[Congressional Record Volume 146, Number 102 (Wednesday, September 6, 2000)]
[House]
[Pages H7253-H7259]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




             PRESCRIPTION DRUG BENEFIT FOR AMERICAN SENIORS

  The SPEAKER pro tempore (Mr. Tancredo). Under the Speaker's announced 
policy of January 6, 1999, the gentleman from New Jersey (Mr. Pallone) 
is recognized for 60 minutes as the designee of the minority leader.
  Mr. PALLONE. Mr. Speaker, I would like to discuss in a little depth 
tonight the issue of prescription drugs and trying to provide a 
prescription drug benefit to America's seniors.
  In that context, I wanted to specifically, Mr. Speaker, make 
reference to the proposal that the Republican candidate for President, 
Mr. Bush, has made in the last few days, and draw the contrast between 
that and the plan that the Democrats have been putting forward in the 
House of Representatives and that is also supported by Vice President 
Gore. I know I am going to be joined tonight by some of my colleagues 
on the Democratic side of the aisle.
  Mr. Speaker, my concern about what has been happening with the Bush 
Medicare plan, or I should say with the Bush prescription drug plan, it 
is just basically too little too late. The Democrats here in the House 
have been talking about expanding prescription drugs through Medicare. 
On the Republican side of the aisle, we have seen fig leaves go out 
about different proposals to provide some sort of voucher or subsidy 
for seniors who might want to go out and buy a prescription drug plan.
  But the Republican proposal really does not do anything, nor does Mr. 
Bush's proposal do anything to help the average senior. I think it is 
just a lot of rhetoric. It does not actually do anything to solve the 
problems that seniors face today. I just wanted to contrast because, in 
many ways, I think that what Mr. Bush has proposed is really no 
different. It is just another version of what the Republican leadership 
in the House has been talking about for the last 6 months.
  On the other hand, the Democratic proposal which we have been putting 
forth and has been supported by Vice President Gore has very specific 
remedies for dealing with the problems that seniors face. So I would 
just like to run through some of the distinctions if I could.
  All that the Republicans are doing, and that includes their 
presidential candidate, Mr. Bush, is throwing some money or proposing 
to throw some money at the insurance companies, hoping that they will 
sell a drug-only insurance policy; and the insurance companies admit 
that they are not going to be selling those kinds of policies, that 
basically a drug-only insurance policy will not be available.
  What the Democrats have been saying is that we have a tried-and-true 
program, a Medicare program, that has been around for over 30 years 
now; and all we have to do is take that existing Medicare program and 
expand it through a new part D where one would pay a premium per month 
and one would get a prescription drug benefit in the same way that one 
gets one's part B benefit to pay for one's doctor's bills right now. 
One pays a modest premium, and the Government pays for a certain 
percentage of one's drug bills.
  The Democrats, and here is one of the most important distinctions, 
the Democrats guarantee that the drug benefit one gets through Medicare 
covers all one's medicines that are medically necessary as determined 
by one's doctor, not the insurance company.
  The Republicans and Mr. Bush tell one to go out and see if one can 
find an insurance policy to cover one's medicine; and if one cannot 
find it, well, that is just tough luck. Even if one does manage to find 
an insurance company through the voucher that the Government might give 
one under the Bush plan, there is no guarantee as to the cost of the 
monthly premium or what kind of medicine that one gets.
  Now I find myself when I talk to seniors that they want certainty. 
They want to know that, if they pay a premium, as they do under part B, 
and now they would under the part D proposed by the Democrats and by 
the Vice President, that they are guaranteed certain prescription drug 
coverage and it is going to be there for them whenever they need it.
  Lastly, I think in contrasting these two plans, the Republican and 
the Democratic plans, and just as important, I see the gentleman from 
Maine (Mr. Allen) just came in, and he has been the biggest supporter 
of this issue, is that the Republicans and the Bush plan leave American 
seniors open to continued price discrimination. There is nothing in the 
Bush plan or in the Republican plan to prevent the drug companies from 
charging one whatever they want. The Democratic plan, on the other 
hand, says that the Government will choose a benefit provider who will 
negotiate for one the best price, just like the prices that are 
negotiated by the HMOs and other preferred providers.
  The real difference, though, is that the Democrats are working with 
the existing Medicare program to basically expand Medicare to provide 
prescription drug coverage, and that would make a difference for the 
average senior. The first prescription drug, the first medicine that 
they need would be covered under the Democratic plan.
  The Republican plan is just, in my opinion, nothing more than a cruel 
hoax on the seniors. It is the same type of thing that the Republicans 
in Congress have been proposing.
  I wanted to just mention two more things, then I would like to yield 
to my colleagues who are joining me here tonight. There was an article 
in today's New York Times where the Republican candidate, Mr. Bush, was 
spelling out his prescription drug program. Interestingly enough, when 
asked about the issue of price discrimination, he actually criticized 
Gore's plan, the Democratic plan, by suggesting that, in the way that 
we set aside benefit providers and say they are going to negotiate a 
good price so that seniors do not get ripped off, and the price 
discrimination that currently exists disappears, what Mr. Bush says is 
that that would do nothing but ultimately lead to price controls.
  I just wanted to use this quote if I could, Mr. Speaker. It says that 
Mr. Bush today, much like the drug industry, criticized Mr. Gore's plan 
as a step towards price controls. ``By making government agents the 
largest purchasers of prescription drugs in America,'' Mr. Bush said, 
``by making Washington the Nation's pharmacist, the

[[Page H7254]]

Gore plan puts us well on the way to price control for drugs.''

  Now, what that says to me is that what Mr. Bush wants, he wants to do 
something that is going to help the pharmaceutical companies, he wants 
to do something that is going to help the insurance agencies, the 
insurance companies; but he is not doing something that helps the 
average American.
  We had time for the last month or so when we were all in our 
districts, and I had a lot of forums and town meetings, many of which 
were with seniors. Whether they were seniors or not, everybody talked 
to me about the price, the cost of prescription drugs. Now do my 
colleagues mean to tell me that when we pass a prescription drug plan 
we are not going to address that issue? If we do not address that issue 
in some way by at least saying this the Government is going to try to 
have someone out there to negotiate a better price, then any 
prescription drug plan that is put into place is not going to really 
solve anybody's problem because the cost is going to be too high.
  The other thing I wanted to point out, and this is something that I 
said before we had our August break, is that what Mr. Bush is proposing 
and what the Republicans proposed here in the House of Representatives 
when we were in session during the summer and the spring has already 
been tried in at least one State; and that is the State of Nevada.
  In the State of Nevada, back in the springtime, they passed a 
prescription drug plan that was very similar to what Mr. Bush and the 
Republicans have proposed; and that is essentially giving a subsidy, 
giving a voucher to seniors so that they can go out and try to find 
their own prescription drug plan, their own prescription drug policy 
through some insurance company. In the State of Nevada, none of them 
were sold. People tried to find a plan, and there were no insurance 
companies that was willing to sell it.
  The only thing that I can see happening with Mr. Bush's plan is that 
some of the HMOs will offer the coverage because if they can take that 
voucher and add it to whatever seniors now get under Medicare, that 
they may be willing in some cases through HMOs to take up the slack and 
perhaps provide some benefits for prescription drugs.
  But the problem with that is that as we know over the last 6 months 
and over the last 2 years since more and more seniors have gotten into 
HMOs, a lot of those HMOs are now cutting back. They are simply getting 
out of the Medicare program. They are telling the seniors they have to 
have a higher deductible, more of a co-payment, basically telling the 
seniors that they have to pay more out of pocket.
  So I do not think pushing seniors into HMOs is the answer. I think 
there is a serious problem with managed care, not that managed care is 
necessarily a bad thing. But if Mr. Bush thinks that we are going to 
solve the prescription drug prices for seniors by simply pushing them 
into HMOs, the experience of the last 2 years shows that is simply not 
the answer.
  What we are facing here is a Republican plan under the Republican 
candidate for President that basically does not do anything for the 
average American senior. We have to realize now the only way we are 
going to get real coverage for seniors is if we add a prescription drug 
benefit to the Medicare program, which is exactly what the Vice 
President and the Democrats have been proposing for the last 2 years.
  With that, I yield to the gentleman from Texas (Mr. Turner), a 
gentleman who has been outspoken on this issue and who I know really 
cares a great deal about the seniors in his district and trying to 
solve this problem. I know he has had a number of forums over the last 
month or so in Texas, his home State. We talked a little bit and shared 
some thoughts today about how the response from seniors that we have 
again been getting over the last month has been really very similar. 
They are really crying out for reform. They have a problem. They cannot 
afford to pay prescription drugs out of pocket. They are crying out for 
relief, which is what the Vice President wants to achieve.
  Mr. Speaker, I yield to the gentleman from Texas (Mr. Turner).
  Mr. TURNER. Mr. Speaker, I thank the gentleman from New Jersey (Mr. 
Pallone) for yielding to me. It is good to be here and to share this 
hour with him and our colleagues on the Democratic side of the aisle 
who have worked for so long now trying to pass a prescription drug 
benefit for our senior citizens under the Medicare program.
  Mr. Speaker, 2 months ago the Republicans tried to diffuse the issue 
by passing a bill on the floor of this House by a very narrow margin 
that was simply a plan that told the insurance companies to go out 
there and offer insurance policies for prescription drugs to our 
seniors. They did it in spite of the fact that, during the hearings on 
the very bill, the insurance companies came in and said that it was not 
going to work. In fact, the president of Blue Cross and Blue Shield 
said the idea of a private insurance drug benefit, and I am quoting, 
``provides false hope to America's seniors because it is neither 
workable nor affordable.''
  Now we see that Governor Bush has belatedly approached the same plan.

                              {time}  2100

  He simply says that we need to rely on private insurance companies to 
provide prescription drug coverage for our seniors. It is quite 
interesting to note that the Republicans and Governor Bush have said we 
can rely on private insurance companies to cover our seniors' 
prescription drug needs when at this very moment the private insurance 
companies are pulling out of providing Medicare+Choice plans for our 
seniors.
  In early August, I had the opportunity to travel around my district. 
I visited about 40 communities and talked to hundreds of seniors who 
are struggling to pay their prescription drug bills. I stopped in many 
pharmacies and talked to many seniors who brought in their prescription 
medicine bottles. In fact, I had urged them to bring in their empty 
medicine bottles to allow me to take them back to Washington. This is 
one of them from Kirbyville.
  I urged my seniors to use these empty prescription medicine bottles 
as a way to send a message to the Congress that they are ready for this 
Congress to do something about the high cost of prescription drugs and 
to provide a Medicare benefit for prescription drugs. I have got at 
least four full boxes of these, and it shows that the seniors that I 
represent are tired of waiting for this Congress to do something. We 
have been working on this for over 2 years now, and the truth of the 
matter is it is time for this Congress to act.
  When I talked to the seniors in my district, many of them had 
prescription medicine bills that run several hundreds of dollars a 
month. I met seniors who are trying to make do by taking their pills 
and breaking them in half; trying to get by and lower the cost that 
way. Others told me they just try to take a pill every other day 
instead of every day as prescribed. I met seniors who are having to 
make the difficult choice of whether to buy their groceries or to fill 
their prescription.
  In the community of Navasota in my district I was there at a local 
pharmacy that is located in a grocery store, and a lady came up to me, 
she did not know I was going to be there to talk about this issue, and 
she just overheard me so she stopped in to listen. Afterwards, she came 
up to me and she said, I just brought my prescription in yesterday and 
I had come back today to pick it up. She said I was just back at the 
pharmacy counter and the pharmacist told me that it would be $125. She 
said I told him he would just have to keep it. I asked the pharmacist 
later if that was a common problem and he said it was. He said many 
people come in and ask to have their prescriptions filled only to find 
that the price is too high for them to afford.
  In a Nation as prosperous as this Nation is, and in a Nation that is 
as compassionate as we like to think and say we are, I believe it is 
time for us to recognize that we can do something for our seniors in 
helping them with the cost of prescription drugs.
  I had a lady in a little town of Teneha come up and hand me an 
envelope, and she said to me, ``Would you please read this on your way 
to your next stop?'' When I got in the car I began to read this letter, 
and I want to share it with my colleagues.
  This lady that handed me the letter had been in the insurance 
business for 19 years and she relates a story about

[[Page H7255]]

her deceased mother. She says, ``Dear Congressman Turner: I am writing 
this in memory of my mother, who passed away last November in Conroe at 
the age of 87. My mother had multiple health problems that resulted in 
her having to take many expensive prescription drugs for the last 20 
years of her life. She was very active and able to live a full life in 
spite of her health problems, and was grateful for medication that 
could help her. She very meticulously followed her doctor's orders on 
medication and diet.
  ``Like most people her age who lived through the Great Depression and 
World War II, she possessed much pride in self-sufficiency. She did not 
ask anyone for handouts. She believed in paying her bills first and 
foremost and maintaining good credit. People of this era worked hard. 
And even though they worked hard and paid the maximum through Social 
Security, their retirement income is still not sufficient to meet the 
total cost of retirement living, especially if there is a prescription 
drug bill every month of $300 or more.
  ``My mother's only income was her Social Security retirement income 
with a prescription drug cost of $300 a month. After her death, I 
discovered that her major indebtedness was a credit card with over 
$6,000 on it. I inquired and determined that it was practically all for 
prescription drugs. She used the card when she needed medicine and had 
no money left in the bank. She knew that the account could be paid off 
when her modest home was sold. Because of her pride and self-
sufficiency, I did not know this until her death.''
  It is of quite a surprise, I am sure, to this lady, to know her 
mother had to charge her prescription drugs on her credit card and run 
up a $6,000 bill just to be sure she could take her medicine.
  These stories and many like it were repeated to me over and over 
again as I traveled around my district during our August work period. 
These people that I talked to are in desperate need of some help. We 
need sound policies and a meaningful prescription drug coverage plan, 
not empty promises, not press releases.
  Today, the problems of the drug crisis has reached a new crisis. This 
is brought about by the fact that all across our country seniors who 
signed up for these so-called Medicare+Choice plans, offered by the big 
HMOs as a substitute for regular Medicare, have been canceling their 
coverage of our seniors. Hundreds of seniors told me that they 
personally received these notices of cancellation to be effective on 
December 31 of this year. In the 19 counties in my district, as of the 
end of December, 15 of those counties will have no Medicare+Choice HMO 
option offered to them.
  All across this country seniors are receiving similar notices of 
cancellation. In fact, at last count there were over 900,000 seniors in 
this country that are receiving notices from their insurance companies 
saying their Medicare+Choice HMO plans are canceled as of December 31. 
Many of those are in my State of Texas. One would think that Governor 
Bush would understand that private insurance HMO coverage for 
prescription drugs is not the answer, particularly in light of the fact 
that hundreds of thousands of seniors across this country are being 
told no by their HMO.

  We have learned, I think, an important lesson, one that our 
Republican friends and Governor Bush also need to learn, and that is we 
cannot rely upon private insurance as a safety net for our seniors. 
Once again the Republicans propose that private insurance can solve the 
problem. Recently, when Governor Bush announced his new plan, he said 
he would begin to cover prescription drugs in year 5 of his proposal by 
reforming Medicare, and for the next 4 years he said he would give $12 
million a year to the States to allow them to do something about the 
problem of prescription drugs for seniors.
  Now, the States tell us that they do not want to have this ball. The 
National Governors Association has already said, and I quote, ``If 
Congress decides to expand prescription drug coverage to seniors, it 
should not shift the responsibility or its cost to the States.'' Why 
should we give money to our States to subsidize insurance companies 
instead of just using the money to provide meaningful prescription drug 
coverage under the traditional Medicare program that seniors understand 
and trust? The insurance companies are abandoning our seniors right and 
left, and yet our Republican friends continue to say that insurance, 
private insurance, can take care of the problem.
  Medicare was signed into law by a great Texan, Lyndon Johnson, in 
1965, in a day when prescription drug coverage was not nearly as 
important as it is today, because prescription drugs were a very small 
percentage of our total health care cost. Today it is a much larger 
percentage and a much more serious problem. After 35 years of 
protecting our seniors, we should be strengthening Medicare with a 
prescription drug benefit, not dissolving it in favor of private 
insurance companies out to earn a buck when we already know from our 
current experience that private insurance companies cannot be relied 
upon.
  We only need to look back to see what has happened to seniors across 
this country in recent months. In rural east Texas, the area of the 
country that I represent, 65 percent of our seniors on Medicare do not 
have access to any of these Medicare+Choice plans that offer 
prescription drug coverage. What are we going to do for those when the 
Republican plan goes into effect? Seniors in my district know what 
their Social Security check is down to the penny. They know how much 
rent they pay and they know their other bills almost to the penny. What 
they need is a specific defined prescription drug benefit.
  The Republican plan, the Bush plan, does not give them that. The Bush 
Republican plan only gives them more questions. Seniors will not know 
how much that plan costs them, seniors will not know what it covers, 
and seniors certainly will not know how long it will be there for them.
  The Democratic plan is very simple. We know how much it is going to 
cost. We have already talked about the cost of the Democratic plan. It 
begins about $24 a month and rises slightly over the period of 
increased coverage. It covers 50 percent of the first $5,000 of 
prescription drug cost and covers everything above that, and it is a 
part of Medicare, not some insurance company plan that may go away next 
year. That is the kind of security senior citizens want; that is the 
kind of security that senior citizens deserve.
  The private insurance industry clearly has to try to make a profit. 
They are not in the business of providing a safety net for our seniors. 
That is the appropriate role of government. We cannot afford to abandon 
our seniors to those same HMOs that have been dropping them all across 
the Nation to date. Our prescription drug benefit plan is universal, it 
is affordable, it is understandable, and it is voluntary. If there be 
any senior who chooses not to sign up for the Medicare prescription 
drug benefit that we propose, they simply will not have to pay the 
premium.
  So our plan, I think, is the one that seniors deserve, and I hope 
that we can continue to push until this goal is accomplished, hopefully 
in this Congress, but, if not, in the future I am confident that we 
will prevail.
  Mr. Speaker, I yield back to the gentleman from New Jersey.
  Mr. PALLONE. Mr. Speaker, I want to thank my colleague from Texas 
because he really lays out the differences between the Bush Republican 
plan and the Gore Democratic plan, but there were two things I just 
wanted to comment on because I thought they were so important.
  First, the gentleman pointed out that when he talked about these 
private insurance-only policies that the Bush Republican plan is 
relying on, they are assuming that there is going to be a voucher of 
some sort that seniors are going to be able to take with them and go to 
buy this private insurance policy for prescription drugs. It is 
illusory. It is not going to happen. The reason is very simple, which 
is that insurance companies do not provide benefits, they insure 
against risk. We know that almost every senior is going to have to use 
prescription drugs, so it makes sense to put it as a benefit under the 
existing Medicare program rather than look at it as some sort of risk. 
Insurance companies are not going to provide coverage when they know 
that every senior would actually benefit and take advantage of the 
plan.

[[Page H7256]]

That is why these insurance policies were not sold in Nevada and why 
they will never be sold anywhere else.
  The second thing is that the Bush Republican plan is sort of a cruel 
hoax. The gentleman laid out that during the month or so that we were 
back in our districts and Congress was not in session that he talked to 
real people, as did I, and they are suffering. They are making choices; 
dividing pills, having to make choices between food and prescription 
drugs. When the gentleman went to a lot of the towns in his district, 
he knew this was a real problem.

                              {time}  2115

  I feel that what Governor Bush has proposed is just something that is 
illusory and is there to give the impression that somehow he wants to 
address the problems that these real people have. And he has really 
only come up with it in the last few weeks because Al Gore has been out 
there talking about the Democratic machine and it has gotten a positive 
response. So all of a sudden Governor Bush had to come up with 
something, knowing full well that it is not going to work. And I think 
that is a real cruel hoax on these people that we have been seeing 
every day for the last month that are crying out for some relief.
  I want to yield to my colleague, the gentleman from Maine (Mr. 
Allen). Again, I know that he has been out there talking about the 
problem of price discrimination because so many seniors now that do not 
have coverage and have to buy prescription drugs at the local pharmacy 
out of pocket pay significantly higher prices than those who are in 
HMOs or some kind of an employer plan that is able to buy the 
prescription drugs in bulk and negotiate a good price.
  The thing that really bothered me was the fact that, in laying out 
his plan today, Governor Bush actually criticized the Democratic plan, 
the Gore plan, because it tried to address the issue of price 
discrimination that somehow even making this attempt was a bad thing, 
and yet that is the biggest problem that seniors face right now and 
everyone faces because of that price discrimination.
  Mr. Speaker, I yield to the gentleman from Maine (Mr. Allen).
  Mr. ALLEN. Mr. Speaker, I thank the gentleman from New Jersey (Mr. 
Pallone) for all his good work on this issue and will begin by saying 
he is absolutely right, people know that the amount they are spending 
on prescription drugs is going up and up, that drugs themselves are 
getting more expensive.
  As people get older, they use more and more prescription drugs. My 
colleague was talking a little earlier about how many people use 
prescription drugs. Well, for seniors it is 85 percent. Eighty-five 
percent of all seniors take at least one prescription drug; and many, 
as we know, take more than one.
  My parents have their rows of pill bottles. And certainly the 
industry has done a great deal to extend people's lives and to improve 
the quality of people's lives. But the fact is that these medicines do 
no good for people who cannot afford to take them and there are 
millions and millions of Americans, at least 13 million seniors alone, 
who simply have no coverage at all for their prescription drugs.
  It has got to be tough to be a Republican these days because watching 
Governor Bush try to thread the needle, as the House Republicans did 
before, we see the same kind of exercise. On the one hand, they want to 
sound like Democrats, they want to sound as if they are reforming 
Medicare, they are providing a Medicare prescription drug benefit. But 
because they do not really want to strengthen a government program, 
which is what, of course, Medicare is, they have to figure out some 
other way to do it.
  It is so different from the private sector because people who are 
employed and have their insurance through Aetna or Cigna or United or a 
Blue Cross plan may very well, and probably do in many cases, have 
prescription drug coverage provided by the health care carrier.
  But the Republicans are completely adverse to having Medicare provide 
a prescription drug benefit just as those private sector plans do; and 
so they go through all sorts of contortions to argue against the 
simplest, most cost-effective, fairest system possible, which is a 
Medicare prescription drug benefit.
  I want to comment a little bit on the Bush plan because it is so much 
like what our friend on the Republican side threw up in this House some 
time ago.
  The interesting thing about this plan, among many interesting things, 
is, first of all, he says we are going to provide a subsidy of 25 
percent for people over the lowest income level, we are going to 
provide a subsidy of 25 percent of the premium. And so the logical 
question to ask is, Well, how much is the premium? Because then we will 
know how much the subsidy is. And the answer is, Well, there is no 
information on that because the premium will be offered and chosen and 
decided by a set of private insurance companies. And so then the 
question is, Well, how much will the deductible be? And there is no 
answer to that because the deductible will be decided by HMOs and other 
insurance companies.
  Then there is the question of the copay and how much will the copay 
be. Same thing. There is no answer to any of those questions. There are 
no details. And the reason is they cannot abide the thought of 
strengthening Medicare, they cannot abide the thought of really 
modernizing Medicare.
  When the Republicans talk about modernizing Medicare, watch out. 
Because they are not modernizing it. They are basically saying, we are 
going to reform it by transforming it; we are going to turn Medicare 
over to HMOs and insurance companies and you will all be better off.
  Now, of course, it is true that when you look at the experience of 
HMOs in Medicare now, they are leaving the program. Seniors are being 
dropped all across this country. And the coverage is very uneven. For 
about somewhere between 14 and 15 percent of seniors in this country, 
they get prescription drug coverage through a managed care plan. But 
the number who get their coverage that way are falling off.
  In my home State of Maine, as of a month or two ago, there were a 
grand total of 1,700 seniors who got their prescription drugs through a 
Medicare managed care plan. As of January 1, there will be none. We 
will have no Medicare managed care in Maine; therefore, no way for 
seniors to get prescription drug coverage through a managed care 
company in my State. There simply will be no way.
  Governor Bush, in presenting his plan, and the Republicans in the 
House, in presenting their comparable plan here some time ago, always 
said, We are going to leave it up to the consumer. It is their choice. 
Well, it is not their choice if there is no plan to chose from.
  And whose choice is it really? What they are really talking about 
when it comes to choice is not the choice of the consumers; it is the 
choice of the insurance companies. Because they are the ones who will 
decide the premiums, the copays, the benefit levels. And those benefit 
levels, those premiums, those copays can change year after year after 
year.
  I have talked to a lot of seniors in my district, and what they want 
and what they need is stability and continuity and predictability and 
equity. They need to know that what they had for a benefit last year 
will be there next year and the year after and the year after, and they 
want to know if there is a copay that it will be about the same year to 
year to year. And most of all, they want to know that the plan will be 
there.
  That is what Medicare provides. Medicare provides a guaranteed 
benefit that will be there year after year after year.
  All of my colleagues on the other side who attack Medicare over and 
over again as a bureaucracy are ignoring the fact that the HMOs and the 
other insurance companies are bureaucracies in themselves, but they are 
much more expensive and much more unfair and much more unpredictable 
than Medicare.
  Mr. PALLONE. Mr. Speaker, I yield to the gentlewoman from Florida 
(Mrs. Thurman).
  Mrs. THURMAN. Mr. Speaker, after what Maine has done, which is kind 
of the leader in the country right now and I think through the 
leadership that the gentleman from Maine (Mr. Allen) has provided here 
in the House, they came

[[Page H7257]]

back in their legislature with a very strong bill based on many of the 
studies that we have done in our districts about the cost of what has 
happened in Canada and what has happened in Mexico.
  But when we talk about these plans with the insurance companies, I 
will say to my colleague, and I think that many of us know this, is 
that in the Committee on Ways and Means, we actually had the chairman 
of the insurance industry and I asked him the question, I said, Mr. 
Kahn, I said, do you believe that insurance companies will offer a 
stand-alone drug benefit? And do my colleagues know what his answer 
was? No, absolutely not. They have no interest in going into any of our 
districts to cover any of the folks, whether they have been on HMOs or 
whether they are in a Medicare program stand-alone, a fee-for-service. 
They have no interest in this. The risk is too high for them to take. 
And we know that insurance companies work off of risk. And because the 
sickest would be the ones going into these programs, they cannot afford 
to offer a plan.
  So what my colleague is saying here is exactly right. It does not 
matter how much money we offer as far as a tax deduction, and nobody 
has told me whether or not they have a liability or no liability on 
their deductions, we do not even know that part of it yet, even though 
it seems to be based just to those that are the very low-income 
seniors. So my guess is that it would only be for those who have tax 
liability; there is no plan out there.
  And we are hitting the same thing in Florida. I mean, in one of the 
counties that I represent, in Hernando County, we had 9,000 seniors 
dropped from two Medicare Choice programs. Two. These people are afraid 
because there is nobody there to pick up this prescription drug 
benefit, and they do not know what they are going to do.
  Mr. PALLONE. Mr. Speaker, reclaiming my time, what I said before in 
response to what the gentlewoman said, we had the example in Nevada 
that implemented the Republican plan almost exactly what Mr. Bush and 
the Republicans in the House have proposed 6 months ago, and not one 
insurance company has offered to sell that kind of a policy.
  So we do not even have to take the word of Mr. Kahn. We have an 
example in a State where there is no policy offered.
  Mrs. THURMAN. Mr. Speaker, if the gentleman will continue to yield, I 
think one of the things that is significant about the plan that is 
being offered by the Democrats is that it is a voluntary program. And, 
in fact, if people want to stay in their HMOs and those HMOs are not 
pulling out, we also provide about $25 billion to them to make sure 
that we strengthen those HMO Medicare Choice programs that are 
available and that are left in this country. And I think that is an 
added advantage to what we are trying to do in this whole debate is to 
never take something away from something, only to add to those that 
have nothing.
  Mr. PALLONE. Mr. Speaker, reclaiming my time, I yield now to my 
colleague, the gentleman from Arkansas (Mr. Berry), who again has been 
one of the main proponents of increasing health care access and 
addressing the problem of prescription drugs and has been working on 
these health care issues for some time.
  Mr. BERRY. Mr. Speaker, I thank my colleague, the gentleman from New 
Jersey (Mr. Pallone), for yielding me the time. He has done a great job 
in the leadership of health care in this House, and we appreciate what 
he has done. He has been at this longer than I have.
  It is also nice to join my colleague, the gentleman from Texas (Mr. 
Turner), the gentleman from Maine (Mr. Allen), and the gentlewoman from 
Florida (Mrs. Thurman). I appreciate their efforts on behalf of the 
American people to see that our senior citizens have a decent 
prescription drug benefit with Medicare.
  We stand here this evening the greatest Nation that has ever been in 
the history of the world. There has never been another country that has 
the economic, the military, and the political power that this country 
does. And yet our senior citizens, many of them, millions of them, are 
going to go to bed tonight and not have enough to eat or not have the 
medicine they need because our prescription drug manufacturers are 
simply robbing them of that.
  Medicare was even admitted to being a success by Governor Bush 
yesterday, even knowing that the former speaker, Mr. Gingrich, and his 
colleagues in the majority have vowed for years that they would see 
Medicare wither on the vine, I believe is the way they put it.
  What we know, and we do not have to spend all of August in the First 
Congressional District of Arkansas to find this out, we can go to any 
congressional district in the country, this is a real problem for real 
people; and it is causing real pain, and it is time that we do 
something about it.
  As Congress takes the next month or so to wrap up legislative 
business for this year, there is simply no excuse for leaving seniors 
and the disabled without a reliable prescription drug benefit under 
Medicare.
  The Republican leadership has reluctantly been forced to put forward 
what they call a plan because of the overwhelming public outcry created 
by rapidly escalating, outrageously profitable prescription drug prices 
charged by manufacturers.
  Being forced to develop a plan, the best Republican leaders have been 
able to do is to listen to their friends in the pharmaceutical 
industry. If they had traveled with any of us over August and listened 
to the stories that we heard, every one of us heard, and they are 
heartbreaking, these are people that worked hard, played by the rules, 
and thought they had made the right decisions to provide for their 
senior years.

                              {time}  2130

  They would know that we have got to do something about this problem, 
and it is time to have a prescription drug benefit for Medicare. The 
Democratic plan will use the purchasing power of our seniors covered by 
Medicare to negotiate large discounts from drug makers. I believe 
Governor Bush said yesterday that that would be a dangerous thing to 
do. It might actually reduce by a little bit the outrageous profits of 
these drug companies. They might actually even have to cut back on some 
of the tremendous salaries that they pay the people that run these 
companies, and that would be too bad to cut some of those folks back 
under maybe $100 million a year.
  The Republican plan is a cynical game being played with our seniors' 
health, a shameful attempt to deceive our seniors. They have proposed a 
large first step toward privatizing Medicare and forcing our seniors to 
deal with private insurance companies to get the care and the 
prescription drugs that they need. The insurance companies say they do 
not want it. They do not want anything to do with it. That is why we 
have to have Medicare. Medicare is a success.
  You can ask the Republicans, ``What does it cover?'' And they will 
tell you, ``Well, we don't know.'' Then you can say, ``How much does it 
pay?'' And they will say, ``We don't know.'' Then you can say, ``What 
are the premiums?'' And they will say, ``We don't know.'' They do not 
want to see drug companies' exorbitant profits damaged. That is what 
the interest is in the plan that Governor Bush put forward yesterday, 
that, and continuing to try to destroy Medicare as we know it.
  Their plan only provides subsidies to their insurance companies, the 
donors and the pharmaceutical companies' profits rather than giving any 
direct assistance to our seniors. It does nothing to see that Americans 
can buy prescription medicine at the same price as every other country 
in the world and we pay two to three times as much in this country. 
Their plan is based on the discredited theory that private insurers 
will offer affordable prescription insurance if they are given enough 
government subsidies. But the HMOs and the insurance companies just 
simply say this will not work.
  It is also unlikely that the country will be able to pay for 
prescription drug coverage under Medicare because the Republicans are 
continuing their attempts to squander any available moneys on tax cuts 
that are disproportionately benefitting the wealthy. The American 
people want a prescription drug benefit for our seniors, and it is time 
for this Congress and the next President to recognize the tremendous 
need that our seniors have and do the right thing and pass a legitimate 
prescription drug benefit for Medicare.

[[Page H7258]]

  Mr. PALLONE. I want to thank the gentleman. Certainly he speaks the 
truth about what we are facing and how the Bush Republican plan does 
not address the problems that we were hearing about during the August 
recess.
  I yield to the gentleman from Maine.
  Mr. ALLEN. I thank the gentleman for yielding. I do not think that 
anyone says it better than the gentleman from Arkansas (Mr. Berry). He 
is a pharmacist himself. He knows what he is talking about when it 
comes to the things that people are going through.
  I wanted to come back for a moment and talk about one part of the 
Bush plan that was announced yesterday or the day before and that 
strikes me as completely unrealistic. What he is saying is we are going 
to provide $48 billion over 4 years in terms of grants to the States in 
order to provide immediate relief for seniors who need help.
  There are several points to be made. The first point. The fact is 
that the people who are suffering the most are not necessarily those 
with the lowest income. They are the people with the highest 
prescription drug cost. I was talking to a man up in Waterville not so 
long ago, Waterville, Maine, who had owned his own garage, his own auto 
repair business, he and his wife were now retired but they were not 
quite 65 and they had a little bit of coverage for their prescription 
drugs that they would lose when they hit 65. His wife's expenses and 
his together were already running at $1,000 a month. He was terrified 
as to what would happen to him when he hit 65, he lost his coverage, 
there is no coverage under Medicare and he knew he would be in great 
trouble. So there is one problem. People all up and down the senior 
income ladder have difficulty paying for their prescription drugs.
  The second problem is this: There are only 16 plans, 16 States in the 
country which have functioning programs for the low-income elderly. 
Now, five States have passed legislation to get them to that place and 
there are a couple of other States trying innovative things, but when 
you look at the number of people covered by these plans, you are 
talking about somewhere between, in most cases, with the exception of 
three States, somewhere between 5,000 and, oh, roughly 50,000 people in 
the entire State. These programs are not working. They are not 
available. They would have to be created. Certainly Texas does not have 
any form of low-income assistance for the elderly, prescription drug 
insurance. These plans are not able to pick up the slack any time soon 
and if they did, they would be misguided.

  The fundamental problem is this: Medicare is a Federal health care 
plan. Republicans do not like that. They do not like the plan, but 
Medicare is a Federal health care plan. It works. It is cost efficient. 
Its administrative costs run about 3 percent a year. When you turn to 
the private insurance industry after all the administrative costs and 
the overhead and those executive salaries, you are talking about 30 
percent a year. And they are picking and choosing among the people they 
want to cover. So the fundamental fact is that if we are going to have 
a cost effective system, it is going to be through Medicare. If we are 
going to have a fair system that covers everyone, it is going to be 
through Medicare. If we are going to have a system where people can 
predict their premiums, their copays, their deductible from year to 
year to year to year, it is going to be through Medicare. It is simply 
wrong to take this issue that is just really doing enormous damage to 
our seniors now, people who cannot afford their prescription drugs and 
their food and their rent and basically to say to them that we have got 
to wait until we can transform Medicare by turning it over to HMOs and 
insurance companies and then if we give them enough money, maybe they 
will give you prescription drug insurance. It is pathetic.
  Mr. PALLONE. I agree. Just one minute and then I want to yield to the 
gentleman from Texas here because he has been waiting. When I had my 
senior forums in August in New Jersey, the people that came were the 
people that could not take advantage of the existing State program in 
New Jersey. Let us face it, if you are below a certain income, very 
low, then you have Medicaid and you have prescription drug coverage, 
not maybe as all inclusive as we would like but something.
  In New Jersey, we have a program financed with casino revenue money 
from Atlantic City that pays for people just above that. But that 
program increasingly is running out of money because the revenues are 
not keeping up with the cost of all these drugs. But the people that 
came to my forums, and my district is not an affluent district, it is 
about middle of the road, middle income, most of the people were not 
eligible for either of those programs. That is the rub. It is those 
people, it is the middle class that do not have the benefit.
  What I wanted to say, what you were talking about specifically is 
that it is funny, I heard Governor Bush keep talking about choice, how 
the Republicans were going to give choice. There is no question there 
is more choice in our plan. It is a voluntary plan. You do not have to 
sign up for part D if you do not want to. If you want to keep your 
State prescription drug plan, you can if you are a certain income. If 
you have an employer-based retirement plan and you want to keep it, if 
you want to go to an HMO, you can keep it. The bottom line is everybody 
is guaranteed the coverage under Medicare. That is what is so beautiful 
about the Gore Democratic plan and so different from what Bush and the 
Republicans are proposing.
  I yield to the gentleman from Texas.
  Mr. TURNER. I just want to say when I heard the gentleman from Maine 
(Mr. Allen) talking about the issue that it is so very true that 
private insurance companies are not the answer, and I think our senior 
citizens understand that. I think they understand full well that 
Medicare works, it has served them well, and the seniors that I talked 
to in August who had received these notices of cancellation, seniors 
that had signed up for these Medicare+Choice plans simply because they 
offered them some prescription drug coverage in addition to the regular 
Medicare coverage, those seniors understand that you cannot count on 
private insurance, and it is just as the gentleman from Arkansas (Mr. 
Berry) said a minute ago, the Republican plan offered by Governor Bush 
does not assure any senior what it is going to cost them, does not 
guarantee them what it is going to cover, does not tell them what the 
deductibles are, and it certainly does not promise them that it is 
going to be there because, as we have learned, these HMOs can pull out 
any time they want to. Our plan is understandable. We have already laid 
out the cost to seniors. It is going to be available to everybody on a 
volunteer basis. Seniors can get the prescription drug their doctor 
prescribes. And they are going to know that it will be there, not just 
today but tomorrow as well.
  Now, that is what our seniors need. The choice that Governor Bush was 
talking about is a choice of confusion. He is saying that private 
insurance companies are going to be offering all kinds of plans and you 
can just choose the one you want. The truth is, that is a false 
promise. It has not worked in Medicare+Choice with over 900,000 seniors 
in this country receiving a notice that as of December 31 their 
Medicare+Choice plan is going to be canceled.

  Medicare is a good program. It has served us well since 1965 and 
there is absolutely no reason to abandon it. We need to pass the 
Democratic plan. It is the plan that seniors can understand and that 
they need.
  Mr. PALLONE. We have about 4 minutes, so I would like to split the 
time between my colleague from Florida and my colleague from Arkansas.
  I will start with my colleague from Florida.
  Mrs. THURMAN. As we are in an era of when we are talking about 
surpluses and times of when things are fairly good, things may not 
always be this good. One of the things that we have to remember is that 
it is our job to protect Medicare and the solvency of that trust fund. 
Quite frankly, one of the things that I see in this debate that gets 
forgotten is that under Medicare today, we pay for prescription drugs 
as they are needed in the hospitals. When we bring somebody in to 
stabilize them, we provide them with those medicines. But when we let 
them out of the hospital and they walk into that pharmacy and all of a 
sudden they are told that what they had to have in the hospital now 
just costs them $400 a

[[Page H7259]]

month and they cannot pay that and they have to make that decision of 
what drug they take that month or that week or that day as versus 
whatever other expenses they might have, we are also costing this 
system millions of dollars every day because we let them out of the 
hospital after we have stabilized them and then we, 2 months later, 
find them back in the same situation as we left them before. And we are 
thinking to ourselves, we want to make the solvency of the Medicare 
program, we want to continue the program. The only thing we can do, 
contrary to whatever anybody else says is, this has got to be a 
Medicare program. It has got to be done under the Medicare program. It 
is good for the solvency and it is good for the patient.
  I think we really have to take all of these things into account. I 
would love to talk to my pharmacist, the gentleman from Arkansas (Mr. 
Berry), and thank all of us for being here tonight. This is a good 
debate and it needs to be had in this country.
  Mr. PALLONE. I yield to the gentleman from Arkansas.
  Mr. BERRY. Like many of you, I know that many of you have held public 
forums and senior meetings and all of those things over and over again, 
into the hundreds. I hear a lot of criticism about a lot of things, 
about the government. We all do. I have never had anyone tell me, ``You 
ought to do away with Medicare.'' I do not understand. Our seniors like 
Medicare. It is a good program. It works. It is successful. It is what 
they need. They just need a prescription drug benefit to go along with 
it. I just simply do not understand why Governor Bush and the 
Republicans are so determined to destroy it. Why would they want to do 
that to our seniors when we know this is the only way we can provide 
decent health care protection for our senior citizens, and it is 
absolutely a mystery to me why they would engage in this attempt, this 
shameful attempt, to destroy Medicare that has been such a wonderful 
thing, and will continue to be if we add a prescription drug benefit to 
it.
  Mr. PALLONE. Mr. Speaker, I want to thank everyone for participating 
in this tonight and make the point that this is our first day back in 
session, but we are going to keep at this. We are going to keep 
demanding that the Republicans take action and that the Republican 
leadership allow the Democratic proposal to be considered and that we 
pass a prescription drug program under Medicare that really is 
meaningful because that is what the people need. It has to be 
addressed. It should be addressed between now and when we adjourn, not 
next year.

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