[Congressional Record Volume 140, Number 115 (Tuesday, August 16, 1994)]
[Senate]
[Page S]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: August 16, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
                          HEALTH SECURITY ACT

  The ACTING PRESIDENT pro tempore. Under the previous order, the 
Senate will now proceed to the consideration of S. 2351, the Health 
Security Act, which the clerk will report.
  The assistant legislative clerk read as follows.

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

  The Senate resumed consideration of the bill.

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

  The ACTING PRESIDENT pro tempore. The Senator from Massachusetts.
  Mr. KENNEDY. Madam President, we do have an amendment dealing with 
children that is before the Senate.
  I yield myself such time as I might use.
  We have, as we understand, if not a time agreement, at least a 
general understanding that during the course of the debate we will have 
fair distribution of time. At least it would be my understanding that 
we would rotate back and forth with the Members who are here.
  The ACTING PRESIDENT pro tempore. The Senator's understanding is 
correct.
  Mr. KENNEDY. That would be the way I would urge my colleagues on this 
side to go through the course of the morning.
  Madam President, we are still waiting to have some resolution or some 
conclusion to the amendment that has been offered by the Senator from 
Connecticut. I think many of us who are cosponsors and strong 
supporters of it hope that it would then be followed by measures in 
other areas where we could begin to develop some common ground, some 
common understanding, some bipartisan efforts.
  We had in our own Committee on Labor and Human Resources about 15 
major policy areas discussed in our mark up. On at least 11 of those we 
were able to develop bipartisan support, and I think even though we 
have had some differences on the floor as expressed over the period of 
the last 2 weeks as we have been debating this issue, many of us are 
still hopeful we will be able to find the common ground which the 
American people are expecting and which the American people deserve so 
that we can move forward.
  I want to take just a few moments away from the issue of children to 
review very briefly with the Senate the central themes that we have 
been examining, Republicans and Democrats alike, over the period of 
these past 2 weeks and to see by identifying them and by also reviewing 
how the principal measures which are before the Senate--the Mitchell 
bill and the Dole bill--actually deal with those issues because they 
are central to the whole health care reform debate.
  Hopefully, after we dispose of the issue of preventive health care 
for children in our country--something for which there is such a 
compelling need, and for which the case I think has been very 
convincingly made--and after we try to make some additional progress in 
the areas of disability, perhaps mental health, perhaps in some rural 
health issues, we then will come back and focus on really the 
overarching policy questions which we are going to have to debate.
  It seems to me to be appropriate to begin to look at those issues as 
we have seen them being discussed over the period of the last 2 weeks, 
so that we can begin to focus on those measures more effectively and 
hopefully more thoughtfully and try to move ahead.
  So, Madam President, the two overarching goals of health reform are 
strengthening our health insurance protection for those who have it 
now, and guaranteeing health security for all Americans. We want 
Americans who have health coverage now to know that it will be ongoing, 
that it will be continuing, and it will be strengthened with 
legislation that hopefully will be reported out of our Senate.
  The central part of that effort must be insurance reform. We have 
talked about that so we can end the insurance companies' abuses and the 
flaws in the current system that have left too many Americans 
vulnerable. That is basically understood as cherry picking, the 
selection of the healthiest individuals and insuring those, and leaving 
others behind.
  This is a goal shared by Republicans and Democrats alike. Virtually 
every speech which has been made on the floor has said that we should 
end preexisting exclusions, No. 1; guarantee Americans the right to 
choose their doctor, No. 2; end the cherry picking that allows the 
insurance companies to choose to insure only the young and the healthy, 
No. 3. No. 4, achieve affordability of coverage for all. No. 5, open up 
the Federal Employees Health Benefits Program so that every American 
can enjoy access to the same high-quality health plan that Members of 
the Senate have.
  We Members have many plans available to choose from. I have a family 
policy. I pay $101 a month for that program, which is one of the best 
in this country. Many of us have felt, and felt strongly, that kind of 
availability ought to be there for other Americans. If it is good 
enough for the Members of the Senate and the House, and the 10 million 
other Americans who are Federal employees, including the President, it 
should be available to other Americans as well. In the Mitchell 
proposal we make that kind of program available to all Americans in the 
community rated pool.
  When debate picks up today, we will hear discussions about layers of 
bureaucracy, and there will be maps and charts. But, access to the 
Federal Employees Program is one of the important features of the 
Mitchell proposal. We do not see a lot of charts or maps when any of 
our Members go and sign up for that program. We do not hear a lot of 
complaints about it. We do not hear a lot of complaints even in the 
course of this debate about how inadequate it has been for them 
personally or members of their family. So we have included that.
  Another aspect was the guaranteed portability. So if you lose your 
job or change your job, you will not lose your coverage.
  We must examine these lofty bipartisan goals: they have been repeated 
and repeated and repeated over the course of this debate. When we look 
at the two different proposals that are before the Senate, there really 
is only one that will achieve them. The Mitchell plan truly reforms 
health insurance to achieve these objectives. The Dole plan does not. 
In fact, if we read the fine print, the Dole plan is so riddled with 
loopholes that it should not be called the American Option Plan, but 
rather the ``American Insurance Company Protection Act.''
  I would like to review those items that we have outlined, and that 
have been mentioned by almost every Member who has spoken during the 
course of the debate so far.
  First of all, on preexisting condition exclusions, they are still 
allowed. This is a matter of such importance and consequence to 
American families. We speak to it, even as a Member of the Senate who 
had a son 12 years old with cancer, who lost his leg to cancer and is 
now well, healthy, happy, and the father of a wonderful young daughter, 
and has a very important and meaningful career in terms of community 
service. That young man would not be able to purchase insurance as an 
individual in my State, and I believe in all States, unless they are 
part of a group.
  There are millions of families like that who have what is called a 
preexisting condition--cancer, heart disease, diabetes, juvenile 
diabetes, lupus. You can name those different items. What we want to do 
is, in our overall health care program, say we are going to eliminate 
the preexisting conditions restriction.
  Mr. REID. Will the Senator from Massachusetts yield for a question?
  Mr. KENNEDY. I will be glad to.
  Mr. REID. It is my understanding that the State of Hawaii would not 
be one of those States without universal coverage, and the Senator's 
son and others similarly situated would be automatically entitled to 
coverage in Hawaii. Is that not true?
  Mr. KENNEDY. The Senator is correct. I appreciate the intervention. 
We have had a good deal of discussion about the whole Hawaiian 
experience, particularly as it relates not only to preexisting 
conditions, but also to children, and how well they do with regard to 
children's issues.
  Mr. REID. I ask the Senator if he agrees with this statement: Even 
though Hawaii is the State that costs more than any other State, with a 
very high cost of living in Hawaii, does the Senator acknowledge that 
it has the lowest cost of health care of any place in the United 
States?
  Mr. KENNEDY. The Senator is correct. If you look at the trend, since 
the implementation of the Hawaiian experience--and as the Senator 
knows, for example, they have twice the incidence of breast cancer--but 
much lower death rates from the disease. They have twice the visitation 
in terms of doctors and hospitalization, and an excellent recovery 
level.
  In the proposal introduced by the Republican leader, treatment of 
preexisting conditions is not assured; there are still exclusions for 
all services. It says on page 80 in paragraph 4: The health plan may 
impose a limitation or exclusion of benefits relating to treatment of a 
condition based on the fact that the condition preexisted the effective 
date of the plan.
  It provides, furthermore, in paragraph (a): The condition was 
diagnosed and treated during the 3-month period prior to the plan.
  So if they were getting treated 3 months prior to the plan for heart 
disease or cancer, they are out.
  Or, it says, limitation or exclusion extends for a period of not more 
than 6 months after the date of the enrollment. It means that if you 
get in the plan, and you need treatment for 6 months, all of your 
treatment that was related to the plan will not be included or paid for 
by the plan.
  Then it continues. As we know, under the Mitchell bill, all the 
preexisting condition prohibitions are effectively eliminated. There is 
an open enrollment period where anyone will be able to enter without 
having consideration of any preexisting condition. There is an amnesty 
period where people would be able to come in, and then by the year 
2000, the concept of preexisting condition is totally eliminated, as 
compared to the Dole proposal.
  In the Dole proposal, they say the participating State may establish 
a limit on the number of new enrollees the health plan may accept 
during that amnesty period.
  So not only do we have a situation which excludes individuals with 
preexisting conditions, but the number of individuals who will be able 
to enter the various plans are going to be subject to some State 
judgment, some agency that will be established within the State, that 
is going to make the judgment as to whether individuals will be 
permitted or will not be permitted to enroll in a health plan.
  You can imagine who is going to have the ear of those various State 
agencies. Do you think it is going to be the public or the individuals 
that are going to be affected with preexisting conditions, or do you 
think that the insurance companies might have some interest in that 
particular question?
  If you then go to page 81, they talk about: The reference to 3 months 
in paragraph 1(a) is deemed a reference to 6 months. So they have a 
description about 3 months, and then in a later page they say any 
reference to 3 months is 6 months, and any reference to 6 months is 
deemed a reference to 12 months.
  So I daresay, Madam President, that those who are most concerned 
about the preexisting conditions, comparing the two different 
proposals, have to reach very simple and clear conclusions.
  Second, on the issue of the guaranteed choice of doctor, we have seen 
in the Mitchell proposal that co-ops and employers must provide a 
choice of plans, including the fee-for-service plan, which is basically 
the choice of doctors. That is explicit on page 136.
  In the Dole bill, you can examine all 600 pages and there is no 
reference to how individuals are going to be able to have the free 
selection of doctors. It is not mentioned on page 96 in the section on 
cooperatives. It is not mentioned in the references to employers on 
page 107.
  Their requirement to offer a choice of plans, or a choice of doctors, 
is not referenced in the legislation. We hear a great deal about the 
importance of choice of doctors. The Mitchell bill has it; the Dole 
bill does not. The Senate wants it, more importantly, the American 
people want it.
  Elimination of preexisting conditions. The Mitchell bill phases out 
any exclusions for individuals that have preexisting conditions in a 
very determined, conscientious way. I daresay that under the Dole 
provisions, in the areas I have referenced, that element is still 
retained. The American people want to have it eliminated.
  We have heard, Mr. President, a good deal about the issue of 
affordability and the issue of taxes. Under the Mitchell bill, it 
allows a maximum of 1.5 percent surcharge or marketing fee for plans 
sold through co-ops. On page 85 of the Dole bill--and this is just 
beyond belief, Mr. President. I hope I have the attention of the 
Members and the American people--``Administrative Charges: in general, 
in accordance with the reform standards, a community-rated health 
plan''--that is what we are basically talking about, community-rated, 
social insurance. We talked about that with the Republicans. Senator 
Chafee talked about the importance of community rating. And we have 
provided it in different ways in the bills before the Senate.
  Listen to this under the Dole bill:

       Administrative charges: In general, in accordance with the 
     reform standards, a community-rated health plan may add a 
     separately stated administrative charge not to exceed 15 
     percent of the plan's premium.

  And to the plan's premium; $900, it could go for. $900. That is not 
even a tax. That goes to the insurance companies.
  Let me point it out again. ``In general, in accordance with the 
reform standards, a community-rated health plan may add a separately 
stated administrative charge not to exceed 15-percent of the plan's 
premiums which is based on identifiable differences in marketing and 
other legitimate administrative costs.'' And then it goes on, and 
toward the bottom of the paragraph, ``or a broker.'' A 15-percent 
additional charge under the comparison between the Dole and Mitchell 
bills. That would be $900. You talk about taxes?
  Mr. DASCHLE. Will the Senator yield for a moment on that question?
  Mr. KENNEDY. Yes.
  Mr. DASCHLE. Let me ask the Senator if it is not also true that the 
Dole plan allows a similar 15-percent administrative charge to be added 
to FEHBP plans. In other words, any non-Federal employee who wanted to 
participate in the Federal Employees Health Benefits Program would also 
pay a 15-percent administrative charge; is that not also true?
  Mr. KENNEDY. The Senator is exactly correct. That is over on page 
117, section 9002, ``Applications to Small Business Participants.''
  On the top of that page it says, ``A carrier offering a health 
benefits plan under this chapter may charge a fee to participating 
small businesses.''
  Have we not heard much about small businesses out here in the last 2 
weeks, about the sensitivity to small businesses? Here, under this plan 
it says, ``a carrier offering a health benefits plan under this chapter 
may charge a fee to participating small businesses.'' Right here, for 
the administrative expenses related to the enrollment of such 
businesses, and to Federal employees. Fifteen percent of the premiums 
charged each such business. That is another 15 percent, another $900.
  We are talking about billions and billions of dollars here. It is 
wonderfully sanctimonious for those around here to talk about the 
Mitchell bill and the various provisions in here about comparing 
cigarette taxes when we spend over $21 billion a year in the health 
care system taking care of people that are using tobacco, and they are 
quoting about all those increases in taxes. Here, this tax isn't even a 
tax; it's $900 that goes right to the insurance company.
  Let me just point out how they define this. So you have those two 
provisions in this measure. If you go to the issue of portability, as 
the Senator knows, under the Mitchell bill, access to the Federal 
Employees Health Benefits Program is for all individuals in what they 
call the community-rated pool, employees and firms under 500, 
nonworkers, the self-employed, 78 percent of all of the under-65 
population.
  So the great number of Americans will have access to the same 
coverage as we have--and we could talk about how we want to strengthen 
this and other proposals that came out of different committees. The 
Mitchell bill makes it available to effectively 80 percent of all 
Americans under 65.
  We have talked on both sides of the aisle, and I have listened about 
the importance of making available to the American people what is 
available for us. I pay, with the family coverage, $101 per month. I 
would think most people would feel that is a very good deal. It is a 
good deal. We do not hear of many people around here talking about it. 
It is a good deal, the kind of deal we want to have for the American 
people.
  We heard from the other side, so the Federal Employees Health 
Benefits Program is a good deal. Let us include it in our program. Look 
at the difference in the Dole bill on page 115. ``Self-employed 
individuals and small employer participants in the Federal Employees 
Health Benefits Program.''
  First of all, there is no mention of a choice of doctors in here 
whatsoever. But let us go on. ``For the purposes of this chapter, the 
term ``small business'' means any business entity which employs 50 or 
less employees, including businesses with self-employed individuals.'' 
And then it goes over the application to small business participants on 
116.
  I would like to have my good friends from Nevada and Washington and 
Colorado listen to this description. ``The Office of Personnel 
Management shall promulgate regulations to apply the provisions 
relating to health benefit plans, to the extent practical, to small 
businesses and individuals covered under the provisions of this 
chapter.''
  One would read that--any child would read it--as small businesses and 
individuals covered under this chapter.
  Now, two paragraphs down, it says: ``Notwithstanding the provisions 
of subsection (a),'' which I have just read, ``the provision shall not 
apply to individuals covered under this chapter, except the Office of 
Personnel Management shall establish a method to disseminate 
information relating to health benefit plans to such individuals 
through small business participants and carriers.''
  In the one place they say it is going to be small businesses and 
individuals, and in the next paragraph they take it away, as the 
language does, from any individuals. Individuals can participate, but 
the only way you are described as an individual is if you are going to 
qualify for coverage from the small business participants.
  Then it says: ``The carrier offering the health benefits plan under 
the chapter may charge a fee to participating small businesses.'' That 
is what we talked about before. Basically, in one paragraph they talk 
about small businesses and individuals, and two paragraphs later they 
say that notwithstanding that paragraph, the coverage shall not apply 
to individuals.
  So this is why, Mr. President, it is important that we consider 
exactly what is in this legislation.
  Finally, I will just mention the issue of portability. This is 
enormously important so that families know if they move from one job to 
another, they are going to continue their coverage. Every worker that 
enters the job market today will have, unlike 35 or 40 years ago, seven 
different jobs.
  Forty or fifty years ago if your father was a shipfitter or iron 
worker in the Quincy shipyards in Massachusetts, your father or 
grandfather had that job for life, and they made good money, so that 
their wives generally stayed at home. Of course, society and market 
forces have changed things a lot. Women are in the job market because 
they want to be, should be, and they need to be.
  We found that in the change in our economy everyone who enters the 
job market is going to have seven different jobs. We are trying to have 
the portability.
  Under the Mitchell proposal, you have a similar kind of a benefit 
package whether you live in Salem, MA, or Salem, OR.
  So you move through the whole process. It may be a different company, 
but it is the same package.
  But it is not within the Dole proposal. It is not within there. There 
is no requirement that your employer pay for the standard package. But, 
you are still going to find that individuals are going to be wanting to 
move. So the idea that you can say, well, it is somehow portable, is 
false. This program just does not meet the most minimal standards in 
terms of portability. If you change jobs and your employer does not pay 
for coverage or offer you a plan, you are out of luck. If you lose your 
job, you could be out of luck.
  These are the essential elements that I think are just worthwhile 
reviewing very quickly. Under the Dole proposal we are permitting the 
insurance companies to charge a 15-percent tax. The Mitchell proposal 
is 1.5 percent. This is a 15-percent tax. The FEHB plan is still closed 
to most Americans. Under Mitchell it is open to 80 percent of all 
Americans under 65. Under the Dole proposal it is a fraction of that.
  There are loopholes allowing insurance companies to limit portability 
of coverage. If you do not have a similar kind of a benefit package and 
access to the same doctors and plans in different companies, then the 
idea that if you move from one job to the other that you are going to 
have coverage defies rational explanation.
  You have no elimination on the preexisting condition exclusions, as I 
talked about in the Dole bill. Under the Majority Leader's proposal, 
all the preexisting conditions for the initial phase, the initial 
enrollment, are phased out so that they are eliminated by the year 
2000. That is still there in the Dole program. Under the Dole proposal, 
there is no mention, none in the 600 pages of the Dole bill, about 
guaranteeing access to your doctor. In every reference to the benefit 
package under the Mitchell bill it talks about the fee for service, 
which is the option with unlimited choice of your doctor.
  It talks about the loopholes that allow the insurance companies to 
continue the cherry picking. The idea is the companies themselves will 
not be required to pick up or insure individuals or individual groups. 
There is the flexibility that will be available to the insurance 
companies to continue to select the healthiest individuals out there 
without responsibility in terms of coverage of anyone else.
  (Mr. CAMPBELL assumed the chair.)
  Mr. KENNEDY. Mr. President, I daresay that these are items which we 
ought to try and find some common ground--hopefully, we will later on 
in the day--in terms of the issues on children.
  But it does seem to me that we ought to be able if we are serious, 
and the whole debate for the last several years has been about 
universality and whether we were going to be able to pay for it.
  We were talking about preventive health care measures, and that is 
the issue that we will be addressing later on with regards to children. 
We have not even gotten into the very extensive programs in terms of 
prevention that are available in the Mitchell bill.
  But we cannot tolerate any measure in this body that is going to 
continue to permit preexisting conditions and say to the 49 million 
disabled people in this country that we have passed legislation that 
has not attended to your needs. It will not be so. We have to say, if 
we are serious about the choice of a doctor or plan, we have to see it 
in the bill. We see it in the Mitchell bill, and we continue to ask 
where, where, where is it in the Dole proposal.
  We have to make sure that the insurance companies' 15 percent tax--I 
read it in the Record the exact language that is included in the Dole 
proposal--that goes not to the Federal Government but goes to the 
private insurance companies at their will and they would be able to 
have that. The exclusion----
  Mr. HATCH. Mr. President, will the Senator yield?
  Mr. KENNEDY. I will wind up in 2 minutes. Then I will be glad to 
yield.
  There is the closing down really effectively of the Federal employees 
program to people outside the Government and the limitation on the 
portability. These are essential elements, Mr. President, and I have 
heard our colleagues talk about them as being desired. I think it is 
important at this stage of the debate as we are moving toward hopefully 
a resolution of the children's preventive programs to say that we are 
going to try and see if we cannot at the successful conclusion of this 
debate and hopefully the passage of the children's amendment, address 
those issues.
  I am glad to yield for a question, and then I do not intend to hold 
the floor any more. I see the Senator from Wyoming on the floor.
  Mr. HATCH. Mr. President, I ask my colleague a question because he 
worked very hard on this issue and I know he feels very deeply about 
it. Is it not true that under the Mitchell plan, other than for the 
purchasing cooperatives, there is an open-ended marketing fee that can 
be charged; there are literally no limits on how much they can charge 
under the Mitchell plan?
  Mr. KENNEDY. Will the Senator clarify this?
  Mr. HATCH. Let me read it to the Senator. This is on page 51 of the 
bill:

       Marketing fees. No. 1, plans offered outside purchasing 
     cooperatives, the community-rated standard health plan may 
     impose a market fee surcharge for community-rated individuals 
     enrolling in a plan through agent, broker, or other otherwise 
     sales method or direct enrollment process. Such surcharge 
     shall be in addition to the weighted average of marketing 
     fees for such plans for community-rated individuals enrolled 
     in such a plan for any purchasing cooperative in the 
     community-rating area.

  I think the Mitchell plan limits the market fee to about 1\1/2\ 
percentage points in the case of purchasing cooperatives, but for plans 
outside the cooperative, it is a completely open-ended fee, which is 
ridiculous.
  The Senator is criticizing the Dole plan. At least Senator Dole 
limits whatever the market fee can be. Let me tell the Senator that if 
the market fee is too high, I guarantee you that insurance is not going 
to be sold or bought.
  Mr. KENNEDY. That is the whole point. Under the Mitchell bill, they 
do not have to pay that because they can remain within the particular 
program. They do not have to pay that. What the Senator is saying is in 
order for the plan to be competitive, it can't tax the people and the 
plan itself it has to pay it. The Senator is making my point for me.
  Mr. HATCH. No, I am not.
  Mr. KENNEDY. Yes, the Senator is. He is saying under the Dole 
proposal anyone who goes on into a plan, into the co-op, is at the will 
of the insurance companies to be charged up to 15 percent extra for an 
additional fee to be paid to the insurance company. Whereas, we are 
saying that if you want to pay a tax to the insurance companies or 
brokers, you can or you can go to the co-ops where people do not have 
those additional kind of fees. So nobody has to pay the tax because 
every plan has to offer through the co- op and every individual can buy 
through the co-op.
  Mr. HATCH. If I could ask one other question?
  Mr. KENNEDY. I yield briefly.
  Mr. HATCH. What the Senator is saying is that there is only going to 
be one plan that the HIPC, the health insurance purchasing cooperative, 
can offer, because nobody else is going to be able to compete. If they 
stay in that plan there will not be any marketing charge. But I have to 
tell the Senator I think the free market system will compete. They are 
going to compete well, and they are going to have to compete. This is a 
false issue at best.
  Mr. KENNEDY. I do not know why you give that kind of flexibility to 
the broker. You have the language here that the 15 percent 
administrative cost can go to the broker. How is that serving the 
American people to say you can tack on another 15 percent on top of 
that premium to go to the broker? What we are trying to do is to 
squeeze out the inefficiencies and the costs of the health care system 
at the present time. The Senator is writing that inefficiencies right 
into it.
  Mr. DASCHLE. Mr. President, will the Senator yield?
  Mr. KENNEDY. Yes.
  Mr. DASCHLE. The Senator is absolutely right.
  To clarify this point, is it not true that under the Mitchell plan 
every person has access to a purchasing cooperative, similar to what we 
have as Members of Congress through the FEHBP? Is that not accurate?
  Mr. HATCH. That is certainly accurate. Of course, it is accurate. So 
you start with that premise that everybody has the same opportunity for 
access to the purchasing cooperative that we have. It is only things 
they are going to choose.
  Mr. DASCHLE. The Mitchell bill guarantees that every single 
individual has access to a purchasing cooperative, which will make 
available to consumers many plans. One co-op may have 40 different 
plans. That is where the competition that we all say we want comes 
from. Is it not the case that, under the Mitchell plan, only if you 
choose not to participate in a cooperative that you could be subject to 
the 15 percent or higher tax that the Dole plan virtually guarantees? 
Is that correct?
  Mr. REID. Mr. President, who has the floor?
  The PRESIDING OFFICER. The Senator from Massachusetts has the floor.
  Mr. KENNEDY. I yield for the answer.
  Mr. HATCH. Basically, you are saying there is only going to be one 
way or one plan you can accept because you are not allowing insurance 
agents their ability to sell insurance. Let me tell you something. 
Unless they are competitive, they are not going to be able to do it.
  But this business of the Mitchell plan saying that we are going to 
have a purchasing cooperative, we are going to allow them to sell 
insurance, we are going to allow free choice, we are going to allow a 
fee-for-service program, all that is rhetoric and words. You are going 
to force everyone into a purchasing cooperative run by the Government. 
That is the point I am making here.
  Mr. KENNEDY. Mr. President, I will just say that we do have the 
competition within the co-op. The point you cannot get away from is the 
limitation under the Mitchell bill.

       In no event may the sum of the membership fee and the 
     marketing fee charged by a purchasing cooperative with 
     respect to a certified standard health plan exceed 1.5 
     percent * * *.

  The Dole bill is 15 percent to a broker. This is 1.5 percent.
  And you can cut it whatever way you want--but there's still an 
additional 15 percent to get the Federal employees program. Under the 
Mitchell bill, any business or any individual can join the Federal 
employees program.
  I hope we will not be talking a great deal about additional taxes 
until we come to the explanation. That is $90 under the Mitchell bill 
versus $900 under the Dole bill. And that is not an insignificant 
amount.
  Mr. HATCH. Could I ask one other question of the distinguished 
Senator?
  Mr. KENNEDY. Sure.
  Mr. HATCH. Do people pay the same premium under this program as they 
would for the Federal employees insurance?
  Mr. KENNEDY. Yes.
  Mr. HATCH. Actually, they do not for 6 years; am I wrong in that?
  Mr. KENNEDY. Are you talking about the age adjustment provision?
  Mr. HATCH. No.
  Mr. KENNEDY. By the end of the phase-in.
  Mr. HATCH. So you are talking about a 6-year phase-in before they can 
get the benefits of Federal employees program?
  Mr. KENNEDY. That is exactly correct in terms of the premium 
payments, but the benefits are the same from day one.
  Mr. HATCH addressed the Chair.
  The PRESIDING OFFICER. Does the Senator yield the floor?
  Mr. KENNEDY. Yes. Whatever time is going to be allocated on the other 
side. I saw the Senator from Wyoming earlier and I indicated to him I 
would not take long.
  Mr. HATCH. I yield whatever time the distinguished Senator from 
Wyoming needs.
  The PRESIDING OFFICER. Senators are not operating under a time 
agreement.
  Does the Senator from Wyoming seek recognition?
  Mr. WALLOP. Yes.
  The PRESIDING OFFICER. The Senator from Wyoming is recognized.
  Mr. WALLOP. Mr. President, it is a curious thing indeed what is 
happening here. The first thing that is happening is that rather than 
defend the Clinton-Mitchell bill, the other side of the aisle is 
attacking the Dole bill. And the curious thing about that is, the Dole 
bill cannot be before us under the rules that the Senator from 
Tennessee and the Senator from Maine have established.
  We do not yet have a Congressional Budget Office scoring of the bill. 
The House wisely has gone home until they do have a CBO score. But the 
Senate excludes having a score, and therefore there is no way we can 
talk about this bill.
  I would also like to comment on the Senator from Massachussetts' 
claims. Only in the Senate of the United States is an option allowed to 
an insurance company called a tax. That is not a tax. It is an option. 
It is not mandatory. It is an option.
  But what is mandatory, make no mistake about it, is that if the 
Secretary of Health and Human Services does not like the plan of a 
State, she imposes a 15-percent tax that goes not to the broker but to 
the Government of the United States. Therein lies the big difference.
  But we are still in an irrelevant conversation, because, the way in 
which the majority leader has structured this debate, the Dole bill 
cannot come before us, because we have been denied, first, printing and 
then CBO scoring. So this is an exercise in parliamentary dominance by 
one person, the majority leader, who has foisted upon the Senate no 
fewer than 4,300-and-some pages over the last week and who insists that 
we all ought to know what is in this when he, himself, has not been 
able to know what was in it, or surely they would have included all 
that they needed to include in the first version of the bill. But some 
things have been taken out and some things have been put in and nobody 
knows what all of those are, and I include the majority leader himself.
  So, let us be fair with the thinking in front of the American people.
  Over the past week, we have heard the First Lady, the majority 
leader, the President of the United States, and others reproach the 
Republicans for not wanting to debate health care reform. Now we are 
being reproached for wanting to debate the health care reform. Now we 
are being reproached for not agreeing to the majority leader's request 
to begin voting on his timetable for amendments. We are called 
obstructionists. We are told we are undemocratic. We are told we do not 
care about the American people. We are told that the only thing we care 
about is politics but that the President's agenda is not political.
  Mr. President, anybody watching American politics knows that the 
President's agenda is no less political than the agenda of everybody 
else. He is, after all, the leader of his party and he has chosen to 
make health care reform a political and nonbipartisan effort from the 
beginning.
  Members on the other side of the aisle are being asked to vote out 
any health care bill to save and conserve the Presidency. The 
Democratic leadership wants to pass the bill before the November 
elections, and it does not really matter what the bill says or what it 
will do to the American people. The Senator from West Virginia, I 
think, explained it the best when, in an interview, he said, ``The 
American people are going to have health care reform whether they want 
it or not.''
  Now all of these accusations are offensive to us in elected office 
who listen to our constituents and are here to represent their views 
and seek to do so even if those views do not happen to comport with 
those of the Senator from Maine or President Clinton.
  The debate on health care reform is a philosophical debate. It is a 
debate which clearly delineates the differences between Republicans and 
Democrats over the role of Government in our individual lives. 
Republicans are unwilling to rush this debate, not because we do not 
want to have health care reform, as the Democrats cry, but because we 
are unwilling to vote for a health reform proposal that is 
philosophically opposed by our constituents.
  Let me put, if I can, the issue of reform into some sort of 
perspective.
  If I look back on nearly 18 years in the Senate, there are three 
defining moments in this period.
  The first was in 1981, when the Senate approved the Reagan economic 
revolution, a program which included reductions in Federal income 
taxes, reductions in domestic spending, and increases in our national 
defense budget.
  The second was the defeat of socialism, graphically illustrated by 
the fall of the Berlin Wall and the collapse of the former Soviet 
Union.
  The third event is the current debate on national health policy.
  All three are linked by a common thread. All are attempts to define 
and to limit or, in the case of the latter, to expand the role of 
central government planning in our lives.
  Reaganomics was an attempt to let people keep the resources they 
created through their private initiative, rather than allowing the 
Federal Government to collect and expend these resources. By limiting 
tax revenues, it was hoped that we would limit the growth of 
Government, because taxes and taxes alone are the means by which the 
Government gains the power over the people of this country. We were 
frustrated by Democrats in Congress who insisted on expanding Federal 
spending through deficit financing.
  The fall of communism was a repudiation by the people of Eastern 
Europe and of Russia of the failed ideology of centralized government 
planning; and the defeat of the philosophy was combined with the fiscal 
defeat of the centralized government when we faced a socialist regime 
in Baghdad during the gulf war.
  And now we are being asked to approve, with minimal debate--and I say 
with minimal debate, notwithstanding the promises of the Senator from 
Maine, the majority leader, who, at the beginning, said no Senator 
would be curtailed and is now seeking to curtail us. But, most 
important, we are being given little time to analyze the most massive 
explosion of Government--maybe in this half century. The Clinton-
Mitchell bill will transform one-seventh of our economy, by creating 50 
new bureaucracies and at least six new open-ended Government spending 
programs; by creating new subsidized entitlement programs that will 
cost $1.4 trillion between the years 1995 and 2004--in that decade, 
$1.4 trillion.

  It will increase Federal taxes by $300 billion over the next decade, 
paid for by 83 percent from middle-class Americans who will find 
themselves not only paying more taxes but higher premiums for their 
health insurance. It proposes almost $1 trillion in unrealistic cuts in 
Medicare and Medicaid.
  These true costs do not vanish because we cut them. They go directly 
onto the backs of the rest of Americans who pay for health care. By 
cutting Medicare and Medicaid you just do not simply eliminate the fact 
that a procedure costs a certain amount of money. And if it is not paid 
for by the Government, then it is going to be paid for by the hospitals 
and doctors who perform them, and who ultimately transfer those costs 
onto the backs of the premium payers, insurance companies, and 
individual Americans seeking health care. It goes to the middle class; 
it goes to small business.
  The health care proposal now in front of us represents a reversal of 
recent successes against Government centralized planning and control. 
There are some in Congress who believe that any issue arising in the 
country must be resolved by creating a new Federal program. There are 
some in America who, every time confronted with discomfort, say, ``Why 
does the Government not do something?'' There are others of us, 
however, in America, who believe that solutions cannot only flow from 
Washington; that neither the private sector nor the State government 
have the ability to solve problems because it is controlled by the 
Federal Government, and we have witnessed how successful the Federal 
Government is at the rest of its efforts.
  There are, unfortunately, those in Congress who subscribe to a ``big 
nanny'' philosophy, and they are the same people who have drafted the 
health care plan now being debated. ``That we Americans have not the 
ability wisely to choose what is good for our families, what is good 
for our employees, what is good for our country. We must have this 
group here in this Senate and in those bureaucracies doing it for us 
because we are not to be trusted. Only inside the Beltway resides 
wisdom''--so those people would think.
  The health care reform debate is a true turning point in this 
country. That is why it is important to analyze it fully and 
accurately. And there is no going back. We step off this ledge into 
Government controlled health care and there is no turning back.
  We have only to look at the amendment that is now before us to 
accurately predict what is going to happen. Once you get a standard 
benefit package there is no end to the bidding--no end to the bidding. 
There is always somebody who is going to want something in that 
standard benefit package. Ask those in Hawaii who now find their health 
insurance program too expensive for the State to support. Because year 
after year, session after session, everybody politically bids up what 
is contained in that package.
  The fundamental issue, therefore, that we must decide, is whether we 
believe in a bigger Government, or in a wiser and more empowered 
people; whether we will be ruled by an anonymous bureaucracy which has 
the power to levy taxes or assign them, which has the power to limit 
choice--or whether democracy will continue to be our form of 
Government.
  Those who believe the Federal Government is the solution of our 
health care problems will vigorously embrace the Clinton-Mitchell bill. 
Those who believe, as do I, that our health care problems can be solved 
better by relying on the common sense and abilities of the people, are 
the people who will support the Dole-Packwood health care alternative, 
or some involvement which solves the basic problems which face 
Americans--that of access, portability, preexisting condition, and the 
issue of malpractice and simplicity.
  Government slowly, slowly, slowly has been overtaking our lives. In 
one generation, Government has doubled the amount of money that it 
takes from Americans and it has increasingly used that money to deprive 
us of control over our own lives. In the same time it has turned our 
public spaces over to criminals and our public schools into factories--
yes, of ignorance. Government has driven us apart on the basis of race, 
and even of sex, and in the name of tolerance has made us almost the 
most intolerant country in the world.
  Throughout the world, big government is in the crisis of legitimacy. 
In South America there is a rush to privatize Social Security and 
Medicare, to privatize the State corporate structure. The Japanese, 
recognizing that their industrial policy has bred corruption as well as 
inefficiency, are deregulating their economy. Europe's welfare States, 
that spend more than half of their GNP, are collapsing and dragging the 
mainstream parties down along with them. Look, for example, at Germany 
and its health care plan which is, in effect, the Godfather of the 
Clinton plan. And in fact, the First Lady is the one who has said that 
she would like us to look more like Europe.
  According to remarks in a Wall Street Journal article by Wilfried 
Prewo, Chief Executive of the Hanover Chamber of Commerce in Germany, 
the German plan provides near universal coverage but at great losses of 
efficiency. The average premium payroll tax is 13.4 percent, paid for 
by every working individual. The German alliances, originally devised 
as nongovernmental health purchasing cooperatives, have degenerated 
into de facto government agencies with 112,000 employees working for 
these alliances.
  The administrative cost of the cooperatives have risen 53.5 percent 
from the last decades--more than the measure of the alliances total 
health costs. As Prewo notes, ``These costs reveal that the disease of 
bureaucracy is the real problem''. Hidden taxes are also an integral 
part of the German plan. A 50-percent employer mandate results in labor 
costs that make Germany the second most expensive place to employ 
people in the world. It is also a country that has significantly higher 
unemployment rates than does the United States.
  Financially, the German plan has vacillated between financial 
distress and collapse, and the Government has intruded with ever 
tighter regulations, including price controls and access rationing. The 
German health care costs are rising rapidly and Germany has taken some 
stopgap measures to control them. But major health care reform will be 
undertaken in the coming years. They have no choice. Germany is 
searching for a way out, to have less Government control and to 
establish some market orientation. Incidentally, many people are now 
going to the Eastern European States for their dental care because it 
is cheaper and you can get it right away, without waiting in line.
  So, why is it, as other governments in the world move away from 
socialization and toward market-based programs, our Government is 
trying desperately to move toward it?
  Let us talk for a moment about the issue of choice. For years, health 
reform has centered on the question of how health care can be provided 
efficiently and effectively. But there has always been something 
missing in this debate, which has doomed efforts at cost restraint and 
access. That is that we have focused so dogmatically on how we can 
expand access to care while controlling costs, that we forgot the 
critical element in a free market-based economy--choice. We have not 
had it.
  If the market is to work, individuals must have the ability to 
choose, to make decisions, to accept responsibility--a key word in a 
democracy, Mr. President: Responsibility--accept responsibility for 
their health care.
  Some would argue that responsibility and choice are unnecessary, that 
the Federal Government will assume all responsibility and make our 
choices for us. That will never work with the American people.
  It may be what is imposed upon us, but because it is imposed, does 
not mean that it works. It is the focus of the Clinton-Mitchell bill. 
Government under that bill would assume responsibility for defining the 
standardized health package that we will have, for telling us how we 
must purchase it through mandatory HIPC's, or by forcing employers with 
less than 500 workers to buy at community rates instead of self-
insuring, or by making experienced rate plans contribute to a risk 
adjustment pool supporting alliance.
  Incidentally, this is where the President of the United States is 
absolutely wrong in his statement that we will have choice. You cannot 
have choice if you are to be fined for exercising it. You cannot have 
choice if your employer is to face a $10,000 per employee fine for 
offering either less or more. You cannot have choice by telling us that 
we must purchase insurance through an individual mandate, for telling 
businesses that they must provide insurance for us.
  The Clinton-Mitchell bill contains at least 23 new mandates on 
employers, employees, individuals, and States. Public policy over the 
past 25 years has been driven by the demands called entitlements. We 
have established by the President of the United States an entitlement 
commission whose job is to seek ways to find relief for the American 
taxpayer, economy, and Government from the dictates of entitlements.
  Incidentally, these are figments of Government fantasy, not the 
Constitution. Nowhere in the Constitution does it say that any American 
is entitled to the earnings of any other American. These are things we 
have done to ourselves. Yet, in this program, we are establishing a 
number of new entitlements.
  People have been permitted to engage in whatever activity they choose 
without assuming responsibility for it under the health care system 
that exists in this country. Indeed, they have come to expect from the 
State and the Federal Government the performance of functions 
traditionally reserved for heads of households. The expanding 
entitlement society is destroying the sense of personal responsibility 
and of collective responsibility and of community responsibility. After 
all, if the Government is going to do it, why should I be charitable? 
If the Government is going to do it, why should I seek any other 
resolution? And why should I care who exercises the choice to be 
entitled to the money that I and my fellow citizens earn?
  The expanding entitlement society has destroyed this sense of 
personal and collective responsibility, and there is no more evidence 
than in the area of health care. Under the Clinton-Mitchell bill, the 
individual is now entitled to standard benefits provided by the 
Government through new mandates on the society. The expectation exists 
that there is a right to health care. The President has stated it; 
advertisements have stated it. But there is no such right--there may be 
an obligation, there may be a sense of that obligation--but nowhere in 
the Constitution does it say that the Government of the United States 
must provide every American, no matter what that American does, with 
all he wishes in terms of health care.
  Under Clinton-Mitchell, there are attempts to provide coverage to the 
23 million uninsured by providing subsidies to benefit 100 million. How 
does that work, Mr. President? Twenty-three million are uninsured; 
subsidies for 100 million. Whose pocket is robbed to pay that? I 
guarantee you that many of those who are going to be subsidized will be 
having the other hand in their pocket taking it right back out on the 
other side.
  The costs of these subsidies will be borne by those unlikely enough 
not to receive a subsidy, mainly the upper portions of the middle 
class. It is time, therefore, to restore the idea of responsibility to 
the health care debate. Responsibility means making decisions. For 
instance, each of us decides whether or not to maintain a healthy 
lifestyle, to exercise, to refrain from smoking, to drink moderately; 
or the opposite.
  As a recent article in the New England Journal of Medicine indicates, 
such decisions to accept greater responsibility for what the authors 
call ``demand reduction'' would reduce annual health care expenditures 
by almost 20 percent. That means $180 billion.
  Mr. President, the Government of the United States cannot have 
lifestyle police. It cannot. It cannot have somebody watching each of 
us in the closets and in our rooms to see if we sneak a cigarette or 
drink an extra martini or do not get enough sleep or eat too few 
carrots. They cannot do that to us. So by imposing all of this 
bureaucratic regime on top of us, competition and choice is 
eliminated--something which is available in the private insurance 
marketplace.
  Another decision which most people cannot now make and which is a 
problem, and that has been cited by those on the other side as well as 
on this side, is that most people cannot choose the health insurance 
plans they are provided by their employer, or by their States. They can 
choose not to have the one by their employer. In fact, I, indeed, could 
choose not to have one by my employer and have one by my wife, who is 
self-employed and provides it for her employees.
  But most Americans receive health insurance coverage through their 
employer, and the employer chooses that plan. But the employee has no 
choice on the benefits of which the insurer will provide. There is no 
choice; therefore, there is no responsibility, and little cost for the 
employee. But there is also no option. If a benefit is covered, use it; 
if it is not covered, forget it, I am not going to do it because nobody 
is going to pay for it.
  No wonder individuals feel they have a right to health care, an 
assertion which ultimately turns free-market economics upside down. And 
the lack of choice is only exacerbated by the Clinton-Mitchell bill 
which has Government mandating the purchase of plans and defining the 
benefits included in those plans and not allowing us the options of 
choice as employers or employees--low-cost plans, high-benefit plans, 
one is taxed, the other is disallowed.
  If the Government takes responsibility for all of these, how are we 
to expect individuals to exercise it on their own?
  What must be understood in this so-called right, this false notion of 
security, is that it comes with a price: A price in freedom and a price 
in coverage. In exchange, individuals on a Clinton-Mitchell regime will 
be given reduced coverage, increased premium costs, and increased 
taxes--I will examine that now--but more importantly, freedom and 
liberty will be lost through the imposition of 50 new bureaucratic 
regimes that will impose so many rules and regulations that 
bureaucrats, not individuals, will tighten the existing controls that 
they have over our lives. And who knows where these people derive their 
power, or who they are when they exercise it?
  There are a number of aspects in the Clinton-Mitchell bill which 
reduce coverage. A new high-cost premium tax I mentioned that CBO says, 
and let me quote--incidentally, CBO was not kind to the Clinton-
Mitchell bill. It basically said that it would achieve some goals and 
it was revenue neutral, but thereafter, it slammed it in almost every 
corner it could find. Let me give you the first of those.

       The new high-cost premium tax would be difficult to 
     implement. Its contribution to containing health care costs 
     would be limited and it might be considered inequitable and 
     an impediment to expanding coverage.

  Some health care reform: Inequitable and an impediment to expanding 
coverage and difficult to implement.

       New Federal and State premium taxes will add 17 to 42 
     percent to the cost of buying a health plan.

  Some cost containment.

       Standardized benefit packages would make illegal many cost-
     effective products now on the marketplace.

  Small employers, those with fewer than 25 employees, who currently 
offer health insurance, would not be willing to offer more than 50 
percent of the cost of the insurance because, otherwise, the employees 
become ineligible for the subsidies. What kind of a crazy thing is the 
Government going to do when it actually says that it wants employers to 
do these things--and many of them are, and those are the people they 
cite--and then turn right smack-dab around and say, ``If you give them 
more than 50 percent, the Government will not subsidize.'' No rational 
employer is going to give more than 50 percent.
  Another thing. In order to achieve this massive coverage by the 
Federal Government health care plan, we have the possibility of a 
State-by-State mandate. The distinguished President occupying the chair 
is from the State of Colorado. They might well make the Government 
requirement for coverage. There is no way that it can happen in the 
State of Wyoming or any other rural State. And those in my State go 
under a mandate and perhaps those in the State of Colorado do not, or 
perhaps both of our States and the States of Kansas and Nebraska do 
not. Our employers are going to be shopping the area to find the 
cheapest place to employ people. But what does that do to the economy 
of the United States when the Government by exercising a willy-nilly 
mandate begins to put inequitable positions on the employers in our 
several States?

  Mr. President, there is this magnificent assumption somehow in the 
minds of socialists that society is ultimately perfectible and that we 
are all essentially sheep and we have no human responses to its 
efforts.
  If firms with 25 employees or less are not to be covered, who will be 
so unwise as to hire the 26th employee? How does that add to jobs in 
America? If your penalty begins with the 26th employee, the best thing 
you can do is start another company, if you want more employees. People 
will respond to the artificial stimuli that are contained in this 
ridiculous piece of legislation because the Government is interfering, 
choosing amongst winners and losers, States, individuals, employers and 
all kinds of things. It chooses, chooses, chooses, and it assumes that 
none of us are wise enough to have a human reaction to the 
opportunities that are put in place by those choices.
  We constantly hear that the Clinton-Mitchell plan is necessary to 
help the middle class. But under that plan direct new taxes and hidden 
taxes, still taxes, if you will, on premiums will both shift and 
increase the cost of health insurance onto the backs of the middle 
class.
  There are at least 17 new taxes, some have said 18--and I believe 
that 18th to be the most insidious of them all--in the Clinton-Mitchell 
bill. They raise $300 billion. The one new tax that is not listed on 
here is that if the Federal Government does not choose to accept your 
health plan, it imposes its own and then charges a 15-percent premium 
on every insurance policy sold within that State. That is not the 
Congress levying that tax. That is the Secretary of Health and Human 
Services.
  There are many other hidden taxes and State taxes that will add to 
the premium costs and increase these middle-class taxes. Two-thirds of 
the new Federal taxes, $200 billion, fall squarely on the shoulders of 
83 percent of all Americans through higher costs on health insurance 
premiums. Two-thirds of it goes right on health insurance premiums that 
people now pay. The 25 percent high-cost plan costs $70.4 billion.
  In other words, if your employer seeks to provide more health 
insurance than a target premium cost, you get a 25-percent tax on that 
premium. A 1.75-percent premium tax raises $74.3 billion, and the 
repeal of cafeteria plans and flexible spending accounts costs $46.8 
billion. These are things that Americans now have for which they will 
be taxed.
  Let us talk about them. The high cost premium tax, $70.4 billion. A 
25-percent excise tax is applied to community-rated and experience-
rated health plans that exceed a certain target cost. This is touted as 
cost containment, Mr. President. This tax, according to CBO, will do 
little or nothing to contain health care costs and might impose an 
impediment to coverage. Some kind of cost containment. Virtually all 
plans would be subject to the 25-percent tax. This tax is really a sick 
tax. You can use that in either way. It is a sick tax or a sick tax.
  Perhaps someone from the other side of the aisle might in their time 
explain it differently. But it appears to this Senator that some of the 
plans which will pay the highest taxes are those that have an 
inordinately high number of sick and older individuals. These are the 
plans that by definition have to raise their prices the most to cover 
the high levels of provider reimbursements.
  In other words, you are going to have certain levels. They have a 
certain inequitable portion of either the aged or the unwell, and they 
have to raise their premiums to cover that, or cease to provide it 
altogether. And guess who gets to pay it? The sick and the aged and the 
unwell. I understand that there is a risk adjustment mechanism to 
compensate plans that have adverse health selection, but it is my 
understanding that no such risk adjustment mechanism currently exists.
  The American Academy of Actuaries, when analyzing the President's 
original risk adjustment mechanism, which may be actually less 
complicated than that of the Senator from Maine, stated:

       Such mechanisms can never be expected to be fully 
     effective. Further, the current state of the art in risk 
     adjustment falls short of meeting the requirements of the 
     act.

  So if risk adjustment does not work, Mr. President, then this tax 
clearly penalizes the elderly and the ill. But that is not all. The tax 
applies to community-rated plans in 1997 but will apply to large self-
insured employers following in 2000. Most small businesses purchase 
insurance in the community-rated market.
  I ask the supporters of the Clinton-Mitchell bill, why should small 
businesses have to pay the tax now when big businesses will not have to 
pay for another 3 years? Is this fair to the small business employers 
of America? Is this not a subsidy to big business by a Democratic 
administration claiming to be on the side of the little people in 
America? And since there are no constraints on large employers for 3 
years and the premiums for those employers are based on their health 
expenditures during that period, you have to ask the question, will not 
this seriously undermine the incentives for these plans to economize 
before the year 2000, as CBO suggests?
  In fact, the incentive does quite the opposite. Insurers have the 
right to collect 50 percent of the cost from providers as long as the 
amount does not exceed the provider's disproportionate share. That is a 
very interesting little complication in life right there. Maybe someone 
will be able to explain to me and the Senate how an insurer is going to 
go about collecting these fees. How is it possible, Mr. President, to 
recover 50 percent of the tax in a timely and efficient manner when the 
provider's proportionate shares are based upon factors not known until 
the time beyond the end of the next tax year? How is that going to be?
  What we have done is not only provided an unfair tax, a monstrously 
complicated tax, but somebody is going to be fined for not complying 
with it when it is impossible yet to achieve compliance.
  And then, Mr. President, why should the low-cost provider have to 
reimburse the plan's sponsor for 50 percent of the tax imposed because 
of the excess charges of high-cost providers?
  So what you have done is you have simply said to everybody, go for 
the gold. Make it as rich and expensive and as nasty as you can because 
if you are a low-cost provider you are going to be subsidizing the 
high-cost providers and nobody is going to be able to figure out how to 
collect the tax.
  How much additional administrative expense do you think will result 
from this giddy collection exercise? Even CBO stated that this tax will 
result in litigation expenses. And is it even appropriate for health 
plans to play tax collector when you are trying somehow or another to 
make the system more efficient, to bring the costs down? You are adding 
administrative and legal costs. There is no end to the complication and 
to the furor that this plan and this tax will impose on our society.
  The fee-for-service plans, which allow unlimited choice of providers, 
are generally more expensive than network-based plans and this tax will 
make the fee-for-service plans even more expensive and potentially 
unaffordable all at the same time the President and Senator Mitchell 
promise us we are going to have choice. So the fee-for-service plans 
under which you have choices are going to be driven up because the 
taxes are higher and potentially unavoidable. It simply denies consumer 
choice of providers. Overall, this high-cost plan tax will tax cost 
efficient plans more than inefficient plans. A funny thing in a country 
that seeks expertise. The worse you are, the less you pay and the 
better you are, the more you pay.
  Mr. President, does the Senate really want to go down that road? Is 
that really what we are up to?
  The sponsors of the tax claim that its purpose is to reduce health 
costs. But it is hard to see how raising premiums makes health 
insurance more affordable when talking about the 1.75 percent tax on 
every health plan to provide for more teaching hospitals. This tax is 
applied to all gross premiums. So straight across the board, 
everybody's health care costs in America goes up 1.75 percent. It 
raises $74.3 billion out of purchasers of health insurance over the 
decade, and falls directly on the middle class.
  The Joint Tax Committee has prepared a distributional chart which 
shows this tax clearly falls more heavily on the middle class. In 1999, 
54 percent of the tax increase will be paid by people with incomes of 
$50,000 or less and 79% by people with incomes $75,999 or less. The 
1\3/4\ percent tax will increase the taxes of individuals with incomes 
between $20,000 and $30,000 by $1,178; between $30,000 and $40,000, by 
$1,303; between $40,000 and $50,000, by $1,099; between $50,000 and 
$70,000, by $1,955, nearly $2,000. Some savings, Mr. President.
  This new tax is not in any way related to making health insurance 
available to the uninsured. In fact, what it serves to do is further 
increase the premiums of the already insured. It has been linked to new 
spending for medical education. Yet, while it raises the costs of 
premiums for everyone by 1.75 percent, it more than doubles current 
funding for medical education.
  Is the purpose of health care reform to tax Americans into doubling 
their contribution out of their own pockets to medical education, at 
the time as everybody is saying that we are producing too many doctors? 
It is bizarre, Mr. President.
  It is my understanding that funds currently available under Medicare 
are transferred into new trust funds: The Academic Health Center Trust 
Fund and the Graduate Medical Trust Fund, and others.
  These transfers total $71.1 billion over the next decade. But 
according to CBO, the tax raises almost $11 billion more than is 
claimed to be spent on these programs. So here is a nice, new little 
tax increase for Americans. Even if they support it going to medical 
education, it gives $11 billion more to Government; just to Government. 
It is not directed.
  It is nothing more than a convenient revenue raiser that can be 
increased every time the Government runs out of money to meet its 
commitments, all while we are calling it ``medical education.'' We will 
raise it another quarter percent. We are already $11 billion more than 
spent. What the heck, let us give you another $20 billion.
  Mr. President, this is hiding real taxes from American people in a 
most irresponsible way.
  So I find it extremely difficult to understand how the bill is 
supposed to cut costs when all it is doing is increasing the cost of 
private insurance. I had thought that the majority leader indicated 
that the plan was necessary to avoid premium increases. Yet inherent in 
the majority leader's plan are several provisions which drive premiums 
up.
  Now we have a wonderful provision. Our States are allowed--the words 
used ``are allowed'' to raise their premium taxes by 1 percent to pay 
for new administrative expenses which they are not allowed to avoid.
  Where is this Congress coming from that it says that our States are 
allowed to raise taxes to cover expenses that we impose upon them? What 
is wrong with the concept that the country was founded on the notion 
that these States are sovereign, and that we here in Congress derive 
our power from the States, not the States from the Congress? What a 
bizarre distortion of American political philosophy.
  The Clinton-Mitchell bill allows them to cover the costs of 
administering, and nobody believes that what they will be allowed to do 
will be enough. So the States are going to raise premiums another 1 
percent. But we will not be blamed for that. Clinton-Mitchell will not 
be blamed for that. The States will be blamed for paying for things 
that we are requiring them to do.
  First, the Clinton-Mitchell health proposal would be forced on the 
States. As CBO states in their report, ``[it] would place significant 
responsibilities on States for developing and implementing the new 
system.'' Then we tell them to raise taxes to pay for the cost of 
administering their new duties which we, who derive our power from 
them, are imposing upon them.
  The States, Mr. President, will have 177 new responsibilities under 
this plan, including determining eligibility for the new subsidies and 
continuing their Medicare program. Administering the subsidy and the 
Medicaid programs, establishing the infrastructure for the effective 
functioning of health care markets, and regulating and monitoring the 
health insurance industry. According to the CBO report--again this very 
thin praise which accompanies the Mitchell bill--``it is doubtful that 
all States would be ready to assume their new responsibility in the 
time frame envisioned in the proposal.''
  So what happens, if they are not ready to assume their 
responsibilities? Guess what? The Secretary of Health and Human 
Services assumes those duties for them, and imposes a 15-percent tax on 
all the premiums. That is a 15-percent tax that goes on every health 
plan premium in the State where the Federal Government takes over. CBO 
says the States will have difficulty meeting their responsibilities, 
and yet we blithely go along, and say, ``What the heck. They cannot do 
it. That is 15 percent more for the Federal Government. We will do it 
for them. We will run their plan and impose a tax on them.'' Goodbye 
States rights. Hello Washington.
  If Secretary Shalala determines that a State health system does not 
meet requirements from her view of the insurance coverage, then she 
takes over the State system. If she takes them over and runs the plan, 
she increases the premiums by 15 percent to pay for the administrative 
expenses of the Secretary. The complaint the Senator from Massachusetts 
was making a little while ago is that the insurance companies might be 
allowed to impose a fee. That is a big difference. One is an option, 
and the other is a tax imposed by a nonelected, but appointed, 
bureaucrat.
  Now we have the disallowance of current tax-free health care 
expenditures made through cafeteria plans and flexible spending 
accounts; another $47 billion out of the pockets of Americans who buy 
insurance. A few more billion out of cafeteria plans--plans that allow 
individual Americans to make the choice of the coverage they wish to 
have.
  Mr. President, I have stated before that it is conceivable that my 
wife and I at this stage in our lives will not need obstetric care. It 
is even more conceivable that the care that I might want would be hair 
transplants and hearing aids. Should I not have the choice to have that 
instead of the obstetric care which we no longer will have use for? Not 
according to Clinton-Mitchell. Cafeteria plans are out. It is a sin to 
provide yourself and your family what you believe to be necessary to 
their well-being.
  Flexible spending accounts, whereby some insured have a high-cost 
deductible, figuring that they can take care of the first $1,000 or 
$2,000 of their medical expenses, in exchange for a really good 
catastrophic plan. Oh, no. That will not be allowed. You are penalized 
$10,000 an employee if you provide your employees more than the 
Government says that you are entitled to have.
  This is a fine Government that comes along and says to employees, and 
families, ``I don't care if you want it.''
  (Mr. BYRD assumed the Chair.)
  Mr. WALLOP. You may not have it without extraordinary, new penalties. 
Clinton-Mitchell eliminates those options and again increases the out-
of-pocket costs of middle-class Americans, and eliminates their choice 
and their right.
  Now, the risk adjustment. An egregious hidden tax is this adjustment 
which requires all employers with over 500 employees to participate in 
a risk adjustment pool with individuals and small employers in each 
State. The risk adjustment provision forces self-insured employers, who 
may have lowered their own costs, to pay higher insurance rates to 
subsidize the higher risk of other employers.
  Why, if we have done something well within a corporation of mine, 
should we be required to subsidize the risk of the employers of another 
corporation that does nothing to contain their health care costs and 
the risk of their employees? By shifting these costs, it is no 
different from a payroll tax increase. Once again, the healthier the 
plan, the more efficient the plan, the better you are--under the 
Mitchell-Clinton bill--the more expensive it will be. Those who are 
good and efficient now had better see to it to get bad and inefficient. 
It certaily is in your own best interest, because it will be cheaper 
when it all rolls in.
  The bottom line is that the middle class gets socked, and socked 
heavily, with the distributional impact of the four taxes in the 
Mitchell-Clinton plan--1.75-percent premium tax, increase in Medicare 
part B, disallowance of cafeteria and flexible spending accounts, the 
tobacco tax increase, offset by the 50-percent deduction for self-
employed. Joint Tax found that 60 percent of all taxpayers with incomes 
of $50,000 or less will pay the higher taxes. Some 78 percent of 
taxpayers with incomes $75,000 or less will also pay the higher taxes. 
Incomes between $20,000 and $30,000 could pay $3,000 more a year. 
Between $30,000 and $40,000, you could pay $3,100. Between $40,000 and 
$50,000, $2,690. Between $50,000 and $75,000, $3,800. Those are big tax 
increases, Mr. President. And they do not reflect all of the tax 
increases mentioned above that will come from the States or the 25-
percent premium taxes.
  The Clinton-Mitchell plan does not stop at increasing premium taxes. 
It also includes a number of hidden taxes that will further increase 
the costs of health insurance. Companies with 500 or fewer employees 
are forced to purchase insurance through a community-rated pool. This 
means that smaller companies who may now self-insure, or may have 
efficient plans, will have to pay for insurance that will be 
significantly higher than they now pay and will not to be allowed to 
self-insure-- that is too much independence from great Uncle Sam--will 
not to be allowed to do something on their own; will not to be allowed 
to be accountable and responsible and to work with their employees.
  It increases costs on all the insured, everybody in America, by 
forcing them to cover more benefits for subsidized people than they 
receive from the subsidies. Guess what, Mr. President? Not only are 
these people from the healthier and more efficient plans being asked to 
subsidize other people, but the cost assessed them for that subsidy is 
more than the subsidies. So it is a cute, hidden little tax that is 
going on the middle class, and it is no small figure.
  Under our current health care system, Medicare accounts for two-
thirds of the cost shifting that occurs. Guess what? We are proposing 
to reduce Medicare again. Nobody does anything about the cost that 
Medicare incurs. Instead, the cost is just shifted onto the backs of 
those who are already healthy and employed.
  The Clinton-Mitchell bill proposes to cut Medicare by $200 billion 
over 10 years, with all of the costs, or most of them, falling on the 
provider. Are the providers to shoulder that entire tax, or does 
anybody suppose they might portion it out to those to whom they 
provide? Look at the reality of this. Nobody is going to pick up $200 
billion all onto themselves when they have the option of spreading it 
out. Guess who gets it when they do that? Middle-class America, 
employees and employers of the small and productive sector of this 
great country.
  So instead of solving the cost shifting problem, as the majority 
leader is so quick to claim, his bill actually exacerbates the already 
existing problem.
  A recent Wall Street Journal article by Martin Feldstein found that 
this will result in at least a $13 billion annual tax increase. But the 
cost-shifting problem does not stop there. Under the Clinton-Mitchell 
bill, Medicaid is cut $788 billion over 10 years. These two cuts total 
almost $1 trillion. Medicaid beneficiaries not receiving SSI or 
Medicare would be integrated into the Federal subsidy program. These 
recipients are placed in the community-rated pool with small businesses 
and individuals. Guess who shoulders that expense? By cutting Medicaid, 
it does not disappear as an obligation for somebody to pay it. That is 
the great boondoggle that is contained in this Mitchell-Clinton bill.
  Incidentally, we have never been able to achieve the cuts claimed. My 
guess is that we will never see the day when we do. So, either way, it 
is going to be the Federal Government who is the biggest imposer of 
health care cost shifting, whether or not we pass this bill.
  The Government would pay the subsidies for these beneficiaries, and 
if the subsidies do not meet the costs, guess what? The insurance 
companies and, therefore, everybody else they insure, will end up 
paying the difference. According to Feldstien, this cost shift could 
end up costing $29 billion a year.
  Increased premium costs for younger workers. Perhaps one of the 
nastiest, most unfair, egregious hidden taxes of them all. As Robert 
Samuelson starkly stated in the Los Angeles Times on the 10th of 
August, it is a ``multibillion dollar tax on younger workers.'' It 
occurs because of community rating, which requires everyone to pay the 
same rate of insurance regardless of age. Guess why AARP is so willing 
to support the Clinton-Mitchell bill? According to a recent Washington 
Post article, young adults under the age of 35 will pay at least $40 
billion a year more to subsidize the middle aged, which translates onto 
the young workers as a 7-percent payroll tax increase--right smack dab 
out of the people just starting in life, wanting to buy a home or an 
automobile, or get married. A Neil Howe and Bill Strauss editorial in 
the Washington Post, called ``A Hidden Tax on Young People,'' is the 
source of that information.
  For example, a 27-year-old male who currently pays an average premium 
of $788 would find himself paying $1,485 under a pure community rating. 
That is an 88-percent increase. So I ask my colleagues, yes, we care 
about the aged and women and children; but do we care nothing about the 
young workers coming along and their hopes and dreams for houses and 
other things, along with the fact that they are inherently healthier 
than we are?
  The administration, in its 1995 budget, declared that future 
generations could face taxes that are upward of 82 percent of income--
82 percent of income--if spiraling health care costs and other 
entitlements are not brought under control. Yet the Clinton-Mitchell 
bill places the burden of health care reform squarely on the backs of 
future generations, without doing anything for cost containment. So 
what they have done is simply looked the other way and promised people 
something that cannot be provided.
  We should not and cannot burden the future of America with today's 
health care costs. It is the job of this generation to leave to future 
generations a standard of living that was better than the one that was 
left to us. And we are dead set on denying people responsibility, 
choice, and most of all opportunity, by enacting this Clinton-Mitchell 
bill. We should not be squandering a standard, passing off costs we are 
too scared to face because they have political ramifications.
  The American people are being deceived into believing that this 
Clinton-Mitchell bill will provide them security at no cost --security 
at no cost.
  There is just a wonderful scam in the papers this morning, Mr. 
President, about a bunch of people who bought wonderful travel 
opportunities at below costs, huge numbers of Americans seduced into 
buying something below costs. They got an extremely expensive lesson, 
but they did not get travel below costs.
  That is what we are about in this process right here. We are about to 
give Americans an extremely expensive lesson that their Government 
cannot deliver to them something that costs them nothing, and we will 
do that by charging 83 percent of them more for their health insurance, 
every one of them more for their taxes. And for what? To create a $1 
trillion-plus Government subsidized program that will transfer the 
wealth of others to 100 million Americans.
  We do not need to be subsidizing 100 million Americans, Mr. 
President. What kind of a country is it that says that 100 million of 
us are dependent upon our Government? Surely, we can reduce that figure 
to those who are truly in need.
  Under the Clinton-Mitchell plan, health care costs do not decline but 
increase, according to CBO, not the Senator from Wyoming. They do not 
decline, but they increase according to CBO.
  Is that where we want to go in the name of health care reform?
  The Senator from Maine claims that the cost containment is when 
health expenditures remain at projected 21 percent of GDP and a few 
more people are covered. Medicare will have been slashed, taxes 
increased by $300 billion. Yet health care costs continue to rise.
  It was the very need for cost control that started this debate, Mr. 
President, and the plan in front of us does not even address the issue. 
The working middle class, which the Democratic leadership is so quick 
to tout will receive benefits, receive the least.
  To end my statement where I began, the debate over health care is a 
debate on the role of Government in our lives and in America. Care must 
be taken not to squander liberty and freedom for the elusive promises 
of Government benefits, and that is what we are being asked to do.
  We are being asked to give up things that we now take for granted, 
for a promise of security that the Government cannot deliver on.
  There are certain periods in America's history when pivotal decisions 
are made regarding the role of Government and society. Those decisions 
have had direct and dramatic impact on lives of Americans and set the 
course of the Nation for decades to come.
  Many of the problems we face today arise from decisions that were 
made during those periods. I believe we are at another of those 
crossroads today. If we embark on the course that President Clinton and 
Majority Leader Mitchell set for us, we will vastly increase both the 
scope of and the power of the Federal Government and the ability to 
wield influence in each of our individual lives.
  Make no mistake, this Government does not seek to serve, but to 
control. Americans are frightened of it. We will let it control us at 
our peril.
  Mr. President, I conclude my remarks and I ask unanimous consent that 
certain articles be printed in the Record.
  There being no objection, the articles were ordered to be printed in 
the Record, as follows:

                       [From the Washington Post]

                      A Hidden Tax on Young People

                    (By Neil Howe and Bill Strauss)

       At the core of health insurance reform lies an enormous 
     hidden tax on youth. It's called strict community rating. 
     Politicians don't discuss it, the media don't cover it, but 
     this multisyllabic catch-phrase threatens to move at least 
     $40 billion a year out of the wallets of young adults (under 
     age 35) and into the wallets of the middle-aged (age 45-64).
       If strict community rating is enacted, you can ignore the 
     talk about all the special ``winners and losers'' of health-
     care reform. The real issue will be generational. The big 
     winners will be Clinton-aged Boomers now entering midlife; 
     the big losers will be the young men and women now entering 
     the labor force.
       Community rating is a much-heralded reform that would 
     prohibit insurers from charging different premiums for 
     different individuals. In its ``modified'' form, it would 
     simply ensure that no one can be charged higher premiums 
     solely due to poor health or pre-existing conditions. This 
     reform appeals to our sense of fairness and entails no 
     systematic income transfer. But in its ``stricter'' form, it 
     would require insurers to ignore all distinctions among 
     individuals--including age--and charge a single community-
     wide fee.
       The premiums an individual pays out of pocket or the health 
     costs companies take out of a worker's compensation generally 
     reflect this differential. After strict community rating is 
     enacted, however, people of all ages will pay the same 
     premium--probably, around $2,000 per year for a single 
     person. Presto! The 25-year-old pays 100 percent more and 
     becomes a $1,000 yearly loser. The 60-year-old pays 40 
     percent less and becomes a $1,500 yearly winner. For family 
     heads, the gap will be even wider.
       If applied to everyone, strict community rating would 
     mandate a total income transfer of at least $40 billion 
     yearly--flowing away from the 55 million adults under age 35 
     and enriching the 49 million pre-Medicare adults over age 45. 
     This ``reform'' would be equivalent to a 7 percent tax on a 
     typical young couple's combined wages. That would make it 
     about as large as their personal FICA tax (through which the 
     young are already subsidizing the health costs of seniors).
       Such numbers are by no means hypothetical. Last year New 
     York State instituted strict community rating for all small-
     group and individual insurers.

                           *   *   *   *   *

       Though not all the plans before Congress agree on this 
     measure, the general outlook for young people is bleak. The 
     Clinton, Kennedy, Gibbons and McDermott plans all prohibit 
     any age-based variation in the premium or taxes payable for 
     all insurance policies covered by their plans. Average price 
     tag: $1,000 per young audit. The Chafee and Michel plans 
     allow a little variation, but would still cost young workers 
     about $700 each. The Moynihan plan would allow an age 
     variation up to a multiplier of two, thereby extracting 
     roughly half as much ($500) per young worker. The Rowland 
     plan and the Dole plan (which allows premiums to vary up to a 
     multiplier of four, close to the actual cost variation) are 
     the only major proposals that would hold the young harmless.
       Few national leaders have bothered to bring this massive 
     youth tax to the public's attention. President Clinton has 
     said that premium variations are unjust. If so, why for 
     health insurance alone? Teenage boys pay four times more than 
     their parents for auto insurance because they're four times 
     as reckless on the road--and nobody says that's unjust. Some 
     politicians argue that community rating, like Social 
     Security, won't take anything from the young that they won't 
     get back as they grow older. But this argument assumes that 
     such young-to-old income transfers are forever sustainable 
     (something most twentysomethings already don't 
     believe about Social Security). It ignores the trillion-
     dollar lifetime windfall that community rating will bestow on 
     Bommers (who incurred no corresponding cost when they were 
     young). And it implies that most 60-year-olds are 
     economically needier than most 25-year-olds (which is 
     patently false).
       Hillary Clinton has advanced the brassiest argument for 
     picking the pockets of the young. One of the big problems 
     with the current system, she says, is the health costs that 
     millions of uninsured young people shift onto insured older 
     workers. In reality, this effect is trivial, certainly when 
     compared with the cost shifting by seniors with Medicare 
     discounts. It cannot justify talking about community rating 
     as an appropriate penalty for the irresponsibility of youth.
       Given the political invisibility of today's young adults, 
     strict community rating could well pass Congress. If so, 
     brace for three consequences.
       First, today's young generation will become even poorer 
     than they are now in relation to the old. Already, according 
     to the Census Bureau, the real median income of households 
     headed by people under age 30 is 15 percent lower than it was 
     when Boomers were their age two decades ago. With strict 
     community rating, their purchasing power could fall by 
     another 7 percent.
       Second, the new health law could defeat its own primary 
     goal: universal coverage. Since adults under age 35 are 
     currently the least insured age group in America, this goal 
     will only be achieved if young people start purchasing more 
     insurance. Huge premium hikes will have exactly the opposite 
     effect. (Over the past 15 months, the New York experiment in 
     community rating has caused a 30 percent rise in policy 
     cancellations by young males.) The only practical remedy to 
     this problem would be to combine strict community rating with 
     universal mandated coverage--which would seal young people 
     into the system, force them to buy vastly overpriced 
     insurance, and make them even more cynical about government 
     than they already are.
       The final and most spectacular consequence of strict 
     community rating may be political. Right now, few young 
     adults are paying attention to health care reform. But once 
     community rating becomes law and young wallets are emptied, 
     that will surely change. Come 1998, people born in the '60s 
     and '70s will comprise America's largest generation of 
     voters. Once mobilized, they will start deciding elections. 
     That's when those who taxed the young to enrich the middle-
     aged could get run out of office by those who find themselves 
     stuck with the bills.
       Everyone knows our health-care system needs change. Costs 
     must be controlled. Poor families must gain access to 
     doctors. Insurers must be barred from discriminating against 
     the sick. All this can be done without forcing all young 
     workers to pay far more for health care (and all older 
     workers far less) than what they actually consume.
                                  ____


              [From the Los Angeles Times, Aug. 10, 1994]

  Rube Goldberg Won't You Please Go Home; Health Reform: the Patched 
  Together Bills Will Have Terrible Side Effects, With Younger People 
                        Paying the Highest Price

                        (By Robert J. Samuelson)

       Among other things, the Democratic health-care plans 
     contain a large--and unjustified--multibillion-dollar tax on 
     younger workers. You wonder whether most members of Congress 
     know this or even care. The whole health-care debate is now 
     completely out of control. The desperate effort to craft 
     something that can be advertised as ``universal coverage'' 
     means that Congress literally no longer knows what it's 
     doing. Anything resembling the Democrats' bills, if enacted, 
     would produce tremendous unintended side effects.
       Apparently, most Americans grasp this. In a Newsweek poll 
     last week, respondents were asked whether Congress ought to 
     ``pass reform this year'' or ``start over next year.'' By a 2 
     to 1 margin, they said start over. They sense that the 
     versions of health reform crafted by House and Senate leaders 
     are hodgepodges of conflicting provisions whose only purpose 
     is to win passage. But what is clear to ordinary Americans is 
     denied in Washington. In the capital, the fiction is that 
     legislators know what they're doing and are debating rational 
     alternatives.
       House Majority Leader Richard Gephardt's plan, for 
     instance, would create a Medicare Part C program for the 
     unemployed, workers in small companies and many existing 
     Medicaid recipients. The Congressional Budget Office 
     estimates that the program might enroll 90 million people. 
     But the projection could easily err by millions in either 
     direction. More important, Medicare Part C emphasizes ``fee 
     for service'' medicine (patients selecting individual 
     doctors), while the rest of the bill emphasizes ``managed 
     competition'' (reliance on health maintenance organizations 
     and similar plans).
       The bill would separate the under-65 population into two 
     groups, mainly based on income and size of employer. Each 
     group would be crudely steered toward a different type of 
     medicine. In practice, this division may not be politically 
     acceptable or economically workable. Gephardt doesn't know; 
     no one does.
       Now, consider the tax on young workers. It arises from 
     ``community rating.'' As people age, their health costs and 
     insurance premiums rise. But community rating requires that 
     everyone pay the same rate. This provision is included in the 
     House bill and, in a modified version, in the Senate bill. 
     The effect would be to raise insurance for younger workers 
     (say, those below 45). If employers have to pay higher 
     insurance, they will pay lower salaries. The invisible tax 
     on young workers might total $25 billion annually.
       Questions swirl around both Gephardt's plan and Senate 
     majority leader George Mitchell's. It is hard even to 
     describe Mitchell's plan. He says it's voluntary and lacks a 
     ``mandate.'' Wrong. True, it doesn't mandate companies to buy 
     insurance for workers. But it does mandate a standard 
     benefits package for firms--the vast majority--that offer 
     insurance. Because the mandated benefits are above average, 
     this would probably raise health spending. Companies below 
     the new standard would increase benefits; those above would 
     have trouble lowering them.
       Next, Mitchell hopes to achieve 95 percent insurance 
     coverage by offering subsidies for low-income workers to buy 
     it. But there's a ``fail-safe'' mechanism to limit subsidies 
     if the budget costs exceed projected costs. However, if 95 
     percent coverage doesn't occur by 2000, Congress could 
     require employers to pay 50 percent of their workers' 
     insurance. But this would apply only to firms with more than 
     25 workers. Got it? No one knows whether this would reach 95 
     percent coverage.
       These plans are confusing because the health debate evaded 
     the basic tension between expanding health services 
     (universal coverage, etc.) and controlling health spending. 
     It's hard to do both at the same time. The plans' 
     complexities--as with the original Clinton plan--aim to 
     disguise this conflict. Republicans haven't been especially 
     constructive in this debate, because they haven't faced up to 
     it either. But they are now correct that a bad bill would be 
     worse than none.
       Chaos is now the most important reality about the health-
     care debate. Dozens of provisions in these bills would have 
     huge unappreciated consequences. John Sheils of Lewin-VHI, a 
     health consulting firm, says premiums for small businesses in 
     the Mitchell bill could be 25 percent higher than for big 
     companies. The budget office puts the gap lower. Who's right? 
     Do most members of Congress understand the gap? Probably not. 
     Still, the pretense is that Congress is making conscious 
     choices.
       The pretense is sustained because in Washington politics is 
     sport. All attention fixes on who wins and loses--and the 
     deals that enliven the game. Rhetorical blasts are taken for 
     reality; political reporters know little of how legislation 
     would work and care less. This often leads to bad laws, and 
     in health care, the potential for blunders is huge because 
     Congress is tinkering with one-seventh of the economy and 
     most aspects of medicine.
       In May, Robert Reischauer, head of the budget office, 
     warned that trying to find a compromise by combining 
     provisions from different bills might make the health system 
     worse. He compared it to building an auto engine with 
     incompatible parts: ``You can't say I want a piston from 
     Ford, a fuel pump from Toyota . . . and expect the engine to 
     run.'' Well, that's what's happened. The contraption is part 
     car, part tractor and part rollerblades. Most Americans seem 
     to understand this. Will Congress?
                                  ____


                [From the Washington Post, Aug. 9, 1994]

                   A Hidden $100 Billion Tax Increase

                         (By Martin Feldstein)

       President Clinton is increasing the pressure on Congress to 
     enact a massive and irreversible entitlement program to 
     subsidize health insurance and redistribute income. The tax 
     cost for this largest-ever welfare expansion would top $100 
     billion a year at today's prices. That's equivalent to 
     raising personal taxes across the board by nearly 20 percent.
       Amazingly, the Senate Democratic leadership has managed to 
     conceal this massive tax increase from the public. The 
     legislative wrangling and public discussion have virtually 
     ignored the cost of financing this spending explosion. 
     Members of the business community have been so eager to avoid 
     employer mandates that they have not considered the tax 
     consequences of the pending legislation. And members of the 
     general public have been so concerned about preserving their 
     ability to choose their own doctors that they have not 
     focused on what these plans would mean for their individual 
     wallets.


                              cbo analysis

       Although the Democrats have yet to agree among themselves 
     on the details of the final plan, it is likely to be closely 
     related to the Senate Finance Committee bill. (The recent 
     proposal by Senate Majority Leader George Mitchell that 
     President Clinton said he would accept is essentially an 
     expanded version of the committee's plan.) To understand the 
     magnitude of the potential tax hike that would be required to 
     finance such a plan, it's useful to look at the Senate 
     Finance Committee bill and the recent analysis of it by the 
     Congressional Budget Office
       Under the Senate Finance Committee plan, the government 
     would pay the full cost of a standard private insurance 
     premium for anyone below the poverty level and would provide 
     a partial premium subsidy that declines with income between 
     the poverty level and twice that income. The insurance 
     premium would vary with family composition but would average 
     about $2,000 per person. A single parent and child would 
     receive a subsidy with income below $20,500, while a couple 
     with three children would receive a subsidy with income up to 
     $37,700.
       More than 60 million individuals would be eligible for 
     subsidies in addition to the 60 million already covered by 
     Medicaid and Medicare. The Senate Finance Committee plan 
     would raise insurance coverage by about 21 million 
     individuals, bringing total coverage to 93 percent of the 
     American population.
       The budget analysis prepared by the CBO never states its 
     estimate of the total additional cost that taxpayers would 
     have to bear to finance the new insurance subsidies. But the 
     CBO figures do imply that the public would be paying about 
     $63 billion a year (at 1994 prices) by the year 2000 when the 
     plan is fully operational, and estimates that I have made 
     with the help of colleagues at the National Bureau of 
     Economic Research indicate that the CBO figure understate the 
     true cost by about $40 billion a year.
       Most of the $63 billion tax burden implied by the CBO 
     numbers is hidden in cost-shifting through insurance 
     companies and providers of health services. Only a relatively 
     small part of the financing plan is an explicit increase in 
     the tax on tobacco products. A second small piece is a 1.75% 
     excise tax on private health insurance premiums. Although 
     this tax of $7 billion a year (at 1994 levels) would be paid 
     by the insurance companies, they would pass it on in the form 
     of higher premiums.
       These higher premiums would be a direct tax on individuals 
     who buy their own insurance. Companies would offset the 
     higher premiums on the insurance that they provide to their 
     employees by keeping wages lower than they would otherwise 
     be. The true burden of the premium tax would therefore fall 
     on everyone who is now privately insured.
       The largest part of the financing is a hidden tax that is 
     built into the plan to replace the current Medicaid program 
     for the poor by subsidized private insurance. Medicaid 
     provides much more generous benefits than the proposed 
     standard insurance package, since Medicaid covers a broader 
     range of services and has no out-of-pocket 
     copayments. Although the government 
     would pay the insurance companies the same subsidies for 
     former Medicaid beneficiaries as it pays for everyone else, 
     the proposed law would require the insurance companies to 
     provide those who are currently eligible for Medicaid with 
     the much more expensive coverage that they have today.
       That complex maneuver would save the government about $29 
     billion a year on the current Medicaid program and would add 
     that amount to the annual costs of the insurance companies. 
     The insurance firms would in turn shift it to everyone who is 
     privately insured in the same way they would shift the 
     explicit premium tax.
       A second very large hidden tax would result from reducing 
     government payments to hospitals and other providers of 
     Medicare services without any reduction in the care that they 
     are expected to give. As a result, the hospitals and other 
     providers would just raise their prices to patients and 
     insurance companies. In the end, it would be the privately 
     insured individuals who bear those costs in the form of 
     higher insurance premiums and lower wages. At 1994 levels, 
     this cost-shifting burden is equivalent to at least a $13 
     billion annual tax.
       In short, buried in the CBO numbers is a projection that 
     the Senate Finance Committee plan would have a $63 billion 
     annual cost (at 1994 price levels) and that all but what the 
     CBO estimates to be $14 billion in cigarette levies would be 
     obtained by hidden taxes in the form of cost-shifting through 
     health care providers and insurance companies.
       It's remarkable that the same politicians who have produced 
     this $49 billion in hidden cost-shifting have the audacity to 
     say that the public should support their plan in order to 
     eliminate the much more limited cost-shifting that occurs 
     under the existing system as hospitals pass on the cost of 
     free care. Indeed, to the extent that hospitals are already 
     giving free care, the increase in formal insurance coverage 
     gives that much less to the currently uninsured and confirms 
     that most of the plan's cost is to achieve income 
     redistribution, not expanded health insurance.
       The CBO report is careful to note that its estimates are 
     ``preliminary'' and ``unavoidably uncertain,'' and fully half 
     of the report is devoted to discussing why there is ``a 
     substantial chance that the changes required by this 
     proposal--and by other systemic reform proposals--could not 
     be achieved as assumed.''
       My own analysis confirms that the CBO's caution is 
     justified and that the CBO estimates understate the likely 
     annual cost by at least $40 billion that would eventually 
     have to be financed by higher taxes. A key reason is that 
     there is no way to limit the premium subsidies to those who 
     are currently uninsured. Those who are now buying their own 
     insurance would automatically receive the government subsidy. 
     Those who now receive insurance from their employers could 
     qualify for an insurance subsidy by switching to an 
     employment situation that paid higher cash wages instead of 
     providing health benefits.
       That subsidy would be worth a very significant $2,000 for a 
     single mother with a child who earns $15,000; if she earns 
     $10,000, the subsidy would be worth more that $4,000. It 
     wouldn't take long for employers and employees to recognize 
     that some combination of new pay arrangements, explicit 
     outsourcing of some work, and individual job changes would be 
     handsomely rewarded by the government.
       There are now more than 30 million individuals who could 
     qualify for a subsidy. The CBO estimate recognizes that the 
     roughly six million of them who now buy their own insurance 
     would receive government subsidies. But when it comes to 
     those who are already insured by their employers, the CBO 
     assumes that only about one-fifth of the income-eligible 
     group would eventually choose to qualify for the subsidy, 
     leaving $27 billion of potential subsidies (at 1994 levels) 
     on the table. It seems totally implausible to me that 
     employees and employers would permanently pass up subsidies 
     of $1,000-plus per person that they could get by relatively 
     easy changes in employment arrangements. When they do choose 
     to qualify, taxpayers would have to pay an additional $27 
     billion to finance the plan.
       The CBO calculation also ignores the effect of the subsidy 
     phase-out between poverty and twice poverty on the incentives 
     to work and to report earnings. The phase-out rule that gives 
     a woman with a child $4,660 of subsidy when she earns $10,250 
     and then takes away more than 40 cents of subsidy for every 
     extra dollar that she earns is a powerful incentive to work 
     less and to shift work to the underground economy.
       The CBO's report acknowledges that ``the effective marginal 
     levy on labor compensation could increase by as much as 30 to 
     45 percentage points for workers in families eligible for 
     low-income subsidies'' so that ``some low-wage workers would 
     keep as little as 10 cents of every additional dollar 
     earned.'' But then, quite incredibly, the CBO calculations do 
     not take into account that this would reduce reported 
     earnings, thereby cutting income and payroll tax receipts and 
     raising the health insurance subsidies for which individuals 
     are eligible. Estimates made at the NBER indicate that these 
     reactions would reduce taxes and increase subsidies by a 
     combined total of at least $17 billion a year.
       This estimate makes no allowance for the impact of 
     increased demand on helath care costs in general. Extending 
     insurance to at least 20 million people who are currently 
     uninsured and giving private insurance to the more than 25 
     million nonaged Medicaid beneficiaries would inevitably raise 
     the demand for health services and increase health care 
     prices. But even without that, the analysis that I have laid 
     out shows that the Senate Finance Committee bill would cost 
     the American public more than $100 billion a year at today's 
     prices. The Clinton-Mitchell plan for even broader coverage 
     would cost even more.


                         income redistribution

       A cost of $100 billion-plus a year to increase the number 
     of insured by 20 million means a cost to the taxpayers of 
     more than $5,000 for each additional person insured--a cost 
     of $20,000 for a family of four. Since the actual insurance 
     premiums are $2,000 per person, it's clear that most of the 
     tax dollars in these plans are for income redistribution 
     rather than the expansion of insurance coverage.
       The most fundamental social program in a generation should 
     not be enacted without full and careful consideration of its 
     costs. Once enacted, the benefits would be an irrevocable 
     entitlement for nearly 100 million people.
       The ability of the politicians to hide a $100 billion-plus 
     tax increase is both amazing and frightening. Using mandates 
     on insurance companies or mandates on all businesses as 
     substitutes for direct taxes destroys the budget process and 
     provides a ready way for politicians to deceive the voters. 
     The politics of tax and spend has entered a new era when 
     politicians can spend $100 billion a year and hide the taxes 
     that we pay for those outlays.
       If President Clinton and his congressional allies succeed 
     in ramming this legislation through Congress in the weeks 
     ahead, the American people will have lost not just $100 
     billion a year. We will also have lost our ability to check 
     the excesses of the political process and to unmask the 
     chicanery of the politicians.
       It political leaders want to deceive the voters, the only 
     safeguard is a democracy in which long and careful public 
     debate and congressional hearings can expose such deception. 
     Although Congress has held hearings on the now defunct 
     Clinton plan and on the broad issues of health care, there 
     has been no serious consideration of the cost and financing 
     of the plans that have recently emerged. The American public 
     deserves a change to know what we are being asked to pay and 
     what we will get for our money. We should be suspicious of 
     any politician who says there isn't time for such a careful 
     examination.
                                  ____


              [From the Wall Street Journal, Feb. 1, 1994]

                         Germany Is Not a Model

                          (By Wilfried Prewo)

       ``We have a lot we can learn from the Germans,'' President 
     Clinton said recently, trying to sell his health care plan. 
     ``The Germans are able to provide a very high-quality health 
     care system at a much lower cost than we are, because they 
     have much more discipline in the way it's organized and 
     financed.'' In an address to the National Governors 
     Association yesterday, German Chancellor Helmut Kohl said 
     that in the ``run-up'' to America's health care reform, 
     ``there was an intense exchange of opinions between American 
     and German experts.
       On the surface, the German system does indeed look good: It 
     insures society comprehensively and gives individuals quality 
     coverage that is permanent and portable from job to job. 
     Germany spends about 10.6% of its gross domestic product on 
     health, as opposed to about 14% spent in the U.S.
       But simple comparisons are misleading. Germany and the U.S. 
     differ greatly in aspects not controlled by doctors and 
     hospitals, such as crime-related injuries, malpractice 
     insurance and nursing care for the elderly. It is worth 
     noting, too, that the costs of Germany's plan have risen by a 
     sharp 23%, after inflation, over the past three years. It 
     pays to take a good look at the German system before 
     prescribing it in the U.S.


                         Striking Similarities

       The similarities between the Clinton plan and the German 
     systems are striking. The president wants universal coverage; 
     Germany has nearly achieved that. German law mandates that 
     everyone enroll in the health insurance system, with the 
     important exception of higher income earners making more than 
     $3,300 a month. The opt-out income level is set relatively 
     high so that about 14% of Germans must join. Another 14% 
     voluntarily join or stay in the statutory health system 
     although their income has risen beyond the cutoff. About 10% 
     (high-income employees, self-employed) have private 
     insurance, and fewer than 1% have no insurance.)
       Regional health alliances, a big Clinton idea, are the 
     cornerstone of the German system. Companies with more than 
     1,000 employees (5,000 in the Clinton plan) have the option 
     of forming a corporate alliance. These roughly 1,000 regional 
     or other alliances are the monopoly buyers of medical 
     services for the 88% of Germans who belong to the statutory 
     system.
       The Clinton team wants a system that guarantees identical 
     benefit standards for all alliances: the American debate over 
     coverage for mammograms and prostate cancer tests already 
     gives a whiff of how controversial the contents of this list 
     will be. In Germany, which already has such unified 
     standards, the contents of the list are so important they can 
     affect elections: coverage of abortions, for example, will 
     play a role in elections this year. The net result, Germany 
     shows, is that the list simply grows over the years.
       Germans pay for their plan through what is essentically a 
     payroll tax, just as the president would have Americans do. 
     Employers and employees in Germany each pay half of the tax 
     [rather than the 80%-20% split proposed in the Clinton plan]. 
     The tax rate differs among the alliances, ranging from 8% to 
     16.8% of payroll (aggregate of employer and employee share), 
     with an average of 13.4%. Yet Germany's program gives us 
     clear evidence of the degree to which this system lends 
     itself to abuse. Once their tax is paid. Germans graze 
     themselves to obesity on medical services. The Clinton plan 
     has the same bias toward excessive individual use of medical 
     services--at the expense of all members of an alliance.
       The German system's major fault is that it doesn't put 
     people first, in the sense of building on individial 
     responsibility and control through effective copayments and 
     other incentives to save. It is interesting that corporate 
     alliances, organized by companies that have an interest in 
     holding their own 50% share down, typically have premiums far 
     below the average regional alliance.
       The Clinton plan's critics believe that this system also 
     strengthens bureaucracy. The German plan proves them correct. 
     While the alliances were originally devised as 
     nongovernmental health plan purchasing cooperatives, they 
     have degenerated into de facto government agencies. Some 
     112,000 employees in western Germany alone work for 
     alliances, their administrative costs per member having risen 
     by 53.3%, adjusted for inflation, from 1982 to 1992. This is 
     more than the increase in the alliances' total health costs, 
     revealing that the disease of bureaucracy is the real 
     problem.
       The Clinton plan's critics also fear that it will quickly 
     become a single-payer system. In effect, Germany's has 
     already become one, financed by the payroll tax (for the 88% 
     in the statutory system). Patients do not see a doctor's 
     bill. Thus, they have no way of realizing whether the charge 
     for a service has been particularly expensive, or even 
     whether the service has actually been rendered. The doctor 
     sends his bill to his regional association of physicians as 
     the financial clearing house and counterpart of the patient's 
     alliance.
       Hidden taxes, a flaw in the Clinton plan, are already part 
     of the German plan. Because the average German carries only 
     50% of his health care costs directly, he is aware of only 
     his 50%, and increases may not bother him too much. But the 
     50% the employer carries is reflected in overall labor costs 
     that make Germany the second-most-expensive country in the 
     world to employ people (after Switzerland), and one with 
     higher unemployment than the U.S. Under the planned 80% 
     employer costsharing in the Clinton plan, this labor-
     depressive effect would even be more pronounced in the U.S.
       Cost-sharing and lack of incentives to save form a potent 
     drug driving health costs up. Unobserved, hidden taxes grow. 
     The German payroll tax rose from an average of 6% in 1950 to 
     8.4% in 1960 and 11.0% in 1980, before reaching its current 
     13.4%.
       Financially, the German plan is also no model. For 20 
     years, it has vaciliated between financial distress and 
     collapse, and the government has intruded with evertigher 
     regulations. Since 1977 alone, there have been nine federal 
     laws trying to curb costs. German measures to control costs 
     foreshadow the results of the Clinton plan: price controls 
     and control of supply.
       Last year, physicians, dentists and prescription drugs were 
     each, as a group, subjected to narrow budget caps, and tight 
     regional quotas now limit the number of doctors allowed to 
     practice under the system. The physician associations have 
     to police their members with respect to ``excessive,'' 
     above-average services. More cost-effective--particularly 
     corporate--alliances now have to cross-subsidize high-cost 
     alliances, thus rewarding inefficiency in the name of 
     solidarity. Prudent insured people and prudent doctors are 
     still not rewarded for cost savings in the form of lower 
     premiums or bonuses. Needless to say, all reform attempts 
     have missed their targets.
       Although only 10% of Germans are covered by private 
     insurance, it offers some obvious lessons for everyone. 
     First, payroll taxes in the statutory system are 25% higher 
     than private premiums, since private insurers compete 
     vigorously. Their benefits are better, and the administrative 
     cost per insured person is only half. Second, the private 
     alternative forces the statutory system to improve, within 
     limits, since otherwise its voluntary members would opt out 
     for private insurance. This beneficial effect is indirectly 
     evidenced by the larger inefficiencies in countries that 
     force everybody into a statutory system.
       Maybe the Clinton team looked at various statutory systems 
     and concluded that Germany's looked best. The one-eyed is 
     king among the blind. But why does the president want to 
     emulate the 90% of the German system that is failing instead 
     of the 10% that is effective?


                           Wrong About Costs

       Perhaps the most interesting revelation from the German 
     plan, though, is that it shows how unrealistic Mr. Clinton's 
     is. In the U.S., the maximum premium to an alliance will be 
     about 10% of payroll. This is supposed to pay for health 
     costs that now amount to 14% of GDP, set to rise to 17.3% in 
     the year 2000 under the Clinton plan's reform projections 
     (18.9% otherwise).
       If a 13.4% payroll tax in Germany is needed to finance 
     10.6% of GDP, it is hard to conceive how, in the U.S., a much 
     smaller payroll tax of 10% can finance U.S. health care costs 
     at a much larger share of 14% to 17% of GDP. The missing gap 
     is too large to be filled by the designated subsidies and sin 
     taxes. If you want to copy pages out of the German social 
     policy book, have your checkbook handy.

  Mr. WALLOP. I thank the Chair.
  The PRESIDING OFFICER. The Senator from New York [Mr. Moynihan].
  Mr. MOYNIHAN. Mr. President, before the Senator necessarily leaves 
the floor, may I tell him how much I have enjoyed his critique. It is a 
careful and analytic tradition that deserves to have a place in this 
body, and it has been very ably filled for 18 years now by the Senator 
from Wyoming.
  Could I make just one comment about the point he makes of the 1.75-
percent tax on health care premiums for academic health centers and 
research? This originates in the Finance Committee, as he knows, and 
knows well--he is a very distinguished member--and it comes about in 
one of those ironies of progress.
  I cannot doubt that the Senator has followed the works of Joseph 
Schumpeter over the years and his particular notion of creative 
destruction of capitalism, that as advances are made existing 
institutions find themselves bypassed and indeed often destroyed.
  One of the things we learned, and as we learned this, it took a while 
for it to sink in on the chairman. I must say that, because the health 
maintenance organizations are making such progress, because cost 
containment is becoming a large managerial function in the United 
States--cost containment and health care, an activity that probably did 
not exist 20 years ago but now firms traded on the stock exchange do 
this, and they do it and they perform and they are rewarded in relation 
to their performance and very conscious of cost.
  This has made them reluctant to send patients to hospitals associated 
with medical schools. Academic health centers is the term we use. There 
are States in the Nation which we associate with being advanced as 
regards coverage in health care, and whose universities are world 
renowned, whose medical schools may close because of this new 
situation.
  The cost containment is good, but it will not last long if those 
medical schools close and the people who bring about the new 
technologies and the extraordinary advances in medicine are not 
trained.
  We had--I hope my memory serves correctly--the director of the 
hospital for the University of California in Los Angeles, Dr. Shultz, 
who said their occupancy ratio now is about 45 percent. There is a spot 
market in southern California for bone marrow transplants, and a vast 
university is half empty.
  It is in response to this that we felt that there has to be, there 
needs to be, and a case can be made for, providing a trust fund with a 
steady stream of income to our academic health centers so that we shall 
have coming out of them a steady stream of doctors, nurses, and 
research scientists that has made this moment the greatest moment of 
discovery in the history of medicine. It is this moment, and it is 
taking place in this country and in those institutions.
  I want to make that point.
  Mr. WALLOP. Mr. President, will the Senator yield?
  Mr. MOYNIHAN. I am happy to. I yield the floor.
  Mr. WALLOP. I do not quarrel with the goal of the Senator from New 
York. I do quarrel with Government's role. I made three points earlier. 
One is that it doubles the money now being spent by the Government, and 
still $10.8 billion is not accounted for. That is being tossed off into 
just general revenues, I guess.
  Mr. MOYNIHAN. That is where we are going to have that one in Casper.
  Mr. WALLOP. In Casper? I am brought on.
  But there is another problem. First of all, Government may be better 
at this--and I will accede that to the Senator--than it is in many 
things that it contributes money to. But it is a long way from perfect, 
and the problem is that it says to the great private contributors of 
this country: ``Forget it, boys. Government's role is to do that now. 
We are out.''
  I have said more than once that the more secular this country 
becomes, the more we pray to Government to do that for which we used to 
pray for our Maker to do or to provide. What happens is that as we have 
increased welfare programs and everything else, the private community 
conscience has diminished co-equally. We spend less in taking care of 
the disadvantaged in our little homes and houses and communities than 
we did, because it is Government's job.
  I just do not think it is wise at this moment in time to tax every 
American 1.75 percent to take care of teaching hospitals. I do not 
quarrel with even keeping where we are at the present level, although 
we seem to be doing that without a premium tax. But it strikes me that 
the worst thing we are doing is saying, OK, you do not have to worry 
anymore, Government will. Government picks up all the worries that are 
there. Therein becomes the kind of losses that I think are inherent in 
a system--too much and too corrupt.
  So it is a difference of opinion as to what Government's role is. It 
is certainly not a difference of opinion on the goal.
  Mr. MOYNIHAN. No.
  The PRESIDENT pro tempore. The Senator yields. The Senator from New 
York is recognized.
  Mr. MOYNIHAN. Mr. President, may I again thank the Senator from 
Wyoming for his balance and courtesy and clarity in these matters.
  My purpose was not to dispute that he has a case. I do not know but 
if we quantified charitable giving, I think we would find it goes up. I 
think we would find it is more a function of total resources than 
individual sense of obligation.


                  additional remarks by senator wallop

  Mr. WALLOP. I would like to clarify for the Record that the figures 
quoted from the Joint Committee on Taxation distributional charts were 
misinterpreted. Instead of individual numbers, they are aggregate 
numbers. I hope to have individual numbers available in the next few 
days that should clarify the amount.
  As I noted, however, with respect to the 1.75-percent premium tax, 
taxpayers with incomes of $50,000 or under will pay 54 percent of the 
net tax increase, while taxpayers with incomes of $75,000 or less will 
pay 79 percent of the increase. Regarding the four taxes mentioned, the 
Joint Committee's distributional charts show that taxpayers with 
incomes of $50,000 or less will pay 60 percent of the net tax increase, 
and taxpayers with incomes of $75,000 or less will pay 78 percent of 
the new taxes. Hefty sums, in either case.
  But leaving that aside, I just want to draw attention to something 
which is in our report I have here, ``The State of America's Health 
Care System and Health Care Crisis.'' I am going to make a bet that one 
crisis you will not read about is the crisis of the financial viability 
of the teaching hospitals and the medical schools. It has come about 
right suddenly, unexpectedly, and it is important. And as long as we 
know about it, I think we will, in the end, make some useful efforts to 
deal with it.
  Mr. President, I yield the floor. I see a number of my colleagues 
have been waiting. The Senator from Washington has been patiently 
waiting to address the Senate for some time now.
  The PRESIDENT pro tempore. The Senator from Washington, Senator 
Murray.
  Mrs. MURRAY. Mr. President, I have listened very carefully and I have 
waited patiently as we have debated the health care reform bill. I know 
the majority leader laid down this bill 2 weeks ago, that we have had 6 
long days of debate, and I know that the Dodd amendment has been on 
this floor for 4 days.
  I came to the Senate a year and a half ago and I was eager and 
anxious to get to the heart of the problems that many of the families 
that I talked to throughout my campaign told me about, and health care 
was at the top of their list. I am frustrated today that, despite 
having this bill on the floor for 2 weeks, not one amendment has been 
voted on on this floor.
  I have heard many of my colleagues state that they disagree with 
parts of the Mitchell bill. That is part of the political process. I 
have heard their criticisms of cost containment or benefits packages or 
new programs, and that is their right. But it was my understanding that 
when someone disagreed with a part of a bill on the floor, that they 
had the alternative to propose an amendment and it was up to us to look 
at that, debate that amendment, and agree or disagree--vote amendments 
up or down and ultimately come to a final bill that we would either 
pass or not pass, depending on what was in it.
  But so far, we have not gotten there. For 4 days, the Dodd amendment 
that would provide benefits for pregnant women and children has been on 
this floor. And this delay has not been without cost. In the 4 days 
that this amendment has been on the floor, 2,544 babies were born to 
mothers who received late or no prenatal health care. I urge my 
colleagues to get on with this debate.
  Even more troubling to me as I have listened to many of the speeches 
over the last 6 days is the people who say, ``Just say no.'' I think it 
is time we remember why we got to this health care debate and why it is 
a critical topic in this country. There has been an increasing number 
of hard-working families in this Nation who cannot afford health care 
in today's world. It is not provided by their employer, they have been 
opted out because of preexisting conditions, they have changed jobs, 
they have moved, and they have found themselves in a position where 
they cannot purchase health care.
  They call up an insurance agent and he says to them, ``No, sorry; you 
are out of luck.'' Under the Mitchell plan, we seek to reduce that risk 
for families so if a preexisting condition exists, you can still 
purchase health care. Under the Mitchell plan, there will be subsidies 
for families who do not have the means to go out and purchase health 
care. These are important steps in the right direction that this Nation 
needs to get on with.
  We are here in this debate today because of the increasing cost to 
every-day families out in the real world. As they get their health care 
insurance bills--and these are people who have insurance today--they 
see that their deductions have skyrocketed, their copayments have 
risen, their premiums have gone up, and their benefits have been 
reduced. And there is no security that that is not going to change when 
they get their next bill. The Mitchell bill seeks to provide some 
security and assurance to those people who have health care insurance 
today, and it is time to take that step.
  We are here in this debate because of the increasing cost health care 
is to our entire system, to families, to businesses, to government. As 
a former State senator, I know we were unable to provide more teachers 
for our classrooms and policemen for our streets because an increasing 
part of our State budget was going to health care costs. None of the 
plans are perfect but certainly it is time to take a step in the right 
direction.
  What has troubled me the most throughout this debate is the 
statements I hear that, ``Well, only 15 percent of the American people 
do not have health care, so let's not mess it up for the 85 percent.''
  Mr. President, we have a responsibility to assure that those 15 
percent of Americans have health care insurance. But we also have a 
responsibility to those 85 percent who have insurance today, to provide 
them security. And that is what the Mitchell bill seeks to do.
  I hear statements if health care reform, any health care reform 
passes, we will have long, long waits. We do not now? Ask any parent 
who sat in an emergency room on a Friday night, like I did recently 
with a daughter who sprained her ankle in a Friday night soccer game. 
We sat there for 6 hours. Those are not long waits today, under the 
current system?
  I looked around that health care emergency room as we sat there. I 
would urge all of my colleagues to go sit in an emergency room and 
watch what comes in the door. I saw young mothers with young children 
who were there because their child had a cold. I saw others who were 
there with general health care problems who should have been seeing a 
physician in the doctor's office during the day. But I talked to a few 
of them and they were there in the emergency room because they did not 
have health care coverage. This bill will eliminate some of those long 
lines in our emergency rooms, and it will save money at the same time. 
It may not be perfect, but it is a step in the right direction.
  What is most troubling to me are some of the statements that I have 
heard about how bad government is, ``Government has taken over 
everything; isn't that awful?'' Mr. President, I am very afraid for 
this country if we continue to denigrate government as we have heard 
over and over again. If the people of this country do not make the 
decisions for ourselves through a representative democracy, let us ask 
who will make the decisions? Large corporations? The insurance 
companies? The wealthy? It is time for us to be a part of that 
representative democracy and forge a bill together that assures all 
Americans have access to health care reform. That is the kind of 
democracy I believe in. That is the kind of government I believe in. 
And I believe that is what this debate is all about.
  And, bureaucracy--what a word. It is intimidating, it is frightening, 
it is scary. But I submit, one man's bureaucracy is another woman's 
assurance of quality health care in this country.
  I hear the word ``bureaucracy'' thrown out and I look in this bill to 
what we are referring to. And perhaps we are talking about the long-
term health care provisions in this bill that provide grants to States, 
matching grants, so that they can put in place long-term health care 
for our elderly citizens, so that instead of having to go to a nursing 
home as they get older or become sick, they can stay in their homes and 
have the kind of care that will provide them the dignity that they 
deserve.
  Mr. President, I believe it is time to remember the American people. 
I came here to bring change, and change means we listen to the American 
people. Maybe change is not comfortable for everybody, but it does mean 
renewed hope for thousands and thousands of American citizens. And we 
should take some risks and put a program out there to provide hope for 
thousands of Americans today.
  People are tired of waiting because the current system does not work 
for too many of us. Like many of my colleagues, I have received 
hundreds and hundreds of letters over the last years about the health 
care crisis, and I want to share a few of those with you.
  I have one from Kent, WA, a young mother who says:

       A year and a half ago, just as most people in our Nation 
     were beginning to look closely at the issues of national 
     health care, our family plunged head first into our own 
     health care crisis and was forced to meet many of those 
     questions head on.
       At that time, our daughter, Tara, who was 8 months old, was 
     diagnosed with severe combined immunodeficiency disease, 
     which is a rare genetic disorder.

  She describes in her long letter the painful decisions that she had 
to make. She talks about preexisting condition; the fact that her 
daughter, 8 months old, will never be able to change policies in this 
country because she now has a preexisting condition. And she says they 
will not be able to move or change our jobs because of what has 
occurred in our lives. She talks about the fact that she had to fight 
with her health care insurance company to get coverage for her child. 
If that is not bureaucracy, what is?
  She says:

       No parent or patient should be forced to argue these kinds 
     of issues, especially in the middle of a crisis.

  But instead of caring for her daughter, she found too often that she 
was having to fight with her insurance company, and that is a sad note 
in this country.
  There is much in the Mitchell bill that we agree with or disagree 
with. But, Mr. President, I submit to all of my colleagues, it is time 
to move on. It is time to get to the amendment process, and it is time 
to make a difference for thousands and thousands of Americans in this 
country.
  It is time to get on with this long-winded debate, Mr. President, 
because, frankly, it has become more painful than my last 6-hour wait 
in the emergency room.
  I thank my colleagues.
  Several Senators addressed the Chair.
  The PRESIDENT pro tempore. The Senator from Ohio [Mr. Glenn].
  Mr. GLENN. Mr. President, I rise to comment on the Dodd amendment and 
also on the Mitchell proposal on health care reform.
  I am pleased to have this opportunity to speak in support of the 
amendment offered by our colleague, Senator Dodd, which would increase 
health care for our Nation's children and, at the same time, help curb 
unnecessary health spending.
  Our distinguished colleague from Washington talked about being in a 
hospital waiting room. I do not know how many of you may have visited a 
children's hospital recently. But if you have, you have seen the 
underweight babies, the preemies, those with birth defects, those who 
are starting out in their first days of life with one strike against 
them, those at risk, those for whom enormous expenditures will be 
incurred and could have been prevented with a little better health 
care.
  Talk to some of the parents who are there with terror in their hearts 
at seeing some of these problems with their newborn, with whom they 
looked forward to sharing a new life. They literally have terror in 
their hearts because they know the problems that lie ahead, and we know 
that many of those situations could have been prevented.
  The amendment we are considering improves upon Senator Mitchell's 
health care reform bill by accelerating the date on which insurance 
companies would be required to include preventive services for pregnant 
women and children in insurance policies.
  This is not something new. This is not some untried, fictional-type 
proposal. It is used now in 16 different States and the District of 
Columbia. This is something that I think could well be supported on 
both sides of the aisle. I note in the list, the State of Kansas has 
had a provision like this in its own law since 1978; Louisiana, 1992; 
Wisconsin, 1975.
  So this is something that has been tried. It is already mandated in 
insurance packages in those States, they are provided in plans offered 
through the Federal Employees Health Benefits Program also.
  One of the basic reasons they are provided is very simple: They are 
cost effective. By providing low-cost prenatal care and well-baby care 
and immunizations, we can avoid the human suffering and the high cost 
associated with low-birth-weight babies and children whose illnesses 
become more severe and ultimately more costly when they are left 
undiagnosed and untreated.
  An important goal of our health care reform debate is to ensure that 
all Americans have private health insurance which emphasizes primary 
and preventive care. By providing these services to pregnant women and 
young children, we can reduce our intolerably high infant mortality 
rate and ensure a healthy start for all of our children.
  Mr. President, we have in this country the finest health care in the 
world. We have the finest health research in the world. We have the 
finest pharmaceutical companies in the world. Yet, our infant mortality 
rate ranks 22d among nations of the world. There is a great disconnect 
here. We have the best of everything except it does not get to 
everybody. It is not distributed, so it is never used in those 
particular cases. All this amendment does is say that those in the 
first stage of life will get a shake at the best health care and the 
best preventive health care that we can offer.
  Twenty-second in infant mortality, let me repeat that again. We 
should be absolutely ashamed of that. We are the greatest, the richest, 
the strongest economic nation in this world, and yet we are 22d in 
infant mortality.
  Along with the reforms in the Dodd amendment, we need to work to 
ensure that all Americans are able to purchase private health 
insurance. I believe Senator Mitchell's bill would make this possible 
by making insurance more affordable and providing subsidies to help 
low-income individuals and employers purchase insurance.
  So I urge my colleagues to complete debate on the Dodd amendment. Let 
us adopt it and move on to other important amendments to Senator 
Mitchell's health care reform proposal. I think the time to act is now.
  Let me back this up with some other statements. What is the price of 
delay? The Senator from Washington touched on a couple of these items. 
I would like to give a couple more.
  Just during the time the Senate has been considering the children-
first amendment, as it is called, children across this country have 
continued to suffer. Just in the 4 days the Senate has considered this 
pending amendment, it is estimated that 2,544 babies were born to 
mothers who received late or no prenatal health care, and 3,204 babies 
were born at low birth weight. That means less than 5.5 pounds.
  Two hundred twenty-four babies died before they were a month old and 
440 babies died before they were a year old. That is just in the last 4 
days.
  Prevention does pay off. It is estimated that for every $1 spent on 
prenatal care, it saves $3.38 on the care of low-birth-weight infants. 
Every time a low-birth-weight delivery is prevented, it saves between 
$20,000 and $50,000 in costs, and every time a very low-birth-weight 
delivery is prevented, it saves approximately $150,000 or more on 
neonatal intensive care costs. Routine preventive checkups can avoid 
hospitalizations that may cost as much as $600 a day.
  So, Mr. President, I urge my colleagues to complete debate on the 
Dodd amendment. Let us pass it and let us move on to the other 
important amendments. The time to act truly is now.
  Mr. President, I would like to continue by making some general 
remarks not just on the amendment of Senator Dodd but on the proposals 
by Senator Mitchell.
  I guess we all have our views formed to a large extent by our own 
personal experiences, our background. We have many examples of this. We 
have heard time after time on the Senate floor in the last few days 
from people who get up and say something about their own personal 
family experience or their own personal experience of having cancer 
themselves of one kind or another and how they had to deal with it. So 
I guess we are all a product, at least in part, of our past experience. 
I can go back to my own days as a younger person in New Concord, OH. I 
knew a couple there. This was back in the early 1960's, I might add, 
just before the Medicare came into being.
  Of the couple I knew, the husband ran a plumbing shop in New Concord, 
OH, and worked very hard. His wife took care of the plumbing shop while 
he was out working. They saved a very modest amount for retirement, 
retired, and 2 years later one of them came down with cancer. That man 
and his wife saw all their lifetime savings go in the first 2 years. A 
lifetime of hard work that went down the tubes.
  Well, I put this in the third person, but it is not really a third-
person story because that couple was my father and mother. So we take 
some of these things very personally and they affect our views for the 
rest of our lifetime, and I have thought ever since that time that we 
can do so much better in sharing some of these dangers together.
  Now, granted, we have Medicare and that protects some of the people 
in their senior years, but how about people who have not quite reached 
their senior years yet? How about people that cannot afford insurance? 
I cannot imagine a more horrible feeling than having a child or a 
father or a mother and seeing that person in need of medical attention 
and not being able to get it. Knowing that health care is down the 
street but not being able to afford it, or seeing a child or a family 
member suffer and maybe die because of not being able to afford it. I 
cannot imagine anything much worse than that.
  So we see these personal experiences, and do they affect our views on 
health insurance? Yes, they certainly do. They affect mine because I 
have believed ever since those days we could do better than we are 
doing with regard to health insurance.
  Why do we need reform? Some say we do not need it or we need as 
little change as possible; we have the best system in the world; we 
have the best research in the world; we have NIH; we have the best 
medical schools in the world; we have the finest drug and 
pharmaceutical companies; they are doing research; they are providing 
medicines. We must do no harm to a system that is the finest medical 
care system in the world.
  Then we have to look into it a little bit, and what is going on with 
the coverage that we have for this finest medical care system in the 
world. Well, 218 million Americans do have health insurance. That is 
fine. Some are not adequately covered but they have a policy. They have 
something. We have 37 million Americans who do not have health 
insurance. They are the havenots or they are between jobs or they are 
locked in. They have a preexisting condition and cannot get insured, or 
they have all the reasons why they do not have insurance.
  Well, if we look at that overall ratio, maybe that is not so bad for 
a country like ours, 218 million Americans have insurance, 37 million 
Americans do not. But I submit that is not very good compared with our 
industrial competitors around the world. Do you know how long the 
Germans have had full coverage health insurance? It is 110 years--into 
the last century; Japan, since 1920; France, since 1928. These are 
basically government plans, single payer. I am not proposing that we go 
to that. Our system did not develop that way. We did not develop that 
kind of a system in this country. We developed along an insurance 
route. We developed an independent insurance industry to do some of 
these things.
  So when we say the Germans have had their plan since the last 
century, Japan since 1920, and France since 1928, so what? We do not 
have to follow them, that is true, no matter what their basis is. We 
have developed our own system in this country, and it has been a good 
system. It has worked pretty well up to now.
  Up to now. This is the important point. We are truly at a crisis 
stage, and that is not something that is manufactured by those who are 
promoting health reform. The problem is that costs are escalating, and 
for those 218 million Americans who have policies, they are not going 
to cover their family adequately into the future.
  That is what is really driving this. It is not necessarily the 
concern that we all have for the 37 million Americans who have no 
insurance. It is the 218 million Americans who write in and say, ``I 
just looked at my policy, and it does not cover my family anymore. What 
am I going to do about this?'' Costs are going up. The 37 million 
Americans who do not have health insurance, if they have a problem, 
they go to the emergency room. That costs something. They cannot pay. 
The costs of running that emergency room then are put back on the other 
218 million in their insurance policies and increased costs.
  So the costs are driven up for the 218 million. Where do we stand? 
Why is this a crisis? Health care costs now as a proportion of our 
gross national product are estimated to be just approaching 15 percent. 
Do you know that by the year 2003 it is estimated to go up to almost 20 
percent? That is of our whole gross national product, everything.
  What does it do just to Federal expenditures? Right now, it is at 17 
percent. It is estimated that by 1999, just in 5 years, it will go up 
to 24 percent.
  Now, that is a 41 percent increase at the Federal level and almost a 
one-third increase as a percent of our GNP. They say, well, these are 
just figures, but I will tell you the one area where the figures have 
been reasonably accurate in the past has been estimates of health 
insurance costs.
  Let me quote from an editorial in yesterday's paper because this 
points out exactly the point I just made, that costs are going to go up 
for everybody, not just for the 37 million Americans who do not have 
health insurance. They are not going to be the only ones who have a 
problem. I quote from yesterday's editorial:

       Meanwhile, the cost of health care continues to soar--and 
     the higher it goes the greater number of people who lose 
     insurance because neither they nor their employers nor the 
     Government can afford it. A seventh of all the money 
     Americans have available to spend today goes into a health 
     care system that leaves a seventh of Americans uncovered. 
     Both numbers are rising. Two years from now, or 4, or 6, they 
     will only be higher and harder to reverse. In the meantime, 
     millions of people who could have been helped will still lack 
     coverage. There will indeed be risks and costs if this 
     Congress acts. It is important to remember that the cost will 
     be enormous if it does nothing as well.

  Mr. President, I ask unanimous consent that the entire editorial be 
printed in the Record at the conclusion of my statement.
  The PRESIDENT pro tempore. Without objection, it is so ordered.
  (See exhibit 1).
  Mr. GLENN. Mr. President, reform is necessary to make sure that we do 
not price too many of our people out of business. If we do nothing, 
then we approach a catastrophe just a few years down the road. I do not 
think it is an option for us to do nothing. As these costs increase, 
fewer than 218 million Americans will have insurance; 37 million 
Americans will still be out there and their numbers will be added to. 
So doing nothing is not one of the options that we have.
  How can we assure affordable health care to all Americans to the year 
2000 and beyond into the next century? Well, we have a lot of systems 
proposed: Single payer; eliminate the insurance industry--basically, 
let the Government take it over--cover everyone; Government subsidies 
to 37 million Americans; a combined system covering certain areas; 
specific programs that would deal with the newborn or the elderly; an 
expansion of the Medicare system. All of these are things that have 
been considered in the past.
  Mr. President, I would not propose that we dump our insurance-based 
system. I think we need to improve it. The President was criticized in 
his plan that he put forward because of some of the mandates and the 
requirements in that bill.
  Let me digress just a moment to give the President some credit. The 
President seems to be a bit beleaguered lately. If we have health care 
reform in this country, it will be because we finally have a President 
who saw this as a requirement, saw the dangers of doing nothing, went 
at it, stuck with it and pushed and pushed. If his policy, if his 
program, if his proposal is not to be what is going to be enacted, then 
he still was for what we could get that was going to improve the 
system, because he believes in it--and I am convinced he believes in 
it, and Mrs. Clinton believes in it. She has worked on it. They believe 
in the future of this country and that the future of this country 
should have health care for all our citizens included. So the President 
has stuck with it. I have to give him credit for that. When we have 
health care reform, when we have health care for all one of these days, 
it will be in large measure because the President and Mrs. Clinton 
believed in it and they acted and they stuck to it.
  We are proud of saying that every President since Harry Truman on up 
to the present time, with one or two exceptions, has proposed health 
care. But what have they done? They proposed it, and as soon as the 
political flak started, they backed off. I have to give this President 
a lot of credit for sticking with this.
  We need reform. But what and how? We want to cover everyone. We want 
to have cost control. We want to have portability. We want to have 
coverage for preexisting conditions, which may come from some of the 
lack of prenatal care that I mentioned a moment ago. We have to figure 
out a way to pay for all of this.
  What is full coverage? Is it 95 percent? That would certainly be a 
good step in the right direction because we are going downward now. I 
think only about 83 percent of people are covered now, and the coverage 
of our overall population has been going down instead of up.
  We cannot have an absolute 100 percent. That is not going to happen. 
Just people coming across as illegal immigrants is going to ensure that 
we will never have 100 percent absolute coverage. Social Security, for 
all the years it has been in, is not 100 percent. So of all of this 
semantic argument about what full coverage is, what it is not, and 
whether we consider 95 percent to be full coverage, or 97 or 98, we 
know one thing--95 percent coverage would be a lot better than we are 
doing right now. So let us go for it.
  We have different bills. They are very complex. They are all over the 
lot. We have different provisions. We have different coverage, 
different percentages, and different ways to pay for it. We stand here 
on the floor arguing about whether one bill is 1,400 pages or not. 
Another bill is trotted out, and we say it is great progress, this one 
is only 780 and some pages.
  I think the American people are not going to be very much impressed 
with what size the bill is when it goes from 780 to 1,400 pages. We 
have bills proposed by a lot of people. We have bills proposed by 
Senator Chafee, Senator Danforth, Senator Dole, Senator Packwood, and 
Senator Mitchell. All of these bills have a lot of merit in them, but 
they take different approaches.
  I think the bill that Senator Mitchell has put forward is an 
excellent compromise. It accommodates the views and the major concerns 
that were expressed earlier concerning health care reform. It takes a 
little different approach.
  Some of the earlier proposals put the mandates up front. They were 
heavy. An 80-20 split on the cost between the employer and the 
employee. These were mandates, and they were up front as a forcing 
mechanism to say we are going to do it and do it now. There was a lot 
of objection to that.
  All of the industry comes in. They come to our offices, and say, 
``Look. We are making a lot of progress. Why upset things right now 
because we are making a lot of progress? States are putting new plans 
into effect. We have new affiliations. We have new groups. There is a 
new awareness out there that the President has helped to spawn, and all 
this discussion has helped push it along. So why do we want to wreck 
things now? Let us do no harm to the system the way it is right now.''
  Let us go at this thing. There are affiliations. These things are 
actually happening. There is a lot of progress being made out there in 
the country with regard to health care reform.
  What does Senator Mitchell propose in his bill? He basically says he 
challenges these people to say, ``OK. Let us go ahead. You are making 
progress. We realize that. It is not as fast as a lot of us would like, 
but we are making progress in these areas. Let us go ahead and do that 
kind of a job. Let us do it, and we will give you several years to 
accomplish this.''
  There is no mandate in the Mitchell bill. I repeat, there is no 
mandate in the Mitchell bill unless the industry fails, unless these 
objectives are not being met, unless the Congress refuses to act at 
that point and take other action. Only then is there a mandate. Then it 
is cut back to a 50-50 sharing. But only after industry has failed to 
improve the system enough, and only after Congress has failed to act. 
Only then as a third order backup do we say that a mandate will cut in. 
Then it is only 50-50.
  Even then it protects small businesses who cannot afford it, who 
might be put out of business. If they cannot afford it, it helps them 
out. It has a subsidy for them to help them out. In this whole process 
we do not dump the system that has built this health care system for 
the country. We do not dump the private insurance industry.
  I think Senator Mitchell has bent over backward to try to accommodate 
those who had legitimate concerns about some of the proposals that were 
being made. It keeps the private insurance system, and it builds on it. 
It is not sudden. It provides time for this to occur. It has been a 
long process. There have been hearings by the Labor and Human Resources 
Committee and the Finance Committee. The House has had hearings and has 
given a lot of consideration in this area. Think tanks have been done 
with innumerable studies in this particular area. It gives something to 
all of these areas. It picks the best of all of them. It is affordable. 
It guarantees high-quality care through our private health insurance 
system.
  If it expands coverage, as the CBO says in their independent 
analysis, then there will be no mandate. If the 95-percent coverage is 
not achieved, then Congress can act on the advice of the monitoring 
commission that is set up to monitor what goes on during that period. 
They can make recommendations, and the Congress can act on those 
recommendations if we are not at 95 percent at the end of that period. 
If Congress has not acted, only then does this 50-50 mandate cut in as 
a last resort.
  I think that is a reasonable approach. In fact, we have some people 
that say that it is too reasonable. They do not like the plan because 
it has gone too far.
  Mr. President, we have heard a lot on the floor here the last few 
days about some of these new taxes, 17 new taxes. I will not go through 
each one of them. That would take a couple of hours to go through and 
define each one of them. But on closer analysis, actually of those 17, 
you could say that 9 of those really are tax cuts. There are revenue 
increases in some of the others, such as a tax on tobacco products, and 
so on. But the 17, on close scrutiny, do not turn out to be the case.

  Mr. President, we have a lot of doomsaying when something as big as 
this comes up. They say it is going to wreck the economy. It is always 
easy to say no. We can always find a reason to be against something. It 
is easier to tear down than it is to build up. It is easier to swing a 
wrecking ball at a building than it is to build that building.
  We heard many of the same arguments against Social Security in its 
time, and we heard some of the same arguments against Medicare in its 
time, also. The health care doomsayers have had a field day with this. 
They have said it would wreck the economy, kill millions of jobs, and 
would cause taxes to rise on middle-class Americans.
  That is what was said about the largest deficit reduction program in 
history that we enacted last summer. The doomsayers were out in full 
force on that one. The doomsayers said the plan would wreck the 
economy, kill millions of jobs, and cause taxes to rise on middle-class 
Americans. Yet, here we are one year later, and the economy is the 
brightest it has been in decades. According to Alan Greenspan, 4.1 
million new jobs have been created during this administration. Income 
taxes have not been raised on the middle class. For the first time in a 
generation, Government deficits are going down, not up.
  So for the doomsayers who are prodding out the old lines and charging 
that health care will wreck the economy, kill jobs, and raise taxes--
well, I think the American people are smarter than we give them credit 
for. I do not think they are going to be scared to death by the buzz 
words of fear and obstructionism. They want health care reform, not 
delay. They want health care reform and not fear mongering and 
ramblings that have been discredited time and time again. The time to 
act is now.
  So these same arguments were used in the old days against Social 
Security and Medicare. We got to speaking about Medicare, and I heard 
somebody in the cloakroom talk about receiving a phone call in their 
office about someone who was talking about--an elderly gentlemen, 
apparently, who said that Government programs are just bound to be bad, 
but ``whatever you people in Washington do, do not mess around with my 
Medicare,'' as though that was somehow not part of a Government 
program.
  I think this is a historic opportunity. I think it comes not even 
once every generation. I think it may come once every other generation. 
Costs are now at 15 percent of GNP, going up to 20 percent of GNP by 
the year 2003. Federal expenditures now of the total Federal budget are 
17 percent on health matters, going up to 24 percent within 5 years by 
1999. So one of our options is not to sit back and do nothing.
  Mr. President, I deplore the political rancor that has gotten into 
this debate. If we started at the other end of the medical problem, if 
I go into an emergency room or you come with me to a hospital and I 
need treatment for something, you go in and the doctor asks you 
questions. Has the doctor ever asked anybody in that situation: Are you 
a Democrat or Republican? Before I treat you, I want to know whether 
you are a Democrat or a Republican.
  If they did that, we would certainly think that was outrageous. That 
would be the worst thing you could be asked, to have a health problem 
and people arguing about whether you are a Democrat or Republican. Yet, 
the Senate is not being constructive in this matter, at our end of 
this, in providing a health care system. At the user end, it is not a 
Democrat and Republican issue; it is just a matter of health, and an 
individual's relationship to that health care system in getting 
treated.
  Yet, we are not being constructive here. We are sometimes opposing 
just to oppose, no matter what. We find people getting up and saying 
they will oppose whatever comes up, no matter how good it is, or 
whatever the provisions are. They will use any means to defeat any 
proposals that are made, and they make that statement in public. It is 
quoted in the papers. To me, that is politics at its worst. That is not 
working together; that is not trying to work together to get health 
reform. Is health reform Republican? Is health reform Democratic? No, 
it is not. Whatever views are held, I hope that we can get together and 
say that we will start amendments, start votes, and we will go ahead 
with this. A good place to start, to me, is the Dodd amendment.
  I hope we can have votes before the day is over today. Mr. President, 
I think this is so important and I think it is maybe once every other 
generation that we have something like health care reform come along--
like Social Security did in its day and like civil rights did in its 
day, and so on--that is going to affect the lives of every single 
American into the indefinite future. We want to do it right. To those 
who say, ``Let us not rush into this thing,'' I ask, let us not rush 
after 60 years of consideration? Let us not rush after piles and piles 
of studies and reports and committee hearings on this matter?
  Now is the time to act. I hope we get on with it and vote before this 
day is over.
  I yield the floor.

                               Exhibit 1

                      Still Time for Health Care?

       The argument is now being made by a lot of people that 
     Congress has let health reform go too late; that not even the 
     authors know what is in the giant bills, some portions of 
     which would likely be unworkable or do more harm than good; 
     and that the problem, while important, isn't so urgent as to 
     require risky action now when measured action can be taken 
     later. In some respects the system may even be in the process 
     of correcting its own defects. Better to wait and try to get 
     it right, this critique goes.
       Clearly, some of those taking this position are doing so 
     for purely political reasons--just as some of the opposite 
     pressure, that for hurrying up and passing a bill in the next 
     two months, is political. But a heavy substantive argument 
     can be made on behalf of delay as well, and most of the 
     complaints have at least some basis, some merit. We continue 
     to think, nevertheless, that there is still time, though 
     barely, to repair the problems and produce what would be a 
     valuable bill and that Congress ought to try. The next 
     Congress will be no better deposed to do a serious job, and 
     may well be less disposed. It will probably be more sharply 
     divided along partisan and ideological lines; it will be 
     heading into a presidential election year; and, anyway, all 
     Congresses are dilatory, so that it too will be unlikely to 
     act until it is forced to do so by the prospect of 
     adjournment, by which time issue will be election fodder.
       Meanwhile, the cost of health care continues to soar--and 
     the higher it goes, the greater the number of people who lose 
     insurance because neither they nor their employers nor the 
     government can afford it. A seventh of all the money 
     Americans have available to spend today goes into a health 
     care system that leaves a seventh of Americans uncovered. 
     Both numbers are rising. Two years from now, or four or six, 
     they will only be higher and harder to reverse. In the 
     meantime, millions of people who could have been helped will 
     still lack coverage. There will indeed be risks and costs if 
     this Congress acts. It is important to remember that the cost 
     will be enormous if it does nothing as well.
       The question is whether there is in prospect any kind of 
     legislation that would significantly improve the situation 
     without creating ominous new problems for either the economy 
     or the health care delivery system itself. The answer has 
     several parts. First: None of these bills is perfect; far 
     from it. But some of their flaws are being greatly 
     exaggerated. And, importantly: most could be fixed before 
     enactment and in such a way as to justify enactment.
       The bill that was put together by Senate Majority Leader 
     George Mitchell, though certainly not itself without 
     problems, does seem to offer the most promising framework for 
     compromise. The measure was drafted in hopes of meeting a lot 
     of the objections that continue to be leveled at it. The 
     original Clinton administration bill was rightly criticized 
     for laying far too heavy a federal hand on the health care 
     system while pretending not to. It turned out to be, in fact, 
     upon inspection, a flow-chart-gone-mad kind of health bill. 
     This conclusion was reached not just by Republicans but by 
     thoughtful members of both parties who felt the government 
     should rely instead on the most modest combination of 
     insurance market reform, government subsidies and government-
     structured competition to achieve its goals of broader 
     coverage and cost containment. Mr. Mitchell attempted to meet 
     these objections. However, some prospective supporters 
     believe that he did not go far enough. Are the differences 
     negotiable? We believe so. Is there more potential agreement 
     in the conflicting positions than meets the eye? We believe 
     that is true as well.
       To take an example, consider the argument in favor of delay 
     made on op-ed page the other day by the respected columnist 
     Robert J. Samuelson. Mr. Samuelson began by noting that ``the 
     Democratic health care plan,'' meaning the Mitchell bill, 
     ``contains a large--and unjustified--multi-billion-dollar tax 
     on younger workers'' which he doubted most members of 
     Congress even knew about. The ``tax,'' however, turned out to 
     be a staple of insurance market reform that is in not just 
     the Democratic health care plan but practically every plan--
     including Bob Dole's. The problem it seeks to address is that 
     too many insurers ``cherry-pick.'' They try to sell separate, 
     low-cost policies to the healthy, including the young. The 
     effect is to relegate higher-risk buyers to costlier pools; 
     the people who need insurance the most are left least able to 
     afford it. Market reform seeks to spread the risk and cost 
     instead across a broader pool, in part through so-called 
     community rating: Everyone in a community pays, if not the 
     same for a given policy, at least closer to the same than 
     now.
       The debate is about how far to go in this regard. The 
     Mitchell bill would continue to allow some rate variation 
     according to age; the Dole bill would allow more; but both 
     would limit current practice on grounds of equity and in 
     hopes of making insurance more accessible. That's the tax. It 
     is one of the (many) constructive principles on which, 
     beneath the rhetoric, Congress appears to agree--and one of 
     those that leads us to believe that with good-faith 
     negotiation a useful bill could still be passed.
  Mr. HATCH addressed the Chair.
  The PRESIDING OFFICER. The Senator from Utah is recognized.
  Mr. HATCH. Mr. President, I appreciate the comments of the 
distinguished Senator from Ohio, and all who have spoken thus far. I 
personally pay tribute to Mrs. Clinton in the efforts she has put 
forward in trying to come up with something that would help solve what 
many think is a health care crisis in our country. One of the problems, 
of course, is who is going to pay for all this? All of us want to solve 
this problem. All of us want what is called universal coverage, which 
is defined in various terms and in various ways.
  All of us would like to make sure everybody has coverage. We would 
all like to stop the cost shifting onto certain segments of our 
society. But it comes down to who is going to pay for it? Anybody who 
believes that by having a huge, additional Federal Government program 
on top of everything else that we have today is going to solve these 
problems and reduce costs, they just do not know what they are talking 
about.
  Why are we all here? We are here because we want to help people. We 
want to help people who are not receiving the health care coverage that 
they need and deserve. We are here because of admirable citizens like 
Helen Roth of Utah, who came to my office and implored the Congress to 
make sure that the disabled receive the care to which they are 
entitled. We are here because of two articulate teens, Ryan Van Dyke of 
Brigham City, UT, and Jason Brown of West Valley City, UT, both 
diabetics who are struggling to get the care they need. We are here 
because of Travis Carlson, born blind and deaf, whose parents have 
struggled to get him the care he needs. We are here to help these 
people, not hurt them.
  When this debate opened, the distinguished majority leader took to 
the floor and made a very eloquent statement. He talked about the need 
for a bill. He said that providing health insurance to all Americans 
``was a matter of simple justice.''
  Yet, the Clinton-Mitchell health care reform bill is not simple 
justice. There is nothing simple about this bill--nothing. It is 
complex. I want to talk about the justice in this bill. Is it justice 
to take almost $200 billion out of the Medicare Program, severely 
jeopardizing its future? Is it justice to cut Medicare on the one hand 
and then propose to expand it with new programs such as a prescription 
drug benefit which may help only a very few?
  Is it justice to impose 18 new taxes on our people?
  As I walked over to the Capitol this afternoon, I thought back to all 
the conversations I have had with my constituents who are so interested 
in health care reform.
  I have had a chance to meet with people from all walks of life to 
discuss every conceivable aspect of health care reform.
  It has been reported that the so-called special interests are 
lobbying Capitol Hill on this issue.
  The fact is, on health care reform, every person in America is a 
special interest.
  Each and every American is a special interest, and rightfully so--we 
all have so much at stake.
  My own feelings about this legislation have been shaped by the many 
conversations I have had with the citizens of Utah. And I will say, in 
all candor, I have learned a lot from them.
  I have learned that the people of Utah care about health security for 
their fellow citizens. When a health crisis strikes a family member or 
friend, all of us want to know that the best possible care will be 
given to that individual.
  The people of Utah care about quality. They know that our Nation 
leads the world in technological advancements in medical science. The 
University of Utah Medical Center in Salt Lake City is one of the 
preeminent centers in the world for innovations in the treatment of 
such complex medical conditions as heart disease and cancer, as well as 
being one of the world leaders in genetic research.
  The people of Utah also care about choice. They believe that all 
Americans should continue to have the freedom to select the medical 
care that best meets their individual needs. They know all to well that 
the role of Government has a finite place in the larger scheme of 
health care delivery.
  The people of Utah sent me to the Senate as their representative to 
make decisions that benefit all the people. And as my colleagues know 
all too well, there are no easy solutions to the complex issues 
addressed in reforming health care.
  This legislation will ultimately impact the lives of every man, 
woman, and child in our great country. No one will be spared. The 
practical implications of this bill are simply staggering--one-seventh 
of the U.S. economy is going to be restructured. If the Mitchell bill 
passes, it will be one-fifth of the GDP, by the year 2000 or shortly 
after. It is nearly $1.2 trillion.
  Its impact would likely be felt for generations to come--well into 
the next millennium.
  The bill has been described as the most significant piece of 
legislation since the establishment of the Social Security Act. Some 
say that it may be the most important piece of legislation considered 
in this century.
  Indeed, we should not underestimate the magnitude of the task before 
us. It has been an extraordinary endeavor. In spite of what ultimately 
happens in the next several weeks, I believe that the American people 
have benefited from the enormous amount of time and energy Congress has 
devoted in examining our health care system.
  As a member of the Labor and Human Resources Committee, the Finance 
Committee, and the Judiciary Committee, I have had a unique opportunity 
to be involved in the development of health care reform legislation. 
Each of these committees played a major role in developing the various 
proposals that have not brought us to this moment on the Senate floor.
  As my colleagues, particularly those on the Labor and Human Resources 
and Finance Committees know all too well, this has not been an easy 
process by any stretch of the imagination.
  The Labor and Human Resources Committee held 46 days of full 
committee hearings over the past year and heard the testimony of 
countless witnesses. We held hearings on issues ranging from the 
consolidation of the 19 different Federal core functions of the public 
health programs, to the issue of creating new categorical grant 
programs aimed at addressing the needs of medically underserved 
populations--an issue, I might add, that is of critical importance to 
Utah.
  We focused on the merits of a standard Federal benefits package as 
well as the categories of provider services covered in a benefits 
package. We focused on the methodology that would be needed to 
determine how those services would be included in such a package.
  On June 9, 1994, after nearly 3 weeks of marathon markup sessions 
that began on May 18, the Labor Committee reported the Clinton-Kennedy 
Health Security Act by a vote of 11 to 6.
  I was one of the six Senators who voted against reporting the bill. 
It was unfortunate that the Democrats on the committee, who comprise a 
majority, repeatedly rejected amendments to lessen the regulatory and 
bureaucratic grasp this legislation would have on America's health care 
system.
  Following the action by the Labor Committee, the Finance Committee 
began its markup of another version of the Clinton bill. There was 
considerable expectation and hope that a bill with fewer Government 
controls, fewer Government mandates, and fewer taxes would be adopted.
  The Finance Committee held 36 days of hearings and heard from 143 
witnesses representing all aspects of health care.
  We heard about the imposition of Government mandates on individuals 
and businesses, about the effects of so-called global budgets on the 
delivery of health care, about cuts in the Medicare and Medicaid 
Programs, on insurance reforms and the effects of guaranteed issue and 
renewability, as well as limits on preexisting condition exclusions.
  We heard about quality from the Nation's leading health care quality 
scholar, Dr. Brent James.
  We heard about the establishment of low-income subsidies for 
individuals and families; about cost-containment including the 
imposition of taxes on individuals, on companies, on insurance 
premiums, and on guns, bullets, and tobacco.
  On July 2, 1994, the Finance Committee reported its version of the 
Clinton health care bill by a vote of 12 to 8. And, once again, the 
same kind of Government-run approach to reform, as proposed by 
President Clinton, was embodied in the legislation as reported by the 
Finance Committee. The prospect for meaningful reform was, once again, 
thwarted.
  I believe that true reform should rely less on Government control and 
more on economic incentives that leave health care decisions in the 
hands of individuals, and not with someone in Washington, DC.
  We should address the problems in the system and fix what is broken. 
We should not overhaul the entire system in the name of reform. To do 
so will jeopardize the standard of excellence which is the hallmark of 
American health care.
  The distinguished Senator from Ohio said there are some who are 
saying ``no,'' they are naysayers; they do not want anything. I do not 
know of anybody on the floor in the Senate right now who is saying 
``no.'' Everybody agrees we need to do something to help the 14 percent 
who do not currently have health insurance. The question is, how do you 
do it with more Government, with more governmental programs, with more 
Government approaches, more mandates, more controls over the States, 
and less incentives for free market reform? That is what these bills 
do. Yet none of the bills reported by the House and Senate committees, 
as liberal as they are, went far enough for the President and the First 
Lady, I might add. And so, we find ourselves on this day in August not 
with a bill reported by the Finance or Labor Committees, but with an 
entirely new piece of legislation which is only days old.
  This is a brand new bill, a melding, if you will, or attempt to meld 
from the Labor and Human Resources Committee and the Finance Committee 
what they had done.
  The latest version of this bill is 1,443 pages long--79 pages longer 
than President Clinton's original legislation. And yet, we are being 
forced to make decisions, of historic importance, with as little as 1 
week in which to analyze the bill's full implication and costs 
ramifications.
  This is not how the legislative process should work. It is the 
legislative process at its worst. The manner in which this bill has 
been hurriedly drafted and presented to the American people, and to the 
U.S. Congress, has been more out of the need for political expediency 
by the President, than by a need for reform. In a very real sense, our 
actions may serve to irreparably damage the viability and integrity of 
the world's preeminent health care system which the proponents of this 
bill claim to be reforming.
  I would remind my colleagues, it was not by government intervention 
that the health care system of the United States became the finest in 
the world. It is the world's finest because the system has evolved in 
an environment relatively free from excessive government control and 
social engineering.
  I do not subscribe to the proposition that a Federal takeover of 
health care is what the American people want. I am fearful that the 
shouts for reform by the President and his lieutenants in the Congress 
will drown-out reason and prudence in addressing the real problems of 
our health care system.
  The Clinton-Mitchell bill is fundamentally flawed. It will unravel 
the very fabric of health care as we know it, and by then it will be 
too late to correct the damage we have done.
  Make no mistake about it, the Clinton-Mitchell bill is health care 
reform. But I can assure you, it is not the kind of reform that the 
American people need, or want.
  This bill contains sweeping and contentious provisions. Many of the 
key elements were cobbled together at the last minute during hurried 
committee markup sessions and are barely understood even by their 
sponsors--let alone the American people.
  The distinguished majority leader has stated that his bill is nothing 
new. He said his bill encompasses many of the same provisions in other 
bills as reported from the Finance, and Labor and Human Resources 
Committees. Well, when I see the Mitchell bill, the Gephardt bill, the 
single-payor bill, and all the others which seem to be coming down the 
pike daily, I am reminded of that old saying: ``It's sad when cousins 
marry.''
  The Clinton-Mitchell bill proposes to expand health care coverage to 
millions more Americans which is a goal I certainly share. But the 
bill's prescription for health care reform includes massive doses of 
new taxes as well as new levels of spending and government intrusion 
which I believe most Americans will find totally unacceptable.
  The bill imposes at least 18 new taxes, including a tax on health 
insurance premiums. These 18 new taxes will hit health insurance plans, 
flexible spending accounts, Medicare beneficiaries, and State and local 
government workers with hundreds of millions of dollars in new taxes.
  And who do you suppose is ultimately going to bear the burden of this 
tax? I will tell you: It is going to be the person who cannot pass the 
cost increase on to anyone else--health care consumers and employees 
all over America.
  This bill contains what amounts to price controls on health 
insurance. The bill imposes several taxes on health insurance premiums, 
including a complicated levy on plans whose premiums grow at rates 
faster than the government prescribes.
  The Clinton-Mitchell bill bans self-insurance for companies with 
fewer than 500 employees. Self-insurance is a classic success story of 
how companies control health care expenditures. This is working for an 
estimated 21 million employees and their dependents at over 400,000 
small- and medium-size companies throughout America.
  These beneficiaries are very happy with their current insurance 
arrangements. Yet, under the Mitchell bill, all of those plans will be 
terminated, and these individuals will be forced to purchase their 
health care through government sponsored health alliances that will 
establish a one-size-fits-all benefits plan.
  If we have programs like self-insurance that are successfully 
controlling health care costs, and serving to expand health care 
coverage to more Americans, then I simply cannot understand the logic 
in not allowing these programs to continue. And I can assure my 
colleagues on the other side, that once these plans are terminated, you 
will certainly be hearing from those individuals.
  I received a fax just last week from the Seniors Coalition expressing 
their concern over this legislation. They are concerned about the 
Medicare cuts in the Mitchell bill, as am I. The sponsors say these 
cuts are only in reimbursements to providers and not in benefits. As 
the fax for this organization clearly points out:

       Reducing reimbursements to doctors and hospitals will lead 
     to a simultaneous degradation in the quality and quantity of 
     care to Medicare patients which will exacerbate the cost-
     shifting problems already caused by Medicare.

  We all know doctors are refusing to take Medicare patients because of 
their low reimbursement rates and that is going to get worse if this 
bill passes. And the Medicare recipients will be the ones hurt.
  These are just a few examples of the so-called reforms, showing the 
pay-more-get-less effect of this legislation.
  I hope all Americans become familiar with the other provisions 
contained in this massive piece of legislation, which has been crafted 
in the name of reform.
  As I stand here today on the Senate floor, I can look up to the 
gallery where I see hundreds of people observing these proceedings. 
Most of them are visitors from across America.
  And, like many Americans during these long, hot days of August, they 
are spending more time with family and friends, and taking some time 
off from otherwise hectic daily schedules.
  Millions of other Americans are watching these proceedings on 
television. All of us are united in our concern over the outcome of 
this historic debate.
  But I can assure you that the crescendo of public concern over health 
care reform has not waned during this traditional time for family 
vacations. Thousands of letters from citizens in my State and from 
across the country continue to pour in.
  The overwhelming message is for reform, but against a Clinton-like 
structure as embodied in the legislation before us today. There is also 
overwhelming support, nearly 64 percent in recent public opinion polls, 
for Congress to take a careful and deliberate course of action that 
will not harm our current system.
  I have been impressed with both the number and substance of the 
letters I have received on the issue of health care reform. Some have 
been very direct and short. Other letters have afforded me with an 
opportunity to learn first-hand the thoughts and feelings of people who 
have truly been affected by the strengths, and weaknesses, of our 
health care system.
  One such letter in that category was from Rodney Ririe of Provo, UT. 
He is a young man with many hopes and ambitions. He is not unlike any 
one of us in this Chamber. Yet, his life has been filled with the kind 
of pain only few people can imagine and, indeed, most of us fear.
  On June 10, 1994, he wrote to me regarding his views on health care 
reform. It was a five page letter--typed--and single-spaced. I am not 
going to read the entire letter. But I am compelled to share an excerpt 
with my colleagues in the Senate.
  I do not ask that you agree or disagree with what he says. I only ask 
that you listen to what he says.
  He writes:

       I am writing with regard to some serious concerns related 
     to health care issues that currently face our Government. 
     Before proceeding, however, let me give you a brief idea of 
     my background, so that perhaps you might better understand 
     where I come from.
       Currently, I am a college student attending Brigham Young 
     University, where I have been for the past five years. Part 
     of the reason I have not yet graduated is because of my 
     health. You see, when I was five years old, I suffered a 
     near-fatal heart attack.
       Before that time, doctors thought of me as a normal, 
     healthy five-year-old child. Doctors diagnosed me as having a 
     form of ``cardiomyopathy'' or disease of the heart which 
     affects the development of the muscle walls. Four years 
     later, I had another heart attack, three more at age eleven, 
     and two at age twelve--a total of seven heart attacks in my 
     brief life.

  He continues:

       At age 17, I underwent a heart transplant operation. Since 
     that time, I have been mostly healthy until about a year ago. 
     Doctors have recently discovered that I am suffering from a 
     form of coronary artery disease commonly found in transplant 
     recipients, for which they say I will need a second 
     transplant within the next several months.
       As you can imagine, paying for these things has been a 
     burden on my parents and family. Fortunately, we have had 
     good insurance in the past, but with my pre-existing 
     condition, premiums have been all but inexpensive, and in an 
     effort to keep the premiums as low as possible, we chase 
     higher deductibles. My father will retire in two years (at 
     age 68) a poor man, devoting nearly all his savings to help 
     pay for my care.
       In May of 1995, I will turn 26 years old which will 
     disqualify me as a dependent on my parent's insurance policy. 
     With my current medical expenses costing between $40,000 and 
     $60,000 a year, the onslaught of another transplant, and the 
     fact that no insurance company in the country will pick me 
     up, this places the entire financial burden on me, a part-
     time college student who works in part-time job making $5.90 
     an hour.

  Finally, at the end of his letter, he states:

       With this background in mind, I write you not seeking 
     sympathy of any kind, but rather to express my heart-felt 
     opinion on the subject of health care. From one who has 
     experienced so much, you might expect this letter to be from 
     one in favor of President Clinton's health care proposal. In 
     fact, there could not possible be a greater opponent of this 
     plan.
       It's sad, but in the past when my government has made a 
     decision I disagreed with, I passively did nothing, thinking 
     that the decision would not really inconvenience me, or 
     affect me directly except for having to pay a few more 
     dollars in taxes. But with this issue, I cannot be silent.
       I oppose the plan for several reasons--many of them 
     personal--but most of them out of simple common sense. For as 
     long as I can remember, the United States has always been on 
     the cutting edge of the latest advances in medicine. Truly, 
     had I not been born and raised in this country with the 
     problems I have had, I know I would not be sitting here now.
       With the plan Mr. Clinton proposes, I feel strongly that 
     with a lack of research funds, the U.S. will quickly fall 
     from its prestigious place in the world of medicine. The plan 
     does not yet acknowledge how to pay for itself, let alone 
     further research in health care.

  The PRESIDENT pro tempore. The Chair will interrupt the Senator to 
say that, unless the time is extended by unanimous consent, there is an 
order for recessing the Senate after this hour.
  Mr. HATCH. Mr. President, I ask unanimous consent through the Chair, 
then, that we be granted another 10 minutes.
  The PRESIDENT pro tempore. Would the Senator speak just a bit louder, 
please?
  Mr. HATCH. I ask for another 10 minutes by unanimous consent.
  The PRESIDENT pro tempore. Is there objection?
  Mr. DORGAN. Reserving the right to object and I shall not object, I 
wonder if the Senator from Utah would do me the courtesy, as he extends 
his time, including in his unanimous consent, that I be recognized to 
speak when the Senate reconvenes at 2:15?
  Mr. HATCH. I apologize, but we do have an objection here because 
there have been three speakers over there to one over here. I have no 
personal problem.
  Mr. MOYNIHAN. No, no, there have been two. We are alternating as we 
can.
  Let me make the request. We are alternating.
  Mr. HATCH. I think the Senator ought to be able to speak at 2:15, 
then maybe we can go to a Republican after that.
  Mr. MOYNIHAN. Sure.
  The PRESIDENT pro tempore. Unless the Chair be misunderstood, there 
is no order for alternating.
  Mr. MOYNIHAN. Yes.
  Mr. HATCH. We have been following that.
  Mr. MOYNIHAN. Mr. President, would it be in order for me to ask 
unanimous consent that at the conclusion of our recess for the caucuses 
that Senator Dorgan be recognized?
  The PRESIDENT pro tempore. It would be in order.
  Mr. COATS. Reserving the right to object, and I am not going to 
object either, I just want to make note of the fact that yesterday 
evening, the majority leader----
  The PRESIDENT pro tempore. Let the Chair interrupt the Senator. The 
first request is before the Senate and has not been acted upon; that 
request being that the time at this point be extended 10 minutes. Is 
there objection? The Chair hears no objection. The Senator from Utah is 
recognized for 10 minutes.
  Now, the second request, if the Senator from Utah will yield for that 
purpose.
  Mr. HATCH. I do yield for that purpose.
  The PRESIDENT pro tempore. The second request is that Mr. Dorgan be 
recognized upon the reconvening of the Senate, following the recess, at 
2:15 p.m. today. Is there objection? The Chair hears no objection, and 
it is so ordered.
  The Senator from Utah is recognized.
  Mr. COATS. Will the Senator from Utah yield for 30 seconds?
  Mr. HATCH. Sure.
  Mr. COATS. Mr. President, I thank the Senator from Utah. I want to 
make the point that last evening the majority leader said on a number 
of occasions that Republicans were filibustering the bill, and yet we 
seem to be proceeding here in the same way we proceeded for the last 
several days, and that is, we have been alternating between Republicans 
and Democrats who wish to speak on the bill, who are doing that again 
today.
  The Senator from North Dakota has asked for time, as have several of 
his colleagues today. The Republicans have granted that. We are all 
trying to understand this bill which has immense implications for the 
people of this country. I do not see any semblance of what was 
described last evening as a Republican filibuster. I thank the Senator 
from Utah.
  Mr. HATCH. Mr. President, I have been reading from a letter of this 
young man, who has had seven heart attacks and now is facing a second 
transplant, as to why he opposes the Clinton health care program. You 
would think that he would not.
  Let me continue.
  He further states:

       Senator, I cannot emphasize enough how extremely important 
     this issue is to me. It is important for me and for many 
     others, I'm sure, to be able to choose the doctors they want 
     to see and to be assured the same quality health care they've 
     been expecting and received for so long. I honestly fear the 
     passage of this bill; I know it is not the answer, and I hope 
     you do to.

  This is a young man who has gone through so much all of his life and, 
to be honest with you, I was very touched by his letter.
  Mr. President, I ask unanimous consent that his full letter be 
printed at the conclusion of my formal remarks in the Record.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  (See exhibit 1.)
  Mr. HATCH. Mr. President, as Rodney clearly and so eloquently states, 
this issue is just too important for ``politics as usual.'' As Rodney 
Ririe further states at the end of his letter, ``I pray you will 
remember why I sent you to Washington--to represent me not the 
President.''
  For Rodney Ririe, and many others like him, we can act and correct 
the fundamental problems with the system.
  For instance, most of us agree that we need insurance market reform. 
On this one issue, there is almost unanimous support to provide for 
guaranteed issue of all health insurance plans regardless of the 
individual's health status, or other risk factors.
  We need to ensure portability so that persons do not lose their 
insurance if they change jobs or are faced with unemployment. These few 
steps along would lead to greater health care coverage for millions of 
more Americans.
  Another area of reform concerns medical malpractice and antitrust 
reform. Both of these issues involve costly regulation of the health 
care market which, in turn, serves to drive up the costs of health care 
services for all of us.
  Unlike most regulation, though, the regulation in these areas is left 
largely to the courts where decisionmaking is incremental, often 
unpredictable, and always expensive. THe results are often 
inconsistent, and not just across jurisdiction.
  There is widespread agreement on the need to reform our medical 
malpractice laws. The estimated 1991 costs of defensive medicine range 
from $4 to $25 billion according to the National Medical Liability 
Reform Coalition. More recent estimates place this year's impact at 
close to $30 billion.
  Medical liability premiums contributed an estimated $9.2 billion to 
the cost of health care in 1991. What is more staggering is that only 
43 percent of each dollar spent on liability litigation reaches the 
patients; the rest is spent on so-called overhead, such as attorneys' 
fees.
  And yet, the medical malpractice provisions in the Clinton-Mitchell 
bill have rightly been called the Mitchell Trial Lawyer's Full 
Employment Act. This bill creates, at least 15 new Federal causes of 
action and 7 new Federal crimes.

  In addition, the bill as drafted proposes to undo any reforms that 
have been achieved in the States while imposing new costs on the 
litigation system. These so-called ``reforms'' will, in effect, hurt 
malpractice victims as well as all patients, by driving up the costs of 
health care, and escalating liability litigation.
  Antitrust works in the same way and has the same problems as the 
malpractice system. The antitrust laws are intended to ensure that 
markets are free to function in their most efficient ways. But make no 
mistake, antitrust is regulation. Too much antitrust enforcement is 
just as dangerous to health markets as too little.
  Antitrust is a complicated area of the law, and violations carry 
large penalties. Antitrust counsel is expensive, and antitrust 
litigation costs can be crippling to small entities. Providers, 
especially small and rural providers, are very concerned about the 
dangers of antitrust litigation.
  As we consider massive restructuring of the health care market, we 
need to reduce antitrust uncertainty that will, undoubtedly, be 
exacerbated by reform.
  We are all aware of the problems. At the hearings in the Finance 
Committee earlier this year, Senators Mitchell, Baucus, and Rockefeller 
pointed out the real concerns of rural providers in their States. 
Senator Chafee expressed to witnesses from the Federal Trade Commission 
about the frustrations providers feel.
  For example, if two rural hospitals decided to discuss the mutual 
allocation of special services in order to achieve some economies of 
scale, they could be liable to an antitrust challenge simply because 
they had established a possible conduit for sharing price and billing 
information.

  Many other providers face the same kinds of risks if they wish to 
come together to compete with other groups. Home health care providers, 
nurses, and nurse anesthetists all equally face the challenges of a 
changing market in which competition itself will force greater 
consolidation.
  Small groups of rural providers--in fact any small group--simply 
cannot be expected to hire expensive antitrust attorneys to review and 
approve every cost-containment option considered. I believe it is in 
our best interests to see health care providers improve their 
efficiency by allowing them to eliminate duplicative services.
  In my home State of Utah, two hospitals had to spend over $7 million 
to prove to the Justice Department that their world-renowned work in 
pediatrics helped patients--and not harmed them. We have seen millions 
of dollars--including millions of taxpayer dollars--spent on expensive 
antitrust litigation. These dollars should have gone toward patient 
care. Whatever the outcome, the process is too costly and we need to do 
something about it now.
  I think what I am trying to say is this: That we could do a 
reasonable reform of the health insurance system of this country that 
will solve most of the problems that we have and get the universal 
access well above 90 percent and possibly as high as 95 percent. I 
remember about 3 or 4 months ago, maybe 5 months ago, Roger Altman came 
to me and met with me in my office. The first words out of his mouth 
were: ``Senator, we know our bill is not going to pass.'' They knew it 
then.
  But he said one thing: ``We have to have `universal coverage.''' And 
I mentioned to him, universal coverage happens to be a set of relative 
terms. He acknowledged that. I said the last 5 percent is so expensive 
to cover that it is almost impossible to have total universal coverage, 
and he acknowledged that.
  And then I said, ``If we would reform the insurance system in this 
country and make insurance portable, noncancelables, except for fraud 
or failure to pay, so that we take care of preexisting conditions, we 
would resolve most of the problems our society has and we would please 
well over 90 percent of the people in our society and make insurance 
available to them.''
  I said that would be a big win for the President, we would all 
support him, we would get it done, it would be a step toward universal 
coverage that you probably are not going to be otherwise able to make.
  And he looked wistfully at me as though ``I wish we could do that.''
  The fact of the matter is, the reason why we have this huge, massive, 
convoluted piece of legislation that nobody here fully understands and, 
frankly, is an amalgamation--and a poor one at that--of a variety of 
plans, is because those who are for that basically want to be able to 
make the claim that they are taking care of every man, woman and child 
in America. In fact, they know they are being taken care of now and 
that we can do a better job of providing care without bankrupting the 
country or turning all health care over to a one-size-fits-all Federal 
health care system. Anybody who believes that approach is going to save 
money really, really does not understand the last 60 years. Anybody who 
believes that is going to bring health care costs down, is not 
thinking. And anybody who believes that will make a better health care 
system than we have today with the partnership between Government and 
the private sector, I think is loco, to be honest with you.
  Another issue that has attracted widespread support is in the area of 
enhancing our network of community health centers. The Federal costs of 
community health centers are estimated to be around $100 per patient 
per year. It seems to me that we should expand the role of these 
centers to provide needed care to underserved areas of the country.
  As we address the issues of rural health care we should be guided by 
a simple formula developed by Pamela Atkinson, a vice president at 
Intermountain Health Care in Utah. Ms. Atkinson is an expert on rural 
health care. She advises me that the problems associated with the 
delivery of quality health care in rural America must be guided by the 
four A's.
  They are: affordability, accessibility, availability, and awareness.
  We need affordable and accessible services in rural and in urban 
areas. And, we need available services that include providers, 
facilities, and the equipment to provide services in a culturally 
sensitive manner.
  It is the awareness issue, however, that has not been discussed much. 
Pamela informed me that there are normally 950 visits scheduled a month 
in Intermountain Health Care's community health centers. However, 
between 150 to 200 patients never show up for their scheduled visits. 
They just do not understand the importance of early diagnosis and 
treatment.
  I do not know if my other colleagues have heard similar statistics, 
but I was surprised to learn the extent of this problem. This is 
especially troubling when you recognize that we are talking about 
scheduled visits, with so many more individuals who never make the 
effort to visit in the first place, and who, therefore, never receive 
needed care.
  Obviously, we need to improve health services in these areas by 
increasing awareness in the community and emphasizing health promotion, 
health prevention, and early detection.
  I would also like to comment about the proposed legislation that has 
been developed by the distinguished Republican leader, Senator Dole. I 
strongly support the Republican leaders' bill. It has many important 
features that go a long way in addressing the needs of those Americans 
without health insurance.

  The bill provides for positive insurance reforms so that people would 
not have their insurance canceled or their premiums increased because 
they got sick or lost their job. Individuals would be able to obtain 
insurance regardless of their medical condition.
  The legislation contains many important incentives to control the 
costs of health care and ensure that all Americans have access to 
quality and affordable care.
  The bill provides for medical savings accounts so that individuals 
would have greater control over the expenditure of their health care 
dollars. Third-party insurance would cover catastrophic expenses.
  The bill provides for tax fairness so that people who purchase their 
own insurance would receive the same tax relief as those who obtain 
insurance through an employer.
  Self-insurance by small- and medium-size employers would be permitted 
to continued. This has become one of the most cost-effective mechanisms 
employers use to control health care costs. The Dole bill allows that 
to continue; the Mitchell bill does not.
  Overall, Senator Dole's legislation offers a commonsense solution to 
the Nation's health care problems. The bill provides health security to 
the middle class through insurance and market reforms while expanding 
coverage to low-income and middle-class Americans.
  It accomplishes these goals without increased taxes, without expanded 
bureaucracies, without spending limits imposed by global budgets and 
price controls, and without employer mandates that ultimately lead to 
wage and job reductions.
  The bill does not contain Government mandates on employers, or 
individuals, that would require them to purchase insurance whether they 
want to or not.
  There are no mandatory Government health alliances that give Federal 
and State control over the insurance marketplace.
  There are no Federal price controls or global budgets that inevitably 
will lead to health care rationing, particularly for those most in 
need.
  Mr. President, I look forward to the debate, and I call on all 
Americans to listen carefully. Your future is at stake.
  For the sake of the country, I hope our actions will be guided by the 
wisdom to do what is right, not what is expedient.
  I yield the floor.

                               Exhibit 1


                                              Rodney E. Ririe,

                                         Provo, UT, June 10, 1994.
     Senator Orrin G. Hatch,
     U.S. Senate, Washington, DC.
       Dear Senator: I am writing with regard to some serious 
     concerns which I have related to health care issues that 
     currently face our government. Before proceding, however, let 
     me give you a brief idea of my background, so that perhaps 
     you might better understand when I come from.
       Currently, I am a college student attending Brigham Young 
     University, where I have been for the past five years. Part 
     of the reason I have not yet graduated is because of my 
     health. You see, when I was five years old, I suffered a 
     near-fatal heart attack. Before that time, doctors thought me 
     to be a normal, healthy five-year-old child. Doctors 
     diagnosed me as having a form of cardiomyopathy, or disease 
     of the heart which affects the development of the muscle 
     walls. Four years later, I had another heart attack, three 
     more at age eleven and two at age twelve--a total of seven 
     heart attacks in my brief life. Shortly thereafter I became a 
     candidate for a new form of technology known as an Automatic 
     Implantable Cardiac Defibrillator (AICD), and had surgery to 
     implant the experimental device, which I carried inside me 
     for more than five years. At age 14, I suffered a stroke 
     which completely paralyzed my left side for several weeks. 
     And, finally at the age of 17, I underwent a heart transplant 
     operation. Since that time, I have been mostly healthy until 
     about a year ago. Doctors have recently discovered that I am 
     suffering from a form of atherosclerosis (coronary artery 
     disease) commonly found in transplant recipients, for which 
     they said I will need a second transplant within the next 
     several months.
       As you can imagine, paying for these things has been a 
     burden on my parents and family. Fortunately, we have had 
     good insurance in the past, but with my pre-existing 
     conditions, premiums have been all but inexpensive, and in an 
     effort to keep the premiums as low as possible, we chose 
     higher deductibles. I am blessed to have had a father who 
     practices dentistry in my home state of California, that we 
     have had the means to pay for these expenses. However, bills 
     were not paid without sacrifice. My father will retire in two 
     years (at age 68) a poor man, devoting nearly all of his 
     savings to help pay for my care.
       In May of 1995, I will turn 26 years old which will 
     disqualify me as a dependent on my parent's insurance policy. 
     With my current medical expenses costing between $40,000 
     and $60,000 a year ($10,000/year for medication alone), 
     the onslaught of another transplant, and the fact that no 
     insurance company in the country will pick me up, this 
     places the entire financial burden on me, a part-time 
     college student who works a part-time job making $5.90/hr.
       With this background in mind, I write you not seeking 
     sympathy of any kind, but rather to express my heart-felt 
     opinion on the subject of health care. From one who has 
     experienced so much, having seen the inside of literally 
     scores of different hospitals, and observing (and 
     participating in) the system for so long, you might expect 
     this letter to be from one in favor of President Clinton's 
     health care proposal. In fact, there couldn't possibly be a 
     greater opponent of this plan. It's sad, but in the past when 
     my government has made a decision I disagreed with, I 
     passively did nothing, thinking that the decision wouldn't 
     really inconvenience me, or affect me directly except for 
     having to pay a few more dollars in taxes. But with this 
     issue, I cannot be silent. It is also sad that such an issue 
     has become so politically polluted, becoming nothing more 
     than a Washington boxing match between the isles of Congress. 
     Health care--people's lives--are not to be used as pawns for 
     a political battle for power on Capitol Hill.
       I oppose the plan for several reasons--many of them 
     personal--but most of them out of simple common sense. For as 
     long as I can remember, the United States has always been on 
     the cutting edge of the latest advances in medicine. Truly, 
     had I not been born and raised in this country with the 
     problems I have had, I know I would not be sitting here now. 
     With the plan Mr. Clinton proposes, I feel strongly that with 
     a lack of research funds, the United States will quickly fall 
     from its prestigious place in the world of medicine. 
     Evidences of this are everywhere. The plan does not yet 
     acknowledge how to pay for itself yet, let alone further 
     research in health care.
       The plan boasts ``security'' by ``providing every American 
     with comprehensive health benefits.'' This obviously means 
     everyone is guaranteed coverage whether one can pay for it or 
     not. I fear there will be many who will take the attitude 
     that ``if I'm going to be covered no matter what, then why 
     pay for it at all? After all, it's guaranteed.''
       Not only will there be a flagrant misuse of the system, but 
     it will bankrupt many small business owners as well. 
     Businesses large and small will find the burden of paying for 
     employees' health care overwhelming, and will opt for layoffs 
     over benefits. From what I understand, the Clinton's 
     conservative estimate on unemployment will be ``minimal''--
     perhaps only 600,000 people will lose their jobs. Recently, 
     my father returned from a meeting with his accountant where 
     the topic was the governmental health care system. The 
     accountant admitted that he didn't have all of the 
     information available, but with the estimates had at that 
     time, he forecast costs in the neighborhood of $400 per month 
     per employee. With my father's small business of only eight 
     employees, that figure translates to a whopping $38,000 per 
     year--enough to seriously damage my father's business, 
     forcing him to not only lay off competent employees, but also 
     raise his dental fees, which many complain are too high now.
       And what happens when we do run out of the amount budgeted 
     for the health-care year? Do we begin rationing care by 
     closing hospitals and denying citizens the care we promised 
     them? I read an article recently from a Toronto newspaper 
     (sent to me by a friend) that reported the Canadian 
     government was running low on funds for their health care 
     program, and that to remedy the situation, they were not only 
     rationing care (postponing badly needed treatments), but 
     closing hospitals--denying their citizens the care promised 
     and paid for. A recent article in the March 1994 Reader's 
     Digest confirms this and further informs readers that the 
     Clinton bill ``specifies heavy criminal penalties (fines, 
     seizures of property, long prison terms) for `bribery and 
     graft in connection of health care.''' Surely, if they are 
     anticipating bribes, they must also undoubtedly be 
     anticipating shortages and rationing. Why else would they 
     impose such stiff penalties?
       Besides the monetary aspect, there are the new 
     bureaucracies that will undoubtedly be formed. Some 
     conservative estimates place the number at 105 new government 
     entities with a minimum of 50,000 new public employees to 
     further enlarge our already over-sized government. If this is 
     true, then the plan promises to be nothing more than another 
     agency of red-tape, long lines, and bureaucratic mumbo-jumbo. 
     This country needs less government * * * NOT more.
       Basic economic principles tell us that nearly every time 
     you take something away from the government and give it to 
     the private sector to operate, free enterprise prevails 
     offering individuals a greater quality of a product or 
     service, better prices, and the choices we Americans demand. 
     If this plan goes through, the opposite will no doubt take 
     effect. The choices will be severely limited (regardless of 
     what they say--the plan basically spells it out). The prices 
     may be controlled (lowered) by the government, but with all 
     of the governmental agencies, alliances, paperwork, and other 
     inefficiencies the government has shown throughout the years, 
     the overall costs can't help but be more than what they are 
     today. And, I believe, and this is the main point I wish to 
     stress in this letter--the one point I feel more concern for 
     over any other--the quality of care will drastically decline.
       Under the managed care (or HMO) system proposed by the 
     President's plan, patient's choices will be minimal and the 
     care itself will deteriorate. In a traditional managed care 
     system, doctors are paid a flat rate for each patient they 
     see each month. Therefore, they have no incentive to see the 
     same patient, sick as he may be, more than once a month. 
     Surely this keeps costs down, but who really comes out ahead? 
     Under similar plans in California, doctors hired by HMOs are 
     paid a flat salary, regardless of the number of patients they 
     see, or the number of procedures they perform. With this way 
     of thinking, doctors could easily adopt a careless attitude, 
     reasoning that they can give quality work, or ``shoddy'' 
     work, and either way, they still get the same pay. 
     Essentially they are worry free when the employer pays all 
     their malpractice and other expenses. I feel strongly that 
     while HMOs do save money in preventative care and other 
     budget-cutting programs, the quality of care is severely 
     compromised, and care is what health care is all about.
       To illustrate this point: My roommate recently had two 
     visitors from Great Britain. Being their first time in the 
     United States, they had many questions about government, 
     etc. and were especially interested in the direction the 
     country was heading with the health care issue. We 
     discussed this at length and they explained that in 
     Britain, people have the choice of private or government 
     health care providers. Ironically, one of the visitors had 
     frequently chosen the government form of care to save 
     money, and the other had chosen private. As they spoke, it 
     became very evident that the visitor who had the private 
     providers, was much more satisfied, and had had quality 
     care, while the other spoke of long lines, poor care (her 
     dental work was visibly bad), and a genuine lack of 
     personalized service and caring that we are so accustomed 
     to as Americans. Again and again she told us how fortunate 
     we were to have a private system of health care.
       Senator, I cannot emphasize enough how extremely important 
     this issue is to me. I have seen hundreds of doctors in my 
     lifetime. Each time I find one I'm not satisfied with, I have 
     the option of going to another. Obviously, we as Americans 
     want the best possible care available. And if doctors have no 
     incentive to work harder, or to go the extra mile, to 
     ``produce the best possible product,'' the care itself can't 
     help but become compromises.
       I have a doctor I see every six or eight months for a 
     procedure known as a biopsy, where small pieces of heart 
     tissue are pulled out through a vein in my neck to be 
     analyzed for possible rejection. THe procedure takes only 10-
     15 minutes, and is fairly uncomfortable. Over the past seven 
     years I have had my new heart, I have watched the doctor's 
     fee for this procedure rise from $550 to over $1400 (aside 
     from the hospital charges). At first, this upset me to think 
     that he does exactly the same thing each time, and in only a 
     seven year period, the fee had more than doubled! But the 
     more I thought about it, the more I had to agree with it. 
     Although it is very difficult to pay these fees and would be 
     next to impossible without insurance, I have to admire him. 
     Those fees are his incentive for continuing to do a quality 
     job with the least amount of physical discomfort, providing 
     the most comfortable atmosphere possible for the patient, and 
     maintaining a good, strong, positive attitude all along. I 
     have had dozens of different doctors perform this procedure 
     on me. While serving a two year mission for the LDS church in 
     Boston, I was seen at Harvard Medical School's Brigham and 
     Women's Hospital, where I never saw the same doctor twice. 
     While attending BYU, I've been to University Hospital in Salt 
     Lake City and had the same procedures performed there. But 
     each time I see someone else, I always go back to my original 
     doctor. Why? Because he cares! He knows my condition, my 
     fears, my history--everything about me, and does everything 
     in his power to make me feel comfortable. So I pay him for 
     that.
       It is important for me and for many others, I'm sure, to be 
     able to choose the doctors they want to see and be assured 
     the same quality health care they've been expecting and 
     received for so long.
       I truly think that if you were to take a random sample of 
     Americans, they would agree that something has to be done. We 
     can't continue to let these costs soar. I believe they would 
     also tell you that the White House's plan is not the cure to 
     what ails this problem. I certainly don't have any answers 
     nor do I propose any solutions, but I do know this: that 
     President Clinton's plan is not the answer. It simply 
     won't work. It will cost billions and billions of dollars 
     we don't have, and will place the health care of Americans 
     in jeopardy.
       Lately the news media has reported that things are slowly 
     coming to a head on Capital Hill and the vote is likely to 
     occur sometime in August or September. I get the impression 
     from these reports that a majority of Congress is leaning in 
     favor of the President's plan hoping that by simply voting on 
     the issue, the problem will go away. Truly something of this 
     magnitude needs to be studied much more carefully. We need 
     more brainstorming, more proposals, and not simply jump at 
     the first plan but before us. As I look back on President 
     Clinton's track record, I must admit it is an impressive one. 
     He has narrowly passed nearly every major bill he has 
     proposed. His strategy seems always to be the same: pull the 
     fence-sitters into his office (behind closed doors) and push 
     push push until he gets the one vote he needs to pass.
       Now I realize that nothing I have written is new to you, 
     that you must get thousands of these letters each day, but 
     Senator, I fear for the future. I honestly fear the passage 
     of this bill. I urge you to please consider the needs of this 
     great nation before any personal political agenda you may 
     have regarding this issue. As I mentioned before, this issue 
     is just too important for ``politics as usual.'' I urge you 
     to please vote against the Clinton Health Security Act, and 
     hope that you will urge your colleagues to do the same. And 
     if by chance, the President calls you to his oval office and 
     does whatever he does behind those closed doors, I pray you 
     will remember why I sent you to Washington--to represent me--
     not the President.
       As for me, I honestly don't know what I'm going to do when 
     next May rolls around and I lose my insurance. I have faith 
     that something positive will happen and my needs will be met. 
     But I do know that this plan is not the answer, and I hope 
     you do to.
           Respectfully yours,
     Rodney E. Rine.

                          ____________________