[Congressional Record (Bound Edition), Volume 149 (2003), Part 10]
[Senate]
[Pages 13579-13581]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           PRESCRIPTION DRUGS

  Mr. DASCHLE. Madam President, let me talk briefly about the important 
legislation addressed by the distinguished majority leader. He had 
spoken about the importance of our effort this month on prescription 
drugs. I applaud him for making this a priority. When I was majority 
leader almost a year ago, we made that same commitment. Of all my 
disappointments, the one that perhaps may be at the top of the list 
last year was our inability to pass the legislation. We got 52 votes. 
The majority of the Senate went on record in support of the plan that 
was taken up by the Senate. We did not have the 60 votes because there 
were opponents to the legislation that made points of order that kept 
the Senate from accomplishing our goal of getting to conference and 
moving through the bill.
  Let me simply list five concerns I have as we begin. Hopefully, all 
of the concerns can be addressed. It is critical we consider them very 
carefully. The first concern is procedural. The distinguished majority 
leader noted that we

[[Page 13580]]

have had 29 hearings on Medicare since 1999 and, indeed, we have 
studied this issue a good deal. What I am concerned about now, however, 
is that we did not have a bill before the Senate. I know Senator 
Grassley is working tirelessly with others to provide a vehicle to 
allow us the opportunity to debate this issue. The administration, of 
course, has come out with their recommendations that Senator Durbin 
addressed a moment ago. However, we ought to have a hearing on the bill 
itself once it is written so we can walk through it and make sure we 
know exactly what we will be voting on and considering. Having that 
hearing on the bill seems to me to be an essential aspect of the 
procedural requirements we have to consider as we prepare for the 
debate on the Senate floor itself.
  The second issue has to do with the context. Some will use Medicare 
and prescription drugs as a Trojan horse to privatize the Medicare 
system. How tragic that would be if in the name of providing good 
prescription drug benefits to seniors, we end up with a system that 
most seniors will not recognize.
  Before Medicare was created in 1965, less than half of Americans over 
the age of 65 had health insurance. Now, 95 percent of seniors over the 
age 65 have health insurance. The reason they do is because of 
Medicare.
  If we privatize Medicare, seniors in rural areas, in particular, will 
suffer. Let us not privatize the system. Let us not destroy a system 
that works so well for so many.
  I find it interesting that those who laud the advantages of private-
sector health care have difficulty explaining why Medicare can have 
such low administrative costs. Medicare's administrative costs are 
about 2 to 3 percent. The private sector administrative costs today are 
about 15 percent--5 times greater than the administrative costs of 
Medicare. We should think about that. I hope we are absolutely certain 
that in the name of prescription drugs we do not remove, we do not 
eliminate, we do not undermine a system that has worked so well for 
seniors, whether they are in urban or rural areas.
  The third concern is what kind of a package we will provide. The one 
thing seniors tell me they need is a clear understanding of what 
benefits they are going to get so they can compare whatever choices 
they may be offered. They need to know what the benefit plan is going 
to be. So let's make sure we define the benefits, describe them and put 
them in writing, so that no one has any question what it is we are 
going to do.
  Seniors also need to know what premium they will be asked to pay. We 
have to define that premium right in the bill itself.
  I hope our colleagues would all share that point of view, as well. Be 
as transparent when it comes to benefit and premiums as we can be so 
that seniors know what their benefits will be and can have confidence 
that those benefits will be there when they're needed.
  Fourth and finally, I hope, more than anything else, that we make the 
benefits consistent. For us to say seniors will be covered for a while, 
and then not covered even though they continue to pay premiums, and 
then covered again, would be a terrible mistake. Such coverage gaps, or 
sickness penalties, would lead to a deep-seated cynicism not only among 
seniors but among all Americans. I hope we recognize how important it 
is that we avoid any coverage gaps by including defined benefits and 
defined premiums.
  That is, in essence, what we are hoping we can achieve. As we draft 
the bill, let's simply do this: Let's make sure we have hearings so we 
know what is in it. Make sure that, in the name of prescription drugs, 
we don't privatize Medicare and dramatically change a system seniors 
depend on. Then let's tell seniors three things. They are going to get 
a defined benefit, a defined premium, and defined coverage all year 
with no sickness penalty. If we can agree on these principles, we can 
get broad bipartisan support for the bill at the end of this month.
  Again, I compliment the majority leader for his determination to 
continue the efforts we made in the last Congress on prescription 
drugs. We have a chance to do it right. We have a chance to do it in a 
bipartisan fashion. We have a chance to ensure that at long last we 
make a real contribution to health care in America, for seniors in 
particular. That is our opportunity that awaits us as we take up the 
drug bill later this month.
  Mr. REID. Will the Senator yield for a question?
  Mr. DASCHLE. I am happy to.
  Mr. REID. I have listened to both the majority leader and you, the 
Democratic leader, this morning. I ask the Senator from South Dakota, 
the distinguished Democratic leader, if he is aware of some statements 
that have been made by Republican Senate leaders talking about doing 
away with Medicare.
  Let me be more specific. Our friend, the distinguished Senator from 
Pennsylvania, said just 2 weeks ago:

       I believe the standard benefit traditional Medicare program 
     has to be phased out.

  Is the Senator aware the distinguished Senator from Pennsylvania made 
that statement?
  Mr. DASCHLE. The comment was made. I was not aware of it until just a 
few days ago. But I think it goes to the heart of what I was talking 
about. I appreciate the Senator from Nevada raising this question.
  Unfortunately, we have a much larger question at hand, if there are 
those on the other side who will see this as an opportunity to 
privatize--to eliminate the Medicare system, as the comments of the 
Senator from Pennsylvania suggest. If they want to eliminate Medicare, 
then I think all hope of accomplishing something regarding prescription 
drugs will be lost. If this is a Medicare debate, if we have to back up 
and first defend Medicare and make sure it is protected and kept 
intact, then we will never have an opportunity to get to prescription 
drugs.
  I hope the Senator from Pennsylvania would recognize the consequences 
of words of that magnitude. Obviously, we are prepared to have a debate 
about Medicare. But it will be at the expense of a debate about 
prescription drugs and whether we can add prescription drugs to 
Medicare sometime this year, hopefully this month.
  Mr. REID. Will the Senator yield for another question?
  Mr. DASCHLE. Yes.
  Mr. REID. The distinguished Senator from Utah, Senator Bennett, a 
long-time friend of this Senator, stated about 7 weeks ago:

       Medicare is a disaster. We have to understand that Medicare 
     is going to have to be overhauled. Let's create a whole new 
     system.

  Is the Senator aware our friend from Utah has made that statement?
  Mr. DASCHLE. There are those on the other side--and I assume from 
that comment that Senator Bennett may be among them--who believe that 
eliminating or dramatically altering Medicare is the only option 
available to us. Frankly, I am troubled by that. I think Medicare has 
been one of the greatest health care success stories in our Nation's 
history.
  My mother is a beneficiary of Medicare. The remarkable consistency 
and the extraordinary access to health care that Medicare has provided 
to her and tens of millions of other seniors simply cannot be 
overestimated.
  As I said earlier, the administrative cost for Medicare is about 3 
percent. The administrative cost for private health care plans is 15 
percent, 5 times greater.
  Medicare provides every senior in South Dakota a chance to get health 
care. There are no private sector plans in large parts of South Dakota 
because HMO's and PPO's don't serve rural America. So from an access 
point of view, from an administrative point of view, from a benefit 
point of view, from an assurance and confidence point of view for 
seniors, I don't know how you could do much better than Medicare.
  Can it be improved? Absolutely. Could we provide more preventive and 
wellness care? Absolutely. Can we provide a prescription drug benefit? 
Absolutely.
  But when we draw down the Medicare trust fund to pay for tax cuts, we 
are, in essence, stealing from that very fund that will be needed in 
future years to provide the kind of health care that our parents, our 
grandparents, and our families depend upon.

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  The quotes from our Republican colleagues are very disconcerting and 
troubling. As I say, if that becomes the debate, if the debate is about 
the future existence of Medicare itself, we will never be able to get 
to a drug benefit debate.
  Mr. REID. Will the Senator yield for one final question? I know there 
are others here wishing to speak. This will be the last question.
  Mr. DASCHLE. I am happy to.
  Mr. REID. The State of Nevada has two large metropolitan areas, Reno 
and Las Vegas, but most of the State population is in small towns--
Mesquite, Ely, Hawthorne, Battle Mountain, Tonopah--places that have no 
managed care. If we change Medicare drastically, I don't know what will 
happen to the seniors in those rural communities.
  I have heard the Senator today and on other occasions speak about the 
problems in South Dakota, which has many rural communities in it. If we 
do not take care of Medicare in the traditional fashion so that it is a 
level playing field no matter where you live, I think our Medicare 
Program as we have known it, that has been so successful, will leave 
many seniors simply without any medical care. Does the Senator agree 
with that statement?
  Mr. DASCHLE. I couldn't agree more. In fact, what troubles me is 
there are those who would turn Medicare into a great big HMO. I don't 
know many people who are enthusiastic about the kind of care they get 
from their HMO. There are some good ones, I certainly would not deny 
that. But I must say, HMOs are not the panacea. There is not a one-
size-fits-all HMO, health maintenance organization, or PPO, for that 
matter, preferred provider system, that would work in rural areas.
  We know. We have seen from our own experience. They have tried it. 
They have attempted to create managed care systems in rural areas. The 
demographics don't work. Our health care delivery system in rural areas 
does not allow for a managed care system that works. Perhaps it does in 
Washington DC, or Los Angeles or New York.
  So we cannot have a one-size-fits-all system. That is the beauty of 
the Medicare system. The Medicare system has adapted over the years, 
organizationally and administratively, to fit Alaska and South Dakota 
and Nevada in a way that has worked far beyond the expectations, I am 
sure, of many who created the system in the 1960s.
  Let us not throw out a system that has worked well. Let's improve it. 
Let's build on it. Let's provide better benefits through it. But to 
privatize Medicare--to eliminate it and replace it with a new HMO in 
the name of Medicare--is a mistake that we will fight to the last day. 
That would be a real tragedy because we have an opportunity to debate 
how to provide a good prescription benefit. Let's agree in a bipartisan 
way to have that debate. This is our moment and our opportunity and I 
hope we seize it.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Kansas.
  Mr. BROWNBACK. I yield myself such time as I may consume under the 
time I have reserved for the National Museum of African American 
History and Culture Museum.
  The PRESIDING OFFICER. The Senator has that right.

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