[Congressional Record Volume 141, Number 2 (Thursday, January 5, 1995)]
[Extensions of Remarks]
[Pages E34-E35]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


                      WHY HEALTH CARE REFORM FAILED

                                 ______


                          HON. LEE H. HAMILTON

                               of indiana

                    in the house of representatives

                       Wednesday, January 4, 1995
  Mr. HAMILTON. Mr. Speaker, I would like to insert my Washington 
Report for Wednesday, October 12, 1994 into the Congressional Record.
                     Why Health Care Reform Failed

       After a long public debate Congress has decided that none 
     of the many health care reform proposals would be considered 
     for final passage this year. Instead, the President and 
     Congress have agreed that health care reform should be 
     addressed during the next Congress which starts in January.
       A recent statewide poll showed that health care remains a 
     top concern for many Hoosiers. I have been reviewing the 
     reasons why health care reform efforts failed this year.
       First, the health care system itself is complex and so are 
     the proposed reforms. Our system is enormous, representing 
     roughly one-seventh of our nation's economy (or over $1 
     trillion in spending). The challenges facing our medical 
     system--such as rising costs and a growing number of 
     uninsured Americans--are not easy to solve and require multi-
     faceted solutions.
       Second, the President's proposal, at over 1,300 pages, was 
     too complex. The President tried to do too much--to create a 
     perfect health care system that would be all things to all 
     people. What resulted was a bewildering bill that fanned the 
     public's fears and gave opponents plenty to attack: 
     bureaucratic structures, regulations, taxes, and other hot-
     button issues.
       Third, many of the proposed reforms have never been tried 
     on a national scale, and people preferred the status quo over 
     the unknown. No one is really sure how the various health 
     care proposals would work. Hoosiers became more skeptical as 
     they learned more about health care reform. They began to 
     focus less on the problems facing the health care system and 
     more on the problems with the solutions. Our system has many 
     strengths, and they want to preserve what works well and 
     build on it, rather than supporting reforms which would have 
     unknown consequences.
       Fourth, Americans simply do not have a lot of confidence in 
     the capacity of government. Several of the proposed reforms 
     would have increased government bureaucracy, increased 
     government regulation over important issues such as what 
     doctor or hospital people can choose, and increased the level 
     of taxes. People want reform but do not want the government 
     to be the agent of reform.
       Fifth, the major interested parties in health care reform--
     consumers, doctors, hospitals, employers, insurance 
     companies, and taxpayers--have widely different views 
     concerning health care, and successful reform hinges on 
     balancing these competing interests. One thing I heard 
     consistently from Hoosiers was to take more time because a 
     consensus had not yet been reached. They were right.
       Sixth, opponents of reform were intense and effective. They 
     spent millions of dollars attacking specific provisions of 
     the reform proposals. Lobbyists for every conceivable 
     [[Page E35]] interest that could be affected by health care 
     reform swarmed over Washington. The reporting by the media, 
     which emphasized conflict rather than explanation, also 
     elevated public skepticism about the reform proposals. The 
     end result was that attacks by opponents were many, but 
     responses by proponents were far fewer.
       Seventh, Congress did not handle the health care reform 
     debate well. The leaders of Congress supported much more 
     wide-ranging health care changes than the average member of 
     Congress. Congress would not agree on any single 
     comprehensive reform proposal, and only one of the five House 
     and Senate committees which have jurisdiction over health 
     care issues successfully produced a bipartisan bill. Although 
     most members decided early on that they could not support the 
     President's bill, or other comprehensive reform measures, 
     Congress was unable to agree on what incremental reforms to 
     support.
       Eighth, outside events slowed the momentum for reform. The 
     economic downturn ended, and the middle class concern over 
     health care subsided. In addition, medical inflation, 
     although still twice the rate of overall inflation, was much 
     lower than the 12% or 15% annual increases from a few years 
     ago.
       Finally, all of these factors delayed consideration of 
     health care reform. Time became the enemy of reform. Further 
     delays occurred when the Administration needed nine months to 
     introduce a bill, and the President and Congress were forced 
     several times to delay health care reform in order to 
     consider other issues such as the budget deficit reduction 
     package, NAFTA, or the 1995 budget. These delays constrained 
     the time available for Congress to consider, develop and then 
     pass a bill.
                             what is ahead

       The health care debate of 1994 was useful, if not 
     satisfactory, and at least began to educate the public on 
     health care and to illuminate some of the choices before us. 
     The process of developing a consensus in the country has 
     begun.
       I have no doubt that there soon will be another health care 
     debate. The problems facing the medical system are going to 
     get worse and the pressure to act will mount. Medical costs 
     still are increasing at rates two or three times inflation 
     and the number of uninsured Americans is increasing. As these 
     trends continue, more and more people are going to find their 
     benefits cut, their choice of doctor constrained, and their 
     employers putting more of the cost of health care on to them.
       I do not believe reform will happen all at once, or in a 
     single bill, nor should it. No bill can solve all the health 
     care system's problems, and probably no bill that tries to do 
     so can pass. I have believed for some time that comprehensive 
     reform is probably not viable and that reform should come 
     incrementally.
       One place to start in incremental reform may be to offer 
     health care coverage for every child. An estimated eight 
     million children lack health insurance and some four million 
     more have substantially less than full coverage. Other 
     incremental reforms Congress will consider include managed 
     competition, insurance reforms, malpractice reform, subsidies 
     to lower income working families, and opening the federal 
     employee health benefits plan (which covers government 
     employees and members of Congress) to small businesses and 
     individuals.
     

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