[Congressional Record Volume 146, Number 115 (Monday, September 25, 2000)]
[House]
[Pages H8036-H8037]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                         GOP'S FALSE ``CHOICE''

  The SPEAKER pro tempore. Under a previous order of the House, the 
gentleman from Ohio (Mr. Brown) is recognized for 5 minutes.
  Mr. BROWN of Ohio. Mr. Speaker, earlier this year, a confidential 
document prepared for House Republicans somehow found its way into the 
public realm. It was not big news at the time, just some talking 
points. They were prepared by a Republican polling firm in response to 
the Democrats' Medicare prescription drug proposal.
  According to their analysis, an effective way to create opposition to 
the type of proposal offered by the President and House Democrats is to 
call it a ``one-size-fits-all'' plan, a ``big government'' plan, or 
worst of all, a ``one-size-fits-all big government'' plan.
  One cannot blame the public for reacting to these phrases. I do not 
know anyone who likes big government simply for big government's sake. 
However, one can blame politicians for exploiting these terms instead 
of confronting the fundamental differences between the Democrat and 
Republican prescription drug proposals.
  The Democrats' plan would add an optional drug benefit to Medicare. 
The Republican plan would bypass Medicare and subsidize private stand-
alone insurance plans instead.
  It is difficult to conceive of a program offering more choice than 
Medicare. The Medicare program covers medically necessary care and 
services. Beneficiaries can see their own health care professional and 
go to the facility that they choose.
  Under the prescription drug plan, similarly, enrollees could go to 
the pharmacy of their choice. FDA-approved medications prescribed by a 
physician would be covered without regard to formulary restrictions.
  Given this level of flexibility, how would a legion of new private 
plans enhance a beneficiary's choice in any way that matters? It is 
more likely these plans, like any other managed care product, would 
find ways of restricting choice which would, indeed, enhance something, 
their bottom line.
  Medicare is a single plan that treats all beneficiaries equally and 
provides maximum choice and access for patients and doctors. The 
Democrats' prescription drug proposal embraces the same choice 
principles.
  Under the Republican prescription drug proposal, Medicare 
beneficiaries would choose between private stand-alone insurance 
company prescription drug plans. Ostensibly, this would enable seniors 
to tailor their prescription drug coverage to their particular needs.
  But what exactly would distinguish one private insurance plan from 
another private insurance plan? Realistically, the key differences 
would have to relate to the generosity and restrictiveness of the 
benefits, how many pharmacies would be covered, how stringent is the 
formulary, how much cost sharing would be required by the patient.
  None of these plans could responsibly in any way, theoretically or 
practically, provide more choice than the Democrats' proposal in terms 
of which medications are covered, since the Democrats plan covers all 
doctor-prescribed medications.
  None of these plans could provide a broader choice of pharmacy, since 
the Democrats' plan does not restrict access to pharmacies.
  It appears that ``choice'' is actually code for ``wealth.'' Higher-
income seniors could afford a decent prescription drug plan under the 
Republican plan, one with the same level of coverage that would be 
available to all beneficiaries under the Democrats' plan. In other 
words, if one is wealthy, one can get as good a plan as the Democrats' 
plan. But under the Republican plan, lower-income enrollees would be 
relegated to restrictive alternatives. Some choice that is.
  When opponents of the Democrats' prescription drug coverage plan 
berate it for being ``one-size-fits-all'' and ``big government,'' they 
are actually berating Medicare itself. In fact, the Republicans' 
prescription drug proposal, which ignores Medicare to establish new 
private insurance HMO policies, is an insult to the program.
  Their plan pays homage to those Members of Congress who favor 
privatizing Medicare, turning Medicare over to this Nation's insurance 
companies. I might add, Mr. Speaker, I have yet to meet anyone outside 
the Beltway who favors such a plan to privatize Medicare.

[[Page H8037]]

  It is no coincidence that the only way a Medicare beneficiary could 
avoid carrying multiple health insurance policies under the Republican 
proposal is to join a private Medicare managed care plan.
  As Congress and the presidential candidates debate the merits of 
competing prescription drug coverage proposals, watch for allegations 
like ``one-size-fits-all'' and ``big government,'' and the like.
  When applied to insurance coverage offering maximum choice in the 
areas that matter, choice of provider and access to medically necessary 
care, choice of prescription drug, pharmacies, and formularies, these 
terms simply fall flat.
  Bear in mind also that more than the structure of a prescription drug 
benefit is at stake during these debates. The future of Medicare may, 
in fact, also hang in the balance.

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