that the 
solution is going to be worse than the perceived disease.
  There are a couple of areas that I want to talk about tonight, and 
one of them is right here to my right, which is a map of my State of 
Montana.
  My friend from Nebraska just now said that we are trying to address 
the costs of health care. That is what we are wrestling with. Nothing 
could be farther from the truth. We are trying to address the way to 
pay for it. At the heart of every one of these speeches is how do we 
pay for it? How do we come up with the money to pay for it? And how 
much do we want to spend on health care?
  You can spend any amount that you want. But I think the patient and 
the people who need health care should make some of those decisions 
instead of the Government making it for them.
  There are a couple of areas. This is the State of Montana. That is 
where I take my counsel. And to give you some idea what problems we 
have in our State, from way up here in Lincoln County in a little town 
called Eureka, down here in Carter County in a town called Alzada, it 
is farther than it is from Chicago to Washington, DC, and there are 
only 800,000 wonderful people who live in 58 counties in that great 
State.
  So we have some problems to look at when you start talking about 
health care delivery systems. How do we pay for it? We have a lot to be 
concerned with, but mine primarily is, how do we cover all of this area 
where we have quite a lot of dirt between light bulbs?
  I want to take a very close look at the rural health care provisions, 
the ability for patients to choose their services and their providers, 
their health care plans, the size of the new bureaucracy that will be 
created, the amount of taxes that are included in financing a huge big 
new entitlement, that is if it becomes a reality.
  They say this is the greatest debate since Social Security. You know 
what I hear from some young folks who are saying, listen, you give me 
the amount of money that I put into Social Security and I can take care 
of my own retirement because the rate of return is not all that good 
for what it is starting to cost.
  We also get letters about people who have been caught between a rock 
and a hard place and had some bad things happen to them, and you have 
to feel for those folks. You have to feel compassion for them, but 
there is a way to take care of those folks. But I am wondering, and I 
speak from being an auctioneer, how much emotion goes through when you 
sell out a person that has gone broke because maybe it is Government 
mandated, maybe its expenses got so high that they just could not stay 
in business. And when do we know where that breaking point is? It is 
not easy to go out and sell out a good friend in a bankruptcy. In fact, 
I think that is more crushing than anything that can happen to anybody 
in this country.
  It is important that we not only read this bill but that we also have 
some kind of understanding of the impact that it will have on us. But 
more importantly, it is important that America gets the opportunity to 
read this bill and understand the impact it may have on them as 
individuals, because here in the United States we are still not to the 
point where they throw us all in a sack and shake us up and turn us all 
out and we are all equal.
  Let me first say that I think the process we have gone through in the 
last 10 months has been very useful and very educational. I did not 
come from an area of the medical field. When I joined the task force on 
this side of the aisle to deal with some of the very problems that we 
are going to talk about here in just a little bit, I would say that I 
probably know more about it now than I ever cared to want to know.
  Having a chance to understand what was in the Clinton bill, to review 
the impact on individuals and on companies in our State has led to 
maybe some positive changes, but it has also been mostly food for 
thought. It has tripped our trigger on curiosity. Maybe there is a 
different way to approach it. But that is what the democratic process 
is all about: Taking an idea to the public, getting their feedback, and 
proceeding with our constituents in mind, and that is called 
responsible legislating.
  I honestly believe it was understanding the Clinton bill and what it 
would actually do that led to the demise of the Clinton bill. Americans 
got ahold of it, they read it, they had a pretty good grasp and 
understanding of it, and then they said ``no.''
  Not just special interests, but the people who vote, people who want 
to maintain their quality of life, and people who vote to preserve 
their family, people who enjoy their freedom and independence, those 
folks are the folks that I have been hearing from. They said they did 
not like the Clinton plan.
  But do you know what else they said? My State of Montana was no 
different. In a poll taken in my State by an independent firm here in 
Washington, DC, 70 percent of Montanans say Congress should take the 
time, study the issue, and take action next year.
  I do not know whether this is a prudent way or not, and I think maybe 
we might be shirking our duties if we did not try to do some tune up on 
a system that sort of needs a tune up.
  Dorothy Bradley, the Democratic nominee for Governor in Montana and 
now the Chairman of the Health Care Authority charged with designing 
reform within my State of Montana, made the statement recently. In all 
the hearings she has held around the State, she found that ``people 
have become very cautious about reform.''
  She said, ``You don't have to embrace a whole new package to make 
significant gains. We are not going to work this through overnight.'' 
They want meaningful reform, but not just for reform's sake. And that 
is what has me worried here, is the timing. We are coming to the close 
of the 103d Congress and we are not well positioned to serve this issue 
or the American people very well.
  We have here now a bill that has been crafted behind closed doors and 
yet, it seems to me that this is the Clinton bill reincarnated. The 
first chance we had to see what is inside it was just a few days ago. 
That was last Friday. Yes, the leader said we have been able to examine 
this for months. Perhaps, in concept, we have. But it was not put into 
writing until last Friday. It has been changed already more than a 
hundred times. Now we are expected to debate it, understand it, and 
even vote on it--all in a matter of days.
  I have a great staff. I would have to have a great staff, because 
they wrote it into my speech. No, I do not want to say that. But I have 
no doubt if they had been working night and day--and they have been 
working night and day on this issue, trying to see what is in this 
bill, to grasp it and how it affects our State of Montana--they might 
even have been able to call a few people in Montana to get some 
feedback on the key provisions. But there is no way that the folks in 
the mountain time zone can have any idea what we are trying to decipher 
and disseminate and make some decisions for them. This is legislating 
in the dark of night.
  We do not want to make this decision for them. We want them to make 
the decision and then tell us what to do. That is what we were sent 
here to do. We were sent here to listen and to carry those views out, 
what they think is best.
  So the feedback from this great State, this great 148,000 square 
miles, is what I listen to. They sent me here to represent them. I am 
supposed to work with them.
  This health care reform bill promises to be the largest program 
ever--certainly the largest I have ever worked on or voted on in my 
history in the Senate. I think it is only right that we have time to 
let our folks back home take a look at just what we are doing. No one 
will fault us for caution, but it is darn sure they will fault us, 
though, if we pass something that they know nothing about.
  So given that, we have no time to discuss this with the folks back 
home, I think we need to proceed with even more and more caution.
  My colleagues, especially those who sat on the Labor and Finance 
Committees, have a deep understanding of the details. And that is where 
really the devil lies, in the details.
  I do not serve on either committee, the Finance Committee or the 
Labor Committee. So we have to do our work as it is presented to us, go 
through it, make sure our people are informed and make our decisions 
from there. I must concentrate on those areas that I know are important 
to Montana. Let us start with those.
  First, it is crucial that this reform addresses the challenges of the 
rural health. When the First Lady visited Montana, she coined a new 
term. She called it ``mega-rural.'' There are a lot of issues that need 
attention if we are truly to expand the access all across America. We 
have eight counties in Montana that are without a health care provider.
  Can you imagine that?
  I am going to turn up some maps here to show you just what we are 
talking about.
  Eight counties that have no doctors, no medical care whatsoever. And 
we have to travel huge distances, so we have a difficult time 
recruiting where there is no support, and even a tougher time keeping 
them there. And we have now areas served by a single physician who 
wants to retire, but there is no one to take his place.
  By the way, this county right here is Garfield County, MT. Only 1,800 
folks live in that county. It is bigger than Delaware. And then, of 
course, we have some more spaces. But these are areas where we have no 
doctors whatsoever.
  To magnify the problem in my State of Montana, the counties in red 
are counties that we have that are without ob/gyn--no prenatal care 
afforded those people.
  And I think this area right here, the central part of Montana, is 
larger than the State of Indiana. So that is what we are talking about 
here when I say I have to look at my State and rural health care and 
how we regard it; and are we going to do something to give some 
incentives for doctors and nurses and technicians to practice medicine 
in these rural areas.
  Second, Montanans want choice. That is what we are looking at. We are 
very independent. We do not want the Government dictating to us what 
services to have or what not to have or where to go get them. I cannot 
imagine there is a State in this Union that does. But, regardless, 
there are provisions in many plans that dictate just what kind of 
health care we should have. If the Clinton-Mitchell bill limits 
choice--choice of services, of providers, of hospitals, of health care 
plans--and I believe that this does--I will tell you that I have to 
strongly oppose those parts of it.
  Cost containment comes when people can take some personal 
responsibility for their health care decisions. When they are given the 
information, they need to make wise and educated decisions. They will 
take cost into account. If control over health care choices is in the 
hands of the Government or any other bureaucracy, there is no incentive 
to be cost conscious.
  I know it is hard to walk into a doctor's office and be diagnosed. I 
have always said, you know, doctors have a terrible time. Sometimes 
they intimidate you a little bit. But you walk in there, and they say, 
``Well, Conrad you have to have your tonsils taken out.''
  And it completely shatters their whole life if you ask them, ``What's 
it going to cost?''
  They come back and say, ``Why do you want to know?''
  ``Because I am going to go down the street and I am going to find 
somebody else that does tonsils and I am going to ask him what he 
charges.''
  That kind of gets their attention. We must never take choice out of 
this thing.
  Third, health care reform cannot be allowed to destroy jobs or 
businesses, large or small. Consider my State of Montana; 98 percent of 
our businesses are considered small. So that is where my focus is going 
to be.
  Yes, we have heard those stories about those people who have been 
caught up in a very, very bad situation. Again, I want somebody from 
this body to go down the street and be responsible for selling out of 
bankruptcy of a family that has gone on the rocks and a business that 
has gone on the rocks. Those small businesses are the people I have 
heard from. And they are very, very loud. It has not been a whisper, 
Mr. President. They cannot handle more mandates; they cannot handle 
more taxes; they cannot handle the Government telling them how to run 
their business anymore.
  The stories that have been relayed to me are real. They speak of 
laying off people. Those of us who have run businesses--and maybe some 
of them not too successful--know it is pretty easy to hire people. It 
is pretty hard to tell them that they have no job left, because an 
employer feels a responsibility to a family, not only to the working 
person they are involved with, but their whole family. They sort of 
take that personally--anyway, I do.
  Let me remind you, this is the middle class. This is where the 
financial burden will fall, on these folks. The very folks we hit with 
tax increases last year are just about ready to be hit again.
  There is no rational reason for businesses to bear the brunt of a new 
program. But if they think they can, they will--but it has to be 
voluntary. And given the choices, given the options, the vast majority 
of them do the right thing.
  Fourth, and I have touched on this earlier, I want to keep the 
Government out of our lives. There are States where a strong presence 
of the Government is not there. In public lands areas, like the West, 
we understand bureaucracy--oh, do we understand bureaucracy, and what 
it takes to get things done. When you have to deal with the Forest 
Service, BLM, U.S. Fish and Wildlife, the Park Service, that is not to 
contend with OSHA, the IRS, EPA--just a host of Government entities, it 
seems like, are in your life every day. They do not run their 
bureaucracies very well, and I am wondering if I want them to run my 
health care system. Would it end up like the Post Office? Does my time 
to go get my hip replacement end up in a dead-letter office? I would 
sure hate for it to. I think Americans kind of worry about that, too.
  So I don't like any plan that expands Government, that increases 
bureaucracy, or imposes more regulations on an already overburdened 
system. No new commissions--I do not like that very much--no new 
boards, no bureaucrats sitting in Washington, DC, this Government on 
the Potomac, deciding what is best for me in Montana.
  The system needs streamlining; it needs simplification. But it does 
not need expansion. I have not heard one of my constituents say, ``I 
wish I had more Government in my life.''
  Fifth is an issue that comes up with many farmers and ranchers in my 
State. I am from an agricultural State. I am from a natural-resource-
based State. That is how we produce new wealth in this country. That is 
the only place we produce new wealth, is what comes from Mother Earth. 
The issue of allowing the self-employed to deduct 100 percent of their 
health insurance cost is very important to us. The last version I saw 
of the Clinton-Mitchell bill only increased this to about 50 percent. 
That is not enough. If we really want to help those folks who produce 
wealth, and I believe we all do, we need to give them a full break, and 
that is 100 percent. Large corporations get a 100-percent deduction for 
their health care costs, and the self-employed should have equal 
treatment. So let us do it. It is one big step toward making health 
care more affordable.
  Sixth and last, and definitely not least, the bottom line is cost. 
This is one area that has caused numerous bills to stumble already. It 
is my understanding that the CBO has not yet figured out how much the 
Clinton-Mitchell bill will cost. We need a price tag on it. Without 
that, I am not going to go back home and even try to offer it to the 
people or try to sell it to the people of Montana. To establish brand 
new entitlements, brand new programs, expand Government, and impose new 
requirements on our States--and by the way, even with the majority 
leader's own words and with the communications with the Governors 
around the States, these mandates we put on the States to administer 
this are almost unworkable. They cannot get it done.
  Those of us who worked in county government, where the rubber hits 
the road, understand, because it will finally fall at that level. 
Increased taxes, we got the biggest tax increase we have ever gotten in 
the history of this country last year. I am not really sure we can go 
through another one of those because I think that would be 
irresponsible. Montanans would oppose it, and I will join them.
  I bring my concerns to the floor today because these are the concerns 
of the people of Montana that they are sharing with me. They want 
reform that makes sense in rural America. They want reform that 
guarantees choice. They want reform that does not jeopardize their jobs 
and small businesses. And they want reform without new Government 
bureaucracies, taxes, and mandates. Most of all, they expect and they 
want us to make wise decisions because what we do with health care 
reform will reach into their lives like no other piece of legislation 
passed in the last three decades.
  I have reviewed the limited portions of this bill. I am glad to see 
the bill includes several provisions to increase access to health care 
services in rural and underserved areas. But is changing the graduate 
medical education focus to primary care important? It may be. But let 
me tell you, seeing those results is way, way down the road. I have a 
daughter, Keely. She is in her second year of medical school, and she 
is committed to returning to Montana, to work in rural Montana. But it 
will be years before she gets to that point. Rural America needs help 
now.
  We need incentives to get physicians into the country: Repayment of 
loans, tax deductions, and peer support. The latter incentive can 
easily be accomplished by increasing the use of telemedicine. It is a 
new technology, a technology not only bringing specialty health care to 
areas where there is no specialist, but bringing much needed support to 
the providers. The technology is up and running in many States across 
the country, Montana being one of those. The only barrier is 
Government.
  I was pleased to see the efforts to expand telemedicine included in 
this bill. I can remember when we just had to argue and fight and 
scratch and claw and fiddle around here to get a study done by the 
Department of Transportation on the impact that telecomputing would 
have on transportation. They did not want to do the study. And folks 
around here did not want them to do the study. But we got it in the 
bill. They did the study, and guess what? It is the centerpiece of 
transportation. Because there are going to be a lot of folks staying 
home 2 or 3 days out of a 5-day week and doing their work at home 
without filling our highways or using the gasoline and fossil fuels. Is 
it not funny how ideas take hold and all at once it becomes their idea? 
I have always had the idea around here if you do not care who gets the 
credit, you will get more done. That is usually pretty true.
  These rural-specific provisions are important in this bill. But just 
as important is the rest of the package and what it will do to rural 
America.
  What will it do to limit the choices we now make? If it has anything 
to do with making the right decision, taking that away from the 
patient, I will fight that. One thing that makes our current system the 
best in the world, besides the high quality, is the freedom the patient 
has to choose what they want. They can choose their doctor. They can 
choose their health insurance, their hospital, their pharmacy, and the 
services they want. Yes, the services may be unnecessary. Who knows? 
Who is going to make that judgment? Or some tests may be done for ease 
of mind. But is that decision not for a patient and a doctor? Do we 
still live in America? Somebody is going to make that decision.
  I have a little cartoon here. There is one thing about this town; if 
you do not maintain your sense of humor around here, it soon goes away. 
What I am hearing--I think it is indicative here of the fears I am 
hearing about, the fears of what will happen if the Government gets 
involved, if patients and their doctors lose their ability to make 
their own decisions.
  Let me read it to you. It is Doonesbury. It says:

       Mmm * * * a lot of fluid here * * *
       So what are we looking at?

  Another person comes in:

       I don't know yet. Could be a damaged anterior--
       I do not know what that stuff is, but ``I have a hurt 
     knee.''
       Uh-hum. What's your plan?

  But the second person ends up being the man's insurance agent. That 
is what we are looking at here. Government is already wondering about 
these kinds of things. That is what Montanans are telling me: They do 
not want a bureaucrat in Washington, DC, to make decisions for them.
  You may think that some folks in the country do not know enough to 
make an informed decision. I think they do. They are very capable, 
hard-working people, trying to take care of their families. They do not 
like the folks inside the beltway making those decisions, and I realize 
the folks inside the beltway probably do not like that, but it is true.
  Then there are the taxes. Taxes are taxes, whether you call them 
payroll contributions, revenue assessments, or whatever. It is all the 
same. They are taxes. I have seen a phony tax. Remember the old one: 
``How much did you make last year?'' The next line says: ``Send it 
in.''
  We may get to that point. We already took a big tax hit last year 
and, yes, you might say it did not hit the middle class. It did. It 
went a little bit deeper than we all think it did.
  We live on the Canadian border. We heard some folks talk about the 
Canadian system, single-payer system. This comes out of the July 15 
Calgary Herald. There are probably some Westerners here who probably 
understand what the picture is here. I will hold it up. But on that day 
when the Calgary stampede was on, they have a picture of a steer 
wrestler who is in a bit of a bind. He caught a horn in the chin. In 
other words, that is a plumb wreck. I thought what better thing to put 
across on the page than the headline: ``Axe Falls on Calgary 
Hospitals.''
  Hospitals are being closed because they do not have enough money to 
make it to the end of the fiscal period so they closed the hospital. So 
you can say in the United States we have universal access but not 
universal coverage. They have universal coverage, but they do not have 
universal access.
  In Montana, if you go down to the medical corridor in Billings, MT, 
one out of every five cars in the parking lot bears a Canadian license 
plate. They are not there for a social occasion, I can tell you that.
  But the highlights of the story is that the Bow Valley, Holy Cross, 
and Grace Hospitals are to be closed, their programs are moving 
somewhere else. Holy Cross renovations and Bow Valley renovation plans 
have been canceled. Alberta's Children's Hospital remains open on the 
current site and continues to offer care but limited.
  Of course, you can go all through this newspaper and even on the back 
where the unions are saying we have to have more money or we are going 
to close these hospitals. If you get sick, they are going to say, 
``Well, we didn't make it till Thursday. You've got to find another 
hospital to go to.'' All of this in this newspaper, and basically what 
you are looking at is a old steer wrestler and he is in a wreck, folks, 
and that is not funny. He catches one of those horns in the chops. I 
guarantee you that.
  So we have a lot of folks here who want to offer their opinion on 
what it would do if we went to a single-payer or a big-Government 
bureaucracy or a Government-run plan and mandates. And they are in this 
bill, do not ever let anybody tell you any different because when you 
get to 2002, they are there. Even some of them will apply to South 
Dakota.
  I also want to put in the Record ``Government Health Care. Thanks 
Anyway, Says Libby, Montana.'' Libby, MT is a little town up in 
northwest Montana. They have had mill closings. They are completely 
dependent on public lands to make a living. I do not know of a tougher 
town in America, but they just take things. But there was a little 
article that came out of their newspaper up there, and I ask unanimous 
consent that it be printed in the Record because I think it deserves 
the attention of my colleagues who serve in the Senate.
  There being no objection, the article was ordered to be printed in 
the Record, as follows:

       Government Health Care: Thanks Anyway, Says Libby, Montana

                       (By William Perry Pendley)

       What were the odds that the Montana town of Libby would be 
     hit with three catastrophic health care cases in such a short 
     period of time?
       In February 1992, Sally Sauer, 26 year old daughter of an 
     unemployed forester, discovered she needed a heart 
     transplant. In February 1993, 5 year old Amanda Johnson, 
     daughter of an uninsured logging truck driver, needed heart 
     valve surgery. Six months later, Kyle Rosling, 17 year old 
     son of an uninsured sawyer needed heart surgery.
       Libby is a tiny community of 2800 in Lincoln County where 
     78% of the land is owned by the U.S. Government. As a result 
     of U.S. Forest Service timber harvest cut backs, to 
     ``protect'' the grizzly bear, Libby's unemployment has been 
     double digit for months.
       Nonetheless, the people of Libby and neighboring Troy set 
     out to save Sally, Amanda and Kyle. Through a variety of 
     campaigns and through the generosity and hard work of the 
     industries and individuals of northwestern Montana, the 
     ``Sally's Heart'', ``Hour Amanda'', and ``Kids for Kyle'', 
     campaigns raised more than $325,000. Today Sally can be seen 
     jogging around town, Amanda is completely cured and Kyle is 
     wrestling in the 152 pound class on the Libby Loggers varsity 
     team.
       What happened to Libby's Sally, Amanda and Kyle might well 
     be cited, by the Clinton White House, as proof that America 
     needs federal health care. Certainly Libby's experience is no 
     less compelling than the other anecdotal evidence heard by 
     Hillary Rodham Clinton's secret health care panel. At least 
     that's what ABC's ``Home Show'' thought.
       When ABC heard about Sally, Amanda and Kyle, it sent a crew 
     to Libby to film men and women citing their ordeal as proof 
     that America needs a federal health care plan. The film crew 
     heard plenty about Sally, Amanda and Kyle, but the lessons 
     the people drew from their experience surprised the folks 
     from ABC.
       Yes, Sally, Amanda and Kyle had been pretty sick. Yes, 
     getting them well had cost a lot of money. Yes, many of the 
     people in Libby didn't have their own health care plan. 
     However, the people of Libby were unwilling to whine about 
     their experience or to jump to conclusions about the state of 
     the nation's health care and what ought to be done about it.
       What the ABC crew heard was not the rhetoric of the 
     Washington, D.C. crowd, but questions real people ask if 
     given the chance. ``What's all of that going to cost?'' 
     ``Who's going to pay for it?'' ``Will we get to select our 
     own doctors?'' One viewpoint the ABC crew heard over and over 
     was that the health care proposal the people had been hearing 
     about was a very expensive program that the American people 
     simply couldn't afford.
       The ABC crew heard something else. Many of the men and 
     women interviewed had been covered by a health care plan; 
     that is, until environmental policy gone wild had taken their 
     jobs. What many of them said was that if President and Mrs. 
     Clinton wanted to do something about health care, the 
     Clintons could get the environmentalist off the backs of the 
     people and allow the harvesting of trees in the forests 
     around Libby once again. Just let the mills reopen, they 
     said. Then health care will take care of itself.
       When people talk about a federal health care program, they 
     forget about all the other things the U.S. Government can't 
     seem to get right. The people of Libby aren't that forgetful. 
     Perhaps it is because they know first hand how the federal 
     government operates. Perhaps it is because they have seen 
     what federal control means to their lives. Whatever the 
     reason, the people of Libby, interviewed on the streets of 
     their struggling town, have said ``no'' to federal health 
     care. Having heard President Clinton's State of the Union 
     Address and his commitment to health care in 1994, they 
     wonder what the rest of the nation will say.

  Mr. BURNS. Mr. President, I want to thank my colleague from Minnesota 
for the time. And as we move this through, we have great challenges. 
But a rush to judgment on this issue does not serve the issue or this 
country or its people very well.
  I yield the floor.
  Mr. DURENBERGER addressed the Chair.
  The PRESIDING OFFICER. The Senator from Minnesota.
  Mr. DURENBERGER. Mr. President, my colleague from Montana pointed out 
that there are two committees that deal with health care in the Senate, 
and he has not been fortunate enough to be on either one of them. I 
must say, I have had the misfortune, if you will, of being on both of 
them.
  It also demonstrated something else to me, and that is, we do not 
have a health committee, as such, in the U.S. Senate. So we are working 
at it from a variety of other sources which makes the job very, very 
difficult.
  I want to thank my colleague from Montana for his commitment. We have 
been going to breakfast together on Thursdays for 4 straight years down 
the Hall. He has been part of the Republican health reform task force, 
medical malpractice reform program, and a variety of others. I am 
really very appreciative of his comments.
  I am reminded also of what he said about the Mitchell bill; that it 
took those of us who think we know something about it 4 straight days 
to get through the first draft of that bill and found in our efforts to 
try to come up with amendments, it is almost impossible to amend.
  So I appreciate very much his comments, and as one who sees a lot of 
Canadian license plates--Ontario, in particular--in parking lots and 
hospital parking lots in Grand Forks, ND, Duluth, MN--a whole variety 
of cities. I am sure glad he told us what happened during the Calgary 
stampede to the hospitals in Canada. That happens in Toronto and other 
areas as well. It is not just in Saskatchewan.
  Mr. DASCHLE addressed the Chair.
  The PRESIDING OFFICER. The Senator from South Dakota.
  Mr. DASCHLE. Mr. President, I listened with great interest to our 
dear friend from Montana. I have a profound respect for him and 
admiration for his great sense of humor. But I must say, I must differ 
with him on a number of points. I have not seen license plates on 
either side of the border enough to count, but I know that there are 
plenty of U.S. license plates on the other side of the Canadian border 
because that is where they get primary care, good preventive care at 
times. I know there are those Canadians who tell us that it is cheaper 
for them to fly first class to the United States and use our high 
technology than it is for them to buy it.
  So I know there are plenty of arguments on both sides. But I think 
the main point that I would make is the same point I made this morning, 
a point the majority leader has made so eloquently on so many 
occasions, most recently last Sunday. And that we talk about how 
concerned we are, or I should say some of our colleagues talk about the 
concern that they have with regard to Government health care. Yet I 
have not yet seen a bill or an amendment to abolish Medicare. I have 
not seen a bill or amendment to abolish the Federal Employees Health 
Benefits Plan. I have not seen a bill or amendment to abolish the 
Capitol physician, or our opportunity to use Walter Reed or Bethesda 
when we need health care.
  The fact of the matter is every Member of Congress uses the health 
care that is so criticized on the other side of the aisle so frequently 
every time we get sick. The President uses it, Senators use it, Members 
of Congress use it. There are times, of course, when our families have 
to use the health care provided so well in the Federal Employees Health 
Benefits Plan.
  We talk about how extraordinary a plan it is and how we really do 
want to give everybody else the same opportunity to have access to good 
quality care that we have through the Federal Employees Health Benefits 
Plan. That is a Government plan. I have not seen any effort to abolish 
the Veterans Administration or the defense hospital system that has 
done such a good job.
  I think we need to be clear here. Every Member of Congress benefits 
substantially from a Government health program and has chosen not to 
offer any legislation that I am aware of to abolish it. So that is 
point No. 1.
  Point No. 2 is that it is somewhat ironic, frankly, that we talk 
about a Government-controlled plan when Senator Mitchell's bill does 
just the opposite in providing 30 million Americans who are now under 
Medicaid the opportunity to buy private insurance. So we shift away 
from Government insurance in that case to a private plan. We want to 
build as much as we can on the private system. Now, ought there be some 
regulation? I think every Member of the Senate would agree that as we 
regulate the air traffic control system, the banking system, our 
agricultural system, our highway system, there has to be some form of a 
regulatory framework within which the private sector works to assure us 
access and confidence and cost control and all of the things we say we 
want.
  So I would hope that as we go through this debate, we can have an 
honest debate, recognize the differences that exist in philosophy and 
position. But I would hope that we also would acknowledge that there 
are Government systems that work pretty well or we would not avail 
ourselves of them so frequently, and that, indeed, while we understand 
how good Government systems can be, that is not the purpose of the 
Mitchell bill.

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