[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]

 
                          CLINTON'S HEALTH PLAN

                                 ______


                           HON. NEWT GINGRICH

                               of georgia

                    in the house of representatives

                       Thursday, October 6, 1994

  Mr. GINGRICH. Mr. Speaker, Ralph Kinney Bennett's article in the 
March 1994 issue of the Reader's Digest, ``Your Risk Under Clinton's 
Health Plan,'' explains what the title promises.
  I submit the article on the important subject of health care reform.

                 Your Risk Under Clinton's Health Plan

       When doctors told him he had lymphatic cancer, Donald 
     Porter's only hope was a risky and expensive bone-marrow 
     transplant. Porter, 64 was thankful for the card in his 
     wallet. Issued by the government, it guaranteed his medical 
     care.
       Then Porter learned the government deemed him ``to old'' 
     for a transplant; younger people had a better chance of 
     survival. So Porter sold his house, took out all his savings 
     and went abroad for the operation. His cancer is now in 
     remission.
       Donald Porter is Canadian. When his country's ``universal'' 
     health plan failed him, he came to the United States, the one 
     advanced industrial country that does not have a universal 
     medical plan. But it does have the highest standard of health 
     care in the world.
       While Porter's case was being cited in the Ontario 
     legislature as an embarrassing failure, President Bill 
     Clinton was telling Congress last September that American 
     medicine is ``to uncertain and too expensive.'' It is time, 
     he said, to reform the system, ``giving every American health 
     security, health care that can never be taken away.''
       The program outlined in 1342 pages of the President's 
     health Security Act of 1993 is breathtaking in scope and 
     intrusiveness. Everything in the $1 trillion health-care 
     sector-hospitals, pharmaceutical companies, doctors and 
     nurses would be subject to federal supervision and control.
       Would Clinton's ambitious plan improve our health-care 
     system--or make it worse? The President challenged the nation 
     to judge his plan by six criteria: ``security, simplicity, 
     savings, quality, choice and responsibility.'' How does it 
     measure up?
       1. ``Security means providing every American with 
     comprehensive health benefits.'' Under the act, the 
     government would issue a ``health security card'' that 
     entitles each citizen to a standard medical-insurance policy 
     covering everything from brain surgery to health-education 
     classes. The insurance could not be terminated ``for any 
     reason, including nonpayment of premiums.''
       To control the expense of covering everyone, a National 
     Health Board would set premiums and establish overall health-
     care spending limits through so-called ``global budgets.'' 
     These are a standard feature of universal health-care plans, 
     including Canada's.
       But as Donald Porter learned, universal medical care is 
     anything but secure. To control the demands on its system, 
     Canada has had to severely ration medical treatments, 
     including state-of-the-art drugs, therapies and surgical 
     procedures. Routinely prescribed antibiotics are often years 
     behind those used in the United States.
       Canadians who need emergency treatment generally get it. 
     But a large number face harrowing waits of many months for 
     heart surgery and other procedures. Some patients with 
     treatable tumors have seen their cancer progress to the 
     incurable stage while awaiting radiation therapy. Others have 
     died waiting.
       Dr. William Mackillop, local radiation oncologist at 
     Kingston Regional Cancer Center in Ontario, was asked what he 
     would do if he were on the radiation waiting list: ``There's 
     no way I'd wait,'' he answered. ``I'd go to the United 
     States.''
       The Clinton bill specifies heavy criminal penalties (fines, 
     seizure of property, long prison terms) for ``bribery and 
     graft in connection with health care.'' Why would there be 
     bribes? Why such stiff penalties? ``There undoubtedly will be 
     shortages and waiting lists,'' says civil-law professor 
     Bradley A. Smith of Capital University Law School in Ohio. 
     ``Bribery and influence peddling will be the natural result. 
     Rhetoric to the contrary, the Clintons must know this plan 
     will result in rationing.''
       2. ``Simplicity means reducing paper work that wastes 
     countless hours and billions of dollars.'' The President 
     promises to make things simpler by establishing a single 
     insurance form to replace the hundreds now used by private 
     health plans. And, he says, ``we will simplify the 
     government's rules and regulations.''
       After plowing through the four-pound, eight-ounce Clinton 
     bill, Carol Miller, president of the New Mexico Public Health 
     Association, told Congress, ``I don't see any simplification. 
     More than 1000 pages of the Health Security Act create 
     administrative complications, not simplifications.''
       Key to the Clinton plan would be ``Regional Health 
     Alliances''--at least one in each state. All citizens would 
     be forced to enroll in a health plan offered by their 
     alliance or face severe fines. These alliances are the 
     backbone of a vast empire--an estimated 105 new bureaucratic 
     entities, a minimum of 50,000 new public employees--that 
     would reach down through state governments into hospitals 
     physicians' offices, workplaces and homes to control 
     virtually every aspect of health care.
       Even Stanford management professor Alain Enthoven, one of 
     the principal architects of the alliance concept, is critical 
     of the plan. Enthoven says President Clinton has ``redefined 
     the concept'' until ``it threatens to be a monopolistic, 
     regulatory government agency that will cause more problems 
     than it solves.''
       3. ``I believe we can achieve large savings.'' The plan's 
     financial engine, the ``employer mandate,'' requires 
     businesses, large and small, to pay at least 80 percent of 
     the health coverage for all employees. President Clinton says 
     businessmen will achieve savings through ``lower premiums,'' 
     allowing them to hire new workers, or even give out raises.
       But many experts believe the mandate would actually 
     increase costs and tax many jobs and businesses out of 
     existence. Economists June an Dave O'Neill of New York City's 
     Baruch College explain that the employer mandate is the 
     equivalent of a $5000 to $6000 wage increase for every worker 
     who is into already under an employer-provided medical plan.
       The White House claims the impact on employment will 
     ``minimal''--perhaps 600,000 people thrown out of work. Other 
     estimates are much higher. The O'Neill study conducted for 
     the small-business-backed Employment Policies Institute 
     projects the loss of 3.1 million jobs nationwide, with entry-
     level and relatively low-wage jobs the hardest hit.
       Ron Chapman, a boat builder in Chalmette, La., says the 
     mandate ``may well upend already overburdened small 
     businesses like mine.'' when Hillary Rodham Clinton, who 
     headed the task force that produced the plan, was asked what 
     might be done to ease its burden on small businesses, she 
     replied, ``I can't go out and save every undercapitalized 
     entrepreneur in America.''
       Rather than achieving large ``savings,'' the program is 
     likely to send overall costs skyrocketing. The plan projects 
     a lower rate of growth in health-care spending, but the 
     federal government is notoriously poor at such projections. 
     When Congress instituted Medicare in 1965, it estimated the 
     program would cost about $12 billion by 1990. The actual 
     figure is $110 billion, despite years of cost-control 
     efforts. Taxes have been raised again and again to pay for 
     the Medicare program. Professor Enthoven concludes, ``The 
     Clinton plan puts the federal budget at enormous risk and 
     will result in huge tax increases.''
       4. ``Quality means improving what is already the highest 
     quality care in the world.'' For most Americans, quality 
     health care means a personal physician armed with the latest 
     diagnostic technology, access to specialists when needed--and 
     no waiting. ``The practice of medicine cannot be managed by a 
     time clock,'' says Dr. Robert Blee, a general practitioner in 
     Chevy Chase, Md. ``The interaction with patients is a very 
     subtle thing, You need time to see the warning signs, compare 
     details with the records of previous visits. And people want 
     to know that you are giving them your attention.''
       But the Clinton plan would force most Americans into so-
     called ``managed care'' programs--health maintenance 
     organizations (HMOs) are the principal type. Businesses with 
     burgeoning employee health-care costs have found HMOs' cost-
     effectiveness attractive, and many patients like their 
     relatively low premiums. Thus, HMOs have grown explosively--
     from 10.8 million enrollees in 1980 to 41.4 million by 1992.
       But in an effort to hold down costs, managed care alters 
     the doctor-patient relationship. In many HMOs, for instance, 
     primary-care physicians are not paid on the basis of 
     individual transactions with patients. Instead, they receive 
     a flat fee--$6, $8 or $10 per patient per month. ``There's a 
     perverse incentive here to have more patients, but see them 
     less,'' says Dr. Steve Reeder, a Dallas vascular surgeon.
       In addition, HMOs often pool a percentage of premiums and 
     hand it out as annual bonuses to doctors who have kept 
     expensive tests, hospitalizations and referrals to 
     specialists to a minimum.
       Dr. Blee, who works with several HMOs, says primary-care 
     physicians become ``preoccupied with keeping costs down. they 
     may tend to discourage rather than encourage a visit to a 
     specialist.''
       Last spring a woman came to the office of New York 
     internist Louis Vorhaus II with excruciating stomach pains. 
     He diagnosed acute appendicitis. She needed a surgeon 
     immediately. But her HMO required authorization before 
     contacting one. Vorhaus got on the phone.
       It rang several minutes before a recorded message told 
     Vorhaus to wait. Eight minutes later, a woman's voice asked 
     what the problem was. When Vorhaus explained, she said 
     authorization was someone else's responsibility.
       The patient waited five hours in intense pain before Dr. 
     Vorhaus could cut through the procedural jungle and get a 
     surgeon to see her: he performed a successful appendectomy. 
     ``The patient was needlessly put at risk,'' says Dr. Vorhaus.
       As long as HMOs have to compete with other methods of 
     health-care delivery, patients have some recourse in the 
     marketplace when they are dissatisfied with quality of care. 
     ``but the Clinton plan will force people into HMOs and 
     eventually, through regulation and coercion, eliminate any 
     alternatives,'' says John Goodman, a leading analysis of 
     health-care economics and president of the National Center 
     for Policy Analysis. Adds Dr. Reeder, ``If the Clinton plan 
     goes through, quality will be a forgotten concept.''
       5. ``Choice means preserving your right to choose doctors 
     and increasing your choice of health plans.'' Choice of 
     doctors under the Clinton plan comes down to this: a managed-
     care physician operating under the plan's restrictions, or a 
     traditional private physician whom you would pay with after-
     tax dollars on top of your dictated premium.
       Even this option--paying for a doctor outside the plan--
     will be limited by the plan's elaborate web of fee-fixing, 
     budget ceilings and regulations. Professor Melvin Konner of 
     Emory University, who backs a Canadian-style system, 
     nonetheless says of the Clinton plan: ``They are taking away 
     our choice of doctor. No amount of rhetoric can conceal that 
     fact. Their proposal will force most of us into managed-care 
     plans.''
       The plan also dictates a standard benefits package for all 
     Americans. The Administration says this will avoid the 
     ``confusion'' that would result if Americans were allowed to 
     choose their own benefits. Thus, Americans would be forced to 
     pay for ``choices'' they may not want or need (such as drug-
     abuse counseling, abortion) and be deprived of others. For 
     instance, the standard package does not pay for mammograms 
     for women in their 40s and covers women over 50 for only one 
     every two years. Critics wonder what other treatments or 
     diagnoses might be denied or rationed--state-of-the-art blood 
     tests for prostate or colon cancer, or hip replacements for 
     the elderly.
       6. ``Responsibility starts with those who profit from our 
     current system but carries on to each and every one of us.'' 
     Under the present system, Americans are largely insulated 
     from responsibility for health-care costs because of the 
     ``third party'' payment system. For every dollar the average 
     patient pays to a doctor, only 17 cents comes out of his own 
     pocket. The remaining 83 cents comes from a third-party 
     payer--his employer, an insurance company or the government.
       But the President's plan only worsens this problem. It 
     takes responsibility away from the individual while vesting 
     more power in the government, all in the name of extending 
     health insurance to those not now covered.
       The vast majority of Americans (over 75 percent) are 
     pleased with their health care. Virtually every citizen has 
     access to medical care, and by law no American can be refused 
     treatment for an emergency condition at a hospital. More 
     than 85 percent of Americans have some form of health 
     insurance. Of the roughly 37 million Americans uninsured, 
     the vast majority are only temporarily uninsured; others 
     are uninsured by choice.
       There are two reforms, both before Congress, that would 
     truly bring individual responsibility back into the health-
     care picture and address the fears that people have about 
     losing their health insurance if they change or lose jobs:
       Give all citizens the same tax break enjoyed by those in 
     employer-sponsored medical plans. Individuals could purchase 
     the health insurance of their choice with tax-free dollars 
     and keep their plans even when they change jobs.
       Allow individuals to purchase ``Medical IRAs,'' in which 
     they could set aside tax-free dollars for out-of-pocket 
     payment of routine medical services. With such medical-
     savings accounts, people could buy low-cost health-insurance 
     policies for major-illness coverage.
       Last Christmas, in an effort to meet budgets, some 100 
     hospitals in Ontario--Canada's most populous province--shut 
     down wards and surgeries for three weeks with doctors going 
     unpaid and nonemergency patients untreated.
       Dr. Walter Bobechko, a world-renowned orthopedic surgeon, 
     left his native Canada several years ago to practice in 
     America. ``The saddest thing to see in the diminished 
     expectations of Canadians,'' he says. ``They are settling for 
     Third World medicine and saying over and over to themselves, 
     `At least it's free.' People are in pain who shouldn't be. 
     People are dying who shouldn't die.''
       Americans, however, have great expectations for their 
     medical-care system. The United States produces nearly half 
     of all new drugs. Doctors from around the world come to our 
     teaching hospitals to stay abreast of the expanding frontiers 
     of medicine. American entrepreneurs are constantly inventing 
     and improving methods to deliver better care at lower costs. 
     ``Yet,'' says House Minority Leader Newt Gingrich, ``at the 
     very moment when we are on the threshold of even greater 
     strides in medicine, the Clintons are telling us, Let's 
     bureaucratize health.''
       The U.S. health-care system is far from perfect, but the 
     quality of care is the best in the world. Donald Porter 
     learned this after price controls, global budgets and 
     bureaucratic decision-makers forced him to leave his country 
     for treatment. Where would he have gone if President 
     Clinton's health-care plan had been in force?

                          ____________________