[Congressional Record (Bound Edition), Volume 146 (2000), Part 10]
[House]
[Page 14725]
[From the U.S. Government Publishing Office, www.gpo.gov]



   THE NEED OF SENIOR CITIZENS TO HAVE A MEDICARE PRESCRIPTION DRUG 
                                BENEFIT

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 6, 1999, the gentleman from New Jersey (Mr. Pallone) is 
recognized for 60 minutes as the designee of the minority leader.
  Mr. PALLONE. Mr. Speaker, I would like to call the attention of the 
House this evening, as I have many times, to the need for senior 
citizens to have a Medicare prescription drug benefit.
  I do not really think it is necessary tonight to go into the reasons 
why this is necessary. We all know that the price of prescription drugs 
continues to rise, that seniors as a particular group have tremendous 
out-of-pocket expenses, and that many of them do not have access not 
only not under Medicare but in general to any kind of prescription drug 
insurance.
  Many times seniors have to make choices between whether they are 
going to pay their bills, the rent, buy food, as opposed to having 
access and being able to buy prescription drugs that are really 
important for them to survive, for them to be able to live a decent 
life and to not have to worry about whether they are going to be here 
the next day. The President, President Clinton, has made it quite clear 
that this is a major priority if not the number one priority for him.
  I listened to the previous speaker, the gentleman from Colorado, talk 
about the marriage penalty, the estate tax repeal. I would remind my 
colleagues and the American people that the Republicans are in the 
majority. It is very difficult for us as Democrats to get a proposal up 
and considered unless the Republicans who are in the majority allow 
that, allow us to bring it to the floor.
  The President and myself and most of the Democrats have not been 
happy with the marriage penalty repeal and the estate tax repeal that 
the Republican leadership has proposed, not because we do not want to 
see changes with regard to tax on married couples, not because we do 
not want to see changes in the estate tax, because we have proposed 
changes, but the President has said and the Democratic leadership has 
said that the bills that the Republicans have proposed essentially 
spend too much and spend too much on a small percentage of the people 
impacted by the estate tax who are very wealthy, whereas the Democratic 
proposal protects the small business owner, the ranchers, the people, 
the overwhelming majority that are paying the estate tax. The same is 
true for the marriage penalty.
  But the President is making an effort to try to get something 
accomplished around here, because I think most people know that not a 
great deal is being accomplished in this Congress. The Republicans, my 
colleague, the gentleman from Colorado (Mr. McInnis) brings up his 
proposal for the marriage penalty, his proposal for the estate tax. It 
differs from the Democratic proposal, so we do not come to agreement. 
Nothing gets accomplished.
  What the President has said is, Look, I will take some form of estate 
tax repeal, I will take some sort of adjustment in the marriage penalty 
that benefits the average person, but along with that we want the 
Republican leadership to agree to provide a Medicare prescription drug 
plan, the one that the President and the one that the Democrats have 
proposed.
  I ask my colleagues, not only my friend, the gentleman from Colorado 
(Mr. McInnis), but my colleagues in general, what better way to try to 
accomplish something, what better way than to take some of the 
Republican proposals and take some of the Democratic proposals, 
particularly this one on prescription drugs, and try to accomplish that 
goal?
  In fact, last week when we voted on the Republican marriage penalty 
legislation the Democrats proposed a motion to recommit that would do 
just that, that would even take the Republican plan, as long as the 
Medicare prescription drug proposal was added to it. And, of course, 
the Republicans rejected that and nothing was accomplished.
  If we are going to accomplish anything, we have to work out things 
together. The most important thing for the Democrats, certainly one of 
the most important things for the Democrats, is that we get a Medicare 
prescription drug plan passed so our seniors have access and everyone 
is covered; just like they are covered now by Medicare for 
hospitalization, for their doctors' bills, that they get a prescription 
drug benefit. It is absolutely crucial that that happen, and certainly 
we can afford it if we all get together and figure out how to deal with 
this budget.
  I wanted to point out that, unfortunately, when the Republicans a few 
weeks ago proposed a prescription drug program and had a vote on the 
House floor with regard to their prescription drug program, which is 
not part of Medicare, that they would not allow the Democratic proposal 
to be considered. Once again, we were shut out. Once again, the 
Democrats were told no, they do not even want to consider our proposal 
on the House floor.
  What are they afraid of? I think their problem is that they are 
afraid that if we look at the Democratic plan, which seeks to include 
prescription drugs within Medicare, that ultimately there would be 
overwhelming support for it with the American people and probably even 
within the Republican caucus among the Republicans here as well, if 
they only had a chance to vote on it; to have the opportunity for us to 
be heard and to explain it and to finally have a vote.
  What the Republicans have done instead is they decided maybe a month 
ago, I actually have an article that was in the June 15 New York Times, 
about 2 weeks ago or maybe 3 weeks ago they asked a pollster to do a 
poll. Basically the pollster came back, this was Glenn Bolger, a 
pollster with Public Opinion Strategies, a Virginia firm, and warned 
the House Republicans that the prescription drug issue was a political 
problem for them.
  In other words, they realized that politically if they ran for 
reelection in November and they did not have a prescription drug plan 
of some sort, that they would probably be defeated and would no longer 
be the majority here in the House of Representatives.
  So Mr. Bolger basically told them that the best thing to do is to at 
least start talking about the prescription drug issue, talk about how 
seniors are negative impacted, seniors suffer, and we have to do 
something about the problem.
  In fact, Mr. Bolger went so far as to advise, and I quote from this 
New York Times article on June 15, ``It is more important to 
communicate that you have a plan than it is to communicate what is in 
the plan.'' Basically what Mr. Bolger said is, ``Look, come up with 
some rhetoric, if you will, about prescription drugs, suggest some sort 
of program, but do not worry too much about what is in it, or certainly 
do not worry about whether it will ever pass or be signed by the 
President. Just bring something up on the floor of the House and vote 
on it, talk about it, and nothing will ever happen, but at least you 
will have something. You can say you approved something, so when you go 
to the voters in November you will have something to say.''
  This is the impetus, if you will, for the House Republican 
prescription drug plan called the Medicare RX 2000 Act. It is an 
illusory plan. It provides no real prescription drug coverage to 
anyone, to seniors or anyone. Instead, what it does is it says, ``We 
will give you some money, depending on your income, and you can go out 
and see if you can get, with your own money and the little bit that we 
subsidize, see if you can get a drug company to sell you a prescription 
drug-only policy.''
  Think about that a minute. We have this great program called Medicare 
that was started in the sixties and that almost all seniors take 
advantage of which provides for their hospitalization, which provides 
for their doctor bills, most of their doctor bills to be cared for.
  Instead of doing what the Democrats say, which is just bring 
prescription drugs under the rubric of Medicare and administer it 
essentially under Medicare, which is a proven program, instead, the 
Republicans say, no, go out and see if you can get a private insurance 
company to sell you a drugs-only policy.
  Now, what the Republican leadership forgot to tell anyone is that the 
insurance industry itself does not want to sell those policies. We had 
representatives from the insurance lobby that came to the Committee on 
Commerce, that has jurisdiction over Medicare prescription drugs, and 
they basically told the committee, we do not want to sell these drug 
prescription policies. We will not sell them.
  There is a good reason why they will not sell them: They cannot make 
any money. It is like some of my colleagues use the analogy of a 
haircut. Everybody gets a haircut. Everybody who is a senior, or at 
least 99, 95 percent, needs some kind of prescription drugs. So 
insurance companies do not want to underwrite something that is 
essentially a benefit that everybody is getting because they cannot 
make any money. They operate on risk. They assume some people will get 
coverage and others will not, and they pool their resources, and they 
make money because some people do not take advantage of the benefit.
  We cannot do that with prescription drugs with seniors. Almost 
everybody is going to have the benefit and need the benefit. That is 
certainly why it makes sense to include it as a benefit under Medicare. 
Just like we include hospitalization and we include doctor bills, we 
include prescription drugs as a benefit.
  Let me just talk a little bit about the Democratic proposal and 
explain really how very simple it is and why it makes sense.
  Right now if one is over 65 and signs up for Medicare, which almost 
everyone does, they get their hospitalization through Part A, and if 
they pay a monthly premium of about $45 or so, they get their doctor 
bills paid for mostly under Part B.
  What Democrats are saying, ``We will do the same thing. You pay a 
certain amount per month and we will set up a program called Part C or 
Part D of Medicare whereby we will pay a certain percentage of the 
prescription drugs,'' just like they get their doctor bills paid for.
  What the Democrats say is that we will guarantee the benefit. Not 
only will we guarantee the benefit through Medicare if they want it, if 
they voluntarily sign up for it like they do for Part B, but it covers 
all the medicines that are medically necessary as determined by their 
doctor, not the insurance company. So they sign up, they are guaranteed 
the prescription drug benefit, and the nature of what kind of drugs 
they get, what kind of medicine they get, is determined by their 
physician in consultation with them, not by the insurance company.
  Now, the Republican bill not only is not under Medicare, not only 
will not work because what insurance company is going to sell it, but 
beyond that, they do not even say to the insurance company what they 
have to cover. The insurance company, if they decide to sell a policy, 
they may decide, well, we will give certain drugs and we will determine 
what prescription drugs they need. They do not define what the benefit 
is, is essentially what I am trying to get across.
  But most important, the Republican proposal, which just says, go out 
and shop around and see if you can find an insurance company that will 
sell you a policy, does not address the issue of price. We know that 
one of the major problems right now with prescription drugs is that 
seniors who do not get prescription drug coverage through their pension 
or their employer after they retire, or because they may sign up with 
an HMO, if they have prescription drug coverage, that is the way they 
usually get it. But if one has to go out and buy prescription drugs 
themselves because one does not have an HMO or coverage through their 
employer where they have worked over the years, they pay a much higher 
price for the drugs than the HMO or those employer pension benefit 
plans because they do not have the ability basically to negotiate a 
price.

                              {time}  2130

  Well, what the Democrats are saying is we are going to address that 
price issue, too, because we are going to say that the agency that is 
in charge of the Medicare program can negotiate a price or at least can 
set up in different regions of the country someone who will negotiate a 
better price for you because now there are so many people in the 
Medicare program, 30 million, 40 million seniors who these drug 
companies essentially we are at the mercy of, because if they want to 
sell them and sell to the government program, they have to offer the 
better price that they are offering to the HMO or to the employer 
benefit plan.
  So the Democratic plan basically operates under the rubric of 
Medicare, is voluntary if one wants to sign up, guarantees one the 
benefit, guaranteeing all medical care, medically necessary drugs as 
determined by one's physician and also seeks to address the problem of 
price.
  The Republican bill does none of the above. Frankly, I would say that 
the Republican proposal would never work and is nothing more than an 
effort to try to talk about something and try to give the impression 
that they care.
  But most important, going back to what I said initially, the 
Republican proposal passed the House of Representatives, but it is not 
moving in the Senate. The President is not going to sign it. Why do we 
not try to get together, Democrat and Republican, and come up with a 
proposal like what the President has suggested where we have the 
Medicare prescription drug program, and then we address the issue of 
the marriage penalty and the estate tax in a way that benefits the 
average American.
  Now, I wanted to, just in case my colleagues doubt that when I talk 
about this Republican proposal for prescription drugs to be doomed to 
failure, there was a very interesting article that appeared, I think it 
was the Saturday before last, July 8, in the New York Times on the 
front page which talked about the Nevada experience.
  I think a lot of my colleagues know that what often happens in 
Congress is that one or more of the 50 States tries something within 
their own State to see if it works; and if it does, then Members 
usually from that State look at the idea and say, gee, that is a good 
idea, why do we not try it on the Federal level.
  Well, interestingly enough, within the State of Nevada, within the 
last 6 months, they decided to implement, on a State level, something 
that is almost exactly like what the Republicans propose for a 
prescription drug program here; in other words, basically giving some 
money, depending on one's income, that one will put with whatever other 
resources one has to go out and buy a prescription drug only insurance 
policy.
  It has not worked. Not only when I say it has not worked, I do not 
mean that it even has a chance at working, because when the State of 
Nevada put out this proposal to the insurance company and said, okay, 
we will entertain proposals from insurance companies to sell this kind 
of insurance, not one single insurance company in the whole State 
offered to do it.
  I think they had one company that did not qualify under the law for 
some reason that asked to do it, and the State knew that they were not 
qualified to do it, so they did not consider it. But not one insurance 
company that was qualified offered to do it.
  Now, what better reason could one have to not adopt that type of a 
program? But what do the Republicans do here in Congress? They see the 
Nevada example, which was adopted by Republicans, their Republican 
Governor, and they seek to enact it into law here.
  Usually what we do in Congress is, if the States are doing something 
that is good, we copy it, and we institute it on a national level. I 
cannot think of a single circumstance where we had a State try 
something that failed and then we adopted it anyway. It makes no sense 
to me other than going back to what I said before, which is the 
Republicans did not really want to pass something that would actually 
be enacted into law and become a law and actually be utilized by 
anybody. So they did not. They just wanted something to talk about.
  I wanted to, just interesting, if I could, just quote a little bit 
from this New York Times article. But this was in the New York Times on 
July 8 of this year, about a week or 2 ago, and I am just going to read 
from a few quotes here. I do not usually like to quote, but this is so 
appropriate.
  It says, ``Nevada has adopted a prescription drug program for the 
elderly very similar to one approved last month by the United States 
House of Representatives, but is off to a rocky road.
  ``Insurance companies have spurned Nevada's invitation to provide 
coverage. The risks and the costs are too high, they say, and the 
subsidies offered by the state are too low.
  Nevada's experience offers ominous lessons for Congress, especially 
Republicans, who want to subsidize insurance companies to entice them 
into providing drug benefits for elderly and disabled people on 
Medicare.''
  ``In March, the State invited hundreds of insurance companies to bid 
for its business providing drug coverage for 10,000 to 14,000 people 
age 62 or older. Only one company responded, but it was ineligible 
because it was not licensed to sell insurance in Nevada.''
  Now, what they did in Nevada is, within the legislature, they set up 
a task force that was going to review whatever proposals came forward 
by insurance companies to see if they qualified.
  Barbara F. Buckley, a state assemblywoman who co-chairs this task 
force monitoring what was going on said, ``I have my doubts that an 
insurance company will be able to offer meaningful drug benefits under 
this program. If an insurance company does bid on it but the benefits 
are paltry, senior citizens will be up in arms.''
  The article goes on and on. But the point is well made. This does not 
work. No insurance company wants to offer it. This is a ruse. This is a 
sham. This is not a serious effort to address the issue.
  The Democrats have a serious plan. But we do not have an opportunity 
to bring it up. We will continue to be here every night until we have 
that opportunity.
  Mr. Speaker, I yield to the gentleman from Maine (Mr. Allen) who 
really, more than anybody else in the Congress, brought this issue to 
the forefront and particularly pointed out the problem with price 
discrimination that exists for many seniors and the problem of, because 
he is in the State of Maine, and he so witnessed it firsthand, about 
how people will go over into Canada and be able to buy drugs for 
significantly less than in the United States. That is simply not fair.
  Mr. ALLEN. Mr. Speaker, I thank the gentleman from New Jersey for 
yielding to me, and I thank him for all the good work he has done on 
this issue. He has been a real leader and has been sort of pounding 
away.
  We have learned, have we not, since our time here in the Congress 
that the status quo is the status quo, and it is very hard to change. 
It only gets changed if people speak out again and again and again 
about an injustice until something is done about it.
  While the gentleman from New Jersey was talking about the State of 
Nevada, and its failed effort to rely on private insurance companies to 
provide prescription drug coverage, I was reminded how proud I am of my 
home State of Maine, which has taken a different tact.
  Basically what the State of Maine did in the last legislative session 
through the leadership of Chellie Pingree, a State Senator, Mark 
Lawrence who is running for the U.S. Senate, and some others, was to 
adopt a law which provides that the State of Maine will negotiate lower 
prices for all of those people, seniors and others, who are not now 
covered with prescription drug insurance of one kind or another. So 
about 300,000 people in Maine would be covered under this plan.
  The way the law is written, the State would essentially act as what 
is calmed as a pharmacy benefit manager. They would negotiate prices 
with the pharmaceutical industry to get a reduced price based on the 
fact that they represent 300,000 people, the kinds of discounts that 
Aetna and Cigna and United negotiate for their beneficiaries, and the 
kind of discount that I have suggested we really should do for Medicare 
beneficiaries here.
  The bill I have introduced, H.R. 664, the Prescription Drug Fairness 
for Seniors Act, is very simple. It involves the creation of no new 
bureaucracy. It does not involve any significant expenditure of Federal 
money, but it would allow pharmacies to buy drugs for Medicare 
beneficiaries at the best price given to the Federal Government. The 
best price is usually what the VA pays for drugs or what Medicaid pays 
for drugs for people who qualify for their programs.
  It is real simple, a real simple idea. If one is part of a big pool, 
one ought to get a decent discount. That is all we are suggesting for 
Medicare beneficiaries. But that is only through that piece of 
legislation. But that is only part of a solution.
  The other part of the solution, of course, is to get a real Medicare 
reform, a benefit under Medicare so that those people for whom a 
discount is not enough would be able to get assistance in covering 
their prescription drugs.
  Basically, the Maine legislation is a path that would get discounted 
prices for our seniors without a significant cost to the government.
  I was listening earlier to some of the commentary from folks on the 
other side of the aisle about tax cuts, tax cuts, tax cuts, how, with 
this huge new surplus, we really need to, first thing, is to have tax 
cuts, tax cuts larger than any we have seen certainly in my lifetime 
here in the Congress. We see them in a variety of different proposals.
  A year ago, the Republican majority came to us with a suggestion for 
a tax cut that was $800 billion. Now they have carved it up into 
pieces, but the total is still $800 billion. What is really tragic 
about this proposal is, not that there are tax cuts themselves, because 
there should be tax cuts. We ought to eliminate the marriage penalties. 
We ought to reduce the estate taxes. We can provide relief in a number 
of other ways. But we should not take the whole on-budget surplus and 
spend it all on tax cuts.
  Why? Because we learn something, we teach our kids something that we 
hopefully learned ourselves; and that is, when we have responsibilities 
to others, we need to meet those responsibilities before we give 
ourselves presence. What I mean by that is this, Medicare is going to 
be under increasing pressure. Right now, there are 39 million Medicare 
beneficiaries. But when we get out to about 2030, there will be close 
to 75 million to 80 million Medicare beneficiaries. At that point, it 
is obvious Medicare needs to be shored up. It needs more funding. We 
cannot get there just going along the way we are right now.
  The real tragedy, the real tragedy, in New Jersey, we see it all 
across this country, and I am glad that people from Maine pointed it 
out to me so long ago now, too many seniors just cannot do it. They 
cannot take their prescription drugs. While folks on the other side of 
the aisle are talking about an estate tax repeal that would benefit 
primarily the 1 percent of the wealthiest taxpayers in the country, 
though I believe we should have estate tax relief, still our priority 
ought to be let us take care of those people who simply cannot afford 
to take the medical care that their doctors tell them they have to 
take.
  Every day in this country, people are trying to decide, can I afford 
to buy the food I need today? Can I afford to pay the electric bill? 
Can I afford to pay the rent? Or can I somehow scrape together enough 
to take the full dosage of the prescription drugs that I am supposed 
to?
  When I talk to people in Maine, many of them are taking one pill out 
of three. They are cutting pills in half. They are not filling their 
prescriptions, because they cannot do it.
  That is not what health care is supposed to be like in this country. 
It is not supposed to be like that. In this country, one would have 
thought, the wealthiest country on earth, at the moment in its history 
when it is most prosperous, we could at least provide prescription 
drugs for our seniors.
  The truth is we can. There is no question, with the surpluses that 
are projected, that we can provide a Medicare prescription drug benefit 
for our seniors. Absolutely no question.
  What have we got? We have got the kind of proposal that went through 
here a few weeks ago on a three-vote margin, not even close to a 
bipartisan approach, that basically said, what we need to do for our 
seniors for prescription drugs is turn them over to HMOs and insurance 
companies; and if we give enough money to the HMOs and insurance 
companies, maybe, just maybe, we will not require it, but maybe, just 
maybe, they will provide insurance for our seniors.
  Now, this might seem logical except that the insurance industry says, 
no, there is no way we are going to provide insurance for prescription 
drugs for seniors. No way. That is what Chip Kahn, the head of the 
Health Insurance Association of America has said. Leaders of the Blue 
Cross plans have made the same point. Why? Because everybody is a 
claimant. If one is a senior, the chances are good, 85 percent, that 
one is on some form of prescription medication. So everybody is a 
claimant.
  I say to people in Maine, if Maine were a low-lying State, and every 
year 85 percent of the people made a claim for flood insurance, one 
would not be able to buy flood insurance in Maine, not at all, not at 
any price. Well, the same is true for prescription medication for 
seniors, and the health insurance industry knows that.
  Who does not know it in this country? Well, the pharmaceutical 
industry does not know it because the pharmaceutical industry is out 
there basically promoting this private insurance scheme. The 
Republicans from this House do not get it either, because they are 
basically proposing a plan that the health insurance industry is saying 
we will never comply with, we will never provide this kind of 
insurance.
  I come back to what I said about responsibility. This country at this 
moment in its history can afford to provide prescription drug coverage 
for seniors, not to pay for all of the drugs that every senior needs, 
but a decent health care plan. We can afford it.

                              {time}  2145

  And what holds us back, what holds us back is the view of the 
majority that the one thing we cannot tolerate in this country is 
strengthening Medicare; the one thing we cannot tolerate is 
strengthening a government health care plan for our seniors. It has to 
be done through the private sector.
  Well, look at the private sector. I do not know in how many States 
this is true, but I know it is true in a lot of places; but as of July 
1, 700,000 people in this country who had some form of prescription 
drug coverage through their HMO simply got dropped by their HMO. Why? 
Because it was not profitable to cover them.
  In Maine, there were a grand total of 1,700 people under Medicare 
managed care, under an Aetna plan. And as of July 1, Aetna announced 
they are pulling out of the State of Maine. So there will be no 
coverage under managed care plans in Maine for seniors who need 
prescription drug coverage.
  What that means for my State is probably about 50 percent of all the 
seniors in Maine have absolutely no coverage at all for their 
prescription drugs. And many of the people that I know are supposed to 
take $200, $300, $400, $600, $1,000 a month in prescription 
medications. They cannot begin to do that.
  What we have in this country now is a rationing system that rations 
prescription drugs by wealth, by how wealthy we are. What kind of 
system is that? It is not fair, it is not right, it is completely 
antithetical to what we should have in terms of health care for our 
seniors in this country.
  People can stand up here and talk about the need to eliminate what 
they call the death tax. I am not talking about relief, because I think 
we need relief for our small businesses. I think we need relief for 
family farmers. I think the rate should come down, and I think the 
exemption should go up. Reform is one thing, but repeal is another. 
What repeal does is put Bill Gates and Steve Forbes and the mega-
billionaires in this country ahead of people who today cannot afford 
their prescription drugs, cannot afford the medication that keeps them 
out of the hospital, that extends their lives, that improves their 
lives. They cannot do it.
  We are stuck in this Congress. We are stuck because the majority 
simply cannot abide strengthening Medicare. The majority simply cannot 
abide having Medicare benefits receive the same kind of discounts and 
benefits that the people who are lucky enough to have private health 
insurance through Aetna or Cigna get. And there are lots of complaints 
about health care in this country. Individuals working for a company 
that provides a quality health care plan, they get their prescription 
drugs covered. But seniors, 12 percent of the population, buy a third 
of all prescription drugs, and somewhere between 40 and 60 percent have 
either no coverage at all or very inadequate coverage.
  We need to act. We need to act this year. There is no reason why we 
cannot. The Democratic plan was a comprehensive plan that would have 
provided a benefit, would have provided a discount, would have worked, 
did not rely on insurance companies saying they would not do anything. 
That plan should have come to this floor and been debated, the way 
substitutes to Republican legislation normally is, but the Republican 
majority would not allow a full debate and vote on that particular 
issue. I think that is the scandal. That is the real scandal.
  We have a responsibility here to take the most serious problems in 
this country and deal with them. We ought to be thinking about the 
country as a whole, what will strengthen this country; what will be the 
best for our citizens; and deal with our responsibilities: to improve 
Social Security, to strengthen Medicare, to provide a prescription drug 
benefit, to invest in education, and, sure, to have some targeted tax 
cuts and to pay down the debt. Do not squander this moment of 
prosperity simply on tax cuts, which inevitably are weighted to 
wealthier people in this country.
  There is a real choice, a real debate going on in this House right 
now, and it seems to me that what we are trying to do on the Democratic 
side is live up to a wide range of responsibilities. We are trying to 
figure out what is best for all of us, all Americans, all the people in 
this country together. We are not saying, as the other side is, me, me, 
me. Give me money. We are saying we. We are saying we have got to hang 
together. And when we have our parents and grandparents unable to buy, 
unable to take medication that their doctors tell them they have to 
take, we ought to do something about it. And we ought to do it this 
year, now, before we go home.
  I thank the gentleman very much for all he is doing on this topic. I 
still hope, I still hope that as we get closer to November that we will 
have some of our colleagues on the Republican side come forward with a 
plan, and not a plan that is a showpiece, not a plan that is just there 
to basically look like something has been done even if it is not 
understood, but a plan that will mean something to millions of American 
seniors who today simply cannot take the medication they should, cannot 
eat well, cannot pay the rent, cannot do all those things that they 
expected to do in their retirement years.
  So I thank the gentleman very much.
  Mr. PALLONE. I want to thank my colleague from Maine. The gentleman 
mentioned a number of things that I wanted to comment on. The tragedy 
is, of course, that what we really want to do is get something done 
around here. That is what the gentleman has said and that is what the 
Democrats have been saying.
  I do not know if the gentleman was here earlier when our colleague 
from Colorado delivered his special order before me; but I think, as my 
colleague just mentioned, he talked about the marriage penalty and the 
estate tax, and I do not think the President could be more plain when a 
couple of weeks ago he said, look, I will take a version of the 
marriage tax penalty repeal, and I want to eliminate the estate tax for 
most of the people that are now paying it, so give me that with the 
prescription drug plan under Medicare, that the gentleman and I have 
been talking about; and I will sign it as one big package, which 
accomplishes all these goals in one fell swoop. But the Republicans 
will not do it.
  The only reason I can think that they will not do it goes back to 
what the gentleman said before, which is, for some reason, 
ideologically they just do not like Medicare. When Medicare was started 
by Lyndon Johnson in the 1960s, with a Democratic Congress, most of the 
Republicans voted against it because they said it was government-
controlled or socialism.
  Obviously, this idea of prescription drug-only insurance policies is 
not going to work, because the insurance companies would not sell them. 
But even if they did, what we would essentially be doing is privatizing 
Medicare. We would set the stage to go back to that old Republican 
ideology that says that we should not have any kind of government 
health program for the seniors. So who is to say they would not next 
say, okay, let us privatize the doctor bills. Instead of having a part 
B, seniors can go out and buy insurance coverage for that. Or let us 
privatize hospital care, so go out and buy insurance for that.
  It is a very dangerous precedent. I just think that they have a 
problem with the Medicare program.
  Mr. ALLEN. If the gentleman will yield once again. I find talking to 
people in Maine, where we have had a number of changes, and I hear 
about this from other colleagues here in the House as well, by and 
large, there are a lot of mergers going on in the health care insurance 
industry. Lots of mergers. We are getting now to about five major 
companies plus the Blue Cross plans, and that is about all there is in 
terms of companies that really represent more than 4 or 5 million 
people in this country. But what happens every time there is a change, 
and this happened with my parents and other people I know, it throws 
the seniors into a position of trying to figure out what to do next.
  If they have to change their health care plan, the first question 
that comes up is, well, will a new health care plan allow me to see the 
doctor I am seeing now. Sometimes yes, sometimes no. It is that kind of 
change, where the benefits change and the premiums change and the way 
claims are handled changes that just really frustrate and upset so many 
seniors.
  Not to mention, not to mention the small business people and the 
self-employed in this country who are now buying catastrophic coverage 
only because they cannot afford the cost of health care, of group 
health insurance, or sometimes individual insurance, which is now 
vanishing from Maine as well. But what I am really troubled by is costs 
are going up everywhere. And it is one thing for people who are 
employed to cope with those changes, but it is another for seniors to 
try to cope with the constant changes with changes in plans, with being 
pushed off one insurance plan into another plan, if they can find it, 
for supplemental coverage, I mean, and it is just too much. It is too 
much.
  Medicare works. Its administrative costs are 3 percent. Turn to the 
private insurance market, and we are talking administrative costs of 
roughly 30 percent. Medicare is efficient. Now, one of the strengths of 
Medicare is its stability and predictability and equity, and one of its 
weaknesses is it has not changed very often, and there are all sorts of 
problems with it. I do not disagree with that. But it is there. It does 
not cover only those people in urban areas. It covers every senior in 
this country who signs up.
  Basically, it provides the equity. It can be strengthened; it can 
work. We simply need to make it work before we go home.
  Mr. PALLONE. One of the things I was looking at in that article that 
talks about the Nevada experience that I quoted before, it is 
interesting, I just noticed that Nevada is the only State that has gone 
this route of trying to get to buy private insurance. It mentioned 
there are 14 States, including my own State of New Jersey that have 
programs to help older people obtain prescription medicines, but in 
every one of those cases the State is the insurer. The State is running 
the program. Just like Medicare, essentially. Obviously, Nevada's 
proposal does not work, so why would we want to emulate that when the 
other 14 States are doing the opposite?
  The other thing the gentleman pointed out, which I think is real 
important, is we actually have some statistics about the HMOs that are 
quitting Medicare. And, of course, we make the same argument as 
Democrats. Right now, the HMOs, which is a form of private insurance 
that a lot of seniors have relied on to get their prescription drug 
coverage, they are pulling out all over the place. This study that came 
out, I guess within the last couple of weeks, said that in the last 2 
years, HMOs have pulled out of more than 400 counties and at least 33 
States, directly affecting 734,000 Medicare beneficiaries.
  And they say that as of July 1, or I guess it is July 3, which was 
the deadline when they had to notify if they wanted to get out by 
January 1 of 2001, we have Cigna, which I think the gentleman 
mentioned, Cigna Corporation is ending coverage for 104,000 Medicare 
beneficiaries, including those in my State. They are dropping 4,800 in 
northern New Jersey alone, not just the whole State. And Aetna, with 
676,000 Medicare beneficiaries, said it would pull out of some markets 
also. And we have to, I guess, get more information about that. So we 
are getting hundreds of thousands of seniors that were relying on HMOs 
to provide their drug coverage that are now canceling.
  One of the things I hear from the Republicans is, they say, well, we 
want to give seniors choice. That is what we want to let them go out 
and buy private insurance because they will have choice. But even for 
seniors who are in HMOs now, or who have employer plans that they are 
getting it through after they retire, we provide under other Democratic 
proposal for the majority of the prescription drug costs for those 
plans. It is anything from like 51 percent to 70 percent, depending, 
that we are going to be paying for by the Federal Government under our 
proposal.
  So I would argue they will have more choice. Because the bottom line 
is they will have no choice with the Republican plan, because no 
insurance company will provide it. With us, if they want to stay in 
their HMO or if they want to stay in their employer plan, they are more 
likely to offer it because we are going to be paying anywhere from 50 
percent to two-thirds of the cost. So to argue that somehow we are not 
providing choice, we are providing choices, lots of choices, in 
addition to the fact that they can just stay in their regular Medicare 
and get the prescription drug plan.
  So I am more and more convinced every day that the Republicans are 
just talking, going back to that original pollster memo. They are not 
really serious; they are just talking about it. And that is basically 
it.
  I wanted to thank the gentleman for joining me. This is certainly not 
the last our colleagues will hear from us. We tried last week to put 
our prescription description drug plan on the marriage penalty, and we 
are going to try every maneuver we can to get it up here and voted on 
before this session is completed.

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