[Congressional Record Volume 148, Number 96 (Tuesday, July 16, 2002)]
[Senate]
[Pages S6856-S6858]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                       21ST CENTURY MEDICARE ACT

  Mr. GRASSLEY. Madam President, Medicare has not kept pace with the

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improvements in health care since its inception in 1965. It was a plan 
that was put together based on the practice of medicine in 1965, which 
you might expect to be natural for any program written at that 
particular time. At that particular time, the practice of medicine was 
to put almost anybody in the hospital who had anything very serious 
wrong with them. Today, the practice of medicine is to keep people out 
of the hospital environment as much as we can. Prescription drugs are 
very much a part of the medical plan to keep people out of hospitals.
  Back in 1965, the cost of prescription drugs as part of the total 
cost of medicine was about 1 percent. Today the practice of medicine 
and the cost of medicine related to the total practice of medicine is 
about 10, 11 percent. So quite obviously, if Medicare is to be brought 
into the 21st century, we have to modernize it by including a 
prescription drug program for everybody, not just like it has been, 
prescription drugs for people who are in the hospital, but once you 
leave the hospital, no prescription drugs.
  We have assumed a responsibility, some of us. I think maybe all 100 
Senators agree on this issue, although they may not agree on how to do 
it, but we have all come to the conclusion that if you are going to 
strengthen and improve Medicare for the 21st century, Medicare must 
include a prescription drug program.
  Several of us in this body--Senators Breaux, Jeffords, Snowe, and 
Hatch, and this Senator--have introduced a plan that we call the 21st 
Century Medicare Act. To cite the most obvious example of Medicare 
being outdated, many conditions that used to be treated in the hospital 
are now treated with prescription drugs. For that reason, employer-
sponsored health plans have changed with the times since 1965 and now 
cover prescription drugs. But Medicare does not cover prescription 
drugs outside of the hospital environment.
  Imagine that private health insurance for a long period of time has 
been including prescription drugs, but the Government-run Medicare 
Program is still back there in the 1960s, not covering prescription 
drugs.
  There is another example of the outdated Medicare Program. The 
practice of medicine has evolved to focus on preventive benefits, since 
everyone knows that an ounce of prevention is worth a pound of cure. 
For this reason, many private health plans have eliminated cost sharing 
for preventive benefits. But the 1960s Medicare plan, run by the 
Government, has not covered preventive medicine in the same way that 
private health plans have by eliminating cost sharing. We still have 
cost sharing in the 1960 plan.
  We ought to have Medicare come into the 21st century from the 
standpoint of eliminating cost sharing for preventive benefits in order 
to make sure that we emphasize an ounce of prevention weighed against a 
pound of cure.
  There is a third example of Medicare being out of step. For those of 
us with employer-sponsored coverage--and Members of the Senate would 
fall into that category--these programs provide a limit on how much we 
will have to spend out of pocket if we become seriously ill. Yet the 
1965 brand of Government-run health program, Medicare, offers no such 
protection for our senior citizens.
  I will give three examples of the 1960-era, Government-run Medicare 
plan that does not give seniors adequate protection. Most important 
among all those is not having a prescription drug program.

  I could go on and on, but I would rather focus on the good news. 
There is a compromise that can be enacted into law this year so that we 
can finally get to the business of bringing Medicare into the 21st 
century; in other words, to have a Government-run Medicare Program for 
seniors that parallels the practice of medicine in the 21st century.
  This compromise, once again, is the only bipartisan compromise inside 
the beltway or outside the beltway. It is offered by Senators Breaux, 
Snowe, Jeffords, Hatch, and this Senator.
  I emphasize the importance of bipartisanship. Nothing can get through 
the Senate that is strictly Republican or strictly Democrat. The Senate 
was meant to function for the last 214 years based on the proposition 
that minority points of view would be protected and considered. 
Consequently, with no limit on debate, with efforts of people to stymie 
the process, it is very essential that we work from day 1, if you want 
to get anything done, in a bipartisan way to craft a bill.
  The five of us didn't just decide to do this. We started last summer 
to work on a prescription drug bill that could garner bipartisan 
support. We even announced about a year ago some basic principles, very 
broad principles, but we immediately got to work on filling in details. 
We had most of the details filled in back in March--not everything 
specific, but pretty much the principles and the details filled in.
  I suppose people are asking: Why just now has this bill been 
introduced? We have even had some of the legislative language written a 
while ago.
  Well, the reason we couldn't present our colleagues in the Senate 
this bipartisan approach was because we had to wait for the 
Congressional Budget Office to do the scoring and also, based upon 
preliminary scoring, some fine tuning on our part. It was just over the 
weekend that we, after we did our final fine tuning, got the final 
figures so that the bill could be put before the people of the country 
yesterday.
  I want to mention bipartisan because obviously the President--there 
is one person there, one party--when he puts forth a proposal, it is 
partisan. There is a House Republican proposal that was passed. That is 
obviously a partisan proposal. There was a House Democrat alternative. 
It was obviously a partisan proposal. And there is a Senate Democrat 
proposal that is obviously partisan. There is no Republican proposal, 
something that represents the point of view of just Republicans in the 
Senate. But there is this bipartisan plan put together by Senators 
Breaux, Snowe, Jeffords, Hatch, and myself that is the only bipartisan 
plan, and not hastily put together, as 1 year of work on it indicates.
  Consequently, it seems to me that if the Senate majority leader had 
allowed the Senate Finance Committee, which has jurisdiction, to work 
its will--and there is a majority of the Senate Finance Committee that 
is backing this proposal--we would have something out here for the 
Senate to consider, a bipartisan proposal.
  That doesn't prove it would get 60 votes, but it has to be further 
down the road to accomplishing that very important goal than any of the 
proposals here in Washington, DC. Any coverage will have to be a 
compromise, a beginning. It is not something perfect.
  I applaud Senator Baucus for seeking a reasonable compromise that can 
pass the Finance Committee. He has held a lot of rump sessions to 
discuss these things and understand them. But we have not had the 
opportunity to have the formal session to actually debate and amend and 
vote out a compromise. So after working on this for over a year, I can 
say this bill is that compromise. This level of total spending--$350 
billion--is the level that can gain a majority of the votes in the 
Senate Finance Committee. In moving it up some to satisfy some people, 
or moving it down to a lower figure to satisfy some other people, it 
begins to lose votes from the high end or from the low end.
  Nobody, including me, considers this a perfect plan, but it is the 
only deal that can be struck, and it is the only bipartisan proposal in 
Washington, DC. I urge Senator Daschle to allow the Finance Committee 
to work on my bill. Let any Senator, in a free exchange and 
consideration in the Senate Finance Committee, offer amendments. That 
is the only way to have a product that can get 60 votes.
  As I have already written to Senator Daschle, to bypass the Senate 
Finance Committee when it can put out a bipartisan project is probably 
to kill any chance of a drug bill, and I hope he will reconsider.
  Let me be very candid. Drug spending by the senior population is 
exploding. The cost between the bill a year ago, when we started, until 
now--as I said, it evolved over 12 months--has gone up $70 billion, but 
not because we as Senators working on this bipartisan compromise 
decided we wanted to spend $70 billion more, no; that is the way the 
drug market is today. So if Senator Daschle wants an issue instead of a 
program for seniors, then we come back next year, and it doesn't matter 
who controls the Senate. We will come

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back next year and we are going to spend another $70 billion to $100 
billion more. Why don't we decide to put that money into the program 
and save it by adopting something right now, when we know, based upon 
the projections of prescription drugs, what is going to happen.
  Let me suggest to you that the passage of strong legislation is going 
to be a damper on those exploding drug prices. So we have an 
opportunity and, if we miss it, it is going to cost Medicare a 
tremendous amount of money. Maybe $100 billion is a little bit high, 
but $70 billion to $80 billion to $90 billion would not be out of the 
realm of possibility. And we should also do it now so that baby boomers 
who have these good corporate plans they want to retire on are not 
shocked with a big difference between what 1965 Medicare is and what 
they have. They won't have to go through that if we have this 
bipartisan plan that gives seniors an option of having a new and 
improved and strengthened Medicare plan that is much closer to what 
they have now in the world of work.
  The baby boomers are going to start to retire in only 8 years. So a 
new drug benefit could be incredibly expensive and could even put the 
existing Medicare Program at risk. In light of these facts, the truth 
is that we cannot afford an extravagant benefit. If we get to work and 
get it done now, it is not going to be so expensive.
  The other main component of the bill that I have already made some 
reference to is a new, enhanced Medicare option, and it is not 
something seniors have to take if they don't want to. If they want to 
keep what they have right now, they can keep it, but if they want 
something a little closer to what they have in the private sector, they 
will have that available.

  I talked about Medicare or a prescription drug program, but there is 
a new and enhanced Medicare option that reflects 21st century health 
care. The enhanced option removes all cost sharing on preventive 
benefits. Just think. If somebody under the present Medicare has an 
opportunity to take a prostate cancer test, and they have a 20-percent 
copay, and they, say: ``I just cannot afford it,'' or ``I don't want to 
pay that copay,'' you are going to discourage that person from taking 
that test. And one out of three men might need an operation to catch it 
ahead of time so that cancer hasn't spread. No copay. That is more apt 
to be. That is an ounce of prevention worth a pound of cure. It brings 
Medicare into the 21st century. It adds protection against devastating 
costs due to serious illness. It features a single deductible of $300 
and a rational cost sharing rather than the irrational cost sharing in 
the existing fee-for-service system. It offers new, cheaper Medigap 
options. And with the improved coverage, beneficiaries might decide 
they don't need to buy Medigap at all.
  This would create a tremendous savings for them and, potentially, for 
Medicare. The enhanced options resemble what beneficiaries had when 
they were still working, and they might decide to take it. But this is 
all entirely voluntary. We don't say to a single senior citizen in 
America that they have to do this. It is their choice. If they like 
what they already have, what has been on the books since 1965, they can 
have it.
  The cost of our reform provisions--this new and improved and enhanced 
Medicare--is only $30 billion over 10 years.
  Now, the AARP held a news conference today. Everyone around here 
knows that Senator Daschle's partisan approach cannot lead to 60 votes 
and can only lead to deadlock. Failure is not acceptable to the people 
of Iowa and it is not acceptable to me.
  Let me comment on the substance of my bill, the 21st Century Medicare 
Act. The drug benefit we offer is a voluntary benefit with affordable 
premiums of $24 a month. Unlike some proposals, it will provide drugs 
in a cost-effective manner, which is crucial. It will protect all 
seniors with drug costs, with special protections for low-income 
beneficiaries and those who incur very high costs. By law, at least two 
plans will be available everywhere in America, including rural areas, 
which is so important to me.
  The Congressional Budget Office tells me that virtually all 
beneficiaries will find this drug benefit a good deal and will elect to 
take it. In fact, when you hear people demanding that ``Cadillac'' drug 
coverage be added to Medicare, what that tells you is that person 
doesn't really want legislation to pass. They just want an issue on 
which to campaign.

  I have been very surprised and somewhat disappointed at the recent 
activity of the AARP on this issue. They ran ads this past weekend and 
they held a news conference today supporting the bill that Senator 
Daschle, we are told, plans to bring to the floor. In the same breath, 
they say they want a drug benefit that is permanent. They should make 
up their minds because Senator Daschle's bill is not permanent. That is 
because making it permanent would reveal how unaffordable it is. It is 
difficult to understand why they are sowing such confusion on the 
issue. Do they believe we should sunset the Medicare Program as a 
whole, as that bill does? I do not think we are going to sunset senior 
citizens. When the prescription drug program ends in 2009 or 2010, do 
they think the senior citizens of America are not going to need 
prescription drugs the next day? I hope AARP's members will tell 
Senator Daschle that is quite ludicrous, and they would be right.
  Believe it or not, my bill--I should not say ``my bill'' because I 
have never had the pleasure of working with so many politically 
different people as Senator Hatch, Senator Snowe, Senator Breaux, 
Senator Jeffords, and myself--I am different, too. Over the course of a 
year, we had give and take by people with so many different political 
philosophies, bringing us to where we are with this bill. So many times 
along the way we thought everything would fall apart, but we would come 
back together because people of good will working together can get 
things done.
  That same good will is on the Senate Finance Committee if we just 
have an opportunity to work the will of the committee. But we have 
produced a product--and I said I am embarrassed it was this Monday; it 
could just as well have been May 1, but we just could not get the 
Congressional Budget Office to score the bill. Maybe it is legitimate. 
It is a whole new Government program. They had to take into 
consideration putting people on board. I suppose CBO had to do a lot of 
education of their own staff. All I can say is, it is here, and it is 
not here too late.
  Believe it or not, this bill is the only true bipartisan bill in all 
of Washington, DC, to add a drug benefit to Medicare. If ever there was 
an issue where true bipartisanship was needed, it is in this bill, it 
is needed beyond the authors of this bill to the entire body, and we 
can get something done this year rather than wait next year to spend 
another $100 billion more with the costs rising.
  In short, the bipartisan 21st Century Medicare Act is the reasonable, 
pragmatic approach that can work even in an election year if Senator 
Daschle wants us to do it.
  I thank the Chair.
  The PRESIDING OFFICER (Mr. Dayton). The Senator from Nevada.
  Mr. REID. Mr. President, I will be brief. The Senator from Utah has 
been waiting for some time. I am not going to talk long in this regard, 
but I say to my friend from Iowa, for whom I have the deepest respect--
I consider him a friend and a fine Senator--that AARP supports Graham-
Miller because it is good legislation. I do not think anyone could ever 
consider the AARP as some wild-like liberal group. They are very 
careful with the legislation they sign on to.
  I also say to my friend from Iowa, it is too bad we had not been able 
to start debating his amendment and other amendments earlier. Every 
time we bring a bill up, we have to fight to get it on the floor, but 
we are going to continue to do that. As on the other bills I listed 
earlier today which we had to fight to pass, we are going to work hard 
on this bill. We are going to pass prescription drug legislation 
because it is necessary we do that.

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