[Congressional Record Volume 144, Number 95 (Thursday, July 16, 1998)]
[Senate]
[Pages S8285-S8287]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                              HEALTH CARE

  Mr. GRAMM. Mr. President, I notice no one is on the floor debating 
this bill, so I thought I would take the opportunity to say a little 
bit about health care. I understand our President has come to Capitol 
Hill today to tell us about how, having rejected his proposal to take 
over the health care system 4 years ago, we now ought to join the 
President and Senator Kennedy in letting the Government tell us how to 
run that health care system. Obviously, we are always flattered when 
the President comes to Capitol Hill to talk to us, to tell us about his 
views.
  I want to make a couple of things clear. Yesterday, we offered the 
Republican alternative. The Republican health care proposal is superior 
in a lot of ways, but there are several ways that I think are very 
important. No. 1, we don't preempt States in those areas where they 
have already acted to deal with problems in providing health care. We 
differ with the President and with Senator Kennedy in that we don't 
believe we know more about the interest of each individual State than 
their Governor and their State legislature do. What we do in our 
alternative proposal is deal with the parts of the problem that the 
Federal Government has jurisdiction over.
  I notice the President and some of our colleagues made a big point 
out of the fact that their bill affects 140 million people, whereas our 
bill affects a smaller number. Why is that? The reason our bill affects 
a smaller number is, in those areas where the States have the power to 
deal with their own medical problems, we don't get involved in telling 
them how to do it. In those areas where they don't have jurisdiction 
because of ERISA, then we step in and try to deal with the problem.
  We differ with the President on the whole issue of how to deal with 
the denial of services. The President says we can improve the situation 
by taking it to court. The President and Senator Kennedy say it is 
indispensable that we give people the power to sue. We think there is a 
better way. We think the better way is setting up an appellate process 
on an expedited basis, both internal and external, to an HMO so that 
people can get a resolution. What happens when you take it to court is 
that it really does not solve the problem that you are trying to deal 
with. It may, after the fact, put money--most of it in the hands of a 
lawyer, maybe some of it in the hands of the patient.
  I assert that when a mother has a sick baby she wants medical 
attention for the infant. She doesn't want the ability to go out and 
hire a lawyer and go to court and 2 years later get a judgment when it 
is too late to deal with the health care concerns of her baby. We 
believe we need to get a resolution in 72 hours on those issues rather 
than

[[Page S8286]]

going into court, exploding the cost of health care, and denying 
millions of Americans their right to health care.
  We also believe in freedom. Here is the problem as stated very 
simply. We have a situation today where there is only one part of our 
health care system where anybody has any incentive to control cost. 
That is in the health maintenance organization, the HMO. Twenty years 
ago, very few people, outside of a very small number of States, were 
enrolled in HMOs. In the last 25 years, we have had an explosion of 
enrollment because the cost of health care has literally skyrocketed. 
The positive effect has been that for the first time since 1965 we have 
brought the cost of medical care and its growth below the Consumer 
Price Index. For the first time since 1965, we are not pricing blue-
collar working families in America out of the health care market. That 
is the good news.
  The bad news is that a lot of Americans are unhappy about a system 
where they have to get approval from the HMO in order to get certain 
kinds of treatment. I liken it to the situation where you go into the 
examining room and you expect to be in the examining room with only 
your physician and you find that you have a gatekeeper in the examining 
room with you.
  Now, Senator Kennedy's solution, President Clinton's solution, is to 
put a government bureaucrat and a lawyer in the examining room with the 
gatekeeper, with your doctor, and with you. That way, the government 
bureaucrat can be there to regulate the gatekeeper and the lawyer can 
be there to sue the doctor.
  We believe there is a better solution. The better solution is 
something we call medical savings accounts.
  I have two cards here. One is from the Mellon Bank. It is a medical 
savings account on MasterCard. The other is with American Health Value, 
and it is a medical savings account on Visa. How the medical savings 
account will work is, for the first time it will empower the individual 
family to make their own health care decisions and to control cost. How 
will it do that? It will do it in the following way: Say today that 
your family has a Blue Cross-Blue Shield policy, family of four, and 
that Blue Cross-Blue Shield policy costs $4,000 a year. If they had 
standard option, Blue Cross-Blue Shield, that would be about the 
average cost. That Blue Cross-Blue Shield policy gives you very low 
deductibles. Under the medical savings account, you would buy the Blue 
Cross-Blue Shield policy with a $3,000 deductible and it would cost 
about half as much as it costs now. You would take the $4,000 that your 
employer is currently spending, $2,000 would buy the high-deductible 
insurance policy and $2,000 would go into your medical savings account. 
Then, you would take the $1,000 that is typically spent annually on 
premiums and deductibles and deposit that in the medical savings 
account, adding it to the $2,000 contributed by the employer. Then you 
would make the health care decisions on when and how to spend that 
first $3,000 of health care. After meeting that deductible, your health 
insurance policy would kick in and cover all remaining costs.
  Now, there are two things that are very important about this program. 
One is, you have an incentive to be cost conscious; the other is, you 
are in charge.
  Under Senator Kennedy's proposal and under the President's bill, if 
you call up the gatekeeper and you can't get to see your doctor, you 
can then call a government bureaucrat and you can talk to him, he talks 
to the gatekeeper, and then if you can't see your doctor, then you can 
call a lawyer, who will talk to the Government bureaucrat and the 
gatekeeper, and he might file suit, and 2 years from now you might get 
a resolution. That is the Kennedy-Clinton alternative.

  Here is our alternative: When you want to see your doctor, under the 
medical savings account, you pick up your card and you pick up the 
phone and you make the decision: Do you need a general practitioner? Is 
it an OB/GYN? Should you call a pediatrician? Is it Dr. Frist, who does 
heart and lung surgery? You pick up the Yellow Pages, you call the 
doctor of your choice, and you have to ask only one question--not, ``Is 
it approved?'' or, ``Are you at our point-of-service option?'' Your 
simple question is, ``Doc, do you take Mastercard or Visa, or do you 
take a check?'' If he takes Mastercard, Visa, or a check, you walk into 
the doctor's office and you make the choice for yourself.
  Now, which would you rather have? Would you rather be alone with your 
doctor in the examining room, where you are in control, because you 
have the ability to give him your medical savings account credit card, 
without anybody saying ``yes,'' ``no,'' or ``maybe''? Or would you 
rather go into the examining room with your doctor, with the gatekeeper 
from the HMO, with a Federal bureaucrat, and with a lawyer? I think 
most Americans would rather do it themselves. They want to get 
everybody out of the examining room, except their doctor. They want the 
freedom to choose.
  The Republican health care bill gives them the freedom to choose, 
because it empowers them.
  Now, as I said yesterday, Senator Kennedy and the President are as 
afraid of this credit card, this Mastercard and this Visa, they are as 
afraid of these cards as a vampire is afraid of a cross. They fear 
these cards because they fear choice, because they know that if we 
empower families to make their own health care decisions, they will 
never, ever tolerate the Federal Government taking over and running the 
health care system. And we know that, deep in their hearts, the 
President and Senator Kennedy want the Government to take over and run 
the health care system, and they want the Government to run the health 
care system because they ``feel our pain,'' and they believe that the 
Government could do it better. They know that if they could make 
everybody go to a Government-run health care system, it would all work 
better, and that the Government would be caring, and that a Government 
that does not work well in any other area of our lives would be magic 
in health care. And so they give us the alternative, which is to 
regulate HMOs so that they can't control costs, so that then we can 
have one HMO--the Government HMO--and it, of course, will control 
costs, because when it says ``no,'' you have nowhere else to go.
  I do think it is an incredible paradox that the same people who, 4 
years ago, wanted to put every American family into a Government-run 
HMO, where the government would have had absolute authority to say 
``yes'' and ``no,'' now they want to tell private HMOs how to be run, 
and they suddenly are concerned that HMOs have too much power.
  We have an alternative, and the alternative is to take the power away 
from HMOs and give it to families. Let families have medical savings 
accounts so that they can determine which doctor they go to see and 
they can decide when they go.
  Finally, I want to respond to two charges that are made by the 
Democrats against medical savings accounts. The first one is that they 
are for rich people. Well, why would rich people need or want high-
deductible insurance? They can buy any insurance they want. But if you 
cut the cost of health insurance in half, you let working families, for 
the first time, have coverage for those expenses when they have to go 
to the hospital, or when something terrible happens. Working families 
can begin, over the years, to build up their medical savings account 
until they have the same kind of coverage everybody else has. Medical 
savings accounts cut in half the cost of the insurance you really need 
and have to have. That is not for rich people, that is for working 
people.
  Secondly, the charge is made that only people who are healthy will go 
into medical savings accounts. I think exactly the opposite is true. If 
you have a chronic health problem, do you want to go to an HMO where 
some gatekeeper makes the decision about your health care? It seems to 
me that if you have a chronic health care problem and any morning you 
might wake up with a life-threatening illness, you would much rather be 
in a position, instead of calling the gatekeeper, the Government, a 
lawyer, or a Government bureaucrat, to call up a doctor and say, ``I 
would like to come in. Do you take Mastercard or Visa?''
  So I think we have a very clear choice, and we are ready to vote. We 
are glad the President has come to Capitol Hill to tell us, once again, 
that he knows what is best for our health

[[Page S8287]]

care. Four years ago, he told us he wanted the Government to take over 
and run the health care system, and we listened with respect and 
reverence, and we said ``No,'' and the American people said ``No,'' 
with an expletive in front of the ``no.''
  Now the President is telling us, 4 years later--he appears before 
Government employee groups and says, ``I haven't changed my mind; I 
still want the Government to take over and run the health care system, 
only we have to do it one step at a time.'' It seems that he believes 
the next step is to let the Government run the HMOs. How does he think 
that make the patient better off? Well, it presumable makes the patient 
better off because when we go into the examining room with the doctor 
and the gatekeeper, a Federal bureaucrat and a lawyer will now join us. 
I don't think that is what people want. People want to be alone in the 
examining room with their doctor.
  The Republican plan, which empowers the family to decide, puts only 
the patient and the doctor in the examining room. It throws out the 
Government bureaucrat, it throws out the lawyer, it throws out the 
gatekeeper, and it replaces all of that mechanism of Government 
bureaucracy with one simple question: ``Do you take Mastercard, or do 
you take Visa, or do you take a check?'' If the answer to any of those 
questions is ``yes''--and it will be yes to all three--then you go to 
the doctor of your choice.
  That is our alternative. It is a better alternative. That is why we 
are going to defeat the President and Senator Kennedy once again. The 
American people do not want a Government-run or a Government-controlled 
health care system, and we can give them an alternative. The 
alternative is freedom.
  Once again, America is at a crossroads. We are going to have to 
choose. Do we believe the solution to our problems in medicine will be 
found with more Government interference, with more time in court, with 
more time working under the control of Government bureaucrats? Or do we 
believe the solution is to be found in freedom? Well, I am going to bet 
the future of my family and the future of the 19 million people in 
Texas, who hired me to represent them in the Senate, on freedom because 
I know freedom works, and I know something else--I know Government does 
not work.
  Four years ago, the American people didn't want Government to run the 
health care system, and today they don't want Government to control the 
health care system. So Republicans and Democrats agree on one thing: 
There are problems in the health care system. But where we disagree is, 
we want to empower families with innovations like medical savings 
accounts, and the President and Senator Kennedy want to empower the 
Federal Government. That is the choice. It is a clear choice.
  I yield the floor.
  Mr. COCHRAN. Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. DORGAN. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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