[Congressional Record (Bound Edition), Volume 149 (2003), Part 10]
[Senate]
[Pages 13316-13317]
[From the U.S. Government Publishing Office, www.gpo.gov]




                            MEDICARE REFORM

  Mr. DASCHLE. Mr. President, I welcome our colleagues back. We are 
looking forward to a very productive few weeks. We know we have a lot 
of work to do in a relatively short time. In particular, work on the 
Energy bill is going to require a good and vigorous debate. I know 
there are a number of Senators wishing to offer amendments. I hope we 
can begin that process in earnest tomorrow. I know there are a number 
of my Democratic colleagues who have particular issues they wish to 
address. We will get into many of those issues in earnest as amendments 
are offered over the next several days.
  I didn't have the opportunity to hear the distinguished majority 
leader, but he has indicated to me--and I understand he has announced--
that it is his interest and his plan to bring up the Medicare reform/
prescription drug legislation the last couple of weeks of June. We 
certainly welcome that. We are looking forward to another debate, 
picking up where we left off last year.
  I am concerned, I suppose, that we are moving quickly to this 
legislation without the benefit of extended discussion or hearings in 
the committee. I was rather roundly criticized last year after giving 
the Finance Committee a certain deadline and having failed to meet 
that, going to the floor so that we could ensure that we would do all 
that was possible to get a bill through the Senate in order to 
conference with the House prior to the end of the session. That wasn't 
possible, but we made every concerted effort and certainly a case that 
we could not afford to wait beyond the August recess, which is why we 
took up the bill last July.
  We have not had, as I say, an opportunity to see the ideas that our 
colleagues on the other side are considering as we look at prescription 
drugs. But I was very appreciative of the report that I got about the 
majority leader's comments with regard to the value of Medicare. I 
think it is important to note that some of our colleagues on the other 
side have argued that we ought to eliminate Medicare, or terminate 
Medicare, or dramatically change Medicare--but the distinguished 
majority leader has noted that Medicare is a very valuable program, and 
indeed that is the case.
  Before Medicare was created--about 1965--less than half of all senior 
citizens had health insurance. Today, almost every senior citizen has 
health insurance. So I think that alone argues very well for the 
importance of recognizing the universality of access to health 
insurance by those at least over the age of 65. We only wish we could 
replicate that for the rest of the population.
  I think it is also important to note two other things. First, 
Medicare administrative costs are about 2 to 3 percent. That compares 
very favorably to the administrative costs of private health care--some 
15 percent. So you have Medicare administrative costs at such a point 
that would leave 97 percent of the revenue generated that could go to 
benefits, where in the case of private health insurance, only about 85 
percent of what revenue is generated is left that could go to benefits. 
That is a dramatic difference.
  So those who argue that somehow the private sector is so much better, 
I argue that at least from a benefits structure, an efficiency point of 
view, you can certainly argue that the Medicare prototype or paradigm 
is so much more efficient. I also argue that in South Dakota it is 
almost impossible to get private health care benefits. You cannot find 
them in many parts of my State. That is true of a lot of rural areas. 
Health care benefits, health care insurance in rural areas is almost 
nonexistent, especially if it is provided through managed care. We have 
no managed care, virtually, in South Dakota.
  So those who argue that somehow there is a panacea in the private 
sector overlook the fact that oftentimes, when it comes to rural areas 
in particular, it is almost impossible to use a private health care 
model. That is why we fought so hard last year. That is why when we 
offered the so-called Gramm-Miller-Kennedy legislation, we said, No. 1, 
there has to be a defined benefit; No. 2, a defined premium; No. 3, a 
way to ensure that rural areas are provided with the benefits; No. 4, 
we have to ensure as well that there isn't a coverage gap, a so-called 
sickness gap that was used oftentimes to make up for the fact that we 
needed to provide benefits right out of the box, but because we had 
limited dollars, they would go through a coverage gap before the 
benefits would kick in again.
  Now, unfortunately, on all of those particular points, the bill 
offered by our Republican colleagues last year failed. There was a 
coverage gap. You paid premiums into this health insurance plan all 
year long, but I'm concerned that in some cases the benefits could kick 
out in February and might not kick back in again until roughly October. 
So you went through all of the spring and summer paying into the system 
but not getting any benefit back. That coverage gap was a serious 
omission and, frankly, one of the reasons we didn't believe that plan 
had much merit. They could not tell us what it was going to cost on a 
monthly premium, or what the benefits were going to be. They suggested 
things, but there wasn't any defined benefit. There wasn't any defined 
premium.
  Then, of course, one of the biggest concerns many of us had is we 
could not count on the plan being offered in rural areas--especially in 
States like mine.
  So I hope as we begin, we can all agree, No. 1, Medicare is a 
critical program, a success story of tremendous magnitude. Any time you 
can say you have eliminated the lack of access to health care for a 
certain group of people almost entirely, that is a success. That is 
exactly what we have done. Can it be improved? Again, like the majority 
leader, I think absolutely it can be. We ought to be providing more 
preventive care. We ought to find ways in which to promote wellness. 
That ought to be part of any plan. I personally believe there ought to 
be a lot more screening, a lot more access to all of the available 
techniques, all of the available methods of ensuring that we catch 
illness early, so preventive care is one of those things we can do. 
Adding a prescription drug benefit--absolutely. But if we are going to 
do this, let's not make this a big roll of the dice with senior 
citizens and say we cannot tell you what the premium is going to be, or 
what the benefits are going to be, or we cannot tell you for sure when 
your coverage kicks out and when it kicks back in with the coverage 
gap, or we cannot tell you for sure whether it is going to be offered 
in rural areas, and we will have just a Medicare backup in case all of 
this fails.
  Well, that isn't a plan many of us would feel very good about, if, 
ultimately, that were the final vote. But I start with the hope and, I 
must say, the expectation that we can work together to find common 
ground; that we can address many of these shortcomings that were so 
evident in last year's legislation among some of our Republican 
colleagues; and that we can work together constructively.
  I don't see any reason we cannot finish this legislation by the end 
of this month. But if that is going to happen, I hope, indeed, we can 
send each other a clear message that we are not looking for a 51-vote 
solution; we are looking for a 70, 80, or 90-vote solution. We are 
looking for a compromise in this legislation that brings about a broad 
consensus.

[[Page 13317]]

  I hope we can use some discipline and avoid bringing up extraneous 
issues. We don't need to get into the array of controversial things 
that have nothing to do with prescription drugs or Medicare. If you 
want to derail prescription drugs, bring up any one of these 
extraordinarily controversial things, but I think it would be a very 
unfortunate set of circumstances. I am optimistic, having been given 
the report of the distinguished majority leader, and I am hopeful that 
we can work together so that by the end of this work period, not only 
will we have accomplished a good deal with regard to energy policy, but 
we will be able to say to seniors and to the country that we have at 
long last agreed on starting a Medicare benefit for prescription drugs 
that we can feel good about, that seniors understand, that would be 
offered in rural areas, and that builds on the model that has been such 
a success now for the last 40 years.
  I yield the floor and suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Mr. McCONNELL. 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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