[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.

                          ____________________