Congressional Record, Volume 149 Issue 93 (Monday, June 23, 2003)

[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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