[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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