George Miller

Mr. MILLER of California

Mr. MILLER of California. Mr. Speaker, I thank the gentleman for yielding, and I really rise to thank the members of the committee who have worked so terribly hard on behalf of this legislation. It has taken a great deal of tenacity and it has taken a great deal of patience to bring this legislation to the floor but it is clear that this legislation is in the best interest of the Nation and it is in the best interest of the Presidio. One need only stop for a moment at the Presidio to recognize immediately why this wonderful, wonderful national asset has such broad popular support across the Nation from every conceivable part of American society, but bringing all those disparate parts together is hard work and takes a great deal of patience and a great deal of counsel. Our colleague, the gentlewoman from California, Congresswoman Pelosi, provided the strategy, the counsel, and the patience; and our colleague, the gentleman from Utah, [Mr. Hansen], provided the counsel and a great deal of patience in dealing with this legislation. What has emerged is a bipartisan piece of legislation supported by every level of government, every level of citizen group, every level of national organization for the preservation for the Presidio. There was no question that the Presidio was going to become a park. That has been done. The question and the challenge has been how can we best support that park, finance that park and deliver all of the assets and all of the uses of the park to the American people and to those of us who live in the San Francisco Bay area. This legislation achieves those goals while trying to get the very best bang for the buck for the taxpayers and trying to make sure that we can maintain all of the reasons and all of the assets of the Presidio that make it such a charming addition, an important addition to the Park Service, and to the cultural history of this Nation and of the bay area that that long history will be preserved with this legislation. Mr. Speaker, this is an important piece of legislation. There really is no other alternative. This legislation was born out of months and weeks and hours of deliberations of other ways of meeting the goals and the needs of support for the Presidio, and that is what has emerged out of those deliberations. I would hope that the House would support it overwhelmingly. I would hope that they recognize that if this is successful, this is, in fact, the blueprint for how we can work out arrangements for other assets within the Federal Government's park system and preserve system so that they can be both utilized and they can be properly supported so that we will not diminish their value, their characteristics, and their importance to both the Nation and to the regions. Mr. Speaker, I also would like to thank Judy Lemons, who has worked terribly hard, Steve Hodapp, who came at this, with all of the support and efforts and difference of views of various constituency groups, and allowed us to fashion this legislation. I urge my colleagues to support it.

Mr. MILLER of California

Mr. MILLER of California. I thank the gentleman. Mr. Speaker, I withdraw my reservation of objection.

Mr. MILLER of California. I yield to the gentleman from Alaska.

Mr. MILLER of California. Mr. Speaker, reserving the right to object, if I might, I would enter into a colloquy with the gentleman from Alaska [Mr. Young]. I would like to have the gentleman clarify a point on H.R. 39 of the Magnuson Act reauthorization. Is it the intention of the Chairman of the Committee that we will only consider the bill under general debate today, and rise to consider the bill for amendment at some later date? [[Page H 9075]]

Mr. MILLER of California

Mr. MILLER of California. The $80 billion that we see the Republicans now starting to talk about is assuming that all of their numbers work. And we see one organization after another, whether it is the hospitals, whether it is the doctors, whether it is the States, questioning whether or not their numbers will work. If their numbers do not work, 80 becomes 85, becomes 90, becomes $100 billion. So this black hole, like the hole in the ozone, will grow every year, because these numbers, just for example, Arizona is the only State in the Union that has its entire Medicaid caseload in managed care. It continues to grow at a 7-percent rate. Under the Republican resolution, the maximum is 4 percent. Arizona, the model on which they are basing, is growing twice what they will allow. That adds to the 80 billion gap in this budget that the gentleman has pointed out.

Mr. MILLER of California. Mr. Speaker, we can have hearings as long as any chairman wants to hold hearings. They are capable of holding hearings. This is a leadership decision. If the gentlewoman would continue to yield. This is a leadership decision by the Speaker and the majority leader, Mr. Gingrich and Mr. Armey, to ram this through before the American public and, mainly the seniors and their families, can find out about it.

Mr. MILLER of California. Well, Mr. Speaker, I think today Medicare reimbursement is about 80 percent of what doctors get in the private market. There is that reluctance. We are now seeing that that same process that drove medicine out of Medicaid, that drove doctors away from taking care of those patients, now comes into play in Medicare. I was at a neighborhood party the other night and a woman came up to me, Rose Quantamatteo, and she said I want you to tell Speaker Gingrich that there is a woman in your hometown Martinez that every night gets down and prays and thanks God for Medicare, for what it meant for me and my husband, Tony, who, unfortunately, passed away a couple of years ago. She said we would never have been able to survive the financial hardships, our children would not have been able to survive the financial hardships. She says just let him understand that this is what it means to our generation. I think it is typical of the person the gentleman described and of people we have all met who want to know the facts. They want to know where Medicare is going to be tonight, tomorrow, after we vote on Thursday, and 3 years from now when we look back. That is what they want to know, and they want to know what kind of changes we are talking about, and the Republicans do not come forward with that.

Mr. MILLER of California

Mr. MILLER of California. Mr. Speaker, I would like to speak to the gentleman's motion and his inquiry of the minority. Sixty-seven percent of the Medicaid costs to go pay for elderly people's long-term care that their families cannot afford. And that is why we want this discussion. But we want this discussion in front of the Committee on Ways and Means where people can be cross-examined, where their points of view can be examined, their figures can be examined and the American public can then make a determination. Having all of this discussion, have all of this discussion prior to the Committee on Ways and Means hearing has nothing to do with this bill. We have examined the options for Medicare since 1948. But this is where the rubber hits the road. This may not cut Medicare, that is your claim, but it is going to certainly cut household income for people, and it is going to certainly cut their disposable income as their premiums continue to go up and the cost of their relatives continue to go up and the care of their parents continue to go up. That is what this debate is about. The gentleman ought to have the courage of your convictions, he ought to put that bill into the Committee on Ways and Means. We have experts on the committee in terms of the Members of the Congress, the staff there, and we ought to cross- examine the different opinions about what this bill is going to do or not do to families in this country who are deeply concerned about their future health care and the health care that their parents and their grandparents are receiving today, because that is what is on the chopping block and we do not know anything about it. But one day's hearing just does not satisfy it. We had hearings on the Committee on Ways and Means I believe earlier this year on every cockamamie tax loophole that some Member wanted for somebody in their district. Those went on for days. But now we are talking about the largest single change in American health care in the history of this country since the beginning of the Medicare-Medicaid system, and it is one day's worth of hearing. What we are asking for and the gentleman is asking for is consider a resolution that says we can examine this in the Committee on Ways and Means for 4 weeks, let the people be heard, let the providers be heard, let the beneficiaries be heard, let the teaching hospitals be heard, let the rural hospitals be heard, and then let the American people decide. But apparently, apparently, there is a great fear on the other side of the aisle that the public discussion will not allow their proposal to be successful.

Mr. MILLER of California. Mr. Speaker, will the gentleman yield?

Mr. MILLER of California. Mr. Speaker, I thank the gentleman for yielding, and I would hope that not only would we get this debate about the debate that we would choose to have, and unfortunately, if the Republicans do not grant us your resolution to have that debate or to provide for several weeks of discussion on these Medicare cuts, then we are left, as the gentleman has said, with 1 day in the Committee on Ways and Means. We do not know what this plan is. We have seen speculation in the press about this, that there is $110 billion taken from providers and there is an $80 billion black hole that looks back and maybe hits providers or beneficiaries 2 or 3 years from now. But the fact is, as the gentleman from Florida knows, the Medicare system is more than just Medicare, it is teaching hospitals, it is poor widows that have the premium, Medicare premiums, paid for by Medicaid; it is a very complex system. And simply announcing the bill and having the hearing and voting on it a week later does not satisfy our obligation to the people that we represent, because the plan will look very different to different people depending upon where they are in the American health care system, whether they are in an urban hospital or a rural hospital, whether they are poor and their premiums are paid by Medicaid, whether they will be able to continue or not continue on Medicare, whether they are a teaching facility, and that takes time. I can understand the Republicans not wanting to have this time, either in the Committee on Ways and Means or anywhere else. But the fact is, this is the biggest change we have in the history of American health care since the advent of the American Medicare system, a system that has provided health care to millions of seniors, that their families rely on. We are now seeing a whole series of discussions by medical analysts that families, people my age who are in their 50's, who are in their 40's, whose parents are in their 80's, now have the threat that these Medicaid cuts could mean that hundreds of thousands, if not more, people will not have access to long-term care, or to nursing home care.

Mr. MILLER of California

Mr. MILLER of California. Mr. Speaker, it is quite telling on how excited my Republican colleagues get when democrats tell the truth about their plan to cut Medicare by $270 billion. I am sure in their districts they got the same reaction that I got in mine when people learned that those cuts in Medicare were not going to be recycled to improve or extend the longevity of the Medicare Program, but rather much of that money was going to be taken away for the first time in history from the Medicare Program to pay for tax cuts for some of the wealthiest people in this country. My constituents understood the need to make adjustments in Medicare. What they could not understand was a plan to raid that system, to make the problems worse, and for the first time in history take money away from Medicare for other purposes in terms of the budget. Medicare ought to be solved within the Medicare system, independent of the drive to pay for tax cuts for the wealthy, to pay for tax cuts for the richest families in this country, while stealing the money from the elderly who need health care that they can afford.

Mr. MILLER of California

Mr. MILLER of California. Mr. Speaker, I am appalled at the message that the Republican Congress is sending to all of the American Indian and Alaska Native tribes of this country. It is saying that not only do we regard you as just another set of interest or lobbying groups, but we don't want to hear from you either. First, the bill, H.R. 2127, treats Indian tribes like any other special interest or lobbying group. Mr. Istook has said, ``It's only groups which ask for Federal handouts that are covered.'' Is this really how the Republican Congress views Indian tribes? Because the bill language, while it specifically exempts State or local governments, makes American Indian tribal governments fully subject to its speech-chilling provisions. Indian tribes are not special interest groups, or lobbyists--they are sovereign nations. And they are not asking for handouts. Second, the bill would prohibit Indian tribes and tribal advocates from using any Federal funds to participate in a wide range of activities, including attempts to ``influence legislation or agency action,'' participating ``in any judicial litigation or proceeding,'' even as an amicus curiae, or lending any support to individual or organization that spent more than 15 percent of its expenditures on political advocacy in the previous year. In addition, the bill gags tribes by defining ``influence'' to include any communications with any Member or employee of a legislative body or agency, or with any Government official or employee who may participate in the formulation of legislation or agency action. Tribes or tribal organizations that engaged in substantial political activity during any of the past 5 years, starting in fiscal year 1996, will lose all of their Federal funding. It is as simple as that. The threshold is 5 percent of the tribe's nongrant funds; in other words, 5 percent of the difference between the tribe's total expenditures and the amount of its Federal funding. Furthermore, any tribe or tribal organization that receives Federal funding will be required to prove by clear and convincing evidence that it has complied with all of the provisions of the bill. How on Earth does this Congress expect Indian tribes--who depend upon Congress, the Executive, and the courts for protection, and who count upon the Federal Government to uphold its trust responsibility to them--to have any role at all in democratic process? Under this ridiculous scheme, Indian tribes and tribal organizations would be left without any say or recourse in the development of laws, the formulation of agency actions, or the decisionmaking of courts--unless they are named parties in a case. For instance, tribes could not consult with the House or the Senate on matters such as the Interior budget, welfare reform, gaming, education, or self-governance. Tribes could not work with the Bureau of Indian Affairs or with the Indian Health Service to improve education, health care, to protect their resources, or otherwise safeguard their rights. Finally, the bill would discourage or prevent tribes from submitting amicus briefs on Indian cases before the Supreme Court. If this bill had been the law, then few if any of the gains that tribes have made in Congress or the courts in the past 30 years would have occurred. We would not have a Self-Determination Act or a Self- Governance Program. We would not have an American Indian Religious Freedom Act or an Indian Child Welfare Act. There would not be a Native American Rights Fund or an Indian health board in existence. Let's not kid ourselves. The Republican Members of this Congress knew exactly what they were going when they chose not to exempt American Indian and Alaska Native tribal governments from this bill--they were trying to silence the voice of this Nation's first peoples. There simply is no excuse for this at all.

Mr. MILLER of California

Mr. MILLER of California. Mr. Speaker, water supplies for California cities are extremely limited. Whenever possible, cities attempt to use their water storage and conveyance systems in the most efficient ways they can. The city of Vallejo has tried to use its water supply facilities more efficiently, but has been frustrated by a limitation in Federal law that prohibits the city from sharing space in an existing Federal water delivery canal. The city of Vallejo simply desires to ``wheel'' some of its drinking water through part of the canal serving California's Solano Project, a water project built by the Bureau of Reclamation in the 1950's. Vallejo is prepared to pay any appropriate charges for the use of this facility. Allowing Vallejo to use the Solano project should be a simple matter, but it is not. Legislation is required to allow the city to use the Federal water project for carriage of municipal and industrial water. Congress in recent years has expanded the scope of the Warren Act to apply to other communities in California and Utah where there existed a need for more water management flexibility. The legislation I am introducing today will simply extend similar flexibility to the Solano project and to the city of Vallejo. I very much appreciate Mayor Tony Intintoli's bringing this situation to my attention. I would hope that we would be able to deal with this matter in the Resources Committee quickly and without controversy.

Mr. MILLER of California

Mr. MILLER of California. Mr. Speaker, together with 63 other Members of the House, today I introduce a bipartisan bill that would enable the President to award posthumously the Congressional Medal of Honor to Sgt. Ruben Rivers. In 1944, a serious injustice occurred. Although Sgt. Ruben Rivers showed extraordinary courage and sacrificed his life for his country during World War II, he nonetheless was passed over by his superiors for the Congressional Medal of Honor. It is most appropriate that we reconsider Sergeant Rivers for the medal this year, while we are commemorating the 50th anniversary of the end of World War II. Sergeant Rivers was part of the all-black 761st Tank Battalion. The battalion was called upon by General Patton to liberate Bougaltroff, France from Nazi control. During a fierce battle, Rivers drove his tank over a mine and was injured, his thigh lacerated to the bone. Rivers was ordered by his commander to retreat to safety for medical treatment. Sergeant Rivers not only refused to abandon his fellow soldiers, he also refused morphine so that he could remain alert and continue fighting. Rivers fought on for days until he was killed during another battle while trying to knock out Nazi positions firing on his company. Rivers, from Tecumseh, OK was 25 years old. Sergeant Rivers' nephew, former Richmond Mayor George Livingston, lives in Richmond, CA, in my district. Capt. David Williams, a white officer, immediately recommended to his superiors that Rivers receive the Medal of Honor posthumously. As was the case with other black soldiers, the recommendation for Rivers was never acted on. The Department of the Army establish a 1952 deadline for conferring the Medal of Honor for service in World War II. This bill waives that deadline for Sergeant Rivers, thereby enabling the President to present the medal to Rivers' sister, who is still alive and is fighting for this recognition. To date, no African-American has received the Congressional Medal of Honor for service in World War II, even though over 1.2 million black soldiers served in that war. This blemish on our Nation's history should be wiped clean, and we should start by allowing the Department of the Army to reconsider Sergeant Rivers for the Congressional Medal of Honor.

Mr. MILLER of California

Mr. MILLER of California. Mr. Speaker, I rise today to pay tribute to Dr. Lonnie Bristow, a concerned physician, a constituent from San Pablo, CA., and a man with a heavy responsibility as we close out this century. Dr. Bristow was recently elected president of the American Medical Association. Dr. Bristow is also the first black president of the powerful medical organization. I have worked with Dr. Bristow over the years as we have tried to find a solution to the many health insurance problems facing our country. Dr. Bristow and the AMA will be at the center of this critical and ongoing debate. I wish Dr. Bristow many successes in his new position and I look forward to continuing to work together. I believe the article attached here from the Los Angeles Times captures the commitment Dr. Bristow has to his new position as president of the AMA and to pursuing health care policies that will benefit the entire Nation. Attached, article from the Los Angeles Times, Tuesday, July 18, 1995 ``He Might Have the Cure for Medicine's Ills''. He Might Have the Cure for Medicine's Ills (By Bettijane Levine) It is oddly reassuring to spend time with Dr. Lonnie Bristow, small-town doctor and newly elected president of the American Medical Assn.--the first black president in the AMA's 148-year history. During those moments, you bathe in the aura of a kindly, assertive man who believes that the current crisis in American medicine is not a fatal condition, and that in his new capacity he can help to make it better. If Bristow can be believed--and he admits it might require a leap of faith for some familiar with AMA history--the way to start curing medicine's ills is for doctors to rejoin the organization that a majority of them have abandoned in recent years. Only 40% of U.S. doctors now belong to the AMA, down from 70% two decades ago. We are in an era when doctors are losing control of the care of their patients. Bristow says; when patients sense that the quality of care is diminishing; when some of the country's great medical institutions are endangered because of lack of funds and drastic cutbacks. ``We now have health care being controlled by MBAs rather than by physicians committed to the Hippocratic oath.'' Bristow says, referring to the corporations from which most Americans receive health insurance. ``And once health care becomes corporatized, as it has, and once it goes on the open stock market, then its major commitment is to Wall Street and the stockholders to maximize profits, rather than to give the best possible patient care. Business principles are introduced that unfortunately put patient care second to corporate profits.'' It is an uncharacteristically direct outburst for Bristow, 65, who has worked his way up through the ranks of the AMA, who appears to be the consummate organization man, and who speaks sincerely but cautiously during an interview. His discretion has apparently been honed to a fine point during 30 years of participation in the AMA, considered by many to have been a racist organization. For much of the AMA's history, black doctors were not allowed to join. Unit 1968, the organization permitted state and local branches to deny membership to black doctors simply because they were black. The AMA also backed South Africa's medical society in international medical meetings, although the group supported apartheid until 1989. Bristow, who has practiced internal medicine for 30 years in San Pablo, Calif., speaks in a soft voice unmarked by anger or agitation. He acknowledges that when he joined the organization in 1958, after finishing his internship at San Francisco City and County Hospital, ``There were parts of the country where black Americans could not join.'' But in San Francisco, he says, ``there was nothing to it.'' His philosophy regarding many tough issues, including racism, he says, ``is that if you want to change something, you do it from the inside. You don't stand outside and complain about it.'' He applies that reasoning to doctors who have broken away from what Bristow calls ``the mother group,'' preferring to belong only to associations related to their own medical specialties. Cardiologists, radiologists, urologists and others have begun to think of themselves as specialists above all else, Bristow says. Many have splintered into even smaller subgroups, he says, preferring to associate with those who are like them in the sense that they support or oppose abortion rights, are Republican or Democratic, are fee-for-service or salaried. Bristow's goal as president will be to ``make all these doctors understand that we have much more to unify us than to divide us. What we have in common is much more meaningful than that which might pull us apart.'' If the defecting doctors can be persuaded to ``come back under the umbrella of the AMA,'' he believes, ``we will have more leverage and a better chance to get the kind of medical care for our patients that most of us want. ``The entire profession of medicine, and the doctor-patient relationship we all respect and love, has sailed into harm's way,'' he says. ``We have to pull together the way any family would in a time of trouble,'' to get medicine back on the right track. Bristow, a tall, imposing figure in a charcoal gray suit, stops to ponder for a moment. ``It's hard for me to explain just how exhilarating and personally satisfying it is to make an impact on another human being's life in a positive way. Doctors share that, above all else. It is the reason we became doctors in the first place. ``That ability to make an impact, to help improve patients' lives'' is being eroded by corporatized health care that is not run by doctors but by business people and that dictates what treatment, and how much treatment, doctors can prescribe, Bristow says. ``It intimidates doctors into acquiescing,'' he says ``That is a major reason for doctors to band together, no matter what their specialties or political beliefs. ``I don't expect all doctors to agree on everything. But on certain key issues, such as the sanctity of the doctor- patient relationship, the importance of freedom to choose which doctor to see, the importance of physicians being able to practice medicine the way they think is appropriate--those are issues which all doctors should be able to rally around.'' He says that AMA will support a Patient Protection Act in Congress at the end of summer. It would guarantee, he says, full disclosure about all insurance programs, so potential subscribers will know the program's track record, whether previous users have been satisfied, and how much of the premium they pay actually is spent on patient care as opposed to dividends to stockholders and salaries for corporate managers. The act would also mandate that physicians who contract with an insurance program may ``not be fired without case and without due process.'' Physicians are being threatened by insurance companies who vow to fire them from the group if they do not practice medicine the way the insurance company directs them to, Bristow says. The AMA, he says, is working to get universal health-care coverage, to make health care portable, and to make it available to people with pre-existing conditions. Bristow was born in Harlem to a Baptist minister father and a mother who was a nurse at nearby Sydenham hospital. His interest in medicine began, he says, when as a boy he would go to the hospital emergency room to pick up his mother and accompany her on the walk home. There were medical workers of all races pulling together there, he recalls, and they were saving people's lives. Bristow received his bachelor's degree from City College in New York in 1953, and his medical degree from the New York University College of Medicine in 1957. He went to Northern California for his internship and residency, and has specialized in occupational health there since. He began cutting back on his practice a few years ago, he says as he became more involved in organizational work and travels on behalf of the AMA. ``As a physician, I was helping one person at a time. I became evident that if I really wanted to improve medical care for my patients, for my community, perhaps even for the whole country, I would have to have some sort of advantage, some greater power than I had as one lone doctor. That's what organized medicine provides.'' He became the AMA's first black member of the Board of Trustees in 1985, and the first black chairman of the board in 1993. He spent about half of last year on AMA business, for which he reportedly received $278,000 in compensation. Bristow and his wife, Marilyn (a former nurse who has been his office manager for 30 years), were in Los Angeles recently to help their son, Robert, settle into a Westwood apartment. He is an obstetrician/gynecologist starting a fellowship at UCLA in gynecologic oncology. Their daughter; Lisa, runs a day-care center in Northern California. Bristow says he hopes to ``get away from the stereotypes'' once associated with the group over which he now presides. He would like the nation's doctors as well as the general public to come to think of it as ``our AMA,'' meaning that it's a group that has the public's health as its major concern, and that it ``takes good care of America.''

Mr. MILLER of California

Mr. MILLER of California. The Chair was not in bounds to speak for the Member.

Mr. MILLER of California. I do.

Mr. MILLER of California. Mr. Chairman, if I could ask either the gentlewoman from New Jersey or the gentleman from Tennessee, both who have worked incredibly hard on this problem, in the case of a public institution, a community college which we have a lot of obviously in California and Texas and other places, what happens there? I mean it is the student who is in default, but you have other students who want to come to the institution who are eligible for Pell grants. Would they be denied Pell grants? You talk about we have a very limited number of loans. But would that be true?

Mr. MILLER of California. Mr. Chairman, I have a parliamentary inquiry.

Mr. MILLER of California. I thank the gentleman.

Mr. MILLER of California. I yield to the gentleman from Pennsylvania.

Mr. MILLER of California. No, I prefer to stand.

Mr. MILLER of California. Has the time in opposition been claimed?

Mr. MILLER of California. Mr. Chairman, could I claim the time in opposition?

Mr. MILLER of California. I think I might, Mr. Chairman.