[Weekly Compilation of Presidential Documents Volume 35, Number 43 (Monday, November 1, 1999)]
[Pages 2142-2146]
[Online from the Government Publishing Office, www.gpo.gov]

<R04>
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.

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.

[[Page 2143]]

    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 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

[[Page 2144]]

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. 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

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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 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

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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.