[Congressional Record Volume 140, Number 116 (Wednesday, August 17, 1994)]
[House]
[Page H]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: August 17, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
                              HEALTH CARE

  Mr. WYDEN. Mr. Speaker, I intend this evening to focus my remarks on 
health care. But before I go to those comments, I just would like to 
come back to the extraordinarily gracious and important statement that 
we have just heard from the gentleman from Connecticut [Mr. Shays].


                               crime bill

  It seems to me that in this time of really over-heated rhetoric and 
extreme partisanship, what the gentleman is really trying to do is heal 
and bring together Members of both political parties so we can get a 
good crime bill passed.
  I think what he has done is exceptionally important, because I am of 
the view that you only get to write a perfect crime bill in your 
dreams. The fact of the matter is, we will never have a crime bill in 
this institution that is not opposed from one quarter or another. That 
is always going to be the case.
  So what we are going to have to do is look to the best in the law 
enforcement area and put a special focus on more police. My community 
has one of the country's most innovative community policing programs. 
This legislation lets us build on that.
  We ought to focus, as the gentleman has, on additional prison space, 
because that is an important deterrent. And we also have to focus on 
preventive kinds of services.
  We know, for example, and the gentleman represents an urban area, as 
I do, that crime feeds on poverty and despair. And so when you have an 
opportunity for good preventive programs, for example, that train young 
people, for employment in the private sector, it seems to me, as the 
gentleman from Connecticut has just indicated, what the Congress ought 
to do is move and move quickly to pass that legislation and make those 
resources available to the American people.
  We know that the Federal Government does not have all the answers to 
the crime problem. But what we know is that the Federal Government can 
be a better partner to local communities.
  I yield to the gentleman from Connecticut [Mr. Shays] for a few 
additional moments of discussion on this matter, because what he has 
done, in my view, is especially important at this time, as Congress 
looks to possibly adjourning for the summer recess, but doing it in a 
way that ensures that before Congress goes home, a strong crime bill, 
built on tough deterrence, so that those who perpetrate violence on our 
streets are dealt with, but also a bill that focuses, as the gentleman 
has correctly said, on preventive programs, such as job training that 
can get our young people in the private sector.
  I yield to the gentleman from Connecticut [Mr. Shays].
  Mr. SHAYS. Mr. Speaker, I thank the gentleman for yielding and also 
to have a bit of a dialog.
  I just do not think we can emphasize enough that there is almost $14 
billion for what we would call straight law enforcement, cops on the 
beat. Policemen went up in the House bill to the conference $5.4 
billion.
  The overall bill went up 5.6. It is true there was a reduction of 
about $3.5 billion from prisons, but we still left over $10 billion for 
the construction of prisons.
  My problem in our State is not the building of prisons right now, it 
is how do we pay to operate them once they are built. We have so many. 
But we do need to make sure that people who are sent to prison stay 
there, and we need to help local governments as well as State 
governments.
  I believe strongly, as I know the gentleman does, that law 
enforcement is essential.

                              {time}  2010

  There are some of us who would like to see the sexual predator bill 
put back in, which passed the House, and the issue of rape penalties, 
which also passed both the House and Senate.
  We would like to see some reduction in this bill, because as the 
gentleman points out, this is not a perfect bill. We had our day. The 
rule failed, and there has to be some adjustment. The question is, 
where do these adjustments go?
  I just do not want the whipping boy to be the programs that are 
preventative, that are absolutely essential to helping young children 
have meaningful activities. I cannot emphasize enough that our children 
in our suburban communities have the opportunities they have to lead 
constructive lives, plus in many cases they have two-parent families, 
and in our urban areas we see a big difference.
  I think both you and I could agree that to some measure the welfare 
state has failed us. I certainly think 12-year-olds having babies and 
14-year-olds who are selling drugs and 15-year-olds killing each other 
and 18-year-olds that cannot read their diplomas is in part the legacy 
of the welfare state, but that is not something we can solve in this 
bill.
  We have a short-term need to address activities, meaningful, whether 
they are employment, recreational, tutorial. After-school programs in 
Bridgeport do not exist unless we have some help from either the State 
or Federal Government. If we have that kind of help, the gentleman will 
see many of these young kids who find themselves choosing to be part of 
a gang for fellowship and protection choosing to reject it.
  Mr. Speaker, my sense is the gentleman's point is well taken. We will 
not find the perfect bill. In our dreams we will, and we could write 
it, and probably our bills would differ, but I would just like to see 
the rhetoric of bashing the municipalities, bashing programs that we 
know are working--and in some cases, we are not creating these new 
programs. They exist. We are taking programs that work.
  Midnight basketball has taken a great hit. It starts at 9 o'clock. 
You cannot participate in these programs unless you are willing to hear 
a lecture from the police chief or a police officer or a social worker 
or someone who wants to talk about job opportunities, getting these 
young kids to dream. I would like to think that someone would choose to 
be in their community with activities, instead of be in jail because 
there are activities there.
  I really thank the gentleman for yielding, and also for being so 
extraordinarily generous, which is kind of the way in this House, 
sometimes, I just want the gentleman to know I have tremendous 
admiration for him and his kindness in having this dialog.
  Mr. WYDEN. I thank my friend. Let me just pick up for a moment on a 
couple of the points the gentleman has made, and continue this a bit.
  First, Mr. Speaker, I think the gentleman is absolutely right about 
the importance of the sexual predator provision that is being 
discussed. I think many of us are especially concerned about this. We 
see these kinds of problems across our country. They are not isolated 
and rare aberrations. I as a Democrat am very hopeful that it will be 
possible to get that addressed in the bill.
  Mr. Speaker, I would also like to talk for a moment on the point the 
gentleman has made about the importance of these after-school programs 
for young people who are at risk and are getting involved in gangs.
  What we know, and there is substantial evidence on this, is that a 
lot of the young people that are getting in trouble, that are getting 
caught up in the gangs and involved with drugs and violence and sexual 
promiscuousness and all of the problems that we see our young people 
facing, they go home to an environment where there is no parent there. 
Very often these are single-parent households. You have a parent, for 
example, struggling very often at two jobs until 7, 8, 9 o'clock at 
night.
  Mr. Speaker, at home in my hometown, in Portland, Oregon, the schools 
get out at 2:30, 3:00, somewhere in that vicinity. You do not have to 
be a rocket scientist to figure out that if the youngsters have nothing 
to do between 3:00 p.m. and 8 or 9 o'clock in the evening when the 
parents get off work, that that is an invitation to trouble, an 
invitation to the kinds of gang activities and drugs and violence that 
the gentleman is talking about.
  Mr. Speaker, I am very pleased that he has hammered at the idea of 
after-school programs. To tell you the truth, I would like to see this 
Country go far further in terms of after-school programs.
  We have in my district a situation where in a number of schools, the 
students that are doing well, that have been lucky enough to come from 
good families and good upbringing, they actually stay after school and 
help the youngsters that have not been so fortunate, help the 
youngsters with anti-drug counseling and things of that nature. I am 
told by school administrators that in our district, if they could have 
a faculty member even part-time to go even further in the after-school 
programs that the gentleman is talking about, that that would save us a 
whole lot of money down the road in terms of welfare, public 
assistance, juvenile justice, these kinds of problems.

  I am happy to yield further to the gentleman from Connecticut.
  Mr. SHAYS. You have hit it. In the City of Bridgeport we have a 
school called Longfellow School. The principal, with the community and 
some of the parents and some of the adult organizations, set up a 
Saturday school program. They were curious.
  They said: ``We are going to have some academics and we are going to 
have some more recreational kinds of activities. They might learn 
karate, they might do dancing, but they will learn how to look for a 
job. They will learn skills about why it is important to show up on 
time an so on, things that some might just take intuitively in your own 
family environment, you pick it up.''
  They were amazed with how many young people signed up. There were so 
many, there were hundreds of young kids who signed up for this program 
on a Saturday, to come to school. They were in school Monday through 
Friday, and yet they wanted to come to school on Saturday and do 
academic programs, but they also did other things, like chess. I have 
to tell you, one of the great joys was to see this chess team play one 
of the suburban schools and win. It was really precious to see that.
  It is also touching to see a very well-dressed, well-trained suburban 
football team, and then see one of the urban schools come and play 
them. They do not have the uniforms, they do not even have a bus. They 
come in sometimes in cars, or in a few vans, and I saw a few of these 
kids after they had lost pretty badly to the suburban team have to 
hitchhike back to their school district.
  Mr. Speaker, I just have to tell you, I felt so darned guilty with 
the fact that we have allowed this debate to deteriorate to the point 
where we are forgetting what we are talking about. It is like someone, 
all they have to do is say ``pork, pork, pork'', they do not have to 
document, they do not have to talk about it. They can give people the 
feeling that this bill became expensive because of pork.
  If they are talking abut why it became expensive, the reason it did 
was all the enforcement side. I am repeating myself, but the 
preventative side stayed at about $6 billion.
  Mr. Speaker, I just thank my colleague for giving me this opportunity 
to have more than 5 minutes, because I needed that, and I just think 
that those of us who represent urban areas have got to be more willing 
to speak out about this. It is almost like because you don't like to 
spend a lot of money, and I vote to cut a lot of programs, we have got 
to be willing to step up here and say ``enough is enough.''
  We have got to pay attention to what is happening to our urban areas. 
We have got to realize that you need strong enforcement, you need 
prisons for people who break the law, and you need preventative 
activities to get these kids to be productive members of society.
  If I could just indulge a little more on the gentleman's time, I 
would like to say that ultimately I think the solution of the cities is 
not all that complex. We need to rebuild them, not bail them out. We 
need to bring businesses back into our urban areas so businesses can 
pay taxes and create jobs. That is what we have to do, but we cannot do 
that overnight.
  In the meantime, let us start with some of these programs, which are 
not new, which are working, which are out there. There just need to be 
more of them.
  Mr. WYDEN. The gentleman is absolutely right. There is no question 
that effective anticrime programs in the inner city are a prerequisite 
to growing businesses. It is not very likely that folks are going to 
locate or folks are going to be willing to put risk capital on the line 
for expansion if they fear that their employees are going to get 
clubbed over the head when they try to come in for work in the morning.
  To me, what the gentleman has done that is so helpful is, first, 
indicate the desire to help bring the House together and heal some of 
the divisions that we have seen over the last few days, and second, and 
equally important, simply set the record straight.

                              {time}  2020

  I was watching one of the CNN shows yesterday, one of our colleagues 
was debating, and the debating partner said, the majority of money in 
the crime bill goes for pork and prevention. It was repeated and it was 
repeated. So I assume millions of viewers got the sense at the end of 
the show that this was the case and the vast majority of money was 
spent for prevention.
  As the gentleman knows, more than 70 percent of the money in this 
bill goes for the deterrence side of the law enforcement effort--police 
and prisons and assistance to local communities.
  Mr. Speaker, I hope that folks that are listening and watching the 
effort to bring Democrats and Republicans together will also pick up on 
that figure, because I think it is so important. The majority of the 
dollars in this bill is not even open to question in terms of it being 
for law enforcement. That is where the money goes.
  Mr. Speaker, I am happy to yield to the gentleman for any comments.
  Mr. SHAYS. I would just like to thank the gentleman for using some of 
his time to discuss health care to discuss what truly is an 
extraordinarily important issue, and to say that who knows what is 
going to happen in the next few days, but I hope in the end our country 
wins.
  Mr. WYDEN. I think the country can win if the Members just pick up on 
the spirit and the concerns of the gentleman from Connecticut.
  I came tonight to talk about health care. I will spend a few minutes 
on that. But I think the country is better off because we have heard a 
little bit more from the gentleman from Connecticut who is so anxious 
to bring this House together and help us get a good crime bill. I thank 
him for participating.
  Mr. Speaker, let me turn just for a few moments to the health issue. 
I am fortunate also to have the gentleman from Hawaii [Mr. Abercrombie] 
here, who comes from a State where they have universal coverage, where 
we have seen that it is possible to cover all citizens.
  I am going to begin with just a few comments on the matter of senior 
citizens and how senior citizens fare in the health reform debate.
  I think that all of us know, and I have a special interest in this 
area, going back to the days when I was codirector of the Oregon Gray 
Panthers at home, we know that Medicare, which was enacted in 1965, was 
just half a loaf. It did not cover prescription drugs and long-term 
care and eyeglasses and hearing aids and many needs of the senior 
citizens. In fact, health costs have gone up so dramatically that now 
many senior citizens pay more out-of-pocket for their health care than 
they did when Medicare began in 1965. This is especially the case 
because prescriptions, a substantial number of seniors, millions, pay 
more than $1,000 out of pocket each year for their pharmaceuticals, and 
millions more need long-term care; cannot even get decent care in their 
own homes.
  I think it is especially important in this health reform effort that 
any bill, and particularly the bipartisan bills which in my view are so 
critical to getting this job done right, adequately address the 
concerns of the Nation's senior citizens.
  The majority leader, the gentleman from Missouri [Mr. Gephardt], has 
taken an approach which I think has a strong consensus behind it. What 
the majority leader is saying in his approach to dealing with the 
concerns of the elderly is that there are savings to be found in the 
Medicare Program. There are areas where we can make the program more 
efficient without harming existing Medicare services. What the majority 
leader, the gentleman from Missouri [Mr. Gephardt], seeks to do is to 
take those dollars saved by making Medicare more efficient and, in 
effect, reinvesting them in new benefits and new services for seniors, 
such as long-term care and prescription drugs. I happen to think that 
that makes a great deal of sense, and I have heard the majority leader, 
to his credit, indicate that he is very open to hearing suggestions 
from Members of Congress of both political parties on how that might 
possibly be improved upon.

  There is another approach that is being discussed. It is the one that 
was drafted and developed by our colleague, the gentleman from Georgia 
[Mr. Rowland]. I have served with the gentleman from Georgia [Mr. 
Rowland] on the Health Committee for a number of years and a more 
decent and caring individual in my view simply cannot be found than the 
gentleman from Georgia [Mr. Rowland]. But I think we have to do better 
for our senior citizens than the approach that is being offered in the 
Rowland bill. What the gentleman from Georgia [Mr. Rowland] and a 
number of our colleagues on the other side of the aisle propose doing 
in their bill is, in effect, taking a substantial portion of the 
Medicare trust fund, more than $60 billion, and simply spending it on 
matters unrelated to the elderly.
  So here we are in a situation where we have a very rapidly growing, 
aging population, the demographics are relentless, we will have many 
more seniors in our country; yet the approach offered by our colleague, 
the gentleman from Georgia [Mr. Rowland] simply takes $60 billion out 
of the Medicare trust fund and spends it on unrelated matters. Instead 
of taking the approach that our colleague, the gentleman from Missouri 
[Mr. Gephardt] has taken, who wants to find Medicare savings and 
reinvest them in long-term care and prescriptions, the approach offered 
by the gentleman from Georgia [Mr. Rowland] takes the $60 billion out 
of the Medicare trust fund and at the same time offers not one dime for 
prescription drug coverage and not one dime for long-term care. As far 
as I can tell, the only reason one would go and take money out of the 
Medicare trust fund and not use it for prescriptions and long-term care 
is you basically subscribe to the theory that Willie Sutton gave for 
robbing banks. As you will recall, Willie Sutton said, ``That's where 
we're going to look, because that's where the money is.''
  I can see why someone might offer that kind of theory, but I think we 
can do better on a bipartisan basis for our country's senior citizens, 
I think we can do better by our elders who so often are getting 
clobbered by these rising prescription drug bills, by long-term care 
costs, and the key to doing better is to build on the efforts of the 
majority leader who is saying, ``Let's find savings in the Medicare 
Program, there are efficiencies to be found,'' and in order to help our 
Nation's seniors when we find those efficiencies, we will take those 
dollars and plow them back into the Medicare Program to provide some 
relief to vulnerable seniors faced with crushing long-term care and 
prescription drug bills.
  Mr. Speaker, what I would like to do and wrap up, if I might, is 
describe a situation where we have one of the Nation's senior citizens 
who currently receives coverage through the Medicare Program describes 
how she would fare under the approach taken by the majority leader, the 
gentleman from Missouri [Mr. Gephardt] and describes how I think it 
would be possible for us in the kind of spirit that the gentleman from 
Connecticut [Mr. Shays] has brought to the House this evening, work 
together to kind of build a coalition in both political parties to make 
sure that in health reform, our Nation's senior citizens get a fair 
shake.
  Under the proposal offered by the majority leader, the gentleman from 
Missouri [Mr. Gephardt] the Nation's senior citizens would continue to 
get coverage through the Medicare Program.
  So right away we have a plank that I think both political parties can 
support, there is no need to frighten the Nation's elderly, no need to 
tear up the sidewalks and cause confusion, but to start, as the 
majority leader does, by in effect building on the Medicare Program.

                              {time}  2030

  The second part of his effort is to make sure that our senior 
citizens continue to have a choice of plan with unrestricted choice of 
physicians or a managed care program. This too is exceptionally 
important. This too is something that I think Members of Congress of 
both political parties can support, because I think if there is one 
thing the American people agree on it is that senior citizens and 
others in our country must have access to a widespread range of 
providers. And plank No. 2 that Mr. Gephardt pursues in his legislation 
is also an effort in my view to try to bring together a consensus to 
make sure that seniors are well cared for.
  The third area is the matter of prescription drugs. Under this 
legislation the majority leader tries to balance the need for concern 
about cost with making sure that our seniors start getting some relief 
from the skyrocketing prescription bills. His proposal would add 
approximately $8.50 per month to a senior citizen's premium so that 
there is going to be an additional cost. But never again would a senior 
citizen have to pay more than a thousand dollars a year on prescription 
drugs.
  I would like to emphasize how important I believe this benefit is, 
because I remember from my days with the Gray Panthers constantly 
seeing instances where senior citizens could not afford their 
pharmaceuticals and seeing very detrimental health effects as a result. 
Many have heard the phrase that seniors are choosing between food and 
prescriptions. I found in my years working with senior citizens is what 
was more likely to happen is not that senior citizens would have to 
give up all of their meals to cover prescriptions, but what would 
happen is they could not afford to take all of their pills and their 
prescriptions in a timely way. So if a physician told them to take 
three pills, for example, for 2 weeks, maybe they would take three 
pills for the first 3 days of the prescription, but faced with the 
prospect of not being able to afford their pharmaceutical bills, after 
3 days they would then have to cut back to two pills, and then 
eventually to one pill. Because pharmaceuticals can be so cost 
effective in terms of a treatment arrangement, when senior citizens are 
in that kind of situation, not able to take their prescriptions in a 
timely kind of way, what is very likely to happen is that their health 
problems will get worse. Some may eventually need hospitalization, and 
it is simply not cost effective to ignore the need for some 
prescription drug relief for our Nation's senior citizens.
  So I am very hopeful in the days ahead on a bipartisan basis the 
Congress will build on the third plank of the majority leader's program 
for senior citizens, and that is to ensure that is a fiscally 
responsible way a prescription drug program is started for our elderly.
  The majority leader in his plan goes on. There is coverage for annual 
mammographies. There is mental health benefits. There is not a total 
limit on the amount senior citizens would have to pay beginning in the 
year 2003. All of these, in addition to the slowdown in the part B 
premium are I think very welcomed and measures that Members on both 
sides of the aisle can support and support enthusiastically.
  But I think it is also important to focus on the last part of the 
proposal for seniors offered by the gentleman from Missouri [Mr. 
Gephardt] and that is the creation of a new home and community-based 
long-term care program for seniors. I emphasize this again as much out 
of personal experience as anything else.
  During my years of codirector of the Oregon Gray Panthers I had a 
chance to work with seniors for many years in developing what I think 
has come to be regarded as really one of the Nation's finest long-term 
care programs At home in Oregon we have a program known as Project 
Independence. It is a program designed to keep our seniors at home. As 
a result of this program we are saving money, we are saving money while 
at the same time having one of the lowest rates of nursing home stays 
in the country. We have in effect revolutionized geriatric care, 
revolutionized health care for seniors, in effect turned the system on 
its head by putting such a strong emphasis on cost-effective home 
health care.
  What this legislation does, the legislation offered by the majority 
leader is in effect build on the model developed in Oregon, the Oregon 
Project Independence Program. The majority leader did not start from 
scratch. The majority leader did not make this up out of whole cloth. 
He is effect looked to the models across this country like we see at 
home in Oregon through Project Independence, and that is what he 
modeled his home health care program around.
  So I am of the view that if the Congress and Members on both sides of 
the aisle look to a new home and community-based program build around 
what we have done in Oregon, and now a number of other States have come 
up with other very sensible kinds of models, we will have a chance to 
do the best in health care for our seniors, which is to do more of what 
they want, which is to stay at home and be in the community and do it 
at a price tag that is less than what we face today when seniors are 
unnecessarily institutionalized in nursing homes.
  So let me wrap up by saying it seems to me we are in effect presented 
with two kinds of alternatives. One is the approach that we have from 
Dr. Rowland which in effect takes $60 billion over the next 5 years and 
takes it out of the Medicare trust fund. At a time when we are going to 
have many more seniors, at a time when the demographics are so clear, 
it takes $60 billion out of the Medicare trust fund and instead of 
spending it on prescriptions and long-term care it spends it on matters 
unrelated to the concerns of the elderly that we are discussing 
tonight.
  On the other hand, we have the approach that the majority leader has 
zeroed in on which is in effect to find cost-effective savings in the 
Medicare Program, find savings in the Medicare program that can be 
routed out without in any ways cutting existing Medicare services. The 
majority leader has said let us take those savings and reinvest them in 
the home and community-based services for the elderly and prescription 
drugs.
  I am very hopeful that in a bipartisan way, as the gentleman from 
Connecticut [Mr. Shays], has done for us tonight on the crime bill, I 
am very hopeful that I and the gentleman from Hawaii [Mr. Abercrombie], 
and other Members of Congress can work together in a cooperative kind 
of fashion, in a bipartisan fashion, so that we can make sure that our 
seniors have a dignified retirement, so they are not wiped out by the 
crushing costs of long-term care and prescriptions, and we do this in a 
bipartisan way as the country wants, and we do it in this session of 
Congress.

                              {time}  2040

  Mr. Speaker, I yield to the gentleman from Hawaii [Mr. Abercrombie], 
who has been such a strong advocate of health care reform, because I 
know he believes it in his heart, but also because he has seen it work 
day in and day out in his home State. I am happy to yield to my friend.
  Mr. ABERCROMBIE. I thank the gentleman for yielding.
  I am very appreciative, and I am appreciative even more so because 
your last statement is, in fact, what I would like to dwell on for the 
remainder of the time in this special order hour.
  Not everyone has had the opportunity to actually see a health plan in 
action. The description that the gentleman from Oregon [Mr. Wyden] has 
given, Mr. Speaker, I think deserves a bit more attention in terms of 
the reason for it.
  He has very ably given what the plan would be in terms of the kind of 
coverage, but I think we deserve to have, and the people of the country 
deserve to have, a bit more of an explanation, a bit more perspective, 
if you will, minus the heated rhetoric that has been expended on the 
health care bill. I would like to do that at the present time.
  I think that the tone, if you will, that was established in the 
colloquy that, in effect, existed between the gentleman from 
Connecticut [Mr. Shays] and the gentleman from Oregon [Mr. Wyden] with 
respect to the crime bill offers us a bit of a model to address this 
question of long-term care and the overall health costs.
  I want to draw on some material that has been presented by the 
director of our executive office on aging in the Governor's office in 
the State of Hawaii, Dr. Jeanette Tacamora, an old friend, an expert in 
the area of aging, gerontology, and geriatrics, who testified here 
before the Subcommittee on Housing and Urban Development last year.
  What do we mean, in fact, by long-term care? What is it that we are 
trying to do? I hope some of our colleagues who may be observing and 
listening in and those Americans who are observing and listening in to 
what we are saying this evening will give us the opportunity to go into 
that in a little more depth.
  Mr. Speaker, one of the things that I have learned in my political 
life is that it is the obvious that needs to be repeated most often, 
because it is the obvious we tend to take for granted and forget first.
  The obvious in this instance is that we all know what long-term care 
means, that we all, after very substantive understanding as to what is 
involved in long-term care, that we have a response to the phrase 
``long-term care'' that is, in fact, meaningful for us and allows us to 
have a presentation for the average American that is comprehensible, 
that is understandable, something that we are able to deal with in a 
manner that does not need further explication.
  I would submit to you, Mr. Speaker, that is not the case. Think about 
it. Long-term care refers to the full range of rehabilitative, medical, 
and supportive social services needed by an individual who is dependent 
upon others for assistance with one or more basic activities of daily 
living, bathing, dressing, eating, ambulating, toileting. These are in 
fact, Mr. Speaker, what we are talking about. This is not an 
abstraction. We are talking about human beings. We are talking about 
human beings who now have a life expectancy beyond that which was ever 
thought to be achievable by any other society.
  Mr. Speaker, we are, in fact, in an era unimaginable even 50 years 
ago. As the United States of America approaches the new century, as we 
approach the turn of this century and enter into a new era, we 
literally will be having before us a situation in which millions, not 
hundreds, not thousands, millions of people will be living 10 and 20 
and 30 years longer than we ever expected, and many, if not most, will 
be dealing with the financial condition and circumstance which was 
fixed 10 and 20 and 30 years ago which did not anticipate in any 
respect the kinds of costs that will be associated with this new life 
expectancy.
  Mr. Speaker, I was the chairman of the Human Services Committee in 
the Hawaii State senate and privileged to serve in that capacity for a 
number of years. I can recall when we made the first attempts to put 
together long-term-care insurance, in fact, I put out the first bill 
offering businesses in Hawaii the opportunity to have a tax deduction 
if they would put forward, as part of the benefit package in our health 
care plan, a plan which has existed since 1974, more than 20 years now, 
if they would put into that health plan a long-term-care insurance 
benefit. Mr. Speaker, you will be interested to know, and Members and 
the public will be interested to know, that I was defeated in that 
effort in great measure because, among other things, our own tax 
department thought that they might lose revenue. They did not want to 
give the businesses, and we are talking in the mid-1980's now, here we 
are less than 10 years later, at a crossroads, financial crossroads and 
social crossroads in our Nation's history, and in fact, the world's 
history; they thought they were going to lose revenue. My argument 
then, based more on instinct, and I hope educated projection, as I hope 
in turn as a responsible chairman of my committee, I said at that time 
to them, ``We are going to have to expend funds beyond that which is 
now imaginable. If you think you are going to lose revenue now because 
we would be encouraging businesses to provide an insurance benefit and 
long-term care,'' I said, ``just think what is going to happen 10 years 
from now.''
  Mr. WYDEN. Mr. Speaker, the gentleman is making a very useful and 
important statement.
  Mr. Speaker, I ask unanimous consent that the gentleman from Hawaii 
[Mr. Abercrombie] may control the balance of my time this evening.
  The SPEAKER pro tempore (Mr. Farr). Is there objection to the request 
of the gentleman from Oregon?
  There was no objection.
  Mr. ABERCROMBIE. Mr. Speaker, I would be delighted to do that.
  Mr. Speaker, I believe I was at a point where I was indicating that 
as chair of the human services committee in the Hawaii State 
Legislature I was observing some dozens of people who were reaching an 
age in which we were, in fact, Mr. Speaker, having to come up with a 
new category. It was not just the elderly or senior citizens any 
longer, the euphemisms that were popular in the vernacular of the time. 
We developed a designation for people as aging elderly.
  Mr. Speaker, I want to indicate for those who may not fully 
comprehend what is involved in that, when you have what we called the 
Medicaid spenddown, what that meant was that a lifetime's worth of 
work, generally in partnership with one's spouse, could be wiped out 
because of the necessity of meeting the criteria established for being 
poverty-stricken and eligible for Medicaid. In other words, your 
principal assets had to be expanded, had to be transferred, 
disapproved. Often that was, for most people, their home.
  And there was an additional element, Mr. Speaker. This was gender-
related. Women outlived men, and so women found themselves in a 
situation of having all of the assets expended of the couple, and then 
finding themselves poverty-stricken, and this category of aging elderly 
came in not only to existence but into an expanded realm beyond which 
we had no comprehension previously.
  So now we find people, many female, widowed, made poor, their assets 
stripped from them, now living under circumstances of dependency, 
medically speaking, in terms of rehabilitation, in terms of support of 
social services, in the tens of thousands, in fact into the millions.

                              {time}  2050

  Mr. Speaker, long-term care may be provided either in an 
institutional setting or home- or community-based care, as the 
gentleman from Oregon [Mr. Wyden] indicated. Long-term care is provided 
most often by paraprofessionals, such as homemakers, personal care and 
home health aides, and families.
  We now find ourselves in a situation again which I anticipated in the 
middle eighties, and here we are less than 10 years later having to 
deal with it, where family leave does not just mean taking care of a 
child, it may mean taking care of a parent as well. Yet we find 
situations in which the newspapers are now regaling us with commentary 
on how people are not just holding down two jobs but three jobs just in 
order to make ends meet.
  How is it possible for people to hold two or three jobs and at the 
same time take care of their parents let alone take care of their 
children? This is what is happening in the country. This is why it is 
needed. This is why the rhetoric has to start meeting reality.
  People say, ``Who is paying for it?'' We are paying for it now. Why 
should those people who have worked all their lives, sacrificed their 
lives, particularly those who have come through the Depression--as the 
President said, played by the rules and worked hard--why should they be 
stripped of every asset at this point? Why are we as a national 
legislature not capable of dealing with this in a straightforward way?
  Is it your mother, Mr. Speaker, my mother, your father, my father, 
one of these statistics? They are not statistics to me. No one in this 
Nation should be a statistic.
  We pride ourselves in looking out for the individual. The only way we 
can do that is on a communal basis. We have to look out for each other. 
We have a choice of whether we are all in this together or whether we 
are all on our own.
  According to the 1990 census--I will give this, I hope, a human 
context--31 million Americans, 12.6 percent of the total population 
were 65 years or older. That is in 1990, 31 million Americans. Think of 
it in terms of individual human beings and their needs, comprising the 
fastest growing segment of the American population as well as the 
segment most likely to require long-term care.
  One of the discouraging parts about some of the health plans, all of 
them put forward in good faith, I am certain, but nonetheless there are 
still health plans coming forward or amendments coming forward which 
differentiate whether or not the plans will be more expensive or less 
expensive, depending on one's age, depending on what the likelihood of 
disease or incapacity is.
  In other words, just at the time when you are most vulnerable 
financially and physically, we say at just precisely that time we are 
going to make it more difficult for you to have health care insurance.
  What has happened?
  One of the reasons I went to Hawaii, Mr. Speaker, was the sense of 
family. One of the reasons I am proud to represent Hawaii, one of the 
reasons that I have such deep feeling about Hawaii, is that we have 
always had a tremendous sense of family, extended family.
  We have what we call ohana, and that means family, that is Hawaiian 
for family. It is an expansive word, we take in everybody. They took me 
in.
  There are no children in Hawaii going to go without a parent, their 
hanai.
  If you have a hanai mother or a hanai father, they take children 
because they love children. It is the Polynesian way. They love the 
kapuna.
  Mr. Speaker, I was at our dinner for the kapuna in the valley in 
which I live, on Malama. We have an organization, Malamao Manoa. Malama 
is where I live. We honored our kapuna. Our kapuna are our elderly, the 
people we look to for guidance, the people whom we respect. There were 
40-plus people whom we honored. And the criteria is that you are at 
least 65 years of age and have lived in the valley for 50 years.
  We are doing an oral and written history of the valley by going to 
our kapuna, going to our elders, to those who have come before us and 
who are sharing the rich heritage and legacy of life in Hawaii with 
those of us who are here now so we can pass it onto those who are 
coming; the sense of balance, the sense of continuance that we have.
  The person living the longest, 86 years, speaking to us and speaking 
about being in the valley for 86 years. Another person, 95 years. My 
mother, now 86 years of age. They have much to share, and yet we want 
to differentiate on the basis of age in a way that disadvantages our 
seniors? How is that possible? How is it possible for us to have that 
attitude?
  No, I want to talk about long-term care and about seniors and about 
our plans in the human context.
  Mr. Speaker, that segment which is growing most and most quickly in 
our country, most likely to require long-term care, individuals 65 and 
older, are expected to number more than 67.5 million people, more than 
22 percent of the population, by the middle of the next century.
  Mr. Speaker, you and I may be--maybe you, but I will not be--here by 
the middle of the next century. There is no statistical possibility of 
that, I am sure.
  But, Mr. Speaker, are we not required as members of a national 
legislature, is it not incumbent upon us to provide for those who are 
coming by the middle of the next century?
  No one, no one has a deeper feeling about the privilege of serving 
here in the House of Representatives, the people's House, than I do.
  I am sure we all share that. And I feel every moment that I am on 
this floor that it is my duty as well as my privilege to be able to 
legislate in a way that reflects the high honor that has been given to 
us by the people of this Nation, the opportunity to legislate on behalf 
of the common good, on behalf of the people of this Nation and in fact 
the world.
  That is what our duty is. That is what we need to do in terms of 
long-term care in the health bill. We do not need to have the rhetoric 
of division, we do not need to have the rhetoric of confrontation. What 
we need is more collaboration, what we need is more cooperation on 
behalf of those who sent us here, on behalf of all the kapuna, on 
behalf of all the grandmothers and grandfathers, all of those who are 
our parents, all of those who have come before us and worked so hard 
and put their faith and trust in us.
  By the year 2010, analysts project that the number of elderly 
Americans in need of long-term care will have grown from 6.2 million to 
at least 9 million. I can go on with these statistics.
  I want us to see it in human terms. In the time remaining to me, Mr. 
Speaker, then I want to discuss a bit further what it is we are going 
to try to do to try to meet this necessity. I want to emphasize that 
word, this is a necessity, it is a national necessity. It is not 
something that Neil Abercrombie thinks would just be desirable in a 
manner that is electorally something which can be beneficial to me 
electorally or to any Member here on the floor. It is a matter of 
trying to be straightforward and honest about what it is we have to do. 
It is not going to be easy.
  It does in fact have to be paid for, and I think we can do that. We 
can do that in one of two ways. We can do it where everyone, as I said, 
is left on their own to try to struggle with it as best they can, or we 
can do it as a Nation, all pull together. We are going to expand the 
Medicare benefit. We are going to have a prescription drug benefit that 
would be added to the Medicare program. You have to have it. My mom has 
to have it right now. We are struggling to find a formula right now to 
deal with some of the physical circumstances that my mom has to deal 
with, at 86.
  Everybody has got a story. It is only a statistic until it hits you. 
Then, oh, yes, we as individuals, then we feel it; but we have got to 
feel for each other. The prescription part of it is one of the things 
that has to be addressed.

                              {time}  2100

  There is not anyone listening to me who does not have, or had at one 
time, their mom, or their dad, or their grandma or grandpa saying to 
them, ``I don't want to be a burden to you, I don't want to be a 
burden.'' Is that what this country has come to? We will have our own 
mothers and fathers concentrating their emotional and psychological 
time as they approach the end of their life on not trying to be a 
burden? Think about it.
  Mr. Speaker, that is not the best that is in America. That is not the 
best that we are as Americans. That is not the best that we can offer 
as national legislators. Far from it.
  An unlimited prescription drug coverage with the cap that has been 
mentioned by the majority leader, that is what we need as a minimum 
start. We need to cover long-term care, home and community based, home 
and community based. We want to keep people in their homes as long as 
we can, and we want to have such services they need that I have 
described being provided out in the community.
  We can do this by giving people a maximum amount of choice in the 
process. That is just exactly what our proposal is all about.
  Those who have suggestions to make it better, I cannot imagine that 
we would not be open to it. I know the majority leader well, as my 
colleagues do, Mr. Speaker, and we both know that he is open to any 
suggestion with respect to expanding our capacity to provide these 
services.
  I do not really want to get into, although I am quite prepared to 
talk about, the inadequacy I see in some of the other bills that have 
been offered: no prescription drug benefits for seniors, the 
utilization, as the gentleman from Oregon [Mr. Wyden] indicated of 
presumed Medicare savings to pay other bills, no long-term-care plans, 
no out-of-pocket caps for seniors, no protection for continuing to 
limit cost increases. All of these things have come up, and all of 
these things can be criticized. I rather concentrate though on what we 
can do and what we should do in this area.
  In Hawaii the population over 65 is expected to grow dramatically in 
the coming decades. We expect it to go to more than one quarter of our 
population, possibly as much as 30 percent. Mr. Speaker, this is a 
sobering statistic when you put it in human terms.
  One of the things we are criticized, Mr. Speaker, in Hawaii for is 
that we are so healthy. In fact, in another special order I will be 
doing in the near future on small business and health care I will point 
out some people even refer to our climate as being the principal factor 
in longevity. The fact of the matter is on a per capita basis we 
probably have more people living longer and living healthier lives than 
virtually any place in the Nation, but there is a cost to that where 
long-term care in Hawaii is concerned. Those who are older than 80 
years of age will triple by the turn of the century, triple. The cost, 
of course, has to be dealt with accordingly. Escalating costs and 
increasing utilization are a potent and ominous combination for Hawaii 
and its people and for the United States and its people.
  The Federal Government, Mr. Speaker, as I draw to a close this 
discussion of the need for long-term care and its role in our health 
program, has been hesitant to this point to deal with this phenomenon, 
this unprecedented social phenomenon. Long-term costs, if left to drift 
on their own, Mr. Speaker, will increase expenditures dramatically, and 
the average family will be unable to cope with the situation. If there 
is anything, Mr. Speaker, that cries out for a national plan, if there 
is anything that demands of us that we address something on a 
nationwide basis, it is long-term care, and the only we can do that, 
the only effective, efficient way we can do this in human terms, in 
social terms and economic terms is to see to it that long-term care is 
part of a national health plan, something that we can all be proud of 
as legislators, something that we can facilitate as national 
legislators because it is, in fact, our duty and out time to see that 
that is accomplished.
  I appreciate this privilege of being able to address our colleagues 
this evening. 

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