[Congressional Record Volume 146, Number 104 (Friday, September 8, 2000)]
[Senate]
[Pages S8247-S8250]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                              HEALTH CARE

  Mr. GREGG. Mr. President, ironically, I came to the floor to talk 
about some of Vice President Gore's proposals, specifically in the 
areas he is spending money. The fact he has created this Pyrhhic 
lockbox--not Pyrhhic, this mystical lockbox he is claiming for the 
extra surplus which has been identified under the new budget estimates, 
which is mystical because he has already spent the entire surplus plus 
whatever would occur as a result of the increased estimates on the 
surplus. In fact, according to the Budget Committee, he spent under the 
high estimate almost $1 trillion more than the surplus. As a result, he 
is significantly invading the Social Security accounts.
  But having listened to the Senator from Massachusetts, I do not 
believe his words can go unanswered because he has, first, made a 
number of statements which are inaccurate about Governor Bush's 
proposals on the drug plans for seniors and, second, I think he has put 
forward the basic premise of the debate between the two parties on the 
issues that should be answered. Let's begin there before I go to the 
specifics of the areas of his presentation, which were unfortunately 
numerous as they related to Governor Bush's positions. The difference 
here is fairly simple between the two approaches.
  What was very distinctly stated by the Senator from Massachusetts is 
that they want to create--they use the term ``universal,'' but a 100-
percent program in the drug benefit area, which is totally managed by 
the Federal Government--100 percent. Vice President Gore wants to do 
for prescription drugs what Hillary Clinton wanted to do for health 
care generally. He wants to take ``Hillary Care,'' which is essentially 
a nationalization of health care, and apply it to the prescription drug 
program.

  There are a lot of problems with nationalizing the prescription drug 
program, with having the Federal Government take over the senior 
citizens' ability to buy drugs. I think most seniors understand that 
having the Federal Government tell them what they are going to be able 
to buy in drugs, exactly what type of drug program they are going to 
have--and it will be one size fits all for this entire country--I think 
most seniors have an inherent understanding, as most Americans have an 
inherent understanding, that that program has some significant flaws.
  One of the reasons this Congress and the American people so 
enthusiastically rejected ``Hillary Care'' is that people intuitively 
understand that taking a program and turning it over to the Federal 
Government to operate, specifically when that program is critical to 
one's well-being, as is health care, is putting at risk one's health 
care, by definition.
  So the Gore plan is essentially a nationalization plan. The term is 
used ``universal, 100 percent.'' That means the Government runs it all. 
Well, 68 percent of the seniors in this country today already have a 
drug benefit. Many of them are fairly happy that they are able to go 
out and purchase a drug benefit that is tailored to what they need. 
There are, obviously, a lot of seniors in this country who need 
assistance in purchasing that drug benefit. There are a lot of seniors 
in this country today who do not have adequate coverage in drug 
benefits. The concerns of those seniors need to be addressed. But we 
don't address them by taking all the other senior citizens of this 
country who have set up their own

[[Page S8248]]

systems--and most of them come as a result of their employer continuing 
to cover their drug benefit as a result of their retirement--and saying 
to them: No longer can you participate in your employer plan, no longer 
can you participate in a plan which you chose which covers the needs 
which you and your family have. No. Now you must participate in a plan 
designed by Vice President Gore and a group of bureaucrats here in 
Washington under the guidance of the Senator from Massachusetts, and 
you either participate in that plan or you get nothing. When you 
participate in that plan, you don't get options. You have to do exactly 
what the Federal Government says. That can be a nightmare. That can be 
a nightmare, as we all know.
  That is the fundamental difference. What Governor Bush has put forth 
is a proposal which will address the needs of seniors who do not 
presently have adequate prescription drug coverage and will address it 
in a way that allows seniors to have choices. It allows them to tailor 
their health care plans to what they need, not to what somebody here in 
Washington thinks they need. That is the difference of opinion here. 
There is the Washington mindset which says we in Washington actually 
know better than you do, John Jones out in Iowa, what you need to buy 
for your prescription drug benefits. It is this arrogance, this elitism 
that just permeates Washington and which was so precisely stated in the 
``Hillary Care'' package and which is now just being repackaged with 
new words--``universal, 100 percent''--under the Gore drug plan.
  Governor Bush has put forward a very thoughtful, very aggressive 
proposal in the area of prescription drugs that does address the needs 
of seniors who cannot afford those programs and seniors who need 
assistance in those programs. It was, regrettably, misinterpreted by 
the Senator from Massachusetts. To begin with, it doesn't start 4 years 
from now. It actually begins much sooner and potentially 2 years sooner 
than the Gore plan. The Gore plan does not go into effect until 1 year 
after the date of enactment, which means we are probably looking--
should we have the fate of having the Vice President become President, 
we are probably looking at somewhere around the year 2002 before it 
even gets operating.

  That is a pretty optimistic viewpoint. The Senator from Massachusetts 
said Texas took a long time to participate in the CHIPS program and all 
the other States took a long time to participate in the CHIPS program. 
What was that? That was an attempt by the Federal Government to make 
sure all the kids who are low income, who need insurance in this 
country, get health insurance. It was passed by the Congress.
  Do you know how long it took this administration to put in place the 
regulations to manage the health care plan for children, CHIPS? They 
have not done it yet. They are still working on those regulations. Why 
have States not been able to put their CHIPS program into place 
quickly? Because the regulations have taken so long to get in place. 
They have a majority of them in place now, but it literally took years 
to get the regulations in place so the States could comply with them.
  So the idea that the Vice President, should he be fortunate enough to 
be elected President, is going to put in place a drug program that is 
going to be managed by the same agencies that manage the present 
systems, that manage the health care system we have--and they couldn't 
even do that--is going to set up a program for the country in a prompt 
way is, on its face, not believable.
  The fact is his plan, if he is lucky, assuming he was able to pass 
the nationalization of the prescription drug programs in this country, 
assuming he was able to inflict ``Hillary Care,'' relative to drugs, on 
our people, assuming he was able to get that through the Congress, 
there is no way that plan would be in place and operating even by the 
year 2002, which he claims it could be. Maybe 2003; maybe 2004.
  This timeframe thing the Senator from Massachusetts talked about is 
just a lot of mush. The fact is, the Gore plan, by definition, cannot 
start until 2002, and we know, as a practical matter, the way the 
Federal Government operates, and especially the way HCFA operates, 
there is no way it will be operating until probably sometime in 2005, 
whereas Governor Bush has proposed a unique and creative idea. He 
recognizes that what we need is fundamental Medicare reform. We need to 
bring all the parties to the table and reach a Medicare package that 
will reform the whole system to get efficiencies into the system, to 
reduce the costs of the operation of the system, to make it work more 
like a system for the 21st century rather than a system designed in the 
sixties, which is the way it works today.
  He said it is going to take time to develop that package, it is going 
to take time to develop that comprehensive agreement, bipartisan in 
nature, so let's have a bridging program and let's begin the bridging 
program immediately. He said one of his first pieces of legislation 
will be a bridging program in the area of drugs which will allow the 
States, during the period when the Federal Government is working out 
major Medicare reform, to address not only drug benefits but everything 
else that deals with Medicare. During the period when the Federal 
Government is working on that, he said let's set up a specific program 
that will benefit seniors who need prescription drugs as a bridging 
program. That program can be in place--if the Congress actually wants 
to get to work, that program can be in place by March of next year.
  There is a distinct difference in timeframe, yes. The difference is, 
under the Gore proposal, which is nationalization of the prescription 
drug program, which is ``Hillary Care'' for the prescription drug 
program, it puts all seniors in America under one system managed by the 
Federal Government. We know it is going to be a bureaucratic disaster 
and there are going to be a lot of delays. By definition, his plan does 
not start for 2 years, whereas what Governor Bush suggested is that he 
understands Government takes time to address major issues such as this, 
so let's put in a bridging program and start the program early. There 
is a time difference. The difference is Governor Bush's plan starts a 
heck of a lot earlier than the Vice President's plan. The Senator from 
Massachusetts was wrong in that assessment.
  Secondly, the Senator from Massachusetts--there are a whole series of 
points, and I am not going to be able to cover them all--the Governor's 
plan only covers 25 percent of the cost and we cover 50 percent of the 
cost. I remember a story told by an attorney in New Hampshire who 
represented the northern part of New Hampshire. He said he was once 
working for a logging company and sent back a report. There were five 
loggers at this base camp, three men and two women. One of the women 
married one of the men, and a report said that 50 percent of the women 
had married 33 percent of the men. This statistic is one of those types 
of statistics. It is a nice statistic. It may make sense, but if you 
look behind it, it makes absolutely no sense because the statistic is 
based on two different programs.
  The Gore plan, yes, covers 50 percent of the cost, but what it says 
is every American must use the federalized system of drug care. As I 
mentioned earlier, 68 percent of senior citizens already have a drug 
program. Many of them do not need a new drug program. Some may want to 
opt into a new drug program if it is available, but many of them do 
not. They are quite happy with what they have from their company which 
continued to cover them after they retired. If they have to pay 50 
percent now under a Federal program, it actually works out for many 
seniors that the premium costs of the Gore plan will be higher than the 
premium costs which they have for their present drug program.

  If one looks behind this 50-percent number, it becomes very clear 
that it is not a positive number for seniors, it is very negative for a 
lot of seniors who will end up paying more for their drug benefit than 
they pay today because they are going to be put in a Federal plan where 
the premium costs more than the premium they have today, and they do 
not have any choice, they have to go into the Fed plan. Why? Because Al 
Gore knows better; because the Members on the other side of the aisle 
know better; they are smarter than the rest of Americans; they

[[Page S8249]]

should design the plan for the rest of Americans, and it should be run 
out of Washington. It is called elitism and, as I said, it permeates 
this city. Whereas under Governor Bush's plan, yes, 25 percent of the 
premium will be picked up by the Federal Government, but he also said 
this is an option, this is not a requirement. In other words, a senior 
will take that option if it is a better deal than what they already 
have.
  He has also said that for low-income seniors, people at 175 percent 
of poverty, his plan covers all the premium. So let's not have any of 
this class warfare jargon we have been hearing from the other side of 
the aisle through their convention and since then. Actually, Governor 
Bush said he will cover all the premium for people up to 175 percent of 
poverty; the Vice President said he is only going to cover all the 
premium up to 150 percent of poverty. Governor Bush has exceeded, for 
low-income seniors, the assistance that will be given.
  This 25-50 percent is a nice number, but it has no relevance to 
reality because they are two different plans which have two huge, 
different impacts on the flow of events around how this is covered.
  Then the Senator from Massachusetts went on to say that block grants 
are a terrible idea generally, which has always been the theory coming 
from the other side of the aisle because they do not like to give 
States any authority, and especially in this instance it is a bad idea 
because of, as I mentioned earlier, the time lag between when the block 
grant is created and when the States will be able to operate under it.
  The point is, once again, that is a Democratic approach to a block 
grant. A Democratic approach to a block grant is: We will give you the 
money, but we will set up a whole bunch of strings in Washington which 
you have to comply with before you get the money. Governor Bush's 
proposal is a real block grant. ``Block grant'' has become a 
pejorative. It should not be a pejorative. It is a return of funds to 
the States, and it says to the States: Manage these funds for low- and 
moderate-income seniors so they have a drug program.
  I happen to think States are going to do that more effectively than 
HCFA has done their job in a variety of different areas, or the other 
Medicare activities that have occurred. I am willing to put the State 
of New Hampshire up against the Federal bureaucracy in health care any 
day of the week, and I can absolutely assure you that New Hampshire 
citizens are going to get a lot better care when the State of New 
Hampshire is making the decisions than when some bureaucrat in some 
building in Washington is making decisions under the guidance of 
Hillary Clinton or under the guidance, in this case, of Vice President 
Gore. Why can I say that? Because it is a fact. It is the way it works 
today. We have seen it time and time again.
  This proves the point of what I am saying: that HMOs have been 
dropping their participation like flies, radically. The Senator from 
Massachusetts pointed out that HMOs have been moving out of States, as 
they have in New Hampshire--senior HMOs, Medicare HMOs. That is 
absolutely right. Why? Because the Federal Government under this 
administration shortchanged the reimbursement to HMOs. HCFA 
specifically undercut the ability of Medicare HMOs to function because 
they would not reimburse Medicare HMOs at a reasonable rate.
  It has become such a crisis that before this Senate adjourns and 
before this Congress adjourns, we are going to adjust that. 
Unfortunately, so much of the damage has been done by this 
administration's Health and Human Services Department that I am not 
sure we are going to recover the HMOs. He is proving my point by saying 
the HMOs are falling out of business. It is another classic example of 
a statement which, on its face, may make sense, but if you look behind 
it, just the opposite is the fact.
  It is like another story in New Hampshire, another legal story, which 
is the guy who shoots his parents and then goes to the court and claims 
he is an orphan and throws himself on the mercy of the court. The 
administration is shooting the Medicare HMOs, left and right, because 
they will not reimburse them. Then they come here and say: Oh, the 
Medicare HMOs are falling off; therefore, plans can't work because they 
might use Medicare HMOs. It is a little hard to accept that logic. And 
it is especially inappropriate for that argument to be made, in my 
opinion, from people in this administration.
  So beyond the specific errors of the statement, which I think were 
considerable as they related to Governor Bush's proposal, and which I 
have tried to outline--I am sure I have not hit them all because I am 
not that intimately familiar with the entire package; but even with 
general familiarity, I noticed a number of mistakes--beyond that, it 
really does come back to this basic philosophical difference: Do we 
want to give our senior citizens in this country the opportunity to 
have quality prescription drug coverage, which they get to choose, and 
have some part in the participation, in making decisions as to what it 
will be, what type of coverage they want, and how much it will benefit 
their families, or do we want to nationalize the prescription drug care 
process in this country, and have what is essentially another slice of 
``Hillary Care'' put upon the Nation?
  That is the difference. That is the difference between these two 
approaches. Both approaches try to address the needs of the low- and 
moderate-income seniors and give them adequate health care and drug 
coverage. Governor Bush's proposal does a little better job because he 
takes 175 percent of poverty and covers all the premiums up to that, 
and Vice President Gore's proposal only goes to 150 percent of poverty.
  So we are not talking anymore about whether or not low-income seniors 
are going to have adequate drug care. We are talking about timing. 
Governor Bush's proposal moves a lot quicker than Vice President Gore's 
in getting the money out and getting support to seniors.
  But what we are really talking about is the ability of seniors to 
play a role and have participation in the choice of the drug care they 
get as versus having the Federal Government doing it all.
  So that is a response to Senator Kennedy's comments on drugs, which I 
guess we are going to hear a lot more about, and which I am sure the 
Senator will have a response to my response, if he decides he deems it 
worthwhile.
  I was going to discuss this other issue, so let me quickly discuss 
it. I know the Senator from Idaho has been very patient.
  I do have to make this one point that this chart illustrates which is 
that the Senate Budget Committee took a look at the Vice President's 
proposals. Anybody who has been listening to the Vice President 
wandering around the country knows he has gone to just about every 
interest group in this country and has suggested money he will spend to 
assist them in some program, which is his right and, obviously, his 
philosophical viewpoint. But at some point you have to pay the piper. 
You have to add those numbers up.
  So the Senate Budget Committee added those numbers up. When you get 
to the bottom line, which is shown on this chart, the surplus, over the 
next 10 years, which is $4.5 trillion, is entirely spent.

  We have heard a lot from the Vice President about how Governor Bush's 
proposal of the $1.3 trillion tax cut, which is about a quarter of the 
entire surplus, is going to eat up the surplus and, therefore, not 
leave anything for anybody else. But what we do not hear about, because 
maybe the press has not focused on it because it is a lot of numbers--
but they can now go to the Senate Budget Committee numbers and focus on 
it fairly easily--is that Vice President Gore has already spent the 
surplus. He has spent the entire surplus.
  If you use the low range, he has overspent the surplus by $27 
billion. That is the low range. That is if you give him every benefit 
of the doubt. If you use the high range, which is not an outrageous 
high range--if it were my high range, it would be a lot higher than 
this is from the Budget Committee; and they tend to be fairly 
conservative number crunchers up there--it comes up to $900 billion, 
almost $1 trillion, that he has spent that exceeds the surplus. From 
where does that come? That comes from Social Security. That is what you 
end up hitting.
  There are a couple numbers on this chart that stand out like sore 
thumbs

[[Page S8250]]

that I want to mention quickly, and then I will stop.
  First, the tax cut relief. In the entire Gore package--we have a $4.5 
trillion surplus--do you know how much tax cut relief there really is? 
The Vice President says he has $500 billion, but that is, once again, 
one of these numbers which, if you look behind it, is not really there. 
The net tax cut relief in his package is $147 billion out of a $4.5 
trillion surplus.
  The American people are paying $4.5 trillion more to the Federal 
Government than the Federal Government needs to operate. That is what 
the surplus is. Everyone in this room, everyone in America who pays 
taxes is paying taxes which the Federal Government does not need to 
operate. It adds up to $4.5 trillion. And all that the Vice President 
can agree to give back in the way of a tax cut--and it is not really a 
tax cut, returning taxes that do not need to be paid--is $147 billion 
out of $4.5 trillion. It is incredible.
  That number distinctly reflects the view that any money that comes to 
Washington is not the money of the taxpayers; it is the money of the 
people who live in Washington. It is the Vice President's money; 
therefore, he does not have to give it back. It is the Government's 
money. They don't have to give it back. Not in my view. Not in Governor 
Bush's view, which is that it is the taxpayers' money. It comes out of 
your pocket. It is your taxes. It is your money. If the Government has 
too much of it, let's give it back.
  The second item that I want to highlight is this retirement savings 
plus plan, which is a brand new major entitlement of huge proportions 
and a massive increase on the next generation. This is only a 10-year 
number shown on the chart. That number explodes, as you move into the 
outyears, into trillions. It is the most significant major entitlement 
ever put on the books of the American Government, in my opinion--if it 
were to pass. It will exceed Medicare by a huge function in the 
outyears, as we head toward the year 2030, I believe. But it will at 
least be competitive with Medicare as a massive new entitlement 
program.
  Who is going to pay it? The next generation. Our kids. My daughter 
who just got her first job. She is out of college, which we are very 
happy about because we don't have to pay tuition. She got a job, which 
we are even more happy about. Unfortunately, around about 10 or 15 
years from now, assuming she keeps her job, she is going to be paying 
taxes at an outrageous rate in order to support a brand new entitlement 
put on the books by Vice President Gore, if he should become President. 
That, to me, is a little number in there that seems little in this 
package, although it is huge--obviously, even in this package; $750 
billion on the upper side. That is not talked about much but should be 
looked at by the American people as they consider who they are going to 
vote for in this coming election.

  Mr. President, I appreciate the courtesy of the Senator from Idaho in 
allowing me to proceed for a little extra time.
  I yield the floor.
  Mr. CRAIG addressed the Chair.
  The PRESIDING OFFICER. The Senator from Idaho.
  Mr. CRAIG. Mr. President, may I ask where we currently are in the 
order?
  The PRESIDING OFFICER. We should be proceeding to H.R. 4444, but if 
the Senator wishes to speak on a different subject, he certainly can 
ask unanimous consent to do so.
  Mr. CRAIG. Mr. President, I ask unanimous consent to speak as in 
morning business for as much time as I consume.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. CRAIG. Mr. President, I thank the Senator from New Hampshire, 
first of all, for being on the floor this morning to discuss what I 
think is a very important issue. For any of us who were listening to 
the Senator from New Hampshire and the Senator from Massachusetts, let 
me see if I can get this together.
  If you are for the Gore prescription drug health plan, then you are 
going to have a major premium increase, and you may get the plan in 8 
years. It will be a Government plan, and it will be a major Government 
takeover of health care for the seniors in this country. And it will be 
limited to no choice.
  If you accept what Governor Bush is proposing, then you have a 
substantially greater choice. The plan is back to the States, where 
doctors and nurses and local health care delivery systems deliver it, 
and you do not move toward a major federalization of health care.
  We had this debate in 1992 and 1993. About 70 percent of the citizens 
of the country said: We don't want the Federal Government as the 
deliverer of health care and health care components, including 
prescription drugs.
  Is there a difference in the debate today? Not at all. Do the seniors 
of America want the Federal Government to control their health care or 
do they want to control it themselves with optimum choices, similar to 
what we as employees of the Federal Government have today? The Federal 
Government doesn't control our health care. We choose. We pay some 
premium, obviously, to offset the costs, and we have choice in the 
marketplace.
  I think as the debate goes on through September and October, the 
clear differences will come out, and they will be very simple. I think 
it is important that we think of it that way. It is called ``Gore and 
the Federal Government and health care,'' or ``George W. Bush and you 
and your choice at the local level delivering health care for 
yourselves with optimum choices and flexibility.''

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