[Congressional Record Volume 149, Number 154 (Wednesday, October 29, 2003)]
[House]
[Pages H10106-H10112]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
{time} 2000
MOTION TO INSTRUCT CONFEREES ON H.R. 1, MEDICARE PRESCRIPTION DRUG AND
MODERNIZATION ACT OF 2003
Mr. DAVIS of Florida. Mr. Speaker, I offer a motion.
The SPEAKER pro tempore (Mr. Nunes). The Clerk will report the
motion.
The Clerk read as follows:
Mr. Davis of Florida, moves that the managers on the part
of the House at the conference on the disagreeing votes of
the two Houses on the Senate amendment to the bill H.R. 1 be
instructed to reject the provisions of subtitle C of title II
of the House bill.
The SPEAKER pro tempore. Pursuant to clause 7 of rule XXII, the
gentleman from Florida (Mr. Davis) and the gentleman from Virginia (Mr.
Cantor) each will control 30 minutes.
The Chair recognizes the gentleman from Florida (Mr. Davis).
Mr. DAVIS of Florida. Mr. Speaker, I yield myself such time as I may
consume.
Mr. Speaker, this motion instructs the House medicare conferees to
reject the provision in the House Medicare bill that I believe can be
fairly characterized as leading to the privatization of Medicare. The
House leadership has cleverly described this provision by calling it
premium support. But how much support this premium support provision
truly provides beneficiaries should be the subject of an open, honest
and detailed debate tonight out of respect for the Nation's seniors who
simply want to see us get something done.
I also want to pause to point out that there are a number of
Republicans and Democrats here in Congress who truly do want to find a
middle ground, a compromise between the House and the Senate, between
Democrats and Republicans, to achieve a long overdue Medicare
prescription drug bill. Many of us have been very consistent in arguing
that that is not achievable as long as the premium support issue, which
is the subject of this motion, is part of a final bill. So the motion
tonight is an attempt to remove a provision which many of us believe
represents an obstacle to a compromise to a truly practical long
overdue prescription drug benefit for our Nation's seniors.
Now, what the premium support provision does is to allow seniors in
the year 2010 to have what is being described as a meaningful choice as
to how to obtain their Medicare coverage. Not just for the drug
benefit. This is for the entire Medicare program. And the concern I
wish to express tonight on behalf of seniors throughout the United
States, Democrats, Republicans, independents, seniors who really are
not interested in politics but are simply interested in seeing a drug
benefit that they can use, is that the premium support provision in the
year 2010 forces seniors throughout the United States to make a choice
as to how they are going to receive health care, and that this is going
to be a problem for those seniors who have health issues.
I think one of the many things that we can agree upon tonight on the
floor of the House of Representatives is that there are a number of
seniors who have health issues as they approach the age of 65, or long
before then; and that is what this debate is about.
I met with the incoming president of one of the major private
insurance companies in Florida a few weeks ago, and it could have been
any insurance company or any CO of an insurance company; and I said to
him, if this were to become law in 2010 and my mom had some health
issues and she went to you and tried to get insurance, would you offer
her insurance? What he told me, and I respect his candor, is we really
do not want people that have health issues in our policies. We are
looking for healthy people. They are easier to insure, the risk is more
certain, it is more affordable, it is easier to earn a reasonable
profit; and so that is the type of beneficiary we are looking for.
And if somebody is in the private sector, I understand his point of
view. He is trying to earn a profit on behalf of his company. And if
the government does not force him to choose to accept people like my
mom or somebody else's mom with some health problems, he is not going
to do it. So what this debate is about tonight is what happens to that
individual, somebody over 65 who has some health problems or develops
health problems.
Now, Mr. Skully, who is the administrator of the Federal agency, the
Center for Medicare and Medicaid Services, which has a slightly
different name now, said in 2001, in the fullest candor, which I
respect, that there was a problem with private plans charging higher
copayments for those people with health risks that they did not want to
accept, and that we who are entrusted in the Federal Government to
provide a Medicare program that truly works should be concerned that
private plans will use higher copayments and other devices to
discourage people from signing up for their plans.
And that is exactly what I am talking about here tonight. Because
under this premium support provision, which I would also refer to as a
voucher, but it is whatever you choose to call it, in 2010 an
individual with a health problem is going to have one of two choices:
they can either try to get into a private plan, which again I would
submit is not going to want them and is going to discourage them and is
going to have the full ability under this bill to do that, and if that
person with some health issues who is over 65, that Medicare
beneficiary cannot get into the private plan, they are left with the
crux, I would say the cruel result of the premium support plan.
I will attempt to explain that. And in the debate tonight, I hope we
can reach some agreement as to what the facts are, and then we can
debate the differences as to how we interpret those facts and where the
values of our country lie in terms of how we treat this beneficiary and
in terms of how Congress designs this plan.
The second choice that is available to that Medicare beneficiary, if
the private plan rejects him, is they receive a voucher. Now, what that
voucher represents in terms of value is a dollar figure that is based
on the average cost of insuring a person who is in a private plan.
Because in a private plan I think we can safely say those beneficiaries
are going to be healthy, their health care bill, of course, is going to
be less. It is going to be less expensive to insure them. So that
individual who receives the voucher is going to receive a voucher that
is equal in value to the average cost of a healthy beneficiary whose
costs are lower.
Now, what does that all translate into? What that means is that with
this voucher, if you have some health issues and therefore your health
care bills are higher, that voucher is not going to provide to you
enough money to get you through the month or to get you through the
year. I believe it is fair to say that we face a situation where these
Medicare beneficiaries with health problems that have been rejected by
these private plans are going to get enough money to almost get them
through the month or to almost get them through the year.
[[Page H10107]]
Matter of fact, the chief actuary who works for the CMS, the Federal
health care agency, said in a piece of paper that under this premium
support or voucher plan, that premiums could go up as much as 25
percent for this individual I am describing who could not get into a
private plan and has to find another way to cover their health care
costs. Twenty-five percent, that is a lot of money.
And remember, when we are talking about a Medicare beneficiary who
has some health problems, we are talking about somebody who probably is
having difficulty paying their other bills. They are fighting for their
health, and they are probably getting into some serious financial
duress. And under this premium support voucher plan, we are going to
add to that duress. Because what you are left with is a Medicare
beneficiary with health problems who at the end of the month or the end
of the year their Medicare runs out.
And that is what we are debating tonight: Do we believe as a Congress
that Medicare should ultimately leave that individual without the
support they have always had when it gets to the end of the month or
the end of the week? And I think the answer is clearly no.
The basis for the premium support, and I salute my colleagues on the
Republican side who have been very clear in explaining what the purpose
of this premium support provision is, is to reduce the cost of
Medicare. You can call that reducing the rate of growth in Medicare,
you can call it cutting Medicare, but what you can fairly say is this
is about reducing the cost of Medicare.
And my colleagues, this is what it boils down to: Are we as a
Congress going to reduce the cost of Medicare by saying to that
Medicare beneficiary who is struggling to recover their health, that at
the end of the week, at the end of the month, you are on your own? You
are on your own; we wish you well. Medicare as we know it is no longer
there to get you through the week. It is no longer there to get you
through the month. We wish you well, and it is on your back that we are
reducing the cost of Medicare.
I would suggest that that is an indefensible proposition; that there
are seniors throughout the United States, Democrats, Republicans,
independents, people who simply want the drug benefit, want the
Medicare program they have come to know and trust who think it is
fundamentally unfair that the growing number of seniors in this country
who struggle with health issues after the age of 65 are forced to try
to find the funds at the end of the week or the end of the month to
meet the health care bills that we will no longer be able to meet for
them through the Medicare program.
Mr. Speaker, I reserve the balance of my time.
Mr. CANTOR. Mr. Speaker, I yield myself such time as I may consume,
and I too am delighted to be here to debate with the gentleman from
Florida the motion to instruct which he offered.
Mr. Speaker, I think there is a consensus in this body that we do
something to save the Medicare program. All of us know the
demographics, all of us know the health of the system itself is in
jeopardy, and we must do something to reform the program to ensure its
financial health and longevity.
It is interesting, Mr. Speaker, the gentleman from Florida insisted
that we ought not go the route of market-based competition and we ought
not allow the competition of private sector plans to come into play to
give seniors a choice of how they want their health care delivered. But
I heard no ideas come forth from the gentleman. Where is his solution?
I think it is fairly indicative that there is no solution coming from
the other side, and that they probably, I do not want to put words in
the gentleman's mouth, are satisfied with the status quo. But we cannot
be satisfied with the status quo. We must reform the system. We must
modernize it, and we must update it so that seniors can have a choice
and seniors can have access to a prescription drug benefit.
So if we call premium support, as the gentleman said, a voucher, I
think it is a characterization that perhaps may not adequately or
accurately reflect what the House bill does. And let us start back from
the very beginning when a bipartisan commission on the future of
Medicare studied this. It concluded that the best way to reform
Medicare was to provide beneficiaries with a choice of plans similar to
the choice available to Members of Congress, the FEHBP plan, which we
all have access to. And certainly I would think we would want to share
that same type of health care with the millions of seniors out there
who may not currently enjoy the same type of options under the plan.
But to talk to the gentleman's allegations that the House bill would
only squeeze out the unhealthy seniors and would deny them access is
simply not true. Absolutely not true. At 2010, when competition sets
in, the rates that are set at that point are not just the average
rates.
And since we are talking about the facts, and the gentleman says he
hopes we can agree on the facts, the facts are that in the House bill
the average rates are a blended rate, a blended rate of the then-
private plan rates as well as the government rate that was used as a
benchmark up until that point. And at that point we will then have
market forces coming to bear, and we will enable plans to compete for
business. And if plans can come in under that benchmark or that blended
rate, then there will be a benefit for seniors to choose those plans
because they, as well as the government, will be able to share in the
savings in the costs of those premiums.
But to speak to the gentleman's conclusion, that if we have
competition we will ultimately deny seniors health care, that is just
preposterous. There are provisions, if he would look at the facts in
the House bill, there are provisions which allow for an adjustment in
premiums of the government program. No one ever said that there would
not be an option in the government program. Nothing changes a senior's
entitlement to Medicare. There is no change in entitlement.
And if, as the gentleman suggests, that perhaps there is a
disproportionate number of the population of ill or more sick seniors
that are in the government program, there is a provision in the bill
which allows there to be an adjustment in the premium so as to avoid
the exact problem the gentleman points out. Those are the facts.
And to conclude, Mr. Speaker, again, we have got to do something
about Medicare. Medicare and the demographics supporting that program
do not bode well given the current state of affairs. I do not hear a
single solution coming from the other side, which seems to suggest that
there perhaps may be an obstructionist plan not to allow Congress to
pass a prescription drug benefit plan this year, but that is what
America's seniors wants and that is what we must do.
The bill that passed the House offers us a way to reform the system,
to achieve savings, to allow seniors to have choice in their health
care, and choice just as we here in Congress enjoy in the FEHBP
program.
Mr. Speaker, I reserve the balance of my time.
{time} 2015
Mr. DAVIS of Florida. Mr. Speaker, I yield 4 minutes to the gentleman
from New Jersey (Mr. Pallone).
Mr. PALLONE. Mr. Speaker, I have great respect for my colleague, the
gentleman from Virginia (Mr. Cantor), but when I listen to the
arguments being made, I have to reject them outright. The gentleman
talked about how Medicare is going broke and the gentleman said, What
is the solution? Well, the solution is for the Republican leadership in
the House and the Republican President to abandon their failed economic
plan, which essentially over the last 2 years has been to create more
and more tax cuts, drive the Federal Government into deficit, the
biggest debt we have had in anybody's memory, and borrow all of the
money from the Medicare trust fund so it goes broke.
Mr. Speaker, if we keep borrowing from the trust fund in order to pay
for tax cuts for the wealthy, of course there is not going to be money
in Medicare. The solution is easy, get rid of the tax cuts that are
primarily favoring the well-to-do and corporate interests, and then
Medicare and the trust fund will have money and there is a solution to
the problem.
That is what we were doing when President Clinton was in office, we
[[Page H10108]]
were getting out of debt, and we had a balanced budget. The other side
of the aisle created the problem, the economic downturn, and the
situation where the trust fund does not have the money; so do not talk
to me about solutions, they are easy: Get rid of the failed Republican
economic plan.
I listened to what the gentleman said, and he was honest about the
facts. He said in 2010 there is going to be a blended rate of the
government plan and private plans, but what the gentleman fails to tell
us is this blended rate is less than what traditional Medicare costs at
that point. Because there is a voucher system in place, the senior who
wants to stay in traditional Medicare is going to pay more. There is a
blended rate with the traditional Medicare and the private plan. If the
traditional Medicare costs more, seniors will have to pay out of
pocket, and most seniors who want to stay in traditional Medicare will
not have enough money to pay out of pocket. It could cost them $500
more a year, $1,000 more a year, $4,000 more a year, the sky is the
limit. Increasingly, a lot of seniors will drop out and not be able to
have traditional Medicare. That is why we say essentially what they are
doing is trying to save money, and they are saving money by keeping
money from access to traditional Medicare.
The gentleman talks about choice of plans. How is there a choice of a
plan if you cannot afford to pay for the plan you want, which is
traditional Medicare. And meanwhile, you lose your choice of doctor and
your choice of hospital because the only way you can get your health
care is by joining an HMO, a private plan. So you do not have a choice
of plan because you cannot afford to stay in traditional Medicare. You
do not have a choice of hospital or doctor because you have to go into
an HMO to get your health care.
The facts are simple. The other side of the aisle is setting up a
voucher. They do not care about the traditional Medicare program. They
say it costs too much when, in reality, they have created the situation
that is making it go broke, and it is not really broke, but certainly
it will be if we continue with this economic policy.
I have to look at it from the point of view as a senior citizen. They
want to privatize. So you have to say, we will give you a drug benefit,
but you have to join an HMO to get the drug benefit. And you are sort
of dangling the opportunity for a drug benefit out there, but in the
course of getting that drug benefit you are setting up a program with
this premium support or voucher which essentially privatizes Medicare
and forces people out of the traditional Medicare program.
So it is really an effort to sort of ``behind the scenes'' get the
seniors out of traditional Medicare and force them into HMOs by
suggesting somehow we cannot afford traditional Medicare and that this
is the only way to get a drug benefit.
I think they have to be honest about what they are doing. I support
the motion of the gentleman from Florida (Mr. Davis) because it makes
quite clear that on the Democratic side of the aisle, we do not want
seniors forced into vouchers or forced into HMOs. We do not want them
losing their choice of doctors or choice of hospitals, and we do not
want to set up a situation where essentially we kill traditional
Medicare. That is what the Republicans are all about, and that is why
we need to support this motion to instruct.
Mr. CANTOR. Mr. Speaker, I yield myself such time as I may consume.
Just to respond to the gentleman from New Jersey's statements, first
of all about the need for us to reverse the trend toward giving people
and businesses back more of their hard-earned money, so they can invest
that money creating opportunity, so we can actually grow this economy
the way we are seeing it grow as a result of the Bush tax cuts that we
have passed in this Congress. And setting that aside, Part A is funded
by the trust fund, and Part A has a surplus in it. But Members know the
demographics. Just like the Social Security situation, the demographics
in this country are betting against us because as more and more people
retire, less money will be paid into the program and more people will
be on the back side benefiting from the program. That is the problem
with Part A.
Part B is funded by general revenues. As we continue to put money
into Part B, and we continue to see rising health care costs, estimates
are that a third of people's income will be used in the next 20 or 30
years to fund the Medicare program. I do not think any of us want to
see our children and grandchildren saddled with that kind of debt off
into the future. That is why we have to act now. That is why we have to
reform this program, we have to afford ourselves efficiencies, we have
to save money, and we have at the end to provide seniors with a health
care plan that affords them choices.
I will also tell the gentleman, I am having difficulty following the
argument about the blended rate and about the fact that we are going to
have a blended rate that reflects both private rates, as well as the
rate in the government program. That is the beginning. That is the
transition into the formula which after 5 years will then reflect
basically the rates that are out there in the marketplace for the
predominance of the public, the seniors who are in the private plans.
And the gentleman just said the private plans will be cheaper, so if
the private plans are cheaper, then the government plan and the fee to
get into the government plan will reflect the costs offered by the
private plan. I am having trouble with the sort of circular argument
that you cannot have these private plans succeed because only the
nonsick will enter them and will leave all of the sick people in the
government-run program which we already said there are provisions in
the bill to address that.
Also, we are talking about doing something to reform and better the
program. We are talking about updating and modernizing the program. I
hear nothing from the other side of the aisle which even suggests that
we should go forward to offer seniors a real choice in health care just
as we have as Members of Congress.
Mr. Speaker, I reserve the balance of my time.
Mr. DAVIS of Florida. Mr. Speaker, I yield 5 minutes to the gentleman
from Ohio (Mr. Brown), the ranking member on the Subcommittee on
Health.
Mr. BROWN of Ohio. Mr. Speaker, I thank the gentleman yielding me
this time, and thank the gentleman for the good work he does on health
care on the Committee on Energy and Commerce.
Mr. Speaker, I rise in support of the Davis motion. Under H.R. 1,
Medicare, pure and simple, ends as we know it, as the gentleman from
California (Mr. Thomas) the chairman of the Committee on Ways and Means
has predicted and has worked towards, it ends in 7 years. In 7 years,
regardless of what Republicans tell us, Medicare will be replaced by a
voucher to cover part of the premium for health insurance. As the
voucher goes into effect, seniors out-of-pocket costs increase.
Medicare no longer, under the plan of the gentleman from California
(Mr. Thomas), under H.R. 1, under the Republican plan, it no longer
guarantees seniors and disabled Americans access to the health care
that is deemed medically necessary for them. The government would
contribute a set number of dollars to an HMO or some other health
insurance; beneficiaries foot the rest of the bill. The government may,
although they have not under HMOs so far, may save money; but every
dollar the government saves comes out of middle-class and lower-income
seniors' pockets.
So much for the Medicare entitlement, so much for guaranteed
benefits, so much for choices that matter: Choice of hospital, choice
of doctor. I love it when Members on the other side of the aisle say
seniors want more choice. They want choice of hospital and doctor. That
is what Medicare gives them. They are not asking for choice of
insurance agent or insurance company or maybe even choice of glossy
HMOs brochure, they want choice of hospital and choice of doctor. That
is what Medicare has given seniors for 38 years.
I hear my friends on the other side of the aisle say Democrats do not
have a solution. First of all, you have to tell me what the problem is
before we offer the solution because Medicare clearly, except it does
not have a prescription drug benefit and it is too expensive for some
seniors, and we need to fix that, but other than that, seniors are
happy with the way Medicare works. They have full physician choice, and
they
[[Page H10109]]
have full hospital choice. I love how the other side of the aisle
argues for market-based competition. That has certainly worked to keep
the price of prescription drugs down. It is good for going to the
grocery store and buying a new stereo, but it does not seem to be
working for prescription drugs or HMOs.
Seniors would choose an HMO over traditional Medicare if traditional
Medicare were funded as well as it should be, I do not think so. But
what I think about this, Mr. Speaker, what I think about the Republican
efforts to privatize Medicare and turn it into a voucher system to
change, as the gentleman from California (Mr. Thomas), the leading
Republican expert in this Congress on Medicare says, to change, to end
Medicare as we know it.
When I think about that, it dawns on me what the Republicans want to
do. They have never, Republicans have never really appreciated and
liked Medicare. In 1965 when Medicare was passed, only 11 Republicans
in this whole body and the other body voted for it: Then-Congressman
Bob Dole voted no, then-Congressman Gerald Ford voted no, then-Senator
Strom Thurmond voted no, then-Congressman Donald Rumsfeld voted no.
Republicans did not want to create Medicare.
Then many years later, the first time Republicans were in control of
this body, the first thing Speaker Gingrich did, the first time they
were in the majority, the first thing he tried to do was cut $270
million from Medicare. Why, to give a tax cut to the most privileged
people in society, wealthy Americans. They do not like this program.
They want to privatize this program. They want to turn Medicare over to
private insurance companies, private HMOs, so instead of choice of
physician and hospital, you will have choice of glossy insurance
company brochure, you will have choice of insurance agent, choice of
insurance company. That is not the kind of choice senior citizens want.
Mr. Speaker, every time since Mr. Gingrich in 1995 tried to cut
Medicare, every other time Republicans have had an ability to do
something to try and weaken Medicare, they have tried to do it.
President Bush said in a State of the Union speech, he said if you want
to get prescription drug coverage, you have to get out of Medicare and
go into a private HMO to get it.
The Democrats simply want Medicare prescription drug coverage to be
done through traditional Medicare, not turned over to insurance
companies. When you look at what Republicans think about Medicare, the
lack of support in 1965, the lack of support in 1993, the lack of
support in 1999, the lack of support in 2003, you know the system
works, you know the Republicans do not like a government program like
that.
Mr. Speaker, I ask for support for the Davis motion to instruct. It
makes sense. We want to preserve and protect Medicare, not privatize
this system and turn it over to the insurance industry which just
happens to give millions and millions of dollars to President Bush and
to Republican candidates.
Mr. CANTOR. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, first I would like to call to the attention of the other
side of the aisle, in H.R. 1 on page 260, line 18, in very bold print
it says, ``No change in Medicare's defined benefit package. Nothing in
this part or the amendments made by this part shall be construed as
changing the entitlement to defined benefits under parts A and B of the
act.''
{time} 2030
Again, nothing is going to change the entitlement for seniors to
these benefits, as we said earlier in the House bill.
I would also, Mr. Speaker, at this time like to point out, the
gentleman from Ohio says that Republicans do not like Medicare. It is
interesting that we on the Republican side are the only ones, once we
took majority in this House, who put preventive benefits into the
Medicare package. We now have as current law colorectal cancer
screening which seniors are entitled to, mammograms, pap smears,
prostate screening. In the current bill that we have before us that is
in the conference committee, there is an initial physical that will be
offered to seniors. There is screening for diabetes, screening for
cardiovascular disease provided to all seniors. All seniors. That is
what the bill provides for.
As the gentleman also knows, there has been much discussion and much
work on the part of the gentlewoman from Connecticut (Mrs. Johnson) in
the area of chronic disease management. Together with these screening
provisions and these benefits that are going to be offered to seniors,
we will be able to address some of the potential for these diseases
early on, thus saving an awful lot of money and lengthening seniors'
lives. I find it hard to even digest the gentleman's suggestion that
Republicans do not like Medicare.
Mr. Speaker, I reserve the balance of my time.
Mr. DAVIS of Florida. Mr. Speaker, I yield 3 minutes to the gentleman
from New Jersey (Mr. Pallone).
Mr. PALLONE. Mr. Speaker, I listened to what the gentleman said about
the benefits. Surely we have all worked on a bipartisan basis to
increase the benefit package. But the bottom line is it is the quality
of care that suffers. We know that our seniors, many of them do not
like to have to join an HMO where they are not necessarily provided
with certain procedures. HMOs routinely deny seniors certain
procedures, certain operations.
Clearly they are forced to have certain doctors and are limited in
terms of their choice of doctors and hospitals. So when the gentleman
says they are going to have a benefit package, sure they have the same
benefit package, but that does not mean they have the same quality of
care, it does not mean they can choose their doctor or choose their
hospital. They may be denied an operation. They may be denied certain
equipment. So do not tell me that just because you are guaranteed a
certain benefit package that it does not make a difference when you
want to stay in traditional Medicare as opposed to having to join an
HMO. There is a big difference.
I just wanted to point out one thing, and I was going to ask my
colleague from Ohio about this because he has been a leader on this
issue. The gentleman from Virginia talked a lot about saving money, but
the one big way that you could save money is if you had some kind of
cost controls and you negotiated the prices of prescription drugs. The
one thing that Republicans have refused to do as part of this package
is to in any way control or limit costs in terms of the price of
prescription drugs. I would venture to say to you that if you did not
have this clause, you have a noninterference clause that says the
Secretary of Health and Human Services or the Medicare administrator
cannot negotiate price. We do it with the VA, we do it with the Defense
Department, we do it with the military. That is one way of saving on
cost. You absolutely refuse to do it. You prohibit it.
Mr. Speaker, I yield to the gentleman from Ohio (Mr. Brown) because I
know that he has often talked about this issue. It is clearly a way to
save money.
Mr. BROWN of Ohio. I thank the gentleman from New Jersey for
yielding. When you talk about cost savings, you can talk about a lot of
things but the greatest opportunity we have to save money for the
Medicare program is to put the prescription drug benefit inside
Medicare and then use the buying power of 39 million Medicare
beneficiaries to bring the price down. That is what the Canadians do.
That is what the French and the Germans and the Japanese and the
Israelis and the Brits do. They use the buying power of millions of
seniors, of millions of citizens in their country to get the price
down.
That is why Americans pay two and three and four times the price of
prescription drugs that anybody else in the world pays. But probably
the reason for that is, again, as the insurance industry, it goes back
to who is helping the Republican Party. The drug industry has already
given $60 or $70 million to President Bush's campaign and to House
Republicans and Senate Republicans. That is why this prescription drug
benefit, H.R. 1, and every other House bill that comes to this floor
sponsored by the Republican leadership will never deal with the high
cost of prescription drugs simply because the drug industry, who
frankly is way, way too influential in this body, the drug industry
simply will not let my Republican friends bring a bill to floor that
will cost them a lot of money.
[[Page H10110]]
Mr. CANTOR. Mr. Speaker, I yield myself such time as I may consume.
I would just like to respond, number one, the gentleman from New
Jersey suggests that the best way that we can control the escalation in
cost in health care is essentially for the government to fix the price
and for the government to be the player. That is essentially what we
have got now in Medicare. We have got a one-size-fits-all government
plan determining benchmarks, government determining reimbursement
rates. I would just ask the gentleman whether he really believes that
we have done anything to really control costs. I am not yielding to him
right now. He can respond on his own time. Does he really believe that
the costs have come under control and that we are facing a deflationary
trend in the cost of health care?
Then I would like to also say that in terms of the accusations that
we in some way through passing the House bill are forcing people into
HMOs, there is no provision which forces anyone into an HMO. In fact,
the bill takes great strides toward creating regional provider
networks, so that individual Medicare beneficiaries will have the
ability to go and seek care within the network. They can go outside the
network. No one is forcing anyone into an HMO, which again goes back to
the central point of what we are trying to do and that is to afford
seniors a choice. Not everyone wants the same type of health care. And
certainly I would suggest that no one wants a Canadian-style health
care. No one wants to see a nationalized health care. It is almost like
the other side calls for Hillary-care. No one wants that.
As far as the gentleman from Ohio in his discussion on the
pharmaceutical end, I thought that the motion to instruct on the part
of the gentleman from Florida related to part C, not part D.
Mr. Speaker, I reserve the balance of my time.
Mr. DAVIS of Florida. Mr. Speaker, I yield myself 4 minutes.
I would like to briefly point out some of the things that clearly are
not a part of this debate and then focus on some of the things on which
there is some agreement here. This is not about nationalizing the
health care system. The statement was made earlier that I am against
market-based competition. Speaking simply for myself, I am not. That is
not the issue here tonight. The issue is how do we answer the question
to a Medicare beneficiary who has some health issues, who has been
rejected by a private plan, how is she or he going to find a way to pay
their bills at the end of the week, at the end of the month when the
Medicare dollars that they receive now run out. That is the question.
The issue has been presented tonight as to whether we are against
choice. I do not think it is whether we are against choice; it is
whether what is being presented here is a false choice. I think we can
agree that if you are a perfectly healthy Medicare beneficiary, this
private plan may work for you. But if you are not, if you have reached
65 and you have had a history of some health problems or you are going
to be experiencing them, I believe, as I stated earlier, that the
insurance companies across this country will say that we do not choose
to insure you; and this bill, and this point has not been refuted by
the other side, does not force a private insurance company to accept
somebody with health issues who is more expensive who they do not
choose to insure because they do not think that person is sufficiently
profitable. That private insurance company has a choice. They have a
choice to say to that Medicare beneficiary, We do not want you.
Instead, you take your voucher and you go off and you take care of your
own health care.
It is also important to point out, there has been no disagreement on
the other side, no even attempted disagreement as to the fact that the
chief actuarial for Medicare has stated that under this premium support
provision, that a Medicare beneficiary's premium could increase by as
much as 25 percent. This is a fact. This is not in dispute. So
notwithstanding these arguments about risk adjusters and blended rates
and the bill saying whether it is defined benefit or defined
contribution, the fact remains at the end of the day that when a
private insurance company turns away somebody with health issues and
their premium goes up by as much as 25 percent, that person is left in
the cold, that person is left in the dark at the end of the week or at
the end of the month when their voucher runs out.
The question remains whether we believe as a Congress, as Democrats,
Republicans, as independents, as United States citizens, that it is
humane to change Medicare as we know it and leave that person in the
cold, in the dark when their voucher runs out. We can look at examples
around the country of the Medicare+Choice plan that has been in effect,
in my State, Florida, in many States where people who had no health
problems enjoyed the benefits of the Medicare+Choice plan. But when as
they got older they started to develop health problems and they were
turned away by their private plan, thank goodness traditional Medicare
was there as a fallback to provide to them the coverage that they had
earned through paying a payroll tax, through the copayments and the
premiums they paid. Thank goodness traditional Medicare was there. But
if this premium support plan is adopted, that person will no longer
have that benefit. They will have the voucher instead.
Finally, the gentleman, I think, credibly points out, where is the
alternative? I wish I was in a position tonight to offer the
alternative. I am forced only to offer a motion to instruct to remove
parts of the bill, not to add them. This motion is offered in an
attempt to take this very destructive issue off the table so we can get
to what we are here today which is to create a reliable, affordable
Medicare prescription drug benefit.
Mr. Speaker, I reserve the balance of my time.
Mr. CANTOR. Mr. Speaker, I yield myself such time as I may consume. I
just want to respond to the gentleman's remarks about discriminating
against seniors and thereby denying them access. I think the gentleman
will agree, again we are talking about facts, that current law already
provides that under Medicare there can be no discrimination based upon
age or based upon one's health. And in this bill there is a requirement
that the plans that participate and opt to participate in the Medicare
program must have uniform pricing and uniform premiums. There are
safeguards. And so all this doomsday prediction that the gentleman
offers is not going to occur because there are safeguards provided in
the bill for that.
I would also like to point out to the gentleman that studies have
shown that the poor that are existing now under the Medicare program,
they by far are opting for the Medicare+Choice plans versus the
standard Medicare program because they are, frankly, more affordable.
Again, this is the marketplace at work. I think it brings us back full
circle to the fundamental difference between the parties here. We
believe that seniors are individuals and they deserve to have a choice
and we should bring in the same type of choice that we all have as
Members of Congress in the FEHBP, that seniors should also have that
and with the safeguards that we have spoken about, seniors can have
that choice just as we do, and not be suffering under a one-size-fits-
all government-run program that, frankly, is going to run out of money.
So we have got to do something.
The gentleman says he is only in a position to offer a motion to
instruct. I have heard no solutions being offered by the gentleman or
any of the speakers on the other side of the aisle other than some
notion of recreating Hillary-care.
Mr. Speaker, I reserve the balance of my time.
Mr. DAVIS of Florida. Mr. Speaker, I yield myself such time as I may
consume.
I think we are getting closer to the facts here. This is about
choice. This is about whether the beneficiary under current law can
fall back on the traditional Medicare program. There has been no
dispute that under this bill as the chief actuarial, the President's
chief actuarial, has said, the premiums can increase by up to 25
percent. Nobody is disputing that. And nobody is trying to answer the
question, what happens to that Medicare beneficiary whose premium
increases by up to 25 percent who runs out of money under the voucher
at the end of the week or at the end of the month.
[[Page H10111]]
With respect to solutions, which are not within the scope of the
motion to instruct tonight, I think the gentleman should respond to the
point that has been made a couple of times here, which is one of the
ways to develop a more affordable prescription drug benefit is to give
to the Federal Government the authority to negotiate a discount. Just
as Secretary Rumsfeld, the Secretary of Defense, negotiates a discount
when he buys a helmet or a hammer, just as Sam's Club negotiates
discounts for the benefit of all the people we represent, why should
the Federal Government not have the ability to negotiate a discount
when it purchases prescription drugs for the benefit of our Medicare
beneficiaries?
{time} 2045
The answer in this bill is that this bill specifically prohibits the
Secretary of HHS from negotiating any discount in the price of
prescription drugs, and that is an unforgivable travesty in terms of
our obligations to defend the taxpayers and the Medicare beneficiaries
of this country who are paying horrific prices.
I would be happy to yield to the gentleman if he would care to defend
the provision in this bill that specifically prohibits the Federal
Government from negotiating any discount whatsoever in the price of
prescription drugs.
Mr. CANTOR. Mr. Speaker, will the gentleman yield?
Mr. DAVIS of Florida. I yield to the gentleman from Virginia.
Mr. CANTOR. Mr. Speaker, I will be glad to respond to the question,
because, again, we are talking about the philosophy. Do you want the
government out there fixing prices? Do you want the government out
there coming up with the formulary? That is what you are talking about.
Many States across the country do that, they come up with a formulary,
and we all know how difficult it is to get anything through this
Congress.
So as the drug industry comes up with more and more miraculous
lifesaving and life-lengthening drugs, we will be stuck and mired in
the bureaucratic process of approving a change in the formulary, so it
will almost be impossible for that to happen.
Mr. DAVIS of Florida. Mr. Speaker, reclaiming my time, does the
gentleman further believe the Secretary of Defense should not have the
authority to negotiate any discounts when he is buying a helmet or a
hammer, or is that a price control also?
I am happy to yield further to the gentleman to respond to that.
Mr. CANTOR. Again, I think that the Secretary of Defense and any
other agency that negotiates on behalf of its agencies, its employees,
has a mission. But we are talking about negotiating on behalf of the
public and people out there that have different needs.
We are a market-based country. We are a country where people have the
option to choose for themselves. We are not living in a country where I
think, one would think, the government can decide which medicine, which
prescription drugs you ought to have and which you ought not to have.
Mr. DAVIS of Florida. Mr. Speaker, reclaiming my time, I find it
incredulous that the gentleman believes that the Federal Government
should not take advantage of negotiating some discount, just as Sam's
Club does to buy discounts on behalf of its customers, or just as the
Secretary of Defense does. This is a disservice to the taxpayers of
this country and the Medicare beneficiaries.
This is the type of debate we should be having in this body, as to
how to develop an affordable Medicare benefit.
Mr. Speaker, I reserve the balance of my time.
Mr. CANTOR. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, just to follow up on that, again, it goes to the
fundamental difference between the two parties here, whether you think
the government ought to be in there for you negotiating prices, or
whether you ought to let the private sector and the plans that have an
incentive to attract customers and attract seniors into the plan to
make their formularies more attractive, if we are talking about
prescription drugs, to give the market the incentive to do that for
seniors. Let the seniors choose which plan is better for them, because
if you have got the government doing it, there will be no choice. There
will be a one-size-fits-all, government-run plan.
Mr. Speaker, I reserve the balance of my time.
The SPEAKER pro tempore (Mr. Nunes). The gentleman from Florida (Mr.
Davis) has the right to close and has 1\1/2\ minutes remaining, and the
gentleman from Virginia (Mr. Cantor) has 15 minutes remaining.
Mr. CANTOR. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, I would say to the gentleman and the Members on the
other side, I have enjoyed the debate. I think it is always a healthy
experience for this body and the country to have an active discussion
on very important issues.
I happen to think that the Medicare reform bill that we hopefully
will be voting on soon is probably one of the most important things we
will do in our careers in this body, because it does affect so many
people. It impacts them in an area of their lives in which everybody is
concerned, and that is health care. So I appreciate the debate.
I would just like to underscore, once again, the bill that we have in
place and that we have passed out of this body is a bill designed to
shore up the failing actuarial numbers in Medicare and the fact that we
are on a road to ultimate bankruptcy of the system if we do not do
something to reform it and if we do not do something to allow seniors
to continue to enjoy that benefit.
The way that this House has spoken, the way we will do that,
hopefully, is through inviting in competition from the private sector,
allowing seniors to choose health plans that best fit their own family
and their own health care needs.
We also, as we have discussed, have in this H.R. 1 provisions which
protect seniors and which ensure that they will have access to quality
health care, and, at the same time, protection that there is never
going to be any denying of the entitlement of Medicare to seniors.
Mr. Speaker, I yield back the balance of my time.
Mr. DAVIS of Florida. Mr. Speaker, I yield myself the balance of my
time.
Mr. Speaker, I think this has been a civil, productive debate as
well. The purpose of the premium support provision is to try to reduce
the cost of the Medicare program to the benefit of Medicare
beneficiaries and the taxpayers, and that goal is a worthy goal.
We have heard debate tonight about one of the ways that can be
achieved, by trying to negotiate discounts in terms of the price of
prescription drugs. I think the argument on the other side is a
philosophical argument, that somehow the government should not be
involved in that, even though it works for the Secretary of Defense, it
works for the VA, in a fashion that no one is questioning.
So where the debate ultimately ends up tonight is should we reduce
the cost of Medicare on the back of that Medicare beneficiary who has
been rejected by a private health care plan, by giving them a voucher
that will not get them through the end of the week or the end of the
month?
I think the answer is clearly no, and there has yet to be a single
Member of Congress who has stood on the floor of this House and tried
to squarely confront that question. And to say to that Medicare
beneficiary, this is why you are on your own, this is why, as the chief
actuarial of the Federal Government has said, your premium is going up
25 percent, you are on your own, there is not a humane acceptable
answer to that.
This is not a Democrat or Republican proposition. This is about
humanity. This is about whether Medicare as we know it is going to
continue to address that person at a very difficult time in their life.
We owe our seniors a choice, but not a false choice. We should respect
them by being honest about what this bill does.
Mr. Speaker, I would urge adoption of the motion to instruct to
reject the premium support provision of this bill.
The SPEAKER pro tempore. Without objection, the previous question is
ordered.
There was no objection.
The SPEAKER pro tempore. The question is on the motion to instruct
offered by the gentleman from Florida (Mr. Davis).
The question was taken; and the Speaker pro tempore announced that
the noes appeared to have it.
[[Page H10112]]
Mr. DAVIS of Florida. Mr. Speaker, on that I demand the yeas and
nays.
The yeas and nays were ordered.
The SPEAKER pro tempore. Pursuant to clause 8 of rule XX, further
proceedings on this question will be postponed.
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