Jim McDermott

Mr. McDERMOTT

Mr. McDERMOTT. Mr. Speaker, I rise today to support the distinguished chairwoman of the Committee on Standards of Official Conduct, the resolution she has introduced, and the committee which she has very ably led. That we are here today is a tribute to her leadership and to her steadfast commitment to the ethics process that this body has so carefully crafted to deal with the sensitive and troubling issues posed by allegations of Member conduct. We meet today, however, not as the last Speaker suggested to deal with one Member, but to consider a rule that if enacted will reflect well on the conduct of all Members. The proposed rule change, to eliminate the copyright royalty exception to the earned income cap, was in fact developed in the context of the Committee on Standards of Official Conduct's review of allegations against a Member, and bringing it to the floor today was a central element in the committee's unanimous vote of December 6. But, regardless of the outcome of the other matter, this is a good proposal. It should be considered on its own merits, free from partisan bickering. The resolution of the Committee on Standards of Official Conduct that we bring here today is a well thought out effort to bring some sense to the earned income restrictions by eliminating a major loophole. Its basic thrust is to ensure that those who offer money to a Member to write a book do so because of the content of the book, not the position of the Member. Similarly, in the past the House has placed restrictions on Members' professional activities so as to ensure that lawyers and teachers among us were not hired solely because they were Members. In the one case we eliminated altogether the possibility of income. That is lawyers. In the other, as we pose today, we placed a cap on it. We did this not because of polls that said it is what we should do; we did it because we think it is right. And if it was right to prohibit compensation to our colleagues who are lawyers and to restrict the outside earnings of all others, it is right to place a cap on royalty income. As the committee noted bluntly, but correctly, in its unanimous report of December 6, it is not appropriate to capitalize on one's office. This is not a body of 435 free enterprise zones. To prevent such conduct, the Committee on Standards of Official Conduct has produced a straightforward measure that prohibits advances to the author, requires all book contracts to be approved by the Committee on Standards of Official Conduct, and subjects royalty income to the same earned income cap that applies to all other activities. This new cap would apply to royalties pertaining to books sold after December 31, 1995, and then only if the book was published when the Member was in the Congress. No advances paid on royalties prior to December 31 would be affected. These provisions, in my opinion, reflect the realistic accommodation of several competing interests. Members are permitted to earn a not insubstantial amount of money, the temptation of multimillion-dollar advances is eliminated, and the public will continue to have the opportunity to read what Members want to write. Now, as to the process, traditionally recommendations of a nonpartisan Committee on Standards of Official Conduct are considered on the floor by way of a privileged resolution without going through the partisan Committee on Rules. Just as traditionally, the Committee on Standards of Official Conduct usually does not suggest substantive measures that are within the jurisdiction of other committees. But after careful deliberation and in compelling circumstances, we did so in this case. And to protect the interests of the committee and the nonpartisan processes, it is vitally important that we be permitted to present our measure to you today as it was written. This is not an attempt to usurp the powers of any other committee or to force the leadership to choose between chairmen. It is, and was, a sincere effort by the committee, made up of 10 Members, 5 Republicans and 5 Democrats, to bring to the floor a measure that we thought demanded immediate consideration. Some may say this rule change has had no public hearings. We spent countless hours talking to publishing industry executives, book agents, and others in the field, and then we drew the rule. We have done it by a trial of fire, and we settled on this as the best way to do it. In closing, I would like to commend the chairwoman for her leadership, and I commend my colleagues on the committee for their thoughtfulness and hard work, and particularly, the gentleman from Ohio [Mr. Sawyer] and the gentleman from Ohio [Mr. Hobson] deserve praise for the time they spent on crafting this resolution. You often hear in this House the lament that none of us asked to serve on this committee. It is true. While I do not suggest, however, that you support our recommendation because of the pain we have endured or will endure, I do believe it is relevant that those closest to the issue have produced a bipartisan solution to a problem of much importance to this House. This is a vote in support of a bipartisan decision on the Committee on Standards of Official Conduct. In the past the House has only strengthened what has come out of the committee. It has never weakened it. With all due respect to the gentleman from New York, his amendment weakens the proposal proposed by the Committee on Standards of Official Conduct. Therefore, I ask Members to support the proposal of the committee and reject the Solomon amendment.

Mr. McDERMOTT

Mr. McDERMOTT. Mr. Speaker, I thank the gentlewoman. I want to commend my colleague, the gentlewoman from Connecticut, for having this special order, because at time like this, it is confusing. Many Members wonder if anybody is paying any attention whatsoever to what the real issues are. As I walked into the Chamber a moment ago, my colleague, the gentlewoman from California [Ms. Pelosi], put her finger on what the real question here is. We are arguing about philosophy. Now, people can get confused. I went home to Seattle this week, and it is always good to go home and talk to people in your district, and I talked to my mother and father. My father is 90, my mother is 86, and their questions were, what is this all about? What is it all about? Why is all this fighting going on? Why do you not just resolve it and get it over with and come on home? The question is one of philosophy. I personally, like Ms. Pelosi, take my hat off to the President for standing up for a philosophy that says that people are entitled to health care. Now, that is at the root of it. You can have all of this argument about CBO figures and whether this is honest scorekeeping or whatever; all it does is confuse people. But if they would simply remember that the issue here is whether people are going to wind up at the end of this session with entitlements to health care in this country, they would understand what the President has put his foot down on and will not move; and I hope he does not move off of that. Mr. Speaker, the programs Medicare and Medicaid get all mixed up in people's minds. The names sound sort of the same, so people confuse them, even when they talk about them. Medicare is basically a program of providing health care for senior citizens and disabled people in this country, and Medicaid is another program. Medicare is all funded by the Federal Government. Medicaid is half State and half Federal Government, and it deals with poor women and children, and with senior citizens; and two-thirds of the money in Medicaid goes to pay for nursing homes. There is another program in Medicaid which people know very little about called the QMB Program; that is, Qualified Medicare Beneficiary. That means if you are a poor senior citizen, you do not have very much money--you have to remember that there are 9 million widows in this country living on less than $8,000 a year; now, that is just getting by. If they do not have the money to pay for deductibles and copays, the QMB Program of Medicaid pays for their part of the health care plan. Mr. Speaker, it is the Republicans' intention to take away the entitlement for both Medicaid and Medicare from all Americans. That is their long-term goal. Speaker Gingrich has said that he does not want to do it now because he knows that politically it is not acceptable, but they want it to kind of wither away and die on the vine. They are simply after that program. To understand what is going on in Medicare, and I do this because I wound up explaining to my parents, right now Medicare is a program of guaranteed benefits; no matter who you are in this country, no matter what color you are, how much money you have, no matter where you live, no matter what, if you are 65, you are in the Medicare Program and you are entitled to a guaranteed set of benefits. Now, the Republicans say, look, we do not want to guarantee anybody any benefits. We will guarantee a fixed contribution. We are going to give them a certain amount of money. You could call it a voucher. They are going to give $4,600 to every senior citizen next year and say, you take your little $4,600 out there and buy a benefit package like you have now, and next year we will give you $4,900, and the next year we will give you $5,200. That is why they can say we are putting more money in. However, the fact is that the second year, that $4,900 will not buy the guaranteed benefit package you have today. So your benefit package is going to shrink, and each year it is going to shrink until you do not have, in the year 2002, what you have presently in that guaranteed benefit package. The guarantee of benefits is gone. All they are going to do is send you the voucher and send you out into the street. Mr. Speaker, I look at my parents, and I think every American ought to look at their parents, if you are in my age range. I am 58, so from 58 down to about 35, you ought to look at your parents and say to yourself, how will it be when my mom and dad go out in the street with that voucher in their hand looking for a friendly insurance company to take care of them? My dad is 90. Now, you just tell me which insurance company in this country wants to have my father as one of their beneficiaries? I mean, he has had a heart attack, he has had a stroke, he has had a whole bunch of things. He is doing just fine right now, but nobody is going to bet on him. Mr. Speaker, that is what they are doing to senior citizens in this country. They are taking away the guarantee that he will be covered and say, ``Mr. McDermott, take your money out there and see if you can find anybody who wants to take care of you.'' Now, I would not have come over here, because I was sitting over in my office reading letters, and a lot of people think it does not do any good to write a letter to their Congressman. I am here to tell you that everybody ought to be writing to their Congressman or Congresswoman and telling them what they think about this whole idea, because I read a letter which was sent out, this was in California, and somebody through that I ought to read this, and I will read it to you because it tells you what senior citizens are sitting there facing. ``Dear non-HMO Medicare patient,'' that means a patient, a senior citizen who does not belong to an HMO, ``As of December 31, 1995, the San Jose Medical Group will no longer provide care to non-HMO Medicare patients and, as such, I will no longer be able to provide your care. Non-HMO Medicare reimburses our doctors at rates so low that the San Jose Medical Group cannot cover costs. I am writing to you now because I wish to continue to provide care to you and would like to inform you about the senior HMO Medicare plans which are available to you. I can continue to serve you when you enroll in one of those senior HMO plans listed below. Should you wish to locate another physician who accepts non-HMO Medicare patients, you can call,'' and they give a number here. Mr. Speaker, they go on. I mean, they are selling HMO's. This is a doctors' group shoving people into HMO's. ``Selecting a senior HMO plan is an option you have under your Medicare health benefits. With a senior HMO, you no longer need to buy Medicare supplements. This saves some of our patients thousands of dollars a year. HMO's have no annual deductible, but you do have to pay $5 or $6 for each office visit. These plans cover everything that Medicare allows and most add in extras like eyeglass benefits, physical exams and prescription drug coverages. Some plans even cover hearing aids, mental, and dental care. ``Now, what is the downside? Well, you do need to select a primary care doctor from whom you must get a referral to see a specialist.'' Think about what that means to older people. Most of them have things wrong with them. I mean when you get to be 70, 80 years old, you have something wrong with you, and you are not going just to see the GP, you are going to see somebody dealing with your diabetes or with your lung problems, or you will see your cardiologist or something special. Before you can see that specialist, you have to have this primary care doctor who must give you a referral. Why? You already know Dr. Johnson takes care of your heart, why can you not just go to him? Why do you have to go to Dr. Thomas and get Dr. Thomas to refer you to Dr. Johnson? It is crazy. It is simply adding cost over, being used to keep the senior citizen from getting the referral to the specialist. Now, this is what is going on, and I always say, with all due respect to my California colleagues, in Washington State we always say, go down to Los Angeles an watch what is happening, because it is going to be in the whole United States in the next 3 years; whether it is Hula-Hoops or music or clothing or whatever, it all starts there. Well, they are starting with the letters now, sending them out in California, and they are going to be sending them out to every senior citizen in this country. You have to ask yourself, why does the doctor put down the name of six HMO's? I will tell you why he does, because I am a physician. He belongs to those. I will bet you he belongs to them. What he did when he signed in, they said to him, now you have to bring your practice in here, otherwise we are not going to need you. So this doctor is writing to all of these senior citizens saying, please join these HMO's, because if you do not join, they are going to kick me out. That is how the HMO's operate; if there are no patients, they throw the doctors out. So the doctors are in the business of urging people to get into HMO's. The President has said, I want to protect people's right to choose their own physician, not have to join an HMO if they do not want to, not be forced, either ecomonically or by an subtle pressure from the doctors, even; I want people to have the right to choose whoever they want. Now, at the end of what the gentlewoman from California [Ms. Pelosi] talked about, she also brought up an issue which I think, I have said to senior citizens groups all over my district and I think everybody ought to be thinking about it, they asked me, what can we do about this? I said, tell your children, because most of the people under 65 in this country think, well, this has nothing to do with me, this is Medicare, that is for old people; or Medicaid, that is for poor people. I am not poor. But the fact is that Medicaid takes the burden and Medicare takes the burden of health care off people like me. Mr. Speaker, most people my age and a little bit younger are struggling to help their kids get through college, so they are busy paying college tuitions, and they have never in my lifetime, in my adult lifetime, no one has ever had to think about paying their parents' health care bills. It simply was off the table. That is what Medicare did in 1965 and Medicaid. When President Johnson signed those bills, he lifted the burden off individuals and said, as a country, we are going to take care of everybody. Nobody is going to be stuck with their particular problems; we are going to share the burden. What this Congress, what the Republicans are doing is trying to put it back on people and say, well, if you are lucky and your parents died young, or if your parents are healthy or whatever, you get off. However, if your parents are sick, you are going to get stuck, because as they take away that guaranteed benefit package in Medicare and your parents are out there with that voucher that does not buy what they have today, they are not going to have it and you are going to say, well, mom, why are you not going to see the doctor? Well, I did not have the money; I could not afford it. So people like me and younger than me are going to be stuck saying to their parents, you go see the doctor; here is the money. So while they are paying for tuition for their kids, they are also going to be paying for their parents' health care. The real impact, though, is if your parents, and our health care system has worked so well that people live and live and live and we have lots of people 80 and 90 years old in this country who ultimately wind up for some period of time in nursing homes. Now, if you have to go and live in a nursing home, the cost is $30,000 a year at a minimum. And if you take the Medicaid Program, as the Republicans are intending to do, and throw it back to the State legislatures, there is going to be a fight in 50 State legislatures about how you pay for Medicaid and how you pay for nursing homes. A very easy thing for Members of a State legislature to do is to say, well, why do we not get some money out of the children of the old people and that will be a way that we can reduce our costs for nursing homes in this State. So they are going to pass laws in the 50 States saying that the parents, or the children, if they are at whatever level of income, have to pay $1,000 or $2,000, or who knows what they will decide, because if the States are short, like they are in the State of Washington, there is no extra money. We passed a tax initiative that says, they cannot raise taxes except with a two-thirds vote. The Republicans put a phony rule in here that you had to have a two-thirds vote to raise taxes, but every time it comes up out here, they waive the rule. In our State, it is law. So the State legislature cannot come up with additional money, and if the Feds do not send down the Medicaid money, the State legislature is going to start looking for somebody else to pay the bills for their senior citizens, and they are going to look to the children. It is going to happen. People are going to wake up here in about a year or two and say, where did this come from? How did it happen? It happened right now in December 1995, and the only one preventing that from happening is the President of the United States who continues to veto this kind of legislation. The chaos that is being wreaked through the health care system is on every level, and the President is the only one at this point who is holding firm, and he is really protecting the American people and their health security net, health safety security net in this country. I think that what you are doing here tonight by giving people a chance, and Members of Congress to come and tell what is happening, is a way of educating people about what the real issue here is. It is not about whether the CBO numbers are better than the OMB numbers and all that kind of gobbledygook that I hear out here. It is about whether or not people in this country are going to have the entitlement to have health care at a level that they have come to expect in this country. We have been able to do it in the past and it is certainly not out of our reach now. I commend the gentlewoman for having this special order.

Mr. McDERMOTT

Mr. McDERMOTT. Mr. Speaker, due to a family emergency, I was not able to attend the House legislative sessions on November 17 and 18, 1995. If I had been here, I would have voted in the following manner: rollcall vote No. 810, ``nay;'' rollcall vote No. 812, ``nay;'' rollcall vote No. 813, ``nay;'' rollcall vote No. 814, ``nay;'' rollcall vote No. 815, ``nay;'' rollcall vote No. 816, ``nay;'' rollcall vote No. 817, ``nay;'' rollcall vote No. 818, ``yea;'' and rollcall vote No. 819, ``nay.''

Mr. McDERMOTT

Mr. McDERMOTT. Mr. Chairman, I rise to enter my remarks in the Record in opposition to this terrible, terrible bill. Mr. Chairman, I rise in strong opposition to H.R. 1833. As a medical doctor, I was trained to evaluate all viable options when accessing a patient's medical condition. I oppose H.R. 1833 because it will ban a legitimate medical procedure, and jeopardize the lives of thousands of child-bearing women. H.R. 1833 will ban a specific procedure used only in the most extreme and necessary cases of late-term abortions, usually when the health or life of the woman is at risk. This legislation provides no exceptions in cases where the health or even the life of the woman are at risk. It is inhumane to unnecessarily risk a woman's life simply to pursue a political agenda. This bill is not only bad public policy, but it is also bad medicine. Why should we interfere with the very personal, ethical, and medical decisions made between a patient and a doctor? Why should we deny a woman's constitutional right to decide whether or not to have an abortion. The answer is that it is not our job to step between a woman and her doctor. We know that the U.S. Supreme Court specifically recognized a woman's right to choose a safe abortion under the principles of Roe versus Wade, and those principles were again upheld in Planned Parenthood versus Casey. The Supreme Court has already ruled that States may restrict late- term abortions, except when the woman's health or life are at risk. This bill is a blatant constitutional challenge to the rights outlined in Roe versus Wade. Mr. Chairman, let me stress that this bill is opposed by several reputable medical organizations including the American College of Obstetricians and Gynecologists, and the American Medical Women's Association. It is not even endorsed by the American Medical Association. Do not be fooled by H.R. 1833. If you vote yes, you are voting to deny a patient's right to receive medically necessary care. I urge you to take a long look at the potential ethical and medical dangers of this bill. Vote ``no'' on H.R. 1833. [[Page H 11613]]

Mr. McDERMOTT

Mr. McDERMOTT. Mr. Chairman, I would suggest to the gentleman from Oklahoma that if this bill had come down from on high, our good Lord would not be doing to the poor, sick, and disabled of this country what is in this bill. We went through a charade here last week to convince the American people that there was no connection between Medicare and the tax cuts. We had speaker after speaker saying no, we are doing one this week, and we are doing one the next week, and there is no connection. But if you take this bill, 724 pages, go to page 1324, and it says ``H.R. 2425 as passed by the House of Representatives is hereby enacted into law.'' Medicare is mixed in with the tax breaks. Now, that is the essence of what this bill is all about. There is no question that the Republican revolution is intended to give 1 percent of Americans who make more than $200,000 annually a tax cut that averages $12,600. But if you are in the 19 percent of the families in this country earning less than $10,000, you will have a tax increase of $25 a year. More than half of the cuts, 52 percent, go to 5.6 percent of the Americans at the top of the schedule. Now, at the same time, this bill takes $23 billion and puts it as a tax increase on the low-income families in this country who are trying to stay off welfare. These families will be hit doubly hard, first by the $23 billion cut in the earned income tax credit, and second by the complete or partial ineligibility they have for the nonrefundable $500 tax cut. We also see in this bill a paltry $2 billion taken out of corporate welfare in this country. The question is, why are the poor people hit 11 times harder than the corporations of this country? It is a bad bill. I urge Members to vote against it. It means that we are going to balance the budget on the backs of the poor, and that is wrong. I would say to the gentleman from Oklahoma [Mr. Largent], God would not have done that.

Mr. McDERMOTT

Mr. McDERMOTT. Can the Chair tell us, are there any changes between the H.R. 2425, which came out of the committees, and H.R. 2485, which was used in the Committee on Rules last night?

Mr. McDERMOTT. Then we have a bill identified as Union Calendar 145, H.R. 2425, which is 900 pages----

Mr. McDERMOTT. I think asking the Chair what we are considering is basically a parliamentary inquiry. We are out here as a parliament to deal with law. The question is, What we are dealing with?

Mr. McDERMOTT. Wait and listen to my parliamentary inquiry. We had a bill introduced, H.R. 2425, in the committee. Then we had a substitute of 435 pages that was dropped on us the day of the first meeting.

Mr. McDERMOTT. Are there any other changes before us----

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

Mr. McDERMOTT. Which is 900 pages, which has never had a hearing, and now we have H.R. 2485. Are there any other----

Mr. McDERMOTT. Since we had no hearings in the Committee on Ways and Means, I want to clarify what document we are dealing with.

Mr. McDERMOTT

Mr. McDERMOTT. Mr. Chairman, like the gentleman from New York [Mr. Houghton], I wish that this debate would be about substance and we could actually talk about what is going to happen. We can argue about $90 billion or $270 billion, but the real issue here is what is happening to the health security of senior citizens. Right now, senior citizens in this country get enough money to buy a program that covers what they need. And the Republicans are saying that in the first year, 1996, in the dark bar, we are going to give them enough to buy exactly what they have today. By the year 2000, you can see that the dark bar does not go as high as the CBO says an equivalent health plan is going to cost. The difference is $1,100. That is the national average. Now, if you are from California and watching this, you are going to need another $1,200. If you are from New York, you are going to need another $1,100. If you are from Texas, you are only going to need $994. Ask yourself where those senior citizens are going to come up with that extra $1,100 to buy the same thing they have today. Every time the Republicans use the word, ``choice,'' listen to that and say to yourself ``voucher.'' They are putting my father and my mother, my father 90, my mother 86, and everybody else's grandparents and parents, out on the street with a voucher. They call it choice. We are going to let you choose anything you want. But if you do not have the money, if that voucher only buys 75 percent of what it buys today, who will make it up? The kids will make it up. This is the hidden agenda here. They are shoving that $1,000, they will not say it is cuts and I will not say it is cuts, they are shoving that additional $1,000 into their kids. If you happen to be out there watching this or if Members are on this floor and happen to have a kid in college, you know what tuition does to you. To have your parents show up at the same time and say, ``well, I cannot afford it. It is not paid for by my health insurance,'' for the first time in 30 years, people my age, 58 and down, are going to have to think about how they make up that difference for their parents. One can talk about $90 billion and actuarials and all the rest of this stuff. There is 96 pages of things where they give away to doctors. As a doctor, I am ashamed by the kind of deal they came in and cut. When we are cutting money from senior citizens and putting them at risk like this, for doctors to come in and negotiate for another $500 million, is a shame. There is no reason to do that.

Mr. McDERMOTT

Mr. McDERMOTT. Mr. Speaker, in these Halls in 2 days we will have a vote on H.R. 2425. It is the Republicans' plan to slash Medicare by $270 billion over the next 7 years. Now, if you believe the Republican rhetoric, every one of us here would think that these drastic cuts are necessary to prevent the Medicare program from going bankrupt. Nothing could be further from the truth. These cuts have little to do with saving Medicare or the part A trust fund. Let me say, we throw terms around in this House that are often not well understood by the public. Medicare is divided into two pieces: part A, which is the hospital payments, and part B, which is the payments to doctors and other providers of services to the elderly. These cuts have little to do with saving part A. The Republicans are cutting $270 billion from Medicare because they want to use that money to offset the $245 billion in tax cuts for wealthy Americans. Now, ask yourself this: If the Republicans were so concerned about the impending bankruptcy of the Medicare trust fund, how come they never mentioned it before November 1994? It is ironic, when you think about it, that with all of the Republican rhetoric about saving the trust fund, the only action they took this year in 1995 was to approve a tax provision in the Contract on America which takes money out of the hospital trust fund through a reduction in the amount of Social Security taxes paid. Over $36 billion would be removed from the fund over the next 7 years as a result of that legislation that has already passed this floor. You heard me right. The first thing the Republicans did was to take $36 billion out of the trust fund. They will stand out here and say we have to put this money into the trust fund, but the first thing they did was to take it out. Furthermore, the issue of the insolvency of the part A trust fund has simply nothing to do with Medicare's supplementary insurance that is part B, the report of the part B trustees, which you never hear mentioned on this floor, is that part B is actuarially sound. It is absolutely financed. Therefore, if you are making cuts in Medicare which are being made solely to save part A, the hospital part, there is no need to take $140 billion in cuts out of part B. Almost $54 billion is in increased premiums to seniors that they pay each month. That is not necessary to save part A. Not 1 cent of the money cut from part B in their proposal, which you will see on Thursday, will go into part A. The dollars go into the general fund to take care of the tax cuts which will follow. As a result of the increasing public opposition to these drastic cuts in Medicare, the Republicans had to do something, which is saying, you are just shifting the money around. So they said, we will create a lockbox which they claim will sever the connection between the Medicare savings and the tax cut. They are going to try and divide it. One of the reasons why we are voting on Medicare this week and the tax breaks next week is they do not want you to think there is any connection. This lockbox is simply an illusion. It is really a return to the kind of smoke and mirrors budget gimmickry that they hope will fool the American people. The Republicans think that the American people are stupid. They want us to believe that by depositing the money they cut from Medicare into a separate account, they can prove that the Medicare cuts will not pay for tax breaks. Now, we all know that money is green. The term we use around here is fungible. You can use it here, you can use it there. It makes absolutely no difference which government account the money is put into or taken out of. The Government must pay its bills, and it does not matter which checking account it is in. You can have a bunch of different checking accounts. It is still government money. It comes from taxes. They are just simply trying to hide it. The bottom line is that the Republican lockbox is just a new Federal bank account. The Republican Medicare bill and the rhetoric that makes it sound as if no spending is allowed out of the lockbox is simply an illusion. Their bill allows borrowing. They put it into the lockbox. You cannot spend it, they say, but you can borrow it. In fact, it requires the lockbox to lend money to the Department of the Treasury. Coincidentally, of course, the Treasury Department needs these funds because of the Republican tax break. The American people need to know that the money from the cuts in Medicare not only goes into the new lockbox, but the money goes right through the lockbox and into the pockets of the wealthiest taxpayers who will benefit from the Republican tax cut. Over half of that $245 billion in tax breaks goes to people making more than $100,000. Now, to further mislead the American people, the Republican leadership has suddenly decided that this Medicare legislation will have a separate vote in the House of Representatives. The Medicare legislation will be considered separate from reconciliation. On Thursday we do Medicare. Next week or sometime thereafter, who knows, we will have the reconciliation bill which will have all the tax breaks in it, and the Medicare legislation will be incorporated by reference. That is a fancy term we use in the Congress to say, what happened a few days ago applies today. They will say they are totally disconnected, but in fact the bill contains an incorporation by reference. Without that phrase, without that incorporation by reference, the Congressional Budget Office would not be able to count the Medicare cuts in determining whether the reconciliation bill includes enough deficit reduction to allow the $245 billion in tax breaks to go forward. The Republican leadership has created a perfect scenario for spin control and deception. They can argue that the $270 billion in Medicare cuts are separate from the $245 billion in tax breaks while at the same time counting the savings from Medicare toward the amounts needed to balance the budget. Now, you can get as fancy parliamentarily as you want to here, but no amount of procedural vote wrangling or accounting gimmicks can hide the fact that the $270 billion in Medicare cuts are tied to the $245 billion in tax breaks. The numbers match. In addition to creating this lockbox, which could be raided at any time, the Republican bill does not extend the solvency of the part A hospital trust fund any longer than the Democratic substitute bill but it slashes Medicare by three times as much. The Republicans cannot hide this any longer. Although they claim that their plan will extend the solvency of part A until 2014, and you will hear this on Thursday, you will hear 2014, it is not true. The net impact of the Republican plan is to extend the solvency of the hospital trust fund, part A, until 2006 at a cost of $270 billion. I dropped in a bill, H.R. 2422, which also extends the Medicare trust fund until 2006, but it costs $90 billion, not $270 billion, $90 billion. Four of the Medicare trustees and the HCFA Administrator--HCFA is [[Page H 10125]] Health Care Financing Administration, for those of you who have forgotten--the HCFA Administrator, who runs this thing, says that the reductions in part A are approximately $89 billion and would be enough to ensure solvency to 2006. The Republicans can only achieve $270 billion in cuts by drastically reducing benefits to seniors and shifting the costs onto beneficiaries; that means senior citizens and their families. The Republicans want to reduce the Medicare Program to a worthless shell. Medicare that seniors know today will exist in name only while providing no real health care or economic security to the beneficiaries and their families. People will pay more and get less. Despite the $270 billion in Medicare cuts, the Republican bill does nothing to solve the problem of baby boomers entering the Medicare Program in 2010. Now, lots of people throw this term baby boomers around. I am not always sure they understand what we mean by that. If you were born after 1945, you will be 65 in 2010, and you come into Medicare. Anybody born after 1945 is a baby boomer. They are the people who come into the program in 2010. On December 27, 1995, I introduced a bill, the Medicare Security Act, which extends the solvency of the Medicare trust fund until 2006 and creates a bipartisan commission to deal with this problem of the baby boomers. In response to the introduction of my alternative Medicare bills, the Committee on Ways and Means chairman, the gentleman from Texas [Mr. Archer], stated in a press release: ``Any proposal that fails to save Medicare until the eve of the baby boom retirement must be considered a failure.'' Well, Mr. Speaker, the chairman by his own standard failed in his Medicare bill. According to the actuaries for the Medicare trust fund, the Republican plan would extend the life of the hospital trust fund, part A, through the third quarter of calendar year 2006. That is a quote from a letter dated 11 October 1995 to the gentleman from Florida [Mr. Gibbons] from the HCFA Administrator, Bruce Vladeck, based on data from the Medicare actuaries. The year 2006 is 5 years before the first baby boomers begin to retire in 2011 and 8 years shorter than the Republican claims of solvency until 2014. In addition to cutting three times more than is needed for Medicare to stabilize the part A trust fund until 2006, the Republican bill is loaded with sweeteners for various interest groups to silence any opposition. As a doctor, it is troubling to me to see members of the American Medical Association put their own interests ahead of their patients by cutting backroom deals with the Speaker in exchange for their support of the Republican bill. In a bill in which beneficiaries are being asked to contribute $53 billion more, the doctors were negotiating provisions allowing them to create their own health care plans and avoid further reductions in their fees. The Republican bill will allow doctors, as well as hospitals, to create doctor-hospital networks to sell health insurance plans directly to Medicare beneficiaries. These new networks will be called provider- sponsored networks or PSN's. It is a new term for you to learn because you are going to hear it endlessly on Thursday. Provider-sponsored networks; that means doctors are out there doing whatever they want with hospitals under special Federal rules which will preempt, which will preempt, override, existing State laws. It will allow the PSN's to operate with lower financial reserve requirements and other standards than are required for HMO's and private insurers. That means the insurance commissioner in the 50 States will not be able to control and regulate what these PSN's are out selling to beneficiaries. To allow these PSN's to operate immediately, Mr. Speaker, the Medicare plan by the Republicans changes existing antitrust laws and says that the States do not need, the PSN's do not need, State licenses. Clearly, being exempt from existing State regulation will give these PSN's an unfair competitive advantage for doctors and hospitals over existing HMO's. If that was not enough, other giveaways to doctors are limits on medical malpractice awards for pain and suffering to $250,000. The approach taken by this bill is extremely one-sided and does nothing to protect and promote the legal rights of injured patients. The Republican bill only seeks to protect doctors from full legal and financial accountability for their negligent behavior while restricting the ability of patients and their families to receive fair and adequate compensation. The list of benefits for doctors goes on, rolling back vital Federal oversight of clinical laboratories in doctor's offices. In other words, doctors can refer to their own laboratories. They eliminate provisions on doctors' self-referral. They provide unwarranted antitrust relief for physicians. They provide the ability to charge Medicare Plus, and that is what they are going to try and push all the seniors into, is Medicare Plus. They are going to allow the doctors to charge higher fees, and they also set a new formula for setting fees in the old traditional Medicare. Mr. Speaker, it is clear that the only interest the American Medical Association has in Medicare is a financial interest for themselves. The Republican plan also offers beneficiaries some false choices and false promises of security. The Republican plan creates Medicare Plus; I mentioned it earlier. It is a program which is advertised as offering seniors more choice of health care options, but in reality will create divisions and inequalities within Medicare. Medicare Plus will actually force beneficiaries to pay more for less while initiating what I call a death watch for the traditional Medicare Program. Medicare Plus under the Republican plan will be available as an alternative to traditional Medicare fee for service. Now what is Medicare Plus? Well, it really is managed-care plans, some new types of specifically specially structured health plans such as the PSN's I talked about, medical savings accounts, and health plans offered by qualified associations like the Chamber of Commerce. I do not know; it is not clear in the bill. It is simply there. Unfortunately for seniors all these new choices for health care are based on a false promise because Medicare Plus, Medicare's contribution to these plans, will be a defined contribution or a fixed amount of money which will be given each year which will decline over time resulting in seniors being able to purchase less and less health insurance. It is right in the bill. Now what does that mean for seniors? Well, it is pretty simple. It means that an underfunded voucher, they hand you something that will buy for this year what next year will buy you 20 percent less, and this time, instead of the Government sending the voucher to the beneficiary, to the senior, they are going to send it to the health plan. Under the Republican plan, Mr. Speaker, the total annual growth in the size of vouchers for health care plans is set at 4.7 percent. Now where did that number come from? It came out of the air. There is no basis for that. We expect, and CBO expects, that private health insurance premiums will grow at 7.1 percent. So, if it is growing for everybody else in the society at 7.1 percent, but we are going to only pay 4.7 for seniors under this Medicare Plus, you can see that gradually the buying power of senior citizens is going down by a couple of percent every year. By the time we get to 2002, you will be paying a thousand dollars more out of your pocket if you are a senior citizen buying health care than you are today. Now that is a rate of 30 percent higher than the Medicare vouchers are allowed to grow. The private sector is still going to grow 30 percent faster than Medicare will be allowed to grow. It does not take a rocket scientist to figure out that the Republican vouchers are putting seniors on a road to second-class health care. The vouchers will quickly buy less and less coverage on their Medicare Plus, and beneficiaries will have to pay the difference, or their families. If you realize that there are more than 3 million widows in this country living on less than $8,000, and you are talking about the year 2002 they are going to have to come up with another grand out of their pocket, you know they cannot do it. Their kids will have to do, if they are lucky to have kids who have the money to do it. Somebody else is going to have to pay for it because these seniors are not going to be able to do it. [[Page H 10126]] Mr. Speaker, the additional out-of-pocket costs which will be paid by seniors makes it clear that the additional choices provided by Medicare Plus do nothing to reduce the health care costs overall. It is an arbitrary 4.7 annual growth limit on vouchers. That saves money to be given for a tax break to the richest Americans. In addition to having to pay the difference between the value of the voucher and the cost of the benefit package, seniors enrolled in Medicare Plus will also be liable for extra charges by providers trying to compensate for Medicare's declining provider reimbursement rates, so if we cut the doctors what they are paid under Medicare, and you allow the doctors to balance bill, they can get it back out of the senior because we have taken off the protection against balance billing. These extra charges, as I say, are called balance billing. It is a practice by which providers charge beneficiaries more than Medicare approves. The restrictions in current law on balance billing, which permits no balance billing by hospitals and only limited balance billing by seniors, will not exist for seniors enrolled in the Medicare Plus plan. This is a very important concept. There will be no protection for seniors against these hidden new charges, and doctors will have a financial incentive to no longer see patients in traditional Medicare. If you stay in traditional Medicare, they cannot charge you balance billing. If you go into Medicare Plus, they can get you. Now that is what I call a real revolution. One of the most egregious examples of waste in this Medicare plan are the Medicare savings accounts which are an option under Medicare Plus. Every legitimate health care expert has agreed that a MSA, medical savings account option, will result in extra costs for the Medicare program and weaken the hospital trust fund. MSA's allow beneficiaries to choose a high-deductible health plan combined with a fixed deposit from the Government into an MSA to cover their routine health care costs. Let us say the Government gives you $5,000, and you take a thousand of it and buy a $10,000 deductible program. Then you got $4,000 in the plan, and you can use that to cover your routine health costs. If you do not spend anything, you got $4,000 bucks for yourself, and the healthy seniors will do very well on that, but people who have real problems are going to be a problem for the system. Mr. Speaker, CBO says that the MSA's in this bill will increase, I emphasize increase, Medicare costs by $2.3 billion. It is not a savings mechanism for the system. It is a giveaway to people who opt out of the Medicare system. Now this money that could have been spent on health care for senior citizens will instead go to the healthiest and wealthiest of seniors. Medicare loses money with MSA's because healthy people will choose the MSA option while Medicare lacks the ability to adjust the MSA payments for the risk factors. Furthermore, the idea that MSA's will protect freedom of choice for seniors is a sham. Once this product, once the MSA's are out there and become widespread, the insurance companies will take over the MSA product, and they will change it to managed care. The result for seniors will be a high-deductible plan with a managed-care product at the end of your deductible. Mr. Speaker, this is not Medicare reform. It is one of the first steps in the destruction of the traditional Medicare and elimination of the guarantee of health care for all senior citizens. The impact of $148 billion in cuts to Medicare providers under the Republican plan will create severe hardships in rural areas. It is not just a city problem. We are talking about rural areas where hospitals exist in many cases almost totally on Medicare and Medicaid payments because retired seniors are living out there, and that is what keeps those rural hospitals going. Rural hospitals and clinics already are in financial difficulty, and they will be hard pressed to absorb the reductions mandated by the Republican bill. In addition, the urban hospitals will be forced to accept added reductions and special Medicare payments for uncompensated care. Big-city hospitals take care of a lot of people who come in who do not have any way to pay, and Medicare gives them money to cover that. It is called dish payments, disproportionate share. Those payments are made by Medicare, and, when we cut those out in this bill, those hospitals are going to be in even worse shape. Now, if all of this was not bad enough, in addition to the $148 billion cut from providers, that is doctors and other people who provide services, the Republican bill includes something called a fail- safe mechanism requiring an additional $37 billion in cuts from providers if Medicare spending does not meet the arbitrary targets set in this budget resolution. What they are admitting here is they do not know how it is going to come out, and just in case it does not work, they will cut another $37 billion out of doctors and whatever with no specificity. You do not know what is going to happen. What will happen to home health care? Who knows. What will happen to nursing visits, Visiting Nurse Association kinds of things? Who knows? That $37 billion is sort of sitting there waiting to take a whack out of these things someplace down the road. Now this fail-safe mechanism will only affect the traditional fee- for-service Medicare system. Is that fair? Why only the traditional one that people have known, and have lived with and felt secure with? Why not the MedicarePlus? Well, it is pretty obvious. It is simply an assault on the Medicare plan that every senior citizen in this country knows and understands. Slashing reimbursements to doctors who remain in the traditional fee- for-service system will result in more and more doctors leaving Medicare to join these PSN's, these provider service networks, where they can escape State regulation and charge beneficiaries more. Over time, Medicare beneficiaries will find that the Republican Medicare bill will force their family doctors to leave them and join a provider service network. If you do a survey of seniors and ask them for suggestions on how to control the rate of growth of the Medicare Program, nine out of 10 seniors will respond that the Government needs to crack down on fraud and abuse in the Medicare system. The Republican plan does nothing, nothing to curtail fraud and abuse, and instead, does the exact opposite by weakening the administration's efforts to combat fraud and abuse. The GAO, that is the Government Accounting Office, they are the people who go in and look and see if the numbers really add up, they estimate that fraud and abuse in the health care industry account for an estimated 10 percent of our yearly private and public health care expenditures. Based on that estimate, fraudulent payments in 1994 amounted to nearly $94 billion in this country. Broken down, that amounts to approximately $258 million a day, or $11 million every single hour. As the General Accounting Office stated in testimony before the Committee on Ways and Means, Medicare has already begun to address the problem, and actually leads the private sector in health care anti- fraud and abuse efforts. Unfortunately, in spite of all the rhetoric you hear about fraud and abuse, the Republican proposal loosens the rules that outlaws kickbacks and that requires providers to exercise due diligence in submitting accurate and true Medicare claims. That is not just Democrat rhetoric against the Republican bill. Under the Republicans, the Congressional Budget Office has estimated that the Republican fraud and abuse provisions will cost, cost the Medicare program over $1 billion from 1996 to 2002. That is right. Get it straight. The Republican bill encourages $1 billion in fraud and abuse in the Medicare program. All three of the Federal Government's health law enforcement agencies have spoken out against the Republican plan. It is too bad, in my opinion, that the Republicans are too stubborn to listen to the people who actually enforce the law. It really is time to focus on the facts. The Republicans are cutting Medicare by $270 billion to pay for unnecessary tax cuts, and they at the same time are starting the death spiral of the traditional Medicare program. My bill, H.R. 2422, the Medicare Security Act, shows [[Page H 10127]] the American people that we can protect the Medicare program without hurting our beneficiaries, or disrupting our health care delivery system. I would be the last person in this House to dispute the fact that Medicare is growing too rapidly, and its rate of growth needs to be controlled, if we are going to avoid bankrupting the Federal Government. However we do not need to cut $270 billion from the Medicare program over the next 7 years. Cuts of this magnitude do nothing to save the Medicare program, or extend the solvency of the part A hospital trust fund any longer than is extended by my bill to 2006. Medicare is being cut for one reason and one reason only: That is, to balance the budget and pay for the tax cuts in the amount of $245 billion. My bill shows Medicare spending by $90 billion over the next 7 years, which would keep the part A solvent until 2006. This gives the Congress and the President 10 years to fix the problem of the baby boomers entering the Medicare system, without imposing any hidden costs on seniors or impeding their access to care. As a reasonable alternative, my bill cuts $67 billion from Medicare part A and $23 billion from part B. All of the part B savings go into Part A to make it solvent. These cuts are basically technical adjustments that the health care delivery system can absorb and that will preserve the same level of Medicare coverage and benefits that beneficiaries have today, which is quite different than the Republican bill. Equally important, my bill ensures that the savings in the Medicare program will not create profound disruptions in the health care delivery system, or our teaching hospitals, or access to quality care by our seniors. My approach avoids the substantial increases in both the cost of private insurance and the number of uninsured persons which the Republican plan guarantees. The cuts in my bill are distributed throughout the health care system in an equitable manner to doctors, hospitals, home health agencies, and skilled nursing facilities. In my bill, there are no increased costs to beneficiaries, and adjustments to provider reimbursements have been specifically tailored to protect the basic elements of our health care infrastructure. The Medicare Security Act will not place any additional financial burdens on our elderly poor or their families. You have to understand that fully 83 percent of Medicare expenditures are for beneficiaries in this country, senior citizens in this country, with incomes of less than $25,000. We are talking about people who are living a comfortable life, they are not in poverty, but they are not rolling in money. This is a program that protects the basic American infrastructure that has built this country, people that paid their way, that made this country what it is. Beneficiary payments and copayments should be increased only as a last resort, because these seniors simply cannot afford a doubling of the part B premium, which is what is anticipated under the Republican plan. Their part B premium, that is, for the doctors, already rises from $46 a month to $87 a month by the year 2002. Under my plan, the premiums, as they have grown each year a little bit, will be increased to $58 per month. That is a savings of $30 a month for senior citizens. The real problem, and I think the thing that has been missed in all this debate, because most people walk around thinking this is a senior citizens issue, it really is not a senior citizens issue only. It is partly theirs, but it really is also everyone else's in the population, because the problem for Medicare starts in 2010, when the baby boomers enter the program. Many young people in this country do not believe that Medicare will be there for them when they reach that age. They say, ``Why should I pay for Medicare, because it is not going to be there when I get to be 65.'' That is a legitimate concern. The Republicans' proposal to slash Medicare does nothing to solve that problem. For that reason, my bill, like the Republican bill, creates a bipartisan commission to specifically address the changes needed in Medicare and in health care coverage and finance generally to accommodate those aging baby boomers in 2010. You may say, ``Why another commission?'' In 1983, this House was worried about Social Security. There were thoughts it was going to be insolvent. It would not be there at some point in the future. They formed a commission, made recommendations to this House, we changed some of the laws, and it is now solvent to about 2040. It is that proposal that we have before this House in terms of a bipartisan commission to facilitate the national debate, which is necessary to determine what kind of Medicare program we want for older Americans, and whether or not we as a Nation are willing to pay for that program. We have to make a decision again that was made in 1965. The reason we have to make it now is that we have been so successful. Medicare has been successful. People are living longer. They are living more productive lives. We have more ways in which we can extend life and make life meaningful, and it is costing more. We have to have that debate again. Are we willing to do that for the rest of the society when they get to be 65, and are we willing to pay for it? This blue ribbon commission created by my bill will be charged with the responsibility of building a national consensus on the future of Medicare. This commission will make recommendations to the Congress by January 1, 1998. That is 8 years before any future Medicare collapse in 2006. It is clearly possible for them to do that over the next 2 years, and they should do it. I firmly believe that this commission is the most important part of the bill, and the most important part of this Medicare debate. Before making radical changes in the structure of Medicare, let us have an open and honest debate about what we can do to fix Medicare without destroying it. Changes in Medicare of the magnitude proposed by the Republicans should not be rammed through the House of Representatives after one day of floor debate. Four hours and we are going to ram it out of here. We had not one day of testimony before the Committee on Ways and Means on the proposal that was voted out last week. We had many days talking about what the problem was. You will hear people say, ``We had days and days of hearings on it;'' yes, describing the problem, but not a single day was spent in careful examination, with people coming in from the outside to talk about what the effects of their proposal really would be, so we are going to ram something out of here destroying Medicare, and it does not have to happen. My bill lays down a marker for honesty and simplicity. According to the Congressional Budget Office, this bill and the Republican Medicare bill take the Nation to the same destination, 2006. Fortunately, my bill costs one-third as much, and I believe that is what the House ought to go for. I can see no reason to dismantle Medicare simply for the sake of a tax cut for the wealthiest Americans. Mr. Speaker, I yield to my colleague, the gentleman from Vermont [Mr. Sanders].

Mr. McDERMOTT. Absolutely. I thank the gentleman very much.

Mr. McDERMOTT. Your last point reminds me of the fact that Seattle is playing, tonight, baseball against the Cleveland Indians. The pitcher on the mound is a guy named Randy Johnson, who throws about a 95-mile- an-hour fast ball. The Republicans are throwing a 95-mile-an-hour fast ball past the American people. They want this jammed through here so fast that nobody can really figure it out. That is [[Page H 10129]] really what this is all about, only they do not understand it. The American people have seen that pitch before, and they are going to hang in there and clobber it. I hope the Cleveland Indians cannot clobber Randy Johnson tonight.

Mr. McDERMOTT. If you are talking about single-payer, I am ready to go.

Mr. McDERMOTT

Mr. McDERMOTT. Mr. Chairman, I yield myself such time as I may consume. I think it is important to clarify what has just been said. There is no embargo on people giving. There is an embargo on any sale of staple foods or medicines or medical equipment in Cuba. No one should come away from listening to that last speech and believe that we can get adequate amounts of these materials into Cuba. Mr. Chairman, I yield 4 minutes to the gentleman from Colorado [Mr. Skaggs].

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

Mr. McDERMOTT. Mr. Chairman, I yield the balance to my time to the gentleman from Indiana [Mr. Hamilton]. Let us have no mistake about that. But it is also true that when you put on top of those failed policies an embargo from the United States, that that embargo increases the suffering of the Cuban people. If you ease that embargo by letting food and medicine go in there, which they desperately need, you are going to ease the plight of the Cuban people. Now, Mr. Chairman, Castro takes this embargo we have and uses it as a repressive tool in Cuba today. He uses it as an excuse for repression. All this amendment does is give the opportunity for more food and medicine to go to Cuba. What in the world is wrong with that? Why should we be opposed to relieving the suffering of the Cuban people? I do not know how much will go in. It may not be huge quantities. But we know the situation there today. They are suffering. They need medicine. They need food. Let us see if we can help them out with this very modest measure. Mr. Chairman, I urge a vote against this bill, and I urge a vote for the McDermott substitute.

Mr. McDERMOTT. Mr. Chairman, I yield myself 1 minute to respond to that. I say to the gentleman from Indiana [Mr. Burton], you just made my case. You require a special license under the law to sell medication. There is no way we can sell food to Cuba. There is no special license. There is no way. What this bill is saying is we intend, if possible, to starve the Cuban people into submission, and that kind of policy from the Federal Government is why the U.N. General Assembly has voted 3 years in a row against our position. Mr. Chairman, I yield such time as he may consume to the gentleman from Indiana [Mr. Hamilton].

Mr. McDERMOTT. Mr. Chairman, I yield myself 1 minute to say if I were a Member setting in my office watching this on television or sitting here on the floor watching this, I would be confused because the gentleman from Indiana [Mr. Burton] said there is no need for this amendment; it is already law; they can do anything they want. And the gentleman from New Jersey [Mr. Torricelli] stands up and says that, in fact, this is repealing the entire embargo. Now, which is it? Either we do not need the amendment because they can already do it, or this is a disastrous amendment which is destroying the whole policy. Somebody is wrong on the other side. The fact is that the gentleman from Indiana [Mr. Burton] is incorrect, or he is correct in one part. It is possible for medication and staple foods to go to Cuba. The difference is this: If we want to sell food to Spain, you do not have to get a special license. If you want to sell food to Zaire, you do not have to get a special license. If you want to sell food anywhere else in the world except Cuba, you have to get a special license, and the policy of the Government is not to grant the licenses.

Mr. McDERMOTT. Mr. Chairman, I yield myself such time as I may consume to respond to that. Mr. Chairman, my distinguished colleague from Florida apparently did not read the bill. This is exactly his bill, with one phrase, that is allowing the sale of medication and staple foods. Everything else in the gentleman's bill is in this. All that demagoguery was directed at some figment of his imagination. The gentleman simply did not pay attention to what is in this bill. It is your bill, with one addition. It simply is the addition of medication and staple foods. We have embargoes against every other country, such as Iraq, but we allow food and we allow medication, and your bill is untouched. Mr. Chairman, I yield 3 minutes to the gentleman from Virginia [Mr. Moran].

Mr. McDERMOTT. Mr. Chairman, I yield myself 30 seconds. Mr. Chairman, there is no explanation that makes any sense to me. We have adopted the policy in every other country that increased trade and involvement would ultimately bring about change in the government. We just opened our trade relationship with the Republic of Vietnam, a government that we still disagree with, that we consider oppressive. In fact, we are opening trade, we are involved in a variety of things. We are already, as the gentleman mentioned, in China doing that. It makes no sense, particularly in this area, where you are not punishing Mr. Castro, you are not punishing anybody in the top of the organization. You are punishing the people. That does not work and is wrong.