[Congressional Record Volume 140, Number 118 (Friday, August 19, 1994)]
[House]
[Page H]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: August 19, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
                              HEALTH CARE

  The SPEAKER pro tempore (Mr. Abercrombie). Under a previous order of 
the House, the gentleman from New Jersey [Mr. Saxton] is recognized for 
60 minutes.
  Mr. SAXTON. Mr. Speaker, I take this time this evening to talk about 
an issue that is on the minds of all American people, that of health 
care, but before I do, let me just remark that I believe the American 
people recognize the important message that the gentleman from New 
Jersey [Mr. Menendez], the gentlewoman from Florida [Mr. Ros-Lehtinen], 
and the gentleman from Florida [Mr. Diaz-Balart] just conveyed as being 
one of a great deal of seriousness and a great deal of importance to 
the American people as well as to the people of Cuba. Obviously this 
has been an issue that has been on the minds of Americans for many, 
many decades, and the actions today certainly are something that 
everybody that I have talked to has had a lot of questions about, and 
we hope that we resolve the Cuban issue in the near term and we do it 
successfully.
  Let me turn to a domestic issue, as I said, health care. As we debate 
the crime bill in this house, the other house is well into the debate 
on health care. It seems to me that there is something in the debate 
that has kind of fallen by the wayside, and that is that our health 
care system today is really a pretty good system.
  As I sat and listened to the debate and the remarks of the previous 
speakers about Cuba and about institutions in other countries around 
the world, I thought just how fortunate we are to be Americans and to 
be able to avail ourselves of the many institutional facilities that we 
have that dispense wonderful health care in our country.
  As a matter of fact, one of my constituents said not long ago at a 
town meeting, ``Congressman, if you were ill and you could be treated 
any place in the world, where would you go?'' And I said, ``right here 
in the United States of America,'' because what we do in the way of 
health care is the best.
  It is not the health care system that dispenses health care, it is 
not that that we have the problem with. What we have the problem with 
is the economics of health care. The economics of health care do not 
work under the system that we have. They have worked somewhat over the 
years but because of some occurrences that have taken place, health 
care today, the economics of health care, really do not work very well.

                              {time}  1720

  Our economic system, the free market economy that we have in our 
country, has been very successful. It has been successful in terms of 
retail sales, it has been successful in terms of manufacturing, it has 
been successful in terms of trade. As a matter of fact, statistics show 
that 85 percent of our economy works pretty good. We have recessions, 
we have up cycles when our economy gets better, we have soft economies, 
but overall America is an economic wonder. The American economy has 
worked very well 85 percent of the time.
  The 15 percent of the time that it does not work well today is the 
economy that we call health care; the way we buy it, the way we pay for 
it are problems and we need to look and recognize those two concepts. 
We have a wonderful health care system in our country where the economy 
of it is weak and does not work, 15 percent of our economy.
  So if it were me calling all the shots, as we all here like to think 
we would be able to do, if I were calling all of the shots I would say 
let us not fix what is not broke, let us worry about the economics of 
health care. What is it that is different we might start by asking, 
what is it that is different about the economics of health care than 
exists in other aspects of our economy?
  We look at the activities, the economic activities that take place 
every day in our country. We manufacture goods and we provide services 
of all kinds to Americans. We buy and sell goods and services. It works 
pretty good. We market and advertise goods and services. And as we go 
through our daily lives, our economic system has one thing that all of 
those activities that I just mentioned, they all have one concept 
implicitly in common in every activity that we do. It is called 
competition.
  We have competition in manufacturing, we have competition in 
retailing, we have competition in marketing and advertising. And when 
we decide to carry out an economic activity, small businesses, for 
example, in our country, a small business person gets ready to initiate 
his economic activity, to establish his establishment and he goes in 
and finds a location. He goes to find a good location because a good 
location helps him compete. And then after he gets his location he says 
well, I have to have some kind of a structure, of a facility, and so he 
says what will the aesthetics of my facility be like, because it is 
important for it to be attractive so that he can compete. And he 
decides what kind of stocks and inventory to buy because stocks and 
inventory are important because he wants to compete. And when he gets 
his stock and inventory he decides on how he is going to price those 
goods, because the price of those goods help him compete.

  I would suggest that that competition is absent in our medical care 
system to a large degree. Mr. Speaker, I was just making the point that 
in the medical care system the 15 percent of our economy that does not 
work well, there is something that is missing, there is something that 
is different than in all of the rest of our economic activities that we 
carry out in our country. It is competition.
  That is because somebody else is paying the bill 83 percent of the 
time. That is right, 83 percent of the time when we go to avail 
ourselves of medical services, 83 percent of the time somebody else 
pays the bill. That has created some changes in the economics of 
medical care that are really very important. That is what we generally 
expect, as a matter of fact. What we have done we have done to 
ourselves, because when we as Americans, when this Congress set up the 
Internal Revenue Code it said to businesses we are going to treat the 
expenses you pay for medical care different than the expenses that 
individuals pay for medical care. Mr. Corporation, we are not going to 
tax yours, but we are going to tax the individual who pays for medical 
care.
  So all of us, recognizing that the Internal Revenue Code influences 
our behavior, all of us said, gee, we want our employers to pay for 
medical care, because they do not have to pay taxes on it and we as 
individuals do. That is what we generally expect. We have negotiated 
with big businesses, small businesses, government employers to pay for 
our medical care for us as well as through programs that this House has 
enacted like Medicare and Medicaid so that 83 percent of the time 
somebody else pays the bill.
  What does that mean to me as a medical consumer? It means when I go 
to the doctor, if the doctor says, ``Well, you need to have these four 
tests,'' I do not have to ask the question: ``Can't we get by with just 
two?'' because 83 percent of the time somebody else pays for it, and it 
does not cost me much or anything. When I go to the doctor it means 
that if the doctor says, ``Well, we need to schedule you for six 
visits,'' I do not have to say, ``Gee, can we do it in three,'' because 
83 percent of the time somebody else pays the bill. And when I go to 
the doctor and the doctor tells me, ``You need to go to the hospital 
for some tests,'' I do not have to say to the doctor, ``Can't we do it 
as an outpatient?'' Because 83 percent of the time somebody else pays 
the bill.
  So if we can look at the economics of health care, the American 
people do not want us to mess up their health care system, but they 
would like to find better ways to pay for it. If we could look at the 
economics of our health care system and creatively find some ways to 
change what we do to make consumers players, players in the 
decisionmaking process, it would certainly help and give individuals a 
chance to say, ``I don't want four tests, I just want one. Can't we do 
it that way?'' It gives individuals a chance to say, ``Gee, can't I 
just come here three times instead of six, can we get it done that 
way,'' and give the individual a chance to say, ``I don't really need 
to be in the hospital. Let's do it as an outpatient.''
  Those are the kinds of decisions that can save billions of dollars in 
our total system.
  There are some examples that we can look to, at people, employers and 
employees who have agreed to do things differently. Earlier this week 
the Republican members of the Joint Economic Committee held a forum on 
this subject and we had a couple of relatively well-known Americans 
here to share with us some ideas and some thoughts on some activities 
that they have been involved in. One of those people was a mayor of 
Jersey City, a young man by the name of Brent Schundler. He recognized 
his taxpayers were having to meet a tremendous bill for medical care 
for city employees, about an average of $6,900 a year. So being a 
creative young fellow he said, ``I think there is a better way to do 
this,'' and through a decisionmaking process they decided that they 
would buy only a catastrophic care policy with a whopping $2,000 
deductible. And of course, having a city with people where the average 
income is below the average income in America, I think he mentioned the 
figure of the average income in Jersey City of about $10,000, having a 
city with relatively low income people and employees as well, obviously 
they could not afford to have a $2,000 deductible. But they are buying 
the catastrophic policy with a $2,000 deductible, and instead of asking 
the employees to pick up the first $2,000, the mayor is putting $2,000 
in a special account for each employee, and the medical care that they 
use in that $2,000 is paid for by the city. At the end of the year if 
the employee has not used that $2,000 to pay their family's medical 
care, they get a check for the balance which may be left.
  Now what has this done?

                              {time}  1730

  Well, first of all, last year the total medical bill per individual 
was $6,900. Mayor Schundler told us that he pays $4,700 for the 
catastrophic care policy, and the $2,000 that he puts in the special 
account to pay for the first 2,000 dollars worth of medical bills for 
each family brings the total of $6,700, or a $100 savings.
  Now, what Mayor Schundler is hoping will happen is that as consumers 
of medical care who are employees of Jersey City go through the year, 
they will say to themselves, ``If I tell the doctor, if I ask the 
doctor the question, `Can we not do this with one test instead of four? 
Can we not do this with three visits instead of six? Can I not do this 
as an outpatient deal instead of going to the hospital,''' that the 
total pool of employees that are covered by this system will use less 
health care and be less costly, and when the mayor goes to buy the 
catastrophic policy next year, it will cost less because it paid for 
fewer services.
  That is putting competition back into the medical system for the 
employees of Jersey City. Are they better off? Well, at the end of the 
year, they get a check. All of their medical bills are otherwise paid 
for, and the system saves money. The taxpayers of Jersey City save 
money, and everybody wins.
  The other witness at our JEC forum earlier this week was Malcolm 
Forbes. He is someone that a lot of Americans have heard of, the 
president of Forbes, Inc., the publisher of Forbes magazine, also has a 
large company, and he recognized something similar to what Mayor 
Schundler did 3 years ago, that is, Forbes recognized it 3 years ago.
  They have in their company a medical health care system that has a 
$500 deductible, and he recognized that competition was missing from 
the consumers who went to the doctor, because they had to shell out 
that $500 regardless, pay the $500, then everything is paid for, or 
there may have been a copayment; most everything is paid for.
  And so what Mr. Forbes said to his employees was this: ``We are going 
to keep the same policy, the $500 deductible, but we are going to take 
care of that $500 deductible for you this way. I am going to put 
$1,000, twice the amount of the deductible, in a special account for 
you, and for every dollar that you spend on medical care this year, we 
are going to deduct $2 from the $1,000 account.''
  Now, what did that mean? It meant that when the family went to the 
doctor and spent $10 on medical services, $20 was deducted from the 
account, and he said, ``At the end of the year, whatever is left I am 
going to write you a check for it.''
  Now, when the family goes to the doctor, the Forbes people, just like 
the Jersey City people, they ask them questions: ``Is there a less 
expensive way to do this?''
  The first year, at the end of the first year, when Malcolm Forbes 
went to reapply to buy his policy for the beginning of the second year, 
he found that their medical care expenses had been reduced by 15 
percent, and at the beginning of the third year, when he went to buy 
the health care policy, same one, he found that medical care expenses 
had been reduced by an additional 13 percent, in 2 years, a 28-percent 
reduction because consumers became players in the decisionmaking 
process.
  Now, as we debate health care here, I know it sounds to many people 
like somehow the Government can do it better. I do not believe that. I 
do not believe that Government can do it better.
  What I think we need to do is to not rely so much on big Government 
to collect our money, send it down here from our employers; the Senate 
version says 50 percent from the employer, 50 percent from the 
employee, send it to a big bureaucracy here in Washington or Baltimore 
or someplace, and then have decisions made as they are currently by 
someone other than the patient.
  I do not think that works. I do not know why we do not understand 
that here.
  This may sound like an oversimplification of an easy way out; that 
some people are going to say it certainly will not work, but it 
certainly makes sense to me.
  There are a few other things we need to do to clean up our act as 
well, expenses that medical care providers must pay, and then pass 
along to consumers, medical malpractice insurance, the practice of 
defensive medicine as a way to keep medical malpractice insurance as 
low as possible. That is an issue we certainly have to address. I think 
we probably need some administrative reform and some action to reduce 
paperwork and standardize forms, those kinds of things. Those things 
can be done.
  We can reduce the cost of medical care without standing the rest of 
the medical care delivery system on its head. That is what the American 
people are concerned about. That is why the American people this week 
in Newsweek magazine, that magazine reported that 65 percent of the 
American people in the survey said, ``Congress, stop, please go home. 
Please, do not do anything with medical care until next year,'' because 
they are afraid in their wisdom, they believe that we are going to do 
this wrong.
  So I wanted to bring this concept to the Members, people who are, I 
know, good-intended, with good intentions, and as the debate goes 
forward in the other House, I hope that everyone recognizes just how 
complicated this issue is and that we really need to stop, take a good 
look, understand that the economy of the medical care system is where 
we ought to put our emphasis and where we ought to fix.
  Mr. Speaker, I ask unanimous consent that the gentleman from New York 
[Mr. Serrano] be allowed to control the remainder of my time.
  The SPEAKER pro tempore (Mr. Abercrombie). Is there objection to the 
request of the gentleman from New Jersey?
  There was no objection.
  The SPEAKER pro tempore. There are approximately 35 minutes 
remaining.


                            the cuban crisis

  Mr. SERRANO. Mr. Speaker, I thank the gentleman from New Jersey [Mr. 
Saxton].
  Mr. Speaker, we are faced once again with a very difficult situation. 
We are calling it the Cuban crisis.
  I think it is important to note that there are some of us in this 
country who believe that this crisis was brought on by our own policies 
and that it is time that we face up to it and begin to deal with it in 
a proper way.
  Let us very quickly review what has been happening. For over 30 years 
now we have had and maintained an embargo on Cuba, and that embargo, 
economic embargo, did not allow travel by anyone in this country, did 
not allow any kind of interchange or exchange, did not allow Cubans to 
come here or Americans to travel there or participate in any way. The 
rhetoric from both sides was a very strong anti-Cuban Government and 
Cuban society rhetoric, and it was destined supposedly to bring down 
the Cuban Government by enticing the Cuban community in Havana and 
other parts of Cuba to rise up against their government. Throughout 
those 30 years, part of that policy has been to invite them to flee 
their homeland and to come here.
  Second, one of the advantages or disadvantages I have is that by 
being able to understand Spanish I can tell you that Miami commercial 
radio stations on a daily basis transmit programs which in fact invited 
the Cuban people throughout these years to rebel, rise up against their 
government and to flee.
  We have sponsored and paid for out of taxpayers' dollars, much to my 
dismay, Radio Marti, which uses thousands of hours every year sending 
not only the message that they should be sending of what American 
society is like, but, in fact, encouraging Cubans again to rise up 
against their government and flee, and when a Cuban shows up in Miami 
with a hijacked airplane, we never treat that person as a hijacker. We 
treat them as a hero fleeing a Communist dictatorship.

                              {time}  1740

  And when a person showed up, for many years and throughout the years, 
from Mexico or from Spain or from Latin America or from Canada, having 
left Cuba and made their way to those other countries, we treated them 
as a hero. We even have had in place until this afternoon--and we are 
not clear if it is still in place or not--a law which allowed only 
Cubans, no other group in the world, to come to our land and be 
accepted immediately, no questions asked, with special assistance, 
funding different organizations in Florida to assist them to become 
citizens in a shorter time than it takes any other alien to become a 
citizen in this country. That would seem to me that that is a policy 
that directly or indirectly has invited the Cuban people to come here.
  Now, since the demise of the Soviet Union and the Cuban economy took 
the brunt of not being able to receive any help from the Soviets, the 
Cuban people started coming here in larger numbers. That began to worry 
some people in Miami and it worried some people in the administration 
and people throughout the country because it was no longer a sexy 
issue.
  When one Cuban a month showed up in Florida, we were able to put that 
person in front of the TV camera on the 6 o'clock news and he would 
denounce the Cuban Government. He would then be lost and integrated 
into the society. But when dozens started to come and hundreds started 
to come this year, when thousands started to come, then the situation 
became a little different. Do we have room for them? Can we control 
what they say? What? Heaven forbid, some people would say if some Cuban 
showed up here and said, ``Hey, listen, my education system back there 
was not bad, my political system, I was born under that system, my 
parents did not have it any better, it has not been any good for a 
lifetime. But I had good sports and recreation and I had a good health 
care system. The reason I am here is because I am hungry.'' That would 
destroy the whole theory of why we want Cubans to come here.
  Now, all of a sudden, all of a sudden we have a situation where we 
find ourselves contradicting what we in fact set up. Let us understand 
what we did today. I am dismayed to find out that our administration, 
the administration I support, has decided that Cubans who flee Cuba 
will now be considered illegal aliens, will now be stopped, again after 
we have been inviting them to come here for over 30 years, they will be 
stopped and will be taken to Guantanamo Bay. The irony of ironies, in 
Cuba.
  By detaining them, which is a fancy word for arresting them, we will 
be setting them in Cuba while accusing Castro of detaining his people, 
and we will be detaining Cubans in Cuba.
  Now, let us understand that, that is really kind of an interesting 
situation we find ourselves in. We are going to now arrest Cubans and 
then put them in a piece of Cuba that we control and have them under 
some sort of arrest because that is what detention is, in Cuba. So we 
will say that Castro is detaining his people on two-thirds of the 
island and we will be holding people in another part of the island 
under our supervision and our control.
  Now, what is to stop the Cuban people from deciding tomorrow that 
instead of taking the chance of facing sharks in the Caribbean waters, 
that they will just go to Guantanamo Bay, stand up again and say, 
``Take me in''? How are you going to deal with that? In my opinion, the 
time has come to deal with this situation in the only sensible way we 
can do it.
  Mr. Speaker, I have introduced legislation this past week which would 
end the embargo against Cuba and let nature take its course after that, 
end the embargo against Cuba, just life it completely and let things 
flow after that.
  People ask, ``What do you mean by that, Congressman? What is it that 
you mean by `things will flow'?'' I will tell you what it means. I will 
tell you what it means. It means that George Steinbrenner will be in 
Cuba the next day signing up 50 ballplayers. That means that Don King 
will be in the next day signing up 25 boxers. That means that Coke and 
Pepsi will be making a mad rush to see who sets up the first processing 
plant in Cuba. It means that Burger King and McDonald's and Wendy's 
will be rushing into Cuba. And the minute Cuba feels that flow of 
capitalism, Cuba will never be the same.
  In the meantime, the situation that we risk is one where thousands of 
people will continue to flee Cuba, we will have to arrest them and 
detain them, so we will be detaining Haitians, we will be detaining 
Cubans, and we have already delicate situation in the Dominican 
Republic, and we have our own problems at home.
  Would it not be simpler and better to say, ``You know, we are dealing 
with Communist China, we are dealing with China, we are ready to deal 
with Korea if they put away the bomb, and Vietnam, we are dealing with 
Vietnam. We lifted the embargo on Vietnam after a war that still has an 
effect on our society, that is felt every day in our society dealing 
with Vietnam, as we should''?

  What is it that still drives us to this misguided policy on Cuba? Is 
it that we are troubled by the fact that this gentleman has lasted for 
35 years under our very noses, 95 miles away? Why do we continue to 
believe that we have to have this policy?
  This is the opportunity, and I know that my colleagues have been 
asked little by little, one on one, to support my legislation. This is 
the opportunity to put an end to what could turn out to be a major 
tragedy.
  Miami cannot withstand the rush of 100,000 Cubans. Cuba cannot 
withstand standing on line 4 or 5 hours a day for a pound of beef, for 
a pound for rice, half a pound of beans .
  Children in Cuba are suffering because they have no food, because our 
embargo does not allow food or medicine or vitamins to go into Cuba.
  If our policy was the same on China, on Vietnam, on Korea, then 
perhaps it would make some sense. But our policy is not the same. I 
would hope that over this weekend, that over this coming week, over the 
next week and the next coming days we would be able to put aside 
whatever it is that irks us as Americans about Cuba and the Cuban 
Government, and understand that for 35 years our policy has not worked; 
that it is time to talk to the Cuban Government, to allow the Cuban 
people the freedom to travel here, to allow us the freedom to travel 
there, to exchange that which made us friends in the past, our 
passionate love for sports, for music, for culture.
  The Cuban people do not dislike the American people; they just do not 
understand the American Government. And we do not dislike the Cuban 
people, we just have a fetish about its leader.
  Let us put it away now, let us open up and let us avoid a bloodbath, 
civil strife, and a catastrophe at sea.
  This is the time to do it, and I think we can do it if we join in 
approving our legislation ending the embargo and wishing the Cuban 
people a new future.
  Let them decide what government they want once they are eating, once 
they are being fed, once they have medicines, once again when they have 
vitamins once again; let then decide what government they want
  If you look at the rest of the world and the changes that are taking 
place, it is easy to understand what changes they will make. But as 
long as we continue to push this embargo on them, the nationalistic 
fervor will envelope that island and will not allow people to dialog. 
This is wrong. This has been a wrong policy
  Somewhere tonight when the Members of this House, the members of this 
Government and the American people go to dinner, maybe we should take 1 
minute to think about the fact that their parents in Cuba, who do not 
know how they are going to feed their children tomorrow, we can put a 
stop to it now and it is the proper thing to do.

                          ____________________