Bill Frist

Mr. FRIST

Mr. FRIST. Mr. President, 5 years ago, this body launched a bipartisan commission on Medicare with the purpose of addressing both the short-term, mid-term, and long-term challenges we have with sustaining Medicare, preserving Medicare, and strengthening Medicare. That bipartisan commission did develop a solid bipartisan proposal. Since 1999, the Senate Finance Committee has held 29 hearings on Medicare, and 7 of those hearings specifically focused on adding a prescription drug benefit to Medicare coverage. We have discussed the issue, we have debated the issue, we have dissected it, and we have deliberated on the issue of Medicare modernization and Medicare improvement for years now--for 6 years since we first began talking about the Medicare commission. I sincerely believe that the stars are aligned for legislative action and a vote to preserve Medicare and strengthen and improve it and address the prescription drugs issue right now, this month. It is now time for us not to just talk about the issue again but to act on the issue. Since I became majority leader, I have made it clear that it would be my intention to address the issue using the normal order of business, and that is to have a proposal that is developed and generated in a bipartisan way through the Finance Committee, bring that bill to the floor of the Senate for further debate and further amendment. The Finance Committee is progressing well. The action of the Finance Committee is on course to accomplish my goal. Our leadership goal is bringing this to the floor on about June 16, 2 weeks from now. I am pleased with the progress to date. I understand we have a long way to go. It is a complex piece of legislation, but a very important piece of legislation that I am absolutely convinced we can bring to resolution for the benefit of seniors and individuals with disabilities. We will have approximately 2 weeks on the floor of the Senate. I have made that very clear as well so that people, for the last several months, have been able to prepare and think through what is important to them, talk to their constituents, talk to their counselors to make sure we address this in a very thoughtful way. I think we will be able to work together--both sides of the aisle--to cull the very best of our ideas and give America's seniors a Medicare system that will do what we want to do: provide our seniors and individuals with disabilities real health care security. I believe we need to work to make sure that seniors do have the choice and the flexibility to be able to choose the type of coverage that best meets their individual needs. We need to make sure that coverage is available to every senior, everywhere. There has to be a special focus, as we all know, on the issues that pertain directly to the rural population. You can do that, for example, by requiring plans to bid in large geographic areas across the country, instead of just cherry-picking, whether it is urban, or suburban, or just a rural population. I think we can get rid of the cherry-picking that has emerged in the current system. If a health coverage plan wants to serve patients in a high-cost, densely populated suburban or urban area, they will also have to offer coverage in rural areas, whether it is Maine, Wisconsin, Montana, or in Iowa. We can do all of this if we focus on the big picture for the future. Our fellow citizens are clearly relying on us and we need to focus on them. Now is the time for us not to just get by another year but to transform this system in a positive way. Seniors deserve choice. They deserve having a system that is focused on the patient, one that is really patient centered. They deserve care that is flexible, with less paperwork and bureaucracy. They deserve care that focuses on prevention and not just in response to acute episodic injury, so that you can capture that early heart disease before it becomes what is called a cardiomyopathy or a chronic congestive heart failure. It ends up being less expensive, more valuable, and certainly keeps patients healthier. They need to be protected from catastrophic out-of-pocket expenditures. Most seniors do not realize today that if they get very sick, there is no limit as to the out-of-pocket costs they have to pay. We need to protect them especially in those events surrounding catastrophe. I think seniors should be in a system that allows them the opportunity to see the doctors they choose. Thus, it is my hope and intention that we will vote on final passage before leaving for the Independence Day recess. Once passed, I am very hopeful that the bill, whatever its final shape, will begin to help seniors as soon as possible. Whenever we bring up to date or strengthen a system, it takes time to implement that plan in a careful and systematic way. I think as we develop that plan and begin to implement it, there are ways we can immediately begin to help those seniors who need help with prescription drugs. In 1963, when leading the fight to enact Medicare, President John F. Kennedy said: A proud and resourceful nation can no longer ask its people to live in constant fear of a serious illness for which adequate funds are not available. We owe the right of dignity in sickness as well as in health. Medicare, as I mentioned yesterday in this Chamber, has served a generation of America's seniors very well. Our challenge now is to take a system which is out of date--if you look at the way state-of-the-art care is delivered--and bring it up to date so we can serve the current generation and next generations of seniors equally well. We have an opportunity to do that now. We have an obligation, I would argue, to do that now so that we can provide real security for generations to come.

Mr. FRIST

Mr. FRIST. Mr. President, I rise today to discuss a particular public health problem--the growing rates of obesity. This epidemic has steadily increased to a level twice what it was thirty years ago. Obesity now affects over sixty percent of adults and thirteen percent of children and adolescents. Among young people, it is escalating at an alarming rate. This condition causes three hundred thousand deaths a year and is second only to smoking as the Nation's leading cause of preventable death. Overweight and obesity are associated with increased risk for heart disease, the leading cause of death, cancer, the second leading cause of death, diabetes, the seventh leading cause of death, and musculoskeletal disorders. Anyone with this condition has at least a 50 percent chance of a premature death. As obesity continues to mount, the morbidity, mortality and health care costs associated with these disorders will skyrocket. Just this last month, a Health Affairs article estimated that nearly one-tenth of U.S. health care costs are attributable to conditions resulting from obesity or being overweight. In 2002 dollars, the authors of this article estimate that obesity and overweight-related conditions cost $92.6 billion. Of which, half is financed by Medicare and Medicaid. Healthy People 2010 calls overweight and obesity one of the Nation's leading health problems and prioritizes efforts to increase the proportion of adults who are at a healthy weight, and reduce the levels of obesity and overweight among adults, children and adolescents. The Surgeon General's report ``A Call to Action'' lists the treatment and prevention of obesity as a top national priority. Now, if this condition was linked to an infectious or bioterrorist agent, the public outcry would be deafening, and the action to control it swift. But it is not. Obesity and being overweight is often seen as an individual problem and a personal choice, and thus does not receive much attention. Most people do not choose to be overweight. Overweight and obesity result from daily lifestyle choices that gradually accumulate. Weight gain occurs slowly, often unnoticed. Today, many Americans struggle to control their weight, collectively spending billions of dollars each year on weight loss products and programs. The good news is that, with healthy eating and regular physical activity, obesity is preventable and treatable. That is why I, along with Senator Bingaman, Senator Dodd, and others, am reintroducing the ``Improved Nutrition and Physical Activity, IMPACT, Act.'' I am pleased that Representatives Mary Bono and Kay Granger, along with other co- sponsors, introduced companion legislation in the House of Representatives earlier this year. This bill will help Americans make healthy decisions about nutrition and physical activity. It emphasizes youth education so that healthy habits can begin early. Finally, it funds demonstration projects to find innovative ways of improving eating and exercise habits. There is no single solution to the growing epidemic of obesity. That is why the IMPACT Act takes a multifaceted approach. It implements evidence-based programs, where available, and includes rigorous evaluation of demonstration projects so we can learn what works best. This important legislation has a modest price tag, reflecting the appropriate role of the Federal Government. Most importantly, the IMPACT Act does not attempt to mandate what Americans eat or drink or to transfer to the Federal Government decisions that are best made at local levels. Let me be clear that I am not against people making choices. I am all for choice, informed choice. What has happened, though, is that we as a society and as individuals have made choices about eating and activity, gradually and incrementally, without understanding or considering the consequences. Finally, and most importantly, this bill does not intend to and should not be considered to stigmatize those who struggle to control their weight or to demonize any sector of the country by blaming them for this epidemic. The IMPACT Act represents a bipartisan agreement that the problem of obesity is important, and takes an approach that is supported by a broad spectrum of interested parties. With the Federal Government providing assistance, all sectors of society will need to work together to help produce a healthier nation. I believe we have crafted a good first response to the growing rates of obesity. A number of public health and industry experts support the passage of this important legislation. I ask unanimous consent that a list of the organizations supporting the legislation and the text of the bill be printed in the Record. I want to thank Senators Bingaman and Dodd for their work on this bill. I also want to thank Senator Gregg for his assistance in ensuring that this legislation can become law. Senator Gregg has worked tirelessly with my staff to ensure that we craft legislation that can be quickly passed by the Senate, and I appreciate his efforts. I look forward to having this bill become law this year.

Mr. FRIST

Mr. FRIST. Madam President, it is probably confusing to people who are watching this debate and discussion. I have just withdrawn the ethanol amendment. As the minority leader suggested, my plans are to reintroduce that amendment at the earliest time feasible, likely first thing tomorrow morning. What has just happened is that while we were talking about ethanol and energy, we were moved to the consideration of something which, yes, could be related but it is on child tax credits, another issue that is important to the American people. What we have agreed to do is to address that issue sometime in the very near future in a way that we can consider alternatives to addressing the issues surrounding child tax credits. Child tax credits are a separate issue from ethanol and energy, a very important issue, one we have been made aware of over the last several days that must be addressed. We will, of course, tonight, figure out the best way to address that, and it will be done in the very near future. We will in all likelihood reintroduce the ethanol amendment, my amendment, with the Democratic leader, early in the morning, and over the course of tonight and this evening and early in the morning we will, hopefully, have a series of amendments lined up, and we will be able to move directly to ethanol, on energy, so that we can progress with this very important legislation, the Energy bill, and this ethanol amendment.

Mr. FRIST. Madam President, it is probably confusing to people who are watching this debate and discussion. I have just withdrawn the ethanol amendment. As the minority leader suggested, my plans are to reintroduce that amendment at the earliest time feasible, likely first thing tomorrow morning. What has just happened is that while we were talking about ethanol and energy, we were moved to the consideration of something which, yes, could be related but it is on child tax credits, another issue that is important to the American people. What we have agreed to do is to address that issue sometime in the very near future in a way that we can consider alternatives to addressing the issues surrounding child tax credits. The Senator from South Dakota.

Mr. FRIST. Madam President, I ask unanimous consent that the Senate now proceed to a period for morning business with Senators permitted to speak for up to 10 minutes each.

Mr. FRIST

Mr. FRIST. I now withdraw amendment No. 539.

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

Mr. FRIST

Mr. FRIST. Mr. President, I rise today to discuss a particular public health problem--the growing rates of obesity. This epidemic has steadily increased to a level twice what it was thirty years ago. Obesity now affects over sixty percent of adults and thirteen percent of children and adolescents. Among young people, it is escalating at an alarming rate. This condition causes three hundred thousand deaths a year and is second only to smoking as the Nation's leading cause of preventable death. Overweight and obesity are associated with increased risk for heart disease, the leading cause of death, cancer, the second leading cause of death, diabetes, the seventh leading cause of death, and musculoskeletal disorders. Anyone with this condition has at least a 50 percent chance of a premature death. As obesity continues to mount, the morbidity, mortality and health care costs associated with these disorders will skyrocket. Just this last month, a Health Affairs article estimated that nearly one-tenth of U.S. health care costs are attributable to conditions resulting from obesity or being overweight. In 2002 dollars, the authors of this article estimate that obesity and overweight-related conditions cost $92.6 billion. Of which, half is financed by Medicare and Medicaid. Healthy People 2010 calls overweight and obesity one of the Nation's leading health problems and prioritizes efforts to increase the proportion of adults who are at a healthy weight, and reduce the levels of obesity and overweight among adults, children and adolescents. The Surgeon General's report ``A Call to Action'' lists the treatment and prevention of obesity as a top national priority. Now, if this condition was linked to an infectious or bioterrorist agent, the public outcry would be deafening, and the action to control it swift. But it is not. Obesity and being overweight is often seen as an individual problem and a personal choice, and thus does not receive much attention. Most people do not choose to be overweight. Overweight and obesity result from daily lifestyle choices that gradually accumulate. Weight gain occurs slowly, often unnoticed. Today, many Americans struggle to control their weight, collectively spending billions of dollars each year on weight loss products and programs. The good news is that, with healthy eating and regular physical activity, obesity is preventable and treatable. That is why I, along with Senator Bingaman, Senator Dodd, and others, am reintroducing the ``Improved Nutrition and Physical Activity, IMPACT, Act.'' I am pleased that Representatives Mary Bono and Kay Granger, along with other co- sponsors, introduced companion legislation in the House of Representatives earlier this year. This bill will help Americans make healthy decisions about nutrition and physical activity. It emphasizes youth education so that healthy habits can begin early. Finally, it funds demonstration projects to find innovative ways of improving eating and exercise habits. There is no single solution to the growing epidemic of obesity. That is why the IMPACT Act takes a multifaceted approach. It implements evidence-based programs, where available, and includes rigorous evaluation of demonstration projects so we can learn what works best. This important legislation has a modest price tag, reflecting the appropriate role of the Federal Government. Most importantly, the IMPACT Act does not attempt to mandate what Americans eat or drink or to transfer to the Federal Government decisions that are best made at local levels. Let me be clear that I am not against people making choices. I am all for choice, informed choice. What has happened, though, is that we as a society and as individuals have made choices about eating and activity, gradually and incrementally, without understanding or considering the consequences. Finally, and most importantly, this bill does not intend to and should not be considered to stigmatize those who struggle to control their weight or to demonize any sector of the country by blaming them for this epidemic. The IMPACT Act represents a bipartisan agreement that the problem of obesity is important, and takes an approach that is supported by a broad spectrum of interested parties. With the Federal Government providing assistance, all sectors of society will need to work together to help produce a healthier nation. I believe we have crafted a good first response to the growing rates of obesity. A number of public health and industry experts support the passage of this important legislation. I ask unanimous consent that a list of the organizations supporting the legislation and the text of the bill be printed in the Record. I want to thank Senators Bingaman and Dodd for their work on this bill. I also want to thank Senator Gregg for his assistance in ensuring that this legislation can become law. Senator Gregg has worked tirelessly with my staff to ensure that we craft legislation that can be quickly passed by the Senate, and I appreciate his efforts. I look forward to having this bill become law this year.

Mr. FRIST

Mr. FRIST. Mr. President, today the Senate will be in a period of morning business until 1 p.m. At 1 o'clock, the Senate will then resume consideration of S. 14, the Energy bill. The chairman and the ranking member will be here and will be prepared for Members to come forward with their amendments over the course of today. This is an important piece of legislation that will enhance the energy security of this Nation. I expect that the Senate will make substantial progress on this important bill this week. As I announced previously, no rollcall votes will occur during today's session. However, Members will be able to offer amendments. I encourage them to do so. Any votes ordered on those amendments will be scheduled to occur during tomorrow's session. Also this week the Senate will need to address the Defense authorization bill that will be received from the House shortly. Prior to the recess, we finished action on the Senate bill; however, we still need to dispose of a few remaining amendments prior to going to conference with the House. That should take only a couple of hours. We will likely consider that bill one night this week after we spend the day on the consideration of the Energy bill. I will keep my colleagues advised as to what evening that will be. In addition, we have continued to try to reach agreements on the FAA reauthorization and the State Department reauthorization bills. At some point we will have to proceed to those matters even if we are unable to reach a consent agreement for their consideration. I should also mention there are a number of Executive Calendar nominations that have been pending for a long period of time. Oftentimes these nominations get caught up in other issues. Again, at some point, I will proceed to the consideration of those nominations that have been pending for a while. If Members want to debate a particular nominee, they will need to come to the Senate floor to do so. In addition to the items I just mentioned, we have a number of other important issues to address, one of which is prescription drug benefits and strengthening and improving our Medicare Program for 35 million seniors and a million individuals with disabilities. I have stated for a number of weeks--in fact, for the last couple of months--that we will be addressing this particular issue, an issue that is important to the American people, both those who are seniors now, those soon to be seniors, and future generations, and we will be addressing that this month. Much of that activity begins in the Finance Committee this week--in fact, today there are discussions going on--and each and every day from now until we bring it to the floor. We plan on bringing that to the floor in 2 weeks. Having said that, I look forward to a busy and productive legislative period prior to the next scheduled adjournment. A number of people are coming back into town today after a period of a week being primarily at their homes with their constituencies across the United States of America. We are hopping right into the Energy bill today and through this week, followed by a number of issues this week. We will begin the appropriations process very quickly and spend a focused period of time on prescription drugs and strengthening and improving Medicare. I yield the floor.

Mr. FRIST

Mr. FRIST. Mr. President, in opening the Senate this morning, I spoke generally of the schedule for the next month. There are a number of items that I outlined which we will be addressing. The first is energy, and we will continue that debate, possibly later today but through tomorrow, the next day, the next day, the next day-- through this week. It is a very important debate as we work toward that objective, increasing domestic production, decreasing our dependence on foreign sources, addressing issues such as renewable energy sources that we all know are so important, and accomplishing all that with a lot of attention and focus and care with regard to the environment as well as the economy of this great country. I mentioned this morning that we have begun, weeks ago--in fact, months ago--addressing the issues surrounding the strengthening of our Medicare Program--strengthening it, preserving it, improving it--and at the same time addressing an issue that seniors feel strongly about, people in Medicare feel strongly about, but also soon-to-be-seniors and that younger generation, and that is to include a new benefit of prescription drugs as part of our health care for seniors program, our Medicare Program. As I talked to a number of people over the last week, a lot of people said, Why now? There are a lot of reasons why now. The bigger question I have is why didn't we do it 6 months ago or a year ago or 2 years ago. Prescription drugs have become an integral part of health care delivery, of the tools, of the equipment, of the armamentarium that a physician has, that a nurse has, that health care providers have, to give people security, health security, and especially to give seniors health care security. That is the purpose of our Medicare Program, to give seniors that health care security. Yet we have this very important benefit today--much more important today than 10 years ago or 20 years ago or 30 years ago when Medicare was started--these prescription drugs, which are vital to health care security for seniors. We will be addressing, 2 weeks from today on the floor of the Senate, for a 2-week period, how to strengthen and improve Medicare. To answer that question, Why address the issue now? I think there are three reasons. First, I think we have a unique opportunity because the political environment is right. When I say political environment, I mean the responsiveness that we demonstrate to what our constituents want and what they demand and, indeed, what they deserve. Indeed, in terms of the political environment, we have seen the call for prescription drugs, proposals to deliver prescription drugs, enter into a number of campaigns 6 months ago around the United States of America, in the campaign cycles from 2 years ago, and that is simply a reflection of the importance of the issue to the American people. Second, we have a unique opportunity because, I believe, the legislative stars are aligned at this point in time--unlike last year, unlike 3 years ago, and possibly unlike 2 or 3 years from now. By that I mean that we have a President of the United States who has spoken out boldly and forcefully that this is important to our domestic agenda. In fact, the President put out a framework several months ago demonstrating his commitment and the commitment of this administration to strengthening Medicare, to improving Medicare, and at the same time adding this new and important benefit of prescription drugs. When I say the legislative stars are aligned, it starts in many ways there because it takes that bold leadership because this will be the single most significant and most expensive change in the history of Medicare, a new benefit at the same time we strengthen and modernize Medicare. But it also takes bold leadership in the House of Representatives and bold leadership on the floor of the Senate. As a physician, as majority leader of the Senate, I have made it very clear that this is a huge priority for the leadership of this body. Indeed, that reflects the leadership in the last Congress where Medicare reform and modernization and prescription drugs were discussed on the floor for 2 or even 3 weeks, but where we were not able to bring to it a conclusion. Then we have a House of Representatives, as we look at these legislative stars. Indeed, it is lined up. This will be the third Congress, maybe the fourth but the third Congress that I recall, that will have put forth and passed a bold, comprehensive plan. So when you have bold leadership in the White House by the President of the United States, you have this body, which is committed--committed to giving our seniors what they deserve, you have a majority leader who happens to be a physician, who has taken care of, personally, tens of thousands of patients who would be beneficiaries of this type of program--and a House that is committed, we can do it. The third reason we have this unique opportunity, and which is one that we have little control over, is the unprecedented aging of the population which was defined post-World War II and what we know today as the baby boomers. This unprecedented fertility curve that happened after World War II, this move in our population which begins to hit in about 6 or 7 years, resulted in a doubling of the number of seniors. From where we are today over the next 30 years, that doubling of the number of seniors is going to call for health care security. It is going to make it very expensive. Therefore, we need to look in whatever we do today to make sure we meet that fundamental criterion of having it be sustainable over time, and not to make promises that can't be sustained when we are going to have twice as many people demanding and deserving the services for that health care security. That unprecedented tidal wave of the aging of our population is what we need to face as responsible legislators. What complicates that huge increase in demand for services is that in the pay-as-you-go system, the number of workers out there who are actually paying into the system is going to fall over time. About seven workers in 1970 would support one senior. I just told you that we are going to double the number of seniors. But no longer having seven workers support every senior, it is now down to about four workers for every senior. And it will go down to about 2.9 workers for every senior. For every one senior you have over here, you are going to have fewer people working harder to provide those services, and on top of that you have a doubling of the number of seniors receiving those services. This underscores the need to approach this modernization, this strengthening, this reform, this improvement of Medicare, especially since we are adding on top of that system I just described the single largest addition of benefits in the history of Medicare. Even with benefits as designed today which we have already promised, the system itself is difficult to sustain because of this doubling of seniors, and with almost a halving of the number of people paying in. On top of that, we have the challenge of adding a very expensive service. It is estimated that seniors will spend about $2 trillion in medicines over the next 10 years. I would say that is a low estimate. If we were to promise all seniors all of their prescription drugs for the next 10 years, that would be $2 trillion which we would be putting on the system. Today, for all health care, we spend about $250 million a year. That simply can't be sustained long term. But that is the challenge which we have. Let me say that as a physician and as someone who has been involved in delivering care to seniors, Medicare has been hugely successful. The Medicare Program, which is now a little over 35 or 38 years old, has been hugely successful. Seniors would have been driven to financial ruin. They would not have received the health care benefits because there would be too many barriers without this great program. The problem and the challenge is that the program itself has not changed very much over the last 30 years. We have changed it a little bit on the floor of the Senate, but at the same time health care delivery has changed dramatically. We know better how to deliver care in a continuous way that looks at quality, constant monitoring, and chronic disease, but none that have ever been incorporated into this great program, but a stagnant program that hasn't kept up with the times, with the great advances, such as difficult heart transplants--I was involved in putting in artificial hearts as a surgeon in that arena--with a little stint; and the angioplasty. None of that was done in 1965 when Medicare started--zero. The system changes so little. And you can go through every specialty of health care. These rapid changes in health care simply are incorporated only very slowly with years of lag time, if they are incorporated at all. In Medicare, there is very little preventive medicine, for example. It has been a great program, a tremendous program, and a program we need to preserve. But we need to improve it and strengthen it over time. Our challenge is that a lot of the seniors listening to me are thinking their Medicare is OK. You politicians up there in Washington, DC may have been a doctor in the past and now may be a U.S. Senator, but just do not touch what I have. I may be 80 years old, or 85. I don't want any politician tinkering with my health care that I think is OK. That is going to be a challenge as well because a lot of people are going to say don't touch it at all. I would argue that seniors deserve for us to touch it. Don't take anything away from seniors. If they want to keep what they have today, they can keep exactly what they have. But at the same time we have an obligation to let seniors and soon-to-be seniors know the program is not as good as health care which can be delivered today, and which is delivered today in the private sector. They need to know that. For example, Medicare doesn't cover catastrophes. That simply means if you are very sick, with Medicare there is no limit of $1,000, $10,000, $50,000, or $100,000 that you are going to pay in. You are always going to be paying out-of-pocket a certain percentage. For example, with physicians, you might be paying 15 or 20 percent of whatever that physician charges. But for the rest of your life--no matter if you have a catastrophe, if you had $100,000 in bills, there is no cap in Medicare. That is not true in the private sector. There is a catastrophe cap for most health care plans. Second, Medicare today does not offer very much in the way of preventive care. We know that if we catch the disease early and we manage it well before you require hospitalization, before you require surgery, and before you require radiation therapy, you are going to have huge cost savings. But, more importantly, you will have a better quality of life for the rest of your life. That takes prevention--catching those cancers when they are tiny, before they have spread throughout the body, or catching that heart disease before it has manifested itself in shortness of breath, or congestive heart failure and not being able to get out of bed. We do it all the time today. Yet annual physical exams are not covered in Medicare. I would tell seniors who say they are getting good coverage today to ask whether there should be some prevention involved. Right now Medicare has very little. Second, wouldn't you like to have a plan that limits your out-of- pocket expenditures? Third, Medicare today--as great a program as it has been--does not cover prescription drugs. If you talk to seniors today and ask somebody who is 80 or 85 years of age, Are you on prescription drugs, they will say, No, hopefully, but in all likelihood they will say Yes, for my diabetes, or for my congestive heart failure, or for my obstructive pulmonary disease, for my arthritis. Really, you can pick any one as you go through. Thus, I would argue, if you are saying you deserve health care security, you deserve some health with your prescription drugs, yet you don't get it today at all in Medicare, there are things which we can do to strengthen it. The value of the benefit package is inferior to what is in the private sector today--inferior to what I would argue seniors deserve today. I list these things because it is important for people to realize that as good as Medicare is, it simply does not provide what is available and what seniors deserve. If you are a senior, look at your total expenditures for health care. Medicare only pays about half of them. That means you have to figure out some way to pay for the other half. You might do it by buying other supplementary insurance policies, or by getting discounts, or whatever you have to do. In some way or another you have to figure out how to pay for it. That is certainly not true for people in this body, or for the 9 million Federal employees who are not responsible for 50 percent of their health care today under their insurance program. We need to change Medicare so it gives a better value and so our seniors will be able to get the health care they need without being unfairly punished by having to pay so much out of pocket--so much more than, say, Federal employees. The list goes on. As we debate, we will talk more at length about these issues. I want to mention one other problem with Medicare that we need to debate on this floor; that is, the fragmentation of the system. In 1965, through compromise at the time, there was a Part A for physicians and a Part B for hospitals. It has been fragmented into two separate categories. Today, health care needs to be continuous. There needs to be a continuum. You want ongoing, continuous quality management, and you don't need different financing systems or different record keeping or different deductibles or different copayments set up. It is just not an efficient and effective way to deliver health care today. In short, the Medicare system--again, as good as it is--does not live up to the standard we have set in the private sector. It is now time to address that gap, which we will be doing on the floor of the Senate. Medicare today is still set up the way it was in the 1960s and in the 1970s to respond to acute episodic care. People get sick and go to the hospital. You treat them, and they go home. That is not the way health care is delivered today in the private sector where you want to keep people out of the hospital, where it is not just acute care, where you are not just responding to a heart attack. The idea today is to prevent the heart attack in the first place. Now we have the expertise to do it, we have the medicines to do it, but seniors are not getting it today. So what are we going to see play out here in the next month? We will begin to hear--probably starting tomorrow--a lot of discussion of the various plans that have been both proposed in the past and that the Finance Committee is thinking about. The Senate Finance Committee now is developing a balanced plan, a balanced proposal that draws upon a lot of the legislation that has come to this body, legislation that, in the last Congress, was the tripartisan plan, and a plan from several years ago that John Breaux and I worked on, and a House-passed plan from last Congress and the Congress before, and the framework put forth by the President of the United States. I hope and pray but I am committed to see that we develop a bipartisan plan, bringing the best out of this body, from Democrats and Republicans, to address some of the needs--hopefully all of the needs-- that I outlined a few minutes ago that make Medicare today less than what seniors deserve. Over the next 2 weeks there will be a lot of discussion on this issue. Two weeks from now, on the floor of the Senate, we will be debating the legislation for 2 weeks. I am hopeful we can pass a plan out of the Senate before July 1 that responds to these needs. I mention it has to be balanced and it has to be bipartisan. I say that for lots of reasons. In large part, it is because this is a huge challenge. We are going to have to take the very best of the Republican ideas, the very best of the Democrat ideas, the very best of the President's ideas, and the very best of the House's ideas and put them together. This will be the single largest expansion of Medicare in the history of the Medicare Program. As I said, it is going to be about $2 trillion that seniors are going to be spending over the next 10 years. We need to debate, as we go forward, how we can lower that barrier so seniors can get those prescription drugs. I will close by saying that reform, modernization, strengthening has to be linked to prescription drugs, and prescription drugs have to be linked to strengthening and improving Medicare. It does not make sense in a fragmented system that doesn't have very much in preventive care that was built on a 1960s model. It does not make sense to superimpose a brand new benefit without taking advantage of putting all that in a single system that gives continuity, quality assurance, a systems approach where you can reduce medical errors that we know occur today. There are five key principles that will guide our legislative efforts. I think, first and foremost, we need to stress that whatever we do needs to be patient-centered. We need to think of that senior, what we can do to give him or her health care security, building whatever changes are needed around that. Second, our seniors deserve the opportunity to voluntarily choose the health care plan, the health care coverage that best meets their individual needs. It is revolutionary in many ways but to look at a senior and say: You will have the opportunity, A, to keep exactly what you have now, what you have under current law, or, B, you can choose a type of coverage that better meets your individual needs, which may focus on your chronic disease of heart failure, which may involve disease management of your diabetes, and which will include preventive care, so whatever your status is when that progresses, we will pick it up early. Seniors will be able to voluntarily choose the type of health coverage and drug benefit that best meets their individual needs. Third, seniors also deserve coverage where they have continuous quality management and safety improvements, and that requires a systems approach. You hear about these medical errors being made in hospitals, confusing prescriptions and medicines that interact with each other. I think that is the sort of thing we can avoid if we incorporate it in the legislation. I know we can do it in the legislation that evolves over the next several weeks. Fourth, as I look at these principles, seniors deserve to be able to capture innovation. If we figure out a newer, better way to do something that will improve health care, that innovation should be captured. You should not have to wait 4 years to have access to innovation. It was 4, maybe even 5 years after heart transplants were widely available that they were made available in the Medicare Program. Seniors should not have to wait that long, if it is crystal clear, if the data is there, that this type of therapy is effective. The fifth principle I would add is that seniors deserve coverage that is less bureaucratic, that has less paperwork, that is more flexible, so it can, indeed, adapt to the times. We have a huge task ahead of us. A lot of people say they don't know if it can be done over the course of the next month. I am confident it can be done, in large part because much of the work was done in the last Congress, and it is being done both on the floor of the Senate and in the House of Representatives. We have made tremendous progress. We are building on a lot of the work that has been done in the past. I am confident it can be done because the American people want it to be done. I am confident it can be done because people in this body-- Democrat and Republican--want to do what is best for seniors, what is best for individuals with disabilities. I think we are going to see that responsiveness of this body play out over the next 4 weeks. I am excited about it. The House of Representatives will likely be considering strengthening Medicare, addressing prescription drugs over the course of this month as well. If we can both accomplish that--which we are going to work very hard to do--within 6 months, 8 months, or less than a year from now, seniors will have a benefit as they reach out to obtain and use those prescription drugs as part of their health care. Mr. President, I yield the floor and suggest the absence of a quorum.

Mr. FRIST

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

Mr. FRIST

Mr. FRIST. Mr. President, I ask unanimous consent the Senate proceed to the immediate consideration of H. Con. Res. 191, which is at the desk.

Mr. FRIST. I ask unanimous consent that the concurrent resolution be agreed to and the motion to reconsider be laid upon the table.

Mr. FRIST. Mr. President, I suggest the absence of a quorum.

Mr. FRIST

Mr. FRIST. Mr. President, I ask unanimous consent that the Senate proceed to the immediate consideration of Calendar No. 110, S. Res. 136.

Mr. FRIST. Mr. President, I ask unanimous consent that the resolution be agreed to, the preamble be agreed to, the motion to reconsider laid upon the table, with no intervening action or debate.

Mr. FRIST

Mr. FRIST. Mr. President, I ask unanimous consent that the Senate immediately proceed to executive session to consider the following nominations on today's Executive Calendar: Calendar Nos. 134, 176, 177, 206 through 217, and nominations on the Secretary's desk in the Army, Foreign Service, Marine Corps, and Navy. I further ask unanimous consent that the nominations be confirmed en bloc, the motions to reconsider be laid upon the table, and the President be immediately notified of the Senate's action.

Mr. FRIST

Mr. FRIST. Mr. President, I ask unanimous consent that the Senate proceed to the immediate consideration of Calendar No. 104, S. 313.

Mr. FRIST

Mr. FRIST. Mr. President, I ask unanimous consent that the Senate proceed to the immediate consideration of S. Res. 156, which was submitted earlier today.

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 the matter be printed in the Record.

Mr. FRIST

Mr. FRIST. Mr. President, I ask unanimous consent that the Senate proceed to the immediate consideration of Calendar No. 108, S. 858.

Mr. FRIST. Mr. President, I ask unanimous consent that the bill be read a third time and passed, the motion to reconsider be laid upon the table, with no intervening action or debate, and any statements related to the bill be printed in the Record.

Mr. FRIST

Mr. FRIST. Mr. President, I ask unanimous consent that the Banking Committee be discharged from further consideration of S. Con. Res. 43, and the Senate proceed to its immediate consideration.

Mr. FRIST. Mr. President, I ask unanimous consent that the concurrent resolution be agreed to, the preamble be agreed to, the motion to reconsider be laid upon the table, with no intervening action or debate.

Mr. FRIST

Mr. FRIST. Mr. President, I understand that S. 1104 is at the desk and is due for a second reading.