[Congressional Record Volume 140, Number 118 (Friday, August 19, 1994)]
[Senate]
[Page S]
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 SECURITY ACT

  The Senate continued with the consideration of the bill.
  Mr. GRAMM. Madam President, finally, let me turn briefly to the 
health care issue, make a few remarks, and then I will yield the floor 
and let my colleagues speak.
  In terms of health care, we have had an opportunity now to listen to 
Bill Clinton. We have listened to him speak about his health care bill 
for 16 months. He has had an opportunity to tell the American people 
about that health care bill and what it would do. He has the biggest 
megaphone in history. The President is a great salesman. The First Lady 
is a great salesman. Their product has not failed to sell because they 
did not get a chance to sell it. It has not failed to sell because they 
were not great salesmen. It has failed to sell because it is a bad 
product. It has failed to sell because the American people have come to 
understand that whether it was in its original form or whether it is in 
the Clinton-Mitchell form or whether it is in the Clinton-Gephardt 
form, that two things are always the same about these Clinton health 
care bills.
  No. 1, they let the Government make decisions for us in health care 
and, No. 2, they include huge increases in spending, spending increases 
that are funded by raising taxes on working people.
  The Mitchell bill has at least 18 different taxes in it that are 
funded by cutting other programs that the taxpayer will then have to 
subsidize through some other means.
  So the bottom line is the President has had an opportunity to be 
heard, the American people have listened respectfully, but they have 
come to the conclusion that they do not want this plan.
  Second, we have had an opportunity now to listen to Senator Mitchell; 
we have had an opportunity to listen to Congressman Gephardt. The 
American people are trying to communicate to Congress. The American 
people are saying to us, ``Stop and listen.''
  If you go back and open your mail, and I would ask every Member of 
the Senate to do that, or if you want to go back to your office and 
just randomly answer your telephone, you are going to find that people 
in your State are trying desperately to tell you, ``Stop listening to 
President Clinton; stop listening to the voices inside the beltway and 
start listening to us.''
  So I have concluded that rather than continuing to flounder around in 
Washington, DC, that we ought to do something that the administration 
and the leadership of the House and Senate fear more than anything 
else: We ought to let Members of Congress go home.
  We have all seen in the newspapers around the country where the 
Democratic leadership has said that if people go home, they are going 
to end up being beaten up by their constituency and that the health 
care bill will be dead. I submit to my colleagues that we ought to have 
second thoughts about passing a health care bill where Members of 
Congress, once they have passed it, would have to have protection from 
the people who pay their salary.
  I believe that the time has come for us to go back home, listen to 
the people, come back in September, and see if we can reach a consensus 
that has a broad bipartisan base of support.
  Mr. ROCKEFELLER. Will the Senator yield?
  Mr. GRAMM. I will be happy to yield when I get through. I would like 
to complete my statement because there are a lot of other people 
waiting to speak.
  We now have all kinds of different rump groups around the Capitol 
that are meeting and trying to come up with some new way to fix one-
seventh of the American economy. This whole debate started with 500 
people meeting in secret in a gymnasium in Alexandria, VA; people who 
were so smart that they were going to be able to fix the health care 
system.
  Now we have very small numbers of people meeting and they want to do 
the whole thing again. I think when we are talking about one-seventh of 
the American economy, we had better be very careful about what we are 
doing. We have a group that calls itself the mainstream coalition. We 
do not know much about their new proposal, but we know two things about 
it and both of them suggest to me that their views may be mainstream in 
Washington, DC, but they are not mainstream in America.
  The first proposal is that we let Government tell people what kind of 
health insurance policy they are allowed to have. I do not think that 
is what most Americans have in mind. I think most families believe that 
they are in a better position than we are in Washington, DC, to judge 
the health insurance needs of their family, and they wonder about our 
arrogance in trying to tell them what kind of insurance they ought to 
have.
  The second thing that we know about the proposal that is being 
generated by the so-called mainstream group is that it would tax the 
health insurance benefits of Americans who have benefits that the 
Government believes they ought not have.
  I remind my colleagues that these are benefits that people, in many 
cases, have worked their whole lives to get. These are benefits that 
people are paying for with their own money and with the money of their 
employers, money that is being paid either to them and they are 
spending it, or being spent on their behalf, for which they gave up 
potentially higher wages.
  Who gives us the right to say these are benefits they ought not to 
have and, therefore, we are going to impose a 25 percent tax on those 
benefits?
  I would simply like to say that is not mainstream Texas, and I do not 
believe that is mainstream America. I think that those proposals are 
going to be rejected by overwhelming votes.
  So we can stay around here, obviously, as long as the majority leader 
wants to stay. I am sort of struck by the fact that in the middle of 
the week, we were hearing threats about round-the-clock sessions. And 
here we are on Friday afternoon, and we do not have another vote. We 
have been told we were going to be in session on Saturday; now we are 
not going to be in session on Saturday. We are not going to have a vote 
before 6 o'clock Monday. I think people believe that there is more than 
a little chaos here in Washington, DC.
  I do not think everybody in Washington has realized it yet, but in 
the words of the old country and western song, I think we can ``turn 
out the lights, the party's over.'' We are not going to pass a health 
care bill before we recess. I think it is increasingly clear that this 
may be an isolated little island here, but the American people are 
shouting so loudly for us to stop and listen that I do not believe that 
we are going to put together a consensus bill until all these bad ideas 
are rejected.
  I think people are not going to give up on this dream they have of 
the Government taking over and running the health care system until 
they have gone back to their individual States and listened to the 
people tell them what they do and do not want.
  So obviously, I am happy to stay here and debate this issue as long 
as we want to debate it, but I personally believe we are wasting our 
time. I think, in any variant, that the Clinton health care plan is 
dead and no additional powder on its lifeless, puffed-up face is going 
to make it attractive to the American people. The sooner we recognize 
that, the better off we are going to be.
  I would simply like to suggest in closing that we get on with the 
people's business. The most important thing we can do to find a 
consensus on health care is to go home and listen to the voice of the 
people who pay our salaries. I submit that if we do that, we are going 
to hear a fairly uniform message. That message is going to fix what is 
broken in the system but leave alone the people who have good health 
insurance they want to keep. I think we can come back in September, and 
if the President will listen to those same voices and hear that same 
message, I believe that we can pass a health care plan.

  I would yield to the junior Senator from West Virginia if he had a 
question.
  The PRESIDING OFFICER. The Senator from West Virginia.
  Mr. GRAMM. Madam President, could we have order. I can hardly hear 
myself talk much less the Senator from West Virginia.
  Mr. ROCKEFELLER. Madam President, the Senator from West Virginia has 
not spoken, so it would not be surprising if the Senator from Texas has 
not heard me.
  I just want to confirm that I really heard what the Senator said, 
that he referred to the health care bill as ``this little matter.''
  Mr. GRAMM. Little matter? If the Senator heard me call this a 
little--if I can reclaim my time.
  Mr. ROCKEFELLER. Will the Senator let me ask a question?
  Mr. GRAMM. OK, go ahead.
  Mr. ROCKEFELLER. The Senator indicated that what we should do is go 
home, that the American people want us to do this next year. I would 
say to my colleague the American people are highly dissatisfied because 
what they have seen is a nonstop filibuster on the part of the 
Republicans of a good-faith effort on the part of the Democrats to pass 
a health care bill this year. The whole concept of the people and the 
children of my State, the 4 million uninsured people of the Senator's 
State saying that they do not care that they are uninsured, they do not 
care if children do not have health care is absolutely extraordinary to 
me.
  For the Senator to say let us go home, let us do this another time, 
let us go back and rethink all of this is also extraordinary. We have 
been at this for 6 years, some of us for longer, and all of us for 2.
  I am baffled by the Senator's ability to take this little thing 
called health care and toss it off until next year. I wonder how he 
justifies that with 4 million uninsured Texans.
  Mr. GRAMM. Madam President, if I can reclaim my time, first of all, I 
have never referred to the health care issue as a ``little matter.''
  In fact, in the 15 years I have been in Congress, this is just about 
the most important issue that we have debated. I believe that the 
health care bill in both variants now before the Senate represents the 
greatest peril to the health and happiness of the American people that 
we have faced in my 15 years in Congress. These proposals would expand 
the power of Government, expand the cost of Government, limit the 
freedom of people to choose something as fundamental as health care, 
and expose people to the bankruptcy of the American Government.
  So this is no little matter. It is a very big matter. This is a 
critically important matter. I have always at all times referred to it 
as that.
  Second, I am not talking about waiting until next year. I am simply 
pointing out the obvious, and the obvious is that the Mitchell bill is 
dead. I do not see a consensus forming. What I am saying is this. 
Senator Kennedy, I see, just came on the floor. He and I go back and 
forth each month as to who gets the most mail in the Senate. I am 
always happy when Senator Kennedy wins that honor because then he has 
more to answer. When I win the honor, obviously, then I have more to 
answer.
  Normally, I get around 1,200 first class letters a day. Day before 
yesterday, I got 3,500 letters, the largest I had ever gotten. 
Yesterday, I got 7,000 letters. My telephones, like your telephones, 
Mr. President, are ringing off the hooks. What are people saying? What 
is the voice of America on this issue? The voice of America says stop 
and listen to us. The voice of America says do not pass a bill that no 
one understands. Do not have the Government dictate to me and my family 
about health care.
  What I am saying is this. I would like to pass a bill in September, 
but the only way I believe we are going to reach a consensus is by 
going back to the people who elected us, listen to their voices, and 
find a consensus about what they want. I do not believe that the people 
of West Virginia think differently on this subject than the people of 
Texas do.
  One of the reasons I believe that is because yesterday I listened to 
the senior Senator from West Virginia [Mr. Byrd], who spoke out and 
opposed the Mitchell-Clinton bill and said, far more eloquently than I 
have, why passing that bill was bad for America and why it was 
dangerous in terms of potentially bankrupting the country.
  So mine is not just one lonely Texas voice that is saying this. This 
is a growing consensus of our Members. And all I am saying is, are we 
staying here to keep certain Members isolated from the voters? I do not 
think we are promoting a consensus. In fact, I believe that we are 
getting further and further away from a consensus, and what I would 
like to do, quite frankly, is to have the Congress go home, listen to 
the people who pay their salaries, and come back in September.
  I would like to make insurance portable so you could change jobs 
without losing it. My guess is everybody here is for that. I would like 
to make it permanent so that your insurance cannot be canceled if you 
get sick. I would like to deal with medical liability. Now, I know some 
people do not want to do that, but I believe the American people do. 
And I would like to try to make it easier to get and keep good health 
insurance.
  Now, other people want to do more. What I would like to do is to see 
if we could find a consensus to do all that we agree on, and then if 
some politicians want to take the issue to the American people in the 
election--and we are going to have an election in some 80 days--if they 
want to take it to the American people and say if you want the 
Government to have a bigger voice in health care, if you think we can 
afford to spend $1.1 trillion over the next 8 years on new programs, 
then vote for me, then they can do that. I personally would be very 
happy to say, if you do not want Government to exercise more control 
over your health care and you do not think we can afford another $1.1 
trillion over the next 8 years, maybe you ought not to vote for that 
other person.
  Mr. ROCKEFELLER. Madam President, will the Senator further yield?
  Mr. GRAMM. I would be happy to yield.
  The PRESIDING OFFICER. The Senator from West Virginia.
  Mr. ROCKEFELLER. The Senator from Texas and I have shared a number of 
forums together, sometimes on television, sometimes elsewhere. I have 
noticed that the Senator says, as he always does in the most articulate 
fashion, constantly negative things, about what Democrats and 
Republicans are together trying to accomplish.
  I think it is no wonder then that the most recent CBS poll says 59 
percent of Americans say that most lawmakers are not really serious 
about reform. I wish the Senator to know that there are some of us who 
really are serious and who care passionately. I care very passionately 
about the 4 million Texans who are uninsured almost as much as I care 
about the 300,000 West Virginians who are uninsured. I cannot imagine 
the Senator thinks that Americans are going to forgive us if we fail. I 
would suggest to the Senator that we will vote on Americans' health 
insurance in October and they will vote on our health insurance in 
November.
  Mr. GRAMM. Madam President, let me interpret that as a question since 
the rules require it.
  The PRESIDING OFFICER. The Senator from Texas.
  Mr. GRAMM. First of all, if it sounds like I am saying negative 
things, I am simply reflecting what I am hearing from the people who 
pay my salary, and I reply that we all ought to be listening to them 
more intensely.
  Now, I have spent a lot of time saying positive things about health 
care. First of all, I have offered not one but two bills to reform the 
health care system. One bill was comprehensive, and when it became 
clear to me that we probably were not going to pass comprehensive 
reform this year, I offered what I called an interim reform 
proposal. Those bills outline in detail how I thought we could fix the 
health care system, but there is a fundamental difference between how I 
approach this problem and how the Senator from West Virginia and the 
President approach the problem. I believe that we have the greatest 
health care system in the history of the world, and I am not willing to 
tear it down and reinvent it in the image of the post office. I want to 
try to fix the things that are broken, but I do not want to start over 
in the health care system. I do not believe the American people do 
either.

  In terms of what people are going to say in November when we take a 
position, we all make judgments about what we think is right and what 
we think is going to influence the American people in terms of how they 
view the debate. Quite frankly, I do not know how this will all play 
out. I think I know one thing, and that is that I do not believe a 
government-dominated health care system can work. I do not believe--as 
generous as some of my colleagues are with the taxpayers' money--that 
we can pay for $1.1 trillion of new subsidies which, when fully 
implemented, would cost the average American family between $3,200 and 
$3,800 a year. We cannot afford that.
  When my mama gets sick, I want her to talk to a doctor and not some 
government bureaucrat. I want her to choose the doctor. On that issue, 
I am not willing to compromise. I have said a lot of positive things, 
but we are not here debating my bill. We are debating the bill that is 
supported by the Senator from West Virginia and is supported by the 
President. And try as I may--and I remember, as I am sure many of you 
do, sitting on my mother's knee and hearing her say, ``If you cannot 
say something good about somebody, do not say anything''--I cannot find 
much good to say about the Mitchell-Clinton bill, but I am not alone. 
Millions of Americans have reached exactly the same conclusion I have.
  In conclusion, let me say that I am again impressed--as I have been 
on many occasions in the 15 years I have had the privilege to serve in 
Congress--at how smart the American people are. I believe that the 
Clinton health proposal, in all of its forms, has failed because the 
President and many of his supporters have greatly underestimated the 
ability of the American people to understand what they are trying to 
do. And as I look at the great peril that we faced a year ago when it 
looked as if one of these bills was going to become the law of the 
land, and there were very few people willing to stand as Horatius at 
the gate and stop it, and when it looked like we were on the losing 
side of this contest, I am very grateful for the wisdom of the American 
people in knowing a bad deal when they see it and in letting their 
voices be heard.
  So we may stay here all of next week and the next week. I have not 
planned a vacation because I am ready to be here debating this 
legislation. I simply want to predict that, in the end, we are not 
going to be able to stay here long enough to prevent us from hearing 
the American people.
  The American people do not want this bill. They want us to stop and 
listen to them. They want us to let them express their views. People 
are scared to death that we are going to pass this bill and that we are 
going to reduce their freedom and bankrupt their country. Fortunately, 
the American people are going to win, and we are not going to do those 
things. But we would not have won had not the American people figured 
this issue out. I am very grateful for their wisdom, as I have often 
been in the past.
  I yield the floor.
  Mr. DASCHLE addressed the Chair.
  The PRESIDING OFFICER (Mr. Pryor). The Senator from South Dakota is 
recognized.
  Mr. DASCHLE. Mr. President, I agree with much of what the 
distinguished Senator from Texas said about the American people not 
wanting a government-controlled system, and not wanting to go to a 
bureaucrat in lieu of a doctor. But I do not know what that has to do 
with this bill.
  They can characterize this bill as often as they like, as something 
other than what it is. But let us be sure that everyone understands 
what it is we are talking about here. What this bill will do, very 
simply--stripping all the rhetoric aside, is give the same opportunity 
to the American people that Federal employees and Members of Congress 
have today.
  We have argued for weeks now about whether this bill creates a 
government-controlled system or not, and we will probably continue to 
argue about this point. But I will go back to the majority leader's 
point. Some people call this a horse, but it is a desk as many times as 
you may try to call it a horse. We have a private system, and we want 
the American people to have a private system. And if this legislation 
passes, that is exactly what they are going to have.
  The Senator from Texas said that he wants insurance reform. What he 
did not say is that those of us in the Congress who have indicated our 
support for the Mitchell bill believe the American people want more 
than insurance reform. They want a plan that provides the same security 
as the one we have. They want to know their policy has no preexisting 
conditions clauses, that there will be no surprise tactics like those 
used by some insurance companies. They want the confidence that their 
insurance is going to be portable and that it is going to be 
affordable. Ultimately, if we pass this legislation, we can give the 
American people that kind of assurance.
  The Senator from Texas said something else that caught my attention. 
He said that we can wait to pass this legislation until some magical 
time when all of this comes together. Maybe the Moon and the stars have 
to be aligned properly. I do not know what it will take. But I know 
this: Every minute we wait, 48 more Americans lose their coverage. In 
the time that the Senator from Texas spoke, we probably lost another 
500 people, and that is a conservative estimate. We may have lost 1,000 
people. Come to think of it, it may now be 2,000; I did not look at the 
time. But every minute 48 Americans lose their insurance. I remember 
reading accounts of past health reform debates, when they spoke about 
the need to wait in the 1930's, and about the need to wait in the 
1940's. We were told we had to wait in the 1960's, 1970's, and 1980's. 
We have been waiting six decades to pass health reform legislation. 
Generations of people have been vulnerable in the meantime, and because 
we have waited they become more cynical, frustrated, concerned, and 
ultimately, more vulnerable. How much longer must we wait?
  For those fortunate enough to have insurance, the cost continues to 
mount. The Senator from Texas said he is worried about $1 trillion in 
new subsidies. I do not know where that figure comes from. But I do 
know this: We are spending more than $1 trillion on health insurance 
today, and if we do nothing, in a few years every single American is 
going to be paying twice what they are paying now. We are going to go 
from a $7,000 average family premium to a $14,000 premium, in 7 years 
if we do nothing. That is the cost of waiting. We can wait all we want 
to. In the meantime, the American people are going to have to dig 
deeper and deeper into their pockets, with less and less ability to 
pull out the change necessary to pay for meaningful insurance.
  As we prepare to vote on this amendment, let us be reminded again 
what it does. It simply strikes a 15-percent administrative charge that 
is used to ensure that everybody else in the country does not have to 
pay for the fact that some States may not be in compliance with 
national standards. How ironic it is that we tell the American people 
that those who comply must pay additional taxes to cover those who do 
not comply.
  We have heard so many arguments and so many statements on the floor 
about how we have to end cost shifting. This provision in the bill was 
simply designed to eliminate cost shifting. We are going to take it 
out, and we can devise other ways to alleviate the problem of cost 
shifting. Mr. President, I must tell you, with each one of these nicks, 
I have become increasingly concerned about the problems we have in 
making insurance work well.
  Other Senators have proposed doing just what Senator Mitchell does in 
his bill. The Chafee-Dole bill has a similar requirement. The Nickles-
Dole bill has a similar requirement. The Packwood-Nickles bill back in 
1984 had a similar requirement. We should all recognize this.
  Mr. COATS. Mr. President, I strongly support the amendment offered by 
Senator Hutchison. Under the Mitchell bill, the Secretary of HHS is 
authorized to terminate a State plan and assume the State's obligations 
under the act, if the Secretary finds that the State plan substantially 
jeopardizes the ability of eligible individuals in the State to obtain 
coverage of the standard benefit package. [Secs. 1412(b)(2) & 1422] 
Should this Federal takeover occur, section 1423 imposes a 15-percent 
tax upon all of the State's community rated premiums, to reimburse the 
Secretary for any administrative or other expenses incurred as a result 
of establishing and operating the system in that State. The Hutchison 
amendment would strike section 1423 and the 15-percent takeover tax.
  The 15-percent tax is the Mitchell bill's estimate of the annual cost 
of running a State system. CBO has warned that the States will not be 
able to handle the burdens of the Mitchell bill. Here's what CBO has to 
say about the feasibility of States implementing the Mitchell bill.

       Most proposals to restructure the health care system 
     incorporate major additional administrative and regulatory 
     functions that new or existing agencies or organizations 
     would have to undertake. Like several other proposals, this 
     one would place significant responsibility on the States for 
     developing and implementing the new system. It is doubtful 
     that all States would be ready to assume their new 
     responsibilities in the timeframe envisioned by the proposal.

  Given this gloomy CBO forecast, it seems that the 15-percent takeover 
tax is inevitable.
  If the States are running their health care systems in response to 
Federal mandates, the Mitchell bill provides no funding support. Yet, 
if the Federal Government must run the State system, a 15-percent tax 
is imposed. How much does this add up to in Indiana? In Indiana, the 
annual aggregate total of health care premiums paid is over $6 billion. 
Fifteen percent of $6 billion means that the Mitchell bill would saddle 
Hoosiers with $908 million in order to establish massive new state 
bureaucracies. Nearly $200 for every resident in the State, a 
backbreaking new tax.
  Is HHS capable of handling the task of running the States health care 
systems? Take a look at the Vaccines for Children Program initiated by 
the Clinton administration and approved by Congress last year. GAO 
issued a report in July of this year that states:

       In conclusion, our review indicates that it is unlikely 
     that [the government] can fully implement the VFC Program by 
     October 1, 1994, and raises questions about whether VFC, when 
     fully implemented, can be expected to substantially raise 
     vaccination rates.

  The HHS plan calls for one-third of the country's vaccine supply to 
be sent to a single distribution point, a General Services warehouse in 
New Jersey that stores paper clips and flammable paint solvents. The 
report found the GSA: Way behind in purchase contracts; Unprepared to 
evaluate whether the system could efficiently process orders from the 
70,000 doctors and clinics that will get the stuff; and, Unprepared to 
adequately test whether its packaging and delivery system would retain 
vaccine potency--vaccines require very strict temperature controls.
  The inability of HHS to design and implement this relatively small 
and straight-forward task raises doubts in my mind as to the ability of 
HHS to run the States' health care systems.
  The Senator from Texas has brought to our attention that, under the 
Mitchell bill, the States have unfairly placed in a difficult 
position--either implement a massive unfunded mandate or, if not, pay a 
still penalty tax. This is unfair to the State of Indiana and I urge my 
colleagues to support the Hutchison amendment.
  Mr. DASCHLE. Mr. President, If there are no other Senators wishing to 
speak on this amendment, I think we are ready for a vote.
  The PRESIDING OFFICER. Is there further debate on the pending 
amendment?
  If not, the question is on agreeing to the amendment.
  The amendment (No. 2571) was agreed to.
  Mr. DASCHLE. Mr. President, I move to reconsider the vote.
  Mr. DORGAN. I move to lay that motion on the table.
  The motion to lay on the table was agreed to.
  The PRESIDING OFFICER. Under the previous order the Senator from Iowa 
[Mr. Harkin], was to be recognized.


                           Amendment No. 2572

       (Purpose: To permit health plans to make flexible service 
     options available under the standard benefit package)

  Mr. HARKIN. Mr. President, I have an amendment I send to the desk and 
ask for its immediate consideration.
  The PRESIDING OFFICER. The clerk will report the amendment.
  The assistant legislative clerk read as follows:

       The Senator from Iowa [Mr. Harkin], for himself, Mr. 
     Kennedy, Mr. Daschle, and Mr. Reid, proposes an amendment 
     numbered 2572.

  Mr. HARKIN. Mr. President, I ask unanimous consent that the reading 
of the amendment be dispensed with.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment is as follows:

       At the appropriate place in part 1 of subtitle C of title 
     I, insert the following new section:

     SEC.   . FLEXIBLE SERVICES OPTION.

       (a) Extra Contractual Services.--A health plan may provide 
     coverage to individuals enrolled under the plan for extra 
     contractual items and services determined appropriate by the 
     plan and the individual (or in appropriate circumstances the 
     parent or legal guardian of the individual).
       (b) Disputed Claims.--A decision by a health plan to permit 
     or deny the provision of extra contractual services shall not 
     be subject to a benefit determination review under this Act.
       (c) Definition.--As used in this section, the term ``extra 
     contractual items and services'' means, with respect to a 
     health plan, case management services, medical foods, and 
     other appropriate alternatives (either alternative items or 
     services or alternative care settings) to traditional covered 
     items or services that are determined by the health plan to 
     be the most cost effective way to provide appropriate 
     treatment to the enrolled individual.


                      Unanimous-Consent Agreement

  Mr. HARKIN. Mr. President, I know the Senator from New Mexico has 
been waiting a long time to speak. I have some remarks I want to make 
on this amendment. He assured me he only wanted to speak for 15 
minutes.
  I ask unanimous consent that the Senator from New Mexico be 
recognized for 15 minutes, after which the Senator from Iowa be 
recognized to make an opening statement on the amendment.
  Ms. MOSELEY-BRAUN. Mr. President, reserving the right to object, I 
was in this Chair, as the Senator knows. I really would like to make a 
statement as to where we are in the process, and the issue generally.
  I do not want to interfere with the Senator from New Mexico or the 
statement of the Senator from Iowa, for that matter, but I would like 
to be part of the unanimous-consent request the Senator from Iowa 
propounds.
  Mr. HARKIN. Mr. President, I will modify that to ask unanimous 
consent that the Senator from New Mexico be recognized for 15 minutes, 
at the end of which the Senator from Iowa be recognized to make an 
opening statement on his amendment, at the end of which time the 
Senator from Illinois be recognized.
  Ms. MOSELEY-BRAUN. Thank you very much.
  The PRESIDING OFFICER. Is there objection to the unanimous consent 
request?
  Without objection, it is so ordered.
  Mr. HARKIN. I thank the Chair.
  The PRESIDING OFFICER. The Senator from New Mexico is recognized.


                      Health Care and the Deficit

  Mr. DOMENICI. Mr. President, I am most appreciative, I say to the 
Senator, and I will try to do it in less than 15 minutes.
  I want to address something that I think is happening around here 
that is very positive. I am not at all sure we are going to get a bill 
this year, but something rather significant is happening, if I 
understand the so-called mainstream group, although I clearly do not 
know enough about their bill to be supportive, and I may not support 
it. But they finally joined with others who have been saying for quite 
some time that, if we pass a bill like the Mitchell bill on the floor 
of the Senate, we are going to leave unattended a huge budget deficit 
that the President of the United States reminded us early on in his 
Presidency, in his first budget submission, that that deficit would 
start going back up and go through the sky at the turn of the century 
unless health care reform caused health care costs to come down. And 
then when they came down, that we used those savings to put on the 
deficit.
  I believe I have been preaching this to the Senate for about 12 
months. I think on the floor of the Senate I have at least three times 
suggested that we are going to saddle our young people, the next and 
the next and the next generation, with a debt beyond anything that is 
responsible if we indeed pass a new health care reform package with new 
entitlements that uses up all of the cost containment savings in 
Medicare and Medicaid and puts all of that on the new program and none 
of it on the deficit.
  It looks like yesterday a group of Senators, Democrat and Republican, 
came to the conclusion, and I am paraphrasing, that it was folly to 
produce a reform package that did not address the deficit along with 
reform of health care. And to the extent that the mainstream group, 
led, I assume, by Senators Chafee and Breaux, are arriving at a 
conclusion that you must put some of the resources that come from 
health care savings on the deficit, I commend them.
  As a matter of fact, it seems to this Senator that a Nation like ours 
that was founded on a principle of no taxation without representation 
ought to stand up and recognize that we are taxing the next and the 
next and the next generation to pay an ever-increasing deficit and they 
are not represented.
  I turn for just a moment to remind the Senate one more time what is 
going to happen if we do not apply some of the savings from health care 
to the deficit, and it is very, very simple.
  The President of the United States said in his first budget and 
vision statement that the budget cuts and taxes that he was proposing 
was the first installment. The second installment would be to provide 
this promise right here, and that would account for all of this orange, 
$307 billion in cost containment from health care going to the deficit.
  Guess what we are doing with the bill on the floor. Every bit of that 
savings and more is being spent. And I rise to once again remind 
Senators that it may be important to have health care reform, but there 
is another important issue and that is to get the deficit at the turn 
of the century under control so that our children and grandchildren 
will not be taxed in a secret way because they are going to have to pay 
for it.
  I think both are big problems. I commend those who are trying to 
solve both of them, even if we take incremental steps to do that.
  Having said that, I want to make a confession to the Senate. I have 
been learning about health care in a rather concerted way for about 8 
or 9 months. And every single new proposal that comes forth that is 
major and supposedly comprehensive, has more problems in it than I ever 
dreamed or learned about in the past 6 or 8 months. I get more and more 
confused about the unintended consequences of what we are proposing to 
do, and I, for myself, have come to the conclusion that not only is the 
Mitchell plan rampant with unintended consequences, but every other 
major bill that I have seen is.
  Let me just give you one example. Mr. President, everybody is worried 
about covering 37 million Americans who are uninsured. According to the 
Congressional Budget Office if the plan pending--which is not going to 
be passed and everybody knows that--if it were passed there would still 
be 14 million uninsured, which means we will have taken care of 23 
million.
  Guess how many Americans we are going to subsidize to get the 23 
million? Sixty-five million. Let me repeat that. The Congressional 
Budget Office says new Americans to be subsidized under the bill 
pending, 65 million will be entitled to it. How many uninsured are we 
going to take care of in this program? Twenty-three million.
  So to cover 23 million we are going to subsidize 65 million. You know 
what that tells me? That tells me we do not know what we are doing. We 
have not yet figured out how to help the uninsured without covering 
more than two times as many with vouchers to buy their insurance and I 
believe we have to make a start in covering those who are poor and 
uninsured. But even the Congressional Budget Office says there is no 
assurance over time that of that 65 million, those who are currently 
insured in whole or in part--and there must be many of them, because 
just do the subtraction, subtract the 27 million that you are going to 
get coverage for from the total number you are giving vouchers to, and 
that is a big number, that is 38 million who have some insurance.

  The Congressional Budget Office is saying there is no assurance that 
you have not produced a plan where many of those who have insurance 
will go without insurance--will go without insurance--because there 
will be a way to figure out that it is cheaper to let the Government do 
it than to have anybody else pay for it. We have to fix that. And you 
start fixing that, and you find another problem.
  So it seems to this Senator, and I believe that nobody can say that I 
am not interested in doing right and staying here and trying to do a 
reform package, but I have come to the conclusion that somehow or 
another the American people got the message right. And this is again no 
aspersion on anyone, but we do not know what we are doing. And when you 
are talking about something this important, you ought not do that.
  Somebody suggested that there are 4 million young people who are 
uninsured and we ought to do something about that.
  Mr. President, it took decades to get where we are. And, on the one 
hand, the greatest health care delivery system developed over those 
decades. Do we need to do something this week, or next week? Can we not 
take one step and do some reform that we understand? And then decide we 
are going to do a better job of trying to understand, learn, and put 
into potential legal, law-written bills things that may really do what 
we want, not what we do not understand or have unintended consequences.
  Mr. DORGAN. Will the Senator yield?
  Mr. DOMENICI. I just want to make one comment with reference to my 
friend from West Virginia, because I do not believe he addressed 
Senator Gramm about Republicans filibustering.
  I want to say this to my friend. I think we ought to be careful when 
we throw that kind of language around. The American people ought to 
know--and if there is any Senator on the other side of the aisle who 
wants to stand up and say, ``We have a bill that can pass the Senate,'' 
then I will stand up and say, ``You make a point.''
  There is no bill that will pass the Senate. How can there be a 
filibuster when the majority party knows they do not have a bill that 
can pass the Senate? And there is none. The mainstream does not have 
one; the Rowland bill has problems. So how can there be a delay of a 
bill when you cannot pass one if you said, ``Let's pass it"? It is 
really not possible.
  So I think we ought to be fair about that. We are learning. The 
American people are learning.
  I think Republicans are acting responsibly. We have not left the 
floor unattended. We are raising very good points. And I, particularly 
from my standpoint, must confess that I learned more about the Mitchell 
bill in the last 5 days, and the more I learn about it, the more 
confused I get, the more certain I am that consequences that we never 
dreamed of are going to result if we dare pass it.
  Then I look at the mainstream, and it changes every other day. And I 
give them great credit. They have worked at it.
  I have now looked at the Rowland bill, which everybody thinks I am 
going to introduce tomorrow. We do not know how much it will cost. The 
CBO has not been able to tell us. We are looking carefully at the 
unintended consequences. I do not think anybody ought to get carried 
away, saying one Senator or one group of Senators is delaying health 
care reform by suggesting that we have not yet come close to a 
consensus and that there is much to be learned before we should pass a 
comprehensive package in this body.
  I close by once again taking a little bit of credit for the new trend 
of being worried about the deficit. I introduced, very quietly, Mr. 
President, the only bill on health care reform--and it is a total, 
comprehensive one, goes very unnoticed, Senate bill 2096. That bill 
provides for a portion of the savings going to the deficit. And I am 
very pleased that after many, many weeks, it has come full circle and 
people now think we ought to be worried about our children, the burden 
they will have of having to pay the deficit off in years to come.
  Mr. DORGAN. Will the Senator yield?
  Mr. DOMENICI. I am pleased to yield to the Senator.
  Mr. DORGAN. The Senator began his discussion, and a thoughtful 
discussion it was, with the background about the Federal deficit. And 
the Senator has been consistent on that subject for a long while.
  I observe that it is interesting, while we talk about health care, 
while we talk about the deficit, this week, on Monday, the Federal 
Reserve Board increased interest rates once again.
  I wonder if the Senator knows--I just had the Joint Committee compile 
for me some information--that, of the five increases in interest rates 
by the Fed in the last 6 months, done in secret, behind closed doors, 
with no thoughtful debate, no public discussion, they have added to 
this Government $110 billion in deficits; that is, they have added $110 
billion to the cost of servicing the debt.
  So, in effect, they have taken back one-fifth of everything we did 
last year in the $550 billion plan to try to reduce the debt. And they 
did it without any public debate, behind closed doors, in secret.
  I just say that I would hope one of these days, those of us who care 
about the deficit and talk about it can have a thoughtful debate about 
Fed policy, because they are contributing to this deficit, in my 
judgment, with wrongheaded monetary policies.
  I just wanted to raise that point and ask if the Senator understands 
how much the five Fed increases are costing the Federal Government.
  Mr. DOMENICI. Yes, indeed.
  Mr. President, how much time do I have remaining?
  The PRESIDING OFFICER. The Senator has 3 minutes remaining.
  Mr. DOMENICI. Senator, I appreciate the Senator raising the question.
  Frankly, I happen to disagree with the Senator; other than I agree 
that we are paying more interest on the national debt because interest 
rates have gone up.
  Mr. DORGAN. By over $100 billion between now and the next 5 years.
  Mr. DOMENICI. I have not checked it out.
  Mr. DORGAN. $110 billion in the next 5 years.
  Mr. DOMENICI. But, Mr. President, let me suggest that if, in fact, 
because the Federal Reserve Board worried about inflation, if they have 
succeeded by attempting to move the cost of interest rates from the 
Federal Reserve to be neutral with reference to the rest of interest so 
that we are not in a subsidized position with reference to the Federal 
Reserve Board, if they have succeeded, and that is their goal, then 
they might also succeed in extending this recovery, let me just 
hypothetically say, 2 additional years.
  I happen to believe what they are doing is going to extend the 
recovery and make it last longer. If they were to be successful at 
that--and they are trying desperately to do that, because we have a 
cycle of recoveries in growth and then we fall off and have a 
recession; they want it to last a couple more years--if they have 
succeeded, then that $100 billion that is being spoken of will pale in 
comparison to the positive things that will happen to the American 
economy to sustain jobs and to grow.
  Second, I absolutely believe and will spend any time I have defeating 
any proposal that takes this power away from the Federal Reserve Board 
and that makes their discussions be open rather than closed.
  Frankly, I do not think we ought to put politics into the interest 
rates system determined by our Federal Reserve Board Commissioners. I 
think, over time, that has been the strongest instrument for solid 
money in the United States, without which we would not be the country 
that we are.
  And, having said that, I want to close my remarks by thanking Senator 
Harkin for yielding time to me.
  I firmly believe this has been a great educational process for 
Senators. That may sound strange. Hopefully, the American people have 
appreciated the debate. It seems to me, from my calls, they, too, are 
learning and they are moving in the direction of do not take too big a 
bite, because you do not know exactly how it is going to turn out. Go 
slow.
  I agree with that, and I agree with them.
  I yield the floor.
  The PRESIDING OFFICER. Under the unanimous-consent agreement, the 
Senator from Iowa [Mr. Harkin] is recognized.
  Mr. HARKIN. Mr. President, I want to speak about the amendment that I 
have just proposed, the extra contractual service option of the 
flexible options plan.
  Before I do so, I just wanted to respond to what the Senator from New 
Mexico said about we do not have a bill or anything around here that 
can pass.
  Well, how do we know? We have not taken any votes on the major 
provisions in the bill yet. That is supposition on his part.
  Senator Mitchell introduced his bill, if I am not mistaken, over 3\1/
2\ weeks ago, and we have not had a vote on it. I would like to see us 
have a vote.
  It is not because we have not been ready to vote. We have been ready 
to vote. The other side has not been ready to vote. So when people say 
we do not have a bill that can pass around here, that is just 
supposition on their part. I think we ought to bring up the amendments, 
let us have a reasonable debate on them, and then let us vote on final 
passage of a bill, whatever we can come up with in our efforts to 
design a bill around here. That is the way to do it.
  I hope we can get on with the amending process. The procedure under 
which we are operating this week we have one amendment every day. At 
that rate we might be finished by some time in the next couple of 
years.
  So when people on the other side say they are not filibustering, 
there is a filibuster and then there is a filibuster. There is a 
filibuster when you talk and talk and talk and then there is a 
filibuster where you keep adding amendments and adding amendments and 
adding amendments and slow everything down. So I hope that is not the 
case on the other side. I hope we can have our amendments and move on 
with getting this passed.
  Having said that, the amendment I have offered gives the plans the 
option of providing, with the enrollee's consent, items and services 
that are not listed in the standard benefits package but which the plan 
determines to be the most cost-effective way to provide appropriate 
treatment to the enrollee.
  For example, under such a provision, Aetna was able to help an 
Oklahoma boy after a car accident left him with quadriplegia and 
dependent on a respirator. The boy lived for 4 years at the local 
children's hospital. Finally, after planning and thinking creatively 
with the boy's family, Aetna was able to maintain cost-efficient 
quality care and bring the boy back home. Aetna agreed--listen to 
this--they agreed to pay for a customized addition to be built on to 
his mother's mobile home. They purchased specialized equipment, they 
provided for home nursing care. So the boy was reunited with his 
family, outside of the hospital, and guess what, the plan was able to 
save about $350 a day even after equipment and supplies were purchased 
and nursing care was arranged.
  My amendment would not require plans to offer the benefit. And 
enrollees are not required to accept it. Moreover, a decision not to 
offer the benefit is not subject to any appeals, other than those based 
on discrimination. Because this optional benefit is made available only 
when it is cost effective to do so, there is no additional cost to the 
guaranteed benefit package associated with the benefit, and the Budget 
Committee assessment confirms that.
  This amendment allows for win-win situations to take place. When a 
health plan decides within its discretion to offer a service and a 
consumer decides within his or her discretion to accept it, this 
amendment allows for that to occur. The extra contractual services 
option is currently made available by all Federal health plans open to 
Federal employees.
  It allows for greater flexibility for plans and enrollees and is 
modeled on a practice by many large insurers today. The idea is that 
for some enrollees, particularly with high health costs over a 
particularly long period of time, it is cost effective for plans to pay 
for a case manager to work with the enrollee or the enrollee's family 
to determine what combination of items and services would be most cost 
effective for the enrollee. The case manager is empowered to authorize 
payments for items and services that fall outside the scope of the 
package for which the plan is contractually obligated to provide 
coverage--hence the name ``extra contractual services.''
  This amendment will call attention to this beneficial practice so 
more people will know about it as a possibility. Although it is widely 
available in the private market today, not all people who might benefit 
from it are familiar with it.
  Second, some have questioned whether these services if offered would 
be considered part of the standard benefits package or would be part of 
a supplemental plan under the Mitchell bill. This amendment clarifies 
that flexible, cost-effective practices may continue as part of any 
standard benefits package.
  Third, extracontractual services have enabled parents of children 
with disabilities and adults with disabilities to play a larger role in 
managing their care, working with plans to meet their health needs in 
the most cost-effective manner. So this amendment is most significant 
for people with disabilities and people with chronic conditions. Just a 
few examples.
  Julie Beckett, a mother from Iowa who testified this year before the 
Labor and Human Resources Committee on health reform and disability was 
able to convince the medical director of Blue Cross-Blue Shield to 
create an individualized case management program for children in Iowa. 
Julie's 16-year-old daughter Katie Beckett, who daily requires 12 to 14 
hours of continual ventilator support attached to her tracheotomy tube 
she has had since she was 5 months of age, has been receiving 
extracontractual services which keep her out of the hospital, let her 
go to school, at a reduced home care cost.
  Blue Cross-Blue Shield of Iowa even did a brochure on what they 
called individual case management for patients with special long-term 
needs. In it, they explain the plan case manager can help with family 
support, home health care programs, respite support, emergency support, 
and equipment vendors.
  I have a lot of different examples here of people who have had these 
extracontractual services who were brought home, placed in home care, 
and actually saved the plan money.
  In Pennsylvania--I might use just one more example--a 30-year-old 
mother of two had problems early in her pregnancy. She was admitted to 
a hospital twice within a week at a total cost of $3,700. At home she 
was unable to comply with the doctor's order for total rest because she 
had to care for her two preschool children, one of whom has a 
disability and must be carried.
  The plan provided benefits for homemaker services at a cost of $578 a 
week. The patient was able to avoid hospitalization, remain at home, 
and get the rest she needed. As a result, she delivered a full-term, 
healthy baby. The estimated savings were close to $70,000.
  So, these extracontractual services could be used in a whole host of 
different situations. The plan might decide to provide medical foods 
not covered under the outpatient prescription drug program which could 
have a significant impact on the containment of costs in the treatment 
of AIDS and cancer and other diseases.
  In summary, this benefit is a win-win situation. It gives plans the 
flexibility to go beyond the basic benefits package when it is cost 
effective to do so. It preserves the right of individuals, the 
individual enrollees and their families, to refuse any proposed item or 
service and gives them more control over the situation. It lets them 
decide what is best for their families. It will give greater visibility 
to a practice that is increasingly common in the private market today 
and it will clarify that this is to be a part of the standard benefits 
package and not a part of a supplemental package.
  I also want to take just a few more minutes after explaining the 
amendment and what it does, to make a few remarks regarding the 
Mitchell bill's standard benefits package and its impact on people with 
disabilities in our society. Clearly, the Mitchell bill contains other 
essential provisions that will benefit the disability community, such 
as the new home and community-based long-term care program and consumer 
protections. I will discuss these provisions at another time.
  I think people with disabilities are the best measure of whether 
health reform will meet the needs of American people. If we pass a bill 
that works for Americans with disabilities, then we know it is going to 
work for everyone.
  Three weeks ago we celebrated the fourth anniversary of the Americans 
With Disabilities Act, which sets forth our national disability policy. 
But we will not achieve the ADA's promise of inclusion, empowerment, 
and independence for people with disabilities without comprehensive 
health reform that addresses the failings of the current system.
  Under the current system, people with disabilities and parents of 
children with disabilities cannot afford to leave jobs or exit the 
welfare system because of the preexisting condition exclusions, because 
of the lack of portability of coverage and benefits, because of work 
disincentives. The cost of private insurance is often prohibitive 
because of adverse selection and a failure to spread risk broadly 
throughout the community. Many people reach lifetime caps on benefits 
in only a few years and high out-of-pocket expenses have forced people 
into poverty and into welfare, simply because they are disabled.
  Moreover, for those that have insurance, there are often problems 
with limited coverage. Some plans exclude or significantly limit 
essential benefits like durable medical equipment, outpatient 
rehabilitation services, mental health services, and hearing aids.
  The Mitchell bill benefits package represents a package that will 
ensure access for people with disabilities. It maintains a balance 
between a sufficient level of description to ensure that the benefits 
will address the needs of all people, including those with 
disabilities, and enough discretion for the National Health Benefits 
Board to make clarifications about the details of what will be included 
under each category set out in the bill.
  The Mitchell bill reflects an understanding that a truly 
comprehensive package will have preventive value for many individuals. 
If we spend money on services like outpatient rehabilitation services, 
hearing aids, prenatal care, and other clinical preventive services, we 
will avert the need for costly operations and other societal costs 
associated with unnecessary dependence and unnecessary illnesses.
  The Mitchell bill's standard benefits package reflects our desire to 
invest in promoting and maintaining the health of all Americans, and I 
am particularly pleased that the Mitchell bill includes coverage for 
children born with congenital disabilities, prohibiting limitations on 
coverage. The Mitchell bill further establishes as a goal the 
maximizing of functional potential of children from an early age. So I 
strongly support the standard benefits package as contained in the 
Mitchell bill.
  Senators Kennedy and Daschle made some good points on Wednesday about 
the need for a standard benefits package that bear repeating.
  As I see it, there are five essential reasons for a standard benefits 
package.
  First, it provides a floor of basic coverage for working Americans. 
Without it, we leave consumers subject to fine-print limitations and 
loopholes that people only learn about after they get sick.
  Second, the standard package prevents the kind of cost shifting that 
goes on in the market today. A standard package spreads costs more 
evenly.
  Third, the standard package promotes consumer choice, ensuring that 
working Americans will not be arbitrarily limited to whatever coverage 
their employers choose.
  Fourth, the standard package makes it easy for the consumer to 
compare plans, for plans competing based on price and quality and not 
on scope of coverage.
  Finally, the standard package prevents cherry-picking, so-called, 
where plans can structure their benefits packages in a way that 
attracts healthy people and discourages high-risk individuals, like 
people with disabilities and chronic illnesses, from enrolling.
  Mr. President, a standard benefits package must provide a solid 
foundation, and that is why we need a standard benefits package. I 
often hear that we do not need a standards benefits package, the 
arguments made by the Senator from Texas earlier and others. But I 
believe that it is an appropriate role for Government to set standards 
for products that will affect people's health and well-being.
  Would those on the other side of the aisle want to do away with the 
Food and Drug Administration, for example? I think consumers have every 
right to feel that when they go into a grocery store to buy food they 
are going to be protected, that the food is safe; or when they buy 
drugs that they are safe; or when they drive a car that somehow the car 
is going to be safe, it is going to meet certain requirements of 
safety. When you buy a child safety seat, you want to know that it is 
safe and effective.
  Why should consumers expect anything less of health insurance? Why 
should consumers not have every reason to believe the package they get 
for health insurance will meet their expectation and that it will cover 
their health and well-being; that it will have a standard set of 
benefits on which they can rely, rather than finding out later that the 
fine print left them out?
  So, again, the standard benefits package is the foundation.
  The opponents argue that a standard package makes people buy 
insurance for things they do not likely need. We hear that a lot of 
times. The senior Senator from Texas, and I quote from his statement 2 
days ago, said:

       Under the Mitchell bill, the Government will tell you what 
     has to be your insurance. If you are a 64-year-old widower, 
     the Government is going to tell you what coverage you will 
     have to carry in your insurance policy. You will have to pay 
     for pregnancy services and for newborn services.

  That is what the Senator from Texas said the other day. You hear that 
and right away you think, ``Well, that sounds logical, doesn't it? Why 
should a 64-year-old have to buy insurance that covers pregnancy-
related services and maternal child health care?''
  Mr. President, in Social Security today, that 65-year-old widower is 
probably on Social Security and young people today pay into Social 
Security to help make sure that our elderly are not forced into poverty 
and forced into welfare. We accept that, because it is good for 
society. So why should a 65-year-old not buy that kind of insurance 
that may help out our young people? The fact is, we spread the risk 
throughout society.
  To say that you should only buy insurance for things that you need is 
very shortsighted. You do not know what you need. Like Forrest Gump's 
mother told him, ``Life is like a box of chocolates; you never know 
what you're gonna get.''
  We cannot predict when one of our family members may get cancer, 
leukemia, have a heart attack, or sustain a head injury. It can happen 
to anyone. So what is the purpose of insurance? What do we mean by 
health security? What it means is we want to know that, whatever 
happens, we are going to be covered--meaningful coverage, guaranteed 
protection, security for the unexpected. That is what insurance is all 
about.
  When we purchase health insurance, we should get a standard package 
of benefits that will cover the range of needs we may have although we 
do not expect to need them. We might even use another example.
  We could say how about a young couple, just got married. He is a 
football player, she is an Olympic swimmer. They are in great health. 
They get married and decide to go to graduate school. And so they look 
at the package of health insurance they want to get. No. 1, they are 
not going to have any children right away, so ``we don't need 
pregnancy-related services which costs a lot; we won't take that. We 
won't take the package that says it covers chronic conditions because, 
obviously, we are very healthy and we don't need that kind of 
coverage.''
  So they carve it all out and they get a minimal health benefits 
package which does not cost them very much, and they think they are 
covered.
  Lo and behold, the wife gets pregnant. She has a difficult pregnancy. 
They have a child that is born with a disability, spina bifida, and 
they do not have health insurance coverage. Who pays for it?
  Well, we are all going to wind up paying for it because we are not 
going to say to that young baby, ``Go out and die.'' So we are going to 
pay for it, and we are going to pay for it in the least cost-effective 
manner. And that young couple who thought they were getting away with 
something has put their entire future in jeopardy. And, when they can't 
pay their bills, the burden falls on the rest of society.
  So that is why we need a standard benefits package and why we spread 
risk throughout society.
  I would say to any 64-year-old, yes, part of your health benefits 
package ought to include something for young people because young 
people are helping to provide for you in your old age through Social 
Security and through Medicare Part B.
  So we need this standard package to include preventive services and 
to make sure that it is comprehensive. We ought to make sure we have it 
because it provides people more choices and not less.
  That is another thing we hear a lot. People on the other side say, 
``We want to provide choices.'' A standard benefits package provides 
more choices, because without a standard package, an employer can go 
out and pick any health plan he wants and offer it to his employees. 
The employees are stuck with whatever the employer offers, even if it 
does not come close to meeting their needs. That is no choice.
  Take the example of outpatient rehabilitation services. Under the 
Mitchell bill, every plan will offer it as a part of the standard 
benefits package. It is part of the foundation you can count on. You 
may not think you will ever need it.
  Without a standard benefits package like the one in the Mitchell 
bill, if you have a child with a congenital disability who needs 
outpatient rehab services, you will just have to roll the dice and hope 
that your plan covers it.
  In my capacity as chairman of the Subcommittee on Disability Policy, 
I have learned how critical this benefit can be, particularly for 
children born with congenital disabilities.
  We had a hearing in February where a mother testified about the 
difference that occupational therapy, speech therapy, and physical 
therapy had made in her son's life, and contrasted this experience with 
that of another boy with the same disability who did not receive the 
therapy.
  The first boy, born with cerebral palsy and diagnosed at 9 months, 
received physical and occupational therapy to relax his tight muscles. 
He received speech therapy to teach him how to eat and help him find a 
way to communicate. As a result of this therapy, he did not develop 
contractions or severe shortening of his muscles, and avoided 
dislocations. He made steady progress for 7 years, and finally he was 
able to take his first steps. Last fall, he walked down the aisle as a 
ring bearer at his aunt's wedding, a tremendous accomplishment for him. 
He continues to make progress and has the potential to become a 
functioning, productive adult who can contribute to his own support. 
That is boy No. 1.
  The second boy, also born with cerebral palsy, never received the 
needed therapy services. They were not covered. His arms are 
contracted; his fingers are deformed; he cannot bend his hips to sit. 
They are twisted as a result of a dislocation that was corrected by 
surgery and a metal plate. His head is nearly permanently thrown back. 
He has many expensive surgeries ahead of him, not to improve his 
condition so much as to slow down the effects of these contractions. 
Eventually, his mother may find it necessary to put him in an 
institution. So you ask, what kind of choice did that mother have?

  Imagine being a new parent of an infant with cerebral palsy and 
sitting down with the doctor for the first time. The doctor says to 
you, ``Your daughter has cerebral palsy. If she gets enough 
occupational therapy and physical therapy and speech therapy from this 
point on she can do pretty well. Unfortunately, your insurance does not 
cover any of this.'' Weekly therapy is very expensive. How are you 
going to pay for it?
  Well, they will not pay for it, and later on that child would be 
unnecessarily dependent, and we will pay more and more money later on.
  So if we allow plans that do not cover, for example, outpatient 
rehabilitation for children with congenital disabilities, we are going 
to force families who are struggling to care for their children at home 
to go it alone and, sure enough, later on that child more than likely 
will wind up needing more intensive care that will cost more for 
everyone.
  Well, that is not right. It is not right for that family, and it is 
not right for the rest of the people of this country. It is not right 
for that child born with cerebral palsy. It is not the American way of 
doing things.
  If we just provide a list of categories to be covered as many have 
suggested, some policies will cover outpatient rehab and some will not. 
And people will not realize the importance of having this benefit until 
they need it, and then it will be too late.
  Hearing aids for children is another good example. Under the Mitchell 
bill, they're part of the foundation. If your child needs hearing aids 
during the crucial window of opportunity for language development, 
you're covered. Without a standard package, you're on your own. This 
makes no sense.
  The critical years in which speech and language develop are 0 to 6. 
By age 5, the child with normal hearing understands 5,000 to 25,000 
words . For a child who needs hearing aids, and does not have them, 
this speech and language acquisition window of opportunity is lost. 
Having failed to make this investment, we all pay down the road in 
special education, compensatory education, and other costs associated 
with educating the child and preparing him for employment.
  Mr. President, I take the time to talk about these examples, and I 
will talk about them more next week and however long we are on the 
health care reform bill because, more and more, we are hearing that we 
do not need a standard benefits package; it does not need to be 
delineated and clarified.
  I use these examples to point out why it is necessary and why we have 
to have a standard benefits package, because if we do not, too many 
people who cannot or will not read the fine print are going to find out 
too late that their choices are limited. They may have one choice and 
one choice only, that is, either to pay it out of pocket, if they are 
rich enough to afford it, or, if they are not, then not get the needed 
services, which are going to create higher costs later on. Of course, 
the third option will be to spend all of their lifetime assets and go 
on welfare and then they will be able to get the coverage they need.
  So, Mr. President, those are the ramifications of the amendment that 
I offer, to ensure that it is part of the standard benefits package 
that an enrollee and a plan concurring together can go outside the plan 
for extra contractual services if the enrollee and the enrollee's 
family feels that is the best thing to do and if it is cost effective.
  However, that will mean nothing and this amendment will mean nothing 
if we do not have a standard benefits package. If we do not have a 
standard benefits package, then, Mr. President, people with 
disabilities in this country will continue to be discriminated against 
and they will not be a part of any health care reform package that 
passes this body.
  I understand we are just going to have a voice vote on this 
amendment. I am glad to hear that the other side and others have agreed 
to accept this. But again I point out that as much support as this 
amendment seems to have on both sides of the aisle, it will mean 
nothing if we do not have a standard benefits package along the lines 
of the Mitchell plan. So I will be coming back to this theme time and 
time again in the future.
  I appreciate the indulgence of my colleagues, but here is an issue I 
have been waiting all week to talk about.
  Mr. President, I would now yield the floor.
  The PRESIDING OFFICER. Under the previous unanimous-consent 
agreement, the Chair recognizes the Senator from Illinois [Ms. Moseley-
Braun].
  Ms. MOSELEY-BRAUN. I thank the Chair. I would like to begin by 
congratulating my colleague, the Senator from Iowa, for this amendment 
and congratulating the Senator on work on behalf of people with 
disabilities over time. This amendment affects a number of important 
goals allowing people choice, allowing people access to the system, and 
at the same time affecting what probably will be some real cost 
containment in the way the system operates. I commend the Senator from 
Iowa for his work in this area.
  Mr. SARBANES. Will the Senator yield to me just briefly?
  Ms. MOSELEY-BRAUN. Certainly.
  Mr. SARBANES. I would like to join the Senator from Illinois in 
commending very strongly the able Senator from Iowa for this amendment 
and for a very sensitive statement about the need for the amendment.
  I really say to the American people, one has to think about it with 
the attitude of, there but for the grace of God go I. Most people 
assume that this will not happen to them, and they need to understand 
that it may. It is all chance. It is fortuitous. But if you are a 
family that has a cerebral palsy child or one of these other disability 
problems and the whole burden of that comes down upon you, there is a 
tremendous psychological burden. But the financial burden at least 
ought to be borne in a way that the costs of that are spread through 
the society on the basis of an insurance principle which is what the 
Senator is, in effect, seeking to guarantee. People, as they think 
about it, have to think to themselves, well, it could happen to me, and 
therefore we ought to provide for it so whoever it happens to is not 
caught completely exposed and has to bear all of the burden of this 
individually.
  I thank the Senator for his contribution.
  Mr. HARKIN. I thank the Senator.
  Mr. SARBANES. I thank the Senator for yielding.
  Ms. MOSELEY-BRAUN. Certainly. The point of the Senator from Maryland 
is very well taken. We are, indeed, all in this together, and that is 
why this debate is so very important.
  Mr. President, in Illinois where I live, in Chicago, there is a 
fellow by the name of Mike Royko, and we consider him to the sage of 
Chicago politics. He was written facetiously, I might add, on occasion 
that the motto for the city of Chicago, which is presently and has been 
since the turn of the century ``urbs in horto''--``urbs in horto'' 
means ``city in a garden,'' and I would commend to anybody listening, 
Chicago is a very beautiful city, particularly in the spring and 
summertime and lives up to the name ``city in a garden.'' But Mike 
Royko has suggested that the term ``urbs in horto'' ought to be changed 
to a more explicit ``ubi est mea,'' which translates into ``where is 
mine?'' He thinks that is really the driving force behind 
decisionmaking and policymaking. And policy and ``ubi est mea,'' 
``where is mine,'' has a lot to say about what goes on and how 
decisions get made.
  Mr. President, I might suggest that it may well be the case in this 
current debate about health care reform that ``ubi est mea'' is playing 
entirely too large a role, that the drumbeat of the public interest in 
this, the interest that the Senator from Maryland talked about, is 
being drowned out in the cacophony of special interests.
  The message that created a groundswell of support for the President's 
efforts to reform health care is in danger frankly of being outshouted 
by the special interests and very often, Mr. President, they are thinly 
disguised but they are special interests notwithstanding.
  I would ask anybody who listens to the debate ask yourself, Who is 
paying for all these expensive ads on the television, in the newspapers 
that are saying we should just stop trying to reform this health care 
system?
  Right now, Mr. President, the American people are confused by the 
mixed messages and the conflicting signals and the images and the 
debate back and forth, and this certainly is a big enough issue that 
lends itself to what I have previously called the thousand points of 
fright that are being put out into the public debate, the thousand 
points of fright representing, Mr. President, the negative messages 
that punch all the buttons of fear that are out there. You hear people 
railing about--and I happened to be in the Chamber listening to an 
eloquent speech. The speeches sometimes can hit all the right buttons 
and all the right fears, and they are very slick and they are very 
smart, and they are thought out well in advance. But the fact is those 
negative messages are punching those fears of ubi est mea. I think it 
is a disguised way of speaking for the special interests, and not being 
as concerned as the Senator from Iowa, the Senator from Maryland, and 
others who worked on this issue about what does this mean for all of us 
as Americans. Those buttons appear; they are going to take away your 
freedom--a thousand points of fright--they are going to have Government 
control; big Government is going to take this over; it is going to mean 
higher taxes.

  Mr. President, I say--and I think a number of people on this floor 
are willing to say--that the only way to combat fear is to stand up to 
it and to talk about it and to expose it and to continue to punch away 
so that the essential messages and the truth win out. For that reason, 
I am especially grateful for those people who have led the fight and 
the debate in regard to health care reform.
  I congratulate the Senator from Massachusetts for his hard work and 
dedication and for the hours he has spent on the floor combating those 
thousands points of fright. The Senator from South Dakota has done so 
much work here, as has Senator Rockefeller from West Virginia and 
Senator Moynihan from New York, and Senator Mitchell for his bill that 
we are talking about at the present time. These are the people who have 
weighed in to take on the button pushers and to take on the thousand 
points of fright and say there is more to this debate than ubi est 
mea--where is mine--and this goes to the future of our country.
  The American people sent us the right message at the outset, which is 
to control costs and provide access to health care. That is a message 
that I think should guide our work now. The people, as far as I can 
determine, are confused as to what they want to have done. The real 
source of confusion is here in Washington as to how to do it. Going 
back to the basic principles, I believe that means we cannot accept 
minor tinkering with what we have now that maintains the status quo, 
protects special interests; nor can we rush to judgment and implement a 
poorly thought out change that reduces access or increases our deficit.
  Many people say comprehensive reform will produce scenarios that one 
cannot predict, and that there may be unintended consequences of the 
bill we are considering. Let us take a moment and look at the present 
system, look at what we have now, the status quo, in terms of its 
effect not just on our country, but on everybody. Everybody who has 
spoken here admits that national health care costs have grown at a 
dizzying pace.
  In 1960, the United States spent $27.2 billion on health care. By 
1980, that figure had increased almost tenfold, to $250 billion. In 
1990, we spent $675 billion, and the Congressional Budget Office 
estimates that in the year 2003--which sounds like a long way off, but 
really is just around the corner--unless something happens to change 
the trend we are on now, we will spend $2 trillion. Looking at the 
figures another way, in 1990, we devoted 12.2 percent of our total 
economic resources to health care. By 1993, that figure had increased 
to 14.6 percent.
  Again, by the year 2003, unless the current trends change, health 
care costs will consume fully 20 percent of our national economic 
resources. Government health care spending contributes a large chunk of 
those expenditures. Between 1981 and 1993, for Medicare and Medicaid, 
the Government programs, spending increased by 113 percent. Health care 
spending was 16 percent of our Federal budget in 1980. It was 27 
percent last year. By 1998, health care costs alone will account for 
some 35 percent of the Federal budget.
  Mr. President, as I mentioned in a previous discussion, I serve on 
the bipartisan Commission on Entitlements and Tax Reform. The findings 
of that Commission state:

       Federal spending on Medicare and Medicaid is projected to 
     triple as a percentage of the economy by 2030. Federal health 
     care spending is projected to increase from 3.3 percent of 
     the economy today to 11 percent of the economy by that time.

  The private sector, private business sector, has also been hard hit 
by rising health care costs. Fewer businesses are able to afford 
comprehensive health care coverage for their employees. An article 
yesterday in the Chicago Tribune noted that more than 3.5 million 
children lost health care insurance coverage under their parents' 
employer-paid plan from 1987 to 1992. The average cost of providing 
health insurance coverage for employers increased more than 100 percent 
between 1984 and 1992. The average cost per employee was about $1,600 
in 1984, and it rose to almost $4,000 per employee by 1992. Between 
1987 and 1992, the average premium for health benefits for a single 
employee rose by 108 percent, or on average, 16 percent per year.
  In 1991, health insurance premiums were about 10.7 percent of 
business payroll. In the year 2000, that figure is expected to increase 
to 22.9 percent of payroll. And the cost growth has been even worse for 
small businesses. Their premiums have increased by as much as 50 
percent a year. Small businesses already pay 35 to 50 percent more than 
large businesses for the same coverage and that, of course, puts real 
pressure on what should be one of the most vital parts of our economy.
  Small businesses also bear the brunt of the cost shifting that is in 
this current ``Rube Goldberg'' of a nonsystem that we have. If you 
think about it, Mr. President, everybody in this country gets health 
care. If somebody gets sick or falls out in the middle of the street, 
whether they have insurance or not, they are going to get taken care 
of. The question becomes: How does that person get paid for? Well, the 
answers are too clear to everybody who is paying attention or knows 
somebody, and I think there is not a person around who does not know 
somebody who has not had a health care crisis.
  So health care costs continue to be the single largest reason for 
personal bankruptcies in this country, and if there is no access left, 
the cost is shifted to somebody else. As a result, and I am talking 
specifically about small business, small businesses now pay 33 percent 
more for insurance just because those who are providing insurance for 
their people are paying for those who are not providing insurance for 
their people.
  Mr. President, again, I do not want to start off painting a horror 
story. This is reality. This is not catch phrases and code words. This 
is what is. The group that is suffering the most from the 
inefficiencies of the current nonsystem are average working Americans, 
the families and the workers, the constituents we hear from every day. 
Health care is just plain unaffordable for millions of Americans, and 
it is only going to get worse if we do not do our job to reform the 
system.
  Right now, per capita health care costs, based on current trends, is 
estimated to double between 1993 and the year 2003. We spent roughly 
$3,500 for every man, woman, and child in this country on health care 
last year. By the year 2003, the figure will be $7,000 for every man, 
woman, and child in this country for health care.
  These rapid cost increases are coming at a particularly bad time for 
working Americans. Over the past 20 years, worker wages, in real terms, 
have actually fallen, while the health care costs were increasing at 10 
to 15 percent per year. If health care inflation continues as 
projected, workers stand to lose another $600 per year in real wages by 
the year 2000. Americans who have employer-provided insurance coverage 
find themselves paying for a greater and greater percentage of that 
coverage out of their pockets.
  In 1988, for example, workers paid an average of $48 a month, or 
roughly 24 percent of the total average premium. By 1991, however, just 
3 years later, the average employee contribution had more than doubled, 
to $98 per month, or 28 percent of the total average premium. Mr. 
President, I say that trend is continuing unabated.
  (Mrs. MURRAY assumed the chair.)
  Ms. MOSELEY-BRAUN. Madam President, in 1965 Americans with average 
incomes had to work--and I found this to be an interesting statistic 
and I wanted to give these figures just again to paint the picture of 
what we have now to deal with. In 1965 Americans with average incomes 
had to work about 3.3 weeks--I do not know how they figured out .3, 
whether 2 days or 3 days--3.3 weeks to pay for health care. It took 
about 6.6 percent of their total earnings. By 1990 workers had to work 
5.5 weeks or 5\1/2\ weeks or pay 10 percent of their earnings just to 
pay for health care costs. And by the year 2003, again if current 
trends continue, they will be working 10 weeks to pay for health care 
and pay 20 percent of their total earnings for health care services.
  Madam President, the net result of these cost trends are that people 
are losing coverage and losing choice. In 1988, 9 out of 10 employers 
offered health care plans that let their employees choose any doctor or 
any provider of services that they wanted. By 1993, only 6 out of 10 
employers offered that option.
  All of these cost trends together have a major impact on the vitality 
of our country and the viability of our future economy, and therein 
lies the real rub in all of this. The impact of rising health care 
costs is not just felt by working people or even their employers or the 
Government. It hurts our economy. It hurts our international 
competitiveness. It hurts our economic future.
  I want to talk about where we are in this global economy and how this 
issue threatens our position in the world.
  In 1991, Madam President, per capita income in the United States was 
$22,240; in Sweden it was $25,110; in Canada it was $20,400; and in 
France it was $20,380. Yet the United States' per capita health 
spending was over a third higher than in France or in Canada and over 
$400 per person higher than in Sweden.
  That kind of cost differential has a real impact on our 
competitiveness in this new global economy. Rising health care costs in 
the United States also contribute to a falling national savings rate. 
As the bipartisan commission, which I mentioned, has found, since the 
1960's private savings have fallen from more than 8 percent to about 5 
percent of our economy, and the supply of savings available for private 
investment has fallen to about 2 percent today--2 percent, Madam 
President. What that means is that that is going to restrict, and the 
bipartisan commission found that this will restrict, our ability to be 
productive, will restrict our productivity and our growth as an 
economy.
  Clearly, Madam President, cost containment is in order. Had we gotten 
some rationality in the system in the past we could have realized 
significant savings already.
  For example, if health care costs had been kept under control in the 
last 12 years, that is, growing no faster than the economy was growing, 
the Federal Government alone would have saved some $79 billion in 1992 
and would have saved a total of $391 billion over that 12-year period.
  And if health care costs had been kept under control in the last 12 
years, personal wages for American workers would not have declined--
would not have declined--and the average working family, and I want to 
underscore this, the average working family would have saved $12,000.
  Now, I think that paints a picture again, not painting a dismal 
picture to frighten anybody because these are realities. People know 
this already. This is not news to anybody. And quite frankly, to go out 
and suggest to people that there is no crisis and we can just go home, 
go on vacation, have a good time, and come back when we get good and 
ready borders, in my opinion, on the irresponsible.
  Madam President, if we do nothing--if we do nothing--we will 
effectively rob our children and our children's children of their 
future, and if we do nothing there will be no money around for us to 
spend in terms of discretionary spending. There will be no money around 
to spend on education, to fight crime, for community infrastructure, or 
for building the industries of the future.
  After all, Madam President, this debate is not a new one. I mean, 
this has been with us. People have seen the handwriting on the wall 
with this debate for a long time. In the seventies, the eighties, since 
Nixon was in office, we tried the regulatory approach. We have tried 
competitive market-based approaches, and, quite frankly, none of those 
approaches have worked very well. Certainly they have not fixed the 
problem. That is why it is so important that we do what this Congress 
is trying to do.
  Madam President, I have my own bias, and I say it for the world, and 
I do not think any colleagues are surprised by it. I have supported and 
continue to support the single-payer system. Quite frankly, it is like 
the old song ``I am looking over the four-leaf clover that I overlooked 
before.''
  The fact of the matter is the single-payer system is the simplest and 
saves the most money and to me that makes sense in terms of achieving 
the goals we are setting out to achieve.
  I would mention, by the way, that yesterday morning--in fact, Senator 
Simon and I have a town meeting every Thursday morning for people from 
Illinois who just want to come to the Capitol and talk about issues. 
And at the town meeting we had a lady who described herself as an 
American who lived in Canada for 30 years. She said: ``I do not 
understand what all this confusion is about. I have been in Canada for 
30 years, and we think our health system is great. So, what is the 
problem?''
  Well, it would have taken too many words, frankly, to explain to her 
what the problem was at the time, but I will submit to you that the 
single-payer system does make the most sense, and for the record, just 
again to combat some of the drumbeat that is out there, single payer is 
not synonymous with Government run. Health services would remain 
largely private, as they are today. All Americans would be covered. The 
major change would be that the financing system would be much simpler 
and much more efficient. There would be financing co-op, if you will, 
and you could choose whatever health plan option meets your needs, but 
instead of your employer or insurance company footing the bill, the co-
op would pay it.
  In terms of savings, the single-payer system beats every other plan 
that has been scored to date by the CBO. In fact, it is estimated that 
the single-payer system would achieve $300 billion in savings over 5 
years.
  So, I just add that to the debate. It has kind of been lost in the 
context of this debate. I point out that there is a little vestige of 
it cropping up. You heard a lot of conversation on this floor about the 
Federal Employees Health Benefit Plan, and, quite frankly, if you think 
about it, if you took the FEHBP and expanded it to everyone, take what 
we have here in Congress now, what we Federal employees have in 
Congress now and expand it to every American, what you have would be 
single payer.
  So, I just put that out there for purposes of discussion, because I 
really would like to talk about what we have before us, which is 
Senator Mitchell's plan, and the plans that have been filed as 
legislative initiatives with this Congress.
  Again, I applaud and congratulate those who have worked to get us 
this far because, quite frankly, in my opinion, Senator Mitchell has 
done a Solomonesque job in reconciling all the competing interests and 
forces and people who have different views about how we should approach 
this issue.
  Madam President, the only way, I think, to make positive change in 
our system and ease the burden of the current health care costs is to 
recognize and examine the realities of our present system.
  First, I think people need to have information about what health care 
costs. Most consumers make health care decisions without regard to cost 
because, quite frankly, the majority of health care bills are paid by 
third-party payers. I think we have all gone through the situation in 
which you get back the bill from your insurance company and you see the 
bottom line and you are shocked enough with the part you have to pay, 
but when you see how much the insurance company has to pay, you go ``I 
stuck that bullet" because the health care costs get paid by a third-
party payer. That contributes to the rising cost and to the dynamics of 
cost in this system.
  Second, Madam President, the incentives are all in the wrong places. 
The more care provided, the more money providers make, and that, I 
think, leads to greater emphasis on inpatient and high-tech care than 
for primary and preventive and outpatient care, and I think we are 
taking a look at that issue as part of this debate.
  Third, requiring all persons to have health coverage either through 
the Clinton plan or the employer mandate or the Chafee plan or the 
individual mandate, frankly, neither one of those are radical ideas. We 
already have mandates in this country. And, again, this gets to other 
funny hot buttons pushed around ``under Government control,'' ``this is 
mandate,'' ``this is going to take away your freedom.'' The fact of the 
matter is we have mandates already. A requirement of this type is true 
already for automobile insurance and, frankly, to a lesser extent for 
life insurance.
  Everybody who has a car is required to have automobile insurance, or 
to demonstrate financial responsibility.
  We do not let low-risk drivers, people who do not have accidents, we 
do not let them go without insurance simply because they are low-risk 
drivers. Neither is it good public policy to have the young people go 
without health insurance simply because they are at a lower risk than 
middle-aged or older Americans.
  That is the point that the Senator from Iowa and the Senator from 
Maryland talked about a little bit.
  We all have to get into this pond, because, in the final analysis, we 
are all in this together and risk-sharing means that everybody needs to 
participate. You do not buy insurance, life insurance or health 
insurance, right when you need it or after you get sick. You buy it in 
advance, and you allow that process to allow everyone access, to get 
the money necessary to fund the system, to have a successful system.
  As a people, we have to sometimes look beyond our individual needs. I 
believe the Mitchell bill and this approach attempts to do that.
  There are cost control measures in this bill. There is a 25 percent 
assessment on high-cost plans and a fail-safe mechanism if outlays 
outpace revenue.
  And, in my opinion, the plan of the Senator from Kansas, to a lesser 
extent, includes cost containment measures, but it is there as well. So 
everybody recognizes that you have to have a cost containment 
mechanism.
  The Mitchell plan I supported, and I asked to sponsor. I asked the 
Senator from South Dakota to add me as a cosponsor earlier on. I 
applaud the effort. I have not set my pace in favor of single payer. I 
think this compromise still makes sense because, it does have cost 
containment and because we are taking a look at the FEHBP Program. If 
we are unable to agree on cost containment measures for the entire 
system, what about infusing some cost control elements in our own FEHBP 
Program? I think we can do this and that will give us the cost 
containment. I think that we have an excellent example in the FEHBP 
participants.
  I would also like to see that everybody has information on the FEHBP 
Program in terms of the range of programs and the employer and employee 
contributions. Private sector employers should share the same 
information about their own plans that are there for their employees so 
they could compare their system with the Federal system.
  I do not see what is wrong with that. Let us share the information. 
If the Federal system is cost efficient and is doing a good job at 
keeping the cost down and providing access and coverage, then I think 
the private sector can begin to share information with their workers so 
that people can make an informed choice.
  Another idea, Madam President, builds on the Mitchell Cost 
Containment Commission. One of the duties of the Commission is to 
monitor and respond to trends in health care coverage and changes in 
per capita premiums and other indicators of health care inflation. I 
would like to propose we strengthen that section, in order for the 
Commission to really do the job there, to have the insurance companies 
give us information on expenditures that justifies the rate changes 
that they may undertake.
  Madam President, I would submit, in closing, because there is a lot 
of this debate to go on, and it will be going on when we come back 
here, but I am reminded of a line out of ``Alice In Wonderland,'' when 
she runs into a Cheshire cat in the middle of the forest and she asks 
the Cheshire cat, ``Which way should I go?'' And the cat's response to 
her is, ``That depends on where you want to get to.''
  I submit that there are some principles, some goals that we want to 
get to and that none of those goals should be left out of this debate. 
We need to have cost containment, we need to have universal coverage, 
we need to have freedom of choice of providers. Americans want to be 
able to choose their hospital, their provider, or what hospital they go 
to, and we ought to maintain the quality of care.
  We do have the best quality care in the world, if you can afford it, 
and if you can access it.
  Now, the reason this debate is so complicated, Madam President, is 
because, at first blush those goals, those cornerstones, may seem to be 
in conflict. How do you have universal coverage and cost containment?
  Well, I submit to you, Madam President, the best way to have cost 
containment is to have universal coverage, because in that way 
everybody is in the pond and you get rid of the cost shifting and you 
straighten out some of the irrationalities of the present system. How 
do you have freedom of choice and maintain the quality of care? I think 
that you do, because those things are not in conflict, because in that 
way you allow people to make informed choices to keep the quality of 
care up, to get rid of the not-so-good plans, the plans that cost too 
much money or do not provide good care; that people can make the 
judgments that will drive the market, if you will, to keep the quality 
of care the best in the world.
  I think, Madam President, that we have these goals to achieve and 
that the significant effort that is being undertaken now by the 
Congress represents the fact that this is a huge part of our economy. 
There is an awful lot of money involved. There is an awful lot at 
stake. And there are an awful lot of conflicting special interests that 
are involved here.
  But I believe that, with the effort and of the energy that is being 
put into this debate, we have a compelling obligation to try to reform 
this nonsystem, to take it piece by piece and step by step, to go 
through the long hours, such as Senator Kennedy has put in here, to go 
through this debate piece by piece, because the truth will come out. 
And, in the final analysis, if we call the American people to a higher 
purpose, which is to say we are in this together and we will all 
benefit and, no, you will not pay more money, this is in the interest 
of all of us doing better in future, not worse, this is in behalf of 
all of us providing a future for our children, not taking away from 
them, if we call the American people to a higher purpose and point out 
why this debate makes so much sense, I believe that we will be able to 
put a ribbon around the energy in this Chamber and achieve real, 
viable, doable health care reform that meets the expectations of our 
people and meets the requirements and the demands of our country as a 
whole.
  Again, I very much look forward to continuing to participate in this 
debate with my colleagues, and trust that we can get this job done in 
this session of the Congress.
  Mr. KENNEDY addressed the Chair.
  The PRESIDING OFFICER. The Senator from Massachusetts.
  Mr. KENNEDY. Madam President, first of all, I want to commend my good 
friend, the Senator from Illinois, Carol Moseley-Braun, for her 
excellent statement and comments about where we are in terms of the 
health care debate and about her analysis of the Mitchell proposal and 
what has been really at risk in not moving ahead at this present time, 
and her superb analysis of the legislation itself.
  I think over the period of the past days we have heard a number of 
statements and comments. I think, for most of us who have been here 
listening to the comments, too many of them have been sort of the 
canned talks and speeches about the general cliches about what the 
American people are really for. They have almost tragically become 
cliches, even in the limited debate that we have had here.
  To have the clear, insightful, perceptive analysis about where we are 
in real terms and in human terms that she has given to us this 
afternoon, as she has on other occasions, and also her sense of urgency 
about action now, I think is very compelling. I once again thank her 
for her constancy.
  It is late in the afternoon. It is 5:20 on a Friday afternoon. She is 
at her post ready to respond and I am sure prepared to vote on these 
measures, as are, I know, the distinguished Senator from Washington, 
Senator Murray, Senator Sarbanes, and others who have been here.
  I saw Senator Dole, as well. I do not know whether he is as prepared 
to vote, but nonetheless our colleagues are here because they are 
deeply concerned. I thank her for her excellent words.
  Madam President, I will just speak briefly about this amendment. I 
see others here who want to comment on this measure, as well. I know 
they have important matters to speak about.
  But I do want to say that, as we reach a late Friday afternoon, I, 
for one, having been here during the greatest part of the time with the 
debate and discussion, both in terms of the presentations of our 
colleagues and their comments, as well as the debate on our amendments, 
one theme constantly is evident, and that is the sense of urgency for 
action.
  I know that there are those that speak, and speak with reason, about 
the importance of putting action off until another year, another time, 
another 2 years, until we have more careful consideration.
  But I must say, the sense of urgency for action I find enormously 
compelling. As I have stated at other times, this has been a measure 
that has been before the Congress in one form or another since Teddy 
Roosevelt's time at the early part of this century. It was here with 
Franklin Roosevelt in the mid-1930's, again with Harry Truman, and then 
with President Kennedy and President Johnson--as they had the debate on 
Medicare. President Nixon as well. It has not been just a matter that 
has been reserved to one party or another. At different times, 
different administrations have advanced their approaches about how to 
deal with these measures, but by and large, health care reform has been 
a matter of urgency for all Americans and for both political parties.
  As has been stated here on the floor, when we are at our best we will 
come together. I know that certainly is the hope of Senator Mitchell. I 
know it is the hope of the President and the First Lady.
  As we conclude this week I hope we will look forward with 
anticipation to the most recent activities and actions. One has been 
the development of a series of proposals from what has been described 
as the mainstream group. I, for one, welcome their involvement. I think 
it is, at this point in the whole debate and discussion, a positive 
development that there are our colleagues who are representative of 
both sides of the aisle who have reviewed these various policy 
considerations and have made them available to the majority leader and 
to the minority leader, or at least are doing so as we speak at this 
time. I know they will be sharing those with the public in the very 
near period of time. I for one am very hopeful they will be 
constructive and positive. There is every reason to believe they would 
be, and that we can move on from those recommendations and suggestions.
  I am sure there will be some with which I would agree. There will be 
a number with which I will differ. But that is the nature of the 
legislative process. What we are interested in doing is finding common 
ground, finding areas where there can be agreement, and then permitting 
the Senate itself to make a judgment by votes, actually, about whether 
certain measures would be in or outside the proposal.
  So, for those who have suggested that this debate and discussion has 
moved beyond the reality, I for one could not differ more. As one who 
has been here, honored to represent my State for a number of years, and 
has been involved in a number of the important debates on matters which 
affect our people--whether it has been on the issues of ending a war or 
trying to eliminate the barriers of discrimination of race or religion 
or ethnicity, or as this amendment that we are considering now is 
related to, disability--I have seen similar times in the debates and 
discussion and legislative process. So that, as we end this week I, 
frankly, believe it is on a more hopeful note than many of the days we 
have had before. So just with those preliminary words, I think this is 
an important discussion and a important debate.
  I want to say just a brief word about the matter before us, 
introduced by our friend and colleague, the Senator from Iowa [Mr. 
Harkin], who has been such a leader in this body and nationally on the 
cause of disability rights. He was a real leader, following the 
extraordinary leadership of a Republican Senator, Lowell Weicker, whose 
record in this body was distinguished for many different matters. I 
remember clearly his battles in terms of preserving the Constitution 
and the court stripping debates and other constitutional issues; also 
at a very early period of time standing up for individuals who were HIV 
infected, where there were only a handful of Senators willing to take 
on those health implications of HIV to try to address that issue on the 
basis of science and health policy rather than ideology and rhetoric.
  The work he did in advancing the cause of the disability movement in 
our country I think was an extraordinary effort. And Senator Harkin has 
not only followed, but has really added an extraordinary chapter to 
that whole movement. It is only appropriate that he has challenged the 
Senate this afternoon, and the American people, to move forward with 
this amendment which makes a great deal of sense in terms of treating 
Americans who have disabilities with the kinds of flexible services 
which are included in the amendment. It will be more humane and also 
will be more cost effective. I, for one, am proud to have a chance to 
cosponsor that amendment and urge its adoption.
  As we reach the end of this week, it is interesting to note the 
amendments which have been offered. Those that have been offered from 
this side of the aisle, have dealt with children and expectant mothers, 
to try to ensure greater attention to the range of preventive services 
for expectant mothers and for children, and to extend the envelope to 
include so many of those who have been left out and left behind. Not 
those necessarily on Medicaid, but the 12 million of our children who 
are the children of working men and women who do not have coverage. We 
have addressed that and the Senate accepted it.
  Then we had an amendment on the other side of the aisle and that 
dealt with penalties, what was going to happen if employers were not 
going to provide the standard benefit package. It dealt with penalties. 
And we worked that out and accepted that. Then we came back to this 
side of the aisle with an excellent amendment from Senators Daschle and 
Dorgan and Kent Conrad and Senator Baucus and many of our other 
colleagues, dealing with the rural health issues. Once again a people's 
issue, trying to make sure those Americans who live in underserved 
areas of rural America are going to have the competent, qualified 
health professionals to deal with many of the challenges which exist in 
rural America. That amendment was accepted.
  Then we came back to the other side. What happened there? We had an 
amendment dealing with how we are going to ensure that if a State is 
going to fail to provide for the requirements to serve the individual 
Americans, how we are going to ensure that those Americans are going to 
be served. We had a considerable debate on that. We finally worked that 
out in a way very similar to the way it had been worked out with other 
proposals before the Senate.
  Then we come back to this side again and what we are talking about is 
people with disabilities. We are talking about human needs. We talked 
about children. We have talked about expectant mothers. We have talked 
about service in rural America. Now we are talking about extending in a 
more effective, humane way, the range of different services for those 
who are facing the needs of the disabled.
  I want to say as we have moved through this process I am proud this 
series of amendments have been related to real human needs of people. 
That is something I am very hopeful that we can continue to deal with. 
It is important, because we know, if we are talking about preexisting 
condition exclusions, there is no group in our society that is more 
affected by the exclusion of health care than those who have 
preexisting conditions.
  If we are talking about portability, there are great numbers of 
families who are affected when individuals who may be covered because 
they are part of a group do have some disability. We are talking about 
the fear that they have and the difficulty they have moving to another 
job that might mean better opportunity and a better future, but fear 
they cannot get coverage of insurance because there is not effective 
portability. We are always going to have that difficulty in terms of 
portability unless we have a standard benefit package. That concept has 
been recognized both in the Chafee bill and in the bill which had been 
introduced by Senator Nickles.
  We know the issue of lifetime caps is something that the disabled are 
affected by. The fine print that is there that sets a ceiling where 
individuals buy the policy and then have some extraordinary needs in 
terms of disability, needs which are unpredictable and uncertain, and 
they reach those lifetime caps far too quickly. They have an interest 
in the issue of eliminating lifetime caps.
  Regarding the access to specialists, we have to be concerned. We have 
to be concerned even today with the growth of managed care and the 
economic pressures that are out there in terms of competitiveness, 
whether those who are the most vulnerable are going to have access 
to the range of services that are necessary to give good quality care 
for those with some disability.

  We have to be very careful to make sure there is an access to 
specialists. Also, that there is going to be access; that these 
individuals with disabilities are not going to be discriminated 
against. We heard the sanctimonious statements earlier in the week 
about how we are filling up the Mitchell legislation with rights that 
are going to be able to be pursued by individuals in the courts.
  I can tell you the reason for that--and so many of those in the 
disability community can tell you--that is because if you have a 
disability, the chances of you being discriminated against today in 
health care policies are rampant.
  If we mean that we are going to have a health care system that is 
going to be available and accessible to all and that we are going to be 
inclusive, we want to make sure that those legitimate providers that 
are out there--and they, by and large, are out there and want to 
provide and will provide for the disabled--are going to be protected. 
But we also want to make sure that those individuals who will 
discriminate against individuals with disabilities will not be able to 
exclude many of our fellow Americans.
  It happens in the most extraordinary ways. We can find examples where 
disabled individuals will be given services for surgery, which will be 
guaranteed in a health insurance program, but not for rehabilitation, 
which makes a greater difference in terms of their recovery. If they 
get the rehabilitation and are given that kind of treatment, it is more 
cost-effective. But the insurance company will say, ``We don't provide 
rehabilitation, we only provide surgery,'' and what happens in too many 
instances is those individuals end up forced into a surgical situation, 
which is wrong.
  So we want to make sure that they are protected as well, and the 
range of different home-based and community-based programs that have 
been cut back, even in the Mitchell program, over what we reported out, 
I think, is unfortunate. But a key element and one of the features that 
troubles me very deeply in our mainstream group, is what they are doing 
or what they are not doing with community-based services for our 
seniors and people with disabilities and their failure to come up with 
the kind of prescription drugs which are so necessary for our seniors.
  I am hopeful that we will be able to address those issues. I am sure 
that we will.
  I want to again just thank the Senator from Iowa for bringing the 
amendment, which is basically the flexibile services option. As I 
understand it, we have the standard benefit package, but now under the 
Harkin amendment, we will have this as an option, the flexible service 
option, which is there for those of us who have the Federal employees 
program, which includes all the Members of the Congress and the Senate, 
and is also available for 10 million other Americans. This is very 
worthwhile.
  So let me just finally say, with the ``mainstream'' proposal, we are 
beginning to make some significant progress toward achieving the kinds 
of health reform that all of us will be proud to support. Clearly, 
difficult negotiations lie ahead, but if we approach these negotiations 
in the constructive spirit of compromise that we have seen in the past 
few days, I am optimistic that we will succeed and that genuine health 
reform will become a reality.
  I urge my colleagues to support the amendment of the Senator from 
Iowa.
  Mr. DOLE addressed the Chair.
  The PRESIDING OFFICER. The Republican leader.
  Mr. DOLE. Madam President, let me yield first to the Senator from 
Iowa. I understand he wants to modify his amendment.
  Mr. HARKIN. I thank the Republican leader.


                     Amendment No. 2572, As Modified

  Mr. HARKIN. Madam President, I have a modification to the amendment. 
It has been cleared on both sides. I send it to the desk.
  The PRESIDING OFFICER. The amendment is so modified.
  The amendment, with its modification, is as follows:

       At the appropriate place in part 1 of subtitle C of title 
     I, insert the following new section:

     SEC.  . FLEXIBLE SERVICES OPTION.

       (a) Extra Contractual Services.--A health plan may provide 
     coverage to individuals enrolled under the plan for extra 
     contractual items and services determined appropriated by the 
     plan and the individual (or in appropriate circumstances the 
     parent or legal guardian of the individual).
       (b) Disputed Claims.--A decision by a health plan to permit 
     or deny the provision of extra contractual services shall not 
     be subject to a benefit determination review under this Act.
       (c) Definition.--As used in this section, the term ``extra 
     contractual items and services'' means, with respect to a 
     health plan, case management services, medical foods, and 
     other appropriate alternatives (either alternative items or 
     services or alternative care settings) determined by the 
     health plan to be a less costly alternative to covered items 
     or services.

  Mr. DASCHLE. Madam president, I rise to support the amendment offered 
by my colleague from Iowa. As chairman of the Subcommittee on 
Disability Policy, Senator Harkin has worked tirelessly over the years 
to ensure that disabled citizens have the same opportunities available 
to them as all other Americans. His amendment is a continuation of his 
efforts to craft health care policies that are sensitive to the needs 
of these individuals.


              disability groups support the mitchell bill

  Before I discuss Senator Harkin's important amendment, I would like 
to emphasize the disability community's support for the Mitchell bill.
  The disability community supports the Mitchell bill because his bill 
ensures universal coverage for all Americans; guarantees a standard 
benefit package to all individuals; eliminates pre-existing condition 
exclusions for all individuals; and includes a significant home- and 
community-based long-term care services program.
  The reforms and benefits included in the Mitchell bill are important 
to all Americans, but are especially meaningful for disabled Americans. 
Only about half of individuals with a severe disability had private 
health insurance in 1992 compared with 80 percent of persons with no 
disability.


                            harkin amendment

  Senator Harkin's bill further improves upon the Mitchell bill from 
the perspective of the disability community.
  Senator Harkin's amendment is simple, but important. It would allow 
insurance companies to continue a practice that greatly benefits people 
with chronic conditions and disabilities.
  This practice is sometimes referred to in the insurance industry as 
``extra-contractual services'' which simply means that, with a 
patient's consent, plans have the option of substituting high-cost 
treatments with equally effective, but less expensive alternatives.
  This option is currently available under the Federal health plans and 
many private insurance policies--Senator Harkin simply wants to ensure 
that private plans continue to have this option available to them.
  Let me give you just one real life example of why it is essential to 
give health plans this type of flexibility. In California, a baby boy 
had been hospitalized for severe respiratory problems. With specialized 
care in the home, the child could have been discharged from the 
hospital. However, he lived in an area lacking any nearby physicians or 
hospitals and situated at an elevation of 9,000 feet--an inhospitable 
environment for a child with respiratory problems.
  His doctor recommended that instead of keeping the child in the 
hospital, the insurance company should pay for a rental apartment and 
24-hour nursing care. This alternative would cost $30,000 a month 
compared to $60,000 per month if the child had remained in the 
hospital. The mother consented to this arrangement, and the child 
recuperated beautifully in his new environment. Meanwhile, the insurer 
saved more than $30,000 for every month the child needed care.
  Senator Harkin's flexible services option amendment would simply 
clarify that such sensible, cost-effective arrangements could continue 
to exist under a reformed health care system.
  I strongly believe that whatever health plan we pass this year, we 
need to guarantee that the legislation is sensitive to the needs of the 
disabled. As I mentioned, the Mitchell bill already has several 
provisions which would ensure access to appropriate health services for 
all Americans, including those with disabilities, such as services for 
outpatient rehabilitation, extended care, and home health care. Senator 
Harkin's amendment adds another important provision to the bill that 
would benefit disabled Americans.
  How people with disabilities fare under the reformed health care 
system is an excellent measure of how well that system is functioning. 
For if we pass a bill that meets the needs of the disabled, the health 
care system we create will likely meet the needs of all Americans.


                               conclusion

  Senator Harkin's amendment adds an important element of flexibility 
for plans that want to provide cost effective services for enrollees. 
We already know this option is working for many people with chronic 
conditions and disabilities. This amendment would simply ensure the 
continuation of a flexible services option under a reformed health care 
system.
  Let us make sure that under health reform, disabled individuals and 
the health plans to which they subscribe, have the maximum flexibility 
and options available to them.
  I urge my colleagues to support Senator Harkin's amendment.
  Mr. HARKIN. I thank the Republican leader.
  Mr. DOLE. Have we acted on the amendment?
  Mr. HARKIN. Madam President, I believe all debate really has been 
finished on the amendment.
  The PRESIDING OFFICER. If there is no further debate, the question is 
on agreeing to the amendment, as modified.
  The amendment (No. 2572), as modified, was agreed to.
  Mr. KENNEDY. Mr. President, I move to reconsider the vote by which 
the amendment was agreed to.
  Mr. DOLE. I move to lay that motion on the table.
  The motion to lay on the table was agreed to.
  Mr. DOLE. Madam President, I do not think there is any objection to 
the amendment on either side of the aisle. I congratulate the Senator 
from Iowa, who has done a lot of work in the field of disabilities.
  Madam President, has leaders' time been reserved?
  The PRESIDING OFFICER. Yes, it has.
  Mr. DOLE. I thank the Chair.
  (The remarks of Mr. Dole pertaining to the introduction of S. 2411 
and S. 2412 are located in today's Record under ``Statements on 
Introduced Bills and Joint Resolutions.'')
   Mr. DOLE. Let me now speak briefly on health care, first to include 
some editorials that have been appearing in different papers, and an 
op-ed piece which appeared today in the New York Times by Ross Perot.
  In my view, and I think in the view of millions and millions of 
Americans, Mr. Perot hits the nail right on the head. He writes, 
correctly, that ``No one can accurately estimate what [the bills 
Congress is debating] will cost American taxpayers.''
  And he accurately points out that Congress has a history of vastly 
underestimating the cost of new Government programs.
  As Mr. Perot says, ``With our $4.6 trillion debt, we can no longer 
afford to make such mistakes.''
  Mr. Perot also echoes what we are hearing from the overwhelming 
majority of the American people: ``Go slow. Take our time. Get it 
right.''
  I ask unanimous consent that the op-ed piece by Mr. Perot be printed 
in the Record.
  There being no objection, the editorial was ordered to be printed in 
the Record, as follows:

             [From the New York Times op-ed, Aug. 19, 1994]

                Before We Wreck the Health System * * *

                            (By Ross Perot)

       Dallas.--America's health care system--the world's finest--
     consists of tens of millions of very complex parts. It took 
     nine years and $300 million, for example, just to develop and 
     test Mevacor, the pill that reduces cholesterol. And that is 
     but one tiny part of the health care industry.
       The health industry is twice the size of the U.S. auto 
     industry. It is 14 percent of our economy. It affects every 
     American from birth to death. Successfully reshaping health 
     care is far more complicated than building an aircraft 
     carrier or designing the space shuttle or inventing the 
     atomic bomb.
       The Clinton Administration's health care plan was drafted 
     in secret by talented, well-intentioned group whose leaders 
     had little experience in health care. This plan did not 
     attract widespread support in Congress, or with the American 
     people.
       Now the Clinton plan is being hurriedly redrafted into a 
     variety of new bills by Congressional staffers who have 
     little experience with health care. Most of these bills 
     include a vast new Government bureaucracy to oversee the 
     health system. Senate leaders are rushing to force a vote in 
     the next few days on bills that have not been read. Moreover, 
     this restructuring has been undertaken along partisan lines. 
     The American people have been subjected to propaganda and 
     emotional anecdotes instead of having these ``reforms'' 
     explained to them in a logical and rational manner.
       Worse yet, no one can accurately estimate what these bills 
     will cost American taxpayers. We do know that the costs will 
     be massive. In 1965, Congress thought the new Medicare 
     program would cost $9 billion a year by 1990. The actual cost 
     of Medicare in 1990 was $110 billion! With our $4.6 trillion 
     debt, we can no longer afford to make such mistakes.
       Can the Government effectively manage health care for the 
     entire nation? Consider the nationwide health care program it 
     manages now--our veterans' hospitals, where services are so 
     poor that only 10 percent of veterans make use of this 
     system.
       But there is a rational way to improve the health system, 
     deliver care to the uninsured and keep costs in line.
       First, identify the parts of the system that need to be 
     improved. Bring in leading authorities to design the 
     improvements. When this detailed plan has been completed, 
     explain the system carefully to the American people in plain 
     language. Skip the propaganda.
       Once a consensus is reached, carefully figure out the cost 
     of these changes and frankly explain how health care will be 
     paid for. Don't mislead the American people by claiming 
     ``companies will pay for it'' and implying that health care 
     will be free--indeed, it will be the ultimate hidden tax on 
     the ordinary American, because companies will simply increase 
     their prices and consumers will wind up paying the entire 
     cost.
       Finally, conduct pilot programs to make sure these 
     improvements work as planned and their costs can be 
     determined. The logical pilot group would include every 
     member of Congress, every member of the White House staff and 
     every Federal employee.
       Testing a government-run program on Government employees 
     shouldn't impose much of a hardship. They already have an 
     excellent health benefits program, so they should have good 
     ideas about the operation of a nationwide system. This would 
     guarantee every citizen that any health care plan would be 
     debugged, optimized and trouble-free before it is imposed on 
     the entire nation.
       Once the pilot operation is working successfully, at a cost 
     we can afford, with the American people fully informed of the 
     plan and its costs, the decision to make changes nationwide 
     can be made with all the facts on the table and at minimal 
     risk. Compare this rational approach with the propaganda, 
     emotional appeals and name calling in Washington today.
       Obviously, no one wants rationing of health services and 
     waits of up to 18 months for surgical procedures, items that 
     are prevalent in Government-run health programs in Europe, 
     Canada and our own veterans' hospitals.
       Democrats and republicans must work together to carefully 
     design, test and price the new health system. Encourage them 
     to go slow, take their time, get it right. What's the hurry?
       Let's not destroy health care in a well-intentioned effort 
     to save it. Remember, the first rule of medicine is ``do no 
     harm.'' The process I have described could take two years or 
     more. It took nine years to develop Mevacor, just one ill. 
     This is a process that we cannot short-circuit if we want a 
     cost-effective health system that truly benefits the American 
     people. In the words of the carpenter, ``measure twice, cut 
     once.''

  Mr. DOLE. Madam President, the Wichita Eagle, which is a highly 
respected paper in the State of Kansas, one of the largest Kansas 
papers, in-State papers, in an editorial dated August 17, says, 
``Forget health-care reform for this year; try again next year.''
  Let me make it clear that this paper supported health care reform 
from day one, initially supported the President's plan, supported all 
the efforts, but they have now concluded, and I think again properly 
so, that it is halftime and we do not have time to explain all these 
bills to the American people.
  I understand we have eight different measures on the Senate side, 
counting the mainstream approach, which will be released sometime next 
week or when they get the language drafted.
  So I think the Wichita Eagle makes a good point.
  Also, an editorial from the Fargo, ND, Forum entitled ``Put Brakes on 
Clinton Health Bus,'' and a piece by Robert J. Samuelson entitled, 
``Did the Press Flunk Health Care?'' Obviously, the press flunked 
health care and maybe for the reasons he states, but also most of the 
press--they are all good people. Do not misunderstand me. This is a 
very complicated measure, and some of the members on the Labor 
Committee who have had hearings all year long, some of us on the 
Finance Committee have a little better understanding, but I do not know 
how many people understand a bill that is 1,400 pages, 1,444 pages. And 
there have been at least three of those, two revisions.
  So it seems to me that the press wants to talk about mandates, and 
they always like to say, well, there will be a filibuster. As far as I 
know, there is no filibuster. And the mandate issue has not been 
addressed.
  But I think the point Mr. Samuelson is making--he is a Democrat and 
economist--is nobody is worried about the cost. Somebody has to pay the 
cost. We can talk about all these things we are going to do and all the 
things we are going to add. And somehow some of us are heartless; we do 
not agree with everything.
  Somebody has to pay the bill. And somebody is going to be a little 
heartless when we start giving these bills to our children and 
grandchildren because we did not want to resist anything that anybody 
asked us; we wanted to do everything for everybody and we did not care 
what it cost, just pass it on to the next generation.
  In fact, the people heard statements by Senator Robert Byrd, the 
chairman of the Appropriations Committee, last night, and a statement 
of Senator Mark Hatfield of Oregon, Democrat and Republican, talking 
about the cost--how much is it going to cost? Who is going to pay for 
it? If anybody around here ever made a case for a little postponement 
while we address some of these issues, I think both my colleague from 
Oregon and West Virginia did last evening.
  We ought to keep in mind that some of these bills have not even been 
scored. By scored I mean the Congressional Budget Office, which is the 
office the President told us we should listen to for figures, they have 
not scored the so-called Dole-Packwood American option plan. They have 
not scored the mainstream plan. They have scored the Mitchell plan. 
They have not scored the so-called Gephardt plan on the other side, or 
the Rowland-Bilirakis plan on the other side. And here we are debating 
health care not knowing what it costs.
  I do not know whether people walk in and just blindly buy anything, 
then look at the cost on the way home after they have paid for it. I do 
not think so. I think the American people expect us to address the 
cost.
  I would say, with reference to the mainstream provision, they made a 
good effort. I met with them this afternoon. But again we do not know 
what it costs. And we will not have any CBO--we do not know whether 
their savings are accurate or how much it costs.
  It seems to me it is almost the bottom of the 9th inning, some would 
say, as far as this legislative season is concerned. And I think most 
Americans have decided they do not care what you call the plan; they 
are going to be skeptical, as they should be, whether it is the 
Mitchell plan or the Dole plan or the Clinton plan or the Michel plan 
or the Rowland plan, the mainstream plan.
  I think most Americans are very concerned about what it is going to 
cost them. Are they going to pay more for their premiums? And they are 
in some of these cases. Are they going to have any choices left? Not 
many in some of these plans. Mandates? Oh, they are going to have 
mandates in some of these plans. They are going to have price controls, 
a lot of new taxes, over $1 trillion in new spending and we have not 
even focused on the costs.
  It is not, as the Senator from Massachusetts pointed out a while ago, 
who is more compassionate, the Members on that side of the aisle as 
opposed to the Members on this side of the aisle. We can play those 
games. It is really a game. It is unfortunate.
  These minor amendments, probably all could have been accepted. We 
talked about cost in our amendments--a $10,000 civil penalty if some 
employer did not offer the right plan. If some little businessman or 
business woman in my State did not offer the right plan, they could 
have been subject to up to a $10,000 fine. That is in the Mitchell 
bill. It was taken out. Why? Because Republicans found it. That is why 
it was taken out.
  And all these decisions are going to be made in secrecy. We had three 
charts yesterday out here. All these were going to be made in secret--
lower your benefit, raise your premiums, all made in secrecy, not 
public hearings. That was in one of the Democratic bills. Republicans 
took it out. Those were rather major amendments.
  We are trying to reflect the views of the American people. Then 
Senator Mitchell himself offered an amendment amending his own bill 
which said in effect, your insurance continues even though you do not 
pay your premiums. Well, somebody has to pay. And so when it gets to be 
a bill that you do not have to pay your premiums, I think we are going 
to have a good signup. But again that was corrected.
  So I do not think we can go around characterizing different 
amendments: Oh, well, we care about the people; we are more 
compassionate; we care more about disabled, more about children, 
pregnant women. That may sell in some circles but I do not believe, if 
you take a poll--and I saw a poll just 2 days ago by Frank Luntz & 
Associates. I do not know much about Mr. Luntz--48 percent of the 
people are worried about the cost--48 percent, not the cost of $1.5 
trillion, which is the cost of the Mitchell bill over the next 10 
years, what is it going to cost me, the consumer--$500 a year more, 
$600 a year more, $100 a year more?
  They are also worried about access. Are they going to have access to 
insurance? So I would hope that we look at some of these things.
  I ask that all of these be included in the Record, along with a 
letter from the Governors association. And this letter is signed by the 
Governor of South Carolina, Carroll Campbell, and the Governor of 
Wisconsin, Tommy Thompson.
  Earlier in the debate, our plan was criticized by Governors in both 
parties, the Dole-Packwood plan, because we put a cap on Medicaid. And 
they thought that was a bad idea. So we worked it out with the 
Governors. The only problem was after we worked it out, we could not 
get the Democratic governors to agree that it was worked out. So we 
finally got a letter from two Republican governors, and in that letter 
they say that, because Democratic Governors are very anxious to 
criticize the Dole plan, they are not so anxious to say, well, you 
fixed it.
  So I will just quote one. It says:

       Our representatives worked with your staff in good faith to 
     develop your new proposal, and representatives of the 
     National Governors Association and various Democratic 
     governors were also involved in these meetings. The politics 
     of this issue have so far proved impossible for Democratic 
     governors to get beyond, but we are continuing to work with 
     them so we can provide NGA's official written responses to 
     your bill and other bills. In the meantime, we want to thank 
     you for your responsiveness to the concerns of the governors.

  I say to the Democratic Governors that we acted in good faith. I 
spoke to the Governors in Boston a few weeks ago, and they said, ``You 
have a problem. When you put on a Medicaid cap, it is going to shift 
cost to the States.'' We worked that out. Where are these same 
Democratic Governors who were on TV in Boston that night and in the New 
York Times criticizing our plan on this provision? We worked it out, 
and they are silent. That is not how we get things done. I hope they 
will recognize that we made a good faith effort. They recommended that 
Senator Mitchell use the same language we worked out for our bill in 
his bill. The mainstream group has taken the same language we worked 
out with all the Governors, Democrats and Republicans, and put it in 
their bill. Come on, if we are going to start playing politics at every 
level, we are not going to get anything done. Why not say, OK, you have 
worked it out, thanks a lot, and we appreciate your working together 
with us?
  We heard a lot of talk the other day on preexisting conditions, on 
how little our bill did and how much the Mitchell bill did.
  I do not think there has been any issue where there has been so much 
agreement. Republicans, Democrats, Independents, I do not care where 
you are in America, all say we ought to cover preexisting condition, 
and that you should not deny coverage on that basis. We have said that, 
and it is in our legislation, and it is in nearly all the legislation. 
It is in the mainstream group legislation. For some people, that may 
mean a very serious condition like cancer or the loss of a limb. For 
others, it might be something less serious like a skin rash.
  Whatever the case, there is no doubt that these conditions lock 
people out of our health care system.
  Just last Saturday--and since we cannot go home for town meetings--we 
asked 20 tourists to come into my office down the hall. They were from 
Maryland, West Virginia, Ohio, California, and a couple of other 
States. The very first question we had was from a man from Florida who 
had a preexisting condition; I guess he was about 55 or 60. He wanted 
to know how he would be helped by the various plans being discussed in 
Congress. It was a very legitimate question by a real person, not a 
Member of Congress, but a real person.
  Over the last few days, there has been a lot of misinformation coming 
from the other side of the aisle over how the Dole-Packwood bill would 
solve these problems. So let me set the record straight.
  Both the Dole-Packwood bill and Senator Mitchell's bill contain a 
provision for a 90-day amnesty period. Both contain the same provision. 
That means that after health care reform is enacted, there is a 90-day 
period where anyone can sign up for insurance, and they will be 
guaranteed to get it--regardless of their health status, no questions 
asked. They have 90 days. Anybody can sign up, regardless of any 
preexisting condition.
  Under the Dole-Packwood bill, once the one-time 90-day amnesty period 
has expired, insurers may impose some limitations on most people who 
wait until they get sick to buy insurance. If you did not have that 
rule and you did not buy insurance until you got sick, you would not 
have anybody willing to sell insurance. It is that simple. If we are 
going to do that, why not extend it to fire insurance, and if your 
house burns down, come in and we will sell you a fire policy. Or if you 
have a car wreck, come in and we will sell you an auto policy. This is 
also in the Mitchell bill.
  Under our proposal, and under the Mitchell bill, if you are insured 
and change jobs or health coverage, you will never face a preexisting 
condition limit again. Never again. That was in our bill and in Senator 
Mitchell's. If you have coverage and get sick, you cannot be canceled. 
It is in both bills. And your specific premium cannot skyrocket. That 
is in both bills.
  If you are pregnant, that condition cannot be treated as a 
preexisting condition. A lot was said about that, and our bill was 
misrepresented. It is not a preexisting condition. A new baby 
automatically receives insurance coverage, regardless of the health 
condition of the baby.
  There was some talk about newborns the other evening. We ought to 
keep the record straight. It is alright to say: I do not like the 
Mitchell bill, or I do not like the Dole bill, or the mainstream 
group's bill. But let us try to be accurate in our criticism, because 
if we are going to make a record for the American people, we ought to 
stand up and say I do not like it because--and then be accurate and 
tell them the truth.
  Under both the Dole-Packwood bill and under the Mitchell bill, if you 
have no insurance coverage today, and walk in to buy insurance, you are 
subject to a one-time waiting period. This is to protect responsible 
people who maintain their health insurance from having their premiums 
go up because of people who wait to buy insurance until they are sick. 
If everybody is going to buy it when they are sick, then insurance will 
be very expensive and somebody has to pay for it. It will be paid for 
by responsible people that have policies out there today. That is not 
fair. That provision is in both bills.
  Then they say, well, the Mitchell bill is going to prohibit any 
exclusion from coverage after the year 2002.
  I wonder who would want to sell insurance if the Mitchell bill is 
enacted.
  First, insurance agents are told what benefits must be included in 
the plans they offer, and what the plan will cost. Then they are hit 
with a tax on the plans the Government defines as too expensive. That 
is still in the bill, and there is an effort to try and take that out. 
Even though the public may be willing to buy these plans.
  Mr. President, we all want to prevent insurers from discriminating 
against those who have been ill. We all want to remove barriers 
wherever possible, and the Dole-Packwood bill does that. It also 
assumes that individuals maintain some responsibility, and I think that 
has been corrected in my colleagues bill, the majority leader's bill, 
and we are pleased about that.
  Finally, Madam President, as I said, the latest entry in the health 
care debate is outlined in the so-called mainstream proposal. I have 
had the opportunity, along with Senator Packwood, to be briefed by a 
number of Members of this group. They are Democrats, Republicans, and 
they are friends of ours. They have worked hard, and they put together 
something they feel strongly about. Some of it is like the Finance 
Committee bill. I am a Member of that committee, so I recognize some of 
its parts. Some of it is taken from the American option in the Dole-
Packwood proposal. Some of it may have come from the Labor Committee, 
or the bill by the distinguished majority leader, Senator Mitchell.
  But let me say, as I said, I do not see any medical savings accounts 
in the bill. It has a standard benefits package. It does not let you 
self-insure if you have less than 100 employees. A lot of people are 
self-insuring with less than 100 employees. It has a lot of different 
things in it. It has taxes that I have some concerns about. But I 
think, overall, it is a real effort, as Senator Packwood said.
  We have not seen the draft language. We understand we may not get to 
see that maybe for a couple of days. There are no CBO numbers on this 
package. We are told they may come next week or the next week. But, 
again, as I understand it, it is probably entry No. 8. It is somewhat 
different. It has different provisions. It is going to be a bill, not a 
package of amendments. So it is going to be probably a substitute to 
the Mitchell proposal, or the Dole proposal or any other proposal, the 
Finance Committee proposal, or the Labor-Kennedy proposal, whatever.

  I think we just have to wait and see. You have to study it, analyze 
it carefully, and see what it costs, and then say OK; maybe this is a 
good place to start, or maybe it is a starting place. I do not know. 
But it is pretty late in the game. It is now mid-August.
  I again do not know whether the American people are willing to say, 
``I do not understand all the other bills. I do not understand the 
other bills. I am merely going to focus on the mainstream bill, and I 
am really going to understand this bill. I am going to pay a lot of 
attention to whether they are going to buy into this program.''
  As I said to the group today, I think to the American people--I am 
talking about the average American across America; maybe 68 percent, 
maybe more--all these bills are so complicated, and we did not make 
them complicated. It is the way the system is; it is complicated. They 
do not know how much it is going to cost. They do not know about 
access, affordability, can they pay for it; if they are low-income, how 
much you are going to subsidize what I buy. To have another plan now 
come along for which we do not have the numbers, it seems to me it may 
be too late in the game.
  I certainly encourage the majority leader to seriously consider 
giving us a couple of weeks to take a look at all these things when we 
get the numbers. We are not going to have the numbers for 10 days. Why 
do we not go back to our States and have some town meetings and get out 
there where the real people are and talk to them about this--kick the 
tires and look under the hood, as Ross Perot used to say; see what is 
in this bill.
  We could be asked a lot of tough questions. We could not answer some. 
We could be asked them by young people. Every time I look around, I see 
a lot of young people. Nobody here is representing young people. Their 
premiums are going up. They are going to be community-raters. They are 
going to pay twice or triple what they should pay when they buy a 
coverage they do not want, because there is going to a standard 
mandated package. You cannot buy less.
  Up until yesterday, if the employer gave you the wrong plan, he was 
subject to a $10,000 fine.
  So I would say, particularly to the younger generation, you had 
better tune in on health care, because you are going to get stuck big 
time. I think that is why we need to provide some more choices in our 
plan, as they provide in the Mitchell plan. Ours is not quite as 
extensive. You buy into the Federal plan, the Federal Employees Health 
Benefits Plan. If you are self-employed or employ less than 50 
employees, you can buy into the plan.
  Again, that was another topic discussed this morning where it was 
indicated there was a big difference on that side; and we were not 
prepared to do it on this side. Again, that is not an accurate 
statement. That is not, I might say, in the mainstream plan of theirs. 
There is no provision to buy into the Federal employee plan. I did not 
see one.
  I think colleagues on both sides will have a number of questions once 
they have had a chance to analyze this package, and I just suggest that 
is something that ought to be looked at very carefully.
  I ask unanimous consent that the material to which I referred earlier 
be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                    Put Brakes on Clinton Health Bus

       Two doctrinaire liberals are driving Bill and Hillary 
     Clinton's health care bus at break-neck speed through 
     Congress.
       Someone should apply the brakes.
       Sen. George Mitchell, D-Maine, and Rep. Richard Gephardt, 
     D-Mo., are pushing health reform bills that don't have the 
     president's name attached, but appear to be little more than 
     slightly modified versions of his plan. Democratic leaders 
     said again and again last week their plans are ``not the 
     Clinton plan.'' Then they advanced legislation that just 
     might be.
       Might be. That's the point. The majority of the House and 
     the Senate don't know because Mitchell's 1,400-page bill 
     hasn't even been read and analyzed by senators. Gephardt's 
     bill, which also promises to be a 1,400-page nightmare, 
     hasn't been written. Yet, House leadership predicts it will 
     pass with Democratic support.
       What's going on here? Why the rush?
       Advocates of pushing through health care reform ``right 
     now'' accuse opponents of dredging up the same arguments used 
     against Social Security and Medicare. Maybe so. But Social 
     Security and Medicare were not jammed through the Congress 
     without sufficient discussion. Both programs stirred 
     passionate debate that lasted for months. When finally 
     passed, support was bipartisan and broad.
       Health care reform is even bigger--by some estimates fully 
     14 percent of the nation's economy. It's also far more 
     complex than Social Security or Medicare.
       Despite the enormity of the risks of doing health care-
     reform badly, the president and his allies seem bent on 
     rushing the process, apparently so they can tell voters 
     before the November elections that Congress ``did 
     something.''
       We'd rather they did nothing than do something wrong.
       The danger of shoving either Mitchell's or Gephardt's bill 
     down the nation's throat is that without extended debate--in 
     Congress, on editorial pages, on news broadcasts and talk 
     shows, in town meetings, board rooms and union halls--
     Americans won't know what they are getting. The devil, after 
     all, is in the details.
       Consider one provision in Mitchell's bill:
       A tax (up to 35 percent) on health insurance policies with 
     benefits better than the basic package mandated by Uncle 
     Sam--unless your insurance is part of a union contract, which 
     would be exempt from the benefits tax.
       Sleight of hand like the benefits tax will be exposed in 
     extended debate in Congress. It's also the kind of outrage 
     that would slip through virtually unnoticed if the process 
     were rushed.
       Slow it down. Do it right. Do it carefully, so as not to 
     destroy the world's best health care system.
       If it takes a filibuster by Sen. Phil Gramm, R-Texas, or 
     Senate Republican leader Bob Dole of Kansas to stop the 
     Clinton/Mitchell/Gephardt bus, so be it.
                                  ____


                    Did the Press Flunk Health Care?

                        (By Robert J. Samuelson)

       As Congress debates health care, the press ought to be 
     asking itself whether it has blown this story just as it blew 
     the savings and loan scandal. The answer is yes, I think--
     though in different ways and for different reasons. We have 
     not ignored this story, as we initially ignored the S&L 
     crisis. but our vast reportage has not made health care any 
     more understandable. We have not clarified in our own minds 
     or the minds of our readers what the debate is ultimately 
     about or shown sufficient skepticism about whether ``reform'' 
     can work as intended.
       In some ways, our problem is that health care is too many 
     stories. It's about personal care, the economy, technology 
     (high-tech medicine), ethics (who deserves expensive care?), 
     styles of medicine (``fee for service'' vs. ``managed 
     care'')--and of course, politics and interest groups. We have 
     written thousands of column inches on all these subjects and 
     in the process have overwhelmed our readers and obscured some 
     of the larger issues.
       The most important of these is health spending. With good 
     reason, this is what the ``health crisis'' was once about. 
     Ever-higher spending is squeezing other government programs 
     and, through employer-paid insurance, take-home pay. For 
     example, Medicare and Medicaid now represent 17 percent of 
     federal spending, up from 5 percent in 1970. President 
     Clinton harped on high health costs in the 1992 campaign, and 
     his initial plan did--on paper at least--deal with them. But 
     the spending issue vanished as the Clintons focused on 
     ``universal coverage.''
       The press went along; the major media stopped listening to 
     concerns about spending. In July, the bipartisan Committee 
     for a Responsible Federal Budget issued a report warning that 
     all health plans could involve huge spending increases. 
     ``Common sense tells us,'' the report said, ``that everyone 
     cannot consume more health care and pay less.'' The committee 
     includes two former heads of the House Budget Committee (both 
     Democrats), five former heads of the Office of Management and 
     Budget (three Republicans and two Democrats) and the ex-head 
     of the Federal Reserve. The report wasn't covered by The 
     Washington Post, the New York Times, the Wall Street Journal 
     or any major TV network news programs.
       Sometimes editors and reporters don't even seem to read 
     their own papers. On Sunday, Aug. 7, Robert Pear of the New 
     York Times wrote a front-page piece saying that ``the goal of 
     cost control has been eclipsed by the furor over universal 
     coverage.'' A solid story. Unfortunately, the Times' coverage 
     the following week ignored health costs. At midweek, the CBO 
     issued a report on Senate Majority Leader George Mitchell's 
     health plan. Previously, the CBO had estimated that health 
     spending could increase to one-fifth of the nation's income 
     (gross domestic product) by 2004, up from a seventh today. 
     The Mitchell plan, the CBO said, would increase it slightly 
     more.
       Now obviously, I have a point of view. I think health 
     spending matters and doubt that these ``reforms,'' if 
     enacted, would work as promised. But it is not necessary to 
     share my views to think that these are legitimate issues that 
     haven't been adequately aired in daily coverage. If a major 
     ``reform'' is adopted and doesn't operate as advertised, 
     people will ask: Where was the press?
       Good question. There have been warnings. Return to that CBO 
     report. The CBO found that much of Mitchell's plan is 
     probably unworkable. States couldn't easily determine who 
     would be eligible for insurance subsidies. A tax on insurance 
     would be ``difficult to implement.'' It would not ``be 
     feasible to implement'' Mitchell's so-called ``mandate'' 
     without causing severe ``disruptions, complications and 
     inequities.''
       This strikes me as ``news.'' The New York Times ignored it, 
     and The Washington Post brushed it off with a couple of 
     paragraphs in a small story. To their credit, the Wall Street 
     Journal and the Washington Times ran major stories; likewise, 
     NBC ``Nightly News'' reported these findings. But in general 
     the major media tend to treat each of these health proposals 
     as a coherent plan without practical problems. This makes the 
     story a neat combat between ``reformers'' (implicitly good) 
     and opponents (implicitly bad).
       There is a paradox here. Many reporters seem infatuated 
     with ``reform'' even when, by personal experience, they ought 
     to know better. Journalists are supposed to be seasoned 
     skeptics, and most Washington reporters are familiar with 
     government's defects. We have covered agencies captured by 
     ``special interests.'' We know of many worthy but unkept 
     promises. We know that Congress evades difficult (a k a, 
     unpopular) choices and, as a result, tends to march off in 
     five directions at once. Yet the skepticism that this ought 
     to breed withers in the face of an appealing ``reform.''
       What also has been missed is the basic political nature of 
     this debate. Once government decrees what insurance must 
     cover (by creating a standard insurance ``benefits 
     package''), it has effectively nationalized insurance. The 
     obvious way of doing this would be a single-payer system that 
     taxes people and provides government insurance. But that 
     looks too much like a government takeover. The use of 
     ``mandates'' and regulation disguises this and seems to have 
     fooled many reporters. Hundreds of billions of dollars of 
     spending would still come under federal control.
       By now it's clear that the public is deeply puzzled by the 
     whole debate. The responsibility for this falls mainly on our 
     political leaders. President Clinton and his critics have not 
     been candid. They won't acknowledge that the goals that most 
     Americans share--better insurance coverage, personal freedom 
     in medical choices and cost control--are, to some extent, in 
     conflict with each other. In this sense, there can be no 
     ideal reform; somehow, incompatible goals will have to be 
     balanced.
       But the conflicts will not vanish just because Democrats 
     and Republicans refuse to discuss them. The press's job is to 
     bring candor and clarity to issues where political leaders 
     haven't shown much of either. We don't make society's 
     choices, but we can illuminate what those choices are. On 
     health care, we haven't.
                                  ____


                [From the Wichita Eagle, Aug. 17, 1994]

      Forget Health-Care Reform For This Year; Try Again Next Year

       What's shaping up as a political disaster for President 
     Clinton--the impending collapse of health-care reform--could 
     turn into a blessing for the country. The country needs a 
     more efficient and humane health-care delivery system than 
     the one it has now, but it seems highly unlikely that 
     Congress can muster the courage to pass such a bill. The 
     bills on the table don't meet that goal.
       So the best course is for national policymakers to forget 
     it for this year and fall back to regroup. Inaction would 
     alter the political fortunes of the president and members of 
     Congress--although how is far from clear because it's far 
     from clear what the American people want Congress to do on 
     this difficult and confusing issue. But inaction could save 
     the federal government from an even more precarious financial 
     crisis than the one it faces already.
       The federal government is broke and falling deeper into the 
     hole. For example, in the year 2001, without major changes in 
     current law, Medicare could go belly up. As a highly credible 
     32-member bipartisan paney of budget experts chaired by Sen. 
     Bob Kerrey, D-Neb., revealed in a frightening report last 
     week, entitlements and interest payments on the national debt 
     are eating up such a huge share of federal resources that by 
     the second decade of the 21st century there will be no money 
     for anything else--defense, education, highways, airports, 
     medical research--unless Americans are willing to endure an 
     economically crippling tax increase. Yet some members of 
     Congress would add another expensive health entitlement.
       The main health-reform plans under consideration in the 
     House and Senate--loosely modeled on Mr. Clinton's original 
     proposal last year--would accelerate this problem. They would 
     hasten the day when government as we know it comes crumbling 
     down, and when the nation's financial unraveling--in progress 
     for about a dozen years now--is complete.
       The original focus of Mr. Clinton's 1992 campaign pitch on 
     health reform--a pitch that struck a chord with the 
     electorate--was controlling the cost of health care, costs 
     that have swollen to the point where health care consumes 
     about one-seventh, or 14 percent, of the economy. But as the 
     shouting match over health care increased in intensity last 
     year and this year--it would be inaccurate to call it a 
     debate because ``debate'' connotes intelligent and orderly 
     discussion of a problem, and that hasn't occurred on health 
     care--the focus shifted. Now health reform is a contest 
     between conservative ``meanies'' who want to deny Americans 
     universal health coverage and liberal ``spendthrifts'' who 
     want to give every American coverage and stick business and 
     middle class with the tab.
       Meanwhile, the voices of those with a vested interest in 
     health-care delivery have risen to ear-splitting intensity. 
     The environment is polluted with all manner of exaggerations, 
     distortions and out-and-out lies aimed at scaring the 
     American people into backing one course or the other.
       As The Eagle has said many times since Mr. Clinton launched 
     the issue last year, universal coverage is a laudable goal, 
     but the main objective of health-care reform should be cost 
     control--led by the restructuring of the government's two big 
     and burgeoning health programs, Medicare and Medicaid. It's 
     possible to have both cost controls and universal coverage 
     if--if--Congress is willing to mandate a basic health-care 
     package for all Americans, while prioritizing the expensive 
     and exotic medical procedures that drive costs through the 
     roof.
       Well, let's pretend that this is a football game, that no 
     one has scored yet and that it's now halftime. Let's let the 
     combatants retire into their locker rooms until the main 
     halftime event--the election--is over, then resume work on 
     the problem next year. Maybe, just maybe, they'll get it 
     right in the second half.
                                  ____



                                       Office of the Governor,

                                                  August 16, 1994.
     Hon. Bob Dole,
     U.S. Senate, Washington, DC.
       Dear Senator Dole: Several weeks ago, we sent you a letter 
     in which we outlined our major areas of interest in national 
     health care reform. In that letter, we discussed our 
     preference to fully integrate the acute care portion of the 
     Medicaid program into a new low income subsidy program. We 
     also strongly opposed your cap on the federal portion of the 
     Medicaid program. In private conversations and publicly when 
     you addressed the National Governors' Association in Boston, 
     you pledged to work with the governors on a bipartisan basis 
     to address our concerns about the structure and financing of 
     Medicaid. Over the past several weeks, your staff has worked 
     effectively with governors' staffs on these issues, and we 
     appreciate that you have fulfilled your commitment.
       We believe that the approach to Medicaid reform presented 
     in your legislative proposal (S. 2374) meets our goal of 
     integrating, to the greatest extent possible, the acute care 
     portion of Medicaid into a new low income subsidy program. 
     This approach is equitable to the working and non-working 
     poor in that it makes the same benefits packages available to 
     all who qualify for subsidies and removes the categorical 
     distinctions of Medicaid.
       By allowing states the option to fully integrate acute care 
     Medicaid into the low income program at the time the program 
     starts, you allow states to choose to move to a maintenance 
     of effort financing mechanism immediately. By providing a 
     three-year window during which states could continue to run 
     their current programs subject to state and federal spending 
     caps, you allow states the option to reduce their MOE 
     baseline. Using the year before a state integrates as the 
     baseline year gives us attractive flexibility.
       We support your general approach to providing supplemental 
     benefits for the new low income subsidy program by providing 
     a capped entitlement to states to target benefits outside the 
     basic benefit package to populations most in need. Your 
     approach makes a broad array of services potentially 
     available to a larger population while being mindful of state 
     and federal budgets. As you know, however, a few states 
     might want to have the option to provide some of these 
     benefits as individual entitlements, and we would like to 
     continue working with your staff to refine the details of 
     this provision.
       Although we have focused primarily on the Medicaid and low-
     income portions, it also appears that your bill is much more 
     state-friendly in terms of regulatory flexibility. However, 
     we note that under most health care reform bills which have 
     been introduced, states will have major administrative, 
     oversight and enforcement responsibilities, and we would also 
     like to continue to work with you in this area to make sure 
     the regulatory scheme makes sense.
       As vice chair of NGA and co-chair of the NGA health task 
     force, we believe that everything we have said in this letter 
     is consistent with the positions taken by the National 
     Governors' Association in official policy and in our major 
     policy interpretation of the Medicaid/low income subsidy 
     program. That view is strengthened by the fact that governors 
     of both parties have pointed to your legislative language on 
     Medicaid as a framework for other bills. Our representatives 
     worked with your staff in good faith to develop your new 
     proposal, and representatives of the NGA and various 
     Democratic governors were also involved in these meetings. 
     The politics of this issue have so far proved impossible for 
     Democratic governors to get beyond, but we are continuing to 
     work with them so that we can provide NGS's official written 
     responses to your bill and other bills. In the meantime, we 
     want to thank you for your responsiveness to the concerns of 
     governors.
           Sincerely,
     Tommy G. Thompson,
                                            Governor of Wisconsin.
     Carroll Campbell,
                                       Governor of South Carolina.

  (Mr. KERREY assumed the chair.)

                          ____________________