[Congressional Record Volume 140, Number 117 (Thursday, August 18, 1994)]
[House]
[Page H]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: August 18, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
                           HEALTH CARE QUOTES

  The SPEAKER pro tempore. Under a previous order of the House, the 
gentleman from Tennessee [Mr. Duncan] is recognized for 5 minutes.
  Mr. DUNCAN. Madam Speaker, one of our larger daily newspapers, and in 
fact a Democratic paper, said it all at the top of its front page this 
past Sunday.
  The Headline said: ``Health Bill Hides Big Pricetag.''
  The sub-headline read: ``Middle-class takes the hit in all plans.''
  Later in the story--but unfortunately not until page A-8, where many 
people would not read them, were these words:

       Whatever is chosen, the pain is likely to wind up hitting 
     the pocketbooks of average working families earning $25,000 
     to $40,000 a year: Whether they pay the bills as workers, 
     taxpayers or consumers, they are footing most of the costs of 
     health reform.

  The middle-class pays no matter what.
  Another important thing to remember: Employer mandates really mean 
higher prices or job layoffs, or both.
  Sometimes, I think that some people hear about opposition to employer 
mandates and they think that person is siding with big business..
  Not true--employer mandates are most harmful to small business and 
simply result in higher prices and/or job layoffs.
  Time Magazine reported several months ago that the administration 
itself has an internal report that estimates their plan could cost as 
much as a million jobs lost over the next 5 years.
  No matter how good something may sound on the surface, if its going 
to result in a million jobs lost, this Congress should not pass it.
  Also, no matter how good something may sound on the surface, we 
should not pass it unless we can afford it.
  This sounds like simple common sense--yet this Congress has passed 
all kinds of things we could not afford in recent years.
  This is why our Federal Government is over $4\1/2\ trillion in debt 
and losing hundreds of millions on top of that every day, even as I 
speak.
  I wish the Federal Government could afford to buy everybody a 
$200,000 house and a fancy new car each year, but it cannot.
  There are limits to what government can do, and there is no way we 
can afford the most expensive social programs ever when we are already 
spending many billions each year more than we take in.
  We cannot even afford to do what we are already doing, much less 
adding new programs every week.
  Already our health care costs almost three times more as a percentage 
of our gross national product than it did before the Federal Government 
got involved in our health care system in a big way a little over 30 
years ago.
  Now, if we pass the Gephardt bill, or some version thereof, costs 
will go way up from where they are now.
  In last Friday's Washington Post, Charles Krauthammer, a very 
moderate columnist, wrote this:

       It was clear and much remarked that expanding coverage to 
     37 million Americans now uninsured, by increasing demand, 
     would substantially raise health care costs.

  Later in the same column, he wrote this:

       In the end, there is no way out of the dilemma: Both 
     extending health care coverage and improving health care 
     quality will increase health care costs. We must pay for that 
     cost by pushing yet health care's share of GDP.
       Or we must ration. No one, of course, dares speak the word. 
     There is not a politician who does not recoil from it. But 
     after this debate--If it produces any bill, costs will 
     increase--we will have the rationing debate. Having boosted 
     medical costs even beyond the bank-breaking level of today, 
     we will have to begin deciding which people with which 
     diseases at which ages will be denied the public provision of 
     which medical producers.

  Then Mr. Krauthammer noted that in Britain, if your kidneys fail and 
you are over 55, you are routinely denied life-saving dialysis, among 
other things. And he says: ``Others have done it * * * and so will 
we.''
  But I say, why? Sure, we have problems with our heath care--mainly 
that it costs way too much.
  But it costs too much because of too much government involvement 
already--not too little.
  When has the Federal Government ever done anything more cheaply or 
more efficiently than the private sector?
  George Will, in his column on Monday, quoted Senator Rockefeller who 
told a newspaper in West Virginia that ``We're going to push through 
health care reform regardless of the views of the American people.''
  This is the same Senator Rockefeller who was quoted in the Washington 
Post a few months ago as saying that Medicaid, another Federal medical 
program, was ``a horrible program, a vile program, and it ought to be 
abolished.''
  Then, George Will summarized our current situation in this way:

       Many Democrats profess to believe that they must pass 
     something, anything, lest they face punishment at the must 
     pass something, anything, lest they face punishment at the 
     polls. But Clinton and the diminishing cohort of Democrats 
     willing to be associated closely with him really want to 
     force health care legislation now for the same reason Clinton 
     does not want to seek congressional approval for any invasion 
     of Haiti: He and his allies are struggling to govern against 
     the American grain.

                          Rationing--Just Wait

                        (By Charles Krauthammer)

       Ever since the Clinton health care reform was unveiled 11 
     months and a dozen plans ago, it has been dogged by an 
     obvious contradiction: It promised both universal coverage 
     and control of exploding health care costs, now 14 percent of 
     American gross domestic product. It was clear and much 
     remarked that expanding coverage to 37 million Americans now 
     uninsured, by increasing demand, would substantially raise 
     health care costs.
       More care means more cost. That is obvious. But there is 
     another, less obvious and quite perverse contradiction buried 
     at the heart of the health care debate: Better care makes for 
     more cost too. The ordinary progress of modern medicine--
     quite apart from the cost of high-tech machines and tests and 
     procedures--makes health care more and more of a fiscal 
     drain.
       ``It is often difficult for lay people to appreciate that 
     good medicine does not reduce the percentage of people with 
     illnesses,'' writes physician-philosopher Willard Gaylin in a 
     brilliant critique of the health care debate (Harper's, 
     October 1993). ``It increases that percentage.'' Good 
     medicine keeps sick people alive, people with heart disease, 
     diabetes, hypertension and other chronic diseases. And sick 
     people are expensive. The dead are a burden to no one.
       Even preventive medicine, that sacred health care cow, 
     increases costs, points out Gaylin. Diphtheria and whooping 
     cough, once the two leading causes of childhood death, have 
     ceased to exist. ``But they were rarely expensive. The child 
     either lived or died, and, for the most part, did so quickly 
     and cheaply,'' Now that child ``will grow up to be a very 
     expensive old man or woman.''
       Because of these hard truths, the great health care debate 
     of `94 will turn out to have been both preliminary and 
     peripheral. Consider: Among the welter of disagreements now 
     highlighted in the Senate debate, there is a clear national 
     consensus for some reforms. Even the Dole plan mandates that 
     health care insurance be portable (you retain it when you 
     change jobs) and accessible (you cannot be denied it for a 
     pre-existing condition).
       Inevitably, however, such guarantees must increase health 
     care costs. If the currently screened or dropped out are to 
     be included and cared for, someone will have to pay for their 
     care. There is no free lunch, Either insurance premiums go 
     up, taxes go up or business pays through ``employer 
     mandates.''
       In the end, there is no way out of the dilemma: Both 
     extending health care coverage and improving health care 
     quality will increase health care costs. We must pay for that 
     cost by pushing yet higher health care's share of GDP.
       Or we must ration. No one, of course, dares speak the word. 
     There is not a politician who does not recoil from it. But 
     after this debate--if it produces any bill, costs will 
     increase--we will have the retaining debate. Having boosted 
     medical costs even beyond the bank-breaking level of today, 
     we will have to begin deciding which people with which 
     diseases at which ages will be denied the public provision of 
     which medical procedures.
       Others have done it, and so will we, In Britain, if your 
     kidneys fail and you are over 55, you are routinely denied 
     life saving dialysis by the National Health Service. If you 
     cannot afford private insurance or the out-of-pocket expense, 
     chances are you die.
       Even the Clinton plan had some rationing, though it had to 
     be kept covert. It would, for example, have severely 
     restricted the number of medical specialists. This is 
     indirect rationing. If you reduce by, say, one-third the 
     number of people who can do brain surgery, then many people 
     who need it and would now get it will not be able to.
       The Clintons defended that measure, tellingly, not as 
     rationing but as an effort to promote currently fashionable 
     primary care over ``specialization.'' No one is ready to talk 
     now about rationing. That talk is too unpleasant, the tone 
     too pinched, the vision too Carteresque.
       Instead, the politicians are holding a picnic and giving 
     away the food. The Democrats are offering ``health care that 
     cannot be taken away,'' a new fundamental right of, 
     literally, untold cost. Even the limited Republican reforms 
     would subsidize health care for more than 35 million 
     Americans.
       That costs money. Where do we get it? Gaylin is right: When 
     this round is over and we are quite through giving away what 
     we cannot afford, the real health care debate, the debate 
     about rationing, will have to begin. And if, like Hillary 
     Clinton, you think Round 1 was nasty, just wait for Round 2.
                                  ____


    Dug in to fight Radical Expansion of Government Into Health Care

                            (By George Will)

       Washington.--George Mitchell, master of the Senate's 
     health-care revels, spoke in a voice mingling reproach and 
     regret. Republicans, he said have been violating the 
     democratic spirit by filibustering promiscuously.
       The next day, Texas Republican Phil Gramm and Alabama 
     Democrat Richard Shelby promised to oppose, like Horatius at 
     the bridge, and with a filibuster if necessary, any radical 
     expansion of government control of health care.
       So, within the health-care debate there is a debate about 
     the ethics of obstructing. The latter debate illuminates the 
     former by revealing the political weakness that is dictating 
     the Democrats' desperate dash to pass a radical program 
     before the November elections register the public's desires.
       The idea that filibusters have become a serious problem is 
     preposterous. Can anyone name anything of significance that 
     an American majority has desired, strongly and protractedly, 
     but has not received because of a filibuster? Who believes 
     that insufficient activity is a defect of modern government?
       It takes 60 votes to end a filibuster. Newsweek's entirely 
     plausible poll shows 65 percent of Americans wanting Congress 
     to delay health-care reform until next year. So Democrats 
     sound strange when they say that it is an offense against 
     majority rule to make them get 60 votes before they can 
     override the wishes of 65 percent of the public.
       Mitchell says that, in the 19th century, ``there were only 
     16 filibusters'' and ``for three-fourths of this century, 
     there were fewer than one filibuster a year.'' And: ``In this 
     Congress alone, I have had to file motions to end filibusters 
     55 times.'' But Mitchell's numbers about filibusters, like 
     his numbers about health care, are misleading.
       In the 19th century, before there was a cloture process for 
     curtailing Senate Debates (before 1917), the mere hint of a 
     filibuster often sufficed to kill a bill. And Mitchell files 
     cloture motions promiscuously, often merely in anticipation 
     of a slight possibility of delaying tactics.
       Filibusters, although important in protecting minority 
     rights and indispensable in registering intensity as distinct 
     from mere numbers in controversies, can be trivialized when 
     used against mild policy proposals. The filibuster Mitchell 
     orchestrated against President Bush's proposal to cut capital 
     gains taxes was trivializing.
       However, Mitchell's 1,400-page health-care bill is not 
     mild. It would produce a more sweeping and intrusive 
     expansion of government than has been produced by any 
     permanent measure in American history. Clearly, Mitchell's 
     bill involves large issues of freedom, privacy and prudence. 
     So a filibuster is a reasonable, proportionate recourse for 
     opponents.
       They believe, reasonably, that Mitchell's bill would be 
     literally lethal as law. For example, by slowing development 
     of new pharmacological and other technologies, it would 
     disrupt the pain-relieving, life-prolonging therapeutic 
     revolution that America's health-care system has produced 
     in our lifetimes.
       Many Democrats profess to believe that they must pass 
     something, anything, lest they face punishment at the polls. 
     But Clinton and the diminishing cohort of Democrats willing 
     to be associated closely with him really want to force 
     health-care legislation now for the same reason Clinton does 
     not want to seek congressional approval for any invasion of 
     Haiti: He and his allies are struggling to govern against the 
     American grain.
       Recently William Kristol, a Republican strategist, 
     discerned ``the opportunity to turn the health-care debate 
     into liberalism's Afghanistan--the over-reaching that exposes 
     liberalism's weaknesses and causes its collapse.'' And the 
     debate has indeed high-lighted the spirit of modern 
     liberalism, as when Democratic Sen. John Rockefeller IV of 
     West Virginia, with a hauteur that would have made his great-
     grandfather proud, said, ``We're going to push through 
     health-care reform regardless of the views of the American 
     people.''
       The liberals' strategy is to pass bills--almost any bills 
     will do--in both houses, then go to conference and write a 
     third bill as liberal as they can make it and still win final 
     passage in both houses. By then, Democrats will be eager to 
     pass something and go home to campaign, so a bill more 
     liberal than even Mitchell's might pass.
       A conference report cannot be amended. It would have to be 
     physically filibustered--stopped with nonstop talking, rather 
     than with the scores of amendments that many Republicans and 
     some Democrats will propose in the next few weeks in order to 
     illuminate the myriad perversities lurking in Mitchell's 
     bill.
       Any filibuster will cast a Senate minority in the role of 
     defenders of the desires of a large American majority. 
     Filibusterers will risk being accused of ``obstructionism''--
     obstructing the largest peacetime expansion of Government in 
     history.
       That is a risk they should relish running.

                          ____________________