[Congressional Record Volume 146, Number 104 (Friday, September 8, 2000)]
[Senate]
[Pages S8272-S8274]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                                MEDICARE

  Mr. FRIST. Mr. President, I want to very briefly continue a 
discussion that was held earlier on the floor today addressing an issue 
that means not only a great deal to me but also to about 35 million 
seniors in this country as well as 5 million individuals with 
disabilities. That is the issue of Medicare.
  Our obligation, I believe, is to modernize Medicare and give those 
seniors and those individuals with disabilities what they deserve; that 
is, health care security as we know it is or should be in the year 
2000, not the sort of health care security that was appropriate for 
1956, back when Medicare began.
  The challenge before us today as a body and the challenge before the 
American people is really pretty clear; that is, how to best implement 
a real plan for real people, those seniors and those individuals with 
disabilities--not just a piece of legislation but a real plan that will 
modernize Medicare in a way that will give them real health care 
security.
  A lot of individuals with disabilities and a lot of seniors out there 
don't really realize how antiquated and out of date the current 
Medicare system is. I would like to make several points.
  First of all, I believe modernization of Medicare today where it can 
truly offer health care security is really a moral obligation that we 
have to our seniors.
  Second, under the leadership of Clinton/Gore, we have had really 8 
years where a lot of opportunities have been squandered, and they 
simply have not led, if we look at this field of Medicare 
modernization.
  Third, we have to ask ourselves in terms of how best to modernize. If 
we have an old jalopy that still is running along and still gets us 
from point to point, do we just want to put new gas in that car--we 
know it is going to eventually fail--or do we want to go ahead and 
modernize that car so that it will still get us from point to point but 
it will do so more efficiently and effectively in a way that will give 
us security and not just get us there but get us there with the very 
best quality?

  First of all, modernization of health care is a moral obligation. Why 
do I say that?
  If we look back to 1965 when Medicare began, Medicare was constructed 
to give health care security--inpatient care and some outpatient care--
in a very effective way. For acute-care models, if you had a heart 
attack, you were taken care of essentially in the hospital. 
Prescription drugs were important but not nearly so important as they 
are today. We simply didn't know very much about preventive medicine in 
1965 and 1970. But all of that has changed. Now we know prescription 
drugs are critically important to health care security. We know issues 
such as preventive health care can not only save money but, most 
importantly, improve the quality of life--not just longer lives but a 
higher quality of life.
  The sad thing is that people don't know Medicare today has very 
little preventive care in it. I talk to seniors all over the State of 
Tennessee in town meeting after town meeting. I say it has a little 
preventive care. They say: We didn't know that. When I talk about 
prescription drugs, it is surprising to many people today; not only 
seniors but others do not know that Medicare does not include 
prescription drugs.
  I ask an audience of seniors or individuals with disabilities: How 
much do you think the Federal Government is helping you with your 
health care in terms of costs? If you are paying several thousand 
dollars a year for your health care, how much does the Government 
actually pay? They say 80 percent, initially, or they say 70 percent, 
or 60 percent. But in truth, on average, for seniors' health care 
costs, only about 53 cents on the dollar is paid for by the money they 
have paid in--by the Government and by the taxpayer. They are 
responsible and end up paying about 47 cents on the dollar in spite of 
the fact they paid into this Medicare trust fund over their lives.
  Thus, I think we have a moral obligation if we are committed to 
health care security and to modernization of a system that we know will 
be modern, that will include preventive care and prescription drugs.
  That leads me to the second point. If that is the case and the 
facts--and it is--where has our leadership been? Where has Vice 
President Gore been? Where has President Clinton been? They squandered 
an opportunity over the 6 years I have been in this body, and over the 
last 8 years, to modernize that system; that is, that Medicare is built 
on a 1965 model, 35 years ago. It is outdated; it is antiquated; it is 
a car that is still moving and getting the care but not nearly as 
efficiently or as comprehensively as our seniors deserve.
  The squandering of the opportunity is a pretty tough term to use, 
saying that our leadership, through President Clinton and Vice 
President Gore, squandered this opportunity. Run down the list. We had 
a National Bipartisan Medicare Commission that I had the opportunity to 
serve on with John Breaux, a Democrat, Bill Frist, Republican. We were 
pretty evenly split between Democrats and Republicans. We had the 
private sector and public sector involved. In essence, the 
administration, under President Clinton and Vice President Gore, walked 
away from the Commission's recommendations that were built on over 40 
open hearings with access to the very best experts in the United States 
of America. At the last minute, they walked away from the proposals 
which had bipartisan support. A majority of the Members supported it. 
An opportunity squandered. The purpose of that Commission was to 
modernize Medicare, to bring it up to date, to give our seniors the 
health care they deserve.
  As to the Balanced Budget Act of 2 years ago, the Budget Committee in 
this body, the U.S. Congress, said: Yes, we need to slow Medicare down, 
make it fiscally responsible, make sure it is around 20 and 30 years 
from now. The way it was implemented under President Clinton and Vice 
President Gore, $37 billion less than we budgeted was spent--$37 
billion less.
  What has that resulted in? It has resulted in facilities closing 
down, over 200 hospitals--some urban hospitals serving the poor, some 
rural hospitals in Tennessee, and around the country--have closed.
  As many as 20 percent of all Medicare-providing nursing homes are 
either at risk for bankruptcy or already have gone bankrupt because of 
this excessive cut in spending--not intended by the U.S. Congress--
carried out by this administration.
  We hear today there are hundreds of thousands of seniors who are 
losing access today to prescription drug coverage because they were in 
a plan called Medicare+Choice plans. Why are they leaving? Why are the 
plans not able to stay in business today? Because this administration, 
through the bureaucratic administrative load burden that sits on the 
shoulders of these plans--when placing the burden on the plans, it 
falls down to the doctors. Basically, they cannot participate any 
longer. Those are plans that are giving prescription drugs, making them 
available. Another squandered opportunity by this administration.
  On top of all of that, we had this demographic shift because of the 
baby boom that we talk about. Yet because of a lack of leadership at 
the Presidential level and the Vice Presidential level, we squandered 
another opportunity. The demographic shift is the following: Over the 
next 30 years, the number of seniors will double compared to what it is 
today. The number of people paying into this trust fund

[[Page S8273]]

will continue to go down. That demographic shift results in catastrophe 
if we don't make the system more efficient.
  Modernization is a moral obligation, No. 1.
  No. 2, our leadership in the executive branch has squandered the 
opportunity over the last 8 years to do something about it.
  No. 3--and this is the fundamental question--do we want new gas 
poured into an old car, an old jalopy percolating along, or do we want 
to have a modern car that can operate efficiently, in a way that 
guarantees that health care security, that would have different 
options, and the option might be preventive health care; it might be 
prescription drug coverage.
  That is what we are faced with today. That is what we talked about a 
little bit on the floor today, and that is what the Presidential 
election is all about.
  With a little more gas, a broken down jalopy is going to fail. 
Everybody agrees because of the demographic shift there is no way to 
continue.
  We have the various options out there that we know our seniors 
deserve, thus the moral obligations that our individuals with 
disabilities deserve.
  Having blocked fundamental reform on this jalopy out there, Vice 
President Gore and President Clinton now, in terms of prescription 
drugs, simply want to take off benefits and add them on to the system, 
without changing the system whatever. Using the old bureaucracy, the 
old broken down car, the Gore plan wants to take 8 years to pour the 
gas into that car. It will take 8 years before that prescription drug 
plan that the Vice President wants to add on to this antiquated, out-
of-date Medicare system, to be fully implemented. Or do we want the new 
car, want Medicare modernized to include prescription drug coverage, to 
include a modern choice of plans.
  I think we have a unique opportunity. Today, workers really can say, 
under a modern program, that every senior will be able to keep exactly 
the same benefits they have today. Under a modern program, every senior 
will be offered a choice of benefits that includes prescription drugs 
for the first time, that will include preventive care for the first 
time, and that every senior will be covered for catastrophic Medicare 
costs.
  I do urge my colleagues in this body and all Americans to recognize 
and to call for real health care security, a real plan for real people.
  Mr. LOTT. Mr. President, I ask Senator Frist if he would yield to me 
before he yields the floor.
  Mr. FRIST. I yield.
  Mr. LOTT. Mr. President, I thank Senator Frist for the good work that 
he does on behalf of his constituents but also the entire Senate. He is 
the only doctor we have in the Senate, a very outstanding heart 
surgeon. He did quite an outstanding number of things before he ran for 
the Senate, the first time he had ever run for office, and he has 
become a very valuable Member of this body. When he talks about health 
care, health care delivery, he has seen it as a doctor; he has seen it 
from the standpoint of the patients with whom he has had to deal. He 
has seen it from the standpoint of what hospitals do or can't do. He 
has seen unbelievably magnificent technological medical advances that 
have allowed our people to live longer and have a better quality of 
life. He knows about heart, lung, and liver transplants. It is a 
miracle.
  We want to continue to improve health care in America. I think we 
have to recognize that it is changing so fast, we have so many people 
living so much longer with different kinds of needs, we have to be 
flexible and we have to make changes. He also understands that we could 
kill the goose that laid the golden egg. We still are blessed in this 
country to have the best health care, the most sophisticated, 
technologically advanced health care the minds of men have ever 
conceived in the history of the world. And we want to make sure that we 
protect that, preserve it, and make it better.
  A good way to begin to kill it is to turn it over to the Federal 
Government. The Government can kill the goose that laid the golden egg; 
it can take it down. That is why the American people and the Congress 
didn't go along with the Government takeover of health care that was 
advocated in 1993.
  Senator Frist, as a doctor, has come in and has gotten involved. He 
is working on these issues. He has been involved in our debate on 
health issues. That is why I asked him to serve also on our Medicare 
Bipartisan Commission. We had five or six Senators on that Commission: 
Senator Gramm of Texas, Senator Frist, Senator Rockefeller, Senator 
Kerrey, and Senator Breaux of Louisiana was the chairman, the Democrat 
chairman of this Bipartisan Commission. I also was very pleased to have 
a lady in her seventies from my State of Mississippi as one of the 
commissioners. She was the only one with gray hair on the whole 
Commission. She was the only one not only eligible for Medicare, she 
was the one person who dealt every day with Medicare, where the rubber 
hits the road, dealing with Medicare cases in my State office in 
Jackson, MI--Eileen Gordon. Dr. Frist will tell you she was an 
outstanding member of the Commission, but she used to say during the 
meeting: Let me tell you how this really works. Among all these 
experts, all those theoreticians, there was one person dealing with it 
on an individual basis who did a magnificent job.

  That Commission did a good job. They came up with Medicare reforms 
which would preserve and improve the system, and it included a 
prescription drug component, with choice, with the private sector 
involved but prescription drug benefits for those with incomes up to 
135 percent of poverty. It was a good plan and a bipartisan plan.
  I thought we should have moved it forward. I called and talked to 
President Clinton on Monday, I believe it was, of the week that they 
were supposed to report, pleaded with him to take another look at it; 
not shoot it down, in effect. He said he had a problem with this or 
that.
  I said: Mr. President, that has been changed. Please talk to John 
Breaux, the chairman of the Commission. Get the latest proposal. Let's 
keep the process going. Let's let it come on up to the Finance 
Committee. The Finance Committee can have hearings and look at it. 
Let's get this thing going. We can get some reforms; we can get 
prescription drug benefits.
  As a matter of fact, he did call Chairman Breaux and he did take a 
look at it. But he did walk out into the Rose Garden a day or two after 
that and said: This is no good. We are not going to do it.
  That was a magic moment missed. That was in the spring of 1999.
  But they got it started in the right direction. Really, that is still 
where we should go. We should have prescription drug benefits available 
to those, the low-income elderly, who really need help who can't afford 
it, can't get it now, but not subsidize it for everybody. We don't need 
prescription drug benefit assistance for Donald Trump or Bill Gates or 
Bill Frist. We need it for low-income elderly people such as my mother, 
who has to live on $859 a month and pay her bills in an assisted care 
facility, and pay her drug bills. She needs help. A lot of people like 
her need help. But they don't need it 15 months from now or 8 years 
from now. They need it now.
  That is why I am pleased that Chairman Roth has come up with a 
package that will do that. It doesn't have the Medicare reforms we 
ought to have.
  Senator Frist is right; if we just put more passengers on this ship 
that is sinking, it is going to sink even faster. So we need to 
preserve Medicare. We need some improvements and reforms. We need to 
make sure none of this money is used for anything but Medicare. Then we 
need to have a very sensible prescription drug component aimed at the 
elderly poor who really need it.
  I appreciate the time he spent in the Medicare commission. I think we 
ought to reconstitute the Medicare commission. I hope the next 
President will reconstitute that group and say: You have 120 days. I 
want to hear from you then. We are going to act on what you recommend; 
up or down, but we are going to act on it.
  I hope Senator Frist will be willing to serve. But have I given an 
accurate assessment of what happened with the Medicare commission? Is 
that a correct description of the prescription drug component of that 
bill?
  Mr. FRIST. Mr. President, in response, the description is very 
accurate. When I say that opportunities have been squandered, I put 
that first

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and foremost because it very much demonstrates the bipartisanship, 
working together, not having roadblock after roadblock after roadblock 
placed in front of good ideas; working together. That serves real 
people, those seniors who are out there today.
  Let me close and say the one other thing the leader mentioned, which 
is critically important--there can be all sorts of solutions proposed, 
whether for prescription drugs or to save Medicare long term. The one 
answer that was clear after a year of work on this bipartisan Medicare 
commission, one idea that repeatedly came forward from the experts all 
over the United States of America, and even people coming in from other 
countries, was that a one-size-fits-all system, dictated by Washington, 
DC, the beltway mentality, is the one thing that will be destructive to 
me delivering health care; whether it is Bill Frist as a heart 
transplant surgeon or my father who practiced for 55 years, initially 
down in Mississippi and then back up in Tennessee. The one thing that 
will destroy quality is one-size-fits-all, which inevitably results in 
price controls, which destroy creativity, research, innovation, the 
hope for cures for Alzheimer's, for stroke, for heart disease.
  One last component. There are things we can do now, now in the next 6 
months, on prescription drugs. We don't have to wait forever. We don't 
have to wait for 8 years to have a program. The Gore proposal or 
Clinton proposal takes 8 years to phase in. We can act now and get 
prescription drugs to the people who need it most within 6 months, 8 
months, or 9 months.
  Mr. LOTT. I thank the Senator for his work. He is right. What we need 
is reform that provides results now, prescription drugs now for those 
who really need it. We don't need more roadblocks. We are going to work 
together to see if we can make that happen.
  I thank him for yielding.
  Now, I believe, Mr. President, I ask for the floor on my own time.
  The PRESIDING OFFICER. The majority leader.

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