[Congressional Record (Bound Edition), Volume 146 (2000), Part 13]
[Senate]
[Pages 18083-18084]
[From the U.S. Government Publishing Office, www.gpo.gov]



                        PRESCRIPTION MEDICATION

  Mr. GRAHAM. Mr. President, prescription medication is one of the most 
significant issues before the family of America. Unfortunately, the 
family is hearing most of this through 30-second television ads. These 
ads tend to be long on rhetoric and short on substance.
  I hope the Senate can serve its national purpose as a great 
deliberative body by bringing some deeper focus on an issue which 
affects, in the most intimate way, tens of millions of our citizens. I 
hope I can contribute to this by a series of floor statements on 
different aspects of this important national issue of prescription 
medication, especially for older Americans.
  Older Americans often must take their medicine on a daily basis. It 
is important that the Senate also get a daily dose of reality of life 
for those older Americans. I invite my colleagues with similar or 
differing perspectives to join me so we can have a daily discussion on 
this important issue. I am pleased today to be joined by my colleague, 
Senator Kennedy, and invite others to join.
  We have before the Senate the opportunity to achieve a broadly shared 
objective--reforming Medicare. Many of my colleagues have discussed 
Medicare reform in the context of administrative changes and 
organizational restructuring. While there is certainly merit to that 
discussion, I believe the most fundamental reform that must be made to 
the Medicare program is changing Medicare from a program that is based 
on acute care, illness, treatment after the fact, and to move it to a 
program that emphasizes prevention, wellness, and the maintenance of 
the quality of life. That is the fundamental reform we must make in 
Medicare.
  To accomplish this shift we must first recognize that the face of 
health care has changed dramatically since the inception of Medicare in 
1965. Thirty-five years ago, America's health care system was almost 
wholly reacting. Patients sought help from chronic conditions that 
flared up, or waited to see a doctor when acute conditions hit or if 
they had a serious accident. Their care was typically delivered in 
hospitals. Medicare responded to this acute care, hospital-based health 
care system.
  The fundamental reason the program was structured as such was based 
on the fact that most Americans lived only a few years after they 
reached retirement. As we know from our colleague, Senator Moynihan, 
the original rationale for 65 as the basis of retirement was the fact 
that date was set in Europe at the end of the 19th century when the 
average life expectancy of a European male was only 62. There was a 
high degree of cynicism in the selection of that date. That date has 
continued to be an important part of our culture. Only a few decades 
ago the average American could only expect 7 years of life expectancy 
after they reached 65. Today the average American has almost 20 years 
of life expectancy after they reach the age of 65, and by the end of 
this century an American can expect almost 30 years of life expectancy 
after attaining the age of 65.
  We must reform Medicare to assure that today's seniors can spend that 
gift of years living healthy, productive lives. This can be done if we 
make an investment in prevention care, which includes screening, early 
intervention, and the management of the conditions which are detected 
through those early interventions.
  The Medicare program should treat illness before it happens. New 
preventive screening and counseling benefits of the Medicare program 
give us that opportunity. The U.S. Preventive Services Task Force and 
the Institute of Medicine have recommended to the Congress that we add 
new preventive screening and benefits to the Medicare program. These 
benefits will address some of the most prominent underlying risk 
factors for illness that face all Medicare benificiaries. These include 
coverage for medical nutrition therapy for seniors with diabetes, 
cardiovascular disease or renal disease, screening for hypertension, 
counseling for tobacco cessation, screening for glaucoma, counseling 
for hormone replacement therapy, screening for vision and hearing, 
expanded screening and counseling for osteoporosis, and screening for 
cholesterol.
  In addition to adding to our current relatively short list of 
preventive efforts within Medicare, we need to change the basic 
structure of how Medicare goes about determining when a new preventive 
methodology is both medically appropriate and cost effective. Today we 
rely upon the conventional congressional process to add new prevention 
methodologies. What I believe we should do is to establish a scientific 
nonpartisan basis to arrive at these determinations. I suggest we 
assign this responsibility to the Institute of Medicine and direct that 
institute

[[Page 18084]]

conduct ongoing studies of prevention methodologies to assess their 
scientific validity and economic cost effectiveness. When they make 
such a determination, they should submit it to Congress, and Congress, 
using a fast-track process, as we typically do in trade matters, would 
make a determination either to accept or reject but not to modify those 
recommendations made by a scientific panel. I believe that approach 
would assure us that we would be providing to our older citizens the 
most modern scientifically tested means of maintaining a high standard 
of living.
  It is critical that we assure Medicare beneficiaries, both present 
and future, those most appropriate health care possibilities. By making 
preventive care the cornerstone of Medicare reform, we can do just 
that.
  This discussion of a new Medicare, a Medicare focused on wellness, 
reminds me of an anecdote. A man walks into the doctor's office and the 
doctor says: I have both good news and bad news. The good news is that 
because we have done a screening process we have detected your disease 
early and we have the opportunity to prescribe the medicines and other 
medical treatments to stop its spread and reverse its adverse effect on 
your health. The bad news is you cannot afford the medicine to do this.
  Sadly, this is not a joke. The list of diseases that were once fatal 
and are now preventable is long and growing. Years ago, people with 
high cholesterol could almost count on developing heart disease. Today, 
cholesterol levels can be kept in check with a number of drugs. One of 
those is Lipitor, a widely prescribed drug for high cholesterol. This 
drug has an average yearly cost of nearly $700. As with many other 
near-miracle drugs, Lipitor is too expensive for many seniors. Yet 
Medicare, the Nation's commitment to take care of its elderly and 
disabled, does not cover Lipitor or most other outpatient drugs. 
Medicare will, however, pay for the surgery after the heart attack 
which that man is likely to have because he was unable to treat his 
condition while it was still subject to management.
  That policy may have made sense in 1965 when the man would only live 
a few years after retirement. Are we prepared in the year 2000 to tell 
an American who reaches 65 and has an average of almost 20 years of 
life expectancy that we are going to treat them only after they have a 
heart attack; that is the point when we are going to provide access to 
the means of managing a health condition?
  I will soon address the critical link between prescription 
medications and preventive medicine. Prevention and prescription drugs 
are a key to a modern health care system for our Nation's seniors. This 
Senate should contribute to delivering that key, and do it now.

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