[Congressional Record Volume 146, Number 108 (Thursday, September 14, 2000)]
[Senate]
[Pages S8537-S8538]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                             SENATE AGENDA

  Mr. KENNEDY. Mr. President, I yield myself 8 minutes.
  First of all, I commend my friend and colleague from Florida on an 
excellent presentation and one that commends itself to the common sense 
of all of us in the Senate.
  The fact is the Medicare program was built upon the existing programs 
in 1965. Since that time, we have discovered the importance of 
preventive health care--how important it is in keeping people healthy 
and how important it is for actually saving Medicare funds over a long 
period of time. The Senator from Florida has indicated a pathway we 
might follow to deal seriously with these issues. We should not have to 
explain to this body that for every $1 we spend for immunizations, we 
save $8 to $9 by preventing disease.
  I admire and am a strong supporter of the administration's series of 
recommendations for preventive care. The Senator from Florida has 
outlined a process and system where we can finally take action on these 
recommendations.
  The bottom line is the Budget Committee doesn't take into 
consideration the savings from preventive care so this body has been 
extremely slow in enacting these programs. But these preventive 
measures make a great deal of sense. They make sense for ensuring good 
quality health care for the families of this country, and they make 
sound economic sense. I certainly agree with the Senator that along 
with preventive care, we ought to understand the importance of 
prescription drugs. I think what he has outlined today is enormously 
important for us to consider.
  I will take a few moments to move beyond this very excellent 
presentation into what the challenge is for all of us in the Congress 
over these next 5 weeks. There is time, I believe, to take action on a 
good prescription drug program. We have, now, two different systems 
which have been offered to the American people. The first is the 
proposal that was advanced initially by President Clinton and is now 
enhanced by Vice President Gore. The proposal has been changed--not 
really dramatically--but I think it has been more carefully attuned to 
the needs of Medicare enrollees than the alternative which has been 
presented by Governor Bush.
  I hope even in the short time that remains--when we conclude the 
action on trade issues we still have more than 3 weeks of Senate time--
I hope we can still take action on a minimum wage. Every Member of this 
body knows that issue well. We know what is before us. We ought to take 
action on the Patients' Bill of Rights. We have a bipartisan effort to 
try to do that. There have been some suggestions and recommendations in 
order to accommodate some of those who voted against this previously. 
We now, hopefully, will gain support for those proposals.
  Finally, and very importantly, the other remaining issue which is of 
vital importance to seniors is a prescription drug program. Let me 
mention quickly some of the concerns I have about this program and some 
of the advantages that I believe are in the Vice President's program.
  The Vice President's program is built upon Medicare. We have heard on 
the floor of the Senate the Medicare system is a one-size-fits-all 
program. The fact is that seniors understand Medicare. They support 
Medicare. They understand there have to be some changes in the Medicare 
program but, nonetheless, it is a tried, tested process and it is one 
which offers the necessary flexibility.
  What has been proposed by the Vice President is a prescription drug 
program that goes into effect a year from now, and is gradually phased 
in over a period of time. The seniors of this country would have a 
benefit for prescription drugs a year from now. I think that is very 
important and one of the most compelling parts of the Vice President's 
program.
  The alternative is the proposal offered by Governor Bush. I read here 
from the Governor's own proposal. It says in his proposal that 
effectively it will be a block grant program that will in effect ensure 
low-income seniors do not have to wait for overall reform.

  Our seniors ought to have some pause, because he is talking about

[[Page S8538]]

overall reform of the Medicare system. That ought to bring some pause. 
We do not really know what overall reform is. I think most seniors 
would say: We have confidence in the Medicare system. We want a program 
that will get the benefits to us quickly.
  He says that low-income people will not have to wait for the overall 
reform. We are not sure what that really means. To have your 
prescription drugs covered, Governor Bush will establish the immediate 
helping hand which will provide $48 billion to States for 4 years to 
deal with low income seniors. So it will be 4 years before 27 million 
seniors will be able to participate because there are 27 million 
seniors who do not fall within Governor Bush's definition of those who 
need an immediate helping hand. Those 27 million seniors will wait 4 
years--and then wait for the overall Medicare reform. The Vice 
President's plan goes into effect 1 year from now.
  Second--and I think enormously important--is what we call the 
guaranteed benefit. This is very simple. A guaranteed benefit means the 
doctor will make the decision on your prescription drug needs. When 
seniors go in--whatever their condition, whatever their disease, 
whatever their problem--the doctor makes the recommendation as to what 
prescription drug is needed. That is fundamental. That is the 
guaranteed benefit.
  That is not true with regard to the Governor's proposal. It will be 
the HMO that the individual is enrolled in that will decide. We will 
find that the HMO will make the decision about what prescription drugs 
are covered--whether it will be the only drug on the HMO's formulary, 
or whether other kinds of prescription drugs will be permitted to be 
used.
  That is interesting, is it not, Mr. President? Most seniors want the 
doctor to make the recommendation. This underlies the basic difference 
between our two parties on the prescription drug issue.
  We are for the Patients' Bill of Rights so doctors are allowed to 
make health care decisions. We want to make sure that doctors are going 
to make decisions about prescription drugs rather than turning this 
right over to the HMO.
  Finally, what is being established under the Gore proposal is very 
clear. The government and the Medicare beneficiary will have a shared 
responsibility in paying for prescription drugs. There will not be any 
deductibles. There will be a premium, and half of the premium will be 
paid for by the Federal Government.
  Under the Bush proposal, we do not know what the HMO is going to 
charge. There is no prohibition against a deductible and we do not know 
what the copayments will be. We have no idea what the premium will be. 
The Governor says the government will pay 25 percent of whatever the 
premium is, but there is no assurance to seniors that there is not 
going to be a sizable deductible in that program. The size of the 
deductible is a mystery.
  Under the Vice President's program, we can give assurance today that 
when the program goes into effect, as part of the Medicare program, 
whatever that senior citizen needs, if the doctor prescribes it, that 
senior citizen will get it.
  Those who are opposed to Vice President Gore's program, who support 
the Governor's proposal, cannot make that claim. They cannot tell us 
what the premiums are going to be over a period of time because they 
are not spelled out, at least in the papers that have been made 
available.
  The only thing that we know--which causes many of us a great deal of 
concern--is that after 4 years, after overall reform of the Medicare 
system, then there will be a program for prescription drugs. That is a 
long time to wait. That is a very long time to wait. What I have found 
in my State is that people want a prescription drug program and they 
need it now.
  The PRESIDING OFFICER. The Senator's 8 minutes have expired.
  Mr. KENNEDY. Mr. President, the final points I want to make are that 
70 percent of Medicare beneficiaries, more than 27 million seniors, 
will not even be eligible for Governor Bush's immediate helping hand 
program.
  Finally, the nation's Governors have already rejected the block grant 
approach. Republican and Democratic Governors have said: This will be a 
massive administrative nightmare for our States; we do not want the 
responsibility even if it is going to be funded. We can understand 
that.
  We have an important opportunity to make a difference for our seniors 
with a good prescription drug program. Let's reach across the aisle. 
Let's join forces. Let's try to get the job done before we recess. The 
opportunity is there. We are willing to do that, but we need to have a 
response from the other side and a willingness of the Republican 
leadership to try to get the job done.
  I yield the floor.
  The PRESIDING OFFICER. The Senator's time has expired. The Senator 
from Idaho has 10 minutes.
  Mr. CRAIG. Mr. President, while I came to the floor to speak on 
another issue, before I do that, I want to respond to the remarks of 
the Senator from Massachusetts.
  There is a very real difference between what Vice President Gore is 
talking about and Gov. George Bush is talking about. Senator Kennedy 
has effectively outlined it today. Senator Kennedy said let the 
Government run your health care; let the Government make your choices; 
let the Government control the process.
  The seniors of America do want choice. They want the same kind of 
health program Senator Kennedy has and this Senator has. They want 
choice, and they want flexibility in the marketplace. That is the kind 
of program we are talking about offering them.
  I cannot imagine we would want another federalized health care 
program where the Government tells the senior community of our country 
what kind of prescription drug they will get and where they will get 
it.
  Those are very real differences that I am afraid were avoided in the 
comments this morning.

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