[Congressional Record Volume 148, Number 57 (Wednesday, May 8, 2002)]
[House]
[Pages H2227-H2233]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                   MEDICARE PRESCRIPTION DRUG BENEFIT

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 3, 2001, 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 I plan to spend most of the 
time discussing the need for a Medicare prescription drug benefit. I 
come to the well, to the floor this evening primarily because of my 
concern that the House Republican leadership is talking about, 
certainly presenting itself to the media, that they intend to bring up 
a prescription drug proposal at some point over the next couple of 
weeks. I am very concerned that their proposal is really nothing more 
than a sham and not something that is actually going to benefit any 
significant portion of the senior population.
  I thought what I would do this evening is that I would start out by 
sort of outlining what I believe, and what Democrats as a whole in the 
House of Representatives feel we should be doing about prescription 
drugs.
  First of all, I should say that the Democrats feel very strongly that 
the biggest problem with prescription drugs is the cost. The fact of 
the matter is that whether one is a senior, whether one is over 65 or 
whether one is under 65, it is getting to be more and more difficult to 
pay for one's medicine, because of the fact that the prices keep going 
up every year. Double-digit inflation, essentially, we have had with 
regard to prescription drug prices for the last 6 years. Every year, 
the cost goes up by a double digit percentage point. Democrats are 
determined to address the cost issue and to say that whatever benefit 
package we arrive at has to address the issue of cost and try to bring 
prices down.
  The other major issue for Democrats is that this plan, this 
prescription drug plan or legislative proposal has to be a Medicare 
proposal. In other words, right now we have a great program called 
Medicare that all seniors over 65 know that they are guaranteed certain 
benefits, whether it is a hospital stay or, if they are participating 
in part B of Medicare on a voluntary basis, their doctor bills are 
paid, and there is no question about what is covered essentially and is 
not covered, because there is a guaranteed benefit package for every 
senior, for everyone who is over 65 who is eligible for Medicare.
  We insist that that be the case for the prescription drug proposal as 
well. This has to be a benefit that is added to the Medicare program 
and that every senior, just like with part B when seniors pay so much a 
month at a very minimum premium to cover their doctor bills, that they 
would pay so much per month at a very low premium to cover prescription 
drugs, and they would know that they would be able to guarantee that 
prescription drugs were paid for pursuant to Medicare as part of their 
program.
  The other thing that we insist on is that this program be generous 
enough, in other words, that the Federal Government be paying enough of 
the cost of their prescription drugs so that it makes sense for one to 
voluntarily pay the monthly premium, like they do in part B for doctor 
bills. In other words, the benefit has to be significant. We have 
talked about as much as 80 percent of the cost. If we analogize what we 
have now for part B for doctor bills, what the Democrats are 
essentially saying is that we want a prescription drug benefit that is 
very similar to the Medicare structure for doctor bills, in other 
words, that there be a fairly low premium per month, that the 
deductible be as low as possible, something like what we have for part 
B to pay for doctor bills; that the amount that the Federal Government 
pays is significant, probably something like 80 percent with regard to 
part B to cover doctor bills; we pay a premium and when the bill comes 
in, the Federal Government pays 80 percent of the cost.
  Well, that is the kind of generous benefit that we want to provide 
for prescription drugs, and that there be some point, we call it a 
catastrophic level, at which point if one paid so much out-of-pocket 
over the course of the year, that the Federal Government would cover 
the entire cost.
  Now, let me contrast what I just said and what the Democrats would 
like to see with what we are hearing from the Republican leadership in 
the House. I want to stress that what we are hearing is not very good 
on any of these

[[Page H2228]]

points. About a week ago, the House Republicans rolled out some general 
principles about what their prescription drug program might be when 
they finally introduce it; and they said, they are trying to give the 
impression that it is going to be a Medicare benefit. They are trying 
to give the impression that it is going to lower costs. They are trying 
to give the impression that we are going to have the choice of 
basically all drugs that would be covered and that one can go to any 
pharmacy and it is just going to operate in a way that provides all 
kinds of choice. But the reality is very different.
  Let me talk about some of those principles.

                              {time}  1845

  First of all, they talk about lowering cost, but they do not have any 
mechanism in their proposal that addresses cost. In other words, they 
are not saying that the Secretary, for example, is supposed to 
negotiate prices, or the Secretary of Health and Human Services is 
supposed to negotiate prices. They are simply talking about a discount 
drug card.
  President Bush about a year ago said that he wanted the Federal 
Government and the Medicare program to promote the discount drug cards 
that some of the drug companies are now making available to seniors. 
Well, that is very nice. It is very nice that some of the drug 
companies are providing a discount drug card. I question how much 
savings there really are in those cards, but the reality is that that 
is not a Medicare program, that is not a Federal government drug 
benefit, to talk about someone going out and purchasing a discount card 
from the drug companies, when that is already available.
  The Republicans cannot kid everyone and suggest to the American 
people that somehow that is going to address the cost issue. This is 
already available. They need to address the cost issue in the context 
of their legislation.
  The other thing they are saying is that they are talking about this 
as if somehow it is going to cover everyone under Medicare, but if we 
look at what the Republican leadership in the House is proposing, it is 
not a Medicare benefit at all. In fact, what it is is giving money sort 
of like a voucher system to insurance companies, hoping that they will 
sell drug-only policies to a select group of senior citizens, probably 
only very low-income seniors, maybe less than 10 percent of the senior 
population.
  So the Republican leadership in the House is not talking about what I 
mentioned before, an addition to the Medicare program that everyone is 
guaranteed that if they sign up and pay their premium they are going to 
get a guaranteed prescription drug benefit.
  They are talking about something like a voucher, essentially a 
private program where some money would go to insurance companies and 
people would go around and try to find an insurance company that would 
cover the prescription drugs, or perhaps an HMO. Because it is clear 
they are continuing to push HMOs and trying to get seniors to sign up 
for an HMO, and they hope that the HMO, with a little more money from 
the Federal Government, is going to provide prescription drugs.
  That is not what Medicare is all about. Medicare is a guaranteed 
benefit. Medicare says that everyone is covered. What the Republican 
leadership in the House is suggesting is that this is only going to be 
available to very low-income seniors, those seniors who are not 
eligible for Medicaid but are maybe just above the Medicaid guidelines, 
maybe 6, 7, 8, 10 percent of the senior population that is not eligible 
for Medicaid and does not have any kind of drug coverage.
  So I just want to debunk this myth, if you will, about what the 
Republicans are really about. They are saying that their program is 
going to strengthen Medicare, but it is not going to strengthen 
Medicare if now essentially what we are talking about is privatizing 
Medicare. It is not going to strengthen Medicare if only less than 10 
percent of the senior population are going to be able to take advantage 
of this program.
  I want to stop my comments now because I see some of my colleagues 
have joined me on the Democratic side. I would like to have them 
address this issue, and we will hopefully have a little debate back and 
forth, as well.
  Mr. Speaker, I yield to the gentlewoman from the Virgin Islands (Mrs. 
Christensen), who is part of our Health Care Task Force and is a 
physician, and is probably more qualified as a physician to talk about 
this issue than anyone else.
  Mrs. CHRISTENSEN. Mr. Speaker, I thank the gentleman for yielding to 
me. I think our seniors are probably the most qualified to speak, and 
they have been speaking very loudly about this issue.
  I want to thank the gentleman for tonight and all of the time laying 
out the issue so clearly, showing the difference between what the 
Democrats are offering and what the Republican plan does not offer. The 
vouchers that Republicans are proposing for education will not help our 
children any more than vouchers for prescription benefits will help our 
seniors.
  I wanted to join the gentleman here tonight because I cannot 
understand, and I am sure that people out across America just have 
difficulty understanding, why we still have not passed the Medicare 
prescription drug benefit. I think maybe it could be just that I have 
not been a legislator long enough, I have just been one for 5\1/2\ 
years, having practiced up until my primary in 1996, and on a limited 
basis for maybe a year after that, and I am assuming it is because of 
that background why I do not understand why it is taking us so long, 
why it is taking this body so long to respond to people who need help 
to buy the medication that they need, and who have been asking for this 
benefit for such a long time now.

  Let me tell the Members about how we are trained as physicians. As 
physicians, we are trained in medical diagnoses. We are told to listen 
to our patients, to examine them, and then use our medical knowledge to 
make a diagnosis, and then to again call on that training to prescribe 
the most specific and targeted treatment to the problem.
  That is the model I used for 21 years or more, really. I suspect that 
is why I just do not understand why we are having this problem here on 
Capitol Hill, because Congress would do well, I think, to apply some of 
those very same principles to every problem that we face in terms of 
legislating.
  First, we should listen to our elderly constituents, as on every 
other issue. What we would hear is that they cannot afford to buy a 
full month's supply of medication that they need to control their blood 
pressure, their diabetes, any of the other diseases that need to be 
treated, or to ease pain, that would then allow them to live full lives 
and to attend to even some of the most basic activities of daily 
living. Without those medications, they might not be able to do that. 
That is listening to the patient.
  Then we would examine. When we examine the issue, we would find that 
most Medicare patients are on fixed incomes, and therefore, they have 
to make untenable choices between food and other necessities and 
medication.
  Just to use one example, a widow living on $12,525 a year, and that 
is above the poverty level, I think it is about 150 percent of poverty 
level, a widow at that income level who has acid reflux, which causes 
acid and burning in the esophagus, discomfort, to treat that she would 
have to spend about $1,455 a year. That is 12 percent of that widow's 
income on just one medication alone to treat one illness.
  In making a diagnosis, then, we would conclude that the patient 
obviously needs help to pay for medications so she can stay healthy, 
free of symptoms, and to prevent complications.
  Then, finally, in seeking a remedy, we would choose one easily 
accessible and widely available. We would also weigh the pros and cons 
of that remedy, as in the case of medicine we weigh the benefit and 
need and side effects. To me, that would lead us to concluding that the 
best way to address the issue of helping our seniors pay for their 
medication is through a Medicare drug benefit that is available to 
every beneficiary. It cannot be through an insurance company.
  I know that is what the Republicans want to do is to have the 
vouchers, as the gentleman says, go to the HMO to provide the benefit. 
They do not want to provide a stand-alone benefit for prescriptions. It 
goes completely against their business model, and it

[[Page H2229]]

would result in lower profits. They just will not do it. It would be 
like sending my patient to a drugstore that I know does not carry the 
medication. They just would not get it there, like America's seniors 
will not get the benefit from the Republican prescription drug plan.
  Now I know that there is a big battle also over the cost of the 
benefit provided by Medicare, but I think it is important for all of us 
to recognize that it is too costly for us not to do this, and in the 
not too far distant future. The cost of not providing this benefit, 
helping our seniors to be able to treat these very important illnesses 
that can cause damage to them in the future is just something that we 
just cannot afford to do.
  When seniors, or any patient for that matter, cannot get the 
medications they need for some of the common diseases, they suffer 
amputations, they suffer heart disease, heart attacks, they suffer 
strokes, kidney failure, and become disabled. That costs far more than 
providing a Medicare drug benefit.
  We need to do prevention. We need to put the investment up front to 
save money in the long run, but more importantly, I think we owe our 
seniors as they approach this time in their lives the ability to have a 
healthy, secure quality of life. We need to make sure that they are 
cared for. They have worked hard all of their lives and they have paid 
into a system that was to make health achievable, sustainable, and 
affordable.
  We cannot forget about the disabled, who also need to benefit from 
this, because they also have multiple issues and needs for multiple 
medications that they would not be able to afford.
  The system of Medicare began in a time when we did not have the 
medication we have now, and people did not live as long or as well. We 
know that we have to modernize all other systems. As times change, 
needs change. The ways we meet those needs are going to change. So why, 
then, are we balking at modernizing a Medicare system which is so vital 
to the well-being of our parents, our grandparents, and not too long 
from now for many of us. At least I can speak for myself.

  So I wanted to say, Mr. Speaker, to our colleagues, that we need to 
pass a prescription drug benefit that is available to every Medicare 
beneficiary. That is the very least that we can do. It is certainly 
more important than providing tax cuts, and for this body to pit the 
chance for a better quality of life in what should be the golden years 
in the lives of elderly Americans against tax breaks that really help 
no one should not even be an issue.
  So I would urge us all not to do the political thing but to do the 
right thing, and to give our senior citizens a full prescription 
benefit, the kind that they need and they deserve.
  Mr. PALLONE. Mr. Speaker, I thank the gentlewoman. I just have to 
remark, when she talked about how Members of Congress might have to 
worry about prescription drugs or the Medicare program and she said it 
was only herself, she did not look around at the rest of her 
colleagues, but we also need to be concerned about it, because it will 
impact us as well.
  I just wanted to mention one thing before I yield to the gentlewoman 
from Florida. I appreciate the fact that the gentlewoman from the 
Virgin Islands brought up the preventative aspect, because many times 
we forget that prescription drugs or medication is really a 
preventative measure and that there are huge cost savings, as with any 
preventative type of program.
  I think in general when we look at Medicare as a whole, we have paid 
too little attention to prevention, and whether it is home health care 
as opposed to having to be in a nursing home, or prescription drugs.
  Mrs. CHRISTENSEN. Just take hypertension and diabetes. This is 
something that affects all Americans, but it affects African Americans 
more so because we have more difficulty accessing care and medication.
  If we just take hypertension or diabetes, either one, and the 
complication of end-stage renal disease, and having to then go on 
dialysis or having a kidney transplant, the cost of providing that 
benefit and controlling the blood pressure or controlling the diabetes, 
and at the very least, forestalling that complication, but probably 
avoiding that complication altogether is really important, we just 
cannot compare not only the cost of the two, but we cannot compare the 
quality of life of the two.
  Mr. PALLONE. And the bottom line is, I guess being a little crass 
talking about the money aspect, is that the Federal Government is 
paying. With the way the system is set up, the Federal Government is 
paying for hospital care and paying for a lot of the things.
  Mrs. CHRISTENSEN. They have to pay for dialysis three times a week.
  Mr. PALLONE. And instead, overall, the cost of paying for the 
prescription drugs is actually going to save the Federal Government a 
lot of money. Our problem is that when we make that case, we are not 
necessarily able to give an exact dollar figure. That makes it more 
difficult to make the case.
  But there is no question in my mind that there are tremendous cost 
savings to the Federal Government if we include a prescription drug 
benefit.
  Mrs. CHRISTENSEN. I think it is common sense. I do not think we 
really have to provide specific numbers. I guess someone could probably 
do that for us, but it is just common sense, with years of dialysis and 
many hospitalizations in between, because dialysis is not easy to go 
through, versus providing medication that can control the problem.
  Those of us who practice know how hard it is to make sure your 
patient has a month's supply of all of the medication they need. We try 
to piece samples together and do all kinds of creative things, even 
with medicines that are not extremely expensive, but it is just not 
possible to do that in the long run.
  Mr. PALLONE. It is just so important in the course of the debate on 
this, if we get to it in the next week or two, that we stress that, 
that the preventative aspect of prescription drugs means cost savings. 
There will be some people who will say that the guaranteed benefit 
under Medicare that covers all seniors is going to be too expensive, 
and we need to come back and say you are going to save money.
  Mrs. CHRISTENSEN. The HMOs are not going to provide that type of 
benefit. They have pretty much said that. So as the gentleman has 
pointed out and others have pointed out, to provide it as sort of a 
program that has to be accessible, like access to HMOs, one has to shop 
around and get it. Many seniors cannot even do that. Some can, thank 
God, but not everyone can. But to have to go and search, and then an 
HMO does not offer it, or does not provide that many benefits. So the 
only way to do it is the way the Democrats want to do it, and that is 
through a full Medicare benefit. It is voluntary, but it is universal. 
It is available to everyone on Medicare.

                              {time}  1900

  Mr. PALLONE. Mr. Speaker, I yield to the gentlewoman from Florida 
(Mrs. Thurman) who is, of course, on the Committee on Ways and Means 
and has been a leading spokesman on the needs for prescription drugs 
benefit.
  Mrs. THURMAN. Mr. Speaker, I thank the gentleman from New Jersey (Mr. 
Pallone) for taking the time to organize this and bringing us together. 
His commitment to this is very important. I just want to give you some 
of those numbers that we were just talking about, particularly with end 
stage renal disease, because I know those numbers, and I can tell you 
that for somebody to be on dialysis, it is about $45,000 a year that 
Medicare generally pays for. And then at some point, hopefully, there 
would be the possibility of having a transplant.
  First of all, being on a list probably is anywhere between 3 to 5 
years, so we have now spent several hundreds of thousands of dollars 
doing the dialysis part of it. Probably another hundred to $150,000 for 
the transplant. And then after that, because we passed something in the 
Congress a couple of years ago that actually extended some drug 
benefits for immuno-suppressant drugs, which is something you have to 
have once you have had a transplant or your body will reject it. So the 
fact of the matter is, and that is about $1,500 a month, so you start 
off with the 45,000 in dialysis, you potentially go to 100, 150 a year 
and probably 3, 4, 5 years, and then once you are through that, you are 
probably about $1,500 a month for maintenance of the organ so that your 
body does not reject it, and that is only $11,000.

[[Page H2230]]

  So once again we continue to go back to the idea of, first of all, if 
they had the medicine available to them for the blood pressure, that 
would probably help them or at least extend the lifetime of their 
kidneys. You would not be looking at the long time for dialysis. But 
once you have to go through that, even on the other side of it, it is 
still better in the final analysis to look at the $1,500 that you would 
be using for immuno-suppressant drugs.
  I guess, the gentleman from New Jersey (Mr. Pallone), one of the 
things that has me concerned is that we understand that there 
potentially will be a bill brought to the floor of the House, which is 
a good thing, that might give us the opportunity to debate the issue on 
prescription drugs. I have some concerns because we are hearing rumors 
up here that the legislation may never even come through committee, 
that it is going to be a major Medicare reform bill with a prescription 
drug benefit that will have had no ability to look at the consequence 
with the committee process which, when we are talking about this as to 
which is better, what could be better offering amendments, giving that 
opportunity, making sure that it either goes through the Committee on 
Ways and Means and/or through the Committee on Commerce is a very 
important part of this process. Because the other part that will happen 
is that what we have seen in the past with the Medicare bills, we have 
not even had an opportunity to offer amendments. And if I remember 
correctly, and the gentleman may help me, I do not even know that we 
were offered a substitute.
  Mr. PALLONE. Reclaiming my time to respond, I think the gentlewoman 
makes a very good point. I started out this evening by saying that the 
Republicans are talking about bringing a bill which they have not 
really outlined. They have just given vague ideas of what it might be.
  Mrs. THURMAN. They have a bill.
  Mr. PALLONE. But they are not sure they want to move it or what to do 
with it.
  Mrs. THURMAN. Right.
  Mr. PALLONE. What I think is happening and what we were hearing last 
week, they had a press conference last week and they outlined these 
broad principles which I pointed out earlier are all essentially a 
sham. They talked about that this will be a Medicare benefit, but it is 
not guaranteed to all Medicare beneficiaries, so how is it a Medicare 
benefit? But what we are hearing is they were supposed to bring it 
directly to markup in the two committees, the Committee on Energy and 
Commerce and the Committee on Ways and Means next week, and then to the 
floor before the Memorial Day recess.
  And what you are pointing out, and this is absolutely right, this is 
probably the most important piece of legislation to deal with in this 
Congress. The normal process is to have one day of hearings, usually 
like months of hearing, and then have a markup and allow amendments and 
then go to the floor. I think what you are saying is they may not do 
any of that, they may bring it directly to the floor.
  I think just a couple of days ago, I think Monday in the Congress 
Daily, they pointed out that the headline said ``GOP Drug Plan Faces 
Intra-Party Critics.'' The problem is that a lot of Republicans who are 
more reasonable and are really concerned about what this is going to 
mean have been suggesting to them that, A, that this prescription drug 
plan is not going to help that many seniors or that, B, the Medicare 
reform is really cutting back on payments for hospitals or others that 
have a great need.
  Mrs. THURMAN. Nurses.
  Mr. PALLONE. The gentlewoman is right. They may not be able to muster 
the votes in committee and they may just take it directly to the floor, 
which is a huge travesty because there will be no debate other than on 
the floor, which is not the way it is supposed to be.
  Mrs. THURMAN. And that is a concern because there needs to be a 
debate. We need to understand the cost. We need to understand the 
consequence of whatever we bring to the floor. We need to understand if 
there is a market product out there for us. I mean, one of the problems 
that we have heard over and over again is if you turn this over to 
private insurance that there may not even be a tier. It may be, oh, 
well, here we go. We have got a prescription drug plan, but it is 
probably not going to start until a little bit later. And by the time 
people figure it out, the fact of the matter is there may not be an 
insurance company that is willing to provide that service without 
having other areas.
  They talk about the Federal health plan. Well, the difference is that 
is a whole package. We get young, we get middle, and we get older. We 
get new Federal employees. We get retired Federal employees. And the 
idea is that you spread it. You have a spread over this and that is not 
what is going to happen in a Medicare or what may be considered in a 
private insurance. You are going to have one group of folks who are, by 
the way, in most cases, the seniors with the least ability to pay, 
which is a fine goal, but they are also sometimes the sickest because 
they have not had the advantages, as the doctor was pointing out, of 
being able to have taken care of health care. So their medicines, 
probably because they have more complicated cases, are going to be more 
expensive. And so when you start trying to use a voucher in a system 
where you have very sick and not a cross risk, it is going to be very 
expensive for an insurance company or anybody to go in and try to 
negotiate for this particular group of seniors.
  Mr. PALLONE. Reclaiming my time, I think the gentlewoman is 
absolutely right. If you remember, two years ago, again, close to the 
election when the Republican leadership tried to bring up a bill, and 
that is what it basically was, that we are going to give money to 
insurance companies and hope that they will cover prescription drugs 
and you can shop around and see if they will cover you. That only 
passed the House and it died. But it was based at the time on a model 
that was used in the State of Nevada, and Nevada, which had a 
Republican legislature and I think a Republican governor, decided to go 
this route. And for 6 months after the governor signed it, they could 
not find any insurance company that would cover anybody. So 6 months 
from the day it was in effect, there was nothing out there for people 
to buy. And then they think what they did is they tried to get one 
company to cover it and even then they could not get anybody. So the 
whole thing is a huge mess and not working.
  Mrs. THURMAN. And we could say the gentlewoman from Nevada (Ms. 
Berkley) has given us a wonderful opportunity to understand what 
happened in Nevada. And it would seem to me that it would be something 
this Congress ought to be looking at where the pitfalls were what 
happened. I mean, correcting and not trying to pass a model that has 
already failed in one State.
  Mr. PALLONE. Mr. Speaker, I think they have made certain changes, and 
I do not know what the status is now. But the one thing I was going to 
say is that part of this is just sort of an ideological problem that 
the Republican leadership has. In other words, they did not like 
Medicare. Most of the Republicans voted against Medicare in the 1960s 
or whenever it started. And it was for ideological reasons because it 
was a government-run program. And I think that is what you are getting.

  The Republican leadership just cannot accept the fact that Medicare 
works and we should add this benefit. They think it is too much 
government interference, so they are trying to send it out to the 
private sector from an ideological perspective.
  The gentlewoman was pointing out, and everybody is pointing out, let 
us look at this practically. Let us not say this is left wing or right 
wing or whatever it is. Medicare works. This is not going to work, what 
they are proposing.
  Mr. Speaker, I yield to the gentlewoman.
  Mrs. THURMAN. And I think there were some issues out here also that 
are very alarming and very concerning and certainly ones that, I think, 
based on the constituency in the Fifth District in talking with them, 
that they were seeing high increases in their prescription drugs today. 
I mean, we know for a fact that they grew almost by 17 percent this 
year. We are not seeing anything in this piece of legislation that 
speaks to the high cost of prescription drugs. And so they understand 
that because they have constantly, and it is

[[Page H2231]]

not just in the Fifth District of Florida. I mean, they get this. They 
understand that they are paying way more than other countries, Canada, 
the borders of Canada, we know what is happening over there. We know 
the busloads of people that are going to Canada to pick up their 
prescription drugs. We know they are out on the Internet to the 
Canadian Drug Store I think is the name of the sites. Mexico, people 
are sending overseas for these medicines, not because they do not want 
to be able to purchase them here, but when they are taking two or three 
medicines and they are costing 3 to $400 with one supply being 150 and 
another being 200 and another maybe 50, they cannot afford it. And they 
understand that they feel better on an everyday basis when they have 
that medicine being taken as the doctor has prescribed it, and they 
understand that they are not having complications with their health 
when they are able to take this. But at some point they just say I 
cannot do this. I cannot afford to continue to do this.
  The gentleman and I have talked about this a thousand times, the 
amount of people that come into our offices, and they talk about 
cutting their pills in half, they talk about taking them one every 
three days or one every two days as versus every day, or they may take 
one a day instead of three a day just for that. But then you also hear, 
because it is sometimes just not one person in that family that is on 
medications, it is two.
  I actually get stories, I had a daughter write to me about her 
parents, telling me how important having a Medicare prescription drug 
benefit was. She was watching her mother not get her medicines to make 
sure that her husband, the daughter's father, who had more 
complications, had his medicines so she could keep him alive. I mean, 
that was the sacrifice that she was making in her mind that was 
important. To the daughter it was a travesty. She was watching her 
parents literally have to choose, one being just able to sustain their 
lives because of medicines because they could not afford it all, or to 
choose that one could not have that same advantage. And I am not seeing 
anything in any of these pieces of legislation. In fact, quite the 
contrary in some ways. We are not seeing the ability for any concerns 
about the rising cost.
  Now, in saying that, let me also suggest for a moment that this is 
not just Medicare at this point. The rising cost issue is a family 
issue. It is a business issue. We have corporate citizens in this 
country that are trying their level best to provide health care 
benefits to their employees. They want to do it. They think it is the 
right thing.

                              {time}  1915

  Two things are happening. GM came in the other day to testify before 
the committee. They said that their Medicare or their prescription drug 
bill went up $508 million last year. How do they continue to offer good 
benefits with a prescription drug without cutting other benefits in 
their plan so that they can continue to offer a prescription drug?
  Well, one of the pharmaceutical companies was there and said, well, 
there are ways to do that. They can negotiate, they can look at 
utilization, they can provide copayments, they can do different things. 
And when we asked GM what they were doing, they said, We are already 
doing those things. We are doing the things that we feel are what they 
have told us would be good business practices.
  Well, there really was not an answer to the question then to the 
company when we said, so, if they are doing all of these things, then 
what is the answer? They had no answer, and so there are issues out 
there.
  AARP just did an article a couple of months ago talking about the 
costs, what was included in this cost. It was the advertising, and I 
would maybe not even call it advertising, but a marketing tool, that 
they called research. It is called research but it is research 
marketing, marketing research. So they know what they can sell to, what 
they can do; and so they use that as kind of their shield.
  What were the numbers we heard? I do not know if my colleague heard, 
it is about, what, Pepsi-Cola versus, I guess I do not know if I can 
talk about brand names, but the idea is that there are companies that 
are spending 10, $20 million less in a year than one company maybe on a 
couple of different medicines.
  Mr. PALLONE. Mr. Speaker, reclaiming my time, this came up in the 
other body, I cannot mention the name of the other body, other side of 
the Capitol and the point was, as my colleague knows, is the drug 
companies, the brand-name drug companies always say that they need to 
charge more because of research and development, when in reality what 
we know is a lot of the extra cost is just for advertising so that they 
can advertise the name-brand drug rather than the generic drug; and one 
of the ways that they could reduce costs is if they tried to encourage 
more use of generics, obviously; or I think in the Senate there was a 
proposal, which I think is a great idea, to say that that someone 
cannot take a tax deduction for advertising. In other words, someone 
can take a tax deduction for money they expend on research and 
development, but not for advertising.
  We, essentially, through the Tax Code, I am talking to a Ways and 
Means member now so I want to be careful here, but essentially 
encourage through the Tax Code that they advertise as much as they like 
because they get some sort of credit or deduction for it. I do not know 
exactly how it works.
  I wanted to say, if I could, to comment on what the gentlewoman 
talked about when she talked about the costs and the pricing because I 
started out tonight saying that the biggest sort of sham out here is 
that when the President about a year ago talked about promoting the 
discount card, which a lot of the drug companies are now offering, he 
talked about that as sort of an interim measure. In other words, we 
have not got a prescription drug program now, so until we do, until 
Congress passes it, let us promote this discount card because at least 
there will be some savings, which I questioned, but in case it is not 
the government helping in any way, this is what the drug companies are 
doing.
  Now, when the Republicans unveiled their sort of principles last 
week, the card became their cost-containment mechanism, which is 
ridiculous because the government is not doing anything; and then as my 
colleague says, the Republicans act as if there is no way they can 
influence the price. That is nonsense.
  If we set up the guaranteed benefit under Medicare, we now have 40 
million seniors, and the Secretary of Health and Human Services has an 
incredible bargaining, negotiating ability because he represents those 
40 million seniors, and he can certainly take actions that would result 
in lower prices.
  Mrs. THURMAN. That is exactly right, and this is not a model that 
quite frankly is obscure in this government. It is going on.
  We are seeing it within the VA system. The VA system, in fact, does 
just that. They negotiate for military retirees and veterans for the 
purposes of buying medicines. We do it. We already do it, and it works; 
and because of it, we have been able to really expand. And for military 
retirees, they now have a prescription drug benefit that costs them $3 
for a generic, $9 for a brand name a month or they can do a mail order, 
which would be for a 3-month period, $3 for generic and $9 for brand 
name over a 3-month period.
  So there are very good things going on and standards that have 
already been set by the Federal Government for some parts. Then if we 
thought about it, if then we are negotiating for, I think it is, 
something like 22, 25 million veterans, plus 40 million Medicare, we 
now have a very good possibility of looking at some things that could 
happen or we can do, I think, what the gentleman from Maine (Mr. Allen) 
has talked about, certainly looking at what the costs are in other 
countries, and at least making it so those costs were no different here 
than they were there, whether it be Canada, Mexico, UK, whatever, 
having that a possibility out there.

  There are just things, but it kind of goes back to what we talked 
about. We are not having a debate. I think what is so frustrating about 
this is everyone in this House, to my knowledge, probably went home and 
talked about a prescription drug benefit in the last campaign. They 
said this is something that was needed. So we can have the

[[Page H2232]]

debate with our constituents at home as to what is good and right and 
the kinds of ideas.
  Our constituents have so much to offer us in this debate. Then why 
can we not we have a real debate in the Congress?
  It may not be that we are so far apart in some of these ideas. The 
first premise is we agree that there should be a prescription drug 
benefit. It is how we get into the details of it.
  So why can we not sit down and get out ideas of how things should be 
one way or another? Throw everything on the table, set it down, come 
in, see what is working, looking at what is happening in other parts of 
government, where we are successful; where we are successful in the 
private sector; where we are successful with Federal employees; where 
are we doing the right things; where are the areas that are not 
successful. Look at those. What is happening? Go in and talk to some of 
these corporations that are trying to negotiate and are trying to do 
the right things to make sure that they have a prescription drug 
benefit for their employees.
  They are experiencing right now what we need to be addressing, and I 
am just very frustrated that we may not even have the opportunity to 
have this debate, that it may be we come out here, no work in the 
committee. We come down to the floor, we have an hour debate on the 
rule and an hour debate on the bill, maybe 2 hours, that is a Medicare 
bill, that quite frankly will probably talk about prescription drugs. 
We will not even get the opportunity to really talk about what 
potentially happens at nursing homes, what kind of cuts are happening 
with hospitals, if there is going to be some kind of a copayment for 
home health care. We are going to hear prescription drugs, and we are 
not even going to give a full debate and disclosure of what is going to 
be in other parts of this piece of legislation.
  These are critical issues that are devastating and potentially could 
be devastating to the infrastructure of our seniors in this country. 
They deserve a strong and lively debate and being able to point out 
where we think there are pitfalls, where the issues are; and we ought 
to be able to have that opportunity.
  Mr. PALLONE. I agree, and I am very fearful about what the 
gentlewoman says, which is that essentially with what the Republican 
leadership is doing here, they just want to bring up a bill so they can 
say they passed something, send it over to the other body and have it 
die.
  Mrs. THURMAN. Just to say that the Senate has it.
  Mr. PALLONE. I think that is what we are headed for. Hopefully, we 
are wrong and maybe we are too cynical and we can be optimistic. I have 
the same fear my colleague does.
  Mrs. THURMAN. Mr. Speaker, the only thing I would say then is maybe 
us being here tonight and talking about this issue, maybe it will give 
some pause; and maybe we will have the opportunity to have that debate.
  Mr. PALLONE. I hope so. I am eternally the optimist, as I know my 
colleague is, too.
  Let me yield to the gentleman from Illinois (Mr. Phelps).
  Mr. PHELPS. Mr. Speaker, I first thank both of my colleagues for 
giving me the opportunity to speak on what I believe is one of the most 
important issues facing our Nation today. The time has certainly come 
for us to implement a real prescription drug plan for seniors.
  Let me talk a little bit about, on a personal note, a couple I know 
and their experience. John and Ann Craig are residents of a little town 
called Muddy, Illinois, just a neighboring town out of my hometown in 
southern Illinois, Eldorado. The Craigs suffer from a combination of 
diseases, including diabetes, heart disease, and high blood pressure. 
His medication runs around $450 each month. They pay a total of $1,300 
a month for prescription drugs and receive a mere $700 in Social 
Security.
  The Craigs own a small farm where they have worked hard most of their 
lives. However, their overwhelming pharmacy bills have effectively 
ruined any chance of worry-free retirement because most of their 
savings has already been used on medication. This is just one example 
of the unnecessary hardships our citizens are facing due to overpriced 
prescription drugs.

  There are many examples of other senior citizens I can give my 
colleague.
  The issue of an affordable prescription drug plan for seniors is not 
just going to go away, and folks like John and Ann Craig are going to 
continue to spend their life savings on medication. Our citizens are 
depending on us to work together to come up with a plan that will bring 
them prescription drugs at a price they can afford and a price that 
does not take a large chunk out of their monthly budget that would 
normally be spent on food and other necessities.
  So we need a plan that is fairly easy and will benefit all seniors. 
Our Nation's seniors have enough to worry about without having to 
figure out where they fit into a complicated prescription drug plan.
  We have a moral and ethical responsibility to look out for our 
seniors, and we must implement a plan that will benefit each and every 
senior that is paying ridiculous prices for their necessary 
medications. It is time that we get together and work on a plan that is 
reasonable and a bipartisan approach. Stop pointing fingers and let us 
try to get it down to what is real for Americans like John and Ann 
Craig.
  Mr. PALLONE. Mr. Speaker, I want to thank my colleague from Illinois 
for joining us. I know we only have a few minutes left.
  I just wanted to, in ending this Special Order tonight, if I could 
just develop a little bit one of the points that he made.
  Part of the reason why the Democratic proposal and what the Democrats 
have been talking about tonight is so much better than what the 
Republicans have been proposing is because of its simplicity. We know 
that right now under the existing Medicare program it is very easy for 
the average senior to sign up, be part of the program and benefit from 
the program.
  All seniors and even the disabled who are under 65 that are eligible 
for Medicare know that their hospitalization is covered. They know that 
if they pay a premium, I think it is about $40 a month for part B to 
cover their doctor bills, that they will have a guaranteed benefit and 
that the Federal Government will pay 80 percent of the cost of their 
doctor bills, and that if they are in a traditional fee-for-service 
plan, rather than an HMO, which most seniors are still in the 
traditional Medicare fee-for-service program, that they can go to any 
doctor, they can go to any hospital and Medicare is going to cover it.
  What we are saying as Democrats is we want to build on that very 
successful Medicare model which is very easy for seniors to understand 
and take advantage of and say if someone pays a premium of say 25, $30 
a month for their prescription drugs, then they will be guaranteed a 
generous portion of that; say, maybe 80 percent or so is going to be 
covered by the Federal Government.

                              {time}  1930

  And that after your first $100 deductible you can be guaranteed that 
your prescription drugs are going to be paid for in that way. Very 
simple model. It is the existing Medicare program; builds on it. Forget 
the ideology, just do it. That is what the Democrats are saying. Do it 
for every senior; everyone who is eligible for Medicare.
  Now, my colleague from Illinois said, well, the seniors are concerned 
about not wanting to have to do some complicated plan. Well, that is 
what the Republicans are saying. They are saying forget the Medicare 
model, we are going to throw some money somehow to some insurance 
companies and we are hoping that the insurance companies will provide 
some sort of benefit, but we are not guaranteeing they are going to 
cover all drugs or any particular kinds of drugs. We are not 
guaranteeing there will be any kind of particular premium structure or 
what the level of the Federal Government's contribution is going to be.
  And the seniors are supposed to shop around. These seniors, who are 
now 70, 80 years old, and they are supposed to shop around to see if 
there is some kind of insurance program that they can get. Now, I know 
some seniors are going to be able to do that, but I would say there are 
a lot that are not going to be able to, and are going to find when they 
are shopping that they do not find a plan that is even available.

[[Page H2233]]

  I know my Republican colleagues will say, well, they can always go to 
an HMO. But remember that HMOs increasingly are not available in a lot 
of parts of the country, and more and more HMOs are dropping seniors 
and do not want to offer to senior citizens. So the complication that 
my colleague from Illinois talks about for seniors, that complication 
is multiplied so much by what the Republicans seem to be proposing.
  And the real answer is to go back to the very simple program, the 
model that we have now that has worked so successfully for the last 30 
years, and that is Medicare. That is all that the Democrats are asking 
for. And, hopefully, if this does come up in the next week or two, we 
can make that point about why a guaranteed Medicare plan is so superior 
to whatever proposal the Republican leadership is bringing up.
  I guess I would just conclude by saying as much as I do not like to 
be cynical, I believe that the Republican proposal really is nothing 
more than an effort to show that they are doing something and that they 
fully understand that their proposal is not going to go anywhere and 
will never be enacted into law. So that is a shame, too, to think they 
are being very cynical and bringing this up as we get close to the 
election, rather than trying to put something together on a bipartisan 
basis that actually can be signed into law.

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