[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. LAUTENBERG. Mr. President, I want to talk for a bit on the health 
care debate that has finally started. I am pleased to see that it has 
begun in seriousness. The moment has been a long time in coming.
  Responding to the real needs of our people, the President and Mrs. 
Clinton proposed that we add security, universality, and cost 
containment to the high quality that already characterizes our health 
care system for those who are covered. I must confess that my own 
personal experiences influence the way I look at this issue. One 
experience is defined by what I have now. As we all know, we in the 
Congress are covered by health insurance largely paid for by our 
employers and partially by ourselves, a good health insurance, paid for 
principally by the people we work for, the American people. That 
experience makes me think that we ought to give the American people 
what they now give to us: Quality health care any time it is needed at 
an affordable price.
  The second experience, Mr. President, is defined by what I used to 
have. Back in 1943, after I had enlisted in the Army, before I ever 
heard of something called health care, my father was stricken with 
cancer. He was 42 years old. My parents worked hard. They did not have 
health insurance. It was fairly uncommon at the time. As my father's 
illness progressed, the bills mounted. After he died, when my mother 
was left with what to her were enormous hospital and doctor bills, she 
was not able to mourn free of her obligation, free of conscience; she 
was forced to worry about these bills at a time when she needed to try 
to adjust to her life as a 36-year-old widow--I was 18--she was forced 
to work two jobs to pay our debts. It took her almost 2 years, month by 
month by month, to finally put those bills behind her. I remember it 
vividly, Mr. President.
  A third experience is defined by what I hear from the people of New 
Jersey. I have listened to families in their middle age trying to help 
their kids get a start in life, while at the same time still often 
having to bear the responsibility for their parents' medical bills, or 
even long-term nursing home care. They cannot make it, no matter how 
hard they work. I have listened to the small business people, who 
cannot afford to buy insurance for their own families, much less their 
employees.
  I come from a business background, and I know how pained those 
business people are when they find out they cannot get insurance 
because of skyrocketing costs or preexisting conditions or a recent 
illness that sends premiums through the roof.
  I have listened to seniors on fixed budgets, people who are watching 
every penny they spend, who are afraid they may need long-term care 
that they cannot afford, or who already cannot afford the medicines 
they need. They deserve better than that. I have listened to families 
who have no health insurance and heard them tell me that they cannot 
afford to take their kids to a doctor. They have few options. They can 
go down to an emergency room when the illness is acute, and wait in 
line while everybody has their needs cared for.
  Unfortunately, it is true there are 8 million American children who 
are not covered by some kind of a health care plan. They do not get 
regular checkups. They need immunization. They cannot help themselves 
not be exposed to sickness or disease, because they are unable to get 
the traditional care that most of us are accustomed to in our own 
families.
  No family should be forced to choose between putting food on the 
table and taking care of their children's health, or choosing between 
helping with a college education or health care, or jeopardizing their 
own retirement to take care of parents stricken with Alzheimer's 
disease. But that happens in New Jersey and in our country every day of 
the week.
  Mr. President, that is what this debate is all about. It is listening 
and responding to the real needs of our people and being sensitive 
enough and committed enough to meet those needs by undertaking 
fundamental reform--reform that builds on the strength of our existing 
system and addresses its weaknesses.
  And so, Mr. President, it has been said by many here that this truly 
is a historic debate. But it is not a debate about a radical notion. 
Over the past 60 years, comprehensive health care reform has been 
proposed three times and defeated three times. President Roosevelt 
first proposed it as part of the original Social Security Act, and then 
President Truman proposed it and, more recently, President Nixon 
proposed it, and that was some years ago. Each time it was offered, 
those who favored the status quo prevailed, and the Congress failed to 
act. And now our time has come.
  I agree with the majority leader when he says that we ought to stay 
in session as long as it takes to enact a bill. I disagree with those 
whose goal it is to talk as long as it takes to kill this bill, to talk 
it to death, or threaten to bury us with a hundred amendments. Mr. 
President, that tells the American people a story. ``We have 100 
amendments,'' kind of cute with a twinkle in their eye. What is that 
saying? It is saying: We are going to derail this health train no 
matter what it takes to do it. That is the message. It does not say: We 
will put out 100 amendments because we want to improve the bill. It 
does not say: These 100 amendments are going to make sure everybody has 
care and the children are cared for, and we will give pregnant mothers 
prenatal care. It says: You bring up this health bill, and I am going 
to make sure it goes down.
  I disagree with those people; I disagree with those who choose to 
deride or scorn attempts to solve this problem, who trivialize the 
needs and concerns of the American people. They deserve an honest 
debate and a real decision, a vote on amendments, and a vote yes or no 
on the bill itself.
  Mr. President, the health care debate has centered around two major 
issues: Security and cost. While almost 85 percent of Americans have 
some type of health care coverage, an enormous percentage of us are 
only one pink slip or one preexisting condition away from losing that 
coverage. People should not lose their health insurance because they 
change jobs or because they become unemployed. They should not lose 
their health insurance because they get sick, and they should not have 
to pay more for insurance for these reasons.
  There are 37 million Americans--over 800,000 in my State of New 
Jersey--who do not have health insurance coverage. Mr. President, it is 
important to understand something about the uninsured. They are just 
the homeless and the unemployed, the other people who drift around the 
edges of our society; they are our neighbors, they are our friends, and 
they are us.
  Approximately, 84 percent of the uninsured work full or part time. 
These are people who play by the rules, work hard for a living, pay 
their taxes and are forced to wait to be treated in emergency rooms or 
go without care altogether. They have not failed to be responsible; the 
system has failed to respond to them. That is not what America is 
about.
  Mr. President, perhaps the most unfair thing about our current health 
care system is this: both the very poor and the rich have health 
insurance. The rich typically get access to health insurance through 
their employment or their own wealth; the poor get access to health 
insurance through Medicaid. It is the rest--in my State, people with 
incomes up to $60,000 per year--that make up the bulk of the uninsured. 
We have created a system which provides health security to the rich and 
the poor, but not for middle class, not for ordinary working Americans.
  If we are to continue to reduce the Federal deficit in a meaningful 
way, we must control health care costs. And the only way to do that is 
through real and comprehensive health care reform.
  And it is not just the Federal budget that is affected--it is the 
family budget as well. Last year, the average American family spent 
approximately $5,000 for health care. This is three times the amount 
they paid in 1980. If we do nothing, our families will spend 
approximately $10,000 annually in the year 2000 for health care 
coverage.
  Now, Mr. President, it is obvious to me that we have three choices.
  First, we can do nothing--just leave things as they are.
  Second, we can adopt a bill that Senator Dole has proposed, which 
makes some needed reforms in the system but still leaves 20 to 25 
million Americans uninsured. Third, we can move toward universal 
coverage by adopting legislation that not only reforms the insurance 
system, but contains costs and provides affordable access to care for 
the uninsured, the self-employed, and small businesses.
  Doing nothing is unacceptable. It also cost too much.
  National health care spending has grown by over 10 percent per year 
for the last 10 years. In 1994, we are projected to spend almost $1 
trillion dollars on health care--approximately 14 percent of our Gross 
Domestic Product (GDP). As bad as that is, it gets worse in the future. 
If we do not act now, then by the year 2003 we will be spending twice 
that much $2 trillion per year on health care, 20 percent of our GDP. 
In 1980, health programs consumed 16 percent of the Federal budget. 
Left alone, by 1998 they will be 35 percent of Federal expenditures.
  One of the problems we have in the present system is called ``cost 
shifting.'' That simply refers to the fact that you and I pay the costs 
that hospitals and doctors shift to patients with insurance in order to 
cover the cost of their unreimbursed care. So if you are working, and 
you and your employer are paying for health insurance, you are not only 
paying for your own health care, you are also paying for those without 
health insurance. The only way to prevent that--the only way to keep 
your premiums affordable and fair, is to cover everyone.
  And when we cover everyone--which the Dole plan does not do--people 
will get the care they need sooner, before illnesses become more acute, 
more difficult to treat, and more expensive to cure. Those 20 to 25 
million Americans the Dole plan leaves out will increase the costs that 
you and I pay as health care costs continue to climb.
  The third alternative is to move toward universal coverage, which is 
what the President proposed and what Senator Mitchell is aiming for.
  Senator Mitchell's plan is simpler and less bureaucratic than that 
which was originally proposed by the President. It builds on our 
private system of health care delivery and insurance. It preserves 
patient choice and provides a cushion for small businesses and less 
affluent Americans seeking to insure themselves and their employees. It 
would stop the kind of cost shifting we now experience, and put an end 
to the insured picking up the tab for the insured. It seeks to cover at 
least 95 percent of all Americans by the year 2000; the Congressional 
Budget Office has confirmed that the bill should reach that target.
  This bill will move toward universal coverage more slowly than the 
President's original, because it depends more on reform of the 
insurance system and competition in insurance rates rather than taxes 
and bureaucracy. But it does promise to extend quality health care to 
our people at affordable prices, whether they work for a large 
corporation, a small company or are self-employed.
  If these reforms do not achieve the goal of health insurance for 95 
percent of the citizens in each State by the year 2000, the Congress 
will be required to find additional ways to expand coverage or 
employers will be asked to share in the responsibility of providing 
health care insurance. Small business will be exempt.
  Mr. President, while I support the general approach of Senator 
Mitchell's bill, I do want to highlight at least two areas where 
further review is needed.
  First, the bill contains a new tax which would be imposed on higher 
cost health care plans. While I understand that this measure is 
included in this bill to help contain costs, I feel it is a punitive 
charge which is unnecessary and unfair to workers who have chosen jobs 
with generous health benefits in lieu, perhaps, of higher wages. It is 
also unfair to high cost states, where premiums and health care costs 
tend to be higher. If we have to raise new revenues--estimated to be 
$35 billion over 5 years--I think there are better ways to do it.
  For example, I would like to increase the cigarette tax. A recent 
study revealed that smoking related illness costs Federal and State 
governments $21 billion a year. The tobacco industry should help pay 
for those costs rather than the taxpayer. The same can be said of an 
ammunition tax. Gun related injuries impose a heavy cost on our health 
cares system and fill our emergency rooms. All of us pay those costs. 
It would be more appropriate for those who profit from firearms and 
ammunition to share in paying for the costs they impose on society than 
for average Americans to pay a tax on their health care plans.
  My second major concern relates to the failure to include a regional 
cost adjustment in the formulas in this bill so that the assistance 
provided to individuals and small businesses is indexed to the cost of 
living in a State. Recent figures in the New York Times listed New 
Jersey, along with only two other States--Hawaii and Alaska--as having 
a cost of living which is 20 percent or more above the national 
average. The relative cost of living should be taken account of in 
providing assistance under Federal programs for citizens of each State.
  I have joined with Senator Lieberman in calling for indexing of 
certain Federal programs to take account of the cost of living in each 
State. Senator Moynihan, the chairman of the Senate Finance Committee, 
is working on a proposal to introduce a cost of living adjustment into 
health care reform. I strongly support his efforts. New Jersey has 
suffered from a low return on our Federal tax dollar because of the 
relative affluence of our citizens. Adjusting Federal formulas to take 
into account the cost of living in a state makes sense and would help 
address this inequity.
  Mr. President, while we debate health care policy, we have to 
remember that more than ``policy'' is involved here. People are 
involved. People who need health care. We all want to make sure that 
our families have health care, our mothers and fathers, children and 
grandchildren--because everyone gets sick.
  We have made enormous progress since 1943 when my father died. Now 85 
percent of our population has health insurance. Our seniors have 
Medicare, the poor have Medicaid and many of us have private health 
insurance. But we have left a segment of society behind without health 
security. They are in the same situation my mother was in over 50 years 
ago. For the most part, they work, pay taxes, raise their families, and 
play by the rules. But they lack health care coverage through no fault 
of their own. They deserve better than what our current system 
provides.
  Mr. President, I hope that at the end of this debate, Congress will 
approve a bill that moves us toward universal coverage and that 
President Clinton will sign it. It will be a great day for America. I 
look forward to working with my colleagues to accomplish this goal.
  I yield the floor.

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