[Congressional Record Volume 143, Number 39 (Monday, April 7, 1997)]
[Senate]
[Pages S2764-S2766]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
MEDICARE
Mr. WYDEN. Mr. President, the process of making public policy, like
much of life, is about opportunity, risk, and reward. That proposition
is clearly demonstrated when the Senate looks at the critical issue of
Medicare reform.
I take the floor today, as I plan to do every day this week, to talk
about a tremendous opportunity that the Senate has before it, the
opportunity to finally remake Medicare for the 21st century in a
bipartisan way. The Senate ought to seize this opportunity to act now
and act boldly so that Medicare can be preserved for future generations
of Americans.
As Senators return from visiting their respective States today, we
begin a legislative period that I believe can be a critical few months
in Medicare's history. There is an opportunity to engage this issue as
serious debate begins on the fiscal year 1998 budget. I believe that
there is now a unique window of opportunity for reforming Medicare that
would come along in only rare instances.
Three factors combine to make this a special opportunity to try to
set Medicare on track for the next century. The first is that the
Federal deficit is less than was anticipated for this year, just over
$108 billion. Second, we have a fairly benign economy. Surely, there
are too many folks still hurting, there are too many folks falling
between the cracks, but overall the economy has been strong. Third, it
is very clear that our country will face a demographic earthquake in
the next century with so many more older people, and we have a window
of opportunity now to act before those demographic trends are set in
place.
My view is that Medicare does not need to be reformed because it has
failed but because it has been such a great success that it cannot be
allowed to deteriorate. I argue that only enemies of this program would
want it to stay exactly as it is, because the status quo, the Medicare
status quo that encourages waste and discourages user-friendly
innovation, in my view, consigns Medicare to very difficult times.
The General Accounting Office, for example, has estimated that the
gap between expected revenues for the program and the enormous service
demands is going to produce a gap of almost a half trillion dollars at
the end of the next decade. This program, which is a lifeline to 38
million senior citizens, faces very serious, if not calamitous,
financial circumstances by the end of the decade. There are a variety
of reasons for this, as I am going to outline this week.
In much of the United States, Medicare is engaging in wasteful
practices that the private sector consigned to the attic years and
years ago. In much of the country, Medicare is inefficient, volume-
driven, clunky health care, and it is one of the first things that
needs to be changed.
I believe that there are substantial opportunities for this Senate to
move on Medicare reform, and I think there are some special areas that
we should be careful to avoid. I say, Mr. President, and colleagues,
that I think it would be a great mistake to appoint yet another
bipartisan commission to study Medicare. A number of our colleagues
have proposed that. I have great respect for them, but if there is
another bipartisan committee that studies this issue, I believe we will
see bipartisan inertia for Medicare for years and years to come. The
first question a bipartisan commission would face is should they report
before the 1998 election. Then there would be a question about whether
they would report before the year 2000 election.
I do not think that a commission can create a forum for avoiding the
tough
[[Page S2765]]
choices. That is why I come to the floor today, as I will this week, to
outline first why it is so important to act and why I believe that
finally, after a substantial period of sharp and acrimonious debate on
Medicare, it ought to be possible to act in a bipartisan way.
I have had a number of private conversations with my colleagues on
this issue over the last few months. I believe that despite some of the
political backbiting that has gone on on this issue, every Senator
understands that this program has to be reformed. In some measure, the
U.S. Senate and the Congress have become like a bunch of reluctant
seventh graders at a junior high school sock hop, standing on the gym
sidelines, all waiting for the first brave soul to hit the dance floor.
In an effort to try to move the process forward, to jump-start the
debate, I recently introduced S. 386, the Medicare Modernization and
Patient Protection Act.
I offered this legislation not as a be-all and end-all solution to
all of the financial challenges we face with Medicare, but rather as a
direction to build on some of the progress that has been made in areas
of the country like my own in Oregon. Much of Oregon is already
operating 21st century Medicare services, operating Medicare in a way
that is good for seniors and good for taxpayers. So when people tell me
it's not possible to get this program on track, I invite them to come
to my own State, because in my own State we have been able to do it.
Mr. President, I would like to outline briefly a few of the specific
items in my Medicare legislation that I will go into further detail on
throughout this week.
The first initiative in any responsible Medicare reform effort has
got to be to bring more choices and more competition to the program. We
have to see Medicare reform in comparison to what the private sector
has done. Members of the U.S. Senate should not have too much
difficulty grasping this concept because a model, the Federal employee
health benefits plan, exists. Members are part of it, and surely it can
be a central plank for any bipartisan Medicare reform to look to the
model of the Federal employees health benefits plan to produce more
choices and more options.
The second plank of any Medicare reform effort should be to eliminate
the rewards that the program has for waste and eliminate the way it
penalizes the frugal. As incredible as it sounds, that's exactly what
happens in the Medicare Program as it relates to health plans. If a
plan holds down their costs, they end up getting penalized, and very
often it is tough for providers, particularly in rural areas, to make a
go of it. If a plan or part of the country sits on its hands and does
not make an effort to hold down costs, they get bigger reimbursement
checks. That's not right. The private sector consigned that kind of
approach to the attic years ago in eliminating the rewards for waste
and penalties. Efficiency should be a central component of any Medicare
reform.
Third, Mr. President, it seems critical, in my view, to protect the
rights of patients. I believe that when there is a modernized Medicare
Program, there will be more managed care available under the program
across this country. Many of our citizens, seniors and others, have had
legitimate questions about managed care, and I believe it is important
to put in place strong patient protections to safeguard the rights of
older people. This would include provisions such as a ban on these gag
clauses that keep older people from knowing their rights in managed
care plans. It would include stronger appeals procedures, grievance
procedures, and also the right of patients in managed care plans to get
data through report cards about how their plan stacks up on key issues.
I believe that part of the effort to reform Medicare ought to be to
protect patients' rights, and this should be a central component of
Medicare reform as the effort to promote more competition goes forward.
Fourth, Mr. President, I would change the reimbursement system that
is used in Medicare, known as the average adjusted per capita cost.
This is a sleep-inducing, eye-glazing concept by any calculus, but it
is the guts of Medicare reform. To reform this system, we ought to
gradually increase the reimbursement levels for low-cost areas, many of
them in rural areas, and we ought to inject more competition in high-
cost areas. There have been a number of recent analyses indicating that
some managed care plans have been overpaid, many of them in the high-
cost areas. Introducing more competition in those high-cost areas
through changes in this Medicare reimbursement formula is a sensible
way to enact bipartisan reform.
Then, Mr. President, it is critical that the Senate tighten up
efforts to fight fraud in Medicare. The General Accounting Office
recently indicated that about 10 percent of all of the costs of
Medicare are lost due to fraud. In a $200 billion program, $20 billion
lost to fraud and abuse has plagued the program. Stronger penalties
ought to be imposed for defrauding Medicare. If someone engages in a
flagrant, reprehensible fraud, they ought to be kicked out of the
Medicare Program for all time, not just some sort of slap on the wrist
in a resolving door situation. For flagrant frauds, there ought to be
lifetime debarment.
Next, Mr. President, in my legislation we would expand the role of
alternative health care providers. Nurses, physician assistants,
pharmacists, and chiropractors, among others, have shown an ability
across this country to deliver good quality, affordable health care to
older people. They ought to be allowed to play an expanded role in the
Medicare of the 21st century, both because these alternative
professions will help us to hold costs down through more competition
and also because they offer good quality care.
Next, Mr. President, I would unleash the power of new
telecommunications technologies in the health care field. A number of
Senators on both sides of the aisle have sought to expand the role of
telemedicine, which is already delivering good quality, low-cost care,
particularly in the preventive area. It is time for Medicare managers
to employ these tools. But as we see in so many parts of Medicare, the
Federal Government program, which is relied on by millions of seniors
and their families, lags behind the private sector. The Federal
Government hasn't even taken baby steps in terms of trying to set out a
policy to utilize telemedicine. So my legislation tries to ensure that
Internet access, which at least will help our rural communities, is
available. And, Mr. President, Senators on both sides of the aisle have
done good work that could be incorporated into a Medicare reform bill.
Finally, Mr. President, I propose in my legislation to clear away the
regulatory underbrush that needlessly and expensively fragments our
system of care for the older folks who are eligible for both Medicare
and Medicaid. These are folks on a low, fixed income. They are the so-
called dual eligibles. Right now, they are a big factor in major cost
increases in both Medicare and Medicaid. It is time for some more
creative approaches for dealing with those older people who are
eligible for both Medicare and Medicaid. My legislation proposes that,
and I intend to outline that further in the week.
Mr. President, the legislation that I have introduced can save about
$100 billion in hard savings over the next 5 years to provide short-
term financial stability for the program. I submit that our challenge
now is to lay the foundation for the next century. My legislation
doesn't, in any way, deal with all of the tough questions that the
Senate is going to face on Medicare. Medicare is not just an important
part of the Federal budget; Medicare is likely to be the Federal budget
for the next 15 to 20 years. When we look at the technological
explosion and the extraordinary technologies that are available, when
we look at the demographic tsunami that is coming in the next century
with so many older people, the challenge now is to lay a bipartisan
foundation to build on in the years ahead. The program that I have
described and the legislation I have introduced takes from the efforts
of both political parties over the last few years on Medicare.
For example, my legislation protects defined, secure, guaranteed
benefits for older people under Medicare. A number of Senators, led by
Senator Kennedy, have made this their priority, and I am of the view
that they are absolutely right. I think it would be a great mistake to
say that the future of Medicare
[[Page S2766]]
ought to be to just involve handing a check to an older person and say,
``Well, ma'am, buy health care until your money runs out. If the cost
of your care is greater than your check, well, so be it.'' I think it
is important to have guaranteed, secure, defined benefits. Many
Senators have stood for this principle. It is at the heart of my
legislation.
Let me also say that I believe that many Senators on the other side
of the aisle have been absolutely right in saying that it is time to
bring more competition and more choice to the Medicare Program. Many
Senators on the other side of the aisle have made the case that
competitive models--be it the Federal employee health plan or be it the
private sector--ought to be the kind of approach that we look to for
21st century Medicare. I believe they are right. I believe, in
addition, that it is now possible to forge a bipartisan coalition on
Medicare between the two parties, where those who have advocated for
guaranteeing secure, defined benefits can work with those who have
called for more competition and more choice and the kinds of changes
that have come to the private sector.
What it comes down to, Mr. President, is, will the Senate have the
political will to do it? Will the Senate have the vision to see beyond
the next electoral ridge? I believe that there is an extraordinary
opportunity now to set out a foundation for the next century. We know
that in the next century we are going to have to be dealing with the
question of whether, hypothetically, Lee Iaccoca ought to be paying
more for his Medicare than should a woman who is 75 years old and on a
low income who suffers from Alzheimer's. I didn't address it in my
legislation, but I happen to think that ought to be done. Senators will
have different views on that issue.
Mr. President, I am not convinced that's the issue that has to be
tackled right now. The issue that has to be tackled by the Senate right
now is to come up with $100 billion of hard savings to deal with the
budget resolution and the short-term financial challenge of Medicare
and then to lay the foundation for the next century. The foundation for
the next century can build on some very good work being done by
Senators of both political parties. I have been meeting with those
Senators privately.
I will have more to say during this week, Mr. President, for I intend
to go into further detail on my comprehensive Medicare reform
legislation every day this week. I will close with one last point. This
issue is so important to our country and so important to the Senate
that I believe in the next century--2010, 2020, 2030--people are going
to ask everyone in public life today: What did you do to try to get
Medicare on track?
I believe the legislation I have introduced opens up the opportunity
for bipartisan discussions toward Medicare reform. I have had a number
of those already with Chairman Domenici, Chairman Gramm on the other
side of the aisle, and have been very gracious in that regard. I have
had a chance to talk to the minority leader, Senator Daschle, and
Senator Kennedy, who have done so much good work.
Mr. President, I close by saying that my concern is to make sure that
the Senate, after years of bitter and acrimonious discussions on
Medicare, now tries to approach it in a different way, in a bipartisan
way, in a way that will allow us to tap the revolution of private
sector health care, in a way that is good for patients, and in a way
that is good for seniors and for taxpayers.
Mr. President, I yield the floor.
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