    [Public Papers of the Presidents of the United States: WILLIAM J. CLINTON (1999, Book II)]
    [October 25, 1999]
    [Pages 1872-1876]
    [From the U.S. Government Publishing Office www.gpo.gov]

    Remarks on Medicare Prescription Drug Coverage
    October 25, 1999

        Thank you very much. Thank you, Mr. Callus, Ms. Kayden, for your
    remarkable statements. Thank you, Secretary Shalala, for your steadfast leadership on this issue. I would like
    to welcome a very large number of Members of the United States Congress
    who are here: Senator Baucus and Senator
    Wyden; Representatives Abercrombie, Brown, Waters, Obey, Vento, and Hoyer; and Congressman
    Berry. And I would like to acknowledge the
    important work of two that are not here, Representatives Waxman and Allen, who have been
    particularly interested in this issue.

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    Death of Senator John H. Chafee

        Before I go into my remarks, I would like to make a statement about
    the passing last night of Senator John Chafee of Rhode Island. Rhode
    Island and America have lost a great leader and a fine human being who,
    in 23 years in the Senate and in his service as Secretary of the Navy,
    always put his concern for the American people above partisanship.
        When you think of the term ``bipartisan,'' you immediately think of
    John Chafee. Known throughout his beloved Rhode Island simply as ``the
    man you can trust,'' Senator Chafee was a consummate statesman and
    patriot. He served with valor in war and peace. I am particularly
    grateful for his commitment to health care, his concern for the
    environment, and his devotion to our children, especially his work for
    foster care and child care.
        John Chafee proved that politics can be an honorable profession. For
    him, civility was not simply a matter of personal manners. He believed
    it was essential to the preservation of our democratic system and the
    progress of our Nation. He embodied the decent center which has carried
    America from triumph to triumph for over 200 years. How we will miss
    him.
        Today our thoughts and prayers are with his wonderful wife,
    Ginny, their five children, and their twelve
    grandchildren. And again, I want to say a special personal word of
    appreciation on behalf of Hillary and myself for the many kindnesses
    John Chafee extended to us and the many opportunities we had to work
    together.

    Prescription Drug Benefits

        Now, last January, in the State of the Union Address, I was able to
    give the American people a great report on our economy and the improving
    condition of our society, which now has the lowest unemployment rate in
    29 years, the lowest welfare rolls in 30 years, the lowest poverty rates
    in 20 years, the lowest crime rates in 30 years, and the first back-to-
    back budget surpluses in 42 years.
        In the State of the Union Address, I said as we approached the new
    century, we could look back on 100 years of Americans meeting the great
    challenges of the century we're about to leave: the Depression, civil
    rights, two World Wars, the cold war. And now, because of the good
    fortune we presently enjoy, we have the opportunity and the obligations
    to meet the great challenges that we know lie before us in the 21st
    century: to build one America out of our amazing diversity; to make
    America debt-free for the first time since 1835; to use this moment of
    prosperity to bring genuine economic opportunity to the people and
    places that have been left behind; to deal with the challenge of global
    warming; to meet the new security challenges of the 21st century,
    including the challenges of high-tech terrorism and weapons of mass
    destruction; to give the largest and most diverse group of children in
    American history a world-class education; and to meet the challenge of
    the aging of America.
        We will double the number of people over 65 in just 30 years. There
    will be two people working for every one person drawing Social Security.
    This challenge would be truly daunting were it not for the fact that all
    of us, as a country, have worked so hard over the last 7 years to bring
    us to this moment of prosperity and to bring us to a point where we can
    predict long-term, consistent budget surpluses into the future which
    give us the means, if we have the will and vision, to deal with this
    challenge.
        No one should have to make the kind of choices Mr. Callus and Ms. Kayden spoke of in
    their remarks in a country that has the strongest economy on Earth. No
    senior should have to forgo or cut back on lifesaving medication because
    of the cost. Neither should any senior be forced to get on a bus to
    Canada where the same medicines cost so much less. Just a couple of days
    ago, the Vice President held up an example
    of one of the most popular drugs for lowering cholesterol. In Canada, 60
    tablets cost $44; in New Hampshire, they cost $102, if you're lucky. I
    think we can do better than that. It's wrong, and we have to deal with
    it.
        We also have to deal with the fact that about three-quarters of our
    seniors simply don't have effective, affordable access to prescription
    drugs. We can afford to do something about it; we know what to do about
    it, and therefore, we have no excuse for inaction.
        This debate over Medicare is more than about politics and budgets;
    it's about people, real people like Mr. Callus. You heard what he said. He said he was in pretty good
    shape, and I think that his speech verified that. [Laughter] But giving
    him and Americans like him all over the country the chance to live to
    the fullest of their God-given abilities, not only to live as

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    long but to live as well as they can, is an important value that we all
    stand for.
        For 34 years, Medicare has helped to achieve that value. And it has
    eased the financial burden on families who care for their loved ones.
    Before Medicare, nearly half of our seniors had no health care coverage
    at all.
        Today, Medicare is truly at a crossroads. As Secretary Shalala said,
    when we took office the Trust Fund was supposed to expire this year. And
    thanks to the good work of the Congress and the people who operate the
    program and the people who administer the health care of the country,
    we've worked together and we got the life expectancy of the Trust Fund
    back to 2015. We've done it by combating fraud and making Medicare more
    efficient and investing some more funds. But we know we have to go
    further because it is simply not going to be enough to stay with the
    status quo.
        This past June I gave the Congress a comprehensive and fiscally
    responsible plan to extend the life of Medicare to 2027, while at the
    same time modernizing it to keep pace with changes in our medical system
    and our medical needs. I proposed new innovations used now in private
    sector health care to keep quality high and costs lower. I said we
    should remove barriers to preventive tests for cancer, for diabetes, for
    osteoporosis, and other diseases. I said we should invest more money,
    not only to deal with some of the hardships caused by the savings in the
    Balanced Budget Act of 1997 but simply because there are going to be so
    many more people on Medicare over the next few years. And I want to say
    this again, no expert who has studied this has said we can deal with the
    challenge of Medicare without injecting more money into the system.
        And finally, I called for adding a prescription drug benefit. Adding
    prescription drug coverage, as Secretary Shalala said, isn't just the
    right thing to do; it is the smart thing to do, medically, over the long
    run. Today, prescription drugs can accomplish what once could be done
    only through surgery, at far less pain and far less cost. We already pay
    for doctor and hospital benefits under Medicare, but we let many of our
    seniors go without prescription drugs and preventive screenings that
    could keep them healthy and keep them from having to undergo expensive
    treatment. It doesn't make sense.
        Unfortunately, the Republican leadership in Congress has refused
    altogether to consider adding a prescription drug benefit, effectively
    rendering meaningful Medicare reform impossible this year. The Congress
    is joining with me to work to alleviate undue strain on hospitals,
    nursing homes, home health agencies, and other providers--and that's a
    good thing--to alleviate some of the most severe burdens of the Balanced
    Budget Act.
        But by ignoring the need for a prescription drug benefit, the
    Republican leaders are squandering a golden moment, leaving more than 13
    million seniors without any prescription drug coverage and millions more
    with inadequate coverage, unreliable at best.
        Now, in human terms, that means a lot. Think of the seniors on fixed
    incomes, like Mr. Callus, who are paying a
    couple of thousand dollars a year out of pocket. Think of men and women
    falling prey to illnesses because they can't afford proper doses of new
    miracle drugs that could easily keep them well. Asking them to wait for
    Medicare reform is like putting their lives on hold, and maybe into a
    lottery. It is unacceptable. It is unacceptable especially because it is
    so unnecessary. And I want you to know I don't intend to give up the
    battle until it is won.
        And the good news is, because I vetoed the tax bill that would have
    taken away all the money to fix Medicare, we can still win it.
        First, let's set the record straight. One of the key reasons no
    action was taken on prescription drugs this session was because the
    pharmaceutical industry spent millions of dollars on an all-out media
    campaign filled with flatout falsehoods. In ads featuring a fictional
    senior named Flo--[laughter]--the special interests say that our
    Medicare proposal--and I quote--``would put big Government in your
    medicine cabinet.''
        I might point out that even though we do, thanks to the leadership
    of these people, have the smallest Federal Government since 1962, it's
    still not small enough to get in your medicine cabinet. [Laughter]
        It says--and I quote--``all seniors will be forced into a
    Government-run plan.'' The truth is, under our plan, there are no
    Government restrictions of any kind. Doctors would be able to prescribe
    any needed drug for any patient at any time, and the benefit would be
    purely voluntary, completely optional. If seniors want to keep their
    current coverage, they're perfectly free to do so.
        We cannot stand by and watch the pharmaceutical industry go on and
    distort this debate.

    [[Page 1875]]

    We have to expose these deceptions and give the American people the
    facts. I wish they'd spend this ad money explaining why seniors have to
    get on the bus and go to Canada to buy drugs at less than half the price
    they can buy them in America, when the drugs are made in America with
    the benefit of the American system and American research and American
    tax systems. I wish they would spend their advertising money explaining
    that to the American people.
        I guess if you've got a weak case, the best thing to do is change
    the subject. [Laughter] But I would like for Flo to get on TV and tell
    me about that. I'm sure she could explain it. [Laughter] And it would be
    so enlightening to us. [Laughter] Meanwhile, the rest of us are going to
    keep on talking about expanding access to affordable prescription drugs.
        Another thing I don't understand is, I know they're worried that if
    we buy drugs in bulk the way the private sector does, that their profit
    per package of drugs will be smaller. But if we cover all the seniors,
    the volume will be so much greater, they will make more money. Do you
    remember when Medicare came in? All the people were saying, ``Oh, my
    goodness, the people providing health care are going to go broke.'' But
    they didn't.
        The pharmaceutical companies are going to do fine under this. We're
    not going to have the Government try to take them over. We're not going
    to have a big price control system. But we ought to be able to bargain
    to get American seniors a decent deal. And the volume, the increase in
    volume will more than offset the better prices that large purchases get.
        Besides that, old Flo's up there arguing for keeping 13 million
    seniors, just like her, from having any access to any drugs. Bet she
    wouldn't be making that ad if she had found herself in the same
    position.
        So this is really important. Look, all these issues are complicated.
    We're a big, grownup country; we don't have to have bogus ads out there
    confusing people about what the truth is. This is a matter of life or
    death. Everybody this man's age, who has the ability to be standing and
    talking and being what he was up here today, ought to have the same
    chance. That's what we believe.
        Now, beyond dealing with the ad campaign to illustrate that the
    failure to add a prescription drug benefit has actual consequences, I am
    going to gather clear and indisputable evidence of what this failure
    costs in physical and financial terms. Today I'm directing Secretary
    Shalala to produce a sweeping study--the
    first of its kind--to examine prescription drug costs in America. In 90
    days she will present me with an analysis of what the most commonly
    prescribed drugs cost for those with and without coverage to help assess
    whether people without coverage are paying too much. The analysis will
    also report on trends in drug spending by age and by income to help us
    document the increasing toll high drug costs are taking on our seniors,
    on people with disabilities, and on their families.
        Combined with a State-by-State analysis on our seniors' prescription
    drug needs, which I've already ordered, the new cost study should help
    to lay the foundation for a more informed debate in the coming year.
        Finally, as part of the plan to safeguard the Social Security
    surplus, tomorrow I will send to Congress legislation that would reserve
    a third of the non-Social Security surplus--the non-Social Security
    surplus--all of which would be gone if I hadn't vetoed the tax cut
    bill--[laughter]--that would reserve a third of this for extending the
    solvency of Medicare and for funding a prescription drug benefit.
        Now, I stand ready to work with Congress across party lines on
    crafting a Medicare reform plan that has the best chance of gaining
    bipartisan support. But even if Congress won't pass the Medicare
    modernization plan this fall, it can and should adopt at least a
    proposal for protecting the Social Security surplus.
        I challenge Congress to pass this legislation as part of the final
    budget negotiations now underway, to ensure that Social Security and
    Medicare will have the resources they need to meet the challenges in the
    new century.
        Let me just say what the difference in my proposal is and the
    proposal of the Republican majority. Anybody under any circumstances who
    saves the Social Security surplus gives America one big benefit, which
    is, if we don't spend the Social Security surplus, we pay down more of
    the debt every year; interest rates stay lower; the economy grows more.
    Our two plans have that in common.
        The difference is that under my plan, starting at about 10 years, we
    will take the interest savings we get from reducing the debt from the
    Social Security surplus and put it into the Social

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    Security Trust Fund, which will take the Trust Fund out to 2050 and go
    beyond the life expectancy of the baby boom generation. That's the big
    difference.
        If you just save the Social Security surplus, if you don't do
    anything else, it doesn't add to the life of the Social Security Trust
    Fund. Because all those years, from 1983 forward, when the deficit was
    made to look smaller because we were spending the Social Security
    surplus, the Social Security surplus got a Government bond, and it gets
    the money back, and it pays the seniors. So if you want to do something
    meaningful for the baby boom generation, it's not enough to save the
    Social Security surplus. You've got to take the interest savings you get
    on the budget from saving the surplus and put it into Social Security,
    so you add to the life of the Social Security Trust Fund.
        So we have a lot more work to do, even though we're already in the
    last week of October. Congress still has not done a lot of things.
    Because they have not taken action to protect the privacy of medical
    records, I will use the power of my office to do that in the coming
    days. I think that's a very important issue. But there are other
    agreements we have to make before we can end this year. Congress made a
    commitment last year, which I applauded, a bipartisan commitment, to
    100,000 more teachers in our schools to reduce class size and paid for
    30,000 of them. Now they want to totally undo it. I think it's wrong.
        They have not yet given our families the vital protections of a
    Patients' Bill of Rights. They took the hate crimes legislation out of
    the legislation that they've sent me to fund the Justice Department.
    They have not yet raised the minimum wage. And they have not yet fixed
    the flawed system that prevents people with disabilities from going to
    work. All those things can be done in the next few weeks, and we intend
    to work hard to see that they are done.
        But let me close again with the subject that brought us here today.
    Colleen Kayden came here and spoke about her
    experience as a pharmacist. She also spoke for every pharmacist and
    every community pharmacy in America. Stephen Callus came here and talked about his life. He could have
    been speaking for millions upon millions of seniors.
        Time is passing here, and I want to get back to the point I made at
    the beginning. I hope to be one of those baby boom seniors one day, and
    it's getting there in a terrible hurry--[laughter]--but I have lived
    already quite a good number of years. Never in my lifetime has this
    country had the opportunity we now have--free of war, free of internal
    discord--to chart a course for the future that will embrace all
    Americans and that will consciously deal with the great challenges
    before us.
        Only once in my lifetime have we had an economy that approximated
    this economy. That was in the early sixties, but we had to deal with the
    civil rights challenge and with the Vietnam war. We have never had an
    economy like this and, basically, the freedom within our own hands to
    just chart a course for the future. And there are some things that we
    know are going to be out there, including how many kids we're going to
    have and what their different backgrounds are; and how many seniors
    we're going to have and what their absolutely certain health challenges
    will be. And we absolutely have no conceivable excuse for walking away
    from the chance of a lifetime to build the century of our dreams.
        Thank you very much.

    Note: The President spoke at 10:55 a.m. in Presidential Hall (formerly
    Room 450) in the Old Executive Office Building. In his remarks, he
    referred to Medicare recipient Stephen Callus, who introduced the
    President; and pharmacist Colleen Kayden.