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…
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.