[Congressional Record Volume 140, Number 137 (Tuesday, September 27, 1994)]
[Senate]
[Page S]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]
[Congressional Record: September 27, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]
HEALTH CARE REFORM
Mr. KERREY. Mr. President, yesterday, Senator Mitchell announced that
the Senate would stop its work on health care reform this session. This
news represents a victory for the politics of the status quo and a
disappointing defeat for Americans.
The debate on health care reform has long since dwindled into
confusion and confrontation. Many Americans became opposed to our
health care reform efforts. A majority of Nebraskans opposed most of
the health care proposals considered by the Congress. They have
listened to ads warning against a big Government takeover, or of
restriction of choice, or of long waiting lines, and the majority has
begun to say maybe it is good that we wait to change our laws.
That is understandable, since in any year the majority will be secure
and will not get seriously ill. The majority does not face an immediate
problem.
It is the minority that has an immediate problem. This year less than
a fifth of us will need to enter a hospital as a patient. Only one in
five Nebraskans each year learns about the complexity and cost of our
existing system of payment and delivery.
Only a fraction of those will learn what it means to have a stranger
in Washington or a stranger in an insurance company tell their doctor:
We will not pay for that procedure. Only a few of us each year face the
prospect of not being able to afford the treatment our doctor tells us
might save our lives.
In our hearts we know that the problem faced by our neighbor this
year is a problem we may face next. Next year it may be our job that is
lost in an act of corporate downsizing. Next year it may be our family
that faces a serious illness or accident that forever brands our
forehead with the scarlet letters: ``preexisting condition.''
In our heads we know that cost of health care is bankrupting America.
This year $318 billion of our Federal taxes will be used to provide
health care to elderly Americans, poor Americans, disabled Americans,
American veterans, and Americans who work for the Federal Government.
And we will provide $90 billion in Federal tax subsidies to encourage
Americans to buy private health insurance.
The year to year increase in Federal taxes to pay health care bills
is $38 billion. That is almost $400 in new Federal taxes paid by each
American household just to pay for the increase. That is on top of
$4,000 in direct and indirect tax spending per household.
In our hearts, where we are able to understand the need for health
care security, and our heads, where the numbers are calculated, we know
that the status quo is not acceptable.
We know that change is needed.
We will fail again next year if we begin by dividing ourselves into
Democrats and Republicans, insured and uninsured, rich and poor, urban
and rural. We will fail if we insist on accentuating our differences.
Unity does not mean we must paper over our differences. Differences
honestly expressed typically allow us to discover win-win solutions.
That is what the mainstream coalition attempted to do in the Senate
this year and will continue to do next year.
The most difficult barrier to changing our Federal laws is the
realization that each of us must change our old habits and ways. As
long as we can blame someone else change is easy. As long as we can ask
everyone to change but ourselves the job looks simple. The minute it
occurs we are going to have to do things differently, too, the fun goes
out the window, the air goes out of our tires.
And change we must:
If we want to continue to have best health care in the world; if we
want all Americans to know with certainty they will get the health care
their doctor prescribes; if we want all Americans to accept personal
responsibility for taking care of themselves at the same time we
provide a safety net for those who cannot; if we want to bring costs in
line with our expectation and capacity to pay; if we want to get
healthier.
The mainstream proposal was not a free lunch. It asked Americans to
change their behavior as consumers of health care services, as citizens
who decide how our State and Federal programs will operate, and as
human beings who must face difficult moral and ethical health care
choices.
As consumers of health care we must change. Over the past 40 years we
have erected a wall of third party reimbursement which now stands
between us and the providers of services. Typically neither the buyer
nor the seller knows the price anymore. To make the market work--in
contrast to a Government run system--Americans must make a greater
effort to learn about the price and quality of health care services.
I believe the market will work if consumers are given more
information about providers and payers. To do this our laws must be
changed so that Americans are not prevented from getting information
about their providers. I believe laws that prevent or discourage buyers
and sellers from learning about each other must be discarded. And, I
believe that tax laws which encourage Americans to buy expensive plans
need to be changed so that all of us face the true cost of health care.
As citizens we must also change. The mainstream proposal asked
Americans to change by giving every taxpayer honest and complete
information which includes how much of their taxes are used to pay for
Federal subsidies, who is being subsidized by whom, and most
importantly what needs to be done to achieve universal coverage. I
believe the American people cannot be expected to make good decisions
about financing health care unless and until they are given the truth
about what we are doing now.
Finally--and perhaps most difficult--we must change as individuals.
Many of the health problems that cost us a lot of money are the result
of smoking, alcohol and drug abuse, lousy nutrition, and other
irresponsible behavior. If personal responsibility is to be a guiding
principle for making payments it must also guide us in making the
personal decisions which often determine how healthy we are.
Further, we cannot expect too much of our doctors and hospitals. Not
only do we need to rein in the movement to sue every time something
does wrong, but we need to face this terrible truth: The system cannot
give us eternal life. The most difficult decision is not a medical or
an economic decision, it is a moral and ethical decision.
I am an advocate of moving the power to make these decisions away
from Washington out to the States and local level. That is the good
news. The bad news is that we will have to decide and will have no one
to blame but ourselves when we are wrong.
The mainstream proposal asked Americans to consider that all
Americans deserve the security of high-quality care. While we did not
start off with universal coverage, we attempted to get there as soon as
possible.
To be clear about universal coverage I would prefer to start with a
clean slate. I would prefer to begin with a simple though radical
change in the way we become eligible for health care. Eligibility
should occur if you satisfy one of two tests. You are an American or a
legal resident. However, to participate you would have to agree to
accept responsibility to make payment according to your capacity to pay
and to participate personally in the job of controlling costs.
High-quality health care is never going to be cheap. It is always
going to be difficult to say no. The mainstream group believed we
cannot and should not make promises we cannot keep. We cannot afford a
new unfunded, non-means tested entitlement. We cannot afford to promise
subsidies which removes the important personal incentive to save for
the rainy day.
The mainstream coalition intends to work toward these objectives
again next year. Although the process has understandably made Americans
suspicious, we must begin again next year in a bipartisan and less
political environment.
We cannot afford to sit smugly in the knowledge that we are in the
majority who are temporarily secure. Today, the bell of health care
insecurity tolls for someone else. Tomorrow, it may toll for us.
Mr. President, I yield the floor and I suggest the absence of a
quorum.
The ACTING PRESIDENT pro tempore. The clerk will call the roll.
The bill clerk proceeded to call the roll.
Mr. DOMENICI. Mr. President, I ask unanimous consent that the order
for the quorum call be rescinded.
The ACTING PRESIDENT pro tempore. Without objection, it is so
ordered.
Mr. DOMENICI. Mr. President, is this time in morning business?
The ACTING PRESIDENT pro tempore. The Senator is permitted to speak
for up to 5 minutes.
Mr. DOMENICI. Thank you.
Mr. President, I ask unanimous consent that I be allowed to speak for
an additional 5 minutes.
The ACTING PRESIDENT pro tempore. Without objection, it is so
ordered.
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