Capitol Words a project of the Sunlight Foundation

Sen. Ron Wyden

Mr. President, the staggering cost estimates for the Medicare prescription drug benefit, coupled with the small number of seniors who have signed up so far, has threatened the very survival of this program. I do not want to see that happen, having voted for this program. I want to see the Senate take the steps to ensure that it works; that it delivers medicine to our seniors in a cost-effective way, and ensures that it reaches the hopes and expectations that millions of older people and their families have for this program.

The fact is, the Medicare prescription drug program now faces two very serious problems. The first is the skyrocketing cost. These are the costs we have been debating throughout the week, that have been far greater than anyone could have predicted.

A second problem may also herald very big concerns. To date, a small number of older people have signed up for the first part of the drug benefit, the drug card. So what you have is a pretty combustible mix. The combination of escalating costs and a skimpy number of older people signing up thus far raises the very real problem that a huge amount of Government money will be spent on a very small number of people. That is a prescription for a program that cannot survive.

I do not want to see that happen. As someone who voted for this program and worked with colleagues on both sides of the aisle to make this program work to meet the urgent needs of the Nation's older people, I think the Senate ought to be taking corrective action and take corrective action now, in order to deal with what I think are looming problems.

As I said, we learned a bit about the escalating costs of the program. But when you couple that with low levels of participation by older people, that is particularly troublesome. I think it is fair to say, if the drug card debacle--the first part of the program and the small number of older people signing up for the drug card continues into the full benefit phase of the program, what you have is a situation where I believe people are going to say this program cannot be justified at a time of scarce Government resources.

To turn for a moment to the drug card part of the program that I don't think has been discussed much lately, the choices are eye-glazing. There are more than 70 cards available; 39 you can get in any part of the country, the other 30-plus you can get only in some States. The Inspector General of the Department of Health and Human Services reported in an informal survey that the program information was confusing and inadequate.

What makes it amazing is that a lot of folks who were looking at it are people who were relatives of HHS employees. So you have a situation where even folks connected with those who would know a fair amount about this program are having difficulty sorting through it.

I have come to the floor today to try to sound a wake-up call, to say those of us who voted for the program, like myself, and those who opposed it, we ought to be working together on a bipartisan basis now to correct it. The first part of that effort should be to put in place sensible cost containment like we see in the private sector. It is incomprehensible to me that this program is not using the kind of cost containment strategies that you see in Minnesota and Oregon and all across the country.

The Medicare Program is pretty much like a fellow standing in the Price Club who buys one roll of toilet paper at a time. They are not shopping in a smart way. They are not using their purchasing power. I and Senator Snowe have sought to correct that and to take steps to use sensible cost containment strategies and ensure that the costs of this program are held down.

Second, I think we need to take steps to make sure that some of the mistakes of the past are avoided. CMS, the agency charged with dealing with this program, needs people with expertise to answer the questions of seniors and family members. There needs to be better information, on the net and elsewhere, that is not incomprehensible gobbledygook. Seniors are going to need information about real savings for each plan. Pie-in-the-sky projections, which is what they have gotten thus far, are not going to cut it. That is what we saw this week with respect to these cost estimates. Suffice it to say, the U.S. Congress is not satisfied.

I believe without effective cost containment and without good administration of the program, particularly as it moves into this next stage, we are going to see the bills continue to run up and we are going to see the participation of seniors continue to run down. That is a prescription for a Government program that cannot survive. I do not want to see that.

I stuck my neck out in order to get that legislation passed. I believe it can survive. Congress needs to hustle, now, to mend it, to mend it with sensible bipartisan cost containment along the lines of what is used in the private sector; mend it with changes in the way the program is administered so it goes into the second phase without some of the problems we saw connected with the drug card. I just hope, as a result of what the Congress has learned this week, that there has been a real wake-up call as to how urgent it is that Congress take these corrective steps and that Congress move quickly. I believe this program now, because of the huge new cost estimates and the problems with getting folks signed up, could well be headed for life support.

I don't want to see that. I think it would be a tragedy. I want the program that I voted for to work. That means it has to be supplemented with good cost containment and improvements in the way it is administered. I intend to work with my colleagues, particularly on the other side of the aisle--Senator Snowe and Senator McCain, who joined me in this legislation--to deal with the cost containment features, plus many colleagues on this side of the aisle who have bills of their own.

I yield the floor.

Sen. Bill Nelson

Mr. President, my comments will come, appropriately, after the distinguished Senator from Oregon, about this program that was enacted a couple of years ago, the so-called providing prescription drugs for senior citizens. There are a number of Senators here who were promised, in order to get their votes, that this program would not cost more than $400 billion over a 10-year period. Of course, we know now that the result of the most recent studies is that it is not $400 billion, it is $720 billion. How many more cost estimates will go up and up?

There is one thing we can do to this legislation, legislation that this Senator didn't vote for because I thought it was quite flawed--not only the true costs, which we were not given, but the fact that we are not allowing the principle of private enterprise to function. There is a provision in the bill that specifically prohibits the Federal Government, through Medicare, from negotiating bulk rate purchases, thus bringing the cost of the prescription drugs down.

All of our colleagues embrace the private marketplace. Free market competition is where you can get the most efficient products at the least cost.

Why wasn't that same principle of free market competition allowed to work here in the purchase of prescription drugs for Medicare recipients? It is certainly not new to the Federal Government. We have done this for almost 20 years in the Veterans' Administration--for the VA contracts for the purchase of prescription drugs in bulk and, therefore, the cost of the drugs to the Veterans' Administration is considerably less than retail price.

If it is good for the Department of Veterans Affairs, why isn't it good for the rest of the Federal Government and for Medicare to do it? But we were not allowed to because the law specifically says we are going to violate the principle of free market enterprise, and you can't negotiate the price of the prescription drugs down. It seems to me that not only violates the principle, it violates good common sense.

Now what do we do? The news has come out. No, the bill isn't going to cost what was promised, $400 billion over 10 years; it is going to cost a minimum of $720 billion over 10 years. We had better be minding our Ps and Qs or else we are going to continue to bankrupt this country by using faulty mathematics.

I yield the floor.

Sen. Byron L. Dorgan

Mr. President, I ask unanimous consent to speak in morning business for as much time as I consume.