Paul Wellstone

Mr. WELLSTONE

Mr. WELLSTONE. Mr. President, I ask unanimous consent that the order for the quorum call be rescinded.

Mr. WELLSTONE. Mr. President, I rise to speak for a short period of time about several key pieces of reform legislation. I ask unanimous consent I be allowed to speak as in morning business.

Mr. WELLSTONE

Mr. WELLSTONE. Mr. President, I rise to express my deep concern--and even some indignation--that several key pieces of reform legislation continue to be bottled up in the Congress, including the gift ban, the lobbying reform bill, and tough, sweeping campaign finance reforms. I am more convinced than ever that one of the key issues, maybe the root issue of American politics, is the way in which we now have to finance campaigns. And the sooner we move toward a system where we are able to get a lot of the bigger money out of politics and have a level playing field for incumbents and challengers and figure out how to do this in a sane way, the sooner we will have a much better political system. The lobbying disclosure bill, a key piece of legislation that Senator Levin has taken important leadership on, is really simple and straightforward. But just to summarize, what this legislation says is that those who are actually [[Page S6197]] paid to lobby, hired to lobby, ought to be officially registered. This is in the spirit of accountability. Nobody is pointing the finger at those who lobby, or suggesting that somehow constitutional rights for citizens to petition our Government should be curtailed. We are simply saying that we ought to have openness and accountability in this political process by requiring all those who engage in lobbying activities to register. But in addition to lobbying registration and campaign finance reform, what I want to focus on more specifically, at least for a short time, is the gift ban. It is very simple and very straightforward. Americans are watching closely to see if the new majority in the Congress delivers on its promise of reform. While some of the new Members ran for office on reform platforms, so far they have not produced much of anything. This should not come as a surprise, because many of those same people who talked about reform were the ones who blocked major reform last year in each of these areas. I think, toward the end of the last Congress--and I will just editorialize on this question--toward the end of the last Congress I think the effort to block the gift ban reform was more an effort to make sure that Democrats did not get any credit for it. It really had nothing to do with the high ground of good public policy. I believe the reform promises have rung hollow all along and they ring even more hollow today. Mr. President, I have an editorial from the Washington Post, I believe it was yesterday. I ask unanimous consent that it be printed in the Record.

Mr. WELLSTONE

Mr. WELLSTONE. Mr. President, I ask unanimous consent that the order for the quorum call be rescinded.

Mr. WELLSTONE. I thank the Senator.

Mr. WELLSTONE. Mr. President, I ask my colleague from California if she has come to the floor to speak on budget and Medicare. She was here first. I will be pleased to follow her.

Mr. WELLSTONE. Mr. President, I ask unanimous consent that I yield myself such time as I might need from the majority leader's time.

Mr. WELLSTONE

Mr. WELLSTONE. I thank the Chair. Mr. President, we are, in a very short period of time, going to have a historic debate about the budget and about priorities in our Nation, the United States of America. Part of that debate--and I know my colleague from California will be speaking to this as well--will focus on Medicare. As I have followed over the last couple of days some of the press conferences and some of the discussions taking place about Medicare, I think it is really important to come to the floor and speak about Medicare, not so much in political terms but in substantive terms. We are faced with a real irony. It may very well be that a good many of my colleagues will now discover that health care reform--not just a focus on Medicare or Medicaid but real health care reform--is a pressing, compelling issue in this country. First of all, Medicare is a benefit program. It is not just an actuarial program. It is important for me to make this point, Mr. President. My mother and father are no longer alive. Both actually had Parkinson's disease, but I can tell you, for my parents in their older age, Medicare, imperfections and all, was extremely important and it continues to be extremely important to senior citizens in this country. It is not by any means perfect. It does not cover catastrophic expenses, it does not cover prescription drug costs, and elderly people over 65 years of age pay four times as much out of pocket as citizens under 65 years of age. But I think this focus on the budget is going to get us to the point where all of us understand some realities about health care and health care policy in the United States. Eighty-five percent of Medicare expenditures pay for care for seniors with household incomes of less than $25,000 a year. So let us also understand that these benefits help hard-pressed people, not people who have plenty of income on their own. Second point, Mr. President. I was on the floor the other day in a debate with one of my colleagues--I think it was the Senator from Texas, Senator Gramm--and he was talking about his efforts to block health care reform in the last Congress and he was proud of that. In another point in time, we will have a debate, and I do not have a practice of debating colleagues when they are not on the floor, but I will say, as a matter of fact, one of the reasons that we are now dealing with the whole question of Medicare and how to finance Medicare is because we did not pass any comprehensive health care reform last Congress. Mr. President, 89 percent of the growth in Medicare spending since 1980 has been due to medical inflation, general inflation, and changes in enrollment. Let me go over those. Medicare is a benefit program that, of course, we have to finance. It is part of what we are about as a country. It is, indeed, a contract with senior citizens, and as we move into the next century, a larger percentage of our population are older Americans, and a larger percentage of those older Americans are older. That means that the cost of the program goes up. Then there is the issue of general inflation. There is not much we can do about the first issue that I mentioned. And there is not that much we can do about general inflation, but we can look at medical inflation. The interesting thing is that the Congressional Budget Office made it clear last Congress--I did not say Democrat, Republican, but CBO--that there are two ways you can contain medical costs. One is through global spending caps, as in the single payer proposal, or, if you do not prefer that, by placing some limits on insurance premiums. Some limit on insurance premiums is a very effective way of containing costs. But, Mr. President, if you just focus on one segment of the population and you cut $250 to $350 billion between now and the year 2002, you will have a severe impact on that population. Let me say to my colleagues, when you were talking about rationing last Congress when we were talking about comprehensive health care reform, when you were yelling and screaming about rationing last Congress, I did not think that you had a case to make. But if you are just going to target Medicare, if you are going to cut expenditures for just one segment of the population, then you will ration by age, you will ration by disability, and if you throw Medicaid into the equation, you will ration by income. But now I do not hear my colleagues talking about rationing at all. Second of all, if you make these cuts in Medicare, you are going to throw this whole health care system into--and I do not want to exaggerate--I would say a fair amount of chaos, if not utter chaos. I ask unanimous consent to have printed in the Record a statement from the National Leadership Coalition for Health Care Reform, which includes many businesses in this case.

Mr. WELLSTONE. Mr. President, I thank my colleague from California for her gracious remarks. It is ironic that indeed we have now come full circle back to the last Congress. The very people who were so proud of having blocked health care reform are now talking about a crisis in Medicare, talking about how we will finance it, and are now making a proposal, I say to my colleague, for rather draconian cuts in Medicare. But they do not want to talk about rationing. Now they really are making proposals that will ration. I think there are certain realities now that we all hope we will face up to and move forward on health care reform. It is the only way to do it. Otherwise, it will be disastrous. The kind of proposals I hear people making now to cut Medicare will not only hurt senior citizens, but as I said, will create absolute utter chaos in this health care system. They do not deal with preexisting conditions, they do not deal with any of the bias of not having community rating, they do not deal with how to make it affordable. If anything, it will just have a severe impact.

Mr. WELLSTONE. That is why the business community is opposed to these cuts in Medicare, because they know it will be a shell game. Mr. President, this will result in utterly irrational charge shifting. What will happen is that the providers already not receiving reimbursement they need will just shift the cost to the private sector, to those of us who have private health insurance plans. The business community knows that. Some of my friends who were talking about Medicare just as a way of reducing the deficit, or even when they talk about reforming health care but just focusing on Medicare, I think really overlooked problems. Third of all, Mr. President, I could tell you right now, I would fight this tooth and nail if for no other reason than in rural Minnesota, greater Minnesota, many hospitals and clinics will go under. In some cases, 75 percent of their revenues comes from Medicare. If you are going to take a meat-ax approach, a slash-and-burn approach, if you are not going to contain costs in the health care field but you are going to have these cuts in Medicare alone, then I could just tell you right now, many of our hospitals will go under and clinics will go under in our rural communities. Fourth of all, Mr. President, this idea of vouchers--this is unbelievable. People are going to have to get real with the people that we represent. To say we will just give you a voucher, that we will set some kind of limited per capita payment, and then you go out, senior citizens, and sort of negotiate whatever plan works well for you. Mr. President, with preexisting condition exclusions, with no risk adjustment between plans, with no community rating, how do you think that is going to work? How do you think that is going to work? If you have a preexisting condition, you may be flat out of luck. If there is no risk adjustment, under a capitated system there will be a tremendous incentive for health plans not to accept people who are older and sicker. You have to make an allowance for that and that involves serious insurance market reforms. Mr. President, my colleagues and I were able, a couple weeks ago, to restore the funding for an insurance counseling and assistance program--unwanted by Republicans, unfortunately. They wanted to even eliminate a small program providing counselors for elderly people to make sure people do not get ripped off by some of these private Medicare supplementary plans. It is as if they are just going to give people a voucher and say, good-bye, you are on your own. Finally, Mr. President, let me make a point that the Medicare payment system is the way in which we finance some of the most important things we do in medical education. If we take away that funding, we are going to lose one of the most important things we do in this country. Training residents is a public good--the competitive private insurance market will not pay for it. You would have to ask everyone to pay into a fund in order to eliminate Medicare funding. But I have not heard such a proposal this year. Mr. President, in Minnesota we have efficient markets. We have done an excellent job of holding down the costs. But there has been very little equity in terms of the kind of per capita payment. Parts of New York get $646 per month per enrollee, and Hennepin County in Minnesota, urban Minneapolis, gets $363 per month per enrollee. This is in terms of our reimbursement now for Medicare managed care plans. My State does not have any fat. If you are going to talk about across-the-board cuts, I will just tell you right now the impact on a State like Minnesota will be severe. We are in a very precarious position. So, Mr. President, let me conclude this way. No. 1, the idea of cutting $300, $350, $250 or $400 billion in Medicare, so that we can have across-the-board tax cuts flowing to the wealthiest segment of the population, is simply outrageous. It is simply outrageous. A family making under $30,000 would be getting, roughly speaking, $100; and families with incomes of over $200,000 would be getting, roughly speaking, $11,000. And for that, we are going to have these kinds of draconian cuts in Medicare? It is outrageous. No. 2, if we do not have that tradeoff--and I think some of our more responsible colleagues understand we cannot do that--I say to my colleagues that you cannot move forward with cuts in Medicare unless you do overall health care reform, and you cannot do it unless you contain overall costs. welcome to health care reform. Welcome to the health care issue. It is back. How ironic it is that when historians write about the 104th Congress, they are going to say that the 104th Congress had to address health care reform, how to finance it, how to deliver health care to people out in the communities in an affordable, dignified way. The reason the 104th Congress finally moved on this question is that some Senators realized, finally, that the only way we are really going to have deficit reduction based on a standard of fairness and the only way we are going to make sure we are able to provide decent health care coverage for all of our citizens, regardless of age or where they live or income, is with significant, meaningful health care reform. I am ready to work with colleagues on both sides of the aisle, because I think that will now have to be one of our major priorities. I yield the floor. Mrs. BOXER addressed the Chair.

Mr. WELLSTONE

Mr. WELLSTONE. Mr. President, I shall be brief. I was one of the first Senators--and I am glad to be out here with colleagues on both sides of the aisle--to oppose the idea of selling the PMA's. I have spoken with the President. I have spoken with Alice Rivlin at OMB. I have spoken to relevant Budget Committee members and written letters to other Senators. I basically see it this way. If you sell the PMA's, if the Government should sell the PMA's above current value, the only people who would want to buy them, some of the private investor-owned utility companies would want to buy them in order to raise rates. That is the only way they can make up the difference, in which case the ratepayers suffer. If you sell the PMA's at below current value, then this is a loss for the taxpayers. If you sell the PMA's at exactly the current value, insulating both the taxpayer and the ratepayer, then the only thing you are doing is privatizing for the sake of privatizing. So this proposal makes absolutely no sense. Mr. President, I believe in the mission of the PMA's and the longstanding contract of the Western Power Administration with Minnesotans, and I think to sell these PMA's would be a serious mistake for greater Minnesota. at production costs to rural electric cooperatives, municipal utilities, hospitals, school districts, and Federal facilities. Without this program, the energy bill for people in greater Minnesota could rise as much as $400 a year per customer--could rise as much as $400 per year per customer. In this time of budget cutting, it is important to point out that WAPA is not an example of wasteful Government spending. In fact, through WAPA we actually pay off a Government loan. And more importantly, WAPA is a Government program that recognizes the unique needs of rural communities that lack the access to affordable energy enjoyed by their metropolitan neighbors. Rural Minnesota is willing to do its part as our country works to reduce the Federal deficit, including selling wasteful Government operations. But eliminating a program that does not cost money and actually contributes to the health of the rural economy is an example of cutting for cutting's sake. It makes neither economic sense nor common sense, and that is why, as a Senator from Minnesota, I put this battle at the very top of my list of priorities. I yield the floor. Mr. DORGAN and Ms. MOSELEY-BRAUN addressed the Chair.

Mr. WELLSTONE. I thank the Chair.

Mr. WELLSTONE

Mr. WELLSTONE. I see other colleagues on the floor. I wanted to speak briefly about an amendment that I have offered.

Mr. WELLSTONE. I thank my colleague, too. I think ultimately where I come down on this question is--while some of my objections I have tried to be clear about--I guess I still do not find the argument about the jury being swayed on a motion to appeal that persuasive--and you know what I am going to say. These are the people who vote for us in elections. I will tell you that my State has struggled with this question, and we have passed some significant reform. You may want to do this in Arizona. I think the Senator from Massachusetts ultimately will have the State-opt-out amendment. It seems that States--the Federal preemption bothers me to no end and not trusting juries, which are citizens, to make these decisions when we trust them to elect us to office, I think is a curious irony. I think that is one of the flaws in the proposal. I know the Senator presents this in very good faith. I agree with the Senator--not on his amendment, but I agree and we share a very strong common commitment and interest--and I look forward to working with you on this--about how we can make sure that some of our underserved areas, where we have men and women that can deliver dignified and affordable health care. In rural Minnesota, the issue is not any longer whether you can afford a doctor but whether you can find one. I do not think the cause of that is what you think is the cause. But I think we can work together. I thank my colleague. I want to briefly speak about a ``Dear Colleague'' letter I have sent out on an amendment I introduced on Friday. This amendment deals with what is called the national practitioner data bank, which was created in 1986. Mr. President, this data bank provides information in two decisive areas that are extremely important to provide this. One is the area of what is called adverse actions. When an adverse action has been taken against a doctor by a hospital or by a medical board, essentially saying to that doctor, ``You cannot practice medicine at this hospital any longer because of a pattern of negligence,'' or ``you cannot practice medicine in the State any longer,'' then that information-- very important information--goes into this data bank. Mr. President, the second kind of information that is critically important that goes into that data bank is information that deals with malpractice payments. When in fact a doctor has made a malpractice payment, then going into this national practitioner data bank is very important information on how many times this has happened and what amount has been paid. Mr. President, this is, I think, the bitter irony to it. This information in the national practitioner data bank is available to hospitals; it is available to doctors; it is available to managed care plans; it is available to just about everybody but the consumers. It is not available to the consumers. Now, Mr. President, what we do in this amendment is a couple of different things. First of all, we really strengthen the disclosure of this information in a couple of different ways. What this amendment calls upon is for the Secretary of Health and Human Services, over a 6- month period--every 3 months he comes to Congress, and 3 months later promulgates rules as to the best way to make sure that this information gets to consumers. Understand, Mr. President, there are 80,000 deaths a year for medical malpractice, from negligence, and 300,000 people injured. Now, I want to be clear for colleagues that tomorrow when I speak on the floor when all of our colleagues are back, in summarizing this amendment, I am going to make this point again. We are very clear that what goes into this data bank is not when someone complains about the doctor--that is not part of the data bank. It is only when there has been an adverse action taken or a malpractice payment has been made. That is all there is. I mean, for example, if you go to a dentist and you do not like the dental work, you are pretty angry about it and you feel like you were put in a lot of pain and you say, ``Look, I want to get my money back,'' and he says, ``I do not want to deal with you, here is your money back,'' that is not in this data bank. It is only when an actual adverse action has been taken or there has been a malpractice payment. That is very important. That is the only information. Moreover, Mr. President, in response to what I think were some fairly legitimate questions from the providers, we have done a couple of other things in this amendment which I think are important. First, we list the norms, we were just talking about obstetricians, and we were talking about that in terms of rural areas. We list the norm for each subsection of the health care profession so that, for example, if you were to see there had been a malpractice payment, one or two with an obstetrician, you might think that is bad. But if you saw the norm for obstetricians and it looked pretty good, you would not be nearly as worried. We make sure the norms are listed for each part of the medical profession that a consumer would have access to. Second, since insurance companies sometimes say to a doctor, ``Look, just settle,'' and the doctor really does not want to, does not feel he or she did anything wrong but that is the best thing to do, we make sure that is part of that data bank, that provider's perspective analysis of what happened and why it is a part of the data bank. This is available as part of the data base. Fourth of all, Mr. President, we deal with what is a very serious problem. Maybe tomorrow, because I see my colleague from Ohio and I promise I am going to try and finish within 5 minutes--maybe tomorrow I will give examples which are very heartrending. But all too often what happens is--and we are not talking about, thank God, many doctors--but all too often what happens is that you have a doctor who has had an adverse action taken against him--and I know my colleague from Ohio is interested in this question--and he actually leaves the State, changes his name, and commits the butchery again. What we make sure of--and we have examples of this in a number of different States, and this has been a proposal that Health and Human Services has made for some time-- as a matter of fact, the Social Security number is entered into this data bank, so it is much easier to track those individuals--so that, Mr. President, if you had to have back surgery in Minnesota and you wanted to check--and God forbid there had been somebody who came from Ohio who literally had an adverse action taken against him, and he no longer was able to practice in the State, changed his name in Minnesota--you could track that person. You could have access to that kind of information. Mr. President, I really believe that this amendment is extremely important. Here we are talking about malpractice reform--med-mal amendments. I am saying that one of the from happening in the first place is to make sure consumers have this information. I really find it a very weak argument, and weak arguments were made as to why we cannot do it. Some say, ``Let us study it,'' or ``We need to improve the data.'' We have, as a matter of fact; we have plugged some of the loopholes. In any case, it is far better that we make sure the consumers have access to this information. I am a little startled at some of the opposition to this. If in fact this information is available--and you could go to a court in any State and get it. But it is not readily available to consumers. It is readily available for hospitals, for doctors, medical boards, medical societies, and managed care plans. The only people that do not have access to this information are the consumers. So it seems to me that this amendment strengthens what we are trying to do here, especially if what we are trying to do here does, I hope, in part, prevent this kind of negligence from happening in the first place. I do not think there is any reason why a Senator should vote against what is a strong consumer protection amendment. Tomorrow morning, I will, if there are any Senators who want to debate this, be pleased to debate it. Or later on today, we will do so, as well. I yield the floor. Amendment No. 612 to Amendment No. 603 (Purpose: To clarify that the provisions of this title do not apply to actions involving sexual abuse)

Mr. WELLSTONE. Mr. President, reserving the right to object, is this a medical malpractice amendment?

Mr. WELLSTONE. Mr. President, I no longer object.

Mr. WELLSTONE. Mr. President, I know my colleague from Illinois is shortly going to introduce an amendment that I will support, which gives States the right to opt out. I am in profound disagreement with this Federal preemption. I think I will respond to my colleague from Utah just with a somewhat different perspective for the record, if you will, Mr. President. Mr. President, I remember last year during the health care debate when we had talked about the cost of medical malpractice premiums that both the Congressional Budget Office--I did not say Democrat or Republican--and the Office of Technology Assessment, which gets high remarks for its very rigorous work--indicated that the medical malpractice premiums account for less than 1 percent of the overall health care costs. A trillion-dollar industry, less than 1 percent. As I remember, there were some other reports that said even if you were to take into account defensive medicine, altogether it was 2 percent of the total cost. By the same token, Mr. President, when the Congressional Budget Office, for example, and the General Accounting Office scored a single payer bill, where there was one single payer at each State level, as I remember, the estimates were that we could save up to $100 billion a year. But that challenged the power of the insurance industry. My understanding, Mr. President, is that medical malpractice insurance is the single most important profitable line of property casualty insurance and generated $1.4 billion in profit in 1992. So we do not talk about insurance reform, record profits being made; we do not talk about how to really contain costs. The Congressional Budget Office also said, Mr. President, that the best single way of containing health care costs would be to put some limit on what insurance companies can charge. We do not do that at all. We go the path of least political resistance. Those folks have entirely too much economic and political power. We dare not confront them. But, Mr. President, instead, we are going to go after those people who have been hurt, those people who have been injured, that have lost loved ones and take away some of their protection and take away some of their rights to seek redress of grievance. Mr. President, I am going to go back to an example--I am sorry my colleague is not on the floor right now. I have a practice of not debating colleagues directly if they are not here. I do not think there is a standard of fairness to that. So I will be more general. Let me raise the question about these caps on punitive damages. For example, I think my colleague wants caps across the board, as I understand it. Let me put a face on this question. Think of Lee Ann Gryc from my State of Minnesota who was 4 years old when the pajamas she was wearing ignited, leaving her with second- and third-degree burns over 20 percent of her body. An official with the company that made the pajamas had written a memo 14 years earlier stating that because the material they used was so flammable, the company was ``sitting on a powder keg.'' When Lee Ann sued for damages, the jury awarded $8,500 in economic damages and $1 million in punitive damages. By the way, children--earlier we were talking about this in debate, and one of my colleagues was making projections for economic damages for children--children do not get much by way of economic damages. Let me ask you, Mr. President, as I cannot ask my colleague, was the jury wrong? Should the company have gotten away with a cap of $250,000 in punitive damages, as this bill would require? Unless you are comfortable answering the question yes, unless you are willing to say that Lee Ann Gryc was entitled to no more than $250,000 in punitive damages, when the company knew that the pajamas were flammable, then you should not be supporting this bill. This legislation is going to have a very negative effect on consumers. I think it is unconscionable. Now, Mr. President, I do not get a chance to ask the question, but I get a chance to present another perspective on the floor of the Senate right now in response to my colleague. The question I would raise is--I do not think my colleagues have an answer to this question--No. 1, if we have this cap on punitive damages, what is the projection on how many citizens are going to be denied, how much by way of compensation, over the years to come? And No. 2, what implications does this have toward weakening the deterrent effect? Like it or not, Mr. President, the company that made those pajamas had a memo written 14 years earlier stating that it was sitting on a powder keg. But for this company the bottom line was the only line. Unfortunately, there are some companies like that--thank God, not too many. For those companies that produced these pajamas that are flammable that burn children, or products that injure or kill people, one of the ways we know they will not do it again is when they are slapped with such a stringent punitive damages suit that they know they cannot do it again. What is the effect of taking away that deterrent? What is the projection on how many innocent people are going to be injured, maimed, or killed by defective products in the foreseeable future? Give me near-term figures. Give me middle-term figures. Give me long-term figures. Mr. President, what we have before us is an agenda that is an extreme. First of all, there is this agenda to, on the one hand, weaken some of the agencies which have as their mandate to protect the health and safety of consumers in this country. Then, on top of that, we try and take away from citizens their right to receive fair compensation. I might add, when it comes to the cap on punitive damages, I think we essentially severely undercut the deterrent effect of this. That is why they are there. I mean, you have the economic and noneconomic damages to make the victim whole. In addition, you have punitive damages to say to a company: By God, you need to understand this is so egregious in what has been done that you really are slapped with a major damage which will prevent you from ever, ever doing this again and will prevent other companies from doing this again. That is what we are attempting to overturn. That is what is so dangerous, no pun intended, for consumers in this country. Mr. President, again, No. 1, for Lee Ann Gryc from the State of Minnesota, 4 years old when the pajamas she was wearing were ignited, leaving her with second- and third-degree burns over 20 percent of her body. Is $250,000 too much? Is any Senator willing to say it was too much? I do not think so. Then my colleagues say, we cannot leave it up to a jury to decide. They are too swayed by emotion. The juries are the citizens that elect Senators. Then, in addition, when my State of Minnesota decides that a cap on noneconomic damages did not work, we may not have any choice in the matter because we have legislation that preempts States. Whatever happened to decentralization? Whatever happened to the idea of States making some of these decisions? Finally, Mr. President, again, on the medical malpractice part, I can simply say that I am not aware of any independent study done by CBO or Office of Technology Assessment since last year that went through the whole question of a $1 trillion industry, that went through medical costs, went through an analysis of health care costs. What CBO and OTA said is 1 percent--medical malpractice premiums account for less than 1 percent of overall health care costs. Medical malpractice premiums account for less than 1 percent; adding defensive medicine, maybe 2 percent. Those are my figures as I remember. When, in the name of controlling health care costs, are we going to pass a piece of legislation which is profoundly anticonsumer, which tips the scales of justice away from people who were seeking redress of grievance in behalf of negligent companies or negligent doctors? It is just outrageous. We take away from people some of the basic legal rights they have, some of the basic consumer protection they count on. On the other hand, I would say to my colleagues, if we want to control health opportunity. Sometime I hope to bring an amendment on the floor that talks about putting a limit on insurance company premiums. Then we will see whether or not we are interested in controlling health care costs. According to the Congressional Budget Office, that is the way to control health care costs. And I will say to my colleagues, if my colleagues are interested in having more health care in rural or urban communities, I am extremely interested in how we encourage more family doctors, nurse practitioners, and how we deliver health care in a humane, affordable way in underserved communities. But do not use these medical malpractice amendments as a reason to do that. We do not have to take away from citizens in this country protection when it comes to their health and safety. We do not have to take away from them their rights in the court system in order to make sure that we provide dignified, affordable health care. That is not a choice. Mr. President, I hope on both the underlying product liability, and much less, some of these medical malpractice amendments--ones with caps--that colleagues will vote no. I yield the floor. Mr. President, I suggest the absence of a quorum.

Mr. WELLSTONE. I wonder whether I would have time to ask a few questions that I would like to ask my colleague from Arizona. I am not a lawyer, but as I understand it, the whole concept of compensation is to make the individual whole, and there is the economic and then the noneconomic. With this cap of $500,000, how many of the plaintiffs, as we project to the future, how many plaintiffs would lose how much by way of dollars in compensation to make them whole again? What are the projections on what impact this is going to have on those individuals that have been injured in a malpractice?

Mr. WELLSTONE. Mr. President, my next question would be: If it is less than 2 percent--and I gather that that, as you say, may focus on a few cases where there are large dollars involved--then I would ask my colleague from Arizona, do you have any projections on what impact this will actually have on more doctors? How many more doctors would be practicing medicine in underserved areas, be they rural or inner city, as a result of this cap? Do you have any projections?

Mr. WELLSTONE. I guess what I am struggling with here, Mr. President, as I try to figure out the logic of this, if my colleague had said, ``Look, there are lots of cases that this would affect all across the country,'' then I would have said, ``Well, then I understand what you are doing in terms of the negative impact on plaintiffs.'' Many times we are talking about people who have been injured. But my colleague's response was, it is a relatively small percentage, in which case then the flip side of the coin is, I am wondering--and I wrote it down--if it is 12.3 percent, the figure on ob-gyn's who talked about the problems of excessive payments, I am not at all sure that there would be--I mean, by definition, if there are very few cases, then why would any of us this would have any significant impact on the number of ob-gyn, if you follow me, practitioners in these underserved communities?

Mr. WELLSTONE. By the way, in the 2 percent of the cases that the Senator mentioned, how much does that translate to in terms of dollars?

Mr. WELLSTONE

Mr. WELLSTONE. Mr. President, I rise to support S. 725, the Veterans' Community-Based Care Act of 1995, introduced by my distinguished colleague, Senator Rockefeller. I am honored to be an original cosponsor of this bill that I deeply believe is of signal importance to veterans and to the future of VA health care. The VA currently is planning to revamp its health care system to reduce its strong emphasis on inpatient hospital care in order to provide more veterans with health care in outpatient and noninstitutional settings, including community-based facilities when such care is appropriate. This bill will not only support VA's restructuring efforts, but also help some of our most vulnerable veterans--those with substance abuse problems who require rehabilitation services; elderly veterans who are infirm; and homeless veterans who suffer from severe mental illnesses or substance abuse problems. Let me stress that these are proven programs with successful track records and this bill will extend existing authorities for these worthwhile and innovative programs for about 5 years. Mr. President, I would like to briefly describe these programs so that my colleagues may more fully appreciate their value to needy individual veterans and to the VA health system as a whole: One provision would extend VA authority to contract with non-VA half- way houses for rehabilitation services for veterans with substance abuse problems. This worthwhile program was first authorized in 1979, and currently operates at 106 medical centers, with 6,300 veterans treated in fiscal year 1994. These community half-way houses perform a vital function in facilitating a veteran's successful transition from inpatient substance abuse treatment and detoxification to independent living within the community. The half-way houses provide a supervised, substance free environment, and help develop independent living and social skills. I strongly and unequivocally supported extension of this program in the 103d Congress and I firmly believe it merits further extension. The bill also would extend VA's authority to provide health and health-linked service to veterans who otherwise would need nursing home care. It enables veterans to live at home and receive, at less cost to VA and the taxpayer, the same type of services that would otherwise be provided in a hospital or nursing home. Mr. President, this can be best described as a win-win-win program. Veterans would be able to continue living at home, costs to the taxpayer would be cut significantly, reserved for veterans for whom there is no other feasible alternative. I am especially pleased that this bill would reauthorize the Homeless Chronically Mentally Ill [HCMI] program. This program has been effective in serving the most disadvantaged, most needy and often most difficult population of vets to reach. It is precisely the kind of program that Senator Hubert Humphrey would have approved of in that passes his litmus test for judging a society by the way it deals with the most vulnerable and needy of its citizens. HCMI authorizes VA outreach workers to contact homeless vets, assess and refer vets to community services, and place eligible vets in contracted community- based residential treatment facilities. This program is one of the two major VA homeless programs and now operates out of 57 medical centers in 31 States and the District of Columbia. I backed extension of this program unequivocally in the 103rd Congress, and I am even more convinced now that it merits reauthorization. Another extraordinarily valuable, effective, and humane program that this measure would reauthorize is known as the Compensated Work Therapy and Therapeutic Transitional Housing program [CWT/TR]. It is a demonstration program authorizing the VA to renovate 50 residences as therapeutic transitional houses for chronic substance abusers, many of whom are also homeless, jobless, and mentally ill. VA would also be authorized to contract with nonprofit corporation which would own and operate the transitional residences in conjunction with existing VA compensated work therapy programs. Once a residence is fully renovated and operational, rent collected from vets in the program usually exceed operating costs. A preliminary VA evaluation of the program indicates that well over 50 percent of participants complete the program and have had substantially better sobriety, employment, and housing status than before entering the program. I strongly backed extension of this program in the last Congress and have no doubt that there is an urgent need to further extend this program that serves those are among the most needy of our veterans. Finally, Mr. President this bill would extend VA's authority to enter into enhanced use leases, which would permit other parties to use VA property so long as at least part of the property will provide for an activity that furthers the VA mission and enhances use of the property. An excellent illustration of how this program would operate is a plan to establish at the Minneapolis VA Medical Center [VAMC] a managed care clinical research and education center on land owned by the VAMC. An HMO would build a facility on VAMC grounds that would be large enough for VA personnel to do important clinical research and provide additional space for VA personnel to provide patient care to vets. Additionally, VA personnel would gain first-hand experience in managed care and make the VA more competitive in a managed care environment. Finally, the program would ready the Minneapolis VAMC for participation in the Minnesota State health care reform program should this become feasible. In closing I want to thank my colleague, Senator Rockefeller for his leadership in preparing this legislation and urge my colleagues to give it their full support.

Mr. WELLSTONE

Mr. WELLSTONE. Mr. President, I actually promised my colleague from Illinois that I would limit my response to 5 minutes, but I am so moved by what my colleague from Texas had to say, I would like to respond. Mr. President, I hardly know where to start, but I can assure my colleague that it is quite possible to turn toward God and to turn toward religion and to have values and spirituality in your life and believe, as the Committee on Economic Development believed, a business organization which issued a report a few years ago, that one of the ways that we do well with an effective, successful private sector is to make sure that we invest in our children when they are young. It is simply the case that if we do not invest in our children when they are young, making sure that each and every child has that equality of opportunity, which is what my parents taught me was what America was all about, then we pay the interest later on with high rates of illiteracy and dropout and drug addiction and crime and all of the rest. Mr. President, when we talk about will there be a higher minimum wage, the answer from my colleague from Texas is no. From what I think I just heard my colleague say, when we talk about whether or not higher education will be affordable, for some sort of reason there is nothing the Government can do, we do not really need to have Pell grants or low-interest loans or work study, but, Mr. President, what has made this country a greater country is to make sure that each and every young person has that opportunity. Nobody talked about the Government doing everything. That is a caricature. That is just sort of political debate. We have a strong private sector, and that is what makes this country go round, but we also think there is a role for the public sector, and that is to make sure that we live up to the promise of this Nation, which is equality of opportunity. I do not think the people in the United States of America believe that whether or not you receive adequate health care or not should be based upon whether or not you have an income. I think people believe that each and every citizen ought to have decent health care. I heard my colleague criticize the post office. I can tell you one thing, at least they do not deliver mail according to your income. Everybody gets their mail regardless of their income. I heard my colleague talk about welfare. My God, you would think AFDC families caused the debt, caused the deficit. I was not here during the years some of my colleague served here, but if my memory serves me correctly, in the early 1980's, we were told what you want to do is dramatically reduce taxes--that was euphemistically called--I ask my colleague from Illinois, I think I am correct--the Economic Recovery Act. What happened was we eroded the revenue base and moved away from any principle of progressivity, I say to my colleague. I am sorry he is not here. Poor people do pay taxes. Many people are poor in the United States of America, work 40 hours a week, if not more, 52 weeks a year, and they pay Social Security taxes. More wage earners, more ordinary Americans pay more in Social Security taxes than in taxes. We have dramatically reduced the corporate rates and, indeed, there has been too much of a pressure on middle-income and working families. But this argument that the problem is that we have relied too much on an income tax just simply does not hold up by any kind of standard if you look at it with any rigor. I think the welfare benefits, the AFDC benefits in some States--I cannot remember Texas--are about 20 percent of poverty. People in the United States of America believe the children have a right to be all that they can be. People in the United States of America believe we should invest in higher education. People in the United States of America believe that an educated, high-morale work force is critical to economic performance. And people in the United States of America believe that it is a combination of a strong private sector and also a Government that can effect good public policy that can lead to the improvement of lives of people in our communities that makes the difference. That is what this debate is about. I yield the floor. Several Senators addressed the Chair.

Mr. WELLSTONE. Thank you, Mr. President. Mr. President, I thought I would take less than maybe 5 minutes to respond to my colleague from Texas. First of all, Mr. President, I look forward to this debate that we are going to have because I think what we have seen too much of here is an attempt to dance at two weddings at the same time, and I think that citizens in this country are going to hold us all accountable. As I said earlier, I do not understand how the arithmetic of this adds up, and I think there are colleagues on the other side of the aisle who would agree with me. It is very difficult to talk about broad-based tax cuts, with the estimates that maybe this is up to $700 billion over the next 10 years, and talk about no cuts in the Pentagon budget. Mr. President, I hear precious little discussion of what we call tax expenditures. And for those who are listening to this debate, I am talking about various loopholes, deductions, sometimes outright giveaways--oil companies, tobacco companies, pharmaceutical companies, insurance companies. I see precious little discussion about any of that being on the table. We are going to pay the interest on the debt. We are going to put Social Security off the table, Mr. President. According to some of my colleagues, in addition, we are going to balance the budget by 2002. I also hear the same colleagues saying but, students, do not worry about being able to afford higher education; veterans, do not worry, there will be no deep cuts there. I doubt whether senior citizens will take great comfort from the remarks of my colleague from Texas because it is quite one thing to talk about a 2-percent increase a year but when the trend line is in fact that more and more of our citizens are 65 years of age and over with more serious health care costs going far beyond 2 percent, then what we are really talking about is eroding again what I talked about earlier here, a contract with senior citizens, the Medicare Program. Mr. President, first of all, let me make the point that to be proposing some rather deep cuts in some programs that are critically important to the concerns and circumstances of people's lives in our country all for the to those on the top does not strike me as something that will meet the standard of fairness I think people demand of us. Second of all, Mr. President, let me just simply say that this argument that when it comes to the most pressing issues of people's lives there is nothing the Government can or should do is a wonderful argument if you own your own large corporation, but as a matter of fact, there are certain decisive areas of life, education being one of them, where we have decided we make an investment as a people to make sure we do live up to our dream of equality of opportunity. So I would simply say, Mr. President, because otherwise I will go on for hours and hours, if you want to talk about real welfare reform, the answer is good jobs and good education. If you want to talk about how to reduce poverty in this country--1 out of every 4 children are poor, 1 out of every 2 children of color are poor--then the answer is good education and good jobs. If you want to talk about reducing violence in our communities, talk to your judges, talk to your police chiefs, talk to your sheriffs, much less talk to people in those communities, and they will tell you we will never stop the cycle of violence unless we invest in good education and there are good jobs for people. If you want to talk about how to build community, the same thing-- good education and good jobs. If you want to talk about how we have a democracy where men and women are able to think on their own two feet, they understand the world they live in, they understand the country they live in, they understand the community they live in, and they understand what they can do to make it a better community or a better country or a better world, then I am telling you, we have to invest in good education. I have to tell you right now that when I travel around the State of Minnesota, a State which values education, I meet too many students who sell their plasma at the beginning of the semester to buy their textbooks; I meet too many students who are going to school 6 years because they are working 35 and 40 hours a week, and we hear proposals that they are going to have to start paying interest on their debt throughout their years of graduate or undergraduate work. In addition, we hear about proposals of cutbacks in work-study and various low- interest loan programs, Pell grant programs. I could go on and on. I could just tell you, these are middle-class programs. These are programs that have made the United States of America a better country, a more just country, a country with more fairness. So let us be crystal clear. The issue is, who decides who benefits and who is asked to sacrifice? The question will be asked, who decides to cut Medicare and who has health care coverage that is good coverage? All of us who are in the Senate. And who decides to cut some of the programs that enable students to be able to afford higher education and whose children get a decent education? I could go right across the board, but I simply say to people in this country, hold us all accountable and make sure you are good at addition and you are good at subtraction and you are good at arithmetic, because I think it is a bit of a shell game here. We are going to have broad- based tax cuts and, in addition, we are not cutting the Pentagon budget, and we are paying the interest on the debt and not touching Social Security, but we are going to balance the budget, cutting, I do not know, $1.3 trillion, $1.7 trillion, by the year 2002. But, veterans, do not worry about your health care; you do not need to worry that you are waiting 2\1/2\, 3 years for just compensation right now with the veterans appeal board. And, students, do not worry because we are not going to cut into higher education and children. No, we would not do anything that would affect nutrition programs, but we are going to balance the budget by 2002. We are not going to make a distinction between operating budget and capital budget. We are not going to go after corporate welfare. Maybe we will. I hope we do. Everything should be on the table. But we are going to balance the budget. I just simply say this argument about there is the Government and there is us, as a matter of fact, is a wonderful philosophy. When it comes to the issues important to your lives, what the Government should do or could do is great if you make $200,000 a year. It is great if you own your own large company. It is great if you are in the Senate and make $130,000 a year. It is not so great if you are a regular, ordinary American. I yield the floor. Mr. GRAMM addressed the Chair.

Mr. WELLSTONE

Mr. WELLSTONE. Mr. President, I know the Senator from Arizona is here. He is going to wish to lay down an amendment and speak about it. I have an amendment that I laid down on Thursday that I want also to speak on. But I thought we might stay in morning business just for a few minutes and I might respond to my colleague from New Hampshire and then we will go back on the bill. I do not come with any well-rehearsed remarks, but as I was listening to the presentation of my friend from New Hampshire, I did want to respond in a couple of different ways. First of all, I was immersed in the health care debate in the 103d Congress. Of course, at the very end, we were deadlocked and there was, on the part of a good number of Senators, I think, a very strong commitment to blocking any legislation from being passed and therefore we were not able to pass any kind of health care reform. I point out to my colleague that many of us made the argument that the only way we were going to be able to contain costs--and that included looking at Medicare and Medicaid, which are two very big Government programs--was within the context of overall health care reform. I take exception to what I heard my colleague from New Hampshire saying in a couple of different areas. First of all, let me just be crystal clear. I think the proposition that on the one hand--at least some Senators have proposed this, and many in the House of Representatives have proposed this--we go forward with broad-based tax cuts which amount to about $700 billion over the next 10 years, of revenue we would have to make up, and on the other hand go forward with cuts--some say just decreasing the rate of increase of Medicare--I think that proposition just will not be credible. It will not be credible with a lot of senior citizens, but that is not even the point. It will not be credible with their children and their grandchildren. You cannot, on the one hand, say you are for deficit reduction and then move forward on broad-based tax reduction to the point where you have to figure out how to offset $700 billion before you even go forward with deficit reduction, and at the same time be proposing fairly draconian cuts in Medicare. I have said all along I actually feel quite credible on this issue because from the very beginning of this debate about balancing the budget by 2002 I have raised the question, ``Why 2002?'' I have raised the question of how you can do it without separating capital and operating budgets. I have tried to be intellectually honest about this. I have talked about dancing at two weddings at the same time. I have said to citizens in Minnesota, beware of any breed of politician--Democrat, Republican, Independent--and others who say: On the one hand, you are going to have broad-based tax cuts, on the one hand you are not going to cut the military budget, on the one hand you are going to pay interest on the debt because we have to, on the one hand Social Security is going to be put in parenthesis and not touched, on the one hand now we are not going to really cut Medicare--but we are going to balance the budget, cut $1 trillion, by 2002. But students, it is not going to be higher education. Veterans, do not worry. And children, it is not true that we are going to cut the nutrition programs. The arithmetic of this does not add up. My colleagues are discovering that they are in this context--talking about balancing the budget--are going to have to propose deep and significant cuts in Medicare and Medicaid. Please remember about 75 percent of Medicaid payments do not go to AFDC mothers, or what we view as welfare, but actually go toward long-term care for the aged. It is not just older people we are talking about. We are talking about older people; we are talking about their children and grandchildren; we are talking about families in this country. Now we have a new wrinkle where colleagues come out and say the trust fund is in trouble, and they talk about this as an actuarial issue. This is a benefits program. You can use all of the insurance language you want to about trust funds and talk about actuarial assumptions and all the rest. The fact of the matter is that in 1965 we passed the Medicare and Medicaid Programs in the U.S. Congress. It was an inadequate installment of universal coverage but nevertheless it was significant. From my family having had two parents with Parkinson's disease, let me just say one more time that Medicare, imperfections and all, was probably the difference between disaster and being able to at least live the end of your lives with some dignity. Both my mother and father have passed away. Even so, with Medicare, Mr. President, elderly people pay four times as much out of pocket as people who are not elderly. Please remember one more time, since we have this stereotype of older Americans being rich and not having to really worry about any economic squeeze, that the median income for men 65 years of age and older is $15,000; for women it is about $8,000. This is no small issue. Mr. President, last Congress we talked about how we could move forward on long-term care in such a way that we could have more home- based care. We, I think, reached some consensus, except, when we got to the point where we will have to dig into our pockets and figure out how to fund it, that elderly people and people with disabilities ought to be able to live as They ought not to have to go to institutions when they could live at home. We put real emphasis on home-based care with a wonderful program in Minnesota, a block grant program not adequately funded. But we are funding it. It is wonderful. It makes all of the difference in the world, and it enables someone who is elderly to live at home. But we did not take any action on that. We were also talking about some legislation. I introduced the single payer bill covering the catastrophic expenses. Medicare does not cover the catastrophic expenses of what happens to you when you are in a nursing home. Nor does it cover prescription drugs. My colleagues are not in any of these proposals talking about any of that. They are talking about cutting Medicare. And they want to make the argument it is not really a cut, that it is just a lessening of the rate of increase. Well, why is it such a big surprise to my colleagues that a larger and larger percentage of our population are 65 years of age and over, and a larger and larger percentage of that population tends to be in their eighties? Of course, it costs money. That is what Medicare is about; the commitment to elderly citizens, and that we will fund a decent level of health care for elderly people in our country. This should not come as any shock. And it is a benefits program. It is a contract. It is a commitment we made. Mr. President, there are, I think, steps that we can take. In some cities and some States you find that the cost of providing coverage is much greater than, for example, what it is in Minnesota. I am sure there are ways that we can move toward more efficiency. But, Mr. President, I must say that all of a sudden this discussion about now what we are going to do is talk about the trust fund, we are not going to really say this is part of deficit reduction although it was always proposed before as part of deficit reduction. And in addition, we are going to give people all of these kinds of options. So they are really not options because managed care is the place in which you can have the savings but in many parts of the country, especially outside your metro areas, it is not a real option. And in addition, we say, if there are any savings by enabling people to develop to purchase vouchers or all the rest, then in fact we will be OK. But, if they are not, then we are going to have to make the deep cuts. There are not going to be any because, if there are savings, by definition they go to those individuals. They do not go to the Government. We are talking about public expenditures here and how to cut down on the public expenditures. So I think that some of my colleagues are trying to dance at two weddings at the same time. There was all this bold rhetoric about how we were going to balance the budget by 2002, no question about it. I saw projections of quotes from colleagues that we were going to be cutting Medicare by $400 billion between now and the year 2002. That figure has gone down. But make no bones about it. That is what is being proposed. Mr. President, I think what we ought to do is move forward on good health care reform, and there are three critical ingredients to that. First, universal coverage; and I promise my colleague from Arizona that I will be finished within 2 minutes. Second, cost containment--and, by the way, the Congressional Budget Office said really the way you can contain costs is you put some sort of limit on what insurance companies can charge. Third, we need to deliver care in some of our underserved communities like, for example, rural areas where we have to put much more emphasis on primary care, on family doctors, on advanced nurse practitioners, on nurses, getting health care out of the communities backed up by specialization. It is in that context that we contain Medicare costs. But, if we just target Medicare, you are going to have the same irrational charge shifting. You are going to have true rationing by age, income, and disability. You are going to be hurting a lot of citizens in this country. And, we are going to be moving away from a basic commitment that we made in 1965. So, I look forward to what I think is going to be an extremely important debate but I did want to respond to my colleague from New Hampshire. I am sorry he had to leave.