Mr. President, I do have quite a lengthy statement. I had estimated it might take me upwards of about 45 minutes. I know others want to speak. I am going to try to collapse it as much as I can, but I had a number of things I wanted to say.…
Mr. President, I do have quite a lengthy statement. I had estimated it might take me upwards of about 45 minutes. I know others want to speak. I am going to try to collapse it as much as I can, but I had a number of things I wanted to say. Hopefully, I can get them said within a certain amount of time. I don't mean to drag it out, but I did have a number of things I wanted to point out about this bill.
We are debating an issue of utmost importance--the health and security of this Nation's elderly and disabled. To repeat what has been said, Medicare was created 40 years ago with the purpose of providing this Nation's aged and disabled with a safety net to protect them from debt and destitution. For years, seniors have counted on health security in their golden years thanks to Medicare. This program stands as a social contract between the American Government and the American people, a social contract between one generation and the next.
The contract is simply this: After a lifetime of work, when you turn 65 you are promised health insurance covering doctors visits, hospitals, and many other health costs. But there has been one exemption from this social contract--no coverage for prescription drugs.
It is not possible to overstate what Medicare means to a citizen of modest means who has worked hard for a lifetime, who doesn't want to be a burden on the rest of his or her family. It is really kind of hard to overstate what it means. Medicare has been a rock-solid, reliable, guaranteed lifeline for a great number of America's senior citizens.
I think back to my father's own experience, my own family's experience in the days before Medicare. In 1958--I just pick that year because I was a senior in high school at that time--my father at that time was 74 years old. He had worked most of his life in coal mines, in Iowa. A lot of people don't know it, but we had a lot of coal mines in Iowa. He had a number of accidents in those mines and elsewhere. He suffered from what was then called miner's lung. That is what they called it at that time, miner's lung. Today we call it black lung disease.
As I said, he had several chronic injuries as well and he was in pretty tough shape. Keep in mind, my father only had an eighth grade education, and all of his work life basically had been prior to Social Security coming into existence.
My father's total income in retirement was less than $1,500. Again, thank goodness during World War II, even though he had been old then, he had worked for a while and was covered under Social Security. Other than that, he had no assets, he had no money, no stocks, no bonds. He did own a small house in Cumming, IA. Oh, yes, he had a model A Ford that was 30 years old. That was the only car he ever owned.
Of course, in 1958 he had no Medicare because the program didn't exist. This meant that my father couldn't afford the luxury of seeing a doctor. But every year, like clockwork, my father would get sick in the middle of wintertime. He had this terrible chronic lung problem, black lung, miner's lung. My mother had passed away 8 years prior to 1958. He was on his own and basically taking care of us. As I said, I was a senior in high school at the time.
Every year he would catch a cold, he couldn't get over it, he would come down with pneumonia, and a neighbor of ours who had a car would rush him to the hospital in Des Moines.
He would arrive at the hospital in Des Moines. They would take care of my father. They would put him in an oxygen tent. They would give him his antibiotics and send him home in a week or two.
How could he afford to do that if we were so poor and had no income? My father was 74 years old. Did we have a rich uncle? No. So what happened? I will tell you how we afforded it. We thanked Sisters of Mercy at the Mercy Hospital in Des Moines who gave us charity care because our family didn't have any money. That is the only way that my father got health care.
We forget. Those of us who are young perhaps forget that 45 years ago that was the status of elderly health care in America. My father was not unique. Our family was not unique. In my little town of 150 people, it was all the same. All my father's brothers, his sisters, our family--of all who were that age, none of them had any health care. None of them had any money. If it wasn't for the charity of the Catholic Church and the Sisters of Mercy, my father would have had no health care whatsoever.
Had my father had any money or health insurance, he could have seen a doctor. He could have had annual checkups. He could have prevented long stays in the hospital. But in the absence of anything like Medicare, he ended up in a dire situation, in effect, in the emergency room. For many uninsured in this Nation, things are still that way. But fortunately, Medicare has offered a better alternative for our Nation's elderly and disabled.
I can remember as though it were yesterday. After I left high school, I went to Iowa State University. I had a Navy ROTC scholarship. I was in the Navy. I was flying planes. And I can remember coming home on leave once. It was Christmas of 1966. I came home, and my father, who was nearing his 81st birthday, still with his bad lung problems--I remember coming home and I remember when he proudly showed me his Medicare card. He said: Now I can go to see a doctor. I can go to the hospital, if I have to. But I can see a doctor. We don't have to take charity anymore.
I think of the impact that Medicare card had on my father, and the impact it had on my family and what it meant to my father to be able to get health care without accepting charity. What a tremendous difference. I often think about what my father's later life would have been like had he had Medicare. I think about how much healthier he could have been with good preventive care, and how much more he could have enjoyed his later years if he had had decent health care.
Today, seniors rely on Medicare. It means everything to them. If you do not have your health in your older years, you just do not have much of anything.
Unfortunately, back in 1966, we weren't nearly as sophisticated about medicine and health care as we are now. Surely, if we were creating the Medicare Program today we would include coverage of prescription drugs. We know that drug breakthroughs and innovations have made it possible to prevent illness, control illness, and keep people out of the hospital. For many in this society, modern prescription drugs have been a lifesaver and a life sustainer. Here we are today debating a proposal that was originally supposed to accomplish one simple goal: To fill in the gap that was left in Medicare--to right the wrong in Medicare by providing coverage of prescription drugs and simply to make medicine more affordable to seniors.
That is what we started out to do.
I deeply regret that in writing this bill Congress has strayed from that straightforward objective. This bill got hijacked, and it got hijacked by the corporate special interests, insurance and HMOs, and it got hijacked by the pharmaceutical industry.
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 that seniors and the disabled rely on each and every day--seniors like my father who relied upon the stability and the affordability of Medicare in his later years, and seniors like him back in my home State of Iowa who simply want and need affordable medical care. That is all they want.
But what they are offered in this bill is something else entirely. This bill totally violates the spirit and substance of the original Medicare Program. I call it the ``Big Medicare Gamble.'' It is a roulette wheel. If you know anything about odds in roulette--I don't. I just learned this: The odds are tremendous against you. Roulette--that is what they are playing with Medicare. This bill threatens to unravel Medicare as we know it. Seniors are being told to head to the back of the line because the special interest drug companies and HMOs are more important than they are.
Seniors are being told there isn't enough money for a full drug benefit. That is because we have already squandered our surpluses in tax cuts worth trillions of dollars for the wealthy.
I heard someone the other day say: Look, we can't do any more in Medicare than we are doing now because we are limited by the $400 billion that was put in the budget. So all of you people want all of this stuff, but we can't do that, you see. We can't do it. We simply don't have the money. The very same person saying that voted for the tax cuts in 2001 and in 2003.
I am saying: Well, fine. If you vote for the tax cut, fine. But then don't say we don't have enough money to have a good meaningful prescription drug benefit under Medicare. What you are saying is you had different priorities. Your priority was to give tax breaks to the wealthy. That is your priority, and the seniors and elderly who need prescription drugs, they can go to the back of the line someplace else.
We had the amount of money--I will continue to say this because it is true--that we gave up in the tax breaks. If you spread that out over 75 years, that money is three times more than what we need to make Social Security and Medicare whole for 75 years--three times. So don't tell me we don't have the money. People just have different priorities on how to spend the money.
Once again, the well heeled on Wall Street are more important to this administration and to the supporters of this bill than the elderly and the 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. Here is the Los Angeles Times: ``Deal Would Alter the Essence of Medicare.''
As Congress prepares to vote on the final $400 billion
Medicare prescription drug bill, there is one thing on which
most lawmakers agree. The legislation would over time change
the essence of the 38-year-old health insurance program for
the elderly and disabled.
We are doing that and we are told that we have 2 days to debate it--2 days, Saturday, today, and tomorrow--and we are going to vote on Monday. My prescription for this bill is to put it out in the countryside, send it out across America, let us get out of here, go back home for Christmas, go back to our constituents, get it out among the elderly, let us see what they say about it, and come back here as we are going to do on January 20 and take it up in February. Let's hear what the American public has to say about it before we pass it. It does not go into effect until 2006, so what is the rush? If it does not go into effect until 2006, why not take a couple, 3 months to put it out there and let people think about it? No, no, we have to debate this Saturday, Sunday, and vote on it Monday.
Here is my own Des Moines Register editorial:
This legislation is a big, sloppy kiss to the
pharmaceutical and insurance industries.
From the Albany Times Union:
This is not only an imperfect bill. It may also be a
disastrous one.
That is what others are saying about it.
Another one, from the New York Times, on the 19th:
. . . gift to pharmaceutical companies and insurers and a
threat to elderly Americans.
From the Los Angeles Times:
Deal would alter Medicare's core.
Continuing:
If a comprehensive bill on prescription drugs passes, the
government program will become a massive subsidized insurance
market.
That is what we are doing. It is not just the media. Here is what conservative organizations are saying. Here is the Cato Institute, a more libertarian institute, perhaps, than conservative. I am not certain if it is conservative or libertarian:
The Medicare prescription drug bill to be voted on by
Congress is a terrible mistake that will dearly cost our
children and grandchildren. This is not a Medicare reform
bill. This is barely a Medicare prescription drug bill. This
is a bill for politicians and special interests. Sometimes
the better part of valor is recognizing when you have made a
mistake. Congress should recognize this bill as a mistake and
go back to the drawing board.
That is Cato director of health and welfare studies Michael Tanner.
From the Heritage Foundation:
The agreement contains an unworkable and potentially
unpopular drug benefit with millions of Americans losing part
of their existing coverage.
That is not just me, a Democrat, saying that. It is the Heritage Foundation. They go on to say:
More than four million seniors with existing private
coverage are bound to lose it or have it scaled back.
Meanwhile, the politically engineered premiums and
deductibles coupled with their odd combination of ``doughnut
holes'' or gaps in coverage are likely to be unpopular with
seniors.
That was November 17, 2003, Heritage Foundation.
From the American Conservative Union:
The Medicare prescription drug benefit bills that have
passed the House and Senate would drive up costs for millions
of senior citizens.
They go on:
Millions more would lose their current coverage under
private medigap insurance and employer-provided plans. The
House-Senate conference committee should reject the current
bill and start over with a bill that includes real Medicare
reform.
That was the American Conservative Union, August 21, 2003.
It probably seems odd for this progressive Democrat to be agreeing with conservatives, but sometimes they get it right, and they are right on this.
This bill would provide billions of dollars in subsidies--make that bribes; they say subsidies, it is bribes; call it to what it is, bribes--to private plans and HMOs. It would ensure billions of dollars in profits, a projected $139 billion in profits to pharmaceutical companies.
It speaks volumes that on Wall Street this week, drug and health industry stocks have surged up on the news of this big money, special interest bonanza. I often pointed out that during the deliberations on this so-called prescription drug bill, you never saw any pharmaceutical companies around here. I can tell you one thing. I have been here 29 years, and I have seen times in the past whenever we had bills dealing with drugs or pharmaceutical companies, if it is something that is going to cost the pharmaceutical companies one penny, they are here. They are in the halls. Their private jets are parked out at the airport. They are calling; they are phoning; they are in our offices. If there is any legislation that is going to take a nick out of the pharmaceutical companies, believe me, you see them up here.
I never saw a one, not one during this entire debate and development of this bill, which indicates to me they love it. Why wouldn't they, with a projected $139 billion in profits?
Now, I don't mind pharmaceutical companies making profits. They have a right to it. They provide good drugs. They do good research. But what I mind is that the $139 billion in profits they are getting are coming out of taxpayers' pockets--not to buy drugs, just as a subsidy, a blatant subsidy. It is not something they are making in the marketplace; it is a funnel from taxpayers to the taxing power of the Government and giving it right back out to the pharmaceutical companies.
One of the oldest statements in medicine goes back to Hippocrates: The first thing in medicine is ``do no harm.'' That is the oath that each doctor takes in this country: First do no harm.
We have to look at this bill. It does tremendous harm. Most egregiously, this legislation seeks to privatize Medicare, despite the fact that 89 percent of seniors are in traditional Medicare, and that is what they have chosen.
I listened to the Senator from Michigan, Ms. Stabenow. She pointed out we offered seniors a choice in this country in 1997. It is called Medicare+Choice. They could stay with traditional Medicare or they could join an HMO. Guess what, 89 percent of the seniors in this country stuck with Medicare and 11 percent went with HMOs. It seems to me they have already stated what they want.
Despite the fact that traditional Medicare is less expensive to administer--this is something else that a lot of people do not understand--they say private industry can do it cheaper than Medicare. The fact is, since we have had Medicare for over 40 years, we have good data. We know. We can look at the figures. This is not something on which you have to guess. So we look at the figures, and what do we find? We find that the average administrative expense in Medicare is 2 to 3 percent. In other words, for every $1 that goes to a Medicare recipient, 2 to 3 pennies are used in administration. In private plans, it is 15 percent. For every $1 that goes through a private plan in health care, 15 cents is used in administration; only 2 to 3 pennies in Medicare.
Why is that? With traditional Medicare, we do not have to spend millions on corporate CEO salaries or give them the private jets in which they fly all over the country. How about all the big page ads they take out in USA Today, New York Times, and Newsweek magazine? Those cost a lot of money. Medicare does not do that. So we have very cheap administrative expenses.
Despite the fact that administrative costs are 2 to 3 percent in Medicare and 15 percent in the private sector, they want to privatize Medicare. Despite the fact that under Medicare+Choice, which I just mentioned--they came in a few years ago in the late 1990s. HMOs have a history of dumping seniors. They get signed up, they are not making enough money, they leave town, and they dump them. But, still, we want to privatize it. They want to privatize it despite the fact that Medicare expenditures are growing at a slower rate than private plans. This is fact. This is not something we are guessing at. We have the data, how much Medicare has grown expenditures percentage-wise compared to private plans. We have the data. No one on that side will ever dispute it because it is factual. Medicare expenditures are growing at about 9.6 percent a year; private plans, 11.1 percent. Their expenditures are growing faster than Medicare.
They want to privatize Medicare despite the fact that private plans are concerned first with what? Profits. I do not say that as a bad word. That is their business. They are in business to make money for themselves and their shareholders. So their first concern is profit.
Senior citizens and the sickest are not profitable. The elderly are not profitable. The sickest and the disabled are not profitable for insurance companies.
Despite the clear wishes of senior citizens in this country, they want to privatize Medicare. The conferees have chosen to ignore all of these facts. Instead, they have concocted a witch's brew--a witch's brew--of seemingly appealing schemes which are designed to let Medicare wither on the vine, and to set the stage, next year and beyond, for attacking Social Security. Make no mistake about it; that is what this is designed to do. And I will have more to say about that in a minute because of what Newt Gingrich stood for.
The ideological experiment that we have confronting us is the result of what I call private sector worship. It is sort of a faith-based notion among some of our colleagues and administration officials 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 because there is no private sector market for health insurance for sick seniors--none, zero, zip, nada--no private sector market because there is no money to be made in insuring the sick, the elderly.
The free market works just fine when you are talking about automobiles and airplanes and TVs, and widgets, et cetera. But the free market is not stupid. It cares about profit, not people. So by its very nature the free market shuts out people with disabilities, people with mental illnesses, people in the last years of their lives--in short, people who are not profitable.
So 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.
When the Americans with Disabilities Act was passed in 1990 and signed into law, it was not the free market that did that. It was Government. It was us, the elected officials here in the Congress, working with the President, who did that. It was our free Government that had to step in to ensure that opportunities and openness in our country was there for people with disabilities. In the survival-of-the- fittest free market, these folks are just simply left behind.
Another example: We have been fighting in this Congress for years now 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 in insurance. That is why I hope, as soon as we get back in our session next year, we can get to work passing the Paul Wellstone mental health parity bill because when we leave it up to the free market, folks with mental illness simply get left behind.
Another prime example of those left behind is simply the elderly. The elderly are not a profitable group of people to include in an insurance risk pool. They are sick. They are older. They have chronic illnesses. They are expensive to treat. On this score, 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 this bill has to bribe these companies with billions of dollars in subsidies to participate in this wrong-headed scheme we have before us.
As I said in my opening comments today, I have seen this proof firsthand. Now, back in 1958, when my father, as I said, was then 74, getting sick every year, going to the hospital, relying upon the charity of the Sisters of Mercy, we had insurance companies. There were a lot of insurance companies in those days.
Why weren't those insurance companies rushing out to Cumming, IA, with a population of 150 people, knocking on our door and competing with one another to cover my father with health insurance? Because they would never make any money off my dad. He got sick all the time. And he did not have any money.
Where was the free market? Where was the free market to cover my father in his time of need when he was elderly? The only market that was there was the charity market. Somehow I get the uneasy feeling that those promoting this bill see that as, once again, sort of the last kind of stopgap to helping our elderly, relying on charity once again, relying upon your kids, relying upon your families.
So do not tell me the private sector will solve every problem. I have lived through its failures firsthand. And I know that many elderly in my State of Iowa and around the country are in the same situation. They do not want to be let to not-so-tender mercies and whims of HMOs.
Now, it may sound like I have a real case against insurance companies. I do not. In fact, in my State of Iowa I think we are proud that we are the second largest domiciliary of insurance companies in the Nation, next to Connecticut, I believe. We are proud of our insurance companies in Iowa. They employ a lot of people. They are good corporate citizens. And they provide a very valuable commodity: insurance.
What the heck, I have a lot of insurance. I have life insurance, health insurance, car insurance. I probably have more insurance than I know what to do with, but it is a good tool, and I can afford it.
Insurance has been good for us ever since the first insurance scheme started about, I think it was, 3,000 years ago, in China, when Chinese farmers
were sending their barges down the Yangtze River, down to the ports, down to the cities. They found the storms would come up, and they would lose some of the barges, so a few of them got together and they decided to pool--to pool--their risks so that if one barge went down, that one person would not be totally wiped out. They found out by doing that, they could cover one another. Thus began the whole idea of insurance-- risk pool, sharing the risk, spreading the risk around.
So, no, I have a great deal of respect for insurance. I think it provides a very valuable, meaningful commodity for all of us. But it is not adaptable here in health care for the elderly. It is just not adaptable.
Many of my colleagues prefer the free market over Government intervention. In many cases this is a wise preference. But in other instances it is a misplaced faith that the free market can do anything. There is a time and a place for the Government to step in where the private sector either fears to tread or fails to tread because it is not profitable. 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.
Come on, let's get real about this. The only competition in this bill will be the competition for healthy seniors. That is where the competition will come.
It says right here in the Washington Post: ``Medicare Deal Likely To Spark More Health Care Competition.'' When you read that, you say that is good, that is what you want. Except when you read in here, it says:
"This could be like the wild west out there,'' Hayes said.
``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.''
If you are sick and you are a senior, you are going to be shunned. If you are a senior and you are healthy, you are going to have people fighting for you. Why? Not on a free-market basis, but that is where the subsidies go. We are going to give them subsidies to do this.
We hear the claim that Medicare should compete with the private sector, but they don't want an even playing field. This bill will give billions of extra dollars to the private plans so they can compete and make profits. That is not competition, that is simply another excuse to shovel taxpayers' dollars to the special interests. In fact, this bill will pay private plans 9 percent more than traditional fee-for-service Medicare.
But that is not the end of it. On top of that, the conferees have come up with what they call a stabilization fund, which amounts to a $12 billion slush fund for private plans.
Once again, the writing is on the wall. Privatization costs everyone more money. So understand this: They say they will pay the private plans 9 percent more, but when you add the $12 billion in this stabilization fund, it is more like 26 percent more. In other words, taxpayers of this country are going to pay, out of our tax dollars, 26 percent more to the private plans so they can compete with Medicare. What a sweetheart deal that is; what a sweetheart deal. And then they say that is competition, that is fair competition. It is nothing more than a scheme to give money to special interests.
We hear the claim that seniors should have a choice. Many people have said seniors should have a choice as we Members of Congress have. I can tell you this: When they find out what is in this bill, they are going to be disappointed to find out their options are nothing like our options.
Yes, I believe the seniors of this country ought to have what we Members of the Senate and Congress have. But they aren't going to get it under this bill.
Many seniors could actually end up with reduced choice with this legislation. Under this plan, if there are two private health plans, say an HMO and a PDP--I know, aside from a few people probably around here, no one has ever heard of a PDP. And why not? Because they don't exist. They have just been conjured up out of this witch's brew. It is called a prescription drug plan. There is no such animal out there now. In a particular area, if a senior wants drug coverage, that senior will be forced to get their drug coverage through one of those private plans, not Medicare. That senior will not be allowed to get their drugs through traditional Medicare. So they can go to the PDP or the HMO.
Well, they don't want to go to an HMO. Eighty-nine percent of seniors have already said they don't want to join an HMO. They want their choice of doctor. They want fee-for-service. So they can join a PDP, but we don't know what they are like because no one has ever built one. But once the senior goes in this private plan, they could face restrictions on what doctors they can see. The plan can change the drugs that are available to them. You could be on one drug and they could say: Well, we aren't going to cover that drug; we are going to cover another drug.
Now, why would they switch from one drug to another? Well, maybe they are getting a kickback from the pharmaceutical manufacturer that is making the drug. Maybe they get a bigger kickback on one drug than they do another. So they tell you: We are not going to cover that drug. So seniors could be forced to change drugs in midstream.
This is not competition. This is another excuse to shovel money to the special interests. I don't call that choice. That is not choice at all.
There is a lot of rhetoric surrounding this bill that doesn't match reality. This administration has said many times that seniors deserve choice, that seniors deserve what Members of Congress have. I am all for that. But let's put our money where our mouths are.
Right now, as a Senator, I pay about 25 percent of my drug costs, period--a heck of a deal. But the prescription drug plan put before seniors today won't even come close to this. Instead, it is a confusing, convoluted maze that--mark my words--will leave our seniors feeling betrayed and bewildered once they find out about it.
I say to my colleagues, if you like our seniors' reaction to the catastrophic health insurance plan of 1987, you are going to love their reaction to this grossly inadequate prescription drug plan.
In 1987, I was here. We all voted for a catastrophic health plan for the elderly. The AARP supported it and said it was wonderful. Guess what. We came back a year later and had our heads handed to us by seniors in our States. I know I had mine handed to me. We came back a year later and undid it.
I can barely lift the bill that we have before us. It got delivered to us sometime this morning or last night. I didn't see it last night when I went home so it must have been sometime during the night or this morning this was handed to us. I am not going to kid anybody. I haven't read this. I have been here all day. I haven't read this. I am not about to. I will have my staff look it over, and we will try to get through it. But no one is going to read this prior to the vote on Monday.
How many seniors in the country will go through this before Monday and be able to tell us what they think about it? Yet we are given 2 days--today and tomorrow--and we vote on Monday. A bill such as this, that is this big, that could have disastrous effects, is a bill that ought to be out there, around the countryside. Let's go home for Christmas and Thanksgiving. Let's let it out there. Let's get people looking at it, talking about it. See what the effect is going to be in your State and mine, urban and rural, wealthy, poor. Come back in February and let's take it up and see how we feel about it then. To me, that is the way democracy works.
This President wants to bring democracy to Iraq. I sure hope they are not watching this. I sure hope they are not watching this exercise. They might think democracy may be something they may not want if they watch this.
Look at what our seniors are going to be faced with. Once a year, we in our plan, the Federal Employees Health Benefits Program, get an open season in which we can leave the plan we are in and pick another one. Here are all the books I get once a year to look through to decide which plan I want.
I get 30 days, or something like that, to look through them and decide which
one. Here is MD Individual Practice Association; here is GEHA; here is NALC; here is the Mail Handlers Benefit Plan; here is BPP and PPP-- never heard of that; here is Kaiser Foundation; here is APWU--on and on and on. You get my point.
So we are now going to say to the seniors that every year you get a change and you will get all these wonderful books, like we do, to read, and you go through them and decide which plan you now want to be in. Give me a break. Maybe a person out there is sick and just hanging on, and they are supposed to decide by looking at these books. I suppose maybe they will have to go out and hire somebody to look at them. They will have to give a subsidy to somebody else. Maybe we will give a subsidy to the trial lawyers to help them decide which one to choose. Every single year. Who knows what drugs will be covered or what doctors? It is convoluted, bewildering. Every year they can bounce them around; you can be in a different plan.
At the end of the year, the plan can say: I am not making enough money, so I am out of town. Nothing in this bill stops them. Nothing in the bill says: We don't care if you don't make any money, you have to stay. If you are not making money, you can get out of there, and the senior is dropped, period.
Let's talk about what Senators are going to pay with this. They are going to find out, to their dismay, what they are going to have to pay. Aside from being confused and bewildered, being able to be dropped every year, let's see what they have to pay. Seniors who have an annual income above $13,470 per year--that is right, $13,470 a year--that is not a lot of money. If they have an income above that, they pay a yearly deductible of $250 before their coverage kicks in. They will pay $35 a month in premiums. Can I tell you also that this $35 is not fixed in law; it is estimated. It could go up every year. It could be $40, $42, $45, or who knows? There is no guarantee it is going to be $35. So now you have about $420 a year. As I said, the number could change every year. When a private plan is not making enough profits, they can increase the premiums every year. So seniors end up paying more.
So after seniors put at least $670 upfront into the program, they can start receiving some benefits. You might say, well, $670 is not a lot of money. If you are making $14,000 a year, or $13,470 a year, that is a lot of money. That is asking a lot. Then, after they pony up the $670, they pay 25 percent of their drug costs up to $2,250. At $2,250, the senior hits the gap--what we call the donut hole--at which point they pay 100 percent of their drug costs until they hit the catastrophic amount, even though they are still paying monthly premiums into the program.
So during the course of the year, a senior could have coverage one day, and the next day they could go to the pharmacy and be charged the full sticker price for the prescription drugs. That is the donut hole. It is not fair. It is outrageous.
Look at what they are paying now: Part A premium, zero. Part A deductible, for hospitalization, $876 per benefit period; Part B premium for doctors, $66.60 a month. The deductible is $100 a year with doctor visits. The cost share for doctor visits is 20 percent. That is straightforward, simple, and easy to understand. There are not income limits, asset tests, or anything else. It is just very straightforward. Seniors who have annual drug costs of $500 actually pay more into the program than what they receive. They would pay $500 for drugs, but they would pay $751.25 into the program. Tell me how fair that is. A senior with $1,000 in drug costs would pay $876.25. At the higher end, a senior with $5,000 in drug costs would pay nearly $4,000 for his or her drugs. What a deal. And for that, they get to read all these books every year. They get all these, I say to my friend from California, every year. And they have to try to decide. They can get bounced every year from one plan to another. For that, they pay $5,000, or they pay 4,000. It should not come as a surprise.
It is estimated that seniors, over the next 10 years, will have $1.8 trillion for prescription drugs costs, but we are allocating $400 billion to pay for it. Where did that money go? Well, it went to tax cuts. Hopefully, the people who voted for the tax cuts now will not bemoan the fact that we don't have the money. They voted to blow the money on tax breaks for the wealthy.
Now, let's look at one other thing. To make things even messier, this program would create several tiers of class under Medicare. Right now, you have one class. Everybody knows what he or she has to pay. Under the new program, we are going to classify you and have a lot of different strata here. There are different low-income benefits for those under 135 percent of the poverty level--$12,123, single--and another set of benefits for those under 150 percent of poverty-- $13,470.
On top of that, to receive the low-income benefits, a senior has to undergo an asset test. Again, hang on here, folks. We will see if we can understand this. We will have a little test afterward. For those at 135 percent of the poverty level and below, the asset test is $6,000 for a single person, $9,000 for a couple. For the group at 150 percent of poverty and below, the asset test is different. In this group, a person cannot have more than $10,000 in assets, or $20,000 for a couple. Follow me?
So what you are going to have is this. I predict this is exactly what is going to happen. You are going to have seniors at the senior citizen center, or at the local McDonald's having a cup of coffee; and old Bob is going to say: You know, this thing they passed is a pretty good deal. I am getting all my free drugs and stuff like that. His friend, Sue, is sitting there and she might say: What are you talking about? I just took a job at the local supermarket bagging groceries or stocking shelves; I am retired and have Social Security, but I need to make ends meet and pay for my drugs. Because I took that extra job to help make ends meet, to pay for heating bills, to meet my drug costs--I took this job that doesn't pay a heck of a lot--minimum wage--but because I got bumped up a little, I don't get the same benefits you get, Bob. And Margaret, who is sitting there, thought she was going to get the low- income benefits, but she filled out her forms and found out she had too much life insurance, over $10,000 in life insurance. She cannot afford her medicine, but her life insurance is considered an asset.
If you are going to go to McDonald's in the morning and you are sitting and having coffee, they are going to talk about this. But for the spread of $25 a year--maybe $50 a year--one person will get great benefits and the other person won't. You tell me if this is not a formula for an uprising among the elderly. It is not rich and poor. I am talking about people who make $13,470 a year, or they make a little less than that.
Or $12,123 versus $12,150. That is the kind of difference you are going to have, and that is going to decide what you get. Then they are going to say: You know, old John over there is getting those low-income benefits, but, by gosh, he is cheating because I know he owns something else. He owns a better car than what he said or he has a little something stashed away someplace. How do we get those low-income benefits? We know he has more than that.
It is going to arouse suspicion among the elderly: Why do you get a better benefit than I get? We are both in the same boat, and you make 50 bucks more a year than I do and you get all these benefits and I don't.
Hang on to your hats. It is going to happen.
How are they going to know where they fit in? You will have several people who make nearly the same amount of money each year and they receive drastically different benefits. This is a formula for confusion and confrontation among the elderly.
Right now, there is only one group. When you have Part A deductible, you all pay. When you have a Part B premium of $66.60, everybody pays it. When you have deductible of $100, everybody pays it. When you have a Part B cost share of 20 percent, everybody pays it.
When they sit around McDonald's having their coffee in the morning, Bob isn't suspecting that Joe is getting away with something or that Sue maybe has a little something extra, and Margaret who took that job at the supermarket to have a little extra money doesn't feel as if she is discriminated against because she has a little extra pocket change. They all pay the same.
Wait until this program heads south. You just wait. You just wait and see what happens.
I don't know, did the authors of this bill deliberately design a system that is going to fail, that does more harm than good? There were a thousand pages delivered to us on Thursday. The drug and health industries are spending millions to ram this bill through immediately, even though seniors across the Nation don't know what is in it.
What is the rush, I ask again? It doesn't go into effect until 2006. What is the rush? Why must we pass this bill before seniors have had a chance to examine the provisions and voice their views?
I saw this cartoon in a newspaper from Newark, NJ. This is the cartoon. Here is the pharmacy and the pharmacist. This, obviously, is a senior citizen who has come in. She has a prescription to fill out. The pharmacist represents Congress. He is saying to her: Have a seat. It'll be ready in 2\1/2\ years.
That is what we are saying: Have a seat; in 2\1/2\ years, this will be ready. Why do we have to rush it through right now? Why do we have to fill the prescription now if she doesn't get it for 2\1/2\ years? Maybe we ought to write the prescription later on, next year after we have had a chance to really look at it.
I think seniors in this country deserve more. They deserve to be put first in the process. They have been given short shrift in this process by the corporate special interests who have a very different view about the direction of Medicare. As I said earlier this week, the stocks of pharmaceutical companies and health insurance stocks have gone up.
Maybe a lot of seniors assume that AARP would stand up for their interests; that AARP would come in here and stick up for them. But AARP, the American Association for Retired Persons, has brazenly betrayed the wishes of its members on this issue. Seniors with whom I have spoken from all across Iowa do not like this bill.
AARP came to Iowa late this summer and had three big town meetings on this drug bill. Several hundred people showed up. I was told when AARP presented it, they presented the House version and the Senate version, as we passed them, in a straightforward manner without editorializing whether one was better or worse or good or bad.
After presenting this to several hundred Iowans in three different locations, at every meeting, they asked the 200 to 250 people who showed up, all senior citizens: How many of you would sign up for this plan? Do you know how many hands were raised? Zero. Not one hand went up. Not one hand. Now AARP is saying this is a great bill. I don't know with whom they talked. When they talked to the elderly in Iowa, they didn't get any takers.
My constituents want an affordable, reliable benefit under the traditional Medicare Program. Seniors across the country agree. A poll released this week found that almost two-thirds of seniors view this bill unfavorably. Most of them identify themselves as AARP members. Among those, only 18 percent said Congress should pass the bill; 65 percent said Congress should go back to work on this bill. They need to know the direction Medicare is taking and whose side AARP is on.
It says everything about this bill that Newt Gingrich is urging Republicans to vote in favor of it. For those of you who have forgotten who Newt Gingrich is, he was Speaker of the House and was the one who uttered the famous phrase: It was his desire to let Medicare ``wither on the vine.''
Mr. Gingrich is one of those ideologs who insists the private marketplace will solve all the problems. It would make his day to see Medicare dismantled through privatization, and that is exactly why he is pulling out the stops in lobbying for this bill--because under this bill, Medicare not only withers on the vine, it is cut away from the vine.
This bill is a realization of Newt Gingrich's fondest dream: to end Medicare as we know it. I might also say that Newt Gingrich made no bones about it. He wanted to privatize Social Security--privatize it, put it out on the stock market. That is next. But he sees this as the first step to that privatization.
The newspapers have been full of accounts of Mr. Gingrich's ``pull out the stops'' lobbying for this bill. He says:
Every conservative Member of Congress should vote for this
Medicare bill.
I submit, if Newt Gingrich is for this bill, that is a serious red flag. That ought to raise a lot of questions because, as I said, Mr. Gingrich has made no bones about it--I give him marks for honesty--he has said time and time again that Medicare ought to wither on the vine; we ought to privatize Social Security. Not only does it privatize Medicare, it is a bonanza for Mr. Gingrich's corporate friends, the big money corporate interests.
This bill is like Christmas in November for Mr. Gingrich's corporate friends. It allows people to sock away thousands of dollars a year in tax-free medical savings accounts. Of course, the people from where I come don't have money for tax-tree accounts. It will be used mostly by the wealthy, not low-income seniors. Newt Gingrich is ecstatic. This Medicare bill is yet another tax cut bill with the benefits flowing overwhelmingly to the wealthy.
Here is more of what Mr. Gingrich has to say about this Medicare bill:
I think this is one of the great historic moments in moving
the Nation in a conservative direction.
He said--get this--this is Newt Gingrich:
If you are a fiscal conservative who cares about balancing
the Federal budget, there may be no more important vote in
your career than one in support of this bill.
I guess as a supply-side zealot, he believes that the tax-cut provisions in this bill will help us balance the budget. That is bizarre. That is just bizarre. They just want to privatize Medicare. That is all they want to do.
They want to privatize Social Security. Mr. Gingrich claims that the shift towards medical savings accounts would be ``the largest change in health policy in 60 years.''
He made this claim to a gathering of his right-wing anti-tax enthusiasts at the Americans for Tax Reform headquarters in Washington. Of course, the head of Americans for Tax Reform, Mr. Grover Norquist, is famous for saying, ``My goal is to cut government in half, to get it down to the size where we can drag it in the bathroom and drown it in the bathtub.''
That includes Medicare and Social Security. That is part of his government. That is what he wants to drown in the bathtub.
So it is no wonder that Mr. Gingrich and his right-wing friends love this bill. Not only does it undermine a Government program that they despise; even better, it serves up another fat tax cut for the rich. Only the wealthy and healthy will benefit from this bill.
Mr. Gingrich is outspoken in his belief that pharmaceutical companies are getting unfair treatment and they are punished by their success. Well, Mr. Gingrich, that is wrong. This bill does not ask one penny from the pharmaceutical companies. In fact, it protects drug companies from Government efforts to negotiate lower costs. I am the first to support drug research and development, but the Medicare burden should not be taken solely out of the pockets of seniors and taxpayers.
In closing, I would have to ask: Exactly why are Newt Gingrich and AARP in the same bed? That seems odd. What are they up to? AARP's slogan is ``the power to make it better.'' They claim to represent American seniors. However, millions of seniors are furious that AARP has endorsed this lousy bill. As I said earlier, a Peter Hart poll found almost two-thirds of seniors viewed the bill unfavorably, and most of those were AARP members. Among AARP members, only 18 percent said we should pass this bill, while 65 percent said we had to go back to work on it.
Yesterday, AARP members from Maryland, New York, and Pennsylvania tore up their membership cards in front of their organization's Washington headquarters. AARP's Web site community message board is filled with outraged comments. Members are accusing William Novelli, CEO of AARP, of selling out to conservatives and Newt Gingrich.
Now, where, I wonder did they get that idea? In fact, the relationship between Newt Gingrich and the bigwigs at AARP goes way back. William Novelli, executive director of AARP, wrote the preface to Newt Gingrich's book, ``Saving Lives, Saving Money.''
In that preface, Mr. Novelli states that: 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 systems change. That is Mr. Novelli's preface in Newt Gingrich's book.
Well, I have to ask: Which of Newt's ideas are ``influencing how we at AARP are thinking''? Is it Newt's fond wish that Medicare ``wither on the vine''?
No wonder members of AARP feel so betrayed. I too feel betrayed that AARP's leaders have chosen to endorse the right-wing principles of this Medicare bill and endorse Newt Gingrich's ideas of how to undermine and privatize our Nation's health care system.
AARP's endorsement is disturbing for another reason. They have a flagrant conflict of interest in this matter. Bear in mind AARP receives vast revenues from the sale of insurance to seniors. Royalties from such arrangements include deals with United Health Care Insurance Company, Metropolitan Life Insurance Company, and Advanced PSC Pharmacy Benefit Management, accounted for more than one-third of AARP's $636 million in revenues last year, according to AARP's 2002 annual report. There we have it. AARP is looking at the insurance end of it, of course.
American seniors deserve better from the AARP and from Congress. They deserve a bill that includes an affordable prescription drug plan, that strengthens Medicare, that does not penalize the sickest and the poorest in our Nation.
This bill reflects the priorities of this Republican administration and of Newt Gingrich who have been hostile to Medicare since its inception. This bill needs to be written by individuals and groups that believe in Medicare, not those who want to undermine it. Seniors know that this bill is a betrayal. They know who the winners and losers are with this bill.
Under premium support, HMOs, PPOs, and pharmaceutical companies, they win; seniors and the disabled lose. Under cost containment, the private companies win; the seniors and disabled lose. Under drug coverage, pharmaceutical companies win; seniors lose. Under health savings accounts, the wealthy HMOs win; seniors and disabled lose. Under the so-called stabilization fund, this slush fund, HMOs, PPOs, and pharmaceutical companies win; seniors and the disabled lose. Under so- called competition--boy, there is a misnomer if I have ever heard it-- HMOs, PPOs, and pharmaceutical companies win; seniors and disabled lose.
The seniors know this. Again, it is a question of priorities. This administration rammed through this Congress $1.6 trillion in tax cuts. Now they say they cannot take care of the elderly who have worked their entire lives, contributed to their communities and served this country. Once again, the administration has made a clear choice. They have chosen the folks on Wall Street over the folks on Main Street.
It is a big deal. I got to thinking the other day. I talked about how my father, during the Depression--I was born November 19, 1939. I just had my birthday this week. In 1939, my father was out of work. He had a wife, five kids, and one on the way. I was the sixth one. He had no money. He had an eighth grade education. My mother was an immigrant who had no formal education. They lived in a small house in a small town in rural Iowa, and my father had no hope. He was already 54 years old, had worked in the coal mines most of his life, and the only thing they had was this tiny little house in this small town.
As I walk out of my door every day, I have on my wall a little framed orange piece of paper. It is dated July 19, 1939, 4 months to the day before I was born. On that orange piece of paper, it is printed and it says: You, Patrick F. Harkin--that is my father--are to report to work at once as a laborer on a project, $48.30 a month. It was signed by somebody, and then my father signed it--4 months to the day before I was born. It was his WPA form when my father went to work on a WPA project.
Now, I look at that because I remember once George Bush, when he was a candidate for President, said: Government cannot give hope to people. Every day when I walk out of my office and I look at that piece of paper, I say: Mr. Bush, you are wrong. If it had not been for Franklin Roosevelt and the New Deal, I do not know what would have happened to my family and my father. They gave him a job. They gave him hope.
Years later, when I was in high school, my father took me to some of those projects he built. One of them was at Lake Okoboji. It is still in use as a recreational facility in Iowa; a high school in Indianola is still being used today built by WPA. Why do I say that? Because I got to thinking about the new deal and I got to thinking, it was a Government program, Roosevelt's New Deal. Who was the benefactor? The unemployed. To my father, who had no hope, it gave him hope and it gave him a job.
Then we had Truman's Fair Deal, and who benefited from that? The uninsured and low-wage workers.
Today we have a new Government program that they are trying to push on us, Bush's Big Deal. Not the New Deal, not the Fair Deal, but the Big Deal. Who wins? The HMOs, big pharmaceutical companies and private health plans. I call it the Big Deal because the bigger you are, the better the deal. Compare that to Franklin Roosevelt's New Deal and Harry Truman's Fair Deal, that reached down and helped bring people up. No, today we have the Big Deal: the bigger you are the better the deal.
This is a radical departure for Medicare. It changes the nature of this program as an entitlement. The conferees set an arbitrary cap on how much Medicare money can be spent. Instead of a cap, we ought to just be spending the money more wisely. We ought to be spending less on HMO subsidies, less on subsidies to the pharmaceutical companies, and more on preventive health care, keeping our seniors more healthy, getting them better diets and better exercise--more preventive health care to keep them healthy.
This is an article called ``Entitlement Change Is Inevitable, Key Administration Officials Say.'' They went on to say: ``In the long run, Social Security cannot meet its commitments.''
That seems to be the constant refrain we hear from this administration. Social Security cannot meet its commitments. Of course not; we just took the huge surplus that had been built up under the Clinton administration and we squandered it on tax breaks for the wealthy.
I say again, the amount of money going out in tax breaks to the wealthy in our country that was passed in 2001 and 2003, over the next 75 years, is three times more than what is necessary to ``save Social Security and Medicare.'' Don't tell me that the money is not there and that Social Security can't meet its commitments. It can't meet its commitments now because we squandered all the money on tax breaks for the wealthy. Sure, Medicare is headed for a train wreck, but it is a train wreck planned and plotted by this administration.
You can be sure as soon as this bill is out of the road they are going to start on Social Security. Headline: ``Bush Pushes For Expanded Private Role in Medicare.'' That is what it is all about.
``The foundation of this . . . compromise--is a level
playing field between Medicare and private plans,'' said
Senator Edward Kennedy. ``What conservative Republicans are
now trying to do is rig the system in a way that would coerce
senior citizens away from Medicare and into private plans.''
Senator Kennedy said it right.
To be fair it is not just Mr. Gingrich and Mr. Bush who are hostile to the Medicare Program. Many others share their views.
The junior Senator from Pennsylvania and third ranking Republican, Mr. Santorum, said--I believe this is a direct quote:
I believe the standard benefit through the traditional
Medicare program has to be phased out.
That is the third ranking Republican on that side of the aisle.
The junior Senator from Utah, Mr. Bennett, has said:
Medicare is a disaster. Medicare will have to be
overhauled. Let's create a whole new system.
Tom Scully, head of the Centers for Medicare & Medicaid, the top Medicare official in the Bush administration, said this about Medicare; he called it ``an unbelievable disaster'' and a ``dumb system.''
Medicare is not a disaster or a dumb system in the eyes of millions of seniors who rely on it every single day. As
I said, this is too big an issue to address in a day or 2 days.
We have to act now, we are told.
Nonsense. The provisions in this bill don't kick in until 2006. We received the bill on Thursday, this right here. We received it this morning on our desks. We didn't have time to look at it. We ought to withdraw the bill, get it out to the public, and bring it back for consideration in February. That will allow time for seniors back home to analyze it, discuss it, and share their views with Members of Congress. Then we can take an informed vote on this bill, taking into consideration the views of seniors in our respective States.
This is the Senate, supposedly the world's greatest deliberative body. We can take more time, as we did last week, in going all day and all night and all day and all night, talking about four judges who were held up--we can take more time to do that than we can to debate and discuss this profound change in Medicare in the United States. What does that say about the state of affairs in the Senate today? Oh, yes, we can deliberate over four judges--168 that got approved and 4 that didn't. We can talk about that for days or weeks on end. But, no, to discuss this profound change in Medicare we take Saturday and Sunday and vote on Monday.
The Senate has ceased being the world's most deliberative body. It is now the world's most rushed body: Rush it through, stampede it, and get it done. This is a complex, confusing, bureaucratic nightmare of a bill. It is a bad bill procedurally.
This bill contains untested experimental privatization plans that especially threaten seniors in rural areas. To top it off, it offers yet another big tax break for wealthy Americans.
There is supposedly a fix in this bill for the disparities. There is supposed to be fairness, in terms of addressing the disparity between the States, in reimbursement for Medicare on a per beneficiary basis.
I have taken the floor many times to talk about how Iowa is No. 50 in the Nation in the per beneficiary reimbursement for Medicare. So Iowa has been 50th out of 50 States.
This bill was supposed to have a fix in it to make it more fair. So they put, I think, $25 billion into this bill to make it more fair over the next 10 years. Right now, the per beneficiary reimbursement in Louisiana is $7,336. In Iowa it is $3,053. In Virginia it is $4,611.
I say to the occupant of the chair, the citizens of Virginia pay the same Medicare taxes as anybody else in this country. Yet the seniors in Virginia get back $4,611 per beneficiary, the seniors in New York get $6,924; the seniors in Texas get $6,539; the seniors in Maryland, right next-door, get $6,301, but in Virginia they only get $4,611 per beneficiary. In Iowa it is $3,053. Yet we pay the same Medicare taxes.
So we have been fighting for a long time to try to straighten this system out and make it a little bit more fair.
They put some money in the bill. But guess what they did--they made it worse because what they basically did is they kind of gave a percentage increase. You know how that works.
If you get $100 and I get $10 and we get a 10-percent increase, you get a lot more money than I get. Right now, Iowa, we are 50th. Louisiana is first in terms of how much money they get per beneficiary. Now we are 50th. The disparity in payments for seniors between Iowa and Louisiana is $4,685. In other words, a beneficiary in Iowa gets $4,685 less. We get less in reimbursement per beneficiary than it cost Louisiana. Under this bill, supposedly meant to fix this, Iowa is still last. We are number 50th. The disparity has gone from $4,685 per beneficiary to $5,017 per beneficiary. It is worse. This was supposed to be fairness?
There are some who will say that Iowa, in terms of the beneficiary and the amount of money they got, is 13th. That is all right. It may be 13th. But other States are more.
As you can see, it increases the disparity rather than lessening it. That is what we want to do--lessen the disparity in the States.
Lastly, the Washington Post this morning said it all. ``2 Bills Would Benefit Top Bush Fundraisers.''
At least 24 Rangers and Pioneers could benefit from the
Medicare bills as executives of companies or lobbyists
working for them, including 8 clients affected by both bills.
Meaning the Energy bill. ``Pioneer'' is someone, I guess, who raises $100,000 for the President, and ``Ranger'' is someone who raises $200,000 for the President.
I ask unanimous consent that the article be printed in the Record.
Mr. President, I apologize to my fellow Senators. I have taken a long time. I have taken over 1 hour and 15 minutes, I believe. But I believe we ought to take a lot longer than that. I think we ought to get this bill out of here, send it into the countryside, let people see it, and come back in February rather than taking Sunday, Monday, Tuesday. Let us, as I said, take a week or two to get into this bill, debate it, discuss it, and yes; and amend it if we need to, rather than being ramroded through as they are doing.
If the seniors reject it, then we can reject it and go back to the drawing board. We should not at the eleventh hour when people want to go home for Thanksgiving be stampeded to support a bad bill, a bill that will destroy Medicare as we know it.
I yield the floor.