National Uniform Food Safety Labeling Act

Mr. Speaker, pursuant to House Resolution 299, I call up 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, and for other purposes, and ask for its immediate consideration.

Mr. Speaker, I yield myself such time as I may consume.

As we begin the 3 hours of debate on the primary bill and an additional hour on the substitute, I do want to indicate that this day, in my opinion, has been too long in coming.

I want to thank President Bush for his position during the campaign that Medicare needed to be modernized and we were overdue for putting prescription drugs in Medicare.

I believe he has continued to be firm in his resolve that both the House, and the Senate now for the first time, pass legislation so that we can conference a common bill and send it to him for his signature.

I also want to thank the Speaker of the House. The gentleman from Illinois (Mr. Hastert) was involved in these discussions prior to our becoming the majority and, of course, prior to his becoming Speaker. If you examine H.R. 1, you will find that the Speaker has been willing to be the lead author. I think it is entirely proper and appropriate that the Speaker of the House lead the House through the most fundamental and important change in Medicare since its inception.

I especially want to thank my colleague and friend and chairman of the Committee on Energy and Commerce, the gentleman from Louisiana (Mr. Tauzin). In this institution, where jurisdictions are guarded with a pretty vicious willingness to have turf wars whenever necessary to hang on to your jurisdiction, the working relationship with the shared jurisdiction of the Committee on Energy and Commerce and the Committee on Ways and Means has been a very pleasant experience, and the working relationship between the staff, of which I will have more to say a little bit later, could not have been better.

And, frankly, the product we have before us, although the gentleman from Louisiana (Mr. Tauzin) joined me in the initial sponsorship of legislation, we could not have gotten it through both committees and back together again in the Committee on Rules to present to you here today as H.R. 1 without complete and open and very comradely behavior between the chairman of the Committee on Energy and Commerce and this committee, and I thank him for that.

I especially thank the gentlewoman from Connecticut (Mrs. Johnson), who is the chairman of the Subcommittee on Health of the Committee on Ways and Means. The members of that committee have been very, very helpful in holding the hearings and continuing to shape this legislation. This bill, as it rightly should be, is the best piece of legislation that we have offered this House, notwithstanding the fact that twice previously we have passed Medicare modernization with prescription drugs.

And let me say that I do want to single out two members of the Committee on Ways and Means, the gentleman from Iowa (Mr. Nussle), who also happens to be the chairman of the Committee on the Budget, and the gentleman from North Dakota (Mr. Pomeroy), who offered together a bipartisan amendment which was very significant in helping us redress the failure to provide those Americans especially in middle America but in principally rural areas with a fair and equitable Medicare program.

I want to thank, and I do not want to go through every staff member, but I do want to thank the chief of our Subcommittee on Health staff John McManus for the enormous number of hours he and the staff have put in. You cannot produce as complex and difficult a piece of legislation as you have in front of you without the dedicated staff. And I mean not just on the committees, but the Congressional Budget Office, and I will mention from Leg Counsel Ed Grossman, who is an institutional glue. He is the one who spends the hours to make sure that the language makes sense in the legislative language that we have before us. He is absolutely indispensable to the functioning of this institution, and I want to personally thank him once again for the hours of commitment that he has put in to produce this piece of legislation.

There are organizations and associations who have very strong feelings about the direction of Medicare and the changes that might be made, and I want to thank all of them for their openness and willingness to present comments upon which we reacted. Most recently, I think one of the more prominent organizations, formerly known as the American Association of Retired Persons, now AARP, and I am indebted to my colleague, the gentlewoman from California (Mrs. Capps), for circulating the letter from AARP, because I think it is very instructive. It provides us with an example of how these organizations point with pride and view with alarm some of the changes that are being made.

For example, the opening paragraph in the letter addressed to me says, and I quote, ``AARP is encouraged by the advancement in the House of legislation to add prescription drug coverage to Medicare. Relief from the high cost of drugs is long overdue. Our members and all older Americans and their families expect and need legislation this year. We appreciate your efforts and leadership toward this end.''

But they go on to say in the letter, in terms of a number of additional points, that they think certain areas need to be strengthened and perhaps some changes need to be made. For example, under low-income protections, they say, ``We are encouraged by the bill's inclusion of all Medicare beneficiaries, including dual eligibles.'' We spend $43 billion over the next decade picking up these low-income seniors. We believe they should be classified as seniors first in the Federal Medicare program and not low-income first, as they currently are today.

But they go on to say that they are concerned because eligibility is limited by a restrictive assets test. And we took that letter to heart and we have examined that provision, notwithstanding the fact that the original bill doubled the assets provision under the SSI, Social Security provisions for low-income eligibility. The bill had doubled it. We examined it, we determined that perhaps we should go that extra mile. Under the bill before you today we have tripled it. We have tripled the SSI standards in terms of low-income protections. These are the kinds of exchanges that improved this legislation as we move forward.

And let me say lastly that I am very pleased that the Senate, I believe, will pass legislation and join the House finally in conference to craft a piece of legislation that will become law. Mr. Speaker, I understand the rules of the House in terms of the very narrow line we must tread, and I am not allowed to mention a Senator, but just let me say that a senior Senator, who has been a leader in health care debate for a number of years, frankly needs to be commended, because without his courageous step forward I do not believe the Senate would have moved as quickly or as rapidly as they have to a conclusion on their legislation.

I have enjoyed my conversations that I have had with him over the years, obviously more frequently as I have moved into a position to help effect adding prescription drugs to Medicare. Although we have profound differences in terms of our view oftentimes of the role of the Federal Government and assistance, we have never ever left the focus of policy, and although we may differ, the differences have always been over policy.

Never, ever has he mentioned Jim Jones, Kool-aid, mass suicide. Never, ever in our discussions has he mentioned the Holocaust. Never, ever has he mentioned blacks or slavery. He has always carried on the discussion on the basis of substance and the differences that we have on substance and the fact that in this society, in this civil society, the debate ought to be over choices of a legislative nature rather than trying to create an atmosphere of fear. For that I am grateful for his friendship and the fact that we will meet in conference and, finally, seniors, who are the last bastion of paying the price of retail for drugs, that will no longer be the case. And for that, all of us will be grateful. Policy will have triumphed over politics.

Mr. Speaker, I reserve the balance of my time.

Announcement by the Speaker Pro Tempore

Mr. Speaker, I yield 2 minutes to the gentleman from Florida (Mr. Foley), a member of the Committee on Ways and Means.

Mr. Speaker, I yield myself 15 seconds.

Mr. Speaker, Members will find periodically during this 3-hour debate that we will take a very short segment of time to make sure that when an outlandish, outrageous, untrue statement has been made, we will correct the record immediately.

Mr. Speaker, I yield 1 minute to the gentlewoman from Connecticut (Mrs. Johnson), the chairman of the Subcommittee on Health for the Committee on Ways and Means.

Mr. Speaker, I yield 2 minutes to the gentleman from Illinois (Mr. Crane), chairman of the Subcommittee on Trade, a long time member of the Committee on Ways and Means.

(Mr. CRANE asked and was given permission to revise and extend his remarks.)

Mr. Speaker, I yield myself such time as I may consume.

This is the first mention of the quote that I made, and it is not surprising that the quote is certainly truncated. Perhaps a journalism spot on The New York Times might be available to some of my colleagues given their ability to take reality and distort it. Here is my quote:

``Some of our friends on the other side of the aisle are saying that if this bill becomes law, it will be the end of Medicare as we know it. Our answer to that is, We certainly hope so. Why should seniors be the last group that pays retail prices for drugs?'' We have not heard that from the other side.

``Old-fashioned Medicare isn't very good. Why should the insurance for seniors be called MediGap? I think that indicates just how good the insurance is.'' We have not heard that from the other side.

But what I did say was, you will hear scare tactics. But seniors with extremely high drug costs when this becomes law will save more than 60 percent of their current costs if they spend $10,000 a year on prescription drugs today. That is real change. That is real progress, making Medicare a real day-to-day benefit. I would say to my colleagues, if you really think that current Medicare should not end, why in the world did you put up such a fit to have a substitute so that if we accept your bill, current Medicare as we know it will end as well? Half quotes are not going to get it done. Try the full quote, because if you do, you will vote ``yes'' on this bill.

Mr. Speaker, it is my pleasure to yield to the gentleman from Pennsylvania (Mr. Gerlach) to enter into a colloquy.

I will tell the gentleman from Pennsylvania that we have a generous amount, and we believe it will be appropriate; but certainly as we get to conference, our intent is to provide a seamless transition for beneficiaries and States and that will be done.

Mr. Speaker, it is my pleasure to yield 2 minutes to the gentleman from Pennsylvania (Mr. English), a member of the Committee on Ways and Means.

Mr. Speaker, I yield myself such time as I may consume. If it has been very, very good, why did the Democrats fight for a substitute which will change the structure significantly?

Mr. Speaker, I yield 1 minute to the gentlewoman from Connecticut (Mrs. Johnson) to point out once again an absolutely outrageous statement that cannot go unchallenged.

Mr. Speaker, I yield myself 1 minute.

You know, it just kind of makes you wonder what the Democrats did for 30 years when they were the majority, because, you know, when Republicans became the majority in 1995, there was literally no prevention and wellness in Medicare. We are the ones that are supposed to be destroying Medicare? We are the ones that added diabetes. We are the ones that added osteoporosis. We are the ones that added prostate and colorectal screening. We are the ones that added the mammography. In fact, in this bill that they continue to speak against, we provide for the first time every new beneficiary should have a physical.

I want to underscore that. Every new beneficiary should have a physical. In addition to that, we believe that cholesterol screening has now been advanced, and it should be provided as well.

I find it amazing that they go back to the same old scare statements.

Read the bill. It is an enhanced and an improved Medicare. What in the world were you doing for 30 years? The fact of the matter is you did not have a competent challenge.

What we have done is provide real change, and they are afraid those old frayed bumper stickers will not work anymore.

Mr. Speaker, I yield 3 minutes to the gentlewoman from Washington (Ms. Dunn), a very valued member of the Committee on Ways and Means.

Mr. Speaker, I yield 3 minutes to the gentleman from Florida (Mr. Shaw), a valued member of the Committee on Ways and Means.

Mr. Speaker, I yield myself such time as I may consume.

Mr. Speaker, well, I guess, if all of the innovations are going to fail, what will be left is the current Medicare. I find it interesting that one of the reasons the gentleman from Wisconsin (Mr. Kleczka), my friend, is going to vote against the bill is because there is no government ultimate negotiation of the price.

Let me tell my colleagues a story, and I believe before I give my colleagues the punch line, they will know the story. We have government negotiation of price. And as is typically the case, currently, in law, in the Medicaid program, it is called ``best price.'' That is where government determines how much the drug is going to cost. It is going to be the best price.

When we looked at ways to change Medicare, we looked at the ``best price'' concept. Guess what? We sat down with the Congressional Budget Office and we said, what would happen if we did not use best price? They sat down and calculated and they said, you know, if you actually had competition for the drugs, instead of putting in the government phony floor of ``best price,'' you could save $18 billion. Do my colleagues know why we do not have government negotiating the price? It would cost us tens of billions of dollars over a real negotiation on drugs. Yet, here we are, hearing the same old same old: I am going to vote ``no'' because we do not have government dictating the price. That is what has gotten us into the problem in the first place.

Mr. Speaker, it is my real pleasure to yield 3 minutes to the gentleman from Illinois (Mr. Weller), a member of the Committee on Ways and Means.

(Mr. WELLER asked and was given permission to revise and extend his remarks.)

Mr. Speaker, I yield myself such time as I may consume.

Mr. Speaker, I will tell my friend from Georgia, we do not intend to turn our backs on seniors. Indeed, we intend to reach out our hand. If someone wants to stay in yesterday's Medicare, they can tomorrow. We want to make sure of that, because in 1965 and yesterday, there were no drugs, there was no preventive care, there was no disease management, that by passage of this legislation, tomorrow there will be.

But Mr. Speaker, as we have carried on this debate about improving Medicare, and I know that to my friends on the other side of the aisle $400 billion does not look like much to them. I understand they are going to offer a substitute that proposes spending $1 trillion, rather than the $400 billion.

But at some point in this debate, we ought to realize that we are in the middle of the greatest intergenerational transfer of wealth in the history of the world. Because while we strive to provide a decent and appropriate health program for seniors, we all know someone else is going to be paying for it. And so we really ought to focus on what we are trying to do to make sure that the young people who are going to be carrying this bill understand that while we are providing additional benefits to seniors, we want to make sure that the program stays within the reasonable bounds of the $400 billion that we are proposing to add to Medicare.

Mr. Speaker, to insist on focusing on that, it is my real pleasure to yield 4 minutes to the gentleman from Louisiana (Mr. McCrery), the chairman of the Subcommittee on Select Revenue of the Committee on Ways and Means.

Mr. Speaker, I ask unanimous consent to place in the Record an exchange of letters between myself as chairman of the Committee on Ways and Means and the gentleman from Virginia (Mr. Davis), chairman of the Committee on Government Reform.

Mr. Speaker, I yield myself 15 seconds.

I see the gentleman from Texas (Mr. Doggett) had two quotes connected with a description of myself, rather than the continuation of the real quote, and I can understand why he would fabricate the quote in that way. Because what I said was, why should seniors be the last group that pays retail prices for drugs? That really did not fit the intention of the gentleman's thrust, but that is simply the truth.

Mr. Speaker, I yield 2 minutes to the gentleman from Iowa (Mr. Nussle), the chairman of the Committee on Budget, but I proudly say also a member of Committee on Ways and Means.

Mr. Speaker, I yield myself 15 seconds.

If the gentlewoman would go to page 260, line 19, from the legislation before us now, I quote, ``Nothing in this part or the amendments made by this part shall be construed as changing the entitlement to defined benefits under part A and B of title XVIII of the Social Security Act.''

Mr. Speaker, I have one speaker to close.

Mr. Speaker, I yield the remaining time to the gentlewoman from Connecticut (Mrs. Johnson), to close for our side, to continue to talk about the bill that for the first time in the history of Medicare provides low-income help, and she is the chairwoman of the Subcommittee on Health of the Committee on Ways and Means.

Mr. Speaker, I yield myself such time as I may consume.

Mr. Speaker, when the chairman of the Committee on Ways and Means, the gentleman from California (Mr. Thomas), opened this debate tonight in presenting H.R. 1 to the floor, he acknowledged the extraordinary cooperation and the spirit by which our two committees, the venerable Committee on Ways and Means and the venerable Committee on Energy and Commerce, of the House have worked together on this bill again this Congress, with the kind of harmony and dedication to accomplishing a good purpose for this country that is seldom seen between committees that often fight and juggle for jurisdiction. I want to commend him for that statement and acknowledge my personal gratitude for him and the entire membership of the Committee on Ways and Means and their great staff for the spirit in which they worked with the Committee on Energy and Commerce to accomplish this historic moment for our country.

I also want to thank the gentlewoman from Connecticut (Mrs. Johnson) of the Committee on Ways and Means for the extraordinary work she has personally given to this effort and the way in which she has worked with members of the Committee on Energy and Commerce, so many long hours, to accomplish this bill.

It is important also that I highlight, while not acknowledging all the staff who contributed so many hours, the head of our health care staff of the Committee on Energy and Commerce, Mr. Pat Morrisey, who has done Herculean work once again on behalf of this effort. And I want to acknowledge and thank, again, Mr. Ed Grossman, who is a legend in the Legislative Counsel's office, in terms of his contribution to this entire body and the work we do in preparing legislation for the floor.

When we began this effort 2\1/2\ years ago to create once again an opportunity for this House to pass a prescription drug benefit for Medicare and, at the same time, to modernize a system that is in deep trouble, we announced that the entire effort in health care would be dedicated to a theme of patients first; the idea that everything we did should be designed to make sure that patients in America continue to have the best health care delivery system in our country and, importantly in this area, that seniors get something they desperately need; and that is that every senior get access to prescription drug coverage and that the Medicare system itself, which has long been absent of that important product in the arsenal of products that keep our seniors healthy and long living in our country, that prescription drugs be added to this system, this important new element of health care in our country that has long been missing from the program.

At the same time, we recognize that the worst thing that can happen to any citizen is to be forced to go to a single store, whether it is a government-run store or a private-run store. We know when there is only one store in town, generally you get bad products and bad services and often bad attitudes. No matter what store it is, no matter who runs it, when more than one store is available, when we have choice, whether it is choice between a government store or a privately-run store, all of a sudden prices become better, products become better, attitudes become better, and service becomes better.

We know that Medicare is described by so many members of the Committee on Ways and Means as being in deep trouble. We know it is on a path toward insolvency. And Medicare, a system by which so many citizens have depended on for years for their health care, is absent this vital asset of prescription drug coverage. So we began our efforts to make sure we could add that coverage to the bill. We have been doing this over several Congresses now, and every year we battle over what is the right number to fund this program and how best to fund it.

I want to point out that we owe a great debt of gratitude to the chairman of the Committee on the Budget, the gentleman from Iowa (Mr. Nussle), for including this year $400 billion for us to fund this effort. In last year's budget, we dealt with considerably less. In fact, in the Democratic budget that was prepared for the year 2002, our friends on the other side allocated only $330 billion to their effort to fund prescription drugs. This year, our Committee on the Budget provided us with $70 billion more than even the Democrats did when they prepared their budget for the year 2002. And I want to thank the Committee on the Budget and Chairman Nussle for that great effort.

With that amount of money available, we have been able to construct this year, as the gentleman from California (Mr. Thomas) and his team have so adequately described, a much better bill, a bill richer in benefits, more secure in the texture of its structure, to make sure that seniors would, in fact, have more choices. Those like my mother, who want to stay in Medicare, cannot only stay in Medicare but enjoy a prescription drug benefit now; and those who might enter their senior years knowing about choice, liking choice, preferring choice, having the availability of different plans offered in the private sector that they could choose their prescription drug benefit from.

That is the kind of world we hope to create when we pass this bill tonight, a bill that historically modernizes the Medicare system and, at the same time, brings some more stores to town and makes sure that every store, the government store and the private stores, all have the products that seniors need so desperately, and that is prescription drugs.

In this bill this year, we do a number of other things. We address the concerns of many of our health care providers in terms of their lack of proper reimbursement from the government, and we add reimbursements to hospitals and physicians and caregivers across America. We have an excellent, and I thank the Committee on Ways and Means again for their work on this, we have an excellent rural package that will provide $27.2 billion of assistance to rural health care givers and hospitals to beef up care in America where care is desperately short and, unfortunately, hospitals are closing and doctors are leaving their practices.

Indeed, because this bill adds to the mix of choices that seniors will have in the future, there are predictions from CBO that Medicare will get back on its

feet, will not necessarily have to go insolvent. It will have a chance to be one of the options that seniors wish to choose for a long time in the future.

These benefits are going to benefit all Americans. I know there is some talk about how the plan has coverage and then there is a donut hole and there is coverage again for catastrophic coverage. The discounts provided to seniors in this bill will be available at all stages of prescription drug coverage, at all stages of prescription drug use and purchase throughout the bill. Seniors will see lower drug expenses in this bill. CBO estimates, in many cases, by as much as 50 to 70 percent. All seniors will benefit.

And for the seniors who live below 135 percent of poverty, and there are thousands and millions of those seniors living across America, this bill provides a 100 percent subsidy, 100 percent coverage for the drugs they are going to need under this prescription drug plan. And that is a pretty good effort and that is a pretty good reform of our system.

Indeed, we are also going to do some interesting things. We are concerned about the high prices of drugs. And like the Senate, we include reforms in the Hatch-Waxman laws that will speed the approval of generic drugs into the marketplace. And we reformed that awful, that awful wholesale price system that the government currently uses with phony wholesale prices that force seniors to pay 20 percent of phony prices whenever they suffer cancer and have to endure cancer therapies and urinary tract therapies and respiratory therapies. In short, we are going to lower the cost of drugs to America across the board, and we are going to increase the availability of drug coverage for every senior in this country and build new options for seniors to choose from. That is a pretty good package.

I want to again congratulate all who worked on it and all in the two committees who contributed so much to it. In the House Committee on Energy and Commerce we had 65 amendments, I think 29 recorded votes, over 22\1/2\ hours of debate again this year. Are we ready for this vote tonight? You bet we are. Are seniors ready for the debate to end? You bet they are. Are seniors ready for us to really do it this year? You know it. Are seniors ready for this House, the Senate, and the President to come together and actually sign a law that gives them these benefits, instead of constantly just debating the issue? You know that is true.

This is a historic moment, and this is our time to get it done.

Mr. Speaker, I reserve the balance of my time.

Mr. Speaker, I yield 3 minutes to the gentleman from Florida (Mr. Bilirakis), the chairman of the Subcommittee on Health.

Mr. Speaker, I yield myself 30 seconds.

Mr. Speaker, the Mediscam bill that the gentleman just described is patterned after H.R. 1495, authored by the gentleman from California (Mr. Stark), the gentleman from Michigan (Mr. Dingell), the gentleman from California (Mr. Waxman), and the gentleman from Ohio (Mr. Brown) just a few sessions ago in the 106th Congress.

It provided a $220 deductible, 20 percent cost share up to $1,700, a doughnut hole with a $3,000 catastrophic coverage, and no defined premiums. Does that sound familiar? The bill we wrote today is patterned after a bill written by my friends on the other side of the aisle back then, and they complain today that it is Mediscam.

Mr. Speaker, I yield 3 minutes to the gentleman from Florida (Mr. Stearns), the chairman of the Subcommittee on Commerce, Trade and Consumer Protection.

(Mr. STEARNS asked and was given permission to revise and extend his remarks.)

Mr. Speaker, I yield myself 15 seconds.

Mr. Speaker, just to correct the record, the Democrats did offer a substitute plan in our committee which was defeated, and I think it is pretty close to the substitute plan we will see later tonight.

Mr. Speaker, I yield 10 seconds to the gentleman from Florida (Mr. Stearns).

Mr. Speaker, I first want to take 15 seconds, if I may, to point out that the bill before us does now contain the drug reimportation provisions similar to the Senate provisions and adds language directing the FDA to conduct rulemaking to make sure that there is safe packaging, to make sure when we do get drugs under any such program, that they are safe and effective.

Mr. Speaker, I yield 4 minutes to the gentleman from Pennsylvania (Mr. Greenwood), distinguished chairman of the Subcommittee on Oversight and Investigations of the Committee on Energy and Commerce, our grand inquisitor.

(Mr. GREENWOOD asked and was given permission to revise and extend his remarks.)

Mr. Speaker, I am pleased to yield 2 minutes to the distinguished gentleman from the great State of Nebraska (Mr. Osborne).

Mr. Speaker, I yield myself 10 seconds to ask a question. If this plan funded at $400 billion is prescription drugs on the cheap, what do you call the $330 billion that was allotted by the Democratic budget for the year 2002?

Mr. Speaker, I yield 3 minutes to the gentleman from North Carolina (Mr. Burr), the distinguished vice chairman of the Committee on Energy and Commerce.

(Mr. BURR asked and was given permission to revise and extend his remarks.)

Mr. Speaker, I yield 2 minutes to the distinguished gentleman from New Jersey (Mr. Ferguson), one of our newer members on the Committee on Energy and Commerce.

Mr. Speaker, now that we have heard from the doctor of showmanship, we are going to hear from a real OB-GYN doctor.

Mr. Speaker, I yield 2\1/2\ minutes to the gentleman from Georgia (Mr. Gingrey).

(Mr. GINGREY asked and was given permission to revise and extend his remarks.)

Mr. Speaker, what is absolutely true is that 529,000 citizens of Ohio are given free coverage under this bill because they live under 135 percent of poverty.

Mr. Speaker, I yield 3 minutes to the gentleman from Rockwall, Texas (Mr. Hall), a Democrat and my dear friend.

(Mr. HALL asked and was given permission to revise and extend his remarks.)

Mr. Speaker, I yield myself 10 seconds. I want to point out our bill provides 430 million new dollars to oncologists in America, twice that provided to any other specialist for nonpractice expenses, twice as much as any other specialist.

Mr. Speaker, I am pleased to yield 3 minutes to the distinguished gentleman from Texas (Mr. Barton), the chairman of the Subcommittee on Energy of the Committee on Energy and Commerce.

(Mr. BARTON of Texas asked and was given permission to revise and extend his remarks.)

Mr. Speaker, I yield 2 minutes to the gentleman from Georgia (Mr. Burns).

Mr. Speaker, how much time remains on each side?

Mr. Speaker, I object.

Mr. Speaker, I yield 2 minutes to the gentleman from Kentucky (Mr. Whitfield), a distinguished member of the Committee on Energy and Commerce.

Mr. Speaker, I yield 2 minutes to the distinguished gentleman from Texas (Mr. Burgess).

(Mr. BURGESS asked and was given permission to revise and extend his remarks.)

Mr. Speaker, who has the right to close?

Mr. Speaker, I reserve the balance of my time and the right to close.

Mr. Speaker, while there is little debate about the need to update and modernize the Medicare system to allow seniors to use Medicare funds for prescription drugs, there is much debate about the proper means to achieve this end. However, much of that debate is phony, since neither H.R. 1 nor the alternative allows seniors the ability to control their own health care. Both plans give a large bureaucracy the power to determine which prescription drugs senior citizens can receive. Under both plans, federal spending and control over health care will rise dramatically. The only difference is that the alternative puts seniors under the total control of the federal bureaucracy, while H.R. 1 shares this power with ``private'' health maintenance organizations and insurance companies. No wonder supporters of nationalized health care are celebrating the greatest expansion of federal control over health care since the Great Society.

I am pleased that the drafters of H.R. 1 incorporate regulatory relief legislation, which I have supported in the past, into the bill. This will help relieve some of the tremendous regulatory burden imposed on health care providers by the Federal Government. I am also pleased that H.R. 1 contains several good provisions addressing the congressionally-created crisis in rural health and attempts to ensure that physicians are fairly reimbursed by the Medicare system.

However, Mr. Speaker, at the heart of this legislation is a fatally flawed plan that will fail to provide seniors access to the pharmaceuticals of their choice. H.R. 1 provides seniors a choice between staying in traditionally Medicare or joining an HMO or a Preferred Provider Organization (PPO). No matter which option the senior selects, choices about which pharmaceuticals are available to seniors will be made by a public or private sector bureaucrat. Furthermore, the bureaucrats will have poor to determine the aggregate prices charged to the plans. Being forced to choose between types of bureaucrats is not choice.

Thus, in order to get any help with their prescription drug costs, seniors have to relinquish their ability to choose the type of prescriptions that meet their own individual needs! The inevitable result of this process will be rationing,

as Medicare and/or HMO bureaucrats attempt to control costs by reducing the reimbursements paid to pharmacists to below-market levels (thus causing pharmacists to refuse to participate in Medicare), and restricting the type of pharmacies seniors may use in the name of ``cost effectiveness.'' Bureaucrats may even go so far as to forbid seniors from using their own money to purchase Medicare-covered pharmaceuticals. I remind may colleagues that today the federal government prohibits seniors from using their own money to obtain health care services that differ from those ``approved'' of by the Medicare bureaucracy!

This bill is even more pernicious when one realizes that this plan provides a perverse incentive for private plans to dump seniors into the government plans. In what is likely to be a futile effort to prevent this from happening, H.R. 1 extends federal subsidies to private insurers to bribe them to keep providing private drug coverage to senior citizens. However, the Joint Economic Committee has estimated that nearly 40 percent of private plans that currently provide prescription drug coverage to seniors will stop providing such coverage if this plan is enacted. This number is certain to skyrocket once the pharmaceutical companies begin passing on any losses caused by Medicare price controls to private plans.

Furthermore, these private plans will be subject to government regulations. Thus, even seniors who are able to maintain their private coverage will fall under federal control. Thus, H.R. 1 will reduce the access of many seniors to the prescription drugs of their choice!

Setting up a system where by many of those currently receiving private coverage are hired into the government program exacerbates one of the major problems with this bill: it hastens the bankruptcy of the Medicare program and the federal government. According to Medicare Trustee, and professor of economics at Texas A&M University, Tom Saving, the costs of this bill could eventually amount to two-thirds of the current public-held debt of $3.8 trillion! Of course, estimates such as this often widely underestimate the costs of government programs. For example, in 1965, the government estimate that the Medicare Part B hospitalization program would cost $9 billion in 1990, but Medicare Part B costs $66 billion in 1990!

This new spending comes on top of recent increases in spending for ``homeland security,'' foreign aid, federal education programs, and new welfare initiatives, such as those transforming churches into agents of the welfare state. In addition we have launched a seemingly endless program of global reconstruction to spread ``democratic capitalism.'' The need to limit spending is never seriously discussed: it is simply assumed that Congress can spend whatever it wants and rely on the Federal Reserve to bail us out of trouble. This is a prescription for disaster.

At the least, we should be debating whether to spend on warfare or welfare and choosing between corporate welfare and welfare for the poor instead of simply increasing spending on every program. While I would much rather spend federal monies on prescription drugs then another unconstitutional war, increasing spending on any program without corresponding spending reductions endangers our nation's economic future.

Congress further exacerbates the fiscal problems created by this bill by failing to take any steps to reform the government policies responsible for the skyrocketing costs of prescription drugs. Congress should help all Americans by reforming federal patent laws and FDA policies, which provide certain large pharmaceutical companies a government-granted monopoly over pharmaceutical products. Perhaps the most important thing Congress can do to reduce pharmaceutical policies is liberalize the regulations surrounding the reimportation of FDA- Approved pharmaceuticals.

As a representative of an area near the Texas-Mexico border, I often hear from angry constituents who cannot purchase inexpensive quality imported pharmaceuticals in their local drug store. Some of these constituents regularly travel to Mexico on their own to purchase pharmaceuticals. It is an outrage that my constituents are being denied the opportunity to benefit from a true free market in pharmaceuticals by their own government.

Supporters of H.R. 1 claim that this bill does liberalize the rules governing the importation of prescription drugs. However, H.R. 1's importation provision allows the Secretary of Health and Human Services to arbitrarily restrict the ability of American consumers to import prescription drugs--and HHS Secretary Thompson has already gone on record as determined to do all he can to block a free trade in pharmaceuticals! Thus, the importation language in H.R. 1 is a smokescreen designed to fool the gullible into thinking Congress is acting to create a free market in pharmaceuticals.

The alternative suffers from the same flaws, and will have the same (if not worse) negative consequences for seniors as will H.R. 1. There are only two differences between the two: First, under the alternative, seniors will not be able to choice to have a federally subsidized HMO bureaucrat deny them their choice of prescription drugs; instead, seniors will have to accept the control of bureaucrats at the Center for Medicare and Medicaid Services (CMS). Second, the alternative is even more fiscally irresponsible than H.R. 1.

Mr. Speaker, our seniors deserve better than a ``choice'' between whether a private or a public sector bureaucrat will control their health care. Meaningful prescription drug legislation should be based on the principles of maximum choice and flexibility for senior citizens. For example, my H.R. 1617 provides seniors the ability to use Medicare dollars to cover the costs of prescription drugs in a manner that increases seniors' control over their own health care.

H.R. 1617 removes the numerical limitations and sunset provisions in the Medicare Medical Savings Accounts (MSA) program. Medicare MSAs consist of a special saving account containing Medicare funds for seniors to use for their routine medical expenses, including prescription drug costs. Unlike the plans contained in H.R. 4504, and the Democratic alternative, Medicare MSAs allow seniors to use Medicare funds to obtain the prescription drugs that fit their unique needs. Medicare MSAs also allow seniors to use Medicare funds for other services not available under traditional Medicare, such as mammograms.

Medicare MSAs will also ensure that seniors have access to a wide variety of health care services by minimizing the role of the federal bureaucracy. As many of my colleagues know, an increasing number of health care providers have withdrawn from the Medicare program because of the paperwork burden and constant interference with their practice by bureaucrats from the Center for Medicare and Medicaid Services. The MSA program frees seniors and providers from this burden, thus making it more likely that quality providers will remain in the Medicare program!

There are claims that this bill provides seniors access to MSAs. It is true that this bill lifts the numerical caps on Medicare MSAs; however, it also imposes price controls and bureaucratic requirements on MSA programs. Thus, the MSAs contained in this bill do nothing to free seniors and health care providers from third party control of health care decisions!

Mr. Speaker, seniors should not be treated like children by the federal government and told what health care services they can and cannot have. We in Congress have a duty to preserve and protect the Medicare trust fund. We must keep the promise to America's seniors and working Americans, whose taxes finance Medicare, that they will have quality health care in their golden years. However, we also have a duty to make sure that seniors can get the health care that suits their needs, instead of being forced into a cookie cutter program designed by Washington, DC-based bureaucrats! Medicare MSAs are a good first step toward allowing seniors the freedom to control their own health care.

Finally, Mr. Speaker, I would like to comment on the procedure under which this will was brought before the House. Last week, the committees with jurisdiction passed two separate, but similar Medicare prescription drug bills. In the middle of last night, the two bills were merged to produce H.R. 1. The bills reported out of Committee were each less than 400 pages, yet the bill we are voting on today is 692 pages. So in the middle of the night, the bill mysteriously doubled in size! Once again, members are asked to vote on a significant piece of legislation with far reaching effects on the American people without having had the chance to read, study, or even see major portions of the bill.

In conclusion, Mr. Speaker, both H.R. 1 and the alternative force seniors to cede control over which prescription medicines they may receive. The only difference between them is that H.R. 1 gives federally funded HMO bureaucrats control over seniors' prescription drugs, whereas the alternative gives government functionaries the power to tell seniors which prescription drug they can (and can't) have. Congress can, and must, do better for our Nation's seniors, by rejecting this command-and-control approach. Instead, Congress should give seniors the ability to use Medicare funds to pay for the prescription drugs of their choice by passing my legislation that gives all seniors access to Medicare Medical Savings Accounts.

Mr. Speaker, I yield myself such time as I may consume.

Mr. Speaker, it is difficult to know where to begin to warn the seniors in this country about this sham of a bill and the beginning of the destruction of Medicare, as the Republicans have wanted to do for a number of years. There is no question that this is a major move toward privatizing Medicare. By the calculations that we have from the last feeble attempt to do this, of course Health and Human Services refuses to give us the most recent actuarial computations, but using the last ones, the Medicare premium for B in this drug benefit would rise to $142 a month if the premium could hold at $35.

By 2010, all Medicare will be privatized and immediately there will be a means test, the first time ever, an attempt to turn a government program into a welfare program, and the interesting thing is that every senior's income data will be turned over to any insurance company in the United States that requests it. So seniors, so much for their privacy. Every one of those people that calls on the phone to sell you some hokey insurance is going to have complete data on your income courtesy of the Republicans.

Mr. Speaker, the sad part even further is that the Republicans would like

to turn this over to private companies to operate it, and it is very interesting that one of the largest and best known private companies, Medco, a subsidiary of Merck was just indicted, or as they say, essentially indicted, by the U.S. Attorney in Philadelphia for a series of crimes committed on our Federal employees' health insurance benefits. This company that the Republicans would turn the management of this drug benefit over to was indicted for canceling, deleting and destroying patients mail order prescriptions to avoid penalties for late filing and mailing; shortchanging patients on the number of pills paid for; making false statements to the insurance plan they were contracted with about compliance with mailing timelines; calling and inducing physicians to authorize switching to higher cost medications while representing that this would save money for the insurance company, which was untrue; fabricating records of calls by pharmacists to physicians, and the list goes on.

This is the type of company who supports the Republicans, and they in turn are paying back that favor by offering Medco and Merck and their ilk the opportunity to provide a so-called benefit to seniors. I say so-called benefit because the next cruel hoax in this bill is there is no benefit defined in the bill. Nowhere in the bill does it define a premium, nowhere in the bill does it define a copay, and nowhere in the bill does it define a benefit. Now, we can all do some math and the CBO actuaries tell us that the actuarial value of a suggested benefit might be $1,360. It is important to add that our actuarial benefit for our health employees' benefit plan is probably closer to $3,000, but there is nothing that states in this law that the U.S. Government shall create, provide, or require a benefit of any type. In other words, if the insurance companies cannot be induced or bribed into offering a benefit, there will not be any. This is a nothing bill. It does not provide a benefit.

Now, I guess perhaps Members may not want to just take my word for it, so I think it is important to note what many others might say about the bill.

Mr. Speaker, the Arizona Daily Star says that ``the Democratic bill is better in every respect,'' and that the House drug bill is ``awful'' and ``repulsive.''

The Chicago Tribune says the Medicare debate ``has more to do with campaign 2004 than providing a prescription drug benefit.''

The Long Island Newsday said that ``the proposals racing through the House are a mess. Unless they improve dramatically en route to passage, doing nothing would be better than enacting such flawed laws.''

The Evansville Courier & Press says the ``ridiculously complex Medicare reform now being considered by Congress may be one of the more irresponsible measures in the long history of cradle-to-grave legislation.''

The Akron Beacon Journal says that while the Medicare reform bills would address the lack of drug coverage in Medicare, beneficiaries might be ``no better off with the benefit than they are at present'' because ``on the key issues of affordability, the structure of premiums, deductibles and copayments, both versions follow an elaborate path to disappointment.'' The list goes on.

In North Carolina, the Raleigh News Observer says the bill's actual benefit does not begin to outweigh the drawbacks of its so-called reforms.

The Roanoke Times and World News says even if the drug bill passes, seniors still will have to fear the possibility they will face crushing drug bills.

In Kansas, the Windfield Courier says the doughnut hole ``hurts many seniors when they need the help the most.'' ``The majority Republicans are at risk of passing a Medicare bill that looks, walks and talks like a political campaign creature.''

Washington State, the Seattle Post-Intelligencer says what Congress finally sends to the White House will surely be a disappointment.

The Oregonian says it is difficult to see the congressional proposals for Medicare drug coverage as much more than a big letdown. They are thin in coverage and convoluted in delivery.

Mr. Speaker, I think we can sum this all up, people will say this is drug coverage for old folks. The truth is this bill is nothing but political coverage for the Republicans.

Mr. Speaker, I reserve the balance of my time.

Mr. Speaker, I yield 3 minutes to the gentleman from California (Mr. Matsui), a member of the Committee on Ways and Means.

Mr. Speaker, I am pleased to yield 3 minutes to the gentleman from Michigan (Mr. Levin).

(Mr. LEVIN asked and was given permission to revise and extend his remarks.)

Mr. Speaker, I am happy to yield 3 minutes to the gentleman from Maryland (Mr. Cardin). The gentleman from Maryland understands that with proponents like Thomas and Johnson, the seniors do not need any scaring from us.

Mr. Speaker, I yield 3 minutes the gentleman from Washington (Mr. McDermott), a member of the Committee on Ways and Means, who understands that seniors are going to have to pay 4,000 bucks for the first $5,000 of drugs regardless.

Mr. Speaker, I yield 3 minutes to the gentleman from Wisconsin (Mr. Kleczka), a member of the Committee on Ways and Means, who, unlike the authors of this bill, did not spend his entire life in the public trough but actually worked in private enterprise; so he understands what privatization is.

Mr. Speaker, I yield myself such time as I may consume, because I do not intend to let unsubstantiated remarks go unchallenged either.

We do not oppose this bill because of what is in it, because there is nothing in it. There are no benefits in it. There is nothing in the bill except to spend money to get private insurance companies, if they decide to come.

Mr. Speaker, I yield 3 minutes to the gentleman from Georgia (Mr. Lewis), who recognizes that.

Mr. Speaker, I yield myself such time as I may consume.

Mr. Speaker, how short memories are. It was just an hour ago that we threw away $174 billion on useless medical savings accounts and over the last year or two we gave $800 billion in inheritance tax relief to an average of 10,000 people a year so we could punish a hundred million people a year by destroying their Medicare. They just do not remember. But the gentleman from Massachusetts, the distinguished member of the Committee on Ways and Means (Mr. Neal) remembers.

Mr. Speaker, I yield 3 minutes to the gentleman from Massachusetts (Mr. Neal).

Mr. Speaker, may I inquire of the time remaining?

Mr. Speaker, I yield 3 minutes to the gentleman from Texas (Mr. Doggett), a member of the Committee on Ways and Means.

Mr. Speaker, I yield 2\1/4\ minutes to the gentlewoman from Ohio (Mrs. Jones), a member of the Committee on Ways and Means who understands that the Republican bill does not extend the life of the Medicare Trust Fund at all. In fact, it probably reduces it some.

Mr. Speaker, if the Chairman could explain the gap, but obviously he cannot. So I am happy to yield 2 minutes to the gentleman from Texas (Mr. Sandlin), a member of the Committee on Ways and Means.

Mr. Speaker, I am delighted to yield 1 minute to the gentleman from Georgia (Mr. Scott).

(Mr. SCOTT of Georgia asked and was given permission to revise and extend his remarks, and include extraneous material.)

Mr. Speaker, I yield 1 minute to the gentleman from Florida (Mr. Wexler).

Mr. Speaker, I yield 1 minute to the gentleman from Texas (Mr. Bell).

Mr. Speaker, I yield 1 minute to the gentlewoman from Texas (Ms. Jackson-Lee).

(Ms. JACKSON-LEE of Texas asked and was given permission to revise and extend her remarks.)

Mr. Speaker, I yield myself the remaining time and will use it to sum up because that is about all the time it will take to explain what is in the Republican bill, which is nothing. It privatizes Medicare, and it promises a benefit as good as we Members of Congress get, and it does not get a third of the way there.

It is a hoax. It is phony. It is a fig leaf. It only gives coverage to the Republicans because there is nothing, absolutely nothing in this bill that requires anybody to provide a drug benefit to the seniors, and perhaps they will give the Republicans enough campaign money or promises and favors of other sorts to get them to change this in the future; but right now, sexual favors will not do it, nothing will do it. We are not giving the seniors anything but a hoax.

Mr. Speaker, I thank the distinguished gentleman from Michigan for yielding me this time and for his tremendous leadership. He has been fighting this fight for America's seniors for access to quality health care for all Americans and an affordable prescription drug benefit for America's seniors. We are all in your debt.

Mr. Speaker, today is a sad day for America's seniors. Another sad day, late at night in the Chamber of the House of Representatives, where the budget priorities of our country should be debated to their fullest extent, but where the limitation on time is placed so that the American people can never really get the full story. This prescription drug benefit bill discussion is an historic occasion for our country because it does indeed, it does indeed give us the opportunity to expand Medicare to provide a guaranteed affordable defined benefit for our seniors. The Senate has taken up the bill for the past 2 weeks. They have considered 30 amendments to the bill. Thirty amendments. The House is considering the bill this evening with no opportunity for amendment.

I do want to commend the gentleman from Michigan (Mr. Dingell) and the

gentleman from New York (Mr. Rangel), the ranking member on the Committee on Ways and Means, for the proposal that they will be putting forth tonight, which is a real prescription drug benefit for seniors. I commend the gentleman from California (Mr. Dooley) for his limited opportunity but great product that he put forth on the previous question on the rule earlier. Another excellent proposal. And I commend the Blue Dogs, the gentleman from California (Mr. Thompson) and the gentleman from Arkansas (Mr. Berry), for their hard work on our motion to recommit, which we hope will be allowed on the floor tonight.

Any one of these would be far superior to the proposal that is being put forth by the Republicans today. Why it is so sad is because we are supposed to honor our parents. Our senior citizens built our country. They raised our families, the backbone of America. They fought our wars. Some of them are part of the greatest generation. Some of them lived through the New Deal, many of them the Fair Deal, and tonight they are getting a raw deal. What makes it so sad is that we had the opportunity to do it right, and one of those opportunities we will hear about next, the Dingell-Rangel/Rangel-Dingell Democratic proposal, of which we are very proud.

Nearly 40 years ago, when Medicare came into existence, it came at a time when many, many seniors had no access to health care, and now almost every senior in America has access to quality health care. At the time, there was no prescription drug benefit included in the package. That was unfortunate. Today, it is imperative that we have a prescription drug benefit in the package. The advances to science have been so miraculous. Seniors today, if they have a prescription drug benefit, would be able to self-administer drugs, which would not only be an adjunct to physician or hospital care but be a supplement for it. It would be a substitute for it.

So think of what it means to the quality of life for our seniors in order for them to have that independence and to be able to know that it is guaranteed, defined, and dependable. Think of what it means to the taxpayer in the reduction of cost in medical services to seniors because they can have access to prescription drug benefits. That is what makes this such a tragedy. It makes it such a tragedy.

So tonight, instead of honoring our parents and our seniors, we are foisting a hoax upon them, at least the Republicans are. And a cruel hoax it is indeed. In doing so, the Republicans insult the intelligence, they insult the intelligence of America's seniors. Many of you are blessed to still have your parents with you, and some of us are even bordering on being seniors ourselves, but any of you who have your parents or dear relatives who are older know that they are into stats. They know their statistics. They know their blood count, they know their blood pressure, they know their bank account balance, they know the cost of everything, many of them, because many of them are on fixed incomes and the slightest change has an impact on their economic security.

So I want those seniors who are so sensitive to changes in cost to take a look at this chart, which was in the New York Times this morning, and it says, ``Under House GOP Bill Seniors' Out-of-pocket Drug Costs Remain Staggering.'' Remain staggering. The average cost that seniors will pay in drug costs in 2006 is reported to be $3,155. So let us take the $3,000 line for the Republican hoax on seniors. If the beneficiary's annual drug costs are $3,000, seniors out there, if you are paying about $3,000, under the House bill your deductible will be $250. Your premium will be $420. The share of initial coverage is $350. Gap in coverage, here is where you fall into the gap, $1,000.

So of that $3,000 worth of drug cost, you, America's seniors, will be paying $2,020 out-of-pocket. Where is the benefit? And this is the best case scenario. These prices that you see here are suggestions to the HMOs. The prices could be much more, and your out-of-pocket cost could be much more.

I do not know how many of you think the hole is the most delicious part of the donut, but seniors, when they fall into this donut hole where they get no coverage, they still pay the premium. They are paying a premium for something that is not there. It is not there. And of course, if they pay $4,500 in drug costs, they are paying $3,520 out- of-pocket. A cruel hoax on America's seniors. And they call that modernization. I call it humiliation. I call that insulting the intelligence of America's seniors.

It was interesting, in this same article today one senior who was quoted on the subject said, ``Do you think anybody in Washington, D.C. has any idea what people on a limited income have to do to live?'' Clearly, the Republicans do not. They are just too busy giving the biggest tax breaks to the highest-end people in our country. They are just too busy giving those tax breaks that they cannot write a decent prescription drug benefit for seniors.

In fact, I might add seniors and children. Where, oh where did the child tax credit go in all of this, as we adjourn tomorrow? Tax cuts instead of child tax credits. Tax cuts instead of prescription drug benefits. At the beginning of life; toward the end of life. It is a cruel hoax.

And so, my colleagues, no matter what the Republicans tell you about their bill, the euphemism that it is a modernization of Medicare is really a laugh. It is an elimination of Medicare. Because no matter what they tell you, the facts are these: The Republicans do not provide a guaranteed defined benefit for seniors. The Republican bill does not reduce the high cost of prescription drugs.

Indeed, the hardest to explain to anyone is that the bill prohibits the Secretary of Health and Human Services from negotiating for best prices. I repeat: Not only does the bill not bring down the cost of drugs, it prohibits the Secretary of HHS from negotiating for the best prices. Every business in America, indeed the VA, does that. Volume gives you leverage; gives you opportunity. Except in this bill it is prohibited.

And at this point I want to say that the proposal put forth by the gentleman from Michigan (Mr. Dingell) and the gentleman from New York (Mr. Rangel), the cost of it would be cut in half, cut in half, if the Secretary had the authority, which our bill calls for, and indeed took that responsibility to negotiate for best prices.

What the bill does also, instead of modernizing Medicare, is to unravel not only Medicare, and I hope seniors are listening, not only the prescription drug benefit, but part A and part B along with the prescription drug benefit, forcing seniors to compete and pay more to stay in Medicare, the Medicare they know and trust. I repeat: When this bill, in 2010, comes to fruition, seniors will have to pay more to stay in Medicare for part A, part B, and prescription drug benefits.

And this is really a sad one in their bill. The employer piece. The employer piece. There are many businesses in America who honor their responsibility to their retirees. The CBO, the Congressional Budget Office, estimates that under the Republican bill one-third of all retirees who get their benefits from their employers will lose their coverage. Millions of seniors will be worse off.

So that is why I say this is really a tragedy. It is a missed opportunity. It could be so good. It could be bipartisan. It could be what seniors expect and deserve. Democrats have a better idea. The Rangel-Dingell/Dingell-Rangel proposal, the two distinguished gentlemen who have spent a lifetime in public policy promoting access to quality health care, whose credentials are impeccable in this regard, they support Medicare. They have promoted a bill that is worthy of the seniors whom we respect. It is a guaranteed defined benefit under Medicare. It does give the authority to the Secretary to negotiate for best prices. It protects seniors' options in terms of their employers giving them benefits; not making millions of seniors be worse off.

America's seniors deserve a benefit that is affordable, with reasonable premiums and deductibles. America's seniors deserve a benefit that is available to all seniors and disabled Americans, including Americans in rural areas.