[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 CARE REFORM AND THE HEALTH SECURITY ACT

  Mr. DORGAN. Mr. President, let me go on to the subject for which I 
sought time today in the U.S. Senate. The subject of health care, 
hospitals, and all of the issues that surround the issue is very 
difficult for me to talk about because of the significant tragedies in 
our family that are attached to the health care system; sitting night 
after night and day after day in intensive care waiting rooms, and 
praying for miracles and the breathtaking and spectacular changes in 
medicine that will save someone you love, and it does not work and does 
not happen.
  I cannot talk very much about it except to tell you that I fully 
understand that when someone you love is in trouble and has a health 
care problem, cost is not an issue. The cost of the operation, the cost 
of the surgeon, the cost of hospitalization, the cost of the very best 
technology available anywhere in the country is not an issue. It does 
not matter. You want someone to save the life of someone you love. That 
is kind of what health care is today, breathtaking, spectacular 
advances to do things we never before thought possible. People whose 
lungs are not functioning and whose heart is gone get a double lung and 
heart transplant. The definition of a dead person was once somebody 
whose heart was not working and lungs were gone. Now we can transplant 
a new heart and lungs all at once. It is breathtaking.

  Those are the spectacular successes we read about and know about. 
There are just as many spectacular failures. All along the way, 
enormous amounts of money are spent in various ways to try and advance 
medical care. Some of it is routine, the ordinary daily health care 
services people need. Some is on the cutting edge of new technology, 
trying to save lives that we before could not save.
  I grew up in a town that had a doctor--one doctor. There were 350 
people in my hometown. He was old Dr. S.W. Hill, a wonderful man, who 
came there and stayed 55 years. Our neighbor took his kid, Alton Ivy, 
to the doctor because his tooth ached. We did not have a dentist in my 
hometown. Doc Hill looked at Alton and got him to open his mouth, and 
he decided he had to have a tooth pulled, so Doc pulled out Alton's 
tooth. The problem was Doc Hill pulled the wrong tooth. Alton's dad was 
pretty upset, and the doctor explained that he did the best he could; 
he was not a dentist, and he sometimes made mistakes. With Alton, he 
pulled the wrong tooth.
  My opinion about health care in this debate is that there is clearly 
a national ache of significant proportions. You cannot ignore that. 
But, we have to be careful not to pull the wrong tooth. I am worried 
that may be what we are about to do.
  I would like to present some information today that I hope my 
colleagues will consider as we try to respond to this issue and decide 
what to do with respect to health care reform. There are those around 
here who say, well, let us essentially do nothing and let the market 
system take care of this. Let us be happy and do nothing. That is the 
easiest possible solution, to do nothing. That would not be the right 
approach. We must do something.
  Too many people are without coverage. Too many people are sick for 
whom health care is not readily available. We must especially do 
something about costs. We are responding when the issue is skyrocketing 
costs in health care by talking largely about coverage. And that, I 
think, is the weakness of our approach. Is coverage important? 
Absolutely. Health care coverage is essential. I will talk more about 
that in a minute. But cost is what is driving this problem. As health 
care costs skyrocket month after month and year after year, it takes 
health care out of the reach of far too many American families. If we 
do not do something about the skyrocketing costs we are chasing, we 
will not succeed in expanding health care coverage because health care 
will always cost too much.
  It is not that coverage is not a problem. It clearly is. We need, it 
seems to me, to make certain every American has access to health care. 
I believe health care ought to be a fundamental right. Some particular 
child today ought not to have a circumstance exist where whether that 
child gets to a hospital or clinic is a function of how much money that 
child's mother or father has.
  So coverage is an issue. Yes, we ought to address coverage, and we 
ought to have universal health care coverage. There is no question 
about that. But the relentless, gripping, nagging problem of 
escalating, skyrocketing health care costs, if ignored, will mean we 
will never attain universal coverage in our country. It will mean that 
families and employers and the governments that finance the Medicare 
and Medicaid programs will simply not be able to contain the monster 
that is eating away at our ability to pay for health care, and that is 
skyrocketing costs.
  In short, we are answering the wrong question first. People want 
something done to bring down the cost of health care. And we are 
telling them that with a new program, we can increase the coverage of 
health care now. But can we do that without controlling costs? No, I do 
not think so. I do not think it is possible.
  The appetite for health care in this country is inexhaustible. We all 
know that. If you have breast cancer and have a 10-percent or 20-
percent chance of a cure with an experimental operation, a bone marrow 
transplant that will cost $250,000, if it is you, do you want somebody 
to pay that $150,000 or $250,000? Of course, you do. There is an 
inexhaustible demand for health care.
  If you go to the cafe in my hometown and ask people about health 
care, I will tell you what you will discover: A discussion and a 
conversation about cost. They will ask, ``Why does it cost $300 to get 
three stitches put in your index finger?'' That is what one North 
Dakotan asked. ``Why did it cost $18,000 for 3 days in a hospital?'' 
The hospital bill including the use of an operating room for 4 hours 
without the physician fee, was $18,000. Why did it cost that much? 
``Why did it cost,'' they will ask, as Judy did, ``$10,300 for a 3-day 
stay in a hospital last month?'' Or ``Why did it cost,'' Tricia asked, 
``for outpatient surgery, with a hospital stay from 8 a.m. to 2 p.m. on 
the same day, $13,000?''
  How did hospital prices increase 413 percent from 1980 to 1991? The 
average total charge per day for inpatient care in hospitals for a 
Medicare beneficiary is $1,230. Yet, a third of our hospital beds are 
empty, and many of those hospitals that are not full are expanding and 
building. A 1993 study found hospital expenditures per day to be over 
$1,000 in the United States; $400 in Canada; and less than $250 a day 
in France, Germany, Japan, and Great Britain. And physician fees are 
extremely high as well.
  In 1989, U.S. physicians, on average, had incomes more than three 
times their British, French, Swedish, and Japanese counterparts. In 
1990, the Canadian Province of British Columbia arranged for some 
Seattle hospitals to do open heart surgery for some Canadian patients. 
The surgeons were paid $4,500 for the heart surgery done in Seattle. A 
surgeon would have gotten $2,500 for exactly the same surgery in 
Canada. And actually, the fee for a United States consumer in Seattle 
for that same surgery would have been $6,000, but the Canadians were 
able to negotiate a better deal. I note that the ratio of physician 
income to an average person's overall income in the United States is 5 
to 1; compared to 3.7 to 1 in Canada; 4.3 to 1 in Germany; and 2.3 to 1 
in Great Britain.
  I asked if I could get some information on the comparative costs of 
procedures, operations such as a tonsillectomy, appendectomy, or a 
hysterectomy, here in the United States and other 
nations. There is not much information but CRS was able to find this 
comparison of Canada to the United States A coronary artery bypass cost 
$16,000 in Canada and $38,300 in the United States. A cesarean section 
was $3,700 in Canada and $6,700 in the United States. An appendectomy, 
uncomplicated, was $2,500 in Canada and $5,700 in the United States.
  I have mentioned this before, and I will do it again very quickly. I 
have talked several times about prescription drug costs. Let me just 
refer to a couple of charts that I have shown Members of the Senate 
before. Valium is certainly a drug that is familiar to a lot of the 
American people. The same drug, by the company, selling the same pill, 
in the same bottle, costs $4 in Sweden, $4 in Great Britain, and $9 in 
Canada. For the same dose of the same pill, made by the same company, 
they charge $49 in the United States. They say to the U.S. consumer: If 
you need Valium from us, we have a separate way we charge. We are going 
to charge you 10 times more than we charge other consumers.
  Here is another comparison. I have a grid sheet of wholesale price 
ratios for 20 of the 100 top-selling drugs in the United States. 
Inderal is $34 in Sweden, $43 in the United Kingdom, $122 in Canada, 
and $428 in the United States for exactly the same number of pills 
produced by the same company and sold in these different countries.
  There is Xanax, a drug prescribed for anxiety. As you can see on the 
chart--$10, $15, $20, but for the U.S. consumer, a special deal, they 
overprice it.
  I have many of these charts. When I offer an amendment on this 
subject I intend to go through them in some detail.
  Finally, Premarine, an estrogen replacement, the largest selling drug 
in this country, as a matter of fact. In Sweden it wholesales for $93, 
the same bottle, the same pills produced by the same manufacturer; $100 
in Great Britain; but they say to the United States consumer you get a 
special price from us--triple--we triple the price.
  Physician fees, hospital costs, prescription drug costs--people are 
worried about prices. The cost of health care keeps rising. The 
salaries of hospital administrators--but first, the salaries of 
prescription drug manufacturers. They say they need these prices for 
research and development. The CEO of one major drug company makes as 
much in a year as the combined salary of every Senator serving in the 
U.S. Senate. He makes as much money by noon in one day as the average 
American worker makes working all year long.
  One insurance company executive is paid $52.8 million. The CEO of one 
Blue Cross/Blue Shield plan, an empire that was losing money hand over 
fist, was making $600,000 a year. Another CEO of a Blue Cross/Blue 
Shield plan was making $800,000 a year. Another one made $1 million 
last year. Another Blue Cross/Blue Shield CEO got a $4.6 million 
retirement package.
  Cost is the issue. In every stage of this debate, why does health 
care cost so much?
  The fact is we do not have a system in which price is the competitive 
regulating mechanism that is normally associated with the market 
system.
  I have studied Adam Smith. Most of us studied Adam Smith. The cloak 
of the invisible hand established price as a mechanism by which 
competition existed.
  It does not exist in health care. There is an inexhaustible demand 
for health care services. The fact is we do not have typical price 
competition. In my home State, we have 640,000 people; and guess what: 
Six separate locations where you get open heart surgery. Do we need 
that? Of course, we do not. But the providers compete based on adding 
additional services, not price. One does open heart surgery, the other 
provider says, ``We have to do that in order to compete.'' One gets an 
MRI, and the other says, ``We have to get an MRI.'' One has a CAT scan, 
and the other says, ``We have to have one.''
  Competition in health care means duplication of services, and, 
therefore, higher prices. You do not hear a Tom Bodett advertise like 
Motel 6 to keep the light on 24 hours a day for you. You do not hear, 
``Come over to the hospital; we have a cheaper room for you.'' 
Competition in health care is not based on price. It is a fact. Those 
who stand on the floor ad nauseam talking about competition, how some 
sort of managed competition is going to magically drive down prices or 
costs in health care, are simply wrong. It is not going to happen.
  With all of that as background, let me turn to some information I 
have developed about all of the plans that exist. Let me say at the 
start this President deserves a lot of credit. We would not be talking 
about health care if it were not for this President. Health care costs 
are gobbling up the Federal budget, the family budget, and business 
budget, which we must do something about. We would not be discussing it 
had we not elected Bill Clinton. So I give him credit for this. Let me 
credit also the majority leader for bringing the plan to the floor. The 
easiest possible thing do is to bring nothing to the floor; let us 
obstruct, wait and do nothing.
  Most important to me is let us do the right thing. The right thing is 
to do something to put the brakes on skyrocketing costs. None of the 
plans now discussed--none of them--effectively does that.
  Let me explain the problem with this chart. This chart shows health 
care costs as a percentage of gross domestic product. Our gross 
domestic product or GDP is the sum total of everything we produce in 
the country, the income, in effect that we are able to use. If you add 
it all up and compare it to health care costs, we spend far more on 
health care than any other country.
  In fact, President Clinton during the State of the Union Address said 
we spent 14 percent of our GDP on health care costs, Canada spends 11, 
and no other country spends 10. In Germany they had a special session 
of the German legislature when health care costs went up two-tenths of 
1 percent of GDP. I believe it was somewhere around 7.6 or 7.8 percent. 
They called a special session. It was a calamity for them. We are not 
at 7, 8 or 9 percent. We are at 14 percent and rising, and rising 
quickly. We are far, far above any other country in the claim health 
care costs have on our total resources.
  Let me show you a chart that says if there is no health care reform 
and we just go on like we have been going along, according to the 
Congressional Budget Office, health care costs will go from 14 percent 
of gross domestic product to over 20 percent in 10 years. In other 
words, we are going to increase by a third the claim on our national 
income for health care. That is if we do nothing.
  If we pass the Clinton plan, which I think is no longer before us, 
but nonetheless, if we pass the Clinton plan as is, what we have is we 
go from 14 percent up to close to 19 percent, and the Clinton plan, 
incidentally, has cost containment in it that is tougher than any other 
plan we have considered. If we pass the Finance Committee plan, which 
was guided by the mainstream or moderate group, we go from 14 percent 
of GDP to over 20 percent of the gross domestic product. If we pass the 
Mitchell plan, health care increases as a percent of our gross domestic 
product from 14 percent to over 20 percent. The Dole plan is not yet 
scored by the Congressional Budget Office, but I cannot believe it 
would have any better numbers than any of the others because it 
probably will have the least amount of bite in it as far as controlling 
cost. Essentially, I think it mirrors where we are today in 
inexhaustible growth of health care costs.
  This chart is a summary of all the plans. What you see from this 
chart is that no matter what plan we pass that currently exists, we are 
off debating coverage and not biting on cost control. If we do not have 
the opportunity to and do not have the will to say that we are going to 
do cost containment and put some cost controls in place that bite, we 
will not be able to get costs under control. We must do something in 
order to keep this country's health care costs at somewhere around 14 
or 15 percent of gross domestic product. Otherwise, our health care 
reform efforts we will surely fail.
  Now, the answers that come in this debate are fairly predictable. 
This is politics, fortunately or unfortunately. I do not happen to 
think politics is bad. John Kennedy said every mother's hope was that 
her son would grow up to be President as long as they do not get 
involved in politics. Politics is the process by which we make 
decisions.
  The politics of the Senate increasingly these days is we tend to 
retreat into familiar terrain, into familiar campgrounds. The 
campground on that side of the aisle is retreating to positions of 
saying let us really do nothing, or let us do nothing and pretend we 
did something, but let us do very little and make it seem like it was a 
lot. That is very familiar ground for that side of the aisle.
  Our side of the aisle tends to try to put our suit right away and say 
let us immediately help people. There is no more laudable goal than 
that, because we have a lot of people suffering and a lot of people who 
need help.
  But going to a spending program immediately without addressing rising 
costs will not solve this problem. Some say to me when I show them 
these charts, you know what you are missing? We are putting 30 million 
people more into this health care system. Of course, it would cost 
more. I say they do not understand. The whole debate about health care 
is that the 30 million people are now getting health care, at least 
some semblance of health care, and there is an enormous cost shift. 
They are already in this system to a large extent. We ought to, it 
seems to me, be able to construct a system with cost containment that 
bites in a real way. That is the toughest thing we have to do around 
here, because it is going to offend everybody. But if we do not do 
that, we will not ever, in my judgment, be able to provide adequate 
coverage because we will not have constrained costs.
  When we get up to 20 percent of our GDP committed to health care, we 
are not going to be able to deal with that in the Federal budget. 
Families are not going to be able to deal with that in the family 
budgets.
  It is my hope, as we move along here now, in the midnight hours 
tonight, or whenever we are going to do to try to wrap this up, that we 
will understand a couple of things.
  One, this President and this majority leader have decided an 
important element in this health care debate is coverage. And they are 
absolutely right. Too many people today are sick and are not getting 
adequate care. No mother in this country should worry that when her 
children get sick she may not be able to get them to a doctor because 
she does not have enough money in her wallet. Coverage is important.
  But we will not advance the interests of coverage unless we do 
something in health care reform that bites on cost containment. We 
cannot have a health care system that eats up from where we are today 
an additional one-third of its claim on our gross domestic product and 
finish this job and say we did a good job. If we pass a bill that deals 
only with coverage and go home, we will have left the most significant 
challenge in front of us.
  As I was coming over today I pulled something out of my files, 
because when my mother passed away she had left, in a series of files 
for us children, things that she had kept and collected. I suppose 
everyone has something like this. My mother had kept a hospital bill 
from St. Joseph's Hospital in Dickinson, ND. When I was a little tyke 
just able to walk, I had a burst appendix and nearly died. They said 
another hour or so I would not have made it. I got to the hospital and 
had emergency surgery--fairly significant surgery in those days. I was 
hospitalized for 6 days. I had extensive care. And my mother kept the 
bill for that extensive hospitalization. It was $71.81.
  It was 6 days in the hospital, 6 days of room charges at St. Joseph's 
Hospital in Dickinson was $39. But then you add to that--that is not 
all they charged--they wanted to charge for the operating room as well, 
and this was surgery, I understand, that took many hours because it was 
very difficult surgery at that time. And they charged $10 for the use 
of the operating room and $10 for anesthesia and $3 for an x-ray.
  When people talk of the good old days, I suppose there were some 
aspects of the good old days we would like to go back to. And $70 
hospital bills might be one. But we cannot reclaim the good old days, 
nor would we want to with respect to some of the miracles and advances 
and breakthroughs and the breathtaking changes that have occurred in 
health care.
  Breathtaking changes and miracle cures are important to all of the 
American people only to the extent that they have access to them. That 
is why I think my colleagues--my colleague from Minnesota is on his 
feet about to speak. No one is more aggressive than he is to talk about 
coverage. He is absolutely right, coverage is essential. But I am just 
telling him, he and others, that if we do not effectively deal with 
costs, with cost controls and cost containment that really bites, then 
we will not succeed.
  I might say to folks on the other side of the aisle who come here and 
talk about competition and so on, the last thing, in my judgment, they 
would ever embrace would be anything that restrains in any way anyone's 
ability to charge any amount to any American. I just cannot believe 
that. Because this is not a market system that works in the traditional 
market ways.
  So I guess I would close pretty much as I began. I full well 
understand the necessity of health care from a personal standpoint and 
I hope that no one will believe in the next few days the solution is 
for us to do nothing. That is not a solution. The solution is for us to 
do something and to do the right thing. The right thing in my judgment 
is two steps: Decide together that the market system does not work to 
control health care costs; and to find an effective way--fair to 
everyone, fair to providers and fair to consumers--to put us on a 
course of restraining, in an adequate way, health care costs.
  And second and importantly, make sure we finish when we are on a 
track and give every American family the assurance that they will have 
health care coverage, coverage they can afford and coverage that 
represents quality health care.
  I hope if and when we can put the brakes on skyrocketing health care 
costs, the American families will once again give this institution the 
credibility that I think this institution can have by tackling tough 
problems in a timely way.
  I yield the floor.
  Mr. WELLSTONE addressed the Chair.
  The PRESIDENT pro tempore. The Senator from Minnesota [Mr. 
Wellstone].
  Mr. WELLSTONE. Mr. President, first of all, let me thank my colleague 
from North Dakota. One of the things I most appreciate about Senator 
Dorgan, since I come from Minnesota, a neighbor of North Dakota, is all 
of the ways in which Senator Dorgan is so rooted in the people that he 
represents.
  The kind of sensitivity toward and feel for regular people he 
demonstrates is rare. I do not think there is anybody in the U.S. 
Senate, whether we are talking about the Federal Reserve System and 
interest rates or the ways in which those kinds of decisions can make 
or break people's lives, or health care, who does a better job of 
really representing a lot of people who quite often do not have a voice 
here. I thank the Senator.
  The other thing I would say, and I promised my colleague from Iowa 
that I would be relatively brief so I do not want to get started on 
this, but I wanted to say to my colleague from North Dakota that I 
believe he is absolutely on target. He said I was a fierce advocate for 
universal coverage--yes. But I think unless we have cost containment--I 
mean, if 37 percent of our gross domestic product by the year 2030 is 
spent on health care, it is going to bankrupt us. I think we have to be 
very serious about cost containment.
  The question is how to contain health care costs. I just simply do 
not buy the argument that the way we contain the costs is by 
essentially undercutting services for people, or not covering people, 
or denying people care that they and their loved ones really need.
  I have to say to the Senator from North Dakota, one of the things 
that attracted me to the single payer option from the very beginning--
since everybody keeps talk about the Congressional Budget Office--is 
that there is simply not another proposal that has been presented that 
does nearly as well by way of CBO scoring. CBO's latest scoring of the 
single payer bill pointed out that single payer, 1997 to 2003, has the 
potential to save up to $700 billion as compared to the status quo, 
projected over that 6-year period. That is not an insignificant amount 
of money, especially when you are talking about a health care bill that 
would make sure that everyone was covered with a comprehensive package 
of benefits, including catastrophic care. So I think he is right on 
target and I hope we get serious about universal coverage. All of which 
is a bridge to what I would like to really focus on, Mr. President, for 
maybe a few minutes.
  Mr. President, let me start out by saying that I recognize that I 
tread on sensitive ground, and I want to make sure my colleagues 
understand the analysis I am trying to make, and that they know it is 
not an analysis that attempts to criticize any particular Member of the 
U.S. Senate or the House.
  First of all, I ask unanimous consent that a Washington Post piece 
dated Monday, August 15 titled ``Health and Insurance Contributions to 
Senators'' be printed in the Record.
  And second, I ask unanimous consent that a New York Times piece 
titled ``Lawmakers Feel the Heat From Health Care Lobby,'' which is 
dated Tuesday, August 16, today, be printed in the Record.
  The PRESIDENT pro tempore. Without objection, it is so ordered.
  (See exhibit 1.)
  Mr. WELLSTONE. Mr. President, I am pleased that these two major 
newspapers have really analyzed this mixture of money and politics in 
the health care debate. I have to say that much of the struggle over 
whether or not we will have a fundamental health care reform has to do 
with our failure to yet enact fundamental campaign finance reform 
legislation. I want to talk about that campaign finance reform bill in 
a moment.
  Citizen Action came out with a study recently--an analysis of Federal 
Election Commission data. From January 1993 to May of this year, the 
health care industry made $26.4 million in political contributions to 
Representatives and Senators. In March, it was a staggering $4 million, 
just in that 1 month alone.

  Other data, Mr. President: During Presidential and congressional 
elections, the 1990-92 cycle, the health industry, broadly defined, 
spent almost $42 million. Common Cause just came out with a study of 
these contributions, which I mentioned the other day on the Senate 
floor, Mr. President. This is a study of PAC contributions--just PAC 
contributions--to the U.S. Senate over a 6-year period, January 1987 to 
December of 1993. During that time, business PAC's contributed $72 
million; labor PAC's, $16 million. That is about a 4-to-1 ratio.
  I want to just make three more points. First, I think that we have to 
figure out a way of financing our campaigns so that people can have 
more faith in our process. By the way, again, I am not talking about 
the wrongdoing of individual officeholders, I am talking about 
something different. I just think that when this kind of money is 
contributed at the same time that we are dealing with an issue that is 
so important to people's lives, it is difficult for people to have 
confidence that we are representing the public interest, that we are 
representing them.
  I think part of the reason there is such anger in the country is many 
people feel ripped off and they think this process is just driven by a 
big money game. It is not just that. But I do not think it looks right, 
and I do not think it is right. I said before on the floor of the 
Senate, and I say it one more time: it is comparable to the referee of 
a soccer game or football game receiving contributions from the two 
teams before the game starts. People would say, ``We're not sure that 
referee can make rigorous, objective decisions that would be best for 
everyone.'' That is my first point.
  My second point, Mr. President, is that I think it does have a 
bearing on policy. From the New York Times front page today just a few 
figures: From January 19, 1993, through May 31, 1994, the American 
Medical Association gave $977,000; the American Dental PAC gave 
$630,000; the National Association of Life Underwriters, $612,000; 
American Hospital Association, $551,000; American Nurses Association, 
$444,000; Independent Insurance Agents of America, $371,000; American 
Family PAC, $345,000.
  We have before us some important decisions we have to make on policy. 
I would like to talk about the ways in which I fear that this virtual 
wall of money sometimes stands between the people we represent and 
Senators and Representatives. For example, how do we contain costs? My 
colleague from North Dakota just spoke eloquently about the need to 
contain costs.
  Mr. President, do you know what the CBO has said rather clearly? If 
we want to have cost containment, if we want to make sure that health 
care costs do not continue to skyrocket, the CBO always focuses in on 
the importance of insurance company premium caps. That is now off the 
table. For some reason that is off the table. Does it have anything to 
do with the power of the insurance industry? Does it have anything to 
do with their ability to effect the tenure or lack of tenure of 
Senators and Representatives? I hope not, but I think this is a way in 
which people have every right to be skeptical as to whether or not the 
insurance industry perhaps is better represented than the vast majority 
of people.
  Second example. Employer mandates. Every time I am in a debate with 
my colleagues on the other side of the aisle, they talk about how 
people now are beginning to question whether any health care reform 
bill should be passed. That is true; $100 million will be spent on TV 
and other advertising before this is all over and plenty of people are 
frightened and scared, and people have a right to raise questions. I 
would not deny any citizen in this country that right.
  But the polls also show overwhelmingly that the vast majority of 
people, throughout all this attack, still say that they believe each 
and every person should be covered, because they know that if some 
people go without coverage, it could be them if they become sick or 
lose their job, and people are absolutely convinced that employers 
should contribute their fair share.
  But when we talk about anything close to what we in Congress, have, 
with our employer contributing 72 percent, or when we talk about 
employers contributing 80 percent, making sure that small businesses 
have a subsidy so they can afford that, that now seems to be off the 
table. Could that have anything to do with the fact that over the last 
6 years $72 million in political contributions has come from business 
PAC's?
  Finally, my last point--and this one bothers me to no end. I was in a 
debate today, a radio discussion, and I asked the host, a conservative, 
good person with an interest in federalism--you have to have a twinkle 
in your eye, you have to enjoy debates and discussions with people. I 
asked him: ``Would you not agree with the proposition that if a State 
wanted to go forward with a single-payer plan, it would be wrong for 
Senators and Representatives to try and knock out of the Mitchell bill 
the option for States to go forward just because the large employers 
want to be carved out, just because the insurance industry does not 
want it to happen? Should it not be the case that if the people of 
Minnesota or Oregon or New York or Iowa themselves vote people into 
office who represent them and the decisions are made at the State level 
that they want to go with a single-payer option, should we not let 
States have that opportunity?''
  I thought the States were to be the laboratories of reform. I thought 
we were a grassroots political culture. I thought we were in favor of 
decentralizing public policy. And, frankly, I just think there is a lot 
of fear about this because I think the evidence is irrefutable; that, 
as a matter of fact, if some States go forward, they will be able to 
cover everyone, it will be good coverage, comprehensive coverage, more 
comprehensive than in any plan that is before us right now and they 
will be able to contain costs. But there is this fierce opposition 
lining up to enable States to have the flexibility to do this.
  Mr. President, could that have anything to do with the huge amounts 
of money that have been poured into the U.S. Congress from health care 
special interests? And not just by health care PAC's. There is too much 
emphasis on political action committees; I also mean individuals within 
the industry, broadly defined, who make the huge contributions.
  I heard one of my colleagues the other day say, ``You know, the 
problem is we have to contain costs and we just don't know when to say 
no. You have all these special interests that are asking for coverage, 
and we don't know how to say no to those special interests.''
  What special interests? People who are uninsured? What special 
interests? Children? What special interests? My colleague from Iowa is 
here. People with disabilities who are saying we hope that you will 
pass a reform bill that will enable us to live at home in as near 
normal circumstances as possible with dignified home-based care, what 
special interests are we talking about?
  I do not see anything in the Washington Post piece yesterday or in 
the New York Times piece today or in any of the analyses I have made 
about the mix and money in politics that tells me any of these people 
are the special interests. But I see a lot of evidence that there are a 
lot of people in this industry, a lot of large companies, a lot of 
hospital supply and equipment companies, a lot of the professionals, 
the insurance companies and all the rest that have poured an 
unprecedented--unprecedented--amount of money into the Congress at 
exactly the time we are debating this piece of legislation. I do not 
hear my colleagues on any of these talk shows talking about those 
special interests at all.
  My final point, Mr. President--and, by the way, I think it would be a 
profound shame if those interests were able to hijack this reform 
effort and if we did not come through with a bill that led to the 
positive improvement in the lives of people.
  I think this health care issue, this debate, and what is happening on 
the floor of the U.S. Senate speaks in as strong and powerful and 
direct way than anything for the need to have tough, comprehensive 
campaign finance reform.
  I will say it just one more time. I am not talking about the 
individual wrongdoing of any office holder. We are all trapped in this 
system. People run for office and you have to raise--what is it?--over 
a 6-year period the standard now is $13,000 a week. You have to raise 
this money to be a viable candidate, so we are told. The campaigns are 
hugely expensive.
  So people try to raise the money, and they raise the money from the 
people who have the money to give. But it undercuts representative 
democracy. If the standard is each person counts as one and no more 
than one--and it should be-- we have moved dangerously far away from 
that.
  So I hope that Senators and Representatives will get going on this 
conference committee. We passed a campaign finance reform bill. It is 
deadlocked. That deadlock should be broken.

  Now, Members of the House say to Senators, you all want us to abolish 
PAC's. How convenient it is for you to say that, Senators, because 
about 60 percent of the big money you raise is through individual 
contributions, large contributions. We raise it from labor and women's 
groups and environmental groups and other groups as well, but we would 
like to focus on how you raise the money.
  It seems to me there can be a compromise. At the very minimum, the 
bill we passed called for an agreement upon spending limits. That is a 
huge first step. Talk about getting rid of soft money, talk about 
having some debates, having some vouchers for being able to buy 
advertising, talk about ways in which we can begin to get some of this 
big money out of politics.
  Now, if the House of Representatives, Mr. President, is willing to 
phase out PAC contributions, then it strikes me that Senators should be 
willing to begin to limit further some of our large contributions. As I 
understand it, one of the proposals is that no more than a third of the 
money Senators raise should be in small contributions. I would not 
settle on a particular figure. I would want it to be something that 
worked. But it does seem to me, Mr. President, that we could drop some 
of our contributions or percentage of what we raise overall in exchange 
for the House being willing to phase down PAC contributions. This 
conference committee could finally meet and bring back to the floor of 
the Senate, and the House a campaign finance reform bill.
  I cannot think of a better reason to do it than what is happening in 
this health care debate right now. All this money pouring in, the same 
imperative of running for office, the same money chase, which undercuts 
representative democracy and undermines people's faith in this process.
  I have come to know colleagues after 4 years here, and there are a 
lot of people on both sides of the aisle who are very committed to 
public service, very committed to doing the right thing, some of whom 
at this moment do not agree with me on this particular issue. That is 
beside the point.
  The point is we ought to really demand that this conference committee 
get moving. We ought to demand that there be some kind of campaign 
finance reform bill passed this year. We ought to demand that we get 
some of this big money out of politics. We ought to demand that we move 
toward a system of representative democracy.
  Mr. President, at this point I yield the floor.

                               Exhibit 1

             Health and Insurance Contributions to Senators

       An analysis released last week by the advocacy group 
     Citizen Action shows that health and insurance companies have 
     contributed $40.1 million to members of the U.S. Senate over 
     the last 15 years. The analysis summarizes campaign 
     contributions received from health and insurance political 
     action committees (PACS) and from individuals giving more 
     than $200 during the same period. The figures are derived 
     from Federal Election Commission reports and include 
     donations from PACs such as those affiliated with health care 
     professionals, hospitals, pharmaceutical firms, clinical 
     laboratories and insurance companies. The individual donors 
     counted identified themselves on FEC reports as being 
     affiliated with either the health or insurance industry. 
     Citizen Action supports a single-payer Canadian style plan 
     for health care reform:

Phil Gramm (R-Tex.)..........................................$1,235,520
Bob Packwood (R-Ore.).........................................1,027,218
Dave Durenberger (R-Minn.)....................................1,021,054
Bill Bradley (D-N.J.)...........................................978,761
Orrin G. Hatch (R-Utah).........................................958,299
Dan Oates (R-Ind.)..............................................913,273
Arlen Specter (R-Pa.)...........................................895,786
Christopher S. Bond (R-Mo.).....................................733,011
Connie Mack (R-Fla.)............................................732,383
Richard C. Shelby (D-Ala.)......................................724,496
John H. Chafee (R-R.I.).........................................721,098
Frank R. Lautenberg (D-N.J.)....................................717,192
Robert J. Dole (R-Kan.).........................................707,794
Alfonse M. D'Amato (R-N.Y.).....................................693,903
Daniel Patrick Moynihan (D-N.Y.)................................670,578
Bob Graham (D-Fla.).............................................639,243
John D. `Jay' IV Rockefeller (D-W.Va.)..........................638,645
Charles E. Grassley (R-Iowa)....................................638,169
Thomas A. Daschle (D-S.D.)......................................620,822
Christopher J. Dodd (D-Conn.)...................................612,154
Kay Bailey Hutchison (R-Tex)....................................611,009
Tom Harkin (D-Iowa).............................................607,423
Richard G. Lugar (R-Ind.).......................................602,772
Jim Sasser (D-Tenn.)............................................568,671
Dianne Feinstein (D-Calif.).....................................534,356
Don Nickles (R-Okla.)...........................................530,658
Trent Lott (R-Miss.)............................................524,303
Max Baucus (D-Mont.)............................................523,364
John C. Danforth (R-Mo.)........................................522,599
Strom Thurmond (R-S.C.).........................................514,512
Mitch McConnell (R-Ky.).........................................513,436
Joseph I. Lieberman (D-Conn.)...................................494,730
George J. Mitchell (D-Maine)....................................491,633
Richard H. Bryan (D-Nev.).......................................478,227
William V. Roth Jr. (R-Del.)....................................467,402
Donald W. Riegle Jr. (D-Mich.)..................................458,167
John Breaux (D-La.).............................................450,707
Ernest F. Hollings (D-S.C.).....................................443,763
Kent Conrad (D-N.D.)............................................440,853
Slade Gorton (R-Wash.)..........................................428,956
John McCain (R-Ariz.)...........................................421,253
Bob Kerrey (D-Neb.).............................................417,999
Jesse Helms (R-N.C.)............................................416,530
Howel T. Heflin (D-Ala.)........................................413,313
Paul Simon (D-Ill.).............................................403,270
Harry M. Reid (D-Nev.)..........................................398,722
Dennis DeConcini (D-Ariz.)......................................396,683
Hank Brown (R-Colo.)............................................369,243
Jeff Bingaman (D-N.M.)..........................................347,695
Byron L. Dorgan (D-N.D.)........................................343,846
Harris Wofford (D-Pa.)..........................................342,921
Carl M. Levin (D-Mich.).........................................342,170
Larry Pressler (R-S.D.).........................................338,687
Wendell H. Ford (D-Ky.).........................................332,440
J. James Exon (D-Neb.)..........................................326,825
Charles S. Robb (D-Va.).........................................325,677
Barbara A. Mikulski (D-Md.).....................................313,912
Edward M. Kennedy (D-Mass)......................................308,689
John Glenn (D-Ohio).............................................293,312
Thad Cochran (R-Miss.)..........................................292,217
David Pryor (D-Ark.)............................................290,914
Alan K. Simpson (R-Wyo.)........................................287,123
Pete V. Domenici (R-N.M.).......................................286,579
John F. Kerry (D-Mass.).........................................282,109
Malcolm Wallop (R-Wyo.).........................................262,754
James M. Jeffords (R-Vt.).......................................250,791
Dale Bumpers (D-Ark.)...........................................250,185
J. Bennett Johnston (D-La.).....................................247,066
Barbara Boxer (D-Calif.)........................................244,282
Judd Gregg (R-N.H.).............................................238,749
Daniel K. Inouye (D-Hawaii).....................................236,300
Mark O. Hatfield (R-Ore.).......................................231,665
John W. Warner (R-Va.)..........................................223,690
Robert C. Smith (R-N.H.)........................................205,700
Larry E. Craig (R-Idaho)........................................198,676
Paul Coverdell (R-Ga.)..........................................197,807
Frank H. Murkowski (R-Alaska)...................................194,950
William S. Cohen (R-Maine)......................................193,091
Ted Stevens (R-Alaska)..........................................188,750
Sam Nunn (D-Ga.)................................................183,037
Paul S. Sarbanes (D-Md.)........................................177,100
Robert C. Byrd (D-W. Va.).......................................170,167
Lauch Faircloth (R-N.C.)........................................165,960
Conrad Burns (R-Mont.)..........................................165,700
David L. Boren (D-Okla.)........................................162,260
Joseph R. Biden Jr. (D-Del.)....................................158,393
Claiborne Pell (D-R.I.).........................................156,430
Howard M. Metzenbaum (D-Ohio)...................................145,587
Daniel K. Akaka (D-Hawaii)......................................129,488
Ben Nighthorse Campbell (D-Colo.)...............................126,919
Patrick J. Leahy (D-Vt.)........................................104,000
Carol Moseley-Braun (D-Ill.).....................................97,442
Dirk Kempthorne (R-Idaho)........................................92,352
Russell Feingold (D-Wis.)........................................87,033
Robert F. Bennett (R-Utah).......................................84,700
Nancy Landon Kassebaum (R-Kan.)..................................83,448
Patty Murray (D-Wash.)...........................................33,052
Paul D. Wellstone (D-Minn.)......................................24,875
Herb Kohl (D-Wis.)...............................................23,960
Harlan Mathews (D-Tenn.)..........................................3,000

     Note.--Period covered for PACS is through the most recent 
     filing, usually June 30, 1994. Includes large donor 
     contributions through March 31, 1994.
                                  ____


             Lawmakers Feel the Heat From Health Care Lobby

                        (By Katharine Q. Seelye)

       Washington, August 15.--The telephone callers to Senator 
     John B. Breaux, a Louisiana Democrat and an influential voice 
     in the debate over health care, are stacked up like planes 
     over National Airport. ``Senator Breaux's office. Can you 
     hold?''
       The Senator's phones are ablaze from dawn until well past 
     dark, with the answering machine collecting at least 200 more 
     messages overnight. Clogged phone lines are one price that he 
     and some of his fellow legislators pay for staking out an 
     independent position on what many say is the most heavily 
     lobbied issue in the nation's history.
       Sentor Breaux and three members of Congress talked recently 
     about their experiences with the health care lobby, painting 
     a picture of special interests overwhelming the decision-
     making process.
       At least 650 groups spent more than $100 million from 
     January 1993 to last March to influence the outcome of health 
     care legislation, according to a recent study by the Center 
     for Public Integrity, a nonprofit Washington group that 
     examines public issues. The spending has only intensified 
     since then.
       ``There is no issue of public policy in which the sheer 
     strength of those special interests have so overwhelmed the 
     process as in the health care reform debate,'' the center 
     said.
       Most of the money goes to the brigade of lobbyists who 
     buttonhole members of Congress on behalf of their clients; 
     some of the money goes directly into the campaign coffers of 
     senators and representatives whose votes they hope to 
     influence. Most of the clients, including many hospital and 
     doctors' associations, oppose comprehensive changes in the 
     nation's health care system, but others, like the leaders of 
     some labor unions and the American Association of Retired 
     Persons, are pushing for the Democratic leadership's bills.
       ``This is the biggest-scale lobbying effort that's ever 
     been mounted on any single piece of legislation, both in 
     terms of dollars spent and people engaged,'' said Ellen 
     Miller, executive director of the Center for Responsive 
     Politics, another Washington-based nonprofit research group. 
     ``It is more fully engaged across the country and at a higher 
     profile inside the Beltway than ever before.''
       The Annenbery School for Communication at the University of 
     Pennsylvania predicts that by October the amount spent by 
     lobbyists on television advertising alone will exceed $60 
     million--more than the $50 million spent on advertising in 
     the 1992 Presidential campaign.
       Citizen Action, a consumer group, has examined the campaign 
     contributions made by lobbyists for health and insurance 
     interests over the years. It reports that for the last 14 
     years, the political action committees representing those 
     interests contributed more than $150 million to Congressional 
     re-election campaigns to ``keep health reform off the 
     national agenda.''
       Citizen Action says these political action committees are 
     spending more than $2 million a month to modify a health care 
     overhaul or kill it outright. They contributed $26.4 million 
     to campaigns from January 1993 to last May, with the biggest 
     donations going to members of committees that produced health 
     care legislation.
       For example, Citizen Action said, members of the House Ways 
     and Means Committee and the Energy and Commerce Committee 
     received, on average, $27,000 more in this session of 
     Congress than in the previous session, while their colleagues 
     who served on no health-related committees received an 
     average increase of $3,000 over the same period.
       In the Senate, the report said, members of the Finance 
     Committee, which produced a proposal that George J. Mitchell 
     of Maine, the majority leader, drew on for his bill, received 
     the biggest contributions, averaging $600,000 since 1979. 
     Four members of Congress received more than $1 million from 
     the health and insurance industry since that time. They were 
     Senators Phil Gramm of Texas, Bob Packwood of Oregon and Dave 
     Durenberger of Minnesota, all Republicans, and Representative 
     Richard A. Gephardt of Missouri, the House majority leader.
       Given the amount of money and the intense competition, 
     ``the Oval Office is reduced to just another trade 
     association,'' said Charles Lewis, executive director of the 
     Center for Public Integrity.
       Senator Breaux said the lobbying ``makes it more difficult 
     to find middle ground.'' He added that pressure from unions, 
     political parties, hospital associations, doctors and the 
     Chamber of Commerce had already pushed some members of 
     Congress to make commitments.
       One of the most effective groups has been the National 
     Federation of Independent Business, which represents 607,000 
     small-business owners. ``The N.F.I.B has more people on the 
     floor of the House than the White House has,'' Mr. Lewis 
     said. ``They are spending millions because billions are at 
     stake.''
       Terry Hill, a spokesman for the federation, says the 
     livelihoods of his members are at stake. ``This is one of the 
     biggest issues we have ever worked on, and it's the most 
     irate and incensed I've ever seen the membership,'' he said.
       In the bill introduced by Senator Mitchell, the federation 
     has helped to stave off any requirement that employers pay 
     their workers' insurance, at least for a few years. On the 
     House side, the small-business lobby has helped rouse 
     opposition to the requirement the employers pay 80 percent of 
     the cost of their workers' insurance, as proposed in the bill 
     offered by Mr. Gephardt.
       Big business, which at first applauded President Clinton's 
     efforts to change the health system, now generally sees less 
     urgency in change and is pretty much against it.
       ``With the economy stronger and a temporary slowdown in 
     inflation for health care, many companies believe they don't 
     need a systemwide solution, that they can solve their own 
     problems,'' Mr. Wiener said.
       He added: This has clearly been startling for the Clinton 
     Administration, which larded up its health care proposal with 
     a lot that was very favorable to big business. But the 
     distrust of government triumphed.''
       This distrust has undermined efforts by unions and other 
     groups that have been lobbying on behalf of health care 
     changes. While union leaders have been pushing for universal 
     coverage and cost controls, Mr. Wiener said, many of their 
     rank-and-file members fear they will suffer if the Government 
     fiddles with the good coverage they enjoy now.
       The lobbying has become so fierce, fractious and well-
     financed, said Mr. Lewis of the Center for Public Integrity, 
     that it can ``overwhelm the decision-making process.''


                             john b. breaux

                        A Must-See for Everybody

       John B. Breaux says he has been hit on by ``everyone from A 
     to Z.'' This means not just the big, professional interests, 
     but also musical therapists, witch doctors and wart removers, 
     all of whom want their specialties covered.
       His office, with its row of colorful football helmets and 
     his case of tennis trophies, is now a must stop on the 
     lobbying circuit. This is partly because Senator Breaux has 
     yet to commit himself to a specific health care plan. It is 
     also because he is one of the mainstream group producing its 
     own set of amendments to the Mitchell bill. Some on Capitol 
     Hill think this bipartisan group may provide the needed heft 
     to get a health care bill through the Senate this session.
       ``Liberals want to do everything all at once and hope they 
     got it right, and conservatives want to do nothing and take a 
     long time to do it,'' he said. ``I'm trying to take one step 
     at a time and make sure we get it right. When you're in the 
     middle, you get beat up by both sides.''
       Mr. Breaux, who was elected to the Senate in 1986, is not 
     unfamiliar with the ways of Washington. He came to the house 
     in 1972 as its youngest member--he was then 28--to replace 
     Edwin W. Edwards, on whose staff he had served. (He came from 
     the same small Cajun town as Mr. Edwards, who is now 
     Louisiana's Governor.
       At the start of the debate over health care, the Senator 
     said, many of the lobbyists were useful because they provided 
     details on subjects that lawmakers did not have time to delve 
     into on their own. But now things are more intense.
       ``We've long passed informational lobbying; now we're at 
     break-your-arm lobbying,'' he said.
       Many are callers from orchestrated campaigns who tell him 
     to vote yes or no. ``I try to hang up on the ones not from 
     Louisiana,'' he said. ``People will really badger you. People 
     will call up and be really ugly sometimes, and threatening.''
       ``People have been scared,'' Mr. Breaux continued. ``That's 
     a great tactic if you want to get people to be against 
     something. You instill the fear that Congress is going to do 
     something to you rather than for you.''
       Moreover, President Clinton's initial proposal ``was 
     technically do-able, but politically not do-able,'' the 
     Senator said. ``It was too much, too soon, too complicated, 
     too bureaucratic, too Washington-oriented.''
       Reforming health care may be extremely complex, but Senator 
     Breaux has set what may be an even higher goal for himself. 
     ``I'm trying to achieve survival,'' he laughed. ``I'll do 
     well if I survive.''


                             bill brewster

                    Lone Pharmacist Far From Lonely

       Bill Brewster is the only registered pharmacist in the 
     House. This makes him particularly sensitive to the pitches 
     from the multifaceted pharmaceutical lobby that has been 
     patrolling Capitol Hill.
       But Mr. Brewster, a 52-year-old Democrat who represents a 
     sprawling rural district in southern Oklahoma, is also a 
     small-business owner, a cattleman and a hunter. He is a man 
     of many interests, and many interests have been seeking him 
     out.
       ``We've heard from more groups than I knew there were in 
     America,'' he said of the health lobbyists, many of whom 
     represent hospitals, doctors and pharmacists.
       ``There's a lot of different pharmacy groups,'' he said, 
     ``and they're all at each other's throats.''
       The main issue within the pharmaceutical industry, Mr. 
     Brewster said, is a drug pricing. ``The pharmaceutical 
     manufacturers are on one side, and they've got every lobbyist 
     hired in town,'' he said. ``The ones they haven't hired are 
     working for the National Association of Retail Druggists and 
     pharmaceutical associations.''
       As a member of Ways and Means, Mr. Brewster said, he was 
     lobbied most heavily from February until late June when the 
     committee passed its proposed bill. ``Obviously they worked 
     the members on the committees prior to the committee votes,'' 
     he said of the lobbyists. Partly because the Gephardt bill 
     has stalled, he said, ``I'm having fewer contacts right 
     now.''
       Mr. Brewster was identified by Citizen Action, the watchdog 
     group, as the ninth top recipient in the House of money from 
     all health and insurance industry political action committees 
     from January 1993 to May 1994. And the Center for Public 
     Integrity identified him as among those who took the most 
     trips sponsored by the health-care industry. Mr. Brewster 
     took 10; the top member took 11.
       ``Who contributes to me has nothing to do with it,'' Mr. 
     Brewster said. ``I figure, anyone who contributes feels like 
     I'm doing a decent job and wants to have good government. I 
     try to look at an issue first off, how it affects my 
     district.''
       The economy in his district is based on small businesses, 
     farms and oil and gas interests. He said he was getting ``a 
     tremendous amount of pressure'' from small-business owners, 
     who oppose any provision to require employers to pay for 
     workers' health insurance. He said he had received numerous 
     letters saying, ``I don't have insurance but I do have a 
     job--please don't mandate insurance coverage that puts my 
     boss out of business and puts me out of a job.''
       He is unhappy with both the Gephardt bill and a rival plan 
     proposed by Representative Jim Cooper of Tennessee, which has 
     attracted some Republican support, on the grounds that they 
     try to do too much. ``If we try to provide a plan that's not 
     intrusive to the 85 percent who have insurance, provide 
     access to preventive care for the 15 percent who don't and 
     went home, the public would be very happy.''


                              Paul Mc Hale

                    Former Marine Faces New Battles

       Paul McHale of Bethlehem, Pa., has approached the health 
     care debate with the order and determination of the most 
     serious student in the class. A 44-year-old former marine who 
     left the Pennsylvania Legislature to return to active duty 
     for the war in the Persian Gulf, his mission is to conquer 
     every detail and do the right thing.
       ``To do justice in evaluating any of the pending 
     comprehensive health care plans,'' said Mr. McHale, a first-
     term Democrat, ``it is absolutely essential for a member of 
     Congress to have done an extensive amount of mind-numbing 
     reading prior to the examination of any individual bill.
       ``Once you know the basic building blocks, once you know 
     the concepts, you can quickly recognize how they're being 
     fitted together. Now when I'm lobbied--by ordinary 
     constituents, businessmen and women and professional 
     lobbyists--when they come in, the dialogue becomes whether or 
     not my position comes close to theirs and whether either of 
     our positions can be found in one of the pending bills.''
       For the moment, Mr. McHale's cannot. An original backer of 
     the alternative discussed by Representative Jim Cooper, the 
     Tennessee Democrat, Mr. McHale said he was disappointed in 
     the plan's final, conservative shape.
       He is also unhappy with the Gephardt plan. He opposes 
     making small-business owners pay for their workers' 
     insurance, and he does not like expanding Medicare, which he 
     says would not control costs.
       All of which makes him a legislator in search of a bill to 
     support. ``The best way to affect my vote is to provide me 
     with information,'' he said. While all the usual suspects 
     have inundated Mr. McHale with information--last week alone, 
     he was visited by at least two dozen lobbyists, including 
     representatives of three drug companies, six of the largest 
     businesses in his district, two unions, including the 
     steelworkers, local health care plans, and four hospital 
     associations--he is still in search of more.
       This has left him open to attacks from all sides. 
     ``Yesterday a very good friend who is a well-respected leader 
     of organized labor said I was too conservative,'' he said. 
     ``And right after that, the National Federation of 
     Independent Business conducted a press conference back in my 
     district where they criticized my position as too liberal.''
       ``In the final analysis, I'm going to pull back in, find a 
     quiet corner, think about what's good for our country and 
     vote on the issue as if it were a secret ballot,'' he said.
       With that, it is time for a House vote. Mr. McHale checks 
     his watch and steps briskly out the door. ``It takes me six 
     minutes and 35 seconds to get there,'' he said. ``I've got 
     this route timed out.''


                            jose e. serrano

                   A Caucus Leader Feels the Pressure

       Jose E. Serrano represents the South Bronx, one of the 
     poorest districts in the nation, its striking poverty and 
     vast expanses of rubble made famous by visits by Presidents 
     Jimmy Carter and Ronald Reagan. A full 60 percent of the 
     district is Hispanic, which helped catapult this 50-year-old, 
     two-term Democrat to the chairmanship of the 19-member 
     Hispanic caucus in Congress.
       Thus Mr. Serrano has not only the interests of his district 
     to worry about but also the interests of his caucus. He said 
     they are generally one and the same. But he also has to worry 
     about the interests of New York City, and that can be cause 
     for Angst.
       The health care industry in New York provides 300,000 jobs, 
     the city's biggest segment of service-oriented jobs, and it 
     has been one of the fastest-growing sectors of the economy. 
     Mr. Serrano has to worry about those jobs--many hospital 
     workers are Hispanic--as well as ensure that the hospitals 
     will continue to treat poor patients, regardless of their 
     immigration status.
       Another big concern is how New York's teaching hospitals, 
     among the nation's most eminent, will fare under any new 
     health care legislation. The bill offered by Representative 
     Richard A. Gephardt of Missouri, the majority leader, 
     proposes a limit on the number of medical residents at such 
     hospitals; Mr. Serrano wants to make sure that whatever the 
     number, Hispanics are fairly represented.
       Mr. Serrano said the caucus was worried about preventive 
     care and about whether a national health insurance system 
     would require people to carry identification cards and what 
     uses those cards might be put to. But it has supported the 
     most controversial provision of the Gephardt legislation, the 
     requirement that employers pay 80 percent of the cost of 
     their workers' health insurance.
       Mr. Serrano hears most often not from insurance companies 
     or other giants of the health care debate, but from fellow 
     caucus members and strictly local interests, particularly the 
     teaching hospitals.
       Mr. Serrano is sympathetic to some of the hospitals' 
     concerns, but he wants them to admit more local residents 
     into their training programs. ``Maybe it's time for me to do 
     a little lobbying,'' he said, clearing his throat, pinching 
     his collar and straightening his tie.
       In his office, which features portraits of Robert F. 
     Kennedy and Martin Luther King Jr., Mr. Serrano pointed out 
     that ``not all the lobbying is done right here. Anywhere you 
     are, you get lobbied.''
       He added, ``It's people saying, `Listen, you want this? You 
     want that? You want this? You want that? Fine.'''
       He reached for a piece of paper. ``This is the White House 
     lobbying,'' he said. ``It has my name on it. They ran off a 
     beautiful computer thing that singles out your district. It 
     gives me information I didn't have, that there are people in 
     my district who are not covered by Medicaid and Medicare and 
     who need universal coverage.''
       The analysis said that 94,000 people, including 36,000 
     children, in Mr. Serrano's district had no health coverage. 
     It also said that with universal coverage, the 72,000 middle-
     class families in his district earning $20,000 to $75,000 
     annually would save an average of $612 a year on insurance 
     premiums.
       The grass-roots groups, he said, ``remind you of what it is 
     they do and their value to society and why we have to be 
     careful not to hurt them.''
       He said insurance companies are the ``toughest'' lobbyists 
     ``because they're very negative in their approach. They say, 
     `Everything is O.K. Why don't we leave things the way they 
     are?' It's hard to negotiate with someone who believes no 
     change is needed.''
       The leading health and insurance political action committee 
     contributors, Jan. 1, 1993, through May 31, 1994.

American Medical Association...................................$977,704
American Dental PAC.............................................630,553
National Association of Life Underwriters.......................612,301
American Hospital Association...................................551,266
American Nurses' Association....................................444,446
Independent Insurance Agents of America.........................371,260
American Family PAC.............................................345,850

Source.--Citizen Action, a consumer group that supports a Canadian-
style health system.


                    keeping track--who gets the most

       Recipients of campaign contributions from the health and 
     insurance industries political action committees from Jan. 1, 
     1993, through May 31, 1994.

                        Top 10 Senate Recipients

1. Kay Bailey Hutchison (R-Texas)..............................$611,009
2. Joseph I. Lieberman (D-Conn.)................................294,020
3. Connie Mack (R-Fla.).........................................293,455
4. Daniel Patrick Moynihan (D-N.Y.).............................280,485
5. John H. Chafee (R-R.I.)......................................272,549
6. Orrin G. Hatch (R-Utah)......................................267,141
7. Dianne Feinstein (D-Calif.)..................................235,755
8. Bob Kerrey (D-Neb.)..........................................223,299
9. Edward M. Kennedy (D-Mass.)..................................221,439
10. Kent Conrad (D-N.D.)........................................216,200
   John B. Breaux (D-La.).........................................5,250

                        Top 10 House Recipients

1. Jim Cooper (D-Tenn.)........................................$540,145
2. Richard A. Gephardt (D-Mo.)..................................228,476
3. Jon Kyl (R-Ariz.)............................................201,758
4. Pete Stark (D-Calif.)........................................190,245
5. Jack Fields (R-Texas)........................................190,215
6. Michael A. Andrews (D-Texas).................................176,925
7. Dan Rostenkowski (D-Ill.)....................................169,050
8. Newt Gingrich (R-Ga.)........................................141,611
9. Bill Brewster (D-Okla.)......................................130,614
10. Robert T. Matsui (D-Calif.).................................129,354
   Paul McHale (D-Penn.)..........................................8,540
   Jose E. Serrano (D-N.Y.).......................................7,000

Source.--Citizen Action, a consumer group that supports a Canadian-
style health system.

  Several Senators addressed the Chair.
  The PRESIDING OFFICER (Mr. Mathews). The Senator from Iowa.
  Mr. HARKIN. Mr. President, I thank the Chair. I will not take too 
much time, I say to the Senators seeking recognition.
  Mr. President, I wish to compliment and thank again my friend and 
colleague from Minnesota for his very eloquent words. He is right on 
the mark on the issue of trying to get back to representative 
democracy, and we will not do it until we have adequate campaign 
finance reform. So I thank the Senator for his contribution in that 
area.

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