Senate Opens Historic Debate on Health Care


The Senate began an epic debate on national health care reform Tuesday night, setting in motion a monumental undertaking that, whatever the outcome, is certain to affect the lives and well-being of every citizen and business in America.

“We are ready to go forward,” declared Sen. Harris Wofford (D-Pa.). “The decisions we are about to make are going to be in the history books.”

With time running short before November’s midterm elections, in which lawmakers will be accountable for their votes on the issue, Senate Majority Leader George J. Mitchell (D-Me.) formally opened the debate with a floor speech that described the health care crisis with a combination of statistics and personal anecdotes.

“We will undertake no more important task in Congress,” Mitchell said. “There is a crisis in American health care. It is a crisis of affordability and price. It has to change.”


Mitchell’s bill, whose prospects are uncertain, seeks to achieve 95% coverage by relying on voluntary, market-based measures and government subsidies for the needy. But if that target is not reached by the year 2000, large employers would be required to provide at least 50% of a worker’s insurance premiums after the year 2002. Such a so-called employer mandate--easily the most controversial element in the health reform debate--would be phased in on a state-by-state basis.

Mitchell called his approach “a fair, reasonable, rather modest effort.”

The majority leader said that he intends to keep the Senate in session six days a week until a health bill is passed, a schedule that will require canceling a good chunk of the Senate summer vacation that had been scheduled to run from Saturday until mid-September.

The first vote in the debate is expected today on an amendment by Sen. Jesse Helms (R-N.C.) to delay consideration of health care reform until next year.


“Delay equals a victory for special interests,” Sen. Barbara Boxer (D-Calif.) said on the Senate floor. “Delay is cowardly. Fifty years is a long time to study health care. Let’s get on with it.”

The House is to take up its version of health reform next week. The bill crafted by House Majority Leader Richard A. Gephardt (D-Mo.) would require employers to pay 80% of an employee’s premiums. It too faces an uncertain fate.

Also on Tuesday, as Democratic and Republican leaders in the Senate haggled over procedural matters governing the floor debate, the White House stepped up pressure on Congress to take bold action.

“If this debate is conveyed in understandable terms to people and they really know what’s at stake, there will be increasing support for doing something sooner instead of later and for doing the hard decisions now and not postponing them,” said First Lady Hillary Rodham Clinton, architect of President Clinton’s reform plan--of which only some elements remain under consideration.


In an interview with reporters, Mrs. Clinton also tried out what will likely be the Administration’s public strategy for the critical days ahead: to portray opponents of health reform as people with vested interests who would have resisted enactment of other social programs that now are a part of the American fabric.

Mrs. Clinton chastised opponents of comprehensive reform for resorting to the “same old bromides” that were uttered by those who, she said, had opposed Social Security, Medicare, civil rights legislation and the minimum wage.

“I’ve seen some of these signs that look like they have been around since (Congress debated and enacted) Social Security--you know, about socialism,” she said.

“Go back and read in your own newspapers what they said about Social Security and Medicare,” the First Lady told a roomful of newspaper and wire service reporters.


Mitchell later picked up the point in his floor speech.

“Many of the same arguments used against health care reform are the same as those used against Social Security and Medicare,” Mitchell said. “Some of the same words used today were used then.”

The Maine senator ended his remarks with a plea to overcome partisan politics. “The future quality of life of millions of Americans depends on how firmly we put aside partisanship now. . . . It is time to act. My bill is a good starting point for action.”

The First Lady also strongly defended Mitchell’s bill, saying that it would “establish for the first time the right of Americans to be guaranteed health insurance and it does it by permitting voluntary efforts to work and insurance reforms to work for a number of years.”


Mitchell’s proposal also got a boost when the Congressional Budget Office, in a preliminary estimate released Tuesday evening, said that his approach could reach 95% coverage by the year 1997.

Mitchell was followed on the Senate floor by Senate Minority Leader Bob Dole (R-Kan.), who said he fears that the Democratic proposal would ruin what is now “the best health care system in the world.”

“Republicans understand there are Americans in need,” he said. “Republicans want to help.”

However, Dole added, health reform “is too important to complete in a rushed and haphazard manner.”


He said that Mitchell’s proposal is “chock full” of 17 new taxes “totaling billions of dollars.”

Dole said that he and his fellow Republicans in the Senate favor a more incremental approach, one that would not impose “job-killing mandates.”

“Why not take the areas where there is universal, overwhelming bipartisan agreement, put them all together in a bill, pass it into law and thereby make insurance more affordable and more accessible for millions of Americans?” Dole demanded.

Sen. Edward M. Kennedy (D-Mass.), in his floor speech, noted that Dole and House Minority Leader Robert H. Michel (R-Ill.) had opposed Medicare in 1965 and added: “I am sure that neither Sen. Dole nor Congressman Michel would propose to repeal Medicare now.”


Kennedy, reflecting the sentiments shared by many liberal senators, also criticized Mitchell’s plan for not providing universal coverage more quickly and for not providing more generous terms in coverage for prescription drugs and long-term care. He said that he intends to offer amendments to strengthen such provisions.

Also on Tuesday, Consumers Union sent a letter to 18 senators that it regarded as swing votes urging them to back Mitchell’s bill, especially its delayed employer mandate.

The group prefers Gephardt’s proposal, but said that Mitchell’s bill deserves its support because “failure to enact meaningful reform will mean continued suffering for those whom the health care system in the country serves inadequately.”

In her remarks, the First Lady suggested that the President is prepared to pursue a strategy of passing health reform legislation with virtually no Republican support.


Recalling that the President got his budget adopted last year with only Democratic support, with Vice President Al Gore casting the 51st and tie-breaking vote in the Senate, Mrs. Clinton said:

“If it’s 51 votes, fine. . . . These are the kinds of trade-offs you make in life.”

Turning reflective, the First Lady rued the “vicious hatred” aimed at the President and herself, calling such personal attacks “very damaging to our political process.”

She also spoke wistfully about the efforts of past presidents to enact major social legislation, noting that Franklin D. Roosevelt “didn’t have to carry around actuarial tables and have arguments with people on television.”


* DOLLARS AND DEFINITIONS: A look at proposed health care financing and a glossary. A5