[Congressional Record Volume 143, Number 108 (Monday, July 28, 1997)]
[Senate]
[Pages S8174-S8175]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                    MEDICARE WASTE, FRAUD, AND ABUSE

  Mr. DORGAN. Madam President, I would like to make comments on one 
additional subject today, a subject that many of us are working on in 
both the Republican and Democratic caucuses, and one that is also very 
important to our country.
  The inspector general about a week and a half ago in Health and Human 
Services released a report on the Medicare Program, and indicated to us 
in Congress and to the American people that they felt that as much as 
$17 billion to $23 billion a year is essentially wasted in the area of 
Medicare, for a range of reasons and a range of areas--waste, fraud, 
and abuse. They describe bills that were inappropriate, bills that were 
erroneous, services billed for that were never provided, and some 
fraud.
  The reason that is an important report is that it follows on the 
heels of the Government Accounting Office, the inspector for the 
Congress, the GAO, which also had indicated that it felt somewhere in 
the neighborhood of $20 billion to $23 billion a year is wasted in the 
area of Medicare. By ``wasted,'' I mean waste, fraud, and abuse.
  A good number of people have tried to tackle this subject at one time 
or another and with some limited success.
  The American people would look at Medicare and probably conclude that 
it was a very important program. I happen to be a supporter of 
Medicare. I think it was a very important program for this country to 
develop.
  Prior to the 1960's, when this country developed the Medicare 
Program, far fewer than half of the American senior citizen population 
had any health insurance at all--and that was for obvious reasons. 
There are not insurance companies formed in this country to run around 
seeing if they can provide unlimited insurance to people who are 
reaching an age of retirement and where they are going to need more and 
more health care in older age. It is not the way insurance companies 
make money. Insurance companies search for that healthy 25-year-old who 
is not going to need any health care and sign them up to pay health 
insurance premiums. All of us know that. That is where insurance 
companies make money. Do you know of an insurance company that says, 
``Our mission in life is to make a profit by searching out old folks 
and seeing if we can provide insurance to old folks''? I don't think 
so. That is not the way it works. In order to have health insurance for 
people at any age, they would have to charge so much that most people 
couldn't afford it. The result was that in 1955, 1960, 1962 fewer than 
half of America's senior citizens had any health care coverage at all.
  We passed Medicare and made certain that the fear of reaching 
retirement age and not having health care coverage would be gone 
forever. Medicare guaranteed those citizens who reached that age--age 
65--that they were going to have health insurance coverage. And it has 
been a marvelous program in many ways. After health care was provided 
for senior citizens in the early 1960's in the Medicare Program, 99 
percent of the senior citizens in this country have coverage for health 
care--99 percent. That is a remarkable success.
  Something else has happened in this intervening period, and it is 
also called success. People are living longer and living better. 
Medical breakthroughs extend life in a very significant way. One-
hundred years ago at the turn of this century, if you were alive, you 
were expected on average to live to be 48 years of age. One century 
later, you have a reasonable expectancy to live to be 78 years of age--
from 48 to 78 in one century. That is progress. These days, on average, 
you live to 77 or 78 years of age. You have a bad knee, replace the 
knee; a bad hip, replace the hip; cataracts, get surgery, and you can 
see again. Plug up your heart muscle for over 50 or 60 years, open the 
chest and unplug the heart muscle with open-heart surgery. I have been 
to meetings where people have stood up at a meeting and said, ``You 
know, I have a new knee. I have a new hip. I had cataract surgery and 
had some blockages removed with heart surgery,'' and then said, ``and 
we are sick of the Government spending money.''

[[Page S8175]]

  Well, all of that cost money in Medicare. It is remarkable. It is 
breathtaking. It is wonderful that people live longer and medical 
breakthroughs allow them the opportunity to walk when they couldn't 
have previously walked and see when they couldn't have seen--and to do 
other things that give them a better life. But it is also very costly. 
It has costs with expanded Medicare payments, and all of us must 
understand that.
  This program has grown largely because of success. The life span 
increases with breakthroughs in medical care. All of that spells more 
money in Medicare. We understand that. I think the American people 
accept that as a success story, except no one will believe it is a 
success story to have a program that has up to $20 billion a year of 
waste in the program. When the American people hear the stories that 
for a bottle of saline solution that you can go down to the drug store 
and buy for $1.03 and Medicare pays $7.90 for it, they have a right to 
say, ``What on Earth is going on here?'' Medicare will pay $211 for a 
home diabetes monitor used by diabetics to test their blood sugar 
levels. You can buy the same one not for $211 but for $39 at the local 
store; or the gauze pad that Medicare paid $2.33 for that you can buy 
for 23 cents. The American people have every right to say, ``What on 
Earth is going on? If you can't run a program, get a crowd in here that 
can run a program.'' Or, ``If the Congress can't pass the laws to make 
sure it is run the right way, then get somebody else to pass the laws 
to make sure it is run the right way.''
  We ought to aggressively pursue fraud. When we see people committing 
fraud in Medicare, we ought to send them to jail, arrest them and 
prosecute them, and say, ``You commit fraud against the American 
people, your address is going to be your jail cell to the end of your 
term.'' When we see overbilling and overcharges, when we see 
administration that is not competent, we need to take action.
  The inspector general report of a week and a half ago sends another 
warning to this Congress that we must take action to prevent this kind 
of Medicare waste, fraud, and abuse.
  Mr. President, $20 billion a year is outrageous. If we are going to 
continue the support that is necessary for a Medicare Program that is 
important for this country, this Congress has to take action and take 
action soon.
  There are some remedies in the reconciliation bill that will come to 
the floor this week but not enough. We must do much, much more. I know 
there are Republicans and Democrats in this Congress anxious to work 
together on this problem to hopefully prevent there from ever again 
being another GAO report or inspector general report that provides this 
kind of awful news about a Federal program that is so important to so 
many Americans.
  Madam President, with that I conclude my remarks.
  The PRESIDING OFFICER. Will the Senator withhold any suggestion of a 
quorum call for an announcement by the Presiding Officer?
  Mr. DORGAN. Yes, of course.

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