[Congressional Record Volume 145, Number 124 (Wednesday, September 22, 1999)]
[Senate]
[Pages S11258-S11260]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. GRAHAM (for himself, Mr. Jeffords, Mr. Chafee, Mr. Bryan, 
        Mr. Rockefeller, and Mr. Kerry):
  S. 1618. A bill to promote primary and secondary health promotion and 
disease prevention services and activities among the elderly, to amend 
title XVIII of the Social Security Act to add preventive benefits, and 
for other purposes; to the Committee on Finance.


                         medicare wellness act

  Mr. GRAHAM. Mr. President, I rise today, along with my colleagues, 
Senator Jeffords, Senator Chafee, Senator Bryan, Senator Rockefeller, 
and Senator Kerry to introduce the Medicare Wellness Act. The Medicare 
Wellness Act represents a concerted effort by myself and my 
distinguished colleagues to change the fundamental focus of the 
Medicare program.
  It changes the program from one that simply treats illness and 
disability, to one that is also proactive. It enhances the focus on 
health promotion and disease prevention for Medicare beneficiaries.
  Mr. President, despite common misperceptions, declines in health 
status are not inevitable with age. A healthier lifestyle, even one 
adopted later in life, can increase active life expectancy and decrease 
disability. This fact is a major reason why the Medicare Wellness Act 
has support from a broad range of groups, including the National 
Council on Aging, Partnership for Prevention, American Heart 
Association, and the National Osteoporosis Foundation.
  The most significant aspect of this bill is its addition of several 
new preventative screening and counseling benefits to the Medicare 
program. The benefits being added focus on some of the most prominent, 
underlying risk factors for illness that face all Medicare 
beneficiaries, including: screening for hypertension, counseling for 
tobacco cessation, screening for glaucoma, counseling for hormone 
replacement therapy, screening for vision and hearing loss, expanded 
screening and counseling for osteoporosis, and screening for 
cholesterol.
  The new benefits added by the Medicare Wellness Act represent the 
highest recommendations for Medicare beneficiaries of the U.S. 
Preventive Services Task Force--recognized as the gold standard within 
the prevention community. Attacking these prominent risk factors will 
reduce Medicare beneficiaries' risk for health problems such as stroke, 
diabetes, osteoporosis, heart disease, and blindness.
  The addition of these new benefits would accelerate the fundamental 
shift, that began in 1997 under the Balanced Budget Act, in the 
Medicare program from a sickness program to a wellness program. Prior 
to 1997, only three preventive benefits were available to 
beneficiaries: pneumococcal vaccines, pap smears, and mammography.
  Other major components of our bill include the establishment of the 
Healthy Seniors Promotion Program. This program will be led by an 
interagency work group within the Department of Health and Human 
Services. It will bring together all the agencies within HHS that 
address the medical, social and behavioral issues affecting the elderly 
and instructs them to undertake a series of studies which will increase 
knowledge about and utilization of prevention services among the 
elderly.
  In addition, the Medicare Wellness Act incorporates an aggressive 
applied and original research effort that will investigate ways to 
improve the utilization of current and new preventive benefits and to 
investigate new methods of improving the health of Medicare 
beneficiaries.
  Mr. President, this latter point is critical. The fact is that there 
are a number of prevention-related services available to Medicare 
beneficiaries today, including mammograms and colorectal cancer 
screening. But those services are seriously underutilized.
  In a study published by Dartmouth University this spring (The 
Dartmouth Atlas of Health Care 1999), it was found that only 28 percent 
of women age 65-69 receive mammograms and only 12 percent of 
beneficiaries were screened for colorectal cancer. These are disturbing 
figures and they clearly demonstrate the need to find new and better 
ways to increase the rates of utilization of proven, demonstrated 
prevention services. Our bill would get us the information we need to 
increase rates of utilization for these services.
  Further, our bill would establish a health risk appraisal and 
education program aimed at major behavioral risk factors such as diet, 
exercise, alcohol and tobacco use, and depression. This program will 
target both pre-65 individuals and current Medicare beneficiaries.
  The main goal of this program is to increase awareness among 
individuals of major risk factors that impact on health, to change 
personal health habits, improve health status, and save the Medicare 
program money. Our bill would require the Medicare Payment Advisory 
Commission, known as MedPAC, to report to Congress every two years and 
assess how the program needs to change over time in order to reflect 
modern benefits and treatment.
  Shockingly, this is information that Congress currently does not 
receive on a routine basis. And this is a contributing factor to why we 
find ourselves today in a quandary over the outdated nature of the 
Medicare program. Quite frankly, Medicare hasn't kept up with the rest 
of the health care world.
  While a vintage wine from the 1960s may be desirable, a health care 
system that is vintage 1965 is not. We need to do better.
  Our bill would also require the Institute of Medicine (IOM) to 
conduct a study every five years to assess the scientific validity of 
the entire preventive benefits package. The study will be presented to 
Congress in a manner that mirrors The Trade Act of 1974.
  The IOM's recommendations would be presented to Congress in 
legislative form. Congress would then have 60 days to review and then 
either accept or reject the IOM's recommendations for changes to the 
Medicare program. But Congress could not change the IOM's 
recommendations.
  This ``fast-track'' process is a deliberate effort to get Congress 
out of the business of micro-managing the Medicare program. While 
limited to preventive benefits, this will offer a litmus test on a new 
approach to future Medicare decision making.
  In the aggregate, The Medicare Wellness Act represents the most 
comprehensive legislative proposal in the 106th Congress for the 
Medicare program focused on health promotion and disease prevention for 
beneficiaries. It provides new screening and counseling benefits for 
beneficiaries, it provides critically needed research dollars, and it 
tests new treatment concepts through demonstration programs.
  The Medicare Wellness Act represents sound health policy based on 
sound science. Before I conclude, I have a few final thoughts.
  There are many here in Congress who argue that at a time when 
Medicare faces an uncertain financial future, this is the last time to 
be adding new benefits to a program that can ill afford the benefits it 
currently offers.
  Normally I would agree with this assertion. But the issue of 
prevention is different. The old adage of ``an ounce of prevention is 
worth a pound of cure'' is very relevant here.

[[Page S11260]]

  Does making preventive benefits available to Medicare beneficiaries 
``cost'' money? Sure it does. But the return on the investment, the 
avoidance of the pound of cure and the related improvement in quality 
of life is unmistakable.
  Along these lines, a longstanding problem facing lawmakers and 
advocates of prevention has been the position taken by the 
Congressional Budget Office, as it evaluates the budgetary impact of 
all legislative proposals.
  Only costs incurred by the Federal government over the next ten years 
can be considered in weighing the ``cost'' of adding new benefits. From 
a public health and quality of life standpoint, this premise is 
unacceptable.
  Among the problems with this practice is that ``savings'' incurred by 
increasing the availability and utilization of preventive benefits 
often occur over a period of time greater than 10 years. This problem 
is best illustrated in an examination of the ``compression of 
morbidity'' theory developed by Dr. James Fries of Stanford University 
over 20 years ago.
  According to Dr. Fries, by delaying the onset of chronic illness 
among seniors, there is a resulting decrease in the length of time 
illness or disability is present in the latter stages of life. This 
``compression'' improves quality of life and reduces the rate of growth 
in health care costs. But, these changes are gradual and occur over an 
extended period of time--10, 20, even 30 years.
  With the average life expectancy of individuals who reach 65 being 
nearly 20 years--20 years for women and 18 years for men--it only makes 
sense to look at services and benefits that improve quality of life and 
reduce costs to the Federal government for that 20 year lifespan.
  In addition to increased lifespan, a ten year budget scoring window 
doesn't factor into consideration the impact of such services on the 
private sector, such as increased productivity and reduced absenteeism, 
for the many seniors that continue working beyond age 65. The bottom 
line is, the most important reason to cover preventive services is to 
improve health.
  As the end of the century nears, children born now are living nearly 
30 years longer than children born in 1900.
  While prevention services in isolation won't reduce costs, they will 
moderate increases in the utilization and spending on more expensive 
acute and chronic treatment services.
  As Congress considers different ways to reform Medicare, two basic 
questions regarding preventive services and the elderly must be part of 
the debate.
  (1) Is the value of improved quality of life worth the expenditure? 
And,
  (2) How important is it for the Medicare population to be able to 
maintain healthy, functional and productive lives?
  These are just some of the questions we must answer in the coming 
debate over Medicare reform.
  While improving Medicare's financial outlook for future generations 
is imperative, we must do it in a way that gives our seniors the 
ability to live longer, healthier and valued lives. I believe that by 
pursuing a prevention strategy that addresses some of the most 
fundamental risk factors for chronic illness and disability that face 
seniors, we will make an invaluable contribution to the Medicare reform 
debate and, more importantly, to our children and grandchildren.
  Finally, Mr. President, I would be remiss in pointing out that the 
Medicare Wellness Act represents the first time in this Congress that 
Republicans and Democrats have gotten together in support of a major 
piece of Medicare reform legislation. This bill represents a health 
care philosophy that bridges political boundaries. It just makes sense. 
And you see that common sense approach today from myself and my 
esteemed colleagues who have joined me in the introduction of this 
bill.
   Mr. President, I encourage my colleagues to join us on this 
important bill and to work with us to ensure that the provisions of 
this bill are reflected in any Medicare reform legislation that is 
debated and voted on this year in the Senate.
  Mr. JEFFORDS. Mr. President, I am pleased to join my colleague, 
Senator Graham, to introduce the Medicare Wellness Act of 1999. This 
legislation will modernize Medicare benefits and improve the preventive 
care received by our nation's seniors.
  The Medicare program was designed in 1965 to provide seniors with 
access to the same health care services enjoyed under private health 
insurance plans. Medical science has grown by leaps and bounds in the 
decades since that time. Most of the private sector acted swiftly to 
cover preventive benefits when they realized that it is cheaper to 
screen for an illness and treat its early diagnosis than to pay for 
drastic procedures in a hospital later on. Congress has been too slow 
in extending to Medicare beneficiaries the same advances in quality 
care enjoyed throughout the rest of the health care system.
  The Medicare Wellness Act adds to the Medicare program those benefits 
recommended by the U.S. Preventive Services Task Force. These include: 
screening for hypertension, counseling for tobacco cessation, screening 
for glaucoma, counseling for hormone replacement therapy, screening for 
vision and hearing loss, expanded screening and counseling for 
osteoporosis, and cholesterol screening. These are some of the most 
prominent risk factors facing Medicare beneficiaries. If these symptoms 
are addressed regularly, beneficiaries will have a head start on 
fighting the conditions they lead to, such as diabetes, lung cancer, 
heart disease, blindness, osteoporosis, and many others.
  Beyond the eight new preventive benefits under this bill, the 
Institute of Medicine (IOM) will conduct a study every five years to 
assess the scientific validity and cost-effectiveness of the preventive 
benefits package. When presented to Congress, the study will recommend 
what, if any, preventive benefits should be added, or removed from the 
Medicare program. By facing such regularly scheduled considerations of 
preventive benefits, Congress will do a much better job of keeping the 
Medicare program up to date with the rapid advances in medical science.
  The Medicare Wellness Act also instructs the Secretary of Health and 
Human Services to coordinate with the Centers for Disease Control and 
Prevention and the Health Care Financing Administration to establish a 
Risk Appraisal and Education Program. This program will target both 
current beneficiaries and individuals with high risk factors below the 
age of 65. Outreach to these groups will offer questions regarding 
major behavioral risk factors, including the lack of proper nutrition, 
the use of alcohol, the lack of regular exercise, the use of tobacco, 
and depression. State of the art software, case managers, and nurse 
hotlines will then identify what conditions beneficiaries are at risk 
for, based on their individual responses to the questions, and inform 
them of actions they can take to lead a healthier life.
  Any modern health care professional can tell you that effective 
health care addresses the whole health of an individual. A lifestyle 
that includes proper exercise and nutrition, and access to regular 
disease screening ensures attention to the whole individual, not just a 
solitary body part. It is time we reaffirm our commitment to provide 
our nation's seniors with quality health care.
  I want to thank my colleagues, Senators Graham, Chafee, Bryan, 
Rockefeller, and Kerry for their dedication to the idea of changing 
Medicare from a sickness program to a wellness program.
  Mr. President, I yield the floor.
                                 ______