[Congressional Record Volume 151, Number 106 (Friday, July 29, 2005)]
[Senate]
[Pages S9544-S9547]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
SENATE CONCURRENT RESOLUTION 50--EXPRESSING THE SENSE OF CONGRESS
CONCERNING THE VITAL ROLE OF MEDICARE IN THE HEALTH CARE SYSTEM OF OUR
NATION OVER THE LAST 40 YEARS
Ms. STABENOW (for herself, Mr. Reid, Mr. Baucus, Mr. Rockefeller, Mr.
Kennedy, Mr. Bingaman, Mr. Durbin, Mrs. Murray, Mr. Corzine, Mr.
Schumer, Mr. Jeffords, Mr. Obama, Ms. Landrieu, Mr. Harkin, Mr. Reed,
Mr. Sarbanes, Mr. Kohl, Mr. Dorgan, Ms. Cantwell, Mrs. Clinton, Mr.
Wyden, Mr. Feingold, Mr. Nelson of Florida, Mrs. Feinstein, Mr. Biden,
Mr. Dayton, Mr. Levin, Mr. Kerry, Mr. Johnson, Mrs. Lincoln, Mr.
Lautenberg, Ms. Mikulski, Mr. Salazar, Mrs. Boxer, Mr. Pryor, Mr. Dodd,
Mr. Bayh, Mr. Lieberman, Mr. Conrad, Mr. Inouye, Mr. Akaka, Mr. Leahy,
Mr. Byrd, and Mr. Carper) submitted the following concurrent
resolution; which was referred to the Committee on Finance:
S. Con. Res. 50
Whereas Medicare was signed into law by President Lyndon B.
Johnson in Independence, Missouri, on July 30, 1965, as title
XVIII of the Social Security Act;
Whereas Medicare was created to provide health insurance to
the elderly in part because only about half of the elderly
population had health insurance;
Whereas Medicare continues to achieve its purpose of
improving health and financial security for Medicare
beneficiaries by assuring access to affordable health care
and contributing to the significant decrease in the poverty
rate among the elderly, which has fallen from nearly 30
percent in 1966 to approximately 10 percent in 2002;
Whereas Medicare played a fundamental role, together with
the Civil Rights Act of 1964, in desegregating the American
health care system by assuring access to care, regardless of
race or age;
Whereas Medicare has contributed to improvements in life
expectancy for persons over 65 years of age;
Whereas Medicare began with 19 million beneficiaries, and
since then has provided health care services for
approximately 105 million beneficiaries over the last 40
years;
Whereas Medicare today provides comprehensive health
insurance for nearly 42 million Americans, which includes
more than 35 million senior citizens and 6 million people
under 65 years of age who are permanently disabled or living
with end stage renal disease, and by 2030 the number of
Americans who will rely on Medicare for their health care is
expected to reach 78 million, which is nearly double the
number today;
Whereas Medicare ensures coverage along a continuum of
health care settings such as inpatient hospital care,
physician and outpatient hospital care, and other post-
hospitalization benefits such as home health care, skilled
nursing facility services, and hospice care;
Whereas Medicare has evolved over time to help
beneficiaries maintain their health, prevent disease and
injury, and to provide better benefits, including more
preventive care, such that Medicare, which covered about 42
percent of expenditures for the elderly in 1968, covered
approximately 55 percent of expenditures by 1997;
Whereas Medicare serves a diverse population of
beneficiaries with complex health care needs--71 percent of
beneficiaries have two or more chronic health conditions, 29
percent are in fair to poor health, and 23 percent have
cognitive impairments;
Whereas many who depend upon Medicare have modest incomes
and assets--a majority of Medicare beneficiaries have incomes
below 200 percent of the Federal poverty level ($19,140 for
individuals and $25,660 for married couples in 2005) and 48
percent of non-institutionalized Medicare beneficiaries have
assets below $10,000;
Whereas Medicare provides health insurance for nearly 6
million individuals under the age of 65 who live with
disabilities or illnesses such as multiple sclerosis, spinal
cord injuries, depression, and HIV/AIDS, and who are more
likely than those who are elderly to be in poor health and be
unable to live independently and perform basic activities of
daily living;
Whereas Medicare provides health insurance coverage for
nearly one-in-five adult women in the United States and plays
an especially important role in assuring access to health
care for older women who have lower average annual incomes
than men of the same age (average difference in income being
$14,000) and fewer resources to pay for health care services;
Whereas Medicare covers important preventive and health
maintenance services, including vaccinations, prostate and
mammography screening, bone mass measurement, and glaucoma
screening;
Whereas Medicare has achieved its major purpose of
providing access for the elderly and individuals with
disabilities to needed health care such that nearly 98
percent of elderly adults report that they have access to
needed health care;
Whereas elderly Medicare beneficiaries are more satisfied
with their coverage than privately insured nonelderly adults
and Medicare beneficiaries are more likely to rate their
health insurance coverage as ``very good'' or ``excellent''
and to report they were very satisfied with the care they
received; and
Whereas Medicare is a remarkably efficient program, with
administrative costs that average less than 2 percent of
expenditures compared to about 12 percent in private plans
and average per capita cost increases below those of the
private sector, further highlighting its efficiency: Now,
therefore, be it
Resolved by the Senate (the House of Representatives
concurring), That it is the sense of Congress that--
(1) for the past 40 years, Medicare has made significant
medical, social, and economic contributions to our Nation;
(2) the access to care provided by Medicare has changed the
course of health outcomes for the elderly and those with
disabilities, preventing physical deterioration and
preventing more individuals from slipping into poverty; and
(3) Congress must continue to support, strengthen, and
enhance the quality of care in this vital Federal health
insurance program that guarantees all Medicare beneficiaries
affordable health care that meets their needs.
Ms. STABENOW. Mr. President, I am very pleased to submit this
Concurrent Resolution on behalf of myself and my Democratic colleagues.
I rise to commend two programs that have served as a safety net for
millions of Americans, Medicare and Medicaid. This Saturday, Medicare
and its sister program Medicaid turn forty, and for millions of
Americans, these vital health care programs have literally meant the
difference between life and death.
I am proud to be sponsoring a resolution to commemorate Medicare's
birthday on behalf of the Democratic caucus and to be co-sponsoring a
similar resolution for Medicaid. Medicare is a great American success
story, and one of the most successful federal programs of all time. It
has lifted countless seniors out of poverty, allowing them to live with
dignity and independence, and it has ensured access to necessary,
affordable,
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quality medical care for our most vulnerable citizens. Prior to the
introduction of Medicare, half of America's seniors couldn't find or
afford health insurance. Today, Medicare is the closest thing our
Nation has to universal coverage, providing health care to nearly 42
million Americans, including over 1 million in Michigan.
Moreover, Medicare has been remarkably efficient, especially
considering the population it covers. Its administrative costs average
less than 2 percent of its expenditures; in comparison, the
administrative costs for private insurance can run 12 to 13 percent,
sometimes as high as 25 percent. Administrative costs this low are
particularly striking when we consider the overwhelming majority of
seniors and people with disabilities 87 percent--are enrolled in
traditional Medicare, giving them full access to specialized care and
their choice of physicians.
Medicaid, too, is celebrating its birthday this weekend. I began my
political career in State government so I know the challenges facing
our governors and State legislatures. One in seven Michiganians, or
more than 1.4 million in my State, are enrolled in Medicaid. Michigan
does a great job at trying to control its Medicaid costs. In fact,
private insurance has been rising almost twice as fast as Michigan's
Medicaid costs. That's remarkable when you realize that the program
enrolls some of the sickest and most vulnerable Americans, people that
could never afford private insurance.
I recognize that there are challenges facing both programs, but I do
not believe that making arbitrary cuts--putting our patients and
providers in jeopardy--is the way to improve either program. We
certainly must ensure the efficiency of the programs' use of taxpayer
dollars. While doing so we must not lose sight of the fact that,
according to the Congressional Budget Office, the Medicare and Medicaid
average spending growth on a per capita basis from 2000-2004 was lower
than that of private insurance. We need to find ways to lower health
care costs system-wide; addressing only Medicare and Medicaid means we
often simply shift unaffordable costs to the states, our businesses,
workers and patients. Let's work together on a bipartisan basis to make
health care more affordable and accessible for all Americans.
Mr. KENNEDY. Mr. President, Medicare has changed the lives of
millions of senior citizens over the past four decades. Before
Medicare, vast numbers of elderly Americans were unable to afford the
health care they needed. Since then, Medicare has made a real
difference in their lives. Medicare has also made a real difference in
the lives of millions of disabled persons, who became eligible for
Medicare in 1972.
Today, Medicare means good health care for more than 42 million
Americans across the country. It is one of the most popular government
programs ever enacted. The number of senior citizens living in poverty
has declined dramatically as seniors because of Medicare. Our seniors
are able to get the health care they so desperately need.
Many important changes have been made over the years to improve the
program. One of the most important changes was extending coverage to
disabled persons. Another important change is moving Medicare's focus
from caring for beneficiaries when they became sick to one that not
only treats illnesses but also emphasizes preventive care and the
management of chronic illnesses that affect so many senior citizens and
disabled persons.
While Medicare has accomplished so much over the past four decades,
there are still improvements to be made. The lack of coverage of
prescription drugs is the most obvious problem, and many of us are
deeply concerned that the new prescription drug benefit enacted by the
last Congress will not in fact benefit many seniors who need and
deserve the coverage. We had a real opportunity to provide all seniors
with a good drug benefit, but politics won out.
Another significant failure has been ``privatization,'' which has
forced many of the elderly into HMOs that cost more than traditional
Medicare.
The lack of long-term care in Medicare is another shortcoming. Too
many Medicare beneficiaries must impoverish themselves in order to
obtain the long-term care they need through Medicaid.
A further serious problem affects the disabled, who often have no
coverage during the two-year waiting period before Medicare is
available.
We can do better. Bills pending this year will modernize health
information technology, and improve the quality of care. We need to
provide stronger incentives to reward quality and encourage the
availability of the best possible care. We can improve treatment and
achieve better coordination of care for those with multiple chronic
conditions. And we can use the purchasing power of Medicare to make
sure that prescription drugs are priced reasonably.
Medicare was a landmark achievement in its day, and we in Congress
who revere it now have a responsibility to see that it continues to
meet the needs of both current and future beneficiaries in our own day
and generation. Putting beneficiaries first is what has made Medicare
so popular and successful over the past four decades, and if the same
fundamental priority is respected by Congress today and in the years
ahead, Medicare will have forty more years of brilliant accomplishment
in meeting the needs of our seniors and our fellow citizens with
disabilities.
Mr. REID. Mr. President, this Saturday marks the 40th anniversary of
the creation of the Medicare and Medicaid programs. On July 30, 1965,
President Lyndon B. Johnson signed Medicare and Medicaid into law in
Independence, MO. There are currently 87 million people enrolled in
Medicare, Medicaid, or both, yet we often talk about these two programs
with inhuman terms and confusing acronyms. It is easy to forget that
Medicare and Medicaid have human faces too.
Pauline Goldmann in Las Vegas is one of those faces. Two months ago,
Pauline suffered a collapse related to diabetes. She is back at home
now, thanks to Medicare's coverage of services she needed in a
rehabilitation hospital. Without coverage for those services, she would
have had to go to a nursing home. Eventually, she would have become
eligible for Medicaid, and the Government would have picked up the tab
for that costly institutionalization. More importantly, Pauline would
have lost her independence and the ability to live in her home and
community.
She is just one of the 42 million people currently served by
Medicare. Before Medicare, about one-half of seniors could afford
private health insurance. Now it is a program that they know and trust.
Without it, many seniors and people with disabilities would have no
health coverage at all. That this is practically inconceivable now is a
testament to Medicare's success.
Over the years, Medicaid has helped ensure that children in poverty
have access to the health care services they need. It has made sure
that pregnant women get the prenatal care we know is so important for
healthy babies. It has helped our senior citizens to pay for the costs
Medicare doesn't cover. And it has assisted people with disabilities as
they struggle to afford the services they need.
In the past 40 years, we have made changes to these programs. For
example, we have expanded Medicare to cover people with disabilities
and end-stage renal disease in 1972. In 1997, we created the successful
Children's Health Insurance Program. And a new Medicare drug program
will begin in 2006.
For years, we worked to add drug coverage to Medicare, but I am
afraid Republican leaders fell short in 2003 when they created this new
benefit. I am very concerned as we enter this time of uncertainty in
the drug benefit's implementation. I hope we will have the opportunity
to revisit some of the problematic aspects of that legislation so we
can make it less confusing and give seniors and people with
disabilities the drug benefit they deserve.
These are also uncertain times for Medicaid. Republican leaders have
demanded cuts to that vital program. To be sure, the cost of Medicaid
is growing, and our states struggle with their budgets as a result. But
Medicaid's problems are the same 5 problems that exist in our health
care system as a whole. Medicaid's rolls grow as more people become
uninsured, and Medicaid faces the same unchecked health care cost
increases we all do. Moreover, Medicaid fills in Medicare's gaps,
covering long-term care and prescription
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drugs for people eligible for both programs. Rather than alleviating
those drug costs, the new drug benefit continues this cost-shift to the
States.
As our Republican counterparts look at ways to derive savings from
Medicaid, we call on them to eliminate waste or other problems in the
program, but also to redirect those savings to Medicaid. We also
implore them to reject increases in cost-sharing for beneficiaries or
allowances for changes to Medicaid's benefit package. Most of all, we
ask them to keep in mind the faces of people covered by Medicaid.
Neither Medicare nor Medicaid could perform their missions without
the providers who participate in the programs. I thank these
individuals and institutions for the services they provide every day.
Their commitment to the health of our citizens is tremendous, and in
exchange, we must ensure that they are fairly treated by our public
programs.
Today, I join my colleagues in submitting resolutions commemorating
this important anniversary. Democrats created these two great programs
in 1965. They are two of our proudest achievements. I look forward to
many future birthday celebrations as these programs continue to address
the basic health care needs of America's seniors, children, pregnant
women, and people with disabilities.
Mr. ROCKEFELLER. Mr. President, on July 30, 1965, with one stroke of
the pen, President Lyndon Baines Johnson created two Federal programs
that gave America's poor and elderly access to high-quality
comprehensive health care. Having grown up in the Hill Country of
Texas, President Johnson knew first hand of the lack of health care for
the poor, the elderly, and the disabled. He had witnessed the bitter
consequences of men, women, and children denied access to meaningful
and affordable health care.
While President Johnson's signing of the Medicare and Medicaid
programs into law was historic, it would be inaccurate to bestow the
sole credit for the creation of these vital programs on one person
alone. The Social Security Amendments of 1965 represented the decades
long work of both Democrats and Republicans who shared a commitment to
improving the health of our nation. The amendments were a compromise
between those who wanted a social insurance program solely for the
elderly and those who believed we needed a similar program for the
poor.
The addition of Medicaid to the Social Security Amendments of 1965
was of particular significance. Far from being the afterthought that it
is typically described as, the creation of Medicaid was actually a
reflection of a tradition of community and mutual obligation that, if
not uniquely, is at least characteristically American. It was an
extension of a guiding principle of our Nation's founding--a shared
responsibility for the greater good of all, despite the broader
spectrum of political beliefs. President Theodore Roosevelt, a
Republican who embodied our Nation's commitment to the public good, was
among the first to propose comprehensive health insurance for working
families. Our language still bears witness to the type of Good
Samaritan ideal that preceded the creation of Medicaid in local
situations such as ``barn raising'' and ``quilting bees.'' And on a
national level, we have always rallied in times of crisis, channeling
personal and individual efforts into a pursuit of the greater good.
This type of social contract with our fellow Americans was the basis
for the creation of Medicaid. The economic disasters of the Depression
left many families unable to pay for health care and, therefore, at the
mercy of preventable and treatable diseases. Because of the poor health
outcomes that occurred during the Great Depression, the Federal
Government began to give serious consideration to a health care safety
net. Democrats and Republicans alike in Congress recognized our
country's moral obligation to its most vulnerable citizens, and they
pushed for action. And, in various ways, virtually every President from
Harry Truman to Dwight Eisenhower to John F. Kennedy helped lay the
framework for the comprehensive health insurance legislation that
Johnson ultimately finished.
Just as significant as the bipartisan support for the creation of
Medicaid is the fact that subsequent administrations--Democratic and
Republican--have reaffirmed a commitment to Medicaid because it is the
fulfillment of a social contract between American citizens and their
representative government.
Unfortunately, during the last decade, we have seen a misguided,
darker view of Medicaid emerge, one that loses sight of the nobler
efforts underlying that social contract. Medicaid had become a
scapegoat for the larger ills facing our entire health care system.
But, Medicaid isn't the problem. Instead, this vital program has
inherited the problems of our entire health care system, and over the
years has been asked to take on more and more responsibility for the
health of our Nation with fewer and fewer resources. Because Medicare
has never provided significant long-term care benefits, Medicaid has
been left to foot the bill for individuals eligible for both Medicare
and Medicaid. And, each year, more and more employers are dropping
their employer-sponsored health insurance coverage, which drives more
working families to Medicaid. With cost shifts of this magnitude, State
governments are finding themselves having to dedicate more and more of
their budgets to Medicaid. As a former governor, I understand concerns
about balancing budgets. However, the solution proposed by this
administration--cutting billions of dollars out of Medicaid--does not
fit the problem, which is our health care system as a whole.
We can and should reform our entire health care system to make it
more responsive to the needs of our Nation's citizens, and there are
relatively easy ways to do this. We can start by creating a Federal
long-term care system to provide all Americans greater retirement
security. At the same time, we can provide employers with more
incentives to retain health care coverage for their employees. And,
finally, the Federal Government can lower the cost of prescription
drugs for all Americans by allowing reimportation and improving access
to generic drugs. If we do these things, then Medicaid can continue to
be a vital, stable, and efficient health care program.
I believe taking care of our most vulnerable people is a moral
obligation.
And it is an obligation that we, as Americans, have fulfilled time
and again because it reaffirms our fundamental belief in democracy and
community. As Alexis de Tocqueville wrote in Democracy in America, a
record of his 19th century travels through the United States, America's
``equality of conditions'' not only characterized the new country's
democratic political structure, but it reflected the community and
mutual obligation that he saw as part and parcel of America's
revolutionary form of government.
The social contract with America that was forged 40 years ago this
week is no less valid or necessary today. According to the most recent
Census data, nearly 24 million people with incomes below 200 percent of
the poverty line were uninsured in 2003, including approximately 18
million adults under age 65 as well as 6 million children. Those
numbers are expected to rise in the years ahead. Our representative
democracy has a responsibility to do for the future what we have
repeatedly done in the past: protect, preserve, and strengthen
Medicaid.
Mr. WYDEN. Mr. President, on July 30, 1965, legislation was signed
into law that created two fundamental programs: Medicare and Medicaid.
The creation of those programs was a landmark for this country. When
signing the Medicare legislation 40 years ago, President Johnson
remarked, ``We marvel not simply at the passage of this bill, what we
marvel at is that it took so many years to pass it.''
At that time, senior citizens were identified as the group most
likely to be living in poverty in the U.S. Many had no type of health
insurance. Since 1965, and largely thanks to Medicare and the access it
has afforded seniors, the poverty rate has dropped significantly and
older Americans are enjoying longer and healthier lives.
As John Gardner, Health, Education, and Welfare Secretary during
President Johnson's administration, once stated, ``Medicare was a great
turning point, but it has to be continually revised.'' And Medicare has
changed. Since 1972, Medicare has also included Americans with
disabilities and those with end stage renal disease bringing access and
coverage to millions of
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Americans in need of it. In 2003, Congress passed the Medicare
Modernization Act to add a prescription drug benefit. Medicare began
with about 19 million seniors, but faces an estimated 77 million
Americans, almost double the number of Americans enrolled in the
program now in 2030. These Medicare beneficiaries will live longer, and
face very different needs than the first 19 million.
With the creation of Medicaid, our Nation affirmed that we wanted
those who were poor to be able to have health care. Like Medicare,
Medicaid has faced changes. Other categories of people in need have
been added; States like my home State of Oregon have been able to
experiment in creative ways to provide care to more people; and as more
seniors need long-term care and do not have the funds to pay for it,
Medicaid plays an important role in providing long-term care. Medicaid
has uniquely borne the brunt of the failings of the health care system.
For many, this program is a lifesaver and it must be maintained.
Both Medicare and Medicaid are facing financial crises. Those who
fought hard for the creation of these fundamental programs could not
have foreseen the technology and scientific breakthroughs that would
change health care delivery. Nor could they have foreseen the costs. We
need to continually revise these programs to find better ways to
provide affordable care and to assure that these programs are up to
date with the best science and medicine but--that they keep their
original purpose--to provide care to those who are aged, disabled, or
poor.
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