[Congressional Record Volume 140, Number 117 (Thursday, August 18, 1994)]
[Senate]
[Page S]
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 SECURITY ACT

  The Senate continued with the consideration of the bill.
  The PRESIDING OFFICER. The Senator from Oregon.
  Mr. PACKWOOD. I will yield 10 minutes to the Senator from New York.
  The PRESIDING OFFICER. The Senator from New York is recognized.
  Mr. D'AMATO. Mr. President, let me say I join my colleagues, Senator 
Mack and Senator Coats, in strongly endorsing and cosponsoring their 
amendment that probably goes to the essence of this ludicrous excuse of 
a health care program for this Nation. I use those words, and they are 
strong words, because it is a ludicrous excuse. And the reason we find 
ourselves in such an untenable position is because of the manner in 
which this document was produced.
  Most of it comes from the great task force. Most of this was done in 
private. Most of this was done in a manner such that, as we now read 
this bill, we find glaring, glaring deficiencies--deficiencies that, if 
there had been public hearings, would never have existed.
  I understand at some point in time the majority leader is going to 
move to rectify this monster. Some time ago, we had ``taxasaurus.'' I 
said kill the ``taxasaurus.'' That goes for this. We should kill it. We 
should kill it because it is a danger to the health and welfare and 
well-being of America and America's families. That is this monster, the 
Clinton-Mitchell proposal.
  Let me say, this is really, for all intents and purposes, the Clinton 
bill. As a result of the manner in which this bill came to life, we 
find ourselves in this terrible predicament where even its strongest 
supporters must admit that it is replete with errors, with substantial 
deficiencies. And then we hear ``We will correct it.''
  Let me cite just one of them. Behind closed doors, a group of people 
got together and came up with this wonderful idea: We want insurance 
for all--not a bad idea--and they went so far as to say that because we 
want to guarantee universal coverage and coverage for all, if a person 
were not to pay his premiums or her premiums, that family would not 
lose coverage. Can you imagine that? I think it is page 1432--I want to 
read this incredible provision. In other words, you enroll in a program 
and you pay for a month, 2 months. And if you read this literally, just 
by your enrolling and paying a premium for 1 month, in the second month 
when your premium comes due, if you do not pay, guess what--you cannot 
be canceled.
  What a terrific plan. Everyone in America should run and sign up for 
this plan. This is the plan that will not cost you a penny. It will not 
cost you a penny. All right, it will cost you the first month's 
premium. You sign up for this great plan; you pay 1 month, and then 
forget it. You do not have to pay. You do not have to pay because you 
cannot be canceled. What a terrific plan. How could the geniuses who 
put this forth have come to this point? Was it in error? Was it a 
mistake? Did they somehow make a mistake? The language is, ``In no case 
shall the failure to pay amounts owed under this Act result in an 
individual's or family's loss of coverage.''
  I am wondering if the Senator from Oregon had an opportunity to take 
a look at that. I ask, does it mean what I think it means? In no case? 
Listen to this: ``In no case shall the failure to pay amounts owed 
under this act result in an individual's or family's loss of 
coverage.''
  It does not say if the person forgets the premium for 60 days or 30 
days, or if there is a terrible accident and they are inconvenienced 
somehow. It says ``in no case.'' Is that an accident? Was that 
thoughtful legislation? Who is going to pay?
  What happens if you have a million people in this one plan and one 
person says they are not going to pay because it says ``in no case.'' 
And then 10 others find out. And then 100 find out. And then 10,000 
find out and do not pay. And then people begin to wonder what is going 
on? And the cost goes up and up and up for the rest remaining in the 
pool.
  If the cost goes up for the rest remaining in the pool, what takes 
place?
  Mr. DASCHLE. Will the Senator yield on that point?
  Mr. D'AMATO. For a question?
  Mr. DASCHLE. Well, for a question or clarification. A question.
  Mr. D'AMATO. I would like to make my point. When I finish I will be 
happy to yield. I do not intend to speak long, but I want to make the 
point. The point is that this thing was put together behind closed 
doors. That is why you have error after error. Penalties: $10,000 
penalty if a person gives a benefit that is too high. How did that get 
in there? And then the whole Senate votes to change it.
  I will tell you how. It got in because you had people who may have 
been well meaning, but they have their own intentions, their own 
program; they are going to put this through come hell or high water. So 
here we are. Now someone will offer an amendment and they will drop 
that provision. But this was the great legislation. How did it come to 
pass?
  If you had open hearings, open meetings, do you not think that people 
who provide coverage, insurance companies--of course, all insurance 
companies are bad now, according to the proponents of this legislation; 
they would have you think insurance companies are some evil monster--do 
you not think maybe they would come and contribute something to the 
debate?
  And they might say, ``Look, if you do this, why, you will discourage 
people from paying; you will have large numbers of people who will not 
pay; you will have premium costs shooting up for the balance of people 
who pay. You create a lack of incentive for people to be responsible. 
You tell them, `Don't pay because you can't lose your coverage.'''
  That is ridiculous. And here we have--in this very same grotesque 
monster of a bill that would cripple health care in this country if 
enacted into law--we have this board that is going to operate outside 
of current law. It is a board that will make some of the most important 
and crucial decisions as it deals with the health care needs of our 
country.
  This board is going to determine the actuarial value of the standard 
and alternative benefits packages. If the health task force could put 
together a bill that is so deficient and secret, imagine giving this 
board, under the color of law, the ability to go ahead and make these 
kinds of determinations. They are going to determine for us the kind of 
medical programs that can and should be undertaken and utilized. They 
will be determining for us the future of medicine--the future of 
medicine--in terms of defining the kind of care considered medically 
necessary and appropriate.
  My colleagues have spoken before me and have enumerated the 
incredible powers that this board will have. I suggest, No. 1, that 
today if we look at a board that operates almost entirely in the light 
of day in determining coverage under the Medicare program, we find 
incredible problems. When new devices and medical procedures are going 
to come into being, even that board has open, public hearings where 
people can present their case, where people on both sides can be heard, 
with certain exceptions, and that is only when there is written notice 
and reason posted.
  The PRESIDING OFFICER. The Senator's time has expired.
  Mr. D'AMATO. It is inconceivable we would allow this provision to 
stand and, therefore, I strongly support the Mack-Coats amendment.
  The PRESIDING OFFICER. Who yields time?
  Mr. PACKWOOD. Mr. President, just to ask a question of the chairman 
and, I think, to explain an arrangement we hope we have worked out. 
After we vote on the Coats-Mack amendment at a quarter of seven, the 
majority leader has an amendment--and we have worked out a pretty good 
system of comity of going back and forth --we would have an amendment 
then for tomorrow morning. I assume that is when we would go.
  Then, as I understand, we will go on an amendment from Senator 
Moynihan relating to the number of residents, interns, whatnot.
  Mr. MOYNIHAN. Mr. President, that is our understanding. It is 
informal, but we have had no difficulty at any time and are not going 
to. I believe the distinguished Republican manager is going to join me 
in the amendment I will offer.
  Mr. PACKWOOD. Absolutely.
  Mr. MOYNIHAN. Mr. President, I have the great pleasure to yield the 
remainder of our time, which I believe to be about 25 minutes?
  The PRESIDING OFFICER. The Senator has about 27 minutes.
  Mr. MOYNIHAN. Twenty-seven minutes. I yield the full 27 minutes, if 
he should so wish, to our revered President pro tempore, the Senator 
from West Virginia.
  The Senator has been thinking about this matter for some length. He, 
of course, is the master of legislative procedure and detail in this 
body, and he is going to give us the benefit of his judgment as to 
where we stand in terms of deliberating this particular issue and, I 
think, the Senate calendar.
  We do have to acknowledge that the calendar is implacable in its 
forward movement, and there is other work yet to be done before we can 
close out the appropriations bills, which have to be enacted, and that 
whole range of things.
  In this setting, I think we very much need the mature judgment and 
the deep, deep learning of the former majority leader, the President 
pro tempore.
  I know that we have felt that there is still good time in which to 
enact a good bill. We have seen a great deal of comity as we go back 
and forth on amendments, and we have seen near unanimity on last 
evening, and we shall see it again this evening as we debate the 
measure laid down earlier today by the Senator from Florida [Mr. Mack]. 
I hope we might find the same degree of accommodation to the majority 
leader's amendment when that vote comes later in the evening.
  The point, Mr. President, is that we are here, and this is the first 
week of the typically normal recess. The calendar is running, and we 
need the counsel of the great wisdom--I took the liberty of saying--and 
the profound learning of the President pro tempore.
  Mr. President, I yield the remainder of our time to the President pro 
tempore.
  The PRESIDING OFFICER. The Senator from West Virginia has 24 minutes.
  Mr. BYRD. Mr. President, I certainly am grateful to the very 
distinguished manager of the bill, the senior Senator from New York 
[Mr. Moynihan], of whom I shall say--not in the past tense--as 
Shakespeare said it:

       He [is] a scholar, and a ripe, and good one, exceeding 
     wise, fair-spoken, and persuading.

  I thank Senator Moynihan for yielding me this time. I hope I will not 
have to take all the time he has yielded me.
  Mr. President, this debate, in many respects, has been for me one of 
the most discouraging of my political career.
  Like many other Americans who are watching and listening to this 
debate, I feel a sense of confusion and apprehension after listening to 
the claims and counterclaims that have been conjured up by the lobbying 
groups on all sides of the issue and by the charges which have been 
hurled from both sides of the aisle on this floor.
  Compounding my sense of frustration is my belief that the health care 
issue is one of the most fundamental problems facing our Nation.
  I know that our present health care system is inefficient and costly 
and that these costs are not equally distributed. I know that in the 
Federal budget, health care costs are one of the primary causes of our 
continuing deficits.
  I also know that our present system of health care amounts to a cost 
equal to 14 percent of our gross domestic product and that the experts 
claim that, by the year 2004, if we do not change our course, those 
same costs will rise to 20 percent of our gross domestic product.
  The last, best hope of real deficit reduction lies in getting these 
spiraling costs under control. Spending in every other category of the 
budget known as discretionary, which is simply everything which is not 
automatic spending mandated by law, has been cut to dangerously low 
levels. We cannot look to this area of the budget for much more in the 
way of further cuts.
  Therefore, other than raising taxes dramatically in coming years, we 
must look to reductions in entitlement spending and to health costs, in 
particular, if we are to achieve further meaningful deficit reduction.
  I am concerned when I note the CBO projections of the total deficit 
reduction in the bill that has been introduced by the distinguished 
majority leader, Mr. Mitchell.
  By the year 2004, the projection by CBO estimates that only $13.8 
billion in total deficit reduction will have occurred.
  It is essential that we not enact a plan that squanders our last real 
remaining chance for significant deficit reduction. We have an 
opportunity to address rising entitlement costs in this health care 
bill, and we must not let that important goal be forgotten as we 
consider and write massive health care reform.
  I believe the word ``reform'' is the operative word in this debate. 
What constitutes reform is central to much of the discussion we have 
heard.
  There is vast agreement, it seems to me, on the goals of fairness, 
universal coverage, cost containment, minimization of cost shifting, 
and maintaining a quality standard for health care. Those, to me, are 
the central pillars of reform. The disagreements arise when we venture 
into areas which are more indirectly related--rather than directly 
related--to health care reform, and I believe that the costs rise as we 
go beyond trying to address much more than those generally agreed-upon 
central goals.
  There is much in the Mitchell bill that I can support. I compliment 
the majority leader for his extraordinary contribution to the cause of 
health care reform. He has devoted many days and months and years to 
this effort. He is one of the Senate's most knowledgeable and dedicated 
experts in this area, and he has moved the debate forward by the 
introduction of the pending measure.
  Mr. President, I have stated my concerns to the distinguished 
majority leader, and he has said to me that he will respond to my 
concerns. He knows, and I know, that this bill is going to be changed, 
and I am going to look at his responses to my concerns with great 
interest. It will be then that I will be better able to judge as to 
just where I will stand on this legislation at the end of the day.
  Beyond the sheer budgetary folly of not trying to get our health care 
costs under control, the basic human tragedies that unfold daily as a 
result of no coverage or less-than-adequate coverage compel us to act.
  But what has been obscured in the debate, it seems to me, and what 
President Clinton emphasized so well in his early statements on health 
care, is that reform of the health care system means a more 
economically secure Nation better able to compete in the global 
marketplace.
  In the President's 1995 budget document, of particular note is the 
statement on page 179 under the heading ``Why We Must Act Now.''

       The costs of doing nothing are enormous. Without reform 
     health care costs will consume an additional $56 billion of 
     our national output in the year 2000--money that could more 
     than double Federal spending on transportation or education 
     and training. Put another way, these savings could also boost 
     productivity and wage growth by increasing the resources 
     available to lift capital invested per worker by roughly 
     half. If current trends continue, real wages will be further 
     eroded by almost $600 per worker by the end of the decade. If 
     we do not curb increasing health costs, we will not be able 
     to continue bringing down the deficit or make the investments 
     in jobs and infrastructure that we need to keep the U.S. 
     economy healthy.

  I believe that the President's statement remains correct today. It is 
in the overall national interest to enact health care reform. However, 
this bill, as it is written, goes beyond what I believe should be the 
scope of health care reform. The Clinton bill would reduce health costs 
in the year 2004 by $150 billion. By contrast, the pending measure 
would increase health costs in the year 2004 by at least $25 billion 
and by over $250 billion for the perid 1995-2004.
  Under the guise of reform, we cannot, we must not, try to address 
every issue that can be lumped under the loose category of health care. 
We simply cannot do it. We cannot micromanage every aspect of the 
social and economic fabric which touches health care in some way.
  We must not use health care reform as a vehicle to increase every 
health-related spending program in the budget. Because, if we go down 
the road, we will squander most of the economic benefits of enacting 
health care reform. We must not enact a piece of legislation that eats 
away at our national productivity potential because we are frustrated 
over years of too tight budgets and now want to address every health 
care problem in our land. We just cannot do it. We have to restrain 
ourselves. That is not to say that there are not health care programs 
that deserve increased funding in health reform legislation. It is to 
say, however, that we should only strive to accommodate any justifiable 
increases in programs that are directly related to the health of our 
citizens without adding to overall health care spending. That should be 
doable--President Clinton's bill, as I said, would cut overall health 
care spending in 2004 by $150 billion.
  Our national heart may be large--our national heart is large--but our 
national pocketbook, sadly, is quite small. I know. In our 
Appropriations Committee, we fund, as best we can, most of these 
programs. And I think we have done rather well in meeting the needs.
  But the spending in this bill goes beyond reform.
  I do not believe that that is what most Americans thought was meant 
by reform of the health care system. Reform of health care was 
explained by Mr. Clinton, and it received public support as a cost-
saving measure. This was the only way to reduce our budget deficit, we 
were told. That was one of the primary things that most appealed to me; 
one of the things. But we seem to be moving away from that goal. We may 
be breaking faith with the people if our version of reform becomes a 
cover for more back door spending.
  To be specific, we do not have to increase spending for WIC. I 
support funding for WIC, and I think we have responded fairly 
generously within our means in the Appropriations Committee from year 
to year. But we do not have to increase spending for WIC to have sound, 
effective reform. We do not have to increase funding for the NIH to 
have sound, effective reform. We do not have to set up a quota for the 
various medical disciplines in which a medical student may be trained 
to have sound, effective reform. We do not have to enact $15.4 billion 
worth of new public health programs to have sound, effective reform. As 
laudable as it may be, we do not have to add money for the Indian 
Health Service to have sound, effective reform.
  We who claim that we are committed to reform, perhaps unwittingly, 
are cloaking these spending programs in the guise of reform at our own 
peril. We risk our credibility, because I do not believe that 
additional spending is what most people have in mind when they think 
about health care reform. The American people think we are talking 
about fairness, cost containment, basic coverage for all, simplicity, 
and reducing deficits when we advocate health care reform.
  This bill, in my view, would be vastly improved if it adhered more 
closely to the American people's understanding and their expectations 
of reform. I fear if this bill were to pass in its present form--again, 
I say Senator Mitchell has indicated that he will respond to my 
concerns, and he expects changes in this bill. We all expect changes in 
it. I am going to look at his responses carefully, together with the 
future actions of the Senate, and make my final judgment as to my own 
vote at that time.
  But I fear that if this bill were to pass in its present form, this 
Senate will have destroyed any possible chance for significant deficit 
reduction, and will have seriously damaged our overall economic future.
  On the other hand, we have a significant opportunity to reduce budget 
deficits, and address the serious need for health care reform, if we 
will but streamline this vast piece of legislation. Change is always 
painful. Massive legislative proposals such as this one always, in my 
experience around here, always attract too much baggage. And the longer 
we are on the floor, the more excess baggage it attracts. We have seen 
some of this just in the last day or so; good programs, but we are 
spending more money. We are not reducing the deficit. They say ``Well, 
it is within the cushion in the bill.'' That may be true. But I 
understood from the President's appeal to the American people and to 
the Congress for health care reform that it was the one way in which we 
could get control over these burgeoning deficits. I fear that, as we 
keep going down the road that we are on with this measure as it is 
presently written, we are not going to cut the deficit. We are going to 
add to it. Massive legislative proposals, as I say, always have a way 
of attracting too much baggage. But this effort, Mr. President, and my 
colleagues, is too critical for the usual program load-up and interest 
group wish lists.
  This President has the economy growing, and he ought to say so more 
and more. And he has the deficit headed downward. Let us not tie his 
hands. If we can get entitlement programs under control, this Nation 
might be able to continue in these positive directions.
  Much of this debate has totally obscured those basic economic 
considerations. I have elected to sit in the chair often this week. I 
have sat in the chair three or four hours a day. Why? I wanted to 
listen to the debate. I will not read it tomorrow morning in the 
Congressional Record, instead, I will be signing mail or will be 
meeting with constituents, or I will be doing this or that, which is 
very important. But if I sit in that presiding chair up there, I will 
hear and learn from what is being said.
  I do not sit on the Committee on Finance over which the distinguished 
Senator from New York presides with a degree of dignity and skill that 
is so rare as a day in June. I do not sit on that committee. I do not 
sit on Mr. Kennedy's committee. Both committees have jurisdiction over 
this bill.
  I have to make some decisions here based in part on what my 
colleagues say. Some of the speeches have been very illuminating, 
interesting, and informative for me. There have been some, however, 
that I must confess I had a hard time staying awake in the chair.
  I compliment Senators on both sides of aisle for their enlightened 
speeches. But there has been a great deal of needless rhetoric--and 
there has to be some rhetoric, of course. That is all right when one is 
trying to sway a great audience. But I want some answers, some 
substantive answers. Nobody has to sell me on the need for health care 
reform.
  But much of the debate has totally obscured those basic economic 
considerations. I hope that in the coming days we can refocus our 
attention on those critically important concerns, tone down the 
rhetoric just a little bit, and try to remember why we began the 
discussion of health care reform in the first place.
  I thought it was the way that we could get control over the 
entitlement and mandatory programs, which will increase over the next 
six years by $824 billion. Our little, puny discretionary funds--which 
include defense spending--are going to be increased over that period by 
only $6 billion.
  So, that is where I thought we were going. Yet, as the days have 
passed, I have become more and more concerned that we really are not 
going in that direction, but we are going in the opposite direction.
  This Senator, for one, is tired of Harry and Louise, tired of scare 
tactics, tired of claims that this legislation could represent the 
undoing of the Republic, or that it is the greatest boon to 
representative democracy since the writing of the Constitution. It is, 
of course, the fear and the slick TV ads, and some of the scare tactics 
emanating from the floor, and from outside the Capitol, that are mostly 
the products of attempts to win elections and promote political 
agendas.
  Of course, we all like to win elections. But I think we ought to 
focus our attention on this, one of the most critical problems that we 
will ever face, on this legislation, on this debate, and keep our eyes 
on that ball.
  Although there have been some thoughtful statements made on this 
floor, unfortunately, those thoughtful statements have been largely 
drowned out by the more highly partisan debate that we have been 
subjected to. Frankly, I do not have any partisan interest in this 
bill, one way or the other. The American people expect us to act and to 
act wisely. I am interested in legislation that will promote real 
healthcare reform, and that, once and for all, will really help to get 
control over our massive budget deficits.
  I am sure that the American people are very sick of it all. I am also 
sure that all of the noise has succeeded in thoroughly frightening and 
totally confusing the citizens who will either be the beneficiaries of, 
or the victims of, what we will do here. I can only hope that we will 
somehow come to our senses, take a reality check, try to put our 
political agendas aside, pare down this bill, salvage the essential 
reform elements in it, and enact sound, effective health care reform. I 
want to do something about this problem. I see it as a bedrock issue 
for the good of our economy and for the welfare of our people today and 
far into the future.
  However, I cannot be a party to any legislation, no matter how well-
intentioned, that goes far afield from what is needed for solid health 
care reform. Neither will I be a party to the political circus, the 
partisan jockeying and interest group tug-of-war which have been too 
much in evidence on this issue.
  It is my hope that in the coming days, the American people--whom we 
have confused, frightened and manipulated--will urge us to stop the 
hype and deal with this issue as they would if they served here--
forthrightly, honestly, and with an eye toward the worthy goals on 
which most of us agree.
  In closing, Mr. President, I congratulate the Senators who are on the 
Finance Committee and on the Labor and Public Welfare Committee for the 
yeoman's work that they have done. Many hearings have been held by both 
of those committees. There are many Senators in this body who are 
experts in this field. I salute them. I am sorry to say I am not one 
who is an expert.
  I hope that what I have said will be accepted in the spirit in which 
I have offered it. I have not offered it as anything other than 
constructive criticism by which I hope we will benefit. I realize that 
I can be wrong, and often am wrong, but I view this in my heart as 
being so serious and as being our only opportunity--maybe--I do not 
quite agree that it is the only opportunity forever. I think that this 
is an idea whose time came some time ago. But it is also an idea that 
is going to take the best of our talents, our patients, and our 
expertise, if we are going to really develop a product of which the 
American people can be proud and of which we in the days to come can be 
justly proud.
  Mr. President, I yield the floor.
  (Ms. MIKULSKI assumed the chair.)
  Mr. PACKWOOD. Madam President, I thank the Senator from West 
Virginia. That speech, which was only 20 to 25 minutes, has put in 
better perspective the problem this Senate faces than it could ever be 
put. We have seen graphs upon graphs upon graphs upon graphs, 
attempting to illustrate the same thing, but they have not illustrated 
it as well as you have said it.
  What the Senator is saying is simply this: We have some programs in 
this country that are on automatic pilot. If you look back only 30 
years, and took only four programs--Social Security, other Government 
retirement, civilian retirement, military retirement, Medicare and 
Medicaid, and then interest, which we have to pay, those four programs, 
plus interest, 30 years ago were 23 percent of our budget. They are 
today 56 percent of our budget. And if we do not make any change in the 
laws, in 10 years they are going to be 69 percent of our budget. They 
will squeeze out education, highways, water and air pollution, Forest 
Service, Park Service, Amtrak, and everything else that we do. What the 
Senator from West Virginia is saying is that in this bill we are now 
considering, we vastly expand those programs and add new programs to 
them. So that the figure is not going to be 69 percent, it will be 75 
or 76 percent. I have never heard it better put by anybody on this 
floor than you have put it. We are indebted to you, and I thank you.
  Mr. BYRD. I thank the distinguished Senator.
  Mr. PACKWOOD. I yield 10 minutes to my senior colleague from Oregon.
  Mr. HATFIELD. Madam President, I want to also commend the Senator 
from West Virginia for a very excellent and thought-provoking speech. I 
would also like to say, concerning the Senator's speech, that the 
remarks I plan to make, I can share with my colleagues--and I am sure 
the Senator from West Virginia could also assure my colleagues--that we 
did not engage in any kind of collaboration on these remarks that we 
intend to share together this afternoon.
  Mr. HATFIELD. Madam President, yesterday I came to the floor to 
explain my position on comprehensive health care reform. As I said, I 
believe the Mitchell bill is fatally flawed. I also believe that the 
Dole-Packwood bill leaves too many problems unsolved, and I am 
realistic enough to know that it cannot pass in what has become a 
politically charged atmosphere.
  For these reasons, I have joined in the search for a middle ground as 
a participant in the bipartisan mainstream coalition. This group meets 
almost hourly to work through the difficult and contentious issues that 
constitute health care reform, including the cost of providing 
subsidies to those who are unable to afford health care coverage. But 
as our meetings continue, and the days pass by, it is becoming 
increasingly clear to this Senator that the window may well have closed 
on the opportunity for comprehensive bipartisan reform of our health 
care reform this year.
  I want to emphasize my identification of comprehensive health care 
reform. Incremental legislation may be another issue.
  Some may believe that such a result is a lost opportunity. But I 
believe--and from the calls and letters coming into my office, I can 
say that the vast majority of Oregonians believe--that it offers a 
chance to catch our breath, check our bearings, and chart a course for 
the future.
  Am I advocating that Congress do nothing this year? I most assuredly 
am not.
  There are, as we know, a number of concepts for how to reform our 
health care system on which we can likely find agreement. These 
provisions include:
  Some form of State flexibility and minimal Federal preemption; 
assistance to rural and underserved areas; small business pools for the 
purchase of insurance; assurance that Americans with preexisting 
conditions cannot be denied coverage and that their insurance is 
portable if they lose their job; and a commitment to the goal of 
universal coverage.
  I believe that the bipartisan congressional leadership should sit 
down with the President and write a bill that includes these areas of 
agreement, and then we should pass it into law.
  Not everyone will be pleased that the bill will not include every 
component of an ideal health care reform bill, but millions of 
Americans in need will be happy when health care insurance is made more 
affordable and more accessible to them.
  Madam President, I truly believe that the procedure I have just 
outlined is the only road that will lead to a result that is beneficial 
for our country at this juncture.
  Let us look at what results are possible if we continue on our 
current path. And that means continuing the process of debating and 
amending--and believe me, it is going to be a long, long process. 
Mandates. Taxes. Entitlements. Medical malpractice. There will be 
amendments and debates on all of these issues--and on many more. And 
this road leads to one of two destinations.
  The first is that the Senate and the House eventually pass a bill by 
the slimmest of partisan majorities. And when the House-Senate 
conference committee puts the two bills together and comes up with 
another bill, which again passes by the barest of majorities, amidst a 
chorus of loud voices and pointed fingers.
  Such a bill will be one that nobody in this Chamber--and more 
important--nobody across the country--truly understands. Nobody will be 
able to say with any confidence that it will work, or what its 
consequences will truly be. It will be a bill that clearly will not 
have the confidence of the American people.
  Senator Mitchell spoke on Wednesday about the disillusionment that 
the America people have with Government. I guarantee you that this 
disillusionment will only increase if Congress narrowly passed a bill 
after a bitter partisan debate.
  The second destination of the road we are on at the present will be 
that somewhere along the way, the bill is defeated, that nothing is 
done, that no one is helped.
  Neither of these destinations, Madam President, is good for my State 
of Oregon, and neither destination is good for America.
  So, perhaps we better listen to what the American people are saying. 
They have followed this debate, listened to it carefully, and, as I 
have had communicated to me, the overwhelming majority have concluded 
that they need more time--and Congress needs more time--to think about 
this issue, to examine the side effects of legislation, and to come up 
with a solution that does not create as many problems as it solves.
  And, Madam President, there is another reason why I feel we need to 
revisit the issue of comprehensive reform. And that is because 
somewhere along the way, we have lost sight of the fact that reducing 
the deficit must be a goal of health care reform legislation, and that 
was clearly stated by the President of the United States in the Budget 
Act that we passed earlier on.
  I would recommend to my colleagues an article in the July 25, 1994 
Newsweek, by Peter Peterson. Many of us know Mr. Peterson as a former 
Secretary of Commerce and a member of the President's Commission on 
Entitlement Reform.
  A brief quote from this article, he states:

       Federal health care spending now amounts to roughly $800 
     billion in direct outlays, much distributed without regard to 
     need, plus an additional $75 billion in tax subsidies for 
     employer health plans. If we do not change course, health 
     spending 10 years from now will consume more than a third of 
     the federal budget, compared to 20 percent today. . . . 
     Further ahead, the outlook is even worse. By 2040, again baby 
     boomers could push the total cost of Medicare past 20 percent 
     of taxable payroll, up from 5 percent today.
       In the face of these alarming trends, you might think 
     Congress would be obsessed by controlling health spending . . 
     . Instead, members are busily spelling out new entitlements 
     that will likely exacerbate the cost spiral. To help more 
     Americans gain coverage, most of the bills offer tens of 
     billions of dollars in new subsidies. Thousands of lobbyists 
     are working overtime to make sure that additional goodies, 
     from prescription drugs to long-term care, are included. The 
     major House bill calls its new open-ended entitlement 
     Medicare Part C. The benefit package in the major Senate Bill 
     might as well be called Medicaid for the Middle Class.
       Whatever legislation Congress passes will be officially 
     stamped `deficit-neutral'--meaning, one presumes, that 
     lawmakers now think that they will have done their job if 
     only they do not make an already unsustainable situation more 
     unsustainable. But even here there is a problem.
       The history of health entitlements is one of wildly over 
     optimistic projections that always understate the cost of new 
     benefits, while overstating the savings from reforms.

  Madam President, no one can doubt that Mr. Peterson is absolutely 
right in that statement.
  In 1965, it was projected that Medicare Hospital Insurance would cost 
the Government $9 billion in 1990. Well, we missed by about $58 
billion, because the actual cost was $67 billion.
  In 1987, we projected that Medicaid special hospital subsidies would 
cost $100 million. By 1992, the actual cost was over 100 times that 
much--it was $11 billion.
  When the Medicare catastrophic legislation was passed in 1988, the 
cost of the new drug benefit was projected at $5.7 billion over 5 
years. Just 1 year after passage, the Government reestimated the cost 
at $11.8 billion over 5 years--triggering repeal of the legislation.
  I could go on and on, Madam President. But my point is clear. The 
$965 billion in entitlements that Senator Mitchell's bill would create 
will cost much, much, more than current estimates.
  The true impact of these entitlements is something that must be 
carefully and thoroughly analyzed. And I do not think that can occur in 
the current atmosphere.
  Madam President, President Clinton and Congress have made great 
progress on an issue that has challenged us for many years. I commend 
the President and Mrs. Clinton for moving the Nation forward in its 
effort to reform our health care delivery system. I also have great 
respect for the work of John Chafee and the mainstream coalition, in 
which I will continue to work. The Nation owes them their gratitude as 
they search to build the bridge between the Democrats and Republicans.
  We all have learned a great deal about the strengths and weaknesses 
of America's health care system. And we all have much more to learn. 
Let us accept the progress we have made, let us help millions of 
Americans, and let us go home with our heads held high.
  And bear in mind as the scripture often said there are those who are 
called to sow and those who are called to reap. Maybe we see this, as a 
futile exercise, but I see it as a very rich and fruitful possibility 
of sowing seed for a future harvest.
  Madam President, we are building the foundations for a medical reform 
     act but this is not the moment.
  I yield the floor.
  The PRESIDING OFFICER. Who yields time?
  Mr. PACKWOOD. I yield 10 minutes to the Senator from Pennsylvania.
  The PRESIDING OFFICER. The Senator from Pennsylvania.
  Mr. SPECTER. I thank my colleague from Oregon.
  Madam President, I compliment the Senator from West Virginia and the 
Senator from Oregon, who have spoken for the last 30 minutes or more 
about the wisdom which they have brought to bear on the pending 
legislation in suggesting that the legislation has not moved in the 
direction which was originally intended, and their statements are true.
  The original thrust of the legislation had as its purpose coverage 
and cost containment, coverage for the millions of Americans not now 
covered, coverage for preexisting conditions, and for change of jobs, 
but also cost containment. And 50 percent of the job has not been done.
  I have been meeting with the task force chaired by Senator Chafee 
going back to 1991 in a little room down the hall every Thursday where 
a group of Republicans would meet in an effort to craft legislation. 
That group has now been expanded until today there were some 20 
Senators present from 9:30 to noon this morning, with Senators coming 
and going because of the complications of other schedules, in an effort 
to find a bipartisan solution to the pending problem.
  Our group was joined by Senator Nunn and Senator Domenici, who have 
approached the issue from a slightly different angle with their 
previous work on trying to hold down entitlements which have risen so 
tremendously in cost.
  Also present in the group were Senator Kerrey of Nebraska, and 
Senator Danforth, who have worked on a bipartisan commission to hold 
down entitlements so we do the best we can within our limited resources 
without bankrupting the country.
  We continue to work on that problem, Madam President. I have had 
doubts all along as to whether we could succeed, but I think we should 
make a maximum effort.
  I think the business of a filibuster was really beyond the pale on 
this bill. No filibuster has been attempted. But, similarly, we cannot 
be rushed to judgment. It is important to have health care reform, but 
it is equally important, perhaps more important, to do it right.
  And when Senator Byrd from West Virginia comes and speaks--for those 
who do not know, Senator Byrd is chairman of the Senate Appropriations 
Committee. He has been in the U.S. Senate now finishing his 36th year. 
For those who do not know, Senator Hatfield is the ranking Republican 
on Appropriations. He was for 6 years the chairman of the committee and 
has been in the U.S. Senate for 28 years.
  During all of my 14 years in the Senate, I have been on the 
Appropriations Committee working with Senator Hatfield as chairman, and 
now with Senator Byrd as chairman, and I can say from firsthand 
experience--having managed most recently the Appropriations 
Subcommittee report on Labor, Health and Human Services, and Education 
with $70 billion in discretionary spending--how hard it is to make ends 
meet. When you talk about a budget of $1.5 trillion, it is a great deal 
of money, but when you try to meet all the needs of the Federal 
Government, it does not really stretch far enough.
  When Senator Byrd and Senator Hatfield say that this bill has 
enormous problems in terms of creating new entitlements, and Senator 
Hatfield outlines what has happened when estimates have gone off by 10 
times what you figure in 1965 will be the costs in 1990, we have to 
pause and we have to take note as to what the implications are.
  We had an opportunity, back in July 1992, to craft important 
legislation which would have taken a significant step toward additional 
coverage, with an amendment to provide full deductibility to the self-
employed and an amendment for insurance market reform. Those amendments 
might have removed a third to one-half of the 37 million to 40 million 
Americans now not covered. Those amendments were defeated because 
people in this body said, ``Let's not do it piecemeal, because if we do 
part of it, it will destroy the incentives to do the rest of it.'' I 
think that was a mistake and said so on the floor back on July 29, 
1992, when that amendment, which I offered, was tabled.
  When Senator Hatfield talks about some piecemeal legislation, Madam 
President, I think he is on target; not that we will not be committed 
to comprehensive health care. I share Senator Hatfield's compliments to 
President Clinton, who has brought this issue to center stage. I 
compliment the members of the Finance Committee, under the chairmanship 
of Senator Moynihan, and Labor and Human Resource, under the 
chairmanship of Senator Kennedy, who have brought these bills to the 
floor, and what Senator Mitchell has tried to do.
  I am not sure at this point that we will be unable to produce a good 
bill. I am sure, however, that we ought not to be rushed to judgment 
and there ought not to be any political timetable.
  Madam President, I had originally sought recognition to comment about 
the pending amendment, but wanted to speak about Senator Byrd's 
comments and Senator Hatfield's comments because I think they are so 
important and will have a real sobering effect on this body in having 
us focus on what we are doing. A reality check. Maybe a sobriety check.
  There is an important amendment pending, Madam President, offered by 
Senator Mack, which would strike lines of secrecy in the pending 
legislation. I compliment Senator Mack for going through this lengthy 
bill to find the three provisions which provide an exemption for the 
National Health Benefits Board, for the National Health Care Cost and 
Coverage Commission, and for the Agency for Health Care Policy and 
Research exemptions from the Federal Advisory Committee Act which would 
allow those boards, commissions, agencies to operate in secret.
  Madam President, the requirements of the Federal Advisory Committee 
Act specify that there must be public meetings, that there must be 
notice, that there must be an opportunity for the public to comment, 
and their findings must be made public.
  It is indispensable in a free society--especially when you have this 
kind of a bill which creates 140 new agencies, boards, and commissions 
and gives new jobs to 40 existing bureaus--that we at least know what 
they are doing.
  Madam President, I will not display the chart again, in the interest 
of brevity. We have seen it perhaps enough on the Senate floor.
  But sunshine is indispensable in a democracy. This is especially 
evident, Madam President, when we take a look at what is pending in 
court today, as reported in today's press, on a lawsuit which has been 
brought against the Clinton administration for violating the provisions 
of Federal law which require public disclosure and open meetings.
  The Court of Appeals for the District of Columbia ruled last year 
that the working groups which were put together by President Clinton's 
administration would be subject to the 1972 Federal Advisory Committee 
Act if any of the members were non-Government employees.
  A very unique thing happened, Madam President.
  Finally, after 18 months, the Clinton administration yesterday agreed 
to release the records from the task force because they were compelled 
to do so by the litigation. There has been an effort made to settle the 
litigation because, as Lloyd Cutler, the President's legal counsel, 
says, they want to focus on health care as opposed to the distractions.
  But the opposing groups have refused the settlement. As they 
characterize it and as reported in the Washington Post, the plaintiffs, 
the board rejected the settlement partly because it would have allowed 
Ira Magaziner, President Clinton's health care adviser, to avoid 
publicly answering a pending contempt of court accusation, where there 
is a contention that Mr. Magaziner did not tell the truth when he filed 
an affidavit saying that all members of the working groups were either 
Government employees or consultants.
  So here you have the White House, the administration, working to 
structure health care reform legislation. They do not comply with the 
law. They are working with groups who, by all indications--and we are 
not absolutely sure yet, because the litigation has not been 
concluded--groups that represent special interests. They violate the 
provisions of law which requires that they be open. When they are 
challenged, a ranking Presidential assistant takes an affidavit that 
they are all Government employees or consultants, which would remove 
them from the obligation for the public disclosure.
  A long, drawn out lawsuit follows, which is taken to the appellate 
court and says they have to be made public. Now the issue arises where 
the White House, the administration, finally is willing to make them 
public, but the plaintiffs who brought the lawsuit refuse to accept 
that on the ground that there was a lie in an affidavit filed trying to 
thwart the lawsuit.
  Now this, Madam President, is simply unacceptable in a democracy. 
Where you have public activity, governmental activity, the public is 
entitled to know. And when it is challenged, to have an affidavit 
taken, which on its face appears to be untrue, is totally unacceptable.
  That is why, Madam President, when these three boards are challenged 
by the pending Mack amendment, we ought to put the imprimatur of the 
Senate on it very squarely in saying that these secrecy provisions have 
to be stricken from the act.
  Beyond these expressed provisions, Madam President, I think that it 
is another indication of the kind of care that has to be undertaken in 
examining this 1,400-plus page bill to be sure that we know what is in 
it.
  You would have thought, after the experience of this very bitter and 
painful litigation, that legislation would not be offered to make these 
kinds of boards a secret.
  So I hope we will adopt this amendment--all of the indications are 
that the amendment will be adopted--and we will pursue the examination 
of the pending legislation, trying to understand all of its 
ramifications and, hopefully, we will yet be able to craft legislation 
which will meet what Senator Byrd and Senator Hatfield have talked 
about, an overwhelming majority. That figure has been put generally at 
70 Senators, so we will have the confidence of the American people in 
what we are to do.
  I thank the Chair and yield the floor.
  The PRESIDING OFFICER. The Senator from Delaware.
  Mr. ROTH. Madam President, I yield myself such time as I may take.
  The PRESIDING OFFICER. The Senator has 17 minutes.
  Mr. ROTH. Madam President, I yield myself 5 minutes.
  I rise in support of the pending amendment and I ask that my name be 
added as a cosponsor.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. McCONNELL. Mr. President, I want to thank Senator Mack and 
Senator Coats for offering this amendment today and applaud them for 
their efforts to ensure that the special commissions created by the 
Mitchell bill are accountable to the American people.
  The Mitchell bill is trying to prescribe a new medication for the 
health care of all Americans, but we know there is one tried and true 
treatment for the expansion of bureaucracy and government--openness and 
accountability.
  After all, if we left it to this administration, we would have a 
bunch of F-O-B's and F-O-H's lock themselves in a closed room, and 
impose their will on the American people.
  That is what they tried to do in concocting their health care plan, 
and luckily a Federal judge is forcing accountability.
  The health care task force, Ira Magaziner would have us believe, was 
all government officials, and that it cost only $100,000.
  But the task force was filled with hundreds of people who had direct 
economic interests in the outcome of health care reform, and the tab to 
the American people for this exercise was somewhere between $4 and $20 
million.
  Now, Mr. Magaziner and Mrs. Clinton may find themselves before the 
Federal judge to tell the whole truth.
  So, we want to avoid any repeat of the health care task force 
debacle. The American people have learned from the experience of Mrs. 
Clinton's task force: Her scheme was a plan for social engineering that 
would herd all Americans into a Government-controlled health care 
system--not an attractive option to the vast majority of Americans.
  And that's why it is important that any new boards, councils, or 
agencies--and there are plenty of them in the Mitchell bill--be 
accountable to the American people.
  One of the intents of Congress when it passed the Federal Advisory 
Committee Act back in the early 1970's was to ensure that committees 
established by Congress or the President are truly advisory in nature.
  But, the National Health Benefits Board and the National Health Care 
Cost and Coverage Commission--two powerful committees established by 
the Mitchell bill--are exempt from FACA. These committees are empowered 
with determining what health services Americans can and cannot receive, 
with deciding what forms cost controls should take, and with ordering 
mandates to be imposed on employers. And, under the Mitchell bill, they 
will be able to operate behind closed doors and will be totally 
unaccountable to the public--because the Mitchell bill would exempt 
them from the sunshine laws.
  If the heavy hand of Government regulation is going to fall hard on 
health care, then the regulators must operate within the bounds of the 
law. Compliance with the Federal Advisory Committee Act will ensure 
just that. And, anything less represents the arrogance of power.
  The American people have learned that such discussions must be held 
in public, that the groups who devise reform plans must be accessible 
by, and accountable to, the American people.
  Whether or not one agrees with the premise that we need a national 
health benefits board, or a national health care cost and coverage 
commission, we should all be able to agree that these committees must 
be accountable to the public, to the very people whose health benefits 
and lives will be impacted by their decisions.
  Mr. ROTH. Madam President, as the ranking Republican at the Senate 
Committee on Governmental Affairs which has jurisdiction over the 
Federal Advisory Committee Act, I would like to take this opportunity 
to explain why I believe this amendment is a good one to support, and 
critical for the public.
  In 1972, the Federal Advisory Committee Act [FACA] was enacted in 
order to assure that Federal Commissions meet under the scrutiny of the 
public eye. FACA was enacted in order to build in assurances to the 
public that all federally appointed Commissions are accountable to the 
public.
  There are several commissions in the pending legislation which are 
exempted from the requirements of public access and scrutiny assured by 
FACA. The two most prominent commissions to which I am referring are 
the National Health Benefits Board, and the National Health Care Cost 
Coverage Commission. The Benefits Board will be the sole entity 
responsible for crafting the final product--the final and only standard 
benefit package that all health insurance plans in this Nation will 
offer. The Cost and Coverage Commission will report on whether the 
employer mandate should be triggered or not.
  The reports to be issued by both of these Commissions could have 
immense--I repeat--immense repercussions on the health care of every 
American in the Nation, and every employer in the country. In fact, if 
this bill is enacted in its current form, then, I believe, that these 
two commissions will be the most important and powerful Commissions in 
the United States--yet--the legislation as drafted would exempt them 
from current law requirements imposed on virtually all Federal advisory 
committees--the Federal Advisory Committee Act.
  As one of the coauthors of FACA in the Senate in the 92d Congress, I 
said then that, ``There is a role for advisory committees to play in 
our Government. Advisory committees provide an opportunity for citizens 
to participate and become involved in our Government.''
  I think it is worth taking a moment to recall the situation that 
Congress faced in 1971. First, we did not know how many advisory 
committees there were--or how much they cost--and we could not find out 
the answer to either of these questions. There were educated guesses 
that ranged from 1,800 to over 3,000 commissions. No agency had the 
responsibility to keep track of the creation, operation, or termination 
of the advisory committees.

  Second, there were no guarantees of public access to the 
deliberations of these advisory committees. Some met in closed 
sessions. And, there was no requirement that public notice be given of 
advisory committee meetings that were open to the public. Accordingly, 
many were concerned that special interests could exercise undue 
influence on Government decisions without scrutiny. So, we addressed 
these concerns in FACA.
  One of the most important aspects of FACA is its sunshine requirement 
which sheds light on the activities of commissions. The importance of 
this requirement was exemplified during a hearing at the Committee on 
Governmental Affairs on December 3, 1987. At that time, the 
Governmental Affairs Committee heard testimony from Adm. James D. 
Watkins, U.S. Navy, ret., who was chairman of the first Presidential 
Commission on the Human Immunodeficiency Virus Epidemic. Ultimately, 
the Commission issued a report which received wide bipartisan acclaim 
for its findings. However, Admiral Watkins was invited to testify 
because there had been questions regarding the Commission's compliance 
with FACA prior to the completion of the report. The hearing brought 
attention to the need for commissions to comply with FACA. Without 
compliance, the integrity of the first report on AIDS would have been 
questioned by the public, and undermined the educational efforts made 
at that time.
  Just to point out, that FACA is not an impediment for the functioning 
of a health care commission, I quote from Admiral Watkins' testimony at 
the hearing:

       I believe very strongly in the government in the sunshine. 
     I feel that almost all advisory committees or commission 
     meetings should be conducted in public. * * * I think nothing 
     so far that I have seen in the Federal Advisory Committee Act 
     has deterred us or slowed us down from getting this 
     Commission underway, so I do not feel that it has been a 
     major bar.

  Clearly, we do not want to set the Commissions in the Clinton-
Mitchell bills back to the situation we faced before the 1972 law. The 
Benefits Board, the Cost and Coverage Commission, and the other 
Commissions in the bill should be subject to FACA requirements for 
commissions. Again, Mr. President, I lend my full support for the 
pending amendment. I yield the floor.
  The PRESIDING OFFICER. The Senator from Florida.
  Mr. ROTH. I yield such time to the Senator from Florida as he needs.
  The PRESIDING OFFICER. The Senator has approximately 9 minutes.
  Mr. MACK. Madam President, I only rise, really, for a couple of 
matters. I ask unanimous consent that the following Senators be added 
to the amendment as original cosponsors: Senator Packwood, Senator 
Coverdell, Senator Craig, Senator D'Amato, Senator Nickles, Senator 
McConnell, Senator Lott, Senator Helms, Senator Hutchison, Senator 
Gregg, Senator Kempthorne, and Senator Roth.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. MACK. Madam President, I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There is a sufficient second.
  The yeas and nays were ordered.
  Mr. MACK. Madam President, at this time I yield the remainder of my 
time.
  Mr. DOLE. Mr. President, there are many reasons why President 
Clinton's health care plan failed to win the support of the American 
people. And one of those reasons was the result of how the Clinton plan 
was created.
  As we know, the Clinton plan was not written in the light of day. 
Rather, it was written in the dark. It was pieced together in the back 
room of the White House by Mrs. Clinton, Ira Magaziner, and 500 
anonymous so-called experts.
  The secrecy surrounding the writing of the Clinton plan was not only 
poor policy, it may well have been illegal. The process may have been a 
violation of the Federal Advisory Committee Act, and the Clinton 
administration is now involved in a lawsuit that was filed to find out 
exactly who, and what, was involved in crafting the bill.
  I do not know how the lawsuit will turn out, but I do know that any 
legislation as important and far-reaching as health care reform 
legislation cannot succeed if it does not have the trust of the 
American public.
  And plain and simple, the American people did not trust the Clinton 
plan. They did not trust the secrecy in which it was written. They did 
not trust the principle that ``government knows best.'' And they did 
not trust the endless maze of new government boards and bureaucracies 
that would have been created.
  Unfortunately, Senator Mitchell's legislation is also riddled with 
provisions creating more bureaucracy, more government control, and more 
boards and commissions.
  And as Republicans carefully read the bill to fully understand the 
authority and power of these commissions, we discovered that at least 3 
of the 55 bureaucracies it creates--the National Health Benefits Board, 
the National Health Care Cost and Coverage Commission, and the Agency 
for Health Care Policy and Research, were all exempted from the 
Government in the Sunshine Act.
  Under this act, Federal boards, panels, and committees must, among 
other things: meet in public, publish notice of their meetings, publish 
the agenda for their meetings, permit the public to attend and testify 
at the meetings, and keep detailed minutes of the meetings, and make 
them available to the public.
  Let me take a moment to describe the responsibilities of the 
commissions and boards that the Mitchell bill would allow to meet in 
secret.
  The Cost and Coverage Commission is charged with determining if 
America and the 50 States have achieved 95 percent health insurance 
coverage. If the Commission determined that 95 percent coverage has not 
been achieved, it has the authority to draft legislation to achieve 100 
percent coverage.
  That legislation might include price controls, it might include 
mandates, it might include taxes, or it could include anything else. We 
have no way of knowing. And we will have no way of knowing, because 
under Senator Mitchell's bill, all decisions can be made in secret--
without one word of input from the American public.
  And then there's the health benefits board. No doubt about it, this 
will be a very, very, powerful board. It will have the authority to 
draft legislation and regulations regarding what benefits are to be 
included in a standard benefits package.
  Included in that authority, is the power to determine what benefits 
are and are not ``medically appropriate and necessary.''
  I guess I'm a bit confused. I thought doctors and nurses went to 
professional schools to be able to determine what was medically 
appropriate and necessary.
  But now if the President appoints you to the Health Benefits Board, 
you can skip to the head of the class. You have been instantly awarded 
the qualifications to determine what is medically appropriate and 
necessary.
  Let me cut through the Bureaucratese and say that what all this means 
is that this board can--as a similar board in Great Britain already 
has--determine that if you're 55 years of age or older, you are no 
longer eligible to receive kidney dialysis through the Government 
program. You can use your own money if you have it. But if you do not, 
you will not receive the lifesaving treatment.
  Needless to say, Mr. President, these boards and commission will be 
making decisions that will affect the financial health of America, and 
the physical health of our citizens.
  There is no reason why these boards should be granted the power to 
meet in secrecy. Indeed, there is every reason why they must meet in 
public. It is simply unjustifiable to exclude 260 million Americans 
from taking part in a decisionmaking process that will have so massive 
an effect on their lives. And the Mack-Coats amendment will ensure that 
these boards comply with all provisions of the Federal Advisory 
Committee Act.
  I congratulate Senator Mack and Senator Coats for the leadership on 
this issue.
  And I conclude by saying that this amendment--like the Nickles 
amendment which was unanimously passed yesterday--are precisely the 
reason why we need to take our time to thoroughly examine the bill.
  The fact is that there are many, many, many more troubling provisions 
in this 1,400-page bill. Some on the other side of the aisle have 
sought to justify quick consideration of the Mitchell bill, by holding 
up bills of similar length that prior Congresses have passed in short 
time periods.
  I believe, however, our duty to the American people requires that we 
do just as Republicans have been doing: That we take out time. That we 
read every page of the bill. And that we do all we can to ensure that 
other wacky provisions do not slip through--which is just what will 
happen if we are denied the opportunity to carefully study this massive 
bill.
  The PRESIDING OFFICER. All time is yielded back on the amendment.
  The question occurs on agreeing to amendment No. 2568 offered by the 
Senator from Florida [Mr. Mack]. The yeas and nays have been ordered.
  Mr. ROTH. Madam President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll to establish if a 
quorum is present.
  The legislative clerk proceeded to call the roll.
  Mr. MOYNIHAN. Madam President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The PRESIDING OFFICER. The question now occurs on agreeing to 
amendment No. 2568 offered by the Senator from Florida [Mr. Mack]. The 
yeas and nays have been ordered. The clerk will call the roll.
  The legislative clerk called the roll.
  The PRESIDING OFFICER. Are there any other Senators in the Chamber 
desiring to vote?
  The result was announced--yeas 100, nays 0, as follows:

                      [Rollcall Vote No. 291 Leg.]

                               YEAS--100

     Akaka
     Baucus
     Bennett
     Biden
     Bingaman
     Bond
     Boren
     Boxer
     Bradley
     Breaux
     Brown
     Bryan
     Bumpers
     Burns
     Byrd
     Campbell
     Chafee
     Coats
     Cochran
     Cohen
     Conrad
     Coverdell
     Craig
     D'Amato
     Danforth
     Daschle
     DeConcini
     Dodd
     Dole
     Domenici
     Dorgan
     Durenberger
     Exon
     Faircloth
     Feingold
     Feinstein
     Ford
     Glenn
     Gorton
     Graham
     Gramm
     Grassley
     Gregg
     Harkin
     Hatch
     Hatfield
     Heflin
     Helms
     Hollings
     Hutchison
     Inouye
     Jeffords
     Johnston
     Kassebaum
     Kempthorne
     Kennedy
     Kerrey
     Kerry
     Kohl
     Lautenberg
     Leahy
     Levin
     Lieberman
     Lott
     Lugar
     Mack
     Mathews
     McCain
     McConnell
     Metzenbaum
     Mikulski
     Mitchell
     Moseley-Braun
     Moynihan
     Murkowski
     Murray
     Nickles
     Nunn
     Packwood
     Pell
     Pressler
     Pryor
     Reid
     Riegle
     Robb
     Rockefeller
     Roth
     Sarbanes
     Sasser
     Shelby
     Simon
     Simpson
     Smith
     Specter
     Stevens
     Thurmond
     Wallop
     Warner
     Wellstone
     Wofford
  So the amendment (No. 2568) was agreed to.
  Mr. MOYNIHAN. Madam President, I move to reconsider the vote by which 
the amendment was agreed to.
  Mr. INOUYE. I move to lay that motion on the table.
  The motion to lay on the table was agreed to.
  Mr. MOYNIHAN. Madam President, may I take yet another opportunity to 
note that we are progressing. We have just had a unanimous vote in the 
body. Once again, we in a spirit of comity, cogency, and unity 
prevailed. It ought not to be missed. It should be celebrated, 
emulated, and continued.
  As the majority leader will be addressing us briefly, I respectfully 
suggest the absence of a quorum.
  The PRESIDING OFFICER (Mr. Akaka). The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. MITCHELL. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
   The PRESIDING OFFICER. Without objection, it is so ordered.


                           Order of Procedure

  Mr. MITCHELL. Mr. President, pursuant to the previous order, I 
shortly intend to seek recognition to offer an amendment. I have 
discussed it with the managers. The amendment has been provided to our 
colleagues, I believe, last evening or earlier today.
  I am advised that the amendment will not require a recorded vote, 
that it will be accepted. Therefore, there will be no further rollcall 
votes this evening. We will take up and pass this amendment by voice 
vote, unless someone now requests a recorded vote. Then, we will 
proceed to the amendment that I believe will be offered by Senator 
Packwood or one of his colleagues.
  Mr. PACKWOOD. I believe, Mr. President, what the chairman and I 
worked out earlier is that we were planning to go after the Senator 
from Maine, and probably start that in the morning. Senator Moynihan 
has an amendment on residents and interns and numbers. Then we come 
back to the Republican side again. I did not think we were planning to 
go tonight. We were hoping when we were finished with the amendment of 
the Senator from Maine that we would be finished.
  Mr. MITCHELL. That is agreeable with me. I was under the impression 
that the amendment was going to be offered by Senator Packwood as the 
next Republican amendment.
  Mr. PACKWOOD. I think we will have it ready tonight, but we will 
offer it in the morning.
  Mr. MITCHELL. Mr. President, there will be no further rollcall votes 
this evening. I now suggest the absence of a quorum.
  Mr. COCHRAN. Mr. President, will the Senator withhold the request for 
a unanimous-consent request to put something in the Record?
  Mr. MITCHELL. Certainly.

                          ____________________