[Congressional Record (Bound Edition), Volume 146 (2000), Part 6]
[House]
[Pages 8950-8954]
[From the U.S. Government Publishing Office, www.gpo.gov]



                   MEDICARE PRESCRIPTION DRUG BENEFIT

  The SPEAKER pro tempore (Mr. Sweeney). Under the Speaker's announced 
policy of January 6, 1999, the gentleman from Pennsylvania (Mr. 
Greenwood) is recognized for 60 minutes as the designee of the majority 
leader.
  Mr. GREENWOOD. Mr. Speaker, this evening my colleague, the gentleman 
from North Carolina (Mr. Burr), and I are going to do a special order 
on the Medicare prescription drug benefit. As most Americans know, 1965 
was a critical moment in America's health care history. That was the 
year that the United States Congress and the President of the United 
States enacted Medicare.
  Prior to that time, if you were elderly or if you were disabled, you 
could not provide for your health care. You did without health care. 
You had no regular doctor's care. You had no access to hospitalization 
and you suffered and you died early.
  In 1965, America proved its humanity and proved the level of its 
civilization by caring for its elderly and eventually extending that 
Medicare benefit to the disabled.
  When it did so, it did not include a prescription drug benefit. It 
did not, because it was an awful lot to accomplish just to get the 
physician coverage and the hospital coverage. At that time, 
prescription drugs were not nearly as utilized as they are today. But, 
today, the miracles of modern pharmaceutical industry, the miracles 
provided by the work on the human genome and biological products have 
brought us to a point where if you do not have access to a 
pharmaceutical drug benefit, you do not have access to first rate 
health care, you do not have access to the best health care in the 
world.
  For years, we folks in Washington in the Congress and White House 
have talked about how terrific it would be if we could create and add a 
prescription drug benefit to Medicare, but it has been all talk for a 
lot of years, and now it is time for action.
  The reason it was all talk and no action heretofore was because this 
country was not in any state financially to provide a Medicare benefit. 
We were adding a $250 billion to the national debt every year, we were 
spending money like drunken sailors in this town, and there was no way 
that we could continue that practice and then add to it the addition of 
a prescription drug benefit.
  But, since 1994, the Republicans in the Congress have changed the 
direction of the country. We have reformed Medicare itself to make sure 
that it will last well into the future. We have reformed welfare, 
removing ultimately half of the welfare recipients from dependency to 
work and to independence. We have balanced the Federal budget for 
several years in a row now. And in the current fiscal year, we have 
taken Social Security off budget and made sure that never again would 
the Social Security surplus be spent for other causes than Social 
Security.
  We are now finally paying down debt. By the end of the current fiscal 
year, we will have paid down $250 billion in debt; and we expect, at 
the rate we are going, to have the United States national debt paid off 
by about the year 2015, if not sooner.
  We have done all of this, and still we have a surplus, so this 
millennial year is the year we can step up to the plate; and we can 
provide a prescription drug benefit to America's elderly and America's 
disabled.
  While two out of three Medicare beneficiaries in this country do have 
access to some kind of prescription drug benefit, that coverage is 
often scant and shrinking. Many of our seniors on Medicare-Plus Choice 
have seen that their plans have had to pull back their benefit and now, 
for instance, are only providing for generic coverage and not providing 
for the brand coverage, unless there is a very expensive extra payment 
paid by the beneficiary.
  For those without coverage, the choices are grim. There are miracle 
drugs available to humanity today, but if you are an elderly woman, an 
elderly widow, living on a small Social Security stipend, and you have 
Medicare but you have no access to prescription drug coverage, there is 
no miracle in that miracle cure. If you are an elderly gentleman in the 
same position, there is no miracle in the miracle cure for you. That is 
the same with the disabled in this country.

                              {time}  1930

  These folks are pressing their faces up against the glass windows of 
the drugstores knowing that while inside a prescription that their 
physician could write for them exists that could relieve their 
suffering, that could extend their lives, that could improve the 
quality of their life, that is not available to them. This is the year 
for the United States Congress to act and to do it in a bipartisan 
fashion.
  Mr. Speaker, I would like to now yield time to my friend, the 
gentleman from North Carolina (Mr. Burr), who has been working with me 
and other members of the Committee on Commerce as well as the Committee 
on Ways and Means to craft this proposal that we hope to have 
introduced in the very near future.
  Mr. Speaker, I yield to the gentleman from North Carolina (Mr. Burr).
  Mr. BURR of North Carolina. Mr. Speaker, I thank my good friend from 
Pennsylvania. The gentleman makes a good point, and that is that if 
Medicare were a program that we developed today, certainly drug 
benefits would be part of the coverage given the access that drug 
benefits have to private sector plans that every employer offers to 
their employees. But the fact is that in the 1960s, that was not a 
common part of health care coverage, because very few new 
pharmaceuticals hit the marketplace, and most of the antibiotics were 
around for years and years. We worked to reform the Food and Drug 
Administration, and we started in 1995 and we completed that task, I 
believe, in 1996 or 1997, with a signature by the President, an agency 
that controlled 25 cents of every dollar.
  The reason that we modernized the Food and Drug Administration was we 
understood the great task that was before them. The FDA is an industry 
that this year will put $21 billion, and that is with a ``b'', into 
research and development. We understood that if we could unleash this 
industry as the human gene was mapped, that through these 
pharmaceutical companies, we could find cures to terminal and chronic 
illnesses that currently in our system today we treat and, at best, 
maintain through a very expensive delivery system. But we owed it in a 
quality-of-care way to make sure that if we could reach cures for 
cancer, for AIDS, for diabetes, that we put every incentive in the 
system to make sure that the private sector invested their money, their 
time, to hopefully find these breakthroughs.
  Now, we are on the verge of breakthroughs. This year alone, the FDA 
will approve over 30 new drug applications. Not every one of them will 
be a big contributor to savings or quality of care, but we are clearly 
on the road to new therapies that we have not had in the past.
  Mr. Speaker, let me say to my colleague that I think it is important 
that, when we talk about adding a drug benefit to Medicare, most people 
think of seniors. But we have a large group of disabled Americans who 
qualify for Medicare benefits. We cannot do a program that leaves them 
behind. Everybody that is eligible for Medicare has to be included 
under the umbrella of coverage for pharmaceuticals. It has been very 
challenging for us as we have designed a program also to make sure that 
it dovetails with the 14 States that currently offer it.
  Pennsylvania is a great example. It probably has one of the most 
generous plans in the Nation.

[[Page 8951]]


  Mr. GREENWOOD. Mr. Speaker, we have 300,000 participants in our 
program.
  Mr. BURR of North Carolina. And I think it goes up to 225 percent of 
poverty.
  Mr. GREENWOOD. All supported by our lottery.
  Mr. BURR of North Carolina. All supported by the lottery. If every 
State had a plan, we probably would not be here tonight. We would 
probably have seniors with coverage that needed it. But there is still 
a greater need, and that is to produce a value for those individuals 
who do not have the option of insurance. They may have more money, but 
the plans just are not available. And what we are trying to do is we 
are trying to create new options through the private sector, which I 
believe is the single most important thing.
  We have some disagreements between Republicans and Democrats. They 
are becoming smaller and fewer. One of the major ones that will 
continue, though, is currently the Health Care Financing Administration 
administers the Medicare benefit. I am not sure of very many seniors or 
health care professionals or hospitals, even my mother understands the 
problems that exist at the Health Care Financing Administration, 
because she has been in the hospital lately. The reality is does 
Congress really want to turn a new benefit that is so vitally 
important, over 38 million Americans, over to an agency that cannot 
even figure out what to do with the technological change of intravenous 
drugs that can now be delivered at home with a self-injection method?
  Mr. GREENWOOD. Mr. Speaker, that is one of the problems. They say, 
where there is a will, there is a way. There is a will to get this 
done. Republicans want to do it. We happen to be Republicans; we have 
been working hard with our Republican colleagues. Democrats on the 
other side of the aisle sincerely want to do it. House Members want to 
do it, the Senate wants to do it, the President wants to do it, the 
elderly want us to do it, the disabled want us to do it, their families 
want us to do it, the pharmaceutical industry wants us to do it. 
Everyone is for this. What there is is a legitimate set of differences 
of opinion. The gentleman is talking about one right now.
  The question is, do we want to give this program, this new benefit, 
to the same bureaucracy that has been administering the current one? I 
do not think there is a beneficiary on Medicare who can tell us or 
anyone else, they certainly do not tell me at the senior centers, that 
they understand the paperwork that they get related to their Medicare 
and they would like to have more paperwork related to their Medicare 
and they would like the decisions made about their health care to take 
as long as ones do today.
  The fact of the matter is that what is available at the drugstore is 
changing at the speed of light. Every day, practically, we can find new 
products out there in the drugstore. What we are concerned about, the 
gentleman and I are, is that we do not want it to be the case that the 
Food and Drug Administration approves a new cure for arthritis or a new 
treatment for colon cancer or a new medicine that will relieve 
suffering. The doctor says to the Medicare recipient, boy, this is a 
great drug for you, I wish I could give it to you, but the bureaucrats 
in Washington, it is going to take them a long time, as it would a 
bureaucracy, to get around to figuring out how much to reimburse for 
this product and so forth. So we are looking at a different system, a 
system that would create a separate board that could make those 
decisions quickly so that these beneficiaries do not have to wait and 
suffer in hospitals, or maybe die, while they are waiting for a Federal 
bureaucracy to get around to making sure that this product is available 
for them.
  Mr. BURR of North Carolina. Mr. Speaker, if the gentleman would 
yield, I am not sure that there are very many seniors, if any, in the 
country that would tell us the creation of a new agency whose sole 
function it is to make sure that the Medicare drug benefit is run 
effectively and efficiently is a bad thing. But clearly, that is a 
difference that we have in Washington. It is a difference that will 
probably exist until this bill becomes law. My hope is that it is this 
year; that, in fact, that long list of individuals that you talked 
about, Republicans, Democrats, the President, the bureaucracy, when 
they say that they are interested in a drug benefit, I hope that they 
are talking about today, this year, the 106th Congress, not the 107th, 
because clearly, we know individuals who do not have the capabilities 
to pay for their prescriptions today, who go without that prescription.
  As the gentleman and I both know, because we deal in Medicare from a 
standpoint of the big picture of Medicare, when those individuals make 
a decision not to take their antibiotics or not to take some drug that 
has been prescribed, the likelihood is that the result is that they end 
up in the hospital. When they end up in the hospital, we have a greater 
cost to our Medicare system than the $100 prescription that they should 
have taken for 2 weeks.
  Mr. Speaker, for the first time, I believe that the Congressional 
Budget Office recognizes there is a savings to making sure that 
everybody has a benefit. The gentleman and I went through the expansion 
of Medicare coverage several years ago when we included mammograms, 
PSAs for prostate cancer, and diabetes daily monitoring, and we now 
cover those under the normal Medicare coverage. But it took us a long 
time to convince people that it was actually less expensive to supply a 
daily monitoring strip for diabetics than it was to pay for amputation 
or blindness. Put the quality of life aside for a second; the sheer 
dollars were more beneficial. Bring the quality of life in; and 
clearly, this is something that we should have done much sooner than 2 
years ago. But we are finally there.
  Now, we are talking about the expansion of an area of Medicare which 
will give us a new treatment method for the majority of the problems 
that seniors and the disabled run into, where hopefully, we can 
eliminate the hospital stay. Hopefully, this is a method of treatment 
where an individual can take it at home, and we do not have the 
transportation needs that are a problem with many seniors. Clearly, 
this is a benefit that we have a responsibility to find a way to get it 
into law.
  Mr. GREENWOOD. Mr. Speaker, there is no reason why we cannot do that. 
It is oh so easy in politics to point fingers and bash the other guy 
for political gain, but the fact of the matter is that the gentleman 
and I have both discovered that all of the intelligence does not lie in 
one party or another here in Washington. It is not all in the House or 
all in the Senate. It is not all in the Congress or all in the White 
House. But in fact, there are good, decent thinking people in all of 
those places that really want to get this job done.
  To the extent that we can recognize that we have some different 
ideas, some people want to go strictly to a price control mechanism, 
some people want to attack the issue of what happens when one goes 
across a border to Canada or Mexico, some people, as the gentleman and 
I do, want to create an insurance model where we think for a very 
reasonable amount we can create a system where every American, 
regardless of income, will be able to afford this benefit, and for the 
lowest income, the Federal Government would pay for all of it.
  Mr. BURR of North Carolina. Mr. Speaker, let me make this point here. 
A voluntary plan, a plan where we create the benefit and say to the 38 
million seniors and eligible disabled, it is your choice. If you 
currently have coverage that was extended by an employer in your 
retirement, you do not have to, you do not have to buy into the Federal 
plan. It is an option. It is a vast difference in approach from the 
catastrophic debate of 1993 or 1994 when we, or it may have been 
earlier than that, when we asked seniors to pay more for something they 
were already getting for nothing.
  Mr. GREENWOOD. They were not very happy about that. We all remember 
Chairman Rostenkowski's car being rocked by a group of seniors because 
essentially what the Congress

[[Page 8952]]

was saying is that if you already have this benefit, we are going to 
make you pay for it anyway. As we said earlier, two out of three 
beneficiaries already have some kind of coverage.
  Mr. BURR of North Carolina. One thing that we learned is that not 
every employer planned for their retirees' coverage. It may cover a 
very narrow set of generics or certain areas of the drug industry. We 
have designed this Medicare benefit to say to employers, if you made a 
promise to retirees, why do you not look at this new plan which might 
be better coverage and less money and buy your employees, pay the 
premium for them to be a part of this, supply the deductible for them. 
Let them be part of a larger plan where we really leverage the volume 
of individuals in the Medicare plan by pooling them all into these 
private sector entities, companies that are willing to create different 
options because of the size of the pool they are interested in 
participating, interested in designing a benefit package that might fit 
the different health care needs.
  Mr. GREENWOOD. Mr. Speaker, our staff, and we with our staffs, have 
been working very hard at this for a long time. The goal is clear, but 
the way to get there is complex and it is difficult and it requires 
some very complex calculations about if we raise the eligibility level, 
for which the Federal Government will pay for anything, what does that 
do to the cost, and where can we put the stop loss benefit for the 
insurance industry so that it is willing to sell the product at a price 
that everyone can afford. That is complicated stuff. But we can get 
there, and we can get there working across the aisle; we can get there 
working with the White House.
  I would hope that anybody watching C-SPAN this evening would take 
from listening to us this evening that number one, it is time to do 
this; number two, the country is financially in a position to do it; 
number three, there is universal desire and commitment to do it in 
Washington.

                              {time}  1945

  Number four, it is complex.
  Number five, anyone who demagogues this issue is really doing a 
disservice to his country.
  I have heard so many speakers, unfortunately on this floor, pointing 
fingers at one party or the other saying their plan is better than ours 
or our plan is no good or nothing is being done, or I distrust the 
motives; I think this special interest is being served or that special 
interest.
  I would hope that as this debate moves on and as we hopefully get to 
the point where we can put a product on the President's desk and that 
hopefully he will sign it, that those who are frequent callers to C-
SPAN, for those who are frequent correspondents to their Members of 
Congress or phone their Members of Congress, that they call to task any 
Member of Congress or the President, if they see those Members or those 
politicians try to take political advantage on this issue. This is not 
the time to do this. This is the time for bipartisanship. This is the 
time for putting our heads together and getting something good done for 
the benefit of the country, and I think we can do that.
  Mr. BURR of North Carolina. I have to think that if an administration 
that is Democrat and a Congress that is Republican can get together and 
be on the same side of a trade bill with the People's Republic of 
China, that surely a Democrat President and a Republican Congress could 
get together in a bipartisan way to design a drug benefit for the 
seniors and eligible disabled in America. Clearly, the trade deal has 
to be more difficult to put together. We know, because we are here, 
that it is not partisan. There are Democrats on one side along with 
Republicans, and there are Republicans and Democrats on the other side, 
and at one time the administration was split. To some degree, it is 
regional across the country.
  Health care is not regional. Health care is something that we ought 
to make sure is the best for every person who is eligible.
  One of the additional tasks that we were given, though, is not only 
did we have $40 billion to work with over the next 5 years, we were 
also given that task that says make sure that the long-term solvency of 
Medicare is protected. Make sure whatever is done does not bust the 
bank down the road.
  We know, as seniors know probably more than we do, that health care 
costs, specifically pharmaceutical costs, are rising. If they have 30 
new drugs next year and 11 of them are targeted toward illnesses that 
seniors are prone to have, we know that our pharmaceutical cost in this 
country is going to continue to rise; and hopefully, we have taken that 
into account. That is one of the reasons that we have chosen the 
private sector to produce the plans because clearly they have a better 
history of the efficiencies in health care than does the Health Care 
Financing Administration or any Federal agency, and I would include 
Congress in that as well.
  Mr. GREENWOOD. If I can refer to this chart here, the gentleman 
referred to the difference between us and the seniors, and despite the 
color of my hair I am hoping to continue to be able to see that 
difference between myself and my parents. And yet if we look at this 
chart, we will see that in 1999, and this is probably very much the 
case now, medication is used by about 33 percent of seniors today. So 
about 1 out of every 3 beneficiaries needs a drug product on a regular 
basis.
  By the time this gentleman is about 80 years of age, and I expect to 
be alive and kicking at that time, 51 percent of the seniors, of our 
generation, will be medication dependent. So this is not an issue of 
importance only for those who are above 65 years of age today or who 
are retired. It is an issue for us because they are our parents today. 
We love them, and we care about them. But it is also an issue because 
in the relatively near future it will be, the gentlemen and I, in our 
retirement, very much not only in need of these prescription drugs but 
having available to us prescriptions that certainly are not available 
to our parents today.
  Mr. BURR of North Carolina. One thing we have both seen is that 
anything that we do in the Medicare model is usually replicated at some 
point not too far down the road in the private sector plans that 
employers provide for their employees.
  I know that the gentleman is familiar with a frustration that we have 
had over the years in Medicare, which is their policy as it relates to 
organ transplants for seniors. Under any organ transplant in the world, 
the recommendation is that the recipient takes an immunosuppressant 
drug for the rest of their lives to make sure that the rejection of the 
organ does not take place, but our current policy in Medicare is that 
we will pay for the immunosuppressant drug for a 3-year period after 
the transplant.
  It is an amazing thing that when seniors go off of the drug, because 
the cost is high, that maybe in the 4th year or 5th year or 6th year 
they begin to reject the organ. But what is our health care policy in 
Medicare? We will actually pay for another transplant, but we will not 
pay for the immunosuppres- 
sant drug any longer than 3 years.
  So it really does make a lot of sense why we are here today talking 
about a drug plan that even some of the entities that oversee Medicare 
are not enthusiastically out front leading the parade saying we have to 
have this benefit and it needs to look like this. Because clearly they 
cannot make the decisions today to extend drug coverage even in the 
cases where we know it makes a difference in the quality of life but 
where we know also the option is another very expensive transplant that 
makes the solvency of the Medicare Trust Fund even shorter than where 
it is today.
  Mr. GREENWOOD. These prescription drugs, as miraculous as they are 
and as beneficial as they are, are increasingly expensive. Not only are 
they expensive, it is not simply that the price of a particular 
medicine goes up and up and up; but as this chart here shows, the total 
pharmaceutical spending between 1993 and 1999, the annual increase in 
those costs, continues to go up.
  So it is not just, if we look at these pink indications here, the 
CPI, the Consumer Price Index per year, has

[[Page 8953]]

been pretty low; but because of the addition of new products on to the 
market, the increases in some of those products once they get on the 
market, what is being spent, the costs for all pharmaceuticals paid by 
individuals and hospitals and insurers continues to skyrocket. It is a 
situation that demands our response.
  Mr. BURR of North Carolina. Not only are we faced with a situation 
where pharmaceutical costs continue to increase at double digit rates, 
we also look at a growth in the senior population. We know from looking 
at the demographics that really do not lie, as seniors grow older, as 
one reaches that magical age of 65 long before I do, then in fact the 
population eligible for Medicare over the next 15 years will grow from 
somewhere in the neighborhood of 38 million today to somewhere in the 
neighborhood of 75 million.
  So if this were a company we were at and we were trying to do long-
term planning as it related to our costs, we would look at some of the 
things down the road that we knew were going to happen and we would try 
to address those as early as we could so, in fact, the impact was more 
predictable, our options were greater and the cost was less. That 
simply is what we are talking about doing with the drug benefit in 
Medicare.
  We know that the senior population will double over the next 15 
years. We know that pharmaceutical costs are going to continue to rise, 
in part, because we have the gold standard in the world in the FDA of 
drug approvals. We know when drugs come through that they have passed 
the safe and efficacy standards. That does not mean that we do not have 
some after-market approval problems, but hopefully we have an FDA that 
is on top of that and monitoring it and getting a lot better.
  The reality is that as we see the population increasing, as we see 
the cost of drugs increasing, is not the smart thing for Congress and 
the administration to do this year to pass a drug benefit to watch that 
benefit to make sure that in fact it is the type of benefit that 
seniors need; that it has the cost controls that we know we have to 
have for the long-term; that we begin to accumulate some information 
about whether we have chosen the right option up front before the 
senior population doubles, in case we guessed wrong, and we could go 
back and change the way the benefit is offered or how the benefit is 
paid for while the size of that senior population is 38 million versus 
when it becomes 70 million and our options are so few?
  Mr. GREENWOOD. That is an issue for our children. How they are going 
to be able to pay for the costs of our retirement. This issue gets 
complicated, and I know some of the viewers across the country watching 
this tonight are maybe trying to decipher all of this language and 
sometimes we in Washington use language that is a little difficult to 
decipher.
  Let me try to give some perspective as to how different folks around 
the country might see this. First off, if one is retired now or soon to 
retire, and they have a good prescription drug benefit because they 
work for an employer, a government employer or a large Fortune 500 
employer that provides coverage, and they are in pretty good shape, 
they do not need to worry about this because they are not going to be 
forced to buy anything they do not need. They are in good shape.
  If that changes at any time, we think we are going to create some 
products in the market that they want to avail themselves of but no one 
is going to force anything on them. If they are retired or disabled 
today and they are one of that one out of three who does not have 
access to a prescription drug benefit, what we are saying to them is we 
are going to make one available to them and one that they can afford. 
And we think we can do it very soon.
  If one is low income, if they are at that 135 to 150 percent of 
poverty level and they do not already qualify for Medicaid or a State-
run lottery program, the Federal Government will pay all of their 
premium. So this is really a great benefit for them. It is at no cost 
and it is real coverage and they do not have to wait until they get to 
some catastrophic level. It is there.
  If, on the other hand, they do not have the coverage or they expect 
that by the time they retire they will not have the coverage and they 
are middle- or upper-income, they just want access to it, they just 
want to find something they can afford, we think that somewhere at a 
cost of about $50 a month, as a Medicare beneficiary they will be able 
to buy this coverage just like they do now, through their part B 
premium, pay for the extra coverage to go to the physician and the 
outpatient care and so forth.
  So from many of those perspectives, it is a good deal.
  Let me make one other comment before I yield back to the gentleman. 
If one is a taxpayer out there and they are looking at this saying, 
yes, it is great for Congress to provide this coverage; but we do not 
want to see the budget broken again, it has been broken before. This is 
not free drugs for all, this is a prudent, affordable plan that tries 
to make it affordable at the low-income level and make it affordable at 
the middle- and upper-income level with those folks contributing 
something out of their pocket so that they understand this is a shared 
responsibility between the Federal Government and the Medicare 
beneficiary.
  Mr. BURR of North Carolina. The gentleman is exactly right, and I 
think for the average American who watches the nightly news or reads 
the morning paper, they would probably go away from that news show or 
from that article in the paper thinking, my gosh, Republicans are over 
here and Democrats are over here as to who they are trying to help, and 
the reality is that we are both right here.
  We are targeting the same people who do not have an annual income 
that is big enough to afford housing and food and health care costs, 
where we are going to supply a government subsidy. We are looking at a 
group right above that where we are trying to figure out how can we do 
some type of phase-in subsidy to help them?
  Then we are looking at the group above that saying they are not all 
high income, but they have the capabilities to buy into a plan to have 
coverage.
  The discrepancies between the plans that are being floated in 
Washington are not about who is being covered. We are using the same 
$40 billion pot of money. It may be configured slightly differently. 
The President gives a subsidy to everybody on the front end. He lowers 
the price of everybody's premium so it is more attractive. We choose to 
have a market value on the premium, and we go to what we refer to as 
the stop loss, a certain dollar amount on an annual basis where we say 
to a senior if they reach this, if they really get sick and they reach 
this point, they do not have any additional cost past that. Their plan 
picks up 100 percent of it. There is no co-insurance. There is no 
copayment, once they reach that point.
  The President's plan does not do that. He subsidizes the premium 
costs. We subsidize the high risk so that, in fact, we can say to 
seniors and disabled who are eligible for Medicare they will never lose 
everything that they have because in any given year they have a 
significant illness.
  I think that is the role of the Federal Government. That is the 
definition of a safety net when things get tough, they are there. What 
we have tried to do is design a plan that says let us put value, let us 
be honest on what the cost is, let us give people confidence in who 
they deal with, which is usually not the Federal Government, that is 
why we chose the private sector, and let us say at what point their 
exposure stops, at what point do they reach where they do not have any 
additional costs.

                              {time}  2000

  To some degree, it is criminal for us to ever present a plan that 
would suggest to individuals when they really get sick and they exceed 
a certain amount that the burden falls 100 percent on them, when they 
have reached that point where they might have 100 prescriptions filled 
in a year. That is when they need us to kick in.
  We are trying to design a plan that gives them coverage underneath 
and security underneath, but more importantly, security for what is 
unexpected.

[[Page 8954]]

We know in health care that happens many times.
  Mr. GREENWOOD. Mr. Speaker, security is what all seniors want. It is 
what we will want when we are seniors, and that is the security, the 
peace of mind to know that I do not have to worry about whether I can 
afford the drugs that my doctor says I need. It is as simple as that. I 
do not have to worry about whether I can afford the drugs, the 
medicines that my doctor says I need. That is what we ought to be about 
providing for Americans.
  I have what I call my Medicare prescription drug advisory group at 
home. I have seniors, I have disabled folks, I have the local 
pharmacists. We sit around and meet regularly and talk about this issue 
and talk about where the hardships are and talk about the people. 
Particularly, the druggist is an interesting participant because he 
talks about the people who come into his little store, his corner 
store, and try to buy a prescription drug, and he has to turn them away 
if they do not have a plan or they are shocked by the cost of this. For 
those people, there is no peace of mind; there is no security that the 
American dream afforded by these miracle products is for them.
  But the bottom line is that we can do it. We can do it as 
Republicans. We can do it as Democrats. We can get the job done, and we 
can get the job done this year.
  Mr. BURR of North Carolina. Mr. Speaker, the gentleman from 
Pennsylvania is exactly right. Let me take this opportunity in closing 
my part of this out to say, for the first 5 months, there has been a 
tremendous amount of work, not only work by Republicans, but by 
Democrats, a tremendous amount of work by the administration and by 
Congress to try to figure out what the right plan is, to try to figure 
out exactly what the benefit should look like and what value we can 
extend to seniors under a drug benefit.
  Will it be perfect? No. But there is no substitute for the commitment 
of this institution to say we need it and not do it today. This is not 
a time where we can delay another year, another generation, another 
Congress, another administration. We do not get a better opportunity 
than this where we have shown fiscal restraint, we have accumulated 
some additional money over and above Social Security surplus, over and 
above every other trust fund that we have got. These are real dollars.
  As I said to my constituents, when we get to real dollars, when we 
know that we are paying down debt in a responsible way, and we have got 
real dollars, we will look at real problems that we think we can solve. 
This is a real problem today. This is a real problem today that we can 
solve.
  All it takes is the will of Republicans, Democrats, the 
administration and Congress. It takes every American out there that is 
listening to us tonight that can benefit from these, calling their 
Members and saying, do it now. Do not wait.
  Mr. GREENWOOD. Mr. Speaker, the gentleman from North Carolina and I 
happen to be Republicans; and we can say, because we work more closely 
and more frequently with our Republican Members on our side of the 
aisle, from the Speaker of the House to the majority leader to the Whip 
to all of the officers and leaders in our party down to every Member, 
freshman on up, there is a complete commitment and a desire to get this 
job done. I think that is true on the Democratic side of the aisle, and 
I think it is true in the White House.
  But we know we cannot get it done by ourselves. We can bring a 
Republican bill out here, a purely Republican bill, and if the 
Democrats in the House and the Senate tell the President it is a bad 
bill, he will veto it. That has not helped a single senior.
  So we have to try to get a bill through the Congress that Republicans 
and Democrats like. We have to be able to do what most Americans want 
us to do, compromise, find the middle, accept each other's positive 
suggestions, get that job done, put the bill on the President's desk. I 
believe that this President, as he leaves town, can say that is one 
thing I got done; and I think this Congress can say, come the election, 
come what may, we got that job done.
  Because the odds are, even if we did not get this done this election, 
this year, wait till the next election, we will be back in the same 
position. There will still be Republicans and Democrats in town. The 
Congress may be divided. The difference between the White House and the 
Congress will still be there.
  So there is no point in waiting. The time to do it, as the gentleman 
from North Carolina (Mr. Burr) said, is now. The will is here. The 
financial situation is here to do it and certainly the need to do it 
is.
  Mr. Speaker, I thank the gentleman from North Carolina for his 
participation in the Special Order this evening.

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