[Congressional Record (Bound Edition), Volume 149 (2003), Part 13]
[House]
[Pages 17881-17890]
[From the U.S. Government Publishing Office, www.gpo.gov]




  APPOINTMENT OF CONFEREES ON H.R. 1, MEDICARE PRESCRIPTION DRUG AND 
                       MODERNIZATION ACT OF 2003

  Mr. TAUZIN. Mr. Speaker, I ask unanimous consent to take from the 
Speaker's table the bill (H.R. 1) to amend title XVIII of the Social 
Security Act to provide for a voluntary program for prescription drug 
coverage under the Medicare Program, to modernize the Medicare Program, 
to amend the Internal Revenue Code of 1986 to

[[Page 17882]]

allow a deduction to individuals for amounts contributed to health 
savings security accounts and health savings accounts, to provide for 
the disposition of unused health benefits in cafeteria plans and 
flexible spending arrangements, and for other purposes, with Senate 
amendments thereto, disagree to the Senate amendments, and agree to the 
conference asked by the Senate.
  The SPEAKER pro tempore (Mr. Culberson). Is there objection to the 
request of the gentleman from Louisiana?
  There was no objection.


          Motion to Instruct Offered by Mr. Davis of Tennessee

  Mr. DAVIS of Tennessee. Mr. Speaker, I offer a motion to instruct 
conferees.
  The Clerk read as follows:

       Mr. Davis of Tennessee moves that the managers on the part 
     of the House at the conference on the disagreeing votes of 
     the two Houses on the Senate amendment to the bill H.R. 1 be 
     instructed as follows:
       (1) To reject the provisions of subtitle C of title II of 
     the House bill.
       (2) The House recede to the Senate on the provisions to 
     guarantee access to prescription drug coverage under section 
     1860D-13(e) of the Social Security Act, as added by section 
     101(a) of the Senate amendment.

  The SPEAKER pro tempore. Under the rule, the gentleman from Tennessee 
(Mr. Davis) will be recognized for 30 minutes and the gentleman from 
Louisiana (Mr. Tauzin) will be recognized for 30 minutes.
  The Chair recognizes the gentleman from Tennessee (Mr. Davis).
  Mr. DAVIS of Tennessee. Mr. Speaker, I yield myself such time as I 
may consume.
  Mr. Speaker, this motion instructs conferees to do two simple things, 
two things that the House-passed bill does not accomplish. One, it asks 
them to provide a guaranteed prescription drug benefit for all our 
seniors. Number two, it asks them to preserve Medicare as we know it 
today.
  Specifically, this motion instructs the House not to abandon seniors 
to the mercy of private insurance and pharmaceutical companies. It 
makes a promise to our seniors. It tells them that if private insurance 
companies cannot make enough money off them, they can still get a 
prescription drug benefit.
  Mr. Speaker, without this provision, the odds of seniors in my 
district getting a prescription drug benefit under this bill are 
virtually slim to none. How do I know this? For years now, private 
insurance companies have had an opportunity to try and make money off 
the seniors in my district by offering them a Medicare+Choice benefit. 
And how many have decided it is worth their while? Only a few.
  I know the people in my district, the people of the Appalachian 
Mountains, of the Cumberland Plateau and southern middle Tennessee, are 
not alone, the people who live in Byrdstown or in Tracy City or in 
Kelso or in Hohenwald in our district. Already, private HMOs have 
abandoned over 2 million seniors.
  The second part of this motion is about nothing less than preserving 
Medicare, a program millions of seniors have come to expect and to 
trust. Under the House-passed bill, Medicare as we know it will cease 
to exist in 7 short years, in 2010. Instead of Medicare, seniors will 
get a voucher for their health care and told to go shopping and will be 
forced to beg insurance companies and HMOs to offer prescription drug 
coverage to them, a request that many insurance companies are already 
on record as saying that they will not be able to fulfill. HMOs will 
compete against Medicare for younger, healthier seniors, while jacking 
up the prices for seniors who have chronic conditions and are in need 
of more care. These ``left behind'' seniors will have no choice but to 
remain in traditional Medicare which will be starved of funds, unable 
to compete with insurance companies and HMOs, and thus will be forced 
to raise seniors' premiums.
  Privatization of Medicare will break up the huge and successful risk 
pool that Medicare has provided. With only the sickest patients 
enrolled, Medicare's costs will rise until it costs more than the 
voucher allotment. Medicare will be forced to price itself out of 
existence.
  Make no mistake. That is exactly the point. During the debate on the 
bill, here is what was said: ``To those who say the bill would end 
Medicare as we know it, our answer is: We certainly hope so. Old-
fashioned Medicare isn't very good.''
  Well, I disagree and I have talked to many seniors in Tennessee who 
disagree as well. Medicare in the past 38 years has been very good to 
millions of seniors, but it should be even better. It should include a 
prescription drug benefit that is guaranteed, that is affordable, and 
that is accessible to all seniors. Our seniors deserve it, and we in 
this House Chamber should demand it.
  Mr. Speaker, I yield the balance of my time to the gentleman from 
Florida (Mr. Davis) and ask unanimous consent that he be allowed to 
control the time.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Tennessee?
  There was no objection.
  Mr. TAUZIN. Mr. Speaker, I yield 15 minutes to the gentleman from 
Wisconsin (Mr. Green) on behalf of the Committee on Ways and Means and 
ask unanimous consent that he be permitted to control that time.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Louisiana?
  There was no objection.
  Mr. TAUZIN. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, there were two visions of Medicare prescription drug 
bills before the House several weeks ago. The vision offered by the 
Democratic Party is revisited upon us today in this motion to instruct. 
That vision was one of simply a government program for prescription 
drugs. It was one that eliminated any real possibility of competitive 
reform. It was one that literally provided for the government to always 
make sure that prescription drugs were available. In short, it 
literally put the government in the business of deciding what 
prescription drugs, at what price and when they might be available for 
seniors.
  There was another vision offered on the floor which was adopted by 
the House when it rejected overwhelmingly the Democratic vision. The 
vision that was offered on this side of the House that was finally 
approved in that long night of voting was a vision that literally said 
we are going to literally provide a $400 billion drug benefit for 
seniors. But, as part of the deal, we are also going to require 
Medicare itself to undergo reforms, to make sure that the Medicare 
system does not itself go bankrupt or bust the business of government 
as the years go by.
  There were predictions, for example, that by the year 2070 if we did 
not accept the vision of reforming Medicare, of making sure that there 
were competitive choices available for consumers so that Medicare 
itself would become more and more efficient, less bureaucratic, more 
responsive to Medicare doctors and Medicare patients, if we did not do 
that by the year 2070, entitlements in this country would eat up every 
single dollar raised from taxpayers, leaving no money to operate this 
body, the Congress or the courts or the Defense Department or any other 
vital function of our government.
  That is the choice we have again in this motion to instruct. The 
Democratic motion to instruct simply says, adopt that Democratic vision 
of a government-provided Medicare benefit only with no competition 
offered to that system and no tension between the private competition 
offered and the public system to ensure that the public system remains 
as intensely efficient as possible under the law. So in effect what 
this motion does is to strike the competitive features of the vision of 
Medicare reform adopted on the House floor and to rely instead upon 
government-backed, government-fallback medicine for Americans.
  Let me state very clearly again. The vision adopted on the floor of 
the House was to provide $400 billion of government-provided Medicare 
prescription drug assistance to seniors, to seniors who wanted to stay 
within the Medicare program or seniors who might want to choose some 
other competitive private plan that would be offered under that vision. 
The vision

[[Page 17883]]

adopted by the House was exactly that, competition, more stores in 
town, a government store and private stores as well. The vision 
rejected that is again offered on the floor of the House is government 
medicine only, government medicine without the competitive choices that 
seniors should have.
  This motion to instruct should be rejected.
  Mr. Speaker, I reserve the balance of my time.
  Mr. DAVIS of Florida. Mr. Speaker, I yield myself 2\1/2\ minutes.
  The motion to instruct represents an attempt to identify two areas 
that must be addressed if there is to be a compromise, if there is to 
be a prescription drug benefit under Medicare in this Congress. I 
daresay virtually every Member of this body has promised to find a way 
to provide Medicare coverage for prescription drugs. There is a basis 
for consensus among Republicans and Democrats to operate within the 
constraints of the budget. This is not the budget many Democrats would 
have chosen but out of a desire to solve this problem immediately and 
begin to provide some coverage for the seniors at home that are 
desperately struggling to meet their drug bills, there is a desire to 
work together.
  The two issues the motion to instruct addresses are very simple. The 
first is whether or not our seniors are forced to rely exclusively on 
private plans to get drug coverage. Since this bill was introduced 
weeks ago, I would say there is not a single private insurance company 
in Washington or the United States that has come forward to the Federal 
Government and said, we want your money, we want to provide this 
private drug benefit you have created. As a matter of fact, in the 
committee one of the responses that was made by the esteemed chairman 
to the apparent lack of interest among the private insurance companies 
was, if necessary, we, the Congress, will subsidize over 99 percent of 
the cost of these drug benefit plans to encourage the private companies 
to come in. That not only is a waste of taxpayer dollars, it is an 
insult to our seniors. Because unless we adopt the Senate fallback 
provision which says that if two private insurance companies will not 
provide the drug benefit, traditional Medicare will, we are holding up 
a false hope for our seniors.
  So the first thing the motion to instruct does is take the Senate 
position that there will be a fallback, traditional fee-for-service 
drug benefit if two private plans fail to do so.
  The second issue addressed by the motion to instruct is the issue of 
the voucher. Under 2010 in this bill, Medicare as we know it ends. 
Medicare is converted to a voucher program. Under the voucher plan if 
you are, as many people are at the age of 65, not entirely healthy, you 
can safely assume these private insurance companies will not want to 
insure you. You will not be a good risk. You will not be sufficiently 
profitable.
  Under this bill, unless the motion to instruct is adopted, people who 
cannot get into a private plan are left with a voucher. The Medicare 
actuary has estimated that could result in as much as a 25 percent 
increase in the cost of Medicare to people that have the voucher. We 
are going to leave people over 65 with health problems without access 
to Medicare unless this motion to instruct is adopted.

                              {time}  1600

  Mr. RYAN of Wisconsin. Mr. Speaker, I yield myself such time as I may 
consume.
  I would like to address a couple of the points that the gentleman 
from Florida (Mr. Davis) made. In the gentleman from Florida's motion 
to instruct, it is akin to passing an amendment to say we are going to 
see to it that Medicare is bankrupt faster than it is already going 
bankrupt. The problem we are trying to deal with, Mr. Speaker, is this: 
we already have financial problems with Medicare. As it stands today, 
if we do not even do anything and we do not add any benefits like 
prescription drug benefit to Medicare, it is going insolvent in 10 
years. At the height of the baby boom retirement when we have 77 
million retirees in place in America, more than the 40 million we have 
today, almost double, we are going to exhaust all of the Medicare trust 
fund by the year 2036.
  So what we are trying to do here is this: we recognize so clearly 
that Medicare is an outdated program. Medicare is not modern. It is not 
comprehensive. It does not cover all the comprehensive health care 
needs a person has over the age of 65, especially; and that is why we 
out of the House passed very comprehensive legislation, comprehensive 
legislation to help not only add a prescription drug benefit to all in 
Medicare but give them access to comprehensive health care so they do 
not have to go out and buy a costly supplemental insurance plan, so 
they do not have to pay out of pocket with high retail prices with the 
buying power of one person for their prescription drugs.
  We have great comprehensive reforms for the current generation of 
retirees. But the one very important part of what we passed in the 
House is not only do we improve Medicare for today's generation of 
retirees by making it more modern; we also have very important reforms 
in this bill to make sure that the program is actually solvent for the 
next generation when they retire, and that is what we are trying to 
accomplish.
  If we simply add a benefit to Medicare on top of the current program 
in its current structure, all we end up accomplishing is accelerating 
the bankruptcy of Medicare. Mr. Speaker, we owe it to all Americans, 
not just the current generation of retirees, to fix this program; but 
we owe it to the next generation, the baby boom generation, to make 
sure that this program is there for them when they retire.
  The reforms that are in question that are being jettisoned or gutted 
in this motion to instruct are the very important reforms that get us 
to solvency for the baby boom generation, and those reforms are not 
vouchers. Those reforms are defined benefit plans that simply give 
seniors the same access to comprehensive health care plans that we as 
Members of Congress have and all other Federal employees and our 
families have; and those plans in competition with one another for our 
business, for the seniors' business will help reduce long-term costs so 
we can extend the solvency of this program for the baby boomers.
  As to the very important criticism, but very wrong criticism, that 
this is going to hurt the people who are not healthy, the sick and low-
income, that is completely false, Mr. Speaker. This legislation very 
clearly has guaranteed issue. No plan can pick and choose who they are 
going to cover in Medicare. If they are in Wisconsin as a person of the 
age of 65, Medicare eligible, and they want an enhanced plan like a 
private PPO or Blue Cross like my wife chose for us in the Federal 
Employee Health Benefit Plan, everybody who is entitled to Medicare is 
entitled to that plan. These private plans cannot cherrypick and cannot 
deny people based on preexisting conditions. And that I would add can 
be found on page 260.
  Another very important part is that this has risk-adjustment 
payments. So if, for example, sicker people are going into a plan, they 
will have risk-adjustment payments, and that can be found on page 248 
as well. So I would simply direct my colleagues to the legislation to 
find out that this does have risk-adjustment payments so it will not 
have a problem with healthy or nonhealthy people going into one plan or 
another. This language is what we must pass into law, not just out of 
the House, to save this vital program for the next generation while 
improving Medicare for the current generation.
  Mr. Speaker, I reserve the balance of my time.
  Mr. DAVIS of Florida. Mr. Speaker, I yield 3 minutes to the gentleman 
from California (Mr. Stark), the ranking Democrat on the Subcommittee 
on Health of the Committee on Ways and Means.
  Mr. STARK. Mr. Speaker, I thank the gentleman for yielding me this 
time.
  Mr. Speaker, I would like to inquire of the distinguished gentleman 
from Wisconsin if he could tell me how many

[[Page 17884]]

years their bill in the House would extend the financial life of the 
Medicare program.
  Mr. RYAN of Wisconsin. Mr. Speaker, will the gentleman yield?
  Mr. STARK. I yield to the gentleman from Wisconsin.
  Mr. RYAN of Wisconsin. Mr. Speaker, the actuaries will not certify 
that it will extend the solvency of Medicare by any certain number of 
days.
  Mr. STARK. Mr. Speaker, I thank the gentleman for his answer and 
reclaim my time.
  Mr. Scully, the director of CMS, said last week that it would not 
extend the solvency of Medicare 1 day and indeed might shorten the 
solvency, and that is of course from the Republican director of CMS. 
Further, both GAO and MedPac, bipartisan groups, have reported to us 
that the proposed privatized plans that are in the Republican House 
bill will increase the cost to Medicare for every senior who is foolish 
enough to sign up for them. So not only does the Republican plan not 
save any money in Medicare. It is in very grave danger of costing 
Medicare money for no extra benefit. But we must not try to focus in 
merely an hour on the multitude problems that exist in the House bill.
  We are constrained in this motion to deal with portions of the bill 
that are before us, and so there are two principal elements here: one, 
to eliminate the cockamammie premium support competition, whatever one 
wants to call it, Medicare+Choice that starts at 2010 in the House-
passed bill. As I have said before, the Republican experts in Health 
and Human Services tell us it will not save any money and will probably 
reduce the solvency of the Medicare trust fund. GAO and MedPac tell us 
that these programs will create additional costs to Medicare over the 
standardized system.
  Secondly, there is no fall-back in the House plan. There is no plan 
in the House plan. There is an estimate of what we might do, but there 
is nothing in the House plan that would require a benefit to be 
provided. Nothing. At least the Senate bill has a provision to ensure 
that there will be a Medicare program to provide a drug benefit in all 
communities should there be no insurance company reckless enough to try 
to understand what the House position is and take the subsidies needed 
to encourage it to participate. So if we want to have any plan at all 
and make sure that the law provides for it, we must recede to the 
Republican part, and if we want to keep Medicare solvent, we must drop 
the House portion which has the premium support. Those two are the 
basic elements that are needed before this plan could go forward under 
any circumstances.
  Mr. TAUZIN. Mr. Speaker, I yield myself such time as I may consume.
  Let me reiterate again, the motion to instruct, to all Members of the 
House who are paying attention to this debate, basically says to the 
Senate and House conferees: accept the Senate language, take the Senate 
bill, take the Democratic vision that was rejected overwhelmingly on 
this House floor, and make it the conference report. It basically 
recedes to the Senate provisions and eliminates the basic competitive 
elements that were approved on this House floor in this historic vote 
just several weeks ago.
  My friend from Wisconsin made the case, but let me make it again. The 
argument that we need to instruct the conferees to adopt the Senate 
provision because somehow the seniors who are sickest and eldest in our 
society are going to lose Medicare in 2010 is just absolutely wrong. 
The fact is that they are not going to be driven into a small class of 
people only covered by Medicare because, as my friend points out, the 
private plans we vision coming into effect have guaranteed issue. They 
cannot refuse anybody. So if their mother, grandmother, grandfather 
wants to take one of these private plans because they offer a better, 
more efficient system of health care than does the Government plan, 
they will have a right to take it. They cannot be denied no matter how 
old or how sick they are.
  Secondly, I want to point out that the basic frame of the bill we 
passed a couple of weeks ago on the House floor said to the poorest in 
our society, those living below 135 percent of poverty that we are 
providing this new prescription drug benefit virtually free of charge. 
The only thing they pay is a copay on the drug, but the premiums are 
free. The deductibles are covered. In fact, we provide for the poorest 
in America the best benefit of any Medicare prescription drug plan that 
we had yet considered on the floor of the House until just 2 weeks ago. 
So the poorest are covered. Those who are the sickest who want to 
choose a better plan have guaranteed access to those plans under the 
bill we adopted on the House floor.
  This motion to instruct is virtually, literally saying that we should 
reverse the votes we took on the House floor; we should approve that 
Democratic vision of the government trying to do it all in a system 
that is already failing because it is beginning to go bust and a system 
that is too bureaucratic and literally too complex for even the 
providers to follow today.
  Our bill provides for bureaucratic reform, regulatory reform, 
guaranteed issue for seniors who are the sickest to choose whatever 
plan they want. And most importantly, it provides for free coverage in 
effect for all those living under poverty for this new prescription 
drug benefit program. So to argue that we have to adopt this motion to 
instruct for the oldest and the sickest and the poorest in our society 
is not quite accurate. On the contrary, the motion to instruct simply 
says go into debate with the Senate and yield in advance, give in to 
the Senate that there will be no competition in Medicare, give into the 
Senate that the government is going to be the provider of this new 
benefit and seniors will never have the kind of choices that Members of 
this body have in choosing the kind of health care plans that best suit 
them in their conditions, in their health care needs, in their 
particular problems as they find it and as they make choices in the 
future.
  Let us reject this motion to instruct just as we rejected the 
Democratic vision on the floor several weeks ago.
  Mr. Speaker, I reserve the balance of my time.
  Mr. DAVIS of Florida. Mr. Speaker, I yield 2 minutes to the 
distinguished gentleman from California (Mr. Dooley), who has been a 
leader on this issue in the House.
  Mr. DOOLEY of California. Mr. Speaker, I rise in strong support of 
this motion to instruct. And what we are really trying to do in essence 
is to have this body of the House of Representatives join with a 
bipartisan majority in the Senate that passed by 76 votes a measure to 
ensure that we would guarantee seniors a prescription drug benefit. For 
those of us who are so supportive of the Medicare fall-back provisions 
in the Senate, this is crucial to Medicare recipients. If we are going 
to stand up and be able to promise to senior citizens on Medicare 
throughout this country that there will, in fact, be a prescription 
drug benefit in Medicare, we must accept the Senate fall-back 
provisions.

                              {time}  1615

  Why should we do this? Because we have a clear example in the past, 
where we have allowed private plans to offer Medicare+Choice on the 
promise that every senior in the United States would have access to a 
Medicare+Choice plan. The private plans did not provide it.
  And the same thing will happen with the House-passed prescription 
drug plan. By offering a drug plan through private insurance, if there 
is no Medicare fallback as the Senate has, there is no guarantee, there 
is no ability that we will live up to the promise that we will provide 
a prescription drug benefit under Medicare.
  We ought to have reason to be greatly concerned, because the Wall 
Street analysts, who really did an assessment of the likelihood of 
private insurers offering this benefit, have come to the conclusion 
that it is quite unlikely, because this is a stand-alone drug policy 
that is difficult to provide and they do not think the private sector 
will stand up and provide that.
  Furthermore, the approach that the House bill is taking is one which 
tries to bribe the private insurance companies to provide this 
prescription drug

[[Page 17885]]

benefit. They come to the conclusion that if the private sector is not 
stepping up to provide this benefit that the Federal Government is 
going to step up and provide taxpayer money to further subsidize the 
private insurer to offer this benefit.
  This is not the approach we should be taking. If we are going to 
guarantee a prescription drug benefit, accept the Senate fallback 
provisions.
  Mr. RYAN of Wisconsin. Mr. Speaker, I yield 7 minutes to the 
gentlewoman from Connecticut (Mrs. Johnson), the chairwoman of the 
Subcommittee on Health of the Committee on Ways and Means.
  Mrs. JOHNSON of Connecticut. Mr. Speaker, I thank the gentleman for 
yielding me time.
  First, let us get some facts straight. Any senior watching this 
debate needs to understand that the law provides a Medicare bundle of 
benefits, period. That bundle of benefits will be provided to seniors 
through the Medicare fee-for-service program and through any plan that 
cares to participate in Medicare. But the law defines that bundle of 
benefits, and there is nothing in this bill that changes that law. So 
do not scare seniors that something is going to happen to their 
benefits. There is not any plan that can participate under this bill 
that is not obliged to offer the Medicare bundle of benefits.
  Then let us look at a statement made earlier about costs. All this 
bill does is allow the government to pay a plan the same amount per 
average senior beneficiary that we spend anyway per senior under 
Medicare. Not a penny more; not a penny less. So this is not going to 
increase Medicare spending. This is not going to explode spending.
  That is why CBO and OMB disagreed, because in the private sector, 
yes, plan costs are rising, but in this program we are only paying the 
plan precisely what it costs us for the care of an average senior under 
Medicare; no more and no less. So that is not the issue.
  There is only one issue here in terms of the plans in competition. In 
2010, something important happens. Our seniors have the right to know 
in 2010 what the plan in any area where it provides the care for 20 
percent of the seniors, what the average premiums are in those plans 
and what it is costing Medicare to provide care for the average senior 
under Medicare in those same areas. This is just a sort of ``right-to-
know'' issue. Then, when you know, you can make the choice.
  If by that time, 2010, the plans have gotten a lot more efficient and 
are either offering a lot more benefits for the same money or lower 
premiums or are inefficient and it is costing them more and Medicare 
turns out to be the more efficient provider, which many of you on the 
other side of the aisle have always claimed was true, then, Medicare's 
premiums will be lower and it will make the plans look bad. If in fact 
the plans are more efficient providers than Medicare, then the premium 
amount will be somewhat higher for the Medicare plan and seniors will 
have a choice.
  The whole process is prejudiced toward weighting the Medicare 
premiums heavier than anyone else's premiums and phasing in any 
discrepancy. But the bottom line is that nobody in the private sector 
is going to be paid any more than the average we spend for a senior 
under Medicare. So if Medicare cannot compete on those terms, I will 
tell you, the seniors have a right to know, and, under this bill, they 
will.
  Now, let us look at this fallback issue. One of the reasons our bill 
is so very efficient and the most efficient and rated by CBO as saving 
the most money for our seniors under the prescription drug program is 
because the plan's sponsors have not only the tools to manage 
prescription drugs in a cost-effective way, they have the motivation.
  I will tell you, how many times have you seen your kid in college 
have all the preparation, have good skills, but they did not care 
enough to work hard and get an A instead of a B-plus? It is not just a 
matter of tools, of intelligence, of skills, it is a matter of will, of 
desire.
  The reason CBO gives us so much higher an efficiency quota than any 
other plan is because our plans have not the big motivation we gave 
them a few years ago, we decided that was too hard for them to meet, 
but just a little motivation. They have a little reason to care whether 
or not they notice whether seniors are going to get the lowest cost 
prescription that will help them, the generic where it is appropriate, 
so on and so forth, or negotiate hard with the manufacturers to get the 
lowest prices.
  So if you do a fallback and a guarantee, what plan in their right 
mind is going to get in? They are going to wait until you get to the 
fallback so they have no risk.
  If you do not have that, two things happen. First of all, this is a 
very big market. A lot of companies cannot afford not to be plan 
sponsors. So they are going to get in, and they are going to get in 
early. Twenty-eight plans wanted to get in when the President offered 
his discount card just as a voluntary thing. Those same 28 companies 
are going to be interested when, under this bill, they get the right to 
offer a discount card. Why? Because they want to line up their 
participants so when the real plan comes along with the subsidies, the 
taxpayer subsidies, they will already have a constituency signed up in 
their program.
  But this is entirely too big a business for plan sponsors not to want 
to be part of it, so they will accept that risk.
  In our bill we guarantee not one fallback but two fallbacks: One that 
is a pure drug fallback, and one is a plan fallback. How are we going 
to get it? There are lots of way. You will have Federal Employee Health 
Benefit Plans that already contract the drug benefit with a plan 
sponsor. That plan sponsor might very well be interested in providing 
drugs-only to seniors. He is already in the district; he is already 
working with the Federal Government. That is one option.
  Other options are to entice enhanced plans and advantage plans to 
provide that. There are lots of ways to do this. But if you check off 
and you check out the responsibility for some risk in the game, then 
you will never have the price cuts, you will never have the efficiency, 
and our seniors will be the victims.
  Mr. DAVIS of Florida. Mr. Speaker, I yield 3 minutes to the 
distinguished gentleman from California (Mr. Waxman).
  Mr. WAXMAN. Mr. Speaker, I thank the gentleman for yielding me time.
  If Members listen carefully to the last speaker, the gentlewoman from 
Connecticut, I think they understand why we need this motion to 
instruct, because seniors need to know that the drug benefit is going 
to be a real one, not one that could depend on the whims of one 
insurance company or another.
  When the gentlewoman from Connecticut (Mrs. Johnson) went through her 
explanation, she had 25 ways this will all work, this company will 
compete against that company. Well, the truth of the matter is these 
companies do not want to compete with each other, and that is why the 
Republican bill gives money to the insurance companies to try to get 
them to provide the benefit, rather than put it in as a benefit in 
Medicare, which is the way Medicare pays for doctors and hospitals and 
physical therapists and occupational therapists.
  So what we are hoping to do is have the conferees come back with the 
Senate provision that says, if all this insurance business does not 
work out as the Republicans hope it will, seniors can count on a 
prescription drug benefit being there.
  The second reason why we need this instruction to the conferees is we 
do not want the Republican conferees to use the prescription drug issue 
as a stalking horse to destroy the Medicare program as seniors know it 
and like it and want it to continue. They should not use this to 
undermine and privatize the Medicare program.
  We should not adopt provisions that will force a Medicare beneficiary 
to pay more simply to stay in regular Medicare, and we should not force 
them into a choice between paying more or entering a plan that takes 
away their ability to see their own doctor.

[[Page 17886]]

  I listened with much attention to what our Republican colleagues were 
saying in this debate, and it is Orwellian: ``We are going to reform an 
outdated program that is going broke.''
  Well, this is not an outdated program. It is an excellent program. 
And it is not going broke, because every time there is a problem with 
that trust fund, simple changes can be made to adjust it so it stays 
viable. But if it is going broke, why did the Republicans give all that 
money away in tax breaks to millionaires? We should be using it to make 
sure Medicare will be there for the seniors that are on the program now 
and those who are going to be looking to it, especially the baby boom 
generation.
  The gentleman from Louisiana (Mr. Tauzin), my friend, my chairman, 
said, ``Those Democrats are asking us to take the Democratic bill.'' We 
are not asking that at all. We are asking that we take the provision in 
the Senate-passed bill, which passed by a large bipartisan majority, 
rather than the provisions that passed by one vote, mainly Republican 
votes, in the House of Representatives.
  I think that we ought to cast away these Orwellian statements, like 
``this will be like Federal employees,'' when we know it will not be 
the same. Let us instruct the conferees. Vote aye.
  Mr. TAUZIN. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, let me point out to my friend from California, the 
Committee on Energy and Commerce had a chance to look at the Senate-
passed bill. My colleagues on the other side offered it in the markup 
of the Committee on Energy and Commerce, and it was resoundingly 
rejected by the Committee on Energy and Commerce in markup.
  I notice my friend did not choose to offer the Senate-passed bill as 
the final motion on the House floor on the debate just several weeks 
ago. Instead, they chose to offer their vision instead of the Senate-
passed bill. Now you wonder why they claim the Senate-passed bill is 
such a great bill.
  Let me also point out the problem I think of this whole Medicare 
debate and why this bill was so important and why for several 
Congresses now we have passed Medicare reform and a prescription drug 
benefits bill over to the other Chamber, never to see them become law. 
The problem is, why have Medicare prescription drugs not been added to 
Medicare many, many years ago?
  Medicine changed many years ago. When Medicare first started, 
Medicare was all about taking a senior to a hospital and putting them 
in a hospital bed and caring for them in a hospital. We know that 
medicine has changed during that period of time. Medicare has not.
  The whole purpose, the whole reason we have been in this massive, 
historic debate over Medicare prescription drugs is because no one in 
past decades before this majority came around chose to modernize 
Medicare with a prescription drug benefit; and without a prescription 
drug benefit, indeed Medicare is outdated. It is not up to the task of 
taking care of senior citizens today. It is built around a premise that 
we are going to put them all in the hospital. It is not built around 
the correct premise today that many seniors depend upon prescription 
drugs to maintain their health, to prevent the need to go to the 
hospital, to maintain their condition, to prevent the spread of disease 
that has begun to inflict their bodies, indeed, to make sure that those 
diseases are kept in some sort of control.
  Prescription drugs is the way in which so many seniors depend upon 
health maintenance today. To claim that Medicare is not outdated, when 
for decades it has not been updated with a prescription drug benefit, 
is not only wrong, it is, I think, the reason we have had this great 
debate in this Chamber for the last several Congresses and the reason 
why this majority is so very proud to say that we finally passed a bill 
that really has a chance of becoming law.
  We are going to go now into a conference with the Senate and we are 
going to debate the issues of whether competition should be a part of 
this program or whether the government should be the sole provider of 
this new benefit. We are going to debate in the Senate whether the 
reforms this House agreed upon are better than the Senate-passed bill 
which was rejected in the Committee on Energy and Commerce. I think we 
will win that debate. But we cannot win it if we give up with this 
motion to instruct and say we will take the Senate bill, which was 
already rejected in the Committee on Energy and Commerce and not even 
offered on the floor by my friends on the other side when they had the 
chance to do so.
  The bottom line is this motion to instruct takes us backwards. It 
indeed says, well, Medicare, which has not been updated, which has not 
been modernized to take care of seniors' real needs today, will be the 
sole provider forever of health care needs for seniors, when we know 
that competitive choices ought to be available to them.

                              {time}  1630

  It says, we will count on the government always to be the provider of 
these new benefits, and that seniors will not have the choice of going 
to a better plan if they can find one and, in fact, if one is offered 
to them in their community. It says, even if we are putting up the cost 
of the premiums, they will not have that choice. That takes us 
backwards.
  We ought not take a backwards step today in this Chamber. We ought to 
move forward, take on the Senate and defeat the Senate bill, as we did 
in committee in the conference, and come out with a better bill that 
looks much more like the House bill passed on the House floor several 
weeks ago.
  Mr. Speaker, I reserve the balance of my time.
  Mr. DAVIS of Florida. Mr. Speaker, I yield 3 minutes to the 
distinguished gentleman from Michigan (Mr. Levin).
  Mr. LEVIN. Mr. Speaker, I am glad I was here for the remarks of the 
gentleman from Louisiana (Mr. Tauzin). We do not have to destroy 
Medicare to add a prescription drug benefit. Add prescription drugs to 
Medicare. We do not need to change Medicare to add a prescription drug 
benefit. Keep Medicare. It is not outdated. Bring it up to date, if we 
want to put it that way, by putting in a prescription drug benefit in 
Medicare. But you do not do that. You are using prescription drug 
benefits to change and destroy the Medicare system.
  The actuary says, under the Republican plan, by 2010, the likely 
increase in costs for the present Medicare will be 25 percent. You are 
not only eroding the possibility of use, you are, in the end, 
destroying Medicare as we know it. And we Democrats will be glad to go 
to the electorate in 2004 with the Republican notion that Medicare is 
outdated, I say to the gentleman from Wisconsin (Mr. Ryan) or to the 
gentleman from Louisiana (Mr. Tauzin), the notion that Medicare is 
failing, ask the seniors of this country whether it is outdated or 
whether it is failing. They are going to say, we need prescription 
drugs; give it to us.
  Our Republican colleagues do not do that, though they use it as an 
excuse for changing or destroying Medicare. What they do is have a 
prescription drug program that is an insurance program without any 
assurance whatsoever. There is no assured premium, there is no assured 
deductible, there is no assured set of drugs, and there is really no 
assured plan. There is no assured plan. The insurance carriers are 
supposed to come into this, and if they do not, what is there? There is 
an empty container of pills, I guess. That is what we are left with.
  So essentially what our Republican colleagues are doing is using the 
alleged bankruptcy of Medicare as a smoke screen to destroy it. They 
are talking about 2036 to wreck Medicare 25 years earlier. That is what 
you want us to do in the conference committee. Go ahead, try it. If you 
try it, I hope you fail. If you succeed, we Democrats are all going to 
vote no. It was not very overwhelming, I think it was one vote, was it 
not, that took you 45 extra minutes to pass your bill?
  Mr. Speaker, we will be glad to go to the country with the Republican 
plan against ours, destroying Medicare versus our determination to save 
it and make it even better.

[[Page 17887]]


  Mr. DAVIS of Florida. Mr. Speaker, I yield 4 minutes to the 
distinguished gentleman from Michigan (Mr. Dingell), the dean of the 
House and the ranking member on the House Committee on Energy and 
Commerce.
  Mr. DINGELL. Mr. Speaker, I thank the gentleman for yielding me this 
time.
  I rise in support of the motion to instruct the conferees. The motion 
is very simple. It says to my colleagues and to the conference, reject 
the motion to privatize Medicare which is included in the Republican 
plan. That is what it says. The Republicans have never liked Medicare. 
I sat in the chair and I watched them with the dirty looks they had on 
their faces when we passed the legislation the first time. They have 
not changed since. Mr. Armey and Mr. Gingrich and now the gentleman 
from California (Mr. Thomas), the chairman of the Committee on Ways and 
Means, have pointed out that that is their purpose, to kill Medicare as 
we know it now. It is my hope that this motion to instruct will prevent 
that kind of unfortunate event from taking place.
  The Democrats oppose very strongly leaving seniors naked to the magic 
of the marketplace. The magic my Republican colleagues would apply to 
the senior citizens is to see to it that their benefits under Medicare 
would magically disappear and to see the magical disappearance of huge 
sums of Federal money into the pockets of the insurance companies who 
would be the principal beneficiaries of this legislation as opposed to 
the senior citizens.
  We already know that these private plans do not work. They cost more, 
some 13.2 percent according to a GAO study which was made. Four hundred 
thousand seniors got dumped last year from these plans, and it is 
interesting to note that only a small percentage of people in the rural 
areas have these kinds of plans available to them.
  Now, what will happen if this takes place? Under this privatized 
Medicare, seniors and taxpayers are going to pay more out of their own 
pockets. The life of the Medicare trust fund is not going to be 
expended; the Republicans have already agreed to that. The 
privatization provisions of H.R. 1 that begin in 2010 would give the 
Medicare beneficiaries a fixed voucher which would magically shrink as 
time passes, and the insurance lobby and the HMOs would get massive 
influxes of government cash and unlimited subsidies which are nowhere 
defined in the legislation except to say that they shall be sufficient 
to ease people into these plans to cause them to do it.
  Privatization of Medicare would take away serious and important 
rights from seniors today. Seniors today get access to their doctor, 
hospital, home health care agency, or nursing home facility guaranteed. 
That will not happen under this legislation. Under this privatized 
Medicare model, insurance plans would determine which doctors seniors 
could see and what drugs they would take. Insurance companies would 
determine which benefits and treatments would be covered and how much 
the seniors would pay. All of this would change year by year at the 
whim of people who are administering this legislation at this 
particular time, who not only support the legislation but who do not 
like Medicare and who want a change.
  America's seniors are being visited with bait and switch. The bait is 
they say they are going to give some kind of prescription 
pharmaceutical benefits. That is mostly hooey, and there is not much in 
the way of pharmaceutical benefits here. But they would be called upon, 
or largely forced, to switch from Medicare as we now know it, and they 
would find themselves then in the cold-hearted hands of the same 
miserable HMOs that have been denying them the rights that they need 
and that they want and that triggered this House in responding a year 
ago to putting forward a Patients' Bill of Rights to try and afford 
them some rights to appeal, some rights to be protected and some rights 
to control their own treatment. That is what is at stake here.
  So when my colleagues vote on this matter, remember, my colleagues 
are voting to protect the rights of senior citizens. They are voting to 
prevent privatization of Medicare, an outrage that should not be 
permitted by this Congress.
  Mr. TAUZIN. Mr. Speaker, I yield myself just 1 minute to respond to 
my good friend.
  First of all, I am not sure who was in this Chamber way back when 
Medicare was first adopted by the House. I assume my friend, the dean 
of the House, was here, but I do not know of anybody else who was who 
currently serves in the Chamber. I can tell my colleagues there were no 
only dirty looks on this side when it comes to Medicare. We support 
Medicare, believe in it.
  My mother depends upon it. As I have often said on this House floor, 
she is a three-time cancer survivor who loves Medicare. That is why 
when we wrote this bill we preserved her opportunity to remain in fee-
for-service Medicare if she chooses. But I want to give her something 
else, and that is why this bill provides for competitive choices for 
her so that she can choose a premium-based insurance program if it is 
better for her. If she wants to stay under Medicare, she can. In either 
case, she gets the Medicare prescription drug benefit that was not 
available to her all of these years until this majority came forward 
and provided one in this bill.
  Reject this motion to instruct. Let us go to the conference with the 
Senate and let us be hopeful and positive that we can negotiate with 
the Senate a version that will pass the House and Senate and get signed 
into law.
  Seniors understand. They are tired of waiting. They are tired of this 
debate. They are ready for a law that gives them a prescription drug 
benefit, and so is my mother.
  Mr. DAVIS of Florida. Mr. Speaker, I yield 2 minutes to the 
distinguished gentleman from Wisconsin (Mr. Kleczka).
  Mr. KLECZKA. Mr. Speaker, if the Republicans love Medicare so much, 
why did they not put this drug benefit in the Medicare program like the 
hospitalization program and a physician program? Unless that is called 
tough love. Because under the bill, seniors, grandma and grandpa have 
to go out and buy a policy outside of Medicare.
  Mr. Speaker, there has been a lot of talk about if we pass this 
motion we are going to bankrupt the program. There is a lot of talk 
about this is the vision for Medicare. Well, let me remind my 
colleagues that this bill passed by a vote of 215 to 214, one slim 
vote. In fact, the rollcall was held open for almost an hour so the 
Republican leadership could twist some arms around here, make some 
promises, and finally get the bill to pass.
  What we are asking today is to change two sections of this 700-page 
bill. Two years ago, we had a hearing on this bill before the Committee 
on Ways and Means, and before the hearing were some insurance 
association people and we asked them point-blank, do you think your 
members are going to sell a drug-only policy to the seniors of the 
country? And they said, are you nuts? Before we get the premium in the 
bank from the policy, the senior who just bought the policy will have 
filed three claims. There is no way it is going to work.
  So what we are asking for today is for a fallback position. If you 
are so sure it is going to work, the fallback position will never be in 
effect. But if, in fact, you are wrong, what we are saying then is, 
then let us have the Medicare program provide grandma the drug benefit.
  But that is not what is going on here. We are told that grandma 
should go and get a private HMO. I come from Milwaukee, Wisconsin. We 
have four companies selling those HMOs. The last one is going bankrupt 
and will be out of business shortly. In fact, over 2.5 million seniors 
in this country were kicked out of their HMO policies.
  It is a failed experiment. This Republican bill starts the experiment 
again, even though we know it does not work.
  Mr. RYAN of Wisconsin. Mr. Speaker, I yield myself such time as I may 
consume.
  I would like to address a few of the points that were made here on 
the floor. The gentleman from California, I think he has left the 
floor, said, Medicare is really not going broke. That is

[[Page 17888]]

a new one to me. Because, Mr. Speaker, if we take a look at Medicare, 
the actuaries, I am not talking about the Congressional Budget Office 
even, but the actuaries are telling us, Medicare has a $13.2 trillion 
liability today. Today's Medicare program is going insolvent in 10 
years, before doing anything, before adding any benefit.
  For example, if we had to actually pass legislation right here 
through taxes and we wanted to make Medicare solvent for the next 
generation, today we would have to raise Medicare FICA taxes by 80 
percent. An 80 percent FICA tax hike is what would be required to fix 
this unfunded liability. Maybe that is, after all, what some on the 
other side are seeking to achieve.
  What we are trying to achieve here, Mr. Speaker, is to improve 
Medicare today by making it more comprehensive for today's seniors but 
also to save it for that baby boom generation. This motion to instruct 
will not save Medicare. It will bankrupt Medicare.
  So when we take a look at the reforms we have in this bill that the 
other side is targeting to try and jettison from this product, what we 
are simply trying to do is add choices. Give seniors more choices so 
they, like us in Congress, Federal workers can choose who their 
provider is. If they like what they have, if they have traditional 
Medicare and they like it and they have their drugs paid for by their 
employer or their supplemental paid for by someone else, great. They 
are the lucky ones, wonderful. They can keep it.
  But if like many of the constituents I have in Wisconsin, they have 
to dig deep into their pockets and buy a very costly supplemental, then 
they have to pay for their drugs out-of-pocket. Medicare is outdated 
for them. It is not comprehensive.

                              {time}  1645

  We want to make it comprehensive. And by giving seniors more choices, 
that active choice drives competition because providers, all of those 
providers who are regulated and overseen by Medicare, who have to give 
a comprehensive benefit regulated by Medicare, those providers 
competing against each other for seniors' business will bring 
competition to the system and competition to the system will bring down 
costs over the long run. And the only way to make Medicare solvent for 
the baby boom generation is to bring down costs over the long run, 
otherwise we will have to raise taxes or we will have to cut benefits. 
That is what we want to avoid.
  Now, this is not Medicare+Choice. One of the speakers, the gentleman 
from Michigan, said this is the same old problem again, like 
Medicare+Choice. This is anything but Medicare+Choice. This is much 
like what Federal employees have, and that is the title of this bill 
that the motion to instruct seeks to remove. And the concept basically 
goes like this: today, under Medicare, if you want to get reimbursed as 
a provider, you have got to have an operation, a procedure. Medicare 
pays providers to operate on people, to have procedures. But if you 
give, as a provider, a person preventative medicine, disease 
management, keep them healthy, have better results, you do not get 
paid. So the incentive structure is really bizarre.
  What we want to do is reward providers for keeping people healthy, 
for giving them preventative medicine, for giving them disease 
management, for keeping them healthy, out of the hospital, out of the 
operating room. And guess what? Not only is that a healthier, happier 
life, it saves money; and that is what we are trying to do over the 
long run so we can modernize this program, give seniors the same 
options and choices like we as Members of Congress have; and if we can 
accomplish that, we can save money over the long run and save this very 
important, very vital program for the baby boom generation when they 
retire.
  Mr. Speaker, I yield back the balance of my time.
  Mr. DAVIS of Florida. Mr. Speaker, I yield 3 minutes to the gentleman 
from New Jersey (Mr. Pallone).
  Mr. PALLONE. Mr. Speaker, I was amazed to listen to the gentleman 
from Wisconsin (Mr. Ryan) on three points.
  First of all, he said that Medicare is going broke. Well, Medicare is 
not going broke. It is doing fine. But the only reason it is losing 
money is because of Republican policies. If you remember in the last 
years of the Clinton administration, the day when Medicare might go 
insolvent kept going further and further away because we were paying 
down the debt. But once the Republicans came in and the Republican 
President came into power, all of the sudden with all of these tax cuts 
and all of this borrowing to pay for the debt, which is now something 
like $500 billion, yes, they are taking money away from the Medicare 
trust fund, and so that day of reckoning gets closer and closer.
  You have caused the problem with the solvency of Medicare because of 
your tax policies as Republicans.
  Then you talked about Federal employees and Members of Congress. 
Well, I was here last year when the gentleman from Florida (Mr. Davis) 
got up on the floor and demanded that we pass a resolution that said 
that Federal employees and Members of Congress would not have to enter 
into this Republican Medicare prescription drug program that you are 
proposing because the fact of the matter is it is not as generous, what 
you are proposing is not as generous as what Members of Congress and 
Federal employees have, and that is why you wanted to make sure that 
they were insulated and would not be part of the program.
  Finally, you said you wanted to keep costs down. Well, the easiest 
way to keep costs down is to allow, as the Senate bill does, to 
negotiate drug prices so that the Secretary of Health and Human 
Services can negotiate on behalf of all the seniors and lower drug 
costs. But you do not want to do that. You put a noninterference clause 
in the House bill so he cannot negotiate and lower prices. So do not 
tell me about saving money. You are not saving money. You are not 
saving the program. You are killing the program.
  And I listened also in amazement to the statements that were made by 
my chairman, who I respect a great deal, the chairman of the Committee 
on Energy and Commerce. But the fact of the matter is you know if we do 
not go to conference and adopt significant portions of this Senate 
bill, we will not have a bill. The President will not have a bill to 
sign. So when we say that we want a drug benefit and we want to make 
sure there is a fall-back so if there is no HMO in the area or no two 
HMOs in the area, that we guarantee that there is a drug benefit, you 
know that if we do not put that in the bill, we will never get the 
votes in the Senate to pass the bill and there will not be a drug 
benefit.
  You know also that if we have this House version that says that by 
2010 we are going to get out of Medicare, we are going to have a 
voucher and that the traditional Medicare is going to cost more, that 
the Senators will never pass this bill. It will never go to the 
President. So what we are trying to say here with this motion to 
instruct is, if you really want to continue the Medicare program, do 
not have a voucher, do not kill the program and force people to pay 
more for traditional Medicare. And if you really want a drug benefit, 
make sure there is a fall-back to traditional Medicare and you can get 
a drug benefit. Because you know darn well that if in a given area 
there is not the HMO or the private plan that is going to be offered, 
then the person will not get the drug benefit.
  But even more than that, practically speaking, if you do not go a 
certain way in the direction of the Senate bill and compromise a 
little, because you know that passed overwhelmingly, we will never have 
a bill that goes to the President. So be realistic and pass this motion 
to instruct.
  Mr. TAUZIN. Mr. Speaker, I yield 2 minutes to the distinguished 
gentleman from Oregon (Mr. Walden).
  Mr. WALDEN of Oregon. Mr. Speaker, I thank the gentleman for yielding 
me time.
  For 3 years the House Republicans have done what the Democrats failed 
to do for the 30 years they were in the majority and that is pass 
prescription drug coverage for seniors. And every

[[Page 17889]]

time we have moved to pass legislation, our colleagues and friends on 
the other side of the aisle have done their best to throw up road 
blocks and Medi-scare, complete this year to buying TV ads already, 
attacking members of the committee who voted for prescription drug 
coverage. They want to make it a campaign issue, and that is wrong.
  My parents until their death relied upon Medicare, and they paid for 
their prescription drugs out of their own pockets because their plan 
did not cover it. My in-laws and others in my district need this help, 
and they need it now.
  Our budget sets aside $400 billion, $400 billion to help provide 
prescription drug coverage for seniors. The last time the Democrats put 
forward a budget, they reserved 360-some billion; $400 billion is what 
we are putting forward over the next 10 years.
  Their plan, for which they did not even have a budget, would cost a 
trillion dollars. Now, on the one hand they will say Medicare is not 
going insolvent, and yet my colleague from New Jersey just blamed 
Republicans for whatever insolvency there may be. You cannot have it 
both ways.
  The way we want it is not to negotiate with ourselves. We want to 
negotiate with the Senate to come out with the best package possible to 
make sure that every senior in America has access to affordable 
prescription drug coverage, and coverage that we can afford to continue 
for the length of Medicare, which should be forever.
  We have got to get this right. We have to do it right. We have to use 
the competitive forces of the marketplace to make sure that we squeeze 
out the excesses so that we can extend the benefit, especially to those 
who need it most. And our legislation does that. It targets the 
greatest relief, the greatest help to the seniors most in need. And 
representing the 12th poorest district in this country, I will tell 
you, I am proud of this bill. I am proud of what it will do for our 
low-income seniors, and I am proud of what it will do for Medicare and 
America.
  Mr. DAVIS of Florida. Mr. Speaker, I yield 1 minute to the gentleman 
from Ohio (Mr. Kucinich).
  Mr. KUCINICH. Mr. Speaker, seniors must have a guaranteed drug 
coverage plan. Has the private market through Medicare+Choice plans 
been able to do this? On the contrary.
  The privatization experiment with Medicare+Choice has shown that 
privatization is a failure. Privatized health care works by limiting 
coverage to healthy people and shifting more costs onto patients. 
Medicare HMOs have done just that by raising premiums and co-payments 
and dropping patients every year. Last year, the Medicare+Choice 
program eliminated coverage for half a million seniors. For those few 
seniors who still have coverage, they pay more and they get less.
  This experience should teach Congress that relying solely on the 
private market is a losing strategy for seniors. Only Medicare has been 
able to provide reliable, stable coverage. Only Medicare has been able 
to minimize excess waste and overhead in order to keep costs down. To 
compare, private plans have 15 percent administrative costs compared to 
2 percent for Medicare. A GAO report has confirmed that Medicare HMOs 
are responsible for increasing Medicare costs.
  Mr. DAVIS of Florida. Mr. Speaker, how much time remains on each 
side?
  The SPEAKER pro tempore (Mr. Culberson). The gentleman from Florida 
(Mr. Davis) has 2\1/2\ minutes remaining. The gentleman from Louisiana 
(Mr. Tauzin) has 1 minute remaining.
  Mr. DAVIS of Florida. Mr. Speaker, I yield 2 minutes to the 
distinguished gentlewoman from Connecticut (Ms. DeLauro).
  Ms. DeLAURO. Mr. Speaker, the legislation that passed this body a few 
weeks ago will essentially turn the Medicare program over to private 
health insurance and the HMOs, the very organizations that have dropped 
52 percent of the Medicare enrollees in my State of Connecticut over 
the last 4 years. It will do so by requiring fee-for-service Medicare 
to compete against private plans to offer doctor and hospital coverage 
by the year 2010.
  You know the phrase ``buyer beware''? Let me just say, seniors 
beware. There has been no HMO or private health insurer who has come 
forward to date since the passage of this legislation to say they want 
to do this. And they do not want to do it. Why? Because they do not 
believe that it is going to be profitable to them. And what they want 
from the Federal Government is a guarantee that they will get subsidies 
from the Federal Government to make sure that their profit margins are 
what they want.
  The goal of the Republican bill is simple: lure beneficiaries away 
from the program. Leave Medicare to care for only the sickest seniors. 
Drive up the program's costs and effectively turn Medicare into a 
program that could be cut or even eliminated.
  This is the beginning of the end of Medicare. It will turn it into a 
voucher program. And you know, down the road, if seniors decide to 
choose the Medicare program versus a private program, they will be 
penalized by paying a higher premium. That is the choice that they are 
going to have. It is not the Medicare in which my 89-year-old mother is 
enrolled today, one that has provided quality health care and a measure 
of economic security to hundreds of millions of seniors over the past 4 
decades.
  Let us not privatize Medicare. Let us strengthen it so that, in fact, 
we can prepare for the retirement of the baby boom generation. Let us 
provide them a real benefit that offers seniors a reliable prescription 
drug benefit that does not change from ZIP code to ZIP code the way 
this motion to instruction wants to engage in.
  Let me tell you that the Medicare prescription drug proposal that has 
been proposed on the other side does not begin until 2006, pegs their 
costs to the increased cost of prescription drugs, and does not allow 
any government to drive down the costs of prescription drugs.
  It is wrong. Let us pass this motion to instruct and do something 
that will be beneficial for seniors.
  The SPEAKER pro tempore. The gentleman from Louisiana (Mr. Tauzin) 
has 1 minute remaining. The gentleman from Florida (Mr. Davis) has 30 
seconds remaining.
  Mr. TAUZIN. Mr. Speaker, I yield myself the final minute on our side.
  Mr. Speaker, I think it is important to point out that while the bill 
we passed, passed by only one vote, without the nine brave Democratic 
votes who came with us 2 weeks ago to vote for a Medicare prescription 
drug reform bill to the Senate, that bill would not have passed. I want 
to thank those nine brave Democrats for standing tall against a lot of 
pressure to do the right thing.
  Secondly, I want to point out that the Democratic vision that is 
literally represented by this motion to instruct was defeated when the 
substitute was offered on the House floor by 175 for to 255 votes 
against. It was soundly defeated. This vision of a government does it 
all. The government provides the benefit; and no one else, no 
competition, no reform was defeated.
  Third, I want to point out that these are not my numbers. These are 
the actuaries who work for Medicare; the Medicare actuaries tell us by 
the year 2016 Medicare starts paying out more money than it is taking 
in. And the actual date on which insolvency occurs is 2026. That is 
what we are up against.
  Defeat this motion to instruct. It is an old vision that was defeated 
on the House floor. Support us going into conference with our new 
vision, which is a Medicare guaranteed benefit, fee-for-service for 
seniors whether they stay in Medicare or choose one of these new 
options. You defeat the new options, and you defeat those vital reforms 
as we go in to conference. Vote ``no'' on this motion to instruct.
  Mr. DAVIS of Florida. Mr. Speaker, the only defense in support of a 
voucher was a misstatement on the other side that there is a guaranteed 
issue that even seniors with health problems over 65 are guaranteed HMO 
coverage. That is a false statement.
  There is no guarantee with respect to the level of coverage. There is 
no guarantee with respect to the price or affordability.

[[Page 17890]]


  Mr. RYAN of Wisconsin. If the gentleman will yield, on page 182 of 
the bill.
  Mr. DAVIS of Florida. Mr. Speaker, I reclaim my time.

                              {time}  1700

  What we are left with is any senior over 65 that has a health problem 
at all under the statement of the chief actuarial of Medicare, this is 
not a Democratic or Republican statement, can experience up to a 25 
percent increase in price and is left with a voucher in no way to 
afford traditional fee-for-service Medicare.
  There are seniors in this country, they are not just Democrats, 
Republicans or Independents, they are senior citizens. They have 
outlived their good health, their savings. They tried to plan 
responsibly for their retirement. Unless we adopt the motion to 
instruct and defeat this voucher, we will leave these seniors in the 
cold.
  I urge adoption of the motion to instruct.
  The SPEAKER pro tempore (Mr. Culberson). Without objection, the 
previous question is ordered on the motion to instruct.
  There was no objection.
  The SPEAKER pro tempore. The question is on the motion to instruct 
offered by the gentleman from Tennessee (Mr. Davis).
  The question was taken; and the Speaker pro tempore announced that 
the noes appeared to have it.
  Mr. DAVIS of Florida. Mr. Speaker, on that I demand the yeas and 
nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to clause 8 of rule XX, further 
proceedings on this are postponed.

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