[Congressional Record Volume 143, Number 23 (Thursday, February 27, 1997)]
[Senate]
[Pages S1726-S1728]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                                MEDICARE

  Mr. ROTH. Mr. President, I rise today to draw my colleagues' 
attention to an opinion piece by Senator Bob Dole entitled ``Medicare: 
Let's Fix It'' that was in last Sunday's Washington Post.
  It is my hope that all my Senate colleagues will read this compelling 
op-ed. Senator Dole has worked on and observed the Medicare Program for 
many years, and there is much wisdom to be gleaned from his commentary. 
He is right--we must address Medicare's problems with real solutions 
while giving seniors more choices.
  On a personal note, I want to thank my friend for his praise of 
legislation, S. 341, recently introduced by Senator Moynihan and 
myself, to establish a bipartisan commission on the long-term solvency 
problems in the Medicare Program.
  As Senator Dole notes, ``a bipartisan commission can recommend sound 
long-term solutions,'' as evidenced by the 1983 Social Security 
Commission.
  Mr. President, the proposed national bipartisan commission on the 
Future of Medicare would be this type of commission.

[[Page S1727]]

  Currently, the Medicare Program is not in the best of health--its 
short- and long-term fiscal problems make it increasingly vulnerable. 
In January, the Congressional Budget Office projected the Medicare 
trust fund is headed for the emergency room; it will go bankrupt in 
2001 with a $4.5 billion shortfall. The trust fund is spending more 
than it is taking in from revenues; this trend will continue, creating 
a trust fund deficit of over one-half trillion dollars just 10 years 
from now. And that's still before the baby-boomers begin to retire in 
2010.
  The prognosis is not good. The Medicare trust fund is limping--and 
soon will be staggering--into the 21st century.
  This national bipartisan commission is the medicine needed to restore 
Medicare's good health. Its recommendations will help the President and 
Congress build the consensus needed to enact effective policies to 
preserve and strengthen Medicare.
  Senator Dole is correct in stating, ``Creating a commission won't 
let--the President and Congress--off the hook to enact needed Medicare 
changes now to avoid bankruptcy in 2001.'' I believe the President and 
Congress must act immediately to extend the short-term solvency of the 
program.
  I am encouraged by President Clinton's willingness in his budget 
package to address the growth of Medicare spending over the next 5 
years. However, I'm troubled by the administration's use of gimmicks 
like the home health transfer and an over reliance on cutting provider 
payments--such policies are just plastic surgery, masking deeper 
problems with a pretty face. Senator Dole says he has ``never seen a 
budget gimmick that solved a real public policy problem''--and neither 
have I.
  In the long-term, Medicare must fight another potentially crippling 
problem. Retiring baby boomers will challenge our ability to maintain 
our promises to beneficiaries. Today, there are less than 40 million 
Americans who qualify to receive Medicare. By the year 2010, the number 
will be approaching 50 million, and by 2020, it will be over 60 
million. Today, there are almost four workers supporting each retiree, 
but in 2030, there will be only about two per retiree.
  The demographic progression of the Medicare population will not come 
as a surprise. We know today what is to be expected.
  To be healthy, the Medicare Program is in need of structural reform. 
Since Medicare's enactment in 1965, there has been a great deal of 
change in the private health care system in the United States--but 
Medicare remains fundamentally unchanged. Medicare is too rigid and 
unable to offer the improvements in delivery of care and technological 
advances that have been made in the private sector. Medicare is the 
Model T Ford of health care programs competing in a race car world.
  These are some of the problems the National Bipartisan Commission 
will address. I believe it will prove to be the intensive treatment 
needed to cure Medicare's growing symptoms. There is agreement over the 
diagnosis, but no consensus over the course of treatment. Meanwhile, 
Medicare's time runs short.
  It is my hope that by working together in a bipartisan effort, we can 
seriously and responsibly address the Medicare issue. Again, I hope my 
colleagues will read Senator Dole's essay, and consider the issues he 
raises.
  The answers to the Medicare problem are not easy and they are not 
politically popular. The consequences of delaying treatment are much 
worse, though. As chairman of the Senate Finance Committee, I intend 
for future generations to inherit a robust Medicare Program with a 
clean bill of health. The Commission proposed by Senator Moynihan and 
myself is just what the doctor ordered.
  Mr. President, I ask unanimous consent that a copy of Senator Dole's 
op-ed be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

               [From the Washington Post, Feb. 22, 1997]

                         Medicare: Let's Fix It

                             (By Bob Dole)

       Some politicians make Medicare decisions with one eye on 
     the next election--something I learned in 1996. Enough 
     already. It's time to focus on present beneficiaries and the 
     next generation.
       Rhetoric won't get the job done. Neither will budget 
     gimmicks nor shell games such as the administration's 
     proposal to move home health costs from Part A of Medicare 
     over to Part B. Such accounting gimmicks have been around for 
     at least as long as the budget deficit. I've seen plenty of 
     them, even tried some, but I have never seen a budget gimmick 
     yet that solved a real public policy problem.
       The fact is, to survive, Medicare will have to look much 
     different in 10 years from what it looks like today. The 
     program obviously requires structural changes, not just 
     tinkering around the edges. In his State of the Union 
     address, President Clinton said: `The enemy of our time is 
     inaction.'' Well, it's time to do what's right for our 
     nation's elderly before the president's words become an 
     epitaph for the Medicare program.
       Doing what's right means doing things differently in 
     several ways. Remember, we face two major problems with 
     Medicare: a short-term problem with bankruptcy in 2001 and an 
     even larger long-term financing problem when the baby boomers 
     start retiring in 2010. Any Medicare ``fix'' has to be 
     mindful of both. I do not have all the answers, but I would 
     advance a few ideas for consideration.
       Affluence-test the Part B premium. Yes, I'll say it: Senior 
     citizens who can afford to pay more should pay more for Part 
     B of Medicare. Unlike Part A of Medicare, Part B is not 
     financed by payroll taxes. Right now, Medicare beneficiaries 
     pay premiums that cover only 25 percent of the cost of Part B 
     of Medicare. General revenues pick up the tab for the 
     remaining 75 percent. If only the well-to-do beneficiaries, 
     those with incomes greater than $60,000 for a single 
     individual and $90,000 for a couple, paid a higher premium 
     (say, 50 percent instead of 25 percent--as was originally 
     intended in the program), we could save $9 billion over five 
     years.
       It's just plain old-fashioned fairness for affluent 
     beneficiaries to pay a little more (still way below the 
     actual cost of the care), and our elected leaders should say 
     so. No more of this strange, silent dance between president 
     and Congress where each partner says to the other, ``You go 
     first!'' The president should propose and a bipartisan 
     majority in Congress should support appropriate increases in 
     the Part B premium.
       Keep the link between Medicare and Social Security. 
     Throughout the history of the Medicare program, the age at 
     which a senior citizen becomes eligible for Medicare has 
     always been the same as the age at which he or she becomes 
     eligible for Social Security. That's as it should be. It 
     makes perfect sense for these two programs to go hand-in-
     hand.
       In 1983 the bipartisan Social Security Commission, on which 
     I served, recommended several fixes to save the Social 
     Security program that were enacted into law. One fix was 
     slowly to raise the age of eligibility for Social Security to 
     67. After all, people will live longer and retire later than 
     they did earlier in the century when the program was created. 
     So, the age of eligibility for Social Security will start to 
     rise a couple of months each year beginning in 2003. We 
     should keep the historical link between Medicare and Social 
     Security, and let Medicare eligibility rise with Social 
     Security.
       Give senior citizens choice. Medicare beneficiaries should 
     be able to choose the kind of coverage they want. Innovative 
     ideas such as medical savings account should be available, as 
     should managed-care plans and traditional fee-for-service 
     plans. The critical word here is choice. No one should be 
     forced into any particular health care model.
       Let's let seniors make their own decisions. It's wrong when 
     some people argue that seniors simply are not capable of 
     deciding their own health care coverage and that the 
     government always knows best. Given the right kind of 
     information, seniors can decide what's best for themselves. 
     The should be given the same kind of choices that federal 
     employees have been offered for years. The federal employee 
     health benefits program is one broad-scale model that shows 
     choice works.
       Giving seniors choice could also help hold down costs. Last 
     year health care costs in the private sector grew only 2.9 
     percent while health care costs in the public sector rose. 
     8.7 percent--three times as fast. Why is the private sector 
     doing a much better job holding down costs? One reason is 
     free-market competition. And choice will spur competition, 
     efficiency and lower costs in the public sector just as it 
     already has in the private sector. What's more, structural 
     changes that help lower overall costs are the only way to 
     address Medicare's long-term problem.
       Cutting providers alone is not the answer. It seems every 
     time the president and Congress address Medicare, payments to 
     doctors and hospitals get cut. Politically, this is a ``no 
     brainer,'' since there are millions more beneficiaries than 
     doctors and hospitals. The president's FY 1998 budget 
     proposal is more of the same: cuts for doctors and 
     hospitals--and now cuts for HMOs, too, reducing their 
     reimbursement rate from 95 percent to 90 percent of average 
     per capita costs.
       Some reductions in some areas are no doubt justified, but 
     you cannot fix the program by hitting providers alone. You 
     can buy a few months or a few years on the short-term 
     problem, but it will not solve the long-term problem. In 
     fact, it may exacerbate it. The reductions must be 
     accompanied by true reimbursement reform. Let's move more of 
     the program into a prospective payment system so the 
     incentives for the wise use of services are in place. Let's 
     pay managed-care plans a fair amount and be certain

[[Page S1728]]

     the care provided is of the highest quality and that funds 
     meant for teaching and indigent care are spent correctly. The 
     real problems faced by rural plans as well as by urban 
     providers must be addressed as should Medicare's role in 
     paying to train our nation's physicians.
       Form a Medicare commission. It may turn out that no matter 
     how much is done, it still will not be enough to offset the 
     long-term challenge we face with the retirement of the huge 
     baby-boomer generation. If the president and Congress cannot 
     agree on how to preserve Medicare long term, as a last 
     resort, a bipartisan commission should be authorized. Sen. 
     William Roth and Sen. Daniel Patrick Moynihan should be 
     applauded for recently proposing legislation to establish 
     such a commission. As the 1983 Social Security Commission 
     demonstrated, a bipartisan commission can recommend sound 
     long-term solutions. But if some politicians hope they can 
     dodge the tough choices by creating a commission, I have news 
     for you: It won't work. Creating a commission won't let you 
     off the hook to enact needed Medicare changes now to avoid 
     bankruptcy in 2001, and even the commission's recommendations 
     to address the long-term problem will require members of 
     Congress to vote on sticky issues and the president to sign 
     or veto the legislation.

  Mr. ROTH. Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. SPECTER. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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