[Congressional Record (Bound Edition), Volume 149 (2003), Part 10]
[Senate]
[Pages 13584-13587]
[From the U.S. Government Publishing Office, www.gpo.gov]




                    HEALTH CARE FOR OLDER AMERICANS

  Ms. STABENOW. Mr. President, I wish to follow what my friend and 
colleague from Iowa was speaking about earlier in terms of the 
importance of Medicare. I think his comments were so right on point.
  I find interesting--I was not around at the beginning for the 
debate--the debate on Medicare. I understand that in 1960, originally, 
there were proposals to provide a broad universal care for all 
Americans and that, in true compromise form, the Congress and the 
President, when there was not support for that, ended up with a plan 
called Medicare for seniors and the disabled in this country. So it was 
a compromise. It was viewed as a first step, not a last step, in 
providing universal care for all Americans.
  I believe Medicare has been a great American success story. We have 
seen both Medicare and Social Security bring our seniors out of 
poverty. Today, we have about 10 percent of our seniors in poverty 
rather than close to 50 percent prior to Social Security and Medicare.
  During that debate, if one reads the Record, there was a major 
concern about who could provide health care to seniors better--the 
private sector or the public sector through Medicare.
  The reason the Congress, in its wisdom, decided to move forward with 
Medicare was because at least half the seniors could not find or could 
not afford health care insurance in the private sector. Seniors and all 
of us who are getting older and using more medications and going to the 
doctors more frequently understand that older Americans require more 
health care, more costs, and are not exactly the prize group an 
insurance company goes for. They want my son and daughter in their 
twenties and younger healthier people to balance out those of us who 
are getting older and needing more care.
  We believed, as a great American value, it was important that older 
Americans have health care. It was important that those who are 
disabled have health care, be able to pick their own doctor, be able to 
go where they choose to receive their care but that they would know it 
was always there, it was stable, a constant premium; they would know 
what it would cost; they could pick their own doctor; and it has 
worked.
  Since that time, there have been a lot of debates, and we have one 
going on today, about how to provide Medicare prescription drug 
coverage. But the real issue is beyond that. It is about how to provide 
health care for older Americans.
  The next big change that happened of which I was aware in 1997 when I 
was in the House was to offer private Medicare HMOs. Also at that time, 
there were major cuts made in Medicare for providers. I believe they 
went way too far. Many of us have been trying to change that ever 
since. There were cuts to hospitals, home health agencies, and doctors 
that have affected people being able to get care.
  At that time, something was put in place that was touted as this 
great new program. In fact, Tom Scully at the time predicted an 
Oklahoma land rush of moves to private health plans in

[[Page 13585]]

1999. He said: You are going to see seniors pouring into managed care 
Medicare.
  In fact, that did not happen. That is not what happened. But what we 
have seen happen, unfortunately, is what the former Speaker, Newt 
Gingrich, talked about in terms of a strategy of cutting off resources 
so Medicare would wither on the vine, an effort to convince people that 
Medicare was not working, even though the majority of seniors know it 
is because they use it every day.
  I found it interesting that back in 1997 there was a strategy paper 
put out by the Heritage Foundation, an extremely conservative 
organization that I know does not support Medicare as we have it today, 
advising my Republican colleagues. They recommended a strategy to move 
to the private sector by doing four things: First, to convince 
Americans that Medicare provides inferior medicine and poor financial 
security. They set out to do that. We are going to hear a lot about 
that in this Chamber, that it is inferior medicine, even though seniors 
know that is not true. There is not evidence that is true, but we are 
going to hear a lot of talk--and we have for 5 years--about how 
Medicare is not as good.
  Second, convince Americans that Medicare cannot be sustained for 
long. We have heard continually that we cannot afford it anymore. As my 
colleague from Iowa pointed out, if there is concern about being able 
to afford it, it is only because we are spending the money on tax cuts 
for the privileged few instead of beefing up Medicare and Social 
Security. So it is a conscious choice. It is a question of values and 
priorities that we have to decide every day, just as American families 
do.
  Third, compare or reform the Medicare system to the Federal Employees 
Health Benefits Program. We hear a lot about that now: Seniors should 
have the same kind of plan that we do. I happen to agree with that, but 
during the tax debate I offered an amendment that simply said we are 
going to defer the tax cut to the privileged few at the very top, less 
than 1 percent of folks who already received a tax cut 2 years ago; we 
are going to defer the next one until we can fund Medicare at the level 
that Senators and House Members and other Federal employees receive. My 
colleagues voted no on that issue. It would cost twice as much as in 
the budget resolution--$800 billion instead of $400 billion--and, 
unfortunately, the majority voted no. But we are going to continue to 
hear about how we should have private sector plans instead of Medicare, 
and it should be the same as we receive.
  I agree with that, and I am happy to offer my amendment any time 
folks want to support it so we can pay for that benefit and make it 
real for our seniors.
  Finally, fourth, they said protect current beneficiaries. They said 
the calculation was the private alternatives generated by the voucher-
style option, private HMOs, would be so much more efficient and so much 
more attractive that fewer and fewer seniors would decide to remain in 
the traditional system. Hence, Speaker Gingrich's remarks that the 
traditional Medicare system would wither on the vine because the demand 
for that option would decline sharply over time.
  Obviously, that is not true. Nine out of ten seniors in this country, 
when given a choice, have picked Medicare. Seniors have made their 
choice. Since 1997 when they were given the option of private HMOs, 
they have overwhelmingly said no.
  It is very interesting; 89 percent of the seniors in this country 
right now are covered under Medicare, and 11 percent are covered under 
a private sector HMO. Some do not have that option. In Iowa, there is 
not a private sector HMO. In Michigan, only 2 percent of beneficiaries 
have that option. Of the 64 percent of the seniors who have that 
option, only 11 percent of them have chosen to go into a private sector 
HMO.
  The PRESIDING OFFICER. The Senator's time has expired.
  Ms. STABENOW. Mr. President, I ask unanimous consent for an 
additional 10 minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Ms. STABENOW. I thank the Chair.
  Mr. President, today I wish to debunk the myths we have heard and are 
going to keep hearing so that we can get through what is fact and what 
is myth and focus on what we need to be doing, which is to strengthen 
Medicare to cover prescription drugs.
  I agree with Secretary Thompson who says we need to focus more on 
prescriptions. We can do that through traditional Medicare in which 
seniors overwhelmingly have voted to remain. We can make sure they have 
their own doctor, the stability of knowing what their cost is for their 
premium and their copay, and still update the system to modernize it, 
using more technology, making sure we have more prevention, and making 
sure we have prescription drugs.
  Fundamentally, I do not believe that is what this debate is about. If 
we can agree that we are going to do it through Medicare, then I 
believe we can sit down with the dollars available and work up 
something together, and I hope we will because the seniors of this 
country have waited long enough. I am very hopeful we will be able to 
do that.
  I will briefly debunk what we are going to hear, unfortunately, and 
that we have to get beyond.
  First, seniors want the choice to be in a private plan. Obviously, 
not true.
  The private sector plans will offer seniors more choices, including 
prescription drugs. Unfortunately, many seniors do not have access to 
the private plans, and there is not one offered in 80 percent of the 
counties nationwide. So the choice is not available to them.
  I find it interesting that my mother, who is a very healthy 77-year-
old woman and plays on three golf leagues--I am so glad I have her 
genes. I am very hopeful I will have the same opportunity she has had 
to enjoy her retirement. As a retired nurse, she chose an HMO. She is 
very healthy. She wanted prescription drug coverage. She could get it 
through an HMO, so she chose a Medicare HMO. The problem was she got 
dropped. This has happened to thousands of seniors where the HMO 
decides it is no longer financially viable for them to cover older 
adults under Medicare, and so they drop them. So my mother lost her 
doctor. She liked the HMO she was in. It worked for her. She lost that 
opportunity.
  So even in situations where people chose Medicare+Choice, the HMOs go 
in and out of the market. Forty-one thousand people in Michigan chose 
Medicare+Choice, and they were dropped because the plans go in and out. 
So it is not dependable, it is not reliable. That is why the majority 
of seniors did not pick it--because they wanted the reliability of 
their own doctor, knowing it would be there, knowing it was not going 
to be complicated by new systems and new paperwork. They like Medicare.
  We also hear that private plans will give seniors more choices while 
letting them continue to use their own doctor. Of course, that is not 
true because if one goes into an HMO or even a PPO and their doctor is 
not part of that system, they do not have the opportunity to go to that 
doctor or they may have to pay more to go to that doctor.
  The private sector Medicare plans will save money; how many times 
have we heard that? We hear that they are more efficient. In fact, it 
is just the opposite. They are not more efficient and, in fact, cost 
more money than being in traditional Medicare.
  In the year 2000, the General Accounting Office estimated that 
payments to Medicare HMOs exceeded the costs that would have been 
incurred by treating patients directly through traditional Medicare by 
an annual average of 13.2 percent. So it cost more for the folks who 
went into the HMO, it cost Medicare more than if they had stayed in 
traditional Medicare.
  Two recent studies found that private health plan fees are about 15 
percent higher than Medicare: This is the other part of the myth. 
Frankly, I think our providers would love it if we funded Medicare at 
the same level as

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private insurance does because on average they would get 15 percent 
more dollars. We are cutting our doctors, hospitals, home health 
agencies, and nursing homes. In the private sector, on average, in some 
cases it is much higher than 15 percent more for the same services. 
Surgical procedures I believe are closer to 25 percent more in the 
private sector. So in terms of dollars, we would see higher costs and 
higher rates.
  The private sector plans have lower administrative costs than 
traditional Medicare: How many times have we heard that? Many studies 
have shown that Medicare has a lower overhead rate than private plans. 
Medicare has a 2 to 3 percent administrative cost. Private Medicare 
HMOs, on average, spend 15 percent on administrative costs, and some 
spend as much as 30 or 32 percent. So, again, it does not cost less. 
The administrative costs are not less under private plans.
  Finally, the myth that we can provide a Medicare drug plan like 
Federal employees benefits for under $400 million over 10 years, which 
is in the budget resolution--in fact, the numbers we have been given 
indicate to us that it would cost twice as much as what is in this 
budget resolution. When given the opportunity, our colleagues on the 
other side of the aisle voted no on funding the same level that we 
receive through Federal employee health insurance.
  So let's talk about myth, let's talk about facts, and let's get 
beyond all of this and say seniors of this country have chosen 
overwhelmingly to stay in Medicare. They like Medicare. It works. It 
just does not cover prescription drugs.
  Mr. HARKIN. Will the Senator from Michigan yield for a question?
  Ms. STABENOW. I am happy to yield.
  Mr. HARKIN. First, I preface my question by thanking the Senator from 
Michigan for her depth of understanding of the whole Medicare issue and 
also for her clarity of argument. I should say her clarity of 
exposition, for exposing what this is all about. It is not about 
tinkering around with it; it is really about an assault on the Medicare 
system itself. So I thank the Senator from Michigan for pointing that 
out, and I hope the Senator will continue to do this so that the 
American people understand what this is really about. It is about a 
fight for Medicare, whether we are going to have it.
  Now, my question is this: As the Senator pointed out, Mr. Scully and 
others, back when Medicare+Choice came in, were lauding it, saying we 
were going to see seniors pouring into managed care Medicare. The 
Senator talked about how Mr. Scully said this was going to be an 
Oklahoma land rush to move to private health plans, and the Republicans 
who put up Medicare+Choice had all of these visions that seniors would 
go into it. But as the Senator from Michigan pointed out, that did not 
happen, did it? It did not happen.
  Ms. STABENOW. That is correct.
  Mr. HARKIN. Now we only have 11 percent of seniors who chose that. I 
ask the Senator from Michigan, does it somehow appear that since 
voluntarily the Republicans could not get seniors into HMOs and private 
health care plans, there now seems to be an approach that we are going 
to force them into HMOs by doing away with the Medicare system and 
restructuring it into a private HMO type system that would force the 
elderly to do what the elderly do not want to do? Does that seem to be 
the kind of thing we see laid out in front of us?
  Ms. STABENOW. Well, I think my colleague is very wise in pointing 
that out. I often say that seniors made their choice and now our 
colleagues on the other side of the aisle have said: We do not like 
that choice. Pick again. You cannot have this choice. Door No. 1 is 
closed and locked. You can only pick door No. 2. That is really what is 
happening. Even among the fancy words, now we are hearing that under 
Medicare there will be the same prescription drug proposal, the same 
plan as our private plans; we are going to give the same prescription 
drug plan. But then we hear, but other things will be better in the 
private sector plans, such as we will have more prevention; we will 
have a better catastrophic cap; we will have other things that are 
better. So they are moving the words around.
  It may appear that the prescription drug part is the same, but other 
things will be better because of the belief--and there is a genuine 
philosophical difference, there is a divide, about what is the best way 
to proceed. There are colleagues who believe that probably Medicare 
should never have been enacted. I have heard it said it is a big 
government program, it should be private insurance run, and they would 
like very much to get back as close as they can to a privately run 
system.
  Mr. HARKIN. Again, I thank the Senator for pointing this out. As the 
Senator knows, the majority of Republicans voted against Medicare when 
it came in, in 1965. Even my good friend Senator Dole, when he was 
running for President, said he voted against Medicare and he was proud 
of it.
  Now I would give them that that is their philosophy, and that is 
where they are coming from. I understand that. I understand when Newt 
Gingrich says he wants to have Medicare wither on the vine. I 
understand when the third ranking Republican in the Senate says the 
Medicare benefit ought to be done away with. That is their philosophy 
and that is where they are headed.
  So again, I thank the Senator for pointing out that this is really 
the goal.
  Ms. STABENOW. Absolutely.
  Mr. HARKIN. This is the goal that is out there, to destroy the 
Medicare system.
  Ms. STABENOW. Absolutely.
  Mr. HARKIN. Again, I ask the Senator from Michigan, when Medicare 
came in, was it not because the private sector had failed in terms of 
elderly health care in America?
  Ms. STABENOW. Absolutely.
  Mr. HARKIN. Was that not the history? And if one has these private 
plans, that they are going to pick and choose, and they are going to 
cherry pick, and they are going to have a segregation of elderly pushed 
off in some corner someplace, begging for some kind of health care if 
we do not have a universal Medicare system? Is that not what might 
happen?
  Ms. STABENOW. I think the Senator is absolutely correct. It is not 
that there is not a place for private sector insurance, but when 
Medicare came into place, it was because half the seniors in the 
country could not find a private plan that would cover them or they 
could not afford it. So there was such a huge need.
  We as Americans have a basic value about making sure older Americans 
can live in dignity and have access to health care and a quality of 
life that they deserve, as well as those who are disabled. This is a 
great American value. I believe it is a great American success story. 
Even though there are those who since that time have been trying in 
some way to undermine it, we should be proud as a country. I absolutely 
agree with colleagues who say it needs to be modernized. We can focus 
more on prevention strategies.
  In addition to prescription drug coverage, there are other ways we 
can make the system better. We can use more technology, less paperwork, 
all of which are good. If we could get beyond the debate that says we 
should move back toward the private sector, and somehow that is cost 
effective and saves money and the dollars will go further--none of 
which is true; there is no evidence of that--if we could get beyond 
that, we could come up with a bipartisan plan that would be meaningful. 
The seniors have been waiting for us to get the message. They want 
Medicare. They just want prescription drug coverage. They want it 
modernized. But they want Medicare. They have been saying that loudly 
and clearly.
  I hope we can get the message and work together to actually get it 
done.
  Mr. HARKIN. I thank the Senator for her leadership on this issue.
  Ms. STABENOW. We appreciate the opportunity to share this today.
  We have a real opportunity here, as Members on both sides of the 
aisle, to do something very meaningful. I hope we will do that rather 
than debate whether or not Medicare has been successful and seniors 
want choices. I believe we should look at the choice they

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made. It is very clear. They want us to work together and get something 
done, and do it in a way that will allow seniors to know that medicine, 
which is such a critical part of their lives and a great cost to their 
pocketbook, will be covered or partially covered and they will receive 
some assistance to be able to afford such a critical part of health 
care today, which is outpatient prescription drugs. It is too important 
to people. We do not want them choosing between food and medicine in 
the morning. We want them to have confidence that Medicare will cover 
and help with the costs of prescription drugs.
  I yield the floor and suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. WARNER. 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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