Date: 1999-07-15
Speaker: MAX BAUCUS (democrat)
Chamber: S

and CHUCK ROBB. One of the most difficult obstacles to meaningful health care reform is that there is an inherent tension between our two most important objectives. The first objective is to ensure the highest possible quality care. Regardless of our vantage point on the political spectrum. we can all agree that the United States offers the best quality health care in the world. Men. women and children flock here from every corner of the globe to gain access to our physicians and our hospitals. Maintaining this high standard of care must be at the forefront of any attempt to reform the means by which Americans pay for their health care. Seemingly at odds with the objective of highest quality care is the need to make sure that health care is affordable. The ability to cure disease or heal the injured is rendered almost meaningless if only a fraction of the population can afford it. Spiraling health care costs have a negative impact upon society in a variety of ways--some obvious and some not so obvious. I well remember the situation in Indiana when I took over as Governor. In themidst of our worst recession since the 1930s. our Medicaid costs were increasing by 20% per year. an increase that mirrored substantial annual hikes in the private market. One clear result was that workers around the state were losing insurance as business after business found themselves unable to pay for even basic health coverage. � But for both the state government and for those businesses that maintained health insurance. the spiraling increases crowded out ) funding for many other significant initiatives and investments. On the state level. paying increased Medicaid bills meant less for education.. transportation and child care. For private businesses the choices were equally starkpay increased insurance costs and in so doing postpone expanding the workforce. offering pay increases. investing in research or modernizing factories and offices. In 1989. we began to make some very tough decisions in Indiana to bring the Medicaid budget under control. private businesses similarly began to turn to managed care. For the past ten years. those changes have helped to keep health care costs under control and have resulted in continuing insurance coverage without having to choose between offering health insurance or creating new jobs. or maintaining Medicaid or education funding. But today. there is ample evidenceacknowledged by Democrats and Republicans alikethat the pendulum may have swung too far towards keeping costs down. and as a result. we are jeopardizing the quality of health care that Americans receive. In trying to redress this imbalance. there are a few lessons that we learned in Indiana that were useful principles for me to keep in mind as this debate progressed. First. and .perhaps most importantly. any significant reform had to be marketbased. Any attempt to have the government control the health care system would be doomed to failure. The ChafeeGraham bipartisan bill that I have supported since taking office is market based. it sets some basic ground rules but leaves that actual management of health care to the experts in the private sectorthe patients. the doctors and the insurers. Unfortunately. the Republican plan takes the concept of marketbased reform to its illogical extreme. That plan falls far short of establishing even the most basic protections for people in managed care. Most egregiously. the NicklesLott bill would only cover a fractionless than 30%-of the people who have private insurance. We have all accepted the idea that there ought to be some minimum protections and guarantees offered to those in managed care to prevent the abuses that we have witnessed over the past few years. But if all sides have accepted that principle. it seems very unfair that the majority would choose to leave nearly 120 million people out of the protections we all believe are necessary. I strongly support the elements of the Democratic approach that advance these principlesaccess to specialists. proper emergency care. access to obstetrician/gynecologists. independent reviews of denial of carebut the bipartisan bill wisely avoids the one element of the Democratic Patients Bill of Rights that I believe will drive health care costs up: expanded liability. If health care costs do not remain under control. there are serious ramifications for both the national economy and for the American taxpayer. The United States already pays moreexpressed as a percentage of GDPfor health care than any other industrialized nation. A rise in these costs will have an appreciable negative impact upon our economic strength in an increasingly competitive global environment. With pressure from a unified Europe and resurgent Asia. the last thing this Congress ought to do is to help spur a dramatic rise in health care costs for a liability provision that is unlikely to make any American healthier. And the American taxpayer is at risk if health care costs spiral out of control because it is the taxpayer who will foot the bill if hundreds of thousands of people are suddenly forced into the Medicaid system if they lose their health benefits. We simply. as a nation. cannot afford a return to the days when health care costs increased by double digits every year. The bipartisan bill does allow some tightly controlled access to the Federal courts for suits that seek restitution for economic loss. It seems to me that before we expose health care plans and employers to unlimited liability and to punitive damages. we must at least try this limited. moderate approach. Mr. President today we will face a test of whether Washington can still work. The American people will be watching to see if their cynicism and apathy towards the political process in general and Washington. in particular. will be deepened or whether we can put partisanship aside and restore their confidence in our ability to govern for the benefit of the nation. Some in this chamber truly do not want to have any legislation that reforms the way in which HMOs operate. some do not want to have any legislation so that they can have an issue for the 2000 elections. Neither approach serves the American people very well and that is why I support the bipartisan bill as the only possibility to actually get something done. The Democratic proposal will not pass the Senate. the Republican proposal will be vetoed by the President and that veto will not be overridden. Compromise is the only possibility before us for success in this area. The bipartisan bill strikes the right balance between additional patient protections and maintaining control of increasing health care costs. In the final analysis. we have a choice to make: do we choose to just give more speeches that wont help anyone. or do we try to get something done? Are we going to insist upon everything that we want. or will we put aside our partisan differences to get some of what the American people want? It is my hope. even if that vote doesnt occur today. that the members of this Senate will pass the test by finally putting aside the rancor and bitterness of the past four days. to put aside the desire to score debating points off each other. and to rally around this centrist. responsible bipartisan bill that will give the American people the key components of HMO reform that they need and deserve.