Jim McDermott

Mr. McDERMOTT

Mr. McDERMOTT. Mr. Chairman, I yield 15 seconds to the gentleman from Massachusetts [Mr. Frank].

Mr. McDERMOTT. And the other side?

Mr. McDERMOTT

Mr. McDERMOTT. Mr. Speaker, I rise today to congratulate and pay tribute to one of my constituents, David E. Ortman, who stepped down in February as director of the Northwest Office of Friends of the Earth to become director of the Seattle-based Wise Use Movement. On this first day of Earth Week, it is most appropriate to recognize his career dedicated to the protection, restoration, and rational use of our planet's natural ecosystems and precious resources. Mr. Ortman began working for Friends of the Earth in 1975 through the Mennonite Voluntary Service program. His endeavors for Friends of the Earth encompassed a broad array of environmental and humanitarian issues. During the late 1970's, he worked with the Alaska Coalition in urging Congress to designate Federal land in Alaska as national parks and wildlife refuges. He participated in the United Nations Habitat Conference in Vancouver B.C., as well as the United Nations Special Session on Disarmament in New York. In the 1980's David's work on wetlands and coastal issues culminated in the establishment of the Grays Harbor National Wildlife Refuge in southwestern Washington. In the 1990's, David organized the Seattle Citizen Host Committee for the 1993 Asia Pacific Economic Cooperation conference, working with labor unions, environmental organizations, and human rights groups to develop and publicize new approaches to international trade policy. Mr. Ortman has testified before congressional committees many times during the past 21 years addressing such diverse matters as trade, forest habitat, wetland and coastal ecosystems protection, oil spill prevention, and the Panama Sea Level Canal. He authored a number of position papers for Coastal Zone Management conferences, served on the Department of the Interior's Outer Continental Shelf Policy Advisory Committee, and on the Aquaculture Assessment panel for the Office of Technology Assessment. In addition, Mr. Ortman is a founding board member of the Puget Sound Alliance and of Earth Share of Washington. David's work has earned him awards from the Seattle and Black Hills Audubon Societies. The Young Alumnus Award from Bethel College, Kansas, and the national Chervon Conservation Award are among other acknowledgments of his commitment to the environment. Mr. Ortman plans to continue this work as director of Wise Use Movement. He will lead this organization's campaign to preserve and protect wise use of public lands and resources, to educate the public, and to promote environmentally sound regulation of private lands and activities. Mr. Speaker, our natural habitat is healthier and the diversity of our ecosystems more sustainable thanks to the work of David E. Ortman, a true world citizen. I thank him for his many years of hard work, and wish him well in his future endeavors.

Mr. McDERMOTT

Mr. McDERMOTT. Mr. Speaker, I ask unanimous consent to remove the gentleman from Oklahoma, Mr. J.C. Watts, as a cosponsor of H.R. 1200 and to add the name of the gentleman from North Carolina, Mr. Mel Watt, to the bill. I inadvertently got the wrong name.

Mr. McDERMOTT

Mr. McDERMOTT. Mr. Speaker, I listened to my colleagues here on the floor talk about this issue. I have the feeling that they have never put themselves in the shoes of a physician or a family dealing with a terminally ill patient. This bill has no definitions in it for what suicide is or what is assisting a suicide. Yet doctors are continually faced with the problem of a patient who wants to die for a variety of reasons. First of all, Medicare does not give parity to the funding for psychiatric services to counsel them out of it so that is the first way in which this is a hypocritical bill. If we are really serious, we would deal with the mental health funding for Medicare. But if someone wants to die and says to the doctor, ``I would like you not to do anything and just give me pain medication,'' now, is that assisting somebody in committing suicide, if they are lying in bed and saying they do not want hydration, they do not want to have intravenous feedings, just give them some pain medication? We all know, if we do a little study, that Demerol or morphine depresses respirations and, ultimately, the physician is depressing respirations and leading to death. Now, is that assisting someone at a time when they want to die? Well, this bill is very unclear. The problem with this bill, it is very simpleminded. It is simply, as my colleague from Texas says, driven by a poll, when we ask people are they for physician-assisted suicide. Nobody on this floor is for physician-assisted suicide, none of us, not even me. But this is not any help in that debate. What we should be talking about is living wills and what real definitions we want to put in here if we want to try and make it so people can actually have the assistance of the medical profession while they choose to end their life. We have to be very careful in what we write. I am going to vote against it.

Mr. McDERMOTT

Mr. McDERMOTT. Mr. Speaker, I rise today to once again introduce the American Health Security Act. The single payer plan I propose is the only plan before Congress that will guarantee health care universality, affordability, security and choice. While this Congress lacks the political will to enact comprehensive health reform, the underlying needs for reform remain prevalent: health care costs are more unaffordable to more people and the number of people without health insurance continuous to rise. These problems are compounded by increasing loss of health care choice and autonomy for those people who have insurance leading to disruptions in care and in relationships with providers. The American Health Security Act I am introducing today embodies the characteristics of a truly American bill. It will give to all Americans the peace of mind--the security--to which all citizens should be entitled. It creates a system of health care delivered by physicians chosen by the patient. No one will have to leave their existing relationships with their doctors or hospitals or other providers. It is federally financed but administered at the state level, so the system is highly decentralized. And it provides new mechanisms to improve the quality of care every American receives. The American Health Security Act (the bill) provides universal health insurance coverage for all Americans as of January 1, 1999. It severs the link between employment and insurance. The Federal Government defines the standard benefit package, collects the premium, and distributes the premium funds to the states. The States, through negotiating panels comprised of representatives from business, labor, consumers and the state government, negotiate fees with the providers and the government controls the rate of price increases. The result is health care coverage that never changes when your personal situation does, never requires you to change the way you seek health care, and never causes disruptions in your relationships with your providers. The bill provides the coverage under a mechanism of global budgets to achieve controllable and measurable cost containment that will yield scorable savings over the next five years. Unlike other single-payer proposals of the past, it provides for almost exclusive State administration provided the States meet federal budget, benefit package, guarantee of free choice of provider, and quality assurance standards. This bill explicitly preserves free choice of provider by providing a mechanism for fee-for-service delivery to compete effectively with HMO's. It will not force Americans into HMO models. The insurance mechanism of the American Health Security Act is easy to use and understand. Quite simply, a patient visits the doctor or other provider. The provider then bills the State for the services provided under the standard benefit package and the State pays the bill on the patient's behalf, just as insurance companies pay medical bills on the patient's behalf now. The difference is that complicated and expensive formulas for patient copayments, coinsurance, and deductibles in addition to premium costs are eliminated. The standard benefit package is in fact extremely generous. It covers all inpatient and outpatient medical services without limits on duration or intensity except as delineated by outcomes research and practice guidelines based on quality standards. It provides for coverage of comprehensive long-term care, dental services, mental health services and prescription drugs. Cosmetic procedures and other ``frill'' benefits such as private rooms and comfort items are not covered. The extent of State discretion is substantial. The Federal budget is divided into quality assurance, administrative, operating, and medical education components. The system is financed 86% by the Federal Government and 14% by the States. That Federal pie is then apportioned among the States. For example, States with large elderly populations can be expected to require a larger volume of higher intensity services and will receive a larger Federal contribution. However, the States are free to determine how that money is allocated among types of providers and to negotiate those allocations according to the State's individual needs, provided Federal standards are met. The ability of HMO's to operate and compete on a capitated basis is preserved. The States must demonstrate the efficacy of their methodologies or Federal models will be imposed. However, States are not required to seek waivers in advance. While the Federal Government will not make separate allocations to states for capital and operating budgets, the states are free to allocate capital separately to assure adequate distribution of resources throughout the State and to develop their own mechanisms for doing so. The financing package reflects the CBO scoring of this bill's predecessor, H.R. 1200, in the 103d Congress. The numbers were provided by the Joint Committee on Taxation [JCT] on the basis of the CBO scoring. Accordingly, the Bill is fully financed. In fact, JCT estimates that the American Health Security Act will lead to deficit reduction approximating $100 billion per year by the year 2004. Everyone will contribute to the health insurance system, except the very poor. Employers will pay 8.7 percent of payroll and individuals will pay 2.2 percent of their taxable income. A tobacco tax equal to $0.45 per cigarette pack is also imposed. These payroll deductions are lower than current insurance costs for most businesses and individuals, even while providing universal coverage and a more generous benefit package than exists in the private market today. The key is that the money necessary to provide coverage to people who cannot afford it comes from the administrative savings achieved through the elimination of the insurance company middle man. Americans are freed from the hassle of obtaining and keeping their insurance and have a federal guarantee that their health care costs will be paid for, regardless of who their employer is, where they move, or how their personal or family situation changes. In addition to providing realistic and affordable financing, the Bill provides quality assurance mechanisms that enhance systemwide quality and truly protect the consumer. It attempts to end the interference between doctor and patient. It establishes a system of profiling practice patterns to identify outliers on a systematic basis. Pre- certification of procedures and hospitalization--getting permission from insurers before your doctor can treat you--is prohibited except for case management of catastrophic cases. Practice guidelines and outcomes research are emphasized as the main quality and utilization control mechanisms which gives physicians latitude to deviate from cookbook medicine where required for individual cases without going through intermediaries. Only if practitioners consistently deviate are they subject to review to ascertain the basis for the pattern of practice. This system includes mechanisms for education and sanctions including case-by-case monitoring when the review indicates serious quality problems with a specific provider. The need for a 1:1 ratio of primary care physicians to specialists is explicitly set forth. Federal funding to graduate medical education is tied to achieving this ratio. Funding to the National Health Service is also provided to achieve this goal. Special grants are provided to meet the needs of underserved areas through enhanced funding to the community health centers, both rural and urban, to enable outreach and other social support mechanisms. In addition, states have discretion to make special payment arrangements to such facilities to improve local access to care. It is anticipated that the revenue streams established for the public health service, community health centers, and education of primary care providers will double the primary care capacity of rural and other underserved areas in this country. In summary, the American Health Security Act will provide all the citizens with the health care they need at a price both they and their country can afford. It is clear that we cannot afford the price of doing nothing.

Mr. McDERMOTT

Mr. McDERMOTT. Mr. Speaker, I ask unanimous consent to remove my name as a cosponsor of H.R. 789.

Mr. McDERMOTT

Mr. McDERMOTT. Mr. Speaker, 2 years ago the President of the United States said he wanted to give all Americans health care that could never be taken away, affordable health care that could never be taken away. Now Members of the then minority and now majority take great pride in saying they stopped the President from advancing that particular change in our public policy. The result has been that more and more people are without health insurance in this country. Now the article in today's Washington Post, page 3, says that one out of seven children in this country do not have insurance. Even more damming than that figure is that 9 out of 10 of those children live in a family where one adult works. These are people who are doing what the American system says we should do: We should work, we should get a job, we should try and take care of our families, but they do not have jobs where they get health care benefits. Now we have waited for 2 years for the Republicans to offer any proposal, and there is none, and there is no budget that deals with it now.

Mr. McDERMOTT

Mr. McDERMOTT. Mr. Speaker, I yield 2 minutes to the gentleman from Pennsylvania [Mr. Fattah].

Mr. McDERMOTT. Mr. Speaker, I yield 2 minutes to the gentleman from New York [Mr. Engel].

Mr. McDERMOTT. Mr. Speaker, may I inquire on a parliamentary basis, is this being credited against the gentleman's time?

Mr. McDERMOTT. Mr. Speaker, I have a parliamentary inquiry.

Mr. McDERMOTT. Mr. Speaker, I yield 3 minutes to the gentleman from Texas [Mr. Stenholm]. (Mr. STENHOLM asked and was given permission to revise and extend his remarks.)

Mr. McDERMOTT. Mr. Speaker, the gentleman from Connecticut heard Mr. Rubin yesterday say that if the---- Point of Order

Mr. McDERMOTT. Mr. Speaker, I yield 2 minutes to the gentlewoman from Connecticut [Ms. DeLauro].

Mr. McDERMOTT. Mr. Speaker, I yield 2 minutes to the gentleman from North Carolina [Mr. Price]. (Mr. PRICE of North Carolina asked and was given permission to revise and extend his remarks.)

Mr. McDERMOTT. Mr. Speaker, I yield 2 minutes to the gentleman from Maine [Mr. Baldacci]. (Mr. BALDACCI asked and was given permission to revise and extend his remarks.)

Mr. McDERMOTT. Mr. Speaker, I yield myself such time as I may consume. The gentleman from Connecticut knows that, if we took the tax increase out of the President's budget, we would have balance now. The question is, where is the gentleman's budget? The gentleman says everything is wrong with the President's budget, but he will not put anything on the table. Mr. Speaker, I yield 2 minutes to the gentlewoman from California [Ms. Sanchez].

Mr. McDERMOTT. Mr. Speaker, I yield 2 minutes to the gentlewoman from New York [Ms. Velazquez].

Mr. McDERMOTT. Mr. Speaker, I yield 2 minutes to the gentleman from Maine [Mr. Allen]. (Mr. ALLEN asked and was given permission to revise and extend his remarks.)

Mr. McDERMOTT. Mr. Speaker, I yield 2\1/2\ minutes to the gentleman from California [Mr. Sherman]. (Mr. SHERMAN asked and was given permission to revise and extend his remarks.)

Mr. McDERMOTT. Mr. Speaker, I think the gentleman recognizes it is taken off my time by the timekeeper.

Mr. McDERMOTT. Mr. Speaker, I yield 2 minutes to the gentleman from Minnesota [Mr. Minge].

Mr. McDERMOTT. Mr. Speaker, I yield myself such time as I may consume. Mr. Speaker, the gentleman from Michigan [Mr. Hoekstra] raises the question. I say Put your alternative on the table; we would love to see it. Mr. Speaker, I yield 2 minutes to the gentlewoman from California [Ms. Woolsey]. (Ms. WOOLSEY asked and was given permission to revise and extend her remarks.)

Mr. McDERMOTT. Mr. Speaker, I yield myself such time as I may consume. The gentleman from New Jersey [Mr. Franks] makes the best case for not reducing taxes. The President's budget would continue down if we did not reduce taxes. Mr. Speaker, I yield 2 minutes to the gentleman from Florida [Mr. Davis].