Medicare

MEDICARE -- (House of Representatives - September 28, 2004)

The SPEAKER pro tempore. Under the Speaker's announced policy of January 7, 2003, the gentleman from Ohio (Mr. Brown) is recognized for 60 minutes as the designee of the minority leader.

BREAK IN TRANSCRIPT

Mr. PALLONE. Mr. Speaker, I want to thank the gentleman from Ohio (Mr. Brown) and also the gentleman from Illinois (Mr. Emanuel) for their comments because they are clearly right on point in talking about why this Medicare premium is going to increase so much in the next year and that this is directly the result of President Bush's policy and Republicans in this House's policy with the Medicare bill, the so-called Medicare prescription drug bill that the Republicans passed last year.

Sometimes I do not know whether to laugh or to cry. To laugh because the hoax that is being played by the Republicans and the Bush administration is so ridiculous, or to cry because of the fact of what the consequences are to America's seniors. And we have to understand, and I know all of us do, that this is something that is really going to hurt seniors. They cannot afford a 17.4 percent increase. These are seniors living on fixed income. The Social Security COLA this year, I do not know what it is, 2 percent, 3 percent, something like that.

Mr. BROWN of Ohio. Reclaiming my time, we do not know yet, Mr. Speaker, but it will be less than 3 percent.

Mr. PALLONE. Yes, Mr. Speaker. This Medicare Part B premium is five times the 17.4 percent increase, at least, of what their Social Security COLA would go up to.

Mr. STRICKLAND. Mr. Speaker, will the gentleman yield?

Mr. BROWN of Ohio. I yield to the gentleman from Ohio.

Mr. STRICKLAND. Mr. Speaker, so if a senior is on a fixed income and the Social Security premium goes up less than 3 percent and yet the Medicare premium goes up 17.4 percent, what is that senior on a fixed income to do when they are already living on the edge, they are already having a struggle to buy food and get their medicines, pay their bills, heat their homes? What are they to do? What does this President say to an 80-year-old man or woman who is living at the edge in terms of their income? What does this President say? What do the leaders in this House have to say to those folks?

Mr. PALLONE. Mr. Speaker, if the gentleman will continue to yield, I have to be honest, one of my concerns is, I mean we know that 99 percent of seniors pay the Part B premium because it pays for the doctor bills, but I would not be surprised if we start seeing a significant portion of them that do not even sign up for Part B because they cannot afford the premium. I mean that is my fear.

And the other thing I wanted to follow up on, though, because I think it says so much about what is going on here and shows how the Bush administration and Republicans have caused this premium.

We have got to understand that the gentleman from Ohio (Mr. Brown) said when President Bush spoke, he tried to give the impression that this was just some natural phenomena, or maybe even worse, it was caused by the Democrats.

This is directly the result of the Bush administration and the Republican Policy Committee, because when they passed that so-called Medicare prescription drug bill, what did they do? Essentially what they are doing is two things: one, giving more money to the insurance companies, particularly to the HMOs, and essentially trying to get Medicare privatized, to get seniors out of traditional Medicare, and this premium increase is a direct result of all that extra money that is going to pay for the HMOs or the other managed care agencies getting this increased money.

The other thing is it is the result of the fact that the Republicans are borrowing from the Social Security and the Medicare trust funds to pay for the deficit that has been the result, again, of their policies. They did all these tax cuts primarily for corporate interests and for wealthy Americans. They had to borrow from the trust funds, including the Medicare trust fund, to pay for those tax cuts, and created a deficit; and that is another significant reason why this premium is going up.

So when the gentleman from Illinois (Mr. Emanuel) talked about the GAO study, which was in the New York Times, today the New York Times had a article on this GAO study, and it is just incredible, because what it found is that Medicare is spending $650 to $750 more per year for each beneficiary in these private plans, these managed care plans. Even though we are spending all this extra money, which is causing the part B premium to go up so much, we are finding that it is costing the government more.

I just want to read this. It was just amazing to me. The New York Times today, the front page: Federal investigators said Monday that the Bush administration had improperly allowed, once again breaking the law, some private health plans to limit Medicare patients' choice of providers, including doctors, nursing homes and home care agencies. Investigators from the GAO also found that the private plans had increased out-of-pocket costs for the elderly and had not saved money for the government, contrary to predictions by Medicare officials.

They have been saying all along the reason we are giving this extra money to the HMOs and the managed care providers, in this case the preferred provider organizations, is because the beneficiaries are going to save money out of pocket. Now this finds out that that is not true.

So what do we have? We are giving the managed care companies more money. We are causing the part B premium to go up. As a result, the seniors are paying more out of money. And the Bush administration is doing all this illegally because they are limiting seniors their choice of doctors, nursing homes, and home care agencies.

The only person that benefits is the insurance companies and the HMOs. I guess, as the gentleman from Ohio (Mr. Brown) said, the Republicans benefit, because they get campaign contributions and other things from the insurance companies. But there is nobody that benefits here.

Even with all this going on, McClellan, the administrator of Medicare, insisted that private plans were an attractive option that would save money and improve coverage for beneficiaries. That was his response to the GAO report. Incredible. I just do not know where it ends. It is sickening.

Mr. BROWN of Ohio. Madam Speaker, reclaiming my time, I want to reiterate that this did not have to happen. We have a very good Medicare system. One of the great things about our system is while we do not always rank at the top around the world in our health care system because a lot of people do not have insurance and all that, if you get to 65 in this country, you in fact do have one of the longest life expectancies in the world because you have very good health care, you have Medicare.

You had a shortcoming. You did not have a prescription drug benefit. You still really do not because it is now a privatized insurance plan. But this did not have to happen. We did not have to take Medicare, one of the great programs this country has ever had, and do what the Republicans did.

I want to outline again, first of all, how they did it. If you do something, if you build a house in a way that is not structurally sound, if you do not use a good quality wood, if you cut corners, you are not going to have a very good house at the end. If you do not have good input into any manufacturing process, you are not going to have a very good manufactured product at the end.

Just again look at how the Republicans did it. They first told the American people and the Congress the bill would cost $400 billion over 10 years. It turns out there was an actuary at the Center for Medicare and Medicaid Services who said no, it will cost $534 billion; but he was not allowed to speak out. He was threatened by Tom Skully, the administrator, and I assume by the President also, who had to know this too, that it really costs $534 billion.

Mr. Skully has since moved on to work as a lobbyist for the drug and insurance industry, no surprise there, while the President has taken tens of millions of dollars apparently to thank him for the Medicare bill. We will get to that in a moment. But the cost estimates were hidden from the Congress. They simply did not tell us the truth about how much it was going to cost. Then the administrator violated ethics laws by the way they treated that employee and other ways.

Then the way it passed this Congress, we remember that night, the debate started at midnight, the vote started at 3 o'clock in the morning, the roll call was kept open for 3 hours. They literally tried to bribe one Member.

Mr. PALLONE. Madam Speaker, if the gentleman would yield further, if I could interrupt, the one thing I thought was so significant and maybe was not played up enough, there was a majority of the House of Representatives that voted "no" on that bill, 218, a clear majority. There was absolutely no reason to leave that board open, because a majority had voted "no." So they basically spent, as the gentleman said, 2 or 3 hours persuading the people that voted "no" to switch their vote.

Mr. BROWN of Ohio. Madam Speaker, reclaiming my time, "persuading" is a very nice word. They did well beyond persuading. They arm-twisted, they cut deals, they tried to cut deals, they made offers, they tried the carrot, they tried the stick, they tried to bribe a Republican Member from Michigan, who talked about it the next day.

So this whole process, from the conception of the bill written by the drug and insurance industry to the cost estimates hidden and then lied about, the ethics violations, then the middle-of-the-night vote, then the bribing of a Member of Congress, the attempted bribing of a Member of Congress, and then the bill passing in the middle of the night, it is no surprise that this bill led to a product where seniors got a 17.4 percent premium increase. Again, the largest increase in Medicare history.

In the 1990s, in the second half, the premiums stayed almost the same. It was between about $46 and $50, within a dollar or two, every year for 4 or 5 years. President Bush came into office. Now it is up to $78 and some cents. It has gone up double digits more than once, and this time it went up 17 percent. Why? Because of all these things that happened.

This was not an accident that it went up 17.4 percent. It went up that much because they lied about the cost and they covered it up, the President and the administration and the Office of Medicare, CMS. Then they violated election laws. Then they strong-armed Members. Then they tried to bribe somebody. Then the bill contained a huge payout to the insurance industry, $290 million every month for 22 months before the bill, the drug benefit, was even into effect in 2006. So the increase to seniors was 17.4 percent.

Of course, the Republicans had to collect their money from the drug and insurance industries for their campaign this year. Republicans may have a good year this year in the election because they have so much money from the drug companies and so much money from the insurance companies. But it is morally reprehensible and outrageous how they did it, and even more outrageous, what ultimately happened to this bill.

Mr. STRICKLAND. Madam Speaker, if the gentleman will yield further, I was just standing here thinking if you are a working person, if you are a senior citizen, if you are a veteran in this country, you had better look out, because this administration is out to get you. They are cutting veterans' health care funding. They certainly are not doing anything for the working people, who are seeing the tax burden of this Nation shifted more and more from the very wealthy on to the backs of the working folks. And then when it comes to the older people in this country, when it comes to our senior citizens, they are really getting the shaft.

The fact is that since George Bush became President, Medicare part B premiums have increased 56 percent. In less than 4 years they have increased 56 percent. But back home in Ohio, in Southeastern Ohio, we have an old saying about the chickens coming home to roost. I think the chickens are coming home to roost for the Republicans, because the senior citizens are starting to understand what is happening to them.

A story in the Columbus Dispatch, September 12, it says: "Medicare expense becoming a big issue in the election fight." If I can just share the opening paragraph, it says: "Medicare has emerged as a volatile issue in this year's elections as Democrats vow to roll back a sharp increase in premiums announced this month."

Those premiums are increasing, as has been said here, 17.4 percent. That means that beginning in January, and that is after the election, but beginning in January a senior citizen will be required to pay for part B, their Medicare part B premium, $78.20. That amounts to $938.40 a year.

I repeat to my friend, the gentleman from New Jersey (Mr. Pallone), the question I asked him a little earlier: If you are a senior citizen and you have health problems that require medication to keep you healthy or to keep you alive, in many cases, and you are on a fixed income, as many of our seniors are, and this President decides to increase your premium 17.4 percent, and your Social Security cost of living increase is less than 3 percent, what can you do? Where can you go to get what you need to buy your medicine, to pay for your food, to heat your home, to pay your rent?

That question is facing hundreds of thousands of American senior citizens tonight, and this President has an obligation to speak to that question, because he is the one who is responsible for putting this additional burden on the backs of our senior citizens.

Mr. PALLONE. Madam Speaker, if the gentleman will yield further, I just want to say two things in response. One is I think we have to keep repeating that this is the policy of the Bush administration and the Republicans in Congress. They have forced this 17.4 percent increase, because of their giving the money back to the insurance companies, the extra money to the HMOs and managed care, and because they are borrowing from the trust fund.

But I want to say I have had a couple of seniors contact me over the last few weeks, because they point out that the costs are even higher. One of the things not mentioned here, and I forgot exactly how much it was, but the Medicare bill actually has an increase in the deductible too. Does it go to $150 instead of $100? I do not know exactly the amount.

But this is the first time in the whole history of the part B program that the deductible is going to increase. So if you add that, and, remember, everybody is going to pay that, because when you go on January 1 and buy your first prescription or your first series of prescriptions, instead of $100, I do not know what it is going up to, it is going up beyond $100. I do not know if it is $150 or whatever at some point. So that is going to be an extra amount of money out of pocket.

Then if you look at what the GAO study says today in terms of the money for these HMOs, what they did is they waived the out-of-pocket limits. So in other words, what this GAO study is saying today, it is costing the senior more if they have joined these PPOs, a form of managed care, because they are going to pay more out of pocket. Think about it: premiums going up, deductibles going up, out-of-pocket expenses going up, because they have waived the requirements.

Mr. STRICKLAND. Madam Speaker, if the gentleman will yield further, I think it is appropriate for us to ask how would this country be without Medicare. There are some people in this administration who never believed in Medicare from the beginning. They opposed it from the very beginning. They think it is something like socialized medicine, and they think that the private sector is not being able to get its fair share.

So, quite frankly, what we face with this administration, and I believe with the President, are individuals who simply do not believe in Medicare as such.

Otherwise when they talked about a prescription drug benefit, they simply would have made this benefit a part of traditional Medicare. They would simply have added A, B, C, and part D and said that is the prescription drug benefit to Medicare. We would have had a modest premium, and it would have been a part of traditional Medicare. But no, no, no, they want to go to the private sector. As a result of going to the private sector, as the gentleman has said, it is costing more, seniors are more limited in their choices, their premiums are going up, their deductibles are going it up, and they will continue to go up.

This year, it is 17.4 percent. Next year, when there is no election facing the administration, if they happen to retain power, it could be 25 percent. No one knows what is going to happen, because this administration, I believe, fundamentally does not believe in traditional Medicare.

So what do you do when you do not believe in a program? Well, you try to change it fundamentally, and that is what they are trying to do. This is the first step in the privatization of medicare, to relieve the government of this responsibility. And I ask, what would America be like tonight without Medicare? If George Bush and the leadership of this House and the Senate of this country have their way, we may find out what America will be like without Medicare.

Mr. PALLONE. Mr. Speaker, I will just read this one section from this report, and then I will yield back to the gentleman from Ohio (Mr. Brown). Again, this is the GAO, the Government Accounting Office, nonpartisan; this is not Democrat or Republicans saying this. This is what the report said: "To draw PPOs," which is a form of managed care "into Medicare," the report said, "the Bush administration offered to pay them more, waive stringent standards for the quality of care, and remove limits on the costs that beneficiaries might be required to pay. As a result," the GAO says, "these plans were subject to no statutory or regulatory limits on cost-sharing for beneficiaries."

Quality of care, cost, standards, they do not care. They are just giving money to their friends, the insurance companies.

BREAK IN TRANSCRIPT

Mr. PALLONE. Mr. Speaker, I just wanted to add a couple of things about price, because I think it was the gentleman from Illinois (Mr. Emanuel) who said earlier that what this is all about is price and cost and how much people are paying out of pocket. I mean, the reason that my colleague, the gentleman from Ohio (Mr. Brown), started this Special Order tonight is because of this 17.4 percent premium increase in Medicare part B, but we have already talked about all of the other additional costs.

One of the things that I think has not been highlighted, and I am not talking about with us, but just in general, is that when this so-called prescription drug benefit, and I do not even like to use the term, kicks in in a couple of years, all of the information that Republicans are giving out relative to the cost, none of it is true. They act as if there is going to be a set premium, that there is going to be a set deductible, that there is going to be some list or formula that is going to include drugs, certain drugs. None of these things are true. There is absolutely nothing in the bill that sets the premium. The premium for the drugs could be $100 a month. Who knows? The deductible, we are thinking because we think of part B that the deductible is $100, the deductible could be $200, $300. There is absolutely nothing in this bill that dictates in any way what the price is going to be for the premiums, for the deductibles, for anything, or that any particular drugs are going to be included. Everything else is true too.

In the interim, we have these so-called drug cards, right? Now, you and I know the seniors are supposed to go on the Internet and figure out whether or not it is worth it to buy one of these drug cards because you look to see whether or not certain drugs that you might want to take are included on these so-called discount drug cards. But we know that that price can change next week. So they could increase the price, and you might find that you sign up and pay for the drug card and then the cost is two or three times. There is nothing here. The idea of not negotiating the price extends not only to the price of the drugs, but to every aspect of this: premium, deductible, you name it.

BREAK IN TRANSCRIPT