[Congressional Record Volume 146, Number 115 (Monday, September 25, 2000)]
[House]
[Pages H8042-H8046]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                 PRESCRIPTION DRUG COVERAGE FOR SENIORS

  The SPEAKER pro tempore (Mr. Aderholt). 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, once again this evening I would like to 
focus on the Democratic proposal to provide for a prescription drug 
benefit under Medicare. I have been on the floor many times in the 
House discussing this proposal because I do think it is the most 
important issue facing this Congress and facing the American people 
today.
  Many of my constituents, senior citizens, have complained about the 
high price of prescription drugs. Many of them have to make choices 
between prescription drugs and food or housing, and I do not think 
there is any question that with the Medicare program that has been 
probably the most successful Federal program in history that if we were 
to just take that program and add a prescription drug benefit, we would 
be solving a lot of the problems that our senior citizens now have with 
not having access or being able to afford prescription drugs.
  Now, of course, both sides of the aisle have been talking about this 
issue in the last week or so, and I, of course, believe very strongly 
that the Democratic plan, which is the only plan that would actually 
include a prescription drug benefit under Medicare, is the only plan 
that would actually help the average American.
  I want to spend a little time tonight explaining the Democratic plan 
and then explaining why I think the proposal that has been put forward 
on the other side of the aisle by the Republican leadership is 
essentially illusory and would not help the average American.
  Let me start out by saying that right now, seniors know that they can 
get their hospitalization through part A of Medicare and they pay a 
monthly premium through part B of Medicare and get their doctor bills 
paid. Now, what the Democrats are saying is that we will follow on the 
existing Medicare program, which has a part A and a part B and we will 
give you a prescription drug benefit in the same way. We call it part 
D, because Medicare part C is now the Medicare+, the HMO option. 
Basically what we say is that you would pay a modest premium and the 
government would pay for a certain percentage of your drug bills. Now, 
the Democrats guarantee you the benefit through Medicare if you want it 
and it covers all your medicines that are medically necessary as 
determined by your doctor, not the insurance company.
  Let me contrast that with what the Republicans have been talking 
about. Basically what the Republican leadership on the other side has 
been talking about and what Governor Bush has been talking about is 
that they will give you, if you are below a certain income, a certain 
sum of money, that the government will provide a sort of subsidy and 
that you can go out and you can try to find an insurance company that 
will sell you a policy and cover your prescription drugs or medicine. 
But if you cannot find an insurance company that will sell you that 
policy, that drugs-only policy with the amount of money the government 
will give you, then you are basically out of luck.
  Also, I would point out that the Republican plan, particularly the 
one that has been articulated by Governor Bush, only covers people 
below a certain income. The other problem with the Republican proposal 
is that even if you can find an insurance policy that will cover 
prescription drugs, there is no guarantee as to the cost of the monthly 
premium or what kind of medicine you get. More importantly, the 
Republican proposal leaves America's seniors open to continued price 
discrimination because there is nothing to prevent the drug companies 
from charging you whatever they want.
  The Democratic plan deals with the issue of price discrimination by 
saying that the government will choose a benefit provider who will 
negotiate for you the best price just like the prices negotiated for 
HMOs and other preferred providers. The problem right now is if you are 
a senior citizen and you are not part of an HMO or you do not have some 
other large employer-based, for example, drug coverage and you want to 
go out to your local pharmacy and pay for a particular drug, you 
oftentimes are paying two and three times what the preferred provider 
or the HMO or some other kind of drug plan is paying. That has got to 
end. If we do not address the issue of price discrimination, then we 
are never going to essentially solve the prescription drug problem that 
seniors face today.
  Mr. Speaker, the Democratic plan is a real Medicare benefit that will 
make a difference for America's seniors. The Republican plan is, as I 
have characterized many times before, a cruel hoax on the same seniors 
who are basically crying out for Congress to act.
  Now, let me talk a little bit more about the Republican plan that was 
outlined by Governor Bush a few weeks ago in reaction to our Democratic 
proposal. Let me point out, first of all, that the Bush proposal 
excludes two-thirds of Medicare beneficiaries because their income is 
essentially too high. Two-thirds of seniors and eligible people with 
disabilities have incomes above 175 percent of poverty, or about 
$15,000, for an individual and they are eligible for Medicare but they 
would not be eligible for the Bush prescription drug plan. The sad 
thing about that is that the problem that we face and the seniors that 
talk to me and talk to my colleagues about the problems they face with 
prescription drugs more often than not are not low-income seniors. 
Forty-eight percent of those without drug coverage have incomes above 
175 percent of poverty and would not qualify under what Governor Bush 
is proposing.
  The other thing is that only a fraction of the low-income seniors 
would actually get coverage even under Governor Bush's proposal. So 
even if you are low income, you are not guaranteed the coverage. Most 
of the Nation's governors have agreed with seniors and people with 
disabilities that the gaps in Medicare coverage should be a Federal 
responsibility and not run or financed by the States. But what Governor 
Bush has proposed basically is to have State-based programs for these 
low-income people. Let me tell you, if you look at the existing 
Medicare program, something like 98 percent of eligible seniors are now 
participating in Medicare. But if you look at State-based programs that 
provide some kind of prescription drug coverage now, only about, well, 
really 45 percent or less than half of the people are actually enrolled 
in those State-based programs.
  So what we have here is the Democrats saying, ``Medicare has worked. 
Medicare is a good Federal program. Let it cover prescription drugs in 
the same way that it covers hospitalization and in the same way that it 
covers your doctor bills.''
  The Republicans are saying, ``No, Medicare doesn't work, it's not 
something that we want to expand, it's not the way to go about this. 
We're just going to give you a subsidy if you happen to be low income 
and you can go out and try to find prescription drug coverage if you 
can. If you can't, that's your problem, not ours.''
  The last thing I wanted to mention today before I yield to one of my 
colleagues is that this Republican proposal has already been tried in 
at least one State, the State of Nevada. Back in March, Nevada, the 
legislature and the governor signed a law that essentially is the same 
thing as what the Republican leadership is proposing in the

[[Page H8043]]

House of Representatives nationally. And it has not worked. The Nevada 
program went into effect, they tried to get some insurance companies 
that would sell these prescription-only drug policies and nobody was 
willing to sell them. It is no surprise. The gentleman from Texas (Mr. 
Green) to whom I am about to yield and I were at a Committee on 
Commerce meeting one day when this issue came up and the representative 
from all the insurance companies came in and said to the Republicans, 
``There's no point in doing this because it's not going to work and 
we're not going to sell these drug insurance policies.''
  Well, Nevada tried it and it did not work. They could not get anybody 
to sell the insurance. Why in the world would we try to emulate 
something that has not worked in a State? In this case, why would we 
want to transfer that to the national government when we have an 
existing program, Medicare, that does work and that merely needs to be 
expanded to provide for prescription drug coverage? That is the way to 
go. That is what the Democrats are talking about. If anyone says to you 
that the Republican plan is something that will work for the average 
American, it is simply not going to work.
  Mr. Speaker, my colleague on the Committee on Commerce has been out 
here as often as I have basically asking the Republican leadership to 
bring up the Democratic proposal for a Medicare prescription drug plan 
because we feel it is so important. He has been a leader on this issue. 
I yield to the gentleman from Texas (Mr. Green).

  Mr. GREEN of Texas. Mr. Speaker, I thank my colleague from New Jersey 
for again requesting this time this evening to talk about the 
importance of prescription drugs for our seniors. One of the biggest 
issues our country is facing today is a lack of prescription drug 
benefit for our seniors. Prescription drugs are expensive for everyone. 
It is just that our seniors cannot go out and work a little more 
overtime to pay for their prescriptions. They are so often limited in 
their ability to increase their earnings.
  I am disappointed that once again this Congress has chosen to delay 
this important issue. We have known for years but especially during the 
last 2 that there has been a problem with prescription drug coverage 
for seniors. I remember in my first town hall meetings I had in 1993 
every once in a while a senior would come up and talk about the 
problems they were having. It was not as big I guess as it has been the 
last 2 or 3 years because of maybe the escalation in cost for seniors 
and maybe the success of our health care system, we are actually 
getting more prescriptions written to help people. But for at least the 
last 2 years we have noted it. Yet here we are again a few days before 
we either recess or adjourn this congressional session and we have not 
made any serious attempt to help those who have worked so hard to make 
this country so successful. As Tom Brokaw said, the greatest 
generation, we should not let that greatest generation be forgotten.
  We simply cannot afford to sit on this issue any longer. We need a 
prescription drug benefit that is part of Medicare. The gentleman made 
that point. It is an integral part of Medicare. Over one-third of our 
Medicare beneficiaries will incur costs of more than $1,000 for 
prescription drugs this year. More than half have costs more than $500. 
The average total drug cost per beneficiary is projected to be $1,100 
for our seniors. Yet nearly two-thirds of our Medicare beneficiaries 
have no prescription drug coverage or have coverage that is unreliable, 
inadequate or even costly. Medicare beneficiaries without drug coverage 
purchase one-third fewer drugs but pay nearly twice as much out of 
pocket for their drugs that they need.
  This summer, the Republican leadership forced through a prescription 
drug benefit bill that provides more political cover than it does 
coverage for our Nation's seniors because all it was was an insurance 
policy, and the gentleman addressed that very adequately. The 
legislation was designed to benefit the companies who make the 
prescription drugs and not the seniors. Even the insurance industry, as 
the gentleman stated, said that such policies will not work and they 
would not offer them. We simply cannot rely on insurance companies to 
have a drug-only policy available for 13 million beneficiaries who now 
currently have no drug coverage. They do not want to cover it.
  The gentleman mentioned again the State of Nevada that tried this, 
not one company applied to sell that insurance coverage. As Democrats, 
we introduced legislation that works. It is cost effective and it 
provides key consumer protections so that seniors will not lose 
benefits if an insurance company goes out of business. But instead of 
working with us, our Republican leadership passed that flawed bill 
earlier this year that will just add more cost to seniors but give them 
even less than what they have. It is no secret that the pharmaceuticals 
are pressuring our Republican colleagues not to allow any progress on 
this issue this year, hoping that ultimately it will just die down next 
year, but I am here to tell you that it will only get worse if we do 
not do something this year. It will get much worse. For many seniors, 
next year is too late. It is not fair that the pharmaceutical companies 
continue to discriminate against American patients. It is not fair that 
countries in Europe and across the world benefit from international 
price competition for pharmaceuticals and yet we do not. Whether it is 
western Europe that is basically a free market economy like we have or 
Japan, their pharmaceuticals are so much cheaper than ours in our 
country. Seniors are having to choose between paying their utility 
bills or their food bills or buying their medication. Oftentimes they 
will skip their medication to make it last that much longer. We have 
heard that many times not only at our town hall meetings but from our 
colleagues all across the country.
  We should be putting the benefits in the hands of seniors and not 
pharmaceutical manufacturers. We should be providing a secure, stable 
and reliable benefit instead of watered-down legislation that does 
nothing to address the problem. It should be included in Medicare.
  Let me talk about that a minute. If we were creating Medicare today, 
there is no way on this Earth that we would not have a prescription 
drug benefit in there. It should be standing on the same level as a 
doctor and a hospital bill for our seniors that it did in 1965. We 
would not do it. That is why we need to modernize Medicare to include 
prescription drugs. I hope that in this Congress, we can work across 
party lines. We did have some of our Republican colleagues support us 
and develop a bipartisan bill that ensures an affordable, available, 
meaningful Medicare prescription drug benefit option for seniors, so 
that again it is voluntary but it is part of Medicare.

                              {time}  1745

  It is just nothing but common sense and fairness, and I have said 
this many times before, and I would hope if our seniors have to wait 
until after November 7 for it, that they will remember on November 7, 
because they need to know who really wants to provide prescription 
drugs as an integral part of their health care, and not something they 
would have to purchase out from an insurance company, like they do 
their Medigap policies that they have now for their 20 percent not 
covered by Medicare. So we need to do that as part of Medicare.
  Again, I thank the gentleman for continuing to make sure that fire is 
burning. I see our colleague from Maine here, which part of our bill 
includes the pricing that we need to be able to do so they can purchase 
and take advantage of the free market system and negotiating for price 
benefits. The gentleman from Maine (Mr. Allen) actually introduced the 
bill, along with the gentleman from Texas (Mr. Turner) and a number of 
people, I think I was a cosponsor of it, to make the prescription 
package part of Medicare so we can actually save our seniors their 
prescription drug benefits.
  Mr. PALLONE. I just want to say I think the most important thing we 
could get across to our colleagues and to the public is the fact that 
what the Democrats are proposing and what Vice President Gore is 
proposing are basically to expand Medicare; to take a good program, 
which is Medicare, that has worked for seniors, and expand it to 
include prescription drugs, because we know that when Medicare was 
started, I guess about 30 years ago, that prescription drugs were not 
that

[[Page H8044]]

important. People were not as dependent upon them as they are now, 
because so many of the wonderful drugs that we have now that are 
available for people simply were not available then.
  So all we are really saying is take this good program and expand it 
to include prescription drugs and follow the example with a new section 
or Part D.
  The irony of it is that the Republicans from the very beginning when 
Medicare was started under President Johnson, I guess 30 years ago, 
most of the Republicans then did not support the Medicare program when 
they were Members of Congress at the time when it came up for a vote.
  I think what you are seeing now is the Republican leadership in this 
insurance subsidy proposal that they put forth essentially, it is 
almost like a voucher, or a voucher proposal, they are saying once 
again they do not like Medicare.
  It is almost a dangerous precedent. If we establish the precedent 
that we are going to add a significant benefit here, but we are not 
going to include it under the rubric of Medicare, we are going to let 
you go out and try to use a voucher, essentially, to buy a prescription 
drug policy, then that same principle can be applied to Medicare 
itself, the existing Medicare. Why not have a voucher to go out and 
shop for your hospitalization coverage or shop for your physician's 
coverage?
  The basic problem is that they do not like Medicare, and they do not 
want to include a prescription benefit under that program. I think it 
is very unfortunate, because Medicare has proven it is a good program.
  I yield to my colleague from Maine, again who I want to thank for all 
the effort he has done on this issue, particularly on the issue of 
price discrimination. I am proud to say I am a cosponsor of his bill as 
well.
  Mr. ALLEN. I would say to the gentleman from New Jersey (Mr. 
Pallone), he has been a cosponsor from the beginning.
  We have worked very hard on the Democratic side of the aisle to try 
to develop proposals that would be meaningful to all seniors. Al Gore 
has the same kind of approach, that we need a Medicare prescription 
drug benefit that is voluntary, so no one is forced into it, but is 
universal; it will basically provide coverage for everyone who wants 
it.
  I thought what I would like to do tonight is talk a little bit about 
some of the arguments that are out there. I was reading an article 
several months ago, an article written several months ago before I came 
over, and it was an article by a commentator who was saying that if you 
think there is no difference between the Republicans and the Democrats 
on prescription drugs, you are not paying attention. This election 
matters a great deal, because these two approaches are so very 
different from each other.
  We had our colleague the gentleman from Ohio (Mr. Brown) down here a 
little bit earlier this evening, and he was reminding us that we found 
this Republican pollster's suggestion several months ago recommending 
that the Republicans come up with a plan. It did not really matter what 
kind of plan it was, as long as they could say they had a plan, and 
that would be enough to get them through the election.
  But that is the fundamental difference. The fundamental difference 
here is that Democrats are saying we need to have a plan that is 
voluntary, that is universal, and that has a guaranteed prescription 
drug benefit. In addition, we are saying we have got to do something 
about price. We have to create some leverage, some downward pressure on 
price. We are not talking about setting prices, we are talking about 
bargaining power, using Medicare, using health and human services to 
get lower prices for seniors who right now pay the highest prices in 
the world.
  On the other side, the Republicans are trying to do everything they 
can not to strengthen Medicare; to make sure that if we have any sort 
of prescription drug legislation at all, the one thing it will not do 
is strengthen Medicare.
  What is the reason for that? Medicare is a government health care 
plan. It covers everyone over 65, and many of our disabled citizens. 
But the fear on the Republican side is that they know people like 
Medicare, trust Medicare, want Medicare to be stronger; better, to be 
sure, but they like it and trust it, and they are afraid that somehow 
if the program is even better, that will be a problem for those who are 
trying to diminish Medicare's influence in this health care system.
  So I want to talk a little bit about the language that is out there. 
One thing the Republican pollster recommended is that they should 
attack Democratic plans as being ``one-size-fits-all'' plans. You hear 
that phrase on the other side of the aisle all the time now, ``one-
size-fits-all.'' So the proposal that they make is they say are 
designed to provide choice.
  Mr. Speaker, when Governor Bush made his proposal for so-called 
Medicare reform, the word ``choice'' appeared in his statement many, 
many times. The word ``HMO'' never appeared in his statement. But the 
choice that he was talking about was going to come from letting HMOs 
come into Medicare, and the government would provide some subsidy to 
HMOs in order for them to, perhaps if they wanted and if it were 
profitable enough, provide some kind of private insurance for seniors.
  That is not a plan that will work for seniors, and it is disguised. 
It is all wrapped up in language of choice, when it is really all about 
letting insurance companies and HMOs have a much bigger role in 
Medicare as it stands today.
  You can see ads out there run by the folks on the other side of the 
aisle that talk about a big government HMO; the Al Gore plan, the 
Democratic plan, is a big government HMO. Well, guess what? There is no 
such animal. HMOs are private insurance companies. Most of the biggest 
ones are for-profit private insurance companies. There are some that 
are nonprofits, but, as we know, the for-profits tend to be gaining the 
most ground and gobbling up some of the smaller ones.
  But that kind of deception is really what we have got to deal with. 
We have got to be explaining to people all the time that there is no 
such animal as a big government HMO, there is just Medicare, and you 
can trust it, you can rely on it, it is there for you, it does not 
change from year to year to year. Whereas when you turn to managed care 
plans under Medicare, and we have some, we have about somewhere between 
14 and 15 percent of seniors now covered by some kind of managed care, 
and just now two of them are my parents, my parents back in Maine are 
two of about 1,700 people on a Medicare managed-care plan in the State 
of Maine. Out of all our several hundred thousand seniors, we have 
1,700 seniors on a Medicare managed-care plan. And, guess what? As of 
December 31, the private company that provides that insurance is 
leaving the State of Maine. We will have no Medicare managed care in 
Maine. Guess what the reason is? Basically it is just not profitable.
  If you want to rely for prescription drug benefits on companies who 
will come and go in your State, in your community, depending on whether 
or not they can make a profit, that is no assurance at all. That is not 
security at all. It is not equitable at all. But that is what you get 
with these Republican plans, which are essentially subsidies to the 
insurance companies to do what can be more cheaply done, more equitably 
done, more fairly done, through our health care plan for the elderly 
called Medicare.
  That is the real division between the parties on this subject. What 
we are also seeing now on the other side of the aisle is a whole series 
of efforts. We passed the plan over here that was a straight-out 
subsidy to the insurance companies that passed by three whole votes. It 
is obviously not going anywhere, because it does not have broad 
bipartisan support. Then we hear about other plans. ``Maybe we could do 
a program to give money to the States only for the poorest people who 
are not covered now.''
  The trouble is that over half of all the people who do not have 
prescription drug coverage have incomes above 175 percent of the 
poverty line. Middle-class seniors are struggling with prescription 
drug bills that can be $200, $300, $400, $600, $800 a month.
  I have talked to them in my district. I have talked to people who 
have coverage now through a private plan, and they are in their 
sixties. I was talking to one couple in Waterville, Maine, and between 
the husband and the wife, both of them have insurance now, but they

[[Page H8045]]

lose it when they turn 65. They are 63 or so. Their cost for 
prescription drugs alone will be somewhere around $800 to $1,000 a 
month, and they do not know how they are going to do it.
  The problem gets worse year after year, because the one thing we know 
about next year is next year spending on prescription drugs is going to 
be 15 percent at least higher than it is this year, just as this year 
it is 15 percent higher than it was last year.
  What we can see here is fundamental. The most profitable industry in 
this country charges the highest prices in the world to the people who 
can least afford it, many of whom are our seniors. Seniors are 12 
percent of the population, but they buy one-third of all prescription 
drugs. The gentleman from New Jersey (Mr. Pallone) knows from talking 
to people in his district, as I know talking to people in Maine, they 
can barely get by, and often they do not. Often they simply do not get 
by.
  So what troubles me most about this is all of the misinformation that 
is out there, all of the TV ads that are being run by Republican 
candidates, talking about a ``big government HMO'' or ``one-size-fits-
all'' plan, which is basically designed to deceive, because the truth 
is that Medicare is a plan which covers everyone. But it is also true 
that we can design and we have designed a Medicare prescription drug 
benefit, which is voluntary, you do not have to sign up for it, but 
which will be a real strong start on making sure that seniors get the 
prescription drugs that they need.
  I just want to say how much I appreciate the good work that the 
gentleman is doing to bring us down here, night after night after 
night, to try to clear the air, to try to contain the rhetoric and to 
try to convey to the American people some sense of the fundamental 
differences between plans, like the Republican plans that rely on 
insurance companies, and plans like ours that cover everyone, that are 
fair and equitable and cost effective and work through Medicare.
  I guess the last thing I would say is this: It is not just the ads 
that are out there being run by the Republican nominee for President or 
others. The pharmaceutical industry is out there running more 
television ads perhaps, the latest projection suggestions, more 
television ads, more money, than any industry has ever run in any 
election until now.
  Citizens for Better Medicare, which is sort of the front group for 
the pharmaceutical industry, they are not citizens and they are not for 
better Medicare, the pharmaceutical industry is running ads trying to 
defeat the discount for seniors contained in my bill, the Medicare 
prescription care benefit contained in the Democratic proposal, or even 
our bills led by the gentleman from Arkansas (Mr. Berry) or the 
gentleman from Vermont (Mr. Sanders), those bills that are designed to 
try to allow drugs to be imported into the United States and then sold 
by pharmacies here, because medicines can be purchased so much more 
cheaply in Canada, Mexico, in fact anywhere else in the world, than in 
these United States.
  Let us always remember that these are drugs manufactured by American 
companies, and they sell for 60 percent more here than they do in 
Canada, in Europe and everywhere, just on average.

                              {time}  2000

  And we have got to change this. We have simply got to keep persisting 
that we are not going to allow the American people to be fooled, and we 
are not going to accept this rhetoric about one-size-fits all or ``big 
government HMOs'' or people who say that we are going to give a choice 
of plans when all they are really talking about is giving an HMO that 
can pull that choice any time it wants to, any plan it wants to.
  So, Mr. Speaker, I just want to say thank you to the gentleman from 
New Jersey (Mr. Pallone), who is doing a great job pounding away on 
this issue night after night. And I am convinced that if we cannot get 
it this month, we will get a Medicare prescription drug benefit for our 
seniors in the next 2 years. This issue is too big, it is too 
important, and we simply cannot let it slide away. We cannot let this 
whole area be taken over by private insurance companies, HMOs, and the 
pharmaceutical industry. I yield back to the gentleman from New Jersey, 
and thank him for hosting this special order.
  Mr. PALLONE. Mr. Speaker, I thank my colleague from Maine. Again, I 
say that the gentleman, more than anyone else, keeps reminding us about 
the price discrimination issue, which is an issue that affects not only 
seniors, but everyone really. Seniors, obviously, because they use more 
prescription drugs are more concerned about it than any other group. 
But the issue of price discrimination has to be addressed in the 
context of what we do on the prescription drug issue, or we are not 
going to solve the problem. I thank the gentleman for constantly 
bringing the issue up.
  Mr. Speaker, I wanted to mention that the most important aspect of 
this in this whole debate is the fact that the Democrats want to 
include prescription drugs under a Medicare plan, under the rubric of 
existing Medicare, and that the Republicans essentially are not doing 
that. They are talking about some sort of voucher or subsidy that would 
be used to go out and find an insurance company that wants to sell a 
drugs or prescription drug-only policy.
  One thing that I really want to stress this evening, and I think is 
so important, is that too often on the Republican side of the aisle 
this issue is described or basically painted in an ideological sense. 
And I, for one, do not see myself as an ideologue. I do not look at 
what we do here from the point of view of what is ``progressive,'' what 
is ``conservative,'' what is ``liberal,'' what is ``moderate,'' but 
rather than from the point of view of what works.
  I get a little tired of the rhetoric that suggests that somehow 
Medicare is socialistic or government-run or in some way that it could 
not possibly work because it is a government program. The reality is 
that every kind of program or initiative has to be looked at from a 
practical point of view, and Medicare works. And so any effort to say 
that we should not include this prescription drug benefit because 
somehow this is going to be a government-run program, I do not care 
whether the government runs it as long as it works.
  Mr. Speaker, I would say the same thing is true with regard to the 
issue of price discrimination that the gentleman from Maine (Mr. Allen) 
keeps bringing up and also spoke about very eloquently this evening.
  What I find is that the Republican leadership, and even the 
Republican candidate for President, Governor Bush, keeps talking about 
the issue of price discrimination in sort of ideological terms. There 
was an article in The New York Times on September 6, which was the day 
that Governor Bush spelled out his own prescription drug program and 
what he was proposing to do for seniors to have access to prescription 
drugs. He was very critical of the Democratic proposal, which is 
supported by Vice President Al Gore, because he said that it would lead 
to price controls.
  I read this before on the floor of the House, but I want to read it 
again tonight because I think it so much spells out this whole 
ideological debate. ``Governor Bush today,'' from the New York Times, 
``much like the drug industry,'' and I quote, ``criticized Mr. Gore's 
plan as a step towards price controls by making government agencies the 
largest purchaser of prescription drugs in America. By making 
Washington the Nation's pharmacist, the Gore plan puts us well on the 
way to price control for drugs.''
  Well, let me say this. The reason why we need to address the issue of 
price discrimination is because the marketplace is not working right 
now with regard to this issue. The problem is that HMOs, employer 
benefit programs that have large volumes of constituents, large volumes 
of seniors that are part of their plan, have the ability to go out and 
negotiate a better price than the guy who is on his own and has to go 
to the local pharmacy to buy the drugs.
  What is the answer to that? Well, we can say, okay, that somehow the 
little guy has got to basically get together with his colleagues and 
exercise some control so he can negotiate a better price. That is 
essentially what we are doing with our Medicare prescription drug plan. 
We are saying that in each region of the country, the Government

[[Page H8046]]

will designate a benefit provider, which is basically an organization 
that would be in charge of negotiating on behalf of all the seniors 
that are now part of this Medicare plan, a price for prescription 
drugs.

  Mr. Speaker, all that is essentially tinkering with the marketplace 
to give the little guy the power that these large HMOs and others 
employer benefit plans have. We can call that government control, we 
can call that Washington stepping in, call it whatever we want. But the 
bottom line is that is the only way to get the average person who is 
not now covered by an HMO or any kind of plan to the ability to have 
some control to negotiate a better price so he or she does not suffer 
this price discrimination that so many seniors are now facing.
  My response to anybody on the other side of the aisle, or to Governor 
Bush, whoever says that that is price control or that is government 
running the program is: I do not care, as long as it works. I have got 
to somehow empower this guy who is going to the local pharmacy and 
having to pay these tremendous prices. I have got to empower him to be 
able to negotiate a better price, and that is what the Democratic plan 
would do. Call it whatever we like, I do not care. It is the only way 
to empower this individual to be able to fight against this price 
discrimination.
  Let me say that the Democratic proposal, the Gore proposal, is much 
different from the type of strict price controls that exist in almost 
every other industrialized developed countries. Most of the European 
countries, Canada, and a lot of other developed countries around the 
World, basically set a price. They have real price controls. We are not 
talking about that. We are not talking about interfering with the 
market that much that we would actually set a price, but we are saying 
that we need to empower the average person so that they are not a 
victim of this continued price discrimination.
  Mr. Speaker, the other charge, and the gentleman from Maine brought 
this up, the other charge that the Republican side and Governor Bush 
has made against the Democratic plan is that somehow it is a one-size-
fits-all plan and people will not have a choice; that we should favor 
the Republican proposal, this sort of voucher, because that gives a 
choice because we can take that voucher and go out and decide what kind 
of plan we want and somehow we have choice.
  Let me say that nothing is further from the truth. As I pointed out, 
in the State of Nevada where this program was instituted, no insurance 
company even wanted to sell these policies that the Republicans are 
proposing. The insurance companies are telling us before our committees 
that they will not offer these drug policies. So what kind of a choice 
is there if we cannot find somebody who is going to sell an insurance 
policy that would cover prescription drugs?
  The Democratic plan on the other hand provides a tremendous amount of 
choice because the Gore plan, the Democratic plan, is voluntary. 
Seniors do not have to sign up for Medicare part D any more than they 
have to sign up now for Medicare part B. No one says that they have to 
sign up for part B and pay a premium so much a month to get their 
doctor bills covered. Eighty, 90, almost 100 percent of the people sign 
up for it because it is a good deal, and I suspect that we will get the 
same thing with our proposed part D for prescription drugs. Most people 
would sign up for it because it is a good deal.
  But I remind my colleagues that it is still voluntary. If Americans 
have an existing employer benefit plan that covers prescription drugs 
and do not want to sign up for the Medicare prescription drug part D, 
they do not have to. We are not forcing them to. If they are in 
Medicare part C now and have an HMO plan that covers their prescription 
drugs and they have to pay so much a month, or they like that plan and 
they do not want to sign up for the Medicare prescription drug plan 
under part D, they do not have to.

  In fact, I would say that the way this is set up, the way that the 
Democratic proposal is set up, we actually offer more variety because 
for those who stay in an HMO, we are going to provide better than 50 
percent of the cost of the prescription drug program. So rather than 
see hundreds of thousands of people who are now being thrown out of 
their HMOs, because the HMO decided as of July 1 that they were not 
going to include their seniors and they are losing their HMO coverage, 
most of the HMOs that are dropping seniors now are dropping them 
because they cannot afford to provide the prescription drug coverage.
  If now the government is going to say under Medicare that we cover 
better than 50 percent of the cost of the prescription drug program, 
then a lot more HMOs are going to want to sign up under the Democratic 
proposal, will sign up seniors, and will not drop them.
  The same is true for employer benefit plans. We are also providing 
money to help pay for the employer benefit plan for those who have it. 
We are increasing choices. We are letting people stay with existing 
plans and boosting and shoring up those plans financially so they do 
not drop them. And if Americans do not want to do that, they always 
have the fall back of going back to the Medicare fee-for-service 
prescription drug program that is a guaranteed benefit.
  When I say ``guaranteed benefit,'' because my colleague from Maine 
again pointed out that, again, a big difference between what the 
Democrats are proposing and what the Republicans are proposing is that 
the Democrats truly have a guaranteed benefit. It is one-size-fits-all 
in the sense that one is guaranteed to know that if they sign up for 
the program, every type of medicine that they need, that their doctor 
says is medically necessary or their pharmacist says is medically 
necessary for their health, will be covered under the Democratic plan 
and under Medicare.
  By contrast, in the Republican plan, that basically leaves it up to 
whoever is going to take this voucher that they are offering and says, 
okay, we will take the voucher; but we are not going to cover certain 
drugs, we are going to charge a copayment, we will have a high 
deductible. These are the kinds of problems that people face now with 
HMOs or with a lot of the private plans that are out there that some 
people have been able to find.
  Those problems will be magnified under the Republican proposal. If 
someone takes this voucher and they are trying to find somebody to 
cover them, they do not have to say how much it is going to cost. They 
do not have to say what kind of drugs they are going to get. They do 
not have to say what the copayment is, what the premium is. Under the 
Democratic proposal, all of that is provided for, all of that is 
structured, all of that is guaranteed.
  Mr. Speaker, it is a significant difference, I think, in terms of the 
way we approach things.
  I guess tonight if I could conclude, Mr. Speaker, I would say that we 
are going to be here many times. I do not know how much longer the 
Congress is going to be in session, probably a couple more weeks or so; 
and I am beginning to have serious doubts about whether this issue is 
going to be addressed by this Congress and the Republican leadership. I 
think the time is running short, and the realization is setting in that 
this Congress is likely to adjourn without addressing the prescription 
drug issue.
  Mr. Speaker, I think that is a shame, because I think there really is 
a consensus amongst the American people that we need a Medicare 
prescription drug benefit. And rather than pose back and forth about 
which plan is better, it would be a lot better if the Republican 
leadership would simply accept the fact that this should be something 
that is included under Medicare and use the time over the next 2 weeks 
to come to common ground so that we could pass this.
  But I do not see that happening, and it is not going to stop me and 
my Democratic colleagues coming here every night, or as often as 
possible, to demand that this issue been addressed before we adjourn.

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