Ted Kennedy

Mr. KENNEDY

Mr. KENNEDY. Madam President, I think we ought to have at least some understanding about what the challenge is. We make decisions in the Senate, and this is basically a question of priorities. The issue that is before us, in the broader context, is whether we believe it's a priority to do something to keep the costs down in terms of prescription drugs for our senior citizens, our fellow citizens. Now, our good friends on the other side say: Look, we want to do something, but we are not going to do very much. It is better than doing nothing at all. I would like to believe we are capable of doing something more for those Americans who have been called the greatest generation. Rather than giving them crumbs, it seems to me we ought to give them a decent benefit package that is built upon the Medicare system. That is what is supported by all of the elderly groups. The question is, do we have the will? Or are we going to just trim something off the edges and give them a little something? If you are making $8,000 or $9,000, you are going to have to spend $1,500 before you ever get anything at all. It seems to me this is a question of priorities here in the Senate for the greatest generation, for our senior citizens: Are we prepared to make a commitment that will ensure them a benefit package that is equal to the request by this President for tax cuts this year--$600 billion? I don't hear any proposals from the other side saying, let's defer that $600 billion tax cut and put it in here for prescription drugs. Let us not try to shortchange our senior citizens. There are two issues which are underlying all of this. One is the issue of cost, which is clearly demonstrated by this chart. The yellow represents the consumer price index, the gradual increase in inflation, and the blue represents the drug costs that are going up every year. There is nothing in the Hagel proposal that does anything to get a handle on these costs. Those costs are going to continue to go up. There is no proposal in there that does anything about cost. But there is another very important proposal that we have before the Senate--and we welcome the support of our Republican colleagues--that can make a difference in terms of cost. Our Democratic program deals with the issues of cost and also with the issues of coverage. Cost is going up. Our seniors need help. Let's just look at what we are facing globally in the United States in terms of prescription drugs and our seniors and where they are. We have 13 million who have virtually no coverage at all; 10 million have coverage in employer-sponsored programs--we will come back to that--13 million have none, and 10 million are in employer sponsored programs; 5 million are in the Medicare HMO; 2 million are in Medigap; 3 million are in Medicaid, and another million have other kinds of public coverage. The only seniors who are protected in this whole group are the ones with Medicaid. They are the ones who are guaranteed. The rest of them are not, and we will see very quickly why they are not protected. Remember now, 13 million have none and 10 million are employer sponsored, 5 million in HMOs, and 2 million in Medigap. Let's take the employer-sponsored group. Look at what happened in the employer- sponsored programs. This chart shows what has been happening in the employer-sponsored programs. Firms offering retiree health coverage dropped 40 percent between 1994 and 2001. That line is going down through the cellar of the Senate. Those 10 million who were covered by employer-sponsored plans are going right on down. They are being dropped every single day. Make no mistake about it. Under the Republican proposal that was before the Senate yesterday, this decrease would have been accelerated for 3 million seniors in that program because the employers would not receive any of the assistance they need to retain them. So the 10 million who have the employer sponsored are going down. We have the 13 million who have none and 10 million who are employer sponsored. They are increasingly at risk every single day. Well, you say, we still have 4 million who have HMO coverage. Look at the bottom line here. Look at the Medicare HMOs, reducing the level of drug coverage. This is going down every single year--70 percent of the HMOs limit their drug coverage to $750. So even if you have some coverage up to $750, you are paying higher and higher costs. That wasn't the case 5 or 7 years ago, but it is the case now. Fifty percent of the Medicare HMOs with drug coverage only pay for generic drugs. So this is what is happening now. The HMOs the 4 million people who have some kind of coverage are being restricted, they are being limited, they are being conditioned every single day. Increasing numbers of our seniors are not being taken care of. This is what we are facing in our country. The answer we had before the Senate yesterday was a comprehensive program built upon Medicare, which is affordable, which is dependable, which is reliable, which is defensible, and which the overwhelming majority of the elderly support. We have 52 votes for it. We would like to build on that. We are attempting to do so. Now, with the Republican program--as I pointed out, I didn't agree with it, I didn't support it. But at least those who did support it made the case that it was going to be able to provide universal coverage. They said, look, we can do it through the private sector, and if the private sector won't provide the coverage in remote areas, we are going to continue to fund them until at last they do. I suppose at the end of the day you can find someone who will sell a prescription drug program in a remote area of Alaska if you pay them enough to do so. Our concern is that with the amount of money we are spending to pay the private sector, we ought to be using it in the benefit package, ought to be enhancing the benefit package, providing additional kinds of relief for our senior citizens. Now along comes a proposal that is opposed by the AARP. Here is a letter that was circulated yesterday. It says: Given these concerns, the AARP opposes your amendment. The reason the seniors oppose it is they don't really believe that this will be any substantial or significant help, or even a little help, to the seniors in this country. They believe what we ought to do is build upon the Medicare system, a system that has been tried and tested, and has performed over the test of time. As the leading organization of the elderly finds, this proposal is completely inadequate. At least we ought to live up to our hopes and our dreams for our seniors, and that is to cover all of them. We ought to cover all of them. What happens to those seniors who are making $7,000 or $8,000, $9,000? They have to pay out $1,500. Think of this: An elderly person who has worked all of his or her life and has $9,000 in income. Now they have to pay out all of this money. They have to pay out $1,500 before they get any assistance at all. On what are they going to live? Think of the difficult choices and decisions they have to make to come up with that $1,500. Then they will have to pay a copay after that. A low-income person with only $18,000 in income will have to pay $3,500, 20 percent of their meager income before they get any help. This is well above what any average senior citizen is paying at this time. The average citizen is paying somewhere around $2,000. A person with an income of $18,000 will have to pay $3,500. They are making $18,000 a year and we are calling that moderate income. How do people get along with $18,000 a year to pay for a mortgage, pay for the heating of their home, pay for their food, pay perhaps for a summer camp for their children or grandchildren? How do people get along on that $18,000? The fact is, people are hard-pressed, and I think for us in this body to accept the concept that we have done something for our seniors with this is a complete misstatement. I just do not see how we can support this proposal. Nothing in this proposal deals with the cost of prescription drugs-- this limited program is unworthy of what we in this body ought to be about. 52 Members of the Senate on our side, and 48 Members on the Republican side voted for a universal plan. Now, we are back in less than 24 hours talking about a catastrophic program that will only reach a small number of people and will put people through the wringer to do so. I think this institution, this body, can do better. I strongly believe that seniors, who are faced with this national challenge and who are suffering and experiencing these extraordinary choices every single day deserves a great deal better. That is why I hope eventually that this amendment will not be accepted. I reserve the remainder of my time.

Mr. KENNEDY. How much time do I have?

Mr. KENNEDY

Mr. KENNEDY. I yield 1 minute.

Mr. KENNEDY. Do we have that understanding?

Mr. KENNEDY. Madam President, I point out to my friend from Oklahoma that there are no provisions in his bill that are going to require the insurance companies to provide more than two drugs in any therapeutic group in a formulary. There is none. What is beyond that is what the cost will be. In our bill, if the doctor recommends that a patient have a particular brand name drug that is not on the formulary, the patient can have it. We write in our bill how much that patient will pay, which is $40. But there is no such provision in the bill the Senator is talking about. The Senator cannot show in his bill what the premiums are, what the cost is for premiums, deductibles, or the copay. It is going to be what the insurance company wants to do. It is a blank check for the insurance companies. There is no provision in there that indicates what the costs will be. That is the big difference. Under the Graham proposal, which was spelled out in great detail last evening by Senator Graham and others, beneficiaries will be able to get that off-formulary drug, and the price will be $40. On page 29: Treatment of medically necessary nonformulary drugs will be whatever is medically necessary. Madam President, I withhold the remainder of my time.

Mr. KENNEDY. I yield 15 minutes to the Senator from Iowa.

Mr. KENNEDY. Madam President, I do not intend to object. If the Senator from Oklahoma should be provocative, which for a moment or two he might be, I hope I can yield a moment to the Senator from Iowa just to be quiet, calm and reserved, and then go to the 9 minutes for Senator Breaux.

Mr. KENNEDY

Mr. KENNEDY. I think the time has expired.

Mr. KENNEDY. Mr. President, pursuant to section 904 of the Congressional Budget Act of 1974, I move to waive the applicable sections of that act for purposes of the pending amendment, and I ask for the yeas and nays.

Mr. KENNEDY. Senior citizens and their children and their grandchildren understand that affordable, comprehensive prescription drug coverage under Medicare should be a priority. Let's listen to their voices instead of those of the powerful special interests. Let's pass a Medicare prescription drug benefit worthy of the name. Every single member of this body has a good prescription drug benefit. Let's do the same for the American citizens. That is what our program does.

Mr. KENNEDY. Will the Chair let me know when there are 15 seconds remaining?

Mr. KENNEDY. Mr. President, I yield 4 minutes to the Senator from Georgia.

Mr. KENNEDY. Mr. President, how much time remains on each side?

Mr. KENNEDY. Mr. President, this vote is one of the most important any of us will ever cast. It is a vote about our national character and national priorities. It is a vote about the quality of our society. But most of all it is a vote about senior citizens and disabled Americans and their right to live in dignity. Medicare is a solemn promise between Government and the individual. It says, ``Play by the rules, contribute to the system during your working years, and you will be guaranteed health security in your retirement years.'' Because of Medicare, the elderly have long had insurance for their hospital bills and doctors bills. But the promise of health security at the core of Medicare is broken every day because Medicare does not cover the soaring price of prescription drugs. Today, we have the opportunity and the duty to mend the broken promise of Medicare. It is time to pass a Medicare prescription drug benefit. It is time for Congress to listen to the American people instead of the powerful special interests. When I first came to the Senate, I was privileged to participate in the debates that led to Medicare's passage. Then, as now, there were two plans before us. One plan was the solid, dependable, comprehensive Medicare program that became law. The other was little more than a political fig leaf for the elections. One plan was supported by all the organizations representing senior citizens and working families. The other plan was supported only by the powerful special interests. That is the same situation we face today. Senators Graham, Miller, and I have offered a solid, affordable Medicare prescription drug benefit that offers senior citizens and disabled Medicare beneficiaries the protection they need at a price they can afford. There is no deductible, there are no gaps, there are no loopholes. The benefit and the premium are both guaranteed in the law itself. Low income senior citizens get special assistance. But the other side has taken a different approach. Their plan is not affordable, not adequate, and not Medicare. Under their plan, benefits are so inadequate that senior citizens will still be forced to choose between food on the table and the medicines they need to survive. There is a high deductible and a large coverage gap. Whether the senior citizen has large drug needs or more modest ones, the program only pays a small fraction of the cost of needed medicine--leaving the elderly to shoulder the rest or go without. Special help for the low income elderly is conditioned on a cruel and intrusive assets test. Instead of guaranteeing benefits for senior citizens, their program provides subsidies for insurance companies--and allows them to set the premium and determine the benefits that the elderly can receive. And to reduce the cost of their plan, they have set it up in such a way that it actually encourages employers to drop the good retirement coverage that more than ten million senior citizens now enjoy. According to the Congressional Budget Office, under the Republican plan one-third of these retirees--three and one-half million--would actually lose the good coverage they have today and be forced into the inferior Republican plan. From the AARP to the Leadership Council of Aging Organizations to the National Committee to Preserve Social Security and Medicare, virtually every organization representing senior citizens and the disabled supports our amendment. Not a single legitimate organization of senior citizens or the disabled supports their proposal. We are proud that our Democratic leader brought this matter to the floor of the Senate. This is the time for us to act.

Mr. KENNEDY

Mr. KENNEDY. Madam President, I commend our Senate leadership for moving so promptly to the consideration of the nomination of Dr. Richard Carmona to be Surgeon General of the United States. Today, the U.S. Senate is in the midst of an historic health care debate. So it is appropriate that we consider at this time a nominee to this position of such crucial importance to the public health. The Surgeon General is our Nation's doctor. He is our country's principal official on health care and health policy issues. He is the leader of the Public Health Service and the Service's Commissioned Corps, one of the seven uniformed services of the United States. In fact, almost exactly 204 years ago, the Public Health Service was created on July 16, 1798. President John Adams signed a law creating what was then called the Merchant Hospital Service for the care of sick or injured merchant seamen. Boston was the site of the first such facility, but the Service soon extended through the Great Lakes, the Gulf of Mexico and to the Pacific. As our country grew in the 19th century, so did the Service. It was Service physicians who inspected the immigrants who arrived at Ellis Island. Even then, the Surgeon General was at the head of national disease prevention campaigns against cholera, tuberculosis, and smallpox. When the Service was renamed the Public Health Service in 1912, it was the Surgeon General who was at the forefront in combating the great influenza epidemic of 1918. At a time when modern medicine was in its infancy, this epidemic took more than 600,000 lives, the worst epidemic in American history. I raise this history to make a simple point. The Surgeon General has been, and continues to be, one of the most important job in our National Government. Our Nation has faced extraordinary public health threats in the past, and today, the challenges are just as grave. Once, the threat was cholera. Today, it is AIDS. Smallpox threatened our cities in the 19th century. Today, it is bioterrorism. It will be the Surgeon General who will continue to promote and protect the health of all Americans. Over the years, our country has been blessed with courageous and outspoken Surgeons General. They did not allow politics to blunt their work to alert the public to health threats. By speaking the truth about public health, they enabled millions of our fellow citizens to live longer, fuller lives. We remember Dr. David Satcher's work on mental health and against the tobacco industry, and Dr. C. Everett Koop's historic leadership on AIDS. There is Dr. Julius Richmond's pioneering work on Head Start and, of course, Dr. Luther Terry's landmark report on smoking. These are big shoes to fill. But today, our country needs another such champion of public health. We need a strong and independent Surgeon General who will put public health first, and leave politics and ideology well behind. In this new century of the life sciences, the Surgeon General must help us take the breakthroughs at the lab bench and ensure they improve the lives of all Americans. He must lead our country in preventing tobacco use by our children and youth, expanding access to health care, ending disparities in health care among our nation's communities, improving childhood immunization rates, preparing for the threat of bioterrorism, and preventing the spread of the AIDS epidemic. These are heavy responsibilities, and they demand an individual of extraordinary expertise and experience, who has demonstrated a strong commitment to improving the public health. Dr. Carmona comes to us with an impressive background. He has taken on many important responsibilities. He is a trauma surgeon, a decorated police officer, a former health care administrator, and a former Green Beret. He is a father of four children. In addition to his heroic service in the Army and as a law enforcement officer, Dr. Carmona made his professional mark in the fields of trauma care and bioterrorism preparedness. The Committee carefully considered Dr. Carmona's nomination. In both his oral testimony and in response to written questions from the Committee, he satisfactorily addressed all the tough questions that would be expected for someone nominated to this important position. Dr. Carmona impressed us with his commitment to preventive health, and made particularly clear his intention to aggressively oppose tobacco use by our children and youth and to combat the HIV/AIDS epidemic. Dr. Carmona is a trauma surgeon and nurse by training. But he has assured us that he will also listen to, and learn from, the greater public health community. There is an army of health professionals and educators in our country eager to help him do his job. Theirs is an army waiting to be led in the campaign for better health. I would close by noting that Dr. Carmona is endorsed by the National Safe Kids Campaign, the National Alliance for the Mentally Ill, the American Medical Association, the American Dental Association, and the National Hispanic Medical Association. For these reasons, I support Dr. Carmona to be Surgeon General of the United States, and encourage my colleagues to vote in favor of his nomination.

Mr. KENNEDY. I ask unanimous consent that the motion to reconsider the vote by which the nomination was confirmed be laid upon the table, and the President be immediately notified of the action.

Mr. KENNEDY

Mr. KENNEDY. Madam President, I yield 30 minutes to the Senator from Florida, and I think I still have 12 minutes or so remaining?

Mr. KENNEDY. OK.

Mr. KENNEDY. May I have 2 more minutes, just on this point. I ask unanimous consent for that, and the same additional time for the other side.

Mr. KENNEDY. Senator, I am trying to get it out.

Mr. KENNEDY. Does the Senator agree with me that there is no requirement for a generic formulary in their proposal whatsoever?

Mr. KENNEDY. Mr. President, I believe I have 12 minutes remaining. I welcome the opportunity to inquire of my friend and colleague. I have a question or two about the legislation and some of the points that were raised earlier this evening. I believe all of us who have listened to the Senator from Florida commend him for a superb presentation. I particularly welcome the final comments he made with regard to what this debate is really all about: It is about real people. It is about a great generation. It is about seniors who have made a difference in building this Nation, who fought in the wars, who fought in World War II, who brought us out of the Depression, and who really made this country great. The Senator brought us back to that element. I certainly welcome it. All of us will be voting tomorrow, and hopefully we will keep that in mind. We heard earlier in the debate and the discussion that the proposal of the Senators from Florida and Georgia misleads the seniors of this country because it is going to sunset in several years. Therefore, we are misleading our seniors by promising them one thing today that after a period of years, by 2010, will not be available to them. I am wondering if the Senator would agree with me that if we had an authorization on Medicare back in 1965--say it was 6 or 7 years, and we came back to debate that--we certainly would have gotten a prescription drug benefit for seniors in this country much earlier than we are now able to, if we hopefully can get this passed. Does the Senator not agree with me that we would have assured some action? Will the Senator not agree with me that in 7 or 8 years we will have the opportunity to find out what needs to be done with this program to make it fairer and more effective for the seniors, and that this would be a welcome opportunity to do so? We should embrace this concept rather than retreat from it. I would be interested in the Senator's reaction.

Mr. KENNEDY. We will do 20 minutes evenly divided.

Mr. KENNEDY. Madam President, I will ask that we have a brief quorum call and that the time not be charged to either side. I suggest the absence of a quorum.

Mr. KENNEDY. If the Senator would refer to page 71, line 14, and I would ask the Senator from Texas to refer to those as well: ``Meets the resource requirements described in 1905.'' That is the assets test, included in the prescription drug program which we will be voting on tomorrow. Thankfully, we dropped that from the Graham proposal. It is in the Republican proposal, that provision, on page 71, lines 14 and 15.