[Congressional Record (Bound Edition), Volume 146 (2000), Part 2]
[Senate]
[Page 2124]
[From the U.S. Government Publishing Office, www.gpo.gov]


[[Page 2124]]

                  AFFORDABILITY OF PRESCRIPTION DRUGS

  Mr. WYDEN. Mr. President, this morning, I come to the floor to talk 
yet again about the issue of prescription drugs. I want to focus on an 
issue that Senator Daschle has, I think, been so correct in identifying 
as a priority, which is the issue of going forward with prescription 
drugs as part of a program that offers universal coverage.
  Of course, when Medicare began in 1965, the Congress made the 
judgment that there would be a program available to all eligible 
seniors, that coverage would be universal for eligible seniors and for 
disabled folks. I think it has been one of the unifying aspects of 
social policy in this country that all older people were covered. I 
think it is absolutely key that as we tackle this issue of prescription 
drug coverage, and do it in a bipartisan way, we remember how important 
the principle of covering all seniors is.
  Now, I know there are colleagues on the other side of the aisle who 
feel strongly about this issue as well. I am very pleased in having 
teamed up with Senator Snowe for more than a year. She and I are on a 
bill together, a bipartisan bill, which offers universal coverage. I 
also appreciate my colleague from Oregon, Senator Smith, for being 
supportive of this effort.
  There are a number of reasons why universal coverage is so important, 
and Senator Daschle has identified it as a priority for Senators on 
this side of the aisle. I want to talk for a moment about why I think 
it is so key in terms of designing a benefit properly. First, it is 
absolutely essential to ensure that seniors have as much bargaining 
power in the marketplace as possible. We have all been hearing from our 
constituents that many of them cannot afford the cost of prescription 
medicine. I have been coming to the floor of the Senate and reading 
from letters where older people, after they are done paying 
prescription drug bills, only have a couple hundred dollars for the 
rest of the month to live on.
  We are seeing all across this country that many older people simply 
can't afford their medicine. If we are going to give them real 
bargaining power in the marketplace--and right now, to belong to an 
HMO, you have plenty of bargaining power--they can negotiate a good 
price for you. But if you are an individual senior walking into a 
pharmacy, you don't have a whole lot of bargaining power. In fact, you 
are subsidizing those big plans. If we design a prescription drug 
benefit so as to offer universal coverage, this gives us the largest 
available group of older people, the largest ``pool of individuals''--
to use the language of the insurance industry--for purposes of making 
sure those older folks really do have bargaining power in the 
marketplace.
  As we address this issue of bargaining power, I happen to think it is 
important that we do it in a way that doesn't bring about a lot of cost 
shifting onto other population groups. That is why the Snowe-Wyden 
legislation uses the model that Federal employees use for the purposes 
of their health coverage. As we talk about how to design this 
prescription drug program, I am hopeful we see universal coverage 
included. Beyond the fact it is what Medicare has been all about since 
the program began in 1965, it is absolutely key to make sure older 
people have the maximum amount of genuine bargaining power in the 
marketplace.
  Second, I think if we were to do, as some have suggested--
particularly those in the House--which is essentially to not have a 
program with universal coverage, but hand off a big pot of money to the 
States, and they could perhaps design a program for low-income people, 
we will have missed a lot of vulnerable seniors altogether. Their 
proposal--those who would hand off the money to the States to design a 
program for low-income people--as far as I can tell, would leave behind 
altogether seniors, say, with an income of $21,000 or $22,000, 
essentially a low- to middle-income senior. In most parts of the 
country, by any calculus, my view is that sum of money is awfully 
modest altogether. I see these proposals that hand a sum over to the 
States for low-income people as leaving a lot of seniors with $22,000, 
$25,000, or $28,000 incomes behind altogether.
  If those individuals are taking medicine, say, for a chronic health 
problem--they might have a chronic health problem due to a heart 
ailment or something of that nature--they could be spending somewhere 
in the vicinity of $2,500 per year out of pocket on their prescription 
medicine. One out of four older people who have chronic illnesses such 
as the heart ailment are spending $2,500 a year out of pocket on their 
medicine. As far as I can tell, if they were in that lower- or middle-
income bracket, they would simply be left behind altogether under these 
proposals that would just hand over a pot of money to the States and 
use this money for low-income people.
  Many of the elderly people I described in income brackets of $22,000 
or $28,000 and paying for chronic illnesses are the people we are 
hearing from now saying: If I get another increase in my insurance 
premium, I am going to simply have to leave my prescription at the 
pharmacist. My doctor phones it in, and I am not going to be able to 
afford to go and pick it up.
  I think it is extremely important that the design of this program be 
built on the principle of universal coverage. That is what Medicare has 
been all about since the program began in 1965. It is what is going to 
ensure that the seniors have the maximum amount of bargaining power. We 
can debate issues within that concept of universal coverage so as to be 
more sensitive to those who have the least ability to pay. I have long 
believed Lee Iacocca shouldn't pay the same Medicare premium as a widow 
with an income of $14,000. I think we can deal with those issues as we 
go forward, if we decide early on that the centerpiece of an effective 
prescription drug benefit ought to be universal coverage.
  There are other important issues we are going to have to discuss. I 
think there is now growing support for making sure this program is 
voluntary. When it is voluntary, you avoid some of the problems we are 
seeing with catastrophic care and ultimately you empower the consumer. 
It is going to be the consumer's choice in most communities to choose 
whether they want to go forward participating in this prescription drug 
program, or perhaps just stay with the coverage they may have. We 
estimate that perhaps a third of the older people in this country have 
coverage with which they are reasonably satisfied. If they are, under 
the kind of approach for which I think we are starting to see support 
in the Senate, those are folks who would not see their benefits 
touched; they could simply stay with the existing prescription drug 
coverage they have today.
  Let's go forward. I think Senator Daschle in particular deserves 
credit for trying to bring the Senate together and for trying to 
reconcile the various bills.
  Let's make sure we don't lose sight of the importance of universal 
coverage. It is key to giving older people real bargaining power in the 
marketplace--not through a government program but through marketplace 
forces, the way HMOs and insurance plans do. Focus on keeping the 
program voluntary.
  I know there are colleagues on the other side of the aisle who share 
similar sentiments as the ones I voiced today. I particularly want to 
commend my colleagues, Senators Snowe and Smith. They have teamed up 
with me for more than a year now on a proposal that I think can win 
bipartisan support. In fact, we already have evidence of bipartisan 
support from the other side of the aisle because we got 54 votes on the 
floor of the Senate about a year ago for a plan to fund this program.
  I intend to keep coming back to the floor of the Senate. Today, I 
thought it was important to express what Senator Daschle spoke on 
recently, which is universal coverage. I intend to keep coming back to 
the floor of this body again and again in an effort to build bipartisan 
support for making sure vulnerable seniors can get prescription drug 
coverage under Medicare.
  I yield the floor.




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