Phil Gramm

Mr. GRAMM

Mr. GRAMM. I am happy to yield.

Mr. GRAMM

Mr. GRAMM. I yield the floor so Senator Domenici may speak. Mr. REID addressed the Chair.

Mr. GRAMM. Will the Senator yield before he gets into his closing remarks?

Mr. GRAMM

Mr. GRAMM. Mr. President, one of the frustrating things about this debate is that when facts are established, our dear colleagues on the other side of the aisle continue to use information that has no foundation in fact and which, in fact, is at variance with the facts. So what I would like to do is to go through and present the facts, not as I would like to make them up, or as our colleagues may have made them up, but the facts in terms of the findings of the Congressional Budget Office, the nonpartisan arm of Government which does estimates on the basis of which we run Government. First of all, the CBO estimate which I have here says that the ultimate effect of the Kennedy bill would be to increase premiums for employer-sponsored health insurance by an average of 6.1 percent. That is not my number, that is the number of the Congressional Budget Office. That converts into $72.7 billion of costs that will be borne by companies that pay insurance and employees that often match that expenditure. Senator Kennedy has made headlines by saying we are talking about a hamburger a month. The reality is that the estimate of the Kennedy bill by Congressional Budget Office is enough money to buy every franchise of McDonald's in America. It is estimated that this cost will mean that 1.8 million Americans will lose their health insurance. That is 1.8 million people who won't have access to health care at least paid for by insurance of any kind. Our colleagues on the Democrat side of the aisle don't seem very concerned about 1.8 million people losing their health insurance. But we are very concerned. We looked at public opinion strategies nationwide poll of small businesses which asked what they would do if the Democrat bill were adopted and you could sue not only the HMO, or the health care provider, but sue the company that bought the insurance policy. The responses indicated that 57 percent of small businesses in America say that they either would be very likely to drop health insurance coverage, that is 39 percent, or somewhat likely, 18 percent. That is 57 percent of the insurance for some 70 percent of the working people in America that would be jeopardized by this bill. Yet, over and over and over again, we hear this talk as if there are no costs involved. Now our colleagues go on and on as if repeating something would make it true, by saying that their bill covers 161 million people and our bill covers 48 million people. The way Federal law and State law is structured, the federal government has jurisdiction over 48 million people in terms of health insurance under a Federal law called ERISA. My State has passed a comprehensive health care Bill of Rights. Maybe Senator Boxer would not support their Bill of Rights, but Senator Boxer would not be elected in Texas. I might not support the Bill of Rights in California, but I probably would not be elected in California. The point is, who elected Senator Boxer to write health care policy for State insurance in Texas? Nobody in Texas elected her. Nor did they elect me for that purpose. If I wanted to write State insurance policy in Texas, I would have run for the Texas senate and not the U.S. Senate. So we have this absurdity that is stated over and over again that they are covering more people than we are. We are covering the people in America who are under Federal jurisdiction. They are preempting State law in every State in the Union, and Senators who have never been to some States in the Union are dictating to them about the jurisdiction of their legislature. Yet, somehow it is suggested that I don't care about people in Oklahoma. I care about people in Oklahoma so much that if the State has the power to write their own health care Bill of Rights--which they do in Oklahoma--I want them to write it. That is how much I care about them. But in that area where it is Federal jurisdiction, I want us to write it. In terms of continuity of care, if there has ever been any debate in history that could be referred to as somewhat contradictory of a previous position, it is this. I want to remind my colleagues who today aren't concerned about a 6.1-percent increase in the cost of health insurance, who aren't concerned about 1.8 million people losing their health insurance, who in 1994 they were so concerned about double-digit health inflation--an inflation rate we would match if their bill passed, they were so concerned that they wrote the Clinton health care bill. And they were so concerned about medical necessity that when they wrote it, here is what their medical necessity was: The comprehensive benefit package does not include an item or service that the national health board may determine is not medically necessary. Today they are jumping up and down about medical necessity. They want a doctor to choose. They want us to write in our bill that we are going to let the Federal Government define it. But when they wrote their health care bill in 1994, they said that a national board would decide. They talk about point-of-service option. But when they wrote their health care bill, if you didn't join their health care collective, you would be fined $5,000. If your doctor prescribed a health treatment that was not approved by the Clinton administration, your doctor would be fined $50,000. And if they provided a health service that wasn't prescribed and you paid for it, your doctor could go to jail for 15 years. Now, that is how much they cared about all these things when they were trying to put America under socialized medicine. They were trying to do it because people were losing health insurance, because costs were going up. Yet today they are trying to pass a bill that would drive costs up and that would deny people their health insurance. Having spent all of this time answering all of this misinformation, let me spend the rest of my time saying a few things that I feel strongly about. No. 1, I have never been prouder of the Republican majority than I am today. I have never seen greater collective political courage than I have seen today. It would be very easy with all of this demagoguery about insurance companies, HMOs, health, consumers, and charts showing scores of HMO's 12, consumers 0. I remind you that our Democrat colleagues invented HMOs. Ted Kennedy in 1978 said: I authored the first program of support for HMOs that passed the Senate. Clearly HMOs have done their job. What is Ted Kennedy saying today? He loved them so much that he wanted to put the whole Nation under one run by the government. But, today, he is trying to kill HMOs. We are not trying to kill HMOs. I am not ashamed of that. I want to give people a choice so that if they don't want to be in HMOs they can get out. We broaden their options. We give people the right to fire an HMO. Senator Kennedy gives people the right to sue one. We guarantee people the right to see a doctor. He guarantees the people the right to see a lawyer. I am proud, when it has been so easy to demagogue this issue, that we have stood up for the interests of this country. We have written a very good bill. It cleans up the things in HMOs that needed to be cleaned up. But it doesn't kill off the only mechanism we have to control costs. We provide tax deductibility for the self-employed. That will mean millions of people will get health insurance that do not have it today. We let people have medical savings accounts--a new, innovative way to let people choose their own doctor and control costs at the same time. I am proud of what we have done. It is easy to demagogue, but it is hard to lead. We have led, and America is going to benefit from our leading. Finally, let me say we have come forward with a bill that works--a bill that works for people, a bill that holds down costs, a bill that promotes equality. I yield the floor.

Mr. GRAMM. It was the other way around.

Mr. GRAMM. Say it 200 times.

Mr. GRAMM. Mr. President, I guess, despite the rules of the Senate, we all have our own rules that we apply to ourselves about what we say. One of the problems is that if one side of the debate insists on getting up and saying things that are verifiably false, we end up with a shouting match going back and forth. Our bill guarantees access to emergency care. Our bill guarantees that any woman at any point at any time can get access to an OB/GYN physician. Our bill deals with people under the Federal jurisdiction because the States have already done a very good job in dealing with the people under their jurisdiction which they cannot reach without Federal action. We have talked at great length. Our colleagues keep saying this bill cost $2 a month. The problem is that the Congressional Budget Office, the nonpartisan budgeting arm of the Congress, says this bill will cost $72.5 billion, this bill will take insurance away from 1.9 million Americans, and this bill will end up driving up costs for Americans who are able to keep their insurance. Obviously, anyone who follows the debate around here realizes that Democrats aren't very much worried about cost. But why are we so worried? No. 1, we are worried about 1.9 million people losing their insurance. We believe we can fix what is wrong with HMOs, and do it without driving up medical costs so much that people lose their health insurance. But I would like to make two final points which I think are critical to this entire debate. If you came from outer space this morning and you listened to our Democratic colleagues, you would think they are opponents of HMOs. But let me read for you from congressional debate on February 10, 1978. I quote: I authored the first program of support for HMOs ever passed in the Senate. The Carter administration has made the promulgation of HMOs one of its major goals. Clearly HMOs have done their job in proving themselves a highly desirable mechanism for medical care delivery. That is Senator Ted Kennedy. That is not Phil Gramm. Our Democrat colleagues are the fathers and the mothers of HMOs. Yet today they have decided to vilify an institution they created. Rather than fixing the problems that exist, they have decided, for political reasons, it would be basically a good idea to destroy HMOs. Why are we concerned about destroying the private health care system? Why are we so concerned about cost? The reason we are so concerned about cost, the last time we had double-digit health care inflation, the Democrats and President Clinton sent a health care bill to Congress, the Clinton health care bill, that would have had the Government take over and run the health care system, a bill that would have required every American to buy their health care through a Federal health care collective. Today, our Democrat colleagues are very concerned about ``medical necessity.'' We have heard them talk about it all day long. When we open the Clinton health care bill, which they supported, on page 86, it mentioned ``medical necessity'' under exclusions. Let me read their solution to the problem of medical necessity when they wanted the Government to take over and run the health care system. Their bill says, on page 86, line 10, under ``Exclusions'': Medical necessity. The comprehensive benefit package does not include any item or service that the National Health Board may determine is not medically necessary. Today, our dear Democrat colleagues are all concerned about ``medical necessity,'' but when they wanted the Government to take over and run the health care system they defined medical necessity as whatever the National Health Board determined it to be, and the National Health Board was the Federal Government. Today, our colleagues have gone on and on about medical access and point of service. When the inflation rate on health care was above double digit and they proposed having the Government take over the health care system, do you know what their point of service option was? If you didn't join the Government plan, you got fined $5,000. The choice they provided in their point-of-service option is if the doctor who had to work for the Federal Government provided care he felt you needed but their Government health board felt you didn't need, he got fined $50,000 for doing that. If he provided a service they didn't allow and you paid privately for it, the physician could go to prison for 15 years. Now, the same people who proposed all these things and came within a heartbeat of forcing Americans into this totalitarian system because they wanted to deal with inflation and access, today they are proposing legislation that would drive the inflation rate up by 6.1 percent and would, by Congressional Budget Office numbers, force 1.9 million people to lose their health insurance. Why are we so concerned about starting runaway medical inflation again? Part of it is because we care about the people who lose insurance. Part of it is because we care about the $72.5 billion in costs for people who get to keep their insurance. But a lot of it is because we remember what Bill Clinton and the Democrats wanted to do the last time we had runaway medical inflation. I am sorry, but I have a very hard time listening to my Democrat colleagues talk about medical necessity when only a few years ago they proposed to let Government define what medical necessity was, and if their board didn't say it was necessary, you didn't get it. I have a very hard time listening to them talk about a point-of-service option when virtually every one of them supported and cosponsored a bill that would have put a physician in prison for 15 years for providing a service that their Government board said was not needed. In listening to our colleagues, it's easy to forget their support of legislation for the last 25 years that created HMOs. One forgets they love HMOs so much that they tried in 1994 to force every American into an HMO run by the Government. And one forgets that they were so concerned about patients rights they let the National Health Board determine what was medically necessary with no review whatever, and they put a doctor in prison for 15 years if he didn't comply with their rules. There is a certain disconnect between what they are saying today and what they have proposed in the past. I yield the floor.

Mr. GRAMM. Will the Senator give me 10 minutes? Mr. REID addressed the Chair.

Mr. GRAMM

Mr. GRAMM. Mr. President, I have to take exception to the comments that Senator Kennedy made. I am not trying to get into an argument, but as anyone who has followed this debate knows, for 2 years we have offered the Democrats the ability to bring up their bill. Then we would bring up our bill and let the Senate choose. The Democrats dictated the format we are debating under, and they would not allow us to pass an appropriations bill until they got exactly the procedure they have today. Now that they have exactly the procedure that they dictated by holding the Senate up, they are unhappy with the procedure. Might I also say, with all of these cries of partisanship, not one Democrat voted for any amendment offered by any Republican yesterday or Monday. Now, I don't understand bipartisanship as existing when Republicans vote to let the Government take over the health care system and to bring lawyers into the system rather than doctors but it is somehow not bipartisan when Democrats refuse to vote for our proposals. You can't have it both ways.

Mr. GRAMM. Could we have regular order, Mr. President?

Mr. GRAMM. Mr. President, I wanted to come over today and try to end this debate by making a point this debate has cried out for all day. What we have heard all day long is our Democrat colleagues stand up and attack HMOs. Every horror story they could imagine, every outrage that the human mind could conceive, they have talked about and laid at the doorstep of HMOs. I think someone watching this debate who just got off a turnip truck or who just emerged from a 10-year trip to outer space would believe that our Democrat colleagues hate HMOs and that they are the enemies of HMOs. But let me remind those who may have just gotten off a turnip truck, or those who may have forgotten what has occurred in America in the last 20 years that you have been listening all day to the fathers and mothers of HMOs. They brought HMOs into Federal statutes. They exempted them from health planning. They liked HMOs so much that in 1994 they sent this bill to the Congress. For those who have forgotten it, this is the Clinton health care bill. The Clinton health care bill, which our colleagues who spoke today all supported and uniformly loved, forced every American to go into an HMO that was set up as a local health care cooperative. It was an HMO run by the Government with all the compassion of the IRS and with all of the efficiency of the post office. They loved HMOs so much and they were so confident in them that they said: If you refuse to join your local health cooperative, HMO, Government-run health care system, we are going to fine you $5,000. That was their position in 1994. Now they have taken a poll. They have done a focus group. They do not love HMOs anymore. But in 1994 they loved them so much that they were going to fine every American $5,000 for refusing to join their Government-run HMO. By the way, they banned suing the HMO when it was their HMO, when it was the Government HMO. They thought we ought not to do it. Today they are worried about doctors providing care, and that for a doctor under an HMO, they can't do it. But when they were writing their health care bill, they fined a doctor $50,000 if he provided health care that their Government-run health care cooperative, HMO, did not allow. So under this bill, when you had a health care collective run by the Government--one great big HMO, and if a doctor prescribed a medicine that they didn't allow, or prescribed a treatment, or provided a treatment that they didn't think was medically necessary, that is Dr. Clinton or Dr. Kennedy didn't think was necessary, a doctor could be fined $50,000 under this bill. If your baby was really sick and they banned the treatment, and if I went to Dr. Frist and I said, Dr. Frist, I want my child to have this surgery, I know you can do it, I know that our Government collective HMO bans it, but I am willing to pay you for it, if Dr. Frist had taken that payment, he would have gone to prison for 15 years under the Clinton health care bill. These are the people who invented the HMO. They are the people who love HMOs. They are the people who wanted to put us under an HMO and fine us $5,000 for not giving it our money, and it put a doctor in prison for 15 years for violating their statute on what they thought was good medicine. Today it has been a horror show about HMOs. I want to conclude. I know people want to go home. How do they fix this problem? They fix the problem with what they call a Patients' Bill of Rights. There are two rights that they guarantee. No. 1, you can look in the blue pages of the phonebook, and you can call up a Government bureaucrat, and you can complain. You can get an appointment. You can go see them next Tuesday at 8 o'clock. You can get a bureaucrat to join you in the examining room. That, to them, is a health care bill of rights. The second right they guarantee is, you can call up an attorney. You can open up the Yellow Pages. Here is one that says, ``No fees unless we get you money.'' Anyway, whoever you find in here--criminal law, family law, personal injury specialist--you can pick any lawyer you want under their health care bill of rights, and you can call him, and you can sue. But what you cannot do under their so-called bill of rights that you can do under our bill of rights is, under our bill of rights you can fire your HMO. You can set up a medical savings account and then you can look in the Yellow Pages under ``Physician.'' You can call any physician you want to call, and you can say to them, do you take a check? If they do, with the medical savings account that you can have under our bill with your employer, you can say ``no'' to your HMO. You don't call up the Government, because you don't like how they are treating you, or, go hire a lawyer. You fire your HMO and hire your doctor. You can see what real freedom is. You can say to the HMO, you haven't done me right, you haven't treated my children right, and you are fired. Our bill does that. Their bill does not do that. I cannot end the day without pointing out two things. One, all day long you have heard from people who invented HMOs and who love them so much that they wanted to put the whole country under HMOs in a mandated Government-run program. And they still do. Second, their remedy for all of these concerns is, call the Government, or call a lawyer. Our remedy is to first deal with the real concerns in HMOs with a review process that really works. But we have one more freedom they don't have. Under our bill, you can fire your HMO. That is what I call real freedom. That is what we provide. If you have listened all day to these horror stories, please remember, this is a monster that they helped create and that they loved so much, they wanted to mandate that everybody be in it. I yield the floor.

Mr. GRAMM. The Senator has no time.

Mr. GRAMM. Mr. President, we have heard, for the last hour, in almost tearful terms, our colleagues talk about how in the amendment they now have before us ``we are down to the heart of what separates the two parties.'' Well, I don't know whether it is the heart, or the lungs, or the liver, but we are sure down to what separates the two parties. Our colleague from Massachusetts has a sign that talks about how we are not protecting Tennessee. That is interesting because Tennessee protected itself by electing one of the Nation's premier physicians to represent them in the Senate and to become the Nation's foremost spokesman on health care. Yet Senator Kennedy believes he is somehow here to protect the people of Tennessee. I don't think they elected Senator Kennedy. I think they elected Senator Frist. I think they elected him because he does represent their views. What is in this amendment that is supposed to be the heart of what defines the two parties? Well, it is very interesting. It is about two things. No. 1, they want to raise taxes about $5 billion. That does define the difference between the two parties. Whether it is the heart of the difference, or some other body part, I don't know. But the first thing that is different--and they are speaking in such passionate, tearful tones about it--is they want to raise taxes by $5 billion on this amendment. So to take them at their word, if you want to know the difference between the two parties, the difference between the two parties is that they, by their own words and deeds and amendments, are the party that wants to raise taxes in the Senate. The tax burden is at the highest level in American history, but it is not high enough to suit them. They want $5 billion, and they want to take it $50 per household in America, and they want it in this amendment. That is the first thing they say defines the heart of the difference between the two parties. The second thing they say defines the heart of the difference--and I agree with them--is that when they read the Constitution, they quit reading too soon because what the Constitution says in the tenth amendment is that those powers not specifically delegated to the Federal Government are reserved for the States and for the people. Why is that relevant? Why it is relevant is, despite all the efforts to confuse people, under existing law, the States regulate insurance. There is a Federal statute that carves out between 40 and 50 million insurance policies where the companies actually underwrite the policies--a law called ERISA--where the Federal Government in these circumstances established its primacy and its jurisdiction so that the State legislature of Tennessee, and the State legislature of Texas, and the State legislature of all the States in the Union are prohibited from legislating in these ERISA plans where the company assumes liability for the insurance. What we have done in our bill is, where the States can't reach, we have passed a bill that guarantees patients' rights, including the one right the Democrats preclude. The Democrats will let a patient look in the phone books' Blue Pages and call the Government if they are unhappy with an HMO, and they will let them look under ``attorneys'' in the Yellow Pages and hire an attorney if they are unhappy with an HMO; but the Democrats don't give them the freedom to fire the HMO. We give them that freedom. Now, we have written a bill that is aimed at dealing with the part of this problem that comes under the Federal Government. Our Democrat colleagues are very unhappy because they want a national health plan. They believe Senator Kennedy and President Clinton know everything there is to know about health care, that Dr. Frist knows nothing about health care, and they would like to write health care policy for Texas. Now, they want to do it without the inconvenience of having to move to Texas, pay taxes in Texas, and run for office in Texas. They want to assume that if you are elected to the Senate from Massachusetts, that allows you to tell people in Tennessee how insurance ought to be regulated, and that allows you to tell people in Texas how things ought to be. Now, Texas has already passed a comprehensive patients' bill of rights, but that doesn't stop those elected to the Senate from some other State from the right to come in and say to Texas: You don't know what you are doing, you don't know anything about health care, and you don't care about the people of Texas. Having been elected in Massachusetts, they care about people from Texas; but they believe the people in the senate and the house of the Texas Legislature are somehow deficient in caring to suit them. So the second thing they differ on is that while States throughout the Union have tried to tailor their programs to meet their individual needs, the Democrats would have us say: Take everything Texas has done, everything Maine has done, everything the 43 States have enacted, and the other States that are about to act, and throw it in the trash can because all wisdom emanates from Washington. So this ``heart'' of the difference between the two parties that we have been listening to for an hour really boils down to two differences. They want to raise taxes by another $50 per family on the amendment they just offered and they want to say to States: We are going to take away from you a right that has been historically guaranteed under Federal law and under the tenth amendment to the Constitution, which allows States, in the area of insurance where they regulate, to state their own policy, to decide what kind of policies they want operating within their own State borders. Our colleagues have decided taxes are too low and that we don't have enough Federal regulation. So what they would do is attempt to substitute Federal mandates for what our Texas Legislature has decided, which would be dictated and enforced by Federal bureaucrats. With all due respect, who is doing a poorer job than HCFA in regulating health care in America? Who is doing a poorer job than we are doing at the Federal level? Our approach is an approach which says where we have responsibility, where only we can deal with a problem, we have put together a comprehensive program that makes sense. Granted, we didn't do a public opinion poll; we didn't get together focus groups and try to say if you ran a 30-second TV ad on this subject, would people tend to agree with it? We have Dr. Frist. We have Susan Collins. We have Jim Jeffords. We sat down for over a year with people who knew something about the problem and we wrote a bill we believe people will be glad we wrote 10 years from now. But the reality is that there are two differences Democrats want to highlight today. There are two things they claim represent the heart of what separates the two parties. They believe taxes ought to be higher. So they raise taxes by $5 billion with this amendment. Second, they don't believe that Maine ought to set its health policy. These people in Maine don't understand health, and they don't care about people in Maine. Only people in Massachusetts care about people in Maine. Only people in Massachusetts care about people in Texas. And we don't understand it. They are right. We don't understand it. We don't accept it. We reject it. If the best they can do in telling us what is right with them and what is wrong with us is that they want higher taxes and they want to tell every State in the Union how to run health care, they are going to be in the minority a very long time. I reserve the remainder of my time.

Mr. GRAMM. Mr. President, how much time do I have remaining?

Mr. GRAMM. Mr. President, I will take a very short amount of time. If I am so wrong about the Clinton health care bill, I hope tomorrow to offer it as an amendment, and we will give everybody a chance to vote on it. We debated it for 2 years. It was like a great big overinflated balloon. When somebody pricked it with a little pin, all of the air ran out of it. We never got around to voting on it. We have it here. We can send it up tomorrow and give everybody a chance to vote on it. If Senator Kennedy thinks it is so right--I know he does in his heart because he is a very sincere person--then he can vote for the Clinton health care bill, and fine these people, and put doctors in prison for 15 years for providing ``unauthorized'' care. Then we will know where we all stand on these issues. I yield the floor.

Mr. GRAMM. Mr. President, we have now listened to the minority use up their time. I think it is time for us to speak. So with all due respect, I didn't ask for them to yield on their time. I don't yield on my time.

Mr. GRAMM

Mr. GRAMM. Mr. President, I yield myself 15 minutes. I have to say we often see people do 180 degree turns around here. It never ceases to amaze me to hear our Democrat colleagues savaging HMOs. Let us remember they are the people who have been in love with HMOs for 25 years. In fact, they loved HMOs so much that in these bills virtually crushing this ancient desk--the 1994 Clinton health care bill and the two Kennedy variations of it--they loved HMOs so much they would have set up health care collectives all over the Nation, run by the Federal Government, and would have fined Americans $5,000 for refusing to join their health care collective. They loved HMOs so much in 1994, they would have imposed a $50,000 fine on a doctor who prescribed medical treatment that was not dictated or allowed by their Government-run HMO health care collective. They loved HMOs so much in 1994, if a doctor provided treatment you needed for your baby that was not provided for in their Government-run health care collective, and you paid him for it, he could go to prison for 15 years. That was their vision of a health care future for America. But having loved HMOs so much that they wanted to mandate that everybody in America be a member of one run by the Government, now all of a sudden they have done a public opinion survey. They have gotten focus groups together, and they have decided Americans are not as much in love with HMOs as they are. And so as a result, now they have a bill that doesn't say, as they said in 1994, HMOs are the answer to everything. They have a bill that now says HMOs are the problem. What we try to do in our bill is fix the problems, but we do something they will not do: We empower Americans to fire their HMO. We allow Americans to buy medical savings accounts, where they have the right to choose for themselves. Our Democrat colleagues are adamantly opposed to that freedom because they want the Government to run the health care system. And you can't get the Government running the health care system if you start giving people the power to fire their HMO. So they want to regulate the HMOs. They want to give you the ability to contact a bureaucrat if you are unhappy. They want to give you total freedom to hire a lawyer. You can hire whatever lawyer you want to hire. But what they will not do is give you the ability to hire your doctor. Why don't they want to do it? Because this is simply one step in the direction of this health care bill that they want and love, and which we killed. But in their heart, they still want Government health care collectives, and they want people fined and imprisoned if they don't provide medicine exactly the way the Democrats want it provided. Now they say, well, something is wrong with the Republican bill because they are not overriding State law. They think that somehow Senator Kennedy and President Clinton know more about Texas than the people in the Texas Legislature and the Texas Governor. They believe we should trample State law and we ought to make every decision in Washington, DC. We don't agree. They say they want America to know the difference. Please know that this is the difference. If Senator Kennedy and President Clinton know so much about Texas, when President Clinton finishes in the White House, maybe he ought to move to Texas and run for some public office. It would be an educational experience, I can assure you, both for him and the people of Texas. But the point is, I am not going to let Senator Kennedy and President Clinton tell the people in Texas how to run their State. I am not going to do it either. If I wanted to do that, I would run for the state legislature. Let's get to the issue we are talking about here. The problem with the Kennedy bill is it drives up costs. The problem with the Kennedy bill is that the Congressional Budget Office has concluded that the Kennedy bill would drive up health care costs by 6.1 percent. What that means is two things: One, 1.8 million Americans would lose their health insurance. Now, granted, if their bill passed, you would have the ability to pick up the phone book, look in the blue pages and call any government agency you wanted; you could hire any lawyer you wanted. But 1.8 million people would not have health insurance under this bill. Their bill would drive up health costs for those who got to keep their insurance by $72.7 billion over a 5-year period. Let me convert that into something people understand. By 1.8 million people being denied health insurance because of the cost of all these lawyers and Government bureaucrats and therefore losing their insurance under the Kennedy bill, that would mean that in breast exams, 188,595 American women would lose breast exams that they would have under current law because Senator Kennedy's bill would drive up health insurance costs so much. Because 1.8 million people would lose their health insurance under the Kennedy bill, there would be 52,973 fewer mammograms. Why? Is Senator Kennedy against mammograms? Of course he is not. But the point is, his bill, by driving up costs, by hiring all these bureaucrats and all these lawyers, where 60 percent of what comes out of these lawsuits goes to lawyers and not to people who have been damaged, hurt, or are sick--by imposing those new costs, 52,973 women per year would lose mammograms that they are getting, which are funded today under their health insurance policies. Under Senator Kennedy's bill, 135,122 women that get annual pap tests funded by their insurance policy would not get them because they would lose their insurance. And so that no one thinks I am totally discriminating against men, prostate screenings would decline by 23,135. That's 23,135 men who would not get screened, who might die of prostate cancer because Senator Kennedy thinks it is more important to be able to hire a lawyer than it is for people to have insurance so that they can get prostate screening. Really, the bill before us is not about doctors. Nothing in Senator Kennedy's bill lets you choose your doctor or fire your HMO. It lets you choose a lawyer and contact a bureaucrat. In doing so, it drives up costs by 6.1 percent and it denies 1.8 million people their health insurance. As a result, we get less care, not more; we get more expensive care, not cheaper. And anybody that believes that being able to hire a lawyer or contact a bureaucrat heals people clearly does not understand how medicine works. The amendment before us is a very simple amendment. My guess is that after they pray over it a while, everybody will vote for it. It kills the Kennedy bill, no question about that. But I don't think they are going to want to vote against it because what this amendment says very simply is this: It sets up a triggering mechanism. It says that if this bill were to be adopted--which it won't be because we are going to defeat it this week because we have a better bill that works better--if it was found and certified that in any year, when fully implemented, this bill would drive up costs by more than 1 percent, the law would not go into effect. Or if in any year more than 100,000 people lost their health insurance as a result of the cost increase also imposed, then this bill would not be operative. Now we know from CBO estimates that both of these things will occur. We have offered this amendment basically to point out the fact that the problem with the Kennedy bill is that it drives up costs, and it denies people health insurance. Finally, let me say do I believe this is the end game? Suppose for a moment that we could pass their bill, if President Clinton could override every legislature and State, and we could have the Government decide, by law, what is the preferred service, what is the means of treating every disease so we would set by Federal statute all those things. Suppose that we did all those things and drove up health care costs, would the Democrats be happy? No, and neither would the American people. Next year, they would come back with their old faithful, the Clinton health care bill, and they would say: Medical costs have risen by 6.1 percent, 1.8 million people have lost their health insurance, and there is only one solution. We have to have the Government take over the health care system. We will make everybody join an HMO. We will take their freedom completely away, and, in fact, we will fine them $5,000 if they refuse to do it, and we will make doctors practice medicine our way. We will fine them $50,000 if they give a treatment we don't approve, or we will put them in prison if they provide medical care that is not on our approved Federal list. That will be their answer to the problem they create with this bill. That is what this debate is about. I am sure, having looked at their bill, they have done a poll, they have looked at a focus group, and they have determined that somehow they are going to gain some political points by the bill they put forward. We have gone about it a little bit differently. We have spent 2 years with people such as Bill Frist--who has actually practiced medicine; not only practiced, he is one of the premier doctors in America-- putting together a bill that fixes the problems with HMOs, that doesn't write medical practice into law. If we had written medical practice into law 100 years ago, we would still be bleeding people for fevers. We have put together a bill that tries to deal with abuses in HMOs so a final decision is made by an independent doctor as to what ``necessity'' is. We go a step further. We expand freedom so that people get a chance with our reforms, if they are not happy with their HMO, they can say something under our bill to the HMO that they can't say under Senator Kennedy's bill. Under our bill, if all else fails, they can say to their HMO: You didn't do the job. You didn't take care of me, you didn't take care of my children, and you are fired. I'm going to get a medical savings account. I'm going to make my own decisions. That is the difference between what Democrats call rights and what Republicans call freedom. Their rights are the right to more government, the right to more regulation, the right to look in the blue pages and call up a government bureaucrat, to look in the Yellow Pages under ``Attorney'' and call up a lawyer. But their health care rights do not include the right to hire your own doctor or to fire your HMO. What kind of right is it when you have a right to complain and petition but you don't have a right to act? Our bill is about freedom, the freedom to choose. That is the difference. Our Democrat colleagues don't support that freedom, because they want a government-run system. Senator Kennedy is not deterred. We may have killed the Clinton- Kennedy bill in 1994 taking over the health care system, but he dreams of bringing it back. If he can win on his bill this week, it is a step in that direction. But he is not going to be successful. I yield the floor.

Mr. GRAMM. That is Graham of Florida.

Mr. GRAMM

Mr. GRAMM. Mr. President, the Kennedy Patients' Bill of Rights drives up health care costs by 6.1 percent. It causes 1.8 million Americans to lose their health insurance. It raises the cost of health care for those who don't lose their health insurance by $72.5 billion. By driving up labor costs, it would destroy 194,041 jobs in the American economy by the year 2003. These are not our numbers. These are numbers based on estimates done by the CBO and private research firms that have used those numbers to project the economic impact. Our amendment simply says if the Kennedy bill drives up health care costs by more than 1 percent when it is fully implemented, or if it pushes more than 100,000 Americans off the private insurance rolls by driving up cost, then the law will not go into effect; it will be suspended.

Mr. GRAMM. Mr. President, may we have order. I can't hear the Senator.

Mr. GRAMM

Mr. GRAMM. If the Senator will yield further, does the Senator believe that HCFA cares more about the people of Oklahoma than the State representatives--the State senator and the Governor--who may not know the Oklahoma needs the way Senator Kennedy and HCFA know them?

Mr. GRAMM. Will the Senator yield before he gets off this point?

Mr. GRAMM. Mr. President, let me begin by explaining how we came to be here. Then I want to take a little walk down memory lane, as Ronald Reagan used to say, and talk about the real Democrat health care bill-- the bill offered in 1993. I then want to talk about the difference between the two bills--the Democratic Kennedy bill, and our bill--and why that difference is relevant to every working American family. Then I would like to conclude by explaining why our bill is a good bill and why I am confident that if Senator Kennedy and I could go into every house in America and sit down with people at their kitchen table, and if he could explain his bill and what he is trying to do, and if I could explain our bill and what we are trying to do, I am confident that 90 percent of the people in America would choose our bill. We are going to have 4 days of debate. But the outcome of the debate, I think, is clear. We are going to win when the votes are cast, and we are going to win this debate because we have a better program. Our program benefits the people who do the work and pay the taxes and pull the wagon in America. I think when the week is over that we will have discredited the approach of this bill as we discredited the bill in 1993. But, of greater importance, we will have passed a real bill that gives Americans real freedoms. Our colleagues have lamented that we have waited this long to deal with this issue. I want to remind everyone that last year throughout the year the majority leader offered to bring this bill up, and he offered to bring it up in two different forms. I thought the most reasonable offer was to let the Democrats write the best bill they could write that does the most that they can provide to help people with health insurance and to impose whatever restrictions they want to write. Then let Republicans put together the best bill they can put together, and bring the two bills to the floor of the Senate and let the Senate choose between one. We could then choose one or the other. That was rejected by the minority. We then offered them the ability to bring the two bills up and each side have five amendments. That was rejected by the minority. Not to waste a lot of time to get into a debate with the minority leader, or with other Democrats, I simply submit that we have been 2 years getting to this point because the Democrats have wanted it to be 2 years getting to this point. We could have brought up bills and voted under an orderly process 2 years ago. But, in reality, the Democrats thought they had a political issue. That is why we are only getting to this bill now. I think we are going to prove this week they don't have much of a political issue, and I think when the debate is over they are going to be glad it is over. And I think the American people are going to be glad it is over. Let me remind my colleagues, and anybody who is watching this debate in America, that this is not the first time Bill Clinton and Ted Kennedy have wanted to rewrite the health care system of this country. I have here on this desk the Clinton health care bills, and the version of it that was sponsored by Senator Kennedy. Let me remind those who followed that debate in 1993--their memories might have gotten a little clouded--what this bill did. This bill said that the problem in America was that we had 43 million Americans who didn't have health insurance, and that in trying to deal with health insurance and make it available, we needed to get rid of the current health care system, and we needed to set up on a regional basis in America health care collectives that people would be forced to join. And these collectives would be run by the Government. The whole idea behind the Kennedy bill in 1993 was give up freedom to control cost. Obviously, I wouldn't have enough time in the day or the week to go through all of these provisions. But let me just remind you of a couple of them. In 1993, Senator Kennedy, Senator Daschle, and President Clinton said: We are going to have the Government take over the health care system in your hometown--in Phoenix, AZ. There would be one health care collective run by the Government, and if you refused to join that collective, you would be fined $5,000. That is what they wanted in 1993. That was their concept of freedom when they last asked us to let them run the health care system in America. Then they said, if this plan did not provide the kind of health care you needed and you sought to get that health care through your physician and the health care was not allowed under this plan, the physician could be fined $50,000. If you needed health care for your child, their concept of freedom, in 1993, in the Clinton-Kennedy health care bill, was: We know what kind of health care you need. They said: We are going to provide it in this bill, and, if you want health care outside this bill and a physician provides it for you, we are going to fine them $50,000. That was their concept of freedom in 1993. In 1993 they said, What about the circumstance where your baby is really sick? So you go to a doctor and say, I need health care, and they, under the Clinton-Kennedy plan, say, We are not allowed to provide this kind of treatment. You say, forget about the plan, I'll pay for it out of my own pocket. In 1993, Senator Kennedy and Senator Daschle and President Clinton thought so much of freedom that they said, If you pay the doctor out of your pocket for a treatment that we do not provide for, and the doctor takes the money, he can be sent to prison for 15 years. That was their concept of patients' rights in 1993. That is what they thought freedom consisted of in 1993. I submit, this is what they still want. The bill that is before us, their bill, is step 1 toward government running the health care system, so when my mama needs to go see a doctor, she first has to talk to a government bureaucrat. We defeated that in 1993, and we are going to defeat it this week in the Senate. What is the plan today? Unlike 1993, when our colleagues were very concerned about the cost of health care, now they are not concerned about health care cost, they are concerned about rights. So all of a sudden they have put together a bill that imposes a whole lot of government restrictions, that expands liability, so 60 percent of the premiums that go to provide insurance against medical liability will end up going to lawyers instead of to doctors and hospitals and clinics. They have put together a bill that the Congressional Budget Office has said, when you take into account all the bureaucracy and all the legal liability, will drive up the cost of health care by 6.1 percent. That is equivalent to taking 6.1 percent right out of the paycheck of working Americans in order for them to be able to keep their insurance. Only a lot of Americans will not be able to keep their insurance. In fact, a study funded by the AFL-CIO has concluded, if you take the increase in health care costs under the Kennedy plan, 1.8 million Americans will lose their health insurance. Mr. President, 1.8 million Americans will lose their health insurance if we should adopt the bill that the Democrats have proposed. For those who are lucky enough not to be one of the 1.8 million people who would lose their health insurance, they would pay $72.7 billion over a 5-year period more for health insurance and health costs than they are paying now. This is not just about dollars, this is about real people and real health care. By 1.8 million people losing their health insurance, that means you would have 188,595 fewer breast examinations every year for Americans, because the Kennedy bill would take away their health insurance. It means 52,973 American women would not have mammograms who would have them under current law, because the increase in cost under this bill would take away their health insurance. It means that 135,122 Pap tests would not be undertaken, because people would have lost their health insurance and therefore lost access to that coverage. Mr. President, 23,135 American men, mostly elderly men, would lose their prostate screening exam as a result of the health care cost increase that would be dictated by the Kennedy plan. So what do they offer us in the name of health care rights? They offer us a bill that would drive up health insurance costs by 6.1 percent, costing 1.8 million Americans their health insurance, and for those who are lucky enough to be able to afford to keep their health insurance, they would pay $72.7 billion more for their health insurance over a 5-year period. In return for all of these costs, what do people get? Rather than going into the details, I am going to reduce it down to a very simple example. I want to define the problem Senator Kennedy sees--and we agree on the problem. Then I am going to explain what he provides in the name of rights that drives up costs by 6.1 percent, costs 1.8 million people their health insurance, and those who keep their health insurance pay $72.7 billion more for it. Here is the problem. The innovation--which, by the way, has been championed by the people who are offering this amendment--is HMOs. They thought so much of them they wanted to force everybody in America into a government-run HMO. But, under HMO, there is a problem. The problem is that people lose the control they want and need over their health care. Let me reduce it down to a simple example. When people with an HMO go into the examining room, too often, in addition to their doctor in the examining room, they have, either literally or figuratively, the HMO gatekeeper in the examining room. So they are going into the examining room--obviously, that often entails taking your clothes off. People are often a little nervous about that. They want privacy. They like to be in the examining room with their doctor, but with an HMO they find themselves with this gatekeeper virtually looking over the doctor's shoulder. They would like to be in the examining room alone with the doctor. We agree. We think they should have the right to make that choice. But how does Senator Kennedy fix the problem? How Senator Kennedy fixes the problem--and you will be able to tell why it is so expensive when you look at it--the way Senator Kennedy fixes the problem is demonstrated by this stethoscope. What people want is the doctor in the examining room with the stethoscope up against their heart, but right now they have an HMO listening in, double-checking their doctor. They would like to get this HMO gatekeeper out of the examining room. So what does Senator Kennedy do? He says: We can fix your problem. It will cost 1.8 million of you your health insurance; those who keep the health insurance, it will cost $72.7 billion more. But look at what you get. What you get under Senator Kennedy's plan is this. He doesn't get rid of the HMO, that guy is still there listening in, but he brings a government bureaucrat into the examining room who will be there to keep an eye on the HMO, and to keep an eye on the doctor, and to regulate. Then, in addition to the bureaucrat, he brings the lawyer into the examining room who will be there keeping an eye on the bureaucrat and HMO and the doctor, so that he can be there to sue the doctor or the HMO. The reason Senator Kennedy's plan drives up health care costs by 6.1 percent and costs 1.8 million Americans their health insurance and drives up the cost for those who can afford to keep it by $72.7 billion is it costs a lot of money to bring all these bureaucrats and all these lawyers into the process. But the point is, what people are unhappy about is the HMO gatekeepers being in the examining room. They wanted to get them out of the examining room. They do not want to bring the bureaucrats in and bring lawyers in. What they want is a health care system that looks like this: They want a health care system where you have two people in the examining room and one of them is you. You are on this end of the stethoscope, and your doctor is on the other end of the stethoscope, and there is nobody else in the room. That is what they want. The difference between the Kennedy bill and our bill is, under his bill, he brings in the bureaucrat and the lawyer. So now you have four people in the examining room. What we do is we get rid of the HMO gatekeeper and give people real freedom. This is such a critically important point. Our Democrat colleagues have gotten caught up in this deal about how they are going to give people rights. I think it is wonderful that it is so easy for somebody to see what they mean by ``rights'' and what we mean by ``freedom'' are two totally different things. Under the Democrat bill, you are not free to fire the HMO your boss picks for you, but you are free to have the Government regulate it. Under the Kennedy plan, you are not free to fire your doctor, but you can sue him. Under the Kennedy plan, you are not free to control your health care cost, but you can share that control with a lawyer and with the Government. What we do is give people freedom. It is an interesting paradox that the Kennedy bill debases the very term ``choice.'' It debases the very term of ``rights'' because it contains no rights; that is, no rights that are really meaningful to somebody who has a child who is sick or whose mama is ill. We give people real rights. We give people the right to fire their HMO by guaranteeing them an alternative, which I will talk about in a minute. We give people the right to fire their doctor. We give people the right to take their health care money and spend it as they choose on their own family. We give people the right to pick the protections they believe are important to their family, not those basic benefits the Government might decide in Washington would be useful. And finally, we give people the right to control their own health care, something the Democrats do not do. The Democrat plan means more Government, more lawyers, more rules, more uninsured and more Government control, but the one thing it does not mean, the one thing it does not provide is more freedom. Our bill provides more freedom. Let me explain two ways it does. First of all, under the current tax system, we have a terrible inequity. If General Motors buys your health insurance for you as their employee, it is tax deductible. But if you buy it for yourself as either a small businessperson who does not have health insurance or a self-employed who does not have health insurance or somebody who works for a company that does not provide health insurance, or if you would rather buy your own health insurance rather than General Motors choosing for you, it is not fully tax deductible. The first thing our bill does is it treats you as well as current tax law treats General Motors. Under our bill, if you buy your own health insurance--let's say you are self-employed. You will get the right to the same tax treatment that General Motors does, so your health insurance is tax free. The second and most important choice we give to people is a totally new program, a new choice. We do not force anybody to take it, but we give people the ability to buy, in addition to all the choices we provide with everything from an HMO to private practice of medicine through a medical savings account, we expand people's freedom. One of the choices we provide, which I am very excited about, is the right to buy a medical savings account. Here is how it would work. A medical savings account is a device that really is aimed at helping people who want health care coverage but who often do not have a lot of money. The way it would work is, in addition to joining the health plan your company might try to impose on you, you have the right to take your money and buy a high-deductible insurance policy and then join with your company in setting aside money to pay the deductibles in what we call the medical savings account. Those medical savings accounts are fully tax free, just like conventional health insurance. Here is basically how it would work. You might buy a health insurance policy with a $3,000 deductible. Normally, that policy would cost less than half as much as a first- dollar-coverage policy. Then you and your employer would begin to build up a savings account up to $3,000, which would belong to you, to cover the deductible. Then how it works is you make the decision, when your child needs to see a doctor, which doctor your child needs to see. You are empowered to make the decision. It is true that under the Kennedy plan, if your baby has a 104-degree fever, you could get out the phonebook and you could look under the blue pages for the U.S. Government and you could find the Health Care Financing Administration, or HCFA as they are called, and at 2 o'clock in the morning you could call up HCFA. You would, in all probability, get an answering machine if you were lucky. Maybe you would not. I do not think you are going to find the Director of HCFA at work at 2 o'clock in the morning. You can call up and leave a message, and then they, under the Kennedy plan, will set up a meeting. Maybe next Tuesday at 4:52 in the afternoon they might meet with you or talk to you on the phone. You also could call up a lawyer. You could look under ``attorney'' in the phone page and you can pick--one thing about Senator Kennedy's health care rights bill is it gives you no freedom with regard to doctors, but it gives you complete freedom with regard to attorneys. Senator Kennedy's bill is unlike the bill he put together in 1993 with President Clinton. Remember, their health care bill in 1993 did not let you sue. They have had a change in heart, it seems, so now he says you can pick up the Yellow Pages and you can look under ``attorney'' and you can pick any attorney. You have your car wrecks. Maybe you want another attorney. This one deals with car wrecks. You have injury. You have family law, criminal law, jail release, traffic tickets, bankruptcy, will and trust, personal injury, board-certified personal attorney. Anyway, you find the one who suits you. You hire that attorney, and you go to court. Eighteen months from now, you might be able to collect some money from some doctor or from some HMO. Our bill does not work that way. Under our bill, if your baby has a temperature, you pick up the Yellow Pages. I have the Yellow Pages from Arlington and Mansfield, TX. This Yellow Pages lists all the physicians who practice medicine in that area. Under our plan, you pick up the phone and you call up the physician you might pick. Let's say I pick Louis W. Adams, pediatric ophthalmologist, and I call him up. Under the Kennedy bill, I would have to ask him some questions. I would have to say: Are you a preferred provider? In fact, we did an experiment on that in Washington, DC. Let me show it to you. In Washington, DC, we took a page out of the phonebook. It was page 1017. These are the physicians who were listed. The first one is Ginsberg, Susan M., M.D., and the last one is Robert O. Gordon. Let's say you are in an HMO or you are in a PPO, and you call up-- let's say you pick Philip W. Gold. You call him up and say: Dr. Gold, I need health care. I have a child who has a 103-degree temperature. Are you in the Kaiser HMO, or are you part of the Blue Cross PPO? We found that out of the 28 doctors, 10 accepted the Kaiser HMO, 17 accepted the Blue Cross PPO. But let me tell you the amazing revelation we made. With a medical savings account, which any American could set up, under the Republican plan, you would get a checking account. This is from Golden Rule Insurance Company in Indiana. This is a medical savings account checking account. Then this is for a medical savings account that is operated by Mellon Bank, and this is a MasterCard. Then this is an American Health Value medical savings account, and this is operated through Visa. Under the Republican plan, you would have the right to opt for a medical savings account where you would make the decision about health care for your family. We empower you--not some lawyer, not some bureaucrat--but we empower you as a parent. So then we called up everybody on page 1017 of the Yellow Pages and we asked them three questions: Do you take a check? Yes. Every one of them took a check. Do you take Visa? Every one of them took Visa. Do you take MasterCard? Every one of them, all 28 of them, took MasterCard. So the real freedom in the Republican bill is the right for you to choose--not to choose a lawyer to sue somebody 18 months from now, not to call up a government bureaucrat and fill out a form and register a protest. What kind of freedom is that? The freedom we give is the freedom to act, the freedom to hire, the freedom to fire, the freedom to say yes, the freedom to say no. That is what freedom is about. Our Democrat colleagues believe freedom is about being able to talk to a bureaucrat. They think freedom is about the right to sue. Under the Republican plan, freedom is the right to say to your HMO: You're fired. I don't like the way I'm being treated here. I'm leaving your HMO. I'm opting for another option. The example I gave is a medical savings account. Freedom, under the Republican plan, is the freedom to pick up the phonebook and let your fingers do the walking. You pick the doctor: I want John V. Golding, Jr. I don't want anybody else. He is the doctor I want. I got his telephone number. I called him up and said: My mama is sick, Dr. Golding, and I would like her to come see you. Do you take a check or MasterCard or Visa? He says: Yes. I am in. As this debate goes on, you are going to hear Senator Kennedy, and others, say: The world will come to an end if you have medical savings accounts. They are going to use the interesting charge they use any time they are against something, and that is it is for rich people. If Democrats are not for something, they claim it is for rich people. Tax cuts are for rich people. Choice, freedom, is for rich people. They are going to say: Oh, the medical savings accounts, rich people will get medical savings accounts and poor people will not have them; it will just be terrible. The facts are that even though we have a limited number of medical savings accounts that can be sold, even though in the year 2000 they lose this option and have to go back into the old system unless we change the law, the people who are buying medical savings accounts are primarily modest-income people. But we are going to repeal those limitations and we are going to do it this week. Uninsured people are buying medical savings accounts because it allows them to buy an affordable high-deductible policy that covers them against terrible things happening and then lets them build up savings accounts with their employer to pay the deductible. So those who are going to criticize medical savings accounts are going to say it is for rich people, but they really do not like it because it is freedom. What they want is this. They want the old Clinton health care bill. They know that if we ever give people the right to choose, they will never nationalize health care. So medical savings accounts are, to our dear colleague from Massachusetts, like a crucifix is to a vampire. They cower, they are struck with fear at the idea that some parent would actually have the ability to fire an HMO and do it without having to call a bureaucrat or without having to hire a lawyer. Why do they fear freedom? Because they are not for it. They want the Government to take over and run the health care system--always have, always will. The basic question is, Who should manage care? Should it be an insurance company? Should it be the Government? Or should it be you? We believe it ought to be you. We believe that parents ought to be empowered to control health care. We believe that parents can make better decisions. That is what this debate is about. This debate is about whether freedom means getting access to a bureaucrat or firing your HMO, whether freedom in health care means hiring a lawyer or being able to hire your own doctor. That is what the debate is about. A final point I would like to make--and I think it is a significant point; some people would say it is a reach, but I do not think so--why, all of a sudden, are our same colleagues who in 1993 wanted the Government to take over and run the health care system and make everybody be in one big Government-run HMO--why, all of a sudden, do they want to drive up costs in the name of expanding bureaucracy and lawsuits? Part of it is, they like bureaucracy and they like lawsuits. But that is not, in my opinion, the real story. The real story is, if, God forbid--and He is going to forbid, because we clearly have the votes to stop him but if, God forbid, the Kennedy plan should be adopted, and health insurance went up by 6.1 percent and 1.8 million people lost their health insurance, does anybody doubt that next year Senator Kennedy would be back with the Clinton health care bill saying: Now 1.8 million people have lost their health insurance, and we have no choice except to let the Government take over the health care system? I think that is what he would say. In fact, I think that is basically what we are debating here: Destroy the private health care system so the only alternative would be Government. Our answer is: Let's make the current health care system better; let's have a meaningful, timely internal and external appeal if you want to stay in an HMO; let's empower people to fire HMOs and go to the private practice of medicine again if they choose; let's expand freedom as a solution to making our current system work better to make it more efficient and to empower families to make more choices. The alternative the Democrats have is: Destroy the current system and then let's let Government take over and run the health care system. Our answer is: Expand freedom and choice within the current system, empower families to decide, and let's forever and ever keep Government out of health care. That is really the choice. Our Democrat colleagues believe that somehow they are going to benefit by Americans knowing they are unhappy about HMOs and they want to expand your access to bureaucrats and lawyers. We do not think that solves the problem. We think what solves the problem is to make HMOs give you an effective internal and external appeal; but we go one step further, and that is, we empower people to fire the HMO and to hire their own doctor. We believe in freedom. We believe freedom works. It built America in every other era. Can you imagine if we had a Clinton-Kennedy car insurance bill or car repair bill so that if you are unhappy with your assigned repairman to fix your car, and if you are unhappy with what he does, you contact a bureaucrat and then, if you are unhappy with what he does, you contact a lawyer? I submit that the cost of repairing our cars would be astronomical. We have a different system. It is one we would like in health care. That is, you pick where you go to get your car repaired, and if you do not like the work they are doing, you say to them, in a traditional American fashion: You are not doing a good job. You have not lived up to our trust. You have not done what you said you would do. And you're fired. That is freedom. That is freedom. That is what we want. We want the right of people to choose. We don't want this substitute for the right to choose, the right to pile up costs in lawsuits or the right to deal with bureaucrats. What kind of right is that? How many wrongs do bureaucrats right? About one-tenth as many as they create. We give you freedom. The Democrats give you bureaucracy. We help lower the cost of health care by expanding choices and expanding tax deductibility. They drive up the cost of health care by 6.1 percent. Their bill would deny health insurance to 1.8 million Americans. Their bill would drive up health care costs by $72.7 billion. Senator Kennedy likes to claim, well, it is just a hamburger a day for however long. Well, with $72.7 billion, you could buy every McDonald's franchise in America for the 5-year cost that this will drive up health insurance. Senator Kennedy doesn't understand that if the company you are working for is paying your health insurance and the cost is driven up, you are still paying it. It is part of your wages. What is going to happen, according to estimates that were undertaken by the AFL-CIO--in support of this bill, by the way--is that 1.8 million people will lose their health insurance. We don't want that to happen, and we are going to stop it from happening. This is going to be a very meaningful debate. I look forward to it. I think people will learn from it. I think in the end they are going to have two different choices about what freedom is. If freedom to you is access to a bureaucrat and a lawyer, then you are with Senator Kennedy. If freedom to you is the right to choose your own health care, your own doctor, the right to hire and the right to fire, the right to say what you want and people either do it or you get somebody else, if that is what freedom means in your hometown, if you would rather be able to pick up the Arlington-Mansfield phonebook when your baby is sick and look up ``physician'' rather than look up ``attorney'' or, rather than look in the Blue Pages for HCFA, if that is what you would like to have, you are with us. On the other hand, if you think your answer is at HCFA in the Blue Pages or with an attorney, then you want to be with Senator Kennedy. It is about as clear a choice as you could possibly have. When the debate is over this week, not only will we have won the vote, but I think, more importantly, we will have won the debate. We will have ended, hopefully forever, any dream of ever getting back to the Clinton health care bill, where every American is forced into a health care collective and, when your momma gets sick, she talks to a bureaucrat instead of a doctor. They tried that in 1993. Eighty-two percent of the American people thought this might be a good idea. Finally, when a few of us stood up and fought it, it was like sticking a great big inflated balloon with a pin. Suddenly, once people understood it, they were against it. They understood that what was at stake wasn't just health care, but what was at stake was freedom. That is what this is about--the right to choose. Don't get confused about it, as we go through the debate. I thank the Chair for its indulgence. I yield the floor and reserve the remainder of our time. Mr. KENNEDY addressed the Chair.

Mr. GRAMM. This is very important. Senator Kennedy keeps standing up and really setting up the straw man and knocking him down, it seems to me. I want to pose this as a question. He is saying this bill covers 160 million people, whereas our bill covers only 48 million people. But isn't it true that under our bill we cover those that are in self-funded plans where the Federal Government has jurisdiction and where the States don't have the freedom to legislate patients' rights? So we deal with the Federal jurisdiction and allow the individual States to set up their own program. But Senator Kennedy wants to do the same thing that he did in the Clinton-Kennedy health bill of 1993, and that is to have the Federal Government set mandates even though 43 States have passed their own laws. Is that not the distinction we are talking about? Senator Kennedy believes that only he knows anything about this and that the State legislature in Texas does not know anything about health care and doesn't care anything about Texas. But Senator Kennedy knows about it. In fact, he helped President Clinton do the 1993 bill, which would have put everybody into a health care collective run by the Federal Government--one big HMO very much similar to and with all the compassion of the IRS. But now he says that States aren't competent, even though 43 of them have passed patients' bills of rights. He is trying to preempt those States, whereas I understand our bill simply goes to the people who can't, because of Federal law, be covered by State patients' rights. Is that correct?

Mr. GRAMM

Mr. GRAMM. You might have to wait in line and fill out a lot of forms, but they will be there, potentially, to help you. Then if that does not happen, you can hire a lawyer, you can choose any lawyer you want, and then you can sue. Under our bill, what we do is we get rid of this. Under our bill, we give you this. What we let you do, if you are not happy with your HMO, instead of fooling around with a bureaucrat and lawyer, you just simply say to your HMO: You're fired. You set up a medical savings account, where for care beyond $3,000 a year you have an insurance policy; and then you and your employer put money in, up to $3,000 a year, out of which you pay medical expenses, through a check. These are various medical savings accounts that are now available through MasterCard and Visa. So what it enables you to do is, if, at the end of the year, you did not spend the $3,000, it belongs to you, and you spend it on other things.