Jim McDermott

Mr. McDERMOTT

Mr. McDERMOTT. Madam Speaker, the Bible says, by your deeds ye shall know them. Now last week by amendment, the Republicans gutted the terrorism bill. Many people asked why did they take out the guts of that bill? By their own words, from the gentleman from Illinois [Mr. Hyde], we know the answer: Because Members on the Republican side trust Hamas more than they trust their own Government. They were afraid that, if we put the power in the hands of the Government to deal with terrorism, we might turn our eyes away from the Middle East and come to look at some of the organizations in this country. People on this floor have forgotten Oklahoma City. People have forgotten what has happened. Madam Speaker, we cannot allow our Government to be powerless in the face of terrorist organizations wherever they come from. Now, tomorrow we are going to add insult to injury. The police officers of this country want the assault weapon ban kept in place. But the Republicans, led by the Speaker, are going to bring out a repeal of that ban to this floor to put those guns on the street again. I urge my colleagues to vote against that bill.

Mr. McDERMOTT

Mr. McDERMOTT. Mr. Speaker, I would like to take this opportunity to enter into the Record this letter to Secretary of State Warren Christopher regarding human rights in Bolivia. Twenty-eight nongovernmental organizations from the United States wrote this letter to ask the United States Government to ensure that Bolivian antinarcotics police receiving United States assistance comply with Bolivian and international laws when carrying out arrests and that the United States support Bolivian measures to improve human rights. I am particularly interested in this letter because it highlights the human rights situation in the Andean nations receiving antinarcotics assistance from the United States. I think it is important that we monitor how U.S. assistance is used to ensure that it is used for its stated purpose, and that it does not contribute to human rights violations in the Andean nations. Our commitment to support human rights around the globe requires congressional attention to this matter. February 15, 1996. Hon. Warren M. Christopher, Secretary of State, Department of State, Washington, DC. Dear Mr. Secretary: We are writing to express our deep concern regarding human rights violations occurring as a result of antinarcotics operations in Bolivia. On March 1, 1996 the Administration is slated to announce its annual ``certification'' of countries cooperating with U.S. antinarcotics objectives. As you undertake your review of antinarcotics efforts in Bolivia, we urge you to look closely at those violations to seek ways to work with the Bolivian government to implement measures that could improve the protection of human rights in that country. Human rights abuses remain pervasive in the Chapare, the rural area in which most of Bolivia's coca is grown and cocaine base produced. For years, the antinarcotics police-- trained and funded with U.S. assistance--has run roughshod over the local population, carrying out arbitrary searches and arrests, stealing the meager possessions encountered, and manhandling and beating individuals during raids and interrogations. Impunity for abuses committed by antinarcotics police is the norm. If investigations are initiated, they are cursory and incomplete; sanctions are rarely imposed. Social unrest and conflict in the Chapare increased significantly over the second half of 1995, as a result of stepped-up coca eratication efforts. Last spring, the U.S. government sent the Bolivian government a letter stating that Bolivia would be treated as ``decertified'' and therefore ineligible for U.S. assistance if it did not, among other conditions, meet coca eradication targets. In response to the U.S. ultimatum, the Bolivian government stepped up antinarcotics operations despite well-founded fears that these actions would unleash a wave of violence. As predicted, the eradication efforts sparked violent confrontations with coca growers, resulting in at least seven deaths, scores wounded and hundreds arrested. Careless and indiscriminate use of force by the Bolivian police against those opposing coca eradication policies is disturbingly frequent. Since mid-January, the Bolivian antinarcotics police have undertaken massive sweeps in the Chapare, arbitrarily detaining over three hundred people. Those detained are typically held several days and released without charges; indeed, without ever being presented to a judge. On January 29, the police also broke up a peaceful hunger strike in support of the women protesting the government's coca policies and threw over fifty people into jail. Neither Bolivian law nor international human rights standards permit these warrantless arrests of individuals against whom there is no evidence of participation in criminal conduct. The government is clearly using police powers to stifle lawful political opposition to its policies. Given the proximity of a decision on certification, we also suspect the Bolivian government is detaining hundreds in the hopes of impressing the United States with its antidrug commitment. The Bolivian antinarcotics efforts also continue to rely on special judicial procedures that violate fundamental due process considerations. Under Bolivia's Law 1008, those who are formally charged with drug offenses--no matter how minor--are imprisoned without the possibility of pre-trial release and must, even if acquitted, remain in prison until the trial court's decision is reviewed by the Supreme Court, a process that takes years. The U.S. government provides funding for the salaries and expenses of special prosecutors for the antinarcotics courts. We recognize the United States does not encourage or condone human rights abuses by Bolivian antinarcotics forces. Nevertheless, the United States shares responsibility for those abuses. The U.S. government provides funds and technical assistance to all of the Bolivian agencies involved in counternarcotics activities and, as just noted, to the antinarcotics courts. Bolivia has passed laws, created institutions and adopted antinarcotics strategies shaped by U.S. concerns and pressure. We urge you to ensure that the U.S. government no longer underwrites human rights abuses in Bolivia by adopting policies more sensitive to the political, economic and social cost of antinarcotics operations in Bolivia. Specifically, we urge the U.S. government to: Support revisions in Law 1008 which would ensure that Bolivia's judicial procedures for drug offenses meet international due process norms and standards. Ensure that Bolivian antinarcotics police receiving U.S. assistance and support comply with Bolivian and international laws when carrying out arrests. Provide the necessary support to enable the Bolivian antinarcotics police to establish effective complaint and review procedures to hold abusive agents accountable. Expand reporting on human rights abuses stemming from antinarcotics operations in the State Department's annual human rights report for 1996. The issue of drug abuse is important to the American people and deserves the attention of our nation's leaders. U.S.- supported coca eradication efforts in Bolivia, however, have yielded little results in reducing the amount of cocaine coming into the United States, and few independent observers believe they can ever succeed in reducing the flow of cocaine to our country. At the same time, they have increased social tensions and fostered human rights abuses. In crafting future policy, adoption of the measures we have outlined could result in significant improvements in the human rights situation in Bolivia and would send an important message to the Bolivian people regarding U.S. concern for human rights. Thank you for your attention to our concerns. Representatives from the following organizations signed on to the February 15, 1996 letter to Secretary of State Warren Christopher addressing human rights concerns as a result of U.S. anti-narcotics policy in Bolivia: Washington Office on Latin America. Maryknoll Society Justice and Peace Office. American Friends Service Committee, Washington, Office. Carnegie Endowment for International Peace. Catholics For Justice, Latin American Task Force, Diocese for Kansas City-St. Joseph, Missouri. Center for Concern. Church of the Brethren. Clergy for Enlightened Drug Policy. Columban Justice and Peace Office. Comboni Peace and Justice Office, Cincinnati, OH. Latin American Studies Program, Cornell University. Criminal Justice Policy Foundation. Drug Policy Foundation. Fellowship of Reconciliation Task Force on Latin America and the Caribbean. Foundation on Drug Policy and Human Rights. Inter-American Dialogue. North American Congress on Latin America (NACLA). Guatemala Human Rights Commission/USA. International Labor Rights Fund. Maryknoll Society. Office of Social Concerns, Maryknoll Sisters. NETWORK: A National Catholic Social Justice Lobby. Open Society Institute. Pax Christi U.S.A. Peru Peace Network. Sisters of Saint Joseph of Carondelet. U.S. Catholic Conference. Unitarian Universalist Service Committee. The following individuals also signed on to the letter: Melina Selverston and Cynthia McClintock.

Mr. McDERMOTT

Mr. McDERMOTT. Mr. Speaker, on Sunday, February 25, most of us picked up our morning paper to read that two planes, piloted by Cuban- Americans, had been shot down near Cuba. This unfortunate incident was appropriately denounced by both President Clinton and the U.N. Security Council. In addition to this initial response, the President quickly imposed several restrictions on Cuba and ensured that the families of those killed would be compensated. The downing of the planes was an inexcusable action by the Cuban authorities, and I believe that President Clinton was right to initiate an immediate and direct response. This is a very emotional situation and the immediate reaction is to strike back, but that is the wrong reaction. It is wrong to define our long-term relationship on the basis of this tragic incident. Passage of the Helms-Burton bill is a shortsighted, irrational response to this international incident. This legislation will not topple Castro, this legislation will only tie the hands of President Clinton and increase the pain and suffering of the Cuban people. In my opinion, this legislation not only violates international law, it punishes our international allies by attempting to force them to comply with our 34-year-old embargo. An embargo that has not worked. This legislation will allow Cuban-Americans to use United States courts to sue foreign companies who invest in properties that were confiscated by the Castro government. While emotionally justifiable, it infringes upon our allies' sovereignty, and possibly violates our trade agreements. Helms-Burton would limit the authority of the President to alter or lift parts of the embargo--even for strict humanitarian purposes--by Executive decree. The Executive orders which make up our policy on Cuba become frozen into law. If the President sought to ease restrictions on Cuba in response to democratic changes, he would only be able to do so with congressional approval. We all know that the Cuban economy is suffering. Cuba is forced to pay a premium for importing staple foods for its people. Medicines are in short supply, causing health care delivery to crumble. Is this what we really want for the Cuban people? Is this how our democracy should operate? Engaging Cuba, increasing dialog, and pressuring for increased human rights and democratic reform is the best way to genuinely democratize Cuba and improve relations with one of our closest neighbors. Passage of Helms-Burton will only deepen the rift between our two countries and cause further suffering of the very people we are trying to help.

Mr. McDERMOTT

Mr. McDERMOTT. Mr. Speaker, 3 years ago President Clinton announced that he wanted to provide Americans with health insurance that can never be taken away. The congressional leadership has publicly bragged, in both bodies, that they killed health care reform. My concern tonight is, what is their alternative? Now, we have in the Senate presently, the other body, a bill languishing, the Kennedy-Kassebaum bill, that gives minimal protection, and yet not even that bill can get out of the other body, so the question is, what is going to happen? It seems to me that the history of this issue needs to be reviewed. As you may know, it was a mere 150 years ago that the first surgery was done under anesthesia at the Harvard School of Medicine. Perhaps that is a good place to begin this examination of where we have been in health care and where we are going. Many in my generation retain a deeply etched image of a painting depicting a physician sitting beside the bed of a small child while the parents huddled pitifully in the background. The title of the painting is something like ``Waiting for the Crisis''. Physicians 100 years ago could do very little beyond setting fractures, amputating, and administering a variety of empirically tested concoctions. Physicians were among the most broadly educated in the society and, as such, they were highly respected and expected to participate fully in the civic life of the society. Even earlier, one of the most prominent physicians in the American Colonies was Benjamin Rush; as a Member of the Continental Congress, Dr. Rush signed the Declaration of Independence. Eventually, he was defeated for re-election, but he spent the remainder of his professional career improving the lot of prisoners and the mentally ill in Pennsylvania. That was the last time a psychiatrist served in the Congress before I arrived in 1989. Maybe some of you see a moral therein. Advances in the diagnosis and treatment of disease between 1846 and 1946 were painfully slow. Services were rendered to patients by individual physicians who were paid on a fee-for-service basis. Health insurance was a rare commodity, and thousands of people simply did without the treatment that was available because they could not pay for it. Others paid what they could when they could. There was no expectation of a societal response to the need for universal health coverage. I am speaking only of the United States here because you must remember that, in 1883, Otto von Bismark instituted government- sponsored health care for German miners as a preemptive strike to halt the spread of socialism. The 1930's were, of course, a time of great turmoil in this country and, during that period, President Franklin Roosevelt proposed a system of universal health coverage for all Americans. He did so at the same time that he was proposing Social Security, and the political weight of the two programs proved too great. So he decided to separate the two proposals and to wait until the next Congress to complete his health care proposal. Unfortunately, the Second World War interfered with his plan. Meanwhile, in typical American fashion, the American people were beginning to develop their own responses to the lack of affordable care. For example, the Kaiser construction company was building dams in rural Washington State. Mr. Kaiser recognized the need to make doctors and hospitals available to his employees who were working at dangerous jobs in isolated areas. Thus were planted the seeds of prepaid health insurance. And during the war, more and more employers, eager to maintain a healthy and reliable workforce, began to offer health coverage. At the end of the war, a wage and price freeze was imposed on the American economy. But smart and thoughtful labor leaders found a way around this constriction on wages by inventing a concept called a benefit package, which was primarily a health insurance program to pay for doctor visits and hospitalizations. Nonunion companies suddenly realized that if they did not also provide a benefit package for their employees, they soon would have union organizers working the floors of their plants and offices. So, they, too, provided a benefit package. Emerging around the same time as employment-based health insurance, the prepaid coverage seeds sown by Kaiser were sprouting among groups of citizens who believed that only collectively could the costs of health care be met and contained. In Seattle, a group of teachers and a few doctors began Group Health Cooperative of Puget Sound. Group health was considered worse-than-radical; it was socialism, and the healthcare establishment repudiated it totally. Because the doctors of group health rejected the concept of fee-for- service payment, they were denied membership in the Washington State Medical Association. A lawsuit that eventually ended up before the State supreme court was necessary to force the association to admit group health practitioners. At the same time, a similar group care program evolved in New York. As it entered the post-war era, then, the United States was pursuing two major approaches to health care delivery and financing. One system, financed by employers, offered no guarantee of continued coverage either during employment or certainly after leaving employment. Only union contracts in certain cases guaranteed coverage during employment. Nonunion employees had no protection whatsoever. The other system of delivery and financing was an adaptation of the cooperative movement that emphasized control by the recipients of the system's services. Keep in mind that the insurance industry did not leap willingly into the mix and only reluctantly accepted the risk of insuring the health of individuals. They were hesitant, I expect, because they had no experience on which to base their rates. It is against this historical backdrop of health care delivery and financing that we must view the medical developments of the postwar period. It was an era in which medical science and technology literally exploded. What is possible today was hardly conceivable to even the most imaginative scientist after the war. Antibiotics revolutionized both infectious disease treatment and postoperative infections. Kidney dialysis laid the groundwork for transplant therapy. Noninvasive imagery such as CAT scans and MRI's made diagnosis more precise, and complicated surgeries more likely of success. Bone marrow transplants and other cancer treatments made certain and speedy death from cancer less likely. Antipsychotic medications recast the treatment of the severest mental disorders. When I walked into the ICU recently to visit my 90-year-old father, it struck me that nothing in that area of the hospital existed when I graduated from the University of Illinois Medical School in 1963. Only the human body remained essentially the same, except, of course, the hip and knee replacements and the cardiac bypass surgeries and the heart valves. If you consider even briefly all of this rapid and turbulent change, you will appreciate the trepidation with which employers and the health insurance industry viewed the modern landscape of health care delivery and, especially, financing. Health care delivery in this country has been conducted primarily by individual providers paid through a fee-for-service system. As more treatment and procedures have been developed, the costs of care have risen exponentially. Employers and insurers began to seek ways to provide coverage to employees while simultaneously controlling expenditures. Unfortunately, they sought cost controls in a system with no incentive whatsoever to limit expenditures. After all, the system suggested, if a treatment for a given condition is known, shouldn't everyone with the condition receive it? To further complicate the mosaic which we call our health system--I would call it a nonsystem--in 1965, the Federal Government entered the scene to provide coverage to two groups not covered by the private sector because they are not employed. The programs created to cover these two groups are Medicare and Medicaid. They were designed to address the health needs of the elderly, the disabled, and poor women and children. Neither the governmental nor the employer-based system had any agreed-upon definition of what constituted adequate care, or who should pay what portion of the bill for whom. Thus, we have, in this country, a hopeless maze of health care delivery and payment schemes. The extent and quality of the health care you receive depends upon your age, where you live, for whom you work, the race or ethnic group to which you belong, and finally, your economic status. The inconsistencies within our present system are truly mind-numbing, and the call for reform of both delivery and financing comes from all quarters. As the cacophony of voices for reform began to rise, thoughtful minds examined other models of health care delivery and financing. Because the cooperatives had been relatively successful in delivering good care at reasonable cost, they attracted the attention of those who, on the one hand, wanted to continue to provide health coverage to their employees but, on the other hand, worried increasingly about the costs of doing so. Stories began to appear in the press, noting, for example, that the Chrysler Corp. was spending more on its payments to Blue Cross of Michigan than it was for the steel in its automobiles. The cooperative model of health care delivery was very democratic; it gave a large role to its consumers both in defining the scope of benefits and in the selection of providers. The doctors were salaried and the organizations were run by executives responsible to a consumer board. It was a functional structure, but one that did not correspond to the political views of most employers in this country. Yet, another significant factor contributing to the present crisis in health care financing is the gradual globalizing of the economy. The United States emerged from the war in 1945 as practically the only functioning, productive nation in the world. But the World Bank, the International Monetary Fund, the Marshall plan, and countless other economic initiatives restored economic stability and prosperity to many countries. As these nations regained strength, they became America's vigorous competitors. By 1980, the United States had lost its dominance of many spheres within the economic universe. A widely held view insisted that production of competitively priced goods and services required curtailment of health care costs. Plans fully paid by employers began to disappear. Deductibles, co- pays, and restrictions on the scope of services became commonplace as employers tried to control the costs of the health care benefits they offered. Where labor and management once had squabbled only rarely over the costs of employee health benefits, they now saw these costs gradually becoming a source of ongoing friction and escalating conflict. Today, reduction of existing health benefits is the single most common cause of strikes by American workers. As the quest for cost control became more urgent employers began to scrutinize the activities of insurance companies. In a booming economy, insurance companies took employers' premium payments, paid employees' claims, and paid dividends to stockholders. They gave relatively little attention to cost control, in part because employers were not pressing for it, and in part because the insurers could simply overcome losses with the next year's inevitable rate hike. But when the economy tightened, this traditional casual dismissal of cost controls no longer worked. Multistate companies became exasperated with varying State legislative mandates and the inquiring eyes of State insurance commissioners; many began to opt for the self-insurance alternatives offered by ERISA legislation. Small and medium-sized employers became increasingly agitated as their health care costs spiralled and their profit margins shrank. They began to do one of two things: As they were not required by law to provide health insurance to their employees, some simply dropped coverage; and others began to complain to their insurers. Employer-based health insurance peaked in 1980; it has been declining steadily since. All of these factors led to the shrinking coverage that now leaves 40 million Americans without any health insurance whatsoever. A majority of these people belong to families in which at least one person works full-time. As employers continued to drop the health insurance policies that covered their workers, insurers understandably sought ways to satisfy the cost and coverage concerns of their departing policy holders. Eventually they seized upon a system of cost-controlled health care delivery known as the health maintenance organization, or HMO. Let me take a moment here to define what I mean by HMO: A health maintenance organization is a healthcare delivery system in which every subscriber pays a fixed monthly fee that is used by a fixed group of salaried healthcare providers, mostly physicians, to provide a guaranteed package of benefits to the subscribers. Although HMO's had existed in this country since the 1940's, they tended to be small cooperatives, not-for-profit entities controlled by the consumers they served. HMO's offered managed care, that is, a predetermined range of medical services for a predetermined charge. Of course, they were considered suspect by the traditional medical establishment. Now back to our narrative: Insurance companies gradually recognized the lucrative potential of HMO's adapted to the for-profit free market. So they devised a new type of HMO to deliver health care to policyholders and profits to stockholders. To do so, they scuttled the old cooperative approach of consumer control and doctors' participation in the program's structure. In its place, they constructed a system of managed care designed primarily to yield generous profits. Accountants took the place of physicians and consumers, and managed care has come to mean a tightly controlled arrangement in which profitability determines the availability of care. This decision of the insurance industry to fashion a scheme of coverage and payment that excluded involvement of both consumers and providers set us on our present course. Insurers have created a system designed to maximize industry profits by incorporating financial incentives that discourage providers from giving appropriate-but-expensive patient care. For-profit managed care has proved so lucrative that it now is offered by companies created to do nothing else. Ironically, we have yet to see any demonstrable evidence that managed care actually produces the cost savings it promises. What is clear, however, is that managed care as practiced by the insurance industry is simply an arrangement to redistribute health care dollars from the delivery of care to administrative functions. In California and Florida, for example, the papers are full of stories about managed care companies denying care to their enrollees or using as much as 30 percent of their premiums for overhead or profit. Clearly, these plans are designed to enroll only the healthy--and inexpensive, while leaving the sick to taxpayer-funded programs. Now the Congress is trying desperately to revise both Medicare and Medicaid to enable private insurers to cover the healthy enrollees of these programs but to relegate the seriously sick and needy to the residual State and Federal programs. This deliberate attempt to deplete the insurance pool of people who are unlikely to need expensive, protracted care simply is exacerbating cost escalation and reinforcing the image of Medicare and Medicaid as incompetent, wasteful, and ripe for overhaul. By now, you may ask, quite rightly, ``What is the answer to this mess?'' The only sensible answer is a single-payor system to finance--not deliver--health care in the United States. As I say this, I see the spines stiffen and the jaws tighten. Let me assure you that I am proposing an American single payor system, not the 112-year-old German system, or the 50-year-old British or Canadian systems. Throughout the world, each nation's single-payor health care system reflects historical factors present at the time of that system's creation. So an American single-payor system must be developed in the current context. If I asked each Member of Congress to define a single-payor system, I probably would receive 400 different responses. So that we might have a reasonable meeting of the minds on this subject, let me propose that we use the following definition, which I have borrowed from Professor Tsaio at Harvard: Any single payor system has these two characteristics: (1) a defined set of benefits guaranteed to all citizens; and (2) a global budget to pay for the health services provided. Let me clarify here that the term ``global budget'' refers to the fixed total amount of money that will be spent for 1 year on a given set of benefits offered to the entire population. Nothing in Dr. Tsaio's single-payor definition prevents the private practice of medicine or restricts application of a variety of treatments, provided that all Americans receive the same access to the treatments, and that it is paid for out of the global budget. Mr. Speaker, how can we justify not having a system of universal health care available to all citizens in the wealthiest, most creative democracy on earth? This brings us to the first decision we must make--and which we so far have avoided: Is affordable, high quality health care a right of all Americans, or is it a privilege subject to all the vagaries of the age, race, income, and residency differences in our society? I categorically assert that, like fire and police protection, like common school education, and like myriad other services available to all Americans, such as highways and air traffic control, Americans should have universal access to health care insurance. Every industrial society around the globe has found the ways and means to do this. And, I might note parenthetically here that successful single payor systems have been developed by virtually all of our most vigorous trading partners. And I can assure you that none of these savvy competitors is contemplating replacement of its popular and cost- effective single-payor system with America's chaotic, wasteful approach to health care. In no other civil society can a citizen be bankrupted by illness, accident, or injury. If you are unemployed and, coincidentally, your house catches fire, we do not deny you the services of the fire department even though you cannot afford fire insurance. Why, then, do we allow your economic future to be destroyed if you develop leukemia and do not have health insurance? Is an automobile accident that leaves you with long-term disabilities and huge medical bills somehow less worthy of a societal response than a house fire? My answer is an emphatic ``no.'' In all of these situations, random events strike individuals citizens with overwhelming force that can be counteracted only by the collective action of the society. If we, as a society, cannot agree that health care must be addressed on an all-inclusive basis, we are accepting the present lottery-like nonsystem which truly personifies Darwin's description of ``survival of the fittest.'' If we can agree that health care financing can be addressed only on a national basis rather than the present stupefying panoply of programs, we then are prepared to begin the design of the American single-payor system. I suggest we call it Unicare. We have only two questions to resolve and our job will be finished: First, what benefits shall all Americans be eligible to receive from Unicare?; and second, how shall we pay for it? Experience has taught me that defining the benefits is perhaps difficult, but it is infinitely easier than deciding how to pay for the program. I contend that the benefit package must be very broad and very generous because anything else will build the inequities of our present system back into the new plan from the start. Let me explain: If we establish a narrow range of benefits for all Americans, we immediately create a market for secondary insurance to cover all those treatments that some may need but that are not covered by Unicare. Individual economic circumstances instantly come to the forefront as the varying capacity of people to purchase supplemental benefits insurance gradually divides us into those who have and those who do not. This is the situation we have today. Creating a limited guaranteed benefit package simply will perpetuate the present system in a different form. So I propose that we begin right now the national debate on a comprehensive package including pharmaceuticals, long-term care, and mental health services. I do not want to take any more time here arguing the content of the benefit package beyond the issue of comprehensiveness, but there are two corollary issues about actual delivery of the benefit package that merit attention. Although our coinage proclaims ``e pluribus unum,'' we are, in fact, many different communities in this country. So, I believe, in the maxim of the great progressive Senator of the 1930's, Robert LaFollette of Wisconsin, that State legislatures are ``the laboratories of democracy.'' I see great practicality in letting individual States decide how best to deliver the guaranteed benefit package. HMO's may be the preferred delivery mechanism in some States, while, in others, a negotiated fee schedule for private practitioners might be the method of choice. We can all agree, I am sure, that all wisdom in these matters does not reside in Washington, DC. I also am convinced that to make a system work, its providers-- primarily doctors--should be at some risk financially; at the same time, however, they must be allowed--encouraged--to participate in the design of that system. Actuaries, accountants, and lawyers cannot be expected to recognize the elements of medical cost escalation and control that are evident to physicians eager to protect both their patients and themselves. Failure to recognize this fundamental fact is the single most telling blunder of recent health reform efforts. Exclusion of physicians' participation in the design of a health care system is a sure prescription for disaster. Evidence of this already is appearing in the press. Time magazine's cover story in its December 23d issue details the ethical dilemma physicians confront when they try to practice responsible medicine in a system they had no part in designing. Lest you think this is purely a theoretical challenge, consider that I recently attended grand rounds at Children's Hospital in Seattle. For 2 hours, I discussed with a dedicated group of seasoned physicians and new practitioners the ethical questions inherent in trying to deliver appropriate care to children within the restrictions imposed by profit-driven managed care. As more and more physicians attempt to practice good medicine within managed care schemes that do not allow them to do so, the very significant shortcomings of our present unworkable system will become only more glaring. Good medical care will become scarce, indeed. Let me turn now to the second major decision that must be made about our Unicare Program for all Americans: how to finance it. It is estimated that, in 1995, we in the United States consumed 950 billion dollars' worth of health care. That is almost 50 percent per capita more than either Germany or Canada spent, and the health statistics of those countries are better than ours. In case you share my difficulty in truly comprehending the purchasing capacity of such huge numbers, consider this: In 1994, the Congressional Budget Office estimated that, with a single-payor system in place by 1997, it would be possible to offer a very generous benefit package, including prescription medications, nursing home care, and home health care, and still be able to apply $100 billion to deficit reduction within 5 years. But these are estimates of the costs involved in running a single- payor system in this country. How shall we get the revenue to finance the system? Right now, employers pay all or part of their employees' health care premiums, and employees pay some part of the premium, plus a Medicare tax to provide health care to senior citizens, plus general taxes to finance Medicaid for disabled persons and poor women and children. Employers also pay taxes to cover injured workers' medical expenses, and all citizens contribute general tax moneys to finance medical care for veterans and for members of the military and their families. In addition, we all pay indirectly for medical coverage related to auto accidents. Health care finance has become a specialty unto itself, and it is no wonder that people struggling to understand this mess are hopelessly confused. Let me offer a simple, straightforward alternative: The ideal funding mechanism for the new Unicare plan would be a single, dedicated source of revenue that is stable and predictable. So I propose an employer payroll tax of 8.4 percent and an individual payroll deduction of 2.1 percent. At these rates, about three-fourths of those Americans whose health coverage is connected to their employment actually would spend less on medical care than they do today, parceling out money to pay for all the different programs I mentioned a moment ago. And, as most businesses presently spend more than 10 percent of payroll to meet their health care costs, they, too, would enjoy an actual reduction in spending. Now, assuming that the Congressional Budget Office's estimates are correct--they usually are--you very reasonably might ask, ``Why has the single-payor idea not been adopted?'' How could the Congress reject a proposal that provides an affordable, generous health care benefit package and reserves control of health care treatment decisions to health care providers and their patients? The apparent answer lies in the economic power of the medical- industrial complex to resist proposals that threaten to encroach on the $950 billion pie. But, to be honest, the real obstacle to universal health care financed by a governmental mechanism is the American public's deep distrust of its Government's ability to operate a large--nondefense-- program successfully. This simmering sense of doubt and suspicion has been fanned to an explosive level by a decade-and-a-half of Presidential proclamations that ``Government is the problem,'' and that all challenges within our society can be overcome by ``getting the Government off the backs of American citizens.'' Only in such a climate could the insurance industry's $100 million advertising campaign so completely undermine President Clinton's valiant attempt to reform health care financing. So--the options before you and the American people basically are two. First, either invite the health insurance industry to maintain its control of healthcare finance at the expense of quality in care. Allow the industry to continue to ignore the valid criticisms leveled by providers and their patients at a system designed to benefit insurers and their stockholders. Second, or change the system to one in which doctors accept some financial risk but regain significant satisfaction in the practice of medicine because they reclaim responsibility to make the treatment decisions they believe to be best for their patients. Ewe Reinhardt, the James Madison professor of political economy at Princeton University, recently observed that ``The way things are going, all doctors may become serfs of insurance companies by the year 2000.'' That is a bleak prospect and one with which I do not disagree. But I also remain optimistic. Why? Because I concur with the sentiments of Winston Churchill, who, when asked what to expect from the Americans, replied, ``You can always count on the Americans to do the right thing--but only after they have tried everything else.'' It is time to do the right thing. We have tried everything else, and we are in far worse condition today than we were when President Clinton began his historic reform effort just a few years ago. Health care is a societal necessity that does not conform to free market pressures. It is foolish and useless to expect our economic system to mirror the fundamental social precepts of the country. Our present shambles of a health care system is intrinsically unfair. It is cruel, it is discriminatory, and it is appallingly wasteful. These qualities have no place in a democracy. We simply must restructure our health care system to the single-payor framework. And we cannot wait any longer. We already know that market reforms will not work in the health care financing arena. They do not work because they can not. Market reforms are not driven by the considerations of fairness, compassion, and adequacy that must define our health care system if we wish to declare ourselves a decent and sensible society. Mr. Speaker, I call upon you to bring the Kennedy-Kassebaum bill to the floor, so that we can at least start this debate. We can no longer wait and let this issue go on. It is one of the fundamental reasons why people are concerned about their economic security. All across this country, we have people who are losing their health care coverage. One million people working a year lose their health care coverage, and that is simply not acceptable in a democracy with the wealth and the creativity we have. We must begin on this problem today.

Mr. McDERMOTT

Mr. McDERMOTT. Mr. Speaker, I am unable to support the Interstate Transportation of Municipal Solid Waste Act of 1995. Regardless of the numerous procedural and environmental concerns which many of us have raised in connection with this legislation, the people of the Seventh Congressional District of Washington would gain little from this bill's passage. The bill lacks a strong affirmation of local government's right and responsibility to direct the collection and disposal of its solid waste. While the bill does grandfather flow control authority for county governments in Washington State that have invested millions of dollars into developing and integrating their disposal systems, the bill does not grandfather flow control authority exercised by the city of Seattle. It was the city of Seattle's ability to exercise flow control authority over commercial garbage, and its ability to direct contract- collected residential garbage to a designated facility, that made it possible for the city to procure a low-cost long-haul disposal contract in 1989. Simply put, the city's ability to guarantee a large volume of waste to the winning bidder made it possible for the bidders to offer the city the huge financial benefits of economies of scale in providing disposal services. The ability of the city of Seattle and other jurisdictions who exercise flow control and use competitive contracting to get the best deal for their citizens should be protected under any flow control bill. Unfortunately, this bill does not offer such protection. I hope to work with the committee to craft another bill that better protects the citizens of Seattle and the nationally recognized solid waste management system the city has created.

Mr. McDERMOTT

Mr. McDERMOTT. Mr. Speaker, I rise in reluctant support of this bill. While I would have preferred a stronger affirmation of local government's right and responsibility to direct the collection and disposal of its solid waste, this bill makes much needed clarification of the conditions under which flow control authority can be exercised, both now and in the future. Also, this measure is an admirable attempt to strike a balance between promoting competition between solid waste management facilities, and protecting communities, facility owners, and operators who have built facilities on the assumption that they would have a revenue base to finance those facilities. However, it is not without reservations that I offer my support. Although the bill does grandfather flow control authority for county governments in Washington State that have invested millions of dollars into developing and integrating their disposal systems, the bill does not grandfather flow control authority exercised by the city of Seattle on behalf of my constituents. It was the city of Seattle's ability to exercise flow control authority over commercial garbage, and its ability to direct contract- collected residential garbage to a designated facility, that made it possible for the city to procure a low-cost long-haul disposal contract in 1989. Simply put, the city's ability to guarantee a large volume of waste to the winning bidder made it possible for the bidders to offer the city the huge financial benefits of economies of scale in providing disposal services. The ability of the city of Seattle and other jurisdictions who exercise flow control and use competitive contracting to get the best deal for their citizens should be protected under any flow control bill. Unfortunately, this bill does not. While I am supporting this bill at this time, I am reserving judgment on the final bill that emerges from House and Senate negotiations. I hope to work with the committee to craft a final bill that better protects the citizens of Seattle and the nationally recognized solid waste management system the city has created.

Mr. McDERMOTT

Mr. McDERMOTT. Mr. Speaker, I urge your support for a letter which will be delivered to French President Jacques Chirac when he arrives in Washington this week. Our letter expresses our support for France's decision to end its recent series of nuclear testing, as well as our concern about the long-term damage caused by the tests in the first place. Our letter is simple and to the point: while we oppose France's series of nuclear tests that began this past September, we ask that the French Government permanently close its testing facilities and immediately begin a comprehensive cleanup operation. France's decision to conduct a series of tests prior to enacting a Comprehensive Nuclear Test Ban Treaty is hypocritical and lacks the sound judgment of a country that aspires to world leadership. By continuing with these unlawful tests, France undermined its credibility in the world community. We are now forced to question the French Government's reliability in what they say is their commitment to eliminate nuclear weapons. We implore France to join the United States and other nuclear powers to immediately push for, and complete negotiations, for a Comprehensive Test Ban Treaty. Much is at stake. If the nations involved do not seize this opportunity to reach agreement on the Comprehensive Test Ban Treaty soon, the world's best and perhaps last chance to end nuclear testing may slip through our fingers. I hope you will join me and Congressman Markey in sending a message to France that the United States objects to their series of nuclear tests, and that an agreement should be reached as soon as possible on the Comprehensive Test Ban Treaty.

Mr. McDERMOTT

Mr. McDERMOTT. Mr. Speaker, I want to commend my colleague, the gentleman from American Samoa, for bringing this issue to the floor. I was sitting in my office listening and watching it on television, and I decided that I ought to come over here, because it seems as I was listening as though this was something that was just an issue of Pacific Islanders, of people out in the middle of the Pacific, or that it was just an issue of people who live in Hawaii, which is a little closer. This is an issue that affects all Americans, affects everyone in this country, and for us, and I agree, I think we ought to boycott, not come to the speech by the French premier, because I personally do not think he should have been invited. I think he deserves the response of the Congress to someone who has done something that is offensive not only to Pacific Islanders, but the whole United States and the whole world community. The insistence by France of doing these tests is simply unacceptable. My view comes, as does that of my colleague from Hawaii, from a personal experience. I am a physician and I work at a hospital in Seattle that has, for a long time, dealt with the folks, the people who were affected by the atomic bomb in Japan. These people have been followed for the last some 40 years now since that bomb was dropped, more than 40 years, and they have been followed as they have increasingly gotten cancers of all sorts, leukemias, a variety of deadly diseases, and we have followed that. We know what atomic warfare does.

Mr. McDERMOTT. The gentleman is absolutely correct. The State of Washington has a facility that has been involved in this, and nuclear waste storage is the biggest threat to our economy. That kind of thing sitting there and rusting, silos and so forth, has been a threat for a long time. The people of the State of Washington passed an initiative, ``Don't waste Washington.'' We don't want anymore nuclear waste. Nobody wants nuclear waste. It is accumulating all over the place. To create bombs means you make more nuclear waste. There is no question about it. So even the process is making a problem for those people. Even if there is no war, there still is the question of how do we deal with the long- term storage of the waste. The thing that is so, to me--if you look at the people who were in Hiroshima and Nagasaki and look at what happened to them, an recognize that if we ever--anybody should be thinking of testing such a weapon simply has never looked at these people and looked at what the effects of it are. My belief is that for us to allow somebody to come here and speak as though it did not make any difference--

Mr. McDERMOTT. As if nothing happened, and simply to say Well, it is OK to us, because it is done way out there in the middle of the Pacific, and somehow that will not affect us. The gentleman is absolutely correct, when that stuff goes up in the air or when it is in the water, it gets into the fish. We have fishing fleets out of my district, the whole Pacific fleet from the State of Washington goes out of my district. They go out and catch fish everywhere. What kind of fish do they catch? What concentration of these elements is in the liver of those fish or in the roe or whatever? And we are feeding it to people. When it comes in the air--we measured Strontium 90 in milk in Wisconsin when I was in medical school. That simply is a threat to our people, that we should be saying to them How dare you do that when you threaten us?

Mr. McDERMOTT. Almost 5\1/2\ million.

Mr. McDERMOTT

Mr. McDERMOTT. Mr. Speaker, I rise in opposition. Sometimes we look at all of this and we wonder where these numbers come from, a 7-year balanced budget. What is magic about the 26th of January? Why does this only go to the 26th of January? Is it tied to the State of the Union Message? I would suggest that this is a resolution to allow the Speaker to go on a fundraising trip across this country. He will be in Seattle on the 10th of January. I do not know where else he is going to be, but this is simply to get people out of town so they can raise money for the next election. It is not to deal with the problems of this country. Mr. Speaker, I rise in strong opposition to the Republican plan to partially reopen the Government and will not be a part of their cynical political game to hold the Federal Government hostage until they can pass their extreme and irresponsible agenda. The House Republicans are offering two separate bills today. They want to partially reopen the Government by paying some Federal employees to go back to work, but without giving them the resources to serve the American people. For example, they want to send the Small Business Administration employees back to work, but will prohibit them from disbursing loans. They want to send Environmental Protection Agency employees back to their offices, but not allow them to make sure that the Nation's waterways remain clean. Everywhere you look, the lights will be on, but no one will be allowed to serve and the public's business will go undone. All Federal workers should be allowed to go back to work immediately, with full pay, but, in my view it is absurd and foolish to put Federal employees back to work without giving them the resources to serve the people who rely on them. The second part of the Republican strategy seeks to blackmail the President by holding Federal employees and the services they provide hostage until he agrees with their extreme political agenda. This legislation states that Congress will pass a clean continuing resolution, one that would both put Federal employees back to work and allow them to adequately serve the American people, if and only if the President supports their economic agenda of destroying the safety net and giving a huge tax cut to America's wealthiest. I will not vote for legislation which seeks to blackmail the President and engages in a blatant attempt to supersede the powers given to Congress by the U.S. Constitution. Mr. Speaker, we could avoid passing this ruinous legislation altogether, if the House Republican leadership would be willing to join their Senate colleagues in passing a clean continuing resolution--with no strings attached. In doing so, they could easily reopen the Government without holding the American people who rely on it for needed services hostage. Unfortunately, Mr. Speaker, they are unwilling to even allow the Senate-passed continuing resolution to come to a vote. Let's get America back on track, let's pass a clean continuing resolution. Most importantly though, let's not put Federal employees back to work without allowing them to do their job.

Mr. McDERMOTT

Mr. McDERMOTT. Mr. Speaker, I rise today to pay tribute to former Seattle Councilman Sam Smith who passed away November 16, 1995. Sam Smith was born July 21, 1922, on a farm just outside of Gibsland, LA. He entered the U.S. Army in 1942, was assigned to a post in Seattle, and achieved the rank of warrant officer. After World War II, he married his high school sweetheart, Marion, and together they raised six children. Sam earned a degree in social science from Seattle University in 1951, and a degree in economics from the University of Washington in 1952. He entered politics in 1956, and was elected to the Washington State Legislature in 1958, representing the 37th Legislative District of Washington for five terms until 1967. Sam then was elected to the Seattle City Council. He was the council's first black member, and he served on the council for 24 years. What made Sam Smith one of the finest elected officials to hold office in Seattle? Was it his insistence that he answer his own telephone with the familiar and friendly, ``This is Sam''? Or his warm smile and greeting of ``Hi, neighbor'' to all he encountered on his regular strolls through the neighborhoods of Seattle? Was it his keen political skills that found answers to problems when others could not? Or was it his unique ability to bring opposing sides together to find common ground? Yes, Sam Smith will be remembered for the way he answered his phone, greeted people on the streets, found answers and not excuses. However, he also is remembered as a champion of economic justice. Sam Smith addressed issues in a direct, thoughtful, and dedicated manner, at a time in our country's history when talk of fair housing and fair employment opportunities for minorities and the working poor too often was met with ignorance and indifference. He is remembered as someone who lifted as he climbed. Sam Smith was among the fathers of the robust diversity that distinguishes Seattle politics nationally. Many city, county, and State public officials attribute their opportunities to Sam and the avenues he opened for them. Mr. Speaker, the city of Seattle mourns the loss of Sam Smith, someone who dedicated his life to public service, who greeted one and all with warmth and respect, and who, above all, cared about his neighbors.

Mr. McDERMOTT

Mr. McDERMOTT. Mr. Speaker, I yield 1\1/2\ minutes to the distinguished gentleman from Cleveland, OH [Mr. Stokes], former chairman of the Committee on Standards of Official Conduct for 6 years.

Mr. McDERMOTT. Mr. Speaker, I yield myself the balance of my time. Mr. Speaker, Members of the House, I think the gentleman from Wisconsin really put his finger on it. You have a clear choice here. The Committee on Standards of Official Conduct looked at this issue and said we do not want to stifle people's ability to write books. We want them to be able to make a modest amount of income in addition to their salary, which we allow everybody else in this House except attorneys, and we said we cannot allow the continuation of the present situation because it leaves itself open to abuse. The amendment offered by the gentleman from New York [Mr. Solomon] not only leaves it open to abuse but broadens it. In my view, you have a very clear choice. It is not two good proposals; it is one bad proposal and one very good bipartisan proposal the gentlewoman from Connecticut [Mrs. Johnson] put together in the Committee on Standards of Official Conduct, and every Member here ought to support it. As I said before, our problem, we looked at a lot. The gentleman from California [Mr. Cunningham] brought up all the other issues. Well, there were some issues we could not figure out how to examine. For instance, book bulk sales; Speaker Wright was brought before this House on that issue, and the fact is that we have no capacity to know how books are sold or anything else. So the only way we could do it was to say you will have $20,040 whether you are writing a book or you are an undertaker or you are a whatever; you can make additional money here, but only $20,040, no matter what you do. You can write anything. You can use the books to be published and promoted by the companies, but you can only come away with $20,040. This is about money, not about the expression of ideas.

Mr. McDERMOTT. Mr. Speaker, I yield myself such time as I may consume. Mr. Speaker, if the Members of this body vote for the Solomon amendment, they do two things: They deny the House of Representatives the opportunity to vote on the proposal of the gentlewoman from Connecticut [Mrs. Johnson], the chairman of the Committee on Standards of Official Conduct, and, second, they leave open the door to multimillion-dollar contracts that we cannot monitor. Mr. Speaker, we removed a Speaker of the House over book sales, bulk book sales. That loophole is still open, and if we do not pass this resolution that we put out of the Committee on Standards of Official Conduct, we are voting to leave the bulk sale loophole open, with no ability of this committee to ever monitor that. That is why this amendment is before us. Mr. Speaker, I yield such time as she may consume to the gentlewoman from Connecticut [Mrs. Johnson].

Mr. McDERMOTT. Mr. Speaker, I yield 1 minute to the gentleman from Florida [Mr. Peterson].

Mr. McDERMOTT. Mr. Speaker, I yield 1 minute to the gentleman from California [Mr. Miller].

Mr. McDERMOTT. Mr. Speaker, I yield 1 minute to the gentleman from California [Mr. Fazio], a former member of the Committee on Standards of Official Conduct.

Mr. McDERMOTT. Mr. Speaker, I yield such time as she may consume to the gentlewoman from California [Ms. Pelosi]. (Ms. PELOSI asked and was given permission to revise and extend her remarks.)

Mr. McDERMOTT. Mr. Speaker, I yield 1\1/2\ minute to the gentleman from Ohio [Mr. Sawyer], a member of the Committee on Standards of Official Conduct.

Mr. McDERMOTT. Mr. Speaker, I demand a recorded vote.

Mr. McDERMOTT. Mr. Speaker, I yield 30 seconds to the gentleman from Wisconsin [Mr. Obey].

Mr. McDERMOTT. Mr. Speaker, I yield 2 minutes to the gentleman from Maryland [Mr. Cardin].

Mr. McDERMOTT. Mr. Speaker, would the Chair inform as to the amount of time that is remaining?