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Public Statements

Authorization of Use of Force

By:
Date:
Location: Washington, DC

March 21, 2003

AUTHORIZATION OF USE OF FORCE

Ms. CANTWELL. Mr. President, I rise today as a cosponsor of the Dorgan prescription drug amendment to the fiscal year 2004 budget resolution.

The fact is, when Medicare was designed in 1965, the system relied on inpatient hospitalization and seldom on outpatient services, preventive care, or patient drug therapies. At that time, prescription drugs only accounted for 4 percent of all personal health care expenditures.

But as we enter the 21st century, the cutting edge of health care has shifted. Every day, as new preventive and therapeutic drugs replace outdated inpatient procedures, Medicare falls further and further behind in providing basic care.

Medicare was written to cover the most basic health care for seniors. When the original bill passed, the legislation's conference report explicitly stated that the program was designed to provide adequate "medical aid .    .    . for needy people, and should "make the best of modern medicine more readily available to the aged."

Well, we are not making the best use of modern medicine when millions of seniors cannot afford the prescription drugs they need. Prescription drugs that had not even been developed when Medicare was enacted are now an essential aspect of basic health care. We owe it to our seniors to live up to Medicare's original mandate and provide them the best medical care.

Unfortunately, today, beneficiaries' current drug coverage options are often expensive and unreliable. And as a result, nearly 7 out of 10 Medicare beneficiaries lack decent, dependable coverage for their prescription drug needs, and more than one-third have no coverage at all. Prescription drug expenditures for the average senior in my home state of Washington are over $2,100 every year—over 122,000 of my seniors spend more than $4,000 a year.

On average, $1 out of every $5 of every Social Security check to Washington State's seniors is spent on prescription drugs. And seniors with the most serious illnesses spend nearly 40 percent of their Social Security check on prescription drugs.

Senator DORGAN's amendment would ensure a fair and adequately funded Medicare prescription drug benefit. The budget resolution, S. Con. Res. 23, currently reserves up to $400 billion for the Finance Committee to report legislation that strengthens and enhances Medicare, improves the access of beneficiaries under that program to prescription drugs, or promotes geographic equity payments.

This amendment would first increase the Medicare reserve fund by about $220 billion, for a total of $620 billion. The amendment also specifies that beneficiaries in traditional Medicare should receive a drug benefit equal to that of beneficiaries who enroll in private health plans.

The $400 billion that is proposed in the committee resolution for the Medicare reserve fund is not adequate to provide prescription drug coverage for all seniors, because this funding could be used for other Medicare "reforms"—leaving even less for prescription drugs.

The Dorgan amendment would ensure adequate funding for a reliable prescription drug benefit in Medicare for all beneficiaries. Seniors should not have to abandon traditional Medicare—and join an HMO or other private health plan—to receive the prescription drug coverage they need. The Dorgan amendment ensures fairness: all beneficiaries would have a prescription drug benefit without being forced into HMOs and other private health plans.

In addition to providing a comprehensive, affordable, and adequately funded prescription drug benefit for all Medicare beneficiaries, the amendment would be fiscally responsible by including language to decrease the deficit by $250 billion and reduce the proposed tax cut by roughly $400 billion.

As I visit senior citizen centers in my State of Washington and discuss a prescription drug benefit, my constituents repeatedly tell me the same thing: They want prescription drug coverage to be comprehensive, simple to administer, guaranteed, stable, and based on the very best medical technology. And most importantly, seniors do not want their prescription drug benefit run through an HMO or other private insurance company.

In fact, according to a June 2002 survey by the Kaiser Family Foundation and the Kennedy School of Government, 67 percent of American people believe we should expand Medicare to pay for part of prescription drugs, but only 26 percent say we should help seniors buy private insurance to pay for prescription drugs costs.

Seniors want a prescription drug benefit run through Medicare—a program they understand and upon which they depend. The Dorgan amendment would ensure that seniors have this choice.

Despite basic Federal standards included in Bush's Medicare Prescription Drug plan, a private delivery model means that insurers can vary premium costs, benefit design, and the availability of drug coverage across the country. They can create strict formularies that limit access to prescribed drugs and bar access to local pharmacies. That's too much flexibility in a program that is supposed to guarantee help for seniors.

The very basic issue here is that the private market will not cover such a high-risk population—especially a population at such risk for adverse selection. I don't want to see this benefit be a repeat of the Medicare+Choice program. And if the private insurance model hasn't worked for the full Medicare benefit, it certainly won't work for a single benefit where utilization is expected to be high.

For seniors who choose to remain in the traditional Medicare program, the Bush plan proposes a prescription drug discount card. The GAO estimates that the prescription drug discount cards will provide less than a $3.50 discount per prescription. However, the National Association of Chain Drugstores estimates that the average retail cost for an outpatient prescription drug in 2001 was $54.55.

Clearly, the prescription drug discount cards do not offer a viable prescription drug benefit for America's seniors. In addition, the low-income subsidy of $600 to supplement the prescription drug discount cards is a false promise of assistance for seniors, who spend an average of $2,317 on prescription drugs each year.

Seniors account for 12.6 percent of the general population—but a third of all prescription drug expenditures. And while prescriptions are expensive—in some cases, prohibitively so—these are the very same prescription drugs that keep people out of the hospital, out of the nursing home, and living vibrant and happy lives. And while it is difficult to quantify in economic terms, prescription drugs preserve health and eliminate unnecessary hospitalization—which is by far most expensive segment of the health care.

Americans are becoming increasingly reliant on more effective—and more complicated—drug therapies. Total health care spending in the United States will total more than $1.5 trillion this year, an increase of 8.6 percent over last year, according to a March report released by the Centers for Medicare and Medicaid Services.

Prescription drug expenditures are the fastest growing segment of the health care market—with spending on outpatient prescription drugs by Medicare beneficiaries alone increasing by 12 percent annually. CMS predicts that prescription drug expenditures will continue to increase faster than any other category of health care spending throughout the next ten years.

In 1970, drug expenditures in the United States were about $5.5 billion. Now, for Medicare beneficiaries alone, the CBO projects that total drug spending will grow from $95 billion in 2003 to $284 billion in 2013. This is a total of $1.8 trillion on prescription drug costs over the next ten years. Medicare beneficiaries alone will spend $1.8 trillion on prescription drugs over the next ten years.

But while we discuss the potential cost of a new benefit, we also need to discuss national priorities. I believe we can do a fair and adequately funded prescription drug benefit while living within our budget, and we can do so by having a clear vision for our country's priorities. One of my top priorities is getting a new prescription drug benefit to the Medicare beneficiaries in Washington State. But this may mean making other tough choices.

I strongly believe that we need to include a prescription drug benefit in the Medicare program and I will continue to fight to ensure that all Washingtonians have access to the prescription medications they need.

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