[Congressional Record (Bound Edition), Volume 149 (2003), Part 4]
[Senate]
[Pages 4990-4992]
[From the U.S. Government Publishing Office, www.gpo.gov]




                                MEDICARE

  Ms. STABENOW. Mr. President, I rise today to speak about the plan the 
White House is unveiling today concerning Medicare and prescription 
drugs. I am surprised and dismayed to see we have basically the same 
old thing being proposed once again by the administration. While we 
hear the right words about wanting to make sure every senior has access 
to prescription drugs, one more time we are seeing the President say 
one thing and do another.
  In January after the State of the Union, many were dismayed to hear 
that the President's proposal for Medicare prescription drug coverage 
would basically be one that would say to a senior, if you stay in 
traditional Medicare, Medicare that has worked for you every day, every 
year, guaranteed access to your doctor, guarantee that you had health 
care available to you--if you chose to stay in Medicare, which has been 
working since 1965, you would not get any assistance with your critical 
prescription drug costs; you would have to go into a private sector 
HMO.
  Now we hear that is not really the plan, that is not really what was 
going to happen. Last week, Secretary Thompson came to the Budget 
Committee. I questioned him about that. No, there was no intention to 
say that seniors would have to go into a private sector HMO in order to 
be able to get critical help; everyone would have help.
  Today we find out that, again, that is really what they are talking 
about: Small change, cosmetic change, to attempt to address concerns 
that have been raised on both sides of the aisle by very prestigious 
Members of this body who are concerned that every senior has Medicare, 
every senior has the right to make sure that plan covers prescription 
drugs and gives them help with their medicine.
  What do we see? We see a proposal that says if you stay in the plan 
that works for every senior--40 million people in Medicare now--if you 
stay in that plan, we will give you a discount card which the GAO says 
does not nearly produce the savings spoken about frequently. Less than 
10 percent savings. You have to make sure you are going to the right 
medicine, have the right medicine, and heaven forbid if you need more 
than one kind of medicine from more than one company because then it 
does not work so well. But we will give you a discount card. Then maybe 
down the road a number of years, we will help you, if you have a very 
large prescription drug bill, with what is called catastrophic help.
  To add insult to injury, the discount card is being proposed to take 
effect in 2004--not even immediately, when we know there are discount 
cards available on the market now. The major companies all have 
discount cards. The President is saying the discounts card will not be 
available until 2004 and the rest of the plan, not until 2006.
  The first thing I say today--and I know my colleagues hear the same 
thing I hear--seniors believe they have waited long enough. We have 
talked about this issue. I have been involved in efforts to get 
prescription drug coverage under Medicare since I was in the House of 
Representatives. Certainly seniors have been speaking about that long 
before. They want us to provide help now, and they are not interested 
in something that forces them into another kind of plan, a private 
sector plan. They want Medicare to simply cover prescription drugs.
  Frequently we hear used the words: Choice. This kind of plan will 
provide more choices for our seniors. If we have more private sector 
HMOs, there are more choices.
  What I hear from my great State of Michigan is not that people want 
more, different kinds of complicated insurance plans to figure out. 
That is not the choice they are asking for. The choice they are asking 
for is the choice to go to the doctor they choose, their own doctor, 
who can prescribe the medicine they need. That is the choice they want. 
It is very clear. The seniors of America have already spoken on this 
issue with their feet. The majority when given the choice of going to 
an HMO under Medicare+Choice, said no and stayed in traditional 
Medicare. That is the reality. Seniors were given a choice about 
whether or not to keep the stable, reliable, Medicare plan that has 
been in place since 1965 or go to a private sector HMO. They stayed 
with Medicare.
  Now the President is saying: Even though you made that choice, we are 
going to give you another choice, and we will penalize you this time. 
Last time, you could choose, stay in traditional Medicare or do Medi-
care+Choice; this time, because we did not like the choice you made, we 
are going to say you cannot get comprehensive help if you stay in 
traditional Medicare. You have to go into a private sector HMO in order 
to get the help you need and the help you deserve.
  When looking at this issue about the private sector HMO approach or 
Medicare+Choice, we also have a situation where in 12 States there are 
no private HMO options under Medicare. In my home State, where people 
did sign up--and I have said before, my mother signed up and had a 
positive experience under Medicare+Choice with her HMO. But the HMO 
dropped Medicare beneficiaries. She got dropped a couple of years ago 
because they believed it was not profitable because of concerns about 
reimbursements. So now in Michigan only 2 percent of those who are 
receiving Medicare are in an HMO, and they are not enrolling any new 
people. You had better live in the eastern part of the State of 
Michigan or you do not have that as a choice.

[[Page 4991]]

  If one resides in the great city of Marquette or Iron Mountain in the 
UP or Sault Sainte Marie or on the west side of the State where the 
President visited after the State of the Union, in Grand Rapids, MI, to 
talk about Medicare, in that community where the President visited, we 
certainly welcome always having a President come to town, but no one 
listening at that speech would have access to a private sector HMO 
under Medicare. So we have a situation where it is too little, it is 
too late, and this is an effort basically to force seniors into an 
approach the majority of them have already said they do not want.
  Another piece I am very concerned about is that as we look at 
prescription drug coverage, it is not just about comprehensive care 
under Medicare; it is about lowering prices. It is about lowering 
prices for everyone: For the business that is paying for prescription 
drug coverage, that has seen their health care premiums skyrocket, 
businesses large and small; for families, workers who are affected, as 
well as for seniors. I am disturbed that this plan does not say 
anything about more competition to lower prices. In fact, while seniors 
are waiting until 2004 for a discount card that will have very little 
effect in lowering their prices--while they are waiting, the fastest 
way the President could join with us to lower prices would be to simply 
drop the barrier that stops Americans from going to Canada to get 
American-made, American-subsidized prescription drugs at half the 
price.
  If we did that today, tomorrow we could drop prices, many of them in 
half, and in some cases even more. That is a proposal that passed the 
Senate last summer on a strong bipartisan vote. I am hopeful we will 
see that happen again this year; that we will once again say we need to 
drop that barrier.
  We are in a free trade economy. We have agreements with Canada. Their 
health care system, in terms of quality controls and the other issues 
of safety we are concerned about, is very similar to those of our 
country. If we want, we can say to seniors, you do not have to get on a 
bus now and go to a Canadian doctor or Canadian pharmacy to get an 
American drug at half the price; we will open the border and get you 
that right here at home.
  That is the fastest way to lower prices. The next fastest way is to 
close loopholes that allow brand name drug companies to stop 
unadvertised brands from going on the market--often called generic 
drugs. It is the same drug, frequently, the same formula. The 
difference is we are not seeing it on television every other minute. We 
are seeing generic drugs come onto the market that are available and in 
some cases can lower prices up to 50 percent, or we have seen prices 
lowered up to 70 percent as a result of the use of generics. There is 
no mention of that here.
  I commend the President in coming forward with a proposal regarding 
generic drugs that has made some inroads. We appreciate it. They have 
gone about half the way. Now we would call upon the President to join 
with us to go all the way to address the issue on generic drugs, and to 
work with us to pass the bill that has been introduced by my colleagues 
Senator McCain and Senator Schumer, again a bipartisan bill, that would 
in fact put more competition into the system and lower prices--not only 
lower prices for our seniors under Medicare but lower prices for those 
covered in the private sector, thus bringing down the costs to 
businesses large and small.
  I am disappointed we do not have in this proposal an effort to 
support our States, our Governors--Democrats and Republicans--who 
indicated last week that health care costs and Medicaid costs are a top 
priority for them. It is a large part of their budgets as they are 
struggling under a weakened economy. Many States, including my own 
Michigan, have been innovative, want to come together with other States 
to do bulk purchasing of prescription drugs in order to get discounts, 
bigger discounts than you can get through a discount card, to lower 
prices. We have seen States such as Maine and Vermont that have come 
forward with innovative plans to lower prices, each time being 
challenged by the brand name industry. In every situation the industry 
is suing or lobbying or doing something to stop competition in 
innovation in lower prices.
  We had a plan as well. Part of our bill, S. 812, which we passed last 
summer, was a bill to address more generic drugs, at the same time 
opening the border with Canada, and also supporting the States that 
have been innovative in coming forward to try to lower prices for their 
citizens. There is no mention of that in this plan as well.
  So we do not see anything addressing any of those issues. We see 
nothing in here addressing the concerns that there is more advertising 
money now spent by companies than research money--2\1/2\ times more 
being spent on advertising of the brand name drugs than on researching 
of new cures. We are seeing that drive up the costs as well, the 
explosion in sales and marketing and advertising.
  Also, there is no mention of the fact that we are paying for a system 
where the majority of patents now are not for new breakthrough drugs 
but for what are called ``me too'' drugs. Basically 65 percent of 
patents in recent years are patents for drugs that have very little 
change in health value but just extend the patent so generics cannot go 
on the market and there is less competition.
  There are so many ways we can be working together to lower prices--
for employers to create a situation where employees are not being asked 
to take pay freezes so their employer can pay for the costs of health 
care; lower the prices for the uninsured, who pay the top price; and 
particularly our seniors. Right now in our country if you are an 
American senior and you walk into the local pharmacy and you do not 
have insurance, Medicare does not cover it. You pay top dollar of 
anybody in the world for your medicine. That is not an exaggeration. 
Americans pay top dollar of anybody in the world, and if you are 
uninsured, you pay the top.
  We are back again talking about these issues of how to provide real 
Medicare coverage and at the same time lower prices for everyone. There 
were comments about what was going to be proposed by the President. 
Then there were indications from the administration that, no, in fact 
they were going to be putting forward something that would help 
everyone and not force people into private sector HMOs. Unfortunately, 
again we see one thing being said and another thing being done.
  I hope my colleagues in the Senate will come together and we can 
fashion what really needs to happen. Again, our seniors are not asking 
for more choices about complicated insurance policies. They are not 
asking to wade through more options in terms of private sector HMOs. 
When they had the chance to pick between staying with traditional 
Medicare or going to an HMO through Medicare+Choice, the vast majority 
of older Americans and the disabled said no. They said no, we will stay 
with traditional Medicare.
  Now that they have said no voluntarily, the White House has decided 
to come back and create a situation where, if they need help, they will 
be forced to go into a plan they said no to when it was voluntary.
  I think the people of this country are going to see what this is. I 
think the seniors are going to understand what this is, and 
overwhelmingly reject this kind of an effort.
  I hope we in the Senate will reject this kind of a proposal and that 
we will come together and be willing to roll up our sleeves and do the 
business of simply designing a plan under Medicare where 40 million 
seniors and disabled have the ability to come together under one plan 
and have the clout to lower prices and get that group discount for 
seniors; so they have something that is stable, where everyone knows 
what the premium is; so everyone knows what is covered; so it is 
reliable; so it doesn't matter if you live in the upper peninsula of 
Michigan or Benton Harbor, Saint Joe, or the city of Detroit, you would 
know and you would have it available to you. You could count on it. 
That has been the strength of Medicare. It has been there for everyone, 
and our older Americans

[[Page 4992]]

can count on it. They are asking for us to simply do the same thing and 
design prescription drug coverage. Unfortunately, what we are hearing 
about the White House proposal is woefully inadequate.
  I urge my colleagues to immediately reject the proposal and give us 
an opportunity to work together on something that we know we can do 
that is best.
  Thank you, Mr. President. I suggest the absence of a quorum.
  The PRESIDING OFFICER (Mr. Enzi). The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. DORGAN. 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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