Medicare Prescription Drug, Improvement, and Modernization Act of 2003-Conference Report

MEDICARE PRESCRIPTION DRUG, IMPROVEMENT, AND MODERNIZATION ACT OF 2003-CONFERENCE REPORT

Mr. DURBIN. Under the unanimous consent, I believe I have been allocated 5 minutes. Is that correct?

The PRESIDING OFFICER. That is correct.

Mr. DURBIN. I ask for 4 and ask if the Chair will notify me when I have 1 minute left.

A few minutes ago, the Secretary of Health and Human Services, Tommy Thompson, was on the floor. It is his right to visit with us. It is an opportune moment for him to come as the Senator from Pennsylvania reminds us that we are not going into socialism, socialized medicine, command and control; we are not going to have the Government bargaining on the prices of medicine.

Yet I guess the Senator from Pennsylvania has forgotten that during the anthrax crisis when Cipro, which was going to be used as an antidote, was $4.67 a pill, Secretary Thompson negotiated for America to reduce the price of that drug in the midst of the crisis to 75 cents. He was quoted as saying:

Everyone said I wouldn't be able to reduce the price of Cipro. I'm a tough negotiator.

Sounds a lot like command and control for me.

For Americans, they are taking a look at this bill and saying: Who is going to speak for us? This 1,100 page bill prohibits reimportation of drugs from Canada. So our friends, the seniors and families and others who are looking there for relief, they will not be getting it out of this bill. Even worse, as has been noted, in this one page that I take out of 1,100, page 53, lines 18 through 26, we prohibit Medicare from negotiating lower drug prices.

The Senator from Pennsylvania says that is because we believe in the free market. Let the market set the price.

I might say to my friend from Pennsylvania, how do you explain the multibillion-dollar subsidies for HMOs included in this bill? How do you explain the $6 billion subsidy for your friends with health savings accounts in this bill? Frankly, you can't, under free market principles.

Let me say, when you take a look at this bill you understand that we are squandering $6 billion for retiree coverage. That is one of the key elements. We create these new health savings accounts. I will not go into the long and lurid history, but when Mr. Newt Gingrich of Georgia took control of the House, he brought with him one of his best pals, the Golden Rule Insurance Companies from Lawrenceville, IL. In fact, the Speaker was so smitten with this company he cut a television ad for them with their medical savings accounts. Frankly, they returned the favor, contributing over $3.6 million to Republican congressional candidates. It was such a sweet arrangement. They would pass bills sending more business to Golden Rule, Golden Rule would send millions of dollars to Republican candidates.

Frankly, that meant nothing compared to this bill. This bill gives $6 billion for health savings accounts that have nothing to do with Medicare and nothing to do with prescription drugs for seniors. This is the largest single giveaway I have ever seen in 21 years. It is in this bill.

Now, let me connect the dots. Turns out Golden Rule Insurance Company was recently purchased. Who bought Golden Rule Insurance Company? A group called UnitedHealthcare, down here, whose CEO, Channing Wheeler, was paid $9.5 million, a sweet salary; compared to other HMO execs-not that great.

Now connect the dots. Golden Rule, a friend of the Republican Party, purchased by UnitedHealthcare; UnitedHealthcare is the largest insurance group working with AARP. It all comes together.

AARP is selling this product for UnitedHealth Group, a $6 billion subsidy in this bill, and now they have discovered this is the best bill in the world.

I suggest to all my colleagues and all those watching this debate, call AARP. Here is the telephone number, 1-800-424-3410. Tell them to stand up for seniors for a change, tell them to fight for Medicare, tell them to stop the sweetheart deals with Golden Rule and UnitedHealthcare. We need to make sure the people who wrote this bill get back to work and eliminate these giveaways, the multibillion-dollar giveaways, the subsidizing for these great free market disciples that are included in this bill. And we need to do it now. Sustain the point of order. Vote no on the waiver of the point of order.

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Mr. DURBIN. If the majority leader will yield for a question, is it the intention of the majority leader to adjourn after that vote?

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

Mr. DURBIN. Mr. President, if the majority leader will yield for another question, will there be an effort to extend unemployment compensation benefits before we adjourn?

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

Mr. DURBIN. I thank the majority leader.

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Mr. DURBIN. Mr. President, I sincerely hope we do something about unemployment compensation benefits. We will be gone for 2 months. Nine million Americans are out of work. Three million have lost their jobs since this President took office. Frankly, many of them have seen their unemployment benefits expire.

Historically, traditionally, on a bipartisan basis, we have extended those unemployment benefits. I think it is a sad situation if we adjourn before this holiday season leaving literally millions of American workers without the basics they need to keep their families together. I hope if we do nothing else, we achieve that.

Those who may be following this debate may wonder why, at 20 minutes to 10 this evening, on November 24, Senators are still on the floor speaking about this legislation. This bill, which in its totality is about 1,100 pages long-and the sponsor of it, Senator Grassley, my friend, has admonished me not to say that the bill is 1,100 pages long but that the bill and its committee report is that length-is a historic piece of legislation.

There are some of us who believe, if this bill passes tomorrow, in the morning, as it is likely to do, that, frankly, for years to come people will be asking questions about how various Senators felt, how they voted, and what they did during the course of this debate. Those who support it believe it will be good and they take great pride in it. Those of us on the other side believe this legislation is an abomination. When we consider the opportunity we had and the challenge we had when this legislation was brought before us, this bill fails to meet the test.

It fails in this respect: We started off saying we need to help senior citizens pay for prescription drugs. Medicare did not include that benefit, and it should have. We know now that prescription drugs keep seniors healthy and strong and independent. We should give them a helping hand to pay for those expensive drugs. I think everybody agreed with that premise.

Then, when we started the debate, things started to change, because in order to achieve that goal many of us thought the Government would have to step in with some money to help seniors but also we would have to say to the drug companies, you have to charge reasonable prices for your drugs. I think those two go together.

To think that the Federal Government is going to somehow subsidize the cost of prescription drugs and do nothing to bring those costs down, frankly, is counterproductive. We cannot appropriate enough money to keep up with the meteoric rise in the cost of prescription drugs that seniors and other families across America face.

Sadly, the Senate passed a bill, supported by Democrats and Republicans, which at least moved in the direction of change but did not move far enough. It did not contain any cost containment. It did not challenge the drug companies in America to treat Americans fairly.

That bill passed and went to conference committee. We hoped it would be improved, but it was not. In fact, the bill was worsened in many respects.

As a result of that, many of us who had hoped for a prescription drug benefit for seniors are going to oppose this particular legislation because it does not achieve that goal.

Sadly, it brings another element to the debate, for which many of us never bargained. There are those in the Congress who believe we have to basically dismantle and fundamentally change Medicare.

Medicare, a system of health insurance for seniors across America for over 40 years, has given seniors quality of life and quality health care, and statistics prove that it has worked. Seniors live longer. They are more independent. They are healthier. Medicare has proven that if we have Federal leadership, we can have doctors and hospitals providing the best care to our mothers and fathers and our grandmothers and grandfathers.

But there are some who opposed it from the beginning, calling it socialized medicine, and others who do not want to meet the obligations of Medicare as the baby boom generation qualifies to receive it. So they have set upon a path to basically change Medicare as we know it.

That was never part of the bargain. This was supposed to be about prescription drugs and seniors. Instead, it switched into a new realm. The House Republican leadership pushed into this conference committee a dramatic, and some say drastic, change in Medicare for its future. That has forced many of us to not only oppose this bill but to oppose it strongly, believing our first obligation is to protect Medicare and our second obligation is to give seniors the benefit they need for prescription drugs.

This bill has failed. This bill will raise Medicare premiums for millions of senior citizens. It will force many senior citizens into HMOs. I do not have to explain HMOs to people who have tried to live with them. A health maintenance organization or similar insurance company basically rations care. It picks the doctor, not the individual covered or insured. But the HMO will pick your doctor and pick your hospital.

I think we have all heard the horror stories about HMOs that basically have denied care, denied basic medical procedures because they do not believe it is a worthwhile economic undertaking. So doctors make decisions about what you need to stay healthy, and HMOs overrule the doctors.

Senator Kennedy, who is on the floor, and will speak after I do, has been a leader in this Senate, in the Congress, on a Patients' Bill of Rights. Why did we have to create a Patients' Bill of Rights? Because of the abuses of HMOs. And that is no surprise to people who have tried to live with them.

Now, this bill, pushed by the Republican leadership, wants to move America's seniors out of Medicare and into these HMOs. They believe that is a better way to go, to ration health care through HMOs. They want the HMOs to pick the doctors and the hospitals. They do not want the seniors to choose them, as they do now under the Medicare plan.

The original argument was that these private insurance companies, because they would be competing in the open market, would provide more economical care for seniors. But, of course, that premise was destroyed by this bill because they included in the bill a $12 billion slush fund, $12 billion of Federal tax dollars that will go to subsidize the HMOs. In other words, they not only do not have to prove profitability; they can enjoy a Federal subsidy as they try to lure the healthier seniors out of Medicare, leaving behind poorer and sicker Medicare recipients who will drive up the unit cost of care under that traditional program, making it more expensive to Congress and the American people, and its critics hope will lead it into a period of unpopularity and perhaps abandonment.

I believe that is their ultimate goal. I think that is what they are setting out to do. They want to force seniors into HMOs, subsidized, incidentally, by Federal tax dollars. They want to undercut full Government funding of Medicare.

That is not why I signed up for this debate. It is not the reason most Senators got involved in it. It, frankly, represents a distorted view of what we were setting out to do.

It also is going to eliminate drug coverage for millions of retirees. The Congressional Budget Office, which makes projections, tells us that 2.7 million retirees in America who currently have health care benefits, including prescription drugs-2.7 million will lose that coverage because of this bill.

There is already a trend in America to take away health coverage for retirees. It is expensive. Many of the companies would like to get rid of it, if they can. The CBO tells us, the Congressional Budget Office tells us, this bill will create a lure and a force to draw these retirees out of their current health care benefits in retirement into a situation where they are not insured-2.7 million.

In my home State of Illinois, 100,000 retirees will lose their health care benefits because of this bill. Was that ever part of the bargain? Did we go into the debate saying, we are going to provide prescription drug coverage to seniors but in the process 100,000 in my State are going to lose their health care coverage?

That is the result, and not a result on which we are speculating. It is from the Congressional Budget Office, as they reported it to us.

There is another element here as well. There is an element that I think really tells the story about why this bill is so popular in some quarters in Washington-not among seniors but with some special interest groups.

You should have seen the area right outside the Senate Chamber this afternoon when the key votes were coming down. You could not even walk through. It was packed with lobbyists.

Now, there is nothing wrong with lobbyists. Lobbyists perform a valuable function when they come to Government and tell us both sides of the story. As a Member of the House and Senate, I value lobbyists who are honest and tell me their side of the story.

But if you took a look at the lobbyists in the hallway outside on this vote, you noticed, overwhelmingly, they were lobbyists supporting this bill and lobbyists representing pharmaceutical companies and HMOs.

Why would pharmaceutical companies support a bill that is supposed to lower prescription drug prices for seniors?

The obvious reason is that under this bill there is no cost control. There is no cost containment. There is no restraint on those drug companies charging even higher prices. In two particular areas, this bill is going to keep drug prices high, not just for seniors but for families across America. This bill virtually prohibits the reimportation of United States-made drugs from Canada and other countries. We have seen the news reports. Seniors in Minnesota, Michigan, and New England are traveling into Canada to buy drugs, American drugs, at a fraction of the cost. We put a provision in the House version of the bill and the Senate version of the bill to allow that trade to continue so that seniors could take advantage of the lower prices.

I have always said that we are not importing drugs from Canada, we are importing political leadership from Canada. Canada and its Government stood up for its people and its senior citizens. Canada said to the drug companies, represented in our hallways by the lobbyists: You can't charge whatever you want to charge. You have to keep your charges reasonable.

Because Canada imposed these standards and would not allow the prices to go sky high, they deeply discount the same drugs sold in America. This bill virtually closes the door for importation from Canada. It is the answer to the prayer of our pharmaceutical companies that don't want cheaper drugs coming to this country so they can sell more expensive drugs to Americans currently living here.

Also, this bill prohibits Medicare from negotiating lower drug prices. When we started this debate on prescription drugs, virtually every senior I talked to said: Senator, I don't understand why it is taking so long to see the obvious. If Medicare as a program offered prescription drugs, that would be the best approach. It would be a universal voluntary program covering everyone under Medicare. Medicare as a program could bargain for lower drug prices and say to America's drug companies: If you want to sell us a drug for high blood pressure, then you have to give us a reasonable price or we will look to another company with a comparable drug. We do that with the Veterans' Administration. We could have done it with Medicare. But this bill expressly prohibits Medicare from entering into these negotiations to lower prices. Why? Because the same drug companies that fought reimportation of drugs don't want to bargain with Medicare. As a consequence, the seniors are the losers. That is basically what we are going to deal with. We are going to continue to see outrageously high prescription drug costs.

Let me give an illustration of one element that I am not sure has been addressed during the course of this debate. That may be hard to believe after 3 full days and more of debate. This bill lacks any serious attempt to lower the cost of prescription drugs. We can reasonably assume that prescription drug prices will continue to rise about 15 percent annually as they have in the past. It is one of the most inflated costs in our health care menu of opportunities, prescription drug prices. One major employer in Illinois, Caterpillar Tractor Company, self-insured for health insurance, told me the price of prescription drugs was the biggest single problem they are facing for employees and retirees.

Consider the example of a senior citizen struggling to make ends meet, the kind of senior we were supposed to help with this bill, a senior who in 2006, when this bill will first go into effect, has an income of $20,000 a year. That is probably in the high end for many seniors. Some survive on much less. But for purposes of illustration, this senior has an income of $20,000 and is struggling to devote 25 percent of their income to paying a $5,000-a-year pharmaceutical bill. Five thousand a year is a little more than $400 a month. Believe me, I have met seniors who are paying an awful lot more than that.

So here we have a senior, $20,000 in retirement income, and $5,000 in annual drug costs. Now let's consider what this bill is going to mean to that senior. This bill steps in and cuts that senior's costs by $1,080. That is not much. That is about 22 percent of the senior's costs. I think it ought to do more, but it is something, to cut the $5,000 bill by $1,080. That is what this bill does. But what happens when year after year the senior's income goes up at the rate of inflation, roughly 3 percent, while the pharmaceutical companies' charges for prescription drugs increase at 15 percent a year? Income going up 3 percent; cost of drugs going up 15 percent a year.

By the year 2015, 9 years after this bill goes into effect, the senior's income will have grown 30 percent to $26,000. The drug costs of $5,000 when it started will have mushroomed to $17,600, a 15 percent increase unchecked versus a 3 percent increase in income. Do you know how much of that $17,600 will be paid by the Government under this bill when we have this period of time, 9 years after it goes into effect? I can tell you: It is $3,800-22 percent of what the senior is supposed to pay. So the senior's out-of-pocket prescription drug costs, not paid by the Government, would be $13,800, 53 percent of the senior's income. So even with the assistance under this bill, unchecked prescription drug inflation will drive seniors in a decade or more from spending a fourth of their income on prescription drugs to spending more than half of their income under the scenario I have just described.

Why? Senior citizens' out-of-pocket drug costs go up even with this bill because the bill does nothing to rein in unsustainable inflation in prescription drug costs. That doesn't help seniors. They need us to take action to bring down the cost of medication.

If you take a look at the pharmaceutical companies and their approach on this bill, here is what they wanted when we started this debate. They wanted private-insurer-administered drug benefits that dilute purchasing power. They got it. They wanted financial incentives for HMOs, another step away from Medicare. They got it. They wanted a prohibition on Medicare negotiating prices. They received it, which I think is the fatal flaw in this legislation. They wanted meaningless reimportation. They got it. So getting drugs from Canada becomes even more difficult. They wanted watered down generic drug access provisions. They were successful. They wanted no public scrutiny of secret PhRMA-insurer kickback arrangements. They got that protection. And, finally, they wanted huge windfall profits, and they will get it.

Wall Street has already costed this out. Pharmaceutical stocks, which were already the most profitable in America, will continue to be such. The loser will be senior citizens who were supposed get the help. That is why the pharmaceutical companies line up outside the door to the Chamber cheering for those who want to vote for this bill-because they know it means more money in the bank.

What I have given you here is not an extreme example; $5,000 a year for prescription drugs for a senior is sadly a reality. The seniors who will face this without a helping hand from the Government in terms of paying these inflated costs of drugs are going to struggle, and they may not succeed in paying for those drugs.

Let me show you this, too. Here are the compensation levels of those who run HMO insurance companies I described earlier. Remember what I said: The intent of this bill is to move seniors out of Medicare into HMOs. These are compensation levels: For companies such as Aetna, here is their CEO, he received $8.9 million; Anthem, $6.8 million; CIGNA, $5.9 million; Coventry, $21.6 million compensation for their CEO; Health Net, $6 million; Humana, $1.6 million; Oxford, $76 million for Mr. Norman Payson, not a bad year; PacifiCare, $3 million; Sierra Health, $4.7 million; and then we get down to United Health Group, this group with a CEO by the name of Mr. Channing Wheeler; he received $9.5 million in compensation.

I would like to stay with United Health Group for just a moment. This is not just another HMO, this is an HMO that is extraordinarily blessed by this bill. Let me tell you why. In addition to $12 billion in a slush fund to subsidize and underwrite HMOs that are going to compete with Medicare, there is an additional provision in here that gives $6 billion for a theory of health insurance called health savings accounts. If you have followed the debate in Washington, you may know that some 9 years ago, a company based in Lawrenceville, IL, the Golden Rule Insurance Company, dreamed up this basic insurance idea that said: We will say to people that if you will take a high deductible health insurance policy and do not use all that you could in terms of health expenses during the course of the year, we will refund some of your money at the end of the year; so it is not only health insurance lite but a chance to recoup your money. They called it medical savings accounts. This was the darling of then-Speaker Newt Gingrich and his conservative Republicans.

They believed this was the answer to America's prayers for health insurance. We have eventually put in a demonstration project and said let's at least try this concept and see how many people want to buy into it. It was a dismal failure. Very few people signed up. That didn't stop the efforts to include some provisions to help that concept of medical savings accounts-now called health savings accounts-in this bill-not just to help them get started but a $6 billion slush fund of Federal tax dollars to underwrite health savings accounts.

Let me say, it is not a one-way street. In order to win the attention of Congress and $6 billion in Federal subsidy, Golden Rule, over the past 12 years, has been extraordinarily generous to political candidates. They donated $3.6 million to political parties in candidates-90 percent to the Republican Party. Mr. Gingrich received more campaign contributions from Golden Rule than any other Federal officeholder over the past 12 years. In fact, he became their poster child and appeared on their television advertisements. The list goes on and on about Golden Rule and all the political contributions they have made.

This bill contains $6 billion for health savings accounts, such as those that have been devised by Golden Rule. This is how it works. Consumers or employers buy high-deductible policies. The deductible is at least $1,000 for individuals, $2,000 for families. The consumer or employer can put as much as $5,000 a year for an individual and $10,000 for a couple into the account. The contributions are tax deductible. Money can accumulate tax free. Withdrawal of the money is also tax free. It is virtually an unprecedented tax shelter that is being added here and subsidized with $6 billion. The funds can be withdrawn to pay medical expenses, including items not normally covered, such as cosmetic surgery.

The problems are numerous. First, it compromises the current health insurance system. People who purchase high-deductible health insurance policies are the healthiest among us. As they opt out of traditional plans, the risk pools in those traditional plans are compromised, leaving people behind to pay higher premiums.

Past research by Rand, the Urban Institute, and the American Academy of Actuaries have found that premiums for comprehensive insurance could more than double if these health insurance accounts become widely used.

Second, wealthy Americans are likely to use these as tax shelters.

In 1996, HIPAA established a demonstration project of health savings accounts. The GAO evaluation of the investigation showed that investment firms such as Merrill Lynch entered the health savings account market because of insurer perceptions that HSA enrollees were using their accounts primarily as tax-sheltered savings vehicles rather than sources of tax-sheltered funds for paying medical expenses.

So here we are setting a new precedent in tax policy. The financial service industry loves it-$6 billion. Now you might ask yourself: What do health savings accounts have to do with prescription drugs for seniors? The answer is nothing. Well, what do health savings accounts have to do with Medicare and seniors in general? The answer is nothing. The $6 billion subsidy in this bill for health savings accounts is making good on a promise by Republican leadership to reward their friends-in this case, Golden Rule. But wait, there is more to the story.

Golden Rule as an insurance company doesn't exist anymore. It sold out. The purchaser was United Health Group. R. Channing Wheller is their CEO who made $9.5 million. They are basically the architects of the health savings account, this HMO.

The story gets even more interesting. This is a publication of AARP. It comes from October of this year. AARP makes a lot of money by selling insurance to seniors. If you open here, this is page 24 and 25, those two pages, you will see three advertisements from AARP on behalf of United Health Care Insurance Company's insurance plans. What is the connection? AARP receives millions of dollars from the sale of health insurance policies and stands to gain under this bill. The AARP insurance-related revenues made up a quarter of their operating revenues last year and one-third in 2001. They receive royalties from policies marketed by United Health Group, the one that purchased Golden Rule. Last year they earned $3.7 billion in premium revenue from their offerings to AARP members-$3.7 billion. This one company.

The royalties AARP earned as a result of that amounted to $123 million; access fees, $10 million; quality control fees, almost a million dollars. AARP also earns investment income on the premiums received from members. That is a total of $161.7 million in revenue from insurance. According to Advertising Age Magazine, AARP and United Health Group hired a direct marketing agency in May to conduct a marketing campaign that could cost $100 million.
United Health Group is going to be one of the biggest winners under this bill we are considering and will vote on tomorrow. It will be a big winner in at least two different directions: First, as an HMO, it is entitled to part of the $12 billion slush fund to lure seniors out of Medicare into their HMO. Secondly, because they have now bought Golden Rule, they will be authors of insurance policies called health savings accounts, which receive another $6 billion subsidy; and guess who is in on it as well. Our friends at AARP.

It is curious to me when seniors who belong to AARP have been asked whether they like this bill, they overwhelmingly say no. Let me get this figure right; I don't want to misstate it. When asked last week whether they supported this bill-AARP members nationally, in a poll conducted-56 percent opposed it and 18 percent supported it; 56 percent of the seniors in AARP opposed it and 18 percent supported it.

Yet Mr. Bill Novelli and AARP have been leading the charge to pass this bill. If it is not that popular among AARP members, what is going on? There is money to be paid. AARP is going to be selling insurance through the United Health Group with a massive Federal subsidy, and through the old Golden Rule health savings account with another massive Federal subsidy. They are not listening to seniors; they are listening to the insurance companies, to the HMOs, and that is a sad thing.

This bill squanders $6 billion that should have been paid for retiree coverage of prescription drugs, creating these new health savings accounts that ordinary Americans cannot afford, undermining employer-based coverage, $6 billion that should have been used to prevent the loss of retiree coverage. As I mentioned earlier, some 25 percent of the revenues going to AARP came off of insurance royalties.

So you ask yourself if the membership of this organization doesn't care for this plan and opposes this plan, by a margin of more than three to one, why then is AARP front and center running ads in newspapers, television, and radio across America? Because, frankly, the ads are paid for by HMOs and pharmaceutical companies and represent an effort by the current leadership of AARP to jam down the throats of senior citizens a proposal they do not support.

What I suggest to seniors across America who are following this televised debate is this: If you belong to AARP, call them first thing in the morning at 1-800-424-3410 and tell them to stand up for seniors, don't stand up for the insurance companies. Don't stand up for pharmaceutical companies, stand up for seniors across America.

I, frankly, went back to Chicago this weekend and met with many people who said they have had it with AARP. They have no idea what happened to an organization created to serve seniors and, frankly, is turning its back on the seniors who needed help the most. That, to me, is a sad commentary. Someone said, basically, if you want to know about legislation, whether it is good or bad, ask the basic question: Who wants it? Who wants this bill, this 1,100-page monstrosity?

It isn't senior citizens. Overwhelmingly across America they say we don't want it. They are calling my office and every office on Capitol Hill. They want help to pay for prescription drugs they can understand. They want it under Medicare so the costs can be contained. They didn't want a full-scale attack on the Medicare system itself, and that is what has happened.

Sadly, we know who really wants this bill: the pharmaceutical companies that stand to make outrageous profits into the future without any competition, and the HMOs that, with their Federal subsidies, will be luring these seniors out of Medicare.

This was an extraordinary and historic opportunity for the Senate and the Congress to do something meaningful. Forty years ago, when we created Medicare, the doctors across America opposed it saying it was socialized medicine. They did not want the Government involved. A few years after the fact, they realized Medicare was not only great for seniors but not bad for the medical profession either. They have been able to expand their practices, create more hospital care, and make for a healthier America.

It worked to everyone's advantage, but the special interest group at the time, the AMA, was opposed to it. Today this is a product of special interest groups. This is not a product that was designed for seniors. It was a product that was designed to reward friends-the pharmaceutical companies that have spent $139 million lobbying Congress over the past 6 months, as well as the HMOs, Golden Rule, and all the old buddy network.

They may win tomorrow, but this I will predict: When this bill goes into effect in 2006, conveniently after the next Presidential election so that all of the bad impact of it won't be realized, when this bill goes into effect and seniors across America realize they have been had, the telephone calls that Congressmen and Senators are receiving today will pale in comparison.

Woe to those Senators and Congressmen who stand for reelection having voted for this bill when it goes into effect in 2006. When the seniors realize how complicated it is, how unfair it is, the gaps in coverage, the fact there is no control on the price of drugs, the fact that the cost of Medicare is going to increase and that they are going to be forced into HMOs with no choice of doctor or hospital, there is going to be a reaction which you will not forget.

I served in the House when we passed something called catastrophic insurance. We thought it was a pretty good idea. I voted for it. The seniors read the fine print and rejected it. When they rejected it, we were forced to repeal that law. It is the only time I recall in my congressional career we have done that.

Trust me, after this goes into effect in 2006, this Congress is going to be scrambling to repeal the most outrageous portions of this bill. And all those who think we are going to get by with a slogan about prescription drugs for seniors are in for a rude awakening.

The seniors across America are men and women who have worked hard all their lives, people of common sense who are not going to fall for what the AARP and so many organizations are now pushing in their faces and saying they must accept. They are going to reject it, and when they reject it, they will reject those who voted for it. I hope my colleagues will think twice before they vote tomorrow morning.

Mr. President, I yield the floor.