[Congressional Record Volume 140, Number 145 (Friday, October 7, 1994)]
[Extensions of Remarks]
[Page E]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: October 7, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
                   QUESTIONS TO ASK YOUR CONGRESSMAN

                                 ______


                         HON. RICHARD K. ARMEY

                                of texas

                    in the house of representatives

                        Friday, October 7, 1994

  Mr. ARMEY. Mr. Speaker, a recent article by Ralph Kinney Bennett, in 
the August 1994 Reader's Digest, outlines ``Questions to Ask Your 
Congressman About Health Care Reform,'' of obvious interest to me and 
my colleagues.
  I ask that this important article on health care be included in the 
Record.
  The article follows:

                [From the Reader's Digest, August 1994]

       Questions to Ask Your Congressman About Health Care Reform

                       (By Ralph Kinney Bennett)

       Late last year President Clinton's Health Security Act was 
     introduced with great media fanfare. But as details emerged, 
     public opposition grew. Polls show that about 80 percent of 
     Americans are pleased with their health care; most are wary 
     of compulsory ``universal'' coverage, especially if this 
     means any loss in quality of care or choice of physician.
       Nevertheless, most Congressional Democrats and even some 
     Republicans still accept the premise of the President's 
     plan--that the nation's health care system is in ``crisis.'' 
     With President Clinton apparently willing to sign any bill 
     that creates a universal health entitlement, Congress seems 
     hellbent on increasing government's control of medical care. 
     ``We're going to push through health care reform regardless 
     of the views of the American people,'' says Sen. Jay 
     Rockefeller (D., W.Va.), a leading advocate of the Clinton 
     plan.
       As you sort through the sometimes bewildering array of 
     proposals to ``fix'' health care, here are the central 
     questions to put to your Senators and Representative:


                  Who will pay for health care reform?

       President Clinton has ardently maintained that his plan can 
     be paid for by mandatory payments from employers, a higher 
     cigarette tax and budget cuts. ``The vast majority of 
     Americans will pay the same or less for health care 
     coverage,'' he promised.
       But the Congressional Budget Office (CBO), which rules on 
     budgetary impact of pending legislation, estimates that 
     within three years of passage, the Clinton plan will be the 
     largest program in the budget--bigger than the Defense 
     budget, bigger than Social Security, bigger than Medicare. 
     Reaching a cost of $740 billion a year within the next 
     decade, the plan ``would require a tax increase of more than 
     27 percent--unprecedented during peacetime,'' says economist 
     Bruce Bartlett of the Alexis de Tocqueville Institute, a 
     free-market think tank in Arlington, Va.
       While still chairman of the House Ways and Means Committee, 
     Dan Rostenkowski (D., Ill.) was one of the few Democrats to 
     admit the huge costs of the Clinton plan. Warning of ``broad 
     tax increases,'' Rostenkowski declared that universal 
     coverage would require ``a substantial amount of new 
     revenue.''
       The White House and many Congressional advocates of 
     Clinton-style reform would like the bulk of revenue to come 
     from forced ``contributions'' by employers. But calling these 
     disguised taxes something else changes nothing. As CBO 
     director Robert D. Reischauer told Congress, ``This is going 
     to be the 800-pound canary in your living room. Whether you 
     call it a mouse or a plant isn't going to trick anyone.''
       Says former Democratic Sen. George McGovern, ``Were I still 
     in business today, I would be frustrated and frightened by 
     the specter of substantial increases in employment costs.''
       These contributions would, of course, affect workers' 
     paychecks. ``Employees pay for health insurance by getting 
     less in cash earnings,'' notes Carlos Bonilla of the 
     Washington-based Employment Policies Institute.
       Herman Cain, president and CEO of Godfather's Pizza, Inc., 
     says his company pays 80 percent of health insurance costs 
     for full-time employees of his 141 corporate-owned outlets. 
     President Clinton's plan would quadruple his costs to $2.2 
     million a year. Covering such expense would require a 16- to 
     20-percent increase in sales--a virtual impossibility in the 
     highly competitive fast-food market.
       ``We would then be put in a position to eliminate jobs or 
     increase prices to the point of being at a competitive 
     disadvantage,'' Cain wrote the President.
       After an extensive study, June and Dave O'Neill of New York 
     City's Baruch College concluded that a Clinton-style employer 
     mandate could cost over three million jobs, with low-skilled, 
     low-wage workers especially hard hit. The restaurant industry 
     alone could lose over 800,000 jobs, retailing over 700,000. 
     Farming, construction and repair services would also be 
     affected.
       Despite a rising furor, Congress has labored to keep 
     employer mandates in a health bill. One device is the so-
     called trigger mandate, which would be hidden in the law and 
     would kick in if a certain percentage of Americans were not 
     covered by a fixed date. Another gambit: a ``play or pay'' 
     scheme, giving smaller businesses a ``choice'' between 
     mandated employee insurance or a payroll tax to subsidize the 
     uninsured.
       Why is Congress so set on mandates, despite public 
     displeasure? ``In general, politicians prefer spending other 
     people's money rather than tax revenues,'' notes Henry 
     Butler, professor of law and economics at the University of 
     Kansas. ``Adverse economic effects are less visible, and 
     political costs lower.''


         will i be paying for only the health benefits i need?

       The Clinton plan and its Congressional alternatives promise 
     all Americans a ``comprehensive'' package of health benefits. 
     Many of these benefits you will pay for but never need. Yet 
     to cover them, millions who already have medical insurance 
     will pay at least $500 a year more in premiums, according to 
     Lewin-VHI, Inc., a health care consulting firm in Fairfax, 
     Va.
       What's more, ``every year will see pressures to expand the 
     package,'' says Edward Gillespie, policy director at the 
     House Republican conference. ``This new entitlement will grow 
     in the best tradition of federal programs.''
       The feeding frenzy began last fall as health care interest 
     groups converged on Capitol Hill, demanding their services be 
     included. Big insurance companies spent millions seeking to 
     refashion the Clinton plan to their advantage. Many more 
     groups--from rural health alliances and dental groups to 
     manufacturers of prosthetic devices--have simply sought their 
     ``cut'' of any new law. Even acupuncturists and biofeedback 
     advocates have lobbied for a piece of the action.
       By June, the American Hospital Association had spent $3 
     million on lobbying; Planned Parenthood, $1.5 million for ads 
     and brochures; the Health Care Reform Project, a coalition 
     backing the Clinton plan, $3.5 million.
       Already, results of this kind of pressure have been seen in 
     states where health groups have forced special mandated 
     coverage on insurance buyers. This ranges form mid-wife and 
     optometry services to provision of toupees and protection 
     from ``accidental ingestion'' of illegal drugs. In 1970 about 
     30 such mandates were in place. Now there are over a 
     thousand, causing premiums to soar.


                     How will costs be controlled?

       The bills before Congress promise to control costs through 
     government ``efficiency.'' But a closer look at those bills 
     indicates the prime method of holding down costs will be 
     government controls.
       Under euphemisms such as ``global budgeting,'' ``premium 
     caps'' or ``fee caps,'' the government would calculate the 
     country's yearly spending limits on medical care. Bureaucrats 
     would decide everything from the ``fair'' price of a 
     prescription to whether it is ``cost efficient'' to replace 
     an 80-year-old's hip.
       The result is clear in countries where medicine is under 
     state control. Doctors' fees are kept artificially low, 
     creating assembly-line medicine--brief, perfunctory visits 
     with as many patients as possible.
       Moreover, government price controls seriously retard 
     development and availability of new drugs because of problems 
     in recovering research costs. In Britain 80 percent of 
     prescribed drugs are at least 20 years old, obsolete by 
     American standards. In Germany, home of some of the world's 
     most renowned drug firms, price fixing has reduced drug 
     innovation. Manfred Schneider, CEO of Bayer AG, fears that 
     ``the research-based pharmaceutical industry no longer has 
     a future here.''
       In Germany, Japan and other countries attempting to offer 
     ``universal'' care, cost controls mean that medical services 
     are restricted and rationed. In Britain at any one time, a 
     million people are on hospital waiting lists--many for years. 
     In Canada 177,000 await surgery for periods ranging from 
     months to over a year; almost half report being ``in pain.'' 
     Ironically, about 20 percent of hospital beds in Canada are 
     empty--in wards and rooms closed down to comply with 
     budgetary constraints.
       To see rationing at work in the United States, visit a 
     Veterans Administration hospital. Even at the best VA 
     facilities, patients who need special care like heart or 
     orthopedic procedures must wait 60 to 90 days to see a 
     specialist and then months more for surgery or treatment.
       Routine care also suffers. Over half such patients, reports 
     the General Accounting Office, wait one to three hours to be 
     seen briefly by a doctor burdened with increasing numbers of 
     patients and piles of government forms.
       Little wonder that 90 percent of the nation's 27 million 
     veterans turn to private hospitals rather than the free VA 
     facilities. Comments former VA attorney Robert Bauman, 
     ``Imagine what it would be like if all Americans had the 
     choice of only rationed care in a government-run system.''


         what choices will i have if a health care bill passes?

       The most basic choice you might want is to drop out of a 
     government-regulated ``managed-care'' plan if you don't like 
     the way you are being treated. Under bills now before 
     Congress, that's not an option. If you don't immediately join 
     another approved managed-care plan, the government will 
     assign you to one. Meanwhile, you would still have to pay 
     your monthly ``premium.''
       If you oppose abortions on demand, will you have to pay for 
     them? Under most bills being considered, you will.
       If you follow a healthful life-style, will you be able to 
     choose a plan with low premiums reflecting your low health 
     risk? Most plans before Congress do not provide this choice. 
     They specify that insurance premiums will be ``community 
     rated''--meaning you subsidize people whose habits place them 
     at higher medical risk. It will not matter, for example, if 
     you don't smoke. Your government-regulated premium must cover 
     those who do.
       ``Community rating'' has been the law in New York State for 
     one year. The result? Premiums have shot up for young and 
     healthy workers, almost doubling in some cases.
       Finally, will you be able to choose your doctor? Most bills 
     before Congress claim to preserve your choice, but contain a 
     web of restrictions. They virtually guarantee that a fee-for-
     service option--where you can choose your doctor and deal 
     directly with him--will not survive the realities of price 
     controls and budget caps.
       ``Allowing patients to choose any doctor, obtain 
     justifiable medical care and send the bill to the insurer 
     cannot survive without freedom to raise premiums to cover 
     costs,'' notes John Goodman, an expert on health care 
     economics and president of the National Center for Policy 
     Analysis. ``As with everything else in managed care, choice 
     will become a very relative term.''


              will my health care be as good as it is now?

       Experience elsewhere is not encouraging. In Canada a world-
     class health care system has been eroding under the steady 
     budget constraints of government-ordained ``universal care.''
       Consider the experience of a 72-year-old woman living in 
     Ontario--Canada's most populous province. In 1992 Lillian 
     Holloway couldn't climb stairs or work in the garden without 
     experiencing trouble breathing. After a year of tests, she 
     returned to her doctor ``in desperation'' in April 1993. He 
     told her no hospital beds would be available for at least 
     three weeks, and advised her to go to an emergency room and 
     say she was having a heart attack. ``Then they will have to 
     admit you.''
       Holloway suffered an actual heart attack before she could 
     do as he'd suggested. She needed triple-bypass surgery, but 
     under Canada's rationed system few hospitals perform such an 
     operation. Flown 1000 miles to Hamilton, Ontario, she was 
     operated on, then released just five days later, even though 
     bleeding rectally.
       Her doctor diagnosed a bleeding stomach ulcer, exacerbated 
     by medication. Within two weeks, she underwent surgery for 
     the ulcer. Sent home despite an infected incision, she 
     suffered recurring heart problems, and she was flown back to 
     Hamilton for an angiogram. In the operating room, she 
     suffered another heart attack. ``It was all downhill from 
     there,'' recalls her brother, George Sterne. ``Lil died July 
     26, 1993.''
       Sterne, a U.S. citizen living in San Diego, says, ``The 
     point is, until her condition was life-threatening, my sister 
     couldn't even get into a hospital. I honestly believe that if 
     she had been covered under a private American health plan and 
     treated in an American hospital, she would be alive today.''
       In Britain old hospitals, old technology, wasted resources 
     and long waits are the norm. Says Dr. Eamonn Butler of 
     London's Adam Smith Institute, ``British citizens are leaving 
     the National Health Service in droves because although the 
     United Kingdom does not spend very much on its health care, 
     neither do we get much for our money.'' Disillusionment with 
     socialized medicine has fostered the growth of a parallel 
     private practice, complete with private health insurance.
       You would have no such choice under the Clinton bill. 
     Someone trying to sell you private insurance would face a 
     $10,000 penalty. If your doctor provided you special care for 
     old time's sake, he would face fines and imprisonment.
       Despite the dramatic fall in support for Clinton-style 
     universal coverage, Americans do favor fixing some problems. 
     They want insurance to be cheaper and more readily available 
     to the uninsured, perhaps by allowing everyone to deduct 
     premium payments from his income tax or to put money into a 
     tax-free medical savings account. They also want 
     ``portability,'' or the option of retaining health insurance 
     after a job change.
       But, polls say, Americans do not favor a stampede into 
     hasty and radical changes. The last question to ask members 
     of Congress is: Do you understand the vast, dangerous 
     consequences of jeopardizing the best health care system in 
     the world?

                          ____________________