[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 Senate continued with the consideration of the bill.
  Mr. D'AMATO. Mr. President, I do not intend to speak for hours in an 
opening statement on health care. But I do intend to reflect my 
feelings and those of an overwhelming number of my constituents in New 
York, at least those who have taken the time to call my office or write 
to us either here in Washington or in one of the offices that I have 
throughout the State of New York.
  I think, Mr. President, that there probably is no area that is more 
important than the area of health care as it relates to each of us 
individually, as it relates to our families, as it relates to the 
American people. It is an area that no one can doubt needs reform. We 
need to improve it. But despite its flaws, it is still the best health 
care system in the world, bar none, the best. I daresay that if the 
poorest of the poor in this country had a problem, they would get 
better medical treatment here than Boris Yeltsin gets in Russia. 
Indeed, if Boris Yeltsin had a severe medical problem, he would 
probably come to this country, if he could, to get medical treatment.
  So let us not take that choice away from Boris Yeltsin. More 
importantly, let us not take that choice away from the American people.
  I have a piece of advice because I have been hearing a lot of people 
offering advice. I say to the President and to the First Lady, passing 
bad legislation that the American people do not want is not good 
politics, and it is not good government. Take it either way. It seems 
to me that what is taking place--at least that is the feeling that I 
get--is that some would have us act such that we would not make 
corrections that we all know need to be made, and not improve the 
system that we know can and should be improved. But, no, they say you 
must take the whole thing. Otherwise, we will accuse you of playing 
politics. Otherwise, we will say that you are holding captive this 
important piece of legislation.
  I say we were not sent here by the people to surrender good judgment 
on the altar of political expedience, or under threat of being kept in 
session around the clock. We were sent here to work to bring about a 
better system if possible, but not to destroy the best system that 
exists in the world.
  Less than 2 weeks ago, we got our first look at Senator Mitchell's 
health reform package.
  That was a bill of some 1,410 pages, 46 pages longer than even the 
1,364-page Clinton bill. That was less than 2 weeks ago. The 
ramifications in that legislation--and it is voluminous--reach right 
into everyone's home. And the people have a right to know, how does 
this legislation affect them, and how does it impact the plan that they 
have at the present time? The people have a right to real answers.
  I daresay that there are many of my colleagues who do not have those 
answers. I do not have all of the answers. I am still learning.
  That was 2 weeks ago when the first bill was placed on our desks. 
Then when I checked my desk Wednesday, I found that the bill had grown, 
and this new bill--call it Mitchell 2--was 1,448 pages long, 84 pages 
longer than the Clinton bill. And, yes, on this Saturday we were 
presented with the third Mitchell bill, 1,443 pages long, actually 5 
pages less than the second one. There is a rumor that there may be 
Mitchell 4; I do not know. But I do know that we cannot implement 1, 2, 
or 3 without doing significant harm to our American health care system 
and the American taxpayers. I do know that it is a flawed bill, deeply 
flawed.
  Whichever bill you choose, the result is the same: More taxes, more 
new entitlements, and much more Government intrusion into our health 
care system.
  Mr. President, I do not intend to tie up my colleagues on the floor, 
but I think these things have to be said. I do not intend to speak for 
2 or 3 or 4 hours on this. This is not an attempt to impede, but it is 
an attempt to educate. I have to tell you that as the days go by, more 
and more people call, and some call and say: You know, we want there to 
be changes, but we want you to do it the right way. Do not just rush 
this through. Take your time. That is what the sentiments of these 
people are, and it is the gist of the numbers which I am going to share 
with you in a little while.
  This bill contains hundreds of billions of dollars in new taxes--
taxes that could have a devastating impact on middle-class America, 
taxes and costs on existing health plans that go well beyond what 
people have ever imagined. Let me just cite two of these new taxes. 
There is a 25-percent tax on health insurance premiums that grow faster 
than a premium cap. Who establishes this cap? Some board on some vague 
principles that no one knows about. If you turn to page 1170, section 
4511(a)(1), it states:

       If a community-rated certified standard health plan is a 
     high-cost plan--

  I do not know what this high-cost plan is. It very well could be that 
the plans most people have would be rated high-cost.

     for any coverage period beginning after December 31, 1996, 
     there is hereby imposed a tax equal to 25 percent of the 
     excess premiums of that plan.

  Mr. President, this tax could force millions of Americans to pay more 
taxes on the plans that they have already chosen. That is not me saying 
this. That is the Congressional Budget Office. They say:

       Virtually all plans would be subject to the assessment 
     called for in Senator Mitchell's proposal.

  The words have meaning. We are talking about something of some 
tremendous significance. So someone who has worked and has bargained 
and who has achieved a plan that in December 1996, may be considered to 
be one of these so-called high-cost plans, finds him or herself in a 
situation where their premiums are raised 25 percent. Let me suggest 
that all the legislation in the world that says the insurance company 
cannot pass the cost on is not worth anything. Do you mean to tell me 
that you are going to raise a tax of 25 percent on the excess of that 
part that you say is too rich? Since when should people be penalized 
for buying health care insurance, whether or not they have bargained 
for it, that is excellent and fully comprehensive.
  I thought this was the United States of America, where people had the 
right to invest in those plans that would give to their families the 
best protection. Now we are going to penalize them. It is absurd to say 
that insurance companies are not going to pass that extra cost on and, 
indeed, some insurance companies, in order to beat that, will raise 
their costs between now and December 1996. This tax will apply 
regardless of the reason the plan was considered high-cost. But it is 
most likely to affect desirable plans which seek to provide the highest 
quality benefits and the broadest choice of providers--or those that 
cover the sickest individuals.
  I cannot understand that. That is under the name of cost containment. 
That is Government regulation at its worst. If we want to get ourselves 
into deep trouble, let us adopt this kind of philosophy. We could be 
debating this principle alone, and its cost and implications, for days, 
and for anyone to suggest that we adopt this whole thing, take it or 
leave it, within a period of hours, days or weeks, is simply wrong. 
That is not why we were sent here. Take it or leave it, or we are going 
to keep you in like little children. You will not be able to go home. 
So what, that is our job. Are we supposed to be cowed by that and 
ignore our rights, and ignore the fact that we were elected to come 
here to look at these provisions, to examine them? These are important, 
these are critical, these are life and death issues.
  I suggest to you that any plan that is so important to the life and 
health of the people of this country should never have been designed in 
a back room with the 600 people in the task force that came together, 
without the benefit of real, comprehensive hearings, and without the 
benefit of a full examination of all of the details that are critical 
to the life of this country and its people. I think it would be a 
political charade if we pushed something through for the sake of saying 
we pushed it through. That is politics and government at its worse.
  CBO estimates that this tax would cost American taxpayers $70 billion 
over a 10-year period of time. Just that 25 percent tax. I have to tell 
you that if you look at CBO estimates, if you look at what they 
estimated the cost of Medicare would be, you would find out that it has 
increased about seven times more than their original estimate. It was 
seven times more. I do not know whether this is going to be $70 
billion. It is certainly not going to be less than $70 billion.
  Here is another tax. There is a 1 percent tax on health insurance 
premiums levied by the State to fund ``administrative expenses.'' That 
only amounts to $50 billion. We take that tax and the other taxes 
levied in this bill and we come out to a total of over $300 billion in 
new taxes.
  Then again when we have people say, ``Oh, well, do not worry; 
Government can do it better, faster, more efficiently, and more 
effectively.'' On want planet? That must be a planet I am not aware of. 
That is certainly not true in this country, and I know of no other 
country on the planet where it is.
  This bill creates and empowers dozens of new Government 
bureaucracies.
  And there is one in particular that would have devastating 
consequences for my home State of New York, one which the senior 
Senator from New York, Senator Moynihan, eloquently addressed--a new 
Council on Graduate Medical Education. We are going to take a bunch of 
bureaucrats, and they are going to determine for us how many doctors we 
should have and what their specialty should be.
  I wonder who it is going to consist of. Will Hillary be on that 
council? Will she tell us how many thoracic surgeons, how many 
specialists there will be in various specialties? Incredible. We are 
now going to micromanage the health of America so that the Federal 
bureaucrats will determine who the specialists in America will be and 
how many. Fabulous. Fantastic.
  They even had a hard number in their original bill. They effectively 
said that you are going to have to eliminate right off the bat in New 
York over 3,000 residents, specialists who come in and get the best 
training, specialists who, by the way, are dispersed throughout this 
country and through parts of the world.
  Let me tell you what this would mean. New York trains 11 percent of 
all the country's medical students and nearly 16 percent of the medical 
residents. Imagine. They have already determined --and I do not know 
where or how this was determined--that they are going to reduce the 
total number of medical residents across the board by one-fifth, and 
that results in a loss of 3,000 medical residents in New York City 
alone.
  Well if we are going to talk about Government deciding how many 
specialists we are going to have--how many cancer specialists, how many 
heart specialists--do you not think that we should have some thorough 
and comprehensive debate as to how this is--testimony not from 
politicians, but from leading educators, from people in the field, as 
to whether or not that is an idea we should even contemplate? Do you 
not think that would be deserving of some kind of introspection, some 
kind of close examination? And I do not mean on the floor of the Senate 
with no facts, with no basis by which to make our judgments. This 
procedure is an absolute sham. We should not be proceeding on this bill 
in this manner.
  I have just touched on two items, and they are pretty doggone 
important to the health of this country.
  And there are thousands of items that are as critical if not more 
critical jammed into this bill that affect the lives of every American. 
That is why Americans are on the telephone and why they are calling. 
And I have these numbers I will submit as a representation of the calls 
that have come into our office from August 8 to August 16 up to 12 
o'clock.
  New York City, against implementing a health care bill this year--by 
the way, most of these people have expressed that they want reform, but 
they say do it right, do not rush it this year, wait until next year, 
and then go ahead--against, 475; in favor of going ahead and enacting 
the Mitchell bill, 291. Even in New York City the ratio is clearly 3 to 
2 against going forward.
  Rochester, NY, 162 against; 12 for--14 to 1 against going forward.
  Our Washington, DC, office--and most of these people call from New 
York City--691 against; 258 for going forward, almost 3 to 1 against 
going forward.
  Albany, NY, 190 against going forward; 25 for going forward, a ratio 
of 7.5 to 1 against.
  Buffalo, 563 against going forward and adopting this bill.
  I tell you if we began to examine this bill in the kind of detail 
that we should in terms of discussing just some of the issues that I 
have brought up here, you will find these numbers will go off the 
chart, and I will assure you that this Senator will look to discuss 
even in as limited and circumscribed a manner as this body prescribes 
that we examine the issues, that we examine them. They are too 
important just to be shoved through without debate.
  Syracuse, 452 against to 35 for, a ratio of 13 to 1 against.
  All in all, it is almost 4 to 1 against, 2,534 to 750.
  Mr. President, I ask unanimous consent to have printed in the Record, 
the tally of health care calls with reference to the Mitchell bill.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

      HEALTH CARE CALLS IN MITCHELL BILL: 8/8-8/16, AS OF 12:00 PM      
------------------------------------------------------------------------
                                               Against     For    Ratio 
------------------------------------------------------------------------
New York City...............................        475     291   1.65:1
Rochester...................................        162      12     14:1
Washington, DC..............................        691     258    2.7:1
Albany......................................        190      25    7.5:1
Buffalo.....................................        563     129    4.4:1
Syracuse....................................        453      35     13:1
                                             ---------------------------
    Total...................................      2,534     750    3.5:1
------------------------------------------------------------------------

  Mr. D'AMATO. Mr. President, as I have said, the loss of these 
residents to New York will have devastating consequences on New York, 
but it is also devastating to the Nation when one stops to think that 
we train almost 16 percent of the medical residents in this Nation.
  It would cost us 3,000 residents. I tell you that the cost would be 
incalculable as it relates to the quality of medical care in the New 
York urban area. The financial cost alone would be well over $500 
million. The quality of care that our people would have would diminish 
tremendously just in this one area.
  Mr. MOYNIHAN. Will the Senator yield for a question?
  Mr. D'AMATO. Certainly.
  Mr. MOYNIHAN. When the Senator speaks of a resident in a hospital, he 
is talking about a doctor?
  Mr. D'AMATO. Correct.
  Mr. MOYNIHAN. The doctor.
  Mr. D'AMATO. Fully certified doctor who is getting his specialty--his 
training--and some going on into the specialties. And so we would be 
taking out--and I thank my colleague for making the point--3,000 fully 
trained doctors, some of them working in their specialties. We would be 
removing them from servicing the needs of the urban poor. It has been 
estimated that to replace them would cost somewhere in excess of $566 
million annually in New York alone. You would have the same kinds of 
consequences in other key centers throughout this Nation.
  Again, I would emphasize the absurdity of thinking we are going to 
turn it over to a Federal bureaucrat or a board to determine how many 
doctors in the various specialties there will be. Have we not ever 
learned about the law of supply and demand? While the rest of the free 
world is looking to come to a market oriented economy, here we are 
moving in the other direction, with Big Brother determining the 
allocation of medical specialists in our Nation. We are not talking 
about plumbers and carpenters and saying maybe we have to increase the 
emphasis on them in our trade schools. We are talking about life and 
death matters. We are talking about people who want to dedicate 
themselves to the service of others. And some bureaucrat is going to 
determine this.
  Mr. President, the Federal Government, to be parochial, does not have 
the right to tell New York, or any other city for that matter, how to 
run its medical schools and teaching hospitals and does not have the 
ability to do that. I spoke to Dr. DeBakey, the great surgeon, the 
great pioneer at Baylor College of Medicine in Houston, and he 
absolutely could not believe it and made reference to what a blow this 
would be to science and to medical care if we were to attempt to 
implement this. By the way, this board's decisions would be final. They 
are the arbiters.
  Mr. ROCKEFELLER. Will the Senator from New York yield?
  Mr. D'AMATO. No; I will not. I have been waiting for days and days. I 
am not going to speak for hours. I want to make my point.
  Young Americans who grow up wanting to be doctors should not be told 
by a Government bureaucrat what career they will be placed in. They 
should not be told we have too many doctors in this specialty or that 
specialty. If they want to try to make it and they have the ability to 
make it, then they have the right to try. There is something called the 
law of supply and demand.
  Government bureaucrats should not have the right to tell any American 
what health plan is best for them, and that if you have one better than 
the standard benefits package we are going to assess you, we are going 
to tax you for it, you are going to pay more for it. The American 
people do not want a Government-run health care system. They want 
Congress to fix what is broken and to leave alone what is not. And we 
have an obligation to fix what is broken.
  We can easily identify it, and we have. But for some reason, we do 
not want to just fix that which is broken. We want to go beyond. We can 
fix what is broken by enacting commonsense reforms that Members of both 
parties already agree will help solve the biggest problems in our 
health care system, reforms like portability, so those who move or 
change jobs can take their coverage with them; insurance protection, so 
people with preexisting medical conditions will not be denied coverage 
and those who fall ill will not have their coverage dropped; and tax 
reforms. My gosh, why should someone who is self-employed lose the 
ability to deduct his cost if we say that is an essential part of 
America? Let us do that. Let us give small businesses and individuals 
the same tax relief for buying health insurance as people with employer 
coverage. It is common sense.
  But, no, some people want to create a political campaign, a political 
storm, and say we are going to fix it all; you are going to take it all 
whether you like it or not, whether you have a good health care plan or 
whether you do not, because we know what is good for you. What the 
American people do not want is for us to adopt the Mitchell bill--or 
any bill--for political reasons. No bill should be adopted for 
political reasons. No bill should be stopped simply for political 
reasons. Congress should not pass a bill simply to pass one. That is 
wrong. And that is what the American people are telling us. They are 
saying take your time and do it right.
  If I have to come down to this floor as we proceed, and go through 
section after section, not to nitpick but to raise issues that are 
critical, it is my obligation to do so if I see we are just determined 
to ram this bill through. That is not a filibuster, and it is not 
intended as one. But it will be intended to explore and to develop all 
of the facts. I suggest this is the wrong forum to do it. These matters 
should have been gone over in detail.
  I know the Labor Committee had their hearings. They did not go over 
these things in detail. I say to my learned colleague, the chairman of 
the Finance Committee, some of these provisions have to be new to him 
and he, too, has to be very concerned about them. We all should be.
  This is just the tip of the iceberg. Tomorrow I intend, for a short 
period of time, to come down to the floor and touch on at least one 
other critical area. We are talking about the health of the people of 
this country. People do not want us to abdicate our responsibilities.
  I broke my shoulder in three places. I was able to pick the best 
doctor, and thank God he did not have a bureaucrat who determined 
whether or not he could or could not go into his specialty. That is the 
last thing we need. When my dad had an open heart procedure--
fortunately, it was an angioplasty--we picked the doctor. He had an 
insurance plan he subscribed to. He went to the hospital of his choice. 
Americans should have that right. No one should lose the ability to 
pick their doctor and the hospital of their choice because we allowed 
Big Brother Government to say, ``Oh, no, that is too good a plan.''
  I hear about this great Canadian plan. Is that why so many people 
come over to use the hospitals in Buffalo, because they do not want to 
wait 6 months, 8 months, a year, a year and a half, for some of the 
optional services that here in this country our people get when they 
are sick or in pain? Are we going to have a bureaucrat say, ``Wait a 
minute; we cannot do any more hip replacements''? Is that what we are 
talking about?
  Let me share two letters that have come to me, one dated August 8 
from a constituent from Honeoye Falls:

       Dear Senator D'Amato
       The thought of a health bill being pushed through the 
     Congress in the next two weeks sends shivers through my 
     spine. How can you people digest the huge amount of 
     information being stacked before you and make a responsible 
     decision on what is best for the people of America?
       I want to know what is being promised in the various bills, 
     what it will cost, who will be covered, how will it work, who 
     will pay for it, how it will affect the health coverage I 
     already have . . .
       I want you to know that is the dominant thing so many 
     people call about. They say: I like my health care coverage. 
     I want to continue it.
       I urge you to wait until we know all the answers to these 
     questions before considering such sweeping changes to the 
     American health care system--1995 is soon enough!
       Sincerely,
                                                   Elinor W. Fisk.

  I ask unanimous consent a copy of this letter be printed in the 
Record.
  There being no objection, the letter was ordered to be printed in the 
Record, as follows:

                                Honeoye Falls, NY, August 8, 1994.
     Senator Alfonse D'Amato,
     U.S. Senate,
     Washington, DC.
       Dear Senator D'Amato: The thoughts of a health bill being 
     pushed through the Congress in the next two weeks sends 
     shivers through my spine. How can you people digest the huge 
     amount of information being stacked before you and make a 
     responsible decision on what is best for the people of 
     America?
       I want to know what is being promised in the various bills, 
     what it will cost, who will be covered, how will it work, who 
     will pay for it, how it will affect the health coverage I 
     already have, why the whole system has to be changed.
       I urge you to wait until we know all the answers to these 
     questions before considering such sweeping changes to the 
     American health care system--1995 is soon enough!
           Sincerely,
                                                   Elinor W. Fisk.
  Mr. D'AMATO. I have another very short letter from Laurrie 
Brinckerhoff, 15 Charles Street, New York, NY.

       Please! No Health Care Plan should be rushed through the 
     Senate this year. If there is a plan, we need a carefully 
     studied and well thought out plan.
           Sincerely,
                                             Laurrie Brinckerhoff.

  Mr. President, passing any bill without the public's informed consent 
is not good government. It is not good health care. It is not 
responsive to the will of the people. We are pushing this piece of 
legislation through at this time, and there is that momentum behind it, 
because of the political ramifications. That is wrong. The American 
people are telling us take your time. They are telling us do it right. 
They are telling us they want change. But they want it done the right 
way.
  I think as people listen to the debate and to the areas of concern--
not just amendments that are put forth, but the various areas of 
concern and the ramifications that this legislation contains--they will 
say resoundingly, ``Don't just push it through.'' That is exactly what 
is taking place here.
  I thank my colleagues and yield the floor.
  Several Senators addressed the Chair.
  The PRESIDING OFFICER. The Senator from Delaware.
  Mr. BIDEN. Mr. President, I rose not to speak to the health care 
debate, but something else that is impacting on the health care debate. 
One of the problems on the health care debate is that a lot of people 
engaged in the debate either have not been around or paid attention for 
the last 2 years that we have been discussing the health care problem, 
or have not paid any attention to the committees in question that have 
held probably hundreds of hours of hearings, all told, on the problem, 
and now stand and wave around a bill as if this, whatever number of 
pages it is, is something that was dropped from heaven or come up from 
hell, and that they have never seen before.
  The criticisms made of this bill in the generic form could be made 
about every piece of major legislation that ever passed through the 
Senate. I remind my colleagues who have had no problems voting on major 
communications legislation, major legislation relating to anti-trust 
measures, major legislation relating to a thousand other areas--the 
Clean Air Act, the Clean Water Act--larger than this. They could have 
said the same exact thing. That is why we have a committee system. That 
is why we have the staffs we have. That is why we are supposed to pay 
attention. That is why we are supposed to understand some of what has 
been done. But it astounds me how little is understood by people who 
engage in this debate--and I am speaking of no one in particular--but 
how little is understood. I will just say one thing to my friend from 
New York. He is my friend, as we say. He and I truly are good personal 
friends. He gave the example of his father wanting to be able to choose 
his own doctor and wanting to be able to choose his own hospital.
  I think that is a phenomenally important right, whether we pass 
health care or not. The vast majority of Americans do not have that 
chance. If they work for major corporations, the corporations decide, 
and by the time this decade is over, I predict there will not be any 
plans that allow that. They will all be HMO's with preferred providers. 
They are coming along.
  Just look at all the people in Washington today, the people who are 
in the galleries, in this city, and the people listening to this 
debate. I ask you: How does your employer change yours--if you are 
lucky enough to have health care plans--how have they changed those 
plans in the recent past? I happen to have chosen a plan that does not. 
I am not in an HMO. HMO's are cheaper. You can spend less money if you 
want to be in an HMO. The point is, a lot of this is changing whether 
or not we do anything at all, and a lot of the choices the Senator is 
worried about are going to be eliminated if we do not do something.
  I will not take the time to discuss it now, but I have a summary of 
responses that have come into my office--I am from a very small State, 
unlike a large State like New York. New York literally has counties 
bigger than my State and New York City has a population that is 
probably somewhere around 13, 14 times as large as my entire State.
  But roughly 7,000 people have written to me in response to a series 
of questions I asked them.
  Mr. President I might point out, the answers have come to very 
different conclusions than the 2,200, or thereabouts, phone calls my 
friend from New York who represents a State with--what?--18, 19, 20 
million people in it? I would not call those calls particularly 
representative.

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