[Congressional Record Volume 140, Number 116 (Wednesday, August 17, 1994)]
[Senate]
[Page S]
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 SECURITY ACT

  The Senate continued with the consideration of the bill.
  Mr. DORGAN. Mr. President, let me discuss briefly the amendment that 
I and a couple of my colleagues will offer to this piece of 
legislation.
  I discussed yesterday the number of health care proposals that are 
before the Senate. I discussed the fact that there is great merit and 
need in discussing universal coverage. Universal coverage is essential. 
No American should wonder whether they have the ability to take their 
child to a doctor when their child is sick. It should not be a function 
of how much money you have in your pocket when you decide to get health 
care for a sick child. So it is clear we need better access to health 
care.
  We need universal coverage. That is not something that I question. It 
is a goal we must move to, and as quickly as possible.
  It is also clear to me, as I mentioned yesterday, that we must do 
something about the cost of health care. If we do not put the brakes on 
skyrocketing costs, we will be chasing the target of coverage forever 
and we will simply not be able to obtain it.
  Yesterday on the floor I used a chart which shows what is happening 
to the cost of health care and I would like to show the chart again. 
The U.S. spends much more on health care than any other country in the 
world. We spend more than 14 percent of our gross domestic product on 
health care; Canada is at 11 percent; and no other country is even at 
10 percent.
  The fact is U.S. health care costs are growing and growing 
exponentially. And every single plan that is before us--the Dole plan, 
the Mitchell plan, the Clinton plan, the mainstream plan, the Finance 
Committee plan--every single plan, at the end of it, in the year 2004, 
will see the cost of health care as a claim on the gross domestic 
product of this country increase by nearly one-third.
  Instead of keeping health care at 14 percent or 14.5 percent, which 
is much more than any other country in the world spends on health care, 
at the end of every plan, by the year 2004, according to the 
Congressional Budget Office, we will be at 19 or 20 percent of gross 
domestic product.
  That is not success. We will not achieve universal coverage unless we 
find some method by which we put the breaks on skyrocketing costs. We, 
I think, need a thoughtful debate about how to do that. I think there 
would be great differences. Some would suggest cost controls, cost 
containment mechanisms that are real; others would suggest a market 
that might incentives cost containment. The fact is, if we do not dig 
in with cost containment devices that work, whether it be in the 
private or the public sector, we will not obtain universal coverage 
under any condition.
  Again, let me say, every plan that I am aware of, including the 
Republican plan, will, at the end of the plan, mean that we will spend 
a third more than we now spend on health care as a percent of our gross 
domestic product. That cannot and will not be viewed as a success by 
the American people.
  On one part of this issue, I am going to offer an amendment that I 
want to discuss today. It is an amendment on the issue of the cost of 
prescription drugs. It would be hard to find a better heeled industry 
than will fight this amendment, I am sure.
  The pharmaceutical industry is a very, very large industry with an 
enormous amount of resources. They do a lot of good things. They 
produce wonder drugs, manufacture life-saving drugs, invest a lot of 
money in research and development. And I salute them for that.
  On the other hand, they produce products that are a necessity, not a 
luxury. People need, as a matter of course in their daily living, to 
take the medicines and prescription drugs that are prescribed by their 
doctor.
  The way they price prescription drugs in this country in my judgment 
defies all good sense. And I have used these charts before. I am going 
to use a couple of them again, just to describe why this amendment is 
necessary.
  The biggest selling drug in America is Premarin, used for estrogen 
replacement. Here is the price for Premarin by the same manufacturer, 
for the same pill, put in the same bottle. I have held up on the floor 
before the bottle of pills for which it is $93 in Sweden, $100 in 
England, $113 in Canada, and nearly $300 to the U.S. consumer. Why? Why 
would we be charged more than triple the price for the drug Premarin 
when compared to Sweden or England?
  Xanax, for anxiety, $10 in Sweden, $56 in the United States.
  Zantac, a drug that is used for ulcers; a wonder drug, as a matter of 
fact, saves the need for a costly operation. But why do we pay $133 for 
the same size bottle, for the same pills, produced by the same 
manufacturer, when it costs $64 in Sweden and $84 in England?
  When I offer the amendment, I will show chart after chart after chart 
that shows exactly the same thing--two different sets of pricing data. 
A price for people who live in Italy, Germany, France, England, Sweden, 
and Canada, and then a separate price, a higher price, for the United 
States consumer. Why? By what justification should we believe the U.S. 
consumer should be charged double, triple, 5 times or even 10 times the 
same price that other consumers around the world pay?
  I intend, with my colleagues Senator Pryor, Senator Sasser, and 
Senator Feingold, to offer two amendments, one which would have the 
Secretary of Health and Human Services do a survey, to collect 
information, and require the pharmaceutical companies to furnish the 
information, on the wholesale prices at which they market their drug in 
various countries. And from that, construct an index that is released 
periodically to the American people so that we know what price we are 
paying for the same drug that is being consumed at a lower price by 
other people in other countries.
  That is number one. It simply requires the drug companies to provide 
the information and requires the Health and Human Services Secretary to 
get it, to compare it, and to produce an index so that we have public 
information and allow the public to put the pressure on the 
pharmaceutical manufacturers for fair pricing.
  The second amendment would be exactly the same step leading to the 
acquisition of these prices and the comparison of these prices, and 
then a determination based on the results. If they find that a drug is 
sold in this country for 25 percent more than the average price at 
which it is marketed in other countries, more than 25 percent above the 
average price at which it is marketed in the rest of the world, then it 
would result in a show cause hearing at HHS. If the drug companies 
could not show cause that was justifiable, then the Federal Government 
would only pay, under the Medicaid contract, the average price of which 
that drug is marketed in all the rest of the world.
  Those two amendments, I assume, will provoke a substantial amount of 
debate. There is certainly room for disagreement about drug pricing. 
But I do think that we ought to have a discussion about that component 
piece of the cost of health care.
  I would like to make one final comment, and then yield the floor.
  There is, I know, great rancor, anger, cynicism by some about this 
health care debate, about Congress generally, about the Government, 
about Washington. All of us see it and hear it. We feel it every day 
from the phone calls we get and contacts when we are back home. Times 
have changed, and part of it is understandable and very real. Part of 
it bothers me some--I listened carefully this morning to some of the 
discussion--the notion by some in this Chamber that somehow Government 
is awful, Government is untrustworthy, Government cannot do anything. 
The fact is, Government is a system by which we put together the 
schools and educate our kids, we construct our roads and a police force 
to keep us in safety, and a force of firefighters to fight fires. 
Government is all of those things. Government was, when it constructed 
REA, and rural telephone system, the instrument by which we electrified 
rural America and brought telephone service to rural America. We have 
done a lot of remarkable and good things through our Government, 
together--things that work. Things that work well.

  I respect the fact that there is great disagreement about how to 
respond to the health care issue. I do hope that, as we move down this 
road, we will, in a thoughtful way, disagree without being 
disagreeable. Even though there are substantial differences in public 
policy between us, all of us now serve in government. I hope we all 
aspire to make government effective. Whatever we do, let us make it 
effective. Let us do it right.
  It may be, some think, we should do less of it. That is perfectly 
legitimate. But we ought not make it our fulltime occupation to 
denigrate everything done. I am telling my colleagues, there are plenty 
of people doing that these days. I hope those of us who work here, 
Republicans and Democrats, and who care about public policy will tone 
down some the description of what we are. I was told recently by a 
person that we are all liars and all a bunch of frauds in Congress.
  I said, ``You know, I do not think that''. I work with the Senator 
from Arizona, Senator McCain. I work with Senator Dole. I work with 
Senator Coats. I do not know of one person in this Chamber I work with 
that I think that of.
  Every person here, in my judgment, is here because they care a great 
deal about public policy. They might have widely divergent views about 
what that policy may be, but they come early in the morning and work 
late at night because they care about public policy and honestly want 
to address it in the right way. I hope, as we move forward in this 
health care debate and as we talk about crime and other things, we can 
always keep in mind that all of us are trying in our own way to do the 
right thing.
  I have indicated yesterday that I desperately believe when we turn 
out the lights for a recess--if we have a recess here--and we have done 
something about health care, if we do not do something about the cost 
of health care, then we will have failed. Costs are skyrocketing. I 
frankly do not think any plan presented at this point will get costs 
under control. I have indicated that. I have some notions about how we 
should try to do it.
  But no one in this Chamber, in my judgment, has the divine wisdom to 
come here with a piece of paper and say, ``Here is the answer. Here is 
the right answer. Here is the only answer. Here is the answer that 
works for America.'' It is just not possible that one person has that 
kind of wisdom.
  What we ought to expect from this Chamber is a debate in which we get 
the best of what everyone has to offer instead of the worst of what 
each has to offer. If we can get the best of the ideas from the 
Republicans and the Democrats and the conservatives and the liberals 
and the mainstreamers and the upstreamers and whoever else is out there 
streaming these days, maybe we can construct something that the 
American people will respect and say: Yes, they did a pretty good job. 
They understood the problem. They searched for the best possible 
solution. We respect them for that.
  I hope that will represent the tone of the debate.
  Mr. McCAIN. Will the Senator yield for a comment?
  Mr. DORGAN. I will be happy to yield.
  Mr. McCAIN. First, I express by apologies for my impatience to the 
Senator. I was unaware he was on the floor since noon. When I came to 
the floor he was not there, and I expressed some impatience. I hope he 
understands I have waited a number of days to give my opening 
statement.
  Second, regarding his statements concerning the level of rhetoric. 
There should be a statement that each of us, even though we may take 
different approaches to this very critical issue, we should be partisan 
but not personal in our remarks and in our debate. I think it is a 
fortunate admonition, since most of us had anticipated being home at 
this time with our families, and from the looks of things, things are 
going to get perhaps more tense around here rather than more relaxed. I 
hope all of us can take the words of the Senator from North Dakota to 
heart. I thank the Senator from North Dakota.
  Mr. DORGAN. Mr. President, I appreciate those remarks. Senator Coats 
is on the floor, and he and I have talked about the fact that this is 
not a family-friendly place. When people say that Government cannot be 
trusted and we are all lazy--the people like Senator Coats and Senator 
McCain, like so many others who work late at night and come in early in 
the morning and spend half their weekends back in the home State make 
enormous sacrifices. I think all of us with young children would prefer 
to be able, during an August break, at least in some small measure be 
able to spend some time with them. But this is not a very family-
friendly place. I hope we can change that, too, at some point in the 
future.
  I will be happy to yield the floor. I appreciate the patience of the 
two Senators.
  The PRESIDING OFFICER. The Senator from Indiana [Mr Coats].


                    Privilege Of The Floor--S. 2351

  Mr. COATS. Mr. President, on behalf of Senator Wellstone, I ask 
unanimous consent Alexandra Clyde, E. Richard Brown, Ellen Weissman, 
and Mark Anderson be accorded the privilege of the Senate floor for the 
duration of consideration of health care reform legislation.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. COATS. Mr. President, I only intend to take a few moments. Then I 
trust my colleague from Arizona could be recognized, who has waited 
very patiently for a number of days in order to make his comments and 
statement regarding the health care bill that is before us. I want to 
take a brief amount of time to respond to the comments just recently 
made by the majority leader.
  The majority leader has on several occasions now, the latest of which 
was just moments ago, come to the floor in defense of the bill that he 
has introduced, which is obviously his right. And we would expect him 
to do that. What I am responding to, however, is that the rhetoric of 
the majority leader does not seem to square with the reality of the 
legislation. I am one of those Senators who took the pledge, the pledge 
to read the entire bill. I wish I could say I have completed the 
reading and understand every line and every word of this 1,448-page 
document. I am well into it. I think I understand a great deal of it. 
But much of it is technical and references other sections of the United 
States Code and other sections of the bill.
  So I am still plowing through it. But as I listened to the majority 
leader make his rhetorical statements, I began to scratch my head and 
think, are the statements relative to the same bill that I am reading? 
I know we have had three bills submitted by the majority leader. We 
label them Mitchell 1, Mitchell 2, Mitchell 3. I have been focusing my 
efforts now on the bill that is before us, Mitchell 3.
  But as I hear comments made by the majority leader and then try to 
square it with what I have just read, there seems to me somewhat of a 
disconnect. For instance, on the subject of consumer choice, yesterday 
and repeated again today, Senator Mitchell came to the floor and 
attacked Republicans claiming that Republican Senators had 
misrepresented the facts about an individual's choice of plans under 
his bill. But in reading the bill, it is clear, at least to this 
Senator, that employers are severely penalized for offering health 
plans that are more generous or less generous than the standard benefit 
package that will be determined by the National Health Board and that 
employers of under 500 employees are prohibited from self-insuring. 
Those are limitations on choices.
  So while the majority leader says, and I quote from a floor statement 
made on August 2, 1994, ``The bill would expand the choices Americans 
have for their health care,'' the bill that I have read, Mitchell 3, 
says this on page 145, section 1309: Employers are subject to a civil 
penalty of $10,000 per employee if they offer a health plan that is 
more generous than the standard benefit package.
  Let me quote from that directly. I want to make sure I am not 
mischaracterizing, or attempting to misrepresent, what the majority 
leader has said. The majority leader said this would expand choices for 
Americans in health care. But on page 145, section 1309 it says:
  In the case of a person that violates a requirement of this subtitle, 
``the Secretary of Labor may impose a civil money penalty in an amount 
not to exceed $10,000 for each violation with respect to each 
individual.''
  The requirements under this subtitle are that a standard benefit 
package, determined by the National Health Board, be offered. And, if 
anything less or more than that is offered--if it is more, it has to 
comply with the supplemental plan-- there is a $10,000 fine that may be 
imposed by the Secretary of Labor.
  That does not sound like an expansion of choices to me. On page 1,170 
in section 7112, the bill imposes a 25-percent excise tax on high-cost, 
high-growth health plans. That 25-percent tax is assessed on the 
difference between the premium and the reference or target premium.
  On page 137, section 1301 of the Mitchell bill, despite what the 
majority leader said about expanding choices for Americans, it says 
``Employers with fewer than 500 employees are prohibited from self-
insuring, cost-sharing benefits.'' Their provision alone would deny 
choice to the 400,000 firms in America that insure 16 million Americans 
today under self-insurance plans. This is when the employer sits down 
with the employees and says, ``We're going to write our own plan. We 
will form our own group. We will determine what benefits best fit this 
company, and we will self-insure.''
  Those firms under 500 employees will now be prohibited from doing 
that. They will be prohibited from offering plans they now offer that 
cover 16 million Americans. That is not expanding choices.
  It seems to me, Mr. President, that consumer choices are severely 
limited under the Mitchell bill because employers are strongly 
penalized for offering anything other than the one-size-fits-all-
Washington-designed standards benefits package.
  Senator Mitchell has claimed that his bill would not raise taxes, nor 
tax small business. On August 15, 1994, on this floor, just a couple of 
days ago, he said, and I quote:

       Over and over again, our colleagues said of that plan that 
     it would raise everyone's taxes and be a tax on small 
     business. Neither of these statements are correct.

  That is the majority leader's statement. But the words of the 
majority leader do not conform with the words of his own bill. This 
bill contains numerous new taxes and tax increases. Let me just name 
three.
  In section 7111, page 1,158, the bill imposes a 1.75-percent tax on 
all health insurance premiums for insured and self-insured plans. So 
whatever your plan now is, as an American, you are going to have a 
1.75-percent tax on that plan.
  Section 7112, page 1170, imposes a 25-percent excise tax premium cap 
on high-cost, high-growth health plans. Section 7132, page 1205 imposes 
a 15.3-percent tax increase on income of certain service-related 
subchapter S corporations, shareholders and partners.
  Mr. President, these are three of the 17 taxes included in the 
Mitchell bill. I will not take the time, in deference to my colleague 
from Arizona, to go through the others, but I have a list of all the 
taxes imposed under the Mitchell bill.
  Senator Mitchell, when he spoke about the impact on business, was 
correct when he spoke about the plight of small business owners. In a 
floor statement on August 9, he said, and I quote:

       These are typical small business people trying to create 
     their own stake in society, building their own enterprise and 
     doing what the rhetoric of entrepreneurship is all about. And 
     yet their efforts are being devastated by something entirely 
     beyond their control.

  I agree with those words. But what is entirely beyond their control 
is where I disagree. What is entirely beyond their control are the 49 
new responsibilities that they are being burdened with. I have a list 
of employer responsibilities under the Mitchell bill. I will not take 
the time to read them, but I ask unanimous consent to print them in the 
Record.
  There being no objection, the list was ordered to be printed in the 
Record, as follows:

     Employer/Plan Sponsor Responsibilities Under the Mitchell Bill


                    responsibilities as an employer

       Sec. 1301: Offer at least 3 certified standard health 
     plans.
       Sec. 1301: Forward the name and address of each employee to 
     the certified standard health plan in which the employee is 
     enrolling.
       Sec. 1101: Maintain records and provide states with data to 
     audit certified standard health plans.
       Sec. 1301: Provide payroll withholding of employee premiums 
     upon request.
       Sec. 1301: Provide employees with information on all 
     certified standard health plans in the community rating area.
       Sec. 1301: Provide employees residing in other community 
     rating areas, information on all certified standard health 
     plans in these other community rating areas.
       Sec. 1111: Provide 180 day notice to participants of plan 
     non-renewal.
       Sec. 1111: Comply with regulations concerning transfer of 
     plan sponsorship from one employer to another due to 
     acquisitions.
       Not available: Modify plan documents and SPDs to reflect 
     legislative requirements.
       Sec. 1486: Maintain certified Wellness Programs to be 
     eligible for premium discounts.
       Sec. 4522: Comply with Nondiscrimination regulations.
       Sec. 1302: Maintain data on standard health plan premiums 
     and employer contributions.
       Sec. 10113: If trigger mechanism goes into effect, 
     employers must contribute 50% of premiums for all employees.
       Sec. 7202: Loss of Section 125 FICA exclusion.


           responsibilities as a standard health plan sponsor

       Sec. 1001: File application for plan certification in each 
     State.
       Sec. 1201: Comply with Standard Benefits Package.
       Sec. 1111: Comply with regulations concerning guaranteed 
     issue, availability, and renewability.
       Sec. 1113: 6 Tiers of premium rates required.
       Sec. 1002: Open enrollment required.
       Sec. 1111: Allow disenrollment for cause.
       Sec. 6006: Provide enrollees with individual subsidy 
     applications.
       Sec. 6006: Forward subsidy applications to states.
       Sec. 5001: Supply data to the National Quality Council at 
     both a state and national level for:
       Sec. 5002: Quality of health care service and procedure 
     measurement;
       Sec. 5002: Determination of access to care;
       Sec. 5002: Determination of appropriatenes of care;
       Sec. 5002: Determination of population health status;
       Sec. 5002: Health promotion/disease control initiatives;
       Sec. 5004: National surveys of plans and consumers;
       Sec. 5005: Consumer report cards;
       Sec. 5007: Additional information requests for health care 
     researchers; and
       Sec. 9000: Workers' Compensation data must also be 
     supplied.
       Sec. 5009: Supply data to the State and National Centers of 
     Consumer Information and Advocacy on plan performance and 
     consumer report cards.
       Sec. 5111: Comply with the standards of the National Health 
     Information Network for electronic transmission of the 
     following health information:
       Sec. 5112: Standard unique health identifiers for each 
     enrolled individual, employer, health plan, and health care 
     provider;
       Sec. 5121: Eligibility data;
       Sec. 5121: Enrollment data;
       Sec. 5113: Enrollee and provider signatures;
       Sec. 5114: Claim forms;
       Sec. 5114: EOBs;
       Sec. 5121: Premium Payments;
       Sec. 5121: First Report of Injury;
       Sec. 5121: Claims Status; and
       Sec. 5121: Referral certification and authorization.
       Sec. 5301: Comply with Attorney General data requests for 
     fraud and abuse enforcement.
       Sec. 1124: Issue Health Security Cards to all enrollees.
       Sec. 1101: Participate in state guaranty funds.
       Sec. 1101: Comply with grievance procedures.
       Sec. 1117: Participate in National Reinsurance Program for 
     multi-state employers.
       Sec. 1118: Comply with solvency requirements.
       Sec. 1122: Comply with performance standards.
       Sec. 1122: Communicate quality outcomes to enrollees and 
     providers.
       Sec. 1125: Provide enrollee communciations in a variety of 
     languages.
       Sec. 1126: Provide information on patients rights.
       Sec. 1128: Coordinate additional payments to providers for 
     individuals with cost sharing subsidies.
       Sec. 1128: Verify provider credentials and licensing.
       Sec. 1128: Demonstrate that sufficient providers are 
     available both in and out of network.
       Sec. 1129: Demonstrate that sufficient specialized 
     treatment expertise is available.
       Sec. 1129: Disclose utilization review protocols to 
     enrollees and providers.
       Sec. 1129: Disclose provider incentives to enrollees to 
     make them aware of potential quality of care issues.
       Sec. 1141: For supplemental plans, maintain a loss ratio of 
     at least 90 percent.
       Sec. 1305: Complying with requirements in single payor 
     states.
       Sec. 2106: Conduct quality case review of sample records.
       Sec. 2106: Reporting instances of abuse, neglect, and 
     exploitation.
       Sec. 2106: Reporting of enrollee/provider complaints.
       Sec. 3093: Special reporting requirements for employers of 
     health care workers.
       Sec. 7111: Pay 1.75 percent Premium Tax.
       Sec. 7112: Conduct test for 25 percent assessment on high 
     plans.

  Mr. COATS. Mr. President, 49 new responsibilities, mandates on 
business under the Mitchell bill. Yes, small business people are being 
burdened by health care, but they are being burdened by the mandates 
that are being placed on them on the so-called proposal to undo that 
burden. Those are the new responsibilities that are beyond their 
control.
  I will skip naming some of those, but there are 49 of them. Senator 
Mitchell said in regard to bureaucracy, and he has said it over and 
over and over again, this bill, he says, the Mitchell bill, is not a 
Government-run program. I heard him say that just a few moments ago.
  Believe it or not, we have counted the word ``shall.'' The word 
``shall'' means it is not discretionary, you do it. If a piece of 
legislation enacted into law and codified into law says ``shall,'' you 
have to do it. If you do not do it, there are penalties, and this bill 
is full of the penalties.
  We have counted the number of ``shalls'' in this legislation--2,681 
times it does not say this is what we recommend insurers do, this is 
what we recommend businesses do. It says this is what ``shall'' happen; 
this is what ``shall'' take place. The States ``shall'' comply with 
these requirements. Small business ``shall'' comply. The National 
Benefits Board ``shall'' do these items.
  So when we say this is not a Government-run program, it does not 
square with the bill.
  I have compiled a primer to the Clinton-Mitchell health care bill's 
new bureaucracies, new mandates, and new Federal powers. This list 
identifies by section number the mandates, the requirements, the new 
agencies, the bureaucracy that is outlined in this 1,448-page bill. 
This is 81 pages of print so small that my eyes can no longer read it, 
but this lists the 55 new bureaucracies that are created, a mixture of 
Federal and State government bureaucracies that are required under the 
Mitchell bill--55.
  This lists the 815 new duties that are given to the Secretary of 
Health and Human Services; probably a new office for every one of those 
and who knows how many employees and how much money to fund that; 815 
duties and powers, new to the Secretary of Health and Human Services; 
83 new duties and powers to the Secretary of Labor.
  I could detail what some of those are--overseeing State plans, 
requiring certain submissions by medical providers, and on and on it 
goes. If that is not a Government-run program, I do not know what is.
  Mr. President, I hope every Member will have a chance to leaf through 
this. This is not political rhetoric. This is language taken directly 
from the bill and referenced to section numbers. Every word in these 
lists is taken directly from the bill and referenced to the section 
number. So Members do not have to see this as just Republican rhetoric, 
Republicans trying to scuttle the Mitchell health care proposal. This 
is factual, it is there for everybody to see, it is there for everybody 
to reference for themselves.
  The worst thing I have ever done and the best thing I have ever done, 
relative to the legislation that is before us, is to take the pledge to 
read this bill, because the rhetoric sounds wonderful and there is 
plenty of rhetoric to go around on both sides. Oftentimes, that just is 
lost in the discussion, and pretty soon it all starts to sound alike 
and everybody is saying the same thing.
  The reality is this legislation. The reality is this legislation, and 
I just challenge every Member of the U.S. Senate to read this bill. If 
you read this bill, you will see it as the single greatest expansion of 
Government in the history of this Nation. You will see it as Government 
control run amok.
  The goals of the majority leader are honorable goals. They are goals 
shared by Republicans. The reforms that are outlined in terms of health 
security, of keeping your plan, of not losing it when you change jobs, 
not being denied coverage when you are sick, of the small business 
reforms and the insurance reforms, they are all incorporated in ideas 
and plans submitted by Republicans. We all agree on that.
  Senator Bentsen, not a Republican but then Senator Bentsen, a 
Democrat, leader of the Finance Committee, submitted legislation 2 
years ago. Had we enacted that, the rhetoric would have been solved. 
The problems that the rhetoric discloses would have been solved. Would 
it have solved every problem in the health care field? No. But it would 
have taken us a long way towards health care reform. Millions and 
millions of Americans today would have health security they now do not 
have because we are presented with this or nothing.
  The President has drawn the line in the sand and said, ``You enact 
this and nothing less or I will not accept it.'' And so those of us who 
have worked together to provide meaningful reform and health care for 
millions of Americans have nowhere to go. This is the bill before us. 
So if it is this or nothing, then we are determined to show the 
American people and our colleagues what this is. And this has been 
detailed now and outlined in section-by-section form for Members to 
check for themselves. I just think that the rhetoric needs to match the 
reality of that with which we are faced.
  With that, Mr. President, I yield the floor.
  Mr. McCAIN addressed the Chair.
  The PRESIDING OFFICER. The Senator from Arizona is recognized.
  Mr. McCAIN. Mr. President, first I would like to note the presence of 
my friend from California, Senator Boxer. I would say to the Senator, I 
intend to speak for about 25 minutes, if that is agreeable to her, so 
that she could adjust her schedule accordingly. And I appreciate her 
many courtesies which have been extended to me for many years. I wish 
to assure her that if I am ever in the majority I will try to extend 
the same courtesies to her that she has to me. And I am very 
appreciative not only of her courtesies but her friendship. She and I 
came to the House of Representatives together longer ago than she would 
care for me to recollect. So I thank the Senator from California.
  Mr. President, one of the most oft-used adages I know is that those 
who ignore the lessons of history are doomed to repeat them. History 
teaches us many things about the prospects for this legislation, and in 
my view none of them are favorable. For the sake of our Nation, I 
believe we should avoid the errors of the past.
  Among history's most important lessons--and I would cite five of 
them--as far as health care legislation is concerned are, first, a 
major piece of legislation that fundamentally alters our basic 
institutions requires strong bipartisan endorsement, not a narrow 51-
percent majority; second, any major health care bill must be understood 
and endorsed by the public before it is passed if it is to have any 
chance for successful implementation; third, Government-run approaches 
to providing health care are overly bureaucratic and do not result in 
quality services or consumer satisfaction; fourth, health care access 
problem is fundamentally a cost problem, and any bill that does not 
strongly address the cost of health care through market forces in my 
view will be doomed to fail; and fifth, the cost of entitlements are 
always underestimated when first proposed, and it is politically 
impossible to remove them once they are enacted.
  I would like to discuss each of these lessons to ensure that we do 
not ignore them in the course of this debate.
  First, health care reform requires strong bipartisan support. Mr. 
President, this is not an issue that should be decided on a party-line 
vote with 51 votes in favor and 49 against. This is an issue that will 
affect every American in a very personal manner. It will fundamentally 
alter an industry that comprises one-seventh of our economy, and 
history shows us that from major civil rights legislation to the 
creation of new Government social programs, if we are to truly succeed 
in changing the status quo, it must be done in a manner that is 
supported by the broadest cross section of Americans.
  It is clear that this bill is not bipartisan. The objective is to 
pass it, even by a single vote. The Clinton-Mitchell bill does not have 
a strong bipartisan support because it does not have the support of the 
American public.
  To try to force through a bill that the public does not understand, 
in my view, will result in disaster and will further undermine the 
credibility of the Congress in the eyes of the American people.
  A second lesson of history is that the public must understand and 
support the health reform bill that ultimately becomes law. History 
assures us that a bill that is not understood by the public will not be 
successfully implemented.
  I would like to remind my colleagues of the last time we passed a 
major health care bill that the public did not understand that was when 
the Congress enacted the Medicare Catastrophic Coverage Act of 1988. 
Once senior citizens learned that they were being forced to pay 
substantially more for benefits that did not meet their top priorities 
and were not worth it for many, they stormed our offices with angry 
letters and calls, and I am proud to have been the sponsor of the bill 
that repealed this legislation.
  I think it would be useful to review the political history of that 
doomed legislation. In 1987, the Medicare Catastrophic Coverage Act was 
introduced to provide seniors with protection against the spiraling 
costs of illness requiring long-term or frequent hospitalization.
  On July 22, 1987, the Senate passed the measure by an overwhelming 
86-to-11 vote, the House measure bearing the same title was passed 302 
to 127. As the bill moved through the legislative process, what 
happened? Benefit after benefit was added. The scope and cost of the 
legislation changed dramatically from the original legislation. Good 
intentions were once again paving a road to a destination the public 
did not understand, want or support. But that did not matter to the 
Congress. We did not seek the consultation and endorsement of the 
American people who would have to live with our reforms. We were going 
to give them what we decided was best, and we did, with the aid and 
abetment and efforts of the AARP. The conference report on the 
catastrophic bill passed the Senate 86 to 11 and the House by 328 to 
72. I voted against the conference report even though I was a prime 
cosponsor of the original bill. I did so because I listened to the 
seniors of Arizona.
  I was looking back in the Record of the congressional debate at the 
time of passage of the conference report on June 8, 1988. I said at 
that time--now, nearly 6 years ago, over 6 years ago:

       In a speech in my State earlier this week at a typical 
     middle-class mobile home park I came to find that none of the 
     80 to 100 seniors present supported the conference report. 
     First, they protested the fact that the cost of the 
     supplemental premium had risen by 50 percent over that of the 
     supplemental premium under S. 1127.

  That is the original legislation.

       Second, they were extremely upset about the fact that 
     participation in the benefit was mandatory, regardless of 
     whether or not they already had private coverage. Third, 80 
     percent of them cited a desire to seek coverage of long-term 
     care and they were willing to pay an additional $500 to $600 
     a year for such coverage. And last, only 5 percent of them 
     supported the prescription drug coverage provided in the 
     bill.

  That is what I learned back in 1988. That is why I voted against the 
catastrophic bill, and that is why inside the beltway, by overwhelming 
numbers, this bill was passed. And what happened? What happened, Mr. 
President, 1 year later, after the seniors realized what the bill did 
not do, a veritable revolt ensued. Still Congress balked. 
Notwithstanding the public outcry, amendments offered to delay 
implementation of the catastrophic bill on April 1, June 7, and July 
27, 1989, were defeated. Each vote, however, received broader support 
as public reaction swelled. By October of that year, public outrage had 
reached a fever pitch. On October 4, I introduced a bill to repeal the 
onerous portions of the bill. The measure was passed on October 6 after 
11 hours of debate and after the defeat of 8 substitute amendments by a 
vote of 99 to nothing.
  Why was the repeal passed, Mr. President? Because the American people 
demanded it. Democracy may take time but inevitably it works. So we 
have a very clear example of how a major change in our health care 
system started and how it ended.
  That is history, Mr. President. We should all learn from it. I will 
tell you what I am hearing from the seniors and younger people and 
middle-aged people in Arizona, and that is they do not understand this 
bill. They do not understand it. They do not know what it is about. 
They want it explained to them before they sign on to it. And by a 2- 
to-1 margin they are saying we prefer a gradual approach. We prefer a 
gradual approach because we do not want to be saddled with Government 
intervention in our health care systems that we do not understand.
  Now, maybe, Mr. President, in the long run the American people and 
the people of my State may accept something along these lines. I doubt 
it. I do not think so. But right now they clearly do not understand it. 
How can you possibly ask the average American, who is working, 8, 10, 
12, 16 hours a day, 5, 6, 7 days a week to understand the ramifications 
of this bill?
  Now, Mr. President, they did not understand catastrophic. It was done 
inside the beltway, with AARP. They do not understand this. And I do 
not know if this is going to pass or not.
  I do not think anybody in this body knows whether this legislation is 
going to pass. If it does, I can predict one thing. It will have the 
same result as the catastrophic bill did, only it is not going to be 
the seniors who will be lying on the hood of the car of the chairman of 
the House Ways and Means Committee. It will be not be seniors who knock 
the chairman of the House Ways and Means Committee over the head with a 
sign in protest. It will be all the American people.
  So I strongly suggest that we learn the lesson of history concerning 
catastrophic.
  While we do not know how much more senior citizens will have to pay 
for these new benefits, preliminary estimates suggest that over 50 
percent of beneficiaries will still have to pay for their prescription 
drugs out-of-pocket because they will never exceed the cost-sharing 
requirements. They, and the many other seniors who currently have 
prescription benefits from other sources than Medicare, will still pay 
higher part B premiums for the new benefit. This is just one of the 
thousands of new provisions in the Clinton-Mitchell bill that we do not 
fully understand.
  I would note that the catastrophic bill had even more public debate 
in open forums than the current bill. Yet, it failed.
  During debate on catastrophic, CBO estimates of the cost were 
woefully inaccurate. The costs of a new skilled nursing benefit was 
increased by 642 percent in just one year from the original CBO 
estimate. Standard benefits packages and making people pay for benefits 
that they may not want like the catastrophic bill is a recipe for 
disaster. All of these concerns are applicable to the Clinton-Mitchell 
bill.
  Mr. President, the American public must know what is in the Clinton-
Mitchell bill. We cannot afford another fiasco like the Medicare 
Catastrophic Act.
  The third lesson of history is that Government-run approaches to 
providing health care do now work well. They are overly bureaucratic 
and do not result in quality services or consumer satisfaction. 
Supporters of the Clinton-Mitchell bill are fond of asking Republicans 
whether we would want to repeal Medicare, which is a Government-run 
program. Well, of course we would not want to repeal Medicare. However, 
if we were to pass Medicare over again, we certainly would have 
designed it very differently. Every day, I receive letters and calls 
from seniors about problems they have with the Medicare bureaucracy and 
the arbitrary rules that it imposes.
  Perhaps as important, the original estimates of the combined costs of 
Medicare and Medicaid for the 1990 was $18 billion. The reality was 
that the actual costs had been 10 times that. There has not been an 
entitlement program in history that has not vastly exceeded the 
estimated costs at the time of passage. Sometimes, as in the case of 
Medicare and Medicaid, by a factor of 10. I have had the opportunity to 
deal with other Government-run health care systems.
  Other Government-run health care systems are even worse. As a member 
of the Armed Services and Indian Affairs Committees, I am constantly 
informed about the horror stories associated with the veterans health 
care system and the Indian Health Service and their bureaucracies. The 
Clinton-Mitchell bill would make their bureaucracies pale in 
comparison. It includes 50 new bureaucracies, 17 new taxes and 
penalties, 177 underfunded State responsibilities, 818 powers and 
duties of the Department of Health and Human Services, 83 powers and 
duties of the Department of Labor, and hundreds of new Federal 
regulations.
  I am not sure we can fit all of these on the T-shirt that we made up 
in response to the Clinton health care bill. We may have to make sure 
they are all extra, extra large.
  Fourth, history tells us that any bill that does not strongly address 
the cost of health care through market forces will be doomed to fail. 
Our access problem is basically a result of rising health care costs. 
Costs are simply not affordable for many Americans. There is nothing in 
the Clinton-Mitchell bill that significantly addresses the problem of 
rising health care cost, and, in fact, it actually makes the situation 
worse.
  For example, the way in which community rating is achieved in the 
Clinton-Mitchell bill, which substantially limits premium differentials 
based on age, will dramatically increase the cost of coverage for 
younger individuals. This enormous cost shift to those who can least 
afford it will induce many young people to drop their coverage.
  Also, the Clinton-Mitchell bill will do very little to address our 
malpractice crisis, which is an important cause of rising health care 
costs. Our malpractice system is seriously dysfunctional. Only 43 cents 
of every dollar spent in the system goes to injured patients. The 
majority goes to administrative expenses and legal fees. The cost of 
malpractice insurance has grown dramatically, increasing by 15 percent 
each year from 1982 to 1989. It may increase by 19 percent this year. 
These costs, which exceed $6 billion annually, are passed on to 
patients. They are creating major access problems in certain areas, 
particularly underserved rural areas.
  Thus, it is clear that we need serious malpractice reform in this 
country. Unfortunately, the Clinton-Mitchell bill does not include any 
significant malpractice reform, and may actually move the country 
backward at east a decade. Incredibly, it could negate positive State 
laws that have significantly addressed our malpractice crisis.
  The first version of the Clinton-Mitchell bill contemplated a total 
preemption of State malpractice law. Such complete preemption of the 
malpractice laws of every State would be incredible.
  It basically says that Congress knows better than all the State 
legislatures in the country.
  It is unclear from its language whether the current version of the 
Clinton-Mitchell bill totally or partially preempts State malpractice 
law. The language implicitly suggests that it totally preempts the 
field, and nothing in the bill states explicitly that it does not 
preempt State law.
  Whether or not it preempts State law, the malpractice and medical 
liability reforms that are proposed are extremely weak. They only apply 
to cases against a health care provider or professional, but not to 
claim concerning a medical product. The most significant reforms limit 
lawyer contingency fees to about what lawyers are now charging, and 
permit periodic payments of awards.
  While these particular provisions are also in the Dole bill, the 
difference is that they are the strongest provisions in the Mitchell 
bill. The Dole and Gramm bills contain other vitally needed reform.
  Mr. President, everyone knows the status quo. Some unfortunate 
individual becomes injured, files a lawsuit and seeks compensation in 
court, wins, and before he or she is able to use the money to pay 
medical bills or put his or her life back together, the lawyers get 
paid. The fact is that while the injured party is still suffering and 
trying to make better his or her lot in life, the lawyers get paid 
first and foremost. They often receive large contingency fees for 
settling a case with a minimum amount of effort.
  The most egregious example I know of was the agent orange case where 
millions of dollars were awarded in the case of victims of those who 
suffered from agent orange in the Vietnam war. The lawyers got paid 
first. Many of the victims of agent orange died before they ever 
received a penny in compensation for the damage that was done to their 
health as a result of agent orange. You tell me, Mr. President, why the 
lawyers should have been paid first while American veterans were 
suffering.
  And what does the Clinton-Mitchell bill seek to do: Codify the status 
quo. Are our priorities that misguided? The status quo is not in 
anyone's interest, except for the trial lawyers. It is the injured, not 
the lawyers, who we should help and protect. The medical malpractice 
sections of this bill are wrong and must be corrected.
  The Clinton-Mitchell bill requires each State to set up alternative 
dispute resolution mechanisms and requires exhaustion of these 
mechanisms before a court action may be brought. While alternative 
dispute resolution, such as mediation and arbitration, is generally a 
good idea if engaged in voluntarily, the mandatory way in which it 
would be imposed in this bill would be highly inflexible and 
bureaucratic.
  While the President is fond of lashing out at the so-called special 
interests, such as the NFIB which represents the many small businesses 
that crate jobs in our country, it is interesting that he has not 
spoken out against the enormously powerful trial lawyer lobby or its 
well-funded political action committee.
  In fact, President Clinton is only concerned about those special 
interests that are not supporting his plan or contributing to his 
political interests. Groups such as the Trial Lawyers Association that 
support him are interestingly exempt from the pejorative classification 
as special interests. Coincidentally, the largest contributor to the 
Democratic coffers is also the largest beneficiary of their ineffectual 
malpractice provisions.
  Compare the Mitchell bill's weak or negative malpractice reforms with 
the powerful reforms in the Republican alternatives, which include 
limits on noneconomic and punitive damages, statutes of limitations for 
brining claims, improvements in standards for bringing claims, and 
consumer protections. Our reforms are based on precisely the innovative 
State laws that the Mitchell bill could nullify. These reforms are 
working, and should be allowed to continue to work and to be expanded 
throughout the country.
  In addition, the Clinton-Mitchell bill is replete with new and 
unjustified burdens on both the private and public sectors, including 
new taxes, mandates, regulations, and legislative pork or other waste.
  The Senator from Indiana has described many of those in detail. So I 
will not.
  One of the most important innovations with respect to cost 
containment that is in the Dole bill and many of the other bills is the 
medical savings account. Medical savings accounts are a market-oriented 
approach which would substantially increase the cost consciousness of 
consumers while allowing them to stay in control of their health care 
decisions rather than having some government bureaucrat make the 
decisions for them.
  Unfortunately, the Mitchell bill does not authorize medical savings 
accounts. Overall, the bill does nothing to contain costs and 
therefore, in my view, will fail in the long run in its goal to enhance 
access.
  Fifth, Mr. President, history teaches us that the cost of 
entitlements are always underestimated when first proposed. When 
Congress passed Medicare in 1965, it predicted that Medicare costs in 
1990 would be under $10 billion. In fact, they were over $100 billion. 
The estimate was wrong by a factor of 10. I cannot think of an 
entitlement program that we have passed that has not cost substantially 
more than originally projected. Once they are in law, they develop 
powerful constituencies that ensure they are never, ever, cut back.
  It is particularly ironic that we are considering a bill with $1 
trillion of new entitlements just as the entitlements commission is 
submitting its recommendations to do precisely the opposite. I can 
understand specifically targeted subsidies for low-income individuals 
to obtain coverage, but a new entitlement for medical schools is 
incomprehensible. What is the American public going to think when they 
learn we are trying to increase their taxes to pay for this nonsense? I 
commend the Senator from Nebraska for his leadership on the 
entitlements commission and his warnings about the new entitlements in 
the Clinton-Mitchell bill.
  Again, let us learn from history. The exercise we are going through 
today is frighteningly similar to the catastrophic bill, with one very 
important exception: The reach, scope, and impact of the Mitchell 
health care bill dwarfs the Catastrophic Coverage Act.
  While I am on the subject, I wanted to again mention the entitlement 
in this bill which is for graduate medical education accounts--a new 
entitlement for graduate medical education. For that account, the 
Mitchell bill authorizes expenditures as follows: For the academic year 
1997, $3.2 million; in 1998, $3.6 million; in 1999, $5.8 million; in 
2000, $6.1 million; in 2001, $6.5 million. In this section of the bill, 
we are authorizing a staggering $23 million for graduate medical 
education and physician training. It appears as if our goal here is to 
make every medical school in America a public school. It also helps 
explain why there is so much academic support for this legislation.
  Our medical schools are the finest in the world and 62 percent of all 
medical students already receive financial aid from guaranteed student 
loan programs. Yet, here we are appropriating money for medical 
research, and we are creating a multibillion-dollar entitlement program 
to supplement our medical schools.
  Just like with catastrophic, we started this effort with good 
intentions to address real and fixable problems with our health care 
system.
  Just like with catastrophic, and in the classic fashion of Congress, 
we are seizing an opportunity to address difficult and complex problems 
with the same old and ineffective answers, more taxes and more 
bureaucracy.
  Just like catastrophic, we are ignoring the will of the American 
people. Polls show that Americans want us to tread lightly, go slowly, 
and do this right. But the answer they receive is best summed up in the 
words of one of our colleagues that the American people were going to 
get health care reform whether they liked it or not.
  Just like catastrophic, politicians are lauding the plan with great 
fanfare and moving speeches which are long on rhetoric and short on 
reality.
  Just like catastrophic, those who question whether the American 
people would support the new programs it would create seem to be voices 
crying in the congressional wilderness.
  But I am afraid that, unlike catastrophic, staying the present course 
is not something we can undo. Drastically changing the way one-seventh 
of our national economy operates is an enormous undertaking. The 
changes Congress would effect with this bill--17 new taxes, vast 
entitlements, 50 new bureaucracies, a job destroying employer mandate, 
and extensive new State mandates--are enormous changes that, once 
started, will be very difficult, if not impossible, to undo.
  History demonstrates that the Clinton-Mitchell bill would be a major 
mistake for this country. Before we make this mistake, we should take 
the time to fully understand the bill, educate the public about what is 
in it, and when it is rejected, like the original Clinton health care 
reform bill, pass a sensible bill that has the support of the Nation. 
We can still pass a good bill this year that enhances access by 
containing costs. There is much that we all agree on. However, we must 
not pass legislation that places our excellent health care system in 
the hands of the Government.
  As we debate the Mitchell health care reform bill, I implore my 
colleagues to remember history and not doom ourselves to repeat it. The 
American people deserve better.
  I appreciate the patience of my friend from California.
  I yield the floor.
  Mrs. BOXER. Mr. President, before my friend from Arizona leaves, I 
want to thank him for his kind remarks. The Senator from Arizona and I 
sometimes disagree, and sometimes we agree. But in either case, we 
never are disagreeable with one another. I think that says a lot, 
because these are difficult times and these are rough issues. I 
appreciate his friendship and his decency to me at all times.
  Mr. President, the reason I decided to speak this afternoon--and it 
was not in my plan--is I was carefully listening to the debate and 
listening to the words of the Senator from New Hampshire, my Republican 
friend from New Hampshire, for whom I also have a great deal of 
respect. He used a word in his speech, and he said it really from the 
heart, and I believe he feels it. What he said is, ``I am afraid of my 
Government.'' He said, ``I think people are beginning to fear their 
Government.'' He said, ``I want the Government to fear me.'' In other 
words, he wants the Government to fear the individual. He does not want 
the individual to fear the Government.
  Mr. President, I find that a very disturbing statement. America is 
not about fearing one another. It is not about us being afraid of our 
Government or our Government being afraid of us. We are the greatest 
country in the world, and the reason that we are the greatest country 
in the world is because we come together to solve our problems. We come 
together as a community, as a nation, to set aside our partisan 
differences and to find answers to the problems that plague us.
  So I was very disturbed to hear all this talk about fear and, 
unfortunately, Mr. President, a lot of fear is being injected into this 
debate, somehow setting up the Mitchell bill as something to be afraid 
of.
  I think it is important to, once in a while, take out the preamble to 
the Constitution. I do it a lot because I think it sets out the reasons 
why we have a Government, and they are the most beautiful words. I am 
going to read them. Why do we have a Constitution? Why do we have a 
Government? Here is the answer:

       We the people of the United States, in order to form a more 
     perfect Union, establish Justice, insure domestic 
     Tranquility, provide for the common defence, promote the 
     general Welfare, and secure the Blessings of Liberty to 
     ourselves and our Posterity * * *

  That is why we have a Government. That is why we have this U.S. 
Senate and the House of Representatives over on the other side, where I 
was proud to serve for 10 years. And together we work--men and women of 
goodwill--and we compromise, and we debate and argue, and we do the 
best we can for those reasons: ``to form a more perfect Union, 
establish Justice, insure domestic Tranquility,'' and all of the other 
things I just read.
  When we say that we fear our Government, I think that kind of talk 
undermines what we are. We are a Government of, by, and for the people. 
What is domestic tranquility? I have already said that it is one of the 
main reasons that we have a Government. Domestic tranquillity, to me, 
means peace at home, peace in our own homes, peace in our cities where 
we live, in our counties, our rural areas, peace in our Nation, and 
peace in our States. Domestic tranquillity.
  How does the health care reform debate coincide with the reasons that 
we are here for domestic tranquillity? Mr. President, you have long 
worked to bring about health care reform for this country, and I think 
you and I, and many Members on both sides of the aisle, understand that 
it is very difficult to have domestic tranquillity when we have the 
kind of crime that we have in our country today. That is why it is so 
important to pass that crime bill. You and I know it is hard to have 
domestic tranquillity when you cannot get a job for your family and 
provide for them and you cannot afford a decent education for your 
kids.

  And, yes, Mr. President, it is hard to find domestic tranquility when 
you are so afraid that you are going to go broke if someone gets sick 
because your insurance for health is canceled. Or when you go to the 
doctor and find out you have ``a preexisting condition,'' say, high 
blood pressure, and then the insurance company says, ``Sorry, we cannot 
take you until you pay an inordinate premium,'' which you cannot 
afford. It is very hard to find domestic tranquility under those 
circumstances.
  How about when an insurance company disappears out of your life when 
you need it most? Can you find domestic tranquility when you counted on 
health insurance and suddenly the company walks out on you because you 
get sick? That is what happens to a lot of our people. I have met them. 
I have seen them. I bet every one of us knows such a case.
  It is hard to have domestic tranquility when you suddenly find out 
that in the small print of your health insurance policy it says that 
there is a lifetime limit. So if someone gets sick in your family and 
it is a catastrophe and it bleeds every dollar, you are told by your 
insurance company, ``Sorry, you are out; you have reached a lifetime 
limit.''
  I have seen people who have had that problem. They did everything 
right. They paid their premiums. They are hardworking. All they did was 
get sick, and the sickness was a devastating one, and they reached the 
lifetime cap.
  I have seen it where little children who get a serious illness reach 
the lifetime cap at age 6, 7, or 8.
  It is hard to have domestic tranquility when you may be forced to 
divorce your spouse so that one of you gets to keep some assets and 
then the other one appeals to the Government for help. You cannot have 
domestic tranquility under that circumstance.
  So I say that if we are about anything here, it has to be about the 
Constitution. How can we avoid a situation that leads to our families 
being worried, if they have insurance, worried that they lose 
insurance; if they have a job that gets insurance, worried if they 
change their job they will not get insurance; worried if they get sick 
they will be kicked out.
  I say it is our constitutional obligation to fix this problem. And, 
yes, we have been debating for 50 hours--50 hours--one amendment, a 
good amendment. We are ready to amend this bill. We are ready to make 
it better. Senator Mitchell himself voted for the Dodd amendment. He is 
willing to amend his bill. He is willing to make it better.
  (Mr. REID assumed the chair.)
  Mrs. BOXER. Mr. President, I remember when I was over in the House, a 
young man came to see me. I have told this story a couple times. His 
name was Andy Azevedo, 16 years old, a strapping young man. I was so 
proud that the majority leader actually told the story when the 
majority leader introduced his bill. At that time --it was many years 
ago--I did not know that much about the insurance crisis. This young 
man came to see me, and he said: ``You know, Congresswoman''--I was a 
Congresswoman at that time from the San Francisco Bay area. He said:

       Congresswoman, I am worried. I have had cancer, but I am OK 
     now. I know when I am off my parents' policy when I graduate 
     from college I will not be able to get insurance because they 
     will say I have a preexisting condition. Can you help me with 
     this? Can you do something about it?

  That is when I got involved in this issue.
  Later, Andy had an occurrence of the cancer. His insurance policy 
would not cover certain treatments that he needed. I went to bake sales 
in Petaluma, CA, to help his family raise money for him.
  This is a proud family. This is a farm family. This is a hardworking 
family. They did not have domestic tranquility for a long time, and 
then they lost Andy. I promised his mother that we would, in fact, pass 
health insurance reform.
  It is hard to be tranquil when you watch the talking day after day. 
And why am I doing it? Why am I participating in it? It is because I 
feel it is important to answer some of the words on the other side that 
deal with fear, because I know people are watching this debate. I want 
to have a chance to tell people, if we do nothing, you should be 
afraid. If we do nothing, you should be afraid. If we do something, you 
should have heart because we know what the problems are. Everyone knows 
what the problems are. It is not the sole province of a Democrat to 
know what the problems are. The Republicans know. They know what it is 
like to worry about a child. They understand.
  The question is, when do we write this bill? You know in the Senate 
we amend every bill that comes before us. I have yet to see a bill, 
very few--maybe on very small issues--I have yet to see a major bill 
that was not amended and made better or sometimes made worse. And then 
we decide if we think it was made better or made worse and do we feel 
it is worth voting for. That is what legislating around here is about.
  You know, I was also interested the other day when the Senator from 
Missouri, a very respected Senator, took to the floor and said that he 
was upset about the Mitchell bill because it provided a new benefit to 
Medicare recipients. It provided actually two new benefits, and he did 
not think we could afford to do it. One of them was prescription drugs, 
the other inhome care. And he felt even though he knew these were 
important benefits, we simply could not take that on. It was too 
difficult.
  I remember when my kids were young I read them a little book about 
the Little Engine That Could. Everyone said, ``It can't be done, it 
can't be done, it can't be done.'' But the Little Engine That Could 
said, ``It can be done, it can be done, it can be done.''
  Yes, it is hard. It is hard for a little engine to go up a steep 
hill. It is hard for this Congress to solve the health care reform 
battle. But we are in it, and I think we can figure out a way to do it 
in a cost-effective manner. And if there are those who feel we should 
not have a prescription drug benefit to our elderly, let them vote 
against it. Let them make the amendment. But let us not hear them say 
we cannot work with the Mitchell bill. We can amend the Mitchell bill.
  I like the prescription drug benefit. I like the fact that we will 
have inhome care for our seniors. Yes, they will pay for some of it. 
But let us help them. I do not want to see grandmas and grandpas have 
to go to a nursing home when it is actually more humane and more cost 
effective to keep them in their homes. And the Mitchell bill starts us 
on that road. That is sensible.
  You know, it is hard to see our people feeling tranquil--and we 
talked about domestic tranquility--when they see Senators on this 
floor, who belong to the Federal Employee Health Benefit Plan, stand up 
here and say it is good for us but we do not think you ought to have 
it. And I think the majority leader pointed that out in a brilliant 
fashion. We have it. It is a good plan. What is it? It is organized by 
the Federal Government. It is private insurance. We can choose the plan 
we want. We get options and choices galore. Our employer pays 72 
percent of it. We pay the rest. And we have peace of mind.
  I want to see that for my constituents. I want to see that for all 
Americans--a chance to get access to that plan. In the Mitchell bill, 
you get access to that plan if you want it. It does not force you to, 
but it makes it available.
  So I have to say that I welcome reasonable debate, and I see some of 
my colleagues are here so I will finish up in the next few minutes, 
probably another 5 or 6 minutes. I welcome reasonable debate and we all 
do. I want to start debating amendments. We debated a good amendment 
last night. As I said, the majority leader voted for that amendment; so 
did the Senator from New York, Senator Moynihan; so did the Senator 
from Massachusetts, Senator Kennedy. They did not say we are not going 
to vote for this amendment because it did not come out that way in our 
committee. The Senator from South Dakota, another leader in this 
battle, supported the Dodd amendment. We are open to change. We are 
open to amendment. We are open to making this bill better.

  Mr. President, could we have order?
  The PRESIDING OFFICER. The Senator from California is right. The 
Senate is not in order. Senators will refrain from speaking in the 
Chamber unless addressing the Chair.
  The Senator from California will continue.
  Mrs. BOXER. So we need to solve the problems of our Nation. Read the 
preamble of this Constitution. It is real clear on what we are supposed 
to do. In short, the message is tranquility. Very important. And part 
of that is making sure our people are not scared--scared that they many 
lose their health insurance; and, by the way, Mr. President, scared 
that they will not be gunned down in the street by an assault weapon.
  And we have our Republican friends over on the House side, except for 
11 of them, voting against the rule to bring up the crime bill, saying 
that there was pork in it. One-hundred thousand police on the streets, 
is that pork? I say it is a necessity. Billions of dollars for prisons? 
I say it is a necessity.
  The violence against women act, which is included in that bill, is an 
absolute necessity. Every 6 minutes a woman is raped in our country. 
Every 15 seconds a woman is beaten; 1,400 a year are killed by a 
boyfriend or a spouse, and they are stalked. The crime bill is a 
comprehensive solution, Mr. President, to a national disgrace.
  So they talk and talk over there, but they do not get to the guts of 
it. The guts of it is, they are afraid of the National Rifle 
Association. That is the guts of it. And they want to bring down our 
President. That is the truth of it. I hope the American people are 
waking up, waking up to the truth, the reality of what is going on 
here.
  In closing, Mr. President, let me say this. The majority leader has 
set out a framework. It is not a perfect framework. I have some 
amendments I am going to offer. I am looking forward to making the bill 
better.
  But I have to tell you, from the largest State in the Union, when you 
look at numbers like this: 6 million uninsured Californians. Nearly one 
in four Californians under the age of 65 is uninsured. Of the 
uninsured, over 5 million are from families in which at least one 
spouse works. So we are talking about working people who do not have 
insurance. We are talking about 1.3 million uninsured children in 
California.
  So I will tell you, I will stay here night and day, I will stay here 
around the clock for those children and those women and those men and 
those hardworking families. I will work. I will support some of the 
amendments that come forward. I will work against others.
  But, it is time. It is time to vote on the crime bill. It is time to 
fix a broken health care system.
  Let us stop injecting fear into this debate. We should not fear our 
Government and our Government should not fear us, because we are a 
Government of, by, and for the people.
  It is our job to get on with it, and provide the domestic tranquility 
for each and every American.
  Thank you, Mr. President.
  I yield the floor.
  Mr. BRADLEY addressed the Chair.
  The PRESIDING OFFICER. The Senator from New Jersey is recognized.
  Mr. BRADLEY. Mr. President, the Senate's effort to reform the 
American system of health care has important consequences for all 
Americans. It will determine the availability and the extent of health 
care for each of us. It will determine in part how long our parents 
will live and how healthy our children will be.
  As we debate this issue, let us remember what brought us here in the 
first place. We are not debating this issue by chance. There is a 
reason why we all speak of this effort as health care ``reform.'' In 
dozens of living rooms and conference halls, in emergency rooms of 
hospitals, and on the street corners, the message that I hear from the 
people of New Jersey is that we need reform. Our current system is not 
working as it should. Those who have health coverage are paying too 
much for it and those without health coverage deserve it.
  Mrs. BOXER. Mr. President, the Senate is not in order.
  The PRESIDING OFFICER. The Senator from New Jersey may proceed.
  Mr. BRADLEY. Mr. President, what people want the most is some control 
of escalating health care costs. What people fear the most is losing 
their health care if they change jobs or get laid off or lose a job 
because of a corporate bankruptcy. What perplexes them, as well, when 
they are confronted with all of these escalating costs of health care, 
is the power of the insurance industry.
  Want coverage for your heart problem? The insurance company says no, 
because it is a preexisting condition. In other words, the insurance 
company will insure you for everything but the heart condition that is 
most likely to generate the health costs for your family.
  In confronting skyrocketing health care costs, small business is left 
to the mercy of insurance companies. Small businesses have no leverage 
to negotiate with insurance companies. Too often, they are presented 
with a take-it-or-leave-it choice that only offers exorbitant costs for 
health care coverage.
  Each of us can enumerate countless occasions in our States when we 
have had interactions with small business people who simply said they 
cannot afford to cover the workers in their particular small business. 
They cannot afford to cover because they were told by the insurance 
company that it is $6,000 or $7,000 a person and they have no leverage 
to negotiate with the insurance company.
  If you get open heart surgery, the tab is $49,000; a caesarean 
section birth, $7,500. Remarkably, women of higher income have more 
cesarean section births. I do not think that is related to a 
differential in the size of the birth canal. It is related to the 
ability to afford to pay.
  And a visit to an orthopedist, $300 for the first visit, $175 for 
each visit after that.
  Most people have become accustomed to good health care, even with 
these costs, but health care simply costs too much; more than it should 
cost.
  When President Clinton proposed health care reform last year, none of 
us thought he was imagining the problem. There was a consensus that we 
should act; that we should do something. The political noise of the 
last 12 months aside, health care reform is as needed today as it was 
then. The families who need it are still in New Jersey and all of our 
States. The families that do not have the health coverage need it as 
much today as they did a year ago. All of us who are paying health 
costs are paying too much today just as we were paying too much a year 
ago.
  Real problems--and these are real problems--deserve and demand real 
reform. But just as we cannot forget what brought us here, neither can 
we forget how our political economy optimally functions. To allocate 
resources and services through the market ensures the greatest 
efficiency. It gives the consumer the highest quality, the greatest 
selection, the lowest price.
  To ask the Government to replace the market generates bureaucracy and 
reduces individual freedom, as the state makes decisions that 
previously were made by the individual. At the same time, it is the 
responsibility of the State to ensure that the market's destructive 
effect does not wreck the lives of human beings. The so-called creative 
destruction, as Schumpeter referred to the phenomenon of inefficient 
firms being put out of business by efficient ones, cannot be translated 
to the individual level when it comes to health care, workers who lose 
their jobs, or move to another job. Workers who lose their jobs, or 
move to another job, or for whatever reason have lost their health 
insurance, should in fact not lose their health care.

  These individuals need some help, some assurance that their health 
and lives will not be endangered by unfettered market forces. It is the 
job of Government to protect the public health and welfare in the short 
and long term of its citizens. How to do this in the area of health 
care is the essence of what this debate is all about.
  Our fundamental goal should be to enable a competitive health care 
marketplace to keep people healthy but take care of them when it does 
not. By and large, America's health care system is an excellent system, 
but it does have a few glaring faults. We should not block or undermine 
those elements that work in our current system. We should fix those 
areas that do not work and, in so doing, improve the overall system.
  Recent trends suggest the health care markets are becoming more 
competitive and efficient. We can spur that process by ensuring that 
insurance companies compete on price and quality, not on their ability 
to omit high-risk patients. Managed competition is beginning to bring 
better health care at lower prices to many Americans.
  The bill that is before us at this moment, offered by Senator 
Mitchell, is really the result of many conversations with many 
individuals and builds on the work that was done in the Finance 
Committee, addresses some of the persistent problems. For example, it 
eliminates preexisting conditions from insurance coverage 
considerations. It assures portability so that the loss of a job or the 
pursuit of a better job will not mean the loss of health care benefits. 
It allows small businesses to bargain for insurance as purchasing 
units, giving employers and employees needed leverage to drive their 
health care costs down.
  These are good steps but they do not attain the level of reform that 
is needed. Two specific problems are foremost in defining the health 
care crisis. I stated them earlier. Too many people do not have health 
care coverage, too many people cannot afford to get health care 
coverage, and costs are accelerating.
  The greater the number of people who are not covered, the more the 
rest of us pay. It is a fairly simple elemental principle of insurance. 
When an uninsured person shows up at an emergency room, he is not 
turned away. He receives care and the rest of us pay his bill in the 
form of an increase of our premiums. It is as simple as that.
  The only real answer to the crisis of 37 million uninsured Americans 
is universal health care coverage. It is the only answer for the nearly 
1 million uninsured individuals in the State of New Jersey. There is 
human misery of enormous proportions in our country because people 
cannot get health care coverage. In all the talk about CBO, HMO's, fee 
for service, triggered mandates, premium caps and so on and so forth, 
we must not forget our simple moral obligation. Expanding coverage and 
making health care affordable are the only ways to address the crying 
need of our fellow citizens for basic health care coverage.
  The bonus here is that by assuring coverage, we will also reduce 
costs by eliminating the shifting of costs from the uninsured who show 
up at the emergency room, to all those of us who are lucky enough to 
have health care plans but have to pay for the uninsured through our 
higher premiums.
  I also believe the only proper way to achieve universal coverage is 
through a system of shared responsibility. I have said this from the 
beginning of this debate. That means everyone contributes: Employers 
and employees. No one is solely responsible for our health care crisis 
and no one should be solely responsible for solving it.
  The bill before us has a provision that does embody that shared 
responsibility. Nor is the promise of the shared responsibility and 
universal coverage an empty promise in this bill. The bill provides 
subsidies that will make coverage a reality for millions of Americans 
who today do not have any. It recognizes that without these subsidies, 
millions of American families simply cannot afford the coverage and do 
not have the coverage; 37 million Americans, and more each year.
  Still, there will be difficulties with the overall cost of health 
care coverage if we do not properly contain these spiraling costs. The 
rest of our good work could be in jeopardy. Without cost containment, 
the promise of universal coverage is a hollow promise. Without cost 
containment, our workers will continue to see their take-home pay 
stagnate. But the issue of cost containment is the elephant in the room 
that everyone knows is there but no one wants to acknowledge.
  You can stand up on this floor and promise this new benefit and that 
new entitlement and this new program and pledge to cut this tax, and 
that tax, and pledge to cut this spending program, and that spending 
program, but no one wants to address the reality that stares us in the 
face, which is the need for cost containment. It is an issue that is 
simply not going to go away.
  In that context, the proposal before us offered by Senator Mitchell 
addresses the issue of cost containment, and he deserves credit for 
attempting to do so. I have a number of concerns with the bill that is 
before us related to bureaucracy, related to the unintended 
consequences of well-intended provisions, related to the method of cost 
containment put forward in the proposal, and the number of people upon 
whom it could place a financial burden.
  I hope it is possible over the next several days and weeks to work 
with Senator Mitchell and others to craft an alternative that is more 
equitable and more efficient in containing costs. I have spent a lot of 
hours meeting with the so-called mainstream group in which I 
participated from the beginning. I agree with some of the things that 
the group has discussed. I disagree with other things the group has 
discussed.
  I have worked with Senator Mitchell in putting forward his bill. I 
agree with some of the things he has suggested and disagree with other 
things that he suggested, as I have enumerated. The fact is, we have 
come up to the issue of national health insurance any number of times 
in the last 50 years and every time that we have gotten close to doing 
it--meaning a White House that is interested, whether it is a 
Republican or a Democrat, and a Congress that seems to be amenable to 
considering some of the tough choices embodied in providing national 
health insurance--something has happened and we always have backed 
away. We have always backed away in my opinion because the people who 
say ``my way or no way'' have always won.
  At some point in this process, the dialog that is necessary for 
successful legislation has broken down. Maybe it is partisanship in 
some cases. Maybe it is the strength of a particular interest group in 
other cases. Maybe it is personality conflicts in some cases.
  For whatever the reason, whether it was 1977 with modest hospital 
cost containment, whether it was 1972 with catastrophic health 
insurance for all Americans, or whether it was any other time when the 
issue has reached the point where it actually was within our grasp, one 
of several things has occurred.
  It is my hope that there will be no non-negotiable demands and that 
we will recognize the legislative process for what it is, which is a 
chance to address the basic questions. If you rigidify and confront, 
you have neither the fluidity nor the flexibility to get to the answer 
that is at the core of the problem, which in this case is cost and 
coverage.
  So, Mr. President, our challenge is complex, but our purpose is clear 
and simple: It is my hope that the Senate will rise to this challenge 
and fulfill this purpose, and that when our work is done, we will have 
produced legislation that works for New Jersey and for the Nation. I 
yield the floor.
  Mr. MOYNIHAN addressed the Chair.
  Mr. KERREY. I wonder if the Senator will yield. I wonder if the 
Senator from New Jersey will answer a couple of questions.
  The PRESIDING OFFICER. If the Senator from Nebraska will withhold, 
the Senator yielded the floor and the manager of the bill sought 
recognition.
  Mr. MOYNIHAN. If my good friend will withhold a moment, I would like 
to propose a unanimous-consent agreement, and then we will resume this 
matter. Is that agreeable to the Senators?
  The PRESIDING OFFICER. The Senator from New York, the manager, has 
the floor.


                      Unanimous-Consent Agreement

  Mr. MOYNIHAN. Mr. President, I ask unanimous consent that upon the 
completion of the exchange of questions between the Senator from 
Nebraska and the Senator from New Jersey and a 10-minute statement by 
the Senator from Colorado on an unrelated matter, that we proceed to 
the Nickles-Moynihan amendment; that Mr. Nickles, in the first 
instance, be recognized to offer that amendment striking section 1309 
of the Mitchell substitute; that there be 3 hours for debate on that 
amendment, equally divided between Senator Packwood and myself; that no 
amendments to the language proposed to be stricken be in order; that at 
the conclusion or yielding back of time, the Senate vote on Senator 
Nickles' amendment with the expectation that that will be the last 
legislative business of the day with respect to the bill before us.
  The PRESIDING OFFICER. The Senator from New York has propounded a 
unanimous-consent request. Is there objection? Without objection, it is 
so ordered.
  Mr. MOYNIHAN. I thank the Chair.
  The PRESIDING OFFICER. The Senator from Nebraska.
  Mr. KERREY. Mr. President, I just wanted to ask the distinguished 
Senator from New Jersey, who has just given a thoughtful presentation 
on health care and I think a very powerful argument for using the 
forces of the market to control costs.
  The market in the last 3 years has done an unprecedented job; in 
fact, there has been an unprecedented shift in the marketplace to 
managed care and that management of care has produced reduction of 
costs. I have sat here and listened to people come to the floor, 
particularly I say with all due respect to my friends on the other side 
of the aisle, with whom I think I agree on this issue, that we should 
move away from Government regulation and Government controls, but I 
hear some statements being made on the other side of the aisle that I 
think are, in fact, in conflict with other principles that they are 
espousing.
  I ask the distinguished Senator from New Jersey, if we move to the 
marketplace, does it necessarily mean--using market forces--that an 
individual is going to have a complete and unrestricted choice of 
doctor or any other sort of thing that they want?
  Is it not true that for those on the other side of the aisle, with 
whom I agree I believe on this issue that we ought to allow the market 
to work and move to managed care and use the management of care, that 
we need to disclose that part which means that we do accept in a 
voluntary fashion, presumably, some limitation, some restriction of our 
choice of doctors? Is that essentially what goes on if we use the 
marketplace? Are we not to a certain extent accepting that there is 
going to be some limitation on choice?
  Mr. BRADLEY. Mr. President, I say to the distinguished Senator from 
Nebraska, it depends on the ultimate form of this legislation. If we 
were to lock people in to managed care with no point-of-service option, 
then they would have a restriction on choice. If we have a point-of-
service option, it means that they can join a large group based upon 
the doctors that are in the group. They will often make the choice as 
to which group they would like to be a part of because their family 
physician is in the group, or good heart doctors are in the group, or 
whatever. That group could be as large as the Mayo Clinic; it could be 
as small as a major urban area. If they join, they join because of the 
doctors that they see in that group; therefore, they have chosen to 
join the group because of the doctors.
  If you have point of service, you have the option. God forbid 
something strikes and you get a disease that none of the doctors in the 
group you feel are adequate to treat you, and you want to go see 
somebody else someplace else in the United States. You have that 
option, under a point-of-service plan. You will pay a little bit more, 
but you will have that option.
  But the basic thought involved, as the Senator has suggested, that 
managed competition forces the consumer to make choices is correct.
  Mr. KERREY. Just to be clear on this so my colleagues understand what 
I am talking about, I am a service-connected disabled veteran. I was 
injured in the war in Vietnam in March 1969 and lost the lower part of 
a limb. As a consequence of that disability, I am considered to be 
eligible for care from a Veterans' Administration hospital.
  The Government does not make my prosthetic devices. I am allowed to 
choose and go wherever I want. They authorize it. I have to wait in 
line sometimes. I hear people talking about that. It is true. I cannot 
just go and get whatever I want. I have to get it authorized, I have to 
get it approved, but I choose wherever I want to go.
  If I was in an HMO without that point-of-service option, which is a 
market alternative--to be clear to my friends on the other side of the 
aisle, understand, I intend to come here and challenge you every single 
time if you come here and say that I want the market to take care of 
it. If you are not prepared to engage in a discussion of what that 
market does, that market taking care of it means as people move to 
managed care, somebody, not in the Government, but somebody in the 
private sector is going to say no to them, is that not true?
  Is it not true what happens? It is not a Government bureaucrat? I 
heard my friends on the other side of the aisle come down and blister 
the Mitchell proposal--and I am not a supporter of the Mitchell 
proposal. I have identified a number of areas where I think it does 
vest too much power in the Federal Government to make decisions--but do 
not come to this floor and expect to be unchallenged with a statement 
that says that the market gives you unrestricted choice. It does not.
  I have an increasing number of citizens in Omaha, NE, for example, 
that are finding themselves choosing HMO's or PPO's. They are finding 
themselves all of a sudden not with a Government bureaucrat saying no 
to them, they are finding a private sector bureaucrat saying no to 
them.
  I just want to make it clear that the point I am trying to make with 
the distinguished Senator from New Jersey--with whom I agree; I agree 
we ought to use the market to control--but is not inherent in that that 
somebody is going to be managing the care and making some decisions 
independent of what I might think I want?
  Mr. BRADLEY. If the so-called managed care providers in my State are 
any example--and New Jersey is not as well developed as a State like 
Minnesota, for example, or Oregon--there is a phase this goes through. 
First there is a managed cost. That is a dangerous phase because you 
are telling people you cannot continue to spend the way you have spent 
on health care. Then you move through that to managed care, where the 
group has as its purpose maintaining and enhancing the wellness of its 
members. And that is the hope of the market, as a mechanism to improve 
the health of the American people.
  Now, you should not be under any illusion, and the Senator's example 
of the Veterans Administration is one example--the other example is the 
continued existence of Medicare. No one is proposing eliminating 
Medicare. That is a very big Government program.
  Mr. KERREY. It is $160 billion a year.
  Mr. BRADLEY. It is a very big purchaser out there. So we are going to 
end up with a mixed system where you have a managed competition, but 
you also have Government as a very big purchaser of health care, either 
in the Veterans Administration or through Medicare, and as a result 
because it is such a large purchaser, it will have an influence on all 
of health care in the country.
  So I would say to the Senator that we will end up with a mix of 
private managed competition as well as Government involvement.
  Mr. KERREY. Mr. President, I say to my friend from New Jersey that I 
find myself almost equally irritated sometimes with Democrats who are 
willing to vote for things that provide new benefits without any money 
attached--I voted last night against the Dodd proposal because I saw it 
doing that--and Republicans who come to the floor and suggest somehow 
that the market is going to increase choice. It does not necessarily 
follow that that is the case. If we believe that costs are the number 
one problem, that cost containment needs to occur, you cannot contain 
costs without affecting either somebody's income or somebody's desire 
for unrestricted opportunity in the health care marketplace.
  I think it is very important in this debate that we come to the 
American people and try to tell them not only the truth about what 
works and what does not work, but it seems to me the truth about where 
Government's role ought to be in all this.
  Mr. BRADLEY. I thank the Senator for his question, and I agree with 
him. As I tried to say in my statement, cost containment is the 
elephant in the room that nobody wants to acknowledge. It is there. And 
I think before this debate has concluded, we are going to have some 
very interesting discussion about cost containment because we will not 
be able to avoid it. Right now we are avoiding it.
  We will not be able to avoid it because it is my prediction that 
there will not be enough votes in this Chamber to pass a bill if it is 
avoided, because the old days of simply adding more and more benefits 
without worrying about costs are, frankly, over. I do not think you are 
going to find 51 votes saying let us move ahead with a lot of new 
benefits but not pay for them. I think that there will then be several 
options, several opinions as to how best to control those costs, and 
that will be a debate for another day. But right now I have to yield 
the floor to the distinguished Republican manager, my colleague from 
Oregon.
  The PRESIDING OFFICER. The Senator from Colorado is recognized for 10 
minutes.
  Mr. BROWN. I thank the chair.

                          ____________________