[Congressional Record Volume 142, Number 97 (Thursday, June 27, 1996)]
[Senate]
[Pages S7071-S7074]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
HEALTH CARE IN AMERICA
Mr. THOMAS. Mr. President, we wanted to continue our effort with the
freshmen focus to bring to the Senate some of the views that from time
to time may be unique because we are freshmen, unique because this is
the first term we have served here, I suppose unique because, perhaps,
we are a little impatient to move forward.
Of course, all of us have great respect for the traditions, but
sometimes it is a little discouraging to say, ``Gee, we ought to be
doing something a little different,'' and to hear, ``Well, it's the way
we've done it for 200 years,'' you know. And there is some merit to the
200 years thing.
I want to talk a little bit this morning--and I will be joined by a
number of my colleagues--about health care and about the issues that
surround health care. I suppose, in a broader sense, we are talking
about choices, talking about issues, and the choices we have among
issues, the choices that we have as to the ways in which we can
accomplish the things that all of us want to accomplish.
I do not think there is a soul in here who does not want to move
forward with health care. There is no one in the Congress, there is no
one in the country who does not want to create a program in which there
are greater opportunities for American families to have access to
superior health care. Nobody quarrels with that.
The quarrel, of course, comes in, how do you do it? There are
legitimately different views as to how you accomplish the things that
we want to accomplish.
Unfortunately, some of it is promotional rhetoric. We make great
speeches about wanting to do this, accomplish health care for American
families and so on, but then when we get down to it, why, there are
differences. One of the differences, of course, was highlighted in the
last 2 years when the proposal was to have a federalized health care
program--a legitimate point of view: Have the Federal Government
provide basically health care for everyone in this country. That idea
was rejected, soundly rejected, I think, throughout the country. I
happen to think that was a good idea to reject it, that we are better
off to strengthen the opportunities for health care in the private
sector.
So that is where we are. I have to tell you that sometimes one
wonders if the opposition to what we are doing now is not an effort to
move back to the idea of having the Federal Government provide health
care for everyone. But nevertheless, now we are on a new track. Now we
are on the idea of, how do we strengthen the health care program in the
private sector?
I guess the real question we ought to ask ourselves is, can we do
better in providing health care? And the answer is, yes, of course, we
can. We have made some progress in the last couple years, made it in
the private sector.
In my State of Wyoming, there has been substantial progress made in
terms of recognizing what can be done to bring together the doctors and
the hospitals and to share among different towns the kinds of services
that are available but cannot be available in every small town. So we
are making progress.
We have the opportunity to make a good deal more progress right here
in this place in the next week. We should have made it 3 weeks ago, but
we have not, because there has been an obstacle to progress. It is sort
of discouraging that my friends on the other side of the
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aisle put out a statement saying, health security, we want the
portability of health care, elimination of preexisting conditions,
guaranteed renewability. This is what the Democrat leadership committee
put out a month ago.
We have that bill before us, Mr. President. We have that bill. We
have had that bill since April, ready to be moved forward. But,
unfortunately, we have had the objection of Members on the other side
of the aisle that have not allowed it to move. I hope that we can do
that.
We support reform of health insurance. We support reform of
availability of health care and have done a great deal about it over
the last couple of years, starting, I suppose, with Medicare, the idea
of strengthening Medicare so that over a period of time that is
available to the elderly. There is no question that if we do not make
some changes in Medicare, it will not be there. We have proposed those
changes. We have been for those changes, those changes to strengthen
Medicare, to make it available to the elderly, to make it continue to
be available after 2001, at which time the trustees say it will fail if
we do not change it.
Medicaid, health care to the low-income families of this country, we
suggested much of that be transferred to the States so that decisions
can be made that fit the needs of the various States. Mr. President,
our health care needs, our distribution system in Wyoming must be
different than the presiding officer's State of Ohio. So we need to
have the opportunity for our States to work in Medicaid. That has been
a proposal that we have been forwarding.
We have favored, and continue to favor and urge, the acceptance of
reform in the private sector. We have been eager to pass insurance
reform, which is out there, which is available now. In March, the House
passed historic legislation to make insurance more portable for
families. In April, the Senate did the same thing. Sixty-five days have
passed, and still no bill.
I think we have to say to ourselves, ``Let's just do it. Let's do
it.'' But there continues to be opposition. The Democrats have blocked
appointment of the conferees, so there is no movement in this area in
which they say they are for: portability of health care, elimination of
preexisting conditions, guaranteed renewability. I say, come on, let us
do it. You say you want to do it. Now is the time.
President Clinton has hinted at vetoing the bill. I hope that does
not happen. On the other hand, Mr. President, frankly I am getting a
little weary of the idea, ``We don't do that because the President may
veto it.'' That is the President's prerogative, but it is our
opportunity and responsibility in the Congress to do those things we
think are right, to pass bills we think are right. If the President
vetoes them, that is his decision, but we ought not to fail in moving,
in doing our part simply because of that.
There are philosophical differences, and I understand that. There are
philosophical differences in most everything we approach here. That is
healthy. There are going to be philosophical differences in the
election. That is what elections are about. That is what we will be
deciding, the direction, whether or not we are going to have more
Federal Government, more expenditures at the Federal level, or whether,
in fact, we move some of these decisions closer to people and move them
closer to the States and to the cities from which families will receive
the services.
So, of course, there will be differences in philosophy. Republicans
believe Americans should be in charge of their own decisions with
respect to health care. One of the great controversies in this bill,
one of the things that has kept it from moving, is the idea of medical
savings accounts. Medical savings accounts provide an opportunity for
people to make their own decisions with respect to expenditure of
money. They provide the opportunity for people to save, to cut down on
the utilization of health care, and at the same time be able to choose
the health care program they think is best for their family.
Employers can accumulate over the years dollars that can be spent for
employees. It has been proven and several recent reports confirm that
out-of-pocket expenses would decline and benefit all Americans. That is
part of this package. Unfortunately, our friends across the aisle would
prefer the status quo and refuse to give medical savings accounts a
try. They think it deviates too far from the idea of the Federal
Government controlling. We think that is the right thing to do.
The Kassebaum-Kennedy bill has a good many things that we need to do.
Certainly it is not a panacea for all health care, but it moves us in
the direction of fixing some of the things that need to be fixed. I
happen to be very interested and involved in rural health care. There
are unique things about rural health care that need to be changed.
Unfortunately, this does not address them, but it does make some of the
changes that we need to make to cause health care to be more available,
more useful for Americans and American families.
Job lock--we all know of people who would like to move forward with
the opportunities of jobs and to change jobs and to move up in the
economic stratosphere, but they are concerned about doing that because
they lose health care, particularly folks that are a little older. This
changes that and provides portability for health care, something most
everyone agrees with. It has to do with allowing people to have
insurance, despite the fact that there are preexisting conditions. If
we are going to be in the private sector with health care, then people
have to be insured. It may cost more for everyone. I guess that is what
insurance is about, spreading the risk. We think we can do something
about it in our State. We have risk pools. They work. But preexisting
conditions should not keep someone from having private health
insurance.
It allows small businesses to join and form purchasing cooperatives
so that you get some kind of volume advantage in small businesses.
Pretty simple stuff, but it is useful and can help with the problems
that exist there.
All these measures go, I think, to the core of what American families
want. They want availability of health care, they want it in the
private sector, they want choice. That is what this bill is about.
I certainly urge our friends on the other side of the aisle to not
resist movement on this bill. We have an opportunity now. That is why
we are here, to accomplish things. We are moving down to where I think
there are 25 or 26 work days left in this session. We have a lot of
things to do. We have spent a lot of time on this. It is not as if it
has not been discussed. We need to move forward.
The question, I suppose, we ask ourselves in health care, as in other
areas, but particularly in health care because all of us are involved,
it affects everyone, all of our kids, and all of our families, the
question is, can we do better? Of course we can. Of course we can. It
is not the job of the Federal Government or the Senate to provide
health care for everyone. It is the job of the Senate, in my view, the
job of the Federal Government, to provide an environment in which the
private sector can do what we want to have it do, and that is provide
an opportunity for all Americans to have access. We ought to just do
it. The time has come to just do it.
Mr. President, I yield to my friend from Minnesota who has joined in
the freshman focus this morning.
The PRESIDING OFFICER. The Senator from Minnesota.
Mr. GRAMS. Mr. President, I join my colleagues today in issuing our
call and asking our Democratic friends on the other side of the aisle
to end that filibuster of the Kassebaum-Kennedy Health Insurance Reform
Act.
Most Americans probably are unaware that the Democrats are blocking a
final vote for portable health insurance for millions of Americans, as
our friend from Wyoming has pointed out this morning.
Mr. President, our Founding Fathers established the filibuster as the
parliamentary tool for use by the minority in the Senate to ensure
that, unlike in the House of Representatives, any issue would have a
full and open debate--without limitation by the majority. In the past,
it was common to have only about one, maybe two filibusters throughout
a session of Congress. Yet, despite President Clinton's remarks lately
that the Senate Democrats ``have not abused the filibuster in their
minority position the way Republicans did * * *'' their record shows
differently.
[[Page S7073]]
Unfortunately, the President and I disagree in our interpretation of
the word ``abused.'' In the 102d Congress, when the Republicans were in
the minority, we filibustered 40 times. Yet the Democrats, this
Congress, have already filibustered more than 66 times and we still
have another 6 months to go before the end of this legislative session.
Mr. President, I will highlight just a few of bills that our
Democratic colleagues have filibustered in the last 15 months. Those
bills include term limits, the line-item veto, welfare reform, product
liability reform, and others. Despite Republican willingness to
compromise and to work with the minority to achieve legislation
amenable to all, they have continued to filibuster legislation which
national polls have shown most Americans want passed by overwhelming
margins.
Mr. President, I want to again emphasize that these are Democrat-led
filibusters--nothing more and nothing less than Democrat gridlock.
There is no question that the most egregious Democratic filibuster this
session has been by the Senator from Massachusetts in his effort to
delay final passage of the Health Insurance Reform Act. The Senate
considered this legislation almost 2 months ago, yet the Senator from
Massachusetts, the original coauthor with Senator Kassebaum, is
filibustering this important bill because he wants to deny hard-working
Americans the ability to put a portion of their pretax earnings into a
savings account that would be designated for medical expenses.
Mr. President, if you will recall earlier this year, the Senator from
Massachusetts and the distinguished minority leader, a number of times,
alleged that Republicans were holding up the bill, even refusing to
allow a vote on it. Unfortunately, our desires to review the final
legislation in consultation with our Governors, State health officials,
industry officials, health and care providers, and, most importantly,
our constituents, were perceived as objections or opposition to the
Kassebaum-Kennedy bill.
This, however, was not the story told by our Democratic colleagues. A
final agreement for consideration was entered into on February 6 to
debate the Kassebaum-Kennedy Health Insurance Reform Act on April 18
and 19, giving all 100 Senators ample time to consult, review, and
improve, prior to floor debate. When all the statements were made and
amendments considered, this body approved the Kassebaum-Kennedy
legislation by a margin of 100 to 0. Despite our diverse membership,
the unanimous vote shows our strong support for expanding health
insurance to more Americans. Even President Clinton urged passage of
this legislation in his State of the Union Address early this year.
Mr. President, in light of President Clinton's support, the unanimous
Senate support, and the millions of cries from American people who
desperately need this legislation, I believe it is reprehensible that
the Senator from Massachusetts has decided to filibuster the joint
priority of health insurance reform for political power rather than
good policy.
Since it has been 2 months since we debated the Kassebaum-Kennedy
legislation, I want to highlight again what the Senator from
Massachusetts is denying to 15 million Americans who will benefit from
this legislation. First, portability, ensuring that when an individual
wants to change a job they can take their health care with them. They
will not lose it. Next, limiting preexisting condition exclusions. That
is, ensuring that individuals who have played by the rules when they
are healthy get to maintain their health insurance when they are
diagnosed with a potentially costly medical condition. We should not
allow insurance companies to only insure the healthy. If this were to
occur, taxpayers would be required to pay for their care under the
Medicaid Program, which we all know is having difficulty sustaining its
current number of beneficiaries today.
Most importantly, Mr. President, this Democrat filibuster is denying
working Americans the opportunities to save money to pay for unexpected
health care costs.
A recent study reported by the Bureau of National Affairs stated in
its June 6 edition that a Workplace Pulse Survey of 1,000 workers,
conducted back on May 20 to May 24 by the Marketing Research Institute,
for Colonial Life & Accident Insurance and the Employers Council on
Flexible Compensation, found the following: 87 percent of respondents
believe that Congress should allow medical savings accounts to be tax
free; 4 of 10 full-time working Americans, with health insurance, would
be more likely to change jobs if Congress enacted legislation mandating
the portability of their insurance.
Now, the Senator from Massachusetts alleges that medical savings
accounts are only for the wealthy; yet, one of the wealthy groups who
would benefit from MSA's is a group the Senator usually rallies behind,
and that is the United Mine Workers. Currently, the United Mine Workers
have medical savings accounts; however, they do not get fair tax
treatment because they are taxed on the amount that they have in those
savings accounts for health care.
Mr. President, continued efforts by a few Senators on the other side
of the aisle are undermining the ability of this body to prove to the
American people that we do listen, we do care, and that we can come
together on important issues to find a compromise and ultimately enact
serious and sensible health insurance reform legislation.
Now, the definition of compromise, according to Webster's, is
``meeting halfway, coming to terms by giving up part of a claim.'' Mr.
President, Republicans have compromised.
Over the last few weeks, the majority leader has sent numerous
compromise proposals to opponents of MSA's, and they still complain
that our proposal is too broad. I disagree.
Mr. President, when President Clinton has indicated his support for
the Kassebaum-Kennedy bill, the Senate passed the same bill unanimously
and we have continued to compromise on the main issue of concern for
the Senator from Massachusetts who claimed earlier this year that
Republicans were denying a vote on the bill, I find it all very
suspicious in this year of Presidential elections.
We should pass the Kassebaum-Kennedy conference report, and we should
urge the President to sign the bill at the earliest date possible,
again, so that 15 million Americans awaiting its enactment can go to
bed knowing that they have portable health insurance.
Mr. President, I yield the floor to my good friend from Wyoming.
Mr. THOMAS. I thank the Senator. I am now glad to be joined by our
colleague from Pennsylvania. First of all, on April 23, this was
published, the Senate Democratic Action Agenda. It says, ``health
security, payroll security.'' Then it turns to health security and says
``portability of health care.'' This is on the 23d of April, this
action agenda. We have that available. We have it here. We have had it
for 65 days.
So I guess the real issue is that it is one thing to talk the talk
and another thing to walk the walk. We have an opportunity here to do
that, to make it available to families, to have health care for
children. What we really ought to do is just do it.
I yield to my friend from Pennsylvania.
Mr. SANTORUM. I thank my colleague.
Mr. President, I think it is interesting to, first, understand why
this bill is being held up. It is being held up--at least the reason
given that it is being held up--because there is an objection to the
concept about the proposal known as medical savings accounts. Now, I
have had town meetings about medical savings accounts ever since I
first introduced a medical savings account bill. I was the first Member
of the House to do so in January 1992. I had been holding town meetings
in the Pittsburgh area when I was a Congressman, as well as across
Pennsylvania.
I consistently find one thing--most people do not know what medical
savings accounts are. The few that do, when I ask them to explain them,
usually do not do a very good job explaining what they are.
Let us explain what is the big holdup here. Why are medical savings
accounts so bad? What do they threaten? What damage can they do? How
will they disrupt the health care system? Why is this such a horrible
thing that we can hold up what most Members--in fact, I think all
Members--would like to see done and believe needs to be
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done to help the current system be better. That is what the Kassebaum-
Kennedy bill does. It improves the current system of health care
delivery in the private market health insurance system.
So let us ask what medical savings accounts do. Well, I like to call
medical savings accounts patient choice accounts, because I think those
who are tuned into what is going on in health care will tell you--and I
am not talking just health care providers or insurers, I am talking
about everybody who sees what is going on in health care--realizes that
managed care is coming to dominate the marketplace and, in fact, will
be, eventually, I believe, if nothing is done, take over the
marketplace in most areas of the country. So the choices will be
limited to just managed care options. The old fee-for-service, doctor-
patient relationship in medicine will go by the wayside.
What I believe medical savings accounts do is give us a chance to
keep that relationship available to patients who want that, to people
who want the doctor-patient relationship. And what managed care is, you
have a doctor, a patient, and you have a third party, an insurance
company, who sort of regulates the transaction between doctor and
patient. They are the ones who sort of dictate what services you can
and cannot have. Well, before managed care, the doctor and patient
determined what services you had. Well, the problem with that was that
neither had incentive to control costs. On the patient's side, you had
fee-for-service medicine with very low deductibles, so you did not pay
anything for the services you got. You had no concern about how much
they cost. Nobody asked how much it costs for health care. On the
physician's side, the more you did, the more services you provided, the
less chance you were going to be sued, and the more money you made. So
there were no incentives here to control costs. Then managed care came
in.
Well, what we are trying to do with medical savings accounts is very
simple--that is, to put some incentives with the patient to be cost
conscious, to encourage them to be careful about what kind of health
care services they consume and how much they consume and where they
consume them, to create some sort of a marketplace for health care.
That is what medical savings accounts do.
I can explain the specifics of how it works, but the bottom line is
that it empowers, it gives the individual the ability to control their
own health care decisions again. It gives power to individual patients
when it comes to their health care needs.
Now, why--why--would anyone be against giving an option to
individuals? It does not require everyone to take a medical savings
account, by any stretch of the imagination. It does not require
anything. It just gives you an option to have a medical savings
account. Why would anyone be opposed to giving individuals powers to
make medical decisions on their own, giving individual power in
America?
I think you sort of have to step back and say, well, let us recall
who were moving forward with the Clinton care health plan and what that
plan did. What Clinton care did--sponsored by the Senator from
Massachusetts--was take power from individuals, give it to Government-
run organizations, and private sector insurance organizations, to
manage care for everyone--big organizations controlling decisions of
people. That is the model that many who were opposing this bill see as
what we should be doing with health care. They do not believe--as Mrs.
Clinton said, when asked about medical savings accounts--that
individuals have the ability to make decisions on their own, that you
are not informed enough, educated enough to make your own health care
decisions.
There are people--and I hope and believe it is not a majority in this
body--who believe that we need large organizations, whether it is
Government or large insurance companies, to dictate to you what
services are available to you. That is the fundamental debate here.
That is the rub; that is the reason we are not moving forward with
this. It is, who has the power to make decisions?
The Senator from Massachusetts believes it is large insurance
companies or big Government. Those of us on this side of the aisle--and
I think many on the other side of the aisle--believe individuals should
at least have the choice to make those decisions themselves.
Mr. President, I yield the floor.
____________________