Sherrod Brown

Mr. BROWN of Ohio

Mr. BROWN of Ohio. Mr. Speaker, I would like to associate myself also with the remarks of the gentleman from Ohio (Mr. Regula), the gentleman from West Virginia (Mr. Wise), the gentleman from New York (Mr. Quinn) and the gentleman from Arkansas (Mr. Berry) in imploring the ITC to rule for the United States steel industry. There is another trade issue that soon will be in front of Congress. Corporate jets are starting to land at National Airport one after another after another, filled with CEOs coming, descending on Capitol Hill to lobby on behalf of the Chinese Communist Government's accession to the World Trade Organization. One prominent Chinese dissident who had spent many years in a Chinese jail simply for exercising what he considered his right to speak out about oppression and speak out against the Chinese Government and its policies, this dissident said that American corporate executives were in the vanguard of the Chinese Communist Party revolution, arguing in this body for special trade advantages, so-called Most Favored Nation status for China, arguing in this body that China should be admitted to the World Trade Organization. Let us step back for a moment, Mr. Speaker, and look at a little bit of the history of China's attempt to join this world trade body and play by the rules that the United States and other countries around the world play by. For 5 years, the People's Republic of China has courted the United States, trying to convince the United States that China, the Chinese Communist Government, should be admitted, acceded into the World Trade Organization, but look what they have done in those 5 years as they in a sense have been courting the United States: illegal sales of nuclear technology to Pakistan; smuggling of AK-47s into the harbor at San Francisco; child labor; slave labor; shooting missiles into the Straits of Taiwan when Taiwan was holding its first free election, something that the People's Republic of China is very unfamiliar with. As China has been courting the United States, this is the way they have been acting. They have violated every norm, every reasonable standard that is accepted in the international community, standards that our country lives by, standards that the great majority of countries around the world live by. China, while she has been courting the United States, has acted this way, yet they want accession into the World Trade Organization. At the same time, China has exported last year $75 billion worth of goods to the United States. We have sold to China, exported to China, only about $12 billion worth of goods. We sell to Belgium more than we do to China, because China simply will not let most of our goods and services in their country. China takes that $60 billion trade deficit, that surplus for them, in a sense that gift of $60 billion, turns around and buys more or less $60 billion worth of goods from Western Europe; generally, our western European allies. Then when we have a problem with China, when there is a human rights violation or some sort of theft of property rights or something that clearly China has acted not according to the rules of international trade, those European countries never are on our side in those trade disputes because they are such a big customer for China. Understand that China has a $60 billion trade surplus with us. They make $60 billion in goods and services from us, turn around and spend that $60 billion in Western Europe; in a sense, buying allies in their quest around the world in the trade arena. Mr. Speaker, what we need to do before granting China World Trade Organization is not listen to what they say, because they always make promise after promise after promise saying that they will behave, that they will play fair, they will stop the human rights abuses, they will stop the forced abortions, they will stop the religious discrimination, they will stop their war against the Tibetans, they will stop what they do against Taiwan, they will stop the child labor, their slave labor. They promise that every year. Every year this country gives them Most-Favored-Nation status. Every year they break those promises. Mao Zedong Dong liked to quote his ideological communist mentor, Vladimir Lenin, the Soviet leader. He said, promises are like pie crust, they are made to be broken. That is what has happened with China as they have courted the United States to join the World Trade Organization. Mr. Speaker, I ask the administration, I ask the President, I ask Republican leadership in this body, I ask the American business community, which is so strongly supportive of World Trade Organization entry for China immediately, I ask them to step back and let us see if China can behave for one year, if it can stop the human rights abuses, stop the slave labor and the child labor, can stop shooting missiles at Taiwan, can stop the nuclear sales to Pakistan, can stop the human rights violations. Let us see if China can stop for 1 year and join the community of nations in its behavior for 1 year. Then let us talk about World Trade Organization accession. Do not let them in based on their promises, let them in based on their actions.

Mr. BROWN of Ohio

Mr. BROWN of Ohio. Mr. Speaker, many in Congress have been on a campaign to scare America's seniors into believing that Medicare is going bankrupt. They say Medicare must be privatized in order to save it. Once again, Medicare privatizers and their Mediscare campaign are wrong. The trustees of the Medicare Trust Fund have just reported that Medicare will remain solvent through 2015, up from its earlier projection of 2008. Those in Congress, the think tanks, and the Beltway pundits who want to privatize Medicare are wringing their hands over the trustees' latest report. They believe these new projections will lead Congress to do nothing towards reforming Social Security and Medicare. With the programs projected to last longer, we cannot rest on the our laurels, they say. The real threat to Medicare, however, is not its alleged pending bankruptcy. That is not true. The real threat is a proposal just rejected by the National Medicare Commission to privatize Medicare and deliver it to the private insurance market. Under a proposal soon to be introduced called premium support, Medicare would no longer pay directly for health care services. Instead, it would provide each senior with a voucher good for part of the premium for private coverage. Medicare beneficiaries could use their voucher to buy into the fee-for-service plan already in effect, sponsored by the Federal Government, or join a private HMO plan. To encourage consumer price sensitivity, the voucher would track to the lowest cost private plan. Ostensibly, seniors would shop for the plan that best suits their needs, paying the balance of the premium and paying extra if they want higher quality health care. The proposal would create a system of health coverage but, most importantly, it would abandon Medicare's fundamental principle of egalitarianism. Today, the Medicare program is income-blind. All seniors have access to the same level of quality care. The idea that vouchers would empower seniors to choose a health plan that best suits their needs is a myth. The reality is that seniors will be forced to accept whatever plan they can afford. The goal of the Medicare Commission was to ensure the program's long- term solvency. The premium support proposal simply will not do that. Supporters of this voucher plan say it could shave 1 percent per year from the Medicare budget over the next few decades. But Bruce Vladeck, a former Medicare administrator, doubted it would save the Federal Government even one dime. Efforts to privatize Medicare are, of course, nothing new. Medicare beneficiaries have long been able to enroll in private Medicare plans. Their experience, however, does not bode well in a full-fledged privatization effort. These managed care plans are already calling for higher government payments, they are dropping out of unprofitable markets, they are cutting back on benefits to America's elderly. Managed care plans obviously are profit-driven and they simply do not tough it out when their profits are not realized. We learned this the hard way last year when 96 Medicare HMOs deserted more than 400,000 Medicare beneficiaries because the HMOs were not meeting their profit objectives. Before Medicare was launched in 1965, more than one-half of the Nation's seniors had no health insurance. Private insurance was then the only option for the elderly. But insurers did not want seniors to join their plans because they knew that seniors would use their coverage. The private insurance market has changed considerably since then but it still avoids high-risk enrollees and, whenever possible, dodges the bill for high cost medical services. The problem is not malice or greed, it is the expectation that private insurers can serve two masters: the bottom line and the common good. Logically looking at the bottom line, our system leaves 43 million people without health insurance, 11 million of whom are children. Only Medicare can insure the elderly and disabled population because the private market has failed to do so. If we privatize Medicare, we are telling America that not all seniors deserve the same level of health care. We are betting on a private insurance system that puts its own private interests ahead of health care quality and ahead of a balanced Federal budget. The goal is simple, Mr. Speaker. Let us keep Medicare the successful public program it has always been.

Mr. BROWN of Ohio

Mr. BROWN of Ohio. Mr. Speaker, conservatives in the Republican Party are proposing that Congress privatize Social Security, turning it over to Wall Street, even though Social Security will be solvent at least until 2034. Privatization in many parts of government has simply gone too far. The purpose of public prisons, for example, is to protect the public, to punish and to rehabilitate. The purpose of privatized prisons is to maximize profit by reducing staff and too often cutting back on security. The purpose of public medical systems is to provide the best health care possible to all people. The purpose of privatized medical systems is to maximize profit, often meaning that the quality of care is compromised. The purpose of a public pension system, a public Social Security system is to provide a bedrock source of income for the elderly to keep them out of poverty. A privatized Social Security system would end that guaranteed income. Mr. Speaker, we must not privatize Social Security. Let us keep Social Security the very important public program that it has been for 60 years.

Mr. BROWN of Ohio

Mr. BROWN of Ohio. Mr. Speaker, we received good news 2 weeks ago when the Medicare and Social Security trustees reported that both programs will be solvent significantly longer than projected. For Medicare, the trustees reported that the Medicare trust fund will remain solvent through at least 2015. Those in Congress, the think tanks and the Washington pundits who want to privatize Medicare are wringing their hands over the trustees' latest report. They believe these new projections will lead Congress to do nothing towards reforming Social Security and Medicare. Once again, Medicare privatizers are wrong. The real threat to Medicare is not its alleged pending bankruptcy. The real threat to Medicare is a legislative proposal just rejected by the National Bipartisan Commission on the Future of Medicare which would have privatized Medicare and delivered it to the private insurance market. Under a proposal soon to be introduced called ``premium support,'' Medicare would no longer pay directly for health care services. Instead, it would provide each senior with a voucher good for part of the premium for private coverage. Medicare beneficiaries could use this voucher to buy into the fee-for-service plan sponsored by the Federal Government or to join a private plan. To encourage consumer price sensitivity, the voucher would track to the lowest cost private plan; Medicare privatizers tell us that seniors could then shop for the plan that best suits their needs, paying the balance of the premium and extra if they want higher quality care. The proposal would create a new, private system of health coverage but it would abandon Medicare's fundamental principle of egalitarianism. Today, the Medicare program is income-blind. All seniors have access to the same level of care. The idea that vouchers would empower seniors to choose a health plan that best suits their needs is simply, Mr. Speaker, a myth. The reality is that seniors will be forced to accept whatever plan they can afford. The goal of the Medicare Commission was to ensure the program's long- term solvency. This proposal will not do that. Supporters of the voucher plan say it would shave 1 percent per year from the Medicare budget over the next few decades. That is still not enough to prevent insolvency, and it is based frankly on overly optimistic projections of private sector performance. Bruce Vladeck, a former administrator of the Medicare program and a commission member, doubted the commission plan would save the government even a dime. Efforts to privatize Medicare are, of course, nothing new. Medicare beneficiaries have long been able to enroll in private managed care plans. Their experience, however, does not bode well for a full-fledged privatization effort. These managed care plans are already calling for higher government payments. They are dropping out of unprofitable markets and they are cutting back on benefits to America's elderly. Managed care plans are profit driven and they do not tough it out when those profits are unrealized. We learned this lesson the hard way last year when 96 Medicare HMOs deserted more than 400,000 Medicare beneficiaries, including in Lorain and Trumbull Counties, Ohio, because the HMOs did not meet their profit objectives. Before the Medicare program was launched in 1965, more than half the Nation's seniors were uninsured. Private insurance was the only option for the elderly, but insurers did not want seniors to join their plans because they knew that seniors would actually use most of their coverage. The private insurance market has changed considerably since then, but it still avoids high risk enrollees and, whenever possible, dodges the bill for high-cost medical services. The problem is not necessarily malice or greed. It is the expectation that private insurers can serve two masters, the bottom line and the common good. Logically, always looking to the bottom line, our system of private insurance has left 43 million uninsured individuals in the United States. If the private insurance industry cannot figure out how to cover these people, most of whom are middle-income workers and children, how will they treat high-risk, high-cost seniors? If we privatize Medicare, we are telling America that not all seniors deserve the same level of quality health care. We are betting on a private insurance system that puts its own interests ahead of health care quality and a balanced Federal budget. The Medicare Commission wisely disbanded without delivering a final product. Premium support proponents must realize that they cannot make Medicare privatization look like an equitable, fair alternative to the public program upon which 36 million seniors in this country depend. Premium support backers also have repeatedly tried to scare America's seniors by predicting that Medicare will go bankrupt. Congress would not let Medicare go bankrupt any more than it would let the Department of Defense run out of money. The goal is simple. Let us keep Medicare the successful public program it has always been.

Mr. BROWN of Ohio

Mr. BROWN of Ohio. Mr. Speaker, the Medicare Commission fortunately has voted down a Medicare reform proposal that would have privatized one of the best government programs in American history. The Commission's charge was to come up with a scheme for putting Medicare on a solid financial footing and improving its value to seniors. Instead, they came up with a scheme to end Medicare as we know it. While the Commission's time may have run out, it is not, unfortunately, the end of the story. Plans are being made to introduce legislation based on the plan, they call it premium support, that the Commission just rejected. Under this proposal, Medicare would no longer pay directly for health care services. Instead, it would provide each senior with a voucher good for part of the premium for private coverage. Medicare beneficiaries could use this voucher to buy into the fee-for-service plan sponsored by the Federal Government or to join a private plan. To encourage consumer price sensitivity, the voucher would track to the lowest cost private plan; ostensibly, seniors would shop for the plan that best suits their needs, paying extra for higher quality care. But the proposal would abandon the principle of egalitarianism that has made Medicare one of our Nation's best government programs. Today the Medicare program is income-blind. All seniors have access to the same level of care. The premium support proposal, however, would be structured to provide comprehensiveness, access, and quality only to those who could afford them. The idea that vouchers would empower seniors to choose a health plan that best suits their needs is simply a myth. The reality is that seniors will be forced to accept whatever plan they can afford. The Medicare Commission was charged with ensuring Medicare's long- term solvency. This proposal will simply not do that. Bruise Vladeck, a former administrator of the Medicare program and a commission member, doubted the commission plan would save the Federal Government even one dime. The same proposal under another name will not do it either. The privatization of Medicare is, of course, nothing new. Medicare beneficiaries have been able to enroll in private managed care plans for some time now, and their experience does not bode well for a full- fledged privatization effort. They are already calling for higher government payments, they are dropping out of unprofitable markets, and they are cutting back on patient benefits. Managed care plans are profit-driven, and they do not tough it out when those profits are unrealized. We learned this the hard way last year when 96 Medicare HMOs deserted more than 400,000 Medicare beneficiaries because their customers simply did not meet the HMO profit objectives. Before Medicare was launched in 1965, more than half this Nation's seniors were uninsured. Private insurance was then the only option for senior citizens. Insurers did not want seniors to join their plans because they knew the elderly would use their coverage. The private insurance market has changed considerably since then, but it still avoids high-risk enrollees and, whenever possible, dodges the bill for high-cost medical services. The purpose of public medical systems is to provide the best health care possible to help people, especially children and the elderly, so that they can live longer, healthier lives. The purpose of privatized medical systems is to maximize profit through private insurance companies, denying benefits and instituting physician and other provider incentives to withhold care. The problem is the expectation that private insurers can serve two masters: the bottom line and the common good. There are 43 million uninsured Americans. If the private health insurance industry cannot figure out how to cover these people, most of whom are middle-income workers and children, how will they treat high-cost seniors? If we privatize Medicare, we are telling Americans that not all senior citizens deserve the same level of care. We are betting on a private insurance system that puts its own interest ahead of health care quality and a balanced Federal budget. As the focus of Medicare reform shifts to Congress, we must question our priorities. The answer is clear: Medicare is a national priority and must be kept the excellent public program that it has been for 3 decades. Thirty-six million Americans depend on Medicare every day, and it has helped our Nation lead the world in life expectancy for people 80 years and older. The Medicare Commission wisely disbanded without delivering a final product. It is time now that we go back to the drawing board and construct a plan that builds on Medicare's strengths and ensures its solvency for decades ahead.

Mr. BROWN of Ohio

Mr. BROWN of Ohio. Mr. Speaker, I rise today in support of H.R. 975 and for America's steelworkers. Mr. Speaker, I rise today in support of H.R. 975 and in support of the thousands of American workers who have lost their jobs because of our obsession with free trade. Since the United States joined NAFTA and the WTO, over 200,000 Americans have seen their jobs exported abroad. These jobs have not become obsolete because of some advance in technology, but because we have deliberately pursued a trade policy that sacrifices productive American jobs for cheap foreign imports. Last year the U.S. trade deficit was a whopping $168 billion, the highest in our history. Nineteen ninety-nine promises us an even larger trade imbalance, especially if we are foolish enough to give China membership in the World Trade Organization or inflict NAFTA-like trade provisions on Sub-Saharan Africa. Yet the opponents of H.R. 975 are telling us the trade deficit doesn't matter. Just look around, we're told. Our economy is the envy of the world. Wall Street is booming. The stock market topped the 10,000 mark yesterday. And those cheap foreign imports, including hot rolled steel, are sending American shoppers into a buying frenzy. Well, an unemployed steel or textile worker will tell you the trade deficit does matter. The booming economy is bypassing the American worker. These Americans don't have enough money to put food on the table, much less enough to invest in stocks and bonds. While H.R. 975 is a good bill and should provide import relief to the steel industry, it does nothing to address the glaring need to regulate the global economy before the next major American industry has to close its doors to unfair competition. We need trade agreements that act as if people mattered, and have an obligation to put the needs of American workers before corporate profit. We can start today by passing H.R. 975. Then we must reject every trade initiative unless it includes meaningful labor and environmental protection standards. This is the only way we can prevent higher trade deficits and protect American workers from the corporate trade agenda. Support H.R. 975, support a trade bill for Africa that benefits American and African workers, and reject Chinese membership in the WTO.

Mr. BROWN of Ohio

Mr. BROWN of Ohio. Madam Speaker, the National Bipartisan Commission on the Future of Medicare is poised today to vote on a proposal that would end Medicare as we know it. The Commission's charge was to come up with a scheme for putting Medicare on solid financial footing and improving its value to seniors. They definitely came up with a scheme, a scheme to privatize America's best government program. Under the Commission proposal, known as Premium Support, Medicare would no longer pay directly for health care services. Instead, it would provide each senior with a voucher good for part of the premium for their private health insurance coverage. Medicare beneficiaries could use this voucher to buy into the fee-for-service plan sponsored by the Federal Government or to join a private plan. To encourage consumer price sensitivity, the voucher would track to the lowest cost private plan. Seniors then would shop for the best plan that best suits their needs, paying the balance of the premium and paying extra if they want higher quality health care. The Commission proposal creates a system of health coverage but it abandons Medicare's bedrock principle of egalitarianism. Today, Medicare is income blind. All seniors have access to the same level of health care. The Commission proposal, however, is structured to provide comprehensiveness, access and quality only to those who can afford them. The idea that vouchers will empower seniors to choose a health plan that best suits their needs is quite simply a myth. The reality is that seniors will be forced to accept whatever plan they can afford. The Medicare Commission is charged with ensuring Medicare's long-term solvency. This proposal will not do that. Proponents of the voucher plan say it would shave off 1 percent of the Medicare budget per year over the next few decades. It will only do that by charging senior citizens more. In fact, Bruce Vladeck, a Commission member and former Medicare administrator, doubts Premium Support will save the government even a dime. The privatization of Medicare is nothing new. Medicare beneficiaries have been able to enroll in private managed Medicare plans for some time now, and their experience does not bode well for a full-fledged privatization effort. Managed care plans are profit oriented, and the theory that they can sustain significantly lower costs than traditional Medicare simply has not panned out. Profit-driven managed care plans do not tough it out when those profits are unrealized. Last year, 96 Medicare HMOs deserted 400,000 Medicare beneficiaries because the HMOs' customers did not meet the HMOs' profit objectives. Before the Medicare program was launched in 1965, more than one-half of America's senior citizens did not have health insurance. Private insurance was the only option then for seniors. Insurers simply did not want seniors to join their plans because they knew the elderly would use much of their coverage. The private insurance market still avoids high-risk enrollees and, whenever possible, dodges the bill for high cost medical services. What is perhaps most disturbing about the Commission's Premium Support plan is what it does not tell us. It does not tell us how we can make Medicare more efficient while still preserving its egalitarian underpinnings. It does not tell us how much the Nation can or wants to spend on health care for seniors. It does not give us options for reconciling what the Nation wants with how much we have or are willing to spend. If we privatize Medicare, like the Commission wants, we are telling America that not all seniors deserve the same level of care. The wisest course for the Medicare Commission is to disband without delivering a final product. We should go back to the drawing board and we should construct a plan that builds on Medicare's strengths and ensures its long-term solvency. Selling off Medicare to the managed care industry is the easy way out and it is wrong.

Mr. BROWN of Ohio

Mr. BROWN of Ohio. Mr. Speaker, the Medicare Commission is expecting to hold its final meeting today. The commission's leaders are advancing a voucher plan called premium support that will end Medicare's guarantee of equal health care to the wealthy, the middle class and the poor. The plan would steer Medicare more into the private sector than at any time in its history. As former Speaker Gingrich infamously said, Medicare would wither on the vine. Privatize Medicare in order to save it. Clearly, the private insurance market has not provided for the common good. A Nation with our wealth should not leave 43 million of its citizens without health care. The Labor Department shows unemployment still holding steady at 4.4 percent, a rate not seen since 1970. Meanwhile, the proportion of Americans without health insurance has increased from 14 percent in 1995, to 15 percent in 1996, to 16 percent in 1997. Turning Medicare over to insurance companies, privatizing it in order to save it, will create two Medicares, one for the wealthy and one underfunded program for the poor and middle class. We should reject that thinking, Mr. Speaker.

Mr. BROWN of Ohio

Mr. BROWN of Ohio. Mr. Speaker, I yield 3 minutes to the gentleman from California (Mr. Waxman).

Mr. BROWN of Ohio. Mr. Speaker, I yield myself as much time as I may consume. Mr. Speaker, I commend the gentleman from Florida (Mr. Davis) for his hard work and obvious commitment to preempting further mistreatment of low-income nursing home residents. I would also like to recognize the outstanding efforts of the gentleman from Florida (Mr. Bilirakis). Under his thoughtful leadership, this subcommittee worked on a fully informed bipartisan basis to move this important piece of legislation. H.R. 540 has symbolic as well as practical importance. In practical terms, it tells nursing facilities they cannot provide a home to some patients and a boarding house to others. There are more than 90,000 licensed nursing home beds in my home State of Ohio. They are licensed for the purpose of providing long-term care. That purpose should not vary with the income status of the patient. It is abusive to evict a Medicaid or pre-Medicaid patient without notice or without cause. But nursing homes in Florida and Indiana did just that, abandoning their residents along with the premise that long- term care signified anything more than short-term profit making. The practical purpose of this bill is to prevent that kind of mistreatment from recurring. Its symbolic purpose is to assert that nursing home residents are not to be mistreated, period. When Congress repealed the Boren Amendment, it in effect silenced nursing homes, removing their right to appeal inadequate reimbursement. If nursing homes are truly being underpaid, then they are not the only ones to blame for the mistreatment of nursing home residents. We should rethink the 1997 Congressional appeal of the Boren Amendment. H.R. 540 is a bold effort because it says Congress can, in fact, prevent mistreatment of Medicaid beneficiaries. Congress should pass H.R. 540 for the sake of low-income seniors and their families and because it is the right thing to do.

Mr. BROWN of Ohio. Mr. Speaker, I yield myself such time as I may consume to simply ask for a ``yes'' vote on H.R. 540 and again thank the gentleman from Florida (Mr. Davis) for his exceptional work.

Mr. BROWN of Ohio. Mr. Speaker, I have no further requests for time, and I yield back the balance of my time.

Mr. BROWN of Ohio. Mr. Speaker, I yield 2 minutes to the gentlewoman from Texas (Ms. Jackson-Lee). (Ms. JACKSON-LEE of Texas asked and was given permission to revise and extend her remarks.)

Mr. BROWN of Ohio. Mr. Speaker, I yield 7 minutes to the gentleman from Florida (Mr. Davis) who worked so hard on this bill.

Mr. BROWN of Ohio

Mr. BROWN of Ohio. Mr. Speaker, the National Commission on the Future of Medicare is poised to recommend to the President and the Congress that one of our Nation's best government programs, Medicare, be delivered to the private insurance market. There is nothing new here. Conservative newspapers like the Wall Street Journal and the Washington Times, and conservative Republicans, have been trying for years to privatize Medicare. Privatize, they say, in order to save it. This is a critical time for Medicare. The program faces significant financial difficulty, in part because of the impending retirement of baby boomers and the fact that people are living longer. The Republican answer has been to move Medicare beneficiaries into managed care and create Medicare medical savings accounts. Privatize the program in order to save it. Medicare is a fundamental part of the fabric of our country. Thirty- three years ago, before Medicare, half of the elderly of this country had no health insurance. Today, virtually everyone over 65 is covered by Medicare. Meanwhile, the private insurance industry leaves 43 million Americans uninsured. That is why our public institutions like Medicare and Social Security are so important. We must keep Medicare the successful public program that it is.

Mr. BROWN of Ohio

Mr. BROWN of Ohio. Mr. Speaker, the National Commission on the Future of Medicare is poised to recommend to the President and to Congress that Medicare be privatized. They are soon likely to propose that Medicare, perhaps the Nation's best government program, be delivered to the private insurance market. There is nothing new here. Conservative newspapers, like the Wall Street Journal and the Washington Times, for years have been attempting to privatize Medicare. Privatize it, they say, in order to save it. This is a critical time for Medicare. The program faces significant financial difficulty in part because of the impending retirement of the baby boomers and the fact that people are living longer. The Republican answer has been to privatize Medicare by moving Medicare beneficiaries into managed care and creating Medicare medical savings accounts. These efforts to undermine the universal risk pool that has long supported Medicare will lead to one private system for the healthy and wealthy and a government-run welfare program for the sick and the less well off. The managed care industry illustrates this point. HMOs understand that providing health insurance to Medicare beneficiaries who need little health care is far more profitable than providing it to those who need expensive care. This is not a theoretical example. HMOs act according to the rules. Their primary purpose is the pursuit of profit, as it should be. Anyone who thinks we can ask the private sector to put qualitative values ahead of their shareholders' expectations of profitability did not take the same economics classes that I did. Medicare is a fundamental part of the fabric of our society. Thirty- three years ago, before Medicare, fewer than 50 percent of America's elderly even had health insurance. Today, almost everyone over 65 is part of Medicare. It has helped people live better, it has helped people live longer. Medicare is such an important part of our lives and our society that it is almost taken for granted. Two things about HMOs: They like profitable enrollees, and they do not stick around when things do not go their way. Last year, Medicare HMOs took it upon themselves to dispel the myth that privatization works. After enduring 1 whole year of reduced profits, more than one- fourth of the HMOs participating in Medicare, 96 plans total, quit. They left behind some 450,000 Medicare beneficiaries. In my home city of Lorain, Ohio, United Health Care of Ohio dropped 2,000 Medicare patients from its plan because Lorain County seniors simply were not profitable enough for them. Yet United Health Care's CEO was paid a 1997 compensation of $8 million and $61 million in stock options. Insurance that may not be there when we need it is not insurance. HMOs that bail out after 1 year are not serving anyone but their shareholders. Clearly, the market deserves its very important place in our society. It is a dynamic engine of job growth in our State and across the country. The market creates wealth and raises our standard of living. There are many things the market does very well. But the purpose of publicly-owned national parks is to protect open space and preserve our Nation's heritage; the purpose of privatized national parks is to maximize profit through development and commercialization; the purpose of public prisons is to protect the public, to punish and to rehabilitate; the purpose of privatized prisons is to maximize profit by reducing staff and possibly cutting back on security; and the purpose of public medical systems is to provide the best health care possible to help people, especially children and the elderly, live healthier and longer lives; and the purpose of privatized medical systems is to maximize profit through private insurance companies denying benefits and introducing incentives to withhold care. Our Nation has a compelling interest to maintain a steady, mutually beneficial balance between the public and private sectors. Private companies are important. Public programs are important. Government regulation is important. We are in danger of becoming a land of two societies: One society for the more affluent and another for the less well off. The problem is that a Nation that produces the wealth that ours does should not leave 43 million of its citizens without health insurance. The private insurance market simply cannot provide for the common good by itself. Let us remember how our country achieved its greatness. We are a Nation that taps the best effort and commitment from its citizens to build the world's strongest economy and the strongest Nation. We are a Nation that marshaled its military might to stop Hitler and protect freedom. We are a Nation that launched the GI bill, Social Security, Medicare, public education and the interstate highway system. We are a Nation that joins the resources of the private and public sectors to help people pursue a decent quality of life. It is a balance that works. Let us keep Medicare the successful public program that it is.

Mr. BROWN of Ohio

Mr. BROWN of Ohio. Mr. Speaker, the National Commission on the Future of Medicare will wrap up its work sometime this month. The Commission members were given the task of putting Medicare on solid financial footing. Unfortunately, they want to save Medicare by privatizing it. Under the Commission proposal, Medicare would no longer pay directly for health care services. Instead, it would provide each senior with a voucher good for part of the premium for private coverage. Medicare beneficiaries could use this voucher to buy into the fee-for-service plan sponsored by the Federal Government, so-called traditional Medicare, or join a private plan. The Commission proposal creates a system of health coverage, but it abandons the principles of comprehensiveness and egalitarianism that make Medicare such a valuable national program, an essential national service for America's elderly. Today the Medicare program is income-blind. All seniors have access to this same level of care. The Commission proposal markets a class- based health care system of two-tiered health care: excellent care for the affluent, only barely adequate or worse health care for the less well off. The idea that vouchers would empower seniors to choose a health plan that best suits their needs is a myth. The reality is that they will be forced to accept whatever health care plan that they can afford. Medicare beneficiaries have been able to enroll in private managed care plans for sometime now, and their experience, unfortunately, does not bode well for a full-fledged privatization effort. Most managed care plans are for profit. The theory that they can sustain significantly lower costs than traditional Medicare simply is not panning out. Because managed care plans are profit-driven, they do not tough it out when those profits are not so forthcoming. We learned that the hard way last year, when 96 HMOs deserted more than 400,000 seniors because the business did not meet their profit objectives. Before the Medicare program was launched in 1965, private insurance was the only option for seniors, and more than half of them were uninsured. Insurers did not want to sign seniors up because they tend to actually use their health care coverage. The private insurance market has changed a good deal since then, but it still avoids high-risk enrollees, and tries not to pay for high-cost services. The fact that 43 million Americans under age 65 are uninsured and the broad-based support for managed care reform in this Congress and all over the country should at the very least give us pause when we consider turning over the Medicare program to the private sector. Medicare Commission leaders would also save Medicare money by raising the Medicare eligibility age from 65 to 67. It is interesting timing for such a proposal, given the growing number of uninsured in the 55 to 64 age range. These individuals cannot find an insurer now who will take them, and they were certainly a better risk as 55- to 64-year-olds for insurers than 65- and 66-year-olds. Shell games simply do not work in health care. Someone still has to pay the bill when a person not yet eligible for Medicare becomes sick. Delayed care received in emergency rooms does not serve the individual or the public. What is perhaps the most disturbing aspect of the Medicare Commission likely proposal is what it does not tell us. It does not tell us how we could make the current program more efficient while still maintaining its egalitarian underpinnings and its orientation in providing the right care to everyone, rather than simply the least expensive care. The bottom line is this, Mr. Speaker. If we privatize Medicare, we are telling America that not all seniors deserve the same care. We are betting on a private insurance system that may not save us any money in the long run, and certainly minimizes care by avoiding individuals who are health care risks. All this is to avoid the difficult questions. Selling off the Medicare program, privatizing Medicare, turning over America's best government program to insurance companies may be easy, but it is simply wrong.

Mr. BROWN of Ohio

Mr. BROWN of Ohio. Mr. Speaker, I rise today to oppose H.R. 434, the Africa Growth and Opportunity Act. The more accurate name would be the NAFTA for Africa Act. H.R. 434 does little to improve the lives of people in sub-Saharan Africa. In fact, there are no binding labor, environmental, human rights or other public interest provisions in this legislation but plenty of measures to ensure easy access to the region's human and material resources for U.S. corporations. I understand the frustration of Africa's supporters. We have seen our government side too often with the worst dictators in Africa, respond all too slowly to the evil of apartheid, and turn its back on the victims of genocide in Rwanda. More pertinent, we have seen Members of Congress who are the staunchest supporters of NAFTA for Africa vote again and again and again against increased aid for that continent. But a bad bill, Mr. Speaker, is worse than no bill. Last session, this Congress did the right thing in defeating fast track not once but twice, defeated the efforts of some to extend NAFTA to the rest of Latin America. Unfortunately, H.R. 434, NAFTA for Africa, would undo that victory. It completely ignores the all-important test that we established in our fight against fast track: No trade agreement unless labor and environmental problems are written into the core agreement. This bill puts us back where we started. The supporters of H.R. 434 claim the bill contains labor rights and standards because some of the bill's trade provisions are based on the Generalized System of Preferences, GSP. In fact, GSP labor rights provisions are hampered by weak enforcement mechanisms. Under GSP, the President merely has to certify that the affected country is ``taking steps'' towards the protection of labor rights. This vague language has allowed notorious labor rights abusers like Guatemala to be certified as eligible for benefits. Moreover, GSP labor rights cannot be enforced through private action, meaning that when a country is clearly not taking steps to protect worker rights but nonetheless is certified as doing so, no legal action can be taken by U.S. citizens to force presidential decertification. The only alternative is a time-consuming petition process which ultimately results in the rejection of the petition in every case with no right of appeal. Finally, GSP labor rights provisions impose no obligations on corporations, just on governments. Corporations that violate worker rights will continue, as they have, to enjoy market access benefits just as long as the country in which they are operating in has been certified as eligible for benefits. A recent amendment to H.R. 434 offered by my colleague, the gentleman from Connecticut (Mr. Gejdenson), placed labor rights on the list of criteria that African countries are supposed to meet in order to obtain benefits under this bill. While this amendment was a step in the right direction, it simply does not provide sufficient protection for workers. There is no labor enforcement mechanism. Instead, the well-being of African workers rests on the President's determination that the country is making progress toward respecting labor rights. The amendment that I offered in the Committee on International Relations markup attempted to correct this problem by adding strong enforcement language and giving U.S. citizens the right to challenge the President's country eligibility determination in U.S. district court. Unfortunately, because the backers of H.R. 434 opposed this amendment, it was ruled out of order by the chair. We need trade agreements that act as if people mattered. Considering the devastating effects that NAFTA has had on Mexico's small, independent manufacturing and retail enterprises and on its small agricultural producers and on the country as a whole, it seems less than generous to expand this regime to Africa. It is certainly not in the interest of the African people. It is certainly not in the interest of the American people. This Congress should not inflict a rejected and backward trade model on the continent of Africa. I urge my colleagues to support this bill, to support the Jackson trade bill for Africa which includes unambiguous and meaningful enforcement mechanisms to protect the rights and the well-being of African workers.

Mr. BROWN of Ohio

Mr. BROWN of Ohio. Mr. Speaker, 5 years ago last month the North American Free Trade Agreement, a trade agreement signed by the countries of Canada, Mexico, and the United States, went into effect. The proponents of NAFTA during the debate earlier that fall, in the fall of 1993, made five central promises: They promised that NAFTA would create hundreds of thousands of new jobs for American workers; they promised that NAFTA would actually improve environmental conditions along the U.S.-Mexican border; they promised that imported foods under NAFTA would benefit American consumers; they promised that NAFTA would not only not hamper our effort, but help our effort to detect and keep out illegal drugs from across the border; and they promised that NAFTA would not reduce the safety of our highways. Mr. Speaker, on all five counts NAFTA has been an abysmal failure. First of all, on NAFTA's promise to create hundreds of thousands of jobs since NAFTA became effective, became law in 1994, January of 1994, what was a $1.7 billion U.S. trade surplus with Mexico fell into a $14.7 billion trade deficit. At the same time, our trade deficit with Canada increased to $18 billion, which, according to economists' estimates, a $1 billion trade surplus or deficit translates into about 20,000 jobs. So the $14 billion trade deficit we now have with Mexico, which was a trade surplus prior to the North American Free Trade Agreement going into effect, has meant a loss of at least 300,000 generally good-paying industrial jobs for America's workers. So we have seen, instead of job increases as promised under NAFTA, we have seen hundreds of thousands of job losses. Secondly, they promised that NAFTA would improve environmental conditions along the U.S.-Mexico border. Since NAFTA's implementation, the maquiladora zone, the region along the Mexican-U.S. border on the Mexican side, has attracted hundreds and hundreds of new businesses, mostly investments by American companies, often by Asian companies and other foreigners going into Mexico. We have seen no progress. In fact, we have seen significantly worse environmental conditions along the American-Mexican border. Hazardous waste transports and dumping are increasing under NAFTA. We have seen an increase in hazardous waste imports into the United States from Mexico of 50 percent since 1996 alone. We have also seen corporations, for the first time in what I can find in world trade history, we have actually seen corporations in one country sue a government of another country. American corporations have sued Canada, the Canadian government, to get Canada, successfully, unfortunately, to repeal one of its major clean air environmental laws. We have seen case after case of corporations in one country suing governments in other countries to weaken food safety, environmental laws, and other laws that protect consumers and protect workers and protect all of us. On the third promise, that imported foods under NAFTA would benefit American consumers, inspections along the border which used to be pretty regular and pretty frequent have now dropped to 2 percent. We inspect less than 2 percent of all foods coming into the United States from Mexico. We have seen problems of Michigan schoolchildren coming down with hepatitis A as a result of importing of strawberries from Mexico. We have seen a variety of problems with pesticides. Pesticides that are banned for use in this country still are manufactured here, sold to Central American and Latin American countries, including Mexico. Then they are applied on crops and sold back into the United States, pesticides that we have made illegal because we know they are unhealthy for consumers. Promise number four was that NAFTA would help us deal with the illegal drug problem. One former drug enforcement official called NAFTA a deal made in narco heaven. In fact, that Customs report where he said that has not been released to the American public. In spite of repeated attempts by me and others to get that report public, they will not release it, in large part because it contains so much bad news about drugs coming across the Mexican-U.S. border. The DEA estimates that the drug trade is bringing in, coming across the border, what amounts to over $10 billion a year. Lastly, Mr. Speaker, promise five, that NAFTA would not reduce the safety of our highways, again has been an abysmal failure. Fewer than 1 percent of the 3.3 million Mexican trucks coming into the United States each year are inspected. For 5,000 trucks per day across the Texas- Mexican border, only two to five inspectors are on duty during weekdays, fewer on weekends. Governor Bush has not done his job, the U.S. Government has not done its job. Then in the year 2000 those Mexican trucks will be allowed to come into all 48 States. Mr. Speaker, NAFTA has been a failure. We should consider repealing or markedly revising that agreement.

Mr. BROWN of Ohio

Mr. BROWN of Ohio. Mr. Speaker, I rise in protest against this unfair procedure, asking for a censure, a vote on censure and against articles of impeachment. Mr. Speaker, I rise to call on the Republican majority to allow the members of the House of Representatives to vote on censure. The overwhelming majority of American people want this Congress to censure the President, not impeach him. I support censure not because the President didn't do anything wrong. His behavior was wrong and reprehensible. I support censure because the President's behavior doesn't rise to the level of an impeachable offense as outlined by our Founding Fathers. His actions were private misdeeds that neither subverted the Constitution nor constituted abuse of the power of his office. I support censure because President Clinton didn't order the break-in of a building. He didn't use the IRS, the CIA, and the FBI against American citizens. And he didn't lie to Congress about selling arms to a terrorist state. Chairman Hyde allowed a vote on censure in the Judiciary Committee last week. He allowed the members of his committee a conscience vote on censure. We thank him for that. The House leadership must allow a conscience vote for all members on this question. In 1995, Republicans shut down the government. In 1998, they refused to pass the Patients' Bill of Rights, they refused to pass campaign finance reform, and they refused to pass an increase in the minimum wage. Imagine what will happen next year if the House approves articles of impeachment. With a Senate trial, the people's government virtually will be shut down for another year. It's time we censure the President and end this process so we can return to the issues that matter most to working people, including reducing prescription drug costs for seniors, protecting our environment, and helping local school districts rebuild their schools. In their zeal to undo two national elections, the majority has trampled on the notion that this impeachment process should be bipartisan and fair. I urge my colleagues to allow a vote of censure against the President.

Mr. BROWN of Ohio

Mr. BROWN of Ohio. Mr. Speaker, in October of every election year the Republican leadership says they support public education. The other 11 months they try to dismantle the Department of Education, they try to cut Head Start and school lunches, they try to weaken the student loan program. Now, for the month before the election, Republicans reluctantly say they want to better fund public education. But the issue is this: Should we adopt the Republican plan, which is a blank check to school administrators, which will mean more money in bureaucracy, more money in central offices, more money wasted in school districts, or do we adopt the democratic plan to put 100,000 teachers in the classroom? Mr. Speaker, we should support the democratic plan. It means more modern schools, it means more teachers, and it means smaller class size. It simply makes sense.

Mr. BROWN of Ohio

Mr. BROWN of Ohio. Mr. Speaker, I yield myself such time as I may consume. Mr. Speaker, I am pleased to support S. 1722, the Women's Health Research and Prevention Amendments of 1998. For far too long, women's health issues have been neglected. The bill is a necessary step to begin addressing critical health issues that are affecting women exclusively or at highly disproportionate rates. Eighty percent of Americans who suffer from osteoporosis are women. One in eight women develop breast cancer, one in 25 will die of breast cancer, the second leading cause of cancer deaths. Despite the misconception that women rarely suffer from heart attacks, cardiovascular disease is the leading cause of death among American women. These are only a few of the devastating statistics concerning women's health issues that signal the need for more research, treatment, and education to prevent women's needless suffering. H.R. 4683 and S. 1722 would extend research and prevention efforts of the National Institutes of Health to explore some of the most dangerous and critical diseases and conditions affecting women, including osteoporosis, cancer, and cardiovascular disease, the leading causes of death in American women. The bill also extends women's health programs at the Centers for Disease Control, such as the National Center for Health Statistics, the National Program of Cancer Registries, and the National Breast and Cervical Cancer Early Detection Program. Expanding these programs will allow the CDC to conduct more research to prevent and treat women's health issues, insure screening for early detection of breast and cervical cancer, and curb premature morbidity and mortality that lead to excessive health care costs. The job will not be finished with the enactment of this bill alone. Issues of quality and access need to be addressed. The Patients' Bill of Rights should be enacted without further delay. The National Partnership for Women and Families and more than 30 other women's organizations have listed numerous elements of the Patients' Bill of Rights that are particularly important to the health of women. This bill would allow women to choose an OB-GYN as a primary health provider, and have direct access to their services or to those of allied health professionals, such as nurse midwives. The Patients' Bill of Rights would require managed care companies to provide access to clinical trials, a direct link between the research authorized by the bill before us today and the actual receipt of health care by women. Listen to what a couple of witnesses at our July hearing on the Subcommittee on Health and Environment said about the importance of clinical trials. Dr. Edison Liu of the National Cancer Institute said, ``Clinical trials are instrumental in these improvements. As examples, within the last two years we have established new standards of optimal therapy for women with node-negative and locally advanced breast cancer, for women with advanced ovarian cancer, for melanoma, and for childhood renal cancer. These new approaches to cancer therapy are the direct result of the Nation's clinical trials system.'' Dr. Leonard Zwelling with the Anderson Cancer Center said at the same hearing, ``Remember, all of the great approved cancer therapies in use today were once being tested in the clinical trial setting. Without clinical trials, we would have made no progress at all.'' The Patients' Bill of Rights would allow women to continue to see the same provider throughout a pregnancy, even if the provider left the plan or their employer changed plans. Prescription drugs that are medically indicated but are not on an HMO's formulary would also be covered. Drive-by mastectomies would be eliminated, performance and quality measures would take the special needs of women into account, as would data collections and plan summaries. Plans would be prohibited from discriminating on the basis of sex. All of that is in the Patients' Bill of Rights. I would hope, Mr. Speaker, that we will authorize all NIH programs so the research priorities of our Nation will be openly and equitably addressed. Although S. 1722 deals with some of the health research issues that impact women, it by no means addresses all of them. A comprehensive reauthorization of NIH programs, coupled with passage of the Patients' Bill of Rights, would achieve this objective. Women are disproportionately affected by disease and conditions that our medical community has the ability to halt. It is essential that we do a better job in addressing women's health care issues. I commend the gentleman from Florida (Chairman Bilirakis) for leading us to act on solid bipartisan legislation. I commend the gentleman from Michigan (Mr. John Dingell), ranking member of the full committee, for his work on this issue, on women's health generally, and specifically, for his leadership on the Patients' Bill of Rights, legislation that this Congress should be addressing before it adjourns. I look forward to working with the gentleman from Florida (Mr. Bilirakis), the gentleman from Michigan (Mr. Dingell), and others on other pressing health care issues that are beyond the scope of this bill. Mr. Speaker, I reserve the balance of my time.

Mr. BROWN of Ohio

Mr. BROWN of Ohio. Mr. Speaker, 9 months ago the President and House Democrats laid out an education agenda for the 21st century. The American people are still waiting for Congress to act. Democrats want to help local governments modernize schools and help build and renovate 5,000 schools. The American people are still waiting for Congress to act. The Democrats in Congress, the Democratic initiative wants to see smaller classrooms and more teachers. Yet the American people are still waiting for Congress to act. Mr. Speaker, what is more important than education? What is more important than smaller classrooms? What is more important than more teachers teaching our children? Unfortunately, Mr. Speaker, the American people are still waiting for Congress to act.

Mr. BROWN of Ohio

Mr. BROWN of Ohio. Mr. Speaker, I yield myself such time as I may consume. Mr. Speaker, I rise in support of S. 1754, as amended by the manager's amendment. This bill is a long overdue reauthorization of the health professions programs contained in titles VII and VIII of the Public Health Service Act. These programs touch almost the entire range of health professions including nurses, physicians and others who make up our health care work force. This legislation does much more than simply reauthorize these programs. It also significantly modifies them. The basic nature of these changes to the existing structure of titles VII and VIII is to provide flexibility to meet changing needs in the health care work force. The Health Resources and Services Administration part of the Department of Health and Human Services administers these programs at the federal level and supports this legislation. The three basic elements of the health professions programs are to increase the number of primary care professionals, one; second, increase the racial and ethnic diversity of the health care work force; and third, to provide access to health care to underserved in rural areas. The bill recognizes that these goals are as complex as they are worthy. The bill also recognizes that resources for health professions, education and training are scarce. The list of organizations that support this legislation is so long that in naming them I risk leaving them out. These include the American Nurses Association, the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Physicians, the American Association of Colleges of Osteopathic Medicine, the Association of Minority Health Profession Schools, the Association of American Medical Colleges, the American Geriatric Society, the Association of Colleges of Pharmacy, the American Public Health Association, the American Psychological Association, the American Mental Health Counselors, the Working Group on Hispanic Health Education, the National Association of Geriatric Education Centers, the Area Health Education Centers, the American Dental Association, the National Association of Social Workers, the American Association of Colleges of Nursing, the American Organization of Nurse Executives and the National League of Nursing among others. I am pleased to note, Mr. Speaker, that the organizations I just mentioned supported the bill when it passed the Senate and continue to support it now with the manager's amendment. New additions to the list of supporters of the bill because of the manager's amendment are the American Academy of Nurse Practitioners, the American College of Nurse Midwives, the National Association of Pediatric Nurse Associates and Practitioners and the Association of Nurse Anesthetists. These are key participants in this country's primary care nursing workforce. As many of us know, the bill which passed the Senate did not have the support of some of these groups. The manager's amendment represents a consensus among nursing professions and is a remarkable achievement made possible first of all by all of the title VIII stakeholders. They participated in a process that brought us to this day, and I want to thank each of them for their tireless effort and cooperative spirit and dedication to resolving these difficult issues. This achievement also could not have been possible without a true bipartisan effort among my colleagues. I know that Members from both sides of the aisle played key roles in the negotiations that I just described. I want to pay special tribute to the work of my friend and colleague and the chairman of the Subcommittee on Health and Environment, the gentleman from Florida (Mr. Bilirakis), as well as the gentleman from Virginia (Chairman Bliley). Many other Members from the chairman's side of the aisle helped to develop this bill, and I will leave it to the chairman to recognize them. On this side of the aisle, let me begin by saying we would not be here today without the participation and leadership of my colleague, the gentleman from New York (Mr. Towns). It is as simple as that. My colleagues the gentleman from California (Mr. Waxman), the gentlewoman from Colorado (Ms. DeGette), and, as always, the gentleman from Michigan (Mr. Dingell), did great work also to get this bill for us today. I also want to recognize the fine efforts of staff on both sides of the aisle, Brenda Pillors, Paul Kim, Libby Mullin, Kevin Brennan and John Ford. Todd Tuten and Eric Berger did outstanding work on behalf of the majority, and I thank them as well. I know our schedule is hectic and many of my colleagues would like to speak on this bill, so I will reserve the balance of my time.

Mr. BROWN of Ohio. Mr. Speaker, I yield two minutes to the gentleman from Michigan (Mr. Dingell). (Mr. DINGELL asked and was given permission to revise and extend his remarks.)