[Congressional Record (Bound Edition), Volume 149 (2003), Part 10]
[Senate]
[Pages 13313-13316]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           SCHEDULE FOR JUNE

  Mr. FRIST. Mr. President, in opening the Senate this morning, I spoke 
generally of the schedule for the next month. There are a number of 
items that I outlined which we will be addressing.
  The first is energy, and we will continue that debate, possibly later 
today but through tomorrow, the next day, the next day, the next day--
through this week. It is a very important debate as we work toward that 
objective, increasing domestic production, decreasing our dependence on 
foreign sources, addressing issues such as renewable energy sources 
that we all know are so important, and accomplishing all that with a 
lot of attention and focus and care with regard to the environment as 
well as the economy of this great country.
  I mentioned this morning that we have begun, weeks ago--in fact, 
months ago--addressing the issues surrounding the strengthening of our 
Medicare Program--strengthening it, preserving it, improving it--and at 
the same time addressing an issue that seniors feel strongly about, 
people in Medicare feel strongly about, but also soon-to-be-seniors and 
that younger generation, and that is to include a new benefit of 
prescription drugs as part of our health care for seniors program, our 
Medicare Program.
  As I talked to a number of people over the last week, a lot of people 
said, Why now? There are a lot of reasons why now. The bigger question 
I have is why didn't we do it 6 months ago or a year ago or 2 years 
ago. Prescription drugs have become an integral part of health care 
delivery, of the tools, of the equipment, of the armamentarium that a 
physician has, that a nurse has, that health care providers have, to 
give people security, health security, and especially to give seniors 
health care security. That is the purpose of our Medicare Program, to 
give seniors that health care security. Yet we have this very important 
benefit today--much more important today than 10 years ago or 20 years 
ago or 30 years ago when Medicare was started--these prescription 
drugs, which are vital to health care security for seniors.
  We will be addressing, 2 weeks from today on the floor of the Senate, 
for a 2-week period, how to strengthen and improve Medicare. To answer 
that question, Why address the issue now? I think there are three 
reasons.
  First, I think we have a unique opportunity because the political 
environment is right. When I say political environment, I mean the 
responsiveness that we demonstrate to what our constituents want and 
what they demand and, indeed, what they deserve. Indeed, in terms of 
the political environment, we have seen the call for prescription 
drugs, proposals to deliver prescription drugs, enter into a number of 
campaigns 6 months ago around the United States of America, in the 
campaign cycles from 2 years ago, and that is simply a reflection of 
the importance of the issue to the American people.
  Second, we have a unique opportunity because, I believe, the 
legislative stars are aligned at this point in time--unlike last year, 
unlike 3 years ago, and possibly unlike 2 or 3 years from now. By that 
I mean that we have a President of the United States who has spoken out 
boldly and forcefully that this is important to our domestic agenda. In 
fact, the President put out a framework several months ago 
demonstrating his commitment and the commitment of this administration 
to strengthening Medicare, to improving Medicare, and at the same time 
adding this new and important benefit of prescription drugs.
  When I say the legislative stars are aligned, it starts in many ways 
there because it takes that bold leadership because this will be the 
single most significant and most expensive change in the history of 
Medicare, a new benefit at the same time we strengthen and modernize 
Medicare. But it also takes bold leadership in the House of 
Representatives and bold leadership on the floor of the Senate. As a 
physician, as majority leader of the Senate, I have made it very clear 
that this is a huge priority for the leadership of this body. Indeed, 
that reflects the leadership in

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the last Congress where Medicare reform and modernization and 
prescription drugs were discussed on the floor for 2 or even 3 weeks, 
but where we were not able to bring to it a conclusion.
  Then we have a House of Representatives, as we look at these 
legislative stars. Indeed, it is lined up. This will be the third 
Congress, maybe the fourth but the third Congress that I recall, that 
will have put forth and passed a bold, comprehensive plan.
  So when you have bold leadership in the White House by the President 
of the United States, you have this body, which is committed--committed 
to giving our seniors what they deserve, you have a majority leader who 
happens to be a physician, who has taken care of, personally, tens of 
thousands of patients who would be beneficiaries of this type of 
program--and a House that is committed, we can do it.
  The third reason we have this unique opportunity, and which is one 
that we have little control over, is the unprecedented aging of the 
population which was defined post-World War II and what we know today 
as the baby boomers. This unprecedented fertility curve that happened 
after World War II, this move in our population which begins to hit in 
about 6 or 7 years, resulted in a doubling of the number of seniors. 
From where we are today over the next 30 years, that doubling of the 
number of seniors is going to call for health care security. It is 
going to make it very expensive. Therefore, we need to look in whatever 
we do today to make sure we meet that fundamental criterion of having 
it be sustainable over time, and not to make promises that can't be 
sustained when we are going to have twice as many people demanding and 
deserving the services for that health care security.
  That unprecedented tidal wave of the aging of our population is what 
we need to face as responsible legislators. What complicates that huge 
increase in demand for services is that in the pay-as-you-go system, 
the number of workers out there who are actually paying into the system 
is going to fall over time. About seven workers in 1970 would support 
one senior. I just told you that we are going to double the number of 
seniors. But no longer having seven workers support every senior, it is 
now down to about four workers for every senior. And it will go down to 
about 2.9 workers for every senior. For every one senior you have over 
here, you are going to have fewer people working harder to provide 
those services, and on top of that you have a doubling of the number of 
seniors receiving those services.
  This underscores the need to approach this modernization, this 
strengthening, this reform, this improvement of Medicare, especially 
since we are adding on top of that system I just described the single 
largest addition of benefits in the history of Medicare.
  Even with benefits as designed today which we have already promised, 
the system itself is difficult to sustain because of this doubling of 
seniors, and with almost a halving of the number of people paying in. 
On top of that, we have the challenge of adding a very expensive 
service.
  It is estimated that seniors will spend about $2 trillion in 
medicines over the next 10 years. I would say that is a low estimate. 
If we were to promise all seniors all of their prescription drugs for 
the next 10 years, that would be $2 trillion which we would be putting 
on the system. Today, for all health care, we spend about $250 million 
a year. That simply can't be sustained long term. But that is the 
challenge which we have.
  Let me say that as a physician and as someone who has been involved 
in delivering care to seniors, Medicare has been hugely successful. The 
Medicare Program, which is now a little over 35 or 38 years old, has 
been hugely successful. Seniors would have been driven to financial 
ruin. They would not have received the health care benefits because 
there would be too many barriers without this great program. The 
problem and the challenge is that the program itself has not changed 
very much over the last 30 years. We have changed it a little bit on 
the floor of the Senate, but at the same time health care delivery has 
changed dramatically. We know better how to deliver care in a 
continuous way that looks at quality, constant monitoring, and chronic 
disease, but none that have ever been incorporated into this great 
program, but a stagnant program that hasn't kept up with the times, 
with the great advances, such as difficult heart transplants--I was 
involved in putting in artificial hearts as a surgeon in that arena--
with a little stint; and the angioplasty. None of that was done in 1965 
when Medicare started--zero.
  The system changes so little. And you can go through every specialty 
of health care. These rapid changes in health care simply are 
incorporated only very slowly with years of lag time, if they are 
incorporated at all. In Medicare, there is very little preventive 
medicine, for example. It has been a great program, a tremendous 
program, and a program we need to preserve. But we need to improve it 
and strengthen it over time.
  Our challenge is that a lot of the seniors listening to me are 
thinking their Medicare is OK. You politicians up there in Washington, 
DC may have been a doctor in the past and now may be a U.S. Senator, 
but just do not touch what I have. I may be 80 years old, or 85. I 
don't want any politician tinkering with my health care that I think is 
OK.
  That is going to be a challenge as well because a lot of people are 
going to say don't touch it at all.
  I would argue that seniors deserve for us to touch it. Don't take 
anything away from seniors. If they want to keep what they have today, 
they can keep exactly what they have. But at the same time we have an 
obligation to let seniors and soon-to-be seniors know the program is 
not as good as health care which can be delivered today, and which is 
delivered today in the private sector. They need to know that.
  For example, Medicare doesn't cover catastrophes. That simply means 
if you are very sick, with Medicare there is no limit of $1,000, 
$10,000, $50,000, or $100,000 that you are going to pay in. You are 
always going to be paying out-of-pocket a certain percentage. For 
example, with physicians, you might be paying 15 or 20 percent of 
whatever that physician charges. But for the rest of your life--no 
matter if you have a catastrophe, if you had $100,000 in bills, there 
is no cap in Medicare. That is not true in the private sector. There is 
a catastrophe cap for most health care plans.
  Second, Medicare today does not offer very much in the way of 
preventive care. We know that if we catch the disease early and we 
manage it well before you require hospitalization, before you require 
surgery, and before you require radiation therapy, you are going to 
have huge cost savings. But, more importantly, you will have a better 
quality of life for the rest of your life.
  That takes prevention--catching those cancers when they are tiny, 
before they have spread throughout the body, or catching that heart 
disease before it has manifested itself in shortness of breath, or 
congestive heart failure and not being able to get out of bed. We do it 
all the time today. Yet annual physical exams are not covered in 
Medicare.
  I would tell seniors who say they are getting good coverage today to 
ask whether there should be some prevention involved. Right now 
Medicare has very little.
  Second, wouldn't you like to have a plan that limits your out-of-
pocket expenditures?
  Third, Medicare today--as great a program as it has been--does not 
cover prescription drugs. If you talk to seniors today and ask somebody 
who is 80 or 85 years of age, Are you on prescription drugs, they will 
say, No, hopefully, but in all likelihood they will say Yes, for my 
diabetes, or for my congestive heart failure, or for my obstructive 
pulmonary disease, for my arthritis. Really, you can pick any one as 
you go through.
  Thus, I would argue, if you are saying you deserve health care 
security, you deserve some health with your prescription drugs, yet you 
don't get it today at all in Medicare, there are

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things which we can do to strengthen it. The value of the benefit 
package is inferior to what is in the private sector today--inferior to 
what I would argue seniors deserve today.
  I list these things because it is important for people to realize 
that as good as Medicare is, it simply does not provide what is 
available and what seniors deserve. If you are a senior, look at your 
total expenditures for health care. Medicare only pays about half of 
them. That means you have to figure out some way to pay for the other 
half. You might do it by buying other supplementary insurance policies, 
or by getting discounts, or whatever you have to do. In some way or 
another you have to figure out how to pay for it.
  That is certainly not true for people in this body, or for the 9 
million Federal employees who are not responsible for 50 percent of 
their health care today under their insurance program.
  We need to change Medicare so it gives a better value and so our 
seniors will be able to get the health care they need without being 
unfairly punished by having to pay so much out of pocket--so much more 
than, say, Federal employees. The list goes on.
  As we debate, we will talk more at length about these issues.
  I want to mention one other problem with Medicare that we need to 
debate on this floor; that is, the fragmentation of the system.
  In 1965, through compromise at the time, there was a Part A for 
physicians and a Part B for hospitals. It has been fragmented into two 
separate categories.
  Today, health care needs to be continuous. There needs to be a 
continuum. You want ongoing, continuous quality management, and you 
don't need different financing systems or different record keeping or 
different deductibles or different copayments set up. It is just not an 
efficient and effective way to deliver health care today.
  In short, the Medicare system--again, as good as it is--does not live 
up to the standard we have set in the private sector. It is now time to 
address that gap, which we will be doing on the floor of the Senate.
  Medicare today is still set up the way it was in the 1960s and in the 
1970s to respond to acute episodic care. People get sick and go to the 
hospital. You treat them, and they go home.
  That is not the way health care is delivered today in the private 
sector where you want to keep people out of the hospital, where it is 
not just acute care, where you are not just responding to a heart 
attack. The idea today is to prevent the heart attack in the first 
place. Now we have the expertise to do it, we have the medicines to do 
it, but seniors are not getting it today.
  So what are we going to see play out here in the next month? We will 
begin to hear--probably starting tomorrow--a lot of discussion of the 
various plans that have been both proposed in the past and that the 
Finance Committee is thinking about. The Senate Finance Committee now 
is developing a balanced plan, a balanced proposal that draws upon a 
lot of the legislation that has come to this body, legislation that, in 
the last Congress, was the tripartisan plan, and a plan from several 
years ago that John Breaux and I worked on, and a House-passed plan 
from last Congress and the Congress before, and the framework put forth 
by the President of the United States.
  I hope and pray but I am committed to see that we develop a 
bipartisan plan, bringing the best out of this body, from Democrats and 
Republicans, to address some of the needs--hopefully all of the needs--
that I outlined a few minutes ago that make Medicare today less than 
what seniors deserve.
  Over the next 2 weeks there will be a lot of discussion on this 
issue. Two weeks from now, on the floor of the Senate, we will be 
debating the legislation for 2 weeks. I am hopeful we can pass a plan 
out of the Senate before July 1 that responds to these needs.
  I mention it has to be balanced and it has to be bipartisan. I say 
that for lots of reasons. In large part, it is because this is a huge 
challenge. We are going to have to take the very best of the Republican 
ideas, the very best of the Democrat ideas, the very best of the 
President's ideas, and the very best of the House's ideas and put them 
together. This will be the single largest expansion of Medicare in the 
history of the Medicare Program. As I said, it is going to be about $2 
trillion that seniors are going to be spending over the next 10 years. 
We need to debate, as we go forward, how we can lower that barrier so 
seniors can get those prescription drugs.
  I will close by saying that reform, modernization, strengthening has 
to be linked to prescription drugs, and prescription drugs have to be 
linked to strengthening and improving Medicare. It does not make sense 
in a fragmented system that doesn't have very much in preventive care 
that was built on a 1960s model. It does not make sense to superimpose 
a brand new benefit without taking advantage of putting all that in a 
single system that gives continuity, quality assurance, a systems 
approach where you can reduce medical errors that we know occur today.
  There are five key principles that will guide our legislative 
efforts.
  I think, first and foremost, we need to stress that whatever we do 
needs to be patient-centered. We need to think of that senior, what we 
can do to give him or her health care security, building whatever 
changes are needed around that.
  Second, our seniors deserve the opportunity to voluntarily choose the 
health care plan, the health care coverage that best meets their 
individual needs. It is revolutionary in many ways but to look at a 
senior and say: You will have the opportunity, A, to keep exactly what 
you have now, what you have under current law, or, B, you can choose a 
type of coverage that better meets your individual needs, which may 
focus on your chronic disease of heart failure, which may involve 
disease management of your diabetes, and which will include preventive 
care, so whatever your status is when that progresses, we will pick it 
up early. Seniors will be able to voluntarily choose the type of health 
coverage and drug benefit that best meets their individual needs.
  Third, seniors also deserve coverage where they have continuous 
quality management and safety improvements, and that requires a systems 
approach. You hear about these medical errors being made in hospitals, 
confusing prescriptions and medicines that interact with each other. I 
think that is the sort of thing we can avoid if we incorporate it in 
the legislation. I know we can do it in the legislation that evolves 
over the next several weeks.
  Fourth, as I look at these principles, seniors deserve to be able to 
capture innovation. If we figure out a newer, better way to do 
something that will improve health care, that innovation should be 
captured. You should not have to wait 4 years to have access to 
innovation. It was 4, maybe even 5 years after heart transplants were 
widely available that they were made available in the Medicare Program. 
Seniors should not have to wait that long, if it is crystal clear, if 
the data is there, that this type of therapy is effective.
  The fifth principle I would add is that seniors deserve coverage that 
is less bureaucratic, that has less paperwork, that is more flexible, 
so it can, indeed, adapt to the times.
  We have a huge task ahead of us. A lot of people say they don't know 
if it can be done over the course of the next month. I am confident it 
can be done, in large part because much of the work was done in the 
last Congress, and it is being done both on the floor of the Senate and 
in the House of Representatives. We have made tremendous progress. We 
are building on a lot of the work that has been done in the past.
  I am confident it can be done because the American people want it to 
be done. I am confident it can be done because people in this body--
Democrat and Republican--want to do what is best for seniors, what is 
best for individuals with disabilities. I think we are going to see 
that responsiveness of this body play out over the next 4 weeks. I am 
excited about it.
  The House of Representatives will likely be considering strengthening

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Medicare, addressing prescription drugs over the course of this month 
as well. If we can both accomplish that--which we are going to work 
very hard to do--within 6 months, 8 months, or less than a year from 
now, seniors will have a benefit as they reach out to obtain and use 
those prescription drugs as part of their health care.
  Mr. President, I yield the floor and suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The senior assistant bill clerk proceeded to call the roll.
  Mr. DASCHLE. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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