May 12, 1995 CONGRESSIONAL RECORD — SENATE S6587

At the appropriate place, insert the following:

SEC. . STUDY OF INTERSTATE SLUDGE TRANSPORT.

(a) DEFINITIONS.—In this section:

(1) SEWAGE SLUDGE.—The term ‘‘sewage

sludge’’—

(A) means solid, semisolid, or liquid residue generated during the treatment of domestic sewage in a treatment works; and

(B) includes—

(i) domestic septage;

(ii) scum or a solid removed in a primary,

secondary, or advanced wastewater treatment process; and

(iii) material derived from sewage sludge

(as otherwise defined in this paragraph); but

(C) does not include—

(i) ash generated during the firing of sewage sludge (as otherwise defined in this paragraph) in a sewage sludge incinerator; or

(ii) grit or screenings generated during preliminary treatment of domestic sewage in a

treatment works.

(2) SLUDGE.—The term ‘‘sludge’’ has the

meaning provided in section 1004 of the Solid

Waste Disposal Act (42 U.S.C. 6903).

(b) STUDY.—Not later than 3 years after the

date of enactment of this Act, the Administrator of the Environmental Protection

Agency shall conduct a study, and report to

Congress on the results of the study, to determine—

(1) the quantity of sludge (including sewage sludge) that is being transported across

State lines; and

(2) the ultimate disposition of the transported sludge.

Mr. BAUCUS. Mr. President, this

amendment also is acceptable.

The PRESIDING OFFICER. If there

is no further debate, the question is on

agreeing to the amendment.

The amendment (No. 1073) was agreed

to.

Mr. FEINGOLD addressed the Chair.

The PRESIDING OFFICER. The Senator from Wisconsin.

Mr. FEINGOLD. I ask unanimous

consent to speak as in morning business.

The PRESIDING OFFICER. Without

objection, it is so ordered.

THE BUDGET RESOLUTION AND

fMEDICARE

Mr. FEINGOLD. Mr. President, I appreciate the comments of the junior

Senator from Massachusetts with regard to the question of including the

Presidential checkoff for campaigns in

the budget resolution. It is an important program for our elections being

free and fair in this country, and it

does not belong in the budget resolution. I intend to comment on that more

as we get into the budget resolution itself. I am grateful to the junior Senator from Massachusetts for those remarks and for his constant dedication

to try to do something about this really awful system of financing campaigns

that we have in this country.

Mr. President, I rise at this time to

offer a few comments on the debate

that really does belong as part of the

budget resolution, and that is the debate that has been taking place about

Medicare. I would like to share my own

perspective on the direction we ought

to pursue.

As we consider the budget resolution,

presumably starting next week, this

will be one of the two or three most

central issues that we debate. As the

Senator from Nebraska [Mr. KERREY]

noted on the floor last week, the Medicare debate has been obviously politicized in quick order. That should not

surprise us given the nature of the program and especially how it is viewed by

millions of Americans. It is a valued

program. The presence of the White

House Conference on Aging last week

certainly had an impact on what was

said, and said by Members of both parties.

Mr. President, the White House conference also gave me an opportunity—

a great opportunity—to talk to many

of the leading aging activists from Wisconsin on the issue. I found their

thoughts interesting. I think Wisconsin

has one of the best groups of advocates

for sound and compassionate policies

for the elderly in the country. They always give the straight view. They tell

me not only what is good for the elderly but what is good for society as a

whole, including their children and

grandchildren.

In a meeting I had with most of the

Wisconsin delegates to the White

House Conference on Aging, there was

a clear consensus that some changes do

need to be made to Medicare. But there

was also agreement, Mr. President,

that those changes to Medicare have to

be done in a certain way. We need to

‘‘cut smart,’’ not ‘‘cut mean,’’ as we

look to keep the Medicare hospital insurance fund solvent and reduce the

pressure on the Federal deficit.

It bears emphasizing that there are

these two features with respect to the

Medicare problem—both the solvency

of Medicare and the impact of Medicare

on the Federal budget deficit.

As every Medicare beneficiary knows,

there are two parts to Medicare called

part A and part B. Part A is what is

formally known as hospital insurance.

It pays some of the costs of hospitalization, certain related inpatient care, as

well as skilled nursing facility care and

home health care. I should add—and I

have always been somewhat distressed

by this—it does not cover chronic or

long-term care in that part of the program. Other than copayments and

deductibles, part A services are paid

from the hospital insurance trust fund,

which itself is funded from payroll

taxes.

Mr. President, it is this hospital insurance trust fund that is in jeopardy,

and it is expected to be insolvent by

the year 2002. The other part of the program, part B, is the supplementary

medical insurance program that covers

doctors’ fees, most outpatient and

some other related services. Part B is

partially funded by the monthly premiums that beneficiaries pay, but most

of the part B program is funded from

the Federal budget.

Mr. President, some are characterizing the cuts they expect to propose to

Medicare as being needed to keep Medicare solvent. That portrayal is entirely

misleading, as, of course, it is meant to

be; for though some changes are needed

to keep the hospital insurance fund solvent, that trust fund is not the whole

story. Medicare is also slated for cuts

as part of the broader effort to reduce

the deficit, possibly leading to a balanced budget.

So let us be clear within this body

and to all Americans, the goal here of

those who want to cut Medicare drastically is not just to make the fund solvent, they want to use a lot of those

billions of dollars to deal with our national deficit problem.

Mr. President, I make this point because I fear that the political spin doctors who have chosen to depict Medicare cuts as being apart and separate

from the rest of the budget are really

doing a great disservice to the cause of

deficit reduction itself. And there is no

other issue I care more about or work

harder on than reducing the Federal

deficit.

In an effort to minimize the political

fallout that surely will come from cuts

to Medicare, I fear they may undermine any chance for a real budget

package that will achieve the consensus it must have if we are going to

make the politically tough decisions

needed to actually balance the Federal

budget.

Mr. President, my message is that we

have to be honest with the American

people on what is really going on with

Medicare. Medicare clearly does have

an impact on the budget. Part of the

reason cuts are being proposed in that

area does stem from our Federal budget deficit, and rightly so. Medicare

does have to be on the table as we look

at the budget. I will say, Mr. President,

Medicare is not Social Security. It has

to be considered along with other areas

of Federal spending. In fact, I have

sponsored legislation that has included

some specific, targeted Medicare cuts.

Medicare cuts were part of the 82-

point plan to reduce the Federal deficit

that I used and created during my campaign for the U.S. Senate in 1992.

More importantly, I have voted for

legislation that contained significant,

but specific, targeted cuts to Medicare

twice during the 103d Congress. The

reconciliation legislation we passed as

part of the President’s deficit reduction package included nearly $60 billion in Medicare cuts. This is not some

new idea. It is not as if Medicare has

not already, in effect, given at the office. It has already been hit to the tune

of $60 billion just 2 years ago.

Mr. President, I also voted for, and

was pleased to be a cosponsor of, the

bipartisan Kerrey-Brown deficit reduction package. It also included significant, specific Medicare cuts on top of

the $60 billion that was included in the

President’s deficit reduction package.

Yes, Mr. President, I am willing

again to vote for certain Medicare cuts

if they are appropriate and do not cut

at the heart of the health care of the

people who need Medicare.
S6588 CONGRESSIONAL RECORD — SENATE May 12, 1995

But while Medicare needs to be on

the table as we search for ways to reduce the deficit, we have to ensure that

any changes make sense both within

the context of the Medicare program

itself and in the broader context of our

entire Federal budget. For just as Medicare clearly has an impact on the Federal deficit, Medicare beneficiaries and

Medicare providers should not be asked

to fund other political or policy priorities apart from the goal of reducing

the Federal deficit.

So I am concerned, Mr. President,

that those who argue the loudest for a

balanced budget tend to be the people

who are the first to demand massive

tax cuts and not decreases but increases in Federal spending. I do not

think the use of Medicare cuts to do

those two things is appropriate in the

context of this budget resolution.

Mr. President, I want to be one of the

people on this floor to say that neither

political party is blameless in this regard. Both Republicans and Democrats

have argued for increased defense

spending and for tax cuts at the same

time they are out here promising a balanced budget and saying that their top

priority is a balanced budget amendment.

We cannot argue that changes to

Medicare are needed to lower the deficit and then devote our very scarce resources to tax cuts and defense increases.

Again, Mr. President, I am willing to

support certain further cuts to Medicare to bring the Medicare trust fund

into balance, and even, where appropriate, to help reduce the Federal budget deficit.

That is not something I would say

about Social Security. I will say it

about Medicare. I am not willing to

support cuts to Medicare, however, to

fund an irresponsible tax cut and increase our bloated defense budget.

Looking to the Medicare Program for

cuts will be hard enough. It would be

far better to be making changes to

Medicare as part of comprehensive

health care reform. In my view, Mr.

President, that would be my first

choice as the health care reform debate

illustrated powerfully last year.

The cost-shifting takes place because

of Medicare, and Medicare mushrooms

health care costs. Making changes to

Medicare unilaterally as we apparently

will do in this budget this year, outside

of comprehensive reforms to the entire

health care system, I am afraid invites

even more of the cost-shifting.

I am afraid, though, Mr. President, to

be realistic, there is no sign that comprehensive health care reform will be

before the Senate in the 104th Congress. That complicates the job of finding savings in Medicare and limits

what to expect in the way of potential

savings.

Nevertheless, Mr. President, I want

to say today and be specific that there

are changes in Medicare that can and

should be made. For example, we could

consider making some changes to the

Medicare home health care benefit.

For example, I am willing to consider

requiring a modest copayment on those

home health services as long as adequate provision is made for those with

lower incomes. Proposals I have seen

for 20 percent copayment may be too

high. Maybe they are looking at a 5-or10-percent copayment, making sure

that those who cannot afford it are

taken care of. It could at least be on

the table.

Moreover, Mr. President—again to be

specific, not just talking in the abstract about Medicare cuts—let me acknowledge that some have suggested

that we might move to have a prospective payment system for home health

care providers under which Medicare

would reimburse services on a per episode basis. Some say that would not

harm people and would be more efficient and save money. Given the dramatic rise in the number of visits per

person served on the Medicare home

health benefit in recent years, such a

change might make sense. It certainly

is something we should examine.

Mr. President, I want to also remind

my colleagues that a great deal of the

increase in the utilization we see in the

Medicare home health care benefit has

been the direct result of previous policy changes to Medicare that were also

supposed to create savings. It did not

work that way, in part, because of

changes to Medicare patients who are

being discharged from hospitals

quicker and sicker than they used to

be. In many cases, Medicare policies

have just moved the site of care from

the hospital to the home, with the resulting increase in home health care

benefit utilization.

I am pleased that much of the care

can be given in the home, but we have

to be realistic about the cause and effect resulting from Medicare changes.

It should serve as a caution to all as we

seek to find savings in Medicare, we

should not just make a cut here and

find out we are paying the same or

more through Medicare at another location. That does not accomplish anything either for Medicare, the people

who benefit from it, or for the goal of

reducing the Federal deficit.

Mr. President, in other areas there

may again be more room for modifications, to the way, for example, we

make payments to hospitals for capital-related costs of inpatient service.

Some have argued that those capitalrelated rates reflect erroneous inflation forecasts, and adjustments ought

to be made to account for the errors.

This sounds like the kind of specific

cut in Medicare that does not go to the

heart of Medicare, does not harm the

individual’s ability to get the care they

need, but the inefficiency and excesses

of the way the system is set up. These

should be at the top of our list, not at

the bottom.

During last year’s health care reform

debate, this kind of modification was

considered. I think it deserves review

again.

Mr. President, one change that must

be a high priority also, is to ask

wealthier beneficiaries to shoulder

more of the cost of part B services, relieving taxpayers of some of the subsidy they are now providing, which

amounts to about 75 percent of the full

value of the Medicare part B premium.

I proposed that in 1992 as part of my

deficit reduction proposal, and I recall

the comments made by the majority

leader that those with higher incomes

ought to be asked to pay a little more

for part B services. So that should be

on the table.

We should also consider making

changes to eliminate so-called formuladriven overpayments for hospital outpatient services. The Medicare part B

copayment of 20 percent is intended to

lower the cost of Medicare to taxpayers

on a dollar-for-dollar basis. For every

dollar of copayment made by a beneficiary, Medicare’s own liability is supposed to drop by $1. It is my understanding there are anomalies in the

Medicare reimbursement formula for

certain outpatient hospital service.

The result, Mr. President, is that the

liability to Medicare is just greater

than it should be.

So we are talking here about real

ways to save dollars to achieve our deficit reduction goals without scaring

the people in this country who need the

basic Medicare services, like the possible changes to inpatient capital-related payment rates. This matter was

debated during the health care reform

debate last session. We did not get it

done. We did not get these cuts implemented. We could be getting the benefit and savings of those today if we had

acted then instead of waiting until

now.

Some suggested we change the formula-driven overpayments. Again, I

want the specific ideas on the table for

the people of this Congress and for the

whole country to examine.

Mr. President, I am willing to consider proposals that provide incentives

to seniors to select managed care alternatives. There are other changes that I

would certainly be willing to consider.

Mr. President, I do want to say a few

other things about changes that do not

make sense. Some we should not be

doing. For example, shifting Medicare

costs on the backs of those with very

low income not only unfairly burdens

those least able to bear additional

costs, but, again, to the extent it

swells Medicaid costs, all it will do is

transfer the tax burden from the Federal taxpayers to the State taxpayers.

Of course, that is a convenient result

for our Federal budget writers, but not

an improvement for the taxpayers back

home in Wisconsin or Minnesota.

Mr. President, I mentioned the

Kerrey-Brown package as legislation

which I supported and which also contains specific and significant Medicare

cuts. As I have noted before on this

floor, the process, Mr. President, the
May 12, 1995 CONGRESSIONAL RECORD — SENATE S6589

process by which Senator KERREY of

Nebraska and Senator BROWN of Colorado and others put together this package was, to me, a model of bipartisan

cooperation.

We did not hear much about it during

the 1994 campaign. People assumed

that everything that happens out here

is partisan. But that is not what I have

found. There are people in this body

who do want to get together on a bipartisan basis to solve the deficit problem.

They have done it. They have put a lot

of time into it. They are willing to do

it again.

For my part, I came away from that

process greatly encouraged that there

were Senators on both sides of the aisle

who were willing to band together to

find some common ground in reducing

the deficit, even if it meant bucking

the partisan political rhetoric of their

respective parties.

Mr. President, I believe that in this

104th Congress we can achieve that

kind of bipartisanship again, and I

want to signal today as we move into

next week of the budget resolution,

that I am not only ready but very

eager to participate in that bipartisan

effort. I yield the floor.

Mr. President, I suggest the absence

of a quorum.

The PRESIDING OFFICER (Mr.

GRAMS). The clerk will call the roll.

The bill clerk proceeded to call the

roll.

Mr. KEMPTHORNE. 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. KEMPTHORNE. Mr. President, I

ORDER OF PROCEDURE

fask unanimous consent to be allowed

to go forward as though in morning

business.

The PRESIDING OFFICER. Without

objection, it is so ordered.

HONORING A COURAGEOUS YOUNG

GIRL, AND CARING COMMUNITY

fMr. KEMPTHORNE. Mr. President, I

would like to spend just a moment

talking about a courageous young girl

in my hometown of Boise, ID.

Nine-year-old Susie Hamilton, a

bright, vivacious, and loving girl suffers from a rare and deadly form of leukemia. She has been in and out of hospitals in Boise, Salt Lake City, and Seattle for the past 8 months. A bone

marrow transplant is her last hope for

life.

Mr. President, Susie is blessed with

two outstanding parents who are leaders in the community. Her father,

Steve, is a Boise Fire Department battalion chief, dedicated to saving lives. I

have worked with him personally on a

variety of projects. Her mother, Becky,

works at Boise Cascade Corp. Both

have spent many long hours away from

their jobs to tend to Susie’s needs.

There have been some rough times

for Susie, Steve, and Becky. I would

like to read from a newspaper column

by Tim Woodward in the Idaho Statesman, who wrote about this family:

Leukemia along is bad enough, but there

were other heartbreaks. When a match was

found for a donor after hundreds of tests, the

donor turned out to have hepatitis. Susie got

it through a transfusion. Last month, she

had to have a lung removed. When a doctor

praised her courage, she whispered, ‘‘What

choice, do I have? I want to live.’’

The community has responded, raising over $12,000 to offset medical bills.

Today there is a silent auction at Susie’s school to raise money. Boise firefighters have switched shifts so Steve

can spend time with Susie. Boise Cascade has given Becky as much time off

as she needs, and has even given the

family use of the corporate jet to fly to

Seattle.

This ribbon I am wearing, Mr. President, is just one more sign of the community’s willingness to rally around

their neighbor. Members of the police

and fire departments, sheriff’s department, workers at Boise Cascade, Susie’s classmates and teachers, employees at city hall, and others in Boise are

wearing these ribbons to show their

support for the family.

I would like to read this letter I just

received from Susie’s grandmother,

Barbara Dennett:

My Granddaughter, Susie, was diagnosed

with adult leukemia in October of 1994 and

since then has endured prolonged hospitalization for chemotherapy and several

surgery’s in Salt Lake. Susie is now in Seattle undergoing preparations for a bonemarrow transplant. This is her only chance

to overcome the leukemia—her only hope for

survival.

After searching for 8 months for a bone

marrow match, isn’t it ironic that on this

50th anniversary of World War II’s death and

horror, a German soldier will be the donor to

save the life of a little 9 year old girl in

America. I believe this to be a noteworthy

occasion.

This soldier was scheduled to go out on

maneuvers, which would delay the bone marrow transplant 15 more days, but chose to

make himself available for the draw instead

stating he did not wish for her to suffer a

minute longer than necessary. His bone marrow will be hand delivered from Germany to

Seattle. Hand carried, the transplant will

begin the minute it arrives.

Thank you for your time and consideration

in seeing that President Clinton receives this

information. When I told Susie, that every

one was praying for her all over the world,

she ask ‘‘even the President of the United

States?’’ How could I answer with anything

other than ‘‘yes, even the President’’. A card

or call from him would go a long way in

helping her believe that we are all telling her

the truth when we say that there is always

hope that she will be well again and a bright

future lies ahead.

Mr. President, I ask unanimous consent to enter this letter into the

RECORD. I also ask unanimous consent

that the newspaper article be printed

in the RECORD.

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

RECORD, as follows:

SPECIAL 9-YEAR-OLD TOUCHES A CITY’S HEART

(By Tim Woodward)

If you’ve seen a Boise firefighter lately,

you may have noticed he was wearing a purple ribbon on his uniform.

They’re wearing purple at City Hall, too.

The mayor, city council members and other

office workers all have purple ribbons pinned

to their clothing.

Purple ribbons dot lapels at the Boise Cascade Corp., the Ada County Sheriff’s Department, Life Care Center, hospitals, doctors’

offices, Highlands School.

The ribbons are symbols of support for a

kid who has had more bad luck than any 9-

year-old deserves. Susie Hamilton has a rare

and deadly form of leukemia. She has been

out of hospitals nine days in the past eight

months. A bone marrow transplant is her

last hope for life.

Steve Hamilton, Susie’s father, is a battalion chief with the Boise Fire Department.

Hamilton has dedicated his life to saving

lives. Now his fellow firefighters are helping

him in the fight to save his daughter’s life.

When Susie got sick, the firefighters donated shifts so her father could be with her.

When she needed a marrow donor, the firefighters raised $4,000 and added 527 names to

the donor registry.

Susie’s mother, Becky Hamilton, works at

Boise Cascade. The company not only extended her leave time, it flew the family to

Seattle in a corporate jet when Susie needed

to see a specialist there.

On May 12, the fire department, Boise Cascade employees, the sheriff’s department,

Highlands School and civic groups will sponsor a silent auction to raise money for medical expenses. Businesses have donated raft

trips, airplane rides, bicycles and other

prizes. The auction will be at Highlands, Susie’s school.

‘‘Everywhere we go, whether it’s the hospital in Salt Lake or the one in Seattle, the

people we work with are just amazed at the

support network we have in Boise,’’ Steve

Hamilton said. ‘‘They say it’s unheard of in

this day and age to have that kind of community involvement.’’

So far, Boiseans have donated more than

$12,000 to the Susie Hamilton Leukemia Account (200 N. 4th St, Boise, ID 83702). Velma

Morrison dropped by last week with a check

for $2,500.

One of Susie’s grandmothers helped her

write a children’s book. ‘‘Lillie the Laughing

Giraffe Loses Her Spots and That’s No

Laughing Matter’’ will go on sale May 12.

Boise’s Legendary Publishing Co. donated its

services. All of the proceeds will be used for

Susie’s medical expenses.

‘‘Boise is known as the City of Trees, but

to me it’s the city of love,’’ Susie said. ‘‘. . .

I’ve learned a lot about love and friendship

and caring since I got sick. I want to thank

everyone who has helped me—my friends, my

family and people I’ll never get a chance to

meet.’’

Leukemia alone is bad enough, but there

were other heartbreaks. When a match was

found for a donor after hundreds of tests, the

donor turned out to have hepatitis. Susie got

it through a transfusion.

Last month, she had to have a lung removed. When a doctor praised her courage,

she whispered, ‘‘What choice do I have? I

want to live.’’

The search for a donor was worldwide. The

winner: a soldier in the German army. The

transplant will be May 10, in Seattle.

Hundreds of people will be thinking about

a brave little girl that day.

They’ll be saying prayers, wearing purple

ribbons, hoping a miracle will save a life

that has touched a city’s heart.