[Congressional Record Volume 149, Number 88 (Monday, June 16, 2003)]
[House]
[Pages H5392-H5398]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




      REFORMING MEDICARE AND PROVIDING PRESCRIPTION DRUG COVERAGE

  The SPEAKER pro tempore (Mr. Franks of Arizona). Under the Speaker's 
announced policy of January 7, 2003, the gentleman from Georgia (Mr. 
Burns) is recognized for 60 minutes as the designee of the majority 
leader.
  Mr. BURNS. Mr. Speaker, I rise tonight to begin the discussion of 
probably one of the most critical things we will consider during the 
108th Congress. Tonight we are going to begin to talk about a need that 
America has had for a long time, and that is a prescription drug 
benefit for our seniors and the reform of Medicare.
  I am delighted that the Speaker has allowed me to represent the 
leadership tonight, along with other members of the freshman class, as 
we begin to talk about the things that are important to America, and to 
begin the discussion, to begin the debate and to work toward a solution 
to all of our seniors.
  Mr. Speaker, to begin that discussion, I would like to yield to the 
distinguished gentlewoman from Michigan (Mrs. Miller).
  (Mrs. MILLER of Michigan asked and was given permission to revise and 
extend her remarks.)
  Mrs. MILLER of Michigan. Mr. Speaker, Medicare was enacted in the 
1960s to address a serious problem, and that problem, of course, was 
the lack of quality health care for our Nation's elderly.
  In the past 40 years, Medicare has become actually one of the most 
popular Federal programs ever. But so much has changed in the days 
since Medicare was first enacted. In the 1960s, quality health care 
usually meant going to the doctor's office and receiving treatment for 
a particular ailment, and, in many cases, it meant hospitalization. But 
today, things are very much different. Advancement in the development 
and effectiveness of prescription drugs has made the trip to the 
doctor, and, more importantly, a trip to the hospital, unnecessary in 
many, many cases.
  Prescription drugs are helping America's seniors to live longer 
lives, and healthier and happier lives as well. And yet, Medicare has 
not changed to cover those life-extending drugs, and too many seniors 
are being forced to make the impossible choice between their 
prescriptions and their other basic needs like food or rent. That, of 
course, is simply wrong. No senior should ever have to make the choice 
between bills and pills.
  The high cost of prescription drugs are forcing seniors to find less 
expensive ways to get the drugs that they need. I represent a district 
that shares an international border with Canada. I was meeting actually 
just this morning with my counterpart in the Canadian Parliament. We 
spoke about a number of issues, and we spoke about health care 
generally. But, more specifically, we spoke about a cottage industry 
that is springing up, prescription drug outlets on the Canadian side of 
the border.
  For many reasons, prescription drugs are less expensive in Canada, 
and many American seniors are driving across the Blue Water Bridge, in 
my district, between the cities of Port Huron and Sarnia, to have their 
prescriptions filled in Canada.
  What happens is they receive a script from an American doctor. Then 
they have it transmitted to a Canadian doctor, and it is rewritten in 
Canada and filled at one of its Canadian pharmacies that literally dot 
the border area there now. Again, it is just simply wrong for America's 
seniors, that they have to go to such lengths just to get the drugs 
that they need.
  So it is time for Congress to act. We must address the requirements 
of our senior population, and we need to bring Medicare in line with 
the medical system of the 21st Century.
  When I was campaigning for this office, I met with literally 
thousands of senior citizens and I asked them what they thought they 
needed in a prescription drug benefit. Through those conversations, I 
came up with what I consider to be four main goals, four fundamental 
caveats that need to be met with any new benefit:
  Number one, the benefit absolutely needs to be voluntary, so that 
many seniors who already have an existing drug benefit are not forced 
into a government plan that might not provide equal assistance that 
they have currently.
  Number two, there needs to be immediate assistance so that seniors 
are no longer forced to make the decision between their prescription 
drugs and other needs.
  Number three, it needs to be permanent so that it cannot be taken 
away or used as a political weapon against them in some future 
Congress.
  Number four, it must substantially reduce out-of-pocket costs so that 
seniors can enjoy their retirement years and health and without 
draining their life savings to pay for drugs.
  I am very hopeful that the plans that are now being debated by the 
other body, in the Committee on Energy and Commerce and the Committee 
on Ways and Means, will meet each of these tests. One of the big 
concerns about the prescription drug benefit being debated is, of 
course, the cost of such a program. In these very tight budgetary 
times, or at any time, for that matter, we must keep a very close eye 
on the bottom line.
  But I truly believe that this benefit in the long run could actually 
save taxpayers money. How is that so? Because if we work together to 
keep seniors healthy through therapeutic drugs, we will actually lower 
the instances of hospitalization, which costs much more than giving 
seniors prescription drugs. Of course, that is the old adage that an 
ounce of prevention is worth a pound of cure. I think it is very 
appropriate in this instance.
  I also truly believe that you can judge a society by the way that 
society treats its seniors. Our seniors have given so much to our 
Nation. Their hard work, their sacrifice is what has made America into 
the greatest country the world has ever known. These are the people 
that have fought wars, to defeat fascism, to defeat communism, to 
spread freedom across the globe. They have worked to build industry, to 
build strong communities, to raise their families that continue the 
American dream.
  Our senior citizens deserve no less than our very best efforts to 
finally solve the problem of a prescription drug benefit within 
Medicare, because that is exactly what they have given us throughout 
their lives. I look forward to working with my colleagues to, once and 
for all, get the job done.
  Mr. BURNS. Mr. Speaker, we have heard from the distinguished 
colleague from Michigan as she shares with us the challenges that her 
constituents face.
  I would like to now yield to the distinguished gentlewoman from 
Florida (Ms. Harris), to gain a perspective from that area.
  (Ms. HARRIS asked and was given permission to revise and extend her 
remarks.)
  Ms. HARRIS. Mr. Speaker, despite the large amount of attention that

[[Page H5393]]

matters of national security have demanded, the House has remained 
steadfast in confronting the threats to security here at home. We 
passed decisive measures to revitalize our financial security and our 
economy. Moreover, we continue to confront the corporate greed that has 
threatened the life savings of millions of Americans. These dramatic 
efforts to restore America's economic security will mean little, 
however, until we address the moral obligation to our seniors. After 
all, they are the people who built America's prosperity in the first 
place.
  The enactment of the Medicare program constituted a sacred pact with 
our seniors. It reflected our Nation's belief that the health concerns 
associated with advancing age should not raise the specter of grinding 
poverty. Nevertheless, while our society enjoys an unprecedented level 
of wealth and material comfort, our seniors still suffer sleepless 
nights worrying about how they will afford critical medical and life 
saving prescription drugs. Far too often, good politics has taken 
precedence over good policy. Meanwhile, men and women who spent their 
lives investing in this country have paid the price of political 
inaction.
  Yet, thanks to the visionary leadership of the gentleman from 
Illinois (Speaker Hastert), the gentleman from California (Chairman 
Thomas) and the gentleman from Louisiana (Chairman Tauzin), our seniors 
at least have reason to hope.
  The Speaker has articulated four principles for improving Medicare 
and providing our seniors with a real prescription drug benefit.
  First, we must lower the cost of prescription drugs now.
  Second, all seniors must have prescription coverage.
  Third, Medicare must have more choices and more savings.
  Finally, Medicare must be strengthened for the future.
  The bill that the gentleman from California (Chairman Thomas) and the 
gentleman from Louisiana (Chairman Tauzin) have proposed passes these 
four essential tests with flying colors. It recognizes our seniors 
deserve the right to choose their doctor, their health care plan and 
their prescription drug plan.
  Most important, this bill completely covers the prescription drug 
costs of low income seniors, as well as the catastrophic medication 
needs of every senior. Further, it modernizes the Medicare system 
through the use of new technology, health, education and preventive 
care.
  Mr. Speaker, I applaud our leadership for developing this outstanding 
legislation, and I look forward to a strong bipartisan effort to 
achieve its passage.
  Mr. BURNS. Mr. Speaker, we enjoy in the freshman class two 
distinguished colleagues within the medical profession. Tonight I would 
like to yield to the distinguished gentleman from Texas (Mr. Burgess), 
a medical physician who has treated thousands of patients and can speak 
authoritatively to this subject.
  Mr. BURGESS. Mr. Speaker, I rise tonight to continue the dialogue 
about the important work that this House will undertake in regards to 
modernization of the Medicare program over these next 2 weeks.
  For too long, seniors in this country have gone without a 
prescription drug benefit. We are at a point in time where the United 
States Congress is at the threshold of passing a comprehensive drug 
benefit for America's seniors. It is time, indeed, it is past time that 
we modernize the Medicare system. Medicare is a 38-year-old government 
program that has done little to adapt to the practice of medicine in 
the 21st Century.
  There can be no doubt that Americans have benefited from the 
development of new and innovative medicines. New drugs can improve and 
extend lives. New drugs exist that can dramatically reduce cholesterol, 
fight cancer and alleviate debilitating arthritis.
  For example, Mr. Speaker, there is a whole new class of medications 
that collectively are called selective estrogen receptor modulators. 
You perhaps know them by the other term as Aromatase inhibitors.

                              {time}  2015

  But, Mr. Speaker, these new class of medications are reducing breast 
cancer mortality, and they hold promise for actually one day preventing 
this disease.
  Mr. Speaker, drugs that fight prostate cancer, diabetes, and other 
life-threatening diseases are not available as a basic part of 
Medicare, forcing beneficiaries to often make difficult choices related 
to their health. Medicare beneficiaries should have access to these 
drugs, just like so many of us have access to prescription medications 
through our own health plans.
  Medicare was put in place to improve the health and well-being of 
America's seniors; and to that end it has functioned very well. But 
because the current program does not provide prescription drugs as part 
of its basic benefit, it is hard to say that Medicare, as is, continues 
to live up to that promise.
  With nearly 40 million people enrolled in Medicare, it is important 
that we approach this issue with clarity and foresight. Many of my 
colleagues and, indeed, myself included, are concerned with the 
entitlement nature of this new program. If we are not careful, if this 
new entitlement is not implemented properly this, in fact, could 
threaten to imbalance future Federal budgets and displace other 
important priorities. However, the bill that has worked its way through 
the Committee on Commerce and the Committee on Ways and Means, the bill 
that they are working on this week, meets the needs of seniors today 
and into the future, and attempts to balance future Federal spending 
commitments.
  But we must also be aware of other ways that we can hold down the 
price of prescription drugs and, further, the taxpayer resources that 
will be devoted to Medicare and a Medicare prescription drug benefit. 
The United States, through our trade representative, must actively work 
with foreign countries to dismantle their drug price control regimes 
and embrace free market principles. No longer should our uninsured and 
our elderly bear the cost of pharmaceutical research and development 
for France, Germany, Canada, Japan, and a multitude of other countries. 
By bringing the purchasing power of the Federal Government to bear, we 
should be able to positively impact the price of pharmaceuticals sold 
in this country through free market principles. However, if we do not 
get serious with other countries that put our most vulnerable citizens 
at risk, we will have been negligent in our obligation to protect the 
American people from the policies of foreign governments that can be 
described as predatory at best.
  The Congress stands at the threshold of improving the lives of 
America's seniors. As we enter into this debate, we must remain 
vigilant to make sure that the program that we establish in the next 
weeks and months is accountable not only to the seniors that it serves 
today, but for those who foot the bill, but, most importantly, to the 
young people, to the citizens who will come after us in the generations 
to come.
  Mr. Speaker, I thank my colleagues for their indulgence this evening. 
I feel obligated to bring up one other point. I heard a news report 
today that the drug Lipitor, a cholesterol-lowering medication, a study 
involved with type 2 diabetes, its effect was so promising in reducing 
the incidence of heart attacks and strokes that the study was in fact 
opened up and no longer were people given the placebo medication, but 
the actual drug was offered to all of the individuals enrolled in that 
study. It is that type of power, Mr. Speaker, that we need to make sure 
that we put in the hands of all of America's citizens.
  I thank the gentleman from Georgia for putting this together this 
evening. I think this is an extremely important part of the debate that 
is going to go on over the next several weeks, and I look forward to 
participating at several levels.
  Mr. BURNS. Mr. Speaker, I thank my colleague from Texas for his input 
and, like him, I look forward to the discussions and debates over the 
next several weeks as we work through this challenging process.
  I have a colleague I would like to recognize now. I know the 
distinguished gentleman from Georgia, a physician, someone who again 
has treated thousands of patients in Georgia and understands the 
prescription medication field, understands Medicare, and can speak 
directly to the challenges we face. I yield to the gentleman from 
Georgia (Mr. Gingrey).

[[Page H5394]]

  Mr. GINGREY. Mr. Speaker, I thank the gentleman for yielding.
  Mr. Speaker, as a physician Member of this 108th Congress, I just 
want to say that I practiced medicine, an OB-GYN practice, for over 28 
years; and, of course, most of my patients were fairly young, in the 
child-bearing age range, and I did not really see a lot of Medicare 
patients. However, if I were back in that practice today and doing just 
the gynecology part of that specialty, my practice would be 
predominantly Medicare patients like my precious 85-year-old mom who 
has been on Medicare now for 20 years.
  This program, as we all know, came to us in 1965. I was a freshman 
medical student in 1965. I really did not understand the system too 
well. But I knew that back then, prior to Medicare, physicians gave 
away a lot of their services. They made a lot of house calls. They took 
a bushel of corn sometimes in lieu of any other financial payment for 
their services; and they were glad to do that, especially for the 
neediest of our citizens, many of them seniors. In 1965, Medicare, in a 
way, was good for these doctors. They were able to get paid for some of 
this care that they were rendering and at least maybe break even.
  Over the past 25, 30, 35 years, of course, medicine has changed very 
much now. And it is extremely difficult, especially for our primary 
care physicians, our family practice specialists, our general 
internists, our physicians who are treating cancer, our medical 
oncologists who see a lot of the seniors. They are not able to continue 
to provide this care. It is costing too much. The reimbursements are 
not there. And so many of our physicians, these primary care doctors 
that are so essential to our precious senior citizens, no longer can 
they afford to take Medicare patients. So as we go forward and talk 
about a prescription benefit for our seniors, we need to keep in mind 
that there have to be providers there, there have to be primary care 
physicians there to write these prescriptions.

  So that is why I say that in this 108th Congress, of which I am 
proud, of course, to be a Member, a freshman Member, this President; 
this administration; this leadership; this Speaker of the House, the 
gentleman from Illinois (Mr. Hastert); this majority leader, the 
gentleman from Texas (Mr. DeLay); this majority Republican Party, and, 
yes, hopefully the minority party and their leadership, we are ready. 
We need to address this issue, not only of providing a prescription 
benefit, especially for the neediest of our seniors, but also of 
reforming and revitalizing Medicare and bringing it from 1965 to the 
21st century. We are dealing now really with what is the equivalent of 
an Edsel. It is time to get a Thunderbird on the market in regard to 
health care.
  Let me just tell my colleagues, Mr. Speaker, and to all of the 
seniors who are out there, hopefully, listening to this great C-SPAN 
program tonight, let me tell my colleagues what is wrong with Medicare 
as it exists today. Not only did we not have any prescription benefit, 
no prescription benefit whatsoever in 1965, also there was no emphasis 
on preventive health care. One cannot go to the doctor today under 
traditional Medicare and have a routine screening physical examination 
done. One cannot go under Medicare and have a routine cholesterol 
screening, lipid profile to determine if you are on the verge and at 
risk of having a serious heart attack or a stroke. If you get that 
service, you pay for it out of your pocket. And, of course, many of our 
seniors can ill afford to do that.
  And the other thing, and maybe most significant in regard to 
Medicare, is there is absolutely no catastrophic coverage. These 
seniors, maybe they can, many of them, afford to pay $2,000, $3,000, 
possibly $5,000 a year in out-of-pocket expenses for a prescription 
benefit. But once they get to the point of needing four or five or six 
medications, very expensive medications, I might add, just to sustain 
the quality of life and to relieve them from suffering, they can no 
longer afford that. And pretty soon, yes, they do reach the point where 
they have to choose between paying the rent, buying the groceries, 
paying the utilities, or getting their prescription drugs filled.
  So this is the situation that we find ourselves in today. It is 
imperative that we do something for our seniors. This issue has been 
with us for several years, long before I became a Member of this 
Congress. But I am proud to stand here today as part of this majority, 
realizing that they understand the big picture. The gentleman from 
California (Mr. Thomas), the gentleman from Louisiana (Mr. Tauzin), the 
gentleman from Florida (Mr. Bilirakis), and the gentlewoman from 
Connecticut (Mrs. Johnson), they understand what needs to be done and 
they realize that this is not just one leg of a stool, but that there 
are three legs to this stool; and it includes not only a prescription 
drug benefit for our seniors, but of course it includes a reform of 
this outdated, antiquated, 1965-era health care system that looks 
nothing like what my colleagues and I and other Members of Congress 
have available to us under our Federal health insurance benefit plan.
  We do not have to worry about being put in the poor house once we get 
into a situation of serious illness. We have prescription coverage 
after a copay. So this is the same thing that we want to offer to our 
seniors. I am proud of the commitment that we have this year, this 
year, today, hopefully within the next several weeks, that we will have 
a bill on President Bush's desk that he can sign to give this very, 
very important relief to our seniors and to reform of the Medicare 
system.
  Mr. Speaker, I appreciate this opportunity to present this 
information tonight and to talk especially, especially to our senior 
citizens, our moms and dads, our grandparents and, indeed, us in the 
very near future. It is critical. We need to do it now, and we are 
going to get the job done.


                Announcement by the Speaker Pro Tempore

  The SPEAKER pro tempore (Mr. Franks of Arizona). The Chair would 
remind Members to direct their remarks to the Chair and not to the 
television audience.
  Mr. BURNS. Mr. Speaker, since we do have two fine representatives of 
the medical profession with us tonight, I would like to have an 
opportunity to engage in a bit of a dialogue as we discuss the critical 
issue of prescription drug benefits and Medicare reform.
  First of all, I would like to get the input on access. How important 
is it for our seniors to choose their physicians? And that is, I 
believe, a key point in the legislation that we are considering now. I 
yield to the gentleman from Texas (Mr. Burgess).
  Mr. BURGESS. Mr. Speaker, I thank the gentleman; in fact, I thank 
both of the gentlemen from Georgia for allowing me to speak on this. I 
will just have to say to the gentleman from Georgia, while I was 
listening to his comments, and they certainly were apropos, I think one 
of the most amazing things I heard was that the gentleman was a 
freshman medical student in 1965. I had no idea that there was someone 
who is that old who is serving in Congress.
  Mr. GINGREY. Mr. Speaker, if the gentleman will yield, my wife told 
me not to dare admit that, but I did it anyway.
  Mr. BURGESS. Well, I appreciate the gentleman bringing that up. My 
father was a surgeon and was practicing at the time; and I remember 
very well, as a very young child, watching the evolution of the genesis 
of Medicare.
  But the gentleman from Georgia (Mr. Burns) brings up a very good 
point and it is the point of access, and the gentleman from Georgia 
(Mr. Gingrey) touched on it a couple of times in his remarks, and that 
is that we certainly have suffered over the last 3 or 4 years with the 
way Medicare reimbursements have impacted physicians and physician 
practices; and the net result has been the loss of physicians to the 
Medicare system, and the net result of that has been loss of access for 
our patients.
  Just like the gentle doctor from Georgia, my practice too was 
obstetrics and gynecology; but even within an obstetrics and gynecology 
practice, one would have ample opportunities for interacting with the 
Medicare population. I have written more than my share of prescriptions 
for drugs that will prevent osteoporosis, for example, a debilitating 
disease that unfortunately affects primarily women, with a 25 percent 
rate of fracture of the hip. Of course, as the gentleman knows, there 
is a 25 percent mortality rate within the first year after sustaining 
that hip fracture. So we have means at

[[Page H5395]]

our disposal for significantly improving the lives of seniors if we 
will only preserve the ability to have doctors there to see them and 
then, of course, the ability of the patients to afford the 
prescriptions that the doctors then write. I yield back to the 
gentleman from Georgia.
  Mr. GINGREY. Well, I thank the gentleman from Texas. Some of the 
things I think that we need to point out is that, as I mentioned in my 
remarks earlier, in 1965, when this plan was devised, there was not a 
great emphasis on drug therapy. It seemed back then that the main 
emphasis on health care was the opportunity, of course, to see a 
physician, to see a health care provider; and many people did not do 
that because of lack of access, and there just was not that great 
emphasis on preventive health care certainly.

                              {time}  2030

  Then a lot of things were cured, quite honestly, by the surgical 
approach, and as we know today, surgery is extremely important, and our 
surgeons and our subspecialty surgeons do a great job, but thank 
goodness a lot of people today, and I think the gentleman from Texas 
(Mr. Burgess) would agree with me, we would love to keep people out of 
the hospital.
  We would love to be able to prevent very expensive surgery, and I can 
certainly give a personal testimony to that, having recently undergone 
open heart surgery. Maybe if 15 years ago I had been taking that drug 
to lower the cholesterol and improve that so-called lipip profile, or 
if I had been taking a little bit of a blood thinner or something to 
lower my blood pressure a little bit, I would not have had to undergo 
that very, very expensive somewhat dangerous and definitely painful 
surgical procedure.
  That is why today it is so important, it is so important that our 
seniors at least have an opportunity not just to go to the emergency 
room to treat that episode of health emergency care or to be admitted 
to the hospital after a motor vehicle accident or those who need to 
after an extended period of stay go to a nursing home, they need 
prescription medication to keep them out of the hospital.
  In the final analysis, we know the CBO, the committee on Medicare and 
Medicaid service and their actuarial services, we know that this 
prescription benefit, Mr. Speaker, will save money in the long run.
  Mr. BURGESS. Mr. Speaker, if the gentleman would yield again for a 
moment, the gentleman from Georgia is exactly right, and I recognize we 
have other Members who want to speak to this, so I will be brief.
  In 1965, the major health care expenditures that a senior might face 
would be the expense of a surgery or, if they got pneumonia and were 
hospitalized for 7 to 10 days, however long the drug therapy would run, 
and Medicare was put in place to protect the family from those very 
serious expenditures. Of course, the fact remains that nowadays, most 
of us are not going to die of our acute illnesses. We are going to live 
with chronic conditions and hopefully live with them for a long time, 
and that requires the interplay of prescription drugs.
  One other thing I feel honor bound to mention is the issue of medical 
liability reform which we took up in this House 2 months ago, and I 
thought did a masterful job of getting a good bill out of this House, 
and off and on its way. I would implore members of the other body to 
look seriously at taking up this important legislation before much more 
time goes by because, as my colleagues know and as I know, the cost of 
defensive medicine really drives up the medical expenditures, not just 
for Medicare, but for private insurers as well, and we can no longer 
afford that type of very expensive defensive medicine in this country.
  Again, I thank both the gentlemen from Georgia.
  Mr. GINGREY. Mr. Speaker, if the gentleman will yield, just as a 
follow-up to what the gentleman from Texas (Mr. Burgess) was saying 
about this other issue, and as everybody knows, we dealt with the 
HEALTH Act of 2003 earlier in this 108th Congress, H.R. 5, the Medical 
Malpractice Tort Reform Accountability Act, and of course, we hope that 
the other body will soon pass that and we will have that legislation 
before our President. He is so much supportive of this. Let me tell my 
colleagues the reason why he is so supportive.
  The savings from bringing a level playing field, we are not in any 
way wanting to take away the right of anybody to have a redress of 
their grievances if they have been harmed by their medical care that 
they received at the practice, either from the physician or from the 
facility is below the standard of care. Absolutely, they should have 
their day in court, but just trying to level that playing field, and 
the estimation, Mr. Speaker, is that there would be $14 billion in 
savings to the Federal Government on what we pay reimbursement for 
Medicare and Medicaid and military and veterans benefits because, as 
the gentleman from Texas (Mr. Burgess) pointed out, the number of 
unnecessary and duplicate tests that are ordered and procedures that 
are done, the doctors know they are not necessary, but they are forced 
into a position because of this risk, this tremendous risk of the next 
case putting them out of practice or causing that hospital, that rural 
hospital, to have to close its doors. That is the reason defensive 
medicine is being practiced, and it is costing us $14 billion. That is 
5 percent of our estimated cost of this prescription benefit for our 
needy seniors.


                Announcement by the Speaker Pro Tempore

  The SPEAKER pro tempore (Mr. Franks of Arizona). The Chair would 
remind Members to refrain from improper references to the Senate.
  Mr. BURNS. Mr. Speaker, I thank the distinguished gentleman from 
Georgia (Mr. Gingrey) and the gentleman from Texas (Mr. Burgess) for 
their remarks.
  I think it is important that we all recognize that the health care 
profession and the prescription drug industry have a lot at stake as we 
deal with this challenging issue, but I would like to remind the Chair 
that what we are dealing with here are some fundamental principles, 
that of affordability so that our seniors can have an affordable health 
care prescription drug plan and our seniors will be protected. It will 
be widely available to all of our seniors.
  I think it is very important that we understand it is voluntary. I 
have heard critics of this plan say that we are going to force the 
senior into one plan or another. That is not true. The senior can 
choose from remaining in the current Medicare system or perhaps 
adopting a different approach, but certainly to give them the option of 
looking at some prescription drug coverage.
  So this is a voluntary plan. This is a plan that deals with choice so 
they can choose a physician, choose a health care provider, and then 
effectively manage their own health care needs, and as my colleagues 
have also pointed out, that it must be sustainable so we can make sure 
that this plan is viable not only in 2004, but in 2014 and 2024 and 
2048 and beyond.
  I think these are key things that we have to remember as we continue 
this discussion and continue this dialogue and debate and mold the 
future of medical care for our seniors.
  I would like to now yield to the distinguished gentleman from New 
Hampshire (Mr. Bradley).
  (Mr. BRADLEY asked and was given permission to revise and extend his 
remarks.)
  Mr. BRADLEY. Mr. Speaker, I thank the gentleman very much for 
yielding to me.
  Mr. Speaker, today I rise to discuss one of the most important topics 
that faces all senior citizens in our country, a Medicare prescription 
drug benefit. It is something that is long overdue, and we have the 
opportunity within a month or two months to do a good job of providing 
drug care for our senior citizens which they so desperately need.
  Mr. Speaker, I have in my hand a letter from a constituent in 
Chester, New Hampshire, a constituent who knows all too well just how 
important this legislation is. She writes to me that while she is not 
of retirement age today, she has a friend who is not able to retire 
because her drug costs are simply too high, but of course, she needs 
these drugs because they are essential to her health.
  Mr. Speaker, this is not an isolated story. This is a story that is 
being told at kitchen tables and in living rooms all across our 
country. It is a story

[[Page H5396]]

that is overwhelming for millions and millions of Americans who have 
fallen victim to the overwhelming costs of high drugs today because 
they are so essential to our health.
  The facts do not lie. Prescription drugs costs have risen at a 
staggering rate. According to a study by Families U.S.A., which is a 
nonpartisan organization, the average senior citizen spent $1,200 on 
prescription drugs in the year 2000, but by the year 2010, that same 
senior citizen will spend $2,800. A Kaiser Family Foundation study 
found that between 1998 and 2000, the average prescription price 
increased more than three times the rate of inflation, and since 1995, 
the annual percentage increases in spending for prescriptions has been 
more than double the cost increases for hospitalization and doctors' 
care.
  While many Americans have felt the effects of these sharp rises in 
costs, it is America's senior citizens who are forced to pay the 
greatest price. Seniors and other Medicare beneficiaries account for 43 
percent of this Nation's total drug spending, even though they 
represent 14 percent of our Nation's population. In total, over 80 
percent, 80 percent of America's retirees use a prescription drug every 
day. With costs increasing at such an alarming rate, more and more 
seniors are forced to choose between putting medicine in their cabinets 
and food on their tables. That is an unacceptable choice, and we have 
the chance to remedy the situation very quickly.

  How will this legislation work? First of all, seniors will pay a $35 
monthly premium and a $250 annual deductible, and then whether they use 
traditional Medicare fee-for-services or a private plan, after these 
initial costs, 80 percent of the next $2,000 of their drug costs will 
be covered. For many seniors, this means an immediate cost savings.
  In addition to this initial benefit, there is a catastrophic benefit. 
Over $3,700 of costs for senior citizens will be fully compensated. 
Seniors will get 100 percent of this coverage, and this is incredibly 
important for those seniors who have very high bills.
  At the other end of the spectrum, for 5 percent of senior citizens 
who have high incomes greater than $60,000 to begin with, the drug 
benefit is income sensitive on a sliding scale. What this provision 
does, Mr. Speaker, is ensure that those people with the greatest need 
and who have limited means are treated fairly and treated first, but 
those with the greater ability to pay for their drugs do so. It makes 
the program more cost effective not only for the seniors but for all 
taxpayers.
  Finally, and just as importantly as everything else, this bill 
provides senior citizens with options. At least two prescription drug 
plans will be available to all seniors. They will have the ability to 
fill their prescriptions at the pharmacy that they choose, and in 
addition, regional preferred provider organizations will compete for 
beneficiaries, bringing market forces to bear, improving care and 
coordination and better choices. This, in turn, will also lower costs 
for seniors and for taxpayers.
  In conclusion, Mr. Speaker, I strongly urge that my colleagues 
support this important legislation so that improved health care for 
senior citizens does not rely on financial sacrifices. The advancement 
of medical research and new drugs has better engaged treatment of many 
diseases that reduce hospitalization, reduce surgery and reduce nursing 
home care. Senior citizens are better able to live more productive and 
fulfilling lives, and because of these advancements, it will be made 
possible by a drug benefit and this important legislation if we act 
now.
  Mr. GINGREY. Mr. Speaker, I just wanted to ask the gentleman from New 
Hampshire to go over once again because it is so important. His 
comments were so important in regard to our senior citizens fully 
understanding what is in this proposed legislation in regard to the 
neediest, and if the gentleman does not mind kind of repeating himself 
for emphasis in regard to those needy seniors and what they would have 
to pay, and what is the cap, if you will, above which they would not 
have to pay anything for those additional drugs?
  Mr. BRADLEY. Mr. Speaker, the catastrophic coverage, the gentleman is 
absolutely correct. The cap starts at $3,700, and above that, on the 
sliding scale, senior citizens would have all drugs paid for based on 
income sensitivity.
  On the other end of the scale, and to me what is very important, is 
that the Americans, the senior citizens who need this benefit the most 
will get the care first, and so for up to 135 percent of poverty, all 
drug costs are covered, and that is absolutely appropriate, that we 
give those senior citizens who have the greatest need for this drug 
benefit the care.
  Mr. GINGREY. Mr. Speaker, if the gentleman will further yield, this 
is so important, and I am glad the gentleman from New Hampshire has 
brought this out because we hear sometimes from constituents proffering 
the argument that, well, why should we provide a prescription benefit 
for all seniors, many of whom already have a prescription drug benefit, 
either through their Medigap supplemental health insurance plan or 
possibly through their former employer?

                              {time}  2045

  And I think the statistic that I have heard quoted is it may be up to 
65 percent of seniors that have some type of coverage, and I think the 
gentleman from New Hampshire agrees with me on that.
  But explain to us why it is still necessary, even though 65 percent 
have some coverage, that there are certainly some gaps in their 
coverage. Would you not agree?
  Mr. BRADLEY of New Hampshire. Well, Mr. Speaker, there certainly are 
gaps; and for those senior citizens that are at the low end of the 
spectrum, they often do not have any coverage whatsoever. And so this, 
unfortunately, and the gentleman, in his profession, knows this all too 
well, is forcing senior citizens into a terrible choice, paying their 
rent, their utilities, or having the prescriptions they need to have 
sound health. And that, in 2003, in the 21st century, is an 
unacceptable choice and something that we have the opportunity to 
remedy; and we should avail ourselves of the opportunity.
  Mr. BURNS. Is it not correct that the proposals we are considering 
have not yet been cast in stone? They are still quite malleable; they 
are still under debate, and we are considering multiple options? And as 
a point of emphasis, I want to recognize that our neediest citizens, 
those who would be at or below poverty level, would have full benefit 
coverage. They would not have a need to pay any of the up-front costs. 
The premium would be waived, any of the co-pays would be waived as well 
as the $250 deductible.
  So I believe what we are doing here is looking at the alternatives in 
this plan, debating it, discussing it, and making sure that what comes 
out is really in the best interest of America and of our seniors.
  Mr. BRADLEY of New Hampshire. Well, certainly my understanding of the 
work the Committee on Energy and Commerce has done so far, as well as 
the Committee on Ways and Means, is to dedicate the drug benefit to the 
senior citizens that need it the most; and that certainly should be the 
principle that we try to enshrine in this legislation. Those that need 
it the most are the most deserving and where we should focus scarce 
resources on serving.
  Mr. BURNS. I agree. I think the gentleman is 100 percent right. The 
proposals I have reviewed indeed focus this benefit on the neediest of 
America's seniors and ensures that, as the gentleman has suggested, 
they do not have to make a choice between paying the rent, buying the 
food, and then providing the prescription drugs that they need to have 
a high quality of life.
  I thank the gentleman for his input, and I thank my good friend from 
Georgia for his point as far as making emphasis to ensure that America 
understands what we are talking about here.
  Mr. BRADLEY of New Hampshire. I thank the gentleman, Mr. Speaker.
  Mr. BURNS. Mr. Speaker, I thank the gentleman from New Hampshire (Mr. 
Bradley) for his input, and I now would like to recognize the gentleman 
from Utah (Mr. Bishop) to give us a perspective from our western 
States.
  Mr. BISHOP of Utah. Mr. Speaker, many years ago, when I was in high 
school, I got my first car. It was new and it was sleek and it was fun 
to drive, and more than anything I would like to have that car back 
today. There

[[Page H5397]]

is only one problem with having that car back today. It is broken. It 
does not run. For it to do anything at all, it would require a major 
overhaul.
  That car is the same age as our Nation's Medicare system. And 
nostalgia for the good old days, which is why I want to have that car 
back, nostalgia may have warped some of our memories of what Medicare 
did or did not do or what it promised or did not promise to do; but 
nonetheless, our Medicare system today has the same problem. It is 
broken. It does not run. It needs some kind of major overhaul.
  Shortly after my election, Henry Kafton, who is a neighbor who used 
to live around the corner from me in Brigham City, talked to me about 
Medicare. And I asked him to put his thoughts down on paper. He wrote 
me a very simple two-page letter, and he delivered it to me the day 
after Christmas of last year. I still have that letter with me. In 
fact, I have it with me here this evening, because Henry suggested some 
good commonsense approaches to solving the problem with Medicare.
  However, in the third sentence of his letter, he put a perspective on 
the debate when he wrote, ``As much as we do not like to think of it, 
when you turn 65, in many ways you become a third class citizen.'' No 
American, Mr. Speaker, should ever have to feel less of a citizen 
because of their age. And, Mr. Speaker, I am happy to report the 
Republican leadership of this body will be presenting a bill to reform 
and modernize our Medicare which addresses many of the comments my good 
neighbor Henry talked about in his particular letter.
  This bill may not be a panacea for our system, but we should also not 
be arrogant or critical enough to dismiss it out of hand, for it is 
attempting to adjust a program stuck in the 1960s mode of medical 
mismanagement for the past 40 years. I am encouraged that it will 
present a program that will have three important principles.
  First, there will be a prescription drug policy which will apply to 
the neediest of our citizens as well as those, especially those, who 
have catastrophic pressing needs. Secondly, it would be based on the 
concept of choice and competition. The Medicare+Choice program will 
always be open for bid. And President Bush has been very consistent 
from the beginning in his emphasis that any kind of medical program we 
have in this country must be based on the concept of choice and 
competition. And, number three, it will be providing information to our 
seniors so that they can make informed choices.
  I also have the opportunity of serving as a voluntary noncompensated 
board member of my local hospital. And though I am certainly not an 
expert in health care, my experience has taught me that all of those 
kinds of principles in developing a health care system has to be based 
on the idea of choice and information if it is going to be successful.

  I also realize that we have a different delivery system than when 
Medicare was first established. We have changed how we care for people 
and where the emphasis is. Doctors and hospitals have made that change. 
Our Medicare system has not kept up with that change and therefore must 
be reformed in major, major ways.
  Mr. Speaker, the Medicare plan that will be coming before this body 
will encapsulate those principles, and I am encouraged that it will 
include benefits for rural health care through the disproportionate 
share rates, and that physicians and hospitals as a goal will not 
endure reimbursement cuts.
  Mr. Speaker, there are 185,603 senior citizens in my State anxiously 
awaiting this Congress to enact Medicaid reform and Medicare reform and 
prescription drug access, including my good friend Mr. Kafton. In the 
last line of his letter he wrote, ``I realize there is probably not 
much that can be done about this due to politics.'' Well, I am 
confident that the leadership of this Congress will break the political 
logjam of the past and make that statement simply inaccurate.
  This will be the first step, the first step of many, to reform a 
Medicare delivery system and a medical delivery system for the seniors 
of our Nation, and I look forward to proceeding in that particular 
direction.
  Mr. BURNS. If the gentleman will yield.
  Mr. BISHOP of Utah. Only if you make it easy on me.
  Mr. BURNS. Mr. Speaker, I wanted to point out one thing and highlight 
a comment the gentleman made. Sometimes we get caught up in perfection, 
and what we need are good commonsense approaches to problems in 
America. I think some of the critics of these proposals as we debate 
them would suggest that they do not go far enough or they do not do 
everything they should do, and indeed we may agree; but yet we must 
make sure that what we produce is a viable, sustainable, commonsense 
approach to the problems that your good friend points out in his 
letter.
  Mr. BISHOP of Utah. The gentleman from Georgia is absolutely correct. 
We did not get into this situation overnight. It took 40 years to find 
us in the predicament that we are in right now. We will not solve this 
problem overnight. This will be the first step of many. But I am 
positive if we base it on the good common principles of choice, of 
information, of competition, that indeed we will move forward in the 
near future to improving our system and, hopefully, moving to that 
panacea that we are all looking for.
  Mr. BURNS. Mr. Speaker, I thank the gentleman from Utah for his 
input. I appreciate his comments as we begin the discussion in Medicare 
reform and in the area of prescription drug benefits.
  Mr. Speaker, I would like to review the key points that we wanted to 
discuss tonight and then summarize what we have discussed on the House 
floor to make sure that the American people and that the Congress 
understand the challenges that we face.
  First of all, Mr. Speaker, we need to make sure that we understand 
the principles of strengthening and improving Medicare. We have to 
guarantee that all citizens, all of our senior citizens, have an 
affordable prescription drug benefit plan under Medicare. This is an 
important part, that the seniors that we have now have an affordable 
prescription drug plan. This needs to be a voluntary plan.
  Critics would say that we are going to force a senior to do one thing 
or another. That is not true. The senior can choose which Medicare 
prescription plan best fits their needs or they can continue in the 
current plan if they so choose.
  It helps our seniors to immediately reduce their prescription drug 
cost. Right now many of our seniors have to go out and they have to buy 
drugs at the highest price, Mr. Speaker. And this gives us an 
opportunity to provide them a negotiated prescription drug price so 
that it will immediately lower their cost. It provides special 
assistance, Mr. Speaker, and additional assistance to our low-income 
seniors who need this benefit most to ensure their high quality of 
life.
  So, Mr. Speaker, as we begin this debate, let us make sure we 
understand that the first thing we have to do is to guarantee that all 
of our senior citizens have an affordable prescription drug benefit 
plan under Medicare and that it is going to be voluntary, Mr. Speaker.
  The second principle we want to deal with, Mr. Speaker, is the fact 
that we need to protect the senior citizen's right to choose the 
physician, to choose the medical provider, to choose the druggist, to 
choose the benefit package that best meets their needs. It is going to 
provide our seniors with a range of options so that they can best meet 
their medical requirements.
  It is going to cap out-of-pocket costs. I think that is extremely 
important. We have a catastrophic failure of our drug system now where 
you can just be eaten alive and into bankruptcy because of the 
prescription drug cost to our seniors. This is going to cap out-of-
pocket costs so that our seniors will be protected and their families 
will be protected so they will not risk bankruptcy in case of a serious 
illness.

  Now, we are going to debate the amount. I have seen multiple 
proposals. The Senate has a proposal. There has been several plans here 
in the House. But I assure you there will with a catastrophic cap on 
our seniors' cost for prescription drugs. So that as we protect the 
senior's right to choose, we give every senior an opportunity to pick 
the plan that best meets their need.
  Finally, Mr. Speaker, we have to strengthen Medicare. We need to

[[Page H5398]]

strengthen Medicare for all of our seniors and for future generations. 
It is 2003; and as we work toward the resolution of this problem, we 
must ensure that it not only meets the needs of our current seniors but 
we also need to make sure that it will meet the needs of our future 
generations. We need to ensure the delivery of the needed health care 
services in both the rural environment and the urban environment.
  Mr. Speaker, in the 12th district of Georgia, I have a large number 
of rural communities that have rural health care systems. I also have 
multiple urban centers of health excellence. But we have to make sure 
our rural communities have affordable health care, that they have a 
Medicare system that allows them to continue in business and service 
their communities. In order to do that, we will very well need to 
create some really significant structural improvements so that we can 
curb the runaway health care costs that have jeopardized Medicare's 
viability in the past. So we are working on those kinds of things.
  I would like to emphasize the fact, as we begin and go through this 
debate, that there is going to be some give and take. There is going to 
be some discussion. There will be some things that are going to have to 
be worked out, but we are prepared to do that. The leadership here in 
this body, the Republicans, have offered a plan; and we will begin that 
discussion, that debate.
  This evening we have had an opportunity here from a number of Members 
who have direct experience with health care. We have heard from the 
gentlewoman from Michigan (Mrs. Miller); we have heard from the 
gentleman from Texas (Mr. Burgess). We have heard from the gentleman 
from Georgia (Mr. Gingrey). And, Mr. Speaker, I would like to now yield 
to the gentleman from Georgia (Mr. Gingrey) for his comments on 
finalizing our discussion here this evening.
  Mr. GINGREY. I thank the gentleman, my colleague from Georgia, Mr. 
Speaker. I really want to thank him for reserving this time tonight to 
give us this opportunity to present during this past hour what it is 
that we are all about.
  I think my colleague did an excellent job of emphasizing something 
that is so important for all of us to keep in mind, which is that this 
is first of all an option that seniors have. And as the gentleman from 
Georgia was talking about, it would do very little good, in fact, it 
may do some harm to try to pass a stand-alone prescription benefit even 
for our neediest of seniors, even for our neediest of seniors, without 
bringing along with that in this Medicare modernization bill some 
significant changes.
  The gentleman from Georgia talked about that and talked about the 
Medicare Advantage, which was the old Medicare+Choice, a new and 
enhanced Medicare+Choice, if you will. He talked about enhanced 
Medicare fee-for-service. These are the kinds of options that this 
President, this leadership, is bringing to the American public and 
bringing to our seniors.

                              {time}  2100

  But as the gentleman from Georgia emphasized, it is a choice. If a 
senior wants to stay in traditional Medicare, certainly they could do 
that, but they would be staying in a traditional health care delivery 
system which gave them no reimbursement for preventive health care and 
gave them no protection, as the gentleman from Georgia (Mr. Burns) 
pointed out, from a catastrophic illness that could literally put them 
out of their home.
  I wanted to ask the gentleman from Georgia to explain to us in the 
remaining few minutes in regard to the prescription benefit for those 
seniors who are scared to move into the Medicare Advantage or the 
enhanced Medicare, which I think would be a better service for them. 
But let us say they do want to stay in that traditional Medicare, it is 
an old shoe, it is comfortable, they are nervous about it initially, 
what benefit, what prescription drug benefit will they get? Is there a 
difference in the traditional Medicare and these enhanced plans?
  Mr. BURNS. Mr. Speaker, certainly as we go through this debate, we 
will see options. But the gentleman is correct, seniors will have a 
choice. They can stay with the current Medicare plan, or choose to move 
forward. But I think we can agree, number one, there is going to be 
some form of a copay, some form of a limited amount of initial cost 
associated with this plan, but it is going to be nominal. We are 
looking at plans that may require a $250 or some small amount of 
initial cost share before they begin a part of this plan, and then 
moving on up to the core part of our plan to cover up to $2,000 of 
their health care costs. It is important to remember that the median 
cost to seniors today is about $1,285.
  But I would like to close by pointing out that Medicare has not kept 
pace with medical care. Medical care has advanced tremendously, 
advanced over the last 40 years. Medicare has floundered. It has failed 
to keep pace with the needs of America's seniors. Talk is cheap and we 
have heard a lot of talk about Medicare reform and prescription drug 
plans over a number of years, but now it is time for action. It is time 
that we get the job done. The debate has begun. It is time that we make 
something happen here in Washington for our seniors. Let us put 
America's seniors first. Let us deliver on our promises. Let us 
implement a prescription drug benefit plan in a reformed Medicare 
package.

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