[Congressional Record Volume 149, Number 91 (Thursday, June 19, 2003)]
[Senate]
[Pages S8167-S8169]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                            MEDICARE REFORM

  Mr. FRIST. Madam President, one last issue I wish to speak about now 
is one we will be talking about today and tomorrow on the floor of this 
Senate, and that is this whole issue of strengthening and improving 
Medicare.
  Over the last several days, we have used terms such as ``actuarial 
value,'' and ``asset tests.'' We hear those terms again and again. We 
use acronyms so often. We talk about PPOs and HMOs and waiting on CBO 
for scoring. All these are important issues and vital issues, technical 
issues that are critical to our decisions that must be made, that we 
are obligated to make and should make to serve seniors in a better way 
with regard to their health care.
  But I do want to step back, just for a second, to set the stage for 
today's debate, to talk to seniors who might be either watching on C-
SPAN or listening on the radio, and try to describe

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what, from a big picture, from sort of 30,000 feet, what this bill is 
all about.
  When I am back in Tennessee, traveling through the State talking to 
seniors, the questions that I receive are not about reform or private 
competition or a market-based approach, and how all that is going to 
work in the bill. It is not how many stand-alone drug provider plans 
will be on the table. It is not what we have to think about here, what 
the 10-year cost is, or even the 20-year cost of the benefits we are 
discussing. Those are critical issues, issues that we must address as 
we address this historic legislation at this very important time, given 
the demographics, given the fact that we are talking about a health 
care system that has not kept up with the great advances in the 
delivery system and the technology and the medical science that have 
occurred over the last 30 years.

  What they ask in these town meetings or in drugstores or when I am 
walking along on a sidewalk is: How is this going to affect me? I am a 
senior. I am concerned about my future. I am concerned about if I get 
sick. I am concerned about the fact that if I have an illness now, how 
is it going to affect me?
  Very quickly, the first thing that will happen is in about 6 months, 
maybe 7 months after the President signs this legislation and makes it 
law of the land, every senior and individual with a disability on 
Medicare--every senior--will have the opportunity to get a little card, 
a Medicare prescription drug card. Every senior will be able to benefit 
from this little Medicare prescription drug card.
  When I am talking to a senior, I tell them: You will be able to use 
this card similar to the way you might have a card for discounts at the 
grocery store, which is becoming increasingly popular today. We 
estimate that by using that little card--a card you do not have today; 
you cannot have today because the law does not allow it, but in 6 or 7 
months after this bill is signed into law, you will have a card that 
will give you a discount of somewhere between 10 and 20 percent, by 
using that card, compared to the way you are getting your drugs today.
  That is important to the senior because the senior knows that, yes, 
this will benefit me. Yes, Government, in a bipartisan way, has 
addressed the fact that the burden before me is huge.
  Why can we do that? Because by using the combined purchasing power of 
up to 40 million people--instead of an individual senior going into a 
retail store and paying retail dollars for that--all of a sudden that 
senior, by having that card, becomes part of a huge purchasing group of 
as many as 40 million people.
  If you are living alone and your income is less than $12,000 or if 
you are married and you and your spouse bring in less than $16,000, on 
that little card will be $600 of value you can use each year right off 
the top. In other words, you not only get a drug discount, but you will 
get an additional subsidy to help offset the cost of those medicines.
  A senior asks me, How am I going to benefit? You take care of the 
details up in Washington, and do it right. But how is it going to 
benefit me?
  Second, beginning in the year 2006, all seniors and individuals with 
disabilities covered by Medicare will be offered comprehensive 
prescription drug coverage. They will have access to a plan that offers 
more comprehensive coverage, when they ask how it is going to benefit 
them in the future.
  Third--and this is what I am most excited about in the entire bill--
we have also taken steps to offer seniors and that next generation of 
seniors a strengthened and improved overall Medicare Program. Seniors 
will have new choices they don't have now to get better coverage that 
meets their individual needs. They will be able to choose the type of 
coverage that best suits their needs.
  They get immediate help, and we do it in a way with a benefit they 
don't have access to today, and, in addition to that, we expand choice. 
They will have an opportunity to choose a plan that better meets their 
needs. This is an exciting improvement in the Medicare Program which 
really brings it up to a modern type of health care delivery similar 
to--not exactly but similar to--the options we have as Federal 
employees and that I have as a Member of the Congress.
  It used to be ``Mediscare.'' The last time we tried, 2 or 3 years 
ago, it was ``Mediscare.'' They said, ``Don't change.'' People will try 
to force you into HMOs. Do not trust Government. They are going to 
strip things away from you.
  Actually the President mentioned this in a bipartisan meeting with 
Senators yesterday. It is no longer ``Mediscare,'' thank goodness. It 
is Medicare. That is really what we are trying to do in a bipartisan 
way.
  People say, You want to have your choice of doctors and not be forced 
into HMOs. That is simply not true. In this bill, if you want to--for 
seniors listening to me--you can keep exactly what you have today in 
terms of your traditional Medicare coverage. You don't have to do 
anything to take advantage of the best choices. You can keep exactly 
what you have today. If you stick with what you have, you can get the 
prescription drug benefit along with everybody else, if you want to. In 
other words, keep what you have but take advantage of only prescription 
drugs. But if you are dissatisfied with your coverage today--and you 
realize that Medicare really doesn't cover preventive care, it covers 
very little in the way of chronic disease and management, it does not 
today, except Medicare+Choice, an organized, coordinated way of getting 
your health care--you don't have to, but you will be able to choose the 
expanded, the more flexible, and the more coordinated kind of coverage 
that today we clearly have as Federal employees and which also most 
working people have today, that sort of coordinated care plan.
  But in Medicare today, you don't have that option. You will have the 
option to get things that are not currently covered by Medicare, such 
as preventive care.

  I mentioned the programs of chronic disease management. There are 
also programs that promote wellness. Annual physical exams we know are 
so important. Again, whether it is annual or every 18 months, it 
probably doesn't matter that much. But right now, it is not covered 
under Medicare. That would be covered in the new program. You will be 
able to have a nurse call you or stay in touch with chronic disease 
management to remind you in case you have forgotten about who it is 
taking your weight or checking your blood pressure or looking for fluid 
retention and blood pressure, all of which are important. If you pick 
those up early, it keeps you from being hospitalized or getting sick. 
That heart is beating. If fluid is building up in your lungs, the heart 
beats harder and harder. You will have to be admitted to the hospital, 
and you will be trying to catch up. If they pick it up earlier and you 
stay healthy through appropriate management, you will not have to be 
hospitalized.
  These are the kinds of coordinated benefits most working people have 
today and, as I mentioned, which Federal employees have today. It is 
the sort of benefit we want to make available--not forcing people but 
making it available to seniors as well.
  Our goal in this bill is to allow you to have options so you can 
choose the kind of coverage and the kinds of doctors and hospitals that 
are most consistent with your needs. That is our goal, to make sure 
those choices are available for you.
  In the days to come, we will have a lot of discussion and amendments 
as to how this plan will evolve. That is the whole purpose of having 
the debate and amendments.
  As all of us know, the House of Representatives is going full steam 
ahead doing exactly the same thing we are doing and developing a plan, 
after which we will go to conference.
  This bill represents the largest expansion of the Medicare Program in 
its history. We are going to be spending an additional $400 billion, 
which is a hefty sum, in providing this new benefit and strengthening 
the Medicare Program, and $400 billion is a lot. But the fact is that 
seniors over the next 10 years are going to be spending about $2 
trillion on medicines and prescription drugs.
  We are trying to target the resources of $400 billion in a way that 
makes the most sense so we can have appropriate benefits for seniors 
who are less well off and seniors who have very high drug costs so they 
get the most help.

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  I am looking forward to the debate. I want America's seniors to be 
able to come back to this picture I have just painted, and I want them 
to understand really these three things.
  No. 1, if you want to, you can stick with what you have.
  No. 2, you can, if you want to, stick with what you have but also get 
help with your prescription drugs.
  And, No. 3, you will have for the first time in our Medicare Program 
the option, the opportunity of choosing a comprehensive, coordinated 
health care plan that keeps up with medical advances, with advances in 
technology and with advances in health care delivery systems.
  When we finish this bill, and when we are successful, you will have a 
plan that offers real health security.
  Madam President, I yield the floor.

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