[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,

[[Page S9545]]

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

[[Page S9546]]

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

[[Page S9547]]

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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