[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

[[Page S7072]]

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

[[Page S7074]]

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.

                          ____________________