[Congressional Record Volume 148, Number 106 (Tuesday, July 30, 2002)]
[Senate]
[Pages S7545-S7551]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




            UNANIMOUS CONSENT AGREEMENT--EXECUTIVE CALENDAR

  Mr. DASCHLE. Mr. President, as in executive session, I ask unanimous 
consent that later today when the Senate considers the nomination of D. 
Brooks Smith to be a U.S. circuit court judge, there be a time 
limitation for debate of 4 hours equally divided between the chairman 
and ranking member of the Judiciary Committee; that at the conclusion 
or yielding back of the time, the Senate return to legislative session; 
that following the vote on final passage of S. 812, the Senate return 
to executive session and vote on confirmation of the nomination; that 
the motion to reconsider be laid on the table; the President be 
immediately notified of the Senate's action; and the Senate return to 
legislative session; and that the preceding all occur without any 
intervening action or debate.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. DASCHLE. Mr. President, it is also then my intention to invoke 
the authority given Senator Lott and I last week with regard to DOD. It 
would be my intention to move immediately to the DOD appropriations 
bill, and we will seek a time agreement on that, perhaps sometime 
tomorrow morning. Let me thank all of our colleagues for their 
cooperation and I certainly thank the distinguished Republican leader.
  Again, let me outline the schedule, as a result of these unanimous 
consent agreements, tonight and tomorrow.

[[Page S7546]]

  We are now in a position to move shortly to the nomination of D. 
Brooks Smith. There is a 4-hour time agreement that has been allocated 
to that debate. We will then resume consideration of the Graham 
amendment tomorrow morning at 9:30. The debate will last an hour and a 
half. It is equally divided. There will be a vote on the Graham 
amendment, a vote on the Dorgan amendment, as amended, and a vote on 
final passage, to be followed by a vote then on the judicial 
nomination.
  I would then move to the DOD appropriations bill, in consultation 
with the distinguished Republican leader. I should also note that it is 
my intention to call up the fast-track conference report, and we will, 
if necessary, file cloture on that motion as well.
  Senators should be prepared, if necessary, to be on the floor to 
accommodate that desire as well.
  I yield the floor.
  The PRESIDING OFFICER. The Republican leader.
  Mr. LOTT. Mr. President, for a couple of clarifications, first of 
all, with regard to the trade promotion authority, from what I believe 
the majority leader was saying, it would be his intent to call it up 
tonight and, if there is objection, you would file cloture on the trade 
promotion authority bill; is that correct?
  Mr. DASCHLE. Mr. President, that is correct. I have been informed 
that there are those who will object, so it is unlikely that we would 
be able to complete our work on the trade promotion authority 
conference report tonight. Expecting that, I would intend then to file 
cloture on the conference report itself.
  Mr. LOTT. Mr. President, continuing, I would like to get a 
clarification because I believe the Senator indicated that after the 
Dorgan amendment was agreed to, then the Senate would vote immediately 
on cloture on the underlying generic drug bill, and only if cloture is 
invoked would you then go to final passage. If cloture is defeated, of 
course, then that issue would still be pending.
  Mr. DASCHLE. The Senator is correct. I anticipate that we would get 
cloture. If we don't, of course, we will stay on the bill for whatever 
length of time it takes and be unable to complete our schedule as it 
has been announced.
  Obviously, cloture on the motion to proceed to a conference report is 
not necessary. This would actually be cloture on the conference report 
itself with regard to the trade promotion authority.
  Mr. LOTT. Mr. President, for those who are following this, I 
emphasize that nobody has given up any position here or lost any 
rights. We are trying to set up a process so Senators would know what 
is going to be the business for the rest of the evening and what would 
be the sequence of votes tomorrow.
  Tonight, we will have the debate on the nomination of D. Brooks Smith 
for the Sixth Circuit. I thank Senator Daschle for going forward with 
it. Time is required for the debate, and that can occur tonight. The 
vote will be tomorrow in the stacked sequence along with votes on the 
Graham-Smith alternative and then on cloture on the underlying bill.
  Depending what happens, we would go to the Department of Defense 
appropriations bill, which we have made a commitment to complete this 
week. We will try to get a reasonable time agreement on that. We would 
have the trade bill following, too. This is a large agenda to 
accomplish. This agreement is to try to put into place when the votes 
will occur.
  Mr. DASCHLE. Mr. President, again, the distinguished Republican 
leader is correct. Because the motion to proceed to the conference 
report on trade promotion authority is subject to a vote, I announce 
that that vote will take place at 6:15 this evening. That will be the 
last vote of the day.
  We will accommodate Senators who have already expected to speak on 
the pending legislation, and the 6:15 vote will accommodate all 
Senators who have come to the floor with an expectation of being 
recognized.
  I yield to the assistant Democratic leader.
  Mr. REID. Is it the intention of the majority leader, when we 
complete that vote, that we would go to the judicial nomination at that 
time, and then the 4 hours will start on or about that time?
  Mr. DASCHLE. The Senator is correct. We would start debate at 
approximately 6:45 on Mr. Smith. Senators should be here. The debate 
will be completed tonight. It is a 4-hour debate. So Senators will have 
ample opportunity to come to the floor and express themselves. It must 
be done tonight. There will be no time tomorrow.
  Mr. President, I ask unanimous consent that, within that 45-minute 
time block that has now been designated for debate prior to the vote at 
6:15, Senator Kennedy be accorded 10 minutes of that time.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The Senator from New Mexico is recognized.
  Mr. BINGAMAN. Mr. President, we are well past the time when the 39 
million older Americans and disabled citizens should be receiving 
affordable, comprehensive, and reliable prescription drug coverage. 
More tan 225,000 of these citizens live in New Mexico.
  Medicare must be brought into the 21st century and that includes 
adding a prescription drug benefit. We must pay special attention to 
the needs of the most vulnerable--low-income seniors and people with 
disabilities. This is particularly important to New Mexico, where the 
median income of our senior citizens is just $11,370, or 15 percent 
below the national average.
  Under the current system, an unconscionable number of these people 
are forced to choose every day between filling a doctor's prescription 
with limited incomes or paying for some other basic need.
  As we consider the drug proposal before us, there are some important 
principles that I believe we should adopt.
  The first principle should be that we ensure that the most vulnerable 
are protected. That includes the neediest, or poorest, the sickest, or 
those with the greatest health care needs. With the Federal Government 
now running significant deficits, we clearly have a limited amount of 
money and cannot ensure all senior Americans and disabled citizens will 
get everything they need, but we should be sure the most vulnerable are 
protected.
  The second principle should be that we must use a delivery mechanism 
that is stable and that seniors can rely on. It must be a system that 
is accessible and not an untried or untested system. It must be a 
system that is reliable and stable and not one that potentially leaves 
seniors without prescription drug coverage or is in transition from 
year to year, as is often the case with the Medicare+Choice program 
now.
  Before us is the Graham-Smith-Lincoln-Bingaman amendment that meets 
these principles. It has been a pleasure to work with all three of them 
on this compromise and others with a similar desire to provide the most 
help to the neediest and the sickest, including Senators Chafee, 
Feinstein, and Nelson. This compromise offers the best hope for a 
prescription drug benefit this year and also compares well to the 
Grassley-Breaux amendment that received 48 votes in the Senate last 
week.
  In comparing these plans to ensure that the principles of protecting 
the most vulnerable and to ensure that the proposal is stable and 
reliable, the Graham-Smith amendment is the only one that meets the two 
basics, but critical, principles I have outlined.
  With regard to protecting the most vulnerable, the Graham-Smith 
amendment ensures that Medicare beneficiaries below 200 percent of 
poverty receive drug program assistance. This provides the 12.3 million 
low-income seniors, or over one-third of elderly beneficiaries, with 
some protections from rapidly increasing drug costs. In New Mexico, 
this protects over 100,000 low-income seniors, or 47 percent of elderly 
beneficiaries.
  For these financial vulnerable seniors, they will receive a 
comprehensive benefit under the Graham-Smith amendment that would be 
questionable under Grassley-Breaux. Briefly, the Graham-Smith amendment 
provides coverage up to 200 percent of poverty; limits low-income out-
of-pocket expenses to just $2 and $5 per prescription compared to up to 
$3700 for beneficiaries below 200 percent of poverty in the alternative 
plan; and, provides coverage for low-income elderly that is as 
comprehensive as state pharmacy assistance programs and without a drop 
in employer coverage, which again, is

[[Page S7547]]

in sharp contrast to Grassley-Breaux. That amendment provides more 
limited coverage than some elderly get through employer coverage or 
state pharmacy assistance programs.

  It makes little sense to spend almost $400 billion and have a 
consequence that some elderly will receive drug coverage worse than 
they currently receive, but that would be the consequence of Grassley-
Breaux. I appreciate all the hard work Senators Grassley, Breaux, 
Jeffords, Snowe, and Hatch have put into their bill and I understand 
this aspect of their proposal is certainly an unintended consequence, 
but it is a consequence that CBO estimates will cause one-third of 
employer to drop retiree health coverage.
  Of great significance, the Graham-Smith amendment eliminates the 
assets test in Grassley-Breaux, which bars low-income beneficiaries 
from having total assets of more than $4,000 a year. Own a car under 
that proposal and you will likely be denied financial protections 
otherwise.
  According to the Kaiser Family Foundation, it is estimated that up to 
40 percent of low-income elderly would not pass the assets test even if 
they are willing to undergo it. In New Mexico, coverage of low-income 
elderly in Graham-Smith is twice that of Grassley-Breaux--102,000 
elderly covered to just 50,000.
  In comparing the two proposals for those that are the sickest in 
society and have the most health care needs, Graham-Smith has a 
catastrophic limit of $3,300 out-of-pocket or 12 percent less than the 
$3,700 in the competing proposal.
  How do the plans fare with respect to providing health and financial 
security for the elderly and disabled? Again, Graham-Smith is a 
stronger proposal.
  The comparisons are stark. Graham-Smith requires a $25 annual fee 
compared to $288 per year or more under Grassley-Breaux.
  Graham-Smith builds on the current employer and state-based systems 
and does not supplant employer coverage in stark contrast to the 
unintended drop of one-third of retirees from employer-sponsored plans 
in the alternative proposal.
  Furthermore, the Grassley-Breaux amendment relies upon a virtually 
untried and untested system. For the full 37 years of the Medicare 
program, private insurance companies have had every opportunity to 
offer the elderly drug-only insurance plans. None have done so. This, 
my friends, is the definition of ``market failure'' and the very reason 
we have a Medicare program.
  We have evidence of only one instance in which we have a drug-only, 
private insurance model and that was attempted by the State of Nevada. 
It is estimated that their current effort cost taxpayers almost 60 
percent more through private insurance than if the State had run the 
program itself. Yet, this is the model the Grassley plan would require 
all 39 million Medicare beneficiaries to participate in.
  This is clearly a risky proposition. Moreover, the proposal allows 
insurance companies to bid on an annual basis. Even if we can spend the 
billions of dollars necessary to induce private insurance companies to 
participate, we are not buying stability or reliability for the 
elderly. Bids would come in every year with plans coming and going, 
just as they do in the Medicare+Choice program.
  A prescription drug benefit should provide the elderly some security 
and not place them in some kind of grand experiment. We should not 
experiment with the health of our Nation's seniors and disabled.
  Furthermore, the Grassley-Breaux model allows insurance companies to 
charge whatever the market will bear. Beneficiary premium costs could 
be very high and vary by geographic area and vary by year-to-year.
  To deal with the similarity with Medicare+Choice, whereby health 
plans often pull out and leave seniors without their health plan, the 
Grassley bill requires the Secretary to provide the plans with whatever 
inducement or incentives necessary to ensure that people have a choice 
of at least two plans.
  The language reads:

       [T]he Administrator may provide financial incentives 
     (including partial underwriting
     of risk) for an eligible entity to offer a
     Medicare Prescription Drug plan in that
     area. . . .

  This could cost billions and billions of dollars without giving the 
elderly any assurance that the plans will be affordable.
  For these reasons, I support the Graham-Miller amendment. It meets 
the principles of providing protections and security to our Nation's 
most vulnerable citizens through a system that is both reliable and 
stable. It is for these reasons that AARP and the National Council on 
Aging support Graham-Miller as well.
  This amendment appears to offer us the final opportunity to pass 
prescription drug coverage for our Nation's elderly this year. To those 
that criticize it because it does not do enough for the middle class, I 
agree and point out this should be seen as a first step and downpayment 
on more comprehensive coverage for the Nations elderly and disabled.
  However, if we do not take this first step, we are giving our 
Nation's seniors absolutely nothing. For those that voted for the 
Hagel-Ensign bill, I note that this proposal is very much like Hagel-
Ensign in design, with a low-income benefit. Why is protecting the most 
financially vulnerable among our elderly objectionable?
  I think this is a terrific compromise that takes aspects from both 
the Democratic and Republican proposals.
  Mr. President, I believe the amendment Senators Graham and Smith have 
offered is a very good-faith effort to provide a genuine benefit to 
Medicare recipients. I am glad to support it. It is a product of a lot 
of discussion. Senator Lincoln deserves substantial credit, as do 
Senator Stabenow, Senator Feinstein, Senator Chafee, and Senator 
Miller. A great many Senators have worked on this issue, in addition to 
Senators Graham and Smith, and I particularly appreciate their 
leadership.
  Let me say that the need is enormous. I see it in my home State. Many 
of the most vulnerable in our society do have very difficult choices to 
make about whether to fill the prescriptions they are given by their 
doctors or to meet their other needs--pay their rent, pay their 
utilities, buy food for the family, whatever.
  We need to solve that problem, and we need to do so in a way that 
makes sense for all the people who benefit from the Medicare Program.
  There are some important principles that I think we need to keep in 
mind as we craft a Medicare prescription drug benefit.
  The first principle: We need to ensure the most vulnerable are 
protected.
  The second principle: We need to have a benefit for all Medicare 
beneficiaries, and I believe we are meeting both of those principles 
with this proposal.
  The third obvious principle: We need to have a delivery mechanism 
that is stable and upon which seniors can rely. It needs to be an 
accessible system. It should not be something that is untried and 
untested so that we do not get into the same kind of mess we had with 
Medicare+Choice in my State, and I think in many States around the 
country. I believe this amendment meets those principles. I believe it 
is a great benefit to us.
  Let me say briefly what the amendment does. I have a chart, which may 
be difficult for some to read, but let me go through it very briefly.
  The estimated cost of the Graham-Smith compromise is in the range of 
$390 billion. I think that is a reasonable price for this kind of a 
very major benefit.
  There is a benefit for all seniors. All seniors under the Medicare 
Program have a negotiated drug discount of something in the range of 30 
percent, with a 5-percent Medicare payment and an additional discount 
added on to whatever discount can be negotiated through this program.
  In addition to that, the seniors have catastrophic insurance coverage 
above $3,300. So if any Medicare beneficiary pays $3,300 out of pocket, 
after that, with a small copayment of not more than $10, they will have 
the Government cover the cost of any additional drugs needed that year.
  There is a substantial benefit for low-income seniors. We are saying 
people with incomes of 200 percent of poverty or less are covered for 
all of their prescription drug needs, with a very small nominal $2 or 
$5 copayment, depending upon whether they purchase generic drugs or 
brand name drugs.

[[Page S7548]]

  This proposal is designed so that no employer will drop coverage for 
those who are presently covered. That is a very important provision. 
This amendment is also designed so there are no additional costs added 
to the States. Many of our States are faced with real financial 
difficulties because of the economic downturn, and this is not a time 
to be adding additional cost to the States. We have guaranteed in this 
proposal that they not be given additional costs.
  That is a summary of the amendment as it is drafted.
  What does it mean for my State? It means that all the Medicare 
beneficiaries in my State, everyone over 65, does get this very 
substantial catastrophic benefit, as well as the discounts.
  It also means that 47 percent of the senior Medicare beneficiaries in 
my State will fall into the category of 200 percent or less of poverty 
and will have all of their drug costs paid.
  Obviously, the choice we have to make is a difficult choice. We can 
do what is possible. Politics is the art of the possible, and I think 
all of us who have served in public office know that politics is the 
art of the possible. Maybe the possible plus 10 percent, but it is not 
a whole lot more than that. We need to get 60 votes. We need to get a 
prescription drug benefit that is understandable, that is 
straightforward, that is an add-on to the Medicare Program, and that is 
what we have proposed.
  We can do what is possible and adopt this amendment or we can take 
the approach that the perfect is the enemy of the good and that we are 
basically not going to go home with anything. We will continue to tell 
the senior citizens of our States that we were not able to come up with 
anything and give them excuses.
  I hope very much the Senate will not take that latter course. I hope 
the Senate will embrace this amendment and move ahead so that we can, 
in fact, deliver a prescription drug benefit. The time is well passed 
for us to do this. I believe it is very important work that we need to 
get accomplish.
  The PRESIDING OFFICER. The Senator from Texas is recognized.
  Mr. GRAMM. I thank the Chair for the recognition. Mr. President, I 
hope people who are following this debate realize that we are having a 
debate about politics; that this is a debate about the next election; 
that this is hardly a debate about Medicare.
  How extraordinary it is that we are here talking about an entitlement 
program that represents the largest single commitment of Federal 
spending in 37 years, one program that will cost in and of itself more 
than defending the national security of the United States. Yet no bill 
has ever been reported out of committee.
  This was a process from beginning until end--and I hope we are 
approaching the end--that was designed to fail. It was designed to fail 
because we did not follow the normal procedure; we did not report a 
bill out of committee. We violated the budget. So, therefore, by not 
reporting a bill out of committee and by violating our own budget, it 
means that each of these proposals that are made have to get 60 votes.
  We have already had one proposal that had we followed the regular 
order, the normal procedure of the Senate, would have already been 
adopted.
  I have to note that basically what is going on is a political debate. 
One of the issues I find alarming about this debate is that it is 
obvious that some people believe the way to win the political debate is 
to spend money. I wish to remind my colleagues of a little history.
  In 1999, we had a report of the Bipartisan Commission on the Future 
of Medicare. Senator Breaux from Louisiana was the chairman. We had a 
clear majority of Members who were in favor of the recommendations for 
reform, but we had to have a supermajority of 11 Members to make a 
recommendation to the Congress and to the President.
  That bill would have funded prescription drugs with the savings that 
we would have obtained by reforming Medicare. Until the last minute, it 
looked as if we would get the 11, but President Clinton had his four 
appointees all vote no.
  When that happened, President Clinton held a press conference and 
released a program and said: If you would give me $168 billion, I can 
fund prescription drugs for American seniors. That was in 1999.
  Then in the year 2000, the Senate debated a proposal, that Senator 
Robb was the sponsor of, that basically said if you will give us $242 
billion, we can provide prescription drugs for America's seniors.
  Then last year, Senator Baucus said we could fund a program that 
meets every need that the American people have, all the needs of our 
seniors, for just $311 billion.
  Then when we wrote a budget, the Democrat proposal in the Budget 
Committee, which was never adopted by the Senate, and we were told--
actually $168 billion, $242 billion, $311 billion--that is not enough, 
we need $500 billion. Then on the bill on which we did not waive the 
budget point of order last week, we were told that it would require 
$600 billion.
  When we fill up the gaps, when we project out for 10 years, we have 
been seriously debating on the floor a proposal that would spend a 
trillion dollars, that has never been reported by any committee, that 
has never had a systematic consideration by a committee of the Senate, 
and that was designed from the beginning to fail.
  I wish to conclude by making the following points: The proposal by 
Senator Graham of Florida and Senator Smith of Oregon that is before 
us, that we are going to vote on in the morning, is being sold as a 
catastrophic coverage proposal that is quite similar to a proposal that 
Senator Hagel, Senator Ensign, and I offered that got over 50 votes.
  I would like my colleagues to understand that this proposal is 
nothing like our proposal. It is better than the original Graham-Miller 
proposal, it is more affordable, but it is not the proposal that 
Senator Hagel, Senator Ensign, and I made. Our proposal said that we 
can set up a simple program where every senior in America will be able 
to engage, through a private company, in buying pharmaceuticals 
competitively so that we can bring down the cost of pharmaceuticals 
between 20 and 40 percent for everybody.
  Then we had a stop loss, a maximum out-of-pocket expenditure, that 
for moderate-income seniors was about $100 a month. They would be 
spending that $100 a month through these private companies that would 
be purchasing pharmaceuticals competitively, and they would be spending 
their own money and therefore would be cost conscious. When they reach 
that $100 a month and the Federal Government starts picking up the 
cost, they have already entered into a situation where they are buying 
pharmaceuticals competitively.
  Secondly, we did not have the same stop loss for everybody. One of 
the reasons the bill before us costs $400 billion over 10 years and 
provides such little coverage is that Bill Gates has the same stop loss 
that my mother has. Ross Perot has the same stop loss that the poorest 
recipient of Medicare in America has. This is not at all like the 
Hagel-Ensign bill, where the stop loss was dependent on one's income.
  I remind my colleagues that was an affordable proposal. It was the 
only proposal that we have voted on that was within our budget, for the 
simple reason that it put the money toward helping the people who 
needed the help the most.
  The problem with all of these other proposals is that for every 10 
people they help, 8 people do not need it. We are displacing massive 
amounts of private health insurance in the name of helping people who 
do not have health insurance. The advantage of the Hagel-Ensign 
proposal, the reason it was within budget and these other proposals are 
not, is that it put the focus of attention on helping people who fell 
into two categories. Either they had relatively low income and 
substantial drug bills, or they were moderate and upper income with 
astronomical drug bills. In either case, they got help. But if their 
drug bills are low relative to their income, they did not get help and, 
quite frankly, people who have incomes and retirement that run into the 
hundreds of thousands of dollars and have private health insurance are 
not the people in need. It is the people who do not have health 
insurance and who are having a very difficult time with

[[Page S7549]]

paying for their pharmaceuticals who need help.
  I hope this amendment will be rejected. When we do not have enough 
unity of purpose to pass a bill out of the committee of jurisdiction, 
in this case the Finance Committee, we should not be engaged in a 
political exercise on the floor where we are literally committing 
ourselves to a trillion dollar expenditure over the next 10 years. We 
are talking about the largest commitment of money that this Nation has 
undertaken in 37 years, and yet there is no substantial bipartisan 
agreement. Every proposal is tailored to some political constituency. 
We are dealing with a process that was designed to fail by not 
reporting a bill out of committee, by not staying within budget and, 
therefore, having to get 60 votes. So my own opinion is that the sooner 
this charade ends, the better off America will be.
  Let the record show there has been only one proposal that was within 
budget. There has been only one proposal that was fully funded by the 
budget and that was logically consistent, that encouraged efficiency 
and economy and met the needs of the people who need the help the most, 
and that was the Hagel-Ensign bill.
  I urge my colleagues to reject the amendment that is currently 
pending before the Senate. We are going to vote tomorrow. It has a 
budget point of order. It is $100 billion above the budget. When we 
adopted this year's budget last year, we said we were going to spend up 
to $300 billion on providing prescription drug assistance. This 
amendment, by the most generous scoring that can be made, costs $400 
billion. I urge my colleagues, do not waive the budget point of order, 
sustain the budget process, and reject this amendment.
  I yield the floor.
  The PRESIDING OFFICER (Ms. Cantwell). Under the previous order, the 
Senator from Nevada is recognized.
  Mr. ENSIGN. Madam President, I wish to talk about the Graham-Miller 
amendment for prescription drugs. First, I compliment the people who 
have been working on it. We think they are at least going in the right 
direction. They have adopted some of the parts of the bill that Senator 
Hagel and I had proposed, but I believe there are some fundamental 
flaws in the amendment as currently drafted.
  I was in a working group yesterday. I tried to point out some of 
these flaws, and I want to point those out on the floor because I think 
these are very important issues that we get fixed in any prescription 
drug bill that we eventually, hopefully, pass out of the Senate and 
someday get to the desk of the President.
  In the Graham-Smith amendment, for the people above 200 percent of 
poverty, they use the catastrophic bill; they use basically what 
Senator Hagel and I had talked about, where seniors pay out of pocket 
for the first x dollar figure and then above a certain dollar figure 
the Government would step in and take care of the costs.
  The problem is in the category of people below 200 percent of 
poverty, they basically give them full coverage with very little 
expected of the senior--only $2 for generic drugs on a copay and $5 for 
name brand drugs. Those seniors in that income category are not going 
to be held accountable. That is not enough money out of pocket to 
affect their behavior, in my opinion. The reason they have to be held 
accountable for the behavior is because we do not want people abusing 
the system and taking drugs.
  People say, well, these are prescription drugs. Why would anybody 
just get prescriptions? I happen to be a veterinarian by profession and 
have worked with people coming in with their pets. Talk to any 
pediatrician, any family practitioner in human medicine, it does not 
matter, they will tell you that people come to them, however they are 
feeling, if they are feeling ill, regardless of whether they need 
antibiotics, they expect them or they expect some kind of a 
prescription. With children in this country, we understand when their 
parents bring their kids to the doctor for an ear infection--almost all 
of those ear infections are caused by viruses.
  Viruses do not respond to antibiotics, yet almost every time when 
somebody walks out of the doctor's office for their kids' ear 
infection, that child is put on antibiotics. It is one of the reasons 
we have so many drug-resistant secondary bacterial infections in ear 
infections--because we treat with antibiotics. The virus is there, it 
kills normal-growing bacteria, and you get a secondary bacterial 
infection, which is a reason that a lot of kids need to have tubes put 
in their ears, along with all kinds of other problems.
  It is the same problem with a lot of seniors. If you are sick, you go 
to the doctor--you have a virus, whatever it is; you have a complaint, 
you expect to get better. A lot of times, physicians will prescribe 
medicine simply as a placebo effect. They know if I do not give this 
person something, they will go to another doctor. If the person is 
paying out of pocket, there is some incentive to ask the questions: Do 
I need these medications? Can I get a better price? Maybe I should buy 
the generic. The only difference between $2 and $5, generic versus 
brand name, is not necessarily that great incentive, but if they paid 
the first dollars out of their pocket, which is what our bill required, 
based on income--a sliding scale based on income--they would pay the 
first dollars out of pocket.
  For instance, somebody who made around $15,000 to $17,000 a year 
under our bill would pay, on average, $100 to $120 a month out of 
pocket. After that, other than a small copay, the Government would pick 
up the costs. That person with diabetes, taking five or six different 
drugs, would have gotten the help they need without losing all of their 
assets. Right now, they get no help, and our bill would have given them 
the help.
  Because we had some complaints about our bill--that if you make $1 
more than $17,700 a year, you went from a maximum out-of-pocket expense 
of $1,500 to $3,500--we are trying to build more of a gradual scale 
into our bill so there will not be the dramatic dropoffs. We are also 
trying to put some of the money and give low-income seniors a little 
more help under our bill. We think we will be able to do this and still 
be within the $300 billion budget.
  What is important about being in the $300 billion budget? The fact 
is, unless we are within $300 billion, we are violating the budget we 
set up. That is the reason it needs a 60-vote point of order. If our 
bill were reported out, if it were done properly, if we would take our 
bill, report our bill out of committee, and take all of the bills that 
have been voted on, report them out of committee, our bill is the only 
one that could become law because it is the only one that only would 
have needed 51 votes. Our bill got 51 votes.
  The bill tomorrow that will be voted on, from what I understand, will 
only get 54 or 55 votes and therefore will not be able to waive the 
budget point of order.
  If the majority leader would take our bill to the Finance Committee, 
let that bill be reported out of the Finance Committee, we actually 
could have this process go forward. Our bill, within the budget, would 
not need the 60 votes. It does not seem as though any proposal will get 
the necessary 60 votes. So let's work together, go through the process, 
through the Finance Committee, and report out a bill like this. We are 
willing to work with people on the numbers. As long as we can fit 
within the $300 billion budget number, we will not have to get the 60 
votes and we can get a bill reported out of the Senate.
  If we want to look at seniors this next year and say, we are really 
going to be helping you, I believe our proposal should get serious 
consideration from people. For those seniors who truly need the help, I 
don't believe we should look at them, especially with the November 
elections coming up, and say, sorry, politics got in the way again.
  The Republicans are blaming Democrats, Democrats are blaming 
Republicans, and the bottom line is seniors are not getting the help 
they need. I truly believe we need to give the seniors some 
prescription drug benefit. However, I also believe we need to do it in 
a fiscally responsible way for the young people in the United States. 
If we do not do that, we will regret it in the future. Let's work 
together on this and pass a real prescription drug benefit that we can 
afford.
  I yield the floor.

[[Page S7550]]

  The PRESIDING OFFICER (Ms. Cantwell). The Senator from Massachusetts.
  Mr. KENNEDY. I understand I have 10 minutes. I yield myself 9 
minutes.
  I have had the opportunity to spend a good deal of time in the Senate 
over the past days and had the chance again this afternoon to listen to 
many colleagues describe what is before the Senate. I have listened to 
the recent comments of my friend from Texas, saying this is just all 
about politics, and others saying we cannot consider the proposal of 
Senator Graham or Senator Smith because of gaps and loopholes. I have 
heard a great deal of characterization of what is before the Senate.
  What is before the Senate is an opportunity to make a very important 
downpayment for the seniors of this country, in a partial fulfillment 
of the promise we made to them in 1965 when we passed Medicare. That 
was a solemn pledge to the senior citizens of this country that said, 
play by the rules, pay into the system, and you will have health 
security when you retire.
  That was the commitment. That is what everyone remembers. And I had 
the opportunity of being there. Our majority leaders, our minority 
leaders, those in support of that program made that commitment to the 
American people. They made it to the workers at that time and to the 
parents and to the grandparents of that time: Health security will be 
yours.
  We all have an opportunity now to travel back to our hometowns and to 
listen to our seniors. Anyone who does that knows that we are failing 
that commitment every single day. Why? Because we provided 
hospitalization and we also provided physician services, but we have 
not provided prescription drugs. That is something we all understand. 
No one can say to our senior citizens: We have met our responsibility 
to you.
  If we do not pass a good benefit package here, we are continuing to 
fail our senior citizens.
  That may be described as politics to the Senator from Texas, and it 
can be described as $400 billion by the Senator from Nevada. Our 
proposal that provided the comprehensive care, where we got 52 votes 
and if we would have had 8 votes from our Republican friends, we would 
be on our way to conference this evening to try to guarantee that kind 
of protection. But no, we say we cannot do that. Then all afternoon, we 
had hearings about gaps in this proposal or that proposal. If you go 
from approximately $800 billion down to $400 billion, you are going to 
find out that you are not going to have the same benefit package. And 
if that is what you want on that side to agree to, we will agree to 
that. But I tell you something else we agree to: We make our commitment 
when we get this passed, and passed with the help of some courageous 
Republicans, we are not stopping there; we are coming back and we are 
going to complete the job. That is our commitment to the seniors 
tonight and tomorrow, that this is a downpayment. But it is only the 
beginning, no matter how concerned you are about why we are considering 
this legislation on the floor of the Senate.
  I was here for 4 of the last 5 years when we could never get this 
bill out of the Finance Committee--buried, buried, buried by Republican 
leaders on the floor of the Senate and leaders on the Finance 
Committee. Finally, we have a courageous Democratic leader who puts 
this before the Senate.
  Then we hear: Oh, no, we cannot consider that because that is 
politics. What was political was denying the ability for the Senate to 
consider this over the period of the last 4 years. Where have you been? 
Where have you been?

  I can tell you where we are. I can tell you where Bob Graham is, and 
Senator Smith is, and that is here tomorrow and they are going to be 
saying: This is a downpayment. This doesn't do all the job. We all want 
to have a better benefit package, but we are denied that opportunity. 
We were denied that by the failure of the votes on that side; make no 
mistake about it.
  Who are the people we are talking about? We are talking about, as has 
been described earlier in this debate--we are talking about the 
greatest generation, those who have fought in World War II, who have 
come back, and are now in their golden years. Those are the people we 
are talking about. That is what is at issue here. Are we going to meet 
our responsibility to men and women who fought in World War II, fought 
in the Korean war, some, perhaps, could even be qualified from the 
Vietnam war--men and women who brought the country out of the 
Depression, served, and built the Nation to the great Nation it is; and 
they need prescription drugs. And we are rattling around down here 
wondering how we gain political advantage. That is what is motivating 
those of us on this side, to meet that responsibility, Senator.
  We heard the same arguments I heard when we were battling Medicare. I 
have read the history and we heard the same arguments when they were 
passing Social Security: We cannot do it. We should not do it. We can't 
make that kind of commitment. Medicare was the exact same thing: We 
can't afford it. It is socialized medicine. I haven't heard about 
socialized medicine out here since 1994 when we were debating a 
comprehensive health care program. I have not heard socialized 
medicine, but that is what we were talking about in the Medicare 
debate. They spared us that, but they still bring it up in opposition. 
And I don't question that because that side of the aisle was opposed to 
Medicare, and they were opposed to Social Security. Are we in any doubt 
they are opposed to this endeavor?
  Tomorrow, make no mistake about it, this will be the key vote in 
terms of prescription drugs. I wish we were back to the time that we 
were considering the more comprehensive program that made sure we were 
going to attend to all the needs of our senior citizens, all of those 
needs. That is what we ought to be doing, but we cannot do it because 
we have been defeated on that. But we are not giving up. We are coming 
back again. We are making the commitment, if we are able and 
successful, to get this downpayment. It will make an important 
difference to the quality of lives for millions of our senior citizens.
  Look what the CBO talks about. The program will reach almost half--49 
percent of our neediest senior citizens, and for those above the 
$3,300--another 15 percent. If you add those together, it is virtually 
two-thirds of all of our seniors. We wish it were 100 percent, but they 
wouldn't give us the eight votes. This is two-thirds. It may not have 
all the benefits, let alone the other advantages in terms of the lower 
discount rates that will benefit those even in that third. But it is a 
sincere effort, the best effort that could be done over the period of 
these last 2 days, to try to continue this battle and continue the 
struggle.
  That is what this is all about. We reject those who say this is not 
the time, this is not the place. I listened with great interest to 
those who were defending the program that was advanced earlier last 
week. That had a drug program for $330 billion, and they are trying to 
compare that to the one that was introduced by Senator Graham, saying 
it was more comprehensive, it was more complete, it would provide our 
seniors with better services? Then why didn't the seniors support it? 
That is our simple answer. Why didn't the seniors support it? You 
couldn't get the support because it failed to do that.

  We welcome the fact that the senior organizations support the Graham-
Smith program. They supported our efforts a week ago when we were 
trying to get the comprehensive program. Over the period of these last 
days, they have looked the range of different options being proposed. 
These groups that represent seniors understand what is at risk and what 
opportunities lie before us now, and they are supporting our efforts to 
get this downpayment.
  When we get this downpayment, that is what it will be. It will be a 
downpayment. We will hear voices continuing to harp on the other side 
that would really like to take even more hundreds of billions of 
dollars and give it to the wealthiest individuals in this country and 
reduce their taxes, but this is about making sure that we are going to 
walk the walk and give to our senior citizens that same kind of 
prescription drug program that my friend Phil Gramm has, right over 
here, in the well of the Senate. He has a comprehensive program. He 
pays about a 25-percent copay on his program. Every Member of the 
Senate has it.
  Should we retreat on a commitment to try and do for the people of 
this

[[Page S7551]]

country what the Members of the Senate have already done for 
themselves? I say vote for the Graham proposal. We will make the 
commitment that this will be a downpayment and we will see the day when 
our senior citizens will be able to raise their heads high and know 
they will not have to fear when they hear from their doctors that they 
need prescription drugs in order to live a healthy and happy life.
  I think the time has expired.
  The PRESIDING OFFICER. The Senator's time has expired.
  Mr. KENNEDY. I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. REID. Madam President, I ask unanimous consent the order for the 
quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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