I noticed that your conference title is "Turning Point." It's an apt choice. We are at a turning point. We just don't know who will be doing the driving -- and in what direction they'll be turning.

Nevertheless, there are some simple facts that won't go away, and that we'll have to confront no matter who is in the driver's seat after the November elections.

The first of these is cost. Many of the major changes in our health care system are being driven by cost considerations, or more specifically, the desire to contain costs. Employers are worried about the costs of covering their employees. More and more workers are finding themselves without coverage. They have to pay for insurance themselves, if they can afford it, or they are forced to use hospital emergency rooms as primary care facilities. The Congress is concerned about increased spending on Medicare and Medicaid. And providers have to deal with pressure from both sides: Rising costs and reduced spending by various payers.

All of these factors have been leading us toward managed care, either in the form of fully pre-paid risk contracts or health care delivery systems, as many of you are developing.

The move toward managed care has in turn spawned other concerns. Consumers are asking what they can expect to receive for their money. Health care professionals are worried that they'll no longer be able to provide Americans with the kind and quality of care they believe they deserve. These considerations and these concerns are only going to grow. More than half of all Americans with health insurance are currently enrolled in a health maintenance organization or another managed care plan.

Managed care programs can provide high quality care, with more choices and lower costs. But not all managed care programs are created equal. What we need to do is find a balanced approach that doesn't compromise quality.

Concern about quality sparked several legislative initiatives in the Congress recently. The Patient Right to Know Act, sponsored by Congressmen Ganske and Markey, would prohibit health plans from restricting or prohibiting any medical communications between health care providers and their patients. A bill I've authored to require health insurers to let all new mothers and their babies to remain in the hospital for at least 48 hours following most normal deliveries recently passed the Senate.

We've also just recently seen the passage of the Kennedy- Kassebaum legislation to guarantee America's workers the availability and renewability of private health insurance coverage, without punitive preexisting condition restrictions. That same bill also creates federal standards for insurers, health maintenance organizations and employer plans, including those who self-insure.

This week, along with Senators Chafee and Rockefeller and Congresswoman Johnson, I will be introducing a bill to provide the same Kennedy-Kassebaum portability protections to America's seniors for their Medigap insurance. It will allow seniors to try a managed care plan and return to the same Medigap coverage they had before if they change their mind during the first year.

Finally, President Clinton this past week announced the establishment of an Advisory Commission on Consumer Protection and Quality in the Health Care Industry to review changes occurring in the health care system, and where appropriate, make recommendations on how best to promote and assure consumer protection and health care quality. This commission received the immediate support of the American Association of Health Plans (the managed care industry group), Blue Cross Blue Shield Association, HIAA, AHA, the AFL-CIO as well as many others.

So the landscape is changing. Although we all remain concerned about costs and will well into the future, concerns about access and quality are moving up the political ladder. More and more we must all be concerned as health care payers and providers about not only the bottom line, but what consumers get for their money.

This flurry of activity represents a welcome change from the attitude of the Congress at the beginning of the current session, when the new majority tried to abolish Medicaid and finance a tax cut with reductions in Medicare. That change in attitude can largely be attributed to the majority's realizing that their proposals on Medicaid and Medicare were hugely unpopular -- and their pursuing them might have cost a great many of them their seats.

I don't deny the need to address the solvency of Medicare or rising costs in Medicaid. I simply think we need to address those issues responsibly, no matter who controls the 105th Congress.

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