Federal Railroad Safety Improvement Act

Mr. President, I yield myself 9 minutes.

Mr. President, let me commend the Senator from Iowa, the Senator from Louisiana, the Senator from Montana, and others who have worked on this so very hard. I want to express my gratitude to them for spending so much time on this issue.

Let me also briefly thank my own staff. I am not a member of the Finance Committee. But this issue transcends committees. This is legislation that all of us have a deep interest in. I thank Jim Fenton and Ben Berwick of my staff for the tremendous effort and time they have put in.

I spoke at some length on Friday about this issue. Let me divide the issue very quickly.

A prescription drugs benefit, I think, would pass 100 to 0. If we had a vote on the prescription drug benefit--you would hear speeches that it didn't go far enough and concerns about the donut hole and whether or not 150 percent of poverty was the right margin to be drawn--but I suspect all Members in the final analysis would support the initiation of a prescription drug benefit on the assumption that we would work to improve it in the years ahead.

If I were voting on that issue alone, I would stand here and raise concerns about matters included in that provision, but it would have my wholehearted support as a long overdue proposition. I won't dwell on that aspect of the legislation here this morning.

The second piece of this bill, however, is one that causes me concern. This second piece is more difficult to understand, it is less clear than just $400 billion for prescription drugs. The second part of this bill is a major change in Medicare. The program has been around for 38 years and is currently serving 41 million Americans. It is probably the most successful and the most wildly supported Federal program of the 20th century. I can't think of any program, except Social Security, which has been so widely supported. We are about to take that program which has worked so tremendously well, and I think disadvantage it significantly. Let me explain briefly why.

The sponsors of the legislation say they are not forcing seniors out of traditional Medicare. They claim they are simply creating competition as a result of offering seniors a choice. Let us talk about this so-called ``competition.''

Private plans under this bill will be reimbursed at a higher rate than traditional Medicare--9 percent higher. On top of that, this bill also makes available $12 billion in a slush fund to be used to lure private plans into the market on a corporate subsidy. You get a 9 percent differential and $12 billion. That is what you get to compete with Medicare. You do not have to have a Ph.D. in math or a Ph.D. in business law to understand that kind of an advantage certainly is not what I call a level playing field. It is not competition, it is a rigged game. The bill stacks the deck against traditional Medicaid and the effects are self-perpetuating. Traditional Medicare grows weaker, private plans grow stronger, forcing more beneficiaries out of the traditional programs and into the open arms of HMOs.

It is easy to get bogged down in the complexities of this bill. Let me state it simply: The weakening of the traditional Medicare Program caused by this bill will force seniors to pay more and face the prospect of fewer benefits.

Remember, Medicare initially said whether you are wealthier and healthier or poorer and sicker, we all work together. Now we are splitting off the wealthier and healthier and leaving the sicker and poorer on the side.

This bill will actually mean less choice, in many ways, for seniors. Seniors like the traditional Medicare Program precisely because it offers choice, the very thing the supporters of this bill claim to be providing. Under the current system, seniors have a choice of doctors. But that choice would soon disappear with a rise in private managed care plans.

I hope this prediction is wrong but I am fearful it is right. If this prediction is wrong, it most likely means seniors have elected not to move into private plans and HMOs will leave the market in many areas, as we have seen in the past with the Medicare+Choice plan, taking $12 billion with them that might have been used to reduce the cost of prescription drugs rather than provide a subsidy for the private plans to compete with Medicare.

Even more ironic is that this highly unfair system is being championed by self-proclaimed champions of free enterprise. This bill gives $12 billion to HMOs to unfairly compete and it does nothing to control drug prices. In fact, it actually prevents the Medicare Program from negotiating lower drug prices. Under law, Medicare is prevented from using its purchasing power to negotiate with drug companies for lower prices. What is wrong with letting free enterprise work here in order to lower drug prices?

If Medicare is so in need of reform, why in this bill are we subsidizing private companies and not allowing the Medicare beneficiaries to compete for lower drug prices? The reason is simple: The champions of free enterprise know that private plans cannot compete with traditional Medicare on a level playing field. The subsidies are necessary because Medicare is actually more efficient. Medicare delivers services at a lower cost.

In 2010, a provision included in this bill will go into effect that begins an experiment with our Nation's seniors. Why we are taking our seniors, the most vulnerable, and turning them into guinea pigs for an experiment is beyond me. That is what we are beginning to do. Given the unlevel playing field I have described, such a competition would further disadvantage the traditional Medicare Program.

The bill writes into it right now a cap of 5 percent premium increases for each year in regions effected by this premium support experiment. The bill anticipates premium increases even before we have tried the program, and they are going to take 6 million seniors and throw them into an experiment, a pilot program, the outcome of which has already been determined by the bill's authors when they talk of a cap at a 5 percent premium increase. How is Medicare going to compete then? The outcome is predetermined, forcing those seniors into a disadvantaged program. The weaker and the poorer and the sicker seniors will end up paying more or having benefits cut.

I am afraid we can only conclude one thing: The architects of the bill, with all due respect, spend billions of dollars not to reform Medicare, but to dismantle it. It puts patients out there to wither on the vine, as Newt Gingrich said 8 years ago. If the man who wanted that embraces this legislation, that could mean one of two things: Either his opinion has changed or this legislation really is intended to end Medicare. I submit that I see no evidence his opinion has changed.

We set out to add a prescription drug benefit to Medicare. I applaud that. We could have had a bipartisan bill that did just that. It could have been approved by this Chamber overwhelmingly. But instead, we are being asked to vote on a wolf in sheep's clothing.

The second part of the bill, the changes in Medicare that will effect 41 million seniors, two-thirds of whom make less than $80,000 and above $13,470, for those in that category, this bill offers disturbing alternatives.

For those reasons, I urge that when the cloture vote occurs, Members vote against it. We can do better. I applaud the efforts made, but we can do better on this legislation than we have done.

I don't believe I used all 9 minutes, but others have gone over 9 minute. I yield back my time for those on the Democratic side who would like to be heard on the legislation.

Mr. President, I commend my colleague from California. Bring that chart down here. Talk about alphabet soup, this is very instructive, it seems to me, in terms of why people are so confused about what is in this bill. There is incredible language here that even the most determined person to learn about this bill would be hard pressed. There it is.

I thank the Senator from California because she has laid out here a lexicon of language which would glaze over the eyes of the most determined people to try to sort out what this bill means.

One of the points the Senator made is worth noting again. This is not the end of a Congress. This is only the end of a session. If we were at the end of a Congress, I presume the argument made that we have no other choice, we can either do it now or it doesn't get done would be valid. Each new Congress has to begin all over. But we can actually come right back, pick up where we left off, and try to work this legislation out to serve a better interest.

I thank her for this. Some of this really needs further explanation. Let me say this--and I am being repetitive to some degree--the prescription drug piece of this is of concern to me. I was willing to accept the argument that having a prescription drug benefit of $400 billion over the next 10 years, while not perfect, was a start. If that is all we were voting on today, I would probably vote for it. What is not being discussed at any great length is the second half of the bill, which is very confusing to people because it has language in it that is unclear as to what the ramifications mean.

So people need to pay attention and understand that if we are just dealing with the second half of the bill, the Medicare-exclusive parts of Medicare, I think there would be a very different reaction in the Chamber to what we are proposing. I suspect the prescription drug benefit piece would pass overwhelmingly, and I suspect that a free- standing Medicare piece might not get 15 votes, when you consider what is being proposed.

You are absolutely prohibited, under this bill, from joining to go out and buy prescription drugs collectively. You are banned under this legislation. Under this legislation, of course, you are going to give a significant advantage in the competition because of the $12 billion subsidy. That is the reason the order holds here. This piece of legislation has a significant subsidy coming up to the private piece of this proposal. Nothing like that is being offered anywhere else.

In fact, a similar point of order was raised in July of last year--at the end of July of 2002--making the exact same point of order that has been made on this legislation. That point of order was raised by the majority leader and the chairman of the Finance Committee against the piece of legislation offered by Senators Graham, Miller, and Kennedy. There, the point of order was against section 302(f) of the Budget Act because it broke the budget ceilings.

That is what is being offered here for exactly the same reasons. It will be curious to see whether or not the people who felt so strongly about not waiving the Budget Act back then will do the same here.

This legislation being proposed, obviously, also makes it extremely difficult for people, down the road, to be able to have a prescription benefit plan that is going to be fair and balanced. I take note that none of these provisions, by the way, will go into effect rather immediately. You can impose many of the things we are talking about here in a matter of days if you are truly interested. Yet they are delaying it until 2006, until after the 2004 elections when, obviously, what happens to beneficiaries under the so-called fair competition-- Medicare, remember, was a program designed to take the wealthy and healthy and the poorer and sicker together, not to discriminate, and to provide for both of these constituencies. Over the years, that is why the program has been so successful. What is going to happen, of course, with this unfair competition of a 9-percent differential and a $12 billion subsidy is that those who are wealthier and healthier will spin off out of Medicare, and only the poor and the sicker will be left in the program; thus, raising the premium costs or reducing benefits. That is what is going to happen here. There is no doubt in my mind about where we are headed with this proposal. We have raised this point of order to suggest that there is a better way of crafting this legislation. We urge our colleagues to support the point of order when the vote occurs.

Madam President, let me first of all commend my colleague from New Jersey for a very fine statement on the pending matter, the Medicare bill. I intend to take some time to speak on the same matter and then I plan to yield my remaining time to the Democratic leader for his purposes.

This is the third time I have spoken on this matter since last Friday. We are now in a situation, I am sure people are aware, where we have had a cloture motion which was approved earlier today. We then considered a point of order which was not sustained, and as a result our efforts to try to use a procedural move short of final passage have been, I gather, exhausted. So we are down now to the question of whether or not we ought to vote for this bill at this juncture or whether or not people will come to the conclusion there are enough flaws in the pending matter that we ought to take some additional time to review it before it becomes the law of the land.

Before I get into some discussion of the substance of the bill, I will take a minute or so and talk about the process of law. Putting aside the matter before the Senate, which has obviously been contentious, I am very worried about how we are doing our work in this institution--not just this body but the legislative branch in general.

I will have served, at the end of this term, some 30 years in the Congress, 6 years in the other body and 24 years in the Senate. I have enjoyed serving in this fine institution and watched it carefully over the years. In that time, I have noticed that there are ebbs and flows in how the institution functions and operates. There have been periods affectionately referred to as the golden age of the Senate and other times when they have been less than golden. I will not use language to describe what others have used to describe the less than golden periods of the Senate.

I am very worried about how we are proceeding at this time with the underlying measure. It is so important in these institutions that we not only just be concerned about what we accomplish but how we go about working toward these accomplishments.

The Founding Fathers of this country were very concerned about that. If they were looking for efficiencies of systems, if they were looking for a process that would guarantee quick results overnight, this is certainly the last system they would have constructed. Particularly in this institution, the Senate, the rights of a minority are paramount. We have always said in the other body, the House Chamber, the rights of the majority should prevail. And the Founders, in their wisdom then, in the creation of the Senate, emphasized the rights of a minority. In so doing, they wanted to guarantee that matters would be thoughtfully deliberated.

I am very worried, over these last number of months, including the bill presently before the Senate, that we are not devoting the time necessary for deliberate consideration of matters before this body. In fact, I was stunned to just learn that when conferees were named on the Medicare bill before us--and for those who are not students of this institution or follow the Congress on a regular basis, when the Senate passes a bill, and the House passes a bill, invariably, with some exceptions, there are differences.

So this body, the Senate, will appoint conferees, representatives of this body--usually from the committees of jurisdiction over the legislation--to meet with conferees of the other body, usually coming from their committees of jurisdiction. And those two smaller groups then meet to resolve the differences between the two bills.

Over the years, of course, many conferences have been lengthy, many have been contentious, particularly those involving difficult matters, but it is the nature of the institution, learned over our 220-year experience that it is in the tension of debate that some of the best ideas emerge, when there is full expression of the views of the American public in those meetings, when people of different persuasions and ideologies come together and work to resolve their differences.

What I find stunning is that it has become popular, in recent days, to have conferees named and then have conferees excluded from meeting in these conference committees. That is exactly what happened here with the measure presently before us. Whether you are a Republican or Democrat, liberal, conservative, or moderate, you ought to be deeply concerned if this becomes the precedent, the operating standard procedure, that when bills are passed and conferees are named, then people are excluded from meeting to try to resolve their differences.

I can only suspect, Mr. President, that most Americans are not aware that this 675-page bill, the Medicare reform bill, was crafted by only Republican Members of the House of Representatives. There was not a single Democratic Member of the House of Representatives from the Ways and Means Committee included in the room to write this bill--not one-- despite the fact that the House is controlled by Republicans by only a small majority. Yet not one member of the minority party of the House of Representatives was brought into the room to sit down when the conferees met to resolve their differences on this bill. And out of this body, only two conferees from the minority side were included, despite the fact that only one Member separates us. Senator Daschle and Senator Rockefeller, duly appointed as conferees, were excluded from meeting. In fact, Senator Daschle, the Democratic Leader of the Senate, was excluded from the conference on this important measure. To say to the Democratic leader, the minority leader of the Senate, and to Senator Rockefeller, two senior members of the Senate Finance Committee: You are not allowed to come into the room to help draft a piece of legislation dealing with 41 million Americans, Medicare beneficiaries, to frame a prescription drug benefit. I am stunned, Mr. President, that a 675-page bill, on as an important a matter as the healthcare of nearly 41 million elderly Americans, that not a single Democratic Member of the House, and only two members of the Senate Finance Committee already supportive of this bill could meet to craft the bill before us. I find it breathtaking that the process was so flawed in the development of this bill that Members of our own respective Chambers were not allowed to come in and work to resolve differences on matters as important as this.

Then, in the House of Representatives on Friday evening and well into Saturday morning, when the vote was being cast on the final passage of this bill, we witnessed a historic moment as the House held open for almost three full hours--the longest recorded vote in the body's history--a vote that was supposed to take 15 minutes to pass this bill. The Presiding Officer said: There will now be 15 minutes to record your votes by electronic device. Having served in the House of Representatives when electronic balloting came into place, I heard that message over and over again: Members will have 15 minutes in which time they can record their ballots by electronic device. And almost 3 hours later, that ``15 minutes'' elapsed, as every possible bit of arm twisting, every possible maneuver you could make to change the outcome of that vote transpired. I believe that this vote constitutes one of the worst moments I can think of in the conduct of the House of Representatives.

Then, when several other members of the minority decided they would change their votes in light of the arm twisting and in light of the final outcome, the gavel came down within a nanosecond, and the traditional opportunity given to Members to change their votes before a final vote is recorded was denied them.

I am stunned as I watch a process around here so deteriorated that it has come to this. And I say to my friends on the other side: Beware. The wheel does turn. The day will come when we will be in the majority. And in the House that will happen as well. Changes in leadership have occurred throughout our history and they will continue to occur. What sort of precedent are we setting if this is how we conduct our business?

Then, last Thursday, late in the afternoon, those of us who were excluded from having Members who represent our views work on this conference report, were delivered this 675-page document.

Suffice it to say, there is not a Member here who has read this in its entirety, nor could they possibly understand it even if they tried to, since last Thursday. Yet we have just voted on several procedural motions here to say that within a matter of hours, we are now going to adopt this historic piece of legislation without fully, in my view, understanding the implications of what is actually contained in the bill.

Mr. President, a bill of 675 pages, delivered just last Thursday, and here it is, Monday at 6 p.m., and we find ourselves only a few hours away from deciding the fate of 41 million Medicare beneficiaries and coming generations of them as to whether or not they will have the incredible safety net the Medicare Program has provided for 38 years.

These process questions cannot go unnoticed, Mr. President. And while we talk about the implications of what we are told is in this bill, I am deeply troubled that the shutting out entirely of Democratic Members of the House, the denial of the Democratic leader of the Senate, along with Senator Rockefeller, the ability to meet and discuss this bill and its full implications. Further troubling then to witness a 3 hour vote in the House of Representatives in the middle of the night, under the guise that we must get this done. As my colleagues know full well, this is the end of a session, not the end of a Congress, and to not take a few more weeks to analyze what we are doing with this bill, to see if there is not some compromise that can be reached, when you consider the great implications of this bill, I think is a sad commentary on the condition of the Congress. I have been here for a quarter of a century, and I do not recall a time like this in my 24 years where we have come to this.

So beware. Beware, America. Beware, America, of what happens when this process breaks down, as it has here with this bill.

Beware, America, when you have a bill of this magnitude and size passed in the wee hours of the morning in one Chamber, and rushed through the other in a matter of hours of debate and discussion--more a litany of speeches than any real debate.

Beware, when almost one-half of the entire Congress is excluded from sitting and working on a product as important as this. There is something wrong when that happens, Mr. President.

I don't care what your politics are; I do not care what your ideology is. Beware, Americans, when you find out other voices are denied being heard. It is the critical quotient, the critical element of what constitutes this democracy: the importance of debate and discussion, the tension the debate brings, and the ultimate improved product that occurs when that happens in America.

When other voices are not heard, when other ideas are not brought to the table, then we all suffer. That is what has happened in the construct, if you will, of this legislative package.

Let me take a few minutes, if I may, and try to share with my colleagues what I believe is included in this bill. I have talked about it to some degree already, and I know, in a sense, why we are being called on to do this as rapidly as we are. Because based on the time I have spent going over this bill, and looking at it, and others who are more knowledgeable than I am about health care issues, who have dedicated almost their entire careers to examining these issues, I would say one of the reasons this is being pushed through as rapidly as it is, is there is a lot in this bill that the more you know about it, the less you would like it, and the more opposition would grow to its passage. The more people are aware of what is included in these 675 pages, the greater concern they ought to have.

There are those who have never liked the Medicare program, who fought against its very creation 38 years ago, and since then have been seeking an opportunity to undo it.

Congratulations to them. Congratulations to them because I think, in effect, they have achieved that result with what I think is going to happen in a few hours; that is, the adoption in the Senate of this particular package, the approval already in the House and the likelihood, of course, that the President is going to sign this into law.

Then I would tell America, as you get to know this bill, you will come to have greater and greater concerns about it. Let me explain why I think that is the case.

We have all been talking about--certainly this side of the aisle has--the great need for a prescription drug benefit for years. However, I have reservations about the prescription drug benefit contained in this bill. Under this bill, 2.7 million retirees are going to lose their existing drug benefit package--2.7 million of the 41 million Medicare beneficiaries. While some might say that doesn't amount to much, when combined with the other millions of seniors who are going to have their premiums increased, and possibly their benefits reduced if this bill is to pass, you begin to realize how troubling this bill is. That is literally what is going to happen under this bill. 2.7 million retirees are going to lose their present prescription drug coverage.

Why? Because they presently are covered under plans offered by their previous employers. They have retired and yet they carry with them those plans. The estimates are that 2.5 million retirees are going to lose coverage because their employers are going to drop those plans if the benefit under this bill is enacted.

In my State, just to put it in local terms, this will mean that 39,000 people in Connecticut who fall into that category will lose their present drug coverage. In Connecticut there are approximately 515,000 people who are of retirement age, and of that number, I am going to have 39,000 who are going to be dropped from their prescription drug coverage.

Further troubling, I am then going to have 74,000 Medicare beneficiaries in my state of Connecticut, and 6.4 million nationwide, who are going to lose as well under this bill. What happens to these people? These are seniors with severely limited incomes, making them eligible for both Medicare and Medicaid. These senior citizens are going to face less access to and higher prices for the drugs they need due to this conference agreement requiring drug co-payments and the creation of an assets test.

I have heard Members say that the price increases these low income seniors will face are not that significant. Well, it isn't much, if you make $158,000 a year as a Senator. A few bucks a month amounts to nothing. But if you are a person making $13,000 a year or less, as these people do, and you are on Medicaid and Medicare and you are working each month trying to pay a mortgage, to put food on the table, to pay for the other essential needs you have, then believe me, these cost increases are terribly hard to bear. We in this body do not have such worries because we have such a great health care program. Members of Congress enjoy a fabulous healthcare plan. We offer nothing like that to the rest of the American public so we don't quite understand what other people go through in many ways.

Taken together--those losing their present prescription drug coverage and those low-income beneficiaries facing increased costs--you have one fourth of all Medicare beneficiaries negatively effected by this bill. Those are, to begin with, some of the concerns we have with what happens to close to 9 million of this nation's nearly 41 million retirees.

Now let me move to address some of the other issues of concern in this bill. While others have already talked about the prescription drug benefit portion of this bill at length, I want to point out that I am worried about certain aspects of this portion of the bill which will present real problems for our seniors. Under the proposed prescription drug benefit, this bill before us contains a gap in coverage, the so- called donut hole. The donut hole is nearly $2,800, twice the size of the one we adopted when this bill was adopted by the Senate back a number of months ago. Under the conference report, Medicare beneficiaries with costs within this so-called donut hole will be forced to pay for the full cost of their prescribed medicines as well as a monthly premium of an estimated $35. This will mean that when your prescription drug

spending falls within this coverage gap that you will receive absolutely no assistance purchasing your prescribed medicines under this bill. To add insult to injury, you're still on the hook for the monthly premiums while receiving no assistance affording your needed medicines.

Also troubling, Mr. President, is the notion of the monthly premium of an estimated $35. Under this conference agreement, if you end up having only one private plan providing the drug coverage in your area, these plans could charge whatever they want, because the lack of a another competing plan. The $35 figure often cited is not a cap; it is the estimate of what the average may be. There is nothing in this bill that prohibits one of those private plans from charging whatever they want in that area. You would end up being forced to charge whatever these plans determine is their price or not having any drug coverage at all.

Despite all of the problems with the prescription drug benefit portion of this package, even with the concerns I have outlined, I would have supported this portion of the bill if it stood alone as I believe it offers a first--though not nearly complete--first step toward adding a prescription drug plan under the Medicare program. I think the idea of doing something in this area made some sense. I would have, even with these bad features, supported this legislation in the hopes that in the coming years we could have modified it and changed it.

But something that few people want to talk about on the other side of the package before us are the structural reforms of Medicare contained in this bill. The conference report we are considering today is not just about prescription drugs. It has a second, much more troubling part. It is over this part that most of us who are expressing our strong objections to this bill have found concern. It is this part of the bill that gives us all pause because it is no less, in our view, than an attempt to end Medicare, certainly as we have known it over these past 38 years.

I tell America to watch carefully. This is the part on which you want to focus. The more you read about it, the more you will draw the same conclusion as those of us who are strenuously fighting adoption of this bill. It is an attempt to force seniors into private plans, producing billions in profits for HMOs but denying seniors access to the benefits to which they have become accustomed and the doctors they trust.

This bill provides a $12 billion subsidy to the private companies and a 9-percent kicker, in effect, to make sure the competition called for by this bill is rigged in such a way that they cannot possibly lose in that competition. The supporters of the bill will tell you it is not forcing seniors out of traditional Medicare. They claim they are creating competition and, as a result, offering seniors a choice.

Let's talk about the so-called competition in this bill and what it would create. Private plans under this conference report will be reimbursed at a higher rate than traditional Medicare--9 percent higher to be exact. How does Medicare compete when you have a 9-percent higher reimbursement for the private insurance plans they are supposed to be competing against? What kind of a competition is that, when all of a sudden you get a 9-percent higher reimbursement rate and claim to have a level playing field? Additionally, this bill makes available $12 billion to be used to lure private plans into the marketplace. If it is going to be a competition, let it be a competition--but we are going to stick $12 billion into the pockets of the HMOs, give them a 9-percent higher reimbursement rate, and say to Medicare: Go out and compete. That is like tying both hands behind their back and tying their legs together and then saying go run a race. A 9-percent higher reimbursement rate and $12 billion to lure private plans into the market amounts to the inclusion of a corporate subsidy in this bill of major significance.

Under this plan, private plans can design their benefits to attract certain beneficiaries, and that is a critical piece. These private plans can design them to attract wealthier, healthier Medicare beneficiaries. In the beginning, one of the magnificent features of Medicare was that we didn't discriminate based on wealth or illness. We said if you reach the age of 65, we are going to provide a safety net for you. The idea was that regardless of whether or not you are healthy, sicker, wealthy, poor, all are together under Medicare.

For the first time--and this is a major change--we are going to start to discriminate if this report is adopted. So the wealthier and healthier people are going to join plans designed by the private companies, leaving in the traditional Medicare program only the sickest and the poorest beneficiaries. When this happens, the premium costs are going to go up and for these seniors, and when they do, they are going to face higher costs and reduced benefits. I don't know what other conclusion you can draw. You cannot accept the notion that we are creating a level playing field. It is not a balanced competition if I provide you a 9-percent higher reimbursement rate than Medicare gets and I then give you an additional $12 billion to lure you into the market. It is just not.

America, pay attention. If you are, today, in the Medicare Program, you could end up watching this program be radically changed. So you end up paying higher premiums and watching your benefits be cut and watching only the poorest of the poor or the very sick be left in a program, as these designer programs created by the private plans will find ways of causing the healthier and wealthier to desert traditional Medicare. This is not a fair competition. It is a rigged game. This bill stacks the deck against traditional Medicare. The effects are self-perpetuating.

Traditional Medicare will grow weaker and private plans will grow stronger, forcing more beneficiaries out of the traditional program and into the arms of HMOs.

It is very easy to get bogged down in the complexities of this bill. So let me state very simply that the weakening of the traditional Medicare caused by this 675-page bill is going to force seniors to pay more and face the prospects of fewer benefits.

Ironically, this bill will mean less choice for seniors. One of the things we are being told is there is going to be a lot more choice under this agreement. One of the great features of Medicare is that you get to choose your doctor. I don't know a single American who doesn't like that feature, who doesn't appreciate the opportunity they have to choose which physician they want to have treat them. Under this 675- page bill, that is over with for many seniors. That fact alone ought to cause people to pause. Why? Why would you deny people the choice of which doctor they use, someone they may have dealt with for years? That choice is gone with this bill.

America, pay attention. It is gone. If this bill gets adopted in the next few hours, that is gone. That is not choice at all. Nothing would make me happier than to find out these predictions are wrong, but they are not. I truly hope seniors can retain the choice that they already have and that traditional Medicare survives.

Let me explain briefly why I get as passionate as I do about these issues, Mr. President. When the Medicare+Choice Program was created and these private plans first came to our communities, many offering zero premiums. People joined in droves, jumped from traditional Medicare at the promise of reduced cost and increased benefits. Then, of course, once the plans looked around in certain areas and discovered there weren't quite as many wealthier, healthier people in certain areas but there were poor and sicker people, they decided--and they can do this at a moment's notice--they said: We are leaving, packing up and getting out. They did that in my State. They packed up and left.

I remember going to a meeting because the senior Medicare beneficiaries I represent were so upset and concerned about these decisions to leave. I convened a town meeting in Norwich, CT. About 350, 400 people showed up, and it was on a Saturday morning. They could not believe what happened to them. One individual was so upset about his wife losing her Medicare+Choice plan--a man who served in the U.S. Navy in World War II and worked at the Electric Boat Division in Groton, CT, for many years. As he spoke passionately about what happened to his wife, being dropped from this program, in his great worry and concern about that, he passed away at this meeting. I will never forget it. It was, obviously, a stunning moment for

the people there. He was so upset about what happened to him because his wife's HMO left, and she was left with nothing in terms of the promised health care coverage. He was a man by the name of Frederick Kral from eastern Connecticut. I have never forgotten that tragic incident and the deeply personal stories shared at this town meeting.

I remember how people felt when these HMOs came running in and then walked away. I cannot say that will happen here. I don't know what is going to happen. We are just playing such a risky game with all of this. Why are we taking these kinds of risks on such an important issue? We should realize the tremendous damage we can do to people.

I recall very well what happened when we had HMOs promise they were going to step in and provide choice and do all these wonderful things. Remember, these are companies that have to make money and they want, as their customer base, healthy people. They would like wealthier people because then they don't have to pay out as deep a benefit. When these plans discover people are not quite as wealthy and healthy, then they design plans that exclude them. My fear is that will happen here.

Even more ironic is this highly unfair system is being championed by the self-proclaimed champions of free enterprise.

The bill, as I mentioned, will provide $12 billion to help HMOs unfairly compete against traditional Medicare, along with a 9 percent higher reimbursement rate. It does nothing to control drug prices. If we really want to do something to promote competition under this plan, wouldn't you think we might have allowed the purchasing power of nearly 41 million Americans to achieve lower prices for prescribed medicines?

That is what we allow with veterans hospitals. The veterans hospitals collectively get together and negotiate with the drug companies for the best price. If you are a veteran in the country, you get a much reduced cost of prescription drugs because the VA has negotiated these prices on your behalf.

As my friend from Florida, Senator Bob Graham, so eloquently described earlier today--what do you say to two people who walk in--a husband, who is a veteran of the Korean war, who is paying one price for drugs because as a veteran the VA has negotiated a lower price, and his wife who stayed home and raised a family and maybe held down another job during that time? She is not a veteran, but she is on the same drug as her husband and she pays two, three, four times what he pays. How do you explain that to people?

Why can we not do in this bill what we have done in the VA? This 675- page bill specifically prohibits the Medicare program to negotiate for lower drug prices. How is this representative of free market principles?

On the other hand, we are being told that we ought to have competition between private plans and Medicare. When it comes to negotiating for lower prices for prescription drugs, this law categorically prohibits the Federal Government from doing so. It is OK for the VA, and I applaud them for doing that, but it is not OK for Medicare. Yet we are told this is supposed to provide a fair competition.

The reason, of course, for all of this is simple: The champions of free enterprise know private plans cannot compete with traditional Medicare on a level playing field. The subsidies are absolutely necessary because Medicare is actually more efficient. Medicare delivers services at a lower cost. That isn't one Senator's conclusion. Those who have examined this program from top to bottom, in every different manner, say Medicare is a very efficient program. And it delivers terrific services at a much lower cost than private plans, and we are about to walk away from that with the adoption of this bill.

We are going to go off now and take 41 million Americans and make them guinea pigs, despite the fact the system works. There is that old expression: If the wheel ain't broke, don't fix it. This wheel is working well--the Medicare wheel.

I am afraid we can only conclude one thing: The architects of this bill are going to spend billions and billions of taxpayers' money not to reform Medicare, but to dismantle it, to push patients out so that it will, indeed, wither on the vine.

I remember so well when the former Speaker of the House, Newt Gingrich, speaking in front of a group of people here in Washington, a group of lobbyists from the health care industry, talked about Medicare withering on the vine. I heard the other day Mr. Gingrich, no longer a Member of Congress, showed up at the House Republican caucus and gave a strong pitch for this bill: It is a great bill, according to the man who wanted to make Medicare wither on the vine. Either he had a great conversion on the road to Damascus, along the lines of St. Paul, or he still believes what he did a few years ago, and he is finally going to be able to achieve what he talked about doing then.

I suspect it is more the latter than the former. I have seen no evidence that there has been a change of heart by Mr. Gingrich in his views about Medicare. So the individual who promised you we are going to let this tremendously-successful program wither on the vine is now applauding the fact we are going to finally achieve what he suggested a few years ago.

I predict we will be back, unfortunately, at great cost to the American taxpayers and at great cost to older Americans. We will be back in this Chamber rewriting this bill. That much I will guarantee will happen.

Unfortunately, we will squander billions of dollars unnecessarily. We will put a lot of people who shouldn't have to go through this, given their age and the problems they face--older Americans shouldn't have to go through the added frustrations and anxieties and wonder every day, as millions of them do, about how they are going to pay for the healthcare needs they have. They are going to have to go through this wringer because there are people around here who just never could stand Medicare and have been looking for ways to undo it since its inception.

This part of this bill, these structural changes to Medicare, if they were to offered before this Chamber as a sole proposition, I don't think would get 15 or 20 votes, but because they have been linked inexorably to the prescription drug benefit, the bill will pass.

As I mentioned at the outset of these remarks, the prescription drug benefit, while it is flawed, in my view, is worthy of support, despite the objections I have to certain parts of it. But it is not so good, in my view, that it ought to override the great damage to the Medicare program that will be caused by this bill.

Allow me to express my concerns about another provision. The conference agreement before us today establishes the dangerous precedent of instituting so-called cost containment measures that could directly lead to service cuts in what Medicare covers and just-as- severe increases in costs to Medicare beneficiaries.

Specifically, the conference report calls on the Congress and the administration to address Medicare's costs when general revenue spending on Medicare reaches 45 percent of the program's total cost. Let me read that again. Specifically, this conference report, calls on Congress and the administration to address Medicare's costs when general revenue spending on Medicare reaches 45 percent of the program's total cost.

Does anyone in this Chamber know of any other Federal program that has a similar provision in it, when we pay for anything else you can think of, when 45 percent of the cost comes out of general revenues, that we must take enact cost containment measures? Only Medicare; there is no other Federal program that has similar handcuffs on it that Medicare does under this bill: It states that when you reach 45 percent coming out of general revenues, then cost containment measures must be taken.

The adoption of this purely arbitrary cap will lead to almost certain erosion of this critical program's scope of coverage and affordability. It is yet another attempt of opponents of Medicare to destroy this program that so many of our senior citizens rely on every day.

Today, after nearly 40 years of Medicare's inception, we find ourselves truly at a crossroads. The opportunity is before us to move Medicare toward the future without threatening its proven availability, to provide for the health and well-being of this Nation's

seniors citizens. Sadly, the conference agreement represents an opportunity lost, an opportunity not only to add comprehensive coverage for prescribed medicines under the Medicare Program, but also an opportunity to strengthen the Medicare Program for future generations.

So it is with a great deal of sadness that I find myself faced with this 675-page document. The entire House minority was not allowed in the room on this bill. There were secret meetings of the conference committee that crafted this agreement--I am not making this up-- clandestine meetings so no one could find out where they were meeting. Not a single representative of the minority in the House was allowed to sit in and help craft this bill affecting 41 million Americans--and all but only two members of the minority on this side were excluded as well from these deliberations. The Democratic leader, a member of the Finance Committee, was told he had no right to go to the meetings. In fact, the chairman of the committee said: If the Democratic leader shows up, then the meeting will be canceled.

What kind of arrogance is that? The chosen leader of a minority of this body was told if he shows up as a member of the conference committee, the House chairman of this conference would close down the meeting and walk out.

This process is broken, Mr President. How much confidence can America have in a product that in the construct of these 675 pages, minority views were almost totally excluded.

I warn my colleagues, a dangerous precedent is set when a bill of this significance is crafted in the manner of the bill before us. This bill before us affects not just those who are direct recipients of Medicare. Think what Medicare has meant to the children and grandchildren of its beneficiaries. Think what costs would have had to have been borne by children trying to raise their own children while they were taking care of their parents had it not been for Medicare.

How many college educations would not have been achieved if the families were forced to choose between making sure that mom and dad could see a doctor or their children might go on to college? That is not hypothetical at all. Think how many people's dreams of home ownership, making investments in things families need, were made possible because there was a program called Medicare. It said to Americans: You have given so much, particularly the generation that Tom Brokaw has called the greatest in our history, that carried us through a Depression, through World War II and Korea, that after all of that, we said to them, look, we are going to create a program that makes it possible for you and your families not to have to face poverty or worse when you face expenses for needed medical attention.

Despite the fact the program works well, has been efficient, and produces services at low cost, we are about to enter a casino, under the best of circumstances, and start playing roulette with people's health care and with the costs associated with it. That is why I am so saddened by the emergence of this conference report.

The process has broken down. This is a product in which one can have little or no confidence. I am being asked as one Member, with only 3 or 4 days to review this product, to agree to sign on to something of this magnitude. There is an opportunity, I think, to get this right and to make this better. We owe it to the people of this country to seize this opportunty.

Older Americans are not Democrats or Republicans. They are not conservatives or liberals. They are just hard-working people. The least they deserve is to have a Medicare Program they do not have to worry about. They need a comprehensive prescription drug benefit so they do not have to make choices between the medicines they need and the food they must have or the heat they must purchase to warm their homes.

We should be able to find a way to achieve that. I am deeply saddened that we have not achieved that goal with this conference report. After all of the reasons I have laid out, I will vote against this bill and I urge my colleagues to do likewise.

I deeply regret we did not prevail on opposing cloture or on the point of order that was raised so that we might have been able to go back and work on this again and come back in January with a better product. This is not the end of this Congress, it is only the end of a session. Yet every effort is being made to see to it that we jam this flawed bill down the throat of America.

We will be back; unfortunately, at great cost to the Treasury, and at great cost to the well-being of an awful lot of people who deserve better than they are going to get through the adoption of this bill, in order to fix this bill. I truly wish this were not the case.

I reserve the remainder of my time and designate the Democratic leader as the beneficiary of any time I may have remaining.

I suggest the absence of a quorum.

Madam President, I ask unanimous consent that the order for the quorum call be rescinded.

Mr. President, today by a 2-vote margin, I guess it was, the Senate, this greatest deliberative body in the world, decided to begin the process of ending Medicare in America. After nearly 40 years in which the elderly in our country have been raised out of poverty, in which the elderly in our country have been given the assurances that they will not have to go to the poor farm to pay for medical care, after nearly 40 years of children being freed from the burden of caring for ailing parents and grandparents, after providing an envy of the world in what we do to care for our elderly in terms of health care, the Senate today began the process of turning our back on all the progress we have made. Medicare was created, as I said, almost 40 years ago, with the purpose of providing our Nation's aged and disabled with that safety net, to protect them from death and destitution.

For years, seniors have counted on health security in their golden years thanks to Medicare. For nearly 40 years, this program has stood as a social contract between the American Government and the American people. After a lifetime of labor, when a person turns 65 they are promised health insurance covering doctors' visits, hospitals, and many other health costs. There was one exception for all of those 40 years; that is, there was no coverage for prescription drugs. It is almost impossible to overstate what Medicare means to a family, a citizen of modest means who has worked hard for a lifetime, a person who does not want to be a burden on the rest of his or her family. Medicare has been a rock solid, reliable, guaranteed lifeline for America's senior citizens.

Today, with a two-vote margin, we are watching that social contract erode. We are taking huge risks with the health and security of seniors, all to satisfy ideological agendas, to satisfy big political donor's wishes and certain political strategies.

With this Medicare bill, we have seen grave abuses of power--such as the recent vote in the House of Representatives in which this bill before us today lost in the House of Representatives, lost under the normal rules, lost under the democratic means over there. But as you know, they kept the vote open for almost 3 hours, from about 3 a.m. to 6 a.m., to twist arms until they finally got the votes.

I was driving to work Saturday morning. I was listening to public radio. A caller had called in and she said President Bush says he wants to bring democracy to Iraq. After what happened last night in the House of Representatives, I hope Iraq wasn't watching. That is not the kind of democracy they need in Iraq.

I am disappointed in the process that we have had here. This has been a sham process.

We have this bill here; I have held it up many times. I can barely hold it up right now--1,200 pages. It is dated November 20. It was delivered on our desks when we arrived here Saturday morning, that big. Saturday morning and here it is, Monday, and we are expected to vote on it.

How many seniors in this country have seen this bill? How many here in

this room have actually gone through it or looked at it--or staffs? We know basically what is in it, but who knows what fine print is included and how some things may work? It is a terrible process.

That is why I argued against it repeatedly and that is why I voted against cloture today on the filibuster. It is not that I want to keep filibustering, but I believe we should have gone home and let this bill get out to the public, let the American people see it, talk about it, digest it. Then we can come back here in late January, as we are going to do, and February, and see what our constituents think about it. To me that seems to be the American way, the democratic process.

That is not the process we followed here. That is not the process. We are debating a proposal that was originally supposed to accomplish one simple goal: to right the wrong in Medicare, that gap that was in there, by providing coverage for prescription drugs and to make medicine more affordable for seniors.

I regret that in writing this bill Congress has strayed from that objective. We have forgotten who we are supposed to be helping--our Nation's seniors. Instead of a straightforward drug benefit, we now have a Medicare privatization proposal that threatens to undo the entire Medicare Program on which seniors and the disabled rely each and every day. Seniors who rely on the stability and affordability of this program, seniors like many in my home State of Iowa, simply want and need affordable medicine.

I have seen no big clamour to change the basic Medicare Program. We had a proposal here in the 1990s to get more competition in Medicare. The Congress came up with this Medicare+Choice Program, where seniors could stay in traditional Medicare or they could join an HMO. So we have had several years of experience with this.

What is the result? Eighty-nine percent of the seniors in this country have chosen to stay with Medicare. About 11 percent in various parts of the country went with HMOs. That is fine. That was purely voluntary. But seniors have spoken. They want to keep traditional Medicare. They simply need an affordable drug benefit.

I want to say more about this as I talk, but under this bill seniors do not really have a choice. You hear my friends on the Republican side say time and time again, choice, choice, choice, we are giving seniors choice, choice, choice. That simply is not true.

I hear all the time they say if a senior wants to stay with Medicare, they can stay with Medicare. That is true. But at what expense? What they don't tell you is, if a senior wants to stay with Medicare, they don't get drug coverage. They get no prescription drug coverage. Yes, you can stay with Medicare but you have to give up prescription drug coverage. If you want prescription drug coverage, you have to go to some private plan. That is what they are not telling. I will have more to say about that choice.

This bill totally violates the spirit and substance of the original Medicare Program. Again, to make it worse, we are rushing it through the Senate. This bill doesn't start until 2006. What is the rush? Why are we here 3 days before Thanksgiving, 7 o'clock in the evening, having a vote on a filibuster today, trying to ram this bill through? Why is it that the House of Representatives, in an all-night session, rammed this bill through? I will tell you why they rammed it through. Because the pharmaceutical companies and the big insurance companies want to get it through before Americans broadly know what is in it. That is why. Get it through in a hurry.

Only a few fortunate people know what is in this: a roomful of Republicans, two Democrats, and big money industries. Seniors didn't have a seat at the table. If they would have, I am sure they would have created a very different bill.

I have this cartoon here. I will show it again. Here is a pharmacy. There is a pharmacist who represents Congress. This elderly woman has come in, has given her drug benefit to Congress, and Congress is saying: Have a seat. It will be ready in 2\1/2\ years--your prescription; 2\1/2\ years. Yet we have to rush this through right now.

As I said, I called this the big Medicare gamble. It is like a roulette wheel. That is what we are doing. Before, under Medicare, it wasn't a gamble. You knew what you had. You had good, rock solid coverage, no matter what part of the country you lived in, whether you lived in rural Iowa or New York City; it didn't make any difference. Now we are rolling the dice, spinning the roulette wheel. It is going to unravel Medicare. The special interests, the drug companies, the HMOs are now more important than seniors.

Seniors are being told there is not enough money for a really good drug benefit. Why isn't there enough money? It is because we already squandered our surplus in tax cuts worth trillions for the wealthy. Once again, the well-heeled on Wall Street are more important to this administration than the elderly and disabled on Main Street.

What we have before us today is a bill drafted behind closed doors in the dark of night that amounts to a bonanza for special interests. Don't take my word for it. Look at what others are saying regarding this bill.

This is from the Des Moines Register editorial board, my home paper:

This legislation is a big, sloppy kiss to the

pharmaceutical and insurance industries.

The Albany Times Union:

This is not only an imperfect bill, it may also be a

disastrous one.

This is the New York Times of the 19th:

This is a gift to pharmaceutical companies and insurers and

a threat to elderly Americans.

Deal would alter Medicare's core. If a compromise bill on

prescription drugs passes, the Government program will become

a massive subsidized insurance market.

That is the LA Times. They have it right. It is not just the media and some of us on this side. From the American Conservative Union, listen to what they say:

The Medicare prescription drug benefit bill that passed the

House and the Senate would drive up costs for millions of

senior citizens. Millions more will lose their current

coverage under private Medigap insurance and employer

provided plans. The House-Senate conference committee should

reject the bill and start over with a bill that includes real

Medicare reform.

This bill would provide billions of dollars in subsidies--bribes--to private plans and HMOs. In fact, this morning's Washington Post had an article which said the Medicare bill would enrich companies $125 million more for employers and health firms. It would ensure billions of dollars in profits and projected $139 billion to pharmaceuticals. I think it speaks volumes that when this bill came out last week, the drug and health industry stocks surged on Wall Street.

I ask unanimous consent that the article from today's Washington Post be printed in the Record.

Mr. President, the legislation before us seeks to privatize Medicare, plain and simple. It seeks to privatize it, despite the fact that 89 percent of seniors say they want to stay in traditional Medicare--and they have done so when they had a choice-- despite the fact that traditional Medicare is less expensive to administer--2 to 3 percent compared to 15 percent in private plans.

Again, there is something the average person doesn't understand. They don't realize. You would think a Government plan such as Medicare would cost more than a private plan. Private plans are supposed to be cheaper because of competition. We have had Medicare for almost 40 years. We have had private plans that length of time. So we have a lot of data. We know. This is not conjecture. We have the data. We know. What does the data say? Administrative costs for Medicare, 2 to 3 percent. In other words, out of every dollar that goes to a beneficiary, it takes 2 to 3 cents to administer Medicare. For a private health care plan, for every dollar that goes out, 15 cents goes for administration.

You might ask, Why is that? Just think about it this way. With traditional Medicare, we don't have to spend hundreds of millions of dollars on corporate CEO salaries. We don't have to spend hundreds of millions of dollars at least for fancy full-page ads in the New York Times and USA Today and Newsweek magazine. We don't have to spend all of that money to advertising agencies. That is where you get chewed up with these private plans.

Despite the fact that Medicare expenditures are growing at a slower rate than private plans, they say government costs are going up. The fact is--again, we have data for 40 years--Medicare has increased by 9.6 percent compared to private plans at 11.1 percent. Despite that, this Senate, this Congress, and this administration want to move us into private plans. Despite the clear wishes of senior citizens in this country, they want to move us into private plans.

I guess for those who came up with Medicare+Choice, somehow their ideology said these seniors would move into HMOs, and 89 percent said no. By gosh, I guess the thinking is here, if they didn't want to voluntarily move into HMOs, we will force them into HMOs. That is what this bill does.

The conferees chose to ignore all of the facts and all of data we have from the past. Instead, they concocted a grand experiment that encompasses all their right-wing ideological fantasies and seniors are the guinea pigs.

What we have in this bill that no one here has read is nothing less than a witch's brew of seemingly appealing benefits. But it is a witch's brew, one that is going to come back to haunt us in the future.

This experiment is a result of what I call private sector worship. It is a faith-based notion among some of our colleagues that the private sector will take care of everything. It is a blind faith that free markets solve every problem. But this private sector worship flies in the face of past experience. The entire reason we have Medicare today is that there is no private sector market for health insurance for sick seniors--none. Why? Because there is no money to be made in insuring sick, older people.

The free market works fine when you are talking about automobiles, airplanes, TVs, widgets, clothes, and that type of thing. But the free market is not stupid. The free market cares about profits--not people. By its very nature, the free market shuts out people with disabilities, shuts out people with mental illnesses, and shuts out people who are in the last years of their lives. In short, the free market shuts out people who are not profitable.

I have news for my colleagues who believe the free market is the answer to everything. The free market did not

break down barriers to people with disabilities in our country. It was the Government--we here in the Congress--that had to step in to ensure opportunity and openness in our country for people with disabilities. In the survival of the fittest free market, these folks were left behind.

Another example: We have been fighting this Congress for years to pass a bill ensuring mental health parity. But people with mental illnesses are not a profitable group. So the free market, left to its own devices, will have nothing to do with mental health parity.

Think about it. We don't have mental health parity. Why wouldn't we? Why wouldn't the free market jump in there and get it? Because there is no profit. That is why, as soon as we get back into session next year, I hope we pass the Paul Wellstone mental health parity bill. Again, if we leave it up to the free market, people with mental illness are simply left behind.

Another prime example of those left behind is the elderly. The elderly are not a profitable group of people to include in an insurance risk pool. They are sick. They have chronic illnesses. They are expensive to treat. The proof is all around us. It is impossible to imagine private insurers fighting and competing with one another for the privilege of covering the elderly. That is why we have to bribe the companies with billions of dollars of taxpayer money to get them to participate in this witch's brew scheme we have come up with here.

I have seen this proof firsthand. The other day, I talked about my own situation. I want to repeat it again.

In 1958, I was a senior in high school. My father was 74 years old. My mother had passed away 8 years prior to that. My father had worked most of his life in the coal mines in Iowa. My father had an eighth grade education. My mother was by then deceased. She was an immigrant with no formal education--little formal education. We lived at that time in a little house in a rural town of Cummings, IA, of 150 people. Because of my father's years in the mines--we called it miner's lung at that time; they call it black lung today--he would get sick every year. We would never see doctors. We didn't have any money. My father's total income was less than $1,500 a year. It was about $1,200 a year. That included bonuses for having kids under the age of 18.

Thank goodness he worked a while during World War II to pay into Social Security and he had some Social Security. That is all he had. My father had no stocks, no bonds, no property, no trusts, nothing. He had the small house we lived in and he had a Model A Ford, the only car he ever owned. That was 1958. And every year during those 1950s, I remember, like clockwork, my father would get sick. He would get sicker; he would get pneumonia. We would rush him to the hospital in Des Moines. They would put him in an oxygen tent, give him antibiotics, fix him up, and send him back home again.

If we did not have any money, and our total family income was less than $1,200 a year, how did we afford that? I tell you how: It is called charity. The Sisters of Mercy at Mercy Hospital would take care of my father, and knowing that we were poor and could not afford it, they would not bill us. That was charity.

I was in the Navy some years later, in 1966. I came home on leave, I think for Christmas, and my father was quite beside himself because he showed me this new card he had, a Medicare card. Now he could go see a doctor. If he had to go to the hospital, he did not have to rely on charity any longer.

I often think of how much better my father's later years would have been had he had Medicare. If he had seen a doctor and had preventive health care, his later years would have been much healthier and much better. But he only had Medicare for 2 years before he passed away.

I tell that story because I wonder, as I stand here and as I listen to all this debate about choice, as I listen to the debate about how insurance companies out there will come in and do all this, I wonder, why didn't insurance companies rush to help my father? Why weren't they knocking on his door, competing with one another, to cover my father? We had insurance companies at that time. Why weren't they knocking his door down to cover him? Why? Because my father was not profitable. Elderly people in health care are not profitable.

So do not tell me the private sector will solve every problem, because I lived through its failures firsthand. I know many Iowans and many Americans have the same situation. They do not want to be left to the volatility and the whims of private HMOs.

I understand many of my colleagues prefer the free market over Government intervention. I do, too, in most cases. But to say that we are going to do it regardless is a misplaced faith. There is a time and a place for the Government to step in, where the private sector fears to tread or fails to tread. No question, this is the case when it comes to helping people with disabilities, people with mental illnesses, and seniors with serious health problems.

We hear the claim that private sector competition will drive down costs and save Medicare. Nonsense. The only competition will be competition for healthy seniors. If you are sick, you will be shunned.

I saw this headline in the Washington Post: ``Medicare Deal Likely to Spark More Health Care Competition.'' I thought, my goodness, and I got to reading it.

On Wall Street last week, drug stocks jumped as investors

anticipated a congressional deal finally announced in

principle last night that would add a prescription drug

benefit to the Medicare Program.

Pfizer was up on Friday. So was Eli Lily. And so was

Johnson and Johnson.

But this is what it is all about, as Robert Hayes, president of the Medicare Rights Center, states:

This could be like the wild West out there.

If suddenly there are five or six or seven plans out there,

the insurance companies will be pricing their product to make

a profit, as they are obligated to do. If the consumer is

kind of shooting in the dark because of the complexity of

this--and the darkness is deepened by age or disability--

you'll have a customer primed for exploitation. We're real

concerned that people could get ripped off.

It is not competition for the elderly out there. It is competition among the drug companies as to who will make the most money. That is the only competition that will be out there. They do not want an even playing field competition. This bill will give billions to private plans so they can compete and make profits.

This is what people have to understand. They should know this before we vote on this bill. That is why we should get it out there and come back in February and vote on it and let the people see what is in there. This bill before the Senate will pay a private insurance company 26 percent more than traditional Medicare; $1,900 more per senior.

Get this straight: We are going to take your hard-earned tax dollars and we are going to give those tax dollars to a private insurance plan to compete with Medicare, and in order to be able to compete, we are going to give them 26 percent more than what we provide in Medicare.

I guess I would kind of like that competition. Man, I would like to get a piece of that action. I would like to have the Government give me 26 percent more than what Medicare is making. That is not competition; it is a corporate giveaway. It is corporate welfare. That is what it is. It is a waste of taxpayers dollars when Medicare, over 40 years, shows it can do the job cheaper, more effectively, and more efficiently.

Seniors know it, trust it, and want to keep traditional Medicare. We are saying: No; we are taking your tax dollars and we are going to give it to private companies, 26 percent more, $1,900 more per beneficiary to bribe them to get into a private plan.

On top of that, the conferees have come up with what they call a stabilization fund. How about that for a nice fancy word-- ``stabilization'' fund? What are we stabilizing? It sounds as if there is an earthquake out there. There may be when seniors find out what is in the bill. It is a $12 billion slush fund for private plans. Privatization, when it comes to medical care for the elderly, costs more money and it will reduce choice.

We have heard the claim time and time again that seniors should have a choice as Members of Congress do. Seniors will be gravely disappointed when they find out what they are getting is nothing like what we have. I hear

about choice all the time. No senior will be forced out of Medicare. How many times have we heard that? They will be able to stay with Medicare.

Listen to the words carefully because what we are not hearing is that if you want drug coverage, you have to get out of Medicare. If you do not care about not having drug coverage, you can stay in Medicare. That is what they are saying. They are saying no one will be forced out of Medicare. No. But if you want drug coverage, you are out of Medicare; you have to go to a private plan.

Isn't that what we are all about, trying to get drug coverage for seniors? And seniors say they want it under Medicare; they do not want it under private plans. Seniors will actually end up with reduced choices under this legislation.

If there are two private plans, say, an HMO and a PDP--maybe you have never heard of a PDP. If you say you have never heard of it, I understand that because they do not exist. But it has been conjured up in this bill. We have conjured up something called PDPs. So if there are two private plans, an HMO, and a PDP, and if a senior who is in Medicare wants drug coverage, that senior is forced to take the PDP or the HMO. You cannot stay in Medicare. You have to move over and take one of the private plans.

That is a choice? That is a choice? That is like you have a choice between getting shot and getting hung. Either way, you are dead. Not a very good choice. They will not be allowed to get their drugs through traditional Medicare.

Again, let's say they go and join one of these private plans, this PDP, or whatever it is, or an HMO. Well, then the HMO can tell them: You can't see your doctor. You have to see another doctor. Oh, you can't take that drug. It is not on our formulary. You have to take this other drug.

Why do you have to take this other drug? Well, they will not tell you why, but they are probably getting a bigger kickback from the pharmaceutical companies for that certain drug. So seniors are forced to change drugs. That is not choice.

It seems to me around here sometimes it is almost to the point that if you hear someone say it is daytime, you might just think it is probably night. If someone says something is black, you probably think it is white. Around here we have gotten to the point where we use these words to confuse people, to make people think something is not what it is.

This idea of choice, that somehow we are giving seniors more choice-- just false. The rhetoric around this bill does not match reality. The President and this administration has said many times that seniors deserve choice, that the seniors deserve what Members of Congress have. I am all for that. But that is not what they are getting.

Right now, I pay about 25 percent of my drug costs. That is it, flat. But the prescription drug plan put before seniors in this bill will not even come close to that.

Instead, it is a confusing, convoluted maze that--mark my words--will leave the seniors feeling betrayed and bewildered. All I can say to some of my colleagues who may have been here in the 1980s is, do you remember when we passed the catastrophic health insurance plan? Well, if you like the seniors' reaction to that plan in the 1980s, you are going to love their reaction to this grossly inadequate prescription drug plan.

Now, look at what they are going to be faced with right here. Every year we, in our plan, the FEHBP, the Federal Employees Health Benefits Plan, have an open season, and we get to choose what plan we want to go in. So we get all these books. Here is one from Aetna. Here is another one from a different Aetna. Here is one from, of course, Blue Cross, and then a different Blue Cross. Here is Kaiser. Here is APWU. Here is PBP. Here is Mail Handlers. Here is NALC. Here is GEHA. Here is MB, Individual Practices Association.

We are supposed to read this and go through them all and decide which plan we want to be in. I wonder how many Senators actually go through these. I can count them on less than one hand. I can count them on less than one finger. Yet seniors every year are going to get this. They are going to be asked: Make a choice. It is confusing. It is going to be bewildering to them every year--every single year.

That is what I mean, a senior could get out of Medicare and go into an HMO or one of these PDPs. They could jack up their prices--I will say more about that in a minute--because the premium is not set in law. It can go up. It can go up. They can get bounced around. So they may be in one plan 1 year, and that plan may not exist the next year.

Then what do they do? What do they choose? Well, that is why I say, you wait. This is going to be a confusing, bewildering mess for our senior citizens.

The only ones making the money are pharmaceutical companies. I think it is instructive that in this bill--if I can find it here, I think on page 53 of this bill, if I am not mistaken. I wonder how many people read this. Page 53, line 18: ``Noninterference--In order to promote competition''--I love this, I love the way they play with words--``In order to promote competition under this part and in carrying out this part, the Secretary''--the Secretary of Health and Human Services-- ``(1) may not interfere with the negotiations between drug manufacturers and pharmacies and PDP sponsors; and (2) may not require a particular formulary or institute a price structure for the reimbursement of covered part D drugs.''

Now, what do you suppose that is all about? Well, what it says is that Medicare cannot negotiate with drug companies to get a better price on drugs for our seniors. That is what was written in the bill. We have said for a long time that we ought to use the power of Medicare to negotiate with the drug companies to get a better price. The VA, the Veterans' Administration, going back to a law that we passed here, I think, in the 1980s, the VA sits down and negotiates with drug companies for the price of drugs for veterans hospitals and veterans throughout the country. That is why veterans' drug prices are 50 percent or more less than what you might normally pay or what an elderly person would pay because they use the purchasing power of the VA to bring it down.

But in this bill, we have said, no, you cannot do it any further than that. Medicare cannot negotiate. Think about it. It is written in here. Medicare is prohibited from negotiating with drug companies to get a better price on drugs.

People always ask: Why are drugs so much cheaper in Canada? I have been to Canada a lot. I am sure the occupant of the Chair has been to Canada. If you go to Edmonton, Calgary, places like that, there are drugstores all over, private drugstores owned by private citizens--free enterprise. You go in there, and the pharmacist is there, and you can get your drugs 50, 60, sometimes as much as 80-percent cheaper than what you get here.

It is the same drug, made by the same manufacturer, that is that much cheaper in Canada. Why? Well, guess what. The Canadian Government buys the drugs. They negotiate with the drug companies to get a lower price because they buy in such huge volumes. Then the private pharmacist makes money on filling the prescriptions, watching your prescriptions.

But in this bill we are forbidding Medicare from negotiating with drug companies for a better price. What a sweetheart deal that is.

Let's see what seniors are going to pay for this and why this is kind of confusing. Here is what seniors are going to find out. Right now, here is what seniors pay under Medicare: Part A premium, hospital, nothing; Part A deductible, $876 for benefit period set for everybody; Part B premium $66.60 a month; Part B deductible for their doctor, $100 per year, and a 20-percent cost share on each visit to the doctor's office.

Very simple, very straightforward; every person in Medicare understands that.

Now what? Well, let's see. Seniors who have an annual income above $13,470 per year will have to pay a yearly deductible of $250. They will then pay a $35-a-month premium, which can go up, by the way. That is not fixed in law. So that is $420 a year. That figure can change every year because if the private plan is not making the profit that they want, they can boost that figure up, and they will.

After seniors have put in at least $670 up front, they can start receiving some

benefits. You might say, well, 670 bucks, that isn't much. Remember what I said: This is someone who is above $13,470 a year. Six hundred seventy dollars is a lot of money to someone making $14,000 a year and worrying about heating bills, buying food, taking care of themselves. So after they pony up $670, the Government will then pay 75 percent of the drug costs up to $2,250.

What happens then? What happens then is that person making more than $13,470 a year will have to pay 100 percent of their drug costs up to about $5,000. That is the so-called donut hole. That is going to be outrageous.

One day you are going in, you are getting your drugs, and you are paying 25 percent. You are going to go in one day and your drugs are $2,200, and then all of a sudden your pharmacist says: You have to pay full price.

Why?

Well, I am sorry. You reached the donut hole of $2,250.

Think of it this way. If your drug costs are $5,000 a year, you will have to pay $4,000 out of pocket. And for that, we bribe HMOs, we give billions of dollars in subsidies to the pharmaceutical companies and to HMOs and to PDPs and whatever else.

Another thing, a senior who has an annual drug cost of only $500 will pay more into the program than they receive. You will put in $500. If you have $500 in drug costs, you will pay $751.25 into this program every year. What a deal.

To make things even messier, the program would create several tiers of classes under the Medicare Program. Again, there are different low- income benefits available to those under 135 percent of the poverty level. That is $12,123 for a single person. There is another set of benefits for those under 150 percent of poverty level. That is $13,470 a person. On top of that, to receive the low-income benefits, a senior must undergo an asset test. We threw the asset test out of here in the Senate. Now it is back in this bill. But now let's look at this asset test. For one group, those who are at 135 percent of the poverty level or below--that is below 12,000 bucks a year--if you are below that, the asset test is $6,000 for a single person. You can't have more than $6,000 in assets. It is $9,000 for a couple.

For the group at 150 percent of the poverty level--let's see, that is $13,470--the asset test there is $10,000 in assets, $20,000 for a couple. So mind you, for a difference of a little over $1,000 a year, maybe about $1,300 a year, your asset goes from $9,000 to $20,000 for a couple; $6,000 to $10,000 for a single person. If this sounds confusing, believe me, it is. How are you going to decide where you fall?

Let's take a group of senior citizens down at McDonald's having their morning coffee. They are all talking about the drug benefit when it goes into effect. Bob is over there, and he gets good benefits under the low-income benefit. But his friend Sue just took a job at the local supermarket at minimum wage to try to make ends meet, pay her heating bills. But because she has a little extra income, even though she barely makes any money, she is in a different class. So, therefore, she is going to get a different drug benefit.

Margaret thought she was going to get some low-income benefits but she filled out her forms and she had too much life insurance, over $10,000 in life insurance. So she is out.

How in the world is the average elderly citizen supposed to know where they fit into this mess? You are going to have several different people who make nearly the same amount of money each year and they are going to receive drastically different benefits.

This is a formula for confusion and confrontation. You are going to be pitting elderly against one another. You are going to have friends wondering: Why is it that Bob over there gets all those benefits and I don't? We know that Bob owns something else. He is cheating maybe. And why did he get that and we didn't? Why is it that George over there gets all these low-income benefits? And you know George. All his life he frittered his money away, gambled it, boozed it up. Sure he doesn't have much now, but the Government is coming in and giving him everything.

How about Bob? Bob over here worked hard all his life, raised a family, educated his kids. He is a man of meager means, but he has Social Security. He was frugal. He saved a little bit. He has a little life insurance policy. No, Bob, you don't get this. Your income may be just about the same as George's, a little bit more, but because you have a little bit of assets--you saved for a rainy day--you are out. Tell me what this is going to be like when the seniors get ahold of this and talk about it.

Then there are those citizens who are going to lose retiree prescription drug benefits. Two to three million are going to lose prescription drug benefits. It is outrageous. This bill would spend roughly $88 billion to try to bribe employers not to drop retiree health coverage yet, even with that, 2 to 3 million seniors will lose their retiree benefits.

Yes, the drug and health industries are spending millions to ram this bill through immediately, even though seniors across the Nation don't know what it contains. The authors of this bill did not let the senior citizens of this country see what was in the bill because they knew once they found out they would have trouble passing it here. Apparently a seat at the Medicare table was quite expensive.

The Washington Post article from Saturday morning was entitled ``Two Bills Would Benefit Top Bush Fundraisers.'' It explains that the Medicare bill will benefit at least 24 Rangers and Pioneers as executives of companies or lobbyists working for them.

A Pioneer in the Bush campaign is one who raises at least $100,000, while a Ranger is someone who has raised at least $200,000.

I ask unanimous consent that this article be printed in the Record.

The article goes on to describe how the drug industry got everything they wanted. I think seniors in this country deserve more. They deserve to be put first in the process. Instead they have been put last. Corporate interests, insurance companies, pharmaceutical companies, they come first. It speaks volumes that on Wall Street the health industry and drug stocks have surged with the emergence of this bill. Corporate executives may be popping their champagne corks in celebration of what happened here today, but seniors are left scratching their heads and wondering why their interests were forgotten.

Maybe they assumed that the AARP would stand up for their interests. But AARP has brazenly betrayed the wishes of its members. Seniors need to know what direction Medicare is taking and whose side the AARP is on.

It says everything about this bill that Newt Gingrich is urging Republicans to vote in favor of it. Remember, this is the same Newt Gingrich who was Speaker of the House and expressed his desire to let Medicare wither on the vine. Mr. Gingrich is one of those ideologues who insists that the private marketplace will solve all of our problems. It would make his day to see Medicare dismantled. If he is for this bill, that ought to give us pause for concern.

Mr. Gingrich and his rightwing friends love this bill, like the head of Americans for Tax Reform, Grover Norquist, who once said:

My goal is to cut government in half . . . to get it down

to the size where we can [drag it into the bathroom] and

drown it in the bathtub.

Today, with this vote on this bill, Newt Gingrich's dream is coming true. The bill is a first step toward privatizing Medicare. You can bet that once the ink is dry, they will be starting on Social Security and going after that, too. Mr. Gingrich even went so far as to say he believed the pharmaceutical companies are getting unfair treatment; that they are punished by the success. Wrong. The bill doesn't ask for a penny from the pharmaceutical companies. I disagree.

On page 53 of the bill, it protects drug companies from Government efforts to negotiate lower prices. That is on page 53, line 18. It says that Medicare cannot negotiate for lower prices for drug companies.

A recent Peter Hart poll found that almost two-thirds of seniors view this bill unfavorably. Most of them identified themselves as members of AARP, American Association of Retired Persons. Among those AARP members, only 18 percent said Congress should pass this bill, while 65 percent said Congress should get back to work. Last week, AARP members from Maryland, New York, and Pennsylvania tore up their membership cards in front of their organization's headquarters here in Washington. Members are accusing William Novelli, CEO of AARP, of ``selling out'' to insurers and selling out to Newt Gingrich. Where did they ever get that idea?

Well, in fact, the relationship between Newt Gingrich and the bigwigs at AARP goes way back. William Novelli, the head of the AARP, wrote the preface to Gingrich's book, ``Saving Lives, Saving Money.'' In that preface, he states:

Newt's ideas are influencing how we at AARP are thinking

about our national role in health promotion and disease

prevention and in our advocating for system change.

That is Mr. Novelli in Newt Gingrich's book. I would have to ask Mr. Novelli which of Newt's ideas are ``influencing how we at AARP are thinking''? Is it Newt's wish that Medicare wither on the vine? Is that influencing Mr. Novelli's thinking?

AARP's endorsement is disturbing for another reason. They have a flagrant conflict of interest in this matter. They receive vast revenues from the sale of insurance to seniors. Royalties from such arrangements include deals with UnitedHealthcare Insurance Company, Metropolitan Life Insurance Company, and Advance PCS pharmacy benefit manager. All that accounted for more than one-third of AARP's $630 million in revenues last year, according to AARP's 2002 annual report.

If you open up any newspaper in the last 3 days, you have seen full- page ads by AARP telling you why this is such a good bill--full-page ads in USA Today, the New York Times, Washington Post, and on and on.

First of all, I want every elderly person who belongs to AARP to think about this and the dues they pay. Think of all that money being siphoned off to ad agencies. Think about all that money being spent on these full-page ads to get Congress to rush this through and pass it. Well, Americans deserve better from AARP. They deserve better from Congress.

This bill reflects the priorities of Newt Gingrich, who has been hostile to Medicare since its inception. Seniors know this bill is a betrayal. They know who the winners and losers are with this bill. HMOs, PPOs, pharmaceutical companies, on premium support, they win, and seniors and disabled lose. On cost containment, they win because Medicare is prohibited from bargaining for better prices, and seniors and disabled lose. On drug coverage, pharmaceutical companies win and seniors lose. On health savings accounts--my, my, my, now we have them--HMOs win, seniors lose; stabilization fund--a slush fund is what it ought to be called--again HMOs and PPOs win, and seniors lose; on competition, pharmaceutical companies win big time on that and seniors lose.

It may seem in what I am saying tonight that somehow I am opposed to insurance companies. Nothing could be further from the truth. In my State of Iowa, I think we are, if I am not mistaken, the second largest domiciliary for insurance companies in America, second only to Connecticut. Insurance has a prominent role in Iowa. It employs a lot of people. Insurance can provide meaningful protection for a lot of people. I happen to have a lot of insurance--homes, cars, life insurance; I have all kinds of insurance. It is a good deal. I have benefited from insurance. Insurance is good. It shares the risk. You put people in a large pool and it shares the risk. That is the basic essence of insurance, and there is one principle of insurance that everyone understands, or should understand: The bigger the pool, the less the risk for everyone in the pool.

But what is Medicare doing? What are we doing in this bill with Medicare? We are dividing up the pool: a little bit here, a little bit there, and a little bit there. Under the health savings accounts, the healthiest will opt out. Under premium support, the healthiest will be cherry-picked by the HMOs.

Will the Senator yield because I was mentioned? I just want 30 seconds. I was opposed to it at that time, too. I was opposed to the noninterference at that time. I have always been opposed to it.

Mr. President, there are a number of significant issues that have been raised in this debate over the last 48 hours. I remind our colleagues and our seniors who may be following this debate with some interest that we have had this bill--this gigantic bill--for 4 days.

This is one of the most significant pieces of legislation that will come before this Congress certainly this year, but I would argue for many years to come. It is a wolf in sheep's clothing. We remember the old fairy tale about the wolf that couldn't get into the hen house or into the shepherd's enclosure to try to go after the hens and go after the sheep and kept trying and trying.

Finally, the wolf figured out that a frontal assault was just not going to work. People would see the wolf sneaking up on the hen house, sneaking up

behind the sheep, and they would scare them off and try to get him before he got the hens and the sheep.

The wolf got really smart. The wolf found some poor old sheep that hadn't quite made it back from the hills and, unfortunately, killed that sheep, got that sheepskin, and snuck in. When people saw it moving across the ground, they thought: That's just an old sheep.

Lo and behold, the wolf got to the hen house and the sheep, and that poor old farmer didn't have any hens or sheep left by the time the wolf got done.

Make no mistake, that is what is going on here. You can dress it up, you can talk about how significant a benefit it is going to turn out to be, how we are modernizing and changing Medicare for the 21st century, but remember that fairy tale. Fairy tales are rooted in ancient folk wisdom and experience, and what we have here is just a classic wolf in sheep's clothing.

There are many reasons to oppose this bill, and my colleagues have been going through them one after another. I think the bottom line is, No. 1, this bill does very little of what it actually advertises doing. It advertises it is going to be a sea change--a positive sea change-- for seniors, and that is not the case.

We have been fighting over prescription drug benefits for seniors for years. A decade ago, when I was working on behalf of the Clinton administration with respect to health care, we included a drug benefit. Some of you may remember that debate. That debate went down, and it went down for many reasons, but one was that it was a 1,300-page bill-- a bill that would guarantee health insurance to every American, a bill that would control prices so that we could actually afford health care for every American, and people said: Oh, my goodness, that is such a long bill; why, look at what the Clintons are trying to do. They are trying to change health care with that gigantic bill.

Remember, we produced that bill with a thousand people involved in the process. We vetted it with everybody. We brought it to the Capitol. It was done in the light of day. We produced a bill and then, of course, all the special interests got everybody confused about what was in the bill, and the bill went down even though, as it was going down, public opinion surveys were asking Americans: What is it you want in a bill?

They said: We want guaranteed affordable health care coverage and the ability to pick our doctor--all of which was in the bill.

It didn't do me any good to keep saying it because $300 million had been spent by the special interests for TV ads, radio ads, and newspaper ads--the whole 9 yards. Oh, my goodness, the bill was so big and so confusing and all these terrible things were going to happen.

Four days ago--4 days ago--we got this bill. I am looking through this bill trying to figure out, my goodness, how long it is. I know it is awfully heavy. I think it is about 1,200 pages. That is just to do something to Medicare. It is not to guarantee health insurance for children and working people. It is not to guarantee health insurance for people 55 to 65, who retired and who start, as you do when you get to 55, to have health kinks and problems and are not eligible for Medicare. It doesn't do anything for that.

It is a 1,200-page bill which we received 4 days ago, and I can guarantee you there are disputes on the floor of the Senate as to what is in it and what it means. Why is that? Because we haven't had a chance to examine and analyze it, and if we haven't, with our staff and our efforts over the last 4 days, I know the American people, particularly our seniors, haven't either.

There are many provisions in this bill that really need to be brought into the light of day. I will be voting against cloture, which is a parliamentary term to try to cut off debate, because I don't think we have had enough debate yet. I don't want anybody being surprised about what is really in this bill because there are going to be a lot of surprises.

The promise of reimporting drugs from Canada--which is really important in a place such as New York because we border Canada. A lot of my seniors from Watertown, Massena, or Plattsburgh go across the border and get those cheaper drugs. In this bill, that is going to continue to be a problem and a prohibition in reality, if not legally, because drug companies are going to be given the go-ahead to basically violate antitrust rules so they can cut back on the amount of drugs they send to Canada.

I don't blame the drug companies. They have a captive market in our country. Our tax dollars do the research at our great universities and research labs. Our tax dollars support the National Institutes of Health. Our tax dollars create the conditions in which drugs are given clinical trials to determine whether they help or hurt. We do all the work for the entire world for determining the efficacy of drugs, quality, and safety, and then other countries, such as Canada, Europe, and other places, bargain with the drug companies.

They say, OK, we have a big market. We have millions of people. It is kind of like Sam's Club, only think of it as the Canadian club or the European Union club. They bargain with these drug companies and they drive the prices down because they are going to buy in volume.

Should we not have an Uncle Sam's Club? Should not Uncle Sam be able to bargain with these drug companies? Apparently that is not what the backroom negotiators and writers of this legislation wanted because in the most wonderful example of Orwellian language, on page 53 of this bill, under a title called noninterference--I love that--it says in order to promote competition--there are magic words around here. It is said that competition is going to be promoted, while they create a monopoly, while they end antitrust, because they are setting up all kinds of special privileges for special interests. Nevertheless, we just hope nobody notices that.

So in order to promote competition under this part and in carrying out this part, the Secretary, No. 1, may not interfere with the negotiations between drug manufacturers and pharmacies and PDP sponsors--those are drug plans--and may not require a particular formulary--that is the list of the drugs one can get--or institute a price structure for the reimbursement of covered drugs.

Basically, what this means is the lid is off. Not only can we not get the drugs from Canada anymore because our drug companies will say to the poor Canadians, keep letting your pharmacists send them across the border and we are going to not send the drugs for the Canadian people. But we cannot even bargain. We cannot have an Uncle Sam's Club. We cannot get the volume discounts.

We have to look at who is doing what in this debate to figure out where the sheep are, where the hens are, and where the wolves are. One of the biggest wolves who has been after Medicare for as long as he has been in public life is our old friend, Newt Gingrich, former Speaker of the House, when he called for Medicare to wither on the vine.

Well, guess who showed up to try to whip those House Republicans in line to vote for this bill, which is why they had to leave the vote open for more than 3 hours, the longest time they had ever had to leave a vote open because basically, there was the wolf in sheep's clothing going up to the House Republicans and saying: Do not worry, we are going to say all of these good things about this bill, but just wait until we get our hands on it; just wait until we get into that hen house.

I do not blame them if that is what they believe. Nevertheless, we are the ones who are going to be paying the price.

I ask unanimous consent for an additional 2 minutes.

I will put a chart up that gives a short summary for any American, and particularly for any senior citizen, watching. This bill sacrifices seniors' interest to special interests.

Seniors need lower drug prices. Forget it. The drug industry wants higher profits.

Seniors need predictable premiums. Forget it. Managed care wants the flexibility to raise their rates even in the middle of the year.

Seniors need a choice of drugs. Forget it. The drug industry wants a restrictive formulary that pushes their brands.

Seniors need to keep their retirement benefits. Forget it. The private plans want a $12 billion slush fund so we are going to lose retiree health care.

Seniors want to stay in Medicare. Forget it because what is going to happen is that Medicare is going to get increasingly the health care plan for the sickest and the oldest of our seniors, which will make it more expensive. In this bill we are going to even see a constriction on the nondrug benefits for Medicare.

So one has to really watch what goes on around here. They have to follow it carefully. This is a bill that is bad for seniors, bad for America, and I hope my colleagues will stand against it.

Mr. President, I am very pleased that my colleague Senator Smith has taken the lead in asking for an extension of the Temporary Extended Unemployment Compensation Program. One might wonder why we are having to do this, but the simple explanation is that once again we have run out of time. People will run out of their benefits by the end of this year. If we go home for the Thanksgiving and Christmas holidays without acting, there will be many Americans and a lot of people in Oregon and in New York who are not going to have the continuing help they deserve in these times.

We have extended unemployment insurance with bipartisan support in the Senate three times in the last 2 years. I am very proud of that because I think it shows how we can work together to help those who deserve our assistance.

Because we are not coming back in, as I understand it, until January 20, we won't be able to do that if we don't act now on the Senator's proposal. If we do act now, the House, which is coming back in early December, will be able to similarly act and the benefits will flow.

It is significant, too, that Senator Smith and I are in the Chamber asking our colleagues to join us because the State of Oregon and New York City have the highest unemployment rates in the entire country. New York City has an unemployment rate of 8.2 percent. We have never recovered from the effects of September 11. Oregon has an unemployment rate of 7.6 percent. So both the Senator and I are very concerned about the good people we represent on opposite ends of our country who have been out of work for a long time. We know long-term unemployment is at the highest level it has been in 20 years. We need to give them some additional time.

This extension would provide another 13-week extension until June. I would urge support of Senator Smith's proposal. If I am not already listed as an original cosponsor, I ask unanimous consent that I be so.

I yield back to the Senator from Oregon.

Mr. President, I believe we are to go back on the schedule for the postcloture Medicare debate; is that correct?

Mr. President, I will say a few words and then yield to my good friend from New Jersey. Before I get into the Medicare debate, I wish to say some concluding remarks in response to my colleague from Nevada.

At the rate that job creation is going under this current administration, we have one job opening for every three applicants, and it will take the next 19 months to get to the level of jobs we had before the March 2001 recession started. So I think we are mixing apples and oranges here.

This has been a jobless period. One can argue about whether or not there has been any kind of recovery. I would take issue with people suggesting it, but if they do, then they need to use that oxymoron ``it is a jobless recovery,'' because the economy sure is not creating jobs. In addition, we have places such as the one my friend, the Senator from Oregon, represents, and my State, where the unemployment rate is far above the national average. There is no way to say New York City, with an 8.2-percent unemployment rate, is creating jobs again. It is not happening.

I have a little problem with this idea that we are comparing welfare recipients with people who lost their jobs. Welfare recipients didn't have jobs, by definition. The whole effort in the 1990s was to create circumstances in which people could move from welfare to work. What we have now are people moving from work to nothing. We have no safety net. So we are telling people who have worked hard, done what they were supposed to do, been laid off from airlines, or telecommunications, or financial services, whose jobs have gone to India or China, and there are no jobs to replace them, we are telling them: Tough luck, happy Thanksgiving, Merry Christmas, Happy New Year.

If that is what the other party wants to send as their Christmas greetings to their constituents, that is certainly their right. It certainly seems not to be in the spirit of the holiday we are about to celebrate.

It is factually inaccurate to say there are jobs being created, and all we have to do is really put the pressure on these people and make it impossible for them to do anything other than go get a job. That would be great if there were jobs to be gotten.

Given the combination of the economic and budget policies of this administration, I don't think we are going to have those jobs available. I predict to you that even if we have an unemployment rate nationally of 6 percent, or 6.1 percent, or 6.2 percent, we are not going to have the jobs coming back because this administration has presided over the largest job loss in American history since Herbert Hoover. If I were on the other end of Pennsylvania Avenue, I would not want to be reminded of that, either. I would not want there to be an up-or-down vote on whether or not to extend unemployment insurance because, if do you that, you admit the obvious: You know what, we are not creating jobs and we have to do something to help people.

I regret that the effort my friend, Senator Smith, and I have joined together in trying to accomplish has been objected to; namely, to bring about an extension of unemployment benefits, which strikes me as not only the right thing to do but the smart thing to do, because every time we extend unemployment benefits to the people who truly need them, you pump more money into the economy, which may create a job or two and obviate the need for uninsurance benefits in the future.

We will be back, as we were last year. We are not going away, obviously. This is something about which we care deeply. It is the right thing to do. If I thought we were having the kind of economy in the future that we had starting in 1993, I might have a different idea, but that is not what is going to happen. All the happy talk notwithstanding, that is not going to happen.

Mr. President, I will now move to the Medicare conference report. I have to tell you that the more I learn about this proposal, the less I like it, the less fair I think it is, the less useful for our seniors.

Just recently, because we got this 1,200 page bill 4 days ago, including a weekend, when people were combing through it, our experts were trying to read it. I can guarantee you that if you put two Senators up in the well of the Senate on opposite sides of the bill, or even on the same side of this bill, they would not agree on every provision because there is not anybody who fully understands what is in this bill.

But what I just learned is that three important items from the Senate bill were changed in conference, in addition to everything else we know that was changed--all the big things, including the reimportation of drugs, the limitation on premium support, the lack of any kind of support for HSAs, all of those things which changed. Here are

some additional changes which are now coming to light as people comb through the fine print of the bill.

First, we thought seniors would know at the time of their enrollment in these private plans what drugs would be on the list. That is called a formulary. It is kind of a fancy term. There are lots of fancy, confusing terms in this bill. My colleague, Senator Boxer from California, has a mind-boggling chart, where she and her good staff have pulled out all kinds of words that no normal human being understands. Heaven forbid, I don't think abnormal people understand them. They are made-up words that describe these processes and events, and nobody understands what they really mean.

So we now found out that these formularies--the list of drugs that would be offered by a plan--are not necessarily going to be available to a senior when that senior signs up.

Now, imagine that. Think about my 84-year-old mother, who takes a number of prescription drugs that are very specific and assigned to her by her physician to meet her needs. Her doctor says: This is what you need, and here is your prescription. So in 2006 or 2007, when she signs up for one of these plans, she is not going to know whether the plan includes a particular drug that she needs. I find that a big problem, because how can you buy something when you don't know what it is you are buying?

This is supposed to be a prescription drug plan. Therefore, prescription drugs are at the heart of it. If you don't even know which drugs you are supposed to get on your plan, that is not much of a plan. This is another typical example of the old bait and switch--maybe it is better to call it buying a pig in a poke. You don't know really what you are buying but you have to go out and buy it.

Second, when the Senate sent the bill to conference, the Senate required that the 10 regions determined by the Secretary of Health and Human Services would be larger than a State. Now, that was supposed to assure that we avoid the problem we now have with Medicare+Choice, where HMOs serve some counties but withdraw from or refuse to serve other counties.

I have that problem all over my State. The most intensely organized seniors in my State are seniors who have had a bad experience with HMOs--HMOs that came into their county and left them high and dry at the end of the year; HMOs that came in and, when they found they had no competition, raised the costs right in the middle of the year. Or at the end of the year, when it came time to change and they were the only game in town, they really increased costs to our seniors.

But the conference report, instead of taking the Senate requirements, eliminates it--eliminates the requirement that the insurers must serve an entire State or a large region.

I also know that as a Senator from New York, I have a special obligation toward the people of Puerto Rico. We have a lot of Puerto Ricans in New York. We are very proud and I am very honored to represent a large Puerto Rican population in New York. But the conference report has less money than the Senate bill for prescription drugs for Puerto Ricans. I know it always comes as a surprise to some people to learn that Puerto Ricans are American citizens. They are not some alien group over here. They are American citizens. They don't live in a State, but neither do the people who live in the District of Columbia, but they are American citizens, too. For some reason, we are not providing adequate funding for the people of Puerto Rico to get the prescription drugs to which American citizens under this bill are entitled.

Those are three hidden provisions in the fine print that we just discovered today. Now we are going to have to vote on this bill today or tomorrow, and we are going to be setting ourselves on a course that will radically change Medicare.

Why should people care? If you are not 65 or older, if you are not my mother's age, if you are not even closing in on Medicare, as I am, why should you care if you are my daughter's age or one of these young people working in the Senate in their thirties or forties? Why should you care?

I would argue you should care because, No. 1, in our country we try to keep faith with each other by providing a safety net for seniors, for people who fought the wars, raised their families, built their businesses, and served their communities. We thought ever since 1965, when Medicare was passed, that it was really good for America to make that commitment to our parents and our grandparents. It was the right thing to do. It was the moral thing to do. It was the smart thing to do. Before 1965, the poorest people in America were people over 65. Now there are poor children. We have had a massive transfer of wealth to take care of our parents and grandparents through Social Security and Medicare. I believe we have neglected our children. We have about 22 percent of our children living in poverty. I am not proud of that, but I am proud of what we have done through Social Security and Medicare.

If we are starting to unravel that now, that says something about who we are as a people. It says something about this generation of American leadership compared to previous generations.

Why else should you care if you are not a Medicare beneficiary? Maybe you are the son, the daughter, or a grandchild of a Medicare beneficiary and maybe you will want to do the right thing if your grandparent or your parent has some kind of medical problem and they cannot afford to pay for it themselves, and you want to step in and help because that is the kind of person you are. And I hope that describes the vast majority of our young people in our country today.

That may be tough because maybe you are saving to send your own child to college or maybe you are saving to buy your first house. Then all of a sudden, a medical catastrophe strikes, and what used to be Medicare to provide that safety net is just not there anymore in 2010 or 2012. All of a sudden, the burden falls back on you.

Why else should you care? Because in this bill it is not only about undermining Medicare, it is about undermining health insurance in general. We already have an increasing number of uninsured people, and we are going to have even more of them in the future because we have a totally dysfunctional system for financing health care that certainly does take care of insurance companies and their executives and pharmaceuticals and their executives but doesn't do a great job for the average person.

This bill will undermine insurance for everyone, not just for Medicare recipients. Why do I say that? Because there are no cost controls to keep the price of a prescription drug down. There is no bargaining power for the Governor to try to hold the pharmaceutical companies in line to prevent them from just blowing the top off whatever the price structure is. There is a really insidious provision that puts a limit on how much money we can spend on overall Medicare if the prices of Medicare go up--that is, hospitals, doctors, and drugs now--which means you have to cut back on everything, not just prescription drugs. So we are going to have Medicare recipients squeezed even more. There is such a thing called cross subsidization. What that means is, if you have insurance and you go to the hospital, you are not just paying for your services that you get, you are, in effect, paying for people who couldn't pay. For example, maybe the day before you showed up in the emergency room, Mrs. Smith came in after a terrible car accident or maybe some kind of acute asthmatic attack or other kind of serious problem, and she didn't have any insurance. The hospital takes care of her, but then they have to charge you, your employer and your insurance company more to pay their bills. Anytime you transfer money away from direct care, you are forcing more people to pay more for the same care. Some of them will be unable to afford it, but the cost to the providers of that uncompensated care will, in turn, raise the price which, in turn, has employers dropping people which, in turn, creates more uninsured individuals. It is a closed system. It is a circuit. The circle should not be stressed. This breaks that circle. This takes the security of Medicare and pulls it right out, causing all sorts of effects throughout the circle.

The reason we created Medicare in the first place was that insuring older people who might be more sick and more frail is not a profitable enterprise. There are people who retire and go to some beautiful place and play

golf all the time. They are physically fit and they look great when they are 75, but now they may live to be 100, 25 more years. At some point, the body starts breaking down no matter how well you take care of yourself.

Medicare was the idea that we needed to provide a product because the marketplace would not provide it, and this bill proves the wisdom of that because the only way you are going to provide these benefits is basically by subsidizing or, some might say inelegantly, bribing insurance companies with billions and billions of taxpayer dollars to provide this benefit that they would not ordinarily provide because it is not cost-effective; it is not profitable.

There are many other reasons this Medicare bill is not in the best interests of either Medicare recipients or our general population.

It is a sad day when we essentially devise this scheme to try to transfer money from the Medicare system and the taxpayers' pocket to those who are already doing very well, indeed. Probably the saddest thing to me is not what might happen to the average Medicare recipient, which I deeply regret, but to the poorest of our Medicare recipients, the people who don't retire from an office job or some other undertaking that gives them the resources to move to some warm place and play golf every day, but the vast numbers of people who are sick, who are frail, who are chronically ill, who are poor, and who end up in nursing homes. Six million of them will be worse off under this bill. That is really hard for me to accept. I do not understand how a great, rich nation like ours can come to this point, where we impose new and extra burdens on the poorest of the poor and the sickest of the sick.

I guess we think if somebody is in a nursing home and not out at a golf course that we will not see them; we will not care; we will not know. Maybe that is true if it is not your relative, your neighbor, your colleague, or your friend. But 6 million low-income, chronically ill or nursing home bound Medicare beneficiaries will be worse off under this bill because of formularies or increased co-pays. I find this not only hard to justify but cynical, cynical because some folks are making a bet that those poor people are not going to raise a fuss or a ruckus: Out of sight, out of mind.

They will not show up to vote or certainly not give anybody any campaign contributions. So basically they do not exist. So we can turn our back on them.

I do not understand what has happened to our country. I do not understand what we believe about our obligations to one another or our values when we would do that to our fellow citizens. I also do not know what universe some people are inhabiting because none of us knows what is going to happen tomorrow. Not a single one of us can predict when we might need help, when we might have that accident, when we might get that terrible diagnosis. We do not know.

I thought the golden rule was the overriding philosophy that should guide us, but unfortunately in this bill that stands for an insurance company that is going to get billions of dollars for the unproven concept of health savings accounts. That is not what I learned in Sunday school but what somebody else figured out how to make some money off of.

It is a sad story, but I have a lot of confidence in the intelligence of Americans and particularly for the generation that lived through the Great Depression and World War II. I am about to yield the floor to one of them. He is someone I admire and think so highly of, who had a lot of blessings in his life and never forgot where he came from. He never turned his back on people who were less fortunate than he was because he knew the basic lesson that I think some people forget--there but for the grace of God go I.

If that were our hallmark, we would not be passing this bill, which puts so many of our seniors at risk, but even more than that puts at risk what we mean when we talk about America and American values.

I yield to the Senator from New Jersey.

Mr. President, I rise to talk about the bill before us.

When the Senate first voted on a prescription drug benefit for seniors back in June I offered an amendment. My amendment was simple. I proposed that we give seniors a prescription drug benefit sooner rather than later. But that amendment was voted down by the Republican majority.

So now, under this conference report, the drug coverage doesn't start until January 2006 23 months from now. Yes, 2006.

So why so long? One clue is illustrated on this chart. Notice that Election Day is 11 months from now. And notice that the prolonged effective date for the drug benefit is conveniently well past election day.

I would like to remind my colleagues that the original Medicare plan was signed into law by President Johnson on July 30, 1965 and 11 months later July 1, 1966--all the people who were eligible for the program were enrolled in the program.

The entire system was created from scratch in 11 months.

I know the President is desperate to take credit for passing a prescription drug bill when he faces voters next year. But he does not want the many shortcomings in this plan to be fully evident to seniors until well after the election. My Republican friends are hoping that seniors won't find out what they don't get from this legislation until it is too late. It is almost a cruel joke.

When a prescription drug benefit is signed into law, all of our offices will be flooded with calls by seniors asking a simple question: ``How can I sign up for this benefit?'' They will have seen President Bush sign a bill with great fanfare, and they will have seen many Members of Congress crowding the stage with him, and everyone will say ``we have put a prescription drug benefit in place.''

And when seniors call to find out how soon they can receive the benefit, we will have to tell them ``2006.'' Sorry, President Bush's 2003 Medicare Prescription Drug plan will not start until 2006.

No one wants to provide a real Medicare prescription drug benefit to seniors more than the Democrats. After all, Democrats created Medicare, and we have protected it for decades.

Everyone knows that Republicans resisted the creation of Medicare and have opposed it ever since. It wasn't too long ago that former House Speaker Newt Gingrich expressed his desire to see Medicare ``wither on the vine.''

Well, the bill before us today is the first major step toward the disintegration of Medicare as we know it.

In reality, this bill isn't as much a benefit for seniors as it is a big benefit for HMOs and other private sector special interests who want to tear the Medicare program to pieces.

So, what is it specifically that the President is afraid seniors will find out before 2006?

Is the President afraid that seniors will realize they are going to pay at least $810 before they break even and get any benefit from this plan?

For many seniors that is more money than they spend on prescription drugs right now. Up to 30 percent of beneficiaries would pay more for enrolling in the plan than they would receive in actual benefits.

Is the President worried that seniors are going to discover that there is a huge gap in coverage?

Under this plan, a senior will pay a premium estimated at $35 a month, a $250 deductible, and 25 percent coinsurance payments until reaching $2,250 in drug expenses. What happens then? Seniors get no coverage. You heard me correctly nothing, zero.

That is right. At that point, seniors will continue to pay their premiums but they will also pay 100 percent of their drug costs. Only until they have reached the catastrophic limit of $5,100 in drug costs does any benefit return. And by that time, seniors will have incurred $3,600 in out-of-pocket spending. This is called the ``hole in the doughnut'' and it sure doesn't sound like such a good deal to me.

And remember that nowhere in this bill does it say that the premium is only $35. It could be significantly higher. The $35 figure is an estimate. We all know how good this administration has been at making estimates.

Is the President afraid that seniors will figure all this out? You bet he is.

Seniors deserve a much better program than what the Senate is considering right now, and they certainly deserve it before 2006.

There are some who will say we must have this gap in coverage because we only have $400 billion to work with. Well, I say if there are insufficient funds in the budget to give seniors real drug coverage, then it is the result of choices made by the President and his party. They chose to provide a massive tax cut to the wealthy the people who need it least and they chose it at the expense of Medicare.

What else is in this bill that the Republican's don't want seniors to find out about until 2006?

This bill will effectively destroy the Medicare program that has worked for almost 40 years. That is right. Say goodbye to Medicare as we know it.

This bill does not expand Medicare; it opens the door for HMOs to take over the program. And that means that seniors will be at the mercy of these HMOs. And as everyone knows, HMOs will not pay for all prescription drugs.

Under this bill, seniors will be limited to the prescription drugs covered by their drug plan or HMO. In order to keep costs down, these drug plans and HMOs will use something called a ``formulary.'' A formulary is a list of drugs that are covered under the health plan. If a particular drug is not on the formulary then it is not covered.

That means that after a senior has paid her premium and her deductible if she needs a certain medication not on the list used by her drug plan or HMO, then she will pay 100 percent of the cost of that medication.

Where is the benefit in that?

Mr. President, this bill goes to great lengths to prop up and protect HMOs at the expense of seniors. Included in this bill is something called the ``Stabilization Fund.'' It should be called the ``HMO Slush Fund.'' This fund is designed to ensure that HMOs succeed by offering artificially lower premiums and better benefits than traditional Medicare. This bill hands over $12 billion of taxpayer money for this effort.

This is $12 billion that could be used to close the coverage gap or lower the deductible but our Republican friends have made a choice to create a $12 billion slush fund for the insurance industry.

I want to spend a few minutes talking about the overall impact of this bill on seniors in the State I represent--New Jersey.

The most important reason why I am voting against this bill is because I am convinced that more seniors in my State will be hurt by this legislation than helped.

There are approximately 1.1 million seniors in New Jersey.

Currently 430,000 New Jersey retirees receive prescription drug coverage from their former employers. Because this bill provides a disincentive to employers to continue offering coverage to retirees, over 90,000 seniors in New Jersey will lose their existing drug coverage, which often offers more generous benefits.

This bill is also going to make poor seniors in my State worse off. In New Jersey, Medicaid covers the drug costs for seniors up to 100 percent of the federal poverty level. That is an income of approximately $9,000 a year for an individual or $12,000 a year for a couple.

In New Jersey, low-income seniors currently on Medicaid have access to whatever drugs they need and they don't have any co-pay for their prescriptions. Under this bill, however, they will now pay $1 per prescription for generic drugs and $3 per prescription for brand name drugs.

Low-income seniors tend to be in worse health and, as a result, they have higher annual drug spending. A senior with an annual income of $7,000 or $8,000 simply doesn't have the discretionary income to shell out $15 or $20 or $25 for the prescriptions that he or she may need.

That may not sound like a lot of money to my colleagues, but for low- income Americans, it can force them to choose between buying medication and buying food or buying medication and keeping the heat turned on in the winter.

Mr. President, this bill represents an enormous opportunity squandered. We had a real chance to do something right here. We had $400 billion to improve the lives of 34 million seniors, 14 million of whom don't have any prescription drug coverage right now. Frankly, we blew it.

When I look at this bill, I see a bill that makes seniors in New Jersey worse off.

I see a bill that makes poor seniors worse off.

I see a bill that takes away choices from seniors.

I see a bill that wastes taxpayer money on a slush fund for HMOs.

I see a bill that ``hides the ball'' until 2006.

And I see a bill that I cannot, in good conscience, support.

I yield the floor.

I have a question, Mr. President, about the process. Is the time available under the cloture rule divided between two sides in equal parts?

So that any speeches now are made under cloture.

I thank the Chair.

I thank my colleague from New York for her eloquent statement and her perception about what is really taking place in front of us. We both have the good fortune to share one of the most interesting areas of this country, the center for finance, industry, and trade, and people, yes, who have to work hard to maintain their living in this high cost area that we share.

One of the problems we see in both of our States is that unemployment is unreasonably high; that people who used to work in manufacturing in the New York City region, in New Jersey, have lost jobs that are not available to be regained. It is a pity, but what has happened is that they were sold out to cheaper prices. We are looking for things cheaper while many of us revel in the fact we can live by such luxurious standards.

What does it tell us? It tells us there is a significant imbalance out there in the way people earn their livings, live their lives. That is one of the things that is so much in our view today when we talk about the outcome of the vote thus far on this purported Medicare bill. It does not have the ``care'' and I am not sure it even has the interest.

One of the things we are looking at is whether or not people who have had the good fortune, as I have--as said by the Senator from New York, I have had very good fortune. My father died when he was 43. His father died when he was in his middle fifties. His brother died when he was in his early fifties. I think the cause of death was probably occupational. They all worked in the same factories in the city of Patterson, NJ, where I was born. My father's death left a permanent imprint on me because of the circumstances of how and when it occurred.

My father was 43 in the year 1943. He lived his life by the healthiest of standards, including the food that he ate. He disavowed smoking in a very vigorous way. He was not someone who drank a lot of coffee. In fact, he did not drink any coffee. He enjoyed his nonworking time by being in a gymnasium. They did not call it ``workout'' then. They called it exercise. They called it the ``gym.''

So he would spend time down there. He used to like to lift weights, wrestle, and play basketball. One day, he was not feeling well and he went to a doctor. The doctor informed our family that my father had colon cancer, a condition that gets ever rarer with the medical care we have today, if it can be afforded. No matter what we did, without the advances that we have today and medical technology and medicines, he suffered for 13 months. From a well built, muscular man, who was a picture of health to behold, he disintegrated before our very eyes until he died 13 months later.

My mother was 36 when my father died. She was a very young widow. I was 18. I had already enlisted in the Army. Why this story? Because it is seared so deeply in my memory. Not only were we grieving, we were poor, and my mother strained to make a living as my father was in his illness. I had a job loading trucks. That was my skill. That was my experience. We just about kept ends together.

When my father died, imagine a family of four--I had a little sister who was 12--grieving over the loss of a father at age 43, so young, and also at the same time worrying about bills that had to be paid, about obligations that occurred as a result of hospital treatment, bills that occurred because of doctors' visits, bills that we had to pay because we owed pharmacists money. That is what I remember. I thought, oh, my goodness, if only we could find the money to pay the bills so my mother and I didn't have to worry so much about our existence and at the same time honor our obligations. We were that kind of a family.

Then, as time passed, we saw developments in America that made us all proud and that, frankly, I think should have caused us in this body to be more tender, to be more understanding, to be more sensitive to the people who have been able to live long enough to be eligible for Medicare and Social Security and all of that that is intended to reward people for their work to build this country. Many of these people come from what has been described as the greatest generation. If they weren't exactly in that generation, they were in the generation that continued to build our country through the 20th century

to make this a stronghold of industry and business and technology and education. That is what these people did who are now concerned about how they continue their life.

Oh, of course, a lot of them can get jobs if they want them at school crossings, at $5.50 an hour, $206 a week--have a good time, go to a restaurant and have dinner. Not on your life.

That is what should have been thought about as we debated this issue. There was a certain degree, I saw, of smugness, as they pirated votes, giving lots of money--$11 billion, $12 billion to a special interest here, special interest there, here a special interest, there a special interest. It reminds me of a nursery rhyme. But that was no game that was being played. They held open the vote in the House of Representatives way beyond the rules. They did anything they could to bypass the process as it was normally.

I wish to show those who can see what I am holding, if I have the strength to hold them--I do. Those who witness this stack, who see it, this pile of paper, may say: What is the Senator talking about? This describes what was in this Medicare proposal in which the Democrats were not invited to participate. That is against the rules. The participation was limited. This was a stealth affair: Sneak it out, get it out there. Why? Because they don't want people to know what is in here.

Do you know what else? Here is a little smaller part of this whole package. This says: ``Joint Explanatory Statement.'' This tells the audience who might read this what is really in this stack here. It is all mysterious. It is all arcane--can't really understand what is happening.

Why is this debate so acerbic? Why is it that those of us, along with the senior citizens of this country, look as if we are losing this debate? It looks as if we are going to lose control of this issue. It is true, that we will have suffered a day in infamy, to steal an expression, because what happens here is we are going to assess poor people more costs.

I come from the corporate sector. I was fortunate to be able to create one of America's great companies with two other young fellows who lived in the same area as I did. Both of them, like me, had fathers who worked in the silk mills. That was the trade in the city in which we lived. They had no money. Their parents had no education. But it gave them the incentive to create something for themselves.

So we created a company. The company is called ADP. A lot of people know it. It is an international company with 40,000 employees. We started with nothing.

One of the things I learned as the CEO and chairman of that company, before I came to the Senate, was that the most important asset my company had was not its customers. The most important asset we had was its employees, because if the employees did their job, the customers were there for us. We could render a service that was an invaluable beginning to outsourcing, to giving specialists opportunities to do jobs that they could best do. But one of the things we had to do was to make sure the employees were considered in everything we did, including health insurance, including an early start with daycare, to make certain our employees were happy and thus productive.

I am happy to yield, with the proviso that I regain the floor.

I assume the time that would have been credited to me for my 1 hour, whatever time remains, is still available.

I thank the Chair.

What I got today was a request from one of America's largest companies. I will not identify them because they are not unique. But they wanted us to pass this bill. They don't make pharmaceuticals; they don't do anything in the health care field; they are not an HMO. They are a manufacturing company, a gigantic company by any standards. They are hoping we are going to pass this bill.

The reason they are hoping we would pass it is because then those retirees who are dependent on their health care continuation could be kicked off the system. Then, because of what we are saying in this bill--this hocus-pocus language that there will be some money to provide premium support for HMOs--go there and you will be able to get it cheaper, and this giant company, this unnamed giant company will be able to say: Whew, we are finally rid of those retirees who we promised we would give this care to all those years they worked for us. But now we don't have to keep that promise--no. All we have to do is say goodbye, thank you, we are eliminating coverage.

In New Jersey, it means that about 90,000 people are likely to lose their company-provided health care.

Coming from a State as I do--a State often called ``the Medicine Chest;'' it is a great State--we produce terrific products that make people feel better and help them live longer. I know because I use a couple of their products here and there. But the entire debate here is the result of the irrefutable fact that prescription drugs cost too much in this country. This bill doesn't do anything to fix that fundamental problem. All over the world, people pay less money for the exact same prescription drugs that they can buy cheaper in other countries.

In Italy, Acoplex is 40 percent less than here in the United States. In England, it is 31 percent less than here in the United States. And just to the north of us, our friendly neighbor, Canada, the price is 37 percent less.

No wonder seniors are getting on buses and making the trip to Canada to get their medication.

If you look at the things that we talk about, and see what happens when prices are not negotiated, the prices keep rising. From 2001 to 2002, drug prices rose 17 percent. The only way to lower drug prices is to give Medicare bargaining power--just the opposite of what this bill does. This bill says they want to prohibit giving what is normally called volume discounts. Instead of taking this step to lower prices, this bill explicitly forbids it.

The company I was talking about with a health plan has over 1 million employees. They want us to pass this bill. Imagine what happens when they say to their retired employees that they will be off their health care system.

We know from experience that allowing agencies to use bargaining power brings down prices. A good example of this is the health care system run by the Veterans' Administration. The VA is encouraged to negotiate prices. In this bill, as it presently exists, they forbid Medicare to negotiate prices.

I want to follow up on a point that our friend and colleague, Senator Bob Graham, made earlier today. This chart really tells the story. The chart compares VA-negotiated prices for medication with what it costs to buy from a local pharmacy.

By way of example, Acoplex, a stomach acid product, in the drugstore it is $4.37. At the VA it is 22 cents.

Let us take a product such as Zocor, to guard against high cholesterol which is very damaging to one's heart. If you want to buy it in the drugstore, you have to pay $3.77 per tablet, and if you are a member of the VA, their price is 66 cents. The list goes on.

At the drugstore for aspirin at 325 milligrams, the cost is 20 cents. If you buy it in the VA, it costs a penny.

Plavix to guard against heart attack and strokes, $3.63 per tablet; $2.01 if you go to the VA.

The list goes on with even better known products. The price comparison is ugly at best when you consider what happens with people on Medicare.

Mevacor reduces cholesterol--four bucks in the pharmacy and 26 cents at the VA.

Many of these medications make the top 50 list of drugs used by the elderly. We ought to learn from that and not prohibit the VA from negotiating volume prices.

Another troubling part in this bill is the effective date. When the Senate first voted on a prescription drug benefit for seniors back in June, I offered an amendment to make this benefit effective within 1 year. But it was voted down with strong Republican assistance. Eleven votes made the difference. We passed that amendment with bipartisan effectiveness to make this benefit effective within 1 year.

Under this conference report, the drug coverage doesn't start until January 2006, 23 months from now.

We have to ask the question: Why is this taking so long? One clue is illustrated on this chart. Notice election day in the yellow box; the original Medicare Program was processed in 11 months. President Johnson signed the law on July 30, 1965, and 11 months later, July 1, 1966, all of the people who were eligible for the program were enrolled in the program. I know something about computer processing. I literally had my career grow in the computer development stage. They had to create the files. The identification had to be punched into cards. They weren't read electronically in 1965 as they are now. It took 11 months and the whole deal was done. It was created from the beginning in 11 months.

Now we are asking for a toleration of 25 months to get it into place. But election day is here, and Heaven forbid that the public at large should find out about this bill. When they learn about it, they are going to be mad as could be.

If they can get safely past election day, the rhetoric is out there flooding the country. They even have the American Association of Retired Persons supporting the bill. That is a mystery that we are going to have to find out about one day. A lot of people we get calls from--Medicare recipients and beneficiaries--are ripping up their cards. We got one batch that was 75 to 2 against the bill. There were two who were doctors also who are concerned about whether they will be able to continue their practice as it was. It is a reasonable question. But 75 to 2--that is while this bill is being discussed. The bill is not yet in place.

Once the phone calls start coming into my office, I know what is going to happen. They are going to ask: When can we sign up? What are the benefits?

We are going to say: Hold your horses. What is the rush? It costs you a lot of money later on. Right now, we have your temper down. Not so much your temperature but your temper is going to go up once you find out after election day that this bill is going to take place with higher prices for medical care and prescription drugs.

The Democrats created Medicare. We protected it for decades. The Republicans never really liked it. They resisted the creation of Medicare and have opposed it ever since.

It wasn't too long ago that a very well known leader of the House, Newt Gingrich, expressed his desire to see ``Medicare wither on the vine.'' That is what he wanted to see happen. He represented a view that was generally accepted.

We may see it wither but not without a strong fight on our hands, even if we have lost step 1 here. The senior citizen population in this country has to raise the alarm and shout it out to those who are in this building and those who are in the House of Representatives. Tell them: We don't like that bill. It is going to cost us more. You are not helping us, you are hurting us. We worked our lives away with certain promises in place, and the promise included a proposition that said as you get older and as we see things develop, we are going to help you get those things to keep your health going.

The bill before us today is the first major step toward disintegration of Medicare as we know it.

In reality, this bill is not as much a benefit for seniors as it is a big benefit for HMOs, the private health care organizations, and other private-sector special interests who want to tear the Medicare Program to pieces. Get them in corporate hands so we can charge more, make more. I wonder whether we could limit the incomes of some of the guys at the top of these companies, in the interest of public service? We regulate lots of industry.

So what is it specifically the President is afraid seniors will find out before 2006? Is the President afraid the seniors will realize they will pay at least $810 before they break even and get any benefit from this plan? For many seniors, that is more money than they currently spend on prescription drugs. Up to 30 percent of the beneficiaries would pay more for enrolling in the plan than they would receive in actual benefits. Is the White House worried seniors will learn there is a huge gap in coverage? Under this plan, a senior will pay a premium estimated at $35 a month, a $250 deductible, 25 percent coinsurance payments until reaching $2,250 in drug expenses.

What happens then? Seniors then get no coverage. I have been heard correctly: Zero coverage. At that point, seniors continue to pay their premiums but they will also pay 100 percent of their drug costs. That is a double whammy, as we say in New Jersey. Only until they have reached a catastrophic limit of $5,100 in drug costs does any benefit restart. By that time, seniors will have incurred $3,600 in out-of- pocket spending. This is the so-called hole in the donut. It does not sound like a good deal to me.

Remember, nowhere in the bill does it say that premiums will be only $35. It could be significantly higher. The $35 is a current estimate. We know how good this administration has been at making estimates. Is the President afraid that seniors will figure all this out? You bet. Seniors deserve a much better program than that which the Senate is considering right now. They certainly deserve it before 2006.

I will spend a few minutes more talking about the overall impact of this bill on seniors in the State I represent, New Jersey. The most important reason I am voting against this bill is I am convinced more seniors in my State will be hurt by this legislation than helped. There are approximately 1.1 million seniors in New Jersey. Because this bill provides a disincentive to employers to continue offering coverage to retirees, it is estimated that over 90,000 seniors in New Jersey will lose their existing, more generous retiree drug coverage from their former employer.

This bill is also going to make poor seniors in my State worse off. In New Jersey, Medicaid covers drug costs for seniors with incomes of less then $9,000 a year for an individual or $12,000 a year for a couple. In New Jersey, low-income seniors currently on Medicaid have access to whatever drugs they need and they do not have a copay for their prescription. Under this bill, however, they are now going to pay $1 per prescription for generic drugs and $3 per prescription for brand name drugs.

Low-income seniors tend to be in the worst health and have higher annual drug spending. A senior with $8,000 annual income does not have the discretionary income to shell out $15 or $20 or $25 for the prescriptions he or she may need.

I will long remember the battles we have had in the Senate to try to raise the minimum wage. It is the old rhyme that says: Try, try again. We tried, we tried, and we tried, but we could not raise it. So there are people out there who are working for $5.15 an hour, $206 a week. Having to pay these extra burdens for their prescription drugs is going to be a torturous outcome for them. The low-income Americans can be forced to choose between providing medication or buying food, providing medication or keeping the heat on in the winter.

This bill represents an enormous opportunity squandered. We had a real chance to do something right. We had $4 billion to improve the lives of 34 million seniors, 14 million of whom do not have any prescription drug coverage right now. Frankly, we missed the opportunity. We ought to scrap this plan and go back to the drawing board to give seniors a real prescription drug

benefit in the Medicare Program. Let's not try to move seniors into HMOs. Let's not leave that enormous gap in coverage. We should give seniors a plan that starts now, not in 2006.

I yield the floor.

Mr. President, today we stand on the threshold of a truly historic moment. Not for Republicans. Not for Democrats. Or for the House of Representatives. Or the United States Senate. But, for over 40 million American seniors and individuals with disabilities, who may finally be getting prescription drug coverage under Medicare.

Saturday morning, the House of Representatives passed H.R. 1, the ``Medicare Prescription Drug, Improvement, and Modernization Act of 2003.''

Also Saturday, President Bush called upon the Senate, once again, to finish the job. He urged us to send him legislation that will provide badly needed prescription drugs to seniors.

For years, Congress has debated whether, and how, to provide prescription drug coverage to seniors and to strengthen and improve the Medicare program. Now, it is time for us to Act.

Mr. President, this generation of seniors survived the depression, fought World War II, and helped make the United States into a prosperous and thriving Nation. Time and again, they stepped forward to serve. Now, is the time to fulfill our duty to that great generation. Now is the time to answer their call.

What President Lyndon Johnson said in 1965 still stands:

. . . No longer will this Nation refuse the hand of justice

to those who have given a lifetime of service and wisdom and

labor to the progress of this . . . country.

Let us not stay that hand of justice now. Let us not turn our back on America's seniors and individuals with disabilities.

There are nearly one quarter of a million seniors in my home State of Tennessee who have no prescription drug coverage. There are millions more across the Nation for whom this legislation, literally, means the difference between life and death. They cannot afford to wait any longer. I have treated thousands of Medicare patients. And I know firsthand that, without Medicare, millions of seniors would not have received needed medical services. Millions more would have faced financial ruin. Medicare has helped save and heal lives.

But this cherished program has failed to keep pace with medical and scientific progress. Prescription drugs are an integral part of modern medicine. They are as important as the surgeon's knife. Yet, they are not part of the Medicare program.

In the nearly four decades since the Medicare program was created, the American medical system has transformed from one focused on treating episodic illness in hospitals to one characterized by an increasing emphasis on managing and preventing chronic disease in outpatient settings with advanced medical technologies and prescription drugs. Life expectancy has increased by nearly ten years. Death rates associated with heart disease have been cut in half, and new treatments and diagnostic tools have improved survival rates for prostate, colon, and breast cancer. Our medical and scientific knowledge and, along with it, our ability to treat illness and disease has improved dramatically over the past four decades. Yet, Medicare itself has not kept pace with these dramatic changes. It has been too inflexible and bureaucratic. Designed for the 1960s health care system, it has been unable to adapt to changing medical practice. Medicare does not provide true preventive coverage, disease management, or protection against catastrophic health care costs.

As a result, we have today glaring and unacceptable gaps in the coverage that is available to seniors and individuals with disabilities--the most obvious of which is the lack of prescription drug coverage.

Over the past three decades, for example, the death rate from atherosclerosis has declined by over 70 percent and deaths from ischemic heart disease have declined more than 6 percent, largely due to the advent of beta blockers and ACE inhibitors. During the same period, death rates from emphysema have dropped nearly 60 percent due to new treatments involving anti-inflammatory medications and bronchodilators.

Today, over 600 medicines are under development to treat or prevent diabetes, cancer, heart disease, stroke, neurological diseases, and other debilitating illness. Nearly 400 drugs have been produced during the past decade alone.

But, under today's Medicare, these drugs simply are not available to seniors.

We must act to ensure that this generation of seniors, and the next, has access to the healing miracles of modern medicine. And we must act to provide our seniors, and the next generation of seniors, with true health care security: quality preventive care, affordable prescription drugs, protection from catastrophic health care costs, better coordinated care, disease management, and access to modern technology.

As voluntary prescription drug coverage the bipartisan bill we are debating today takes a major step in that direction. It devotes $400 billion over the next decade to adding a new, voluntary prescription drug benefit to the Medicare program. And it takes concrete steps to speed less expensive generic drugs to the market to help make prescription drugs more affordable for all Americans.

Within months after this legislation is signed into law, seniors will be able to get a voluntary Medicare-approved prescription drug discount card that will reduce the costs of their drugs by an estimated 10-25 percent. Lower income seniors will get an additional subsidy of $600 on top of these discounts to help them purchase needed medicines. Thus, seniors will get immediate relief even before the comprehensive drug benefit is fully implemented, with additional help for those who need it the most.

Beginning in 2006, seniors will have access to the new drug benefit. Those who wish to add the new prescription drug benefit to their traditional Medicare coverage will have that choice. The new drug benefit is completely voluntary and available to all seniors. Appropriately, it provides the most generous help to lower income seniors and those with catastrophic drug costs.

substantial assistance for lower income seniors

Seniors with incomes below 135 percent of the Federal poverty line ($11,648 for individuals and $14,965 for couples) will pay no premiums, no deductibles, and only a modest co-payment for their comprehensive coverage. Beneficiaries with incomes below 150 percent of poverty ($12,942 for individuals and $16,327 for couples) will pay only a portion of the premium and a $50 deductible. After that, the government will subsidize 85 percent of their drug costs.

In my home State, over 430,000 low income Medicare beneficiaries-- nearly half of all beneficiaries in Tennessee--will have exceptional prescription drug coverage under this bipartisan plan. One quarter of a million Tennessee seniors who today have no prescription drug coverage at all will gain access under this proposal, along with millions more across the Nation.

improvements to traditional medicare

The legislation also strengthens and improves the traditional Medicare Fee for Service program. It adds new preventive coverage for diabetes and cardiovascular disease. For the first time, Medicare will cover initial preventive physical examinations. And this agreement responds to the six percent of seniors with chronic disease who account for about 50 percent of all Medicare spending. The legislation will launch a series of major pilot programs on disease management and quality payment incentives that could result in dramatic improvements in the care of the most ill and the most needy. This will help us better target health care resources to those who require it most.

The legislation also puts in place national standards for electronic prescribing, along with incentives for doctors to fill prescriptions electronically. These reforms should dramatically improve medication therapy management, reduce medical errors, and improve patient safety.

As the Senator from Montana, the Ranking Member of the Senate Finance Committee, has said so eloquently during these past several days, this bill does nothing to destroy the existing Medicare program. In fact, it immensely strenghtnes the traditional Medicare program.

As my colleagues know, this legislation has received broad support from well over 350 organizations, including from the AARP--which represents 35 million seniors. In its letter of endorsement last week, the AARP also makes clear that, at a result of this legislation, ``millions of older Americans and their families will be helped by this legislation.'' In addition, AARP writes: ``The integrity of Medicare will be protected.''

new health care choices

Today, most seniors choose to enroll in the traditional Medicare Fee for Service program. But this may not be the best choice for all seniors, and it may not be the choice of all seniors in the future.

There are about five million seniors who are covered by private health plans under the Medicare program today. Beginning immediately, the legislation will strengthen Medicare's local HMO coverage. It will help stabilize and improve the coverage of those five million seniors in the current Medicare+Choice program. As a result, Medicare+Choice will become a more stable, secure, and strong option for those seniors who have already chosen to enroll in coordinated care plans.

This bipartisan plan also provides seniors with even more choices-- the choice to enroll in regional preferred provider organizations--or PPOs. The majority of Americans under age 65 get health coverage through PPOs. Most members of Congress, Federal employees, and Federal retirees also get coverage through PPOs. Employees covered by PPOs report high levels of satisfaction with their coverage. PPOs typically provide coverage for preventive care, chronic care management, disease management, and access to a broad range of doctors and hospitals.

Under the bipartisan agreement, seniors will have the opportunity to participate in these innovative plans if they choose.

Moreover, beginning in 2010, we will test on a limited basis whether these private health plans provide higher quality than traditional Medicare. We will also test whether Medicare private health plans are most cost effective than traditional Medicare. All beneficiaries will be protected during this test. And the demonstration cannot be expanded or extended unless Congress acts to do so.

Throughout, seniors will always be able to stay in the traditional Medicare program. And they will have the option of adding prescription drug coverage. Meanwhile, tomorrow's seniors, many of whom are covered through PPOs now, may choose to continue private coverage when they retire. We are looking down the road to prepare for the baby boom population. We need to be ready now, not scrambling when it is too late.

strengthening health care in rural america

This bill contains the most sweeping and strong rural provisions ever in a Medicare bill to come before this Congress. It also makes improvements to payments for graduate medical education and takes concrete measures to protect seniors' access to physicians.

For example, hospitals in my home State of Tennessee will receive $655 million under this legislation. Physicians, who otherwise would face real cuts next year of 4.4 percent, would instead see a 1.5 percent payment increase in both 2004 and 2005. I am very proud that the American Hospital Association, the Tennessee Medical Association, the American Hospital Association, the Tennessee Hospital Association, the American Association of Medical Colleges, and the Alliance for Specialty Medicine strongly support this legislation. The bill has also received strong support from the Rural Health Care Association, the Rural Hospital Coalition and the Coalition for Geographic Equity in Medicare.

controlling prescription drug costs

Some of my colleagues have said that this legislation does nothing to control prescription drug costs. I respectfully disagree.

First of all, under this bill, seniors will be able to get a drug discount card right away. They will be able to present their Medicare discount card to their pharmacist and receive a 10 to 25 percent cut right off of the top.

This bill also works to contain drug costs before the drugs get to the pharmacist's shelf. It does so in a number of ways. The bill speeds generic drugs to the market. It encourages competition

to lower prices, and it gives the Medicare recipient new power to comparison shop.

Let's start with the generic drug provisions. In 1984, Congress passed the Hatch-Waxman law to encourage cheaper generic drugs to come onto the market. Under that law, generic competition has flourished. When the law was passed, generics drugs were less than 20 percent of the market. Today, generic drugs represent nearly 50 percent of the entire market.

The Hatch-Waxman Act has been incredibly successful in allowing consumers to get low cost alternatives. But there have been some abuses. Therefore, we are moving to close loopholes in the system through this bill. And the core of the provisions build on the work of Senator Gregg and Senator Schumer.

Under the new system, a new drug applicant will receive only one 30- month stay of approval of a generic drug's application. This is a major change. Under the old system, drug companies could receive multiple stays of approval for generic rivals. Now, they will get one stay only.

The agreement takes additional steps to get generic drugs to the market faster--through which patients will get safe, effective, low cost generic drug alternatives to brand name medicines.

That is why this bill is supported by the Generic Pharmaceutical Association and the Coalition for a Competitive Pharmaceutical Market.

the bipartisan Medicare agreement also empowers drug plans to negotiate discounts from drug companies. The Congressional Budget Office says that this approach will enable drug plans to significantly control drug costs for their beneficiaries.

Moreover, the savings they negotiate will not be subject to Federal limits. They will be able to get the lowest prices possible, even if those prices are lower than those negotiated under Medicaid. The Congressional Budget Office has estimated that this provision alone will save $18 billion dollars.

Not only will the Medicare agreement help lower prices, it will help give consumers more information about their medical options. This bill expands Federal research into the comparative effects of different drugs and treatments.

With this new information, seniors will be able to comparison-shop in the medical marketplace, just like they would for any other product or service. Patients and their doctors will be able to compare treatment options and choose the course of action that best addresses their medical needs. And Medicare and health consumers will get better value for their money.

Health Savings Accounts

I am also very pleased that this legislation will make tax-preferred Health Savings Accounts available to all Americans. HSAs will help control costs over time, and give individuals the ability to better control their health care dollars and health care decisions.

I wish we could have gone even father. I wish we could have added provisions from the House bill that would have allowed individuals to roll over some funds each year from their flexible spending accounts. I also believe we must do more in the coming years to allow individuals to invest funds on a tax-free basis to meet their health care needs in retirement, just as we do with 401(k) plans and Individual Retirement Accounts. I am committed to coming back and addressing these issues in the years ahead.

Demographic and Structural Challenges

Our first priority must be to provide seniors with health security. But, at the same time, we know that Medicare also faces serious financial and demographic pressures in the coming years. Between now and 2030 the number of seniors will nearly double from 40 million to 77 million; the program's costs will more than double to nearly $450 billion annually, even before we add prescription drug coverage or improve other benefits; the number of taxpayers paying into the system to finance health coverage for seniors will drop from 4 today, to 2.4 by 2030; seniors, who represent 12 percent of the population today, will represent 22 percent of the population in 2030; and one last fact: each senior will be in the Medicare program longer. Life expectancy at age 65 will increase approximately 10 percent over the next 30 years.

The demographic underpinning has been defined: more seniors; each senior living longer; and fewer workers to support each senior.

So, while we need to act to provide prescription drug coverage to seniors, we also need to do so responsibly. This legislation takes an important first step in linking Medicare payments to quality. It also relies on competitive market forces to help control health care spending.

Moreover, for the first time in Medicare's history, we will ask those seniors who can afford to pay more for their coverage, to do so. And we will put in place more accurate and more transparent measurements of Medicare's fiscal strength--as well as special procedures for attempting to better control Medicare spending growth in the future.

These reforms do not go far enough for some of my colleagues. At the same time, they go too far for others. Overall, however, I believe this is a balanced, bipartisan bill that is worthy of the support of the United States Senate.

It is not a perfect bill. But, it is a meaningful step in the right direction. It will provide substantial relief from high prescription drug costs for millions of seniors. It will help rectify payment inequities for rural health care providers. And it will begin to inject into the Medicare program new health care choices and much needed flexibility so that seniors will have the option to choose the kind of health care coverage that best suits their needs.

Today, America is one step closer to being a more caring society for millions of seniors and individuals with disabilities struggling with high prescription drug costs and outdated, often inadequate medical care. Today, we are one step closer to providing real health security to seniors all across the Nation.

As a physician, I have written thousands of prescriptions that I knew would go unfilled because patients could not afford them. With this bill, that will change. As a senator, I have watched as a decades-old Medicare program has operated without flexibility, and without comprehensive and coordinated preventive care, disease management and catastrophic protection against high out-of-pocket medical costs. With this bill, that will change also.

This legislation is historic. By dramatically expanding opportunities for private sector innovation, it offers the possibility of genuine reform that can dramatically improve the quality of care available to seniors. At the same time, the legislation preserves traditional Medicare for those who choose it. It combines the best of the public and private sectors and gives today's seniors innovative health care options and positions Medicare to serve tomorrow's seniors as well.

This legislation is possible because of the work and dedication of every Member. I would like to take a moment to thank those whose commitment was critical to this effort. First and foremost, Chairman Charles Grassley and Ranking Member Max Baucus deserve credit. As does Senator John Breaux who joined me six years ago on the Bipartisan Commission on Medicare and again on this Conference Committee. All Members of the Conference Committee showed a degree of dedication and resolve seldom seen in either Chamber, especially Senators Hatch, Nickles, and Kyl. But we wouldn't have reached this point without building on the strong foundation laid by Members over the last several years, especially Senators Snowe, Jeffords, Gregg, Hagel, Ensign and Wyden. Finally, the Senate could not have done this alone. The House Leadership, Speaker Hastert and Leader DeLay, deserve special recognition, as does the Chairman of the Conference, Chairman Bill Thomas, and the Chairman of the House Energy and Commerce Committee, Chairman Billy Tauzin.

In closing, I would like to thank again every member of this body who has worked so hard on this legislation--not just in this year, but in the previous six years of our most recent effort to strengthen and improve Medicare. I urge every Senator to support this bill. I implore every Senator to avoid filibusters and other partisan political maneuvers that threaten the prescription drug coverage, and health

care security, our seniors need and deserve.

I yield the floor.

Mr. President, we bring debate to a close prior to a very historic vote in which we are making a decision whether to give 40 million seniors the opportunity, for the first time through Medicare-- the program that has been constructed and been used to give them health care security--whether for the first time these 40 million seniors will have access through that program to prescription drugs, to the tool which is the most powerful element of health care security today. Seniors don't have it. What we are voting on today is to give them that true health care security.

America's seniors have waited 38 years for this prescription drug benefit to be added to the Medicare Program, and today they are just moments away from prescription drug coverage that they desperately need and deserve.

It is clear that in this body there is a bipartisan majority--and I would say an overwhelming bipartisan majority--in favor of this Medicare Prescription Drug, Improvement, and Modernization

Act of 2003. Yet we have before us an attempt to block this body from expressing, through an up-or-down vote, their will to give seniors and individuals with disabilities access to affordable prescription drug coverage and, thus, stand in the way of health care security for those seniors.

We are about to vote on a cloture motion in an attempt to overcome this filibuster.

Later today, we are likely to face additional procedural hurdles that the minority has threatened to prevent passage of this bill. Make no mistake, these are not one and the same. The result of this filibuster and of the procedural points of order will be once again to deny these 40 million seniors access to modern prescription drug coverage, something they need and something they deserve.

In my own State of Tennessee, there are nearly one-quarter of a million seniors who right now have no prescription drug coverage. There are millions more all across the Nation for whom this legislation literally means life or death. Think hypertension, heart disease, chronic obstructive pulmonary disease, asthma, or emphysema, all for which we have effective prescription drugs which are not made available through our Medicare Program today. Our seniors cannot afford to wait longer. Then why wait? They cannot afford to wait. It is a matter of their health.

This generation of seniors did survive the Depression, did fight World War II, did help make the United States the prosperous and thriving Nation we have today. Again and again, they answered the call. Now is the time for us to fulfill our duty to that generation. Many of them are poor and many of them are sick. It is time to answer their call.

When he signed Medicare into law in 1965, President Johnson said:

No longer will this Nation refuse the hand of justice to

those who have given a lifetime of service and wisdom and

labor to the progress of this . . . country.

Let us not stay this hand of justice now. Let us not turn our back on America's seniors and individuals with disabilities. Our seniors deserve better than to be held hostage to Washington politics.

There is a life-or-death issue in many ways in this legislation for millions of Americans and they cannot wait. Opponents of this bill would deny coverage to essential medicines.

Mr. President, I will go on leader time for my remaining 2 minutes, if necessary.

What will people tell millions of Americans or millions of low-income seniors if we go home and say, no, you are not going to have access to prescription drugs that this bill would have made available or tell individuals with disabilities, no, you are not going to have access to the preventive care that is actually in this bill?

The elderly, the sick, and the disabled are now being told to wait for action in the future. Now is the time to act.

We will do it next year, some say, but our seniors tell us time is running out. People are waiting for help.

Just 2 days ago in my office was Dorthea Yancy of Lakewood, CO, a retired African-American woman who worked for years but lost her pension when her company went bankrupt. She needs our help now. Dorthea Yancy needs our help now.

We are an eyelash away from fulfilling our promise to seniors. I ask my colleagues not to thwart the overwhelmingly bipartisan majority in this body because of using the tactics of some sort of parliamentary maneuvering. Do not hold America's seniors hostage to Washington politics. Our seniors deserve better.

I want to close by just reading a statement issued today by the AARP on behalf of 35 million seniors that fine organization represents. This is from the AARP today, and I will close with this:

The fate of the landmark Medicare prescription drug bill

now stands in the hands of the U.S. Senate. More than a vote

is at stake. With the final passage in the Senate, the

Congress will honor a longstanding promise to 41 million

older and disabled Americans and their families by finally

adding a prescription drug benefit to Medicare. This bill

will help millions of people, especially those with low

incomes and high drug costs. It will strengthen Medicare by

adding this long overdue benefit and preserving the basic

structure of the Medicare program. We urge the Senate to act

to seize this historic opportunity and vote to pass this bill

now.

America's seniors are watching. America is watching. I urge my colleagues to do the right thing, to seize this historic opportunity, to vote up or down on this bipartisan legislation, and to pass this historic bill.

Cloture Motion

Mr. President, on behalf of myself and Senators Grassley, Baucus, and Breaux, pursuant to section 904 of the Congressional Budget Act of 1974, I move to waive the applicable sections of that act and the budget resolution for the consideration of the conference report.

Mr. President, I ask unanimous consent that there now be 2 hours of debate on the pending motion to waive, with that debate time equally divided between the two leaders or their designees; further, I ask consent that following that debate time, the Senate proceed to a vote on the motion to waive, with no amendments in order to the motion.

Mr. President, we will shortly begin debate for 2 hours, as we just agreed to, after which we will have the vote--approximately 2 hours from now.

I move to reconsider the vote.