[Congressional Record Volume 144, Number 140 (Thursday, October 8, 1998)]
[Senate]
[Pages S11892-S11896]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




              MEDICARE BENEFICIARY FREEDOM TO CONTRACT ACT

  Mr. KYL. I thank the Senator from Utah.
  Mr. President, I rise with several of my fellow Senators in support 
of S. 1194, the Medicare Beneficiary Freedom to Contract Act. S. 1194 
currently has 48 Senate and 192 House cosponsors.
  We believe that Medicare beneficiaries should have the same right to 
obtain health care from the physician or provider of their choice as do 
Members of Congress and virtually all other Americans.
  It is dangerous to have the government control health care decisions 
in a free society.
  What is the problem addressed by this legislation?
  The problem is simply one of health care choice for seniors--a 
problem which has been brought to our attention by countless 
constituents all over America.
  As I have mentioned on the Senate floor several times, this problem 
was first brought to my attention in a letter I received from Mr. and 
Mrs. C.B. Howard of Prescott.
  Mary Ann Howard is a diabetic. The medicine she was taking was not 
working, and she wanted to change doctors to one who specialized in 
treating diabetics.
  Her doctor told her that this was not possible. Amazed, Mary Ann 
asked why, and her original doctor replied that, due to the regulatory 
and administrative burdens of the Medicare system, the specialist 
cannot afford to take any more Medicare patients.
  When Mary Ann--who had recently turned 65 and enrolled in Medicare--
asked the specialist if she could pay for the treatment out of pocket, 
the specialist said no. ``If I accept you as a patient, I would be 
accused of Medicare fraud.''
  Yes, it's true: Because of a flawed interpretation of the Medicare 
law, the government has barred Medicare beneficiaries from using their 
own money to receive treatment from the doctor of their choice. It's 
Medicare or no care!
  To end this unfairness, the Senate passed the Kyl amendment to the 
Balanced Budget Act of 1997 that would allow health care choice for 
seniors.
  But the Administration threatened to veto the entire budget over this 
provision, and forced the Senate-House conference committee to include 
a poison pill:
  In order to enter into a private contract, a physician or other 
provider would have to sign out of Medicare for two years.
  The two-year exclusion presents your doctor with a difficult choice: 
He can either treat you, his patient of 30 years, on a private contract 
basis, and drop his other Medicare patients for two years; or refuse to 
treat you in favor of his current Medicare patients.
  Over 96 percent of doctors accept some Medicare patients and would 
not likely be willing to impose such a hardship on their current 
patients.
  So your options will likely be reduced.
  To remove this ``two year'' limitation on patient-choice, House Ways 
and Means Chairman Bill Archer and I introduced the Medicare 
Beneficiaries Freedom to Contract Act.
  The bill removes the two-year exclusion and ensure that any Medicare 
beneficiary can enter into an agreement with the provider of his or her 
choice for any health care service.
  In his 1998 State of the Union address, President Clinton said that 
all Americans ``should have the right to choose the doctor they want 
for the care they need.''
  We could not agree more. But as of January 1 of this year, seniors no 
longer have this right because, as I mentioned, the President insisted 
last year's Balanced Budget Act be changed to effectively preclude 
seniors from going outside of Medicare--even if they are willing to pay 
for the care themselves.
  S. 1194 could also be referred to as the Senior Citizens ``Medicare 
Point of Service Option.''
  Just as with a Point of Service Option in a private plan, this 
``Medicare Point of Service Option'' would allow seniors to go outside 
of the Medicare network to obtain care from the doctors of their 
choice.
  The only real difference is that the senior-patient would pay 100 
percent of the cost of exercising this right, whereas the private plan 
would subsidize this choice to some degree.
  Sandra Butler, president of United Seniors Association, represents 
the organization's 640,000 members who strongly support this bill.
  United Seniors Association members believe that the government's view 
of private contracting ``violates a basic--no, the basic--principle of 
American life: freedom.''
  In addition, a broad array of organizations have expressed support 
for the case to overturn current law.
  This group includes the Christian Coalition, the American Civil 
Liberties Union, the Heritage Foundation, the American Enterprise 
Institute, National Right to Life Committee, the American Medical 
Association, the American Conservative Union, Citizens Against 
Government Waste, and the National Center for Policy Analysis.
  Opponents of the bill make three basic arguments: the bill will 
increase fraud, will put seniors at the mercy of doctors and other 
providers, and will hurt Medicare.
  1. With respect to fraud, the bill contains extensive anti-fraud 
measures, including the requirement of a written contract with clear 
terms, such as the fact that the service could be paid for by Medicare.
  2. Others believe that unethical doctors would take advantage of 
vulnerable seniors.
  Common experience with medical professionals who save lives without 
reimbursement in emergency situations, and seniors who read and 
question virtually every line in their Medicare bill, clearly refute 
this claim.
  Further, a senior can for any reason terminate the contract 
prospectively and return to Medicare for the covered benefit.
  3. Some believe private contracting will destroy Medicare.
  However, private contracting will result in fewer claims being paid 
out of the near-bankrupt Medicare trust fund.
  We believe that the right of seniors to choose the health care 
provider and benefits that suit their individual needs is essential to 
our Nation's concept of liberty.

[[Page S11893]]

  In fact, there is no more fundamental principle at stake in any 
legislative issue before the Congress.
  We must not be the Congress that denied seniors the right to spend 
money they may have saved for years on a medical procedure needed for 
themselves or a loved one.
  Imagine a law that made it illegal for seniors to supplement their 
Social Security check with private funds!
  In sum, Mr. President, we believe that the Congress should enact 
legislation that ensures that seniors have the right to see the 
physician or health-care provider they want, and not be limited in such 
right by the imposition of unreasonable conditions on providers who are 
willing to treat seniors on a private basis.
  Even Great Britain's system of socialized medicine gives its 
beneficiaries this freedom.
  Senators and their staffs have this freedom. Surely, America should 
do no less for its seniors.
  Mr. President, I take this opportunity to express my appreciation for 
my colleagues' willingness to work with me to ensure seniors the 
critical right of health-care choice.
  I am joined by many of my colleagues in the Senate to ask the 
Majority Leader, Senator Lott, and Senate Finance Committee Chairman 
Roth, to work with us and the numerous outside organizations to address 
this issue of Medicare freedom of health-care choice as soon as is 
reasonable in the 106th Congress.
  As we know, President Clinton and some of our colleagues on both 
sides of the aisle want the government to continue to control all 
medical decisions of seniors.
  We must not rest until seniors are granted this basic civil right to 
choose the doctors and benefits that best address their particular 
health needs.
  Mr. ROTH. Mr. President, I thank the majority leader and my 
colleagues for bringing the important issue of Medicare private 
contracting to my attention in this constructive way. The individual 
stories described today on the floor illustrate why private contracting 
has generating intense interest and deserves careful study. 
Organizations including the United Seniors Association, American Civil 
Liberties Union, Christian Coalition, American Conservative Union, 
Heritage Foundation, National Right to Life Committee, CATO Institute, 
and Citizens Against Government waste share the concerns with current 
law and the belief that Medicare beneficiaries should be provided more 
freedom-of-choice in Medicare. In the months ahead, I intend to work 
closely with my colleagues here in the Senate to review the private 
contracting provisions of the Balanced Budget Act of 1997.
  (At the request of Mr. Kyl, the following statement was ordered to be 
printed in the Record.)
 Mr. HOLLINGS. Mr. President, I want to express my continuing 
support for S. 1194, the Medicare Beneficiary Freedom to Contract Act.
  It is ironic that the Balanced Budget Act--which purported to expand 
seniors' freedom of choice--took away most of the rights they already 
had to spend their own dollars to purchase health care of their 
choosing. Many senior citizens and disabled individuals in my state are 
outraged at this loss, and justifiably so. I must concur with the 
comments made recently by Art Spitzer, legal director of the American 
Civil Liberties Union of the National Capitol Area in an amici curiae 
brief in United Seniors Association vs. Donna Shalala:

       ``. . . the government should be able to say `We are going 
     to provide a certain amount of health care, and that is how 
     much we will provide and we are not going to provide more 
     than that.' But it seems quite outrageous to us . . . that 
     the government could say `and you may not get any more health 
     care than we are willing to provide you, even if you and your 
     doctor agree that it would be good for you, even if you are 
     able to pay for it with your own funds.' ''
  I ask that a letter I recently sent to the ranking member of the 
Senate Finance Committee be printed in the Record.
  The letter follows:

                                                  U.S. Senate,

                                  Washington, DC, October 5, 1998.
     Hon. Daniel Patrick Moynihan,
     Ranking Member, Senate Finance Committee,
     Washington, DC.
       Dear Pat: As you know, the American Civil Liberties Union 
     of the National Capital Area has joined as an amici curiae 
     participant in the United Seniors Association vs Donna 
     Shalala lawsuit to enjoin enforcement of Section 4507 of the 
     Balanced Budget Act of 1997. I support the views expressed in 
     this lawsuit that Congress made a mistake in the Balanced 
     Budget Act by disallowing seniors from making the broadest 
     array of physician and medical point-of-service choices in 
     instances where they want or need services out of the 
     Medicare system badly enough to spend their own money. It 
     stepped far over the bounds of ``protection'' into erosion of 
     freedom.
       I strongly supported requirements that physicians file 
     Medicare claims on behalf of beneficiaries. We've gotten the 
     program so complicated that hardly anyone understands it, but 
     doctors are better able to fight complex coding disputes and 
     coverage rules than their patients. Also, not getting paid 
     adds the incentive to resolve claim disputes while keeping 
     money in beneficiaries' pockets. Little did I realize this 
     protection would be used to restrict access to care. Section 
     4507 is an unwarranted intrusion on freedom of choice for 
     physicians and Medicare beneficiaries and adds unnecessary 
     costs to the Medicare that is already suffering financial 
     problems that scream for resolution.
       While most of us are able to find satisfactory care for 
     which we are glad to have Medicare pay, many of my 
     constituents have given reasons why an individual may choose 
     to go outside the Medicare system from time to time. Take the 
     example of a Federal employee who retired to the Charleston 
     area after living sixty years in Washington. She wanted to 
     return to have eye surgery at the Wilmer Eye Institute at 
     Johns Hopkins but was prohibited from doing so because the 
     surgeon did not accept Medicare patients. She wrote me that 
     she is not wealthy and has chosen to live frugally so that 
     she has something left over after living expenses to spend as 
     she sees fit. ``What right does the Government have to tell 
     me I can't spend my own money to buy the health care that I 
     think I need,'' she asks. I have to agree that the Federal 
     Government telling us senior citizens what we can do with our 
     own money is simply unacceptable.
       A great deal of confusion about Section 4507 remains. I 
     continue to believe we can reach a consensus that will permit 
     private contracting for seniors who choose to do so while 
     providing adequate protection for Medicare beneficiaries and 
     request that you give this matter your much respected expert 
     consideration early in the 106th Congress. If I can answer 
     any questions or be of any help, please don't hesitate to 
     call on me.
       With kindest regards, I am,
           Sincerely,
                                               Ernest F. Hollings.

  Mr. HOLLINGS. Mr. President, we clearly cannot move forward with 
Medicare+Choice until the confusion over Section 4507 is resolved, and 
I join my colleagues in urging your earliest consideration of this 
matter in the 106th Congress.
  Mr. GORTON. Mr. President, I speak today in defense of an essential 
freedom--the right to make health care decisions outside of the 
governmental bureaucracy. Yet there is a segment of our population--our 
seniors--who have lost that freedom. At the administration's insistence 
a provision was included in the budget reconciliation bill of 1997 that 
prohibits physicians from participating in the Medicare program for two 
years if they accept private payment for services normally covered 
under the Medicare program from a patient who is eligible for 
Medicare--essentially trapping our seniors in a government controlled 
health care program.
  It is clear that the provisions included in the Balanced Budget Act 
are hurting seniors. One of my constituents stories was featured in the 
Reader's Digest. Ray Perry wanted to pay for routine screening tests 
for he and his wife because years before, prior to enrolling in 
Medicare, the Perry's had conducted a similar series of tests and were 
able to detect his wife's lymphatic leukemia very early when it was 
still treatable. Medicare decided not to pay for the tests because the 
Perrys didn't have certain symptoms that would indicate these tests 
were required. But, when the Perrys offered to pay out of their own 
pocket, the doctor still wouldn't order the tests for fear of being 
penalized by Medicare. While both the Perrys and their doctor wanted 
medical services that were clearly reasonable, and the Perrys were 
willing to pay for these services, the restrictions currently found in 
Medicare prevented them from getting the kind of health care they 
needed.
  It is unconscionable that in a nation founded on the principles of 
freedom that we would limit the freedom of the Perrys and millions of 
American seniors just like them.
  Mr. CRAIG. Mr. President, I rise today to make a few remarks 
concerning the Medicare Beneficiary Freedom

[[Page S11894]]

to Contract Act. Most Americans believe that should control their 
health care to the greatest extent possible. Others continue to favor 
comprehensive federal control of seniors, health care which results in 
rationing. All patients should be able to choose their own doctors and 
have complete freedom to supplement their insurance, including 
Medicare, as they see fit. The right of seniors to pay out of their own 
pocket for the health care of their choice is an essential element of 
our nation's concept of liberty.
  Under this Act, Medicare would pay the standard fee for the standard 
procedures by the standard practitioner with private contracting 
reserved for more specialized procedures. While it would be a right 
that--because of economics--would be exercised only in special 
circumstances, private contracting is a basic right every senior should 
have. And importantly, it would provide a safeguard from government 
manipulation--something which under the Clinton Administration is an 
all-too-real possibility.
  Under this act, seniors would be even less likely to privately 
contract than they are to go to nonparticipating physician, because 
with private contracting they agree to pay the full cost of the service 
themselves (just as they historically have.) In fact, if the desire to 
pay out-of-pocket were widespread, seniors wouldn't join Part B (which 
is voluntary) at all. But seniors overwhelmingly choose Part B 
insurance--just as most other Americans do in choosing doctor-visit 
coverage in their health plans.
  President Clinton said in the State of the Union that all Americans 
must have the right to doctor choice, and assess to specialists without 
referral. Why not seniors, too?
  Mr. President, I believe that Americans are right when they tell me 
in letters and phone calls and personal visits that they do not want to 
be trapped by a one-tiered Medicare program. I think I am correct in 
stating that senior citizens over age 64 are right in being angry at 
all members of Congress and the Clinton Administration for denying them 
their right to make any medical choice for themselves, to see any 
physician they want for any service they want if they want to spend 
their own money. It is for this reason, that I ask all my colleagues to 
work with us to restore to seniors their right to privately contract 
for any medical service with physicians of their choice. I look forward 
to working with the distinguished Chairman of the Senate Finance 
Committee, Senator Roth, and other Members of the Senate toward that 
goal.
  Mr. NICKLES. Mr. President, I thank the Chairman for his work and 
support of this very important legislation.
  I also thank Senator Kyl for his dedicated work on this issue. I was 
pleased to join him as an original cosponsor of this bill, because I 
believe that this is a fundamental issue of freedom for all senior 
citizens. Every senior citizen should have the fundamental right to pay 
out of their own pocket for the health care they want from the 
physician they choose.
  President Clinton has repeatedly stated, most recently in his State 
of the Union address, that ``all Americans should have the right to 
choose the doctor they want for the care they need.'' But apparently, 
the administration does not believe this should apply to Medicare 
beneficiaries. In fact, during the debate on the Balanced Budget Act 
(BBA) of 1997, the administration repeatedly stated their opposition to 
giving his unfettered freedom to senior citizens.
  Finally, the administration agreed to drop their objections to this 
provision if the BBA would grant seniors only limited freedom with 
certain restrictions. In the spirit of compromise, the BBA included a 
limited provision to allow physicians to enter into private contracts 
for Medicare-covered services. Unfortunately, the provision in the BBA 
did not go far enough.
  Under BBA 97, in order to enter into these contracts, a physician or 
other provider would have to opt out of Medicare for two years and sign 
an affidavit, approved by HCFA, to ensure that no Medicare patients 
were treated. But the two-year exclusion presents the doctor with a 
difficult choice: either treat the patient on a private contract and 
drop all other Medicare patients for two years; or refuse to treat the 
patient in favor of current Medicare patients. This is a difficult 
decision that neither a physician or beneficiary should be required to 
make.
  Now, one can argue that the reforms in the BBA were a step forward 
for Medicare private contracting. If is true that HCFA had interpreted 
Medicare law, prior to the passage of BBA 97, as effectively 
prohibiting private contracts. In fact, HCFA had gone as far as 
threatening physicians and other providers with fines and exclusion 
from Medicare and even criminal prosecution. So if HCFA's 
interpretation was correct, perhaps the provisions included in BBA 97 
were a step forward.
  On the other hand, many respected Medicare experts have suggested 
that HCFA did, in fact, misinterpret the Medicare statute. In other 
words, Medicare law did not prohibit private contracts, but rather it 
was silent on the issue. As I read the Medicare law, prior to BBA, I 
see nothing that prohibits Medicare beneficiaries and providers from 
entering into these private arrangements. So if this interpretation is 
correct, the provisions included in BBA could be viewed as a step 
backward.
  In either case, the right thing to do is to allow seniors unfettered, 
unrestricted access to the doctor of their choice. The Kyl legislation 
does just that. It would extend this right to Medicare beneficiaries 
with no limitation, allowing Medicare beneficiaries to be treated for 
Medicare-covered services by the physicians of their choice on a 
``case-by-case'' and a ``patient-by-patient'' basis. No doctor who 
chooses to enter into a private contracting arrangement with a senior 
would be faced with fines or expulsion from the Medicare program.
  Opponents of private contracting make two primary arguments against 
this legislation: unethical doctors will take advantage of seniors to 
increase their income; and it will result in excessive fraud and abuse 
in the Medicare program.
  The argument that perplexes me the most is the concern that unethical 
doctors would take advantage of vulnerable seniors and use private 
contracts to increase their annual income. If I were a Medicare 
beneficiary I would be offended by the notion that I am unable to make 
my own financial and medical decision. Senior citizens are some of the 
most frugal and well informed health care shoppers in the country. 
Additionally, if I were a physician, I would be offended by the 
assumption that most doctors are unethical in their professional 
activities. Any physician that were to engage in unethical or coercive 
practices faces tremendous risks, including the loss of their medical 
license for ethical violations.

  I assume that those who believe physicians will use the Kyl 
legislation to line their pockets would also be concerned with new 
federal coverage mandates on private health insurance. Every federal 
coverage mandate we place on health insurance providers increases the 
cost of health insurance and increases the revenues of physicians. But 
I haven't heard many members who are concerned that federal mandates 
which require insurance companies to pay for a variety of treatments 
may increase the profits of physicians. Do we assume that physicians 
and other practitioners will be ethical when an insurance company is 
paying the bill and unethical when a vulnerable senior is paying the 
bill? The fact is that the opponents of this legislation simply want 
more control over the health care of senior citizens.
  The bill also contains strong consumer protection standards to ensure 
that Medicare beneficiaries are not exploited. Private contracts must 
be in writing, signed by the beneficiary, and identify the services 
covered by the contract. It prohibits private contracts in emergency 
situations, unless the contract was entered into before the onset of 
the emergency medical condition.
  Private contracts may only be entered into on a prospective basis and 
may not apply to services rendered prior to the signing of the 
contract. Such contracts must also notify the beneficiary that Medicare 
is not responsible for the payment of any services covered under the 
contract and that the beneficiary has the right to have such services 
provided by other physicians or practitioners to whom Medicare payment 
would be made.

[[Page S11895]]

  Other opponents of this legislation argue that private contracting 
will result in double billing and outright fraud. Perhaps the opponents 
haven't looked closely at the extensive anti-fraud measures included in 
this legislation. The legislation prohibits double payments by 
requiring physicians and practitioners entering into private contracts 
to submit to the Secretary such information as may be necessary to 
avoid any payment under Part A or Part B for services covered under the 
contract. Fraudulent billing would be detected and punished through 
existing fraud and abuse laws and standard auditing procedures used by 
Medicare and private plans. If Medicare did pay for a service, the 
patient would receive a statement and could easily notify Medicare of 
the payment error.
  Mr. President, this legislation adequately addresses the concerns 
that have been raised by the opponents. The integrity of Medicare 
system is not at issue here. The defining issue is really quite simple. 
This is a fundamental issue of individual freedom. Do you support 
giving senior citizens the freedom to pay out of their own pocket for 
the health care they want from the physician they choose? Or do you 
support limiting that freedom and restricting the health care choices 
available to senior citizens? I hope my colleagues will join Senator 
Kyl in supporting this legislation and supporting individual freedom 
for every senior citizen.
  Mr. ALLARD. Mr. President, I rise today in support of Senator Kyl's 
initiative to provide more choice for our nation's senior citizens. I 
encourage the majority leader and Senate Finance Committee Chairman 
Roth to continue to work to address the issue of private contracting so 
that S. 1194 can be enacted into law.
  I believe that our seniors should have the right to make their own 
decisions when it comes to matters of their health. Somewhere along the 
way, it has been mistakenly assumed that once a person reaches 65, they 
no longer are able to make their own decisions and do not desire the 
freedom of choice that others enjoy. Since when did the seniors of our 
nation become so helpless? Shouldn't seniors be afforded the same 
rights that the rest of us enjoy--to determine what is in their best 
interest?
  Current law does not permit seniors to purchase their own health care 
services if those services are covered under Medicare and provided by a 
physician who accepts Medicare payments. This is ludicrous. Not only 
does this law take away rights of senior citizens, but these types of 
regulations within the Medicare system also discourage the 
participation of doctors. If a physician decides to accept a private 
contracting fee, the doctor must give up all Medicare patients for two 
years. In effect, this law has the potential of limiting physicians who 
participate in the Medicare program. This could consequently decrease 
the quality of physicians in the Medicare system because doctors refuse 
to be part of such an oppressive system.
  This issue is one of fundamental rights. No other government program 
restricts the participants as does Medicare--including Medicaid and 
health programs for government employees. Medicare beneficiaries should 
be given the right to pay out-of-pocket and to choose their own health 
care provider.
  One of the guiding principles of this nation is individual freedom. 
Congress should not support measures that clearly restrict freedom. I 
urge the enactment of S. 1194, the Medicare Beneficiaries Freedom to 
Contract Act.
  Mr. MACK. Mr. President, I am pleased to be a co-sponsor of the 
Medicare Beneficiary Freedom to Contract Act. I want to commend the 
efforts of Senator Kyl, who introduced this important legislation and 
who has worked so hard to secure its passage.
  The central questions with respect to the issue of Medicare private 
contracting are clear. It is the proper role of the Federal government 
to deny Medicare beneficiaries the ability to use their own money to 
get the health care services they believe they need? Is it good public 
health policy to force doctors who treat Medicare beneficiaries on a 
private-pay basis out of Medicare for two years?
  I think these questions must be answered with a resounding ``no''. If 
a Medicare patient--or any patient, for that matter--wants to spend his 
or her own money to pay for a health care service, it should be their 
decision and not the government's decision. I also believe it is wrong 
to put a doctor in the position of having to decide between treating a 
Medicare patient who chooses to pay out-of-pocket, or stop treating all 
their other Medicare patients for two years.
  The administration makes the argument that its opposition to this 
legislation is based upon its desire to ``protect senior citizens''. I 
certainly don't question the sincerity of their concern. However, 
judging from the response my office has received, seniors neither want 
nor need the Federal government to ``protect them'' from themselves. 
Florida is home to the second largest Medicare beneficiary population 
in the nation. My office has been deluged with thousands of letters, 
telephone calls, faxes, postcards and telegrams from Medicare 
beneficiaries who are, quite frankly, outraged that the Administration 
is opposed to this legislation.
  The communications I have received from seniors in Florida all have 
common themes--How can something like this be happening in America? Is 
this not a profound assault on the freedom of American citizens? What 
right do you people in Washington have to tell me what I can and can't 
do with my own money when it comes to my own health care? Who asked you 
to make this decision for me?
  I couldn't agree with them more. It is clearly wrong to take 
important health care decisions out of the hands of patients and put 
them into the hands of the Federal government. Moreover, this policy 
results in a two-tiered system for those Americans who receive their 
health care from the Federal government. Patients who are beneficiaries 
of Medicaid, CHAMPUS, the Indian Health Service and Federal workers who 
participate in the FEHBP, which includes most of us in Congress and our 
staffs, may legally enter into private contracts with physicians of our 
choice. But this is not the case for Medicare beneficiaries--because 
the government supposedly knows what is best for them.
  Isn't it also ironic that a citizen of Great Britain, with its 
socialized health care delivery system, has the ability to privately 
pay for medical services, but Medicare patients in the United States 
are denied the ability to make this decision for themselves unless 
their physician is willing to opt-out of Medicare for two years?
  To me, this issue exemplifies one of the most fundamental differences 
I have with this Administration when it comes to either health care 
policy or the proper role of the Federal government in general. This 
absurd policy is simply another example of big government run amok, and 
it's time to put a stop to it. The Senate should pass the Medicare 
Beneficiary Freedom to Contract Act now.
  Mr. GRASSLEY. Mr. President, the issue of private contracting in the 
Medicare program is very important to my constituents in Iowa. I have 
received hundreds of letters asking Congress to repeal the provisions 
in the Balanced Budget Act of 1997 requiring physicians who enter into 
a private contract with beneficiaries to opt out of the Medicare 
program for two years. Seniors in my state believe it is not the role 
of the federal government to interfere with relationship with their 
physician. They want to have as many choices and options as possible. I 
want to make sure their freedom is protected. That is why I want to 
thank the majority leader, Senator Lott, and the chairman of the Senate 
Finance Committee, Senator Roth, for recognizing the importance of this 
issue to our nation's seniors and for agreeing to address this problem 
next Congress. I want to offer my support to help with these efforts as 
a cosponsor of Senator Kyl's legislation and as the Chairman of the 
Senate Special Committee on Aging and senior member of the Senate 
Finance Committee.
  Mr. BENNETT. Mr. President, I rise to thank my colleague from 
Delaware, Mr. Roth, for his commitment to look further into the issue 
of medicare private contracting and to thank the honorable Senator from 
Arizona, Mr. Kyl, for his leadership as the sponsor of S. 1194, the 
Medicare Beneficiaries Freedom to Contract Act. As one of 48 cosponsors 
of Mr. Kyl's bill, I believe that we need to take steps to maximize 
choice, access and care for Medicare

[[Page S11896]]

patients, not restrict them in the name of patient protection. I have 
been contacted by hundreds of seniors from my state who understandably 
expressed outrage that Congress had passed a law that will inevitably 
restrict access to health care from the provider of their choice even 
when they are willing to pay for the care out of their own pocket. We 
have been told that this provision was included in the Balanced Budget 
Act as a protection for Medicare patients. However, I believe we can 
protect Medicare patients from fraud and abuse without restricting 
their access to desired care.
  Mr. President, I thank my colleagues, once again, for their 
commitment and leadership and I look forward to working with them in 
the near future to address this important issue.
  Mr. INHOFE. Mr. President, I, too, rise in support of S. 1194, the 
Medicare Beneficiaries Freedom to Contract Act.
  You and I, Mr. President, and all other Americans not covered under 
Medicare, may obtain health services without informing the federal 
government. However, our nation's senior citizens must first seek out 
Washington's approval--even when they prefer to pay for those services 
out of their own pocket.
  Congress intended to correct this situation by permitting private 
contracts. Unfortunately, the President insisted he would veto the 
entire 1997 Balanced Budget Act unless this fundamental right of all 
Americans was eliminated or severely limited for senior citizens.
  Medicare beneficiaries should have the same freedom to obtain the 
health care they choose from the physician or provider of their 
choice--as do Members of Congress and virtually all other Americans. 
It's ridiculous that this right was taken away and unfortunate that 
it's taken so long to correct.
  Mr. President, I thank the majority leader, Senator Lott, and Senate 
Finance Committee Chairman Roth for acknowledging the importance of 
this issue and for pledging to look into it further next year in the 
106th Congress.
  Mr. SHELBY. Mr. President, I thank my distinguished friend, Senator 
Kyl, for introducing S. 1194--the Medicare Beneficiary Freedom to 
Contract Act and for his leadership on this issue.
  I firmly believe it is my obligation, as an elected member of the 
United States Senate, to defend the liberty of the constituents that 
put me in office. Freedom manifests itself in various ways, but one 
fundamental concept of importance in America is the protection of one's 
discretion over one's financial resources. I often raise this issue in 
the context of taxes, but in addition to allowing one to reap what one 
sows, it is equally important that people have the ability to spend 
their earnings as they see fit.
  I want to be perfectly clear what I think the essence is of what we 
are discussing when the issue of Medicare private contracting arises. 
We are talking about allowing people to spend their money as they see 
fit. This is a very simple, yet important, freedom that people enjoy. 
We are not talking about letting people buy illegal products, but 
rather about the right of people to spend their money on health care. 
Only in Washington DC could such a notion be considered controversial. 
But to those who have little regard for individual freedom, and who 
have a vested interest in seeing the scope and power of government 
grow, this is a controversial matter.
  H.L. Menken once said that ``the most dangerous man, to any 
government, is the man who is able to think things out for himself.'' 
That is the threat, Mr. President. Those that favor the Medicare 
monopoly, often even to the detriment of Medicare beneficiaries, resist 
the freedom of people to make these private decisions, because it 
threatens the government's control of health care delivery.
  Unfortunately the era of big government is not over. In fact, it is 
alive and well and is embodied in Section 4507 of last year's Balanced 
Budget Act. Therefore, I want to request that Majority Leader Lott and 
Finance Committee Chairman Roth help us attach S. 1194 to the first 
appropriate legislative vehicle, so that we can repeal Section 4507. 
Mr. President, we must restore the right of our elderly to buy the 
health care they feel they need, without any ``big government'' 
constraints on their decisions. This effort is important not only to 
our ensuring quality health care to our elderly, but also to the larger 
battle of defending freedom in America.
  Mr. KYL. Mr. President, I thank the majority leader, Senator Lott, 
and Finance Committee chairman, Senator Roth, for recognizing the 
problem of many seniors who are not afforded choice in determining 
where they get their health care and on agreeing to address this 
problem in the 106th Congress.
  I also thank Senators Hollings, Roth, Gorton, Craig, Nickles, Allard, 
Mack, Grassley, Bennett, Inhofe and Shelby for participating with 
statements for the Record. We do intend to address this problem in the 
next session of the Congress because we could not get it done this 
session. I appreciate my colleagues' commitment to doing that and, 
again, thank the Senator from Virginia.
  The PRESIDING OFFICER. The Senator from Virginia.

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