[Congressional Record Volume 140, Number 133 (Wednesday, September 21, 1994)]
[Extensions of Remarks]
[Page E]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: September 21, 1994]



                           HEALTH CARE REFORM

                                 ______


                          HON. LEE H. HAMILTON

                               of indiana

                    in the house of representatives

                     Wednesday, September 21, 1994

  Mr. HAMILTON. Mr. Speaker, I would like to insert my Washington 
Report for Wednesday, September 7, 1994 into the Congressional Record:

                           Health Care Reform

       In the last few days, the health care debate has shifted 
     away from the idea of comprehensive reform (which would 
     involve widespread changes to the health care system) towards 
     incremental reform (which would make fewer changes). The 
     question now is whether there will be incremental reform or 
     no change at all this year. For some months now I have 
     advocated incremental over comprehensive reform, and I prefer 
     the incremental approach over nothing at all.


                           health care system

       Some people advocate making no changes to the health care 
     system this year. I believe, however, some problems could 
     worsen if not addressed soon. Incremental reforms could 
     address some of these issues. First, about 39 million 
     Americans, or 15 percent of the population, lack insurance 
     coverage, and the number is rising. Second, health care costs 
     continue to rise faster than inflation. Factors such as the 
     aging population and technological improvements will continue 
     to force cost increases. Third, insurance companies often 
     refuse to cover families with high risk, preventing many 
     Americans from purchasing health care insurance. Fourth, the 
     health care marketplace provides incentives for waste and 
     inefficiency--often rewarding doctors and hospitals for 
     providing additional services whether needed or not.


                          incremental approach

       Congress should consider incremental rather than 
     comprehensive health care reform for several reasons. First, 
     comprehensive reform is so complicated, and so wide ranging, 
     no one can really be sure how it would work in practice. 
     Incremental reform is a simpler approach. Second, while 
     universal coverage is a desirable goal, it would be a mistake 
     to implement it in a way that involves too much government. 
     Hoosiers do not want government at the center of the health 
     care delivery system. Universal coverage could set in motion 
     a series of government actions--like major tax increases and 
     regulations--that interfere with the marketplace and make me 
     uneasy. Third, while some people will be left out under 
     incremental reform, it makes sense to address their problems 
     later when we know more about what works and what does not, 
     who is uninsured, and why they do not have coverage. Fourth, 
     no comprehensive health care reform proposal now before 
     Congress has majority support. I do not think the way to 
     enact health care reform is with the votes of only one 
     political party. There must be a shared responsibility of 
     what reform is and how to achieve it. In a late rush to get 
     something enacted, Congress should not toss together a 
     comprehensive reform bill with a major impact on every 
     American and all aspects of the health care system.


                            possible reforms

       Incremental reforms under consideration include a variety 
     of proposals which have been supported by many Democrats and 
     Republicans.

                          Managed competition

       Managed competition is the general term for measures that 
     promote individual responsibility and market competition to 
     contain spending. I favor using market forces in an effort to 
     restrain health care costs over the other option: heavy 
     government regulation and control.
       Such incremental reforms would make it easier for small 
     businesses and individuals to join together voluntarily to 
     purchase insurance. This would increase their purchasing 
     power, allowing them to negotiate better prices and service 
     and helping businesses protect themselves from cost shifting. 
     Reforms also would encourage the use of managed care where 
     the health care provider charges a flat fee in return for 
     providing coverage. This system encourages the use of 
     preventive health care in an attempt to hold down costs.

                            Insurance reform

       Insurance reform could require insurers to take all comers 
     and would limit exclusions based on pre-existing conditions. 
     These reforms would reduce the ability of insurers to 
     exclude--or lock out through prohibitive premiums--those who 
     are at greatest risk in the system. Reforms also would give 
     workers the right to take insurance with them when they 
     change jobs.
       These reforms would guarantee no one could be denied access 
     to coverage, but they do not guarantee everyone will be able 
     to afford it. Insurance reforms could have unintended 
     consequences. If insurers are required to accept customers 
     who are bad health risks and charge them roughly the same 
     rates as everyone else, premiums for all customers could be 
     driven up--encouraging some people with health coverage to 
     drop their insurance.

                               Subsidies

       Incremental reforms could include subsidies to lower-income 
     working families to help them buy insurance. All the major 
     health care reform bills before Congress include some type of 
     subsidy. Subsidies need to be generous enough to help, and 
     solidly financed lest they drive up the deficit. Congress 
     should be careful subsidies do not encourage businesses that 
     employ lower-income workers to drop health insurance coverage 
     because the government will pay for it.

                           Malpractice reform

       Malpractice reform could reduce insurance costs and limit 
     defensive medicine. Indiana is a leader in this area.

                         Standardized benefits

       Insurers could be required to offer at least one 
     standardized benefit package, so consumers can more easily 
     compare policies' cost and service. Insurers could also offer 
     other benefit packages if they wished.

                   Federal employee health insurance

       Small businesses and individuals could be allowed to buy 
     into the federal employee health benefits plan which covers 
     government workers as well as members of Congress. Self-
     employed individuals would receive 100% deductibility for 
     their health care premiums.


                               conclusion

       Congress should aim to produce a fully financed bill that 
     puts the country on a course toward health care cost 
     containment and reduces the number of uninsured. Incremental 
     steps would help some people who need it without dismantling 
     a system that works well for most Americans. I do not want to 
     replace the current system with one that is unproven and 
     untested.
       Congress will be returning to the issue of health reform 
     for years to come. An incremental bill might not be all we 
     want but it would be a major accomplishment. Such a bill 
     would not achieve the President's goal of universal coverage 
     and it almost certainly would not be a permanent solution. 
     But incremental reform now would help some people and improve 
     the current system.

                          ____________________