[Congressional Record Volume 149, Number 93 (Monday, June 23, 2003)]
[House]
[Pages H5690-H5696]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




        MEDICARE PRESCRIPTION DRUG AND MODERNIZATION ACT OF 2003

  The SPEAKER pro tempore (Mr. Garrett of New Jersey). Under the 
Speaker's announced policy of January 7, 2003, the gentleman from 
Georgia (Mr. Gingrey) is recognized for 60 minutes as the designee of 
the majority leader.
  Mr. GINGREY. Mr. Speaker, I rise tonight to talk about one of my 
favorite subjects, health care, and in particular to talk about the 
Medicare Prescription Drug and Modernization Act of 2003.
  I am surely thankful this evening that I have this opportunity to 
talk about something which truly should be a bipartisan issue, the 
health of our Nation. I am particularly pleased that it is bipartisan 
on a day like today, when I learned before boarding a plane to come 
back to the Congress that a

[[Page H5691]]

great man in Georgia had fallen. Former mayor, three-term Mayor Maynard 
Jackson has died. And I stand here tonight with a great deal of 
humility following some of the speakers who have already paid tribute 
to Mayor Jackson: the minority leader, the gentlewoman from California 
(Ms. Pelosi); the gentlewoman from California (Ms. Watson); the 
gentlewoman from California (Ms. Waters); and my colleagues and friends 
from the Georgia delegation, the gentleman from Georgia (Mr. Lewis); 
the gentleman from Georgia (Mr. Bishop); the gentleman from Georgia 
(Mr. Scott); and the gentlewoman from Georgia (Ms. Majette).
  Maynard Jackson was a great Georgian and a great American. For me to 
stand up here this evening and talk about the many things that he has 
accomplished would be a little bit redundant. I could talk about his 
efforts to bring the Olympics to the city of Atlanta in 1996, and he of 
course played a great part in that; but that is just a small thing that 
Mayor Jackson has done, and it would be not nearly enough just to point 
to that. My colleagues have done a wonderful job tonight in describing 
him and their deep friendship with him.
  Let me just say that all Georgians mourn tonight the passing of Mayor 
Maynard Jackson, and we extend our heartfelt sympathy to his family. I 
would like to actually take just a few seconds of my time tonight for a 
moment of silence in tribute to Mayor Maynard Jackson.
  I thank my colleagues.
  Mr. Speaker, America has the world's best health care system because 
it relies on innovations of the private sector. A competitive free 
market system provides incentives to develop better drugs, better 
treatments, better care, and better forms of health care delivery. The 
President's framework for Medicare reform would apply the best 
practices of the private health care market to Medicare.
  As successful as Medicare has been, it has not kept pace with 
dramatic improvements in health care because it is a government 
program, immune to many market forces. Medicare still does not provide 
seniors with an out-patient prescription drug benefit, full coverage 
for preventive care, or limits on high out-of-pocket expenses. As a 
result, our seniors lack many of the choices and benefits available to 
millions of Americans who have private health insurance.
  Mr. Speaker, I would like to call on some of my doctor colleagues in 
this body who are with me tonight to talk about Medicare and the reform 
that we are going to pass in H.R. 1. So at this time I would yield to 
my colleague, the gentleman from Pennsylvania (Mr. Murphy), to address 
this topic.
  Mr. MURPHY. Mr. Speaker, I thank the gentleman from Georgia for 
yielding time. Mr. Speaker, I rise today to voice my support for the 
Medicare prescription drug bill that will be considered by the House 
later this week.
  In the coming days, we are going to hear a lot of reasons why this 
bill is so important to our seniors. And, frankly, many of those 
reasons are correct. This is an important and long-overdue bill. I 
would like to say that prior to coming to Congress I was honored to 
serve as a State Senator in Pennsylvania, and there I served as 
chairman of the Committee on Aging and Youth, where we constantly 
worked to provide much-needed services for all seniors, but especially 
low-income seniors in Pennsylvania.

  I should note that, in Pennsylvania, over 15 percent of our 
population is age 65 and older. Some of my colleagues might be 
surprised to learn that only Florida has a higher percentage of seniors 
age 65 or older. Access to prescription drugs means a lot to 
Pennsylvania seniors, as it does throughout the Nation; but in 
Pennsylvania we are fortunate to have a comprehensive State 
pharmaceutical assistance program that has been in existence since 
1984. It is referred to as PACE and also PACENET.
  For the last 19 years, low-income seniors in Pennsylvania have 
enjoyed access to affordable prescription drugs funded through the 
lottery program. Pennsylvania's PACE and PACENET programs currently 
serve about 220,000 seniors, spending about $500 million a year. It is 
the second largest program in the Nation. I have spoken to many of my 
constituents that have used PACE and PACENET over the years, and they 
have all told me one thing: it is a good program, they trust it, and it 
makes a huge difference in their lives.
  Other seniors in Pennsylvania, as well as throughout the Nation, are 
asking, however, is there something else that can be done to assist 
them? Even in some small way, given the cost of prescription drugs for 
so many of them, very often over a thousand dollars a year, they need 
some assistance. And, Mr. Speaker, I want to point out that we are not 
just talking about quality-of-life issues. These drugs are often about 
life and death itself, and this is why this legislation is so 
incredibly important to our seniors.
  When I won my election to this House of Representatives, one of my 
top priorities was to ensure that States with pharmaceutical assistance 
programs would be protected under this bill. That is extremely 
important because over a dozen States dedicate funds to provide some 
level of pharmaceutical assistance for the elderly. It is important for 
those citizens to know that Congress is working to protect those States 
that have invested so much. Some of the neighboring States to 
Pennsylvania, New York, New Jersey, nearby Connecticut, Florida, so 
many States have these programs and have invested so much. So seniors 
are asking us, will we still have some of these benefits, and the 
answer is yes.
  I am pleased how closely Pennsylvania's delegation has worked 
together on this issue, and I particularly appreciate the Chair of the 
Subcommittee on Health of the Committee on Ways and Means, the 
gentlewoman from Connecticut (Mrs. Johnson), her guidance, support, and 
leadership on this issue. This legislation will fully integrate PACE 
and PACENET for Pennsylvania and other State pharmaceutical assistance 
programs into the new Medicare prescription drug benefit.
  This means that for low-income seniors in Pennsylvania they will 
continue to enroll in and benefit from PACE and PACENET even if they 
have a choice of other plans to participate in. It gives PACE and 
PACENET the opportunity to continue to wrap around those programs and 
make sure that low-income seniors can continue to benefit from them. It 
also creates a commission so that PACE, PACENET, and Medicare are 
integrated into a single seamless benefit. Pennsylvania will have a 
seat on that commission, ensuring minimal disruption for PACE and 
PACENET beneficiaries.
  Let us not forget that when people are in their 70s, 80s, and 90s, 
the last thing they need to juggle is how to deal with prescription 
drug benefits. They need a single seamless entity, whether it is a 
magnetic card they can swipe or whatever. The pharmacist and the 
physician will know what that senior's coverage is and will be able to 
help them in the simplest possible way to make sure they have access to 
that coverage.
  For Pennsylvania, an integrated benefit means Medicare will share a 
significant portion of PACE and PACENET drug costs, and this freezes up 
additional funding for PACE and PACENET, possibly some $200 million a 
year. So the General Assembly can both shore up the financing of those 
programs in Pennsylvania as well as expand eligibility into higher-
income levels, good news to many seniors, who up to this point have 
been paying out of pocket or trying to pay for other insurance 
policies.
  But this bill is not just good for Pennsylvania citizens; it is good 
for all of our seniors. I would like to focus on another important 
aspect of this bill. Our seniors cannot afford to wait any longer. We 
in Congress must act to create a Medicare prescription drug benefit 
because seniors should never have to choose between food and drugs. The 
unfortunate truth is that seniors without drug coverage are more likely 
to skip doses or go without filling a prescription.

  According to a 2002 study of seniors in eight States, among those 
with serious health problems, such as congestive heart failure and 
diabetes, one-third of those who lacked drug coverage reported skipping 
dosages in order to make their prescriptions last longer. What this 
means is that rather than controlling their diseases, they are more 
likely to end up in the hospital for expensive procedures.
  In addition, access to newer prescription drugs has been shown to 
lower

[[Page H5692]]

spending on other services, such as hospital care, due to fewer 
inpatient stays. Prescription drug coverage just makes sense. And if a 
senior does not take their medication, they are more likely to fall ill 
and end up in the hospital.
  I fully expect over the next couple of days that, despite people 
calling for bipartisan cooperation, which sometimes, unfortunately, are 
just words in this town, people will try to poke holes in this bill. 
They will say it does not cover enough; it is not all things to all 
people. Mr. Speaker, I do not think there is a single piece of 
legislation that ever comes out of this assembly that everybody agrees 
on all portions of. But seniors have been asking for help, and it is 
important to them that we say help is on the way. It is time to 
dedicate our energies not just to rhetoric and partisan politics to use 
this as a mechanism to attack each other. Because seniors see right 
through this. One elderly gentleman told me, my eyes may be failing, 
but sometimes we are not as dumb as you think we are. We know what is 
going on, and we need help and we need it now. So it is important we 
pass this bill.
  It is 2003, and seniors deserve comprehensive insurance coverage that 
includes prescription drugs. I urge my colleagues to join me in voting 
for this bill later this week. It is important, it is necessary, and it 
is critical we do it now. I thank my colleague.
  Mr. GINGREY. I thank, Mr. Speaker, the gentleman from Pennsylvania 
(Mr. Murphy), who, of course, talked a lot about the prescription drug 
benefit and how important a part of this Medicare reform that piece is, 
and indeed it is.
  I want to call my colleagues' attention to this poster to my left in 
regard to, of course, strengthening Medicare. There are some other 
points that I want to make that I think are extremely important and 
that the President and the leadership of this Congress know all too 
well. Of course, my colleague from Pennsylvania was talking about the 
prescription drug benefit for our seniors, but this plan does so much 
more than that. So much more than that.
  The Republican plan preserves Medicare for the future. We all know of 
the actuarial studies. We know of the bipartisan Commission on Medicare 
Reform. Everybody knows that if we do not do something in this 
legislation about preserving Medicare for the future that by the year 
2030 the program, particularly the trust fund, the hospital trust fund, 
will be completely insolvent.

                              {time}  2045

  Then the other thing about this reform is the very, very important 
point of giving seniors choices. What this bill will give to our 
seniors is a choice to remain if they want to remain in traditional 
Medicare, fee-for-service, something they are comfortable with. If they 
are not ready for a change, yes, they can remain in traditional 
Medicare and get the complete prescription drug benefit that the 
gentleman from Pennsylvania (Mr. Murphy) was talking about. So this is 
very important. This is not a one-legged or two-legged stool; it is a 
three-legged approach, and we are going to have a good program for our 
seniors.
  Of course the gentleman from Pennsylvania (Mr. Murphy) was talking 
about sometimes a senior in his district could not see very well or 
hear very well or maybe their limbs are aching and they do not get 
around as well as they used to; but if Members come to my district and 
my town hall meetings, Members know they are thinking and are smart and 
understand this issue and want relief and want it now. That is what 
H.R. 1, the Medicare Prescription Drug and Modernization Act of 2003, 
is going to give to them.
  Now, let us talk a little bit about some of these seniors. The 
gentleman from Pennsylvania (Mr. Murphy) did a great job of touching on 
that and talking about some of the people in his district. Let me point 
out in this poster, providing for catastrophe, assistance for seniors 
in need, provisions in this legislation assist seniors facing 
catastrophic medical costs. Let me give an example of some folks in my 
district that are facing catastrophic medical costs.
  Mr. And Mrs. Grady Jenkins are senior citizens who live in Rome, 
Georgia, in Floyd County, northwest Georgia, the heart of my district. 
Mr. Jenkins is 79. He is a World War II Navy veteran, and he worked at 
Georgia Craft, a paper mill. He and his wife have to pay $1,200 a month 
for their medicine. After they pay for their medicine and their living 
expenses, they can barely afford to eat. This could easily be a picture 
of Mr. And Mrs. Grady Jenkins. They are worried because the cost of 
fuel for heating and air keep rising. They do not know how they are 
going to make it.
  Let me give another example, again in the 11th Congressional District 
of Georgia, George and Vera Rohr live in Buchanan in Haralson County. 
Mr. Rohr is a 72-year-old veteran and a Purple Heart recipient. He 
worked and retired from Lockheed. They are drawing Social Security, and 
they have a supplement. Unfortunately, he suffered an aneurysm last 
year; and with the doctor bills and the medicine they both have to 
take, they have depleted their savings, and now they are struggling to 
make ends meet. They go from paycheck to paycheck. She tries to pick up 
odd jobs when she can just to buy the groceries.
  Horace Cline was a pharmacist for 49 years in Cave Springs, Georgia. 
He remembers a time when it only cost 50 cents to fill a prescription. 
Now he sees antibiotics that cost more than $10 a pill. He does not see 
how people can afford their medicine. Most of his elderly patients are 
on a fixed income, and most have three or four prescriptions a day to 
take. Many people have more than that. The average 75-year-old senior 
is taking 4\1/2\ prescription medications a day, and many of these do 
cost $10 a pill. This cannot stand.
  In his little community, this pharmacist, he hears tragic stories 
every day of people sacrificing basic needs to buy the drugs they or 
their spouses need to stay alive. He remembers a little lady that only 
received $400 a month from her husband's retirement fund. Her 
prescriptions cost $300 a month, hardly leaving anything for food. He 
said it is not uncommon for people to ask for a stronger dose of the 
medicine so they can buy fewer pills and break them in half to be able 
to afford them.
  Mr. Speaker, if you have ever tried to break apart one of these 
pills, let me say it is not easy. It is not easy for some of our 
weight-lifting friends, much less our senior citizens who are not so 
strong any more. People are improvising anywhere they can just to be 
able to afford the medicine and the doctor bills.
  Mr. Speaker, it is a great honor to be in this 108th Congress, to be 
a freshman Member of a great group of men and women. I have great 
respect for Members on both sides of the aisle. I have a special deep 
respect for some of my physician colleagues who are Members of the 
108th Congress, and one in particular, a freshman like myself who for 
many years practiced obstetrics and gynecology in Texas. He has only 
delivered fewer babies than I have because he has not been at it as 
long as I have.
  Mr. Speaker, I yield to the gentleman from Texas (Mr. Burgess) to 
speak on this very important issue.
  Mr. BURGESS. Mr. Speaker, I thank the gentleman for yielding; and I 
would add to what the gentleman has just said, he is quite right, we do 
have a good class on both sides of the aisle and certainly a lot of 
people look to our freshman class for leadership on this and other 
issues.
  I thank the gentleman from Georgia (Mr. Gingrey) for inviting me to 
talk about this important work that this House has undertaken to 
improve the Medicare program. The gentleman of course knows that 
Medicare is a 38-year-old government program, having been there at its 
inception. I came along a little later.
  Mr. GINGREY. Mr. Speaker, I must say I absolutely deny being there at 
the inception of Medicare; maybe it was close, but not at the 
inception.
  Mr. BURGESS. Mr. Speaker, I thank the gentleman for pointing that 
out. Medicare is a 38-year-old program, but unfortunately it has done 
little to adapt to the practice of medicine. There is no doubt that 
Americans have benefited from the development of new and innovative 
medications. These new drugs can improve and extend lives. It is a 
simple fact that fewer and fewer of us will die from acute illnesses, 
but more and more of us will be living with chronic conditions which 
mean the use of medications.

[[Page H5693]]

  Drugs exist that can dramatically reduce cholesterol, fight cancer, 
and alleviate debilitating arthritis. Potent cancer-fighting drugs are 
reducing breast cancer mortality rates with great success. An entire 
new class of medicines, collectively known as selective estrogen 
receptor modulators, are reducing breast cancer mortality rates and one 
day may see an expanded role in the actual prevention of this disease.

  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 decisions related to their 
health. Medicare beneficiaries should have access to these drugs, just 
like so many of us have access to prescription drugs through our own 
health plans. Medicare was established to improve the health and well-
being of America's seniors.
  Because the current program does not provide prescription drugs as 
part of its basic benefit, it is hard to say that Medicare as-is lives 
up to that promise. With nearly 40 million people enrolled in Medicare 
and the number of Americans over 65 expected to increase substantially 
over the coming years, it is important that we approach this issue with 
clarity and foresight. We should be aware that if this Medicare change 
is not done right the first time, we could be leaving for our children 
and grandchildren a commitment that will be difficult, if not 
impossible, to meet.
  This new entitlement, if not implemented properly, could threaten to 
imbalance future Federal budgets and displace other important 
priorities.
  The bill that the Committee on Energy and Commerce and the Committee 
on Ways and Means approved last week tries to meet the needs of seniors 
today and on into the future and attempts to balance the future Federal 
spending commitments, but we must also be aware of ways that we can 
hold down the price of prescription drugs and further the taxpayer 
resources that will be devoted to a Medicare prescription drug benefit.
  The United States, through our trade representatives, must work with 
foreign countries to dismantle their drug price control structures 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.
  It is time to deal seriously with other countries that put our most 
vulnerable citizens at risk. We acknowledge our obligation to protect 
the American people from policies of foreign governments that can be 
described as predatory at best. And if we cannot hold down the price of 
drugs through market principles, the taxpayer will suffer. Because of 
the decisions made by this Congress, the beneficiary could bear more 
and more of their medical costs, and the health of all Americans could 
suffer because of less access to innovative drug therapies. This 
Congress stands at the threshold of improving the lives of America's 
seniors today and of course tomorrow's seniors as well.
  Mr. Speaker, this is the first and possibly the only chance that we 
will have to get it right. We debate this Medicare bill largely through 
the lens of how we think our entire health care system should be 
reformed. We must implement commonsense, market-based reforms to hold 
down the cost of care and improve the doctor-patient relationship.
  Bills such as H.R. 2114, the Health Access and Flexibility Act, would 
increase access to medical savings accounts for all Americans and grant 
States the flexibility to provide Medicaid and children's health 
insurance program recipients with health coverage under an MSA model by 
providing Americans with incentives to hold down medical spending 
through mechanisms such as a medical savings account and giving them 
more flexibility in how they spend their own money on medical costs. We 
can do a better job of containing the cost of health care and achieve 
better health outcomes.
  And so it is with the current debate. We must all ask ourselves the 
question whether this legislation will meet the health needs of seniors 
and be accountable to taxpayers for the generations that will follow 
us. We are here debating this issue because of the absence of action, 
the absence of action by prior Congresses; but the failure of past 
Congresses and administrations must not hinder us from these two goals.
  Mr. Speaker, we stand at the threshold of implementing important 
reforms that will impact the health of millions of Americans; but the 
gentleman from Georgia (Mr. Gingrey) is right, we need to do it now and 
we need to do it right.
  Mr. GINGREY. Mr. Speaker, I thank the gentleman from Texas (Mr. 
Burgess) and, of course, the gentleman brings up some very good points 
about other reforms that this Republican majority, this administration 
and this leadership are going to present to the American public.
  The gentleman mentions the new and improved medical savings account. 
These are not for our seniors, and we are here tonight primarily 
talking about what we are doing to reform and improve Medicare, both 
the traditional fee-for-service and the Medicare advantage and the 
enhanced fee-for-service option; but also as the gentleman from Texas 
(Mr. Burgess) points out, we are thinking much broader. We are thinking 
about what we can do for younger workers so they can plan for their 
future, so they can plan for the day that they become a senior. That is 
what the gentleman is talking about with regard to medical savings 
accounts which are so important because so much of the money that is 
spent on health care in this country today is going toward extended 
care and skilled nursing facilities as an example, many times after 
prolonged hospital stays.
  The current Medicare program has no catastrophic coverage whatsoever. 
After an individual has spent 60 or 90 or at the very most 120 days in 
the hospital in any 1one year, there is no coverage. Our seniors have 
no coverage; and whatever nest egg that mom or dad or grandparents have 
accumulated it is gone, it is exhausted. In many instances when they 
have to go to an extended nursing care facility for a prolonged stay 
those benefits are extremely limited and there is no money left to pay 
for it. The part paid for by Medicare is very limited.

                              {time}  2100

  So what happens to these individuals? They do not get thrown out on 
the street. Thank God, we are more compassionate in this country than 
that. We would never let that happen. But they become indigent. They 
literally become indigent. Then they are Medicaid eligible and so much 
of that Medicaid money which, of course, being a Federal-State cost 
sharing, in some instances 60-40, maybe 50-50, very expensive, and 
where are most of the dollars going? They are going to pay those bills 
in these extended care facilities.
  The gentleman from Texas is so right. I am so appreciative, Mr. 
Speaker, to the gentleman from Texas for pointing that out to us. We 
are doing more than just reforming Medicare for the future and 
providing a prescription drug benefit for our seniors. We are going to 
make sure that those who will become our seniors in the future and ad 
infinitum will have a way to pay for things like extended care 
insurance. This is so very important and I am so appreciative of the 
gentleman from Texas for bringing that up.
  Mr. BURGESS. If the gentleman will yield, of course this is a little 
bit off the subject but so terribly important that we make our 
constituents aware, especially those who are younger or middle-aged 
that the time to look into long-term care insurance, not a program that 
will be provided by the government but something that you should do as 
being a responsible member of society, the time to look into providing 
for long-term care for yourself and your spouse, the time to do that is 
now. I again recognize that that is a little bit off our subject 
tonight, but it does tie into the greater knowledge that at some point 
the Federal Government's ability to pay for everything that is going to 
be required possibly could be outstripped. By someone being responsible 
and providing for themselves and their families now with long-term care 
insurance, this is the time to do it for individuals our age and a 
little bit younger.

[[Page H5694]]

  Mr. GINGREY. I thank the gentleman for bringing that to our attention 
because he is so right, and to have someone like the gentleman from 
Texas who has spent an entire career practicing medicine, being there 
every day and, of course, as an OB-GYN every night and every weekend as 
well, he understands the big picture. That is why it is so important to 
have Members like the gentleman from Texas bringing this information 
forward.
  I see the gentlewoman from Florida (Ms. Ginny Brown-Waite) has joined 
us, the former Speaker pro tem of the Assembly in the great State of 
Florida. I yield to her on this very important subject. I thank the 
gentlewoman from Florida for being with us tonight.
  (Ms. GINNY BROWN-WAITE of Florida asked and was given permission to 
revise and extend her remarks.)
  Ms. GINNY BROWN-WAITE of Florida. Mr. Speaker, I would just like to 
correct the previous speaker. I was the President pro tem of the 
Florida Senate, not the Assembly or the House. It was the Florida 
Senate. When I was a Florida Senator, we had an option that we pushed 
for and actually achieved. That was, we offered prescription assistance 
to low-income seniors. When we were developing the bill, of course we 
had to live within a budget. We lived within the budget. I can just 
tell you that it is almost like I can predict what will happen. We will 
hear from the other side that it is not enough. For those people who 
are benefiting, something is better than nothing. The plan started out 
relatively small and it grew and it expanded. But we were helping the 
very low-income seniors in the State of Florida.
  I rise today to remind my colleagues of the extreme importance of 
providing a prescription drug benefit for our seniors on Medicare. I 
cannot emphasize enough what a difference having a prescription drug 
benefit will make in the lives of our seniors, especially those low-
income seniors, many of whom reside in Florida. I have a large number 
of seniors who are retired who regularly call my office, who regularly 
stop me in the grocery store and after church to tell me of the 
problems that they are having paying for their prescription drugs that 
equate to a quality of life. Seniors who rely on Medicare have nothing 
to help defray the cost of their prescription drugs, the majority of 
them. Some do have prescription drug programs, but the majority of them 
have only Social Security in my congressional district and they truly 
do need the help that a good prescription drug bill will provide. 
Seniors covered by Medicare right now are probably the select few who 
are paying retail prices for their prescription drugs. You and I might 
go to the pharmacy and pay either a small copay or a very small 
fraction of the cost of our drugs. We would go ballistic if a 
pharmacist told us that the prescription that we needed, quote, wasn't 
covered. Well, guess what? Seniors face this every single day.
  A constituent called just as I was leaving the office this morning 
and told me how she has to pay $7.50 per pill for just one of her 
prescriptions. For people on a fixed income or anyone, for that matter, 
that is an enormously expensive drug. Yet this is a prescription drug, 
costly as it is, that my constituent needs to stay alive.
  Mr. Speaker, I am new to this body. I have not been around for years 
of debate on this issue in this House. I was not here for the two 
previous sessions where there was a successful vote to bring a 
prescription drug benefit to our seniors. Maybe that makes me 
idealistic, maybe less jaded, whatever you want to call it. But I just 
cannot envision going home and telling my constituents, justifying to 
them, or trying to justify to them why Congress cannot give them a 
prescription drug benefit. I hope that I never have to try to justify 
that.

  The previous occupant of the congressional seat from Florida's Fifth 
District voted against the prescription drug bill that was there in 
2002. I made a commitment early on that I would vote for a prescription 
drug bill. The prescription drug bill that has been worked through two 
committees, both Ways and Means and Energy and Commerce, is coming 
along very well. It is a bill that I have some reservations about, but 
the reservations are mainly about the cost. But we should begin a 
program and we should actually probably tie that program to the $400 
billion that we have appropriated to make sure that we stay within the 
budget guidelines.
  Mr. Speaker, I again ask the Members of this House to join me in 
voting for the prescription drug bill that will be before us later on 
this week. It is important, I think, not just for a State like Florida 
where there are many senior citizens, I have the fourth highest senior 
population in this whole Congress, but it is important to every senior 
who struggles to meet those prescription drug costs.
  Mr. GINGREY. I thank the gentlewoman from Florida. The gentlewoman 
from Florida brought up a couple of, I think, really, really good 
points, and that is the fact that our seniors who are not on a plan, 
and they are probably close to 30 percent, by anybody's estimate, 
probably 30 percent of our seniors have absolutely no coverage 
whatsoever. They do not have so-called MediGap or supplemental 
insurance. They are not getting a retirement health benefit that 
includes prescription medications from their employers. Thank goodness, 
many in that group are not poor enough to be dual eligible; that is, 
eligible for both Medicare and Medicaid. Those dual eligibles, of 
course, have a prescription benefit. And so we do have maybe 65, maybe 
70 percent of our seniors do have a prescription drug benefit, but even 
those, Mr. Speaker, probably spend at least 50 percent out of pocket, 
what they have to pay. That 50 percent when you are talking about being 
on four or five or six pills a day and some of them costing $9 and $10, 
that mounts up in a hurry and that is where you get into these 
situations where people are having to choose between groceries and 
their medications. That is a very sad, dangerous situation.
  I really appreciate the gentlewoman from Florida bringing up the fact 
that when these seniors go to their internist, to their primary care 
physician, indeed, yes, occasionally to their OB-GYN and get a 
prescription, but sometimes it is not just one prescription. They have 
these multi-system diseases. Sometimes there are two or three things 
that are failing at the same time. It takes these medications to keep 
our seniors healthy and well. So when they go to that pharmacist, as 
kind, as caring, as loving as the local corner druggist may be, they 
have got a handful of prescriptions, they do not have a plan to help 
them get a discount with volume purchasing and that sort of thing. 
There is no pharmacy benefit manager for them. They are paying sticker 
price. Our seniors know it. They are paying sticker price. It is pretty 
painful when they go back to that car and maybe they were only able to 
get half of that prescription filled or as we pointed out earlier, I 
think, one of the speakers mentioned that our seniors sometimes will 
ask for double the dose or maybe quadruple the dose so they can go home 
and get out that little pen knife and cut that pill in half or in 
quarters so they can stretch the budget, if you will. It is a very 
dangerous situation. Mistakes can be made, sometimes catastrophic, 
tragic mistakes.
  The gentlewoman from Florida is bringing out a very important point, 
that these seniors are getting no breaks in the marketplace. We need to 
give it to them. That is what we are going to do in this prescription 
drug benefit under Medicare modernization.
  Ms. GINNY BROWN-WAITE of Florida. If the gentleman will yield, 
actually in my district it is more like 50 percent of the seniors have 
no retirement prescription drug plan. I have many low-income seniors 
who have a little bit above their Social Security income, or just their 
Social Security income. My mother-in-law is a perfect example. She only 
has Social Security. If it were not for her children helping her, she 
would be one of those seniors making those very dangerous decisions. 
But not every family can help and not every family is willing to help. 
And so for the sake of the seniors who truly need assistance, this is 
the right thing to do and it is the right time to do it. I am sure that 
when we go home over the Fourth of July break that we will be hearing 
from our constituents throughout the Nation, thanking us for taking 
this step and keeping our fingers crossed that we come out with a great 
bill, between the Senate proposal and the House proposal that we truly 
will have a bill that will help seniors desperately in need of 
assistance.

[[Page H5695]]

  Mr. GINGREY. I thank the gentlewoman. Mr. Speaker, no Member of this 
body understands this better than the gentlewoman from Florida. The 
Sunshine State is where all of us want to go to retire and live out a 
very, very healthy life there in that beautiful State of Florida. She 
has got probably a disproportionate number of her constituents who are 
our beloved senior citizens. She knows of what she speaks. I really 
appreciate her bringing that to us.
  I would like to at this time recognize once again my physician 
colleague in the House, the gentleman from Texas.
  Mr. BURGESS. I thank the gentleman for yielding. I would like to 
point out that when this Member retires, of course, he plans to go to 
the Lone Star State and make his retirement there, but his comments are 
well taken. The gentleman from Georgia knows this very well. He pointed 
out that an occasional senior will see their OB-GYN and, of course, 
they see their OB-GYN for monitoring and diagnosing conditions such as 
osteoporosis. Those medicines for osteoporosis, now fortunately a lot 
of those are administered on a weekly basis. But if a senior goes home 
with that prescription and finds it is too expensive to fill, the next 
time that doctor is going to be aware that the medicine has not been 
taken is when the follow-up bone density study is done 12 or 23 or 24 
months later and no improvement or in fact a worsening of the condition 
has occurred because the medication could not be afforded by the 
patient, putting them at serious risk for hip fracture and all of the 
costs attendant with that. Of course as the gentleman knows, there is a 
25 percent mortality within the year of that hip fracture for some 
groups of seniors.
  This is a terribly important point. Although the gentlewoman from 
Florida is quite correct, there are some concerns about the cost of the 
bill, there are also concerns about the cost of doing nothing. 
Certainly the gentleman from Georgia and I both recognize that.
  I also feel obligated to mention one other aspect, and we have talked 
about this before on the floor of this House, that is, of course, the 
bill H.R. 5 which we passed last March. Getting meaningful medical 
liability reform in this country will do so much to improve the 
affordability of not just Medicare but health care in general. The cost 
of defensive medicine in this country, according to one study that was 
done out at Stanford in 1996, is nothing short of staggering and it is 
really almost beyond my comprehension that we could expect to have any 
type of meaningful Medicare reform with cost containment without 
somehow getting our arms around the problem of the expense of medical 
liability in this country and the expense of the practice of defensive 
medicine.
  Mr. GINGREY. I wanted to ask the gentleman, I am glad he brought that 
point up, about medical malpractice premiums and what it is doing and, 
of course, has resulted in a lot of defensive medicine practiced not 
just by our physicians like myself and the gentleman from Texas, Mr. 
Speaker, but also by the hospitals, by our facilities who are forced to 
protect themselves, to order in many instances a lot of tests that they 
really feel are not absolutely necessary but it is done in the interest 
of defending themselves against possibly a frivolous lawsuit that could 
be devastating to either that individual practitioner or to that little 
rural hospital in our small communities, and like my 17 counties in the 
11th Congressional District of Georgia, many of these hospitals as an 
example, these rural hospitals, disproportionate-share hospitals that 
see so many Medicare and Medicaid patients, they are going to end up 
closing their doors.

                              {time}  2115

  And I really appreciate the gentleman from Texas, that Lone Star 
State mecca where actually, as he pointed out, every day is a good day 
to be in Texas, not just during retirement years. But I wanted to ask 
the gentleman from Texas about the cost and what kind of estimates, if 
any, do we have on the cost of defensive medicine without getting a 
good tort reform bill passed?
  Mr. BURGESS. Mr. Speaker, I am going to apologize to the gentleman 
from Georgia. I do not have those figures at my fingertips. The last 
time I looked at that study by McKissick out of Stanford, for two 
diagnostic groups within the State of California, only that being chest 
pain and acute myocardial infarction, the cost was in the billions; and 
when we extrapolate that over hundreds of diagnostic codes over the 50 
States, obviously that is a significant number of dollars.
  Mr. GINGREY. Mr. Speaker, to the gentleman from Texas, I appreciate 
that. And that is exactly right, when we extrapolate that, and I have 
gotten verification of these numbers from the gentlewoman from 
Connecticut, the chairman of the Health Subcommittee under the 
Committee on Ways and Means who has done so much work on this bill, and 
I really commend her leadership. She has indicated to me that defensive 
medicine is costing the Federal Government and indeed the taxpayers of 
this country $14 billion estimated over the next 10 years. That would 
go a long way toward paying for this prescription benefit that we are 
going to be offering this year.
  Mr. Speaker, the gentleman from Texas was talking earlier about the 
cost of prescription drugs and what we can do about that. Of course we 
are going to be providing a good prescription benefit for not just our 
neediest seniors. Of course the program is weighted toward them as well 
it should be, but we are providing a benefit for all of our seniors. 
But along with that, along with that, as the gentleman pointed out, it 
is very, very important that we address this issue of the cost of 
prescription medication. I think most people in this country, certainly 
the seniors that have to go and purchase those expensive drugs, know 
that it is just too much; and we need to continue to work very hard, as 
the gentleman from Texas points out, to get the market forces working 
to bring the price down, to make the pharmaceutical industry compete, 
as well they should and they are doing; and that is what we want.
  We do not want government price controls. We want the market to 
determine, and we want of course these businesses, pharmaceutical 
businesses to have an opportunity to make a fair profit to recover, as 
the gentleman from Texas pointed out, the tremendous cost involved in 
research and development; and that of course is something that I think 
is extremely important. But we definitely feel that the competitive 
forces of the marketplace will bring prices down. And certainly, as we 
pointed out earlier, when a senior is part of a group, as we know, with 
the wonderful organization many of our seniors have memberships in AARP 
and they have a drug discount card.
  In fact, I would like to just point out if I can get everyone's 
attention on one of the posters to my left, this is the typical medical 
prescription card which seniors will have, and they will be issued by a 
number of organizations. And with those cards if we did nothing else, 
and we are doing much more, as we pointed out earlier, but if we did 
nothing else, just the opportunity to buy as a group and the force of 
the marketplace, it is going to bring down the price of prescription 
drugs for all Americans but especially for our seniors.
  Mr. Speaker, I wanted to spend a little bit of time talking about the 
Medicare program; and of course the gentleman from Texas mentioned a 
little earlier that the gentleman from Georgia, myself, was there from 
the inception of Medicare, and my wife told me to be sure to let the 
Members of this body know that of course I was there from the 
inception. I was just a very precocious first grader, but I do remember 
very well in 1965 when the Medicare bill was first passed, and the 
emphasis then in most health care was seeing one's physician, 
occasionally of course being admitted to the hospital for a needed 
surgical procedure. Nobody thought too much really in 1965 about the 
fact that here in 2003 that people would be on maybe four or five 
drugs. The average person 75 years old could be on that much 
medication. So there just really was not the emphasis in 1965, but 
things changed. Things have changed in many other aspects of our 
society. When I was in college, we used a slide rule. Nobody even knows 
what a slide rule is today. Our automakers gave us an Edsel, and now we 
have the new and improved and revised and beautiful Thunderbird. We 
need to

[[Page H5696]]

do that with Medicare. We truly need to do that with Medicare.
  I have been practicing long enough to see some significant changes; 
and I have seen managed care, health maintenance organizations with a 
great emphasis on preventative healthcare, preventative healthcare; and 
I applaud that because it is extremely important. If we wait to treat 
people when an episode of poor health or an accident has occurred, then 
it is so expensive, not to mention the tragedy and the suffering and 
the loss of life that occurs, but just the expense of waiting until 
a person is so sick and they show up in the emergency room, that 
paradigm has got to shift. That paradigm has got to shift.

  I tell my colleagues in the House, Mr. Speaker, of my experience 
recently of going through so-called open heart surgery that I was faced 
with right after winning this election to the Congress, and now I am on 
five prescription medications every day. I am not a senior citizen yet. 
I am not Medicare-eligible. But I know they are very, very expensive, 
very expensive; and it just makes me think how important it would have 
been for me and how important it is for our seniors who maybe just 
turned 65 to be able to get the medications that they need to 
strengthen their bones, to prevent osteoporosis, to lower that blood 
pressure so they do not have a premature heart attack or a stroke and 
end up in a nursing home for the rest of their lives.
  So things are changed. Society has changed. And now I do not think 
there are many physician colleagues of mine in this great United States 
who would not agree that a prescription benefit is every bit as 
important as a hospital benefit or a surgical benefit, and we have got 
to make that change. And that is what this President is doing. That is 
what this administration, that is what this leadership, what the 
gentleman from Illinois (Speaker Hastert) and the gentleman from Texas 
(Mr. DeLay) and the chairmen of our committees of jurisdiction, the 
gentleman from California (Mr. Thomas) of the Committee Ways and Means 
and the gentleman from Louisiana (Mr. Tauzin) of the Committee on 
Energy and Commerce, and their subcommittee Chairs are bringing to us. 
They are bringing not just this prescription benefit, but they are also 
bringing an option for change so that our seniors can get the same 
health care benefit that we, Members of Congress, have available to us 
and that all Federal employees have available to them, to be able to go 
to enhanced fee for service or a Medicare advantage plan where there is 
an emphasis on preventative health care, where they can get a routine 
physical done, where they can get their blood screened for lipid 
profile and cholesterol so that we will know early, early on, if they 
are at great risk for developing one of these serious illnesses. That 
is what it is all about. Colonoscopies, mammograms, things that will 
keep people healthy and prevent them from getting so far down the line 
with an illness that they cannot recover.
  So that is what we call, Mr. Speaker, compassionate conservatism. 
That is what this President and this administration and this Republican 
majority and this leadership is all about, and that is what we are 
going to bring to the seniors of this country. We are going to bring a 
prescription benefit that is weighted toward the needy, that has a 
catastrophic cap; and, yes, that cap is going to vary depending on a 
person's income or net worth, as well it should. I think it is only 
appropriate that we take care of our neediest first, but all seniors 
need the same kind of benefit that I enjoy and other Members of 
Congress and Federal employees enjoy.
  So that is a very, very big part of this program. It is not just 
providing a prescription benefit but also giving our seniors an 
opportunity and an option. Of course, they can remain in traditional 
Medicare, which we all know about a comfortable pair of shoes and we 
get used to something and change is difficult. I know change was 
difficult for me when I gave up a medical career to join the Congress 
and get on this rather steep learning curve. It is scary. It is scary, 
and maybe some of our seniors will decide to stay in traditional- fee-
for-service Medicare, but they will have a prescription drug benefit. 
They will have the same prescription drug benefit.
  What they will not have in that traditional paradigm is they will not 
have any catastrophic coverage. They will still have catastrophic 
coverage of course for the prescription benefit, but not for other 
costs involved like hospital stay or nursing home stay; and that is 
what we are trying to avoid by giving them an opportunity to join one 
of these other options where it is a competitive environment and an 
opportunity for these plans to compete against each other and lower the 
cost at the same time they are providing this preventative health care 
benefit like I mentioned, routine physicals, routine screening, and, 
yes, indeed, catastrophic coverage so that people who have worked all 
of their lives to build a little nest egg not become destitute and 
burdens on society in their senior years. That is not right. That 
destroys their dignity.

                              {time}  2130

  And if I do anything in this Congress, I am going to work hard to 
make sure that that does not happen to our seniors.
  So in conclusion, Mr. Speaker, I want to thank my colleagues who are 
with me tonight to discuss this tremendously important issue. We do not 
have the perfect plan. Yes, bills can be improved, and that is what the 
committee process is all about. That is why we have two committees of 
jurisdiction and very intelligent people working on this bill to 
perfect it. This is so much better, Mr. Speaker, this is so much better 
than what we have currently. I am just very proud of our leadership, 
and I am very proud to be supportive of the Medicare Prescription Drug 
and Modernization Act of 2003.

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