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Mr. MOYNIHAN. Mr. President, today the United States took an important step toward bringing justice to the criminals who directed the cold-blooded murder of the passengers on Pan Am flight 103 over Lockerbie, Scotland. The Justice Department has announced the indictment of two Libyan officials for planning this crime. This announcement performs two vital functions. First, it initiates a process of bringing to justice the mass murderers who perpetrated this outrage. There is much more to be done. We should not permit those who ordered and financed the operation to escape. But it is a start.

Second, it sends the message that state terrorism is a violation of law for which there are remedies. If the new world order of which President Bush has spoken is to stand for anything at all, it must stand for the proposition that the rule of law will be enforced and terrorists will be brought to account under law. I welcome these indictments both for the purpose of bringing justice to these individual criminals and for the purpose of attacking international lawlessness sponsored by states.

These indictments cannot repair the damage, cannot erase the suffering of those who lost innocent loved ones because of this crime. But I know that more than anything else, these family members want the truth to be told and justice to be done. That process has begun.

Like many others, I am somewhat surprised, however, that the administration has stated so unequivocally that Syria and Iran were not involved in this crime. The administration has stated emphatically that Syria and Iran remain state sponsors of terrorism, along with Lybia. The links between the criminal, terrorist groups sponsored by these three states are difficult to trace and, of course, money is fungible. I do hope that, in the days to come, the administration will remain open to evidence that contradicts its declarations this afternoon. If Syria and Iran were even partially responsible for this outrage, they should be held accountable.

Mr. DOMENICI. Mr. President, I want to congratulate my colleague from Rhode Island, Senator Chafee, for leading the Republican Health Task Force through many months of hard work on health care issues, and I am proud to be a cosponsor of the bill that was put forward by the task force and introduced in the Senate last Thursday.

Its never easy to get Senators to agree on a significant proposal, much less on one that is so complex. Yet, the task force proposal now has 22 cosponsors, a clear indication of Senator Chafee's able leadership and the significance of this new entry in the health care debate.

In announcing my cosponsorship of this bill last Thursday, I said I would comment more specifically on a couple of sections of the legislation today. In particular, I am going to focus on increased funding for community health centers, medical liability reform, and how to finance this proposal.


On Monday, November 4, I introduced S. 1912, which would double the funding for community health centers and the National Health Service Corps over a 5-year period.

I am very pleased that the Republican Health Task Force proposal includes similar funding increases for these programs.

Community health centers are simply the most cost-effective primary health care delivery system available. We can provide comprehensive primary and preventive care to an uninsured individual for under $90 each year in Federal spending. It would cost $625 per person, or 600 percent more, to provide similar services to these persons through the Medicaid Program.

Like S. 1912, the Republican task force proposal authorizes significant expansions in health center funding in each of the next 5 years, sufficient to cover some 7.5 million more Americans by 1996. The bill also expands funding for the National Health Service Corps to ensure a growing pool of physicians is ready and willing to work in underserved areas.


I believe it is absolutely essential that we reform our medical malpractice laws if we are going to control health care costs.

In June, I introduced my own proposal, S. 1232, with the endorsement of former Surgeon General C. Everett Koop. That bill is cosponsored by Senators Danforth, Rudman, Chafee, and Gramm, and was referred to the Finance Committee.

The evidence is certainly there to support reform. The costs of defensive medicine, though hard to pinpoint, are certainly in the tens of billions of dollars each year. Doctors are ordering countless unnecessary tests and performing unnecessary procedures to protect themselves from lawsuits. And it is no wonder. Eighty percent of the lawsuits filed have no evidence of negligence. The number of malpractice lawsuits per 100 physicians more than doubled in the 1980s, from 3.2 to 7.4, and malpractice insurance premiums increased 15.1 percent annually.

I am very pleased that this Republican health care proposal recognizes that reform is needed in this area, but I am somewhat concerned that the current proposal will not fix the problem.

In my proposal, I advocate mandatory, binding arbitration for nearly all medical malpractice cases, with some judicial review to make sure cases are decided fairly and impartially. Binding arbitration and other forms of dispute resolution will deliver more consistent, more timely, and more efficient decisions for both patients and health providers. Over time, these improvements will reduce the pressure on physicians to practice defensive medicine.

In the Republican task force proposal, arbitration and other forms of alternative dispute resolution are voluntary on the part of patients and health providers. I am concerned that a voluntary approach will not get the job done because lawyers will simply advise their clients to bypass arbitration and go straight to court. Doctors would then still face expensive court litigation and inexpert juries, and, consequently, would likely continue their unnecessary defensive practices.

Nonetheless, I am very encouraged that this bill acknowledges the significance of the medical liability problem, and I plan to work with my colleagues in the coming weeks and months to enact a proposal that will truly slow the growth of health care costs.


Most health care reform proposals advanced in Congress to date have two noticeable and glaring omissions: real cost containment and financing provisions. That is no accident. It is very easy to promise the American people more health care. It is much tougher to tell them how you are going to control costs or how you are going to pay for it.

I am very pleased that the Republican Health Task Force proposal includes some tough cost containment provisions, including medical liability reform and incentives to use managed care health plans. However, like the proposals offered by most Democrats, this one does not yet include financing provisions.

There should be no doubt that Republican Senators are committed to fully financing any new health care spending. At the same time, it should also be clear that some financing proposals are acceptable while others are not.

Some Democrats would like to pay for their grandiose health care plans by raising taxes in ways that are completely unrelated to our health care system. They would simply pour money from new sources into expanding access without any consideration for cost containment. This approach will lead to higher proportions of our Nation's GNP going to health care spending and will threaten long-term economic growth.

It is critical that we finance wider access to health care in ways that simultaneously encourage cost containment.

Last week, Senator Dole suggested one approach that I believe has merit. Under current law, employer-paid health insurance premiums are completely tax free--they are fully deductible by the employer and excluded from taxable income to the employee.

This tax subsidy costs the Treasury some $65 billion annually, including about $13 billion for persons with incomes over $75,000 per year. And the subsidy encourages some employers to offer generous health plans in lieu of higher plans in lieu of higher salaries, which in turn leads to less cost-conscious consumption of health care.

Senator Dole suggested that we could set a reasonable limit on the amount of health insurance that can be excluded from taxes. Workers could still get comprehensive health insurance paid by their employers, but employers and employees would have a greater incentive to economize on marginally beneficial health care.

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Mr. CONRAD addressed the Chair.

The PRESIDING OFFICER. The Senator from North Dakota.