[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. ROCKEFELLER. Mr. President, I want to compliment the Senator from 
Delaware on his remarks and say I agree wholeheartedly with not only 
what he said but with the thrust of what he said.
  It is very obvious now that Senators who want to pass a health reform 
bill are going to have to spend many long days and nights in their 
effort to do so. This is not happy news for our families--our own 
families. I shudder to think of some of the conversations--I know the 
one that took place in my own house last night--many of us with spouses 
and children have had about canceling plans. Many who are not so 
fortunate financially have had to lay down nonrefundable tickets to 
places and they cannot get their money back. They want to go camping or 
visit relatives.
  Nevertheless, we are here to do the work that the people want us to 
do. So we shall stay until this health care reform bill is passed, 24 
hours a day if that is the right amount of time. And I am delighted, 
personally, that we are doing it. I think it is the kind of leadership 
and toughness which is correct.
  But then we also have to remember why so many of us are unwilling to 
give in to the faction that is arguing for delay, or for postponement, 
for doing nothing, for ignoring the problems, for accepting things 
exactly the way they work and accepting them for the way they do not 
work.
  Mr. President, I have a stopwatch here, and I arrived on the Senate 
floor about 90 minutes ago and have been waiting to speak since that 
time. I have made a simple calculation that during that time, the 90 
minutes I have been waiting to speak, that 4,698 Americans have lost 
their health insurance and that 1,368 American children have lost their 
health insurance.
  Yes, the voices for delay and obstructionism are right when they say 
that in that same time, other Americans, other children got back their 
health insurance. That is true. It proves the point about one 
distinctive feature of America's so-called health care system and that 
is that it is the ultimate revolving door. Yes, we are a country where 
health insurance can be returned. But for the most part we all know 
when we talk about 39 million Americans being uninsured, we are really 
talking about 60 to 64 million Americans who, for some significant part 
of a year, do not have health insurance.
  Yes, we are a country of researchers, doctors, nurses, hospitals, 
vast medical complexes, drugs, medical discovery and breakthroughs. And 
that we all celebrate.
  But we are also a country that leaves basic health security for its 
people, for its children, to something called ``pure chance.'' If you 
work in Germany or France or Japan, you can count on basic health 
security in the same way that you can count on the Sun coming up. It 
does not fail. If you work in the United States of America, you cannot 
count on health insurance, whether you have it or whether you do not--
unless you are lucky enough, that is, to live in Hawaii.
  In America, playing by the rules, working full time, paying your 
taxes, does not mean that you can stop worrying even for one second 
about whether you can take a child to the doctor for a checkup or get 
some tests when a serious ache or pain sets in--unless, that is, you 
are lucky enough to live in Hawaii where they are approaching universal 
health insurance coverage.
  If you have health insurance in the United States of America but have 
to change jobs, that is when you better start worrying. You better make 
sure you do not have something called a preexisting condition on your 
records, because in America that means that any insurance company can 
slam the door in your face--and they do. I said last night--I see the 
Senator from Connecticut here--that it is absolutely beyond my wildest 
imagination that in this country called America, a young woman who is 
married and becomes pregnant but who does not have health insurance--
becomes pregnant and then goes to try to get health insurance, cannot 
get health insurance because she has something called a preexisting 
condition; to wit, she has become pregnant. Only in America. That is 
why so many of us feel we have absolutely no choice but to go on and on 
and to persist and to persist.
  Here we are trying to advance a bill--it happens to be the majority 
leader's bill--that does exactly what the vast majority of Americans 
have said over and over and over again that they want from this Senate 
and from this Congress and from this town. They want their health 
insurance to be there when they need it. They want their health 
insurance to be there when their children need it. They want their 
health insurance to live up to its word, to its printed word, and not 
hide dirty secrets like lifetime limits, exclusions for past illnesses, 
in a sea of fine print. And how many times have we seen that in our 
various States?
  Americans want the revolving insurance door to stop. They want to 
focus on raising their kids, saving up for college, doing a good job at 
work instead of worrying that one false move, one accident at school or 
at the school playground--one lump will pull the rug out from 
underneath them.
  I repeat, since arriving here this afternoon in the Chamber, more 
than 4,698 Americans have lost their health insurance and more than 
1,368 children have lost their health insurance. That is in the 90 
minutes that I have been waiting to speak. The revolving door turned 
them out. A few of them may get back in, but the revolving door has now 
turned them out, so even if they get back in, they could go out again, 
and they know it.
  Now to turn to the very specific question before us. I also want to 
say something about the amendment from the good Senator from 
Connecticut, Senator Christopher Dodd. Talk about an idea that is as 
clear as day. This amendment calls on insurance plans to remember 
children when figuring out what it will cover and what it will not 
cover.
  As my distinguished senior colleague knows, I was proud to Chair the 
Bipartisan National Commission on Children just a few years ago, and it 
gave me the opportunity to travel across this country, across our State 
of West Virginia and meet with thousands and thousands of parents and 
children in all different kinds of situations, in the worst housing 
development slums in Chicago, to barrios in San Antonio, to all kinds 
of places.
  Those of us who served on the Commission were incredibly diverse--
diverse in our background, diverse in ideas, diverse in our 
philosophies, diverse in our professional backgrounds. There were, in 
fact, three members of the Bush administration, acting officials of the 
Bush administration, on that Commission.
  But after 3 years of studying life of families and children in 
America, we reached the same unanimous conclusion. Fortunately, no one 
tried to keep us from concluding our work through filibusters. Our 
conclusion was that America has to turn what we say about children into 
deeds in terms of what we do about children and families.
  The amendment before us, the Dodd amendment, tries to do precisely 
that. One of the essential ways to help families is to make sure that 
their insurance covers the most basic kind of health care for their 
children. It is a simple proposition. If you have private health 
insurance, it should cover what counts the most. If you are a family 
with children, the amendment says that your insurer has to cover the 
basics--prenatal care for pregnant women, essential care for babies, 
immunizations, and the like.
  If we care about children and families, as we all say we do, we must 
come together on health care reform. How can we pretend that basic care 
for children should be left to chance--that is what we do today--left 
to economic chance, left to circumstantial chance? Even the insurance 
companies are not fighting Christopher Dodd's amendment.
  Five million women in America have private insurance policies this 
day that do not cover maternity care--5 million. That might just be a 
reason that so many pregnant women do not get the prenatal care that 
they should be getting. Not the only reason, but certainly a very big 
one.
  One out of every 10 under the age of 10 in America, I am embarrassed 
to say, is uninsured. Talk about costs. These are children whose 
earaches can turn into lifelong disabilities, probably will turn into 
lifelong disabilities, who develop diseases that can be prevented with 
medicines and vaccines, all things which are readily available to us as 
an advanced industrial society, and who head for school, therefore, 
without the benefit of all of these things are already behind. We talk 
about Head Start, these children are starting way behind.
  We have to do something about this, Mr. President. We have to weigh 
and measure and contrast the Mitchell plan, or any other plan, with the 
costs and the consequences of doing nothing. The numbers of uninsured 
children can be absolutely numbing, if you try to see them in your eye. 
I think of certain ones in West Virginia, Minnesota, and other places 
that I have been, but when you think in terms of the numbers of 
millions of children, it just becomes numbing, and then you know that 
in no other industrial society are any children uninsured, except in 
our own.
  So let me share one story of a West Virginia family, that I visited 
recently, with the Presiding Officer and my colleagues who might be 
listening, the Bosworth family in Wheeling, WV.
  The Bosworths are good people who are struggling. They have two 
daughters, Stephanie, who is 23 years old and who has cerebral palsy, 
and Nicole, who is 15. Steve, the father, was a salesman but became 
unemployed and is working odd jobs whenever he can find them. His wife, 
JoAnn, works part time at their church. No insurance involved in either 
case.
  The family, in fact, tried to buy insurance, but because Stephanie 
has cerebral palsy, the cheapest plan that they could find to buy was 
$400 a month; hence, $5,000 a year, way out of reach for the Bosworth 
family, just out of the question. They could not afford it and, 
therefore, could not get it.
  Medicaid covers Stephanie's health care, but the rest of the family 
is uninsured. Steve and JoAnn--the father and mother--and Nicole simply 
cannot get the health care that they need because they have no health 
insurance. Remember, they are both working as best they can. Nicole, 
the younger child who is 15, recently had a seizure and the family has 
no idea what the cause was. Without insurance, this young teenager has 
the seizure and does without medical analysis.
  Our system is unfair, Mr. President, for Nicole Bosworth. Our system 
is unfair for the Bosworth family. The father is working and the mother 
is working as best they can, but they cannot scrape together enough 
money to buy health insurance.
  They are fortunate that the child with cerebral palsy has Medicaid, 
but they are unfortunate in every other aspect of their life, as far as 
health care is concerned.
  Under the Mitchell bill, over 7 million children will get insurance. 
Under the Dodd amendment, coverage for preventive services, children 
and pregnant women would begin in July of next year, less than a year 
from today. In West Virginia, the Mitchell bill would give 74 percent 
of children who are uninsured today coverage by 1997 and coverage for 
the rest would be phased in over the next few years.
  Forty-eight thousand children will get private health insurance 
coverage--not Medicaid--but private health insurance coverage through 
this bill. At the end of our debate, I want to be able to go back to 
Wheeling, WV, and I want to tell the Bosworth family that they can 
sleep this night, or maybe tomorrow night knowing that their Nicole 
will have something called reliable, affordable health insurance 
coverage. I think that is a dream that ought to come true, and it just 
so happens that that is a dream that we can make come true if we adopt 
the Dodd amendment.
  Mr. President, I thank the Presiding Officer, and I yield the floor.
  Mr. McCONNELL. Mr. President, having been here a couple of hours and 
having listened to debate on other subjects than health care, I am here 
principally to talk about health care reform but I did want to make one 
observation before beginning.
  I listened with considerable interest to my friend, the junior 
Senator from Minnesota, earlier this afternoon railing about the 
contributions from political action committees and asserting that 
somehow that was slowing the process of health care reform. I am not 
here to make a campaign finance speech, but I want to make a couple of 
observations.
  No. 1, political action committees--of which Republicans are no fan, 
I might add. And, as a matter of fact, I was the first Senator to 
suggest that we get rid of PAC's altogether, a proposal which was 
subsequently adopted as the Senate position in the campaign finance 
bill last summer. But it is interesting to note that the PAC's, which 
my friend from Minnesota believes are slowing down the process, in the 
last cycle in Senate races gave 57 percent of their money to Democrats 
and only 43 percent to Republicans, and in the House 67 percent to 
Democrats and only 33 percent to Republicans. In the House of 
Representatives, the political action committees gave 67 percent of 
their money to Democrats, only 33 percent to Republicans.
  My own view is that the PAC's are not buying influence on this issue. 
I think this is an issue much too important to the American people to 
be sort of kissed off in terms of political contributions. If anything 
buys votes in the health care debate, it is promising big taxpayer-
funded solutions to these problems. There are those on the floor of the 
Senate who would seek to buy those votes with tax dollars by promising 
this group or that group or this group that the Treasury is going to 
pick up the tab for your problems. If anybody could rightly be accused 
of trying to buy votes on health care reform with dollars, it would 
seem to me it would be those who use, not their money, not the money of 
the political action committees, but the money out of the Treasury, out 
of the Treasury I repeat, to promise benefits to one group after 
another.
  Of course, those are largely the same people who would like to dip 
into the Treasury to pay for political campaigns as well--the ultimate 
perk, the ultimate entitlement. There are those who seriously believe 
that we ought to start a new taxpayer entitlement program for each of 
us as we sit here on a multitrillion dollar debt.
  That is a subject for another day, and I raise it only by way of 
observation after listening to my friend, the junior Senator from 
Minnesota, whose position I believe is that we should have a single-
payer system. That is the ultimate, total, final Government takeover of 
health care, the ultimate buying of influence, if you will.
  With regard to the subject before us today, I want to start by 
reiterating a point the Republican leader made very effectively in his 
opening statement just the other day. It bears remembering as we move 
down the road toward some kind of health care reform.
  America has the best health care system in the world. America today 
has the best health care system in the world. Right now, every other 
nation on Earth looks to the United States as the quality leader in 
health care, the leader in surgical innovation, the leader in 
pharmaceutical breakthroughs, the leader in medical technology, the 
leader in health care education, the leader in hospital design, and the 
leader in health care management.
  Now, Mr. President, the second point I wish to make is equally 
important. The reason why America has the best health care in the world 
is not because of some mammoth legislation enacted by Congress. It is 
not because of any regulation implemented by the U.S. Department of 
Health and Human Services, and it is not because of some health care 
task force put together by the White House. It is because the free 
market system and the forces of competition gave an incentive to 
hundreds of thousands of individuals and companies to improve the 
quality and availability of health care services for every single 
American.
  The Government did not make our health care system the best in the 
world. People did, people who are highly trained, totally dedicated, 
and thoroughly experienced--and free to make a fair and honest wage 
from the work they do so well.
  Yet, we have before us today a massive, 1,400-page social experiment 
based on the dubious premise that the Government can do a better job of 
managing our health care system than the hundreds of thousands of 
dedicated experts who do it every day, 52 weeks a year.
  Somehow, the Government that purchases $200 toilet seats and $60 
nails is going to bring cost efficiency to hospitals and doctors' 
offices.
  Somehow, the Government that leaves millions of postal letters 
languishing in warehouses in the District of Columbia is going to make 
millions of delicate decisions about who gets what kind of health care 
services and when they get them.
  Somehow, this same Government that absorbs more and more of our 
paychecks every year is going to give us a bargain, a bargain on our 
health care.
  The President and his allies in Congress would have us believe that 
if we just turn our health care system over to the Government, we will 
get a Neiman-Marcus product, with Tiffany's accessories and Nordstrom's 
service, all at K-Mart prices. What is not to like about that? But when 
you test this dubious premise against the daily practical experience of 
most taxpayers, it just does not hold any water.
  Because of that, the American people have become deeply fearful of 
what Congress may be about to do to the best health care system in the 
world, deeply fearful about what we may do to the best health care 
system in the world. By an overwhelming margin, Americans are telling 
us that Congress should not pass a radical, top-to-bottom restructuring 
of our health care system. According to a USA Today-CNN survey 
conducted just a few days ago, voters favor a gradual, multiyear 
approach to health care reform instead of the radical Democratic 
leadership bills, by a margin of 68 to 28 percent.
  I heard the Senator from New York, Senator D'Amato, talking about the 
phone calls he had gotten in his office, various offices in New York 
over the last few days. Just looking at the mail count in my office 
just since last Saturday--looking at only the mail now, not the 
telephone calls; I have received 68 pro Clinton-type reform letters; 
1,011 against. And again looking at letters since the last week of 
July, 250 letters in favor of the Clinton approach; 4,251, against.
  Now, looking back at the USA Today poll, which assesses the mood 
across the country, nearly 60 percent of our constituents believe that 
the middle class, as usual, will be hurt the most by the steep tax 
increases and the social engineering contained in both the House and 
the Senate Democratic bills. And even more than the important issue of 
universal coverage, voters are concerned that Congress will pass a bill 
that gives the Government too much control over their health care.
  Are the voters just misinformed, as the White House spin doctors 
claim? Folks out there, I guess, are not smart enough to know what is 
going on. That seems to be the White House position. Perhaps they are 
simply unable to comprehend the great public policy issues which the 
administration has so thoughtfully resolved for them. Just a 
communications problem, the White House says. People do not understand 
what is going on. And apparently they have been preaching to members of 
their party to rise above those nasty people. The way to be a profile 
in courage is to go against your constituents.
  It is an interesting argument, Mr. President. The American people, I 
do not think, see it that way. They do not think they are misinformed. 
They do not think they do not know what is going on. They would like 
for us to respond to their desires on this issue. In fact, the American 
people are a lot smarter than the Democratic leadership gives them 
credit for. I think they have figured out the Clinton bill and its 
Democratic offspring.
  They figured out that it was putting the Government in charge of 
their personal health care. They figured out that the Democratic 
leadership bills would set spending caps through global budgets that 
would eventually result in health care rationing. They figured out that 
these bills would herd them into Government purchasing monopolies, and 
force one-size-fits-all policies on everybody, whether they like it or 
not.
  Our elderly constituents have figured out that these bills would cut 
deeply into Medicare spending. They have figured out that a Government-
run health care system would be more expensive, more bureaucratic, and 
less responsive to each individual's medical needs than the system we 
have today. And the American people clearly do not want any part of it. 
I mean virtually every phone call coming to my office here and into the 
six offices in Kentucky are about this. They do not want it. Nobody can 
orchestrate this kind of telephone contact. I have never experienced it 
before in my 10 years in the Senate.
  Could it be that the majority leadership is right, and millions of 
Americans are all wrong? Let us take a look at the bill before us to 
attempt to answer that question.
  First of all, this bill would radically change our entire health care 
system from top to bottom, radically change it. It would change the way 
Americans obtain insurance, what kind of benefits they would be 
allowed, and how much they would have to pay in premiums, not to 
mention new taxes and how much the Government would be involved in 
deciding all of that.
  The bill before us contains 8 new entitlements, 17 new taxes, 50 
newly minted bureaucracies, 177 new State mandates, and nearly 1,000 
new Federal powers and responsibilities. The Great Society is over. 
Welcome to the ``Great Bureaucracy.''
  If this bill becomes law, the competitive free market character of 
our health care system would be radically transformed into a top down, 
highly centralized regime. It is clear that the proponents of this 
legislation want to go far beyond our shared goals of making health 
care more accessible and affordable for all Americans, and increasing 
the number of individuals who have adequate health care insurance.
  We could accomplish both of these important goals without 17 new 
taxes or a single new bureaucracy. But the goal of the bill before us 
is not increased coverage but increased control; I repeat, not 
increased coverage, but increased control, Government control. The 
manifestation of this control agenda is the mandated, standardized 
benefits package that would be designed by Federal bureaucrats and 
forced on every single American citizen.
  For the average person who already has insurance, this mandated 
approach is a sure way to increase the cost of health care. Many 
Americans will see their premiums rise dramatically to compensate for 
the added benefits they must purchase in a compulsory one-size-fits-all 
package. For many middle-income families, the cost of health insurance 
will balloon even more under the Mitchell bill's community rating 
provision. The bill stipulates that premium rates may vary only by 
family size and by age. Lifestyle habits cannot be taken into account. 
Geographic location cannot be considered, and no incentives are offered 
to use services in a responsible, cost-efficient manner.
  Can you imagine what would happen to automobile insurance rates if 
insurers could not take driving records into account? That is 
essentially what this bill does. It charges the mild-mannered Sunday 
driver the same rate as the drag racer with three drunken driving 
convictions.
  Moreover, the bill requires all cost differences to be phased out by 
the year 2002. As a result, younger, lower-income families will be hit 
the hardest as their premiums skyrocket to subsidize coverage for older 
and frequently wealthier Americans.
  The other side of this legislation's control agenda is the burden it 
puts on small businesses, as well as their employees. Under the 
Clinton-Mitchell bill, every employer must provide a choice among three 
Government-designed plans. Keep in mind that the bill does not require 
choices among benefits packages, but rather choices of how to pay for 
the plan. This three-option requirement will add considerably to the 
administrative costs that businesses will face in offering insurance.
  Many businesses today are using an insurance funding mechanism called 
self-insurance to keep their costs down. The Mitchell plan bans self-
insurance for companies with less than 500 employees. Some predict that 
400,000 businesses will be impacted by this provision alone.
  For example, I recently heard from an independent broker in Fort 
Mitchell, KY, among whose client is a self-insured steel mill with just 
under 500 employees. He told me that the administrative cost of this 
plan, the Clinton plan, is less than 4 percent of the plant's total 
cost. But by prohibiting this company from self-insuring and forcing it 
to offer three different plans, this legislation will add hundreds of 
thousands of dollars to the annual cost of providing health care for 
its employees. Basically, this company and thousands like it will have 
only two choices: cut wages or cut work force. That is the painful 
decision that employers all across America will be faced with because 
of this bill.
  In general, however, Americans have relatively few decisions to make 
under the Mitchell bill because the Federal Government will make most 
of the decisions for them, at least as they pertain to their personal 
health care.
  The most powerful and intrusive monolith envisioned by this 
legislation is the National Health Benefits Board. This board would 
have the authority to unilaterally decide what medical services 
Americans should receive.
  Just looking at the section on the Board in the bill, as you can see, 
this is not exactly a small bill:
  A, the Board shall be authorized to establish a criteria for 
determinations of medical necessity or appropriateness; B, procedures 
for determinations of medical necessity or appropriateness; and C, 
regulations or guidelines to be used in determining whether an item or 
service, under categories of items and services described in another 
section, is medically necessary and appropriate.
  Suffice it to say, Mr. President, this is a very powerful Board. This 
National Health Benefits Board is going to have enormous authority.
  Federal bureaucrats ensconced in their marble-lined office suites 
will be making the most personal, life-or-death decisions for each and 
every American family, stamping out cookie-cutter health plans as if 
they were just another mass-produced widget. Not only will this board 
have unprecedented powers over every single American citizen, it will 
also be completely unaccountable to those who are impacted by its 
decisions.

  The members of this health care junta will be unelected and by the 
terms of this bill, they will also be exempt from the Federal Advisory 
Committee Act. The Federal Advisory Committee Act establishes some 
basic management and oversight criteria for commissions to keep them 
from becoming a law unto themselves. Coincidentally, it is the same law 
that Hillary Clinton's health care task force may have run afoul of, 
and that issue is now the subject of intense litigation.
  Under the Federal Advisory Committee Act, each and every Federal 
Commission must be rechartered every 2 years. They have to be 
rechartered every 2 years. I understand, however, that this bill takes 
the liberty of exempting the National Health Benefits Board and its 
companion, the National Health Care Cost and Coverage Commission, from 
such troublesome obligations. Under this bill, these faceless agencies 
are established as permanent--I repeat, permanent--fixtures on the 
bureaucratic landscape. So what we have is an all-powerful Federal 
agency, created through a process that may have violated the Federal 
Advisory Committee Act, and which is, itself, exempted from the very 
same accountability and safeguards. You can say one thing about this 
bill: it sure is consistent.
  It is important to note here that this National Health Benefits 
Board, which is totally unaccountable to the American people, will be 
easily accessible to special interest lobbyists who want special 
treatment for their clients.
  But there are a few things this Jabba-the-Hut board will not be able 
to do. For example, it will not be able to authorize medical savings 
accounts, which are a flexible and innovative way for Americans to 
finance their medical needs. That is because medical savings accounts 
are not an option under this legislation. That is really too bad, 
because experience shows that people who have medical savings accounts 
tend to become more cost conscious about the services for which they 
are paying.
  This bill also does not allow self-employed Americans, like most of 
our Nation's farmers, to deduct all of their health costs from taxable 
income. The bill does raise the deduction to 50 percent, but that 
hardly amounts to equitable treatment for those in this country who are 
self-employed. I had supposed that equitable treatment was one of the 
goals of real health care reform.
  Mr. President, one should not conclude, however, that this bill does 
nothing but take away and restrict and limit and reduce. It does all of 
those things in spades, but it also vastly increases opportunities for 
one very special group of Americans: lawyers.
  Lawyers are going to love this bill, Mr. President. While many 
Americans will be heading toward the unemployment line as a result of 
this bill, such as the employees of the steel mill in Kentucky I talked 
about earlier, the lawyers of our country will be heading to the courts 
in droves and laughing all the way to the bank. Medical schools will be 
heavily regulated under this bill, with a Commission on Medical 
Education breathing down their necks, while law schools will not be 
able to turn out lawyers fast enough to meet the demand for litigation.
  Let me pause on that point. This legislation's ham-fisted regulation 
of medical schools throughout the country stands by itself as a 
monument to congressional hubris. What we are saying through this 
particular provision is that the Government knows better than all the 
health care educators and administrators in America. We up here in the 
Government know better about this than you educators and 
administrators. We are going to fix it for you. We are saying to all 
those aspiring to be health care professionals: Forget your dreams, 
forget your desires; the Government can tell you what to do from now 
on. We are going to be in charge of your life if you are going to be a 
health care provider. We will decide for you.
  This provision does not belong in a bill that is being considered in 
what is usually thought of as a free country. I can only imagine what 
the response would be if we had a provision in this bill that 
contemplated regulating the numbers and specialties of lawyers. Imagine 
that, Mr. President. Imagine what the reaction would be if we had 
provisions in this bill regulating the numbers and the specialties of 
lawyers. There would be great breast-beating and stirring speeches, not 
to mention intense lobbying by the American Trial Lawyers Association, 
all arguing the point that such a heartless provision would deny people 
the one thing they need most: legal services. Legal services. What if 
some national commission discovered there was a shortage of corporate 
tax lawyers in the Rockies? Imagine that--a national commission decided 
there was a shortage of corporate tax lawyers in the Rockies. Would we 
then use the heavy hand of the Government to force some of those Gucci 
loafers out there into the Rockies?
  As it stands, this bill is very good to lawyers. It will employ lots 
of them and compensate them quite well. A little advice to you parents 
who may be watching: if this bill becomes law, send your kids to law 
school, not medical school. Leaving aside possible legal claims for 
fraud, medical malpractice, and privacy violations under this bill--now 
listen to this--this legislation will create no less than 16 new 
varieties of lawsuits, Mr. President. Just what our country needs, some 
new causes of action to pursue in the courts of America. We will have a 
shortage of lawyers. We will need to produce new lawyers, and we will 
have new causes of action and go out and clog up the courts of America. 
If you think that is what America needs, by golly, you will love this 
bill. It may ruin your health care, but this may put an extra BMW in 
the garage of every enterprising lawyer in America--maybe two BMW's in 
the garage of every enterprising lawyer in America. Well, at least 
somebody will benefit from this thing.
  Of course, we are already paying an enormous litigation tax on most 
goods and services we buy, including health care.
  Let me say that there was an article today in the New York Times on 
this question of increased lawsuits under this bill, entitled ``U.S. 
Judges Warn of Health Lawsuits,'' written by Robert Pear.
  There is great concern among the judges who have to wrestle with all 
of this increased litigation and the impact of this legislation.
  I ask unanimous consent that today's New York Times article entitled 
``U.S. Judges Warn of Health Lawsuits'' be printed in the Record at 
this point.
  There being no objection, the article was ordered to be printed in 
the Record, as follows:

                [From the New York Times, Aug. 15, 1994]

            The Courts: U.S. Judges Warn of Health Lawsuits

                            (By Robert Pear)

       Washington.--The top policy-making body for the Federal 
     courts has expressed concern that health care bills pending 
     in Congress would generate a flood of litigation by people 
     trying to enforce new rights to medical benefits and 
     insurance payments.
       The judges said they were worried that many of those 
     disputes would end up in Federal courts.
       The organization, the Judicial Conference of the United 
     States, took no position for or against the legislation, 
     which is intended to control health costs and widen access to 
     health insurance. ``Policy decisions concerning health care 
     reform are properly within the province of the other branches 
     of Government,'' it said.
       But the judges noted that Federal courts were already 
     inundated with drug cases, which have caused delays for civil 
     cases in many regions. The anti-crime bill now pending in 
     Congress would give Federal courts jurisdiction over many 
     additional offenses, including gang violence.
       The Judicial Conference laid out four principles that it 
     said would guarantee that disputes over health benefits were 
     resolved quickly and efficiently, without clogging Federal 
     courts. In general, it said, these disputes should be handled 
     through administrative proceedings and then, if necessary, in 
     state courts.
       President Clinton's health care plan and the bills offered 
     by the Democratic leadership are, in many ways, inconsistent 
     with the judges' recommendations. For example, the bills 
     would give consumers more immediate access to Federal courts 
     than the judges consider appropriate. But these provisions 
     have drawn little attention for lawmakers.


                             more lawsuits?

       In several decisions over the last decade, the Supreme 
     Court has severely restricted the rights of consumers to 
     recover damages when their claims were improperly denied or 
     delayed by insurers.
       Senator Howard M. Metzenbaum, Democrat of Ohio, said, 
     ``It's ridiculous to suggest that the legal floodgates will 
     be opened merely by giving people the right to sue if they 
     have been wrongfully denied badly needed coverage.''
       Gwen Gampel, president of Congressional Consultants, a 
     health care consulting company, said the experience of 
     Medicare suggested that the Federal courts would not be 
     flooded with new lawsuits.
       But Barbara J. Rothstein, the chief judge of the Federal 
     District Court in Seattle and the chairwoman of the Judicial 
     Conference subcommittee on health care, said any bill 
     guaranteeing a right to health care or health insurance would 
     increase litigation.
       ``It could have a drastic impact on the courts,'' she said 
     in an interview today. ``That's what we're concerned about.''
       Judge Rothstein, who was appointed in 1980 by President 
     Jimmy Carter, said that if the courts were overwhelmed with 
     new cases, people with urgent medical needs would be unable 
     to have their claims resolved promptly.


                           advice from judges

       In its statement of principles, the Judicial Conference 
     said:
       ``The full exhaustion of administrative remedies for 
     benefit denial claims should be a requirement for any health 
     care legislation. Claimants should not be permitted to bypass 
     administrative remedies and to proceed directly into a court.
       ``Following the exhaustion of administrative remedies, and 
     consistent with the general principles of federalism, state 
     courts should be designated as the primary forum for the 
     review of benefit denial claims.
       ``Traditional discrimination claims and actions should be 
     handled differently from benefit denial claims based on 
     issues such as medical necessity.
       ``To insure the effectiveness of the enforcement provisions 
     of any health care legislation, it is critical that 
     sufficient resources be provided to the responsible 
     administrative and judicial entities.''
       The same principles were endorsed this month by the 
     Conference of Chief Justices, representing the top judges of 
     the nation's state courts. The group said many state courts 
     were already ``struggling with inadequate resources to meet 
     the demands of ever-increasing caseloads.''
       The bills proposed by President Clinton, by the Senate 
     majority leader, George J. Mitchell, and by the House 
     majority leader, Richard A. Gephardt, would allow 
     consumers to go into Federal courts to challenge the 
     denial of health benefits. Consumers could pursue their 
     claims in mediation proceedings or in administrative 
     hearings at complaint review offices, but they would not 
     have to use such alternatives.
       The bills would also permit consumers to sue health plans, 
     state governments and the Federal Government for failure to 
     carry out duties established by the legislation.
       The bill generally say courts should take such cases 
     ``without regard to whether the aggrieved person has 
     exhausted any administrative or other remedies that may be 
     provided by law.''
       Victims of discrimination could file Federal or state 
     lawsuits to get compensatory damages, punitive damages, 
     punitive damages and injunctions. Plaintiffs could also seek 
     ``reasonable attorney's fees'' at the prevailing rates.
       Under the Mitchell and Gephardt bills, thousands of 
     community health centers, public hospitals, family planning 
     clinics and doctors in inner-city neighborhoods would be 
     designated ``essential community providers,'' and health 
     insurance plans would generally have to sign contracts with 
     them. An essential community provider ``aggrieved by the 
     failure of a health plan'' to obey this requirement could 
     file a lawsuit in Federal or state court to compel compliance 
     and to recover damages.


                    diary--health care developments

       Yesterday: After a day of long Republican speeches and 
     Democratic rebukes, Senator George J. Mitchell, the majority 
     leader, threatened to keep the Senate in session 24 hours a 
     day starting tonight if Republicans do not allow the first 
     votes on amendments to his health care bill.
       Congress: Senator Bob Packwood of Oregon, who is 
     orchestrating the Republican opposition on the Senate floor, 
     contended that Mr. Mitchell had promised that senators 
     ``would not be rushed.'' Republicans denied that they were 
     filibustering, although many of them spoke for hours. Mr. 
     Mitchell said that if by this evening, no vote had taken 
     place on an amendment to bolster private coverage for 
     pregnant women and children, ``then the Senate will remain in 
     continuous session thereafter, through the evening through 
     the night.''
       White House: A doctors' group has rejected a proposed 
     settlement in a lawsuit over whether the Clinton 
     Administration's 1993 Federal health care task force must 
     make its records public. Charles McDowell Jr., president of 
     the doctors' group, the Association of American Physicians 
     and Surgeons, said in a brief Monday that its board of 
     directors voted 13 to 4 reject a settlement. He asked a 
     Federal judge to delay further action on the case.

  Mr. McCONNELL. We already pay an enormous price for the litigation 
under today's laws without adding these 16 new causes of action that 
are going to be made available under this legislation before us, if it 
passes. Just taking a look at the situation today, we have a chart up 
here called ``The Price of a Suit.'' We are not talking about a suit of 
clothes, but the price of a lawsuit. Experts have calculated that 
hidden litigation tax for insurance, lawyers, and trials built into the 
price of consumer goods today.
  Mr. President, we are not talking about what is going to happen under 
this bill. Under this bill, we are going to get 16 new causes of 
action. This is going to be a two-BMW bill for every lawyer in America.
  For an 8-foot aluminum ladder, the average retail price today is 
$119.33.
  Now the true cost of that ladder is only $94.47. The litigation tax 
is $23.86.
  Picking out a couple of products here that are more related to the 
health care debate which we are having here in the Senate, let us take 
a look at a heart pacemaker. The average retail price is $18,000, but 
the true cost $15,000. Mr. President, that is a $3,000 litigation tax 
on every heart pacemaker, and that is today. That is before we get into 
the 16 new causes of action created under the Clinton-Mitchell bill.
  A motorized wheelchair, average retail cost $1,000, true cost $830, 
$170 litigation tax on a motorized wheelchair.
  Tonsillectomy--let us pick out two more health care items here--
doctor's fee, average retail price $578, true cost $387, a litigation 
tax of $191. So of the doctor's fee on a tonsillectomy of $578, $191 
goes to the lawyers, the litigation tax.
  Let us look at a 2-day maternity stay: $3,367, for 2 days in the 
hospital, but, Mr. President, the real cost is only $2,867. A $500 
lawyer's tax, litigation tax of $500 on a 2-day maternity stay.
  Mr. President, that illustrates the nature of the problem today. 
Certainly, what we need in this country are a few more causes of 
action. Certainly, what we need in this country to be more productive 
is a little more litigation. If you think America has a problem because 
it has too few lawyers, you are going to love the Clinton-Mitchell 
bill, a boondoggle for lawyers if one ever existed.
  Looking at the Clinton-Mitchell bill, section 1602 of the bill--now 
we cannot be sure that the current version of the bill lists this 
provision as section 1602 because there have been several different 
versions floating around here the last few days. It could be that the 
reason for all these different versions is to show America how 
efficient health care is going to be after it has been redesigned by 
Congress and run by the Government.
  Anyway, this provision, if it is still called section 1602, adds a 
number of new protected categories to the traditional discrimination 
classifications of race, sex, national origin, religion, age and 
disability. Those are the traditional categories, but we have some new 
ones here.
  The result is that a person could bring a lawsuit against his or her 
employer, or against a health plan or provider, or even against a 
State, alleging discrimination on any of the following additional 
bases.
  We just outlined the litigation tax today on a number of different 
products, many of them health-care related. But under the Clinton-
Mitchell bill, there will be new causes of action possible in the 
following categories: a plaintiff could allege discrimination based on 
language, based on income; based on sexual orientation; based on health 
status; or alleging discrimination based on anticipated need for health 
services.
  Counting these up, that is five new causes of action right there 
alone, Mr. President, five new causes of action.
  The lawyers are out there licking their chops right now just thinking 
about the potential. As I said, it is not going to be one, but it is 
going to be two BMW's per garage for every plaintiff's lawyer in 
America. And, of course, the Clinton-Mitchell bill gives access to any 
court, any court Federal or State, for anyone to bring a lawsuit 
alleging discrimination.
  Now, there is no doubt that every employment decision in America will 
be affected by this provision. In that regard, section 1602 is really a 
civil rights provision, and we should not be using health care reform 
to change well-established civil rights laws.
  Although this bill radically changes discrimination laws in a way 
that will generate a lawyer's feeding frenzy, there is one large area 
of the law where the Mitchell bill quite literally turns the clock 
back, and that is medical malpractice.
  In the last several years, there has been enormous progress among the 
States in ensuring fair compensation to victims of medical malpractice, 
while at the same time curbing the excesses of malpractice litigation, 
which we all end up paying for.
  This bill guts those important reforms. It turns back the clock on 
malpractice reform by preempting State law and effectively repealing 
the work of over 20 States to get health care costs under control.
  This is unacceptable, Mr. President. It is antireform, and it must be 
reversed.
  I have heard for many years opponents of any kind of tort reform at 
the Federal level say that it ought to be left to the States, 
suggesting that the States should be free to pursue this area if they 
chose on a State-by-State basis, but this takes that away, Mr. 
President. It takes away that innovation and says you cannot legislate 
in this area any longer.
  Instead of doing this, Mr. President, we need to build upon what the 
States are doing, not turn back the clock on their progress. For 
example, we should abolish the collateral source rule to stop wasteful 
double recovery. We need controls on sky-high punitive damages. We need 
to modify joint and several liabilities so that those who are 
responsible for the harm pay their fair share.
  Mr. President, I am sure that every Senator wants injured patients to 
be fully and fairly compensated for the harm they suffer. That is not 
in debate. We all want a system to deter negligence, and we all want 
the few incompetent health care providers that exist to be held 
accountable. But the bill before us merely perpetuates and even spreads 
the worst in the current malpractice system. Clearly, we can do better 
than that.
  That brings me to my final point about how we ought to go about 
health care reform. My view is we should be focusing how to fix our 
current problems and how to reduce costs, not how to expand Government 
control and bureaucratic interference.
  As I said at the outset, our system is the best in the world because 
of its reliance on private sector competition and market driven 
innovation. The Clinton-Mitchell bill, on the other hand, will move 
American health care in the exact opposite direction. It will create a 
system where bureaucrats, politicians, and lawyers have more authority 
over health care than doctors, nurses, and researchers--let alone the 
patients. As government control expands under the Clinton-Mitchell 
bill, the incentive--as well as the power--to cut costs, improve care, 
find new medicines, and treat patients in a personal manner will 
decrease by inverse proportion.

  We just need to look across our northern border, or over the Atlantic 
to our European neighbors, to see the effects of Government-run health 
care. These results are not something I believe our country wants to 
emulate. Citizens are often taxed at 50 percent or more of their 
income. Structural unemployment persists at 10 and 12 percent. There 
are waiting lines for medical services, and there is rationing of the 
use of medical technology that can detect diseases and save lives.
  We have all heard these numbers and facts, but let me put a human 
face on the results we can expect from a Government-run health care 
system on living, breathing people:
  A young woman from Scottsville, KY, the daughter of a friend of mine, 
was spending a semester abroad studying in London England, this past 
winter. Unfortunately, she awoke in the middle of the night with 
excruciating abdominal pains. She went to the hospital, was given 
medication, and at the time was very impressed that everything was 
free. However, her condition deteriorated; so she went to a local 
health clinic 2 days later. She was examined by a doctor whom she 
described as overworked and preoccupied with other problems. This 
doctor gave her more medication, but still her condition deteriorated.
  Waking in the middle of the night with a fever, chest pain and 
labored breathing, she decided to use the house call service which the 
National Health Service requires of all its doctors. Despite the house 
call, she became more and more ill, and decided the next morning to 
return to the second doctor she had seen. By this time, her very 
worried father had contacted my office to ask whether we could be of 
any assistance.
  My office contacted the United States Embassy and obtained a list of 
several private doctors for the family to call. The young woman quickly 
made an appointment with one of these physicians, who soon diagnosed 
the cause of her illness and treated her properly.
  Let me read an excerpt from a letter which this young woman sent me 
afterward--because I think she speaks very well to the issues we must 
resolve in this debate. That is what she had to say:

       Senator McConnell, I always thought it might be a good idea 
     to have free medical coverage for all citizens. And in an 
     ideal world, it could be. But the reality is that socialized 
     medicine is not successful. It leads to crowded clinics and 
     hospitals, with over-worked and underpaid physicians and 
     staff who cannot spend enough time with any one patient. Yes, 
     I eventually did find a good doctor, but I had to pay much 
     more for him that I would have in the U.S.. My experience has 
     led me to the conclusion that socialized medicine, if adopted 
     by [our country], will result in a society of doctors who do 
     not have the time, money, or interest to spend enough time 
     with their patients.

  I also heard recently from the president of a hospital in London, 
England, who shared his perspective on our struggle over health care 
reform. We would do well to listen to this voice of sober experience. 
He writes:

       If a plan passes that has a global budget, or contains 
     price controls, a National Health Service-style health care 
     system will eventually evolve in the United States. I, for 
     one, would not like any member of my family being told that 
     they cannot get a service, or will have to be put on a 
     waiting list stretching more than a year because of lack of 
     resources. The market . . . has shown time and time again 
     that it is far better at determining prices and directing 
     capital to where it is needed. The government's record is 
     abysmal in this regard.

  Those are just two glimpses of how government-run health care has 
fared in other countries. Unfortunately, examples of the disastrous 
consequences of government-run health care can be found right here in 
America, too.
  As most of us are painfully aware, the Federal Government operates 
its own medical care system for our Nation's veterans, through the 
Veterans Administration. I say painfully aware, because many of us in 
this body devote a lot of time and energy on behalf of veterans in our 
states who simply cannot get the care they need without long waits and 
pointless bureaucratic hassles.
  I remember a few years ago, to give an example, my office was 
contacted by a Vietnam veteran who had lost his leg in combat. He 
desperately wanted a replacement leg, so that he could work and enjoy a 
whole life again--but the VA made him go through one bureaucratic hoop 
after another. At one point during his ordeal, he heard from some other 
veterans that my office had a good track record in helping people like 
him get results from the VA. So he called my office and we went to 
work.
  After a lot of calls and letters back and forth, we eventually got 
the VA to give this man a replacement leg. In the process, we 
discovered that one factor in the VA's refusal to help this gentleman 
was plain-and-simple retribution: The VA saw this patient as a 
troublemaker, someone who rocked the boat--and for that reason they 
decided to jerk him around on medical treatment that he needed.
  Is that the kind of health care system we want for all Americans? 
Where faceless bureaucrats can get even with patients who raise too 
much of a fuss about the health care they are getting--or not getting? 
And as much as I was pleased to help this veteran and all the other 
veterans who call me, do we really want to create a health care system 
where you need to have a U.S. Senator get involved before you can get 
the medical care you need?
  Imagine that. Every American, in this new world brought to us by the 
National Health Benefits Board, has to call his Senator to get his or 
her Senator to intervene with the Government to get the care that is 
needed.
  Let me give you another example of what I'm talking about. I recently 
heard from another veteran in Madisonville, KY, who had contacted the 
VA office in Louisville to request a medical examination for back pains 
that he was experiencing due to an injury he had suffered on duty. The 
VA told him that he could not simply make the request over the phone; 
he had to put it in writing.
  So the gentleman wrote a letter, and one month later, he still had 
not received a response. So he called again and the VA told him to wait 
for 30 more days. A month and a half later, he still had not heard. Of 
course, his back was causing him intense pain throughout this entire 
ordeal. So as a last resort, he contacted my office and now we are 
working to help this man schedule an appointment for an examination.
  He is just trying to get an appointment for an examination and he is 
in intense, excruciating pain--brought to you by Government medicine.
  Is that where health care in America is headed? When you want an 
appointment, will you be able to just call your doctor--or will you 
need to wait for months on end and then, in desperation, call in your 
U.S. Senator.
  The kind of shoddy treatment I have been describing is happening in 
this country today to our veterans--men and women who are courageously 
serving our Nation. Yet they wait over 2 months to hear about a request 
for an appointment.
  This is the kind of garbage that is going on today--in America--in a 
Government-run health care system. Long waits. Faceless bureaucracy. 
Retribution against patients who dare to complain. So I would say, Mr. 
President, if we really want to pass meaningful health care legislation 
this year, we ought to try to reform the VA health care system. That 
would be a good place to start, rather than spread it to the rest of 
the country.
  I can hear the proponents of this legislation protesting that I am 
comparing apples and oranges; that the VA is really a single-payer 
system, whereas their bill makes everybody pay through the nose.
  The problem with this legislation is not just who pays and how much 
they have to pay, but who regulates. This bill gives unprecedented, 
plenary powers of regulation to the Federal Government. Unprecedented.
  If it becomes law, the Government will effectively control every 
single important facet of our health care system. Directly or 
indirectly, it will regulate the financing of health care decisions 
about benefits, costs of policies and reimbursement rates for all 
medical services.
  Under this legislation, the Federal Government will even decide 
whether a physician may enter a particular speciality and which 
geographic areas should be entitled to certain kinds of health care 
providers. So make no mistake, this may not be a single-payer bill, but 
it is without question a single-regulator bill--a single-regulator 
bill--and the end result is likely to be just as disastrous.
  We can reform our health care system without giving the Government 
monopolistic control over one-seventh of the economy and over a very 
important and extremely personal part of each of our lives.
  We can reform health care and actually make it better instead of less 
responsive, more expensive and more bureaucratic. We could, for 
example, make some simple changes in the way health insurance is 
marketed--to improve access and guarantee that coverage is portable and 
renewable. We could restrict the practice of exclusion from preexisting 
conditions and limit the ability of insurers to drop policy holders 
like a hot potato after they incur some costly illness or accident.
  We could reduce health care costs enormously in four easy steps: 
enact meaningful medical malpractice reform; create private sector 
purchasing alliances that are truly voluntary; simplify administrative 
procedures; and allow the market to eliminate services that consumers, 
rather than bureaucrats, do not want.
  We can help family farmers and others who are self-employed by 
letting them deduct 100 percent, not 50, but 100 percent of their 
health insurance costs. All of the measures I have described, as we all 
know at this point, are in the Dole-Packwood bill. They almost 
certainly are supported by the vast majority of Americans.
  Yet, we are debating today a bill that is largely despised--
despised--if not feared by most of those we represent. They hate it. We 
know that because they are calling our offices and we see the polls. So 
we ought to stop listening to the special interests, stop listening to 
the White House political shop, stop listening to the party bosses, and 
start listening to the calls we are getting from home, listen to the 
voters, listen to the families in our States.
  They are telling us by an overwhelming majority that they do not want 
this bill. They do not want a Government takeover of their health care 
system, whether it be single payer or single regulator or whatever. 
They want control of the health care decisions that affect them, and 
they do not want to give that control away to a faceless, passionless 
bureaucracy in Washington.
  So we better listen to our constituents' views on health care now or 
we will certainly hear from them loud and clear in November.
  Let us pass a bill that brings real reform to health care without 
letting Big Brother in the door.
  So where does that leave the bill before us? We will need to diagnose 
it first to answer that question.
  First of all, we observe that the bill is plainly overweight. One 
could even say obese. In fact, the bill suffers from legis-sclerosis, a 
condition which is caused by unhealthy levels of bureau-cholesterol. It 
also shows symptoms of ``Clintonitis,'' such as swollen entitlements 
and acute taxation.
  The bill has inflamed constituents, and according to samples that 
have been taken very recently, it appears to have a dangerously low 
vote-count.
  Evidently, the attending Senate Democratic physician has attempted to 
treat the patient with heavy doses of ``mandatol'' with its predictable 
side effects of impaired autonomy and severe economic contractions.
  The other drug which is being administered liberally is 
``spenditol,'' which as we all know, merely aggravates the patient's 
fiscal deficit disorder.
  So what course of treatment should we prescribe for this ailing piece 
of legislation? First, we should note that its intended beneficiaries, 
the American public, have hung a large sign on the bill which reads: 
``Do not resuscitate.''
  That being the case, the first thing we should do with this bill is 
put it on a strict diet. We need to reduce the intake of bureau-
cholesterol, cut out all the administrative fat, and help it shed some 
of its socialized cellulite. If that does not work, we may need to 
consider major surgery: a ``mandate-ectomy,'' for example. Otherwise, 
this flabby bill is going to keel over under its own weight.
  Mr. President, I yield the floor.


                           Order of Procedure

  Mr. MITCHELL. Mr. President, I ask unanimous consent that the Senate 
vote on or in relation to Senator Dodd's amendment No. 2561 at 6:30 
p.m. this evening with the time prior to that vote equally divided in 
the usual form, and that no amendments be in order to Senator Dodd's 
amendment.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  Mr. MITCHELL. Mr. President, the time will be equally under the 
control of the Senator from New York and the Senator from Oregon.
  Mr. PACKWOOD. That gives us about 7 minutes apiece roughly.
  Mr. MOYNIHAN. It means the Senator had better hurry.
  Mr. PACKWOOD. I yield 3 minutes to the Senator from Kansas.
  The PRESIDING OFFICER. The Senator from Kansas [Mrs. Kassebaum], is 
recognized.
  Mrs. KASSEBAUM. Mr. President, I rise to discuss for a few moments 
the amendment put forward by the Senator from Connecticut [Mr. Dodd].
  It is hard to argue against this amendment because who here does not 
want to offer what health services we can to pregnant women and to 
children? No one has been more committed to this issue than the Senator 
from Connecticut.
  But, as my colleagues know, women's and children's benefits are 
included in the standard benefits package. Under the Mitchell bill, all 
insurers would be required to offer such benefits beginning in 1997. 
The Dodd amendment would speed up required coverage for prenatal and 
well-baby care. Given the poor health status of many of our Nation's 
children and the high infant mortality rates in many areas of the 
country, it is difficult at first glance to oppose the amendment.
  However, this amendment, I would suggest, goes to the core of the 
question of who should design and arbitrate benefits package issues? 
Should it be Congress? We have found it impossible to do that in any 
reasonble or measured way. The Senator from Minnesota [Mr. 
Durenberger], made an eloquent statement last evening regarding the 
endless controversies we invite when Congress attempts to define the 
specific benefits to be offered. Not only can Members of Congress never 
say ``no'' to any particular benefit, but we also quickly find 
ourselves in a situation where new technologies and procedures can 
render our decisions obsolete.
  I am concerned that the Dodd amendment will be just a preview of the 
future congressional tinkering with and expansion of the benefits 
package. I have serious reservations about this precedent, Mr. 
President. Where does it end? Should we move up earlier mammograms to 
the front of the line? Should we move up prostate cancer screening to 
the front of the line? There are serious health concerns in preventive 
medicine that we should consider. Do they not deserve priority as well?
  I support a standard benefits package. But that is not what this 
debate is about. This debate is just the beginning of a process 
Congress is ill-suited to handle.
  Like many others, I have advocated that an independent, nonpolitical 
commission should be responsible for designing a benefits package which 
makes sense and which we can afford.
  On the surface, the Dodd amendment has enormous appeal. We cannot, 
however, risk having that appeal blind us to the precedent it sets and 
the serious questions that remain regarding how a benefits package 
should be shaped.
  I yield the floor, Mr. President.
  The PRESIDING OFFICER. Who seeks recognition?
  Mr. MOYNIHAN. I yield 1 minute to the distinguished Senator from 
Massachusetts.
  The PRESIDING OFFICER. The Senator from Massachusetts [Mr. Kennedy] 
is recognized.
  Mr. KENNEDY. Mr. President, I was particularly interested in the 
comments by my good friend from Kansas, since Kansas was the second 
State to have legislation that was similar to that which we are 
considering this evening and was a real leader in terms of children's 
issues.
  Mr. President, I have just two thoughts. This is an important moment 
for the children of America. Under the leadership of the Senator from 
Connecticut and others, we start this great debate on national health 
putting children first, those that are the most vulnerable who have 
been left out and left behind. That is point number one.
  Second, Mr. President, this is a good moment for the American people, 
for at last we are beginning the serious process of the serious debate 
on national health insurance. It is appropriate that children are 
first, and it is appropriate that we begin this debate with meaningful 
votes on the direction that we are going to take on health care for all 
Americans.
  I yield.
  Mr. PACKWOOD. I yield 2 minutes to the Senator from Minnesota.
  Mr. DURENBERGER. Mr. President, I agree with my colleague from Kansas 
and my colleague from Massachusetts, if that is possible. I think we 
are debating what is best for women and children in this country.
  I regret that I made this argument last night at an hour which 
probably was not available to a lot of people. But I think the argument 
is fairly basic. Is the best care, both prenatal care and well-baby 
care, that which is determined by the doctor and the health plan in 
conjunction with the doctor, the obstetrician or the pediatrician? Or 
is it going to be determined by the Secretary of HHS? I do not have a 
problem with the first part of this amendment because it is basically 
what has been debated and argued here in the last 3 or 4 days. And that 
is that we ought to cover clinical preventive services, including 
prenatal care, well-baby care, immunizations for pregnant women and 
children. We all agree on that. The problem for me is when you direct 
the Secretary of HHS by July of next year to have come up with a 
schedule of the routine services that are going to be required in every 
single health plan in America for every single child and every single 
mom in America.

  They talk about the Academy of Pediatrics. I tell you, the Academy of 
Pediatrics will tell you it depends on the family history of the child, 
on whether there is a history of disease, it depends upon some of the 
cultural background, and it depends on a whole lot of factors as to 
what is the best care in a particular case. There is no way that the 
Secretary of HHS is going to be able to promulgate by regulation what 
service is the most appropriate in a given case for every kid. You 
cannot have one standard for every pregnancy and every child in 
America.
  The PRESIDING OFFICER. The time of the Senator has expired.
  Mr. MOYNIHAN. On our time, I would like to state that New York is one 
of the States which already has the provisions of the Dodd amendment, 
and they should be available to all Americans in every State.
  I yield 1 minute to the undaunted champion from Pennsylvania [Senator 
Wofford].
  Mr. WOFFORD. Mr. President, Senator Dodd worked with women and 
children in the Dominican Republic in the Peace Corps, and it is very 
fitting that he has carried that work forward to the American people 
and American children and American women sooner rather than later. That 
is the lesson of this amendment. Let us not be proud of dragging this 
process out into the next century. Let us be proud of how we find the 
ways and means to give health security and preventive health care to 
children sooner rather than later.
  This amendment was not so complicated. We were able to get to work on 
it. It is a page and a half. Implemented not later than July 1, 1995. 
Harry Truman, who started this fight, would be proud of us. Remember 
his words:

       Where there are differences remaining as to the details of 
     the program, we should not permit these differences to stand 
     in the way of our going forward. They should be thrashed out 
     with honesty and tolerance, as is our democratic fashion. We 
     should enact the best possible program and then all of us 
     should get behind it and make it work.
  The PRESIDING OFFICER. The time of the Senator has expired.
  Who yields time?
  Mr. PACKWOOD. I yield 2 minutes to the Senator from Rhode Island.
  Mr. CHAFEE. Mr. President, first, I want to congratulate the Senator 
from Minnesota. I share his sentiments. What are we trying to do here? 
The goal is to cover all of these services in the uniform benefit 
package that we are going to come up with. I do not think we want to be 
so specific that what is put into regulation then has to be changed in 
the following year.
  I suppose the proponent of the amendment would say that this is just 
for during the interim period. This will come out by July of 1995. But 
we all know that once we start down that track, once the Secretary of 
HHS comes out with this very detailed schedule--and everybody is 
familiar with this, and I presume it has been read before--she shall 
establish a schedule of periodicity that reflects--and so forth and so 
on. This is just the path I do not think we want to go in. To me, it is 
reminiscent of Medicare. In Medicare we have every possible contingency 
covered by regulation, and it is chaotic. I have had a hand in all of 
that. I think I mentioned in the remarks I made the other evening that 
you find the bizarre situation of Senator Chafee and Congressman Pete 
Stark, both in part of the conference on Medicare at 2 a.m. in the 
morning deciding in some remote part of this Capitol who will get paid 
for reading an EKG. I am totally--and I might speak for Representative 
Stark in the same manner--incompetent to do that. We were beyond our 
realm on that. That is not in our job description.
  The PRESIDING OFFICER. The time of the Senator has expired.
  Mr. CHAFEE. Mr. President, I just want to say that these are 
decisions that should be made by doctors, and the plan, and by 
individuals, and not by the Secretary of HHS.
  The PRESIDING OFFICER. Who yields time?
  Mr. PACKWOOD. How much time do we have left?
  The PRESIDING OFFICER. There are 21 seconds remaining.
  Mr. MOYNIHAN. I yield 42 seconds to the gallant and learned Senator 
from Connecticut [Mr. Dodd].
  Mr. DODD. If you keep talking like that, I would ask you come to 
Connecticut and say those words.
  Let me just say how pleased I am, Mr. President, that at long last we 
are finally going to have a vote on this proposal.
  Let me repeat for the benefit of my colleagues what the amendment 
does. It is very simple. It merely says that all private insurance 
policies--private insurance policies--must include coverage for 
preventive care for pregnant women, children, and infants as of next 
July, to expedite and accelerate that coverage. It creates no new 
Government bureaucracy. It builds on our current system of private 
insurance to make certain that we start giving our children a good 
start right away.
  Why is this so important? Why is it important to start providing 
these benefits earlier? I think the facts and statistics, Mr. 
President, speak for themselves. Every time that a low-birthweight 
delivery is prevented, it saves between $20,000 and $50,000. Every time 
a very low-birthweight delivery is prevented, it saves approximately 
$150,000. Not much more needs to be said.
  Clearly, if we can accelerate the coverage of these children by a 
year and a half or 2 years, we will eliminate significant future costs. 
We mandate well child care already in 22 States. The Senator from New 
York pointed out that his State has had this type of program for some 
time. The first State was Wisconsin and the second, Kansas. These 
programs were started under Republican Governors, I might add, that 
insisted that we reach out to children as quickly as possible.
  There is a legitimate debate about individual proposals to deal with 
the benefit package, but I think there ought to be some consensus here 
about children and pregnant women, that it is in our collective 
interest to see that we do everything to prevent--not treat but 
prevent--these problems from occurring.
  If we can prevent these health problems from occurring, more promptly 
and earlier, we all win and all gain. Therefore, Mr. President, I think 
this amendment is critically important. Of course, I think all of us 
agree that we must figure out a way to reach the 12 million children 
uninsured children.
  I want to stress that this amendment does not create any new 
Government organization. It is all done under private carriers. HMO 
programs in this country require this, and have insisted upon it, to 
their credit.
  I believe that Republicans and Democrats, on the very first issue 
addressed in this body on national health care reform, on the issue of 
pregnant women and children, ought to be able to come together. We may 
divide in the days ahead on the issue of mandates, and alliances, and 
cooperatives and whatever. But on children and pregnant women, let us 
say to the American people tonight that as far as those citizens are 
concerned, we unite and stand together to see to it that they will at 
least get the basic kinds of health care coverage that they deserve and 
need to make this a stronger and healthier and better Nation.
  Mrs. HUTCHISON. Mr. President, I rise to oppose the Dodd amendment. 
This amendment would have the effect of changing insurance laws 
throughout America, starting immediately, preempting State laws and 
requiring every person to take this coverage regardless of whether or 
not they will have children in their families. It is a mandate on 
people to take a standard benefits package whether they need it or not. 
This takes away the freedom of choice, and the cost requirements are a 
tax which will have to be borne by each individual and his or her 
employer. This is what is wrong with a standard benefits package 
mandated by the U.S. Congress, and why I do not support it in the 
Mitchell bill.
  Mr. THURMOND. Mr. President, before beginning my statement on this 
bill, I wish to acknowledge the efforts by the President and Mrs. 
Clinton to focus the Nation's attention on the need for health care 
reform. While they have worked very hard to reach this point, I cannot 
support the far-reaching plan which we are now considering. Hopefully, 
during debate on this issue, we can agree on reforms which will improve 
our health care system without burdening our society and economy.
  We all agree that our health care system needs repairing. Our primary 
goal should be fixing the current system without losing the advantages 
of choice and quality coverage we presently enjoy. We must not forget 
that the American health care system is the envy of the world. Foreign 
leaders and dignitaries come here for treatment because their own 
systems simply do not provide the same quality and advanced care.
  Last year the United States spent approximately $900 billion on 
health care. This is 14 percent of our gross national product. 
Obviously, any reform in health care will have a large impact on our 
economy. However, it is our responsibility to assure Americans that any 
reform will benefit the finest quality health care system in the world.
  Mr. President, I believe the best starting point for health care 
reform is prevention. If Americans have ample information and 
incentives concerning preventive health care, many of the health care 
problems can be avoided. Proper diet, reasonable exercise, self-
discipline, and an optimistic attitude toward life promote health. It 
stands to reason that such sensible measures are cheaper and cause less 
suffering than curative medicine.
  Prevention programs are especially needed in the maternal and child 
health fields. The lack of prenatal care causes thousands of easily 
avoidable birth defects each year. For example, many women who smoke do 
not realize that smoking during pregnancy may contribute to low-weight 
births. Also, many Americans do not know that the use of alcohol or 
drugs during pregnancy may result in a child with fetal alcohol 
syndrome or addiction. Simply providing obstetrical and gynecological 
services can prevent these and other infant health problems.
  We can save an immeasurable amount of suffering if we simply promote 
and practice preventive health care, starting with prenatal health and 
continuing throughout the life of a child.
  Prevention programs are also needed in the areas of substance abuse 
and mental health. As you know, the cost to our Nation caused by 
substance abuse and mental illness are tremendous. In 1990, Americans 
spent $314 billion on health and social problems created by drugs, 
alcohol, and mental disorders--$100 billion more than the cost of AIDS 
and cancer combined. We pay not only in medical care costs, but also in 
a rising crime rate; an overburdened social welfare system; 
productivity losses; premature deaths; and emotional suffering that 
cannot be measured.
  The importance of helping those who suffer from addictive and mental 
disorders is evident. Studies have shown that treatment programs can 
reduce the enormous social and economic costs of these disorders. For 
example, half of the patients receiving treatment for schizophrenia, 
either completely recover or can function with minimal support; thereby 
cutting rehospitalization rates, preventing homelessness, and improving 
employment outcomes for those patients.
  Mr. President, for every dollar spent on treating someone with 
substance abuse problems, $11.54 is saved in social costs. For example, 
the estimated 10 million alcoholics in this country spend two times 
more on health care than those without alcohol problems.
  Costs associated with substance abuse are not limited to health care. 
Addictive and mental disorders have added to our society's greatest 
problems: crime, joblessness, and welfare. Therefore, we can not ignore 
the beneficial effects of prevention and treatment.
  Mr. President, there are issues on which I believe we can agree. For 
example, we should not allow the cancellation of health care coverage 
because of illness, or allow coverage to be denied because of a pre-
existing condition. Further, I believe we all agree that coverage 
should be portable. If individuals lose their jobs or decide to change 
jobs, they should not fear a reduction in their health care coverage, 
nor that they may lose it entirely.
  I am pleased that there is some common ground in these areas. 
Unfortunately, this legislation reaches far beyond these common issues. 
It creates one of the greatest social spending programs in history. It 
also creates one of the greatest intrusions into the rights of the 
States and the rights of individuals.
  No one wants to be denied health care when it is needed. However, 
there are distinct and subtle differences between what is called 
universal coverage and universal access.
  Universal coverage essentially means that the Government will run our 
health care system. Everyone may have coverage, but at what price? Some 
of the looming prices include less quality, less access to needed 
services, less freedom, more government, and more taxes.
  Universal access means that a person cannot be denied coverage 
because of a preexisting condition or on the basis of employment or 
wealth. It is founded on personal responsibility which means it is not 
a free ride.
  Many Americans are disgusted with the free ride welfare system in 
place today. Is it because people do not want to help their fellow 
Americans? I doubt it. We prove time and time again that we are the 
most generous Nation on Earth. Americans traditionally come to the aid 
of those in need. Everyone recognizes that some help is needed every 
now and again. However, people are willing to give someone a hand-up 
but not a hand-out. That is why people are upset with welfare--it is a 
handout. It is a self-perpetuating cycle of dependency. The American 
people are tired of hearing that their hard earned income goes to some 
wasteful and inefficient program.

  Yes, there are problems with our current health system, but they will 
only be made worse if this plan is enacted in its current form.
  I have a number of specific concerns surrounding the Clinton-Mitchell 
bill. My first concern is the issue of the guaranteed basis benefits 
package.
  The Clinton-Mitchell bill would entitle all Americans to a package of 
guaranteed national health benefits. This guaranteed benefits package 
includes mental health services, substance-abuse treatment, and some 
dental and clinical preventive services. The mandatory package includes 
not only major medical services, but also incorporates routine eye and 
ear examinations and even elective abortion services.
  The Clinton-Mitchell bill would require every health plan to provide 
this standardized package of health care benefits. This requirement 
will take away the consumer's ability to choose benefits. Moreover, as 
the Government aggressively promotes managed care, the ability of 
doctors to treat patients according to their independent professional 
judgment will be severely circumscribed. These limitations will make it 
difficult for Americans to take advantage of new or specialized medical 
services.
  The National Health Board will set national guidelines for 
determining which treatments can be provided or upgraded, which 
treatments are medically necessary, and even how often approved 
treatments or tests can be conducted. New benefits, including new 
treatments, medical procedures, or devices used in the treatment, 
prevention, or cure of disease will have to be approved by the National 
Health Board, or Congress, before they can be covered in a basic 
benefit package.
  New benefits will be approved slowly and with great difficulty. I am 
concerned that there will be extended bureaucratic delays and major 
political debates surrounding any attempt to alter benefits. For 
medical specialty groups, or groups afflicted with particular medical 
conditions, the National Health Board and, inevitably, Congress will 
become the central focus of intense lobbying over the addition or 
subtraction of medical benefits, further politicizing the health care 
system.
  I believe we can avoid these problems by allowing consumers their own 
choice of doctor and health care plan. We can do this by ensuring 
portable, universal access to health care, regardless of pre-existing 
conditions and without mandating specific benefits.
  Another area of concern is the treatment of the system for graduate 
medical education. I agree that we have a shortage of primary care 
physicians and providers in America. Many people are concerned that 
there are too many physicians, that our distribution of specialists is 
poor, and that there is no government control on training programs. 
However, we have the best health care system in the world. I believe 
that is due in part to the fact that we allow our students and medical 
professional to choose their fields of endeavor and to pursue their 
careers without interference.
  Unfortunately, this legislation will directly interfere with the 
career choices our students will make. This legislation directs that 
National Council on Graduate Medical Education to decide how to cap the 
physician supply by not allowing students to enter a nonprimary health 
care training program. This commission will define the goals for 
specialty mix, the number of residency training positions, and where 
residency programs will exist.
  This legislation dictates that the national council shall ensure that 
55 percent of the students in primary care programs will pass. I am 
concerned that this will lessen the quality of the education received 
by these students.
  I believe we are approaching the shortage of primary care providers 
from the wrong angle. We should be encouraging our students to pursue 
careers in primary care. We should not limit the number of positions 
available in specialized areas.
  Mr. President, a third area of concern is the expansion of 
prescription drug coverage, and the potential for price caps and 
shortages in this area. There is no question that all Americans need 
access to affordable prescription drugs. Unfortunately, too many 
Americans are supporting this plan because they believe it will expand 
their drug coverage.
  They must think this through. At what cost will drug coverage be 
``expanded''? Some of the costs will surely be: Reduced research, 
reduced choice of medications--many of our senior citizens prefer to 
use certain products--premium caps, shortages in drug supply, and 
taxes.
  Mandated Government prices controls or price review boards would 
penalize pharmaceutical research, and eventually drive companies out of 
the industry. Recent studies of the pharmaceutical industry indicate 
that the free market, along with strong safeguards to ensure quality 
help, contains price increases.
  As you know, in 1993, the pharmaceutical industry spent an estimated 
$12.6 billion on research and development. The Office of Technology 
Assessment estimates that in 1990 the average cost of research and 
development for each new drug marketed in the United States was $359 
million.
  The best hope for treatment and possible cures for many of the health 
problems we face today is in the area of pharmaceutical and 
biotechnology advances. If we try to establish price discipline, we 
will see a decrease in pharmaceutical research and development, and 
fewer pharmaceutical and biotechnology breakthroughs.
  I am also concerned that the Workers' Compensation Program has been 
included in this legislation. The proponents of this legislation will 
argue that it is only establishing a system of data collection and a 
commission to study whether workers' compensation should be 
incorporated into health care reform. This is true for the Senate 
version of this legislation. Unfortunately, it is fully incorporated in 
the House version. My concern is that the Senate version will be 
dropped before the conference even begins.
  Let me address my reasons for this concern.
  As you know, workers' compensation was created over 80 years ago and 
is the result of a common compact between business and labor. If a 
worker is injured on the job, the financial burden of an industrial 
accident is shifted away from the injured worker and charged to the 
employer. All of an injured worker's medical expenses are covered, and 
the work-related disability payments are made until the worker returns 
to the job. In addition, workers' compensation insurers attempt to 
manage treatment and rehabilitation in order to minimize an injured 
worker's loss of earning capacity and/or physical function. In return, 
the injured worker agrees not to sue his or her employer to receive 
compensation for the injury.

  The House's inclusion of workers' compensation in this legislation 
will jeopardize the current freedom and flexibility of States to 
experiment with new ideas and approaches to improve the system. A 
number of States have had recent successes controlling the growth of 
workers' compensation costs. In the last few years, Massachusetts, 
Florida, Oregon, New Mexico, and Washington have all undergone efforts 
to reform workers' compensation. Dozens of workers' compensation 
legislative proposals are also pending in various State legislatures. 
Each State has taken a different approach in its reform, and we should 
not impede this progress.
  Mr. President, the goal of workers' compensation is simple: Get an 
injured worker back to work and normalcy as soon as possible. Much of 
the success in achieving that goal is due to the fact that insurers and 
employers who foot the bill for medical care should continue to have 
significant decision-making authority. The House version will prevent 
the employer and the State workers' compensation agency from 
questioning whether appropriate medical treatment is being received. 
Employers and insurers are concerned about separating the 
responsibility for medical management from the financial responsibility 
for cash benefits, and losing control over the medical portion of the 
workers' compensation premium which amounts to approximately $24 
billion a year.
  Inclusion of workers' compensation would also eliminate the benefit 
of experience rating. Experience rating encourages employers to 
directly influence their premiums by implementing workplace safety 
programs to reduce the number of accidents among their employees. The 
integration of workers' compensation would seriously and adversely 
affect employer safety incentives by moving workers' compensation from 
an experience-rated to a community-rated system, and the public would 
bear the cost of an employer's unsafe workplace.
  I believe the workers' compensation system is unique in its mission 
and its approach. I also believe that including it in this reform 
package would be a mistake. Workers' compensation has always been a 
successfully State-managed system, and I believe it should remain with 
the States.
  Another concern I have with this bill is the inclusion of the 
antidiscrimination provisions. Under current law, employers, schools, 
and places of public accommodation are not allowed to discriminate on 
the basis of race, sex, age, national origin, religion, or disability. 
The Clinton/Mitchell bill would add five new categories that have never 
been considered as protected groups under our civil rights laws. They 
include: Language, income, sexual orientation, health status or 
anticipated need for health services.
  This language is simply not needed to ensure that there is no 
discrimination. Section 1002 clearly establishes that all health plans 
shall ``accept all eligible individuals for coverage.'' There is no 
room for discrimination in this section.

  I believe our employers, health plans, States, and other entities 
will be exposed to unlimited damages and lawsuits that will further 
raise the cost of health care and further overwhelm our judicial 
system.
  This is an unprecedented expansion of law. We do not know how broad 
these new categories are. We also do not know what effect this new 
expansion will have on our employment policies. Therefore, we must 
question why these new categories have been included.
  Mr. President, as the ranking member of the Senate Judiciary 
Subcommittee on Antitrust, Monopolies and Business Rights, I have two 
additional concerns that relate to the antitrust laws.
  First, I oppose the attempt in this legislation to repeal the 
McCarran-Ferguson Act for the provision of health benefits by insurers. 
This repeal would be bad for both competition and consumers and would 
interfere with State control over the regulation of insurance.
  The repeal applies to ``health benefits,'' which might appear quite 
narrow, but in fact encompasses many lines of insurance. The term is 
far broader than mere health insurance, and could cover workers' 
compensation, homeowners, auto, medical malpractice, and general 
liability insurance.
  Any repeal of McCarran-Ferguson will inevitably lead to a decrease in 
competition rather than the increase proponents claim. The insurance 
industry is now highly competitive with thousands of firms competing 
for business. Without the ability to engage in certain joint 
activities, especially sharing of information, many of the smaller 
companies may go out of business and competition will be diminished.
  If McCarran-Ferguson is repealed, I believe it would only be a matter 
of time before Federal regulation crept in. Federal regulation is 
generally cumbersome, slow, and unresponsive to local and individual 
needs, while the State regulation encouraged by McCarran-Ferguson is 
better suited to the needs and interests of the consumer and the 
industry. The net effect of McCarran-Ferguson repeal in this 
legislation is that consumer welfare will not be enhanced. The 
uncertainties associated with such a change will likely decrease 
competition as regulation increases, to the detriment of the consumer 
and the marketplace.
  My other antitrust concern is that this legislation makes no attempt 
to address the many uncertainties of the antitrust laws, which are 
worsened by health care consolidation under this legislation. Last 
November, Senator Hatch and I introduced the Health Care Antitrust 
Improvements Act to establish a framework for adjusting the antitrust 
laws to health care reform. We have recently modified our proposals to 
address concerns which had been raised, but continue to pursue the key 
goal of clarifying how the antitrust laws apply in the health care 
industry. The purpose is to save money and improve quality in health 
care, not for the benefit of providers, but for the ultimate benefit of 
patients and those who pay the bills.

  Saving money through lower antitrust costs is achieved by greater 
antitrust certainty so that fewer questionable cases are brought, by 
giving more responsibility to the Federal antitrust agencies to 
determine what conduct is desirable and what is not, and by focusing 
antitrust enforcement on the areas that truly need it rather than on 
areas that generally do not.
  Quality is improved by removing unnecessary and artificial antitrust 
barriers that prevent medical providers from organizing themselves to 
achieve the combinations which can deliver the highest quality of care. 
The antitrust laws currently chill much desirable conduct by medical 
providers. This has a negative effect on quality but can be avoided by 
greater certainty about the applicability of the antitrust laws in the 
health care field.
  In order to permit desirable activities and organization by health 
care providers, the Hatch-Thurmond provisions direct the Justice 
Department to develop safe harbors for specific categories of conduct 
which need not be subject to the antitrust laws. Because of the 
difficult in determining where to draw the lines in changing markets, 
the Attorney General is authorized to review applications and issue 
antitrust waiver covering individual situations. In addition, our 
provisions permit health care joint ventures to be disclosed to the 
Attorney General in exchange for single damages, following the pattern 
of the production joint venture bill that passed the Congress and was 
signed into law last year. These provisions establish a framework for 
adjusting the antitrust laws to changing health care markets, to 
achieve the ultimate goal of more efficient, higher quality medical 
services at reasonable prices for the benefit of all Americans.
  Finally, Mr. President, perhaps the most pressing issue is that of 
the mandates included in this bill. This legislation will require each 
State to submit a health care reform plan to the National Health Board 
detailing how the State will comply with the Federal rules and 
regulations established by the Board. The States will have to 
demonstrate to the Board how they will certify health plans, administer 
subsidies for individuals and small employers, collect data on health 
plan performance, and meet Federal quality and management requirements.
  There are at least 50 new mandated bureaucracies created under this 
legislation. I believe the American people can do without more 
bureaucracy.
  Also contained in this legislation are 17 new federally mandated 
taxes. When you tax someone it means less money in that person's 
pocket. It means that person has less freedom to do what they wish with 
their hard-earned income. It often means that person must also try to 
get by with less money to pay for food on the table, diapers for the 
baby, the utility bills, or any other necessary expenses.
  Mr. President, this legislation sets the goal of coverage at 95 
percent. If that goal is not reached, an employer mandate is triggered 
that requires the employer to pay 50 percent of the costs of an 
employee's health plan.

  The employer mandate imposes additional labor costs on our economy, 
and when businesses are faced with an increase in labor costs they 
first look to the employee to make up the difference. This will take 
the form of lower wages, fewer benefits, and job loss.
  What small business is going to want to hire another employee when 
they are facing a 50-percent tax on health care? That is what it is. It 
is a tax business. You can call it shared responsibility or employer 
contribution, but the simple fact is that the Federal Government is 
directing the private sector to spend its money in a particular way. 
That is a tax.
  Webster's Dictionary includes among its definition of the word tax 
``to impose a burden on; put a strain on''. The employer mandate places 
an enormous burden on the individuals and businesses of this great 
Nation.
  According to a preliminary study done by the Heritage Foundation, 
businesses in South Carolina may suffer an additional $806 million a 
year in additional taxes. That is $806 million that will not go toward 
creating new jobs or to support existing jobs.
  The people of my State do not want a federally imposed employer 
mandate. The American people do not want an employer mandate. They know 
it is not good for business and, in the long run, it is not good for 
the economy.
  Many of the proponents will advocate that this trigger will only 
happen if the reformed free market fails. These advocates say they are 
going to give business a chance. That is like tying my hands behind my 
back and asking me to box 15 rounds with Mohammed Ali.
  The result is obvious. The system is designed to fail; and the 
trigger will be pulled. Even in the highly touted Hawaiian system--with 
employer mandates--coverage has only reached 94 percent.
  This trigger is on a gun placed at the head of American business 
entrepreneurs and Americans themselves.
  Mr. President, the Charleston Post and Courier, a local newspaper in 
South Carolina, recently reported the results of a poll taken by Mason 
Dixon Political/Media Research, Inc. When asked, ``what issue will be 
most important to you when deciding how to vote in the congressional 
race?'' only 7 percent responded ``health care.'' Twenty-six percent 
responded that taxes and government spending were most important to 
them, followed by crime and drugs with 24 percent, education with 14 
percent, and employment with 8 percent. Health care was fifth on the 
list, barely out-polling deficit reduction.
  The results of this poll are telling. The American people want health 
care reform done for the right reasons, not for political gains. Also, 
based on thousands of handwritten constituent letters and phone calls, 
I know the people of South Carolina do not want this legislation. The 
people of my home State do not want bureaucrats in Washington, DC, 
making decisions on the best way to treat patients in Allendale, 
Walterboro, Pomaria, Taylors, and the other towns and communities in 
South Carolina.
  It is our responsibility to the American public to ensure that health 
care reform will be truly beneficial and not harmful to the finest 
quality health care system in the world. I urge my colleagues to oppose 
this legislation and work for real health care reform that works and 
not for another government entitlement program.
  Mr. DODD. Mr. President, I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There is a sufficient second.
  The yeas and nays were ordered.
  The PRESIDING OFFICER. Who yields time?
  The floor leader controls 1 minute 5 seconds.
  Mr. MOYNIHAN. Mr. President, we yield back the remainder of our time.
  The PRESIDING OFFICER. The Republican floor manager has 21 seconds.
  Mr. PACKWOOD. I yield back the remainder of my time.
  The PRESIDING OFFICER. The majority leader.


                      Unanimous-Consent Agreement

  Mr. MITCHELL. Mr. President, there will be no further roll call votes 
this evening after this vote.
  I have discussed the matter with the managers and the distinguished 
Republican leader and following this vote, I ask unanimous consent that 
Senator Feingold be recognized to complete his statement.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. MITCHELL. Following Senator Feingold's statement, which he had 
begun prior to this debate and vote and for which I again thank him for 
his courtesy in permitting an interruption, there will be 2 hours for 
debate, which will be equally divided and under the control of Senators 
Moynihan and Packwood, and after those 2 hours the Senate will remain 
in session for as long as Senators wish to speak but without any 
specific division of the time. The managers will take care of that. I 
put that in the form of a unanimous consent.
  The PRESIDING OFFICER. Is there objection?
  Mr. BROWN. Mr. President, reserving the right to object, my 
understanding was I was to have the floor for an opening statement 
following the Senator from Wisconsin.
  Mr. MITCHELL. I made this suggestion as the request of Senator 
Packwood.
  Mr. PACKWOOD. I think we will work this out. We are going back and 
forth under controlled time, and I will recognize the Senator from 
Colorado.
  The PRESIDING OFFICER. The Senator from New York.
  Mr. MOYNIHAN. Mr. President, we will be happy to have the Senator 
from Colorado as the first speaker following the Senator from 
Wisconsin.
  The PRESIDING OFFICER. There is a unanimous-consent request 
propounded.
  Without objection, it is so ordered.
  Mr. MITCHELL. Then, Mr. President, on tomorrow Senator Packwood has 
indicated to me that he or one of his Republican colleagues will have 
an amendment to offer, which will be the subject of debate and we hope 
vote tomorrow, although we are not attempting to reach an agreement on 
time. Senator Packwood has indicated that he hopes to be able to let us 
see a copy of that amendment this evening so that we have a chance to 
review it and be prepared.
  With respect to the pending amendment, we provided a copy of that 
amendment several hours before it was taken up.
  I thank colleagues for their cooperation, and I now yield the floor.


                       vote on amendment no. 2561

  The PRESIDING OFFICER. Pursuant to the unanimous-consent agreement 
heretofore entered, all time having been yielded back, the question is 
on agreeing to the amendment of the Senator from Connecticut. On this 
question, the yeas and nays have been ordered, and the clerk will call 
the roll.
  The legislative clerk called the roll.
  Mr. FORD. I announce that the Senator from Georgia [Mr. Nunn] and the 
Senator from Tennessee [Mr. Sasser] are necessarily absent.
  Mr. SIMPSON. I announce that the Senator from Oregon [Mr. Hatfield] 
is necessarily absent.
  The PRESIDING OFFICER. Are there any other Senators in the Chamber 
desiring to vote?
  The result was announced--yeas 55, nays 42, as follows:

                      [Rollcall Vote No. 288 Leg.]

                                YEAS--55

     Akaka
     Baucus
     Biden
     Bingaman
     Boren
     Boxer
     Bradley
     Breaux
     Bryan
     Bumpers
     Byrd
     Campbell
     Conrad
     Daschle
     DeConcini
     Dodd
     Dorgan
     Exon
     Feingold
     Feinstein
     Ford
     Glenn
     Graham
     Harkin
     Heflin
     Hollings
     Inouye
     Jeffords
     Johnston
     Kennedy
     Kerry
     Kohl
     Lautenberg
     Leahy
     Levin
     Lieberman
     Mathews
     Metzenbaum
     Mikulski
     Mitchell
     Moseley-Braun
     Moynihan
     Murray
     Pell
     Pryor
     Reid
     Riegle
     Robb
     Rockefeller
     Roth
     Sarbanes
     Shelby
     Simon
     Wellstone
     Wofford

                                NAYS--42

     Bennett
     Bond
     Brown
     Burns
     Chafee
     Coats
     Cochran
     Cohen
     Coverdell
     Craig
     D'Amato
     Danforth
     Dole
     Domenici
     Durenberger
     Faircloth
     Gorton
     Gramm
     Grassley
     Gregg
     Hatch
     Helms
     Hutchison
     Kassebaum
     Kempthorne
     Kerrey
     Lott
     Lugar
     Mack
     McCain
     McConnell
     Murkowski
     Nickles
     Packwood
     Pressler
     Simpson
     Smith
     Specter
     Stevens
     Thurmond
     Wallop
     Warner

                             NOT VOTING--3

     Hatfield
     Nunn
     Sasser
  So the amendment (No. 2561) was agreed to.
  Mr. MOYNIHAN. Mr. President, I move to reconsider the vote.
  Mr. DODD. I move to lay that motion on the table.
  The motion to lay on the table was agreed to.
  (At the request of Mr. Dole, the following statement was ordered to 
be printed at this point in the Record:)
 Mr. HATFIELD. Mr. President, today I was necessarily absent 
for the vote on the Dodd amendment Number 2561. Had I cast my vote, I 
would have done so in opposition to Senator Dodd's amendment because I 
do not believe the Secretary of Health and Human Services should be 
designating specific benefits to be provided in health insurance plans. 
I have always had a strong commitment to preventive efforts, including 
maternal and child health, and I would hope that any health care reform 
package we enact will favor these services without the imposition of 
Federal mandates.
  Several Senators addressed the Chair.
  The PRESIDING OFFICER. The Senator from New York.
  Mr. MOYNIHAN. Mr. President, before turning to the distinguished 
Senator from Wisconsin, who so courteously allowed us to interrupt him 
for this rollcall, may I make the point--
  The PRESIDING OFFICER. The Senator will suspend. The Senate is not in 
order. The Senator from New York claims the floor.
  Mr. MOYNIHAN. May I simply make the point, sir, that we have been on 
this bill for almost 2 weeks and we have not lost an amendment yet. 
Thank you.
  The PRESIDING OFFICER. With that observation noted, under the 
previous order the Senator from Wisconsin, Senator Feingold is 
recognized.
  Mr. FEINGOLD. Thank you, Mr. President. I thank you for all your 
extremely hard work on this piece of legislation.
  Mr. President, I had the opportunity on Sunday morning to see some of 
the talk shows about the Federal Government and national issues, and I 
happened to watch the McLaughlin Group.
  One of the panelists on the McLaughlin Group said something about 
what was wrong with the Democrats' approach to health care. His 
conclusion was that we had made two big mistakes. One mistake, he said, 
was proposing the idea of a health security card for all Americans and 
waving the card around. He thought that was a terrible mistake 
strategically.
  The other terrible mistake he said was for the President to have held 
up a pen and say that he would veto legislation that did not provide 
universal coverage. I was somewhat amused by these remarks because 
these two symbols--the card and the pen--have been among my favorite 
aspects of the health care debate. These were symbols of hope, that all 
Americans at the end of the 103d Congress would have health care 
guaranteed for them.
  So I waited a while before I spoke on the floor. Many Senators have 
already spoken on health care. Many more will later on. But I wanted to 
get an initial impression of whether my original view of the importance 
of this legislation held up after listening to all the speeches.
  I still think the reason for this legislation holds up, and that is 
the central proposition that every American should be guaranteed health 
care. The problems with the legislation, the controversy, is not about 
that principle. There is a tremendous amount of debate about employer 
mandates and whether we should have a premium tax or the mix of 
generalists versus specialists, and other very important issues. But it 
still seems to me that a reasonable centerpiece of the health care 
debate is whether or not we are going to provide a guarantee of health 
care for all Americans.
  So, Mr. President, I wonder why that issue has seemed to have dropped 
from view, relatively speaking. To me it is still the most important 
issue, and that if we do anything with the Mitchell bill, we should 
strengthen the provisions for universal coverage.
  I have felt this way for a while and, naturally, we all campaigned in 
1992 on the notion that we would provide health care for all Americans. 
I think everybody, on both sides of the aisle, probably said something 
along those lines.
  But we did not stop there. We went beyond that into the legislative 
period, and the words from the famous campaign of the Senator from 
Pennsylvania have been repeated in many different ways, but they still 
hold true:

       If criminals have a right to a lawyer, sick people ought to 
     have a right to a doctor.

  Those words are, to me, still the basis of a hope and an expectation 
that we have presented to the American people over the last few years, 
but in particular in this year. I give credit--tremendous credit--to 
the President and the First Lady for repeatedly making that known.
  The President said in his famous speech on September 22, 1993:

       So I say to you, let us write that new chapter in the 
     American story. Let us guarantee every American comprehensive 
     health benefits that can never be taken away.

  I was grateful to have both the President and the First Lady travel 
to my State of Wisconsin. They did not just visit the big cities. They 
came to some of our middle-size communities, like Wausau and 
Janesville, and they repeated over and over again that proposition: 
That if nothing else, the end of this process will be that every 
American will have one of these cards to guarantee them health care 
coverage.
  I remember sitting next to my friend, the junior Senator from West 
Virginia, during the President's State of the Union. Senator 
Rockefeller and I were chatting now and then during the President's 
speech, and Senator Rockefeller let me know that he was wondering if 
the President was going to hold up that pen. He hoped he would, and so 
did I. We thought it was a critical moment to see whether the President 
of the United States would say, ``If you don't give me universal 
coverage, I will veto this bill.''
  So those two symbols gave a lot of people hope--maybe a lot of 
expectation, but they gave a lot of hope. And to me it is not a case of 
overpromising. To me this card and this pen are some of the best 
examples of leadership and strength that the people of this country 
have come to look for in their President and in their Congress.
  The President said in his speech, ``I have no special brief for any 
specific approach, even in our own bill, except this. If you send me 
legislation that does not guarantee every American private health 
insurance that can never be taken away, you will force me to take this 
pen, veto the legislation, and we will come right back here and start 
all over again.''
  So, Mr. President, I think the card and the pen are very powerful 
symbols. One expresses the promise of guaranteed health care for every 
American that could never be taken away. The other gives meaning and 
force to that promise. And I can tell you, having been all over 
Wisconsin holding town meetings and listening sessions, the card and 
the pen meant a lot to the people of the State of Wisconsin, and they 
expect us to act on it.
  We have not seen much of those symbols lately. For many, the comfort 
and the reward of the status quo have been a little too tempting. The 
very interests that have fattened themselves on the inequities and 
inefficiencies of the current system have understandably fought to keep 
those defects and weaknesses in place.
  To date, I am sorry to say, those interests have been successful in 
obscuring the debate, and many who have aligned themselves with these 
interests have done a tremendous job, a masterful job of misstating our 
health care problems. The other side has a tremendous skill. The other 
side knows how to keep it simple. They weigh a bill. They say it is Big 
Government. They bring out a chart that looks complex but is actually 
less complicated than the current system. They are darned good at that.
  We need to get good at it, too. We need to talk about the simple 
message that this card and this pen are about a commitment that this 
side has to every American that the other side does not.

  I remember well last year during the deficit reduction debate there 
was another symbol. In fact, some Boy Scouts handed me this symbol. It 
was a false symbol but it had been mass produced. It said, ``No middle-
class tax increase.'' Some of the folks on the other side had everybody 
in this country including Boy Scouts in Ripon, WI, believing that 
everybody's income taxes were going to go up under the President's 
deficit reduction bill.
  It was not true. And the statistics show that only 1 percent of the 
people in this country had their income tax rates increase. But the 
symbolism worked. That little card misrepresented the deficit reduction 
bill and it took us months to undo, the consequence of people being 
misinformed of what the bill really did.
  Mr. President, we need to return to talking about guaranteeing every 
American this health security card.
  I am struck by the sort of having-your-cake-and-eat-it-too attitude 
that I heard out in the Chamber during the last 10 days. Just about 
everybody in this body says they are for universal coverage, but they 
say it is a question of how and when you get there, and whether or not 
somebody is willing to vote for the tough law that is necessary to make 
that kind of health care coverage possible.
  Now, of course, there are some people who take the view that 
universal coverage is a bad concept. Some say it is an example of 
socialism--it is socialism to talk about letting every American have 
health care cards. Others pay lip service to the concept of universal 
coverage but say what we really need is universal access. But universal 
access is different than universal coverage. Universal access means if 
you have the dough, if you have the money to pay for it, you get 
coverage. It does not guarantee coverage.
  Perhaps this problem of terminology was best shown yesterday when I 
had the chance to hear the junior Senator from Texas indicate that she 
believes that universal coverage is a noble goal and one that she said 
she shared. My question for you, Mr. President, and my colleagues is, 
how did we get from a guarantee of health care coverage and a right of 
health care coverage to the idea that it is simply a noble goal, like 
eliminating poverty or eliminating all environmental pollution.
  For me, universal coverage has long been the core issue of health 
care. That does not mean there are not other terribly important issues. 
One is cost containment, the fact that this system, a combination of 
private and public health care, is going to go over $1 trillion this 
year for the first time; another is, the issue of comprehensive 
benefits including mental health benefits and it is extremely central 
to this debate; the issue of home and community-based long-term care 
for the elderly and people with disabilities is the issue I have spent 
the most time on and talked to most every Member of the Senate about.
  All of these are important and all of these should be addressed, but 
all of these are part of a larger reform which has its first principle 
in this, universal coverage. Sometimes I fear that there is not much 
talk about universal coverage or guaranteeing health care and that all 
these other issues are raised so that that issue does not have to be 
discussed. It is too central. It is too obvious. It is too simple that 
this country has come too far to still be one of the few industrialized 
countries in the world that does not guarantee health care.
  For me, this goes back all the way to 1972. I was 19 years old at the 
time. I bought and read a book by the senior Senator from 
Massachusetts. It was called, ``In Critical Condition.'' It was one of 
the first and most important articulations on the notion that health 
care should be a right for all Americans. And I admit I was young at 
the time. I also believed in 1970 that when we started Earth Day, we 
would not have much of a problem with environmental pollution some 20 
years later, but we still do. But that was youthful optimism, and I 
really believed that when Senator Kennedy's book came out it would not 
be long before we could say that health care is a right of all 
Americans.
  I am embarrassed that this country has not achieved that goal. I am 
embarrassed that the most powerful and rich country in the world still 
cannot say that each and every person in this country has a right to 
coverage. I am very proud of my country, but I am embarrassed by that.
  This has been an article of faith for me and has been throughout the 
years until 1988 when I held hearings in Wisconsin on long-term care. 
And it was all supposed to be about home and community-based care. But 
it was interesting; some people came to the hearing, some representing 
labor, some representing health care groups, and they said, ``State 
Senator Feingold, would it be OK if we talked a little bit about health 
care in general?'' They taught me something I did not know. I did not 
know that 500,000 people in Wisconsin were uncovered. I knew that some 
were, but I was astonished to know that over 10 percent of the people 
in the State of Wisconsin did not have that coverage. Growing up in 
Janeseville, WI, I believed and I assumed that all kids had health care 
coverage, whether they were rich or poor. And what really got me was 
learning at these hearings in 1988 that the only other industrialized 
country in the world that did not have that commitment to universal 
coverage was South Africa. Why the United States and South Africa? Why 
our country?
  How can it be that we have the best health care system in the world, 
as the other side is so fond of saying, if 37 million Americans are not 
covered?
  So that is why this card and this pen are so important. They are the 
key to showing all Americans that we are committed to each and every 
one of them. As the President said on November 20, 1993, under this 
legislation every citizen and legal resident will receive a health 
security card that guarantees the comprehensive benefit package.
  So the question before us, that I think ranks above all other 
questions, is, do all Americans have a right to one of these cards? And 
will the President use the pen to enforce it? I certainly hope so.
  But I have been a little disappointed lately. I made note of it at 
the time to read a headline in the Washington Post: ``Clinton Backs 95 
Percent for Health Care.'' To me, 95 percent is not 100 percent. That 
is a disappointment. The problem with the analysis of the 95 percent 
figure is that it involves a confusion, a confusion between the 
practical problem of making sure that everybody uses their right to 
coverage, and the legal notion that everyone should have a right to 
health care. In other words, you can have universal coverage for all 
Americans, but only 95 percent of the people may actually make use of 
that protection.
  I am not saying that this is a constitutional right. Perhaps you 
could make that argument. The Founding Fathers talked about life, 
liberty, and the pursuit of happiness. That is not what we are talking 
about here. What we are talking about here is whether we are going to 
provide a statutory right, a public law that creates a statutory right, 
for every American to have health care. That is not in the 
Constitution, but the act of the Congress and the President.
  Part of the problem with the sort of have-your-cake-and-eat-it-too 
added to universal coverage is that, if you believe that universal 
coverage for all Americans is impossible, you get statements like, ``It 
is a noble goal.'' And many Senators come out and say it just cannot be 
done, that there is no such thing as universal coverage. That is not 
the case. It is based on a misunderstanding. I hope that 
misunderstanding is accidental.
  The junior Senator from Texas said yesterday on the floor of the 
Senate that Canada did not have a guaranteed right to universal 
coverage. I have before me the provisions of the Canadian law.
  Mr. President, at this point let me say that I could not be more 
delighted with the outcome on the amendment just preceding. I 
congratulate the Senator from Connecticut.
  Mr. MOYNIHAN. Mr. President, may we have order.
  The PRESIDING OFFICER. The Senate is not in order. Senators are 
encouraged to carry their conversations off the floor.
  The Senator from Wisconsin, Mr. Feingold, retains the floor.
  Mr. FEINGOLD. Mr. President, I again thank the Chair and would like 
to say again that amendment was an important moment in this health care 
debate. It took us a long time to get to it. The other side did try 
seriously to defeat it, but they were not able to because the force 
behind this effort to provide health care to all Americans, including 
children, will prevail. In that spirit I would like to take a moment to 
cite a statement of the senior Senator from Massachusetts, from 1972, 
from his book, ``In Critical Condition.''
  Senator Kennedy said:

       I believe good health care should be a right for all 
     Americans. Health is so basic to a man's ability to bring to 
     fruition his opportunities as an American, that each of us 
     should guarantee the best possible health care to every 
     American at a cost he can afford. Health care is not a luxury 
     or an optional service we can do without.

  Senator Kennedy said:

       Every child who is retarded or whose arms or legs remain 
     twisted because his parents could not get care, every family 
     that faces financial disaster because of the cost of illness 
     or is broken by unnecessary suffering or death, is kept from 
     fulfilling the right to life, liberty, and the pursuit of 
     happiness that we cherish in America.

  Those words are 22 years old. But today, a few minutes ago, the U.S. 
Senate began the long march to making sure that dream can become a 
reality for all Americans.
  Mr. President, let me reiterate that when you say health care is a 
right for all Americans, or that we guarantee health care for all 
Americans, you are not necessarily saying it is a constitutional right. 
It may be. You could argue that. But what we are about here in this 
effort, in this Congress, is to try to create a law, a national law, a 
Federal law, a statutory right for all Americans to basic health care 
benefits.
  But again, there are those who want to have their cake and eat it too 
on this issue. They want to say universal coverage is a noble goal but 
that it cannot be done; there is no such thing as universal coverage in 
any country or in any place. But that is based on a misunderstanding of 
what the notion of guaranteeing universal coverage is all about. I hope 
it is an accidental misunderstanding. Too often during this debate I 
fear it has become a convenient misunderstanding; an effort to confuse 
the American people and make them think that it is literally impossible 
to guarantee every American the right to health care. That is not the 
case.
  The junior Senator from Texas said yesterday, ``Look at Canada. They 
do not have universal health care in Canada.''
  That is incorrect. In Canada universal coverage is not a goal. It is 
not a hope. It is a right.
  All residents of a province must be entitled to insured health 
services.
  That is what I mean by a statutory right. As a matter of law in 
Canada, every Canadian has a right to health care. I know of no 
exceptions.
  The Senator from Idaho yesterday tried to point out that in Hawaii 
not everyone is covered, even though they, apparently, have an 
excellent system based on an employer mandate. It is the case that a 
certain small percentage of the people of Hawaii are not covered. But 
that is because they have not chosen to make health care a right for 
all Hawaiians. There are statutory exceptions--apparently for State 
employees and for certain part-time employees. So they have not made 
that commitment, although they have made a tremendous effort in the 
absence of it.
  Others have said universal health care coverage is impossible. They 
say look at the Social Security system. We have had it for many, many 
years but not everyone is part of Social Security. Mr. President, that 
is because we have chosen to exempt as a matter of law, as a matter of 
statute, certain people from the Social Security system. We have never 
said in this country that Social Security is a right of every senior 
citizen or every individual.
  The PRESIDENT pro tempore. Will the Senator suspend? The Senate will 
be in order.
  The Senator will proceed.
  Mr. FEINGOLD. I thank the Chair.
  In all candor, Mr. President, colleagues, I have to say that even 
under Senator Mitchell's bill, the statement by some that we can never 
get to 100 percent and therefore we will go to 95 percent does not 
really add up. If that is the case, why is there a provision in the 
Mitchell bill saying that if we have reached 95 percent by the year 
2000, that a congressional commission will be formed in order to make 
recommendations so we can go that final mile, so we can get the next 5 
percent, the 100 percent coverage? I think a lot of this confusion 
again comes from not understanding the distinction between the 
practical problem of actually delivering health care to all Americans 
and the existence of a statutory right. The difference is between 
coverage and usage. Everyone can and should be covered by law. But that 
does not mean that everyone will use health care services. That is a 
practical problem. Maybe we can compare it to the right to vote. All 
qualified electors in this country have the right to vote.
  Mr. President, we all know painfully that not everyone exercises that 
right to vote. We have one of the worst records in the world in terms 
of the exercise of that right. But that does not make it any less the 
right. Every person 18 years old who is qualified and is not 
disqualified for reasons of having committed a felony has a right to 
vote. That is the difference between a right and the effective problems 
of trying to get everybody out to vote. So too is there a difference 
between coverage and actual usage.
  I believed, and I am not ashamed to say anywhere, that I think in the 
United States, health care should be available on demand for a person 
who seeks it. No one should be able to be turned away. Yes, Mr. 
President, I say it is a guarantee that should be given to all 
Americans, and I use that word in a positive sense.
  I will go further. It is an entitlement. I will stand here on the 
floor of the U.S. Senate and say health care should be an entitlement. 
Well, you are not supposed to use that word these days. It is a bad 
word, and I agree we need entitlement reform in a lot of areas. There 
are programs that need to be looked at. But I am not afraid to stand 
here on the floor of the Senate and say when it comes to the notion 
that every American should be guaranteed basic health care coverage, 
that is an entitlement that stems from being an American, and the fact 
that we have not made it an entitlement for every American is a shame 
on this country, not something to be proud of.
  So, Mr. President, you cannot force someone to go and get a checkup. 
We are not going to put a gun to their head and say, ``If you don't get 
a checkup, you're in violation of the law.''
  But if someone wants a checkup, if any American in this country feels 
they need a physical, they should have a right to do it, they should be 
entitled to it as a result of their being Americans citizens. So the 
key distinction here is between coverage, 100 percent coverage, and a 
100-percent right to coverage.
  Let us try to break it down briefly. It is very hard to examine all 
the provisions of the bills that have been introduced from the 
beginning, from the President's bill all the way through. And, yes, 
some of them are 1,500 pages and some are 700 pages.
  But on this issue of whether health care is established as a right, 
that is basically a yes or no answer for each of the plans. Let me run 
through them.
  Under the President's plan, the answer is yes, health care is a 
right.
  Under Senator Wellstone's excellent plan for a single-payer system, 
health care is guaranteed and is a right.
  Under the Labor Committee bill, health care is guaranteed for all 
Americans; it is universal coverage.
  Under the Finance bill, that is not the case.
  Under Senator Gramm's bill, the Senator from Texas, the answer is no, 
it does not provide for universal coverage.
  Under the bill of the Senator from Oklahoma, Senator Nickles' bill, 
the answer is no, it does not include universal coverage.
  One of the members of the Republican caucus, Senator Chafee, has a 
bill, frankly, which does provide universal coverage.
  The bill from the House, from the other body, by one of the 
Representatives from Tennessee is a no. That bill, the so-called Cooper 
bill, does not provide universal coverage.
  The Mitchell bill is not entirely clear. There are two scenarios 
under the Mitchell bill where universal coverage could occur, where 
that right would be guaranteed. One is if all the States did not 
achieve 95 percent coverage by the year 2000, then the mechanisms would 
kick in that would, in effect, require universal coverage. The other 
scenario is if we do not achieve 100 percent coverage by the year 2000, 
then a Commission is supposed to make recommendations to Congress that 
would provide for the type of legislation and rules that would get us 
to complete coverage.
  I think this aspect of the Mitchell bill needs to be strengthened, 
but at least there are provisions in that bill that could move us in 
that direction if it worked out right.
  Finally, let me say the bill proposed by the majority leader in the 
other body does provide universal coverage.
  So I say to my colleagues and anybody who is watching, this is not 
all that complicated, this piece of the issue, this central issue. Some 
of the bills make the commitment to every American and some do not, and 
to me there is no more important issue than whether that is provided.
  To me, giving health care coverage to all Americans is the touchstone 
of this entire issue, regardless of how we implement it.
  Mr. President, we supporters of universal coverage run into a little 
bit of a problem if we start talking about trying to get close to 100 
percent coverage, if we start playing the numbers game. One problem 
that the President and the majority leader both identified very clearly 
is that if you do not cover all Americans, there is cost shifting 
involved. Somehow the system works in a way that the costs get shifted 
and those who are not covered or choose not to be covered actually 
cause those who are covered to pay more.
  Insurance reforms, such as banning restrictions based on preexisting 
conditions and guaranteed portability, extend coverage to the sick and 
other high users of the health care system. What happens, Mr. 
President, is the newly insured sick drive up the premiums for the 
currently insured and this, in turn, causes higher premiums because 
some healthy individuals who are currently part of the health care plan 
of the insurance company drop coverage. They decide to go without that 
coverage because it is getting too expensive.
  This shrinks the insurance pool. Because the sick and the high users 
of health care remain in the pool, the average costs for the pool 
increases and it drives up the premiums again. Higher premiums again 
cause more healthy individuals and firms to drop coverage, and it keeps 
going. The costs of the system go up rather than down if you do not 
have complete coverage.
  There is also a problem with saying that we are going to try, as the 
Mitchell bill suggests, to get to 95 percent. That is sort of the new 
goal that was identified. The problem for me is that in Wisconsin, a 
pretty good-sized State--not one of the biggest, but I think 16th or 
17th in the country, about 5 million people--if we only get to 95 
percent, 250,000 people will not be covered, a quarter million people 
in the State of Wisconsin alone will not have health care coverage.
  Finally, what troubles me about this numbers game, saying we will 
never get higher than 95, let us go for it and try for 96, 97, or 92, 
is that it leads us down the slippery slope that the Republican leader 
wants us to go down. Obviously, he knows what he is doing. He gets up 
on the floor and says during his opening statement, which I had a 
chance to witness here in the Chamber, ``What is all the argument 
about?'' He thinks his bill will get to 92 percent, we will get to 95, 
so what is all the hullabaloo about 2 or 3 percent?
  Two or 3 percent does not sound like very much. But 2 or 3 percent is 
a lot. Fifty-eight million Americans were uninsured for some part of 
last year. But what is the difference between 92 and 95 percent? Three 
percent of the Republican leader's State of Kansas is 75,000 people. 
Three percent of Wisconsin is 150,000 people. Three percent of the 
United States of America is 7.5 million people. That is not a little 
number, that is the combined population of Kansas and Wisconsin. 95 
percent is not universal.
  The difference between 95 percent and 100 percent is 5 percent. Five 
percent of Kansas is 125,000 people. As I have said, 5 percent of 
Wisconsin is about a quarter million people, about 250,000. Five 
percent of the United States of America's population is 12.5 million 
people, five times the size of Kansas, 2\1/2\ times the size of 
Wisconsin, and it equals the combined populations of 13 States and the 
District of Columbia: DC, Wyoming, Vermont, Oklahoma, Mississippi, New 
Mexico, Delaware, Nevada, Alaska, Montana, Rhode Island, Idaho, 
Nebraska, and Utah. That is what the Republican leader says is only a 
little 2- or 3-percent difference; ``What is all the arguing about?''
  Well, that is very significant. We cannot allow the moral force that 
we have on this issue that Americans have a right to coverage to be 
trivialized by the use of percentages.
  We have to confront it head on. We have to confront the fact that we 
are talking here about 12 to 15 to 16 million Americans, depending on 
which bill you are talking about.
  To put it in more human terms, I have to ask, who are these people? 
Who are these 12.5 million people who will not have health care 
coverage? And what am I supposed to tell them after we get this done? 
What am I supposed to tell them? Am I supposed to say, ``I am sorry; 
you don't get one of these cards. Better luck next time, 50 years from 
now, when we do health care again.''
  Am I supposed to tell them that the homeless people will have the 
coverage--they will under any one of these plans--but that the working 
poor will not? Am I to tell them that somebody who is on welfare gets 
this card but they do not? Am I to tell them that all the Members of 
the Senate will have the coverage but they will not?
  My good colleagues from Minnesota and Illinois, Senators Wellstone 
and Simon, the other day put on a little performance where they picked 
out 5 Ping-Pong balls out of a group of 100 and said, ``I wonder which 
5 Senators will not get health care coverage if 5 percent of the 
American people are not going to get health care coverage.''
  We know very well that no Member of this body and no Member of the 
House will have that consequence. So the question really becomes who 
are these 12.5 million Americans that are not in on the deal, that are 
not going to get one of these cards?
  Recently, in the Washington Post, there was an article making light 
of the fact that the Members of the Senate come out here and give human 
examples of this health care issue almost as if to say when are they 
going to stop telling about their mom or dad. But that is the only way 
it can be done, by putting it in human terms. So, forgive me, but I 
think it is appropriate to talk about the fact that I believe these 
12.5 million Americans are, by and large, lower and lower middle-income 
people, a lot of them women, who work for small businesses, who make, 
let us say, $15,000, $20,000 a year. My analysis is that this is the 
largest share of the people who will not get health care under this 
bill--not the very poor; they are covered; they are covered now, but 
the working poor.
  I encountered two examples of this back in Wisconsin in recent 
months. I was sitting on the airplane going back to Wisconsin on our 
own Wisconsin airline, Midwest Express, and I started talking to a 
young woman who told me that she was on her way to law school. She had 
been divorced. She has two children. She told me during the course of 
our conversation that she had had cancer, but, fortunately, she has had 
a clean bill of health for 5 or 6 years.
  So I asked her, ``Do you think you will be getting health care 
coverage?''
  Answer: ``No.'' In part, because of the preexisting condition issue. 
But even if we eliminate barring coverage for existing conditions she 
still may not be covered. That is because she did not have the economic 
wherewithal to buy insurance. She has some child support. But she is 
trying to go to school. She is trying to get that law degree. And what 
this does, because she makes too much for a subsidy but not enough to 
pay for the health care, is leave her out in the cold. This person who 
has had some rough breaks along the way already is trying to make 
something of herself, and in this country we cannot deliver her this 
health care.
  One other example. I was in a beautiful place in the State of 
Wisconsin earlier this year, Buffalo County, WI, on the Mississippi 
River. It has had the great experience of having bald eagles restored 
there that were once gone. I went there to hold a town meeting. It was 
going fine, and near the end of the town meeting, one lady got up and 
said that her job was to be an elderly benefit specialist which is a 
program in Wisconsin where people help older people try to figure out 
their tax forms and health care benefits. It is an excellent program 
and I had the good fortune to help create it in the State of Wisconsin.
  She was telling me about the program. But all of a sudden she sort of 
broke down in tears. She told me that she was probably going to have to 
leave that job where she tried to help other people understand the 
health care system and she was going to have to become a receptionist 
at another place of work because she did not have health care. Here is 
a person serving the health care system who is going to have to leave 
that system and will not be covered under many scenarios under this 
plan.
  What are we to say to these people? ``You are not part of the 
American dream.'' Are we supposed to say, ``Sorry about that.'' Are we 
supposed to say, ``Sorry about the lack of coverage for you and your 
children, too.'' I do not look forward to the prospect of doing that.
  It leaves me to yet another problem, sort of the flip side of the 
issue. I have heard the Republican leader and others all across the 
country say, hey, this is only an issue for 15 percent of the people of 
the country or 38 million Americans. Why not just take care of that 
group. Why not just give them health insurance.
  That sounds pretty good. It is really simple, just like holding up a 
bill and weighing it. Really simple. But the problem is it is so simple 
that it oversimplifies the issue so as to make it not accurate. The 
health care crisis is not about some fixed group of people. That 15 
percent or that 38 million is just a snapshot. It is the number of 
people at any one time that are uncovered, and it is constantly 
changing. It would be like trying to remove a flaw from a movie by 
correcting only one frame. That particular frame might look better, but 
the rest of the movie will still be flawed.
  As I have said before, during any particular year, we can expect that 
58 million Americans will be without any health insurance for part of 
that year. And the coverage appears to be slipping.
  The First Lady, in continuing her hard and courageous fight for this 
legislation, announced today that since we started working on this 
bill, 500,000 more Americans have had their coverage dropped. And those 
businesses that continue to provide coverage for their employees are 
subsidizing more and more of their competitors.
  Beyond that, the health care crisis is also about controlling costs. 
And here again it is well established that the only way you can control 
costs is through universal coverage. As I have said, another tempting 
diversion is the refrain that we should, of course, strive for 
universal coverage as a goal but that 95 percent or 92 percent or 90 
percent is acceptable. Again, it sounds reasonable on its face. Let us 
do what we can for the President may be the notion. After all, 95 
percent or 92 percent or even 90 percent coverage is better than what 
we have now.
  But this goes to the heart of the issue, both in the general 
perception of our health care problem and the underlying philosophy of 
reform.
  First, there can be no effective cost containment without universal 
coverage. So the failure to guarantee health care coverage that can 
never be taken away means that costs will go up. And as costs go up, 
certainly coverage will go down. But, Mr. President--and this is really 
the central point--even if costs could be contained without universal 
coverage, the failure to guarantee health care coverage that can never 
be taken away means that health care coverage can be taken away. As 
long as there is any gap in coverage, everyone, every American, is at 
risk.
  Let me move to the last part of my opening statement by just 
presenting a couple of analogies to illustrate this. A couple of them 
are a little more lighthearted. The first one is appropriate for 
Wisconsin. It has to do with mosquitoes.
  In Wisconsin, in August, there is nothing more compelling than the 
notion of mosquitoes. Some have even suggested that, given the size of 
mosquitoes in Wisconsin at this time of year, instead of the robin, the 
mosquito should be our State bird. The analogy is to good mosquito 
netting. Guaranteed coverage is like good mosquito netting. Anything 
less than 100 percent is not much good. It does not matter if the hole 
is an 8 percent hole or 10 percent hole. Unless the mosquito net gives 
you 100 percent coverage, it is not very pleasant camping in Wisconsin 
at night.
  Let me try a different analogy for our coastal States. It is like a 
lifeboat in the middle of the ocean. If there is a hole in the bottom, 
it does not much matter if it is a 7-inch hole or 10-inch hole. Unless 
you completely plug up the hole to get 100 percent coverage, you are 
going to get pretty wet.
  The final analogy is that health care coverage is kind of like a 
chain, Mr. President. It does not matter much if 10 percent of the 
links are weak or only 5 percent are weak. Unless 100 percent of the 
links are strong, the chain will break.
  Mr. President, in this case, it is a human chain of Americans who 
should all be linked together in one respect, that each and every one 
of them knows, as a right of their birth as an American citizen, that 
they have that coverage.
  Mr. President, let me come to the final part of my statement by 
pointing out the simple fact that there are two major bills being 
discussed out here now: The bill of the Republican leader and the bill 
of the majority leader.
  There is no comparison between the two with regard to the issue of 
universal coverage. The bill of the Republican leader leaves such a 
gaping hole that there is no chance of achieving universal coverage.
  According to the Lewin-VHI analysis of the Dole proposal, three out 
of the four uninsured Americans would be left without coverage in the 
year 2000. That same analysis of the Dole bill found that 6 million 
children will still be uninsured at the end of the decade. Under the 
Dole-Packwood bill, Congress is not even required to consider 
recommendations for achieving the goal of universal coverage, as does 
the bill of the majority leader.
  As I have said before, I think the universal coverage provisions of 
the majority leader's bill need to be improved, but at least there is a 
serious effort there to create mechanisms that can lead to universal 
coverage. In this respect, there simply is no comparison between the 
Mitchell bill and the Dole bill. The Mitchell bill has its goal of 
achieving universal coverage for all Americans.
  To conclude, let me just say I again want to return to these two 
symbols, a card that every American should have and the pen that the 
President should be ready to use if this bill does not provide 
universal coverage.
  I saw a cartoon in one of our major newspapers in Wisconsin of a 
couple of days ago. It is lighthearted, but sort of lets us know how 
far away we have come from this simple symbol of a universal health 
care card. What it shows is President Clinton on the ground holding a 
crime bill, and he is pretty battered. He has been treated pretty 
harshly by a couple of elephants. There is even a donkey behind him 
with sunglasses. One of the elephants says to the other, ``What did you 
find?'' After he looked through the President's wallet, the other 
elephant says, ``No cash, just one of those cards supposed to guarantee 
health care coverage.''
  I am concerned that is all that is going to become of this card, that 
it will end up being a subject of humor for political cartoons.
  It is sobering for me to think that 22 years ago I read the book by 
the senior Senator from Massachusetts. But I think he was right then, 
and I think he is right now. This country has to provide universal 
coverage to all Americans.
  He said in his conclusion:

       We have a choice of conscience to make in America. It is a 
     choice of whether we will assure each other and all Americans 
     good health care at a cost they can afford. The pages of this 
     book are filled with the tragic stories of the people who 
     have been hurt because we do not make this assurance. We can 
     put an end to such stories, and I believe we should. I urge 
     Americans to search their hearts to choose and to make their 
     choice known. To take so major a step the government needs 
     your support.

  Mr. President, I say today, some 22 years later, we need the support 
of this body. We need the support of the U.S. Senate to finally 
guarantee to all Americans health care that can never be taken away.
  Mr. President, there ought to be a law. Mr. President, there ought to 
be a law that guarantees every American--every American--a right to 
health care coverage before the end of the 103d Congress.
  Mr. President, I yield the floor.
  Mr. MITCHELL addressed the Chair.
  The PRESIDENT pro tempore. The majority leader.
  Mr. MITCHELL. Mr. President, I want to thank my colleague from 
Colorado for permitting me to proceed next. I do not have a lengthy 
speech, but I do have a few comments I would like to make. I know he 
has been waiting for some time. I am grateful for his courtesy, as I am 
of the earlier courtesy of the Senator from Wisconsin for permitting 
his remarks to be interrupted.
  Mr. President, during the course of this debate so far, my bill has 
been the subject of many misrepresentations, distortions, and some 
outright untruths.
  There have been so many that I have not been able to respond to all 
of them. But I want now to respond to statements made today which were 
categorically untrue for which I believe a response is necessary.
  It is clear that the tactic of the opponents of this legislation, at 
least many of them, is to confuse and frighten the American people, and 
they are attempting to do so by making statements about my bill that 
are untrue.
  This is a document distributed today by several Republican colleagues 
criticizing the legislation under the headline ``Clinton-Mitchell 
denies consumer choice.'' It then states, ``You can keep your own plan 
unless your plan is less generous; you can keep your own plan unless 
your plan is more generous.'' And the text that follows is intended to 
clearly convey to the American people that there can be no plan other 
than the standard benefits plan contained in my legislation. That is 
untrue. I repeat. That is untrue.
  Mr. President, my bill, like many of the bills introduced by 
Republican Senators as well as Democratic Senators, provides for a 
standard health benefits package, the purpose of which is to provide 
uniform coverage and to make it easier for consumers to choose between 
competing health plans based upon price and quality, as opposed to 
different types of options.
  The bill requires employers to make three types of delivery plans 
available to each consumer so that, although the benefits package would 
be the same. There would be a traditional fee-for-service plan, a 
health maintenance organization type plan, and other plans commonly 
referred to as ``preferred providers.'' And the individual would choose 
among the three plans. But--and this is an important but--under my 
bill, individuals can purchase supplemental benefit coverage above the 
basic benefits plan if they choose. If they want to have additional 
benefits or different types, or different types of cost-sharing 
protection, they are free to do so. So the suggestion that no one could 
purchase better coverage than the basic benefits plan is incorrect.
  Second, my bill also includes an alternative standard health benefits 
package which would cost less because, although the coverage would be 
the same, the deductibles and copayments to be paid by the consumer 
would be higher.
  So an individual, therefore, could choose an alternative benefits 
package with lesser coverage in the sense that the deductibles and 
copayments would be higher. So the suggestion that a person could not 
buy anything less than the benefits package is also untrue.
  I want to repeat that so there can be no misunderstanding. Every 
person would be offered three types of delivery plans of the standard 
benefits package. But any person could choose either to supplement that 
with additional benefits coverage if he or she wishes to do so, or an 
alternative standard package which would cost less because the 
deductible to be paid by the individual or the copayment to be paid by 
the individual would be higher than in the standard benefits package.
  On this question of choice, that it denies consumer choice, the fact 
is that the legislation would increase choice, and it would increase it 
in the following way: Right now, most Americans receive their health 
insurance through employment. A person gets a job, the employer makes 
health insurance available in some form or another, and the employee 
is, therefore, covered. But for the overwhelming majority of Americans, 
the only choice of plan is to accept or reject a plan which the 
employer negotiates with the insurance company. So the employer meets 
with the insurance company, agrees on a plan, then makes it available 
to employees, and the employee must then choose to participate in that 
plan or not. One plan.
  Under this legislation, employers would be required to make available 
to employees three different plans. Although the benefits package would 
be the same, the method of delivery would be different and, therefore, 
the price and cost would be different. And so the employee could 
choose, for example, a traditional fee-for-service plan, in which the 
employee retains the right to choose any doctor he or she wishes to 
visit, or the employee could choose an HMO-type plan in which the 
employee agrees to be treated by the organization and the physicians 
who are in the employ of the organization. The individual then gets the 
choice, and each individual will be able to make it based upon price 
and what he or she sees as important to them.
  I repeat and emphasize that if that individual does not think that 
the coverage provided in the standard of benefits package is broad 
enough, he or she can go out and buy supplemental benefits. And if he 
thinks that is a good plan, but he cannot afford to pay that premium 
and is willing to take a chance of having to pay a higher deductible, 
he can choose the alternative standard benefits package and, 
accordingly, pay less but be subject to higher deductibles and 
copayments if the person becomes ill.
  So, Mr. President, I hope very much that we can have a good debate on 
this bill. But I hope it will also be accurate.
  Finally, I will conclude with one further point, and that is this: 
Over and over and over again, the statement has been made that this 
bill provides for a ``Government-run'' health insurance system. That 
has been said dozens, if not hundreds, of times. A ``Government-run 
health insurance system.'' I make two points on that. First, the bill 
does not so provide. It does not provide for a Government-run health 
insurance system. It provides for a voluntary system in which Americans 
would purchase private health insurance. Indeed, in that respect, my 
bill does the opposite of what has been suggested, because right now, 
there are 25 million Americans who receive coverage under Medicaid, 
which is a Government program. And, under my bill, that portion of 
Medicaid would be abolished, and those individuals would be encouraged 
and assisted in the purchase of private health insurance. So they would 
receive health insurance coverage in the private market on the same 
basis that other Americans are now receiving. So it actually reduces 
one of the largest Government programs and has those people enter into 
the private insurance market. And so I hope that people will look 
beyond the rhetoric.
  I know the mood in our country today is that a popular way to attack 
anything is to say it is ``Government-run'' and to suggest somehow that 
it is therefore inefficient. Of course, our colleagues who make these 
statements all support the Veterans Administration health care system. 
It is the largest health care delivery system in the country, and it is 
a Government-run system. Not only do they support it, they go around to 
veterans parades and veterans facilities and veterans meetings, and 
they tell the veterans how they are going to protect their health care 
system, and they run television ads when they are up for reelection 
saying how they are going to protect the Veterans' Administration 
health care system. They do not go around to their States and say, ``I 
am against Government-run systems, and the Veterans Administration 
system is a Government-run system, so we ought to abolish it.'' They 
say just the opposite.
  The same is true of Medicare. Medicare is a Government-run system. 
Not one of our colleagues who stood here and said, ``I am against 
Government-run health programs'' goes back home and says to the elderly 
citizens, ``I am against Government-run health insurance systems, so I 
favor abolishing Medicare.'' They say just the opposite. They go to the 
senior citizens homes and coffees and stand up and say to our elderly 
citizens, ``I am going to protect your Medicare system,'' and they run 
television ads promising to protect the Medicare system, a Government-
run health insurance system.
  Of course, the largest Government-run program in the country is 
Social Security. It is a Government-run program, and it includes health 
insurance with Medicare, Part A. Not one of our colleagues goes back to 
their States and goes around to senior citizens centers and says to 
those people there, ``I am against Government-run programs, so I am 
going to vote to abolish Social Security.'' They say and do just the 
opposite there as well. They go and they say to the senior citizens, 
``I am going to protect Social Security,'' and they run television ads 
telling people how they are going to protect Social Security.
  So while they stand here and say they are against ``Government-run 
programs,'' when they go back home to their constituents, they spend a 
lot of time and effort and money telling their constituents how they 
are going to protect those very Government health insurance programs. I 
hope people will keep that in mind as they listen to this debate.
  I want to say that Senator Moynihan happens to be sitting here, and 
we had a ceremony at the White House yesterday in which the President 
signed into law the legislation to make Social Security an independent 
agency. Senator Moynihan is the author of that bill and the person who 
has done more in our Nation to protect and enhance and improve Social 
Security than any other. This legislation is the latest in a series of 
achievements in that regard. I think, better than any of us, Senator 
Moynihan understands the importance of Social Security to our Nation.
  I conclude by saying that the arguments made today against this 
legislation are almost word for word the arguments made against Social 
Security, and almost word for word the arguments made against 
Medicare--almost word for word.
  Mr. President, those items did not prevail then, and I hope they will 
not prevail now. I thank Senator Brown again for his courtesy. I think 
I went on longer than I had anticipated. I apologize, and I thank him 
for his courtesy.
  Mr. BROWN addressed the Chair.
  Mr. PACKWOOD. Mr. President, out of curiosity, how much time is on 
our side?
  The PRESIDENT pro tempore. The Senator from Oregon has 60 minutes 
under his control.
  Mr. PACKWOOD. I yield such time as the Senator from Colorado wishes.
  The PRESIDING OFFICER. The Senator from Colorado [Mr. Brown], is 
recognized for such a time as he may consume, within the 1 hour that is 
under the control of Mr. Packwood.

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