[Congressional Record Volume 146, Number 110 (Monday, September 18, 2000)]
[House]
[Pages H7707-H7713]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
PRESCRIPTION DRUGS FOR ALL
The SPEAKER pro tempore (Mr. Hulshof). Under the Speaker's announced
policy of January 6, 1999, the gentleman from New Jersey (Mr. Pallone)
is recognized for 60 minutes as the designee of the minority leader.
Mr. PALLONE. Mr. Speaker, this evening, as I have so many times, I
would like to talk about the need for a Medicare prescription drug
program. I have to say that I will be partisan this evening. I know
some of my Democratic colleagues will be joining me, because I believe
very strongly that the only reason that we do not have a Medicare
prescription drug plan is because of the opposition of the Republican
leadership.
I have to say that I have been very disturbed to see that the
Republican presidential candidate, George W. Bush, Governor Bush, has
now come up with a proposal to deal with the problem that seniors face
with prescription drugs, but it is really no different than the same
plan that we have been hearing over and over again by the Republican
leadership in this House that does not provide a prescription drug
benefit under Medicare but rather simply tries to provide some sort of
government subsidy, primarily for low-income people, that I believe
will never succeed because essentially it is not practical. It is not
under the rubric of Medicare because the Republicans traditionally and
now have opposed Medicare and do not want to see it expanded to include
a prescription drug benefit.
Mr. DOGGETT. Mr. Speaker, will the gentleman yield?
Mr. PALLONE. I yield to the gentleman from Texas.
Mr. DOGGETT. In short, we have been there and done that in this
House, have not we? We have already had a vote on that very proposal
which was really a plan not to help the seniors of this country but to
help the insurance companies to reach out and touch someone, but in
this case it was to touch and subsidize insurance companies and assist
them but to leave out the vast majority of what we might call the
working-class or middle-class seniors that worked to build this into
the greatest country in the world, but they just have been left out of
the Republican plan. Is not that correct?
Mr. PALLONE. Absolutely. And the thing that disturbs me most about
it, and I know that the gentleman is very knowledgeable about this, is
that the fact of the matter is that every time the Republicans have
come up with a proposal to deal with the prescription drug issue it has
always been defensive. In the case of the House of Representatives,
because the Democrats were out there with our proposal to bring
prescription drugs under the rubric of Medicare and we had a proposal
out there that was a very good one, and they tried to avoid it by
coming up with this plan that essentially did not help anybody.
Mr. DOGGETT. Is not it true, in fact, that what they did was to have
a focus group or they got some high-powered, expensive political
consultant to tell them what going by any meeting of the American
Association of Retired Persons or retired teachers or many of our
retired veterans could have told them for free, and that is that the
Republicans are perceived here in the House and around the country as
having done absolutely nothing to help seniors when it comes to the
outrageous price of prescription drugs? They have sat on their hands.
They have been here in charge now for right at 6 years, and they have
done absolutely nothing. So after they got that input from this high-
powered consultant, it only took a few days and then they were out in
our Committee on Ways and Means with a proposal to subsidize insurance
companies and make it appear that they were finally getting around to
doing something.
Mr. PALLONE. The irony of it is that the insurance companies
testified before your Committee on Ways and Means and before my
Committee on Commerce and said that they would not sell the policies.
They were not interested in it.
Mr. DOGGETT. I believe that their famous comment on that of one of
the insurance folks was that it would be like insurance for haircuts
being proposed.
Mr. PALLONE. Exactly.
Mr. DOGGETT. And even though they were going to get a general
subsidy, they did not know whether they could ever provide the
policies.
{time} 2030
I believe though Texas, unfortunately, has been way behind on doing
anything to assist our seniors, there have been some States that have
tried this approach that the Republicans have advanced, and what has
been their experience?
Mr. PALLONE. Well, Mr. Speaker, we have the perfect example in Nevada
which, I believe around March or so of this year, passed a plan that is
almost exactly the same as what the Republicans in the House proposed.
The insurance industry told the Nevada legislature it was not going to
work and there was not a single insurance company that wanted to sell a
policy that would meet the specifications of what the Nevada
legislature passed. So it has been a total failure in Nevada.
[[Page H7708]]
Basically, what the House Republicans are saying is that they want to
adopt a State example that has failed.
Mr. TURNER. Mr. Speaker, if the gentleman will yield, I think one of
the central issues that distinguishes the Democratic plan for
prescription drugs for seniors and the Republican plan is that the
Republican plan does not tell the senior citizens what they are going
to get in terms of coverage, it does not tell them how much it is going
to cost, and it certainly does not tell them how long the coverage is
going to be there.
I had the experience in my district just recently going around
talking about the issue of prescription drug coverage for seniors under
Medicare, and I was met by seniors who were quite upset. They had
signed up for this Medicare+Choice plan that is sponsored by the HMOs
that a lot of my seniors were lured into because the HMO option for
traditional Medicare said, well, we will offer you a little
prescription drug coverage.
So all of my seniors that needed prescription drug coverage were very
interested in those plans. A whole lot of them signed up. Now, we have
5,000 seniors in my district alone who have received notices that their
HMO Medicare+Choice plan is being canceled as of December 31.
So I think the history of HMO coverage for Medicare is very clear. We
cannot depend on it. We do not know if it is really going to be there.
Over 200,000 seniors they tell me across this country have gotten
similar notices that as of December 31, they will no longer have their
Medicare+Choice plan in effect, and as I said, most of them signed up
because it offered them some kind of little prescription drug coverage.
So what we know about the Republican approach is that the seniors
today, when they look at that plan, they do not know what they are
going to get, they do not know how much it is going to cost, and they
do not know how long it will be there for them.
The Democratic plan, on the other hand, is a plan that offers seniors
the drugs they need from the pharmacist that they trust. Our plan
covers all drugs; our plan tells the seniors exactly what it is going
to cost. If they want to sign up, keep in mind, the Democratic plan
under Medicare is optional. If a senior says I do not want this
coverage, they do not have to sign up. But when they sign up, they know
that initially it will cost $25 a month; those costs are projected to
increase as the coverage increases up to about 40 some odd dollars and
it will cover one-half of the first $5,000 in prescription drug costs.
Over that, it will cover all of it.
We know that low-income seniors will be able to have that premium
paid for by the government. But that plan is a very clear plan that
gives seniors a defined benefit at a cost that is understandable with
coverage that they understand.
So I say the Republican HMO plan simply offers confusion and
uncertainty to seniors, and that is a big difference. Because one thing
I have learned the older I get, what we look for is security, and the
Democratic prescription drug plan offers security for seniors, and the
Republican plan does not.
So I think that when it comes right down to looking at the two plans,
we clearly have the plan that seniors are going to choose. I think if
we do that, we will be doing the right thing for our seniors. We will
have a plan that is workable, one that seniors understand, and one they
can count on. After all, Medicare, since 1965, has been a plan that
seniors can count on. All of these other private insurance plans like
our Republican colleagues advocate, they are here today, they are gone
tomorrow. Only Medicare has been there for seniors since it was first
put into law in 1965, signed by, I might say to the gentleman from
Texas (Mr. Doggett), a great President, Lyndon Johnson from Texas.
So I think we need to stay on that course and make sure that we take
care of the security that our seniors need.
Mr. DOGGETT. Mr. Speaker, will the gentleman yield?
Mr. PALLONE. Certainly.
Mr. DOGGETT. Since the name of the great Lone Star State has been
invoked here, I have to tell my colleagues about an experience that I
had, and my colleague may have made the same kind of inquiry in New
Jersey, about what was happening to seniors in the capital of the Lone
Star State of Texas.
Now, we have pretty high regard, particularly in some parts of the
State, I know over in East Texas where my colleague is from, for our
dogs. There some people have dogs that are pet dogs and then there are
other people that have bird dogs and some have hunting dogs and they
think pretty highly of them, but it seems to me that we ought not to
think so highly of them that if the dog got arthritis, the dog could
get the prescription drugs cheaper than one of our retirees, one of our
retired teachers or a senior who had a small business in the community
and had given back to the community through the years.
Mr. Speaker, I found when I did a study on arthritis medicine, for
example, there in Austin, Texas, the capital of the Lone Star State,
that it was going to cost almost, it was 150, almost 200 percent more
for the very same type of medication that could be given to a dog or
given to a senior, and there was that kind of price discrimination. If
all we do is just subsidize insurance companies with all of the
uncertainty that my colleague from Texas has talked about, there is
nothing to keep the seniors from getting treated literally worse than
dogs in Texas and I expect in some other parts of the country. They
still are going to be gouged; they are still going to have higher and
higher co-pays, even if some insurance company will write the policy.
So I am really concerned that this Republican plan will leave our
seniors around Texas and undoubtedly around the country literally being
treated worse than dogs when it comes to the price that they have to
pay for their prescription drugs.
Mr. TURNER. Mr. Speaker, will the gentleman yield?
Mr. PALLONE. I certainly will.
Mr. TURNER. Mr. Speaker, I think the point the gentleman made is one
that we need to have the people of this country understand, because in
Texas, if one can go across to Mexico, and a lot of folks do, they buy
their prescription drugs at about half the price that they pay in
Texas. As the gentleman pointed out, one can go to the veterinarian to
take care of their dogs and pay less for their medicine than they can
get at their local pharmacy.
The truth of the matter is, the most vulnerable people in our society
today are paying the highest prices for prescription drugs of anyone,
and that is just not right.
I think that is another benefit of our Democratic plan for
prescription drugs, because we put the power, the buying power of the
senior citizens of this country together to be able to bargain with the
big pharmaceutical companies. And when the buying power of all of our
seniors are united rather than divided as they are today; right now, a
senior citizen without prescription drug coverage is on their own when
they walk into the local pharmacist. I have talked to many a one of
them who tell me they went up there, they turned in their prescription,
they came back a few hours later to pick it up and they had to say, no,
I am sorry, I cannot afford that medicine.
So we are going to put, under the Democratic plan, the buying power
of all of the seniors in this country together so that they will have
the necessary clout to be able to bargain with those pharmaceutical
giants for fairness in prices. If we do that, I suspect we will not
have to talk about, as we have done for about 2 years here on the floor
of this House, about the problem of price discrimination between the
price of drugs in Mexico and Canada and anywhere else in the world, and
what our seniors in this country are having to pay.
Mr. PALLONE. Mr. Speaker, reclaiming my time, let me tell my
colleagues that the gentleman's example with the dog is certainly true
in New Jersey. I actually have a cat; it is actually my wife's cat that
I inherited, and she had, I guess it was a thyroid problem, and in New
Jersey, I guess one can get the prescription drugs at the veterinarian
or one can get it from the local pharmacy. So I had to refill the
prescription and I went to the local pharmacy to purchase the medicine
for our cat. I was told by the pharmacist that the same drug would be
twice as much if it
[[Page H7709]]
was for a human. So there is absolutely no question that we have a huge
discrepancy between a cat and a senior citizen or a dog.
The other thing that is so interesting and I think so really sad is
that when Governor Bush proposed his prescription drug plan and was
asked by one of the reporters on the day when it was proposed, because
I have the article here, The New York Times that was from September 6
of this year, he actually was critical of the Democratic plan, because
of the negotiation power that the gentleman from Texas (Mr. Turner)
talked about. He said it was like price control. It is just ridiculous.
That is not what it is.
The Democrats are not establishing price controls; they are simply
saying that we want the government, it is not even the government, but
in different regions of the country that a benefit provider would be
set up, basically a group that would be able to go out and purchase the
medication at a cheaper price because they represent so many people and
they have the buying power to negotiate a better price, just like the
HMOs do now or some other large employers do now. And Governor Bush,
when he was asked about that, and I will just give my colleagues the
quote from the New York Times here. He said that much like the drug
industry, he criticized Mr. Gore's plan as a step towards price
control. ``By making government agents the largest purchaser of
prescription drugs in America,'' he said, ``by making Washington the
Nation's pharmacist, the Gore plan puts us well on the way to price
control for drugs.''
Well, why should not a regional provider be able to go out and
negotiate a better price for all of these seniors? Why should they have
to pay twice the price? It does not make any sense.
I could not believe that he actually had the nerve to criticize the
very provision in our bill that would reduce the price in a competitive
way, sort of the American way, competition. You negotiate a better
price.
Mr. TURNER. Mr. Speaker, if the gentleman will yield, I think we all
understand that the free market system is not working today for our
senior citizens. Every country in the world has some kind of price
control over prescription drugs, because they understand that the big
drug manufacturers with their patent protections have a monopoly. So
they have accepted the fact that we cannot have a free market if those
who are providing the prescription drugs have a monopoly.
Now, we have always tried, and I think rightly so, to preserve the
free market, and all we are doing here is asking to allow our seniors
to be able to have their position at the bargaining table as a group.
We already do that for our veterans in this country. They get lower
prices, those who go and get their prescription medicines through the
VA, because we have that kind of arrangement for our veterans. All we
are trying to do is expand it to be sure our senior citizens have the
same deal.
As I say, we have to make a choice in this debate. There is no
question in my mind that there is a fundamental choice here. One either
has to take on the pharmaceutical industry, or one has to stand to
protect them, because the only impediment, the only barrier to passing
a prescription drug benefit under traditional Medicare is the
opposition of the pharmaceutical industry.
And if we do not take on the pharmaceutical industry, if we side with
them, if we try to protect their bottom line, then we are going to have
a hard time supporting a plan that is going to bring prices down for
our seniors and make prescription drugs affordable for them. I just
think in a country where we have granted patent protection to our
pharmaceutical manufacturers to encourage them to invest in research,
to come up with a lot of new and wonderful medicines, that the least
the pharmaceutical industry owes back to the American people is
fairness in pricing.
Mr. DOGGETT. Mr. Speaker, will the gentleman yield?
Mr. PALLONE. Surely.
Mr. DOGGETT. Mr. Speaker, I think that is just such a critical point.
The pharmaceutical industry has been masquerading under something
called Citizens for Better Medicare. It sounded like from the news
report that the gentleman from New Jersey read that the Republican
candidate had been watching too many of their ads. Because they put out
ads under the pretense of being for better Medicare, but the truth is
that their group is really ``Citizens for Leaving Us Alone to Let Us
Charge Whatever We Want to Charge.''
My colleague from Texas referenced the fact that some people along
the borders of America are going south or they are going north to go
right across the boundary and get prescription drugs at significantly
less cost, because they are sold at less cost in Mexico and in Canada.
Some of those prescription drugs are made right here in the United
States, and they are made and sold by our manufacturers in the
pharmaceutical industry for less in Mexico and Canada than they are
sold to our seniors here. They give them maybe as good a deal in Mexico
or Canada as they will give a dog here in the United States. And to be
sure, the prices that our uninsured seniors are having to pay are the
highest I think in the entire world.
My colleague referred to the experience of some of the other
countries around the world, but I do not believe anyone gets gouged as
much as a senior in Texas or New Jersey or any other part of this
country, and unless we come to grips with that problem and bring in the
negotiating power so that it is not one retired police officer, or one
retired nurse or teacher who is out there trying to take on these
pharmaceutical giants that can afford to spend hundreds of thousands of
dollars in campaign contributions, millions of dollars in lobby
expenses, millions of dollars in these television ads, giving
misinformation to everyone, we pit one senior against those
pharmaceutical giants, they do not have a prayer.
{time} 2045
The only hope we have through this Democratic plan is to come in and
add a little balance in the system so it can be evened out a bit.
Mr. PALLONE. The reason why the prices are so much more here is
exactly based on what our colleague from Texas said, and that is that
since there are price controls and negotiating power for citizens in
other countries, the only place left on the planet where there are not
the price controls and the negotiating power is here in the United
States. So the drug companies make up the difference here. They cannot
make the money in these other countries, so they jack up their prices
here to make up for the fact they cannot do it abroad. So that is just
unfair to the average American.
Mr. TURNER. It is amazing to me how hard the pharmaceutical industry
is fighting to preserve the status quo. The gentleman from Texas (Mr.
Doggett) mentioned Citizens for Better Medicare. The first time I ran
into that group I thought this must be a group of seniors trying to
improve Medicare.
We got to looking into it, and we found out just what the gentleman
from Texas (Mr. Doggett) said, and that is it is an arm of the
pharmaceutical industry. In fact, studies showed in the first 6 months
of this year, the so-called Citizens for Better Medicare spent $65
million in advertising to try to persuade the Congress and the American
people to preserve the status quo. They ran TV ads with a character on
it, a lady named Flo, and she began to talk about how she did not want
government in her medicine chest.
Then we had letters mailed out to our seniors. I had a gentleman in
Wal-Mart, a friend of mine, I have known him for years, John Perkins,
walked up to me in the parking lot and said, ``Here Jim, I have got a
letter that said to write you, and now that I have caught you, it will
save me writing a letter.''
I said, ``Well, fine, John, what do you have?''
He said, ``Well, here is this letter.''
It kind of looked like a telegram. And down at the bottom it said
Citizens for Better Medicare.
I read it. I said, ``John, this letter is telling you to write me and
tell me to vote against the very bill that I am sponsoring, trying to
help our seniors have some prescription drug coverage.''
He said, ``Oh, just forget about the letter.''
Well, all of those direct-mail pieces, all of that television
advertisement, they even ran ads in our major newspapers, full-page
adds. I think the one
[[Page H7710]]
they ran in the Washington Post cost something like $80,000 or $85,000
for one ad for one day. It is just amazing to me how much money the
pharmaceutical industry is pouring in to try to defeat our efforts to
provide a meaningful prescription drug benefit under the Medicare
program.
They have got a lot to protect, I know that. They are the most
profitable industry in the country today. I read that they spent $148.5
million on lobbying expenses in the last Congress. The top drug
manufacturers, the top 12, paid their executives $545.5 million in
salaries last year, and $2.1 billion in stock options last year to
those same executives. They are a very profitable industry.
As the gentleman well pointed out, the truth is every other country
in the world provides prescription drugs for their seniors at about
half, on average, the price that our seniors in this country pay. That
has just got to stop. I think it is our responsibility. When the free
market system has broken down, when it is not working, and particularly
when it is not working for the most vulnerable people in our society,
this Congress has a responsibility to do something about it. I think
our plan is the right plan to provide some security for our seniors.
Mr. PALLONE. Let me just mention another aspect of this that I think
is important, and that is that what Governor Bush is now saying is,
well, maybe we cannot cover all the seniors; but, if we cannot, then at
least let us try to cover the low-income seniors, because the bottom
line is that he does not have a Medicare plan.
I mean, what he has proposed and what the Republican leadership
proposed here is not Medicare. I would argue that it ultimately would
lead to the destruction and dismantling of Medicare. The reason for
that, and the issue I want to bring up, is the fact that now the
Republicans are saying, okay, we will at least try to help the low-
income people and see if we can provide them with a prescription drug
benefit. Because if you look at the Bush plan, there are about 25
million seniors under Medicare that would get absolutely no help and
have no option for prescription drug benefits because two-thirds of
seniors have income above the 175 percent poverty level. In other
words, under the Bush plan, as a single individual you would have to be
making less than $14,600 a year. Otherwise, you would not get any
subsidy whatsoever.
The problem that I have with just targeting the low-income seniors is
that it breaks the whole principle that Lyndon Johnson put forward with
Medicare. When President Johnson established Medicare, the idea was you
were going to get Medicare, regardless of income. It was primarily to
benefit middle-income people, of course. But everyone received the
Medicare benefit, regardless of income.
I am very fearful of the fact if you say okay, let us just deal with
the low-income and let us not deal with the average senior, that you
set a very bad precedent, because you suggest that somehow Medicare
perhaps should be almost like welfare, just for low-income people. If
you start that precedent, you could see that for other aspects of
Medicare as well.
I should also hasten to point out that only a fraction of low-income
seniors would get any coverage either, because basically what Governor
Bush does is he says this is going to primarily be administered through
the States. It would be up to the States to establish a prescription
drug program for low-income seniors.
We know that the record is very unclear about States. Some States
have some prescription drug programs. Most do not. Those that do have
it for low-income people tend to have only coverage for certain
aspects.
Mr. DOGGETT. If the gentleman would yield on that, first I think is
the very, very important point you made about welfare. When President
Johnson was leading that struggle 30 years ago, these same Republican
voices were being raised in this room, maybe not the same individuals,
but the same philosophy; and they said just extend the welfare program
and take care of those most in need.
They were opposed to Medicare. In fact, you remember it was only a
short while ago that Bob Dole was bragging about how he was one of a
few people to stand up and oppose Medicare and Speaker Newt Gingrich
was in this very room, and he was boasting of the need to let Medicare
wither on the vine. They do not really believe in Medicare, and this is
a way to start the concept that we just need a welfare plan for those
most in need.
I think Medicare and Social Security have been two of the best
programs this Congress has ever devised under Democratic leadership,
over Republican opposition, and over continued Republican efforts to
undermine those programs. I believe if we go with a welfare program for
prescription drugs, that is really what the focus will be.
The second very important point the gentleman makes is just turning
this over to the States is not a very good answer. Texas could have
done this, but Texas has not, unfortunately, met the needs of its
seniors on prescription drugs. It has not done anything. And when Texas
had the opportunity after Democratic leadership in promoting the
children's health insurance program to provide health insurance to meet
the needs of children in our State, and we have in Texas more uninsured
children than any State in the country, I think, except possibly one,
we are right at the top, and we, unfortunately, at the State level,
there were delays, no effort was made to expedite the program; and
Texas has foregone hundreds of millions of dollars that could have
helped get children there with insurance for prescriptions and other
things.
With that kind of example, it does not inspire confidence that
seniors who want help now would be able to get that help, even the few
poor seniors who would be covered under this Republican scheme, that
they would get help in a timely manner to meet their needs.
Mr. PALLONE. If I could use an example on the opposite side of the
country in my home State of New Jersey, we have a program for certain
low-income seniors to provide prescription drugs. It is financed
through our casino revenue fund from Atlantic City casinos. I had
numerous senior forums throughout the August recess. My district, a lot
of the towns I represent, I would say they are very middle income, not
necessarily poor, not necessarily rich; and I remember particularly one
day being at the Neptune Senior Center, which is a town which is very
diverse, poor people, wealthy people, and mostly middle-class people.
There were probably 100 seniors in the room.
There were maybe five or six that were covered by a prescription drug
program under Medicaid, and they were complaining about how they could
not get certain prescription drugs because they were not listed under
Medicaid; and there were maybe another 10 or 15 out of the 100 covered
under the State prescription drug program, financed with casino revenue
funds, and they were fairly happy with their program. But there were
collectively, between the Medicaid and the state-funded program, out of
the 100 people, I doubt there were more than 20 that were receiving any
coverage. The other 80 people in the room had no prescription drug
coverage.
This is not a problem that is faced primarily by low-income people.
This is a problem that everyone faces. It is primarily middle-income
people that are complaining to me now and saying, look, I cannot afford
the drugs; I do not have the benefit.
Mr. TURNER. If the gentleman will yield further, I think the point
the gentleman made really goes to the heart of it. Whether or not you
need some help in being able to pay for prescription drugs just does
not depend upon your income; it depends on how sick you are. That is
one of the beautiful things about our Medicare program that was
established in 1965; everybody over 65 is eligible. I think it has been
a program that has received broad public support because it is
available to every senior.
If we go to a system where we try to take care of prescription drugs
by putting together another welfare program, all we are going to do is
send money out to the States. They will struggle trying to figure out
how to put a program together, and I do not think they can do it nearly
as quickly as we could put a prescription drug benefit under Medicare,
and it would turn out to be wholly inadequate; and it will turn out to
be different all across the country.
One of the other fundamental issues that one has to come to grips
with in
[[Page H7711]]
this debate is whether or not you believe that as a senior citizen you
should have the same benefit and the same coverage under Medicare, no
matter where you live in this country. I can tell you, representing a
rural district in east Texas where those 5,000 seniors just got notices
a few weeks ago that their Medicare-plus Choice plans are going to be
canceled, I can tell you that those seniors are no longer going to have
any help with prescription drugs, because you could not count on those
HMOs that came in there and offered those plans and are now turning and
running away from them; and those seniors I think are all going to
probably go back into regular Medicare. They have no other choice. But
at least under regular Medicare we know that we get the same benefit no
matter where you are in this country.
I think when we look at the Republican proposal of trying to rely on
the States to set up welfare programs for low-income seniors, what we
are going to find is that where you live will depend on what kind of
benefits are provided for you, and there will be nothing for those
middle-income seniors that are the ones I am hearing from too in my
district who are struggling trying to pay those ever-increasing prices
of prescription drugs.
So I think that traditional Medicare, if we believe in it, if we
think it is important for every senior, no matter where they live in
this country, to have the same coverage and the same protection and the
same benefits, then I think we need to add a prescription drug benefit
to traditional Medicare. That is our plan, and I think it is the only
plan that provides seniors with the security that they need.
Under our plan, keep in mind, you do not have to go order it by mail.
You can go to your local pharmacist, and you do not have to determine
whether your insurance company has it listed on the formula, because
under our plan you will get the medicine that your doctor prescribes at
your local pharmacy.
That is the kind of security that the seniors need. They need to know
what it is going to cost, they need to know what they are getting, and
they need to know it is going to be there for them without any
question. That is the Democratic plan, and I think it is the best plan
for our seniors.
{time} 2100
Mr. PALLONE. Mr. Speaker, I would also point out, because I know that
the Republicans keep talking about choice and sort of give the
impression that the problem with what the Democrats are proposing is
that it is one-size-fits all, in other words, it is under the rubric of
Medicare and, therefore, it is going to be national and somehow it is
bad because it is national and it is one-size-fits all. Nothing could
be further from the truth.
I would argue that the way the Democrats have set up this plan under
Medicare, they have more choice, real choice than they have under the
Republican plan. And I will say why. First of all, just like Medicare
in general, this is voluntary. If they do not want to sign up for what
would be Part D and pay the premium of so much a month the way my
colleague described and the way the Democrats have put it forward, they
do not have to do it.
But, more importantly, if they could have the Democratic plan in
effect, those who are in HMOs, those who are in employer retirement
plans where they are getting a prescription drug benefit can keep those
plans and the Federal Government would be helping them and helping
those plans to continue to provide the prescription drug coverage. Let
me explain why.
Let us say that I am in an HMO and I would like to keep the HMO.
Well, the reason why so many of the HMOs are now dropping seniors is
because they cannot afford to cover the seniors or in many cases
provide the prescription drug benefit. Well, under the Democratic plan,
the HMOs will get the money to provide the prescription drug benefit,
they will actually be paid by the Federal Government to provide the
benefit because it is a basic benefit that everyone is entitled to
under Medicare.
So, if anything, there should be more choices available. I would
suggest that both in New Jersey and Texas we will see more HMOs willing
to provide a prescription drug benefit and cover seniors than we have
now because now they will be getting reimbursed for most of the cost of
the prescription drug benefit plan. So if they want to keep their HMO
and they like an HMO, they are probably more likely to keep it under
the Democratic proposal.
The same thing with employer-based plans. Some people may not want to
opt for the traditional Medicare coverage, which would include the
prescription drug benefit, because maybe they, through their
retirement, get prescription drugs as part of their employer-based
health care plan. Well, we would reimburse that, as well, and they
could keep their employer-based plan.
So all we are saying is that everyone gets the benefit and the
Federal Government will provide the money to pay for the benefit
regardless of what program they are in, whether it is their veterans or
their employer-based plan or their HMO. But there is always going to be
the guarantee, the floor, that if any of those fail and they do not
have the option of any of those things they can get it through their
traditional Medicare plan.
Mr. TURNER. Mr. Speaker, that sounds like a good competitive program,
because they have got traditional Medicare there to keep the private
HMO industry honest.
What would happen to us if we did not have traditional Medicare in my
rural east Texas district today? With all of those HMOs pulling out,
with 15 of my 19 counties having no Medicare+Choice HMO option, my
seniors would be left with nothing if they did not have traditional
Medicare.
I submit to my colleagues, there are those in this House who do not
like traditional Medicare for one reason or another. But the truth is,
if we are going to have a system of health care for seniors, if we are
going to keep the HMOs honest in terms of what they offer and the
prices they are demanding to offer it, we need to keep traditional
Medicare in place.
I will also submit to my colleagues, if we are unable to provide a
prescription drug benefit under traditional Medicare, those who
advocate getting rid of traditional Medicare will carry the day.
Because when faced with the choice of choosing a private HMO plan with
prescription drug coverage and a Medicare plan without it, many of our
seniors will be forced to exercise the choice of choosing the private
HMO plan.
So it is essential for those who really believe in privatizing
Medicare and turning it over to the insurance companies, they had
better think a little bit. Because if they ever expect it to work, they
had better keep a viable traditional Medicare program in place as the
safety net to ensure that every senior will always have the option of
having coverage for their health care and their prescription drugs.
Mr. DOGGETT. Mr. Speaker, that is so very vital. We have talked about
the fact that too many of our seniors are forced to choose between
groceries and prescriptions and to make very challenging decisions. For
some it is literally a matter of life and death.
I had a woman from Austin, Texas, write me recently about an
experience that is really of great concern to her family. She says that
her brother recently underwent a kidney transplant and he is about to
turn 65, at which time he will be forced to go on Medicare and give up
the insurance that he previously has had. But he is now going to have
to have these anti-rejection drugs after having had the transplant, and
she expresses the concern that they just do not know where they will
find the money because the cost of these anti-rejection drugs is really
prohibitive, they cannot get any coverage on Medicare and at this
point, though they are not wealthy people, they do not qualify for any
kind of welfare program. And these kind of folks I gather would just be
excluded from the insurance subsidy plan that the Republicans are
advancing.
Mr. PALLONE. Mr. Speaker, I think that is what our colleague the
gentleman from Texas (Mr. Turner) was pointing out, which is that even
though the Republicans may argue, well, let us just do this for low-
income people, what they are forgetting is that middle-income people,
depending on their circumstances as such, they could be completely
wiped out with the cost of these drugs. So the notion that somehow this
is not something we have
[[Page H7712]]
to do just for the average person is nonsense because they could be
wiped out in a minute because of the cost of these drugs.
I also say that what we are finding today is that a lot of the more
expensive drugs the HMOs or some of the insurance companies
characterize as not medically necessary, in other words, they will say
this is experimental or this is something that is not exactly approved
at this point, and it is those very things that are very expensive that
end up not being covered.
When we say in our Medicare prescription drug plan that they are
going to have access to whatever is medically necessary, we put that
language in there because we want to make clear that if their physician
or the pharmacist says that this is medically necessary, it will be
covered.
I know that my colleague, the gentleman from Texas (Mr. Turner), has
made a big point of that that one of the problems with the Republican
plans is that not only is it primarily for low-income people but they
never know exactly what they are going to get. And it is very easy to
exclude things under the rubric of saying they are not medically
necessary or they are experimental or those kinds of things, which is
why it is important to establish in the plan what kind of drugs they
are going to get and to make it clear.
Mr. TURNER. Mr. Speaker, I had a similar experience to the gentleman
from Texas (Mr. Doggett). I talked to a lady in August during my tour
of the district when I was going around to 40 communities talking about
this very issue, and she came up to me and she said that her HMO had
just canceled her and she wanted to know from me what I could do to
help her.
It would almost bring tears to your eyes. She was a kidney transplant
patient. From January until August, her prescription bills totaled
$17,000. That had been covered by her HMO. As of December 31, she has
no coverage, like 5,000 other seniors in my district.
Now, most of my seniors I talk to have prescription drug bills of
$300, $400, $500. Many of them are paying their entire Social Security
check just to cover their prescription drugs. This lady has $17,000
just from January through August.
I could not tell her what she was going to do. I had no answer for
her. I told her about what we are fighting for in Congress, why we
believe that we need a prescription drug benefit under traditional
Medicare.
I talked to a fellow at a bank down in Liberty County. He told me
that he and his wife spend $1,400 a month on prescription drugs. Now, I
did not have the heart to ask him how long could he keep doing that.
But these stories are real stories from real people who have real
problems. And I think that the reason we come here week after week
talking about this problem is because we want to try to provide some
help for those seniors who need it. And the way to do it is through the
Democratic plan where we can provide seniors with a clear plan with a
defined benefit, we can tell them what they are going to get, that is,
they are going to get the prescription their doctor prescribes from the
pharmacist they trust. We can tell them what the premium is and if they
elect to take the coverage, how much it will cost. We can also tell
them that under traditional Medicare the plan is here and it is going
to be guaranteed by the United States Government and by the people who
believe in traditional Medicare, not a plan that relies on the private
insurance company that, by necessity we all understand, has to make a
profit and, if they find out they are not making a profit, as
apparently many of them did in my district, and decide to cancel their
coverage for 5,000 seniors, then they are gone.
That is not the kind of security seniors in this country deserve.
Mr. PALLONE. Mr. Speaker, one of the reasons and I think both
examples highlight it in my mind, one of the reasons why the Republican
proposals just do not work is because they are too selective. In other
words, originally when we started this evening we talked about how the
Republican leadership proposes a bill that basically says we will give
them some money and they go out and buy private insurance company and
the insurance company says, we are not going to sell it. The reason
they are not going to sell it is because they cannot make any money.
In other words, for most people, particularly seniors, probably 80 or
90 percent of them are using prescription drugs. It is a benefit. It is
not a risk. It is not sold. In other words, if they are an insurance
salesman or insurance company, they are not going to cover all these
people that use the benefit because they cannot make any money.
I think we are also seeing the other phenomena, which is that the
people that will go and try to sign up for the HMO are the people that
really need the prescription drug coverage and they will tend to be the
people that have the higher prescription drug bills and so the HMOs
cannot even afford to provide it.
So what we are saying as Democrats is let us create this huge pool
with all the people, everyone, every senior under Medicare. That create
a huge pool. Some people use some drugs. Others use a lot. And by
having this huge pool, the cost for everyone on the average becomes a
lot less, they do not have the selective situation where people are
trying to buy insurance or go into an HMO because they have high
business. That is why it does not work.
I do not know if I am making it totally clear, but the beauty part of
the Democratic proposal is that, by putting everybody in this big
essential insurance pool, it is not as expensive and it is more
realistic to cover them as opposed to what we are getting now with this
selective insurance.
Mr. DOGGETT. Mr. Speaker, when we hear the story like the one that
was just recounted, a person who is going to be facing $17,000 in bills
with no remedy, we have to ask, well, why is this Congress not out here
working on it tonight.
It was a little over a year ago that I offered in the House Committee
on Ways and Means with our colleague the gentlewoman from Florida (Mrs.
Thurman) a proposal to deal with this price discrimination problem that
would not have set up any government bureaucracy. In fact, that aspect
of it would not have entailed any substantial cost.
Every Republican member of our committee voted against that proposal.
And we have advanced it again this year. Every one of them voted
against it again. Only after their public relations firm told them they
had a problem did they come up with the plan the Republican
presidential candidate is advancing.
The presidential elections I know are capturing most of the
attention, but there is no good reason why the Congress should not be
acting now. The gentleman from Illinois (Mr. Hastert) could put this
back on the agenda. It could be put on the agenda in the Senate and
present the next President of the United States with a plan that was
already in place that could be implemented. This Democratic plan that
we have been talking about tonight, it could go into effect now.
I just mention to my colleagues the reaction that I think probably a
lot of people have across this country that was embodied in another
communication that I got from a constituent that lives out on Oakwood
Drive in Austin. It begins: ``Shame on you pharmaceutical companies.
Where is the compassion for human life? Have you just gotten so
absorbed into making big profits that you can just say, we don't care
if you don't have the money, roll over and die, see if we care?''
And this person does not face the $17,000 problem. She says, ``When
you have a heart problem and you need three kinds of medication every
day and just one prescription costs $120 each month, something is
wrong. When these pharmaceutical companies have luxurious jets that
transport candidates to the convention as shown on the news, then
something is very wrong, especially when needed medications have these
kind of exorbitant prices.''
Well, I think we are here again tonight because something is very
wrong and that wrong is the failure of this Congress to respond to
these needs, a failure that is extended over a number of years and was
just papered over with this insurance subsidy plan that does not meet
the need of these kind of folks that are out there tonight facing these
tough decisions.
{time} 2115
Mr. PALLONE. It is such a cruel hoax, too, because as both of you
have
[[Page H7713]]
pointed out, this is a real problem. We are getting real people coming
up to us on a regular basis saying that they are suffering. How cruel
it is really for the Republican leadership in this House to say, well,
we are going to solve their problem by throwing a few bucks at the
insurance industry when the insurance industry is telling us that they
are not going to provide the benefits, anyway.
I just wondered if I could for a minute go back to this article in
the New York Times that talked about what had happened in Nevada.
Nevada as I said in March of this year passed a piece of legislation
that was very similar to what the House Republicans had proposed in
terms of providing subsidies to seniors if they could go out and buy an
insurance policy that covered prescription drugs. It has been a total
failure. This is a reference here in the article. This is from July 8,
New York Times, of this year. It quotes Barbara Buckley, a State
assemblywoman who is cochair of a task force that monitors this
potential program. She says that the task force refused to authorize
the release of any money until it could see the details of a drug
program that met the eligibility criteria in terms of premiums,
deductibles, copayment, and benefit limits. Most of those details would
be decided by the successful bidder.
The problem was that no insurance company wanted to offer a program
that met the standards that the legislature set in terms of specifying
what the premium would be, what the copayment would be, what drugs
would be proposed. It says in the article, asked why insurers did not
show any interest, a retired Navy captain, a Mr. Fend, who serves on
this task force, said, probably because they did not think they could
make any money. If they thought they could make a reasonable amount of
money, they would probably buy into the program and bid on it.
The bottom line is, it is just a hoax. The Republicans here have
talked about a prescription drug program that will not work. It is
really awful to think that they know it will not work, it has not
worked in a State where it was proposed, yet they keep bringing it
forth as if somehow they are trying to address the problem when they
are not.
Mr. TURNER. The Medicare program probably never would have been
passed in 1965 if the private insurance industry could have taken care
of the health care needs of our seniors. That is why we passed
Medicare, is because private insurance would not work. I had a letter
from a lady who had been in an insurance business 19 years. In fact, I
have it here with me. It was a letter that was actually handed to me at
a town meeting I had in Shelby County in my district. The lady asked me
if I would read this letter on the way to my next stop.
This lady writes very eloquently to say she had been in the insurance
business 19 years and her letter calls for us to provide a prescription
drug benefit under Medicare for our seniors. She tells the story about
her mother who died last November at the age of 87. As she was going
through her mother's papers, she knew, of course, her mother had been
on prescription medicines, I think, for about 20 years, the last 20
years of her life. She was going through all her bills, seeing what she
had spent on medicine. She came across a credit card bill that had a
balance owed of $6,000, and she was just shocked. She could not believe
her mother, as frugal as she was, would have run up a $6,000 credit
card bill and not taken care of it.
So she wrote letters to Visa. She found out what were all these
charges. It turned out all of them were for prescription medicines. Her
mother had been spending about $300 a month on prescription medicines,
and her Social Security check just was not enough for her to get by and
take care of those medicines. The lady wrote me, she says, I think my
mother understood that when she died, her home could be sold and I
could pay off that $6,000 Visa bill for her. But she said my mother was
a very proud woman.
No senior in this country should have to struggle like that to pay
for their prescription medicines. We have seniors who are breaking
their pills in half trying to take their medicine and being able to
afford it. I have seniors that told me at a meeting that they routinely
just take one every other day. A pharmacist was standing there. He
said, ``For some medicines, that can be extremely dangerous for you to
do that.''
I had seniors come up to me and tell me that they actually have to
make a choice every month of whether to buy groceries or to go fill
those prescriptions. In a country as prosperous as we are today and as
compassionate as we like to say we are, I believe we can do something
about the problem of a prescription drug crisis for our senior
citizens.
We talk about this big surplus that is going to arrive here over the
next 10 years. I hope it does. I am not sure it will, but I hope it
does. Some as we know on the other side of the aisle have proposed that
we cut taxes to the tune, I believe Governor Bush says, of $1.6
trillion when we only have an estimated, hoped-for $2 trillion budget
surplus. But I think if we are as compassionate as we like to say we
are that surely we could set aside 10 percent over the next 10 years of
that $2 trillion surplus and provide our senior citizens with a
meaningful prescription drug benefit.
I know everybody wants tax cuts. I know everybody enjoys getting
their taxes lower. But the truth is there is a basic need here that
should not be ignored. And I think the vast majority of the American
people agree with that. That is why I think on close examination of the
Democratic prescription drug plan as compared to the Republican
proposal that the overwhelming majority of our seniors and of all
Americans would be in favor of a prescription drug benefit under
traditional Medicare as the Democrats propose in this country.
Mr. PALLONE. I want to thank the gentleman. I think we are running
out of time. The last point the gentleman made is so important. I
really believe that one of the reasons why Governor Bush has proposed
this scaled-down prescription drug plan that really only addresses some
of the problems for low-income people is because he has proposed using
so much of the surplus for this grandiose tax cut plan, which primarily
benefits the wealthy and corporate interests, and so he does not have
enough money left to pay for a Medicare prescription drug program the
way the Democrats have proposed. And so that has actually forced him in
some ways to propose this more scaled-down version that will only help
some low-income people. That is unfortunate, because if we have a
surplus, and you and I both I know are worried about these estimates
and whether the level of surplus that is being talked about will ever
materialize, but there is certainly enough that we could provide the
prescription drug program along the lines of what the Democrats have
proposed. I would hate to see that not happen just because of Governor
Bush's tax proposals and the tax proposals that the Republicans have
put forward, which I think really do not help in any significant way
the average American.
I just want to say we were here again tonight as Democrats because we
believe strongly that this is a major issue that should be addressed in
this Congress, that is, providing a prescription drug program under
Medicare. We are going to continue to be here every week until this
Congress adjourns demanding that this issue be addressed.
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