Mr. President, I thank the chairman of the committee. We have now come to the time of decision with regard to whether we are going to have the capacity to, in fact, reach a compromise on one of the great issues of the day; that is, whether…
Mr. President, I thank the chairman of the committee.
We have now come to the time of decision with regard to whether we are going to have the capacity to, in fact, reach a compromise on one of the great issues of the day; that is, whether the Congress has the political courage and political will to set aside partisan differences and to allow both sides to come together and reach agreement. We can argue about which party benefits from a Medicare reform bill and which party will suffer, but the real issue is not whether the Democratic Party or the Republican Party wins or whether the President gets to sign a bill that reforms Medicare in the Rose Garden. The real question before this institution on both sides of the aisle should be whether for once we can come together and craft a piece of legislation that creates a program that is substantially better than the 40 million seniors currently have under Medicare.
When Medicare was created in 1965, it was bipartisan. It was a change. Some say we should not change Medicare. I would argue that Democrats have never feared change. In 1935, when we wrote the Social Security Program under Franklin Roosevelt's leadership, Democrats changed the status quo. When we led in 1965 the effort to provide medical assistance for our Nation's seniors, we challenged the status quo. We stood up for change and created a new program. Today, over 38 years later, we have the opportunity to once again change a program which has served seniors well but not nearly as well as they deserve. Democrats should not fear that type of change.
Medicare today, on average, does not cover 47 percent of the average senior's health care costs in this country. Not one of us in this institution--our employees, Members of Congress--has health care insurance that is that deficient in what it does not cover. Forty-seven percent of those costs have to be borne by the senior citizen individually or, if they do not have enough money, by their children or their grandchildren or, if they become so poor,
they are put into the State Medicare Program for the poorest of the poor. That is unacceptable. That is not in keeping with the greatness of this Nation, to have a health care program for seniors that is that deficient.
This institution cannot let the perfect be the enemy of the good. This bill is not perfect, but this bill is good. We cannot let political pundits on both sides of the aisle who try to dictate what our choices are say, well, let's pass a Republican-only bill so that we can blame the failure of its passing on the Democrats. Neither can we allow Democratic political pundits to say to us we should not pass this bill for the reason that it would allow the President of the United States to sign it in the Rose Garden and that would be a political benefit for him.
If we cannot take good legislation and pass it and both claim credit for it, then, quite frankly, we should be doing something else. Good government is good politics. This is good government. This is a good bill.
There are two different approaches to solving health care. Some of my friends on the Republican side would say: The Government should have nothing to do with it. The private sector should do everything, keep the Government out of it, and we can design a program with the free enterprise system that will work just fine.
Unfortunately, there are some on my side who would say: No, the Government has to do everything. Government would have to do it all. The private sector cannot be involved at all.
Both of those approaches are incorrect. The best way to solve health care problems is to do what this bill does; that is, to combine the best of what government can do with the best of what the private sector can do and come up with legislation that says: Yes, the Federal Government can supervise it but not micromanage it. Yes, the Federal Government can help pay for it through the tax system--and this bill does that--but the private sector needs to be involved as well. The private sector can bring about innovation. They can come up with new ideas and new concepts faster than we can in the Congress and in the Federal bureaucracies here in Washington. The private sector can bring about a degree of competition which is sorely lacking under the current micromanaged system with 133,000 pages of rules and regulations. That does not allow innovation or competition. That is one of the reasons the program as we know it today, as good as it is, can be made a lot better.
The issue for our Nation's seniors is not just living longer lives; it is also about living better lives. For the first time, seniors will know that when they need prescription drugs, they will be available. Four hundred billion dollars will set up a structure where they will have insurance that covers prescription drugs, just as in 1965 when we made changes that said the Federal Government will help provide insurance to cover hospitalization, we said that for the first time the Federal Government will help with a program that will provide insurance coverage for doctors.
This is a good program. We should not fear change. This is a major step in the right direction.
Mr. President, I think one of the subjects that really united both Republicans and Democrats was the question about dual eligibles. There was a large number of seniors being treated as second- class citizens
of this country because, if they were poor, they were not in the Medicare Program. If they were poor, they were not allowed to get through the Medicare door, and for no other reason than they were poor.
Under that scenario, low-income seniors, maybe 80 years old, who worked all of their lives, but ended up in a very low-income status, were relegated to the Medicaid Program, where there was not a consistent amount of benefits for their health care programs. They were subject to the will and whims of the various State legislatures. Some treated them better, some treated them worse, and some didn't treat them hardly at all.
What we were able to do, which I thought was a priority for many Republicans because it was in the House bill--but it also was a priority for many Democrats in this body--was to say that we are going to bring those low-income seniors, for the first time, into the Federal Medicare Program. We did that. That is part of this bill. Those low- income seniors now are going to have the opportunity to be in the Federal Medicare Program. They will know what their benefits are. They will know, for the first time, they have access to prescription drugs, which is what I think the bill is all about. In addition, we were able to find an extra amount of money to help them with any type of copayments they might have.
Some States have high copayments; some States have no copayments on drugs. But what we were able to do was to say: Here is extra money for the purpose of helping States to reduce the copayments down to $1, if they are buying a generic drug and only $3 if they are buying a prescription drug. In addition to that, the subsidies and assistance we have for low-income seniors in general is extremely important.
Starting in April of this coming year, they will get a drug discount card. If they are low-income, they will start off with a $600 credit on that card, to be able to immediately have the benefit of something, where they have nothing at all today.
On balance, when you have a 150 percent of poverty and below special assistance program, when you have a discount card that starts in April, and all of the seniors, for the first time, will be in the same Federal program, I think that is significant. For the first time, we will say to seniors who are low income that you will no longer be treated as a second-class citizen and be different from all of the other seniors you know. You will be part of the Federal program and you will have access to prescription drugs.
Again, I think the question is, Have we designed a perfect bill? The answer is no. But I think when you look to associations such as AARP and the National Council on the Aging, we have a bill that merits their support.
Mr. President, we have reached that point where the debate is on the size of the bill and not the merits of the bill.
Let me just say, 38 years ago this Congress passed this document that I have in my hand for the first time. It was in 1965 that we enacted Medicare, which was a noble experiment. It was led by Democrats and signed into law by President Lyndon Johnson. It was, indeed, a change and a challenge. No one knew whether it was going to work. People could not be guaranteed it was going to serve the needs of America's seniors. But it was a chance worth taking. It was a change. I suggest today Democrats in particular should not fear change if it is aimed at improving a document that has served this country so well.
The only defect of this legislation was that it didn't do everything that it should have. For instance, while it covered doctors and it covered hospitals, it did not cover what at that time were new innovations in the area of prescription drugs. Members of Congress knew we had to take care of seniors going to the hospital. We had to take care of seniors seeing their doctors. But no one really thought that seniors getting prescription drugs was going to be that important.
Today we have the opportunity to correct what we did not do in 1965 and bring about a reform to this program which is greatly needed. I would just say that is why organizations such as the National Council on Aging, which represents all of these seniors who go to these senior centers throughout our States and congressional districts, as well as the AARP--and Democrats many times cite the AARP when they agreed with them. But now when they do not agree with them they find fault with the organization.
I suggest the Nation's largest organization representing over 35 million seniors has had their health economists and their lawyers carefully study the document that is before us and made a recommendation to those of us in Congress. They said this is something we support because it is indeed, on balance, the bill we should approve and send on to the President for signature.
Again, I say it is not a perfect bill. But, once again, we can't let the perfect be the enemy of the good. We also cannot let the political pundits of both of our parties suggest we cannot vote for this bill because somehow it may give credibility to the other party. I have actually heard that from both sides of the aisle. I think that would be a tragic mistake.
The issue today is not which political party wins. The issue today is whether we can craft legislation that allows America's 40 million seniors to come out a winner. I think on balance this bill does that because it combines the best of what government can do with the best of what the private sector can do.
Many on my side of the aisle think the Federal Government should do everything all the time. We can't do that. We can't do it very effectively. So I think it is important to note that on the other side of the aisle, many of them think the Federal Government should not do anything and that the private sector should do it all.
The truth lies, as most truthful matters lie, somewhere in between. The fact is, we ought to combine the best of
what Government can do with the best of what the private sector can do and create a new Medicare reform for the 21st century.
With regard to the points of order, I made it very clear the two points of order we are going to be voting to waive are not dealing with the so-called premium support language that is in the bill. It doesn't deal with the cost containment provisions that are in the bill. It doesn't deal with whether we are going to bring in the Medicare Program all low-income seniors who are currently in, under the State Medicare Program--it doesn't deal with any of that. It deals basically with the fact that we are spending more money in this legislation than the structure of the budget would allow us to do.
That is not uncommon, and the proper procedure is to have a waiver of those points of order, which is what we are going to be voting on.
The first point of order really lies because of the fact that we put more money to help the State Medicaid Programs, something that most people on my side of the aisle strongly supported, to make sure we help those programs make sure the drugs that they are going to still be involved in helping seniors with--that they will be able to help them to the maximum degree possible.
In addition, one of the other reasons the first point of order lies is because previously the Finance Committee helped the States with their unemployment insurance, something most people on my side of the aisle strongly supported. It is not sufficient for people to go back to our States and tell seniors that we somehow prevented this bill from being adopted because of a point of order that was very technical in its essence. I think people want to know where we stand on the merits of the bill. Are we for prescription drugs for the first time, for seniors, since 1965? Are we for giving them a program where the Federal Government pays 75 percent of their drug costs? Are they for or against a program that is going to give particular help and assistance to our Nation's low-income seniors, which is so terribly important? Are we for bringing low-income seniors into one standard national Medicare Program or are we not?
I would not want to go back and somehow argue the technical merits of the point of order and say this is why I could not vote for prescription drugs for seniors, a $400 billion package. There are going to be some on the more liberal wing and more conservative wing who will find reasons to be against this bill, but on balance it represents a centrist coalition, and I urge my colleagues to support it.
I coauthored Section 507 of H.R. 1, the Prescription Drug and Medicare Improvement Act of 2003, which would amend current law regarding physician self-referrals. I would like to engage in a colloquy with my colleague, Mr. Grassley, in relation to the exception language contained in this provision.
I would like to clarify congressional intent with regard to the ``exception'' language included in S. 1, as this language may ultimately be included in any compromise between the two bills.
I would like to discuss the extent to which the Secretary would have discretion to exempt a hospital based on the factors identified in the language. The language in the conference agreement states that, for the purpose of determining whether a hospital qualifies as under development, and therefore exempt from the self-referral limitation, the Secretary:
. . . shall consider--
(1) whether architectural plans have been completed,
funding has been received, zoning requirements have been met,
and necessary approvals from appropriate State agencies have
been received; and
(2) any other evidence the Secretary determines would
indicate whether a hospital is under development as of such
date.
It was my intent in crafting this language that the factors outlined would serve as an illustrative guide to the Secretary. The Secretary ``shall consider'' these factors, but will not be required to see that each and every factor is met. Is it your interpretation, that the Secretary would have discretion to make a reasonable determination of whether a specialty hospital is ``under development''?
Is it your understanding that a specialty hospital that has, as of November 18, 2003, met zoning requirements, received approval from the local planning board, and received partial funding, but has not yet completed all architectural plans would quality for the exception?
Similarly, is it your understanding that a specialty hospital that has completed or substantially completed architectural plans but has not yet received full funding would also qualify for the exception?
I thank my distinguished colleague for engaging in the colloquy.
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