[Congressional Record Volume 151, Number 14 (Thursday, February 10, 2005)]
[Senate]
[Pages S1252-S1253]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                   MEDICARE PRESCRIPTION DRUG BENEFIT

  Mr. WYDEN. Mr. President, the staggering cost estimates for the 
Medicare prescription drug benefit, coupled with the small number of 
seniors who have signed up so far, has threatened the very survival of 
this program. I do not want to see that happen, having voted for this 
program. I want to see the Senate take the steps to ensure that it 
works; that it delivers medicine to our seniors in a cost-effective 
way, and ensures that it reaches the hopes and expectations that 
millions of older people and their families have for this program.
  The fact is, the Medicare prescription drug program now faces two 
very serious problems. The first is the skyrocketing cost. These are 
the costs we have been debating throughout the week, that have been far 
greater than anyone could have predicted.
  A second problem may also herald very big concerns. To date, a small 
number of older people have signed up for the first part of the drug 
benefit, the drug card. So what you have is a pretty combustible mix. 
The combination of escalating costs and a skimpy number of older people 
signing up thus far raises the very real problem that a huge amount of 
Government money will be spent on a very small number of people. That 
is a prescription for a program that cannot survive.
  I do not want to see that happen. As someone who voted for this 
program and worked with colleagues on both sides of the aisle to make 
this program work to meet the urgent needs of the Nation's older 
people, I think the Senate ought to be taking corrective action and 
take corrective action now, in order to deal with what I think are 
looming problems.
  As I said, we learned a bit about the escalating costs of the 
program. But when you couple that with low levels of participation by 
older people, that is particularly troublesome. I think it is fair to 
say, if the drug card debacle--the first part of the program and the 
small number of older people signing up for the drug card continues 
into the full benefit phase of the program, what you have is a 
situation where I believe people are going to say this program cannot 
be justified at a time of scarce Government resources.

  To turn for a moment to the drug card part of the program that I 
don't think has been discussed much lately, the choices are eye-
glazing. There are more than 70 cards available; 39 you can get in any 
part of the country, the other 30-plus you can get only in some States. 
The Inspector General of the Department of Health and Human Services 
reported in an informal survey that the program information was 
confusing and inadequate.
  What makes it amazing is that a lot of folks who were looking at it 
are people who were relatives of HHS employees. So you have a situation 
where even folks connected with those who would know a fair amount 
about this program are having difficulty sorting through it.
  I have come to the floor today to try to sound a wake-up call, to say 
those of us who voted for the program, like myself, and those who 
opposed it, we ought to be working together on a bipartisan basis now 
to correct it. The first part of that effort should be to put in place 
sensible cost containment like we see in the private sector. It is 
incomprehensible to me that this program is not using the kind of cost 
containment strategies that you see in Minnesota and Oregon and all 
across the country.
  The Medicare Program is pretty much like a fellow standing in the 
Price Club who buys one roll of toilet paper at a time. They are not 
shopping in a smart way. They are not using their purchasing power. I 
and Senator Snowe have sought to correct that and

[[Page S1253]]

to take steps to use sensible cost containment strategies and ensure 
that the costs of this program are held down.
  Second, I think we need to take steps to make sure that some of the 
mistakes of the past are avoided. CMS, the agency charged with dealing 
with this program, needs people with expertise to answer the questions 
of seniors and family members. There needs to be better information, on 
the net and elsewhere, that is not incomprehensible gobbledygook. 
Seniors are going to need information about real savings for each plan. 
Pie-in-the-sky projections, which is what they have gotten thus far, 
are not going to cut it. That is what we saw this week with respect to 
these cost estimates. Suffice it to say, the U.S. Congress is not 
satisfied.
  I believe without effective cost containment and without good 
administration of the program, particularly as it moves into this next 
stage, we are going to see the bills continue to run up and we are 
going to see the participation of seniors continue to run down. That is 
a prescription for a Government program that cannot survive. I do not 
want to see that.
  I stuck my neck out in order to get that legislation passed. I 
believe it can survive. Congress needs to hustle, now, to mend it, to 
mend it with sensible bipartisan cost containment along the lines of 
what is used in the private sector; mend it with changes in the way the 
program is administered so it goes into the second phase without some 
of the problems we saw connected with the drug card. I just hope, as a 
result of what the Congress has learned this week, that there has been 
a real wake-up call as to how urgent it is that Congress take these 
corrective steps and that Congress move quickly. I believe this program 
now, because of the huge new cost estimates and the problems with 
getting folks signed up, could well be headed for life support.
  I don't want to see that. I think it would be a tragedy. I want the 
program that I voted for to work. That means it has to be supplemented 
with good cost containment and improvements in the way it is 
administered. I intend to work with my colleagues, particularly on the 
other side of the aisle--Senator Snowe and Senator McCain, who joined 
me in this legislation--to deal with the cost containment features, 
plus many colleagues on this side of the aisle who have bills of their 
own.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Florida.
  Mr. NELSON of Florida. Mr. President, my comments will come, 
appropriately, after the distinguished Senator from Oregon, about this 
program that was enacted a couple of years ago, the so-called providing 
prescription drugs for senior citizens. There are a number of Senators 
here who were promised, in order to get their votes, that this program 
would not cost more than $400 billion over a 10-year period. Of course, 
we know now that the result of the most recent studies is that it is 
not $400 billion, it is $720 billion. How many more cost estimates will 
go up and up?
  There is one thing we can do to this legislation, legislation that 
this Senator didn't vote for because I thought it was quite flawed--not 
only the true costs, which we were not given, but the fact that we are 
not allowing the principle of private enterprise to function. There is 
a provision in the bill that specifically prohibits the Federal 
Government, through Medicare, from negotiating bulk rate purchases, 
thus bringing the cost of the prescription drugs down.
  All of our colleagues embrace the private marketplace. Free market 
competition is where you can get the most efficient products at the 
least cost.
  Why wasn't that same principle of free market competition allowed to 
work here in the purchase of prescription drugs for Medicare 
recipients? It is certainly not new to the Federal Government. We have 
done this for almost 20 years in the Veterans' Administration--for the 
VA contracts for the purchase of prescription drugs in bulk and, 
therefore, the cost of the drugs to the Veterans' Administration is 
considerably less than retail price.
  If it is good for the Department of Veterans Affairs, why isn't it 
good for the rest of the Federal Government and for Medicare to do it? 
But we were not allowed to because the law specifically says we are 
going to violate the principle of free market enterprise, and you can't 
negotiate the price of the prescription drugs down. It seems to me that 
not only violates the principle, it violates good common sense.
  Now what do we do? The news has come out. No, the bill isn't going to 
cost what was promised, $400 billion over 10 years; it is going to cost 
a minimum of $720 billion over 10 years. We had better be minding our 
Ps and Qs or else we are going to continue to bankrupt this country by 
using faulty mathematics.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from North Dakota.
  Mr. DORGAN. Mr. President, I ask unanimous consent to speak in 
morning business for as much time as I consume.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  (The remarks of Mr. Dorgan pertaining to the introduction of S. 355 
are printed in today's Record under ``Statements on Introduced Bills 
and Joint Resolutions.'')

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