Apr-18-94 (HOUSE)  TWO SUBJECTS OF UPCOMING DEBATE

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PART      CONGRESSIONAL RECORD (HOUSE)
DATE      April 18, 1994
PAGE                                                            PAGE H2394
TITLE                  TWO SUBJECTS OF UPCOMING DEBATE
                              HEALTH CARE REFORM
TEXT   Mr. KINGSTON. Mr. Speaker, what I wanted to talk about are two of
    the subjects that we will be debating in the course of this
    spring.  The first one, of course, is health care reform; the
    second one, gun control.
      I wanted to talk first about health care and specifically about
    an article I read and, unfortunately, I am not exactly sure which
    publication it was in, but I believe it was the New York Times. It
    was about the Columbia Health Corp., which is the largest hospital
    company in the United States, has a net worth of about $267
    million, and has a game plan to double in size over the next 5
    years.
      Currently, Columbia Health Corp., owns 195 hospitals across the
    country, and that is up from about 22 when the company was founded
    in 1988. They have all kinds of plans to grow.  But the question
    about how they are going to grow, I think, is interesting and
    something that probably we should consider as we debate health
    care.  And that is that what they plan to do is, because of the
    volume, get discounts from the suppliers when they buy things and
    have lower overhead and use this to basically negotiate better
    provider contracts.
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      Now, as we all know, health care is shifting from a cost-plus
    based reimbursement system.  The way the cost-plus arrangement
    traditionally was is that the more services a doctor or a hospital
    performed, the more they got paid for it.  So if you went in for a
    broken arm and they could x ray it three different ways, put on two
    different kinds of bandages, maybe test your blood, each procedure
    you got billed for.
      And Medicare has changed that because of a lot of their
    reimbursements.  But now managed health care is changing that as
    well.  A long of insurance plans, HMO`s and PPO`s, are doing the
    same sort of thing.
      So now we are seeing hospital and provider groups seeing how they
    can cut some of the expenses out.  One example that this article
    showed that Columbia was using is, instead of testing a patient`s
    blood after and operation, the blood gases, every 15 minutes, what
    would happen if you let it go for 30 or maybe 20 minutes.  They
    were not saying there was an absolute but just stretching it out a
    little bit more.
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      There was a savings there, and there is a savings to be realized.
      Obviously, early release of patients is going to save a lot of
    money, and they encourage their doctors in their provider networks
    to get folks out of the hospitals a lot faster.  So that is another
    method that they are using.
      Then one that I thought was real interesting, when you look at
    the economies of scale, and I thought this was particularly
    interesting because one of the proposals that we are talking about
    is allowing the formation of purchasing groups.  And we are
    debating if that should be voluntary or mandatory.  But in any
    case, listen to this.
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      Prior to Columbia`s merge with the Hospital Corporation of
    America, they were purchasing a volume of x-ray film.  That level
    now is about $30 million worth of x ray film each year.  As a
    result of such a volume, they actually pay 40 percent less now than
    they did prior to the merger with HCA. I thought that was very
    indicative of what we are looking at in terms of potential health
    care savings, because $30 million by one corporation which,
    incidentally, only owns 3 percent of the for-profit hospitals in
    America, which for-profit hospitals, I believe, only constitute
    about 13 to 14 percent of the total hospital marketplace, the total
    delivery system for health care.  So that shows what a relatively
    small player can do.  Think what we can do as we merge together.
      Another thing that they are practicing is somewhat controversial,
    and that is the cookbook type medicine where computer programs are
    getting doctors, nurses, and everyone else along the provider line
    to go and prescribe certain after-treatment therapy or certain
    treatment, depending on the ailment, by a computer program rather
    than `It is all in my head and I know what to do next.` That
    structured application of medicine sometimes is called a cookbook
    form.  I do not think that is always the case.  Sometimes that is a
    good description, but it is not necessarily a derogatory term.
      I think that is interesting.  But to give you an idea what all
    this has meant to Columbia is that last year for the county
    contract in Lee County, FL, for the county employees, they underbid
    their closest competitors 38 to 58 percent providing health care
    services.  I think there is a lesson out there, Mr. Speaker. I
    think this says something about the volume argument, something
    about purchasing groups, something
    that I would hope would be voluntary purchasing groups.
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      But it also shows you that reform is happening right now in the
    private sector.  As I talked to hospitals and physicians around the
    country, I always ask, are you doing things differently this year
    than you did last year or 2 years ago.  Every time the answer is
    yes.  And if you say 5 years ago, you are talking ancient history.
      So I think that the lesson of Columbia Health Corp. is that
    reform is going on.  It is going on in the private sector right
    now.  The sabre rattling by the administration and by Congress is
    very helpful in this.  It is a catalyst to the private initiatives.
      What I would hate to see us do in Congress is come in with a
    cookie-cutter approach on health care reform which would stifle
    initiatives.  Certainly, Columbia is going to have its detractors,
    as does anyone else.  But there are some positive things that are
    going on.  I wanted to bring that to the attention of the Members
    here.
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                                GUN CONTROL
      Mr. Speaker, rather than continue talking about health care, I
    want to talk about gun control.  I do not want to talk about all of
    gun control, because there are so many different aspects.  And
    there is so much emotion.  But I think because there is emotion, it
    is important for Members of Congress to look at gun control not
    based on philosophical bias but based on empirical data and
    objectivity.
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      Yet, I realize this is one of those issues that whenever you talk
    about it, you will have people already bristling, Where is he going
    with this?
      Here is where I am going.  I am going to talk about an article
    that was in the March Journal of Medicine, which is the publication
    of the Georgia Association of Medicine. In it they took to task
    some of the articles that have been printed by the CDC and the New
    England Journal of Medicine. They have done a good job, because
    they have referenced everything that they have put in there.  They
    back it up.
      The article that I am going to talk about was written by a lawyer
    named David B. Kopel. I hope I pronounced it correctly.
                                                               PAGE H2395
      The name of the article is, `The Lure Of Foreign Gun laws.`
                                 TIME: 1850
      In it he talks about countries that have strict gun control laws
    and what it has meant in terms of the crime rate.  The first
    example he uses is in Japan.
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      In Japan, and incidentally, Mr. Speaker, anyone who wants a copy
    of this, please call my office, because I will be happy to share
    it.  This magazine has more objective data on gun control than any
    publication I have seen.
      It talks about Japan. Japan has strict gun control laws which
    actually go back to 1588, when the Emperor put a nationwide ban of
    swords and went through the samurai and the shoguns, I guess, and
    basically disarmed the peasants, and went up from the aristocracy
    from there.  Today you cannot own a gun or a rifle in Japan. You
    can own a shotgun, only through very rigorous licensing laws.
      Is it a safe country? It certainly is a safe country.  They have
    a very low crime rate.  What does that mean? Maybe if we look at it
    at first glance, get rid of the guns and you get rid of the crime
    problem, if you only look at the law and the crime rate.
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      Let us look at Switzerland, as Mr. Kopel did.  In Switzerland, it
    actually has a lower murder rate than Japan. They have strict gun
    control laws, but in a completely different way.  Every male in
    Switzerland has to join the militia.  If you are between the age of
    20 and 50 and you are male, you are a member of the militia.  You
    spend 3 or 4 weeks per year training, and as part of your duty in
    the militia you are given a fully automatic assault rifle which you
    take home.  You do not leave that at the National Guard armory for
    weekend duties.  You do not pick it up for your 3 weeks of summer
    training.  You take that home to suburban Zurich or wherever you
    live, and you keep it at home.  Every male must be proficient in
    marksmanship.  Every male between the ages of 20 and 50 will get
    tested on marksmanship.
      In a country which is about two-thirds the size of West Virginia,
    there are over 3,000 shooting ranges.  Ammunition, while we have
    one proposal right now to tax it, is subsidized in Switzerland. To
    get a handgun or rifle there is a very easy permitting process.
    Just about any adult can get one.  You can even get an antitank
    gun, antiaircraft gun, and you can buy some types of cannons.  This
    is just the folks on the street.
      I said earlier, Switzerland has a lower murder rate than Japan,
    which has a lot smaller murder rate than America. Are the Swiss
    just great people? Are they more responsible than Americans? Are
    they safer?
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      Are they smarter? What is it about them that is different than
    us?
      I would submit that they are not more responsible, they are not
    safer, and they are not smarter, but what they do have in
    Switzerland, and they also have in Japan, is a strong family
    structure, tightly knit communities, and good relationships from
    generation to generation.
      In short, in these two countries culturally young people are
    socialized into noncriminal behavior.  That is so important,
    because as we look at the murder rates in America, and we have some
    of the diagrams and graphs in here, and I do not know that we will
    have time to get into them, but it does show that the homicide
    rates in America, the correlation is that it is still going up in
    the inner city, where you do not have the strong family structure
    and the tightly knit communities, and that is such an integral part
    of crime control and criminal justice reform that we as a Congress
    would be negligent if we do not put these folks into it.
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      If we just superficially kid ourselves and say we are going to
    get rid of the guns, we are going to get rid of the problems, the
    statistics do not show that at all.  They show it to be a cultural
    socializing process which we are not doing a good job at in
    America, particularly in the inner cities, where we have the
    highest murder rates.
      In Britain, they have very tough gun control laws.  They have had
    those, I think, for about 30 or 40 years right now.  Mr. Koppel
    says yet, despite that, in a country where only 4 percent of the
    households legally have guns, their murder rates are higher now
    than they were before the strict gun control laws went into effect.
      Let us talk about Jamaica, because one of the things we hear so
    often from second amendment proponents is that you are not
    necessarily owning a gun to defend yourself against a burglar, but
    you are doing it to defend yourselves against the government.
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      In 1974 Jamaica enacted very strict gun control laws, which
    include house-to-house searches randomly, secret trials, detention
    incommunicado, mandatory life sentences for possession of a single
    bullet, very strict gun control laws.
      What happened? Violent crime dropped significantly for about 6
    months, but then, within a year, it went back up to the level it
    was before the gun control laws, and in fact has been increasing
    since.
      What is the most significant is that one-third of the murders in
    Jamaica were perpetrated by the police.  Think about that in terms
    of the second amendment people who are saying, `You have to worry
    about the government, not just the burglar,` because what human
    rights groups are saying is that the police, what they would do is
    shoot their enemies, because their enemies were not armed, and then
    they would later go back and report that the citizen, the private
    citizen, had started it, and that he was killed in a shoot-out and
    the police shot him in self-defense.  Of course, there were no
    witnesses.
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      Could government potentially be the enemy? Ask one-third of the
    people murdered in Jamaica and they would tell you absolutely yes,
    if they were around to say so, but they are not.
      Think about what we are saying, Mr. Speaker. Why is it that
    police can have guns but you and I and the average American citizen
    cannot? Are they going to be that much safer, allowing police to
    have them and disarming ourselves? I do not think that is the case.
      I trust my fellow Americans, as I know you do and most Members of
    Congress do, but I trust them to use their judgment.
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      This article, as I said, I can give any Member of Congress or
    anyone else a copy, but the publication itself is so full of
    statistics and facts and nonemotional discussion of the gun control
    issue that I think it ought to be required reading, particularly as
    we go into this debate.
      Is this by a group that is an NRA-backed group? Certainly not.
    This group, if anything, is a more progun control group, but they
    have come to the conclusion that you cannot argue with the fact
    that the statistics do not merit outlawing guns.  You are not going
    to get the achieved results.  What you will do is have an argument
    that takes the emphasis off using the death penalty, off mandatory
    sentencing, off truth in sentencing, and so forth, but that is
    where we need to change.  We do not need to take the guns.
      Mr. Speaker, I am going to conclude with that for the time
    being.  I look forward to discussing this magazine with Members of
    the House. I look forward to citing some of the graphs that are in
    here.  There is just tons of good information.  I appreciate the
    opportunity to address the House tonight.
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                                                           PAGE H2396
OUTLINE   1. TWO SUBJECTS OF UPCOMING DEBATE                    H2394
            HEALTH CARE REFORM                                  H2394
          2. GUN CONTROL                                        H2395
          3. TIME: 1850                                         H2395


