[Congressional Record Volume 141, Number 137 (Wednesday, September 6, 1995)]
[House]
[Pages H8587-H8591]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


                            CUTS IN MEDICARE

  The SPEAKER pro tempore. Under the Speaker's announced policy of May 
12, 1995, the gentleman from New Jersey [Mr. Pallone] is recognized for 
60 minutes as the minority leader's designee.
  Mr. PALLONE. Mr. Speaker, again, I would emphasize that I do not 
intend to use the majority of that time, but I would like to take the 
time that I plan to use to talk about medicare and what reaction I 
received during the last 4 weeks when we were having our August 
district work period.
  I found through visiting my constituents and having forums and trying 
to 

[[Page H 8588]]
address them, in particular on the medicare issue, that many of them 
were not aware of the challenges that face medicare when we come back 
in September at this time. But when they were told about the level of 
cuts, the $270 billion in cuts that have been proposed by the 
Republican leadership, and are included in the Republican budget that 
was adopted last spring, they were very concerned about the impact that 
that record level of cuts in the medicare program would have.
  Mr. Speaker, I think they have every reason to be concerned because I 
feel very strongly that that level of cuts, the $270 billion that has 
been proposed, cannot be implemented without major changes, negative 
changes, in the medicare program, and probably also without significant 
out-of-pocket, additional out-of-pocket expenses for senior citizens 
and those who take advantage of the medicare program.
  I wanted to make a few points about these drastic cuts in medicare, 
if I could, tonight. The first point I would like to make is that the 
Republican sponsored medicare reductions really should come as no 
surprise, because 30 years ago, when medicare was first adopted, there 
was tremendous opposition to the medicare program by the majority of 
the Republicans in Congress, both in the Senate and the House of 
Representatives. In fact, the leading Republican presidential candidate 
now, Senator Bob Dole, voted against the creation of the medicare 
program 30 years ago when he was a Member of this body, the House of 
Representatives.
  If you look back at the record of key votes in the history of 
medicare, going back to 1960, when it was first being proposed, 97 
percent of the Republicans in the Senate voted against the creation of 
the medicare program; and then, 2 years later, on July 17, 1962, 86 
percent of the Republicans in the Senate voted against the creation of 
medicare. Later that year, on September 2, 1962, 85 percent of the 
Republicans in the Senate voted against the creation of medicare.
  The same was essentially true in the House of Representatives, in 
this body. In 1965, when some of the key votes took place on April 8 of 
1965, 93 percent of the Republicans in the House of Representatives 
voted for a Republican substitute which would have replaced the 
medicare program with a voluntary health insurance program for the 
elderly with no guaranteed financing and no guaranteed benefits. Then, 
on July 27, 1965, 49 percent of the Republicans in the House voted 
against the creation of medicare on the vote on the adoption of the 
conference report on the medicare bill.
  Thus, many House Republicans who had voted for the Republican 
voluntary plan I mentioned before, turned around and also voted for the 
final Democrat sponsored medicare bill, perhaps out of fear of the 
wrath of their constituents once the medicare program finally got 
started. Now that the Republicans are in power here again in both the 
House and the Senate, and we are talking 30 years later, they want to 
finance their
 tax cuts for those better off with Medicare cuts.

  If you look at this budget that I talked about before, the one that 
was adopted back in April by the Republican majority here in the House 
and in the Senate, $270 billion in Medicare cuts roughly translate into 
a tax cut to the tune of $245 billion. So if you took a chart and you 
looked at the level of the Medicare cuts, it is pretty much the same as 
the level of the tax cuts that have been proposed.
  I would maintain that although Medicare may need some minor reform, 
it is not as disaster prone as the Republicans are trying to portray 
it, and that, in effect, what they are doing with these Medicare 
reductions is basically budget driven and is not any effort to reform 
the Medicare Program.
  Mr. Speaker, I have heard some of my colleagues in the House mention 
that the trustees' report on Medicare, that comes out every year, this 
year indicated that Medicare would be insolvent within 7 years. I would 
point out, however, that that is one of the longest periods of times 
projected for money to be available for the Medicare Program. If you 
look back at some of the trustee reports in prior years, they were for 
2 years or 3 years before the program became insolvent.
  The bottom line is that, historically, in Congress, we have tried to 
keep a short rein on the amount of money that is available in the 
future for Medicare so that it is not raided, so that the hospitals and 
other health care providers do not say, well, gee, there is this huge 
pot of money out there that will last us a long time, so why do we not 
raise our rates and why do we not, in effect, take some of that money 
to pay us as providers because of the need that we have.
  So we cannot here in the House of Representatives or in Congress in 
general say that Medicare should have a huge pot of money that is 
available for the next 10 or 20 years, because the end result of that 
is that that money would probably be raided. We must keep it on a short 
rein.

                              {time}  1915

  Lester Thurow is not an isolationist. He believes in free markets, he 
believes in the global economy. Lester Thurow cannot be easily 
pinpointed or pigeonholed as a conservative or a liberal. What we do 
know is that he is an outstanding thinker, an outstanding economist. I 
think that some of the things that Lester Thurow had to say in this 
article last Sunday are absolute must reading for every American. Every 
adult American should begin to try to understand what is happening to 
them, what is the matter with our economy, what is affecting our 
culture, what is destroying our families. Here is an economist who 
started out from the point of view of an economist and makes a very 
strong statement about American families.
  Let me just share with you some of the paragraphs and some portions 
of Lester Thurow's article. Mr. Speaker, I ask unanimous consent that 
the entire article by Lester Thurow which appeared in the Sunday, 
September 3d New York Times be entered into the Record.
  The first paragraph is the most shocking statement. The first 
paragraph should be emblazoned
 on the walls of this hall to remind all of us as to where we are right 
now. Mr. Thurow opens with this statement. Listen carefully: ``No 
country without a revolution or a military defeat and subsequent 
occupation has ever experienced such a sharp shift in the distribution 
of earnings as America has in the last generation. At no other time 
have median wages of American men fallen for more than two decades. 
Never before have a majority of American workers suffered real wage 
reductions while the per capita domestic product was advancing.'' Mr. 
Speaker, that is the end of first paragraph of Mr. Thurow's article.

  Mr. Speaker, it is so outstanding, and it does such a great job of 
summing up exactly where we are in this ongoing, radical change. It is 
under way already; it has been under way for two decades now, Mr. 
Thurow says. Let me just repeat: ``No country, without a revolution or 
a military defeat and subsequent occupation, has ever experienced such 
sharp shift in the distribution of earnings as America has in the last 
generation. At no other time have median wages of American men fallen 
for more than two decades. Never before have a majority of American 
workers suffered real wage reductions while the per capita domestic 
product was advancing.'' Mr. Speaker, that is the end of the quote from 
Mr. Thurow's first paragraph.
  Mr. Speaker, I suppose it is very significant that Mr. Thurow's 
article appears on Sunday, September 3, the day before Labor Day where 
we do pay some homage to the working people of America. On Labor Day we 
stop and consider the plight of the workers or the conditions of 
workers, and it is quite appropriate that this article should appear on 
that day.
  Mr. Speaker, I serve on the Committee on Economic and Educational 
Opportunities that used to be called the Education and Labor Committee. 
There was a time when the official Government of America paid more 
recognition and homage to organized labor. Just a year ago we had a 
committee with labor in the name of it.
  But now the Education and Labor Committee is no more, it is called 
the Committee on Economic and Education Opportunities, and none of the 
subcommittees have the name labor in them. The change in name is 
reflective of the change in attitude, because a 

[[Page H 8589]]
massive war has been declared on organized labor and on workers in 
America. Let me just get that straight. Because workers in America all 
need a wage increase. A raise in the minimum wage is not just for 
people who are unionized, a raise in the minimum wage benefits all 
workers, and most of the workers who are working at minimum wage now 
and who would benefit from an increase in the minimum wage are not 
unionized. Most unionized workers are making more than the minimum 
wage.
  It has been proposed by President Clinton and by Democrats in 
Congress that we raise the minimum wage two steps, a mere 90 cents, and 
that has met all-out war. The leadership of the majority Republicans 
have declared, never. Never will we permit minimum wages to move 
forward at all. So minimum wages benefit all workers. There is no 
consideration in the program of the majority for relieving workers of 
the wages that have led to the condition that Mr. Thurow is describing 
here in the first paragraph.
  Mr. Speaker, in addition to not tolerating any discussion of forward 
movement on minimum wage, the majority Republicans here have declared 
war on workers on a massive basis. Speaker Gingrich uses the phrase 
that politics is war without blood. Well, they have declared war on 
workers and war on organized labor.
  We have a whole series of bills that have been introduced which seek 
to undercut the gains of the last 50 years for working Americans. We 
have bills that have been introduced which will radically change OSHA. 
OSHA is the safety agency, the Agency which is responsible for 
workplace safety. We have a bill which is designed to curb the 
activities of the National Labor Relations Board. We have a bill which 
is designed to cut the budget drastically and curb the activities of 
MSHA, the mine safety agency. We have a bill which is designed to 
undercut the organization of workers called the Team Act, which is 
allowing employers to select the people who are going to be the 
collective bargaining agents.
  We have a number of bills of that kind which are stymied in the sense 
that they have to move through a two-stage process. they have to go 
through the House where there are definitely enough votes. The 
Republican majority has enough votes to make certain that they pass. 
They also have to go through the Senate. That is a slow process.
  So what has the Republican majority of the House decided to do? They 
have taken the appropriations bills and they have used the 
appropriations bills to legislate these changes. They do not have 
authorizing legislation to deal with the gutting of OSHA and the 
destruction of safety measures for American workers, so they have cut 
OSHA by more than 30 percent, about 33 percent in the appropriations 
process.
  In the appropriations process they have put in language which says, 
no funds may be used for certain activities. They cannot even study 
ergonomics. Ergonomics, which is a serious problem where workers who 
are involved in repetitive motion have well-identified ailments and 
problems and we cannot even study that anymore. So there is an 
onslaught on working people and an onslaught on organized labor which 
is very significant in light of the fact that Mr. Thurow says, these 
people that you are waging war against have already suffered greatly in 
the last two decades.
  Mr. Speaker, let me just continue reading from Mr. Thurow's article. 
Another paragraph reads as follows: ``The tide rose, the real per 
capita gross domestic product went up 29 percent between 1973 and 1993, 
but 80 percent of the boats sank. Among men, the top 20 percent of the 
labor force has been winning all of the country's wage increases for 
more than two decades.''
  Twenty years. For more than 20 years, the men at the very top already 
are the only ones who have been winning the wage increases. Listen 
closely again. ``The tide rose, but 80 percent of the boats sank.'' 
Remember Ronald Reagan invented the slogan, all tides will rise if you 
cut taxes and you take care of corporations and you deal with providing 
maximum benefits for the rich, they will invest and all tides will 
rise, everybody will benefit.
  Well, here is an economist who says that, it worked in terms of the 
tide rising from 1973 to 1993, a 20-year period. But 80 percent of the 
boats sank; 80 percent of the American population does not benefit from 
this great prosperity that we have experienced in the last 20 years and 
are still experiencing.
  Mr. Speaker, let me just pause for a moment, because I think it is 
very important that we consider that Mr. Thurow later on offers no 
solutions, but consider the fact that for a small percentage, for 20 
percent, we have great prosperity. Wall Street is booming, profits are 
higher than ever before. These are the benefits of technology, 
computerization,
 automation, all kinds of various technological changes, most of which 
are the result of Government research, most of which are driven by the 
fact that in our defense race, in our military arms race with the 
Soviet Union we did tremendous amounts of research.

  Since World War II tremendous amounts of research have laid the basis 
for much of the booming economy that we have today. One of the biggest 
beneficiaries has been the telecommunications industry. 
Telecommunications benefits all the way from computerization and 
miniaturization of parts which were perfected first in Government 
research trying to get things together for our missiles and our space 
program, all the way to satellites that are up there in the atmosphere 
now, satellites that were perfected and developed by the Government.
  The biggest industry in terms of the hardest industry in terms of 
dollars, in terms of transaction is the communications industry, 
telecommunications and media. All of those have benefited. They have 
benefited from the public expenditure, the public participation. But 
now, only 5 percent of the population benefits from the profits. Part 
of the solution to the long-term problem lies in the recognition of the 
fact that there should be some sharing of those benefits, that the 
small percentage of Americans are reaping as a result of the effort 
made by the larger mass of society. Sharing that is part of where the 
answer to the problem lies.
  Mr. Speaker, let me just continue to read from Mr. Thurow again:

       New production and distribution technologies require a much 
     better educated force, a much better educated force. If 
     decisions are to be pushed down the corporate hierarchy, 
     those at lower levels have to have skills and competency 
     beyond what was required in the past. With our global economy 
     where anything can be made anywhere and sold everywhere, the 
     supply of cheap, often well-educated labor in the third world 
     is having a big effect on first world wages. One month's 
     wages for a Seattle software engineer gets the same company 
     an equally good engineer in Bangalor, India for a whole year. 
     One month's wages for an engineer, a software engineer gets 
     the same company an equally good engineer in Bangalor, India 
     for a whole year.

  Consider the implications of that. You have heard a lot about 
unskilled jobs and manufacturing jobs leaving the country. Well, here 
are jobs for which a college degree is required. Here are jobs which 
require extensive training and experience, and you can go overseas and 
get the same quality of workers for one-twelfth the cost of the worker. 
I think engineers probably do not like to be called workers. They are 
professionals. That is a great myth in this country.
  Professionals think they are different, they are safe. Large numbers 
of people who did not join unions are now talking about forming 
associations, in order to deal with a situation where the country is 
being hijacked. The multinational corporations are ignoring the plight 
of the workers.
  Corporations are not in business to take care of workers. 
Corporations are not in business to make America great. Corporations 
are not in business to promote national security. There are a lot of 
things we have been led to believe, but which are just ridiculous. 
Corporations are in the business to make money and that is what they 
are supposed to do. Nobody should worry about that. They are there for 
profit and that is their business. All power to corporations to make 
profits.
  Government and the people who run the Government, Congressmen, 
Members of the House of Representatives and Members of the Senate, the 
President, Government has the responsibility of taking care of the 
country, of seeing that our society is not destroyed, of seeing that 
families are not destroyed. Whatever is necessary to be 

[[Page H 8590]]
done now is up to us, not to corporations. Let them go. They will do 
whatever they can to increase their profits. That is their business.
                              {time}  1945

  The Republican plan to reduce Medicare funding by this $270 billion I 
believe is going to force seniors to pay out of their pocket as much as 
$1,000 per year over the next few years. The biggest problem, though, 
is that right now we really do not know what the Republican leadership 
is going to suggest as a means of implementing this major reduction in 
Medicare. If we look at some of the proposals that are out there, we 
can see that they are devastating, but so far, there is not a specific 
proposal that we can examine in detail.
  I am concerned that what we are going to see is that sometime toward 
the end of this month, in September, we are going to see a plan put 
forward at the last minute, without an opportunity for a great deal of 
debate, and it is going to be brought to the House floor in some manner 
through a procedural vote so that there are only a few hours or a few 
days or perhaps a little longer than that for this great national 
debate on how to change the Medicare Program.
  I would say that that is essentially a stealth plan; to bring this up 
at the last minute, bring it up when there is not a lot of time for the 
public to review it, and then pass it. I think we have to guard against 
this stealth attack, and hopefully, certainly myself and others will 
bring it to the attention of the American public when this finally 
comes out, that there has not been enough time, and there should be 
enough time to review it in detail.
  Mr. Speaker, this past month, in August, when we did have our 
district work period for about 4 weeks, I had the opportunity in my 
home State of New Jersey to join with the other Democratic Congressmen 
from my State to essentially try to put forward to the public through 
various means our concern about these Medicare reductions. We had a 
very successful bus trip around the State which started at the State 
House in Trenton and traveled from Trenton to Edison, in my district, 
and then to Elizabeth, and finally to North Bergen in Hudson County.
  We expressed the concern, both myself, Mr. Torricelli, Mr. Andrews, 
Mr. Menendez, and Mr. Payne, that the Republican plans of gutting 
Medicare would essentially end the Federal Government's 3-decade-old 
commitment to provide health coverage for older Americans.
  We gave four top reasons, pursuant to our bus trip, we called it the 
Medicare Express, why the public should oppose the Republican Medicare 
cuts. I would like to highlight those four reasons now, if I could. One 
I already sort of hinted at, and that is that we are going to see 
dramatically increased health costs for seniors. We have to understand 
that this $270 billion in cuts outlined in the Republican budget 
resolution is the largest cut in the history of Medicare. No matter how 
we figure it out, it is going to result in major out-of-pocket 
expenditures to our senior citizens, and increased costs essentially.
  Second to that and just as important when we were out on the road and 
talking to seniors was the concern that we found on the part of senior 
citizens in New Jersey, and I am sure it is shared with the rest of the 
country, that the Republican plan will restrict choice and also reduce 
the quality of care; because essentially what I think we are going to 
see, and we have already heard some talk about that, is that on the 
House side, the Republicans have put forward this idea of a voucher 
plan, that somehow they will give senior citizens a check or a voucher, 
as it is called, and that the seniors then take that voucher or check
 to go out and buy their own health insurance in the private market.

  I think a lot of people do not realize that Medicare now is a 
government-run program. If we simply give people a voucher and make 
them go out and buy their own health insurance, a lot of them are not 
going to be able to afford the existing what we call fee-for-service 
system, which allows them to choose their own doctor or their own 
hospital and then have the Government reimburse the doctor or the 
hospital for the care.
  What will happen, I believe, is that if we do a voucher system, which 
again is budget-driven or cost-driven, a lot of seniors will find that 
they cannot buy a fee-for-service system that allows them to choose 
their own doctor or their own hospital with the amount of money they 
get in the voucher. Therefore, they will be forced into what we call 
HMO's or managed care systems, which basically prevent or limit 
seniors' choices with regard to doctors and with regard to hospitals.
  That is why we, as Democrats, have been very suspicious of the 
Medicare cuts, not only because of the increased health costs for 
seniors, but also because if we move to a voucher system, where somehow 
we force senior citizens into a HMO, we are restricting their choice of 
hospitals and we are restricting their choice of physicians. In many 
cases many of the seniors have used the particular hospital or 
physician for 30, 40 years, and all of a sudden they will find they do 
not have a choice anymore.
  However, the Medicare cuts not only harm seniors, they also harm all 
Americans, because if we look at what has happened in the past and what 
existed before the Medicare system was established 30 years ago, young 
families were often faced with the prospect of caring for a seriously 
ill elderly relative, and faced bankruptcy in order to care for that 
relative. Medicare has basically made it possible for young families to 
spend their hard-earned resources on other things, other than seniors 
or their parents or grandparents' health care; for example, for their 
children's education. If we go back to a system where seniors do not 
have quality care or do not have sufficient care, then a lot of those 
costs are going to be borne by younger people and make it more 
difficult for them to do other things; for example, care for their 
children or their children's education.
  Again, Mr. Speaker, I would stress that it really is not fair, 
because 30 years ago this Congress made a compact or a contract, if you 
will, with senior citizens that said that they would be provided with 
health care when they reached the age of 65. That contract is 
essentially broken if Medicare is gutted or if seniors do not have 
access to the doctors or hospital of their choice, or have quality 
care.
  The Republicans on the Committee on the Budget have put forward a 
number of suggestions for implementing this $270 billion cut in the 
Medicare program. They put together what they call a budget task force 
that came up with about over 30 recommendations about how to implement 
these cuts. I just wanted to highlight a few of them. I mentioned the 
voucher plan, which I think is the worst of all. However, some of the 
other ideas that were mentioned were increased premiums for new 
beneficiaries who use Medicare fee-for-service. In other words, if 
instead of going to a voucher system, you say to seniors,

       Look, if you want to stay in a fee-for-service system where 
     you choose you own doctor, as opposed to an HMO, we will 
     simply make you pay more for that, for
      that type of a system, the one you have now.

The other option, of course, is to just increase deductibles or to 
increase copayments. Many seniors, most seniors know now, that there 
are deductibles and there are copayments for various services, so you 
could simply increase those and there would be more out-of-pocket 
expenditures.
  However, the one thing that has not been highlighted very much, and I 
wanted to spend just a little bit of time on it today, because when I 
was back in my district in New Jersey and I went around, a lot of the 
people who showed up at either the forums or who called me were from 
hospitals who were concerned about the quality of care, and what it 
would mean to the hospitals if this program of Medicare cuts were to 
take place.
  I was amazed when I got information from the State Hospital 
Association and from some of the hospitals in my 6th Congressional 
District about how these cuts, what these cuts would mean in terms of 
dollars, because so many of the hospitals in my part of the country, 
and I am sure in others, are so dependent upon Medicare, as well as 
Medicaid funding. Medicaid is the program, the health care program, for 
poor people. Medicare is, or course, the health care program for senior 
citizens.

[[Page H 8591]]

  If I could take as an example Monmouth Medical Center, which is in my 
hometown of Long Branch, which we did visit, and where I talked with 
the president of the hospital and some of the hospital executives about 
the problems that they would face with these levels of Medicare cuts, 
they estimated that at Monmouth Medical Center, which is the largest 
area hospital in my district, that the Monmouth Medical Center would 
lose an estimated $77 million in Medicare payments over the next 7 
years under this Republican proposal.
  Interestingly enough, Monmouth Medical Center receives 55.17 percent, 
or a majority of its revenues, from Medicare and Medicaid. That figure 
is pretty much repeated for a lot of the other hospitals in my 
district. Jersey Shore Medical Center, which some people know recently 
had to lay off a lot of personnel, 56.29 percent of its revenues are 
from those two programs; Riverview in Red Bank, 51 percent; John F. 
Kennedy Medical Center in Edison, 59 percent; South Amboy Medical 
Center, also in my district, 57 percent.
  Although the Republican congressional leadership has been vague about 
the specifics of their Medical proposal, it is inevitable that 
reductions in hospital spending will have to be a big part of this 
Medicare reduction package. The effects of these cuts will be felt 
throughout the community and force many hospitals to make some really 
tough choices. I think that we are going to see increasingly hospitals 
laying off staff, that is already happening to a lot of them, and many 
of the community benefits that hospitals now offer, such as multiple 
health screening centers, transportation services, and some of the 
clinics that are so important to a lot of people in my district and 
around the country would probably end up closing.
  The reductions in Medicare spending that are being proposed by the 
Republican majority did not cover the additional costs of program 
enrollment growth plus inflation, so in other words, what we are doing 
here is we are not anticipating that a lot more seniors will be 
entering into the Medicare program and taking advantage of it when we 
estimate what these costs are going to mean.
  I have a lot of other information, and I do not want to repeat it 
all. The bottom line is that increased Medicare admissions are a 
substantial part
 of the revenue that a lot of New Jersey hospitals receive, and we 
estimate through the hospital association, again, the New Jersey 
Hospital Association, that there are about 76 hospitals that would be 
on the critical list, in other words, either face closures or face 
significant downsizing if this Republican Medicare reduction takes 
effect.

  Mr. Speaker, I would like to just mention a couple more things in a 
larger sense before I conclude today. Then I am going to yield some 
time to my friend, the gentleman from American Samoa [Mr. Faleomavaega] 
who I think would like to use some of the time that I have remaining.
  I cannot help, in discussing Medicare and the proposals that the 
Republican majority have put forward, not only with Medicare but also 
with Medicaid, the health care program for the poor, but think about 
what the situation was like in this House a year ago when the President 
had put forward a proposal for universal health coverage, and whether 
or not we liked President Clinton's proposals, and I frankly did, but 
whether or not you did or you did not, the focus of the debate in this 
House was on universal coverage, or at least trying to achieve an 
increase in the number of Americans that were covered by health 
insurance, rather than a reduction.
  We talked then, a year ago, about the fact that there were something 
like 30 million to 40 million Americans that had no health insurance 
coverage. The bottom line is if we look at the statistics, that figure 
has only gotten worse since that time a year ago. A year ago we had 
fewer people that were uninsured, and we had the hope that we were 
going to try through some mechanism to cover if not all of them, then a 
significant portion of them.
  Now one year later we face a situation where significantly more 
Americans, we estimate something like 43 to 44 million Americans, have 
no health insurance, yet, the focus in this House is on cutting back on 
the Medicare program for the elderly and the Medicaid program for the 
poor, which I would suggest ultimately is going to result in even more 
people entering the rolls of the uninsured.
  Mr. Speaker, I would like to, if I could, just quote some excerpts 
from a recent editorial that was in the Star Ledger on September 3, 
which is the major, the largest daily circulation newspaper in the 
State of New Jersey. It says: ``Last year at this time it was not just 
the major policy issue,'' talking about health care reform under 
discussion, ``but almost the only one. This year, for all practical 
purposes, it'', the health care reform agenda:

       Does not exist. Despite the intensity of today's political 
     debate, it plays no part in the dialogue.
       One would think the problem of bringing health care 
     coverage to the uninsured had disappeared, or miraculously 
     been solved, except it has not. Things are worse. Last summer 
     when President Clinton unsuccessfully pressed Congress to 
     enact a system to provide universal health care coverage, 
     estimates of the number of people without insurance ranged 
     from 37 million to 39 million. This summer, with the fight 
     for health care reform only a memory, the number of uninsured 
     has increased. Estimates now range as high as 43.4 million. 
     This means that one of six Americans is without coverage, and 
     that does not take into account those who are underinsured 
     and those who are paying scandalously high individual rates 
     for their insurance. The number of uninsured will continue to 
     grow rapidly.
       The Clinton administration claims that Republican plans to 
     cut projected spending on Medicaid, the
      Federal-state program of health insurance for the poor, over 
     7 years could deprive nine million more people of 
     coverage. The big mistake that both parties are making now 
     is to ignore the larger need for a universal health care 
     plan. The debate may have gone away but the problem is as 
     acute as ever. Polls still show universal coverage to be a 
     concept that has wide support.

  I think it is very sad that we are going to spend the next month here 
talking about how to cut back on the Medicare and the Medicaid program 
at a time when the number of uninsured continues to grow. What I hoped, 
and I hope that some day we will see it, is that the debate on Medicare 
reform would focus on what we could do to expand Medicare in a way that 
made the quality of health care better, and emphasized preventative 
care, and also saved money.
  Those of us who have been concerned about Medicare for a number of 
years in this House, many of us on both sides of the aisles have talked 
about, in the past have talked about expanding Medicare to include 
prevention measures such as prescription drugs or home health care. We 
know and studies have shown if you emphasize those prevention measures 
and you include prescription drugs or home health care and long-term 
care in the Medicare program, that prevents senior citizens from having 
to go to a hospital, being institutionalized in a nursing home, or 
whatever, and ultimately saves the Federal Government billions of 
dollars in costs for that institutionalized care.
  But instead of moving in that direction, looking for a Medicare 
reform proposal that would actually expand Medicare, emphasize 
prevention, and ultimately save money without negatively impacting 
seniors' health care, we are just talking about this budget-driven 
proposal by the Republican leadership that would slash Medicare by $270 
billion and I believe ultimately gut the Medicare program and 
significantly decrease the quality of health care for America's 
seniors.
  Mr. Speaker, at this time, I would like to yield the balance of my 
time to the gentleman from American Samoa.

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