[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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