[Congressional Record (Bound Edition), Volume 148 (2002), Part 11]
[EXTE]
[Page 15262]
[From the U.S. Government Publishing Office, www.gpo.gov]




                       WE FILLED THE PRESCRIPTION

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                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                         Friday, July 26, 2002

  Mr. STARK. Mr. Speaker, Dan Rostenkowski, former chairman of the Ways 
and Means Committee, recently wrote an op-ed in the Washington Post 
that I commend to my colleagues. It follows.
  In 1998, I served as Chairman of the Ways and Means Health 
Subcommittee. Essentially, I was the pharmacist who filled his 
prescription for the Medicare Catastrophic Coverage Act.
  I share his sentiment that if that law had stayed in effect, we would 
not be here more than a decade later trying to figure out how to get a 
prescription drug benefit into Medicare--it would already be there. The 
law may not have been perfect, but we had a drug benefit and we 
snatched defeat from the jaws of victory.

                       We Filled the Prescription

       I have a prescription drug plan for you. Here's what it 
     does:
       It pays 80 percent of drug costs after a $710 deductible 
     has been met, and it costs a relatively modest amount--a $4-
     a-month premium for 40 percent of beneficiaries and a maximum 
     of $800 a year for the richest 5 percent.
       It'll never happen, you say. Well, it already has. Just 
     such a plan was enacted by Congress and signed into law by 
     President Reagan in 1988. Unfortunately, mistakes were made 
     in implementing the plan, and it was repealed a year later. 
     But the concept behind it is worth another look today, as we 
     contemplate huge new federal expenditures for prescription 
     drugs for the elderly.
       Of course, if we attempted something similar now, the 
     numbers would be different. Because of inflation, the basic 
     monthly premium would be nearly $8, the maximum premium would 
     be in the $1,600 range and the deductible would rise to 
     nearly $1,100.
       It's important to note that the original program was 
     designed to cost the federal government nothing. It was to be 
     self-financed by the elderly population. That was a big issue 
     back then, when people were concerned about big deficits and 
     the need to bring the budget back into balance.
       Priorities have changed. Today we see dueling plans that 
     would, over the next decade, cost our government $350 billion 
     to $800 billion. That's not chump change, especially 
     considering that the Medicare program is already unstable and 
     expected to run out of money fairly early in this century 
     unless some big changes are made.
       In today's free-spending atmosphere, the promised benefits 
     are also a bit more liberal than those offered by the old 
     program, kicking in after only $100-$250 is spent, depending 
     on the plan. Obviously my successors have learned one lesson: 
     Proposing an insurance program that doesn't promise benefits 
     to most of the people who pay premiums can be a provocative 
     and dangerous act.
       Nevertheless, the odds are very long indeed against any of 
     the plans now on Capitol Hill actually becoming law. This is 
     especially true for the GOP plan, which requires private 
     sector providers to bid. Some of us remember what happened 
     when we invited private firms to provide Medicare coverage: 
     Few took the challenge, and many that did failed to stay the 
     course, deterred by government reimbursement that was less 
     generous than what they had anticipated.
       The plan we passed 14 years ago providing Medicare drug 
     coverage was repealed by legislation signed in 1989 by the 
     first President Bush. I'm convinced that had we stayed the 
     course until 1992, when the benefits would have been fully 
     phased in, the program would still be operating.
       One of the mistakes we made was collecting the premiums 
     immediately while adding the benefits only slowly. This was 
     the fiscally responsive thing to do, of course--ensuring that 
     money would be available to pay the promised benefits. But it 
     was a big political mistake.
       To be sure, if the program we enacted had survived, it 
     would have changed over time, much as the tax system changes 
     or the Medicare program has evolved in response to cost 
     pressures. Perhaps it would be a bit less generous. Maybe 
     there would be a formula to push patients toward the drugs 
     that are most cost effective; the government has gotten quite 
     sophisticated at squeezing other Medicare providers so as to 
     maintain benefits while controlling cost increases.
       But in any event there would be a program, however 
     imperfect, helping a lot of people who need the aid--
     something we don't have now. Personally, I'd be surprised to 
     see any Medicare drug benefits paid until the latter half of 
     this decade, if then. And if the fiscal health of Medicare 
     declines further, the entire issue may be put on hold.
       More than 300 House members voted for the prescription drug 
     program in 1988. More than 300 voted for repeal the following 
     year, a drastic switch strong enough to induce political 
     whiplash. In the interim, I was reminded once again of how no 
     good deed goes unpunished: Unhappy seniors blockaded my car 
     when I tried to exit a meeting called to discuss the issue. 
     That was temporarily embarrassing for me, but they're the 
     ones who are feeling the long-term pain. I suspect they 
     wonder where the benefits are now that they need them.
       After that failure, the issue became politically 
     radioactive and went virtually untouched by Congress for a 
     dozen years.
       Will Washington be smart enough to learn from the past so 
     that America's elderly will get the help they need in the 
     future? My fear is that we're witnessing an unrealistic 
     debate that will, at best, yield nothing more than a crop of 
     partisan and empty talking points.

     

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