[Congressional Record Volume 146, Number 109 (Friday, September 15, 2000)]
[Senate]
[Pages S8629-S8630]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




PRESCRIPTION DRUGS AND PREVENTIVE CARE: THE KEY TO TRUE MEDICARE REFORM

  Mr. GRAHAM. Mr. President, yesterday I started the first of what will 
be five or more brief statements on issues related to the subject of 
the Federal Government providing a prescription medication benefit to 
Medicare recipients.
  Yesterday, I opened this series with a discussion of what I consider 
to be the most important reform required in the Medicare system; and 
that is reforming a 35-year-old health care system which was 
established to provide acute care; that is, care after an illness had 
matured into a major condition, or after an accident had caused a 
person to require specific medical attention largely in a hospital 
setting.
  What was not included as part of the 1965 Medicare program was an 
emphasis on what seniors want today; and that is, they want a system 
that will not just treat them after they are seriously ill but to have 
treatment that will avoid or reduce the impact of those illnesses 
through effective preventive strategies.
  Those preventive strategies have many components, including regular 
screenings for those conditions that can be detected at an early time; 
and then the management, through a variety of sources, of those chronic 
conditions so that they do not mature into serious health concerns, in 
some cases even death.
  To me, the conversion of Medicare from a sickness program to a 
wellness program is the fundamental reform that this Congress must 
achieve.
  If we are going to have this new orientation on wellness, 
prescription drugs will play a critical role. Prescription drugs are a 
part of almost every methodology of managing a medical condition which, 
if not appropriately managed, could mature into serious complications. 
Prescription drugs are a key to providing true quality preventive care 
for our senior citizens.
  My point is illustrated by an example.
  Mrs. Jones is a Medicare beneficiary. She has, like an increasingly 
large number of Medicare beneficiaries, no drug coverage. 
Unfortunately, Mrs. Jones also has diabetes, hypertension, and high 
cholesterol. These are three conditions which in the past would have 
been debilitating, even fatal. Today, thanks to the miracle of modern 
medicine, Mrs. Jones can treat these conditions and continue to live a 
healthy life.
  Mrs. Jones is likely to be treated with Glucopahge, Procardia XL, and 
Lipitor.
  The annual cost of Glucophage will be $708. The annual cost for 
Procardia XL will be approximately $500 to $900, depending on whether 
30 or 60 milligram tablets are prescribed. The annual cost of Lipitor 
is approximately $700. The total annual spending for these three drugs 
alone for Mrs. Jones will range between $1,900 and $2,300. These costs, 
for most seniors--I would argue, for most Americans--are likely to 
cause significant economic hardship. But if Mrs. Jones does not take 
these drugs, she will find her conditions raging out of control and 
will surely be a candidate for expensive hospital stays and surgery.
  Those last two comments underscore the fact that this is a medical 
issue in terms of will we make available and affordable to our older 
citizens those drugs which are available to manage conditions and avoid 
those conditions maturing into the need for expensive hospitalization, 
surgery, or even conditions that are beyond the ability of those heroic 
measures to stop the unending pace towards death. It is also an 
economic issue.
  For most seniors, there are many years of preparation for retirement, 
preparation which is particularly oriented to assure that there will be 
an economic foundation under their retirement years. There are many 
challenges and risks to that economic foundation. Today the most 
prominent of those risks, the one which is most feared by millions of 
older Americans, is the fact that they will, in fact, be diagnosed as 
having some condition which, the good news is, is treatable and 
controllable. The bad news is, it will wreck their economic foundation 
to pay the cost of those drugs. We are dealing not only with an issue 
of medical humanity but also of economic security. We owe it to our 
Nation's seniors that they have the chance to live a full, healthy, and 
economically secure life in retirement. Prescription medications are a 
key to allowing them to do so.
  When Medicare was established in 1965, Mrs. Jones may have benefited 
most by a system that provided effective hospital care, that did not 
have a particular focus on preventive benefits, where outpatient 
prescription drug coverage was not a particularly significant factor. 
But in the 35 years since that time, medical science and our set of 
values of what we want from our health care system have changed 
dramatically.
  Today pharmaceuticals, not surgery, are the first line of defense 
against illnesses. The number of prescriptions for American seniors 
grew from 648 million as recently as 1992 to more than 1 billion in the 
year 2000. One example of this transition from surgery to 
pharmaceuticals is the treatment of ulcers. It used to be that the 
standard treatment was surgery. Today surgery for ulcers is a very rare 
event. What has happened is the substitution of effective 
pharmaceuticals to treat, remedy, and reverse ulcerous conditions.
  A senior is better because he or she has avoided the necessity of 
intrusive surgery. Our taxpayers are better because they have avoided 
the cost of that surgery, and the senior is able to resume a normal 
quality of life.
  We should think of preventive medication today as the anesthesiology 
of the last century. I have suggested that if Medicare had been 
created, not in 1965 but at the end of the Civil War in 1865, there 
would have been the same debate that we are having today over whether 
we should include anesthesiology. As we know from our study of Civil 
War history, it was not uncommon for very serious surgical procedures 
to be conducted without anesthesiology. Today we would think it to be

[[Page S8630]]

ludicrous to the extreme and inconceivably inhumane not to have 
anesthesiology as a core part of a health care system. I suggest that 
in a few years people will look back on this debate with the same shock 
and surprise that we thought there was any debate over the question of 
whether pharmaceuticals should be part of an appropriate humane health 
care system as we begin the 21st century.

  Medicare beneficiaries should not have to choose between bankrupting 
themselves and their families or succumbing to a preventable disease. 
The key to modernizing Medicare is turning it from a sickness program 
to a wellness program. Prescription drug coverage is a crucial 
component of that change.
  Let me give another example. A senior with gastrointestinal problems 
is most likely to be prescribed a drug known as Prilosec. Based on 1998 
data from the Pennsylvania Pharmaceutical Assistance Contract for the 
Elderly program, which is the largest outpatient prescription drug 
program in the country, Prilosec is the second highest selling drug 
prescribed for seniors. The annual cost is $1,455. For a senior who, 
for instance, is at 200 percent of the poverty level, $16,700 per year, 
Prilosec will consume $1 out of every $11 of that senior's income. This 
price is very high for that senior. But the price the senior would pay 
if he or she did not take Prilosec is even higher. They would sacrifice 
an active, pain free life for one riddled with chronic pain.
  This body should recognize that prescription drugs are an integral 
part of a preventive care strategy for the Medicare program. As one of 
the primary guardians and trustees of the Medicare program, the Senate 
has the responsibility to reform and modernize Medicare so that it 
focuses on health promotion and disease prevention for all of our 
Medicare beneficiaries. It can improve the quality of life for older 
citizens through making this conversion from a sickness to a wellness 
program.
  The Medicare program can also slow the cost to the taxpayers by 
making this transition. The cost of one senior, typically an older 
woman who falls and, because of her shallow bone mass, injures her hip 
and requires hospitalization, often surgery, and always a long and 
painful recovery period, the cost of that to the taxpayers is much 
greater than the cost of one of the preventive measures which is now 
being recommended but which is yet to be covered by Medicare; that is, 
effective hormone management techniques which will contribute to 
maintaining strong bone conditions and reducing the vulnerability to 
that kind of a serious mishap.
  It has been proven time and time again that a combination of 
preventive services and appropriate medication can reduce the incidence 
of stroke, diabetes, heart disease, and other potentially fatal 
conditions.
  Detailed programmatic changes--changes based upon the realization 
that prescription drugs and preventive services go hand in hand--are 
necessary to convert the current Medicare system into one that best 
serves our citizens by keeping them well as long as possible.
  Mr. President, we are very fortunate to be living in an era of 
unprecedented prosperity. This period gives to us, the trustees of the 
Medicare system, an even greater responsibility and opportunity. We can 
use this period of prosperity to reform the Medicare program, to assure 
that our seniors will be able to live longer, healthier lives through 
preventive care and the treatments that are available to us today. To 
capitalize upon this opportunity we must provide a prescription benefit 
which is affordable and comprehensive for our Medicare beneficiary 
citizens.
  I implore each of us to take advantage of this opportunity and use 
the funds that are available to us now to implement change that will 
benefit our seniors today, our children and grandchildren tomorrow.
  We have discussed the need to reform the Medicare program to shift 
its focus from the treatment of illness to the maintenance of good 
health. We have discussed the critical role that prescription 
medications play in ensuring a successful preventive care strategy for 
Medicare. If we agree on these issues--and I believe there is broad 
consensus--the next question we must answer is: How should a 
prescription drug benefit be made available for our Medicare 
beneficiaries?
  Next week, I will discuss the critical question of whether a 
prescription drug benefit should be part of the big tent of Medicare 
program, or if it should be placed as a sideshow act outside of 
Medicare. I look forward to discussing this with my colleagues next 
week.

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