Bill Frist

Mr. FRIST

Mr. FRIST. Mr. President, through the Chair, we are currently still negotiating and working on the omnibus, and we will continue to work for the next probably 6 to 7 hours. So I will not be able to comment definitively until probably first thing in the morning. Again, we continue to work. Initially, we hoped to make progress even tonight on the omnibus, but we were unable to do that. So we will not be adjourning right afterwards. We will likely be in through tomorrow and would like to get as far as we can with the omnibus at that time.

Mr. FRIST. Will the Senator from Montana yield on that point?

Mr. FRIST. Mr. President, I have a unanimous consent request to clarify plans for at least early in the morning. I ask unanimous consent that when the Senate resumes the conference report to accompany H.R. 1 on Tuesday at 8:15 a.m., the time until 9:15 be equally divided between the chairman or his designee and the Democrat leader or his designee; further, I ask consent at 9:15 the Senate proceed to a vote on the adoption of the conference report, with no intervening action or debate.

Mr. FRIST. I move to reconsider the vote.

Mr. FRIST. Mr. President, I thank the Senator from Montana and rise to say that I concur with his remarks that the statement of managers is in error and that the statutory language must control. The result would be faithful to the intent of the conferees on this measure.

Mr. FRIST. Mr. President, at this point I really cannot comment intelligently until we further have our discussions through the night in terms of what the plans will be over the course of tomorrow.

Mr. FRIST. Mr. President, over the past few days, we have heard a number of criticisms of the bill. And there is one criticism in particular that I want to address. Opponents have claimed that the bill fails to contain prescription drug costs. I can only presume that this criticism reflects a misunderstanding--because the bipartisan agreement includes a number of critical provisions to lower prescription drug costs. Under the Hatch-Waxman law, generic approval is allowed when a new drug's patent and market exclusivity protection expires, or when a 30- month stay terminates. The intent is to provide incentives to develop valuable new drug treatments through patent protection, but also to facilitate access to generic versions of the drug after the innovator's patent expires. However, access to generic drugs has sometimes been improperly delayed. Earlier this Summer, the Senate voted 94-1 in favor of reforms developed by Senators Gregg and Schumer to close existing loopholes in the law. And the bipartisan agreement retains these critical reforms, ensuring speedier access to generic drugs for all Americans. Under the bipartisan agreement, a new drug applicant will receive only one 30- month stay of approval of a generic's application, for patents submitted to FDA prior to the generic application. The agreement also takes additional steps to reduce or eliminate the delays in the movement of generic drugs to the marketplace. As a result, patients will benefit from grater access to safe, effective, low-cost generic alternatives to brand name medicines. That's why this bill is supported by the Generic Pharmaceutical Association and the Coalition for a Competitive Pharmaceutical Market. I would like to submit their letters of support for the Record. The competition in this bill achieves significant ``bang for the buck'' because it relies on drug plans to negotiate discounts. CBO says the private insurance model has a cost management factor of 25 percent--the effect of price discounts, rebates, utilization controls, and other tools that a PDP might use to control spending. By relying on the bargaining power of drug plans, this bill will drive down the costs of prescription drugs. The bipartisan agreement enhances research on the comparative clinical effectiveness of prescription drugs. This information will be quickly disseminated. By giving patients, health care professionals, health plans and the Medicare program better information on the comparative effectiveness of treatment options, this provision will ensure that patients and health care consumers get the most value for their money. The bill includes other key cost containments. Prescription drug negotiations will not be subject to the Medicaid ``best price'' rules. Competing plans will get even better prices for seniors and disabled persons. Last year, the Congressional Budget Office estimated that exempting Medicare from best price rules would save $18 billion between 2003 and 2012. The bipartisan Medicare agreement will lower prescription drug costs. That is why it has been endorsed by pro-consumer groups including the American Association of Retired Persons and the Coalition for a Competitive Pharmaceutical Market. However, opponents have claimed that this language ``prevents'' the Federal Government from negotiating drug prices. The bill specifies that the government ``may not interfere with the negotiations between drug manufacturers and pharmacies and PDP sponsors'' and ``may not require a particular formulary or institute a price structure.'' In fact, this provision first appeared in May 2000 in a Democratic bill. The provision protects patients by keeping the government out of decisions about which medicines they will be able to receive. Through this bill, we are giving seniors new access to affordable prescription drugs. We are speeding the pace of cheaper generic drugs to the market. We are providing for research on the comparative effectiveness of prescription drugs. We are providing a drug discount card and greater relief for low-income seniors. And we are unleashing powerful new market forces that will drive down the costs of prescription drugs. But some continue to advocate for so-called ``reimportation.'' This is unnecessary and unsafe. The FDA has much evidence of counterfeit, expired, mislabeled, subpotent and superpotent drugs shipped into the United States from all over the world. Health Canada is on the record saying that they will not guarantee the safety of drugs sold to Americans. Numerous current and former FDA and law enforcement officials have testified that this is not safe. Just last month, the Washington Post ran a detailed series revealing a vast, complicated network of ``criminal profiteers, unscrupulous wholesalers, rogue Internet sites, and foreign pharmacies.'' The result has been deadly. In St. Charles Missouri, a 61-year-old breast cancer patient was unknowingly sold diluted cancer medication by her local drugstore. Seven months after being sold the phony batch, she was dead. In Sacramento, a wife found her 47-year-old husband on the living room couch dead of an overdose of painkillers. He had obtained the pills from multiple pharmacies all over the world. These disturbing reports bear directly upon the importation of prescription drugs. There is the faulty notion that this is a solution to drug costs. But as real life illustrates, the black market in pharmaceuticals is a very dangerous place. In 2000, Congress passed the Medicine Equity and Drug Safety Act. But in the 3 years and two administrations since the law has been in effect, no Health and Human Services Secretary--either Democrat or Republican--has been willing to verify its safety. So this bill requires the Department of Health and Human Services to undertake an in-depth study on whether there is a safe way to reimport drugs from Canada. What we need are sensible policies. And in the Medicare legislation we have them. The Medicare bill under consideration will make sure that seniors get the prescription drugs they need, with the safety they expect. Mr. President, Medicare beneficiaries have waited too long for this debate. The practice of medicine has changed dramatically since the inception of the Medicare Program in 1965. Unfortunately, the program has seen few changes or improvements. Today we finally consider providing 41 million seniors and Americans with disabilities with access to prescription drug coverage. Currently, 9.9 million Medicare beneficiaries have NO drug coverage and many more have only limited coverage. Prescription drugs have become integral in the practice of Medicine and this legislation is critical to the health of current and future beneficiaries. Beginning next year under this bill, seniors will receive immediate, voluntary assistance with their drug costs. All Medicare beneficiaries would receive a discount drug card that will help bring down the cost of prescription drugs by 10-25 percent. Moreover, low-income seniors will receive $600 to help with their drug costs. In 2006, beneficiaries will have access to a comprehensive prescription drug benefit. Seniors with incomes above 150 percent of the Federal poverty level will see savings of about half of their drug costs as a result of this coverage. Low-income seniors will no longer be forced to rely on Medicare for help with their drug costs. This legislation will provide coverage for drug costs for even our lowest-income seniors under the Medicare program. Seniors with incomes below 150 percent of the Federal poverty level will receive coverage for all but a small percentage of their drug costs. Prescription drugs not only treat disease, but they can help to prevent disease when used as part of therapeutic treatment. For this reason I am proud to say that prescription drug coverage is only one of the major improvements we will make to the Medicare Program. For the first time, the Medicare Program will put an emphasis on chronic care coordination and disease management. Beneficiaries will receive coverage for a welcome to Medicare physical. The preventive physical visit is one of the best opportunities physicians have to measure health status, screen for various diseases and educate patients about their health needs. The legislation will also add coverage for screenings for heart disease and diabetes. Moreover, this bill directs the Secretary to integrate disease management and chronic care coordination into the basic Medicare program. Beginning immediately upon enactment with a large-scale pilot program, the Secretary will test methods to help beneficiaries with chronic conditions, ensuring they receive preventive tests, procedures and treatments to better manage their disease and improve their health status and quality of life. This program will put the emphasis on prevention and treatment, rather than acute episodes of care. This is one of the most important reforms in the conference agreement. Beneficiaries with multiple chronic conditions account for the greatest share of Medicare spending. And low-income beneficiaries are more likely to suffer from multiple chronic diseases and to have poorer health outcomes than higher income seniors. Diabetes is a good example of how prescription drug coverage and prescription drug therapy along with a regular care regiment promise more effective treatment and outcomes. Approximately 17 million Americans suffer from diabetes and another 16 million adults are at risk for developing diabetes. Undiagnosed and improperly treated, diabetes can and will result in a host of complications that can result in disability and even death. These complications include kidney failure, blindness, heart disease and loss of limb. According to the American Diabetes Association, $91.9 billion dollars was spent last year in direct medical expenses for diabetics. Since 1995, five new classes of medicines have been introduced to treat diabetes. These medicines, coupled with health management and coordinated care programs, are powerful tools to increase health status and reduce complications. For example, a comprehensive disease management program for approximately 7,000 diabetic patients produced savings of $50 per diabetic patient per month. While pharmaceutical costs increased under the program, total health care spending declined. This was due to substantially fewer inpatient hospitalizations and reduced lengths of stay. All that stands between seniors and prescription drug coverage, disease management and improved health coverage is the upcoming Senate vote. I am confident that we will pass this conference report and send the legislation to the President's desk. Seniors deserve no less. Mr. President, millions of Americans experience serious health disparities based on ethnicity, race, gender, or a lack of access to health care. Great progress has been made in narrowing health disparities. Through advances in medical research and public policy, we are working to ensure better access to quality health care for all of our citizens. More, however, needs to be done. Let me list a few examples of where there are still serious disparities in health. The number of diabetes cases among African Americans has tripled since the 1960s. Moreover, African Americans experience higher rates of diabetes' most serious complications: blindness, amputation and kidney failure. One of seven Hispanics have diagnosed or undiagnosed diabetes and the prevalence of type-2 diabetes is twice as high in Hispanic Americans as in non-Hispanic whites. American Indians and Alaska Natives are 2.3 times as likely to have diabetes as non-Hispanic whites of similar age. Diabetes cases are more concentrated among American Indians in the southeastern United States. Asian Americans and other Pacific Islanders are approximately two times as likely to be diagnosed with diabetes as compared to their white counterparts. When it comes to cardiovascular disease, African Americans have the highest rate of high blood pressure of all groups and tend to develop it younger than others. Stroke is the only leading cause of death for which mortality is higher for Asian-American males. Breast and cervical cancer also hit African American women more often than their white counterparts. Although deaths caused by breast cancer have decreased among white women since the 1980s, African American women continue to have higher rates of mortality from breast and cervical cancer. African Americans are more likely to develop cancer than whites and are about 30 percent more likely to die of cancer than whites. In the Medicare legislation before us, we have an opportunity to address the problem of health disparities head on. Today, roughly 20 percent of all Medicare beneficiaries are members of minority groups. And the Census projects that, by 2025, minorities will compose 35 percent of all seniors. Racial and ethnic minorities covered by Medicare suffer from more illnesses and are more apt to live in poverty than white beneficiaries. So I am pleased that this bill particularly benefits racial and ethnic minorities, and assures that minority seniors and disabled people have access to needed medicines at affordable prices. The bipartisan Medicare agreement will ensure better Medicare coverage for minorities through new disease management services, a new ``welcome to Medicare physical'' and new cardiovascular disease and diabetes screening programs. Beginning in 2005, each year, nearly 360,000 newly enrolled minority Medicare beneficiaries will be covered for an initial physical examination. The initial preventive physical exam includes measurement of height, weight and blood pressure, and an electrocardiogram, as well as education, counseling and referral related to other preventive services. The bipartisan Medicare agreement includes new cardiovascular and diabetes screening blood tests that do not have deductibles or co-pays, so beneficiaries with limited resources who might not otherwise access these benefits are not deterred by the cost. Disease Management is being introduced into the original Medicare program to provide beneficiaries the tools and support systems to help them manage their chronic illnesses. Through these new benefits, conditions such as obesity, diabetes, heart disease, and asthma could be made far less severe for millions of Medicare beneficiaries, including those racial and ethnic minorities who suffer most from these conditions. The bipartisan agreement provides immediate help to those who need it most: low-income Medicare beneficiaries who do not have prescription drug coverage and do not qualify for Medicaid. This starts with the prescription drug discount card and builds on it to provide needed relief to low-income seniors with a generously subsidized drug benefit in 2006. Over 13 million beneficiaries under 65, across all racial/ethnic groups, have very limited financial means. But these limitations are particularly acute among some populations. In 1999, 46 percent of African Americans and 55 percent of Hispanics had incomes below the Federal poverty level, compared with 15 percent of white beneficiaries. Nearly two-thirds of African-American and Latino beneficiaries have incomes below twice the poverty level, compared with 41 percent of whites. Starting in 2006, more than 1.5 million minority beneficiaries will gain access to new drug coverage, including over a half million Hispanic and nearly 700,000 African-American Medicare beneficiaries. The Bipartisan Agreement will help cut their prescription drug bills in half. The poorest seniors--including nearly 2 million minority beneficiaries--with incomes below 100 percent of the Federal poverty level who are eligible for Medicaid would pay no premiums or deductibles, and would pay only nominal cost-sharing of $1 for a generic drug or a preferred multiple source drug and $3 for all other drugs. 2.5 million low-income minority beneficiaries with incomes below 135 percent of the Federal poverty level would pay no premiums or deductibles, and would only pay nominal cost-sharing of $2 for a generic drug or a preferred multiple source drug and $5 for any other drug. More than 400,000 minority beneficiaries, with incomes below 150 percent of the Federal poverty level would get sliding scale subsidies for their premiums, and pay both a lower deductible and lower cost- sharing compared to the standard benefit. In addition to the low-income benefit, the bill provides that the Federal Government will assume the costs of dual-eligible beneficiaries, allowing them to receive their medicines through a private-sector drug plan, remove the stigma of Medicaid coverage, and provide fiscal relief to the States that currently pay for them. Because only a third of African Americans and a quarter of Hispanics have Medigap or employer-sponsored retiree benefits, compared to two- thirds of white beneficiaries, they are more likely to rely on Medicaid to supplement Medicare. In fact, 43 percent of dually-eligible beneficiaries are minorities. The bipartisan Medicare agreement improves services available to individuals suffering from these diseases. The agreement particularly improves access to prescription drugs and new services for low-income individuals, many of whom are racial and ethnic minorities. The agreement includes critical provisions to study and disseminate the latest research on the comparative clinical effectiveness of prescription drugs and other health care services--including among specific patient subpopulations. This will ensure that patients and providers can make informed choices about their treatment options. It will also make prescription drugs more affordable for all Americans through important provisions, speeding generic drugs to market. Ultimately, by adding much-needed prescription drug coverage to services already covered by Medicare, the agreement ensures that these individuals have access to more comprehensive, higher quality health care and treatment options.

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

Mr. FRIST. Mr. President, today we stand on the threshold of a truly historic moment. Not for Republicans. Not for Democrats. Or for the House of Representatives. Or the United States Senate. But, for over 40 million American seniors and individuals with disabilities, who may finally be getting prescription drug coverage under Medicare. Saturday morning, the House of Representatives passed H.R. 1, the ``Medicare Prescription Drug, Improvement, and Modernization Act of 2003.'' Also Saturday, President Bush called upon the Senate, once again, to finish the job. He urged us to send him legislation that will provide badly needed prescription drugs to seniors. For years, Congress has debated whether, and how, to provide prescription drug coverage to seniors and to strengthen and improve the Medicare program. Now, it is time for us to Act. Mr. President, this generation of seniors survived the depression, fought World War II, and helped make the United States into a prosperous and thriving Nation. Time and again, they stepped forward to serve. Now, is the time to fulfill our duty to that great generation. Now is the time to answer their call. What President Lyndon Johnson said in 1965 still stands: . . . No longer will this Nation refuse the hand of justice to those who have given a lifetime of service and wisdom and labor to the progress of this . . . country. Let us not stay that hand of justice now. Let us not turn our back on America's seniors and individuals with disabilities. There are nearly one quarter of a million seniors in my home State of Tennessee who have no prescription drug coverage. There are millions more across the Nation for whom this legislation, literally, means the difference between life and death. They cannot afford to wait any longer. I have treated thousands of Medicare patients. And I know firsthand that, without Medicare, millions of seniors would not have received needed medical services. Millions more would have faced financial ruin. Medicare has helped save and heal lives. But this cherished program has failed to keep pace with medical and scientific progress. Prescription drugs are an integral part of modern medicine. They are as important as the surgeon's knife. Yet, they are not part of the Medicare program. In the nearly four decades since the Medicare program was created, the American medical system has transformed from one focused on treating episodic illness in hospitals to one characterized by an increasing emphasis on managing and preventing chronic disease in outpatient settings with advanced medical technologies and prescription drugs. Life expectancy has increased by nearly ten years. Death rates associated with heart disease have been cut in half, and new treatments and diagnostic tools have improved survival rates for prostate, colon, and breast cancer. Our medical and scientific knowledge and, along with it, our ability to treat illness and disease has improved dramatically over the past four decades. Yet, Medicare itself has not kept pace with these dramatic changes. It has been too inflexible and bureaucratic. Designed for the 1960s health care system, it has been unable to adapt to changing medical practice. Medicare does not provide true preventive coverage, disease management, or protection against catastrophic health care costs. As a result, we have today glaring and unacceptable gaps in the coverage that is available to seniors and individuals with disabilities--the most obvious of which is the lack of prescription drug coverage. Over the past three decades, for example, the death rate from atherosclerosis has declined by over 70 percent and deaths from ischemic heart disease have declined more than 6 percent, largely due to the advent of beta blockers and ACE inhibitors. During the same period, death rates from emphysema have dropped nearly 60 percent due to new treatments involving anti-inflammatory medications and bronchodilators. Today, over 600 medicines are under development to treat or prevent diabetes, cancer, heart disease, stroke, neurological diseases, and other debilitating illness. Nearly 400 drugs have been produced during the past decade alone. But, under today's Medicare, these drugs simply are not available to seniors. We must act to ensure that this generation of seniors, and the next, has access to the healing miracles of modern medicine. And we must act to provide our seniors, and the next generation of seniors, with true health care security: quality preventive care, affordable prescription drugs, protection from catastrophic health care costs, better coordinated care, disease management, and access to modern technology. As voluntary prescription drug coverage the bipartisan bill we are debating today takes a major step in that direction. It devotes $400 billion over the next decade to adding a new, voluntary prescription drug benefit to the Medicare program. And it takes concrete steps to speed less expensive generic drugs to the market to help make prescription drugs more affordable for all Americans. Within months after this legislation is signed into law, seniors will be able to get a voluntary Medicare-approved prescription drug discount card that will reduce the costs of their drugs by an estimated 10-25 percent. Lower income seniors will get an additional subsidy of $600 on top of these discounts to help them purchase needed medicines. Thus, seniors will get immediate relief even before the comprehensive drug benefit is fully implemented, with additional help for those who need it the most. Beginning in 2006, seniors will have access to the new drug benefit. Those who wish to add the new prescription drug benefit to their traditional Medicare coverage will have that choice. The new drug benefit is completely voluntary and available to all seniors. Appropriately, it provides the most generous help to lower income seniors and those with catastrophic drug costs. substantial assistance for lower income seniors Seniors with incomes below 135 percent of the Federal poverty line ($11,648 for individuals and $14,965 for couples) will pay no premiums, no deductibles, and only a modest co-payment for their comprehensive coverage. Beneficiaries with incomes below 150 percent of poverty ($12,942 for individuals and $16,327 for couples) will pay only a portion of the premium and a $50 deductible. After that, the government will subsidize 85 percent of their drug costs. In my home State, over 430,000 low income Medicare beneficiaries-- nearly half of all beneficiaries in Tennessee--will have exceptional prescription drug coverage under this bipartisan plan. One quarter of a million Tennessee seniors who today have no prescription drug coverage at all will gain access under this proposal, along with millions more across the Nation. improvements to traditional medicare The legislation also strengthens and improves the traditional Medicare Fee for Service program. It adds new preventive coverage for diabetes and cardiovascular disease. For the first time, Medicare will cover initial preventive physical examinations. And this agreement responds to the six percent of seniors with chronic disease who account for about 50 percent of all Medicare spending. The legislation will launch a series of major pilot programs on disease management and quality payment incentives that could result in dramatic improvements in the care of the most ill and the most needy. This will help us better target health care resources to those who require it most. The legislation also puts in place national standards for electronic prescribing, along with incentives for doctors to fill prescriptions electronically. These reforms should dramatically improve medication therapy management, reduce medical errors, and improve patient safety. As the Senator from Montana, the Ranking Member of the Senate Finance Committee, has said so eloquently during these past several days, this bill does nothing to destroy the existing Medicare program. In fact, it immensely strenghtnes the traditional Medicare program. As my colleagues know, this legislation has received broad support from well over 350 organizations, including from the AARP--which represents 35 million seniors. In its letter of endorsement last week, the AARP also makes clear that, at a result of this legislation, ``millions of older Americans and their families will be helped by this legislation.'' In addition, AARP writes: ``The integrity of Medicare will be protected.'' new health care choices Today, most seniors choose to enroll in the traditional Medicare Fee for Service program. But this may not be the best choice for all seniors, and it may not be the choice of all seniors in the future. There are about five million seniors who are covered by private health plans under the Medicare program today. Beginning immediately, the legislation will strengthen Medicare's local HMO coverage. It will help stabilize and improve the coverage of those five million seniors in the current Medicare+Choice program. As a result, Medicare+Choice will become a more stable, secure, and strong option for those seniors who have already chosen to enroll in coordinated care plans. This bipartisan plan also provides seniors with even more choices-- the choice to enroll in regional preferred provider organizations--or PPOs. The majority of Americans under age 65 get health coverage through PPOs. Most members of Congress, Federal employees, and Federal retirees also get coverage through PPOs. Employees covered by PPOs report high levels of satisfaction with their coverage. PPOs typically provide coverage for preventive care, chronic care management, disease management, and access to a broad range of doctors and hospitals. Under the bipartisan agreement, seniors will have the opportunity to participate in these innovative plans if they choose. Moreover, beginning in 2010, we will test on a limited basis whether these private health plans provide higher quality than traditional Medicare. We will also test whether Medicare private health plans are most cost effective than traditional Medicare. All beneficiaries will be protected during this test. And the demonstration cannot be expanded or extended unless Congress acts to do so. Throughout, seniors will always be able to stay in the traditional Medicare program. And they will have the option of adding prescription drug coverage. Meanwhile, tomorrow's seniors, many of whom are covered through PPOs now, may choose to continue private coverage when they retire. We are looking down the road to prepare for the baby boom population. We need to be ready now, not scrambling when it is too late. strengthening health care in rural america This bill contains the most sweeping and strong rural provisions ever in a Medicare bill to come before this Congress. It also makes improvements to payments for graduate medical education and takes concrete measures to protect seniors' access to physicians. For example, hospitals in my home State of Tennessee will receive $655 million under this legislation. Physicians, who otherwise would face real cuts next year of 4.4 percent, would instead see a 1.5 percent payment increase in both 2004 and 2005. I am very proud that the American Hospital Association, the Tennessee Medical Association, the American Hospital Association, the Tennessee Hospital Association, the American Association of Medical Colleges, and the Alliance for Specialty Medicine strongly support this legislation. The bill has also received strong support from the Rural Health Care Association, the Rural Hospital Coalition and the Coalition for Geographic Equity in Medicare. controlling prescription drug costs Some of my colleagues have said that this legislation does nothing to control prescription drug costs. I respectfully disagree. First of all, under this bill, seniors will be able to get a drug discount card right away. They will be able to present their Medicare discount card to their pharmacist and receive a 10 to 25 percent cut right off of the top. This bill also works to contain drug costs before the drugs get to the pharmacist's shelf. It does so in a number of ways. The bill speeds generic drugs to the market. It encourages competition to lower prices, and it gives the Medicare recipient new power to comparison shop. Let's start with the generic drug provisions. In 1984, Congress passed the Hatch-Waxman law to encourage cheaper generic drugs to come onto the market. Under that law, generic competition has flourished. When the law was passed, generics drugs were less than 20 percent of the market. Today, generic drugs represent nearly 50 percent of the entire market. The Hatch-Waxman Act has been incredibly successful in allowing consumers to get low cost alternatives. But there have been some abuses. Therefore, we are moving to close loopholes in the system through this bill. And the core of the provisions build on the work of Senator Gregg and Senator Schumer. Under the new system, a new drug applicant will receive only one 30- month stay of approval of a generic drug's application. This is a major change. Under the old system, drug companies could receive multiple stays of approval for generic rivals. Now, they will get one stay only. The agreement takes additional steps to get generic drugs to the market faster--through which patients will get safe, effective, low cost generic drug alternatives to brand name medicines. That is why this bill is supported by the Generic Pharmaceutical Association and the Coalition for a Competitive Pharmaceutical Market. the bipartisan Medicare agreement also empowers drug plans to negotiate discounts from drug companies. The Congressional Budget Office says that this approach will enable drug plans to significantly control drug costs for their beneficiaries. Moreover, the savings they negotiate will not be subject to Federal limits. They will be able to get the lowest prices possible, even if those prices are lower than those negotiated under Medicaid. The Congressional Budget Office has estimated that this provision alone will save $18 billion dollars. Not only will the Medicare agreement help lower prices, it will help give consumers more information about their medical options. This bill expands Federal research into the comparative effects of different drugs and treatments. With this new information, seniors will be able to comparison-shop in the medical marketplace, just like they would for any other product or service. Patients and their doctors will be able to compare treatment options and choose the course of action that best addresses their medical needs. And Medicare and health consumers will get better value for their money. Health Savings Accounts I am also very pleased that this legislation will make tax-preferred Health Savings Accounts available to all Americans. HSAs will help control costs over time, and give individuals the ability to better control their health care dollars and health care decisions. I wish we could have gone even father. I wish we could have added provisions from the House bill that would have allowed individuals to roll over some funds each year from their flexible spending accounts. I also believe we must do more in the coming years to allow individuals to invest funds on a tax-free basis to meet their health care needs in retirement, just as we do with 401(k) plans and Individual Retirement Accounts. I am committed to coming back and addressing these issues in the years ahead. Demographic and Structural Challenges Our first priority must be to provide seniors with health security. But, at the same time, we know that Medicare also faces serious financial and demographic pressures in the coming years. Between now and 2030 the number of seniors will nearly double from 40 million to 77 million; the program's costs will more than double to nearly $450 billion annually, even before we add prescription drug coverage or improve other benefits; the number of taxpayers paying into the system to finance health coverage for seniors will drop from 4 today, to 2.4 by 2030; seniors, who represent 12 percent of the population today, will represent 22 percent of the population in 2030; and one last fact: each senior will be in the Medicare program longer. Life expectancy at age 65 will increase approximately 10 percent over the next 30 years. The demographic underpinning has been defined: more seniors; each senior living longer; and fewer workers to support each senior. So, while we need to act to provide prescription drug coverage to seniors, we also need to do so responsibly. This legislation takes an important first step in linking Medicare payments to quality. It also relies on competitive market forces to help control health care spending. Moreover, for the first time in Medicare's history, we will ask those seniors who can afford to pay more for their coverage, to do so. And we will put in place more accurate and more transparent measurements of Medicare's fiscal strength--as well as special procedures for attempting to better control Medicare spending growth in the future. These reforms do not go far enough for some of my colleagues. At the same time, they go too far for others. Overall, however, I believe this is a balanced, bipartisan bill that is worthy of the support of the United States Senate. It is not a perfect bill. But, it is a meaningful step in the right direction. It will provide substantial relief from high prescription drug costs for millions of seniors. It will help rectify payment inequities for rural health care providers. And it will begin to inject into the Medicare program new health care choices and much needed flexibility so that seniors will have the option to choose the kind of health care coverage that best suits their needs. Today, America is one step closer to being a more caring society for millions of seniors and individuals with disabilities struggling with high prescription drug costs and outdated, often inadequate medical care. Today, we are one step closer to providing real health security to seniors all across the Nation. As a physician, I have written thousands of prescriptions that I knew would go unfilled because patients could not afford them. With this bill, that will change. As a senator, I have watched as a decades-old Medicare program has operated without flexibility, and without comprehensive and coordinated preventive care, disease management and catastrophic protection against high out-of-pocket medical costs. With this bill, that will change also. This legislation is historic. By dramatically expanding opportunities for private sector innovation, it offers the possibility of genuine reform that can dramatically improve the quality of care available to seniors. At the same time, the legislation preserves traditional Medicare for those who choose it. It combines the best of the public and private sectors and gives today's seniors innovative health care options and positions Medicare to serve tomorrow's seniors as well. This legislation is possible because of the work and dedication of every Member. I would like to take a moment to thank those whose commitment was critical to this effort. First and foremost, Chairman Charles Grassley and Ranking Member Max Baucus deserve credit. As does Senator John Breaux who joined me six years ago on the Bipartisan Commission on Medicare and again on this Conference Committee. All Members of the Conference Committee showed a degree of dedication and resolve seldom seen in either Chamber, especially Senators Hatch, Nickles, and Kyl. But we wouldn't have reached this point without building on the strong foundation laid by Members over the last several years, especially Senators Snowe, Jeffords, Gregg, Hagel, Ensign and Wyden. Finally, the Senate could not have done this alone. The House Leadership, Speaker Hastert and Leader DeLay, deserve special recognition, as does the Chairman of the Conference, Chairman Bill Thomas, and the Chairman of the House Energy and Commerce Committee, Chairman Billy Tauzin. In closing, I would like to thank again every member of this body who has worked so hard on this legislation--not just in this year, but in the previous six years of our most recent effort to strengthen and improve Medicare. I urge every Senator to support this bill. I implore every Senator to avoid filibusters and other partisan political maneuvers that threaten the prescription drug coverage, and health care security, our seniors need and deserve. I yield the floor.

Mr. FRIST. Mr. President, we bring debate to a close prior to a very historic vote in which we are making a decision whether to give 40 million seniors the opportunity, for the first time through Medicare-- the program that has been constructed and been used to give them health care security--whether for the first time these 40 million seniors will have access through that program to prescription drugs, to the tool which is the most powerful element of health care security today. Seniors don't have it. What we are voting on today is to give them that true health care security. America's seniors have waited 38 years for this prescription drug benefit to be added to the Medicare Program, and today they are just moments away from prescription drug coverage that they desperately need and deserve. It is clear that in this body there is a bipartisan majority--and I would say an overwhelming bipartisan majority--in favor of this Medicare Prescription Drug, Improvement, and Modernization Act of 2003. Yet we have before us an attempt to block this body from expressing, through an up-or-down vote, their will to give seniors and individuals with disabilities access to affordable prescription drug coverage and, thus, stand in the way of health care security for those seniors. We are about to vote on a cloture motion in an attempt to overcome this filibuster. Later today, we are likely to face additional procedural hurdles that the minority has threatened to prevent passage of this bill. Make no mistake, these are not one and the same. The result of this filibuster and of the procedural points of order will be once again to deny these 40 million seniors access to modern prescription drug coverage, something they need and something they deserve. In my own State of Tennessee, there are nearly one-quarter of a million seniors who right now have no prescription drug coverage. There are millions more all across the Nation for whom this legislation literally means life or death. Think hypertension, heart disease, chronic obstructive pulmonary disease, asthma, or emphysema, all for which we have effective prescription drugs which are not made available through our Medicare Program today. Our seniors cannot afford to wait longer. Then why wait? They cannot afford to wait. It is a matter of their health. This generation of seniors did survive the Depression, did fight World War II, did help make the United States the prosperous and thriving Nation we have today. Again and again, they answered the call. Now is the time for us to fulfill our duty to that generation. Many of them are poor and many of them are sick. It is time to answer their call. When he signed Medicare into law in 1965, President Johnson said: No longer will this Nation refuse the hand of justice to those who have given a lifetime of service and wisdom and labor to the progress of this . . . country. Let us not stay this hand of justice now. Let us not turn our back on America's seniors and individuals with disabilities. Our seniors deserve better than to be held hostage to Washington politics. There is a life-or-death issue in many ways in this legislation for millions of Americans and they cannot wait. Opponents of this bill would deny coverage to essential medicines. Mr. President, I will go on leader time for my remaining 2 minutes, if necessary.

Mr. FRIST. What will people tell millions of Americans or millions of low-income seniors if we go home and say, no, you are not going to have access to prescription drugs that this bill would have made available or tell individuals with disabilities, no, you are not going to have access to the preventive care that is actually in this bill? The elderly, the sick, and the disabled are now being told to wait for action in the future. Now is the time to act. We will do it next year, some say, but our seniors tell us time is running out. People are waiting for help. Just 2 days ago in my office was Dorthea Yancy of Lakewood, CO, a retired African-American woman who worked for years but lost her pension when her company went bankrupt. She needs our help now. Dorthea Yancy needs our help now. We are an eyelash away from fulfilling our promise to seniors. I ask my colleagues not to thwart the overwhelmingly bipartisan majority in this body because of using the tactics of some sort of parliamentary maneuvering. Do not hold America's seniors hostage to Washington politics. Our seniors deserve better. I want to close by just reading a statement issued today by the AARP on behalf of 35 million seniors that fine organization represents. This is from the AARP today, and I will close with this: The fate of the landmark Medicare prescription drug bill now stands in the hands of the U.S. Senate. More than a vote is at stake. With the final passage in the Senate, the Congress will honor a longstanding promise to 41 million older and disabled Americans and their families by finally adding a prescription drug benefit to Medicare. This bill will help millions of people, especially those with low incomes and high drug costs. It will strengthen Medicare by adding this long overdue benefit and preserving the basic structure of the Medicare program. We urge the Senate to act to seize this historic opportunity and vote to pass this bill now. America's seniors are watching. America is watching. I urge my colleagues to do the right thing, to seize this historic opportunity, to vote up or down on this bipartisan legislation, and to pass this historic bill. Cloture Motion

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

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

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

Mr. FRIST

Mr. FRIST. Mr. President, I ask unanimous consent that the resolution be agreed to, the preamble be agreed to, the motion to reconsider be laid upon the table, and that any statements relating to this matter be printed in the Record.

Mr. FRIST. Mr. President, I ask unanimous consent that the Senate proceed to the immediate consideration of S. Res. 274 which was submitted earlier today.

Mr. FRIST. Mr. President, the Permanent Subcommittee on Investigations of the Committee on Governmental Affairs has received requests from various law enforcement and regulatory officials and agencies for assistance in connection with pending investigations for copies of records that the subcommittee obtained during its recent investigation into the role of accountants, lawyers, and financial professionals in the tax shelter industry. This resolution would authorize the chairman and ranking member of the Permanent Subcommittee on Investigations, acting jointly, to provide investigative records, obtained by the subcommittee in the course of its investigation, in response to these requests.

Mr. FRIST

Mr. FRIST. Mr. President, I ask unanimous consent that when the Senate completes its business today, it adjourn until 8:15 a.m., Tuesday, November 25. I further ask that following the prayer and pledge, the morning hour be deemed expired, the Journal of proceedings be approved to date, the time for the two leaders be reserved for their use later in the day, and the Senate then resume consideration of the conference report to accompany H.R. 1, the Medicare Prescription Drug Modernization Act, as provided under the previous order. I further ask unanimous consent that the final 10 minutes prior to the 9:15 a.m. vote be equally divided between the two leaders, with the majority leader in control of the final 5 minutes.

Mr. FRIST

Mr. FRIST. Mr. President, it is late tonight and we will be in session early tomorrow morning, but I did want to take a brief moment and give thanks to a very special group of people around this institution. There are a number of professional and dedicated individuals who spend each and every day working to keep this body functioning. But I want to give special thanks to one group of people tonight, and that is our Senate pages. These are hard-working young men and women who help us each day with a broad range of tasks. They do really pretty much everything from preparing these desks today--as you look around here and see what is on these desks, you can see that that can be a huge task--to running errands for Members, errands that we greatly depend upon as we try to juggle our various responsibilities of the day, to making copies of amendments literally just one after another. In fact, you see the copies of the Medicare legislation on the desks today. When you look at them, you know that somebody has generated each and every one of those copies. The duties really go on and on. In the middle of my talk last night, I was speaking from this desk. And I thought, I have to get rid of this. How will I do it? I was thinking, and all of a sudden the page came and slipped it away so I could continue my discussion at the time. I thank them and praise the tremendous work they do each and every day. This past week we have had very busy days. It has been unusual working through last week, through Saturday, through Sunday, through Monday, today. Very late seems to be the norm these last few days, as we have really worked to complete our work before the holidays. It is the pages who have been with us in the past few days where we had not anticipated being here this late. We have had very special pages with us. I will slip out in a few minutes as we close down, and they will still be here as they tidy up for early tomorrow morning. They will soon be out for their Thanksgiving holiday as well. I really do I want to thank them, several of whom are sitting right here looking at me on the floor tonight. I thank them for their hard work these last several days: Yael Bortnick, Emily Holmgren, Ferrell Oxley, Sarah Smith, Melissa Meyer--and it is her birthday today--Margaret Leddy, and Krista Warner. In particular, I want to thank Melissa Meyer. But I thank them again for their tremendous work.

Mr. FRIST

Mr. FRIST. Mr. President, tomorrow morning there will be 1 hour of debate prior to the vote adoption of the conference report to accompany H.R. 1, the Medicare Prescription Drug Modernization Act. We have had 3 days of vigorous debate on this monumental legislation. Tomorrow it will culminate in a historic vote. I do thank all Senators who have participated in the discussion, and I particularly congratulate the chairman and ranking member of the Finance Committee who have worked to bring this legislation to completion. I also announce that we are continuing our efforts to finish action on the remaining appropriations bills. It is my hope that we will be able to move forward with the appropriations process tomorrow. I will have more to say about this tomorrow, but Senators should expect the possibility of additional votes tomorrow.

Mr. FRIST

Mr. FRIST. Mr. President, if there is no further business to come before the Senate, I ask unanimous consent the Senate stand in adjournment under the previous order.

Mr. FRIST

Mr. FRIST. Mr. President, we are at a truly historic time. A lot of times we exaggerate a bit to make a point. It seems as if on every bill somebody says: This is a historic bill. As a physician, as someone who has had a great privilege in life, a blessing in life to have served as a physician and to have taken an oath to serve humankind in such an intimate and personal way, I truly believe it is an historic time because with the action we are almost certainly going to take tomorrow night, we are going to change the lives of 40 million seniors and also 77 million baby boomers who will be seniors over the coming years by this single piece of legislation. It is rare we can say that. It is so rare. Everybody gets sick at some point later in life--everybody. If it reaches a certain threshold, you seek medical care. This bill will affect the type of care you receive, whether or not you have appropriate access, the quality of that care, and the response of the type of care that is given to you. That is why I say it is a historic bill. I am confident we will pass this bill tomorrow night. I know there are a lot of statements that have been made: We are going to obstruct; we are going to filibuster; we are going to use procedural moves. But at the end of the day, nobody from this body, I believe, can go home and say--when we are an eyelash away, after 6 years of hard work of trying to put together the very best bill possible--that we would go home having denied the President, with the leadership he has shown, and the House of Representatives, with the leadership they have shown, and the hard bipartisan work on this floor, and then tell seniors: It is not going to happen. Once again the promises that have been made have been denied you. Why do I say that? That is the question I wish to answer over the next few minutes. I want to start from afar and then come down to some of the specifics of the bill and paint a picture, paint a portrait that I think helps, at least in my own thinking, to explain to the American people why this is a pivotal time, why we have to act now, why we can't wait another year or 3 years or 5 years, why at this moment in history events have come together in conversion. There is a reason, and when we act, we will have a much more dramatic impact in improving health care and improving health care security than if we were to wait. In 1965, Medicare began. I didn't start practicing medicine until the eighties, but through that period of time, it is just amazing. We have seen health care advances that are remarkable in terms of medicine, science, and technology. The half-life of medicine--that is a statistical way of looking at medicine and advances. It got smaller and smaller and smaller and smaller because of our knowledge and understanding. Advances have been made in both health services delivery--that is how health care is delivered and how it is organized--as well as scientific and technological advances. I am going to show three graphs using this same format. On this Y axis is change. It is fairly arbitrary in describing change, but it is improvements, it is how things change over time. Along this X axis, it starts in 1965 when Medicare started and ending in the year 2005, as we project ahead. We can see this change came along pretty steadily, and all of a sudden it started to go up, up, up, and I would put it way up off the chart. That is where this change is going. The first successful heart and liver transplant was in 1965. That is a fascinating history. That is the field I ended up going into, heart transplant surgery. Coronary angioplasty, when people have drug-eluting stents, and we hear about it all the time. It wasn't that long ago. That was just in 1977. We had the first open heart surgery cases in the 1960s. In 1974, the HMO Act was passed in this body. Prozac, a drug many people are on today, was first used in 1988. It is interesting, when the PPOs--and I will talk more about PPOs shortly--began in 1985, 1 million people were enrolled. Within 13 years, 90 million people are enrolled in these PPOs. We had the human genome project, a fantastic project which just finished this year. It was a successful public-private partnership. This chart shows all the advances. The point is, these advances are getting faster and faster. The next chart uses the same format, but it shows what Medicare has done. Has it changed as well? Medicare has not changed very much. It started in 1965. It was enacted into law in 1965. It is a great program, a fantastic program. I had the opportunity to treat thousands of patients in Medicare. It has given them health care security. But, contrast Medicare to all the health care advances, and we can see it hasn't changed much over time. In 1972, it was expanded to include end-stage renal disease and dialysis. That was a a good advance. There was a good advance in 1985 with prospective payments for patients who are actually in hospitals. It was pretty revolutionary at the time. We have had people refer to catastrophic coverage. Notice line went up and went down because catastrophic coverage was repealed. A lot of people said: Is this bill going to be repealed? If I have time, I will comment on that because there is a clear answer to why that is different. There were prospective payments for physicians 1990. In 1997, we added the Medicare+Choice Program and other prospective payments. Now we are in 2003. And tomorrow night are we going to improve and change Medicare in a positive way. People say you can change Medicare and that is bad. That is not bad; that is good. We are going to strengthen and improve Medicare, and that is the whole purpose. The next chart shows very clearly the advances in technology go on up, but Medicare is too rigid. It does not change. We are not capable of changing the structure of Medicare fast enough in this body and therefore that rigid structure cannot adapt to new drugs, new pharmaceutical agents, new ways to deliver health care, new types of PPOs. We just do not change. So the gap, is what we are addressing. If we do not pass this bill tomorrow night or tomorrow afternoon--the sooner the better on my part--I think we are not going to fill this gap, and we are going to be stuck down here when all of these advances are up here and these advances are being denied seniors. That is why when people say ``filibuster,'' use procedural moves to stop this, do they mean they want to stay down here when we have the opportunity, to catch up and let these health advances be delivered to our seniors? So that is the way I think about things--in terms of what is at stake. I do not think anybody can defeat this bill and go home from here. They cannot face 40 million seniors and say we are not going to give them the advances that are available to the rest of the world. It is not right, if that is the case. Now, why today? I have heard from the other side of the aisle again and again: Let's do it next year, 2 years from now, 3 years from now. It is because we have this earthquake, or this mountain, moving towards us, defined in 1945 by the baby boomers. This is a fertility curve. We know after the war, fertility went up 3.5 births per woman. Then it fell back down. This is moving through the system to the point that in about 2008 or 2010, this curve will begin to move through the Medicare program as these baby boomers age, beginning in about 4 to 5 years. When they hit the system, what happens is potentially catastrophic if we have not prepared the system for that. To explain that, I will use the following several charts. No. 1, let's say I am the Medicare system right here. I have seniors who are taken care of over here, and I have people who are paying--that is all the working people today--to support the Medicare system which takes care of these seniors. Well, what is happening is we are having a doubling of the number of seniors because of the baby boom. So the population is getting bigger because of the baby boom demographic shift. It is this point in history that it occurs. It was not 10 years ago, and it is not 30 or 40 years from now. It is beginning right now. We have a doubling of the number of seniors. At the same time, because there is a big curve moving through, we have fewer people working to pay. So we have fewer and fewer people paying the health care of more and more people over time because it is a pay-as-you-go system. The people supporting the system today are the people working today. I will show my colleagues graphically exactly what I said. Medicare enrollment--that is the number of seniors over 65 years of age--in 1970 it was only 20 million. What is important is that there are 40 million people today, but because of the baby boom--look at this curve going up--we are going to have twice that in 2030, right at 77 million, this chart says, but it will be right at 80 million. So we have a doubling of the number of people we are going to be taking care of over the next 30 years. What about the people who are actually taking care of each one of those? In 1970, there were seven people over here working to take care of every senior, but because the fertility curve is moving through in the year 2000, it was about four people working. So for every person working to support one, they are having to work a lot harder. There are fewer people. Instead of seven working, four are working for each one. What is even worse is that over the next 30 years, instead of four people, it goes to two people. So they are going to have to be working twice as hard for every one person that is benefiting. Yet we have twice as many people who are benefiting. That is the challenge that we have and that is the reason for ``why now.'' That answers the question as to why we should do it in this Congress. We should have done it 2, 4, even 6 years ago. If we do not do it now, it is too late. That is the reality of Medicare. So people say, why do we not give a drug card and leave it at that, take care of a group of people and give them 50 or 70 percent on the card? The point is, that does not address everything that I have said to date. It does not address the challenge of having a rigid, inflexible, outdated, antiquated Medicare Program, and that is why not just a drug card, though a drug card is important, and I will come back to that. But that is why that is not the answer. A lot of people say we should not be spending $400 billion. They say we should spend $100 billion and take care of the people who need it the very most. But, that approach does not address the fact that we have an outdated system. I have said on this Senate floor many times the most important tool a physician or a nurse has today to treat a patient is not the surgeon's knife that I used every day. It is not the hospital bed. It is not even the hospital. It is pills. It is medicines. It is prescription drugs. Why today? Why are we acting today? That was not true 10 years ago. It was not true 20 years ago. But today it is the most important tool a physician has. Yet it is denied seniors in the Medicare Program. Seniors cannot get outpatient prescription drugs through Medicare today. It is the most important part of health care. Yet we deny it to our seniors. That is why nobody can filibuster this bill in good conscience because we are denying our seniors the most important tool in medicine today. Tomorrow, after we pass this bill, since it has been passed by the House, and the President is going to sign it, for the first time in the history of this Medicare Program we are going to have the most important part of health care as a tool. The most important tool in a physician's armamentarian is prescription drugs. It is being denied seniors today. Now, just an example: Cancer, diabetes, rheumatoid arthritis, osteoporosis--there are drugs for all of these diseases. There are 402 drugs right now in clinical development for cancer. So whatever we do, we do not want to destroy the research that is going on in this country. If drugs are the most important part of health care today, we want to make sure that we promote research and development. That is why we do not engage in governmental price fixing, setting prices by Government, because it destroys all of this in terms of research. NIH does a good job, and we can fund it. We fund several billion dollars through our NIH, but the private sector's contribution to research is many fold what the government provides. So we have to continue to support that private sector research. So what do we do? Where are we today? Here we go in terms of how we modernize this system, and at the same time address the issue of prescription drugs. How do we marry it? This bill does it in a bipartisan way. I predict this bill will pass tomorrow with a bipartisan vote. I know a lot of people are bringing partisan issues to the floor and saying we are going to stop it with such things as procedural votes, but this bill is going to pass with a strong bipartisan vote tomorrow. Again, what are we going to do? Today, a senior right now has a choice. They can stay in traditional Medicare, just like 35 million have, with good care and a strong system. It is antiquated, it is out of date, and it is inadequate compared to other options that people have today. It does not include prescription drugs, for example. Or a senior can go into Medicare+Choice. Five million seniors have chosen to go into Medicare+Choice. They do get some prescription drugs. Prescription drugs are in green on these charts. For my colleagues who are in the Chamber tonight, they can see the green. So seniors can get some prescription drugs, but there are no prescription drugs in traditional Medicare today. No. 1, I mentioned the drug discount card. In this legislation, maybe 6 or 8 months from now, after we pass this bill and the President signs it, seniors will have access to a drug discount card. It will last for a 2-year period. What it says is while we are developing this system, they can get immediate relief through a card. This card will allow a senior to go to the local pharmacy and get an additional 20-percent discount. Maybe it is a 10 or 25-percent discount, but however a senior gets the drugs they might get today, they will have an additional discount. It is voluntary. This word ``voluntary'' is key because everything that we put into this program today in terms of prescription drugs or giving a choice of a health care plan that might better suit a senior's needs is voluntary. They can keep exactly what they have today--and this is important for people who are listening. They can keep exactly what they have today, with no change in their benefits. They might already have prescription drugs so they would not want prescription drugs. All of this is voluntary. It is not mandatory. Nobody is making any senior even make a decision to do anything. They can keep exactly what they have if they are satisfied. In addition to this discount, there is a $600 value if a senior is low income, less than 135 percent of poverty. The chart I just showed my colleagues was Medicare today. Remember, the senior could choose either traditional Medicare, which 35 million people have, or Medicare+Choice. After this bill passes, we are going to expand the opportunity to choose, so seniors for the first time can choose the health care plan that best suits their individual needs. If you have Alzheimer's you might choose a plan that specializes in Alzheimer's. If you have Parkinson's disease or coronary artery disease or you have had a stroke or you have seizures, there may be plans out there that can best suit your needs that for the first time you will have access to. That is not available in traditional Medicare. So a senior can choose under new Medicare. Either the traditional Medicare, keep what you have, don't change anything. If you stay in traditional Medicare, for the first time, if you want it--you don't have to take it--you can choose from one of two and maybe three or four drug plans. They will have equal value, but you can have that choice. People say what if the drug plans don't show up? If they don't show up, there is a fall-back Government plan there. Everybody can have this new choice, but if you don't want to, keep what you have. In addition, you can choose Medicare+Choice, which are primarily HMOs. HMOs are maligned on the Senate floor a lot. You talk to these 5 million people who are in them, they really like them. But if you want to, you are also going to be able to choose, from a preferred provides organization or PPO or C. There may be five, there may be three, there may be two, there may be one PPO. These PPOs are integrated health care plans. They have disease management. They have this little green down there showing all of them will have access to prescription drugs. People say sick people may stay here or they may go into here or they may go into here. You don't really know. My heart transplant patients, who are among the sickest patients going in--before they get their transplant they are all going to die. Coming out, they require a lot of medicines. I would encourage a lot of those who are among the most challenging to take care of, I would encourage them to go into these PPOs. Why? Because they can have a health care plan that is tailored to their needs, that is able to respond to infectious disease, acute care, chronic care, disease management, coordinated care, none of which is available under traditional Medicare. So this is the design. Opportunity to choose all of this. Nobody is forced to choose at any point in time. Transformational: I won't go through all of this, but I wanted to show this because it is hard as you listen to everybody. Everybody is talking about little pieces. Using the same format, let me show some of the things we do. In the PPOs, in the choice over here that we are going to give for the first time--I say it is FEHBP-like. What that simply means is we in the Senate have a choice among a group of plans. I happen to take the Blue Cross/Blue Shield plan. That might be one of these plans. But seniors will be able to choose, just like we choose, a plan that might best suit their needs. These are integrated plans; that is, acute care, chronic care, preventive medicine, coordinated care. You have a choice. You can choose among these plans. There is competition in that these plans will compete one versus the other based on quality, access, and cost. They give the same benefits as traditional Medicare, but there will be competition among those plans based on any of the issues that I just mentioned. The flexibility: What that really says is that this PPO may be different than this PPO, different than this PPO. It may give a different range of benefits, although all of them will give at least the benefits given in traditional Medicare. If you look at the drug plans, I have down that they are risk bearing. Risk bearing means the Government itself shares the risk with the plan. That plays into the marketplace. That is the way the private sector works. It captures the dynamism of the marketplace and, over time, and with the element of competition, that can bring the cost of drugs and Medicare down. These are competitively bid. Again, they have the flexibility. Traditional Medicare: You have heard people talking about income relating, means testing. For the first time, the very rich, the Ross Perots of the world, will no longer have their assistants or their secretaries subsidizing their Part B premiums, their health care. For the very rich, they are going to have to be responsible for more of the subsidy--not all of the Government subsidy for them but more. There is cost containment built in. There are disease management programs that are going to be part of the traditional Medicare. Quality is going to be rewarded. This is fantastic. I will come back to this if I have time. For the first time, the hospitals, for example, if they report the quality data, they will get their full, what is called, market basket update. The important thing is if they don't report that quality data over time, they are not going to get paid as much. Quality is being rewarded. It is amazing; as a heart specialist, 50 percent of people in this body are going to die of heart disease, probably. It is higher for women than it is for men. A lot of people don't realize that, in terms of morbidity. More women will die of heart disease than men this year. Right now there is no screening test reimbursed. Your cholesterol level right now, as a screening test, in Medicare is not reimbursed. Once we pass this bill tomorrow, and it is implemented, cholesterol screening and lipid profiles, preventive tests will be reimbursed for the first time. People say, come on; it has got to be reimbursed today. It is not reimbursed today. That is just an example--prevention. As to physical exams, people know that is important as a screening measure. A lot of people get to 65 years of age and have never had a physical exam. For the first time in Medicare, everybody is going to have available to them, under Medicare, an entry level physical exam. Before, it wasn't there. It is not there today, but it is going to be there under the bill. Information technology, I mention that because it has to do with medical errors. Right now we know there are too many medical errors that are being made. We need to facilitate, and adapt information to come into the system and be handled in a way that is consistent, in which the data can be assimilated and reported back. There will be e- prescribing for prescriptions with incentives--not mandatory, but incentives to encourage physicians to be able, instead of writing each prescription and have it go through 10 or 15 different hands and come back where mistakes can be made, by computer it can go all the way through the system where the mistakes are less likely to be made. It is a complicated chart, but it gives my colleagues the feel for everything that we are accomplishing in this bill--not everything, but how important the various elements of this bill are. Senator Kent Conrad in this body is the person who is probably as focused as anybody on this particular issue. I agree with him 100 percent. How much time do I have?

Mr. FRIST. Mr. President, I will be speaking for about 30 minutes. I ask that the Chair notify me when I have used 25 minutes.

Mr. FRIST

Mr. FRIST. Today, the Senate will resume debate on the Medicare prescription drug conference report. We had an extended and vigorous debate on this historic legislation yesterday. Again, it is unusual to have a Saturday session and even more unusual to have a Sunday session, but the historic level which this debate has reached demonstrates the importance of doing just that. There are a number of Senators who will be on the Senate floor to discuss this matter during today's session, and in an effort to accommodate the number of Senators who are seeking floor time today, we would encourage Members to limit their statements to no more than 30 minutes. We hope to work out a schedule so that Members will have a better understanding of at what point in the day or the evening they will be able to speak. If we can lock in 30 minutes per Member, or possibly work out alternating hours, which we will do, hopefully, in a few minutes, we will then have an orderly way to move forward so that everybody will have an opportunity to address this important issue. Yesterday, it became apparent that we would not be able to lock in a time certain for an up-or-down vote on this important legislation, and at least one Democratic Member said that a filibuster would be the road to pursue. Thus, I filed a cloture motion on the conference report. That vote on the motion to invoke cloture is expected to occur sometime around 12:30 on Monday. All Senators will be notified when that vote is set.

Mr. FRIST

Mr. FRIST. Let me also clarify that on the Republican side we are not locked into any order. The opponents to the bill are locked into an order of speakers. Ours has been just an agreement, so we are not locked into any order, but there will be a 30-minute limit, and we will be alternating back and forth.