[Congressional Record Volume 144, Number 91 (Friday, July 10, 1998)]
[Senate]
[Pages S7924-S7925]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                    HEALTH CARE QUALITY LEGISLATION

  Mr. ENZI. Mr. President, I rise today to speak about the popular 
issue of health care quality. You can't mention health care without 
pulling on everyone's heartstrings. While several of the measures in 
both the House and the Senate have been pitched as being essential to 
enhancing the quality of care Americans receive, I hope that my 
colleagues will carefully evaluate the impact that any Federal one-
size-fits-all mandate would have on our Nation's health care system.
  Health care is as personal as it gets. More importantly, though, our 
decisions must not be tainted by simple anecdotes. This is not a one-
line sound bite issue. Like any Member of this body, I believe that 
America's health care providers are the best in the world, and I 
believe that our health care system is the most technologically 
advanced in the world--the most technologically advanced in the world. 
Perhaps we don't hear that enough. The reason for that could be that 
this issue is being used by some folks as a political ad campaign, 
dwelling entirely on the negatives and failing to illustrate any 
positives. That is not rational, that is not fair. People are prone to 
believe something if they hear it enough, even if it isn't true. 
Repetition doesn't right a wrong, although repetition may lead a person 
to think a wrong is right.
  While watching this debate unfold, I have seen people wield surveys 
and polls around this body like they were weapons of mass destruction. 
It stands to reason that if you want to make a bill popular, back it up 
with a survey or a poll. Why? Because you can always get the answer you 
want by the way you word the questions.
  Legislating our Nation's health care system in such a fashion is like 
trying to cross a chasm in two jumps. It is detrimental to everyone's 
health.
  I will, however, illustrate how unreliable survey and poll results 
have been in relation to various health care quality provisions. For 
instance, in May, a Democratic polling firm showed that 86 percent of 
those questioned supported the Patient Access to Responsible Care Act 
or PARCA bill. In the same month, a Republican poll found that more 
than 90 percent of those questioned favored

[[Page S7925]]

federal legislation to guarantee protections such as full information 
about their conditions and treatment options, a list of benefits and 
costs, as well as access to specialists.
  But when folks were asked how they feel about their own health plan, 
an April survey by the Employee Benefit Research Institute showed that 
53 percent of respondents were extremely or very satisfied with their 
health plan. And in a November 1997 Kaiser/Harvard survey, 66 percent 
of Americans in managed care plans said they would give their own 
health plan a grade of A or B. Such mixed results are more reason to 
approach any debate of federal mandates with the greatest degree of 
caution.
  What would the polls show if people were asked about additional 
costs? What would the polls show if changes could eliminate being able 
to see a doctor at all?
  I will talk in a minute about the frontier, the rural, aspects of 
that.
  Yes, another factor that has produced mixed results is the cost of 
each of these bills. I've seen estimates for a number of pending bills 
that could raise the price of premiums by at least 2.7 percent all the 
way up to 23 percent. Why aren't the people being polled about that? I 
don't believe that you can get quality out of any bill that forces 
people not to purchase insurance. We'd essentially be driving people 
away from coverage, not toward coverage. This is why cost estimates for 
the different proposals are vital. But with mixed results like this, 
I'm not about to assume that my constituents--who budget their incomes 
on a day to day basis--will swallow any additional price increases that 
federal mandates could create.
  We are always asked that we not judge a book by its cover. Well, 
don't judge a bill by its title. The devil is in the details. Or, as we 
accountants like to say, the numbers should make us nervous, or the 
numbers should show the nightmare.
  Aside from the morass of misleading information pertaining to this 
issue, I also have serious reservations about any legislation that 
would dismantle traditional state regulation of the health insurance 
industry. While serving in the Wyoming State Legislature for 10 years, 
I gained tremendous respect for our state insurance commissioner's 
ability to administer quality guidelines that cater to the unique type 
of care found in Wyoming. That is critical. I firmly believe that 
decisions which impact my constituent's health insurance should 
continue to be made in Cheyenne--not Washington.
  I cannot emphasize how important it is to consider demographics when 
debating health care. Wyoming has 465,000 residents living within 
97,000 square miles. That is living in a State that is 500 miles on a 
border. We are one of those square States that couldn't exist if 
somebody hadn't invented the square. There are 99,000 square miles with 
only 465,000 residents. The State has an average elevation exceeding 
4,000 feet. We have high altitude and low multitude.

  Most communities have a higher altitude than population. In fact, if 
you look at one of the Wyoming roadmaps, you will find a list of about 
150 cities. We call them cities out there. If you look at the 
population following the name of the city, you will see that half of 
them have no population at all. They are a place where the ranchers 
come to pick up their mail. Even the Postmaster doesn't live in the 
town where the Post Office is. It is a long way between towns. I live 
in the sixth largest town in the State. It is 135 miles to the next 
biggest town--135 miles. The town I am from has 22,000 people. The 
biggest city in Wyoming is 50,006. We don't have that much population. 
We have a lot of miles. It is tough to get to doctors.
  It's in those conditions that my constituents have to drive up to 125 
miles one-way just to receive basic care. Moreover, we have a tough 
enough time enticing doctors to come to Wyoming, let alone keep them 
there once their residency is finished. Even more troubling is the 
limited number of facilities for those doctors to practice medicine in 
Wyoming. Let me just say that if you don't have doctors, or facilities 
for them to practice in, you sure don't have quality health care.
  We have even talked here about an overabundance of doctors in parts 
of the country. In Wyoming, we wish for that affliction.
  The majority of bills now pending consideration in the House and 
Senate are primarily geared to overhauling managed health care plans. 
In a rural, under-served state like Wyoming, managed care plans account 
for a very small percentage of state-wide health plans and services 
currently available. This is partly due to the state's small 
population. Managed care plans generally profit from high enrollment, 
and as a result, the majority of plans in Wyoming still remain fee-for-
service. In terms of legislation, however, this doesn't make a bit of 
difference. Many fee-for-service insurers in my state also offer 
managed care plans elsewhere. Those costs could be distributed across 
the board. Is it fair for the federal government to force my 
constituents to pay for a premium hike that's caused by federal 
mandates on managed care? The availability and cost of care for 465,000 
rural frontier residents may not mean much to some folks, but it sure 
means a great deal to me.
  Is this a problem that can be fixed from Washington? I certainly 
don't believe so. People from Wyoming understand that life in our state 
is much different than in California or New York. A one-size-fits-all 
policy doesn't help states like Wyoming, it only excludes them further 
from obtaining the type of care they deserve. I encourage my colleagues 
to look at the fine print when considering legislation in the coming 
days. You just might agree that getting quality out some of these bills 
is like trying to squeeze blood out of a turnip. And we'll want to 
spend some time talking about whose blood!
  Thank you, Mr. President.
  I yield the floor.
  Mr. KENNEDY addressed the Chair.
  The PRESIDING OFFICER. The Senator from Massachusetts.

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