[Congressional Record (Bound Edition), Volume 149 (2003), Part 16]
[Senate]
[Pages 21676-21677]
[From the U.S. Government Publishing Office, www.gpo.gov]




                                MEDICARE

  Mr. NELSON of Florida. Mr. President, I wish to talk about cancer as 
well as finalize details of this appropriations bill which includes 
more than $5 billion for the Cancer Institute. I am reminded of a 
related issue that threatens cancer care in this country. I am 
extremely concerned with several provisions in the Medicare 
prescription drug coverage bill already passed by the Senate and the 
House.
  As we know, when the Medicare Program was first enacted, much of the 
care provided to patients was delivered in the hospital inpatient 
setting. That was 1965 when Medicare was enacted.
  Over the course of the next 37 years, as science and medicine has 
progressed, patient care has shifted dramatically to the physician's 
office. Perhaps nowhere has this shift been more prevalent than in 
cancer care. Today, over 80 percent of all care is delivered in 
physicians' offices, and that is cancer care. This is due in large part 
to the introduction of the new outpatient drugs which have 
significantly reduced the need for inpatient hospital care for cancer 
patients.
  If Congress was designing the Medicare Program today, in 2003, 
instead of in 1965, there is little doubt that outpatient prescription 
drug coverage would be a central part of that program. That is a lot of 
the argument we made when we passed the prescription drug benefit, a 
bill that passed earlier in the summer.
  The current Medicare system, however, only provides limited coverage 
for outpatient drugs. Clearly, that needs to change, especially for 
cancer care.
  Medicare does provide coverage for many cancer drugs, such as 
chemotherapeutic agents and supportive drugs. In addition, Medicare 
provides reimbursement to physician practices for professional services 
associated with the administration of those covered drugs under 
Medicare. As has been noted by the General Accounting Office and the 
HHS inspector general, the current system for reimbursement of cancer 
care is seriously flawed.
  Medicare payments for cancer drugs frequently exceed the cost to the 
providers, and at the same time, however, Medicare reimbursement for 
drug administration covers only a small fraction of the actual cost of 
providing quality cancer care.
  It is estimated that the current Medicare reimbursement only covers 
about 20 percent of the actual practice expenses.
  I have heard from many of Florida's 775 oncologists, and they have 
told me

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that the overpayment for covered drugs has helped make up for the 
significant underpayment in practice expenses incurred by physicians' 
offices. This includes expenses for oncology nurses, pharmacists, case 
managers, medical equipment, and other services and supplies involved 
in providing cancer patients with the highest quality of care.
  The goal for reform ought to be simple. Medicare should neither 
overpay nor underpay for drugs and related expenses. Unfortunately, the 
legislation passed by both Houses does not achieve the balanced reform 
that I think all of us agree is needed.
  Instead, the legislation passed by the Senate on prescription drugs 
calls for a cut of $16 billion over the next 10 years. The House-passed 
bill is no better, and it includes a cut of over $13 billion from the 
current Medicare reimbursement levels.
  The consequences from cuts of this magnitude are going to be 
dramatic, including the closure of satellite clinics in rural areas, 
forcing cancer patients to drive hundreds of miles for treatments. 
Oncology nurses, pharmacists, social workers, and the like will lose 
their jobs. Clinical research in community-based clinics, where 
approximately 60 percent of all cancer clinical trials are conducted 
today, are going to be brought to a halt. Many doctors will be forced 
to significantly reduce the number of Medicare cancer patients they 
treat, while others will stop accepting new cancer patients altogether.
  Patients are going to be forced to seek treatment elsewhere, but 
hospitals have indicated they have neither the physical capacity nor 
the nursing staff to treat a large volume of new cancer patients. In 
fact, a recent survey conducted by the American Society of Clinical 
Oncology found that if the proposed cuts in Medicare reimbursement are 
enacted into law, 73 percent of physicians surveyed would send 
chemotherapy patients to a hospital instead of treating them in the 
office. Fifty-three percent would limit the number of Medicare patients 
they treat, and nearly one in five indicated they would stop treating 
Medicare patients entirely.
  If that happens, it is exactly the opposite of what we ought to be 
doing, because a person can keep their costs a lot lower if they are 
doing this treatment in a doctor's office instead of doing it in the 
hospital.
  I am sure all of us unanimously would agree that we cannot let this 
happen, especially at a time when such tremendous progress is being 
made in cancer research and treatment. Yet it is happening under our 
eyes. It happened in this bill that we passed.
  According to the statistics from the American Cancer Society, 
approximately 1.3 million new cancer cases will be diagnosed this year, 
and 60 percent of those cases will be among Medicare beneficiaries.
  In my home State, more than a million people will be told over the 
next decade that they have been diagnosed with cancer. If the $16 
billion of cuts in cancer care that have been proposed are enacted into 
law, this would mean a $1.6 billion reduction in Medicare cancer care 
reimbursement in my State of Florida alone. This cut is second only to 
the cut in California, which would be hit with a $1.7 billion cut.
  Let's face it, cuts of this magnitude are not sustainable. This is 
just Medicare reimbursement that we are talking about because private 
payers frequently follow the Medicare payment formulas. In the private 
sector, those cuts will be even more dramatic. The cumulative effect of 
all of these proposed Medicare cuts, combined with the private payer 
cuts that will undoubtedly follow, will have a very serious impact on 
the ability of cancer patients to receive the care they need in order 
to survive.
  I remind everybody that there is not one among us who has not been 
touched by cancer in some way, if not among ourselves, among our loved 
ones and our friends. We have the greatest system of cancer care in the 
world. Patients are living longer. They are living productive lives 
thanks to the scientific advances and the dedicated men and women who 
provide the high-quality care in convenient and cost-effective 
community clinics throughout this country. People from around the world 
travel to America for cancer care.
  My colleagues ought to see the Latin American market, how it comes to 
Florida for that care, because they know we have the latest 
technologies, the best doctors, the most compassionate nurses, and the 
best trained medical workforce in the world. That is why people come to 
the United States for their health care, especially cancer care.
  Advances in cancer research have led to the development of new 
therapies that are more targeted, and those therapies are less toxic. 
As a result, cancer mortality rates in the U.S. have been declining. We 
are winning this war on cancer. Now is not the time to call for a 
retreat, a surrender, by slashing Medicare payments.
  The conference committee on the Medicare prescription drug bill is 
meeting right now, and all across this land people who care about what 
I am trying to articulate ought to be sending their ideas, their 
requests, and their pleas, along with their prayers, to that conference 
committee and let them know what they think. We have a saying in the 
South: Let them have an earful.
  While many issues still have to be ironed out in that conference 
committee, it is putting the Congress one step closer to enacting the 
most sweeping reform of the Medicare Program since its inception.
  In closing, I urge my colleagues to continue the discussions with the 
cancer care community to develop a proposal that will preserve patient 
access to community-based cancer care. Cancer patients and their 
families are counting on Congress to preserve high-quality community-
based cancer care. This is one of the most serious issues we are 
facing, and when we make tradeoffs because of budgetary limitations, as 
we did on the floor of this Senate in the consideration of the Medicare 
prescription drug benefit, where we traded cuts in cancer care for 
increases in rural health care, that is a tradeoff that we should not 
have to make. We ought to be able to do both. The consequences, if we 
allow it to stand, are going to be extremely great.
  I yield the floor.

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