S6136 CONGRESSIONAL RECORD— SENATE May 4, 1995 

the States, are reserved to the States 

respectively, or to the people.’’ I would 

posit, Mr. President, that this fundamental idea should animate all that we 

do here in the coming weeks. 

The task of defining the constitutional line between Federal and State 

power has given rise to many of the 

Court’s most challenging and celebrated cases. In United States versus 

Lopez, the Court reaffirmed the belief 

that the powers of the Federal Government have proscribed limits. Now, it is 

the opportunity of this Congress to 

recreate the dual sovereignty that the 

Framers envisioned. For ‘‘in the tension between Federal and State power 

lies the promise of liberty.’’

Mr. President, I suggest the absence 

of a quorum. 

The PRESIDING OFFICER. The 

clerk will call the roll. 

The legislative clerk proceeded to 

call the roll. 

Mr. WELLSTONE. Mr. President, I 

ask unanimous consent that the order 

for the quorum call be rescinded. 

The PRESIDING OFFICER. Without 

objection, it is so ordered. 

Mr. WELLSTONE. Mr. President, I 

ask my colleague from California if she 

has come to the floor to speak on budget and Medicare. She was here first. I 

will be pleased to follow her. 

Mrs. BOXER. Mr. President, I thank 

my friend, but I will be delighted to 

follow my friend. So if he would like 

his time now, that is just fine. 

Mr. WELLSTONE. I thank the Senator. 

The PRESIDING OFFICER. The Senator from Minnesota is recognized for 5 

minutes. 

Mr. WELLSTONE. Mr. President, I 

ask unanimous consent that I yield 

myself such time as I might need from 

the majority leader’s time. 

The PRESIDING OFFICER. Without 

objection, it is so ordered. 

f 

MEDICARE 

Mr. WELLSTONE. I thank the Chair. 

Mr. President, we are, in a very short 

period of time, going to have a historic 

debate about the budget and about priorities in our Nation, the United States 

of America. Part of that debate—and I 

know my colleague from California 

will be speaking to this as well—will 

focus on Medicare. 

As I have followed over the last couple of days some of the press conferences and some of the discussions 

taking place about Medicare, I think it 

is really important to come to the floor 

and speak about Medicare, not so much 

in political terms but in substantive 

terms. 

We are faced with a real irony. It 

may very well be that a good many of 

my colleagues will now discover that 

health care reform—not just a focus on 

Medicare or Medicaid but real health 

care reform—is a pressing, compelling 

issue in this country. 

First of all, Medicare is a benefit program. It is not just an actuarial program. It is important for me to make 

this point, Mr. President. My mother 

and father are no longer alive. Both actually had Parkinson’s disease, but I 

can tell you, for my parents in their 

older age, Medicare, imperfections and 

all, was extremely important and it 

continues to be extremely important to 

senior citizens in this country. 

It is not by any means perfect. It 

does not cover catastrophic expenses, 

it does not cover prescription drug 

costs, and elderly people over 65 years 

of age pay four times as much out of 

pocket as citizens under 65 years of 

age. But I think this focus on the budget is going to get us to the point where 

all of us understand some realities 

about health care and health care policy in the United States. 

Eighty-five percent of Medicare expenditures pay for care for seniors with 

household incomes of less than $25,000 a 

year. So let us also understand that 

these benefits help hard-pressed people, 

not people who have plenty of income 

on their own. 

Second point, Mr. President. I was on 

the floor the other day in a debate with 

one of my colleagues—I think it was 

the Senator from Texas, Senator 

GRAMM—and he was talking about his 

efforts to block health care reform in 

the last Congress and he was proud of 

that. In another point in time, we will 

have a debate, and I do not have a practice of debating colleagues when they 

are not on the floor, but I will say, as 

a matter of fact, one of the reasons 

that we are now dealing with the whole 

question of Medicare and how to finance Medicare is because we did not 

pass any comprehensive health care reform last Congress. 

Mr. President, 89 percent of the 

growth in Medicare spending since 1980 

has been due to medical inflation, general inflation, and changes in enrollment. Let me go over those. 

Medicare is a benefit program that, 

of course, we have to finance. It is part 

of what we are about as a country. It 

is, indeed, a contract with senior citizens, and as we move into the next century, a larger percentage of our population are older Americans, and a larger percentage of those older Americans 

are older. That means that the cost of 

the program goes up. 

Then there is the issue of general inflation. There is not much we can do 

about the first issue that I mentioned. 

And there is not that much we can do 

about general inflation, but we can 

look at medical inflation. 

The interesting thing is that the 

Congressional Budget Office made it 

clear last Congress—I did not say Democrat, Republican, but CBO—that there 

are two ways you can contain medical 

costs. One is through global spending 

caps, as in the single payer proposal, 

or, if you do not prefer that, by placing 

some limits on insurance premiums. 

Some limit on insurance premiums is a 

very effective way of containing costs. 

But, Mr. President, if you just focus 

on one segment of the population and 

you cut $250 to $350 billion between now 

and the year 2002, you will have a severe impact on that population. Let me 

say to my colleagues, when you were 

talking about rationing last Congress 

when we were talking about comprehensive health care reform, when 

you were yelling and screaming about 

rationing last Congress, I did not think 

that you had a case to make. But if you 

are just going to target Medicare, if 

you are going to cut expenditures for 

just one segment of the population, 

then you will ration by age, you will 

ration by disability, and if you throw 

Medicaid into the equation, you will 

ration by income. But now I do not 

hear my colleagues talking about rationing at all. 

Second of all, if you make these cuts 

in Medicare, you are going to throw 

this whole health care system into—

and I do not want to exaggerate—I 

would say a fair amount of chaos, if 

not utter chaos. 

I ask unanimous consent to have 

printed in the RECORD a statement 

from the National Leadership Coalition 

for Health Care Reform, which includes 

many businesses in this case. 

There being no objection, the material was ordered to be printed in the 

RECORD, as follows: 

THE NATIONAL LEADERSHIP

COALITION FOR HEALTH CARE REFORM, 

Washington, DC, April 3, 1995. 

Senator PAUL DAVID WELLSTONE, 

Hart Senate Office Building, Washington, DC. 

DEAR SENATOR WELLSTONE: We are writing 

to express our serious concerns about the 

proposed cuts in the Medicare and Medicaid 

programs. Our Coalition is the nation’s largest nonpartisan alliance of business, labor, 

consumers, and providers dedicated to improving the health care system—in order to 

enhance the availability, affordability, and 

quality of care. (Our membership list is attached.) 

We have long been on record as strong supporters of cost containment for both public 

and private payers. Until we contain costs, 

our citizens cannot be secure in coverage for 

themselves and their families. However, we 

believe that further drastic cuts in Medicare 

and Medicaid, coming on top of deep cuts 

legislated in 1993, would pose program difficulties and force the provider community 

to increase the shifting of costs to the private sector. Such cost-shifting would result 

in even more limited access, especially for 

low and middle-income Americans, and an 

increase in the number of uninsured. 

We are troubled by approaches that focus 

primarily on cutting the price of services. 

One of our central concerns—as patients, 

payers, and providers—is that the quality of 

care be enhanced by changes in the health 

care system. If draconian cuts are made in 

prices, quality could further suffer. We urge 

a balanced approach, one that would control 

total system cost while improving quality, 

stopping cost-shifting, and expanding universal coverage. 

We believe that if our nation were to concentrate on better outcomes and quality initiatives in addition to measures targeted on 

costs, there would be significant gains both 

in the appropriateness and efficiency of services, and in the reduction of costs. Strong 

quality assurance mechanisms are also essential as we shift more to better systems of 

managed care. 

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May 4, 1995 CONGRESSIONAL RECORD— SENATE S6137 

We urge Congress to take an integrated approach to addressing our three serious and 

interrelated problems of cost, quality and access. We fear a one-dimensional approach, or 

one dealing only with federal programs, will 

only make matters worse. We stand ready to 

work with you on a balanced solution that 

will create a better system for all our citizens. 

Sincerely, 

PAUL G. ROGERS, 

Co-Chair. 

ROBERT D. RAY, 

Co-Chair. 

MEMBERS OF THE NATIONAL LEADERSHIP

COALITION FOR HEALTH CARE REFORM

Acme Steel Company. 

Almalgamated Clothing & Textile Workers 

Union, AFL–CIO. 

American Academy of Family Physicians. 

American Academy of Pediatrics. 

American Association of Retired Persons. 

American Automobile Manufacturers’ Association. 

American College of Physicians. 

American Federation of Teachers, AFL–

CIO. 

American Iron & Steel Institute. 

American Nurses Association, Inc. 

American Physical Therapy Association. 

American Psychological Association. 

American Subacute Care Association. 

Association of Academic Health Centers. 

Association of Minority Health Professional Schools. 

B. C. Enterprises. 

Bannon Research. 

Bethlehem Steel Corporation. 

Blue Cross Blue Shield of Iowa. 

Blue Diamond Growers. 

Brown & Cole Stores. 

Burlington Coat Factory. 

Ceridian Corporation. 

Christian Children’s Fund. 

Chrysler Corporation. 

Cold Finished Steel Bar Institute. 

Communications Workers of America. 

CoreStates Financial Corp. 

Del Monte Foods. 

Designworks Inc. 

Drummond Company Inc. 

Families USA Foundation. 

Filter Materials. 

Ford Motor Company. 

GEC-Marconi Electronic Systems Corporation. 

General Motors Corporation. 

Giant Food Inc. 

The Great Atlantic & Pacific Tea Company, Inc. 

Gross Electric Inc. 

The Heights Group. 

H. J. Heinz Co. 

Inland Steel Company. 

INSIGHT Treatment Services. 

International Brotherhood of Electrical 

Workers. 

International Multifoods. 

Internatinal Union of Bricklayers and Allied Craftsmen. 

Johnstown Corporation. 

Keller Glass Company. 

Lincoln Telephone & Telegraph Co. 

LTV Steel Company. 

Lukens Inc. 

Mankoff, Inc. 

Maternity Center Association. 

Maytag Corporation. 

MEDNET. 

National Association of Childbearing Centers. 

National Association of State Boards of 

Education. 

National Council of Churches of Christ in 

the U.S.A. 

National Education Association. 

Natinal Steel Corporation. 

Navistar International Transportation 

Corporation, Inc. 

Norwest Corporation. 

Olympia West Plaza, Inc. 

PAR Associates. 

Pella Corporation. 

Preferred Benefits. 

R. R. Donnelley & Sons Co. 

Ralphs Grocery Company. 

Regis Corporation. 

Rohm & Haas Company. 

Safeway Inc. 

Sara Lee Corporation. 

Scott Paper Co. 

Service Employees International Union, 

AFL–CIO. 

Sokolov Strategic Alliance. 

Southern California Edison Company. 

Strategic Marketing Information, Inc. 

Texas Heart Institute. 

Time Warner Inc. 

United Air Lines,Inc. 

United Food and Commercial Workers 

International Union, AFL–CIO. 

United Paperworkers International Union, 

AFL–CIO. 

United States Catholic Conference. 

United Steelworkers of America, AFL–CIO. 

U.S. Bancorp. 

The Vons Companies, Inc. 

Westinghouse Electric Corporation. 

Wheat, First Securities, Inc. 

Wheeling-Pittsburgh Steel Corp. 

The Whitman Group. 

Wisconsin Public Service Corporation. 

Xerox Corporation. 

Mr. WELLSTONE. That is why the 

business community is opposed to 

these cuts in Medicare, because they 

know it will be a shell game. Mr. President, this will result in utterly irrational charge shifting. What will happen is that the providers already not 

receiving reimbursement they need 

will just shift the cost to the private 

sector, to those of us who have private 

health insurance plans. The business 

community knows that. 

Some of my friends who were talking 

about Medicare just as a way of reducing the deficit, or even when they talk 

about reforming health care but just 

focusing on Medicare, I think really 

overlooked problems. 

Third of all, Mr. President, I could 

tell you right now, I would fight this 

tooth and nail if for no other reason 

than in rural Minnesota, greater Minnesota, many hospitals and clinics will 

go under. In some cases, 75 percent of 

their revenues comes from Medicare. If 

you are going to take a meat-ax approach, a slash-and-burn approach, if 

you are not going to contain costs in 

the health care field but you are going 

to have these cuts in Medicare alone, 

then I could just tell you right now, 

many of our hospitals will go under 

and clinics will go under in our rural 

communities. 

Fourth of all, Mr. President, this idea 

of vouchers—this is unbelievable. People are going to have to get real with 

the people that we represent. To say we 

will just give you a voucher, that we 

will set some kind of limited per capita 

payment, and then you go out, senior 

citizens, and sort of negotiate whatever 

plan works well for you. Mr. President, 

with preexisting condition exclusions, 

with no risk adjustment between plans, 

with no community rating, how do you 

think that is going to work? How do 

you think that is going to work? If you 

have a preexisting condition, you may 

be flat out of luck. If there is no risk 

adjustment, under a capitated system 

there will be a tremendous incentive 

for health plans not to accept people 

who are older and sicker. You have to 

make an allowance for that and that 

involves serious insurance market reforms. 

Mr. President, my colleagues and I 

were able, a couple weeks ago, to restore the funding for an insurance 

counseling and assistance program—

unwanted by Republicans, unfortunately. They wanted to even eliminate 

a small program providing counselors 

for elderly people to make sure people 

do not get ripped off by some of these 

private Medicare supplementary plans. 

It is as if they are just going to give 

people a voucher and say, good-bye, 

you are on your own. 

Finally, Mr. President, let me make 

a point that the Medicare payment system is the way in which we finance 

some of the most important things we 

do in medical education. If we take 

away that funding, we are going to lose 

one of the most important things we do 

in this country. Training residents is a 

public good—the competitive private 

insurance market will not pay for it. 

You would have to ask everyone to pay 

into a fund in order to eliminate Medicare funding. But I have not heard such 

a proposal this year. 

Mr. President, in Minnesota we have 

efficient markets. We have done an excellent job of holding down the costs. 

But there has been very little equity in 

terms of the kind of per capita payment. Parts of New York get $646 per 

month per enrollee, and Hennepin 

County in Minnesota, urban Minneapolis, gets $363 per month per enrollee. This is in terms of our reimbursement now for Medicare managed 

care plans. My State does not have any 

fat. If you are going to talk about 

across-the-board cuts, I will just tell 

you right now the impact on a State 

like Minnesota will be severe. We are 

in a very precarious position. 

So, Mr. President, let me conclude 

this way. No. 1, the idea of cutting $300, 

$350, $250 or $400 billion in Medicare, so 

that we can have across-the-board tax 

cuts flowing to the wealthiest segment 

of the population, is simply outrageous. It is simply outrageous. 

A family making under $30,000 would 

be getting, roughly speaking, $100; and 

families with incomes of over $200,000 

would be getting, roughly speaking, 

$11,000. And for that, we are going to 

have these kinds of draconian cuts in 

Medicare? It is outrageous. 

No. 2, if we do not have that tradeoff—and I think some of our more responsible colleagues understand we 

cannot do that—I say to my colleagues 

that you cannot move forward with 

cuts in Medicare unless you do overall 

health care reform, and you cannot do 

it unless you contain overall costs. 

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S6138 CONGRESSIONAL RECORD— SENATE May 4, 1995 

I say to the Senators on both sides of 

the aisle, welcome to health care reform. Welcome to the health care 

issue. It is back. How ironic it is that 

when historians write about the 104th 

Congress, they are going to say that 

the 104th Congress had to address 

health care reform, how to finance it, 

how to deliver health care to people 

out in the communities in an affordable, dignified way. The reason the 

104th Congress finally moved on this 

question is that some Senators realized, finally, that the only way we are 

really going to have deficit reduction 

based on a standard of fairness and the 

only way we are going to make sure we 

are able to provide decent health care 

coverage for all of our citizens, regardless of age or where they live or income, is with significant, meaningful 

health care reform. 

I am ready to work with colleagues 

on both sides of the aisle, because I 

think that will now have to be one of 

our major priorities. 

I yield the floor. 

Mrs. BOXER addressed the Chair. 

The PRESIDING OFFICER. The Senator from California is recognized. 

Mrs. BOXER. Mr. President, I want 

to thank my colleague for really putting out in very clear and simple terms 

the kind of crisis that we knew about. 

Indeed, President Clinton was so clear 

in his very first and second State of the 

Union Address when he said, ‘‘If we 

want to have meaningful deficit reduction, we better address the issue of 

health care reform.’’

Here we have a situation—and I serve 

on the Budget Committee. I am waiting for the Republican budget, by the 

way. It is way late. Since I came here, 

I have been on the Budget Committee, 

and the Budget Committee has been on 

time. Not this year. Do you know why? 

Because the Republicans have promised 

certain things they just cannot keep: 

huge deficit reduction, increases in the 

military, big tax breaks for some of the 

wealthiest again. Guess what? They 

said they would not touch Social Security. Thank goodness. Frankly, I think 

a lot of my colleagues made that point 

clear in the balanced budget debate. So 

the only cash cow they can look at is 

Medicare. And at this point, they want 

to cut hundreds of billions of dollars 

out of Medicare, and they realize, how 

can we sell that to the seniors? So they 

are creating this big crisis. 

We talked about the need for health 

care reform. My friend, Senator 

WELLSTONE, was one of the leaders in 

this fight. So I say to my friend, thank 

you for your remarks this morning. It 

is almost poignant that we are at this 

point. Does he not agree? 

Mr. WELLSTONE. Mr. President, I 

thank my colleague from California for 

her gracious remarks. It is ironic that 

indeed we have now come full circle 

back to the last Congress. 

The very people who were so proud of 

having blocked health care reform are 

now talking about a crisis in Medicare, 

talking about how we will finance it, 

and are now making a proposal, I say 

to my colleague, for rather draconian 

cuts in Medicare. But they do not want 

to talk about rationing. Now they really are making proposals that will ration. 

I think there are certain realities 

now that we all hope we will face up to 

and move forward on health care reform. It is the only way to do it. Otherwise, it will be disastrous. 

The kind of proposals I hear people 

making now to cut Medicare will not 

only hurt senior citizens, but as I said, 

will create absolute utter chaos in this 

health care system. They do not deal 

with preexisting conditions, they do 

not deal with any of the bias of not 

having community rating, they do not 

deal with how to make it affordable. If 

anything, it will just have a severe impact. 

Mrs. BOXER. I just want to thank 

my friend again. He is, of course, correct. The kinds of cuts that my colleagues on the Republican side are 

talking about out of Medicare simply 

will ruin Medicare. We cannot possibly, 

in the name of deficit reduction, destroy the Medicare system or the Medicaid system, for that matter. 

f 

SENATE AGENDA 

Mrs. BOXER. Mr. President, I am 

very pleased that the leader has reserved some time to discuss general 

matters. I want to tie a few pieces together. 

Before Senator WELLSTONE took to 

the floor, the Senator from Missouri 

was praising a Supreme Court decision 

that gave more power to the States. 

Rather than get into that decision, I 

want to point out that in vote after 

vote, the vast majority of my Republican friends here in the Senate have 

voted in these last few days to replace 

State product liability laws, State 

medical malpractice—indeed, all other 

civil laws—with Federal laws, with 

Federal caps. 

We certainly know—at least I certainly feel confident in stating to the 

American people—that these changes 

are going to hurt them. They are going 

to hurt consumers in our Nation by 

substituting politicians’ judgments for 

local judges and juries. 

Here we have spent many, many days 

and many, many hours on a power 

grab—essentially, a Federal Government power grab—brought by this Republican Congress in the Contract With 

America, a power grab to say that we 

in the almighty Senate know better 

than a judge or jury what someone who 

has been burned beyond recognition 

ought to be able to get from those at 

fault; what someone who perhaps was 

paralyzed should get; what someone 

would be able to get if a physician, perhaps in a stupor, makes a dreadful mistake. We have heard of some of those 

situations occurring. 

I think it is very ironic that Senators 

would come to the floor on the Republican side and talk about how they 

think more power ought to be invested 

in the States and then support this 

kind of a bill. 

I hope today, when we vote cloture, 

that we will be able to stop this horrific bill from becoming a law of the 

land. 

Mr. President, while I feel we should 

not be doing that, there are many 

other things I feel we should be doing 

here in the Senate, that we should be 

working on. 

One of those, certainly, to my mind, 

is the confirmation of a new Surgeon 

General for this country, Dr. Henry 

Foster. I want to say that, in between 

my going to committees and my work 

on the floor, I have watched Dr. Foster. 

I am very proud of the way he handled 

himself. 

I see, today, he has gained the support of one Republican on the committee, assuring that there will be at 

least a tie vote. I want to reiterate to 

the majority leader, Senator DOLE, 

what I have written to him twice 

about. I see that the Democrat leader 

is on the floor and I want to thank him 

for being so clear on this point. 

Americans are fair, Mr. President. 

Americans are just. The fact is, this 

man deserves to be heard on this Senate floor. 

We have an AIDS epidemic, we have 

a breast cancer epidemic, we have a 

lung cancer epidemic, we have an epidemic of teen pregnancies, we have too 

many cases of Alzheimer’s, cancer, and 

heart disease in this country. 

We have too much smoking going on 

in this country, too many young kids 

taking up smoking. We need a Surgeon 

General. I do not know why it has to 

take 3 more weeks for the committee 

to vote out Dr. Foster, but so be it. 

I want to say today on the floor what 

I have written to Senator DOLE, that if 

Senator DOLE refuses to bring this 

nomination to the floor, even if it is a 

tie vote or, Mr. President, even if it is 

a losing vote, if Senator DOLE refuses 

to bring this nomination to the floor, I 

reserve my right as a Senator to object 

to Senate business until we can have 

this nomination on the floor. Senator 

DODD yesterday said he thought it 

would be childish for Members to avoid 

this discussion on the floor and I want 

to, again, say that I agree with that. 

Now, Mr. President, I would like to 

speak to one question in my remaining 

5 minutes. Where is the Republican 

budget? Where is the Republican budget? By law, the Budget Committee was 

required to complete work on that 

budget by April 1. It is May 3, 33 days 

after that date, and we still have no 

budget. By law, the entire Congress is 

required to complete work on the budget by April 15. It is May 3—18 days after 

that date—and still no budget. 

For years, my Republican colleagues 

have said we could easily eliminate the 

deficit, and we know how. Not one of 

my Republicans friends voted for the 

budget last year, which cut $500 billion 

from the deficit—not one. They said, 

‘‘We can do it better; we can do it 

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