[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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