[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. DASCHLE addressed the Chair.
  The PRESIDING OFFICER. The Senator from South Dakota.
  Mr. DASCHLE. Madam President, I ask unanimous consent that Lucia 
Giudici and Jeffery Geller, congressional fellows of my office, be 
granted floor privileges during the consideration of S. 2351.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. DASCHLE. Madam President, I yield such time as he may consume to 
the distinguished Senator from Massachusetts, Senator Kennedy.
  The PRESIDING OFFICER. The Senator from Massachusetts is recognized.
  Mr. KENNEDY. Thank you very much, Madam President. I have been 
listening over the course of the late morning and this afternoon to the 
various speeches about the Mitchell bill, and the Dole bill, and some 
general expressions of concern, particularly with regard to children.
  It is important for the American people to understand that this is 
the third day that we have been debating the Dodd amendment, of which I 
am proud to be a cosponsor, to accelerate protections for preventive 
services for children in this country, up to 1995.
  We have been trying to get the Senate to go on record to approve this 
particular measure, which is of such incredible importance to children 
in this country. I spoke earlier in the debate about the importance of 
Senator Dodd's amendment, as did Senator Riegle, who offered a similar 
amendment to the Finance Committee bill, which was approved with 
bipartisan support. The Senator from Illinois, and a number of other 
Members also spoke in favor of this measure.
  But we are trying now, in our third day, to come to a decision. Those 
who have put forward this amendment--which is not very complicated and 
is supported by a number of insurance companies--feel that we must 
build on the protections for children established in the Mitchell bill. 
If we are going to have a bill--and I believe we will have a bill--we 
ought to give priority to children, for all the reasons outlined in the 
earlier discussion.
  But we are now in the early afternoon of the third day, and many of 
us would like to see a resolution of this matter, so that we can move 
on to other proposals to strengthen the Mitchell bill. Senator Harkin 
has a proposal with regard to disability issues, which I think makes a 
great deal of sense. It will be cost effective and responsive to some 
of the very special needs of persons with disabilities. There will be 
other amendments to strengthen the bill that deal with rural health 
needs and mental health provisions.
  In the brief discussion last week between Senator Domenici, Senator 
Moynihan, myself and others, we talked about various provisions in this 
legislation dealing with mental health. The issue is parity of coverage 
for individuals with physical health care needs and mental health care 
needs.
  We are eager to debate all these issues and to permit the Senate to 
go on record on these matters. Nonetheless, 3 days into the debate we 
are still discussing the first amendment. There are those who say ``We 
are not trying to stall this proposal,'' and yet we cannot come to 
grips with something that is as basic, as fundamental as the amendment 
that is before us, which would improve coverage for the 12 million 
children who do not have coverage under Medicaid or through a working 
parent's health insurance policy.
  The number of children without insurance is growing year after year 
after year. The Carnegie Commission estimates that by the year 2000 
about half of all of the children in the country will not be covered by 
a parent's employment-based health insurance policy. We are talking 
about working parents, men and women who are playing by the rules, 
working 40 hours a week, 52 weeks a year, trying to provide for 
themselves and their families.
  All this amendment does is say that beginning next year insurance 
policies are going to cover a range of preventive health care services 
for children. Contrary to what we heard from some of our colleagues, 
this amendment is not about subsidies. It is a very simple proposal 
that ensures that beginning in 1995 private insurance policies will 
provide preventive health care services for children.
  That is what we would like to see the Senate decide this afternoon. I 
imagine we will have a chance this afternoon to talk about some of the 
other principal differences between the Mitchell bill and the Dole 
bill. We will discuss not only how these bills affect children but how 
they affect working families and senior citizens. The Dole proposal 
does not provide prescription drug coverage or home and community-based 
long term care services for our seniors, as the Mitchell bill does.
  We are hearing the voices on the Senate floor saying that they care 
about the elderly and they care about prescription drugs. One bill 
covers it and the other bill does not.
  We hear Members saying they care about community-based long term care 
services so that seniors are able, as a matter of choice, to remain 
home and get the health care services and support they need. Seniors 
may want to be able to receive community-based long term care services 
during the day, and then return home to receive the care, affection, 
and love of the members of their family. There are provisions in the 
Mitchell bill to provide these services to seniors and the disabled. 
There are no such provisions in the Dole bill.
  I will take just a few moments to review once again why this 
particular amendment is important.
  First of all, I will take a moment to describe the difference between 
the Mitchell proposal and the Dole proposal when it comes to protecting 
children. Families with income below 100 percent of poverty would be 
protected under either proposal. However, for a family with income at 
150 percent of the poverty level, which is $22,000 for a family of 
four, you see that under the Dole proposal the family would have to pay 
$5,883 to provide insurance for their children, while under the 
Mitchell proposal the same family would receive a full subsidy to buy a 
health insurance policy for their children. We can see that the 
Mitchell bill targets subsidies to provide coverage for children. 
Working families earning $29,000 per year would have to pay only $232 
for coverage for their children under the Mitchell bill, compared to 
$5,883 under the Dole bill. Families earning 250 percent of poverty, or 
$37,000 would be able to provide coverage for their children at a cost 
of only 2.7 percent of their income, compared to 15.9 percent under the 
Dole bill. For working families that want to provide insurance for 
their children, the cost is virtually prohibitive under the Dole bill, 
and that is unfortunate.
  Mr. President, we have seen also in recent times that the percentage 
of children who are being covered by Medicaid has been increasing for 
the past several years. So we have a phenomenon where of more and more 
children are falling into the Medicaid Program. That is certainly 
better than no coverage at all. However, the percentage of children 
being covered by their working parents is going down, and the 
percentage with no insurance at all is increasing every year.
  The majority of uninsured children, as I pointed out earlier, are 
from working families. I can not overstate the importance of providing 
preventive services for these children, and for all children. The 
Mitchell bill provides these necessary services for children without 
deductibles or copayments. Under the Dole bill, we can not be sure that 
preventive services for children will be available without copayments 
or deductibles. The Mitchell bill also provides vision care, dental 
care, and hearing care for children. Under the Dole bill, we can not be 
sure whether these services will be available to children.
  We heard from our colleagues recently that they support the WIC 
Program, but they do not believe necessarily believe that we ought to 
fully fund the WIC Program. The WIC Program helps ensure that children 
will get the nutritious food they need to develop and grow. And yet 
some of our colleagues do not want to provide adequate funding for this 
program, which helps keep children healthy.
  We heard one of our colleagues earlier in the day talk about the need 
for school-based health clinics that are to be developed with input 
from parents, school officials, and teachers. In the areas where they 
have been developed, this is enormous support for these clinics.
  We passed this provision in our committee 17 to nothing. We had 
Republican support for it. We worked with our Republican friends who 
recognized the importance of making sure that we address the needs of 
America's children. We need to provide assistance not only to parents, 
but also to children, in the form of school-based health clinics, which 
can make such a difference in improving the health of children.
  When you read through the Carnegie Commission report and other 
reports, you read about the problems facing many schoolchildren today. 
Many are suffering from hunger and malnutrition, and many have to deal 
with problems at home such as spousal abuse, or other violence or 
substance abuse. When a child is sick, many times a working parent can 
not stay home to care for the child. If a parent can not afford to pay 
someone to look after the sick child, the parent must send the child 
off to school. The child not only does not learn, but in many instances 
may pose a health threat to other children. School-based health clinics 
can make an important difference not only for the sick child, but also 
for his or her classmates.
  The difference between how the Mitchell bill and the Dole bill treat 
children and families is quite apparent from that chart. You can see 
the difference in the cost to families that want to provide insurance 
for their children. Many families simply can not afford to pay 13, 15, 
19, or even 26 percent of their income to provide insurance for their 
children.
  Then if you go even beyond just the special program to provide 
coverage for children, you can see that the Mitchell proposal, which 
assumes shared responsibility at some point in the future, makes 
insurance coverage much more affordable for families than the Dole 
proposal, based on CBO estimates of the premiums.
  The chart shows that families with income from at 125 percent of 
poverty pay only about 4 percent of income for family coverage under 
the Mitchell bill, compared to 12.7 percent under the Dole bill. Under 
the Dole proposal working families would be forced to pay 3 or 4 times 
as much as under the Mitchell bill.
  And we can listen to our colleagues talk about how their proposal is 
going to deal with and solve the kinds of problems that the Mitchell 
program addresses, but the Dole approach it is just unrealistic. It is 
absolutely unrealistic to think that families will be able to afford 
coverage under the Dole proposal. Sure they will be able under the Dole 
proposal to participate in a health care program and a health care 
system, but this is what they are going to have to pay.
  And does that really improve on the current situation for most 
families? In theory everyone has health care available to them today, 
but many people cannot afford it, and most of them will not be able to 
afford it under the Dole proposal either.
  So, Madam President, just very briefly on this, I am hopeful that we 
will be able to get to a resolution this afternoon on the issue of the 
children's amendment. I hope we will also be able, as we move on 
through, to talk about how the different bills treat working families. 
This chart indicates at least what the cost of coverage would be for 
working families. We also must discuss the comparison between how the 
Dole and Mitchell bills treat senior citizens.
  We must include a comprehensive program that to improve coverage for 
our seniors. We have studied that issue enough. We have the excellent 
bipartisan Pepper Commission report that made a series of 
recommendations. Some of those recommendations have been adopted in the 
Mitchell proposal, including additional asset protection to ensure that 
seniors will not be wiped out with an extraordinary, sudden illness 
that would basically swallow all of their savings.
  There are also provisions in the Mitchell bill to ensure the 
integrity of the insurance programs that many individuals, the seniors, 
participate in. We find extraordinary facts that many of the long-term 
care insurance programs for our elderly, are not available to those who 
need them.
  We have standards that have been established. I must say, those 
standards were worked out a year ago in a bipartisan way and have been 
included in this legislation. Senator Hatch and I reported it out of 
our committee. It is very, very important in terms of protecting those 
seniors who do have long-term health care needs.
  We have important features. One, we have an asset protection for our 
seniors in the Mitchell bill, which the Dole bill does not provide. 
Second, we have the preservation of the integrity of the long-term 
insurance, which the Dole bill does not provide. Third, we have the 
prescription drug proposals that will be fully implemented by the year 
1999. And beyond that, you have the home, and community-based long-term 
care program, which is phased in to help assist our elderly and 
disabled. These are all very solid, responsible programs.
  In each of these areas, we find a difference of approach between the 
Dole bill and the Mitchell bill.
  So we are very hopeful, Madam President, that we will be able to have 
some early resolution of these particular amendments in an early way.
  Madam President, I ask unanimous consent that certain staff members 
be able to have access to the floor during the consideration of this 
legislation. I send their names to the desk.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Who yields time?
  Mr. DASCHLE. Madam President, I yield such time as he may consume to 
the distinguished Senator from Illinois.
  The PRESIDING OFFICER. The Senator from Illinois is recognized.
  Mr. SIMON. Madam President, I am pleased to speak again on this 
health coverage for all of our citizens.
  We face now two choices: The proposal by Senator Mitchell, the 
majority leader, that frankly is not as strong as I would like, but 
moves us in the right direction; and the bill proposed by the minority 
leader, that I think should be called the Insurance Industry and 
Tobacco Industry Protection Act, because that is what it does. It 
offers no taxes, no taxes whatsoever on tobacco, and it has a whole 
series of loopholes that are designed specifically for the insurance 
industry.
  Let us take a look at where we are in this country. It really is 
incredible, when you think of it. We join other industrial countries in 
providing health insurance protection for one group and one group 
alone--that is people who are in our prisons. If you are convicted of 
murder and you go to prison, you will get health protection in our 
country. But if you are someone who is struggling at a job that may be 
a minimum-wage job, working 40 hours a week, two countries do not 
protect you in the Western World--South Africa and the United States of 
America.
  If you work in France, you are protected. If you work in Great 
Britain, you are protected. If you work in Japan, you are protected. If 
you work in Italy, you are protected. But in the United States of 
America, you are not protected. Every one of those other countries 
protects all children. We do not.
  I fear that we may not do what is right in this country and, in the 
next few weeks, as we make the decision, I fear we will not do what the 
American people want us to do, and that is to protect all of our 
citizens.
  We are also unfair to employers. If you were to start with a blank 
slate, Madam President, and say: Let us design a system where you can 
volunteer as an employer to protect your employees and if you volunteer 
then you can also pick up the tab for those who do not volunteer, we 
would say that is a ridiculous system. And yet, that is precisely the 
system that we have. And under the Dole proposal, we will continue to 
shift that burden.
  It is very interesting, as you look at the series of proposals made 
by the minority leader. In his bill, he says, just as the Mitchell bill 
says, if you want to get the same protection that Senator Murray from 
Washington has, Senator Craig from Idaho has, Senator Wellstone from 
Minnesota, Senator Reid from Nevada, Senator Daschle from South Dakota, 
or Paul Simon from Illinois, if you want to get the same protection we 
have in the Mitchell bill, you have a 1.5-percent administrative fee 
that insurance companies can collect for this cost. The Dole bill says 
you can do that, but there is a 15 percent administrative fee, 10 times 
as much. That is a pretty nice largess for the insurance companies.

  The American public wants coverage. I have never seen a poll like the 
New York Times poll that says 79 percent of the American people say it 
is very important that we have universal coverage for all of our 
citizens; 17 percent say it is somewhat important. That is a total of 
96 percent. Three percent say it is not important and 1 percent do not 
know. Madam President, 96 percent--I cannot think of another 
controversial issue in which 96 percent of the American people are on 
one side, properly so. And the question is whether we are going to 
respond.
  The bill that came out of the Labor Committee which Senator Kennedy 
chairs by bipartisan vote says we are going to cover everyone. We had 
special breaks in there for small businesses. Employers who now cover 
everyone would be better off, clearly, under that bill.
  The Clinton bill calls for universal coverage. Both of them do not 
attain it as rapidly as I would like but they cover it. The Mitchell 
bill covers 95 percent by the year 2000. That is not as strong as I 
would like but at least it moves us in the right direction.
  The Dole bill--we are now at 83 percent coverage, 17 percent of all 
Americans not covered. That means if there are 100 people in the 
gallery right now, 17 of them are not covered. I do not think you will 
find 17 people in the gallery who do not want to have health insurance 
coverage.
  Last week my secretary went to dinner with two friends and during the 
course of the dinner one of the people at the dinner--some of my 
friends, at least on this side of the aisle, know her because she has 
helped raise funds, she is a fundraiser and has been a professional 
fundraiser--and she started to perspire and turn pale and had some of 
the symptoms of a heart attack. They wanted to take her to a hospital. 
But she said no, she could not go to a hospital. They then got in a cab 
to take her home and she had nausea in the cab on the way home. 
Fortunately it turned out she had food poisoning rather than a heart 
attack. But she did not have health insurance and she was afraid to go 
to the hospital.
  (Mr. BYRD assumed the chair.)
  Mr. SIMON. We should not have that in this country. Every American 
ought to be covered. If we pass the Dole bill, we are not only going to 
stay at the 17 percent, we are going to slip further. I want to see 
every citizen of West Virginia covered, Mr. President. I want to see 
every citizen of Illinois covered. If that means that we have to have a 
tobacco tax--I am speaking for myself now, not any Senators from West 
Virginia--if we have to have a tobacco tax, I am willing to vote for 
it. If we have to have a payroll tax, I am willing to vote for it. I 
know you cannot do this on the cheap. We have to pay for it. There is 
no free lunch. But we are paying for it in the worst possible way right 
now.
  Mr. President, 14 percent of our national income is going for health 
care. No other nation on the face of the Earth spends that much. And 38 
million Americans are left out.
  I want all Americans to be covered. That is what the American people 
want and I hope we do the right thing in this body.
  Mr. President, I yield the floor.
  The PRESIDENT pro tempore. The Senator from Idaho [Mr. Craig].
  Mr. CRAIG. Mr. President, I yield myself such time as I may consume.
  The PRESIDENT pro tempore. The Senator is recognized for such time as 
he may consume.
  Mr. CRAIG. Mr. President, for a good number of days now, the Senate 
has been engaged in what I have to believe and what I think most 
Senators believe to be probably the most valuable debate or at least 
the most important debate that we have been about in a good number of 
years.
  We are debating S. 2351, better known as the Clinton-Mitchell health 
care proposal. While at this very moment the Dodd amendment is pending 
on the floor, the one thing that became very obvious to this side of 
the aisle, to Republicans, was that we were not going to be openly 
granted the opportunity to debate the Clinton bill in its entirety 
before we started the amendment process. So we found it very important 
to come to the floor and, as best we could, to not only debate the Dodd 
amendment but, more important, to discuss with our colleagues here in 
the Senate and the American people the Clinton-Mitchell health care 
proposal.
  I say that because I think most Americans agree with me, this is 
probably the most important and substantive debate that has occurred on 
the floor of the U.S. Senate in a good number of years. Why? Because it 
affects every American in the most personal of ways. It affects whether 
he or she, or they will be able to deliver to themselves or their 
families, the quality of health care that every American desires. That 
is the substance of this debate and that is why it is important and 
that is why it is more important that we are here today--not in the 
August recess--debating this issue.
  So for the next few moments I would like to talk about the importance 
of that debate, talk some about the Clinton bill, but also to talk 
about a variety of other issues that I think spiral around this debate 
that certainly the citizens of Idaho have engaged me in over the course 
of the last several years and that I think are important.
  This morning I attended a press conference with some citizens and 
business people and representatives of small businesses especially from 
the State of Hawaii. The reason I was with them was because they flew 
all night from Hawaii here to tell the American people in a press 
conference that the much-touted State-mandated health care plan in 
Hawaii is not what many have said it is, or that it has been ever since 
it was enacted in 1971.
  The Governor of Hawaii was over, saying, my, this is a marvelous 
program and it just covers everybody. But State employees are exempt 
from it. Why are State employees exempt from it if it is such a 
wonderful program? The reason is because the State program is a better 
program. And that the employer-mandated program in Hawaii is causing 
great problems in the small business community today. You are finding a 
lot of employment that is part time simply because if it is over 20 
hours a week, then it is full time, and the employer has to pay for the 
mandate.
  So there are a lot of people working part time in Hawaii--maybe a 
great number of jobs--but not getting the kind of coverage because it 
is a mandated tax. It is a requirement if you are in business in Hawaii 
that you have to have this program. And if you have to have it, doggone 
it, the average human beings being what they are and trying to save a 
little money and oftentimes trying to just keep their business doors 
open are going to find a way around that kind of mandate, a legal way, 
if they can, so they can make ends meet so they can hire the people 
they can afford to hire. And that is an important issue that is 
embodied in the Clinton-Mitchell bill, and that is an employer mandate 
that a lot of people will be talking about over the course of the next 
several days that a good number of us are very concerned about.
  Whether it is the Rand study that showed it could put 300,000 to 
400,000 people out of work in this country or whether it is the NFIB 
CONSTAD study that showed nearly 800,000 people could be put out work 
by this kind of mandate, the very simple and often rhetorical comment 
back from the other side is, ``Oh, well, but this program is going to 
hire a lot more people.''
  What about those who are put out of work? They are not saying they 
will be put back to work, because it is a different kind of work. It is 
a different kind of employment under a different kind of knowledge or 
understanding or training base than that which those people who were 
mandated out of work by this kind of legislation found themselves 
working at when they were put on the unemployment rolls. That is an 
issue we are all going to have to deal with in the coming days of this 
debate.
  But I think what is fundamentally important here are some of the 
remarks that I want to pass on that are well beyond the general range 
of philosophy or attitude about whether we do or do not want a 
particular kind of health care reform. Because what I think is most 
significant is that every Senator that I visited with, that I have 
worked with here in the last several years as this issue of health care 
reform has emerged amongst the American people, has said they want 
health care reform. We not only want it, we not only desire it, we 
think it is important for our country to resolve the problems of the 
current health care delivery system, as numerous as they are.
  But the question is, what kind of reform? That is why this debate 
becomes so important. That is why it is darned important that we have 
canceled the August recess because this is the time that the majority 
leader, Mr. Mitchell, decided we are going to debate health care.
  Then let us be here debating it. Let us put all of these bills out on 
the table, spread them out for the American people to understand, 
spread them out for them to leaf through and to read the fine print and 
to be able to make the individual determination as to whether this is 
going to affect them in the right way or the wrong way, whether it is 
going to give them the options that they need.
  Mr. President, before I go any further, I would like to add that I am 
extremely frustrated, though, by this process, and I am frustrated 
because I am not quite sure where we are at this moment.
  When I say that, I am not sure which version we are talking about, 
because when the debate began, we had Clinton-Mitchell 1, some 1,404 
pages that we were to study, to understand and to spread upon the 
table, as I have just mentioned. But that is not the case at this 
moment. At this moment, we are on Clinton-Mitchell 3 or, as Senator 
Packwood would say, Lethal Weapon 3. But we are on the third version in 
less than 1 week's period of time. I do not blame the American people 
for scratching their heads and saying, ``What are you doing?'' But more 
importantly, ``Why are you doing it that way? Why aren't we being given 
the ample opportunity to see, to understand and to compare the 
differences of all of these programs and then to be able to call you or 
write you, Senator Craig, and say, `we prefer this over this or this 
particular bill will affect us in this way, as this bill would cause us 
some problems.'''
  That is the frustration we are dealing with, and my constituents have 
been clamoring to see the bills since they were originally introduced. 
The moment the Mitchell bill became available, we started getting phone 
calls. So we sent copies of those bills out to our district offices 
across the State. But as I just mentioned, the mail takes 3 days from 
the time you send it from the office here in the Senate to an Idaho 
office. And in that 3 days, that 1,400 page document that was in 
transit in the mail was obsolete because Leader Mitchell had come to 
the floor with another bill.
  As a result, we said to our district offices, ``Cancel that bill; it 
is out of date, wait for the other bill. As citizens come in, they can 
take a look at it. Tell them the chapters, sections, and subsections 
will be different, because the new bill, version 2, is on its way.''
  Mr. President, before version 2 got to our district offices in Idaho, 
version 3 was on its way.
  I am told that the first printing of this particular piece of 
legislation cost the American taxpayers about half a million dollars, 
give or take. If it is true that the first version cost a half a 
million dollars, I think it is reasonable to assume, when you look at 
the sizes of them, that the second version of Clinton-Mitchell, and 
possibly the third version of Clinton-Mitchell, cost about the same 
amount to print and to disseminate a given number.
  So we are already well over a million dollars in costs just to print 
a concept or an idea, long before it gets debated, long before it gets 
amended, long before it arrives at the refinement process that then 
might be acceptable to you or to me or to anyone else serving in the 
U.S. Senate.
  Why is this going on? I am not a veteran legislator compared to you, 
Mr. President, but I do know one thing: That normally this kind of 
activity happens in committees. When we get a bill to the floor, it is 
usually the final version, it usually has been worked over by all of 
the people of authority in a given committee or a committee of 
authority, or maybe two committees, and then it is merged into a final 
product that has had months and months of work before it ever comes to 
the floor for a final vote. We have not only saved the taxpayers a 
phenomenal amount of money, we have done the workings, the craftings of 
the legislative process in the right way.
  I cannot say that that has happened here. I am not proud of this 
process, and I do not think the American people are proud of it and, 
frankly, I do not think they are very happy with it. But that is 
another matter. We are going to debate it and we are going to try to 
resolve the differences and, in the end, we will decide whether the 
product that is in process today is worthy of our support, worthy of 
the support of the American people or, in fact, it ought to be defeated 
and then we ought to go home and talk again with our constituency and 
come back and try to resolve it another day.
  There is a bottom line, and that bottom line is that the American 
people believe, as I do, that the current health care system of our 
country deserves to be reformed; that it should not be a moving target; 
that it ought to be a very real, stationary, subject that we all know 
the pros and cons about, that we were given ample opportunity to see 
and work out, and then we decide in the appropriate legislative fashion 
that this Senate has become known for and respected for over the last 
200-plus years.
  For the next few minutes then, let me talk about the debate that has 
gone on in Idaho, in my home State, for the last several years, and 
what I have done as a participant in that debate and as a Federal 
legislator for the citizens of the State of Idaho.
  Starting back in 1989 and working forward to today, I have been the 
sponsor of a variety of health care conferences. They have really ended 
up being quite large conferences, 300, 400, 500 people attending from 
all over the State. We have been able to draw in such speakers as 
former Secretary of Health and Human Services Lewis Sullivan; former 
Administrator of the Health Care Financing Administration, better known 
as HCFA, Gail Wilensky; from the Heritage Foundation, Stuart Butler; 
from the University of North Carolina, Kenneth Thorpe; and from Harvard 
School of Public Health, Dr. William Hsiao--all of these people, noted 
authorities of their time, of their day in health care. They have come 
to our State at my encouragement to explain, to debate and to answer 
questions for the citizens of the State of Idaho.
  I have also held town meetings and health care conferences--in a 
smaller fashion--on reform across the State. I guess in the last year I 
have probably held six or seven of these kinds of conferences, 
providing for the citizens of Idaho just as much information as was 
available at the time.
  And there has been one theme line that I have encouraged in Idaho--
not that I showed a bias, or not that I suggested one program over 
another. I told them the programs that I was a cosponsor of, but I 
said, ``It is time, Idaho, that you get involved in this debate, that 
you get to know as much as you can about President Clinton's plan or 
about the Heritage plan or about any other plan that is out there,'' 
because at that time, and very similar to what I said just a few 
moments ago, I used a very simple line, and that was, Mr. President, to 
the citizens of Idaho, I said: ``This is the most significant piece of 
public policy that you will be involved in your lifetime. You deserve 
to know about it and, more importantly, I deserve to know what you 
think about it before I cast my final vote.''
  As a result of that, from the conferences to the town meetings to the 
publications, to all of these Mitchell plans that I have been sticking 
in the mail and shoving out to our district offices and letting the 
people know that they were there and they could come in and read them, 
sort through them, question them, call me back, Idahoans became engaged 
in this debate more than any other I have ever been involved in in the 
14 years I have represented them.
  Thousands of cards and letters have come back, telegrams, faxes. We 
are receiving hundreds of letters a week now from them on the health 
care issue. That is what I hoped Idahoans would do. Their resounding 
message that comes back in almost all instances would be and is, 
Idahoans are saying to their Senator: We would prefer no bill to a bad 
bill.
  So the question is, Mr. President, what, by the definition of the 
Idaho understanding, is a bad bill? In my opinion, in reading all of 
those letters, Idahoans define a bad bill as that which requires more 
Government involvement in the health care delivery system of their 
State. They want reform, because all of those letters that talk about 
getting a piece of legislation talk about reform.
  But I am telling you, they understand very clearly the kind of reform 
they want. They recognize what needs to be done. But Idahoans also 
recognize a lot of other things, as I think most of our citizens do. 
Idahoans realize the importance of the fact that 84 percent of all 
Idahoans are now currently insured, are now currently covered under a 
variety of health care insurance programs. In anyone's book, that is an 
overwhelming majority.
  Does that mean there are no problems? No, I have already said, 
Idahoans want reform because they recognize that there are problems, 
significant problems. But they also recognize that when you look at the 
figures of 84 percent insured, that means there are 16 percent that are 
uninsured. And guess what? As logical and conservative as Idahoans are, 
they say, ``Why don't you work to solve the problems of the 16 percent 
instead of creating a whole new, large, Federal bureaucracy to deal 
with the whole system when 84 percent of Idahoans, like many other 
Americans, are already covered?''
  That is the issue at hand.
  So I think Idahoans have defined what they think is the problem. 
People are worried that they will lose their health care if they have a 
serious illness, because their insurance might be canceled. They think 
that is a problem in Idaho, and they want us to solve that problem, or 
try to work with them in solving it.
  They worry that they would be kept from getting insurance if they 
were to change their jobs. I think we call that portability around 
here. And Idahoans say, ``Larry, fix that.'' They are concerned about 
whether they will be able to afford insurance by reason of the rate of 
increase in cost. And they say, ``Can't you resolve some of the cost 
factors that are driving that?''
  They have a strong desire to be able to purchase the services they 
want from a doctor or a health care provider they choose. In other 
words, Idahoans want choice of the kind they have felt they have always 
had. They do not want a Federal agency or a regional agency or some 
kind of federally created co-op saying no, here are the doctors that 
are going to provide you with this kind of care. We are not going to 
give you that kind of flexibility or choice. That is a concern that I 
think most Idahoans have.
  And another thing I think they feel is most important is they do not 
want what they have changed. In other words, they say, ``Take care of 
the 16 percent, adjust us around a little bit, deal with some of these 
problems, if you can, but do not change the system to an all-
federalized system.''
  In other words, they are saying we do not have to sacrifice the 
quality that we are getting or pay billions more in new taxes to make 
that system accessible for those who are currently locked out.
  Let me make it very clear, Mr. President, I am not saying we do not 
need reform. Idahoans are not saying we do not need reform. It is quite 
the opposite. We need reform, the kind that will solve the problems in 
the system. What we need is not a new Government program that costs us 
billions of dollars to resolve this problem. There are pieces of 
legislation, there are bills before us that approach it just exactly 
the way I think a majority of Idahoans would want us to deal with it.
  Idahoans are not unique in their rejection of the Clinton bill or 
other Clinton-like proposals. Their concerns arise from the fact that 
most Government one-size-fits-all programs really do not fit Idaho.
  Idaho and other frontier States have unique needs in health care 
delivery. For example, Idaho has one of the worst doctor-to-patient 
ratios in the Nation. Therefore, access to care is not merely a 
question of the ability to pay. Under the bill that we now know as 
Dole-Packwood, there are a number of very important provisions listed 
under title III, ``Special Assistance to Rural, Frontier and Unserved 
Urban Areas.''
  There is a special word in the title, Mr. President. I have now used 
it twice. And that is the word ``frontier.'' That word does not appear 
in the Clinton-Mitchell bill. According to my research and a run of the 
computer and a check in the way we can check things today, the word 
does not appear. It is alarming to me that the Clinton-Mitchell bill 
does not recognize, nor does it understand, what I call the rural West.
  Frontier and rural are two very different situations because they, 
say, ``Well, Senator, if you are talking about rural, then we are 
dealing with the question of frontier.'' But I will tell you that it 
means two distinctly different kinds of communities that we clearly 
have in our State of Idaho and that many other Western States have. 
Residents may have the benefit of a clinic but often they have to 
travel many miles to a larger community to be treated for a complex 
health problem.
  It is important to note that in Idaho that drive is not 20 miles down 
a stretch of interstate. Rather, it is on a winding mountain road that 
is closed part of the year because of snow or ice. While that depiction 
may seem melodramatic, it is also very accurate and relates to the 
definition of frontier. And I suspect in the President's State of West 
Virginia that definition also applies, because oftentimes it is not 20 
miles down the interstate but 200 miles to the nearest doctor or the 
clinic or to any environment in which health care can be delivered.
  The question of access in Idaho is more than we can afford these 
medical services. It is can we get to a doctor or a hospital when we 
need help. Idaho and other frontier States face this and other very 
unique problems. The Dole-Packwood bill does more than reference our 
needs.
  Now, remember, I have just said a computer check of the language 
suggests that those words do not even appear in the Clinton-Mitchell 
proposal. The Dole-Packwood bill speaks to rural or frontier provisions 
in title III, as I have mentioned.
  For example, there are funding provisions to help providers and 
health plans establish networks in underserved areas. Subtitle A 
provides for demonstration grants, subtitle B provides for technical 
assistance grants, and subtitle C includes capital assistance loans and 
loan guarantees.
  The Packwood-Dole bill also establishes safeguards to enhance access 
to local health care services and practitioners for vulnerable 
populations.
  Under subtitle D, there is funding to increase the number of primary 
care providers in medically underserved areas which is critical to my 
State of Idaho and many of the, by definition, rural and frontier 
States of the West and other parts of the country where we have the 
worst doctor-patient ratio than any other place in the Nation.
  Another important provision under this rural frontier title is 
subtitle F, which is on the emergency medical system side. This 
subtitle includes grants to States for aircraft in transporting victims 
in medical emergencies, and that is section 361. In Idaho, Life Flight 
and other similar services have saved many lives, and I think the 
President knows what I am talking about. A person injured in the back 
country can be brought out instantly, or nearly instantly, as fast as 
the helicopter can fly from the point where the person was injured to a 
major medical complex sometimes 200 and 300 miles away.
  The Dole-Packwood bill addresses this issue very clearly. Again, it 
goes unaddressed in the Clinton-Mitchell proposal.
  Now, I have also mentioned Idaho has a varied terrain and climate 
with many remote frontier communities that are unreachable during 
certain times of the year except by aircraft, and section 361 is 
critical in any kind of health care reform we do to make sure that all 
of America is served, not just the urban areas but certainly the rural 
and, by definition, the frontier areas of our country. Again, the 
continual reference to and focus on frontier health issues in the Dole-
Packwood bill are two of the many reasons why I have been able to 
support it and why most Idahoans, after they have been given the 
opportunity to read it and understand it, begin to support it also.
  As we work out a health care reform bill, we must address the unique 
needs of frontier States and acknowledge that a one-size-fits-all plan 
simply will not work in Idaho, and other rural or frontier States.
  In light of some of these frontier access problems that I have 
mentioned, I would like to talk a little bit about how Idahoans are 
already working to solve problems in our State. I will be brief about 
these topics, but I think they are important to understand, because 
Idaho is not unique. Like many other States, they are working to solve 
their own problems. Proposals under consideration, and already passed 
by the Idaho Legislature, clearly begin to drive the issue of health 
care delivery in our State and make it more accessible to more people.
  Specific strategies are being employed by the Idaho Legislature. 
Communities like Twin Falls, ID, are developing unique plans, and in 
the five northern Idaho counties, health care facilities, along with 
health care providers, are coming together in a very innovative 
community health care network.
  So, Mr. President, my purpose in sharing these ideas and activities 
going on in Idaho is to encourage my colleagues to take a close look at 
what is happening in their own States.
  In this Congress, we have the unique opportunity of developing an 
infrastructure that will empower people. Empowerment should be our 
focus, not restrictions and prohibitions.
  Let me restate that. When we look at what our States are doing, Mr. 
President--and many of our States are being very innovative at this 
moment in health care delivery--what we do here ought to be played in 
the backdrop, or at least alongside, of what our States are doing. We 
ought to assure that what we do empowers our States and does not 
restrict them or prohibit them, and saying again that we know better 
and that one size fits all. Because of our very specific needs--and I 
have addressed some of them--the reforms in Idaho have been focused on 
increasing accessibility while containing costs.
  Over the past few years, the Idaho Legislature has passed laws to 
improve health care accessibility and coverage by reforming the 
insurance industry. You and I both know that the insurance industry of 
our country is primarily regulated at the State level. We have not ever 
created a great national, federalized bureaucracy that controls that 
industry. We have said that is primarily a State responsibility. And, 
as a result, almost every State to my knowledge has an insurance 
commission. An insurance company, to do business in that State, has to 
conform with the rules and the regulations of the State.
  Our Idaho Legislature, understanding that of course, then has worked 
inside the State to reform the insurance industry to develop a variety 
of things, but beyond that, to make sure that there is greater 
accessibility.
  The Idaho Legislature has also allowed the development of medical 
savings accounts. Of course, that means you can put away pretax 
dollars, State tax dollars, to be used for the purposes of purchasing 
health care. Guaranteeing health care access to individuals in small 
communities has been improved by these kinds of approaches.
  Other proposals under consideration include the development of 
incentives to further reduce health care costs and improve that doctor-
to-patient ratio that I mentioned that in Idaho is the worst of any 
rural State in the Nation. Insurance reforms that passed the Idaho 
Legislature this immediate past session include the transferability of 
policies so that people will not lose insurance coverage simply because 
they change jobs. In other words, the Idaho Legislature has done what 
we are debating about doing. It is called portability. But let us make 
sure that our portability, if we can get that far, does not wipe out 
the kind of portability that the Idaho Legislature has provided for the 
citizens who live within that State and buy health care coverage there.
  There is also an individual insurance plan called the Individual 
Health Insurance Availability Act, which guarantees access to health 
insurance for individuals. That legislation was passed a couple of 
years ago in Idaho. For the last year and a half, I have met with a 
variety of insurance companies that have worked together to build a 
basic policy that allowed people of lesser means to buy minimum health 
care coverage to gain access to that system. That policy is now 
available in the State of Idaho. It costs less but provides the kind of 
minimum coverage that many of our citizens are looking for. That is 
what health care reform is all about. The Idaho Legislature is doing 
that right now.
  We should not, by our actions here, risk canceling out any of those 
kinds of activities. These provisions are similar to provisions 
included in many of the health care reform proposals that I have 
mentioned here. They are also real solutions to problems that cut 
people out of the current system.
  That is what I think our reform should be dealing with, Mr. 
President. I am not saying that the Clinton-Mitchell bill does not deal 
with some of those because they attempt to in their own way. But they 
set up this vast bureaucracy around it that is going to create the 
Federal regulator determining what is good or bad for Idaho, instead of 
an Idaho Legislature or an insurance company working with an Idaho 
insurance commission to assure the portability or to ensure the minimum 
insurance policy that Idahoans can afford.
  Reducing paperwork and establishing medical savings accounts are both 
proposals that I support and are included in legislation that I have 
cosponsored here in the U.S. Senate. The Idaho Legislature has already 
addressed those very items. But under a Clinton-Mitchell type bill, all 
those positive actions in most instances would be wiped out and in 
other circumstances could be wiped out.
  In addition, new burdens would be placed on States both financially 
and administratively. Why should we do anything that would wipe out any 
action that any of our States would be taking to drive down these 
costs, to reduce the paperwork, and create the greater accessibility?
  In recent reviews of the original language received on the Clinton-
Mitchell bill, there were 175 new responsibilities that would be 
imposed on our States. I would suggest that probably the State of Idaho 
is not going to be able to afford to administer the kind of very 
simple, clean, and adequate proposals that it has brought about if it 
has to address the 175 new responsibilities that are involved in the 
Clinton-Mitchell approach.
  The Idaho Legislature has taken major steps toward solving the 
State's health care problems. As I have already mentioned, Federal 
reform should enhance, rather than inhibit, what we are doing here. In 
other words, what I said before, let us empower people, let us empower 
our States, and let us empower the systems of government that are 
closest to the people to reform their health care instead of prohibit 
them from doing so or restricting them or burdening them down with 
bureaucracies through this legislation.
  In the private sector, a number of voluntary actions have been taken 
to improve access to care in Idaho. Over the past 6 months, as I 
mentioned earlier, a group of community leaders in the Twin Falls area 
have adopted the vision to make their region the healthiest place in 
America. That is the program they are talking about. They are calling 
it the ``Healthiest Place in America.'' County facilities are beginning 
to work together under the joint exercise of powers agreement, and 
physicians are beginning to form larger group practices to work with 
hospitals under physicians and hospital organizations. Why? To allow 
greater coverage, to drive down costs, to make access simpler. That is 
going on as we speak.
  In Twin Falls, ID--and in the ``Twin Falls'' across this Nation--
whether it is in your State of West Virginia or any other State, 
communities and providers are coming together saying they can solve a 
lot of these problems on our own, and they are doing it. The tragedy 
is: Is what we are doing here going to thwart that or wipe it out? More 
than likely, it could. However, for the Twin Falls community to develop 
its network, it cannot be obscured by Federal legislation.
  Mr. President, I hope that the Senate will take into consideration 
the reform efforts already passed by State legislatures across this 
country.
  In my opinion, after having read at least half of the Clinton-
Mitchell bill now and having read all of the Dole-Packwood bill, I 
would say that the Dole-Packwood bill comes much, much closer to 
working as a cooperating partner with States and local providers than 
the large, Federal dictating bureaucracy that inevitably will be 
constructed coming out of final passage of a Clinton-Mitchell approach. 
The Congress needs to focus on establishing a framework in which the 
market can develop a process that naturally fits the States and that 
the States are working toward today.
  I mentioned also the communities in the north end of my State. One-
hundred-sixty physicians and north Idaho hospitals have come together 
to create what they have called the North Idaho Physicians' 
Association. They will serve as a discussion and an educational group. 
They are working together with a coalition of hospitals in the area. 
This association has performed a local study of the needs of the 
beneficiaries, the employers, and the providers. It is very likely that 
there is no other group that understands the health care needs of 
northern Idaho better than that association I have just mentioned and 
the residents of the communities they serve--certainly not the 
bureaucrats here in Washington, or certainly not a regional office or 
offices that would be established in Seattle, or Portland, or Salt Lake 
City, or some other place, that would dictate and begin to control 
under any of the plans being proposed that we call greater bureaucratic 
plans, much like the Clinton-Mitchell approach.
  The north Idaho organization is dedicated to providing accessible, 
high-quality health care while containing costs in their communities. 
This confirms my belief that health care is most efficient when it is 
coordinated both locally and privately. And, again, I hope that this 
Senate in its debate and in the amendment process and in the final 
resolution of health care will clearly recognize that in communities 
and States around this Nation today, health care is being 
revolutionized not by a Federal edict, not by overpowering Federal 
legislation, but by the simple needs of the marketplace and the 
recognition that you can get quality health care if you deliver it 
privately, or if you cooperate with State and local units of government 
instead of a large Federal bureaucracy.
  Propelled by a sense of community and desire to improve health care 
in their own area, I have just mentioned three major efforts going on 
in Idaho, whether it was the legislative effort, the community effort 
in north Idaho, or whether it is Twin Falls wanting to make themselves 
the healthiest place in the country.
  Mr. President, these are examples of what we can do and, more 
importantly, what we are doing in our health care delivery system in 
this country. The pressure is on, or we would not be debating health 
care reform here today. But let us make sure that pressure does not 
drive us over the edge toward a greater Federal bureaucracy but, in 
fact, it causes us to work hand in hand.
  Before going on to discuss legislation here in the Senate that I 
support, I would like to add that thousands of letters and phone calls 
have been pouring into my office stating opposition or concern about 
the Clinton-Mitchell bill.
  I ask unanimous consent that two letters in opposition to the 
National AARP endorsement of the Clinton-Mitchell bill be printed in 
the Record.
  There being no objection, the letters were ordered to be printed in 
the Record, as follows:

                                                 James O. McMains,


                                  Certified Public Accountant,

                                    Lewiston, ID, August 11, 1994.
     Eugene Lehrman,
     AARP, Washington, DC.
       Dear Mr. Lehrman: I watched as you endorsed the Democratic 
     Health Care bills on National TV yesterday on behalf of the 
     members of AARP.
       How dare you presume to speak for me without asking my 
     opinion first!
       I know there are many, many members who feel as I do; that 
     the principal reason for the rise in health care costs over 
     the past three decades has been the Government programs that 
     are already in existence (including Medicare, Medicaid, 
     Welfare, etc.).
       The federal Government has no business mucking about in 
     health care. This is solely a concern of the various states 
     and individual citizens.
       I thought AARP, because of the age and experience of it's 
     members would have better sense. Apparently the leadership of 
     the organization has concluded that money grows on trees and 
     that the Government can give people something without taking 
     it from someone else (your children and grandchildren).
       Since the AARP does not represent my views, and since I was 
     not even asked my views before the announcement of support 
     for the Government takeover of the health care system, I 
     hereby cancel my membership. My membership card is enclosed.
           Sincerely,
                                                 James O. McMains.
                                  ____



                                                    Boise, ID,

                                                  August 10, 1994.
     Anne May Kinsey,
     President,
     American Association of Retired Persons, Washington, DC.
       Dear Ms. Kinsey: It may come as a surprise to the 
     individuals at A.A.R.P. who took it upon themselves to 
     announce their support, and by inference, my support of the 
     Clinton/Mitchell health plan today, but I did not give them 
     my proxy to do my thinking for me or to represent my beliefs 
     to others.
       Like millions of others, I have followed the health care 
     debates for some months, and when the smoke and mirrors are 
     eliminated, one must conclude, at least based on the 
     information available to us to date, that the opposition's 
     charges of political expediency, massive boon-doggling and a 
     liberal dose of socialism are correct.
       I can not believe that anyone at the A.A.R.P. has made a 
     careful study of the two major bills presented by the 
     administration, much less have an intelligent and objective 
     opinion at this stage as to the merits and/or demerits of 
     same.
       You may be sure that the arrogance of the A.A.R.P. 
     ``leadership'' in supporting the Clinton/Mitchell plans is 
     resented by a large share of its membership. This is merely 
     one more example of an unwarranted belief by may residents of 
     the Washington, DC ``beltway'' that they possess superior 
     intellect and judgemental capability, whereas just the 
     opposite would appear to be the case.
       Now that the A.A.R.P. has taken it upon its self to falsely 
     represent my views, I have a right to insist that, following 
     your ``careful evaluation'' of the Clinton/Mitchell plans, 
     you tell me:
       (1) How much will the Clinton/Mitchell plans cost me, 
     including EVERY SINGLE HIDDEN COST, and
       (2) What benefits will I receive as compared to what I am 
     able to obtain from existing private health plans, including 
     the A.A.R.P./Prudential Plan.
       I look forward to a detailed early reply, complete with 
     your SPECIFIC evaluations which caused you to arrive at your 
     publicly announced decision to support the Clinton/Mitchell 
     plans.
           Sincerely,
                                                Vernon B. Clinton.

  Mr. CRAIG. For the last several days, there have been a great deal 
said on the other side of the aisle about this AARP endorsement. I 
noticed that in the last few hours those comments have gone silent. Let 
me refer to these letters, to give you an example of why no longer do 
we talk so openly or do the Clinton-Mitchell supporters talk so openly 
about this kind of an endorsement.
  Here is a letter from James McMains, in Lewiston, ID, to Eugene 
Lehrman, AARP, 1909 K Street, Washington, DC.

       Dear Mr. Lehrman: I watched as you endorsed the Democratic 
     health care bills on national TV yesterday on behalf of the 
     members of AARP.
       How dare you presume to speak for me without asking my 
     opinion first!

  The reason a member of AARP can say that is because, historically, 
that organization has been very good at polling its members before it 
took positions on a major piece of legislation.
  Mr. McMains goes on to say:

       I know there are many, many members who feel as I do; that 
     the principal reason for the rise in health care costs over 
     the past three decades has been Government programs that are 
     already in existence (including Medicare, Medicaid, Welfare, 
     etc.).
       The Federal Government has no business mucking about in 
     health care. This is solely a concern of the various States 
     and individual citizens.
       I thought AARP, because of the age and experience of its 
     members, would have better sense. Apparently, the leadership 
     of the organization has concluded that money grows on trees 
     and that Government can give people something without taking 
     it from someone else (your children and grandchildren).
       Since the AARP does not represent my views, and since I was 
     not even asked my views before the announcement of the 
     support for the Government takeover of the health care 
     system, I hereby cancel my membership. My membership card is 
     enclosed.
       Sincerely, James O. McMains of Lewiston, Idaho.

  Here is a letter to Anna May Kinsey, President, American Association 
of Retired Persons. This letter is from Vernon B. Clinton of Boise, ID.

       Dear Ms. Kinsey: It may come as a surprise to the 
     individuals at AARP who took it upon themselves to announce 
     their support, and by inference, my support, of the Clinton-
     Mitchell health plan today, but I did not give them my proxy 
     to do my thinking for me or to represent my beliefs to 
     others.
       Like millions of others, I have followed the health care 
     debates for some months, and when the smoke and mirrors are 
     eliminated, one must conclude, at least based on the 
     information available to us to date, that the opposition's 
     charges of political expedience, massive boondoggling and a 
     liberal dose of socialism are correct.
       I cannot believe that anyone at the AARP has made a careful 
     study of the two major bills represented by the 
     administration, much less have an intelligent and objective 
     opinion at this stage as to the merits and/or the demerits of 
     same.
       You may be sure that the arrogance of the AARP 
     ``leadership'' in supporting the Clinton-Mitchell plans is 
     resented by a large share of its membership. This is merely 
     one more example of an unwarranted belief by many residents 
     of the Washington, D.C. ``beltway'' that they possess 
     superior intellect and judgmental capability, whereas just 
     the opposite would appear to be the case.
       Now that the AARP has taken it upon themselves to falsely 
     represent my views, I have a right to insist that, following 
     your careful evaluation of the Clinton-Mitchell plan, you 
     tell me: (1) How much will the Clinton-Mitchell plans cost 
     me, including every single hidden cost and, (2) What benefits 
     will I receive as compared to what I am able to obtain from 
     existing private health plans, including the AARP/Prudential 
     Plan.
       I look forward to a detailed early reply, complete with 
     your specific evaluations which caused you to arrive at your 
     publicly announced decision to support the Clinton-Mitchell 
     plans.

  That is signed Vernon B. Clinton from Boise, Idaho.
  Well, at least this gentleman did not resign his membership card. But 
he does call upon that organization to examine thoroughly the very 
bills we are talking about.
  Mr. President, you know, it is the same kind of call that many of us 
have made and why we are now here on the floor asking the questions and 
debating this issue. I know that, earlier on, Senator Kennedy asked, 
``Why are we not debating the Dodd amendment?'' I do not argue that 
that is not an important amendment. It is a critical amendment, as is 
any kind of legislation that we do.
  Mr. KENNEDY. Mr. President, will the Senator yield just on that 
point?
  Mr. CRAIG. I am happy to yield.
  Mr. KENNEDY. Mr. President, I was listening with great interest to 
the Senator talk about the different initiatives that were taking place 
in the State of Idaho. I found those enormously interesting.
  I was just reviewing the census figures on the number of uninsured 
children, because this is something which the Dodd amendment was 
addressing, and I thought at least I gathered from the Senator from 
Idaho he is indicating that Idaho was really just reacting, dealing 
with their own kinds of problems, and, therefore, we did not need or at 
least have the kind of comprehensive approach that might be included in 
the Mitchell proposal or perhaps even in the Dole proposal.
  According to last census, which is March 1992, there are 13 States in 
the United States that have a higher percentage of uninsured children 
than Idaho.
  The PRESIDENT pro tempore. The Chair will observe that the 
Republicans' time has expired.
  Mr. KENNEDY. Mr. President, will the Senator yield 4 or 5 minutes?
  Mr. MOYNIHAN. Of course, Mr. President. I am happy to yield 5 minutes 
to the distinguished Senator from Idaho.
  Mr. CRAIG. Mr. President, let me respond to the Senator from 
Massachusetts. He does bring up a very valuable point. That is why I 
said at least twice or three times during my discussion this afternoon 
that the Dodd proposal is a worthy proposal and ought to be debated.
  This is why the Idaho legislature 2 years ago said by law to their 
insurance providers in the State you have to do better, and that is why 
those providers came together and are just introducing a new plan that 
is now on the ground in Idaho that is a comprehensive minimum plan that 
would allow hopefully increased coverage for many of those children the 
Senator talks about.
  Idahoans are very aware and very concerned about that problem. That 
is why Idahoans say we want health care reform.
  I have said that, Mr. President, today time and time again on the 
floor. We want health care reform. We want Idahoans to have that 
choice. We want to make sure that our children are covered.
  The tragedy is Idahoans cannot pay for the 20 percent tax increase 
that the Clinton-Mitchell proposal would require of most Idahoans to be 
able to afford that kind of insurance.
  We in Idaho believe that under the proposal of the Idaho legislature 
that is created and the portability issue that they are now addressing 
and the medical savings account issue that they are now addressing we 
can handle the issue of uninsured children in our State more adequately 
than can be provided under a larger Federal bureaucratic umbrella.
  I thank the Senator for questioning. He is absolutely correct. It is 
of major concern in my State. We want to be responsive to it. But I 
think Idahoans under the choice of their plans would prefer to be 
responsive under a Dole-Packwood plan and a plan that would not cancel 
out the initiatives that are currently underway in our State.
  Mr. KENNEDY. I thank the Senator for his comments.
  There are several States that effectively have included what the Dodd 
amendment would achieve and accomplish. I was not aware that Idaho was 
one of those. But I appreciate the fact. In the Dole proposal, to which 
the Senator referred, according to the Lewin VHI assessment, there will 
be 6 million children that will be uninsured at the end of the decade.
  I also heard the Senator talk about the value that Idahoans place on 
the freedom of choice proposal. I have examined the Dole legislation, 
all 600 pages of it, and I cannot find where the guarantee of choice is 
evident in that legislation. I do not know.
  If the Senator wanted to review it and answer another time, I will be 
glad to defer. I do think, that one of the key elements of any reform 
is what is going to happen to children. The Dodd proposal does provide 
the requirement that States make available to children preventive 
health care services which quite frankly, according to other GAO 
studies, show just about every other industrialized society in the 
world provides except the United States.
  Would the Senator reason with me about how we are going to try and 
deal with the needs of the 6 million children that will be left 
uninsured by the Dole proposal. Maybe there will not be as many 
uninsured children in the State of Idaho as might be even now. But if 
we are looking at how we are going to insure the total coverage of 
children, how would he expect that the Dole proposal would do it, and 
if he could help me locate within the Dole proposal where freedom of 
choice is guaranteed.
  Choice is a major factor that is included in the Mitchell proposal, 
but as we move on through now in the third day of at least the debate 
on the children's proposal we would like to find out how you are going 
to address the studies that show there will still be 6 million that 
will not be covered, and there are no guarantees of freedom of choice 
under the Dole proposal. If the Senator could just respond to that.
  The PRESIDENT pro tempore. The time has expired.
  Mr. MOYNIHAN. Mr. President, I am happy to yield to my friend from 
Idaho such time as he requires to answer the Senator from Massachusetts 
and to finish his opening statement.
  Mr. CRAIG. I thank my colleague for yielding.
  The PRESIDENT pro tempore. The Senator from Idaho is recognized for 
such time as he may consume for such purposes.
  Mr. CRAIG. Mr. President, the Senator from Massachusetts makes an 
excellent point, and I must restate again that the citizens of Idaho 
are very aware and very concerned about uninsured, uncovered, and 
underserved children. It would be wrong to suggest in any regard that 
the children are not being served. We all know that they are being 
served.
  The question is, is it of the ongoing quality accessible in 
reasonable fashion that, first of all, creates a healthy environment 
for that child? By that I mean from the time of that child's birth 
forward, and of course through the mother's pregnancy, are those 
services being provided and do they get their necessary immunization, 
and all of that?
  That is what concerns Idaho most. While I recognize that it is hard 
for the Senator from Massachusetts to realize that the Dole bill does 
not speak to choice, it is choice. It does not have to speak to choice 
because it does not control the marketplace. It only enhances the 
marketplace. So choice by itself is the bill.
  The difference between the Dole and Mitchell bill is that in the 
Mitchell bill you create a restricted Federal bureaucracy that says you 
do thus and so and that guarantees certain kinds of things. The Dole 
bill says, and I refer to the section which talks about insurance 
reform and the standard applicable health care plans and the right of 
renewal, and all of that, and that was the very thing that Idahoans 
attempted to address was that when you make those kinds of programs 
available by driving costs down you bring uninsured families into the 
market. You bring them into coverage.
  There is another issue that has to be spoken to here when you talk 
about uninsured children. Dad may be insured because he works under an 
environment in which he is covered, or mom may be insured, but the 
family may not be insured. That does not say that the children are not 
going to be cared for or that they are not being covered. By the very 
nature that their family can afford health care coverage, they are 
being covered.
  So we know that those statistics, depending on how you break them 
out, always vary a little bit. But what I think we are talking about 
here are two fundamentally different proposals. I have not analyzed the 
Dodd amendment. I do not know how it fits inside the Clinton-Mitchell 
proposal or whether something similar could fit inside the Dole-
Packwood proposal. I do recognize when you drive down costs and when 
you create the kind of reforms that are out there is a substantial 
chance that you are going to create greater coverage for children who 
are uninsured or you are going to create a much more affordable 
environment so that the parents of those children can provide for their 
children as, of course, most of them want to do.
  Let me make a few closing comments because the chairman has been 
generous in his time with me in so doing.
  Mr. President, this debate is one of the most significant debates our 
Nation has ever held. Now, the Congress will work to approve a bill.
  It is my hope that we can work to represent the will of the American 
people and will end up with legislation that will change what is not 
working in the health care system, while retaining what is good in it.
  There are numerous issues that will be debated over the next few days 
or weeks--as long as it takes to work through these issues. We should 
be here debating and developing a better understanding of what we do.
  Mr. President, I have been dismayed by the remarks made regarding 
those of us who wish to clearly express our opinions on this issue and 
the bills before us prior to entering debate on amendments.
  This bill is lengthy and has changed no less than three times as of 
today. The points of debate on the bill will likely range from major 
philosophical differences to more technical details.
  As we work through this process we need to remember that what is done 
here will dramatically affect the lives of each and every American and 
deserve careful consideration. Therefore, our efforts should reflect 
what our constituents have been telling us. In the final days of the 
103rd Congress--health care reform should not be used as a political 
tool to save a President. Health care--quality-accessible health care 
and its reform is more important than a President and his political 
life.
  Mr. President, I would now like to talk a little about what the 
people of Idaho have been telling me about health care reform, and the 
position I have taken as a result of those comments and my study of 
this issue. It is also important that I explain the concerns I have 
about the Clinton-Mitchell bill.
  Mr. President, before I go any further, I would like to add that I am 
also extremely frustrated that not only have we had very little time to 
review the very lengthy Clinton-Mitchell bill, but it remains a moving 
target.
  We now have version three--Senator Packwood would say lethal weapon 
III--of the Clinton-Mitchell before us. Numerous changes were made in 
version two and as I have begun to review version three, it appears 
that changes again have not been minor.
  My constituents have been clamoring to see the bill since the 
original introduction. Copies of Clinton-Mitchell one were immediately 
mailed to my State offices so that Idahoans could come in and review 
areas of interest. Before those bills even reached my State, they were 
outdated.
  In addition to being outdated, it came to my attention that the cost 
of that first printing was in the range of half a million dollars.
  Again, Mr. President, we are on Clinton-Mitchell three--this bill is 
costing American taxpayers too much before it has even passed the 
Congress. We all knew these bills were costly--what we did not know is 
that millions would be spent before they ever became law.


                                 idaho

  Mr. President, in Idaho we have all been working to educate ourselves 
on this moving target called health care reform.
  I felt that it was important to get information out to the State, and 
to help pursue this debate in Idaho.
  Toward that end starting in 1989 I have sponsored health care 
conferences that have drawn such speakers as: former Secretary of 
Health and Human Services Louis Sullivan, former Administrator of the 
Health Care Financing Administration Gail Wilensky, Ph.D., from the 
Heritage Foundation Stuart Butler, Ph.D., from the University of North 
Carolina, Kenneth Thorpe, Ph.D., and from Harvard School of Public 
Health Professor William Hsiao.
  I have also held town meetings on health care reform all over the 
State and spoken to a variety of civic and private groups on this 
issue, in addition to receiving thousands of letters.
  A resounding message that has been coming from Idahoans is that:
  They would prefer no bill to a bad bill. And Idaho defines a bad bill 
that requires more Government involvement in health care.
  Reforms should focus on what is wrong with the system and leave what 
is good alone.
  Idahoans realize the importance of the fact that 84 percent of 
Idahoans have health insurance.
  In anyone's book that is an overwhelming majority.
  Does that mean that there is no problem?
  Not at all, but it does mean that some things in the system are 
working.
  In reform, we need to focus on what is not working and resolve those 
problems--the problems that are keeping 16 percent of Idahoans and 
other Americans uninsured.
  Many Idahoans have written in explaining problems they have 
experienced. Some of the biggest problems Idahoans have identified are 
things like:
  People worrying they will lose their health insurance if they get a 
serious illness.
  Worries we can not keep an insurance plan we like, or need, if we 
lose a job or decide to change jobs.
  Concerns about whether we'll be able to afford insurance because the 
costs of health care go up too fast.
  A strong desire to be able to purchase the services they want from 
the doctor or health care provider they choose.
  Those are important concerns and important problems and they're what 
I want the Congress to address.
  Mr. President, as we address these concerns, we must not lose what is 
good in the system--what takes care of most Americans--in order to get 
coverage for those without insurance.
  We do not have to sacrifice quality or pay billions more in new taxes 
to make the system accessible for those who are currently locked out. 
Let me be clear Mr. President, I am not saying we don't need reform. 
Quite the opposite. We need reform, the kind that will solve the 
problems in the system.
  What we do not need, Mr. President, is a new Government program that 
costs us billions in new taxes and doesn't meet our needs.
  Idahoans are not unique in their rejection of the Clinton bill or 
other Clinton-like proposals. Their concerns arise from the fact that 
most Government one-size-fits-all programs don't usually fit Idaho.
  Idaho and other frontier States have unique needs in health care 
delivery. For example, Idaho has one of the worst doctor-to-patient 
ratios in the Nation; therefore, access to care is not merely a 
question of the ability to pay.
  Under the Dole-Packwood bill there are a number of very important 
provisions listed under title III: special assistance for rural, 
frontier and underserved urban areas.
  There is a very special word in the title, Mr. President, and that is 
``frontier.'' That word does not appear in the Mitchell-Clinton bill, 
according to my research. This should be an alarming point for the 
rural west.
  Frontier and rural are two very different situations. Idaho is a 
State of both rural and frontier communities. Some communities in Idaho 
do not have a physician.
  Residents may have the benefit of a clinic, but often have to travel 
many miles to a larger neighboring community for treatment of more 
complex health problems.
  Mr. President, it is important to note that in Idaho that drive is 
not 20 miles down a stretch of interstate. Rather, it is often a 
winding mountain road that is closed part of the year because of snow 
and ice. While that depiction may seem melodramatic, it is also very 
accurate and relates to this definition of ``frontier.'' 200 hundred 
miles to a doctor or a clinic is just not an unusual situation.
  The question of access in Idaho is more than ``can we afford these 
medical services?'' It is, ``can we get to a doctor or a hospital when 
we need help?'' Idaho and other frontier States face this and other 
unique problems.
  The Dole-Packwood bill does more than reference our needs. There are 
a variety of rural or frontier provisions in title III of Dole-
Packwood:
  For example, there are funding provisions to help providers and 
health plans establish networks in underserved areas. Subtitle A 
provides for demonstration grants. Subtitle B provides for technical 
assistance grants. And, subtitle C includes capital assistance loans 
and loan guarantees.
  The Packwood-Dole bill also establishes safeguards to enhance access 
to local health services and practitioners for vulnerable populations. 
Under subtitle D there is funding to increase the number of primary 
care providers in medically underserved areas, which is critical for 
Idaho--where we have the worst doctor-to-patient ratio in the Nation.
  Another important provision under this rural/frontier title is 
subtitle F, which is on emergency medical systems. This subtitle 
includes grants to States for aircraft for transporting rural victims 
of medical emergencies (Sec. 361). In Idaho, Life Flight and other 
similar services have saved many lives. As I mentioned before, Idaho is 
a State with varied terrain and climate, with many remote frontier 
communities that are unreachable during certain times of the year 
except by aircraft.
  Again, the continual reference and focus on frontier health issues in 
Dole-Packwood are one of many reasons why I have supported it.
  As we work out a health care reform bill, we must address the unique 
needs of frontier States and acknowledge that a one-size-fits-all plan 
simply will not work in Idaho and other rural or frontier States.
  In light of some of these frontier access problems I have mentioned, 
I would like to talk a little about how Idahoans are already working to 
solve problems in our State. I will briefly address three specific 
topics today:
  First, proposals under consideration and already passed by the Idaho 
State Legislature;

  Second, specific strategies being employed in the Twin Falls area; 
and
  Third, an innovative community health network developing in five 
northern Idaho counties.
  Mr. President, my purpose in sharing these ideas and activities going 
on in Idaho is to encourage my colleagues to take a closer look at what 
is happening in their own States.
  In this Congress, we have the unique opportunity of developing an 
infrastructure that will empower people. And, empowerment should be our 
focus, not restrictions and prohibitions.
  Because of our specific needs, reforms in Idaho have focused on 
increasing accessibility while containing costs.
  Over the past few years the Idaho Legislature has passed laws to 
improve health care accessibility and coverage by reforming the 
insurance industry, developing medical savings accounts, and 
guaranteeing health care access to individuals and small businesses.
  Other proposals under consideration include developing incentives to 
further reduce health car costs and improve the doctor-to-patient 
ratio.
  Insurance reforms that passed Idaho's legislature this session 
include the transferability of policies so that people will not lose 
insurance coverage simply because they change jobs. That's call 
portability, there is also an Individual Health Insurance Availability 
Act which guarantees access to health insurance for individuals. I have 
met with the insurance companies as they worked to offer this 
affordable approach. These provisions are similar to provisions 
included in many Federal health care reform proposals. They are real 
solutions to problems that cut people out of the current system.
  Mr. President, in addition to these insurance reforms, Idaho has 
passed laws reducing the amount of paperwork required and establishing 
medical savings accounts.
  Reducing paperwork and establishing medical savings accounts are both 
proposals I support and are included in legislation I have cosponsored 
here in the U.S. Senate.
  Under a Clinton-Mitchell type bill all those positive actions would 
be wiped out. In addition, new burdens will be placed on the States 
both financially and administratively. Why should anything we do here 
wipe out what our States are trying to do.
  A recent review of the original language revealed no less than 175 
new responsibilities will be imposed on States under Mitchell-Clinton.
  The Idaho State Legislature has taken major steps toward solving the 
State's health care problems. Mr. President, as I have already said, 
Federal reforms should enhance rather than inhibit what we are doing in 
Idaho.
  In the private sector, a number of voluntary actions have been taken 
to improve access to care in Idaho. Over the past 6 months, a group of 
community leaders in the Twin Falls area has adopted the vision to make 
their region ``The Healthiest Place in America.''
  County facilities are beginning to work together under the joint 
exercise of powers agreement, and physicians are beginning to form 
larger group practices to work with hospitals under physician-hospital 
organizations.
  However, for the Twin Falls community to develop its network, it 
cannot be obstructed by Federal legislation.
  Mr. President, I hope that the Senate will take into consideration 
the reform efforts already passed in the Idaho State Legislature.
  The Congress needs to focus on establishing a framework in which the 
market can develop and progress naturally in the States.
  Coinciding with the developments in the Twin Falls area, the 160 
physicians of northern Idaho founded the North Idaho Physicians 
Association to serve as a forum for discussion and education.
  Together with the coalition of hospitals in the area, this 
association has performed a local study of the needs of beneficiaries, 
employers, and providers.
  It is very unlikely that any single group understands the health care 
needs of northern Idaho better than this association and the residents 
of the communities they serve--certainly not bureaucrats in Washington 
DC.
  This northern Idaho organization is dedicated to providing 
accessible, high-quality health care while containing costs in their 
communities. This confirms my belief that health care is most efficient 
when coordinated locally and privately.
  Propelled by a sense of community and desire to improve health care 
in their own area, the organization is implementing solutions to 
problems.
  Mr. President, these examples I have mentioned clearly illustrate how 
the health care market can successfully respond to pressures when given 
the liberty to do so.
  Before going on to discuss legislation in the Senate that I support, 
I would like to add that thousands of letters and phone calls have been 
pouring into my office stating opposition or concerns about the 
Clinton-Mitchell bill. I ask unanimous consent that two letters in 
opposition to the national AARP endorsement of Clinton/Mitchell be 
inserted into the Record.
  They are talking about the endorsement a few days ago now they don't. 
Here is why.
  The Congress can enhance what is already happening in Idaho, or it 
can put up obstacles and restrictions. It is my hope that the choice 
will be enhancement.


                   bills that promote consumer choice

  Mr. President, the various reform bills that I have cosponsored in 
this Congress and in the previous Congress are designed to resolve the 
problems identified by Idahoans that I mentioned earlier, without 
throwing away what is good in the system.
  I have heard some people criticizing Republicans saying we are not 
for reform. Or, Republicans have no bill. That is simply not true, Mr. 
President.
  Just because many of us are not for Clinton-style reform doesn't mean 
we are opposed to reform or improving our health care systm.
  Quite the contrary, Mr. President, Republicans are for reform. Look 
at the numerous bill introduced this Congress on health care reform, 
and many of them have been sponsored or cosponsored by Republicans.
  I have cosponsored several bills that are focused on resolving 
problems, improving access, retaining what is good in our system, and 
without increased Government involvement.
  These bills have included provisions that would:
  Establish medical savings accounts;
  Require no new taxes or tax increases;
  Reform medical malpractice; and
  Reform antitrust laws.
  They would reform the insurance market: People could not have their 
insurance canceled or their premiums increased because they get sick.
  They would provide assistance to the poor through vouchers for low-
income families: States would be allowed to privatize Medicaid, and 
low-income families would qualify for subsidies to purchase private 
insurance, at or below 150 percent of poverty.
  They would retain the high quality of care we currently have in this 
country: There are no mandatory alliances or excessive Government 
involvement or other provisions that could contribute to a decline in 
quality.
  They would not include employer mandates that would cost jobs;
  They would not limit or standardize the benefits people could choose;
  They would not limit our choice of health care provider; and
  They would improve health care in our rural and frontier areas.
  The goal of these private-oriented plans has been to empower the 
individual to improve the system by maximizing the ability to make 
choices.
  Individuals are certainly better able to determine their needs than 
the Federal Government, just as experienced health professionals can 
best decide on the best method of treatment.
  We do not need extensive Government intervention to reform our system 
and improve access to health care.
  There are major differences between the Clinton-Mitchell bill and the 
Dole-Packwood bill. Some of the main concerns I have are as follows:


                            clinton-mitchell

  Overall, I have concerns about the massive increase in the Federal 
Government's involvement in our health care system. In my review of the 
Clinton-Mitchell bill I found a continual theme of boards or 
commissions in all three versions that would be established to examine 
and evaluate all aspects of health care imaginable.
  With each of the new Government bureaucracies comes a price tag that 
the American taxpayers will have to cover.
  Conservative estimates on the increase in the Federal Government's 
involvement show that Clinton-Mitchell as originally introduced would 
create: 50 overall new bureaucracies; 83 new responsibilities for the 
Secretary of Labor; 175 new responsibilities imposed on States; and 815 
new responsibilities for the Secretary of Health and Human Services.
  These figures may have changed with the numerous changes that have 
been made to the bill since the introduction. But even a fraction of 
these numbers would be unreasonable and oppressive.
  Other main concerns with the Mitchell-Clinton bill include:
  New and increased taxes: Clinton-Mitchell imposes at least 17 new 
taxes, including a tax on every health insurance premium. These 17 new 
taxes will hit: health insurance plans, flexible spending accounts, 
Medicare beneficiaries, and State and local government workers--not 
good for the middle class;
  The lack of a medical savings account provision: The Mitchell-Clinton 
does not allow for medical savings accounts [MSA's].
  One of the most innovative ideas advanced during the debate on health 
care reform has been medical savings accounts, a portable fund that can 
be used to pay out-of-pocket medical expenses and control costs.
  MSA's would provide a source of funds for people to keep their 
coverage continuous during periods of unemployment and would 
significantly reduce the numbers of short-term uninsured.
  MSA's also represent the one idea that has the real potential to 
reduce health care costs without resorting to the rationing of care and 
artificial price controls.
  Along the lines of cost containment, MSA's also would restore the 
patient-physician relationship, thus empowering people to become 
knowledgeable consumers of health care services and would make patients 
more cognizant of the cost and quality of their care.
  Mr. President, early in the 102d Congress Senator Steve Symms and I 
introduced the Affordable Health Income Tax Act, which would have 
established medical saving accounts. It was a good idea then and is an 
even better idea now.
  Also, as I mentioned before, my home State of Idaho has passed a 
statewide provision for medical savings accounts.
  Less choice: The Mitchell-Clinton bill contains a Government-defined 
standard benefit package that will make existing health insurance 
policies illegal or taxable.
  Current employer-sponsored and individual plans that respond to the 
varied needs of American families would be supplanted by a one-size-
fits-all plan designed by the Federal Government, and many self-insured 
programs would no longer be allowed to exist.
  Additional concerns are:
  The impact it will have on jobs and our economy;
  Price controls on health insurance that will impose taxes on some 
health insurance plans;
  The establishment of a National Health Board;
  The ban on self-insured plans for firms with fewer than 500 workers; 
and
  The numerous mandates, including a ``triggered'' mandate on employers 
that would be triggered by State in the year 2000.
  The Congressional Budget Office didn't seem to think it was such a 
great idea, reporting that:

       Because of the disruptions, complications, and inequities 
     that would result [from the Mitchell triggered mandate], CBO 
     does not believe that it would be feasible to implement the 
     mandated system in some States but not others.

  In fact, Mr. President, CBO's estimate includes a number of 
references to difficulties in implementing other provisions in the 
Clinton-Mitchell bill.
  The mandate issue is a very important part of this debate, which I 
intend to discuss in greater detail at a later time on this bill. 
However, I would like to share with Senators the concerns of one of my 
constituents who is a small business restaurateur.
  In short, he is concerned about maintaining the number of employees 
he has, the increased financial burden he would face with an employer 
mandate, and the lack of options to pay for the increased cost. He is 
in the fast food market, so raising prices is not an options. Mr. 
President, I ask unanimous consent that my constituent's letter be 
included in the Record.
  The impact it will have on our budget deficit, safeguarding the 
Federal Treasury, not to mention taxpayers' wallets, is hardly the top 
concern in the Clinton-Mitchell bill. The so-called fail-safe 
provisions intended to prevent runaway spending are in the very last 
portion of the bill. They appear to have been tacked on at the end as a 
sort of hollow salute to questions about spending.

  The Clinton-Mitchell bill attempts to control what will be runaway 
health care spending by requiring the President to make sequesters in 
health care spending if it goes over budget.
  Sequesters are ordered every October 1, if necessary. What's the 
track record for Congress with October sequesters? This begs the 
question of what happened to the Gramm-Rudman law. The first cuts--if 
they ever actually occur--come in premium subsidies, the heart of the 
program:
  Insurance premium subsidies for individuals;
  Subsidies for small businesses paying for insurance;
  Reduce the tax break for self-employed buying insurance;
  Raise the deductible for Medicare prescriptions;
  Reduce direct Federal health spending across the board.
  Who's the main target when costs rise out of control? In an earlier 
draft authors of the Clinton-Mitchell plan tripped their hand--
increasing Medicare deductibles was the No. 2 target.


                          sequester exceptions

  The Clinton so-called economic bailout package comes to mind. Though 
the Bush recovery was under way, the stampede for unemployment pork was 
nearly unstoppable.
  Economic projections, on which sequesters could be suspended, can 
come from either the Department of Commerce or the President's OMB. If 
you were President, which would you pick?
  The National Health Benefits Board is required to issue, ``A report 
including alternative proposals to offset the projected excess.'' Can 
you read ``higher taxes'' between those lines?
  Mr. President, there are many more issues to be covered, and in more 
detail, than I have included today. I fully intend to make further 
comments as this debate continues.


                               conclusion

  Mr. President, I cannot say strongly enough that this is one of the 
most important debates that we, as a nation, have ever entered into. 
There are some who feel a bad bill is better than no bill. I don't 
happen to agree with that philosophy.
  It is important for all of us to be involved in this debate, and I 
mean the American people, not just the Congress, because:
  Health care is a very personal issue;
  Health care reform touches each of our lives;
  Health care reform could affect a large portion of our economy;
  Health care means taking care of people and their needs;
  Health care means jobs.
  Mr. President, in closing, let us remember that when most of us were 
kids and caught colds, we'd stay home from school and get some rest, 
maybe take some common cold medicine.
  That's the way you treat a cold. You take care of it so it doesn't 
get worse. You don't have x rays and other tests, or surgery. It's 
unnecessary and wasteful.
  That's how I see the Clinton-Mitchell plan for health care reform. 
It's an amputation, when what we need is some commonsense treatment.
  I would close by saying this afternoon that in all of those trips to 
Idaho and all of those health care conferences and town meetings there 
has been the emergence of what I believe most Idahoans recognize as the 
kind of health care reform they want. They want their own choice. They 
largely want to be able to control their own health care, but they do 
recognize that there are some overpowering consequences across the 
country that would cause them to have to ask us to deal with some of 
the issues.
  And those issues they want are the establishment of medical savings 
accounts. They require no new taxes, so they could have more spendable 
income to deal with it. They recognize that medical malpractice is a 
very real problem and that there has to be some tort reform. There 
needs to be some antitrust law change. And they clearly recognize the 
need for insurance reform in the broad scale.
  I had once said to me very clearly, ``If you could get the U.S. 
Congress to do what the Idaho Legislature has already done, we think 
you would go a long way towards driving health care down so that it 
would be increasingly more affordable, not just for Idaho's citizens, 
but for the rest of the country.''
  In closing, I think something else that concerns Idahoans a great 
deal--and I am talking about the primary employer in Idaho, and that is 
a small business person--is that a Clinton-Mitchell-like bill is going 
to have to cause them to fire or to release several of their employees 
so they can provide health care for their other employees. That is a 
very high risk and, frankly, in my opinion, and in the opinion of an 
awful lot of others, that is the wrong approach.
  So whether it is the Clinton-Mitchell bill, as amended, or whether it 
is another approach, let us stay here, debate these issues, and 
understand them in a way that the American people can respond to us as 
to the type of health care proposal that they want that will ultimately 
get the majority support here in the U.S. Senate and in the United 
States Congress, and that can be signed into law.
  I thank the distinguished chairman of the Finance Committee for 
yielding the necessary time for me to conclude my remarks.
  Mr. MOYNIHAN addressed the Chair.
  The PRESIDING OFFICER (Mrs. Boxer). The Senator from New York.
  Mr. MOYNIHAN. Madam President, I thank the Senator from Idaho for a 
thoughtful and factual account of the situation in the State of Idaho. 
And I note a thing that might not occur to an Easterner, that the term 
``rural'' does not extend to the reality of the frontier. There are 
areas legitimately so described and we have to think about them.
  But may I say, with respect to this business of bureaucratic 
organizations, just 3 days ago the Republican mayor of New York, a very 
distinguished and able man, Mayor Giuliani, in the company of two union 
leaders, wrote to Mr. Gephardt on the House side that: ``America is 
debating universal health care. New York has given universal coverage 
for most of this century.'' I make the point that we have done. And 
that universal health coverage in New York City provides an 
extraordinarily diverse environment. There are municipal hospitals; 
there are for-profit hospitals--I think there are some. The greater 
part of the system is run by private, nonprofit hospitals, most of them 
either began or continue to be associated with a religious 
denomination.
  We have a large municipal workforce that handles these things. But 
the greater part of the workforce involved is in the private sector. 
And the coverage is not only good, it is, in fact, the best in the 
world--not for every individual. But the finest medicine practiced on 
Earth is practiced in the city of New York.
  So there are ways of getting from where we are in the main in the 
country to universal coverage without a Federal dictate on every 
detail, and I hope we will find one.
  I see the Senator from Hawaii, who made such a striking address the 
other day about the effects and about the fortunate fit that the 
universal coverage in health care has had with the growth and 
prosperity of small business, has risen. I want to note that I was 
struck by the statistics, by the data he brought to us. I look forward 
to his remarks and yield him such time as he may desire.
  Mr. AKAKA addressed the Chair.
  The PRESIDING OFFICER. The Senator from Hawaii.
  Mr. AKAKA. Madam President, I thank the chairman for yielding time.
  Madam President, it appears that there are those who feel afraid that 
the success of Hawaii's health care system represents too good an 
example when used by the proponents of meaningful health care reform. 
During the past week, we have witnessed the dissemination of misleading 
and erroneous information about the effectiveness of the Aloha State's 
health care system and, more particularly, its impact on small 
business.
  The health care system is being blamed for supposedly some of the 
problems in businesses that Hawaii has had. I want to present some 
facts here that will allude to this. Let me give you just one example.
  As they have in recent weeks, and they did again this morning, the 
National Federation of Independent Business cites a jump in 1992 
business failures and 1993 job losses in Hawaii and implies that these 
events are somehow related to the Hawaii Prepaid Health Care Act.
  Do you find this to be strange, to pick two different indices from 
two different years to illustrate the supposed evils of a 20-year-old 
program?
  It is not so strange when you note that the NFIB fails to mention one 
other ``very small'' concurrent event of that unfortunate time for 
local businesses. That event was the September, 1992 billion-dollar 
devastation of Hurricane Iniki, whose economic impact was felt well 
into 1993 and is still being felt today.
  Let us get some basic perspective on this, Madam President. Hawaii is 
not the small business black hole of the universe. The facts are simply 
these: According to accepted small business indicators, Hawaii ranges 
from being far better than the national averages to--at the very 
least--on par with the rest of the country. At the same time, we are 
the only State that requires the employer and employee to contribute to 
health insurance coverage. The point is, shared responsibility is not 
the fear of some poison arrow it is characterized to be by those who 
oppose serious health care reform.
  At this time I feel that I must address the scare tactic information 
being spread, so let me just direct your attention to two matters of 
Hawaii's Prepaid Health Care Act history that I believe are of special 
interest because they mirror so well what we are now going through on 
the national level today.
  First, when Hawaii's Prepaid Health Care Act was being considered, it 
was opposed--it was opposed--by the Employers' Council, the chambers of 
commerce, and a raft of small business associations. They were afraid 
of the economic consequences, and no reasonable person could have 
blamed them at that time. Naturally, the greatest concern by far was 
the potential impact on small businesses, the lifeblood of our economy. 
As a result, the Hawaii Prepaid Health Care Act specifically sought to 
ensure adequate protection, especially protection for the most 
vulnerable of all small businesses, those with less than eight 
employees, the little mom-and-pop operations.

  The act established the premium supplementation fund to provide small 
business relief, and $375,000 was set aside solely for that purpose. 
Today, in 1994, without any further appropriation having been made in 
the last 20 years, the fund now stands at $2.5 million. Assistance was 
applied for by only five businesses during that time, and paid for by 
the fund over two decades, and that amounted to a total of $110,000. 
There has been no apocalypse.
  My second example of deja vu all over again is this. All of the 
groups I previously mentioned were joined in their opposition to the 
Prepaid Health Care Act by, among others, the Hawaii Medical 
Association. Here is an excerpt from the HMA's testimony in 1973:

       The national Government is already moving in the direction 
     of a national health insurance program which seems likely to 
     become law within the next year or two. It would seem foolish 
     for the State of Hawaii to embark on a program that would 
     perhaps be superseded by Federal regulation within a short 
     period of time.

  At that time, HMA, the Hawaii Medical Association, felt that a 
Federal national program was going to happen in 2 years. Here it is, in 
1994, and we still have not had one. And we need it today.
  The Medical Association recommended that we not proceed with such 
major reform, but that we defer action. Does that not sound familiar? 
You bet. Fortunately, Hawaii had the courage to act and not wait. And 
Hawaii, indeed, became the health State of our country.
  Our country cannot afford to wait. We must have the courage to pass a 
universal health care act. Our people need it. It is the best thing for 
our country at this time. And I urge my colleagues to support this act.
  Mr. MOYNIHAN. Madam President, may I once again thank the Senator 
from Hawaii, who comes to the floor with experience and with facts. 
Some have experience; some have facts. But singularly, the State of 
Hawaii represents both. And we are grateful for that.
  I see the Senator from South Dakota. I am happy to yield him 5 
minutes. Would that be helpful?
  Mr. DASCHLE. I thank the chairman. I appreciate his yielding me time.
  Madam President, what is the pending business?
  The PRESIDING OFFICER. S. 2351, and the question is the Dodd 
amendment.
  Mr. DASCHLE. The Dodd amendment is the pending business?
  The PRESIDING OFFICER (Mr. Akaka). That is the pending question, to 
the Mitchell substitute.
  Mr. DASCHLE. Mr. President, I asked that somewhat rhetorically, there 
has been very little discussion today of the Dodd amendment. We have 
heard many long and very eloquent speeches about health reform. Members 
on both sides of the aisle have indicated their positions. But the 
amendment of Senator Dodd now has been pending 4 days. I think the 
message in all that is we have waited and waited, accommodated and 
accommodated. The majority leader has laid down a proposal, now 2 weeks 
tomorrow. He introduced the proposal 2 weeks ago tomorrow--2 weeks ago, 
August 2. On August 3, he introduced the bill. That was Wednesday, 2 
weeks from this coming Wednesday.
  On August 9, the floor debate began. That was Thursday. The 
Republican leader asked for a week's delay to be able to look at that. 
The majority leader accommodated that request. They requested no votes 
to be taken last Monday and Tuesday to study the bill. That request was 
accommodated. There was a request that no amendments to health reform 
be voted on last week. That, too, was accommodated. We were told that 
no votes would be allowed last Saturday; no votes would be allowed 
today. Yet, with speech after speech, requests are made to seek yet 
additional time to talk about the bill.
  My question would simply be, if you do not like the bill, where are 
the amendments? I hope we can get to work. We have accommodated every 
single request from Members on the other side, every one. I hope we can 
go to some votes and finally get on with the real nuts and bolts of 
trying to improve the bill, change the bill, do whatever we are going 
to do with the bill. But let us get to work. We have waited now 2 
weeks. The last time we went to war, it did not take this long.
  So I hope we could get on with some constructive debate, that we 
could talk about amendments, we could have a vote on the Dodd 
amendment.
  There are many other amendments pending, at least on our side. We 
could go to those votes. But let us get on with it. I think the 
American people expect us to finish this legislation. I hope we can do 
it sometime prior to Labor Day. But with each passing day, with each 
passing additional request, I become increasingly pessimistic, frankly, 
about whether we are ever going to be able to get to amendments.
  Let us vote.
  Mrs. BOXER. Will the Senator yield?
  Mr. DASCHLE. I am happy to yield to the Senator from California.
  Mrs. BOXER. Mr. President, I thank the Senator from South Dakota for 
his leadership in bringing us back to the matter at hand. As a matter 
of fact, the Senator from Hawaii was kind enough to take the chair for 
me for just a moment so I can say to the Senator how pleased I am he 
reminded the Senate that we have been supposedly debating this first 
amendment for many, many hours.
  I say to the Senator, according to the numbers I have, approximately 
12 million Americans under the age of 21 do not have health insurance--
12 million young Americans. I have been in the Senate for a couple of 
years, in the House for 10 years, and the Senator and I have served for 
a long time together. I have heard the most eloquent speeches from both 
sides of the aisle in all those many years about how children are our 
future, and if we do not care about the children, what is going to 
happen to America?
  I would say this is the moment to stop the talk and start to vote for 
the children of this country. It is absolutely immoral not to cover the 
children. It is also economically insane not to do it. We know every 
dollar we spend on immunization saves $10. We know when we give 
prenatal care, we save money and we get healthy babies. This is an 
amendment that deserves to be voted on.
  I just ask the Senator a question, since I must do that under the 
rules, and that question is: Does the Senator feel--and I ask because 
he has been in such a leading role in this, along with Senator 
Kennedy--does the Senator form a sense from the other side of the aisle 
that we are moving together in a bipartisan way to begin voting on this 
bill?
  Mr. DASCHLE. Mr. President, I wish I could answer in the affirmative 
to the Senator from California, but the fact is, I do not. We still do 
not have a commitment from the other side to allow us a vote on the 
Dodd amendment. This is the fourth day now that we have debated the 
Dodd amendment, although there is very little discussion about the Dodd 
amendment from the other side. This is an important amendment. Senator 
Dodd made a very compelling case for its passage. I believe in other 
circumstances, there would be strong bipartisan support for it.
  The Senator has indicated there are a lot of people who are really 
riding on the decisions we are making here; 48 people every minute lose 
their health insurance, so with every 10-minute speech, we have 480 
additional people who have lost health insurance in that period of 
time.
  How many people, day after day over the last couple of weeks, would 
have been covered, would have been protected, had we been able to enact 
this legislation months ago?
  So I am pleading, at some point in the not-too-distant future, that 
we get on with it, we go to work, we offer amendments, we have votes. 
If there are differences of opinion, let us work them out. If there are 
ways by which we can improve the Mitchell bill, let us work them out. 
Let us offer amendments and resolve these differences. Let us go to 
work.
  I yield the floor.
  Several Senators addressed the Chair.
  The PRESIDING OFFICER (Mrs. Boxer). Who yields time?
  Mr. PACKWOOD. Will the Senator yield for a question?
  Mr. MOYNIHAN. Certainly, I yield for a question to my friend.
  Mr. PACKWOOD. Madam President, the question is as follows: Did 
Senator Mitchell not indicate--and I am quoting--``There will be ample 
opportunity to debate this bill. I have said many times no one will be 
rushed. We will stay here as long as it takes, as many days, weeks, 
months as necessary for every Senator to be able to consider the bill 
amply?''
  I think Senator Mitchell said that, and there are still many Senators 
who want to discuss this bill amply.
  Mr. MOYNIHAN. Which we understand.
  Mr. COATS. I wonder if I could also ask a question of the Senator 
from South Dakota.
  Mr. MOYNIHAN. I am afraid our time is constrained by the 5 o'clock 
cutoff. The Senator from Missouri wishes to make his opening statement. 
So I yield 5 minutes to the Senator from Massachusetts, our champion 
from Massachusetts.
  The PRESIDING OFFICER. The Senator is recognized for 5 minutes.
  Mr. KENNEDY. Mr. President, I want to join in the, I think, 
compelling question that has been raised by the Senator from South 
Dakota and the Senator from California. The issue about children is an 
issue that is well understood by the Members of this body.
  We are a country that has one of the highest infant mortality rates 
in the world, and this has been stated and restated and restated on 
both sides of the aisle. We have one of the highest incidence of low-
birthweight babies in the world and this has been stated by Republicans 
and Democrats. We produce about 80 percent of the world's vaccine, and 
we still have one of the poorest records in terms of vaccinating 
children throughout the country. And this is a real problem.
  Time after time we have had demonstrated on the floor of the U.S. 
Senate what is happening in other countries of the world, countries 
that have standards of living similar to ours and have had health 
insurance, universal health coverage. What has happened when they have 
given focus and attention to preventive health care programs for their 
children? Their children grow, their children blossom, their children 
are healthy. They have seen the savings that have been out there in 
terms of financial resources and the savings that have been there in 
terms of health challenges. Day in and day out, it is uncontroverted.
  What the Senator from South Dakota and the Senator from California 
and the Senator--I am sure--from New York and I are saying is, let us 
get about the business of just having the vote on that particular 
measure and then get on with other areas, get on to other provisions of 
the legislation. But the majority leader, when he was out here the 
other night, said, fine, all right, go ahead and have equal division of 
time on Saturday, but maybe we will get some kind of answer if we can 
talk and find out whether we can vote on the basis of either the Dodd 
amendment or the other three or four amendments which have been shared, 
as I understand it, with the minority leader; that we were prepared to 
move ahead on and we were hopeful that on Saturday we would get some 
indication.
  Now we are here in the late afternoon on the floor of the U.S. Senate 
on an amendment that is understood by the Members, all the Members of 
this body, and unquestionably will make a significant and important 
difference to the children of this country. The only responses are: 
Other Members want to make opening statements; other Members want to 
talk at length; other Members want to get off their chest, and say what 
is on their minds on health care.
  When are we going to say that the children are the important ones and 
call the roll on that issue, and let us get about the business of what 
this debate should be about, and that is making some judgments?
  Maybe this amendment will not carry. I think the compelling case has 
been made for it by the Senator from Connecticut and the other Senators 
who have spoken for it.
  All we are asking is, let us shorten our speeches and try to take 
some action. I think the American people would applaud that action. I 
understand what the Senator from Oregon is saying, that we are going to 
have day after day after day after day of long speeches, and we wonder 
why people back home do not believe that this institution is relevant.
  The issue is children; the issue is preventive care; the issue is 
their future and whether they are going to have a bright and hopeful 
and healthy future, and do it in a way that is going to save money. We 
ought to be able to agree on that.
  I would think that we could go shorter on the long and extended 
speeches that have been talked about, I think even threatened. Talk 
about Senators wanting to talk 3 and 4 hours--we have to ask ourselves, 
do the American people think this institution is better served by 
Senators speaking 3 or 4 hours on these matters of general subject, or 
taking action for children?
  Mr. COATS. Will the Senator from Massachusetts yield to me for a 
question?
  Mr. KENNEDY. Whatever time I have, I will gladly yield for a 
question.
  The PRESIDING OFFICER. The Senator has spoken for 5 minutes. The 
Senator from New York controls the time.
  Mr. MOYNIHAN. I do not want to be in any way discourteous, but the 
Senator from Missouri has been very patiently waiting.
  Mr. COATS. I will propound it at a different time.
  Mr. KENNEDY. I will be around.
  Mr. MOYNIHAN. He will be around. As soon as we vote at 5 o'clock, we 
resume debate.
  Madam President, I am happy to yield the remainder of our time to the 
able and learned Senator from Missouri, who is one of those who helped 
pass the Finance Committee's bill out of committee.
  The PRESIDING OFFICER. The Senator from Missouri is recognized for 34 
minutes.
  Mr. DANFORTH. Madam President, I thank my chairman.
  I will offer my view of where we are in the health reform debate and 
how I think we should proceed from here. Maybe I am the only person in 
the Senate who feels this way. But I will unburden myself of my 
thoughts.
  Right now we are hopelessly bogged down. We, not only being the 
Senate, but the Congress and, indeed, the country. We are hopelessly 
bogged down on the question of health care reform legislation. I do not 
think we are going to get moving by continuing to spin our wheels on 
the floor of the Senate by proceeding from amendment to amendment.
  I think that there is one answer, and that is that we regroup, and 
attempt to come up with a consensus health care reform proposal that 
can be passed. It is my judgment now--and it has been my judgment for a 
very long time--that where we are going to end up is approximately 
where Senator Chafee has been for about 4 years now. Therefore, I think 
that if we are going to pass health care legislation this year, it 
should be a bill which is somewhere in the neighborhood of the effort 
that is now underway in the various meetings being held by Senator 
Chafee and Senator Breaux, and others, who have styled themselves as 
the so-called mainstream coalition.
  Let me say that there are, obviously, a whole variety of opinions in 
the Senate. There are people who think that we should pass no 
legislation; either we should pass no legislation at any time or we 
should pass no legislation this year because when the election comes, 
the makeup of the Congress will be changed. On the other hand, there 
are people who think we should pass very sweeping legislation and the 
sooner we do it the better.
  However, I believe there is a strong core group in the middle in this 
Congress and in the country that believes that we should pass 
legislation, that we should attempt to reform health care, but that 
what we should do is avoid the extremes that have been presented to us.
  The interest in health care reform legislation on the part of Senator 
Chafee and those who have rallied around him is not something that has 
begun in the last few months. It did not even begin with the Clinton 
administration. It began 4 years ago.
  Four years ago, our Republican leader, Senator Dole, with, I think, 
great foresight, saw that health care was going to be a coming issue, 
and he asked Senator Chafee to chair a task force of Republican 
Senators to address the question of health care.
  Senator Chafee has done that with great determination. Virtually 
every Thursday morning while the Senate has been in session, over a 4-
year period of time, Senator Chafee convened a meeting in his hideaway 
office to educate Republican Senators on the question of health care.
  Those meetings were held in a very systematic fashion, well prepared 
in advance. And normally there were 15, 20, 25 Senators who would show 
up at 8:30 on Thursday mornings for an hour to discuss health care and 
various aspects of health care.
  Then, after a period of time--years really--we finally put together a 
bill. This bill was introduced by Senator Chafee and it had something 
like 19 or 20 Republican cosponsors.
  The ideas in that bill have continued to be the views which have been 
held by the mainstream coalition, a group of people consisting of 
Republicans and Democrats. It is something of a changing group, but 
last week we had up to 16 Senators, just about evenly split between 
Republicans and Democrats, who showed up at our meetings. The basic 
ideas of the Chafee legislation have been at the heart of what we have 
been discussing and, in fact, were at the heart of the bill that was 
reported out of the Senate Finance Committee about 5 or 6 weeks ago.
  What are those ideas? Universal coverage, but universal coverage 
achieved as and when Government can pay for the subsidies that would 
undergird universal coverage; insurance reform to assure portability 
and to assure that people who become sick are not dropped from 
insurance coverage; cost control, not by price control or premium caps, 
but cost control achieved by enhanced competition, with a view that a 
competitive marketplace works better than Government; control of 
Government spending through a fail-safe device which provides that we 
are not going to have the runaway spending by the Federal Government 
which has characterized Government health care spending for the past 
couple of decades; and significant medical malpractice reform.
  These were the core concepts of the Chafee legislation, and these 
have been the core concepts of the mainstream group that has been 
meeting. I believe they are good concepts and sensible concepts, and I 
do not believe they are the kinds of ideas that frighten the American 
people.
  One of the significant things about these meetings is the attitude 
that has been manifested in them. Go to the floor of the Senate and 
obviously there is a lot of contentiousness. But back in the hideaway 
office of Senator Chafee, when we meet for a couple of hours at a 
spell, Democrats and Republicans, the basic attitude is one of 
cooperation and attempting to seek mutual understanding.
  But there is something else that characterizes those meetings, and 
that is nervousness, nervousness that we are dealing with something 
very big and very important, nervousness that we are dealing with the 
whole health care system of this country, nervousness in knowing that 
what we are touching is something that affects the lives of every 
American, nervousness and worry that maybe we are going to make our 
health care system worse, not better, and nervousness about the budget, 
the cost of health care, and the concern that already our Federal 
budget is spinning out of control.
  So there has been a lot of goodwill in those meetings and there has 
been a lot of nervousness. And I think the nervousness is important as 
we proceed with this legislation because we do not want to do something 
that is terrible for the country. The basic feeling of the group, and 
the basic feeling that is obviously shared by a lot of Republicans 
because they have been making speeches on it in the last week, is we 
just do not think the Mitchell bill is a very good bill. We think it is 
too big, that it goes too far. And so I would like to talk about the 
Mitchell bill, not in a partisan way, but simply to point out where it 
differs from where we are and from what we think in our group.
  Now, much of the discussion in the media about the Mitchell bill, and 
the Clinton bill, and the Gephardt bill, and the Dole bill has been on 
the subject of universal coverage, and particularly employer mandates. 
In about 1 minute I am going to stop talking about employer mandates.
  One of the interesting things about our meetings is that almost no 
time have we spent talking about employer mandates. That may be an 
exaggeration, but I would say maybe 5 percent of our time, and no more 
than 5 percent of our time, have we spent on the subject of employer 
mandates. But if you read the newspapers, you think that is all we talk 
about, that is the only subject.
  So when Senator Mitchell introduces his new legislation, and he seems 
to be making compromises on the subject of employer mandates, the way 
that is covered in the media is, ``Well, Senator Mitchell has come our 
way, and he has met us halfway. Isn't that good? We are on the brink of 
compromise.''
  He has not met us halfway. We are light years away from Senator 
Mitchell. He has come closer to us on employer mandates, but not on 
other subjects. Then, when, I have tried to make that point to the 
media, the conclusion is, well, these mainstream people do not care 
about the employer mandate idea, or they have given up on that. Well, 
there are a variety of opinions among our 15 or 16 Senators on the 
question of employer mandates. But I think it would be fair to say that 
most of us do not like the idea. We do not think it is a good idea. We 
do not think it should be included in the legislation. But my point is 
that that is a fraction, and a small fraction, of the total issues 
before us.
  Now, what are these other major issues? I would like to talk about 
them.
  The first question is cost. Cost. First of all, cost with respect to 
the Federal Government--the cost to the Federal Government of this 
program is thought to be in the neighborhood of $1.2 trillion of new 
Government spending on entitlement programs over the next 10 years--
$1.2 trillion of new entitlement programs over the next 10 years. That 
is a lot of money. Every program that we are talking about--the Dole 
program, the Chafee-Breaux program, all of these have more spending on 
at least one entitlement, and that is subsidies for low income people 
to help them purchase coverage. But the problem with the Mitchell 
program is that it is just too much. It is too extreme. It does not 
start with one new entitlement program, a subsidy program for low-
income people, but adds all kinds of other entitlements and some very 
big ones:
  Prescription drug benefit. Is that a good idea?
  Well, helping people pay for prescription drugs, who can argue with 
that? But it is expensive--$95 billion over the next 10 years.
  Home health care. Is that an important thing to do? You bet it is. 
And I say that as the father of a home health care nurse. But can we 
afford $48 billion for home health care? I would suggest that the 
answer to that question is no, not now.
  I want to point out with a chart that I have here why I think the 
answer to the question has to be no. Senator Bob Kerrey and I are the 
chairman and the vice chairman of the bipartisan Commission on 
Entitlements. This is a very striking chart because it shows what is 
now happening in Federal Government outlays as a percentage of gross 
domestic product. The green line shows the rate of taxation in our 
country, which has hovered at about 18 or 19 percent since the 1970's.
  What this chart shows is what is happening to Federal spending. The 
fact of the matter is that by the year 2012, entitlement spending plus 
interest on the national debt will consume all of the money that we 
raise in Federal taxes in our country. By the year 2012--18 years from 
now--entitlement spending and interest on the national debt will spend 
everything we raise. There will be nothing left, other than borrowed 
money, for everything else that we do as a country.
  Take national defense, some people say we spend too much, some say we 
spend too little. Assume we spend nothing on national defense. We have 
a crime bill. Some people will say that is too much to spend on a crime 
bill. Assume you close down all the prisons; assume you close down the 
court houses and you close down the FBI. That is what we would have to 
do. There would be nothing for national defense, nothing for crime, 
nothing for highways, airports, the environment, and whatever else we 
do as a country. All of it would be consumed by interest on the 
national debt, plus entitlements.
  By the year 2030, four entitlement programs--Social Security, 
Medicaid, Medicare, and the Federal retirement program--will consume 
all of our revenues. We will not even be able to pay for the interest 
on the debt. There will be nothing left over.
  So that is why I think we have to be very careful about getting into 
new entitlement programs.
  Are they popular? Of course, they are. That is why we do them. Yes, 
they are popular. But how much can we do? We cannot afford $1.2 
trillion in new entitlement programs, no matter how wonderful they are.
  So, from a cost standpoint, I believe that the Mitchell program is 
just too expensive.
  A number of Senators have talked about the additional bureaucracy. 
More than 30 new Federal agencies or commissions are created by the 
Mitchell program. It is too much; it is just too much for us to choke 
down as a country. It is too much. It is too big. If we are going to 
pass health care legislation, we are just going to have to get off of 
this Mitchell bill. And I do not say that in a disparaging way to the 
majority leader. I am just saying it is too much. It is not going to be 
passed. We have to cut it down to a reasonable size, and to a 
reasonable concept. That is what Senator Chafee and Senator Breaux and 
others, on a bipartisan basis, have been trying to do.
  Let me make some additional comments about the Mitchell bill and 
where it differs from our legislation. Again, I am not even getting 
into the subject of employer mandates. But what I want to make clear is 
that there are other big areas where we believe that the Mitchell bill 
is just wrong. I want to underscore the fact that I do not think it can 
be amended back into shape. I think we are going to have to start with 
something new. I would recommend that it is the Chafee approach.
  First of all, with respect to cost containment, cost containment has 
a couple of aspects to it. One is cost containment relative to the 
chart that is behind me now. The Federal Government costs: How do we 
contain the Federal Government cost of health care?
  Senator Mitchell has a proposal to do that, so he says. Senator 
Chafee and Senator Breaux and the so-called ``mainstream group'' have a 
very different kind of proposal. The basic problem with Senator 
Mitchell's proposal is that he excludes from the purview of cost 
containment existing Government health care programs, and the Chafee-
Breaux approach includes within cost containment existing Government 
health care programs.
  That is the big difference. Should they be included or should they be 
excluded? Should Medicare, which is the biggest one, just be excluded? 
Should there be a constant debate on whether or not the increased cost 
of health care is caused by the legislation that we may be about to 
pass, or by an existing program?
  Should that kind of gaming of the system be part of the ongoing 
national debate on health care? Or, instead, should the so-called fail-
safe device for making sure that whatever we do is not going to create 
a worse budget deficit than we have right now, should that apply to all 
of health care? That is the issue. Our view is quite different from 
Senator Mitchell's view on the design of fail-safe.
  The second big question pertains to the cost of health care, not just 
from the standpoint of the Federal Government, but from the standpoint 
of the Nation as a whole. Some people do not want any cost containment. 
Some of my Republican colleagues really do not have cost containment in 
their legislation. That is popular, I know. It is good politically. But 
it is not really responsible.
  So if you believe that there has to be some way of containing the 
cost of health care, not only for the Government, but for the country 
as a whole, how do you achieve that cost containment? How do we put 
together the kind of legislation designed to control the cost of health 
care?
  Again, there is a very different approach between the Chafee-Breaux 
idea and the Mitchell idea. The Mitchell idea is very close to price 
controls, to premium caps. Senator Mitchell's bill would tax the 
increase in cost of health care. It would tend to lock in--almost 
grandfather--high-cost existing plans, ratifying them, and then create 
a Government formula for taxing increase over a set rate.
  It is our view that low-cost plans would be penalized if that kind of 
calculation were put into place. It is also our view that to tax 
increases is very much like a premium cap. It is a premium cap using a 
tax mechanism as the device to accomplish the premium cap.
  The Chafee concept is designed to enhance competition between plans, 
between insurance companies; to create competition so that insurance 
companies are competing with each other to try to keep the cost of 
insurance down for the American people.
  That is a very shorthand way of explaining the difference between the 
two. The Chafee idea is closer to a tax cap. The Mitchell idea is 
closer to a premium cap. The Chafee idea builds on competition. The 
Mitchell idea builds on Government control. They are philosophically 
different. We believe that the Chafee plan is much, much better.
  What are some of the other problems with the Mitchell proposal, as we 
see it? One set of problems is what the Mitchell plan does to health 
care networks such as health maintenance organizations.
  One thing it does is to mandate that these health care networks have 
to contract with what are called the ``essential community providers'' 
and the essential community providers are defined in a very sweeping 
way. What it says is that these networks which are supposed to be 
competing and trying to keep prices down are required by Government to 
do business with various hospitals and health care organizations which 
they might not want to do business with.
  You cannot have a market system that works effectively when you tell 
people who are trying to work within the market that you have to do 
business with people who you do not think are very good; or you have to 
have large numbers of institutions as part of our program that you do 
not necessarily want, or even very high-cost institutions. Furthermore, 
the Mitchell bill causes health plans to have to hire every type of 
specialist, even if the health plan does not think that the specialists 
are needed and even if they are costly.
  There is another big problem we see with the Mitchell plan: 
Litigation. We thought that trying to get a handle on litigation was 
essential to health reform. It is estimated that defensive medicine 
costs $25 billion a year in the United States--just doctors and 
hospitals trying to prevent lawsuits. And access to medicine is 
affected by the litigation explosion. Take, Howell County, MO; the 
county seat is West Plains. Nine counties surround Howell County, some 
in Arkansas and some in Missouri. In these nine counties, there is 
nobody that will deliver a baby except at the West Plains Hospital. 
Nobody will deliver a baby because people who have done it are out of 
that business. It is the lawsuit explosion that has done this. To deal 
with this, we have real malpractice reform in our legislation. We 
provide real incentives for alternative dispute resolution. Senator 
Mitchell does not. He has alternative dispute resolution, but it is 
add-on litigation. There is no incentive built into it to use 
alternative dispute resolution. We have that incentive.
  We have caps for noneconomic damages. We have real reform for the 
punitive damage system so that it is something more than a windfall for 
attorneys. Senator Mitchell scraps all that.
  This is not just a matter of trying to further amend the Mitchell 
bill. His whole bill is wrong. And crammed into that bill are all kinds 
of incentives for litigation. He has so-called antidiscrimination 
provisions. He has major, major changes in the civil rights laws of the 
United States contained in his legislation. I know something about 
civil rights laws, because in 1990 and 1991 I spent the better part of 
2 years of my life working on what became the Civil Rights Act of 1991. 
That whole legislation would be changed in this health care 
legislation. We took 2 years working on it and, believe me, it was 
tough going. Now we have in the health care legislation major changes.
  For example, we cap both punitive damages and compensatory damages in 
our current civil rights law. In the Mitchell bill there is no cap--
unlimited compensatory and unlimited punitive damages for lawsuits--and 
there is an expansion of the groups that are protected by civil rights 
laws in the United States. Under his bill, there would be causes of 
action on the basis of language, or income, or sexual orientation. That 
is a big change in the civil rights laws. Some people might say that is 
good. But what does it mean? Does it mean that, henceforth, hospitals 
have to have interpreters in the hospitals? Say, in California, where 
our Presiding Officer resides, are the hospitals supposed to have, for 
all the various nationality groups that live in California, 
interpreters or they will risk a lawsuit? How about income 
discrimination? We have had hospitals in my community of St. Louis that 
have moved. Saint Luke's Hospital, for example, and DePaul Hospital 
have moved from the city of St. Louis to St. Louis County. If they were 
to do that in the future, would they be sued because they were 
violating civil rights laws? I think that the answer is clearly, yes, 
they would be, under the Mitchell legislation.
  And then there are the Section 1983 Actions. I spent 8 years of my 
life as a State attorney general, and Section 1983 was the biggest 
problem I had as State attorney general. These are civil suits against 
State and Federal officials. In 1993, there were 51,000 civil rights 
suits filed under Section 1983 against the Federal Government. In 
general, 10 percent of the cases pending in State attorney generals' 
offices are Section 1983 cases.
  This Mitchell bill has a major expansion of civil rights causes of 
action, so that lawsuits will be filed against the Federal Government 
and the State government, as well as against insurance companies, 
insurance plans, employers and the like. And the so-called Mitchell-3 
provided yet another new cause of action against health plans and 
purchasing co-ops if they fail to carry out their responsibilities 
under his bill.
  Graduate medical education. Do we really want a national council on 
graduate medical education telling us how many physicians we should 
train and in what specialties and in what hospitals?
  So, Mr. President, these are some of the problems with the Mitchell 
bill. I do not state them because I want to pick on the bill that is 
before us. I simply want to make one fundamental point: This thing 
cannot be passed. It cannot be passed. We could be here for the next 2 
months. We could come back for a lame duck session and start again next 
year. It is too big, it is too much, it is too expensive, it is too 
bureaucratic, and it is way too litigious.
  So where do we go from here? I believe that the answer to that 
question is within this mainstream group. I believe that it is not too 
late to put together a bill that can be enacted into law if we stick to 
the principles where we can build consensus, and that is my 
recommendation.
  I think we should go back to the drawing boards. We are at the 
drawing boards and we hope to have legislative language, possibly 
tomorrow, with specific recommendations.
  This underlying bill that is before us now is never going to be 
amended to a point where it is not something that scares the willies 
out of the people of this country, and for good reason. It is just too 
much for us as a country to choke down.

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