[Congressional Record Volume 146, Number 136 (Thursday, October 26, 2000)]
[Senate]
[Pages S11064-S11067]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                   THE CREDIBILITY GAP IN HEALTH CARE

  Mr. KENNEDY. Mr. President, few, if any, issues are of greater 
concern to American families than quality, affordable health care. 
Americans want an end to HMO abuses. They want good health insurance 
coverage. They want a prescription drug benefit for senior citizens 
under Medicare. They want to preserve and strengthen Medicare, so that 
it will be there for both today's and tomorrow's senior citizens. And 
they want these priorities not only for themselves and their loved ones 
but for every American, because they know that good health care should 
be a basic right for all.
  The choice in this election is clear, and it is not just a choice 
between different programs. it is also a choice based on who can be 
trusted to do the right thing for the American people. Al Gore's record 
and his program are clear. He has been deeply involved in health care 
throughout his career.
  The current administration has made significant progress in improving 
health care in a variety of ways--from expanding health insurance to 
protecting Medicare. He has consistently stood for patients and against 
powerful special interests.
  Al Gore lays out a constructive, solid program that is consistent 
with his solid record. He is for expanding insurance coverage to all 
Americans, starting with children and their parents. He is for a strong 
Patients' Bill of Rights. He has a sensible plan for adding 
prescription drug coverage to Medicare. He will fight to preserve 
Medicare, without unacceptable changes designed to undermine Medicare 
and force senior citizens into HMOs and private insurance plans.
  George W. Bush's approach is very different. His proposals are deeply 
flawed. But even worse than the specifics of his proposals is his 
failure to come clean with the American people about his record in 
Texas or about his own proposals.
  On health care, George Bush doesn't just have a credibility gap. He 
has a credibility chasm. He has consistently stood with the powerful 
against the people. He refuses to take on the drug companies, the 
insurance companies, or the HMOs. His budget plan puts tax cuts for the 
wealthy ahead of every other priority, and leaves no room for needed 
investments in American families. On health care, his values are not 
the values of the American people.
  On the issue of the Patients' Bill of Rights, George Bush said in the 
third debate that he did support a national Patients' Bill of Rights. 
He said he wanted all people covered. He said that he was in favor of a 
patients' right to sue, as provided under Texas law. He said he brought 
Republicans and Democrats together in the State of Texas to pass a 
Patients' Bill of Rights.
  That's what he said. But the reality is very different. Governor Bush 
vetoed the first Patients' Bill of Rights passed in Texas. He fought to 
make the second bill as narrow and limited as possible. He was so 
opposed to the provision allowing patients to sue their HMOs that he 
refused to sign the final bill, allowing it to become law without his 
signature. That's not the record of a person who is candid about where 
he stands and what he has done. And it's not a record that recommends 
him for national office for any citizen concerned about a strong, 
effective Patients' Bill of Rights. It's the record of a candidate who 
stands with powerful insurance companies and HMOs, not with American 
families. And it isn't a record that shows leadership, either. In 
Congress, the House of Representatives passed a good Patients' Bill of 
Rights by an overwhelming bipartisan margin. That bill is supported by 
all the organizations of doctors, nurses, and patients. No other 
proposal enjoys support from any of those groups. Yet it remains mired 
in the Senate because of the adamant opposition of the Senate 
Republican leadership.

  On the most recent vote on this bill, we were one vote shy of having 
a majority. Governor Bush is now the leader of his party. One phone 
call from Governor Bush to Trent Lott and that bill would be law today. 
But Governor Bush has declined to make that call, just as he has 
declined to support the Patients' Bill of Rights itself.
  Yesterday, my good friend from Texas stated that the only reason 
Governor Bush vetoed that first bill and let the right to sue under the 
second program become law without his signature was that there was a 
disagreement on how much the caps on pain and suffering would be. I 
regret that my colleague has been misled. The fact is there was no 
provision for lawsuits in the first Patients' Bill of Rights bill 
vetoed by the Governor. To reiterate, there was no provision for 
lawsuits at all in the first bill, yet the Governor vetoed it.
  In the second bill, there also was no issue about the caps on pain 
and suffering. Texas already had caps on pain and suffering under their 
existing general tort law, and everybody assumed those caps would apply 
to lawsuits against HMOs. There was never any discussion of this issue. 
The fact is that Mr. Bush, despite what he may say today, simply 
doesn't believe health plans should be held accountable. That is why he 
refused to sign the law allowing suits against HMOs. Once again, he 
distorted his record in Texas, and both the record and distortions call 
into serious questions where he would stand as President.
  In the course of the debate yesterday, my colleagues from Texas said 
they were tired of hearing Texas ``trashed''. They implied that I had 
said offensive things about their State. Let me be clear. I think Texas 
is a wonderful State. I have many good friends in Texas. Texas has 
produced statesmen who have made our country a better place--from Sam 
Houston to Lyndon Johnson. It produces much of the oil that keeps our 
country running. I have no quarrel with the State of Texas. My quarrel 
is with George W. Bush's distortion of his record in Texas. My quarrel 
is with the priorities that the Bush record in Texas demonstrates. My 
quarrel is with the idea that the interests of powerful special 
interests are more important than the interests of patients. My quarrel 
is with the idea that tax cuts for the wealthy are more important than 
health care for children.
  On health insurance, the record is equally clear and equally bleak. 
Governor Bush claims he wants insurance for all Americans. He blames 
Vice President Gore for the growth in the number of uninsured. Governor 
Bush's record in Texas is one of the worst in the country. Texas has 
the second highest proportion of uninsured Americans in the country. It 
has the second highest proportion of uninsured children in the country. 
Yet Governor Bush has not only done nothing to address this problem, he 
has actually fought against solutions. In Texas, he placed a higher 
priority on large, new tax breaks for the oil industry instead of good 
health care for children and their families.
  When Congress passed the Child Health Insurance Program in 1997, we 
put affordable health insurance for children within the reach of every 
moderate- and low-income working family. Yet George Bush's Texas was 
one of the last States in the country to fully implement the law. 
Despite the serious health problems faced by children in Texas, 
Governor Bush actually fought to keep eligibility as narrow as 
possible.

  In fact, the Bush campaign's defense of this unacceptable record is 
almost as telling as the record itself. According to the New York 
Times, the Bush campaign acknowledges that Governor Bush had fought to 
keep eligibility narrow, but that he did so because he was concerned 
about costs and the spillover effect on Medicaid. This so-called 
spillover effect is the increase in enrollment of Medicaid-eligible 
children that occurs when the Children's Health Insurance Program is 
put into effect. Vigorous outreach efforts by State governments would 
identify children who qualify for the new program, and many other 
children would also be identified who qualify for Medicaid.
  In other words, Governor Bush not only opposed expanding eligibility 
for the new program, he was worried that uninsured children eligible 
for Medicaid might actually receive the coverage to which they were 
already entitled. It is no wonder his Texas administration was cited by 
a Federal judge for its failure to live up to a consent order to let 
families of poor children know

[[Page S11065]]

about their eligibility to enroll their children in Medicaid and about 
the health services to which they were entitled.
  An article in Time magazine says it all. It is titled ``Tax Cuts 
Before Tots. Candidate Bush is pushing his compassion, but poor kids in 
Texas have not seen much of it.'' Under a box entitled ``Lost 
Opportunity? Bush and Poor Kids,'' the author makes the following 
points:

       Bush helped to secure tax cuts by underfunding Medicaid, 
     causing a $400 million shortfall in the program. He delayed 
     on State law to expand Medicaid coverage for 303,000 new 
     kids. They went five years without health insurance. He 
     fought efforts to require automatic coverage for families 
     forced off welfare rolls.

  There it is, Mr. President. That isn't the Senator from Massachusetts 
talking, that is Time magazine and their conclusion based upon the 
facts in Texas.
  Yesterday, my colleague from Texas offered all sorts of explanations 
for Governor Bush's miserable record with regard to covering children. 
She said the court case I referred to was begun before Governor Bush 
took office. That is true, but the consent decree settling the case was 
agreed to by Governor Bush's administration in February of 1996. And 
the recent action by the Federal judge was based on the Bush 
administration's failure to live up to the consent decree to which it 
agreed. The Bush administration did not keep its word. Children were 
simply not its priority.
  She said Texas could not implement the CHIP program promptly because 
its legislature only meets every 2 years. But other States have 
legislatures that meet every 2 years and they were able to get their 
programs going more promptly. In fact, Texas was the next to last State 
in the whole country to approve the CHIP program.
  Now my colleagues yesterday and my friend from New Mexico today 
raised a red herring in trying to defend the indefensible. They claimed 
that I criticized Governor Bush for failing to spend all his CHIP money 
and said that 40 other states had not spent their full allotment. I did 
nothing of the kind. many states had difficulty in implementing the 
program promptly and fully enough to spend all their allotted funds. 
But they did not delay for almost three years in passing their 
programs. They do not set up barriers that make it difficult for 
children that enroll. They do not put a higher priority on tax cuts 
than children's health. Their Governors, by and large, did not fight to 
keep eligibility narrow instead of broad. But Governor Bush has done 
all these things, and then he tries to mislead the American people 
about his record.
  The fact is that Bush's shoddy record on children goes well beyond 
CHIP. Far more uninsured children are eligible for Medicaid than CHIP, 
and Bush fought efforts to get them enrolled. He fought a bill to 
provide for automatic re-enrollment in Medicaid of children whose 
parents lose cash welfare payments. Texas remains one of only ten 
states that impose an assets requirement on children seeking Medicaid 
eligibility, and it is one of just a handful of states that require 
parents to go in person to the welfare office to apply for their 
children. In fact, Governor Bush's record is so bad that, although 
Texas has more than one million children who are uninsured, Texas is 
one of the few states where the number of children enrolled in CHIP or 
Medicaid actually declined in 1999.
  When it comes to health care for children, George W. Bush gives new 
meaning to the term ``compassionate conservative.'' Based on his 
record, he is compassionate because he claims to understand the pain of 
uninsured children and their families, and he is conservative because 
he won't do anything about it.
  Governor Bush's misstatement of his Texas record does not end with 
uninsured children. In the debates, Vice-President Gore pressed 
Governor Bush on the Texas record on the uninsured. Governor Bush said 
that Texas was spending $4.7 billion a year for uninsured people. But 
it turns out that actually only one-quarter of that amount was being 
spent by the State of Texas. The vast majority of the spending was by 
hospitals, doctors, and county governments.
  On the Texas record on the uninsured, Governor Bush stated that the 
percentage of the uninsured in Texas had gone down, while the 
percentage of the uninsured in America has gone up. In fact, in 1994, 
when Governor Bush took office, the percent of the uninsured in Texas 
was 24.2. By 1998, that percentage had increased--not decreased--to 
24.5. The number of the uninsured had grown by 300,000. In 1998, the 
overall percentage of the uninsured dropped by identical amounts both 
nationally and in Texas--4.9 percent in Texas and 4.9 percent 
nationally.
  But, because of Governor Bush's inaction on children, the percentage 
of children who were uninsured dropped almost twice as much nationally 
as in Texas--10 percent nationally and only 5.2 percent in Texas. When 
Governor Bush took office, Texas ranked second from the bottom of all 
50 states in covering children and citizens of all ages. Today, after 
six years under his watch, Texas still ranks second from the bottom.
  Perhaps the most ominous revelation about Governor Bush's true 
attitude to this issue came in the third debate, when he said, ``It's 
one thing about insurance, that's a Washington term.''
  Insurance a Washington term?
  Governor Bush should try telling that to hard-working families in 
Texas and across the country who don't take their children to the 
doctor when they have a sore throat or fever because they can't afford 
the medical bill.
  He should try telling that to the young family whose hopes for the 
future are wrecked when a breadwinner dies or is disabled because an 
illness was not diagnosed and treated in time. He should try telling 
that to the elderly couple whose hopes for a dignified retirement are 
swept away on a tidal-wave of medical debt.
  He should tell that to the 200,000 families who are forced into 
bankruptcy every year because of medical bills they cannot pay. He 
should tell that to the nine million families who spend more than one-
fifth of their income on medical costs. He should tell that to the 
parents of the four hundred thousand children suffering from asthma who 
never see a doctor--to the parents of the five hundred thousand 
children with recurrent earaches who never see a doctor--and to the 
parents of the more than five hundred thousand children with severe 
sore throats who never see a doctor. Mr. President, he should tell that 
to the 27,000 uninsured women who are diagnosed with breast cancer 
every year--and are 50 percent more likely to die of the illness, 
because they are uninsured. He should tell that to the 83,000 Americans 
who die every year because they are uninsured and, as a result, do not 
receive timely or adequate medical use.

  Insurance is far more than just a Washington term. It's a Main Street 
term in every community in America, and its lack of availability is a 
crisis for millions of families across the country.
  Prescription drug coverage under Medicare is another major aspect of 
the health care challenges facing America. Few issues are more 
important to senior citizens and their families. They deserve a 
prescription drug benefit under Medicare--and we should provide it in a 
way that strengthens the promise of Medicare, not in a way that breaks 
that promise and breaks faith with the elderly.
  The differences between Vice-President Gore and Governor Bush on this 
issue are fundamental. Governor Bush stands with the big drug 
companies, and Vice-President Al Gore stands with senior citizens. But 
Governor Bush has sought at every turn to blur the differences between 
their two plans in a way that is so misleading as to make a mockery of 
his own attacks on the Vice-President's credibility.
  Vice-President Gore laid out his vision for Medicare in clear terms. 
He wants a guarantee--a lock-box--to assure that the current Medicare 
surplus will be used only for Medicare--and not diverted to other 
purposes. He wants to use some of the surplus to strengthen Medicare 
and keep it solvent for the future. He wants an immediate prescription 
drug benefit under Medicare that will benefit all senior citizens, not 
just very low income seniors. He wants to assure that senior citizens 
who prefer to stay with the current Medicare program and retain the 
right to choose their own doctors are not penalized for that choice or 
coerced into joining an HMO.

[[Page S11066]]

  In spite of direct challenges from Vice-President Gore, Governor Bush 
refused to endorse a lock-box. It's not part of his priorities, and the 
reason is clear. He needs to use some of Medicare's surplus to finance 
his massive tax cuts for the rich.
  Vice-President Gore has clearly pointed out the many flaws in 
Governor Bush's prescription drug plan for senior citizens. But 
Governor Bush has no response on the merits. Instead, he hides behind 
phrases like ``fuzzy numbers'' and ``scare tactics.''
  But the numbers aren't fuzzy, and senior citizens should be 
concerned. Let's look at the facts.
  Prescription drug coverage under the Bush plan is not immediate, and 
most senior citizens would be left out. As Vice-President Gore has 
pointed out, for the first four years, the Bush plan would cover low 
income seniors only. Al Gore cited the example of a senior named George 
McKinney. He said, ``George McKinney is 70 years old, has high blood 
pressure. His wife has heart trouble. They have income of $25,000 a 
year. They cannot pay for their prescription drugs. And so they're some 
of the ones that go to Canada regularly in order to get their 
prescription drugs.''
  Governor Bush responded, ``Under my plan, the man gets immediate help 
with prescription drugs. It's called immediate helping hand. Instead of 
squabbling and finger-pointing, he gets immediate help.'' He kept 
accusing Vice-President Gore of using ``fuzzy math'' and ``scare 
tactics.''
  But Governor Bush's own announcement of his Medicare plan proves Al 
Gore's point. This is what Governor Bush said:

       For four years, during the transition to better Medicare 
     coverage, we will provide $12 billion a year in direct aid to 
     low income seniors . . . Every senior with an income less 
     than $11,300--$15,200 for a couple--will have the entire cost 
     of their prescription drug covered. For seniors with incomes 
     less than $14,600--$19,700 for couples--there will be a 
     partial subsidy.

  George McKinney has an income of $25,000. He would clearly be 
ineligible for help under Governor Bush's plan. If Governor Bush thinks 
that's fuzzy math, then education reform is even more urgent than any 
of us realized. And in the third debate, Governor Bush finally admitted 
that the first phase of his program is only for ``poor seniors.''
  George McKinney is not alone. The vast majority of senior citizens 
would not qualify for Governor Bush's prescription drug program--and 
many of those who did qualify would not participate.
  Even this limited program for low income seniors would not be 
immediate, because every state in the country would have to pass new 
laws and put the program in place--a process that could take years in 
many states.
  The low priority that Governor Bush places on this problem is also 
demonstrated by the fact that sixteen states have enacted programs to 
help low income senior citizens with their prescription drug costs, and 
Texas is not one of them.
  George Bush's prescription for middle-income senior citizens is 
clear--take an aspirin and call your HMO in four years.
  Governor Bush's prescription drug plan would also require senior 
citizens to go to an HMO or an insurance company to obtain their 
coverage. In the first debate, Vice-President Gore pointed out that 
most senior citizens ``would not get one penny for four to five years, 
and then they would be forced to go into an HMO or an insurance company 
and ask them for coverage. But there would be no limit on the premiums 
or the deductibles or any of the terms or conditions.''
  Again, Governor Bush did not respond to the Vice-President's specific 
points. Instead, he claimed that the Vice-President was trying to 
``scare'' voters.
  The facts are clear. Governor Bush's policy paper states that, ``Each 
health insurer, including HCFA-sponsored plans that wish to participate 
. . . will have to offer an ``expanded'' benefit package, including 
out-patient prescription drugs . . . . This will give seniors the 
opportunity to select the plan that best fits their health needs.''
  In other words, to get prescription drug coverage under the Bush 
plan, you have to get it through a private insurance plan. How high 
will the co-payments be? How high will the premiums be? How high will 
the deductible be? Governor Bush has no answer. Those important points 
are all left up to the private insurance companies.
  Governor Bush says senior citizens will have the opportunity to 
select the plan that best meets their health needs. But what they will 
really have is the opportunity to select whatever plan private insurers 
choose to offer. If it costs too much, senior citizens are out of luck. 
If it doesn't cover the drugs their doctor prescribes, they're out of 
luck. The Bush plan is an insurance industry's dream, and a senior 
citizen's nightmare.
  Governor Bush believes that private insurance companies and HMOs are 
the best way to provide prescription drug coverage to seniors. I don't 
question his sincerity. But I do question his unwillingness to defend 
his position in an open debate in front of the American people. When 
Vice-President Gore points out the facts, it isn't enough to evade the 
issue by calling the facts ``fuzzy math'' or a ``scare tactic''.
  The ads that the Republican National Committee is running for the 
Bush campaign against the Gore plan reach new lows in disinformation. 
Under the Bush plan, senior citizens would have to get their 
prescription drugs through an HMO or private insurance company, but the 
GOP ads stand reality on its head by stating that under the Vice-
President's proposal, senior citizens would have to obtain their 
coverage from a ``government-run HMO.''
  In fact, under the Vice President's plan senior citizens would obtain 
their drug coverage through Medicare, in essentially the same way they 
obtain physician and hospital coverage today. The Gore plan 
specifically guarantees that it will cover any drug that a senior 
citizen's doctor prescribes. That's not true under the Bush plan--and 
it is a glaring omission.
  Another issue in the debate over prescription drug coverage has not 
received sufficient attention--the linkage in Governor Bush's proposal 
between prescription drug coverage and other cutbacks in Medicare. When 
the American people and senior citizens understand what Governor Bush 
is proposing, they will reject it resoundingly.
  Governor Bush has been very clear. His drug benefit won't be 
available to senior citizens unless they are willing to accept severe 
changes in Medicare's coverage of their doctor's bills and hospital 
bills. He reiterated that point in the second debate. He said, ``I 
think step one to make sure prescription drugs are more affordable for 
seniors . . . is to reform the Medicare system.'' Prescription drug 
coverage that senior citizens need should not be held hostage to 
changes in Medicare that senior citizens don't want--and it won't be 
held hostage under Al Gore's plan.
  Governor Bush thinks that Medicare is obsolete and should be sent to 
the scrap heap. He favors a new model--in which senior citizens have to 
join HMOs or other private insurance plans or pay exorbitant premiums. 
But Medicare is still far and away one of the most successful social 
programs ever enacted. Senior citizens don't think that Medicare is 
ready for the scrap heap. They don't want to have to give up their 
family doctor and join an HMO in order to obtain coverage. But under 
the Bush plan, the price of staying in current Medicare and keeping 
your own doctor could be a premium increase of as much as 47 percent in 
the very first year, according to the Medicare actuary. For the vast 
majority of senior citizens, this heavy financial pressure could force 
them to give up their current Medicare coverage and their own doctor, 
and join an HMO.
  Under the leadership of the Clinton-Gore administration, Medicare has 
gone from a condition of imminent bankruptcy to one in which Medicare 
will be solvent for the next quarter century--the longest period of 
projected Medicare solvency in the program's entire history. The 
independent Medicare Commission recently considered a proposal similar 
to the Bush plan, and the Commission said it could cause Medicare to 
become insolvent as early as 2005--just five years from now. If so, 
Congress would be faced with the stark choice of raising taxes, cutting 
benefits, or raising premiums. That's the Bush plan--and it's not a 
plan to protect senior citizens. It's a plan to privatize Medicare, and 
turn it over to the tender mercy of HMOs and the private insurance 
industry.
  On prescription drugs and every other aspect of Medicare, the choice

[[Page S11067]]

between the two presidential candidates is very clear--and it is clear 
on every other aspect of health care. The Bush record in Texas is one 
of indifference and ineptitude--of putting powerful interests ahead of 
ordinary families.
  The Bush record in the campaign is one of consistent deception and 
distortion. The Bush proposals are at best inadequate and at worst 
harmful. Tax cuts for the wealthy are not as important as health care 
for children and prescription drugs for seniors. The American people 
understand that--but Governor Bush does not.
  Al Gore has a career-long record of fighting for good health care for 
families, for children, and for senior citizens. The current 
administration has a solid record of bipartisan accomplishment, ranging 
from protecting the solvency of Medicare to improving health insurance 
coverage though enactment of the Kassebaum-Kennedy bill and the Child 
Health Insurance Program. Al Gore's program responds to the real needs 
of the American people with real resources and a detailed action plan.
  I am hopeful that every American will examine the records of the two 
candidates carefully. On health care, there should be no question as to 
which candidate stands with powerful special interests and which 
candidate stands with the American people. The choice is clear. 
Governor Bush stands with the powerful, and Al Gore stands with the 
people.

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