[Congressional Record Volume 149, Number 169 (Thursday, November 20, 2003)]
[House]
[Pages H11868-H11874]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                    MEDICARE PRESCRIPTION DRUG BILL

  The SPEAKER pro tempore (Mr. Rogers of Alabama). Under the Speaker's 
announced policy of January 7, 2003, the gentleman from Georgia (Mr. 
Gingrey) is recognized for 60 minutes as the designee of the majority 
leader.
  Mr. GINGREY. Mr. Speaker, it is good to be back tonight to talk on an 
issue that is really very, very dear to my heart. We have got an 
exciting day. In fact, I do not think I could even, though it is a late 
hour, I do not think I could go home and sleep tonight in anticipation 
of a historic moment tomorrow when we will finally deliver on a promise 
that has been made to our seniors, and that is a prescription drug 
benefit under Medicare.
  Mr. Speaker, I would like to start out by maybe addressing some of 
the remarks that I just heard made from the other side, and it is the 
kind of remarks which I would really refer to as ``Mediscare'' 
comments. I just heard the gentlewoman from Texas refer to the 
government not being able to set prices. I think that is exactly what 
the Democrats tried to do in 1993 under ``Hillary care.'' They wanted 
the government to set prices. They wanted a one-size-fits-all, 
essentially a national health insurance program, and the people of this 
great country rejected that.
  Another comment I have heard them say just repeatedly is this 
business about, well, who is going to benefit from this prescription 
drug availability for our seniors, who is going to benefit the most, 
and they keep saying, well, it is the drug companies, the evil, greedy 
drug companies. Well, of course, no duh. Who makes the drugs? Who has 
made this country the greatest Nation on Earth in regard to having 
access to life-saving drugs? The pharmaceutical industry. Who do we 
expect? Who does the other side expect to provide these drugs? The 
chocolate cookie company or the potato chip factory? No, it is the 
pharmaceutical industry, of course.
  Did they say the same thing in 1965, 40 years ago when Medicare was 
first enacted, that gosh, you know, we cannot do this, this program 
because who is going to benefit the most from Medicare part A, the evil 
hospitals, the evil skilled nursing homes; or who is going to benefit 
the most from Medicare part B, the doctors? Absolutely the doctors. 
They are the ones that provide health care.
  So this argument about the drug company being the big beneficiary, it 
is absolutely bogus. Sure they are going to provide drug coverage, sell 
more drugs certainly, but the price of those drugs, Mr. Speaker, is 
going to come down. Their profit margin per sale is going to be 
drastically reduced. So, again, we hear these arguments over and over 
again, and it truly is nothing but ``Mediscare.''
  Another argument we hear, and we have been hearing it today, we will 
probably hear it all day tomorrow and as long as this debate goes on, 
is the

[[Page H11869]]

Republicans want to take Medicare away; they want to destroy Medicare 
as we know it. Of course, they like to throw in the infamous ``P'' 
word. As far as destroying Medicare as we know it, let us talk just a 
little bit about Medicare as we know it and what my seniors in the 11th 
Congressional District of Georgia have told me about Medicare as we 
know it.
  It is a good program. It served us well, but it is not 21st-century 
medicine; and I say that, Mr. Speaker, because, first and foremost, 
there has never been a prescription drug benefit under Medicare. There 
has really never been any real meaningful, preventive care under 
Medicare. It is all episodic. If you get sick, you get to go to the 
doctor, and the visit is paid for. If something catastrophic happens to 
you, like a heart attack or a stroke, you get to go to the hospital, 
and you certainly have the benefit of that hospital stay. If you have a 
family history of heart disease or you have high cholesterol and you 
develop coronary artery disease, sure, you get admitted to the 
hospital; and there is some coverage for you to have that open heart 
surgery.
  It is the same thing for a diabetic patient who unfortunately under 
Medicare, many of those patients cannot afford to buy their insulin, 
cannot take their medication, glucophage, something to lower that blood 
sugar, to keep that disease under control. So they end up going to the 
hospital; and, yeah, it is paid for, if they have to have a leg cut off 
or they have to go on dialysis for years because of end-stage renal 
disease that probably would not have occurred if that diabetes had been 
checked with timely medication.
  So when my colleagues talk about destroying Medicare as we know it, I 
want to just say to my colleagues on the other side of the aisle and 
who are opposed to this bill in contradistinction to the opinion and 
the feeling of 35 million seniors who are members of the American 
Association of Retired People, the AARP, of which I am proudly a 
member, they can talk all they want to about burning their membership 
cards and sounds like back in the 1960s, the people burning their draft 
card or burning the flag. I mean, if they want to do that, that is 
fine, but I will guarantee my colleagues that the seniors in this 
country respect that organization, as we all do and should, because 
they have certainly delivered for seniors and have a proven track 
record, and we are not talking about an organization, Mr. Speaker, that 
is necessarily a bastion of conservatism, that is known for their deep 
and unending support of Republican issues. That is not true at all. We 
all know that. The other side knows that, but they are talking about 
again ``Mediscare,'' trying to scare people when clearly what we are 
trying to do is not destroy Medicare, but just improve it, improve it 
with a prescription drug benefit that is long overdue.
  The other way we are going to improve it, Mr. Speaker, is we are 
going to finally put some emphasis on preventive care. We are going to 
give our seniors a chance to get into a managed care system, an HMO or 
a PPO, really very similar, in fact, exactly what 435 Members of this 
House of Representatives and probably 100 Senators in other Chamber, 
the kind of health care they have. It would be interesting to take a 
poll and see what they do have. I will guarantee my colleagues, it will 
be 95 percent or higher have that kind of a coverage where they can go 
in or their wives or their spouse can go in and have screening tests 
done for high cholesterol, elevated lipids, osteoporosis screening, 
colonoscopies, timely mammograms. These are the kinds of things that 
until just recently none of that was covered under Medicare as we know 
it, and there still is not really any catastrophic coverage for part A 
and part B.

  Unfortunately, a senior goes into the hospital in any one episode of 
illness and can only stay a certain number of days. There is a very 
high copay, but once you have exhausted those days in the hospital or, 
God forbid, in a skilled nursing home, it happens so often, if a 
patient has had a stroke, then what happens to our seniors who have 
worked all of their lives to save up and hope and pray that they will 
be able to leave a little something to their children or more likely 
their grandchildren, so that their lives would be a little easier? For 
the seniors to lose all of that and end up in poverty and end up 
basically as a ward of the respective States because they have gone 
broke because of a long stay in a hospital or skilled nursing home, Mr. 
Speaker, there is something wrong with that picture.
  Democrats on the other side of the aisle, they can complain all they 
want to and try to scare our seniors and talk about taking away 
Medicare as we know it. We are not taking away Medicare. Traditional 
Medicare, fee-for-service, that option will remain. It will be there 
for our seniors, and I am sure there are some that kind of get used to 
the old system, and they may not want to change. I think we all 
understand that. Do not for a minute think that they will not have the 
option to also get this prescription drug benefit if they stay in 
traditional Medicare.
  That is what the other side is trying to do. They are trying to scare 
seniors into thinking that if they do not move into managed care or 
Medicare+Choice or advantage type program, that they will not be 
eligible; they will not get the prescription drug benefit. Mr. Speaker, 
we know on this side of the aisle, we absolutely know that that is not 
true.
  Again, this is one of the greatest times of my life, and I am so much 
looking forward tomorrow to this historic piece of legislation and 
voting enthusiastically for it and for its passage. Make no mistake, I 
feel every confident that it will pass, and I think at the end of the 
day we are going to have our colleagues from the other side, no, not 
all of them, but I think this will be a bipartisan-supported bill 
because I know that they love the seniors as much as I do.
  I am often asked in the districts, Dr. Gingrey, you had a great 
medical practice and you delivered all those babies, and do you miss 
it? The answer is, of course I miss it, absolutely. In fact, just 
yesterday on the floor of this House, my cell phone rang on the silent 
mode, on the vibrate mode, and I went out to take the call, and it was 
from the husband of one of my patients whose two children I had 
delivered. She is now pregnant with their third in about 8\1/2\ months 
and was starting to have some problems, and he just wanted to call Dr. 
Phil, even though she has got a great doctor, one of my former 
partners, back home in Marietta, Georgia. I talked to him, an old 
friend and a patient about his wife. It, of course, made me realize 
once again how much I do miss that, but this opportunity to come to the 
Congress of the United States, this 108th Congress and be a part of 
this great body and have an opportunity tomorrow to cast a vote, to 
give finally a prescription benefit and to modernize Medicare for 40 
million seniors, a third of whom are probably living right at or below 
the poverty level, who have nothing, nothing, Mr. Speaker, to live on 
other than Social Security and no health care except basic Medicare. 
They cannot afford Medigap or their former employer did not offer a 
health care plan.
  So that is what it is all about. That is why I am so excited to be 
here, and even though I miss my practice, I feel in many ways that this 
is a high calling, and I am really proud to be here, proud of being 
part of this majority and working with the leadership of this Congress, 
with our great Speaker and our great leader and answering the call of 
President George W. Bush when he said, Men and women of the Congress, 
we have got to keep this promise.
  We tried so hard last year to do that, tried so hard to pass this 
bill last year, and it did pass the House with the Republican 
leadership, but what happened on the Senate side? It gets over to the 
Senate where the Democrats had control, and again, I heard one of my 
colleagues just a few minutes ago talking about, well, we need to send 
this bill back for more study, it needs more study. Well, we can study 
things to death. That is exactly what they did last year. They studied 
it to death, and we had no bill until we finally now have the 
leadership in both the House and the Senate, and I think we are going 
to get the job done this time.
  It is like the president of AARP, Mr. Bill Novelli, said, We cannot 
wait for a perfect bill. There are no perfect bills. Seniors need our 
help now. They have been needing it for a long, long time.

                              {time}  2245

  And this business about waiting for the perfect bill is a total 
farce. This is

[[Page H11870]]

a good bill. It is not perfect, but it absolutely is a good bill.
  Mr. Speaker, I would now like to yield to one of my colleagues and 
good friends, the gentleman from Colorado (Mr. Beauprez), who has 
worked very hard on this bill, and I know he is just as excited about 
its impending passage as I am.
  Mr. BEAUPREZ. I thank the gentleman, Mr. Speaker, and he is 
unnecessarily kind. The gentleman from Georgia is admired by every 
Member of this House for his tenacity and his dedication and his 
intelligence and understanding about this bill that we are going to 
consider on the floor here very shortly.
  And the gentleman is correct, I agree with him completely, that this 
is an historic moment. The gentleman knows full well the history of 
Medicare, founded with the greatest of intention and the greatest of 
purpose about 40 years ago. And for most of those 40 years, there has 
essentially been a very little change in modernization with the bill, 
with Medicare, with the program, to keep up with the rapidly changing 
nature of health care and medicine as we deliver it. And that is the 
dilemma we are in right now.
  I am proud that the gentleman is a Member of my class. I am proud he 
is a Member of this 108th Congress with me. And I am also proud that, 
as I take a little bit of pride in myself, in coming to this Chamber 
the gentleman has some real-world experience. I had some experience 
running businesses before, a family dairy farm, and later on a 
community bank. And as a community banker, I came in contact with a 
great number of individuals with a whole lot of different experience. 
And when I wanted some information about something in particular, I 
usually went to someone with that particular type experience.
  So for me it is especially valuable and important that at a time when 
we are really talking about making some important reform and 
modernization to something as personal as important to especially our 
senior population as their health care, that we have someone like 
yourself, a doctor, who has supplied that health care to individuals 
and that we can ask for counsel.
  For me, and I expect, for my colleague, because he just related a 
great story, a great testimony to how personal this issue is for him 
with his patients, I have two parents at home. And I am fortunate that 
I still have them. My dad is 85, and mom is 83. They both live in 
assisted living.
  I believe mom has eight prescriptions a day, dad is on nine, and both 
suffering with some of the things that come with getting a little bit 
older. But, again, I am grateful that I have them. But their health 
care, how it is delivered, their insurance coverage, Medicare, is 
critically important to them. Right now, they do not have a 
prescription drug plan for Medicare. They had to go get a supplemental 
plan. And they are at a point in life where any change in how they are 
doing things is difficult for them to comprehend and understand.
  I have a brother, hard to imagine, but I have a brother that is about 
eligible himself, and it is not going to be very long until some of the 
rest of us are going to be there too. So it becomes real personal real 
fast.
  And, certainly, as I talk to my constituents back home, as I asked 
them to give me this job of representing them here so that we could 
come back here and collectively give them what Medicare has denied 
them, a prescription drug coverage option, I came back here after 
listening to folks back in my district who said they wanted 
prescription drug coverage, yes, but they did not want to be forced 
into anything.
  They wanted to make sure it especially took care of the poorest among 
us. And I have to admire a lot of the seniors, at least in my district, 
who recognized that we probably cannot provide everything to everybody 
100 percent of the time and pay 100 percent of the cost out of the 
government. They said, we will pay some of the cost of that, but we 
want to make sure that for the poorest it is there, and especially for 
those times in life, those last few weeks, months, maybe years when 
their health deteriorates and the costs really escalate that we as a 
Nation are there for them, for what I think most of us call the 
catastrophic coverage.
  Mr. GINGREY. Reclaiming my time, Mr. Speaker, for just a moment, I 
wanted to touch on that point and maybe get the gentleman to elaborate, 
because I think he really, really hit the key point here, and that is 
that the major emphasis, as we understand the bill, the major emphasis 
is on those who need it most.
  Mr. BEAUPREZ. I thank the gentleman, for emphasizing that, Mr. 
Speaker, and I am delighted to hear that, because that is consistently 
what I heard from our seniors. And not surprisingly, I think our 
seniors are some of our best citizens. They are the most experienced, 
and they have lived a full life. They know what it means to be a good 
citizen and a good American, and they are willing to do their share. 
But they also want to know that when necessary, if it becomes 
necessary, that this Nation will be there for them. When they do pass 
on, they want to be able to pass on in dignity, and they want that same 
thing for their fellow Americans.
  If the gentleman would be so inclined, because I do rely on his 
expertise, his experience and understanding, especially of this 
critical issue, which candidly is far too complicated for most of us in 
this Chamber to fully comprehend, so we have to rely, I think, on 
experts, and I consider the gentleman one.
  Mr. GINGREY. Well, Mr. Speaker, I appreciate the gentleman stating 
that, but, of course, it works both ways, and the gentleman from 
Colorado is a former farmer and very successful banker and successful 
businessman. Of course, we physicians need to understand that we are 
businessmen and women, but far too few of us do understand that.
  I will be glad to answer any questions on the medical issues that the 
gentleman might have, but I am going to ask him some business 
questions, particularly in regard to the health savings accounts. And 
he knows a lot about that, having employed a lot of folks. But, yes, I 
will be happy to respond to any questions the gentleman might have on 
medical issues.

  Mr. BEAUPREZ. Well, I look forward to a few minutes of a colloquy 
here. And if I might begin, one of the issues I heard consistently, and 
especially from the doctor community, as well as from their patients, 
was this issue that surrounds the doctor reimbursement rates that we 
have been dealing with; and the fact that because of apparently low 
reimbursement rates, many doctors have literally been forced to not 
accept any more Medicare patients, against their own better wishes, 
their own training, the oath I think they took.
  They simply found themselves, I am told, in a position that they 
cannot take any more patients. I even had a constituent recently tell 
me that when her husband became Medicare eligible, he was told he would 
have to go find someone else to be his doctor. Now, is that the case? 
And if indeed it is the case, I ask the gentleman, are we addressing it 
in this legislation?
  Mr. GINGREY. Well, the gentleman is so right, Mr. Speaker, and 
physicians who take Medicare patients really do so out of great 
compassion. I do not think they would be doctors if they did not love 
people and want to care for them. But, of course, as I just mentioned a 
few minutes ago, they are businessmen and women and they have got 
practice overhead, not the least of which, as the gentleman knows, is 
the high cost of malpractice insurance.
  We tried to address that issue, did we not, earlier, way back in 
February or March; trying to get some meaningful tort reform; just 
trying to balance the playing field? And we got practically no help 
from the other side. And with those kinds of escalating expenses and 
decreases in Medicare reimbursement, as the gentleman knows, I think 
the physicians were scheduled in 2004 and 2005 to take another 4.5 
percent cut in Medicare reimbursement for each of those 2 years, on top 
of what has already happened in a downward trend when their practice 
expenses are going up.
  I have often said to people that ask me about this, the excitement 
about getting a prescription benefit under Medicare, and the reason why 
we cannot just do that as a stand-alone part D of Medicare, if you 
will, run by the government and price setting by the government, the 
reason we cannot do that is because we just cannot afford it. We

[[Page H11871]]

literally cannot afford that. And if we do that, and we continue to cut 
the reimbursements to the physicians, what will happen is there will be 
no physicians out there, except in Medicare patients.
  The primary care physicians, the general internists, and these are 
the physicians who are on the lowest income scale of our profession, 
they are just going to throw up their hands and say we cannot continue 
to lose money doing this, and all of a sudden our patients, our 
seniors, have prescription benefits but nobody to write the 
prescriptions.
  So I am so glad the gentleman asked the question, because in this 
bill that is part of the modernization piece. We are going to make sure 
that we keep these doctors in the system.
  Are they getting rich off of Medicare patients? Absolutely not. The 
other side wants to suggest that there are winners and losers in this 
modernization of Medicare and the prescription drug benefit. I suggest 
to them that we are all winners. Very modest winners. The major one, of 
course, as it should be, are our seniors, and especially our neediest 
seniors.
  Mr. BEAUPREZ. Well, the gentleman has already acknowledged, Mr. 
Speaker, that I have been a community banker, and as a community 
banker, I, of course, see financial statements from various people, 
some of them doctors. And I know full well that while it may appear 
that they have significant revenue, so too do they have significant 
expense. My own personal physician back home told me, a very 
compassionate man, that, unfortunately, he could not take any more 
Medicare patients, and that grieved him greatly.
  Let me ask the gentleman very specifically, because this question has 
come up a lot. Cancer docs: A growing population and a growing need out 
there. They seem to be quite concerned about what this bill does to 
them or does not do to them. Have we addressed that critical issue in 
this legislation?
  Mr. GINGREY. Well, Mr. Speaker, the gentleman is asking a great 
question. And, of course, what they are saying too, as the gentleman 
from Colorado has asked, is what is it going to do; what is this bill 
going to do to their patients? Not so much their bottom line, but the 
patients who are stricken with cancer.
  And, of course, a lot of those cancer patients have been here, have 
been to Washington, and some of them, God bless them, in the midst of 
their chemotherapy; having lost their hair and maybe not looking as 
good as they would like to look physically. They got on that plane, 
flew up to Washington, and a lot of them came along with their doctors 
and talked to us about that. They wanted to make sure that we 
understood that, yes, they agree that certain changes needed to be made 
in regard to how they were reimbursed for cancer care, but they wanted 
to make sure, though, that they could keep their offices open and 
continue to provide that community cancer care. Because if they could 
not, if they had to close their doors and be denied the opportunity to 
see those patients, where would they go? Would they go back to the 
hospital? I am not sure. I think it is very likely that many of them 
would not get care; would not get care in a timely fashion.
  So we have worked very closely with and we have listened to these 
patients, patients suffering from leukemia and breast cancer and bone 
cancer. We know, of course, that today there are medications that in 
some instances can yield a long remission for these patients and, with 
the help of God, occasionally a cure. Here again, years ago, when 
Medicare first started, there was no cancer chemotherapy. That just did 
not exist. And it would be a shame today if one of these seniors who is 
receiving chemotherapy, and that is actually one of few drugs that is 
covered under current Medicare Part B, because it is administered by a 
physician in an intravenous fashion, but if we did not have these kinds 
of benefits, what would happen? These patients would die, pure and 
simple.
  So we have listened to the doctors, we have listened to their 
patients, and the answer to the question the gentleman from Colorado is 
asking is, I think they are pretty satisfied. They are going to take a 
significant hit on this bill, but I think they understand that for the 
overall good, for the greater good, they are willing to make those 
sacrifices. So I think they are going to be fairly pleased with the 
bill.

                              {time}  2300

  Mr. BEAUPREZ. Mr. Speaker, I thank the gentleman for that 
comprehensive answer. Once again, that issue is very personal as cancer 
has touched members of my family, as it has probably touched members of 
almost every family in this great Nation.
  I would like to pursue one more issue regarding reimbursement rates 
and that is in regard to our hospitals, and even more specifically 
rural hospitals because it has become apparent to me that we do have a 
significant issue with the tens of thousands of usually small, more 
rural hospitals around this great land. And I believe in the 
gentleman's opening comments he made reference to an issue I am also 
aware of, and that is from the patient's side how Medicare up to now 
has treated extended hospital stays.
  I would like the gentleman to address that greater issue of 
hospitals, specifically rural hospitals, and then extended stay for 
patients and how Medicare does or does not take care of them currently 
and what this legislation would provide.
  Mr. GINGREY. Mr. Speaker, I am glad that the gentleman asked about 
that because in the hospital payment system, there has been this 
disparity for a long time. The rural hospitals and the rural 
physicians, those doctors who are practicing in an area outside of a 
metropolitan service area or a big city, they are reimbursed for the 
exact same service at a lower rate than a doctor who might be 
practicing in Boston or Atlanta or Denver, and there is just something 
wrong with that system. Again, that has been addressed.
  In fact, if the gentleman will allow me to read here, there are 
hospitals referred to as disproportionate share facilities, by that I 
mean a disproportionate share of Medicare and Medicaid patients in 
their population. Some of these hospitals are in small towns, and I 
know in my district and probably the gentleman's district, but I know 
for sure in southwest and northwest Georgia, the 17 counties that I 
represent, in some of the towns in the county, the hospital is the 
major employer in town. It is the only source of revenue and health 
care. When they are seeing mostly Medicare and Medicaid patients, and 
there is not much industry so there is not much good, private health 
insurance, they do not have full pay rather than deeply discounted pay 
that we have under Medicare and Medicaid, and if we continue to treat 
them in an unfair manner, not only does health care go away, but jobs 
go away as well.
  Here is one thing that I wanted to read in regard to what we are 
doing about this problem: ``The bipartisan agreement modifies 
Medicare's payments for those hospitals that furnish care to a 
disproportionate share of low-income and uninsured patients. Currently, 
the disproportionate share hospital adjustment paid to rural and small 
urban hospitals is capped at 5.25 percent. The bipartisan agreement 
increases the rural and small urban cap to 12 percent.''
  Mr. BEAUPREZ. Mr. Speaker, I thank the gentleman for that, and as I 
think about Colorado and the eastern plains and smaller mountain 
communities, that is good news for many folks back home because I am 
sure they will fit in that category.
  If I can shift gears a little bit and continue this probing of the 
gentleman's wealth of knowledge and personal experience, let us talk a 
little bit, a big evolution in the past 40 years in medicine has been 
the importance placed on preventive medicine. My doctor tells me get 
your physical, exercise and watch your nutrition; and it is my 
understanding that as we age, preventive medicine is even more 
important, and yet another glaring weakness in Medicare, at least at 
the moment, has been a lack of coverage for many preventive medicines 
that most of us think of as fairly routine. I believe the gentlewoman 
from Connecticut (Mrs. Johnson) who is an expert in this field as well 
has been a big proponent of incorporating preventive health care within 
Medicare. And my question is: Have we managed to accomplish that?
  Mr. GINGREY. As Members know, the gentlewoman from Connecticut (Mrs. 
Johnson) is the chairman of the

[[Page H11872]]

Subcommittee on Health on the Committee on Ways and Means. What many 
Members may not know is her husband is a retired OB-GYN physician. She 
is very knowledgeable about this issue. I have told Members if they do 
not understand the bill, and it is 1,100 pages, parts of it are arcane, 
and it is not necessary for every Member to understand every bit of 
minutia, but of course they need to understand the things that are 
important, and the gentlewoman has been a great resource to me.
  In regard to medication, let me get personal. I had open heart 
surgery right after I won my election, just a month before we were 
sworn in. I think back and wonder if a senior, I am not there yet, I am 
getting pretty close, but if a senior at age 65 who was used to managed 
care and that attention, which has been described as prevention, not 
just episodic, let us say that they had the same kind of coverage that 
most Members of Congress have today, all of a sudden they turn 65 and 
Medicare, as we know it, and we have heard it before, we will hear it 
tomorrow, I am sure, and Medicare as we know it is taking over their 
care, and they have been on a cholesterol-lowering drug, we call them 
statins, or maybe they have been on something to prevent osteoporosis, 
and then all of a sudden they do not get that. All of a sudden they are 
on Medicare, and Medicare is primary. They do not have Medigap. Their 
employer did not give them health care in their retirement, and all of 
a sudden they are on Medicare and they have no coverage. Those are the 
very patients that were getting the benefit of the drug for 
osteoporosis prevention or to lower cholesterol. I am telling Members 
within 5 to 10 years, they will end up with coronary artery blockage. 
And when they go in the hospital then, sure, it will pay for open heart 
surgery. Or if they fall and break their hip and have an extended stay 
in the hospital, it will pay for that, but who wants that? That is why 
I have said a lot of times about this bill in commending the President 
for bringing this to us, this is compassionate conservatism, and I 
emphasize compassionate in its finest hour.
  Mr. BEAUPREZ. I think the gentleman puts that very well. Not only 
does it make fiscal sense, as we have an obligation in this body to 
exercise, spending the taxpayers' money wisely, but we are providing 
better quality of life and better health care to our seniors, 
especially in this case, by allowing them to have access to preventive 
care which is less expensive earlier in life rather than taking care of 
the manifestation of disease later in life. Would that be a fair 
statement?
  Mr. GINGREY. Mr. Speaker, that is exactly right. The gentleman was 
talking about rural hospitals, and we talked about the disproportionate 
share, and I explained that, but let me just read a letter that was 
written to our Speaker from the Rural Hospital Coalition in regard to 
the gentleman's question earlier: `` Dear Speaker Hastert, The Rural 
Hospital Coalition, which is comprised of more than 150 rural hospitals 
in America, applauds your leadership in working in a bipartisan fashion 
to achieve a compromise Medicare bill. We support your efforts to 
modernize Medicare and give senior citizens a prescription drug benefit 
that they deserve.

                              {time}  2310

  ``Most importantly, this bill strengthens health care in rural 
America. For that alone, you should be proud.
  ``We urge all Members of Congress to support the compromise Medicare 
Prescription Drug and Modernization bill. It reforms a Medicare system 
that has for far too long reimbursed rural hospitals at a lower rate 
than their urban counterparts for the exact same services. Passage of 
this conference report will give rural physicians, nurses, clinics, and 
hospitals a fair shake when it comes to the Medicare payments. It will 
create a financially stronger hospital for rural communities, provide 
more jobs, and provide more services.
  ``Thank you again for your leadership to get this legislation this 
far. The Rural Hospital Coalition appreciates your strong leadership on 
rural health care issues and looks forward to working with you to see 
it is enacted into law in the very near future.
  ``On behalf of the Rural Hospital Coalition, sincerely yours, William 
F. Carpenter, senior vice president.''
  This is really exactly where we are. And I said when we began our 
colloquy that I wanted to ask the gentleman from Colorado (Mr. 
Beauprez) an important question as well. As a businessman, having been 
in the banking business and very successful in what he does, I wanted 
to get his opinion about the health savings accounts. There are a lot 
of things in this bill that people do not want to talk about; they do 
not want to talk about the good. They want to just kind of confuse 
folks with, as I say, ``Mediscare'' rhetoric; but there are so many 
things in this bill, we could probably talk about it for 2 hours. But 
would the gentleman tell us a little bit about health savings accounts 
and what he thinks that will mean to the uninsured in this country.
  Mr. BEAUPREZ. Mr. Speaker, I am attempting to not overstate or 
overemphasize my enthusiasm for health savings accounts. But I honestly 
believe that this may be as revolutionary an action that this body has 
considered in a very long time. The concept is a fairly simple and 
straightforward one, but it is so revolutionary that I think it bears 
some very careful consideration, and I thank the gentleman for his 
question.
  This is simply a personal account whereby an individual can make a 
tax-free, before-tax, contribution to that account, year after year, 
skip if they like, but an account that can accrue over time. It is 
again tax free going in. The earnings, the interest that is accrued on 
that account is tax free, and the real key is on the back end as long 
as they spend it for health care, it is likewise tax free. What that 
means is that over time that account can grow, and I think we are all 
familiar with 401(k)s and IRAs and those incentive mechanisms that this 
great body in previous Congresses has enacted to encourage us to save 
for retirement.
  Likewise, this encourages us to save, but coming out the back end, it 
is still tax free. They never ever pay a dime of tax on the money going 
in, the earnings on that money over however extended a period of time 
it happens to be, nor on the money as it comes out to pay for long-term 
health care, for specialty surgery, for catastrophic care, for whatever 
that individual finds himself in a situation to want or need in their 
advanced years.
  What this really does in my mind is what has been lacking in much of 
our health care system, and I am talking about the larger system now, 
and that is the empowering of the individual to control their own 
destiny, their money, their choices, their decision. It puts the 
patient and the doctor, as we have said for years, ever closer together 
and the patient in control of their dollars. Further, it provides an 
enormous incentive, and I do not know how we provide a larger 
incentive, an enormous incentive for individuals to do this.
  Now, perhaps the biggest component of this is not only can 
individuals deposit into these accounts, so too can family members. So 
if I want to contribute to my parents in their advanced years as they 
certainly contributed to me in my younger years, that is not only 
allowed, it is incented and invited. Because I get to do that tax free 
as well. Further, if I wanted to downstream it, I have a grandson, a 3-
year-old grandson, who is about to have a birthday next week. A nice 
birthday present might be to make a contribution to his health savings 
account which will grow and grow and grow over the young man's life.
  Mr. GINGREY. Mr. Speaker, it is my understanding too that in these 
accounts, that money that the gentleman described is growing at 
compound interest, the tax on that is deferred, and that this money of 
course can be used, as I understand it, for anything related to health. 
I mean, it can do the things that a lot of people are now spending 
money on for the so-called Medigap insurance. It could take care of 
that. It is my understanding also that one could pay for long-term 
care, to purchase a long-term care policy out of that account. Is that 
also the gentleman's understanding?
  Mr. BEAUPREZ. Mr. Speaker, that is exactly my understanding and 
exactly correct, and I think even more to the point, it gets at health 
care as it is provided today, the long-term care, the assisted living 
facilities, exactly what my parents are going through.
  Now, there is one additional item. Before I came to this body, I was 
an

[[Page H11873]]

employer. The gentleman cited that. I had about 160 employees. And we 
provided not only the normal salary compensation, but benefits as well, 
health care being one of those. 401(k) matching contribution being one 
of those. And we were also looking for other ways to take care, if the 
gentleman will, to compensate, provide benefits to our employees. This 
health savings account allows an employer to make tax-free 
contributions as well to this health savings account. So what we have 
is the opportunity for funds from multiple directions incented, 
inspired to help out an individual, a particular individual, that will 
be there for them later in life when they most need it; and if it is 
unused, it can be passed on to their heirs tax free.
  Mr. GINGREY. Mr. Speaker, as the gentleman points out, we are saying 
that this Medicare Prescription Drug and Modernization conference 
committee report of 2003, which we are going to vote on tomorrow, it is 
not just to the benefit of our seniors. Of course that is very 
important to provide this prescription drug benefit, as the gentleman 
pointed out, especially to the neediest. But it helps our younger 
workers as well, does it not? I think there are maybe 40 million, maybe 
it is 43 million now uninsured. I started to say unemployed, but the 
truth is 65 percent of the uninsured, no health insurance, are 
employed. They have got jobs. They are working hard. They go to work 
every day. But their employer, maybe it is a small shop, five, 10, 15 
people, they cannot go out in the marketplace and afford to buy that 
policy, that first dollar coverage or $500 deductible. It is just too 
expensive, and they cannot individually afford to do it either.

                              {time}  2320

  But this opportunity the gentleman describes is going to be a 
tremendous help to our workers at whatever age and, finally, they are 
going to get an opportunity to get health care. As the gentleman 
pointed out, or I heard someone say earlier in the week that in the 
history of the rental car industry, nobody has ever paid to have their 
oil changed. And, of course, what they are implying is that if you do 
not have some ownership, you are not going to be as good a shopper, you 
are not going to do the due diligence, you are not going to take care 
of yourself quite as well as if it is your money and it is growing and 
it is in that account, and you know that later on you might need that 
for, as the gentleman pointed out, long-term health insurance. So you 
are going to shop. You are going to go out in the market. You are going 
to make sure that you find the best doctors and the best hospitals. And 
just because they are lower-priced, that does not mean they are not 
good. In many instances, lower is better.
  Mr. BEAUPREZ. Mr. Speaker, I think that the doctor says it very well. 
This addresses a good conservative principle. We as the Federal 
Government are willing to forego some tax revenue from individuals, but 
believing in individuals to manage their own funds and then make their 
own choices, rather than have choices made for them by government. I 
think that is good conservative principle. I think it will help us hold 
down eventually the cost of health care. But it is such a powerful 
incentive for folks all over the age spectrum from again, my grandson, 
who is going to be 3 years old next week, to my parents, who are in 
their 80s.
  Mr. Speaker, might I pursue at least one or two more questions with 
the gentleman, if he has time.
  Mr. GINGREY. Of course, certainly.
  Mr. BEAUPREZ. Mr. Speaker, the question of prescription drugs, if I 
can return to it, the question exists of choice and whether it is 
voluntary or not voluntary. I will cite my parents again. They, 
obviously, do not have prescription drug coverage in Medicare now, so 
they have gone out and purchased their own policy. Frankly, I do not 
think they would like it very much if I told them, well, the policy you 
have now does not exist any more because you have to take Medicare.
  Are we forcing anybody to take this prescription drug plan, or do 
they have a choice?
  Mr. GINGREY. Mr. Speaker, absolutely. The gentleman is asking about 
the choice issue, and that is what is so important.
  Mr. Speaker, back in 1988, we were not here. We just got here as 
freshmen. But I do remember when there was some attempt to include 
catastrophic coverage under Medicare. I think that was an important 
thing to look at. But the mistake that Congress made at that time is 
they passed a law that included, for the first time, catastrophic 
coverage. But there was no choice. All seniors had to have that 
coverage. Their Part B, Medicare Part B premiums just went through the 
roof. And there was much, much concern about that. We learn lessons.
  This program, this Medicare modernization and prescription drug 
program, is all about choice. It is all about choice. In fact, a 
senior, and I am sure some will, will decide to stay in traditional 
Medicare, something they have been used to; maybe they turned 65 20 
years ago and they just do not want to go to the trouble, if you will, 
and get out of their comfort zone. They may decide not to even take the 
prescription drug benefit. Certainly they can; they have that option, 
as well as the option to remain in the Medicare fee-for-service, the 
traditional Medicare program.
  But as the gentleman points out, and I am so glad he asked the 
question, it is all about choice. We know that a third of our 40 
million plus Medicare beneficiaries, they do not have any health 
insurance. They do not have that employer plan. They are not retired 
military. They do not have Tricare. They cannot afford Medigap 
insurance. Their only income is a Social Security check, and their only 
health coverage is your basic, traditional fee-for-service Medicare.
  So we are giving them the opportunity, and I think under the 
circumstances it is so important that the gentleman brings that up. 
That is what is going to make this program so successful. It is not a 
one-size-fits-all. We are not forcing anybody into anything.
  Now, certainly, I would love to see seniors, and when I turn 65, I am 
going to look very carefully at a managed care, Medicare advantage 
where I know that I can go and get disease management benefits and a 
lot of screening for things and, hopefully, some catastrophic coverage.
  So the gentleman is absolutely right. The keystone of this thing is 
choice, from start to finish.
  Mr. BEAUPREZ. Mr. Speaker, I thank the gentleman for this opportunity 
for this colloquy and certainly for his expertise. I am certainly 
comfortable with this bill. The gentleman said it earlier. It may not 
be perfect; only history will determine whether or not it is perfect. 
But I certainly think it is good enough. I think we have made huge 
strides in the direction that my seniors and my own intuition tell me 
we need to step, and I will be comfortable in supporting the passage of 
this bill.
  Mr. GINGREY. Mr. Speaker, I thank the gentleman from Colorado for 
being with us and helping to bring a little bit sharper focus on this 
bill. Because our seniors need to know, they need to be well-informed, 
and I think they are going to feel a lot better, those who have a 
little insomnia tonight and maybe had an opportunity to watch this 
late-night show on the medicare modernization and prescription drug 
act.
  Mr. Speaker, there are so many people that are supporting this bill, 
so many organizations. As I mentioned earlier, the AARP and 35 million 
seniors; the American Medical Association, which represents 330,000 
physicians. But even more important than that, they treat 280 million 
Americans and lots of seniors.
  Listen to this letter. I want to real briefly read this letter. Real 
quickly, this is one from the United States Chamber of Commerce. Here 
is what they say:
  The United States Chamber of Commerce applauded word that House and 
Senate leaders, along with the administration, have reached an 
agreement to bring a Medicare conference bill to the floor for a final 
vote. Quote: ``With employers being the source of retirement health 
care for 12 million seniors, it is critical this bill allows businesses 
the flexibility to integrate the new prescription drug benefit to their 
existing retiree health benefits, while allowing opportunities to 
partner with Medicare. The Chamber is pleased this bill is nearing 
final approval and welcomes

[[Page H11874]]

congressional and administration action to modernize the Medicare 
program and ensure its long-term viability for future generations. The 
final Medicare conference report is expected to include significant 
reforms to modernize the Medicare program structure and delivery system 
by emphasizing quality care, establish a much-needed prescription drug 
benefit, and offer preventive health care services and disease 
management.''
  Mr. Speaker, in conclusion, as I said last night, this bill, this 
bipartisan effort; and yes, it is bipartisan, and we will have support 
on both sides of the aisle, this is all about compassion. We hear 
concerns about cost and certainly we are all concerned about cost and 
wanting to keep that down as much as we can. But this $400 billion new 
benefit under Medicare, I say this: it is going to only cost $400 
billion if it does not work, and this is what I mean by that. You spend 
the money on taking timely prescription medications, and some of our 
neediest seniors need three or four pills a day, could be spending 
$600, $700 a month on prescription drugs. But if that will keep them 
out of the hospital, if that will prevent them from having a stroke; we 
heard earlier tonight from the Congressional Black Caucus talking about 
the fact that African Americans are more prone to have high blood 
pressure. Well, they ought to be so enthusiastic about this bill, we 
ought to have 100 percent support from the Congressional Black Caucus, 
because it is true, it is true that they suffer, particularly African 
American males, more from hypertension. And what happens? They end up 
in too many cases, far too many cases suffering from a stroke. What 
kind of life is that, no matter how long they live after, possibly not 
able to move one side of their body or utter a word.

                              {time}  2330

  So as this President has said to us, Mr. Speaker, this is all about 
compassion and caring, and caring for the most precious seniors that 
are so important to all of us. So, yes, I am very excited. I will 
probably leave here in a few minutes and go home and lay awake for 
another couple of hours because I cannot wait to vote for this bill 
tomorrow. I am an OB/GYN physician, and I want to be able to say to my 
constituents and to the seniors of America, The real Dr. Phil, he 
delivered.
  Mr. Speaker, I yield back the balance of my time.

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