[Congressional Record Volume 142, Number 134 (Wednesday, September 25, 1996)]
[Senate]
[Pages S11215-S11217]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




              THE CONGRESS, THE PRESIDENT, AND HEALTH CARE

  Mr. KENNEDY. Mr. President, this past weekend, Bob Dole used his 
Saturday radio address to attack the President's record on health care. 
He repeated his attack yesterday. He even claimed credit for passage of 
the Kassebaum-Kennedy health insurance reform bill.
  Few issues are more important to the American people than access to 
affordable, quality health care. They want it for their children, for 
their parents, and for themselves. But Bob Dole was wrong on his facts, 
and he was wrong in his conclusions.
  On health care, the choice in November is clear. President Clinton 
and Democrats in Congress stand on the side of American families. Bob 
Dole and the Republican leadership in Congress have consistently put 
families last and special interests first when it comes to health care 
and health reform.
  The Republican leadership in this Dole-Gingrich Congress tried to 
slash Medicare. They tried to trash Medicaid. Bob Dole personally tried 
to kill the Kassebaum-Kennedy bill. The Republican leadership blocked 
mental health parity and new protection for mothers and infants, until 
Democratic members of Congress forced them to act. Republicans continue 
to resist enactment of a simple rule telling HMO's and insurance 
companies that they can't prohibit doctors from telling patients about 
medical treatments they need.
  Throughout this Congress, Republicans have been obstructionists on 
health care reform. There is no reason to believe they will deal 
constructively with the problems facing our health care system if they 
retain control of the Congress or win the White House.
  President Clinton and Democrats in Congress are committed to genuine 
progress on health reform. The American people know we're on their 
side. Every American who works hard and plays by the rules should have 
access to affordable health insurance coverage. Senior citizens deserve 
the Medicare they have earned. They should also be able to keep their 
own doctor, and be protected against profiteering by private insurance 
companies.
  Senior citizens deserve quality nursing home care, without 
bankrupting their families. President Clinton has led the effort to 
fill the gaps in Medicare by providing coverage for prescription drugs, 
and for long-term care in a nursing home or a senior citizen's own 
home.
  Americans deserve protection against the excesses of insurance 
companies that put healthy profits above healthy patients. They deserve 
a strong FDA to protect people from harmful drugs, guarantee a safe 
food supply, and crack down on shameful tobacco industry practices that 
entice children to start smoking.
  These are basic principles that the vast majority of Americans 
support--but not Bob Dole, Newt Gingrich, and Republicans in Congress. 
Newt Gingrich has said that he wants Medicare to wither on the vine.'' 
House Majority Leader Dick Armey has called it a program that he would 
have no part of in a free world.'' Bob Dole said that he is proud to 
have voted against Medicare at the beginning. As he told the American 
Conservative Union, ``I was there, fighting the fight, voting against 
Medicare, one of twelve, because we knew it wouldn't work.''

  That was said not in 1965, Mr. President, but in his run for the 
Presidency.
  The Dole-Gingrich Republican budget would have slashed Medicare by 
$270 billion. Under the Republican budget Bob Dole forced through the 
Senate, Medicare premiums would have doubled, deductibles would have 
doubled, and the Medicare age of eligibility would have been raised.
  Every senior couple would have paid an additional $2,400 over the 
life of the plan in increased premiums alone. Make no mistake, Bob Dole 
and the Republican Congress are no friends of Medicare.
  To make matters worse, Bob Dole and Newt Gingrich formed an unholy 
alliance with the private insurance industry to try to privatize 
Medicare, to force senior citizens to give up their family doctor, 
leave conventional Medicare, and join a private insurance plan. The 
Republicans claimed their plan was intended to give senior citizens a 
choice. But as all elderly Americans know, giving up the doctor they 
have chosen to provide billions of dollars in profits for private 
insurance companies is no choice at all. Again and again, Congress 
voted on these issues. Again and again, Bob Dole voted with most 
Republicans in favor of private insurance plans and against senior 
citizens.
  Bob Dole claimed before the 1994 election that Republicans had no 
plan to cut Medicare. He said that President Clinton and the Democrats 
were just using scare tactics. Bob Dole is saying the same thing this 
year--but this time the American people know better, because they know 
Medicare was put on the chopping block by this Republican Congress.
  Despite various promises made prior to the 1994 election that there 
would be no cuts in Medicare, the Republicans proposed cuts of $270 
billion to Medicare to pay for a $245 billion tax cut. Now Bob Dole is 
talking about an economic plan that will cost $681 billion over a 7-
year period. He has indicated he is not going to cut the defense 
budget; in fact, he has said he would increase the defense budget with 
additional funding for B-2 bombers and a number of other areas.
  The whole question is how can we have any confidence that the 
Medicare cut is not going to be of a similar proportion in spite of his 
statements made prior to the election. ``President Clinton and Vice 
President Gore are resorting to scare tactics falsely accusing 
Republicans of secret plans to cut Medicare benefits.'' Bob Dole said 
this just before the election in 1994. Haley Barbour said the same 
thing: ``As far as I'm concerned, the Democrats' big lie campaign is 
that the Contract With America would require huge Medicare cuts. It 
would not.''
  Soon after the election, the GOP introduced their plan: $270 billion 
in cuts in Medicare to pay for $245 billion in tax cuts.
  Republicans in Congress didn't stop with Medicare. They also proposed 
deep cuts in Medicaid--a devastating one-two punch for senior citizens 
and the disabled. Under the GOP plan, 9 million Americans--children, 
senior citizens, and the disabled--would have lost health care coverage 
under Medicaid. They proposed to slash the program by $180 billion. 
They also proposed to eliminate Federal nursing home quality 
standards--not modify them, not improve them, but eliminate them.
  No one should be forced to go back to the time before Federal nursing 
home quality standards were enacted in 1987. Elderly patients were 
often allowed to go uncleaned for days, lying in their own excrement. 
They were tied to wheelchairs and beds under conditions that would not 
be tolerated in any prison in America.
  Deliberate abuse and outright violence were inflicted on helpless 
senior citizens by callous and sadistic attendants. Painful, untreated, 
and completely avoidable bedsores were widespread. Patients were 
scalded to death in hot baths and showers, sedated to the point of 
unconsciousness, or isolated from all normal life--all because fly-by-
night nursing home operators were profiteering from the misery of their 
patients.
  Congress stopped all that by insisting that all nursing homes must 
meet basic standards. Yet those are the standards that Bob Dole and 
Newt Gingrich tried to eliminate. They would also have removed 
protections against impoverishing children and spouses of senior 
citizens who need nursing home care.

[[Page S11216]]

  Democrats opposed all of these Republican schemes. As the debate in 
Congress took place and the American people came to understand what was 
at stake, Republicans retreated from their most extreme proposals. But 
the retreat was always grudging. The desire to roll back basic 
protections was always there. If Republicans retain control of the 
Congress, we are likely to see a new Republican effort to enact these 
cruel and unfair proposals.
  The Dole-Gingrich Republican plan for Medicare and Medicaid made a 
mockery of the family values they claim to support. Under their plan, 
millions of elderly Americans would have been forced to go without the 
health care they need. Millions more would have to choose between food 
on the table, adequate heat in the winter, paying the rent, or paying 
for medical care. Senior citizens have earned their Medicare benefits. 
They have paid for them. They deserve them. And we don't intend to let 
Republicans take them away.
  President Clinton and Democrats in Congress stopped the Republican 
assault for the time being. Now it is up to the American people to stop 
it for good, by the ballots cast in November. Republicans must never 
again have the opportunity to turn Medicare into a slush fund for tax 
breaks for the wealthy.
  Younger Americans, too, deserve affordable health insurance for 
themselves and their families. President Clinton has fought hard to 
give all Americans the guarantee that health care will be there when 
they need it.
  The Kassebaum-Kennedy health insurance reform bill passed by this 
Congress will end some of the worst abuses in the current system. It 
guarantees that, as long as you faithfully pay your premiums, your 
insurance cannot be taken away--even if you become seriously ill, or 
lose your job, or change your job. Under that bill, insurance companies 
can no longer impose pre-existing condition exclusions on your 
coverage, as long as you do not let your insurance lapse. The bill 
opens the door of opportunity for Americans locked in their current job 
and afraid to pursue new opportunities for fear they would lose their 
coverage or face exclusions for preexisting conditions.
  In the end, this legislation was bipartisan. It passed the Senate 98 
to 0. But without President Clinton's leadership it would never have 
become law. The bill languished on the Senate Calendar for months, with 
no hope of passage, because Bob Dole refused to let the Senate act. It 
passed the Labor and Human Resources Committee 17 to 0 on August 2, but 
in spite of repeated requests Senator Dole refused to bring it up. He 
hid for months behind a series of rolling, anonymous holds placed by 
Republican Senators at the insistence of the insurance industry.
  Ultimately, Bob Dole, who controled the Senate Calendar, stalled, 
stonewalled, and sabotaged every effort to bring the bill forward and 
succeeded in delaying it for 9 months. And, if he had his way, he would 
have killed it.
  The gridlock finally began to break when President Clinton 
highlighted the bill in his State of the Union Address last January. 
When the press focused on the anonymous holds that were holding the 
legislation captive and Senator Dole's refusal to bring it to the 
floor, public pressure began to mount. But he still refused to act. 
Only when the ``Nightline'' program confronted Senator Dole directly in 
New Hampshire and demanded to know why he was holding up the 
legislation did he finally agree to bring the bill to the floor.
  How ironic that Senator Dole has the gall to claim credit for the 
insurance reform bill. It passed the Labor Committee in August. It was 
on the Senate Calendar by the beginning of October. Time and time 
again, Senator Dole was asked to bring the bill up by Senator Kassebaum 
and myself. We asked for floor time in November, but he refused. 
Senator Kassebaum and I, we asked for floor time in December, but he 
refused. We asked for floor time in January, but he refused. And he 
claims credit for this legislation.
  What was Bob Dole's excuse? Well, there were holds on the bill--
anonymous holds. But those holds were not anonymous to the majority 
leader. He knew who was blocking the bill. And he knew that he could 
bring the bill to the floor any time he wanted. But he did nothing--
because his friends in the insurance industry did not want the bill to 
pass. And he claims credit for this legislation.
  It was President's Clinton's call to pass this legislation in the 
State of the Union on January 23 that focused the attention of the 
press and the public on the Senate's failure to act. Editorials called 
for action, but still Senator Dole refused. There were holds on the 
bill, he said--even though everyone knows that a majority leader can 
override any hold from any Senator. But Bob Dole still refused to act.
  The press kept up its drumbeat. What is this rolling hold? Where is 
Senator Dole? The press even identified some of the Senators placing 
holds--but where was Bob Dole? Did he urge any of these Senators to 
lift these holds?
  And then came the breakthrough. ``Nightline'' confronted Senator Dole 
on January 31 in New Hampshire. He refused to explain why he would not 
bring the bill to the floor. Miraculously, the next day, Senator Dole 
moved to lift the holds. But he still tried to delay the bill as long 
as possible, so the health insurance industry could mobilize to kill or 
gut the bill.
  He asked that the consent agreement delay the bill for an additional 
6 months, to the July 4 recess. When Democrats refused to go along with 
yet another delay, Senator Dole proposed to delay for 5 months--until 
Memorial Day. And he wants to claim credit for this bill.
  Finally, with increasing pressure from the public, Senator Dole 
finally agreed to schedule the bill--but he still delayed its 
consideration to April 15, at the earliest.
  Anyone would think that there was tremendously important legislation 
tieing up the floor for these many months. But what was Senator Dole 
finding time for? Mostly nothing. Of course, there was work going on 
off the Senate floor on the budget, but for most of February, Senator 
Dole kept the Senate out of session, so he could campaign. When he came 
back to Washington, his main priority was extending Senator D'Amato's 
investigation of Whitewater. He also found time to schedule votes on 
legislation that would have gutted food safety, environmental safety 
and a host of other consumer protection for the benefit of big 
business. But health insurance protection for the American people was 
not on Senator Dole's priority list. And he wants to claim credit for 
this legislation.

  Even when the bill passed the Senate, Bob Dole and the House 
leadership still delayed it for months by their insistence on stacking 
the deck of the conference to include a provision on medical savings 
accounts that was a giveaway to the Golden Rule Insurance Co. and a 
threat to everyone with a comprehensive insurance policy.
  As late as the day before the bill was finally passed, congressional 
Republicans and their special interest allies in the insurance industry 
were trying to weaken key provisions allowing people to buy individual 
insurance coverage if they lost coverage through an employer.
  For many months this moderate, non-partisan bill was adamantly 
opposed by insurance companies that profit from the worst abuses of the 
current system. And Bob Dole was actively supporting their opposition 
and delay.
  The story of insurance against mental illness is similar. The 
Domenici-Wellstone amendment to give the mentally ill and their 
families fair treatment was a bipartisan effort. It received 
overwhelming votes in the Senate both times it was considered. But the 
insurance industry opposed it. And so the Republican House leadership 
insisted on dropping it from the Kassebaum-Kennedy bill, and fought up 
to the last moment to keep it out of the VA-HUD appropriations bill. 
And Bob Dole never lifted a finger to help. He was MIA at every 
critical stage of the debate.
  Quality health care for the American people also depends on a strong 
Food and Drug Administration, to guarantee that food is healthy, that 
prescription drugs will cure and not kill, and that medical devices 
will sustain and improve life, rather than end it.
  But Republicans in Congress have a different priority. They want to 
turn critical functions of the FDA over to the tender mercies of 
private companies hired and paid for by the very

[[Page S11217]]

manufacturers whose products they are supposed to regulate.
  President Clinton and Democrats in Congress refuse to allow 
Republicans to expose Americans again to drug disasters like 
thalidomide and DES and device failures like the Dalkon shield and the 
Shiley heart valve.
  And unlike Senator Dole, President Clinton and Democrats know that 
tobacco is addictive, and that children deserve protection from the 
unconscionable targeted assaults of tobacco advertising.
  Another key health issue for families is the quality of the insurance 
they purchase with their premium dollars. The growth of managed care 
and HMO's in recent years has been soaring. Today, more than half of 
all Americans with private insurance are enrolled in such plans. 
Seventy percent of covered employees in businesses with more than 10 
employees are enrolled in managed care. Between 1990 and 1995 alone, 
the proportion of Blue Cross and Blue Shield enrollees participating in 
managed care plans rose from just one in five to almost half. Even 
conventional fee-for-service plans have increasingly adopted features 
of managed care, such as ongoing medical review and case management.
  At its best, managed care can improve quality while reducing costs. 
But at its worst, managed care puts the bottom line ahead of the 
patient's health--and pressures physicians to do the same. The most 
widespread abuses include failure to inform patients of particular 
treatments; excessive barriers to specialists for evaluation and 
treatment; unwillingness to order appropriate diagnostic tests; 
evicting mothers and infants prematurely from hospitals; and refusal to 
pay for potentially lifesaving treatment. In too many cases, these 
failures have had tragic consequences.
  President Clinton and Democrats--Senator Bradley, Senator Wyden, 
others--have fought to end these abuses, and we will do more in a 
Democratic Congress. We fought for the Mothers and Infants Protection 
Act, which guarantees that a mother will not be forced to leave the 
hospital too soon after her baby is born. We are urging legislation to 
bar HMO gag rules, to prevent insurance companies from prohibiting 
physicians from giving all the facts to their patients. The Mothers and 
Infants Protection Act is on the verge of becoming law--because 
Republican opposition was proving too costly with the public.
  But just the other day, the Republican leadership in the Senate used 
a parliamentarian technicality to kill legislation to prohibit managed 
care plans from gagging doctors. Negotiations are continuing, and I 
hope this legislation can still be passed before the end of the year.
  But if it does pass, it will be in large measure because President 
Clinton and Democrats in Congress have championed it over relentless 
Republican opposition.
  We all know the many other serious health issues facing the country. 
Down-sizing, layoffs, cutbacks, the growth of the contingent work 
force, and the escalating cost of health insurance are peeling back the 
protections that most Americans count on for themselves and their 
families. According to recent projections, less than half of all 
Americans will enjoy reliable, on-the-job health insurance by the year 
2002.
  President Clinton and Democrats in Congress will work to reverse 
these trends and give all families the health insurance protection they 
deserve. President Clinton has already proposed assistance to help 
workers between jobs keep their health insurance. Democrats in Congress 
are pledged to put affordable health insurance for children within the 
reach of every family. That is leadership provided by my colleague and 
friend from Massachusetts, Senator Kerry.
  The Republican leadership in Congress and Bob Dole refuse to deal 
with these issues. They oppose us every step of the way. Their record 
shows that they care more about protecting powerful special interests 
than protecting American families.
  It is ironic that Bob Dole in recent days has been attacking 
President Clinton on health care. Whether the issue is Medicare, 
Medicaid, health care for working families, safe and effective medical 
products, mental health parity, or protection against the abuses of the 
private insurance industry, the record is clear. President Clinton and 
Democrats in Congress want to preserve and protect the benefits that 
the American people have earned. We want to do more to meet the 
challenge of providing adequate health care to senior citizens and all 
working families.
  By contrast, Bob Dole and Republicans want to turn the clock back. 
Whether the issue is slashing Medicare to pay for new tax breaks for 
the wealthy, enabling insurance firms to reap greater profits at the 
expense of senior citizens, and other families, Republican priorities 
are as clear as they are wrong. President Clinton and a Democratic 
Congress will reverse those backward Republican priorities in the next 
4 years.
  Bob Dole is right. Health care is a defining issue, but the issue is 
not, as he claims, whether the Government should run the health care 
system. That kind of charge is a smokescreen. The real issue is whether 
Government is on the side of American people, or allied with the greedy 
guardians of the status quo. On all of the critical issues of health 
reform, President Clinton and Democrats have consistently fought for 
better health care for families, and we will continue to do so in the 
years ahead.
  Mr. President, I yield back my time.
  Mrs. MURRAY addressed the Chair.
  The PRESIDING OFFICER. Under the previous order, the Senator from 
Washington. [Mrs. Murray] is recognized to speak up to 10 minutes.
  Mrs. MURRAY. I thank the Chair.

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