[Congressional Record Volume 140, Number 121 (Monday, August 22, 1994)]
[House]
[Page H]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: August 22, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
                              HEALTH CARE

  Mr. DORGAN. Let me, having said that, and compared the cost of the 
crime bill to what the Fed is doing, turn to one other brief topic, 
health care.
  As I have watched and listened to the debate on health care, it has 
been interesting to try to understand the connection between what the 
American people want and what is being discussed here in Washington, 
DC. I noted the distinguished President pro tempore of the Senate gave 
a speech last week. I was not on the floor to hear it, but I heard part 
of it on my television set in my office and then I rushed over to his 
office to get a copy of the speech. I thought it was a very thoughtful 
speech, a very interesting speech.
  Unfortunately, we do not have much credibility these days. The U.S. 
Congress does not have a great deal of credibility with the American 
people. Why? There are a lot of reasons for that. There is a cottage 
industry out there of magazine shows and news shows and others that try 
to hold us up to the light and say, ``Look at this ugly imperfection 
here; isn't this grotesque?'' It is not just true with this 
institution, it is true with every institution in America. We have now 
become--not just Congress, but other institutions as well--fodder for 
the ``infotainment'' industry. You entertain by looking at that 
institution or the other institution and saying, ``Isn't this awful? 
Isn't this ugly?''
  It is imperfect. We know that this place is imperfect. I come from a 
town of 350 people, and this place is very much like my hometown. We 
have a lot of wonderful people, basically solid, honest people who work 
hard and want to do the right thing. They try to do the best job they 
can. We also have a few people who make mistakes. When a Member of this 
body makes a mistake, it is on the front page of the paper someplace. 
That is the difference.
  In health care, frankly, I think we sometimes become more ambitious 
than we should. The American people, I am convinced, have said to the 
Congress, ``We want you to do something about health care because 
health care costs too much. Frankly, when health care costs too much, 
it is priced out of the reach of too many of the American people, and 
we would like you to do something about that.''
  And Congress, as is generally its desire, I think, wants to delve 
into this and construct a system, construct a big mechanism to try to 
deal with it. But I do not think the American people are saying, ``Go 
to Washington and change the health care delivery system; the health 
care delivery system does not work.'' I do not think that is what they 
were saying.
  They were saying, do something about health care costs, because for 
most people--middle-income families, businesses, and our governments--
health care costs are skyrocketing. What does that mean? It means too 
many other families, especially the most vulnerable ones, cannot afford 
the cost of health care
  I gave some examples of these costs the other day. I will give just a 
couple again. The average person would ask--and these are all people 
who have come to me--``Why does it cost $300 to put three stitches in 
my son's index finger?''
  ``Why did it cost $18,000,'' one woman asked, ``for 3 days in the 
hospital and the use of the operating room for 4 hours, not including 
physicians' fees?''
  ``Why did outpatient surgery cost,'' a woman writes, ``$13,000 with a 
hospital stay from 8 a.m. to 2 p.m.?''
  That is what they ask. They ask why in the United States does it cost 
$38,000 for coronary artery bypass surgery and in Ontario, the exact 
same surgery costs $16,600? Why does it cost $5,700 for a simple 
appendectomy in the United States when in Ontario, Canada, it costs not 
$5,700 but $2,500? Those are the questions they ask.
  What has happened is, we have seen plans to construct massive changes 
in the health care delivery system and, frankly, very few initiatives 
to deal with costs. Because the debate has become increasingly a debate 
about how do we cover people instead of how do we deal with costs.
  I am convinced we can never, ever resolve the question of coverage 
until we resolve the issue of skyrocketing costs. I will say again, 
none, not one of the plans being offered--the Finance Committee plan, 
the Mitchell plan, the Dole plan, or the Senate mainstream group's 
plan--contains costs.
  We now spend 14 percent of our gross domestic product on health care, 
Canada spends 10, and no other country spends 10. The President made 
the point that this spending makes us noncompetitive. We have less 
money available for investment because we are spending so much more on 
health care. Under every single plan, including those proposed by 
conservatives, health care costs in this country will increase from 14 
to 19 percent and, in most cases, 20 percent of GDP. That is not 
success. We must, in my judgment, address the question of health care 
costs.
  If we address that question, we will ratchet up even further the 
opposition to what we are doing in health care. But honestly, we ought 
to shine the spotlight on how do we deal with the skyrocketing costs of 
health care?
  I intend to offer an amendment on costs. I think we ought to have a 
target out there at some point, a target that says we think we ought to 
aim for no more than 15 percent of GDP committed to health care. We 
ought to have a target. Right now, there is no target. The sky's the 
limit, whatever it costs. We will construct the system, debate coverage 
and whatever it costs it will cost.
  In my judgment, that is not a satisfactory answer. Pharmaceutical 
companies are charging an arm and a leg for what they do. The head of 
one pharmaceutical company makes as much money as the salaries of every 
U.S. Senator combined. They say, ``We need these high prices for 
prescription drugs because we need money for research and 
development.'' Well, that is fine, but then why do you pay your CEO's 
so much?
  Insurance companies--we have one insurance company that pays the CEO 
over $50 million in compensation and stock options.
  There is a lot of money at stake in this question of health care cost 
containment, and that is why the fear of real cost containment has all 
these special interests weighing in, in a very aggressive way.
  We have not even gotten to real cost containment, but that is what 
the debate ought to be. All the special interests in the country have 
now weighed in with television advertisements, radio advertisements, 
and there is a new approach to grassroots lobbying that has nothing to 
do with grass and nothing to do with roots. Let me describe it.
  It is facilitated telephone calling. Let us assume you are an 
insurance industry and you decide, ``I don't like what those folks are 
going to do up on Capitol Hill. We want to continue to make as much 
money as we feel like making. I don't like what they are doing to us.'' 
So they hire a company in Washington, DC, and they say to that company, 
``Would you go out and put together a grassroots organization for me?'' 
And they will do that.
  So this Washington, DC, company puts together a phone bank, probably 
in Washington, DC, or some other area. So the phone bank gets lists of 
people, and the lists of people are called and a telephoner says, here 
is the circumstance, ``How do you feel about that?''
  And the caller says, ``Well, I don't like that.''
  They say, ``Let me make a deal for you. I tell you what we will do, 
we will hook your call right now to your Senator and you tell him 
that.''
  Let me give you a telephone call we got the other day. This is a 
fairly good example. We do not tape calls or anything like that. This 
is a staff person of mine in the office who said it was just an 
interesting call so she, just from memory, jotted it down.
  This was from a small business person who called my office. Here is 
what the small business person said:
  ``I was just transferred by the small business people''--that would 
have been the phone bank people hired by the Washington group to create 
grassroots lobbying--``I was just transferred by the small business 
people to your office. Do you know what I'm supposed to tell you? It 
was something to do with voting.''
  My office staff person said, ``No, sir, I have no idea. Didn't they 
tell you what this was about?''
  The caller said, ``Something to do with the health plan, I think. Is 
that up for voting now?''
  My staff person said, ``They are working on it. Do you have an 
opinion you would want to forward'' to the Senator?
  The caller said, ``Not really. I don't know how I feel yet. I told 
that lady that when she called, but she said she was going to transfer 
me'' to your office ``anyway.''
  My staff person said, ``Well, call back when you do know where you 
stand and we'll forward that information to the Senator.''
  This is new grassroots advertising. This is a radio ad that says 
``Call 1-800,'' and they get a facilitator and the facilitator says, 
``OK, if you feel that way about that issue, we will hook you into your 
Senator's office.''
  There was a radio ad in North Dakota partially funded by the 
pharmaceutical manufacturers, and when you listen to the message, you 
think, ``Boy, that is the kind of message I would buy into,'' and 
somebody calls the 1-800 number and, guess what? They immediately get 
passed into my office. That is grassroots lobbying.
  They spend $50 or $100 million on that sort of thing. Can you affect 
public opinion? You bet your life you can. If we get involved in the 
kind of fight we ought to be involved in to contain costs in health 
care, do you think we are not threatening some of the biggest, 
healthiest, wealthiest corporations in this country? You better believe 
we are. Do you not think they would spend $50 or $100 million just like 
that to save their skin? You better believe they will.
  And you think it is not effective? Just see what has happened so far 
and then wonder what happens when we really confront cost containment.
  It is very difficult in these circumstances to legislate effectively 
and to legislate in a manner that really accomplishes what the American 
people want us to accomplish. It is not unusual to get a call these 
days from someone who says, ``I don't want Government to have anything 
to do with health care,'' and then you discover this is said by 
somebody who is on Medicare. It is not unusual to go to a town meeting 
and have someone stand up at the town meeting and say, ``Government is 
awful, Government is the problem, we need to get Government out of 
health care,'' and then find out, as I did, that 75-year-old person 
just had open heart surgery paid for by Medicare, not making any 
connection that the Medicare system is a health care system that was 
established by that very Government.
  We need to address the health care system. If there are people here 
who stand up and say, ``Let's not bother with this, let's let the 
private sector do it,'' they are wrong. There is not competition in 
health care, as Adam Smith envisioned, with pricing as a competitive 
regulator. It does not exist.
  In health care, competition means higher prices. One hospital does 
open heart surgery, and the other one has to do open heart surgery. One 
gets an MRI, the other wants to get an MRI. That is how they compete, 
and it means higher prices.
  The market system has not worked. We must do something in the U.S. 
Congress to deal with skyrocketing costs in health care. If we do not 
put the brakes on health care costs, then we will have failed. And at 
the end of the day, those who say let us do nothing about health care 
costs ought to understand that consigns us to a circumstance where more 
and more and more American people are going to be priced out of an 
increasingly expensive health care system.

  So my hope is that in the coming weeks we in the Congress will decide 
we have a lot more to agree about than to fight about. I hope that most 
of us understand that the costs of health care, having risen now to 
over 14 percent of GDP, on there way to 20 percent, are costs which are 
out of control. I hope we all understand that we must do something 
about health care costs.
  Mr. President, I thank you for your patience.
  I yield the floor and make a point of order that a quorum is not 
present.
  The PRESIDENT pro tempore. The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Mrs. FEINSTEIN. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDENT pro tempore. Without objection, it is so ordered.
  Mrs. FEINSTEIN. I ask unanimous consent to speak as in morning 
business.
  The PRESIDENT pro tempore. Without objection, it is so ordered.
  The Senator from California [Mrs. Feinstein] is recognized to speak 
for 10 minutes as in morning business.

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