Date: 1991-06-05
Speaker: JAY ROCKEGELLER (democrat)
Chamber: S

I must say. also made physician payment reform a reality and made the Pepper Commission work. Democrats and Republicans in the Congress have been working on changes in the way America pays for health care since I arrived here In 1979 to meet the specter of something called hospital cost containment. There can be no question that America must change the way we produce. the way we well. and the way we buy medical services. Just as health is a basic issue to every person. it is a fundamental issue for every business. every institution. and every level of Government in America. Like a person with very high blood pressure. each Institution of our society today is threatened with an explosive increase in medical costs. This year American health expenditures will be $750 billion. By the turn of the centuryonly 8% years from nowthat amount will have tripled. to over $2 trillion. Can employers afford three times their current health care costs? Can Government? Can individuals and families? Of course not. We have 31 million Americans who have no health insurance at all. with millions more soon to Join the ranks because of cost increases. We have major sectors of our societyin rural and urban areasgrossly underserved. Change is urgently needed. I commend my colleagues for laying this proposal on the table. As I look over the proposal. I see a number of very necessary reforms which have been discussed In the Finance Committee and in the Pepper Commission. The bill is a great improvement on the Pepper Commission final report because it begins to address a major gap in the documentcost containment. I wish to thank the sponsors for including a number of proposals which I have just put forward over the last several years. and I am especially pleased to see a small business insurance reform component which I have been working on since March of last year and on which I have Introduced S. 700. the American Health Security Act. But. Mr. President. before I sound any more like a cosponsor of this proposal. which I am not. there are several flaws which will cause this bill to fall short of Its own ambitious goals. This afternoon I will mention just four. First. introducing a bill without any financing to it is like wrapping up an empty box and putting it under the Christmas tree. It is designed to disappoint. One of the lessons we were supposed to have learned from the 1980s is that government should not promise for what It cannot pay. or is unwilling to pay. Unfortunately. this bill falls into that trap. The bill is quite explicit about what we will do for the American people and silent on how they will pay for it. It proposes $3 to $8 billion in Medicaid changes. From where is that money going to come? It proposes a payroll tax on businesses that do not choose to provide insurance. How big will that be10 percent. 15. 20? This legislation gives no answers. The failure of the sponsors to agree upon a financing mechanism even among themselves does belie the socalled comprehensive nature of the bill. Second. by relying on employer mandates to solve the uninsured problem. the bill prescribes a treatment that has already failed clinical trials in the State of Massachusetts. There is a major problem. of the working uninsuredpeople who have jobs but cannot get insurance in the workplace. But the problem is not that their employersmostly small businesseswill not provide Insurance. it is simply that their employers cannot. Finding and keeping affordable insurance in the current cost spiral has been nearly impossible. and to add a mandate to buy insurance in this situation is simply to mandate bankruptcies. The bill requires employers to either provide a health plan for their employees or pay into a State insurance fund. in other words. "play or pay." The eventual result will be employers abandoning their responsibility to insure workers and dumping them into a huge State system. In other words. we will get a Canadian system by the installment plan. But the greatest unfairness in this mandate is it treats all employers and all businesses as though they were the same. it ignores differences which are crucial to how these employers make their health care decisions. even the decision to play or pay. There are differences between employers located in urban and those in rural areas. different kinds of businessesmanufacturers. service industrythe kind of business that can pass on these costs on goods and servicesand those that cannot. There are differences between the coastal areas of this country and Its heartland. To say these disparities do not exist guarantees bad policy outcomes. The third flaw in this bill is that it leaves totally unreformed $100 billion a year in Federal health spending on the tax side of the ledger. There is a very large hole in the Nations health bucket that simply must be plugged if we are going to get the kind of efficiency we need in this system. Every year. we hand out $100 billion in tax benefitsor the taxpayers dofor health expenditures. and the American people get no better system for it. We subsidize the average lawyer in this city about $2.000 a year for his health insurance. a tax subsidy paid for by farmers in Minnesota who do not get that kind of subsidy and have to pay twice as much for their premiums without the benefit of a deduction. Fourth. I am sure the sponsors would also agree that even passage of their bill today would not nearly finish the job of health reform. We still have to deal with Medicare restructuring and optional services for longterm care. We have to deal with the medical arms race in this country which is raising costs by 11. 12 percent a year. We have to deal with restoring Individual resonsibility and changing the wasteful way in which health care is currently delivered in this country. This is the real key to cost containment in America today. changing the way people access health care and changing the way medicine is practiced. I would suggest that if every health professional in America practiced as part of a Mayo Clinic we would double quality assurance in America. and I know we would cut the costs by at least a third. The majority leader. Senator MiTCHELL. in his statement said this is a "comprehensive bill to reform the Nations health system to provide access to affordable heath care for all Americans." But without the details of the financing. without a sustainable solution to the uninsured problem. without a tax component or reform in other major areas. this bill will have trouble living up to that reputation. Mr. President. the process of health reform will be a long and difficult one. Changing how 13 percent of the GNP in this country operates when it is operating in a drug company over here and in a small town clinic over there. is a huge challenge. But we have to start some place. And some place is the bill our colleagues. Senators KENNEDY. MITCHELL. and ROCKEFELLER. have put before us. I commend them for their leadership and for the correct choices they have made. and I look forward to working with them in the areasand there are manywhere we will have disagreements. This will be a long journey10 years worth of work perhaps. But we cannot get there unless we get started. Credit belongs to those Senators today. Because of their efforts. we are finally underway. Mr. President. I suggest the absence of a quorum. I yield the floor.