The Rx Campaign: George Bush
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GOVERNOR GEORGE W. BUSH: When Medicare was passed in 1965, President Lyndon Johnson said: “No longer will older Americans be denied the healing miracle of modern medicine. No longer will illness crush and destroy the savings that they have so carefully put away over a lifetime so that they might enjoy dignity in their later years.”
Thirty-five years later, it is time for our nation to come together and renew that commitment.
My party has often pointed out the limits and flaws of the Great Society. But there were successes as well – and Medicare is one of them.
Before 1965, fully half of American seniors lacked health insurance. They were just an illness or accident away from destitution. Since 1965, more than 80 million American seniors have found a measure of security – a measure of confidence and dignity – in Medicare.
By history and by choice, our nation makes a promise: We will honor our fathers and mothers by providing quality health insurance to every senior citizen.
Keeping the promise of Medicare, and expanding it to include prescription drug coverage, will be a priority of my administration.
Seniors on Medicare knows Medicare is showing its age. Its current benefits were modeled on a good private insurance plan – from 35 years ago, in1965. Back then, the primary concern was hospital costs. Today, many seniors are treated at home, or in a doctor’s office, with drugs and new medical technologies. Back then, in 1965, the focus was acute care. Today, there is a greater emphasis on preventive care.
Medicare is an enduring commitment of our country. It must be modernized for our times.
This program is top-heavy with bureaucracy in the federal Health Care Financing Administration, the agency that runs Medicare. Its regulations run over 100,000 pages – three times more pages of regulations than the IRS – making Medicare rigid, and sluggish and slow to change. In 1994, doctors began using a new technology that speeds the healing of bone fractures. Six years later, it has not been approved by the Washington bureaucracy. The program refuses to cover a now standard test for brain tumors. It actually took an act of Congress to force the washington bureaucracy to cover prostate screening.
When you need a drivers license, bureaucracy can be frustrating. When you need medical care, bureaucracy can be a hazard to your health.
Medicine is changing every day, with breakthroughs on arthritis and mood disorders, breast cancer and multiple sclerosis. There is something very wrong when the nation’s greatest health care program can’t keep pace with the latest health care progress, because of HCFA’s bureaucracy.
Medicare also has long-term budget problems – rooted in rising costs and an aging population – that threaten to make it insolvent by 2025.
Medicare is a vital program – too vital to be neglected. It needs preventive care now to provide quality health care and prescription drug coverage for all America’s seniors. For eight years, the current administration had this opportunity – and squandered it. At first, the Clinton/Gore administration proposed an ill-advised – government takeover of American medicine that was wisely rejected by Republicans, Democrats and the American people. Since then, the administration has been too partisan – playing politics at the expense of reform. All the while, our problems have grown deeper. A combination of added bureaucracy and cost controls have resulted in unprecedented slowdowns in Medicare spending. Hospitals are laying off staff and shutting down needed services. Home care agencies are closing or reducing services.
Nursing homes have been placed in financial jeopardy.
And on top of all this, in its 2001 budget, the administration proposed cutting Medicare by $70 billion over ten years – putting added stress on health care providers.
Just last month, we discovered that the administration is planning to deny Medicare payment for anticancer drugs given in doctors’ offices, affecting chemotherapy for hundreds of thousands of seniors.
And, according to one report, Washington bureaucrats have even begun threatening to investigate hospice patients for living too long.
When patients survive past six months, the government labels it “a negative outcome.” Some call this cost saving. I call it a sure sign of a bureaucracy grown clumsy and cold.
Yet this administration has been a roadblock to reform. In 1997, a commission of Republicans and Democrats was appointed to propose ways to modernize Medicare. It outlined a bipartisan direction for fixing the program. But, at the last minute, the Clinton/Gore administration turned against the commission and undermined its work. Instead of solving an important problem, they chose to score political points. Afterward, the cochairman of the commission, Democratic Senator John Breaux, commented in frustration: “We are not going to fix [Medicare].
We are going to be looking for issues to beat each other over the head once again. That is the old way of doing it. That is old politics.”
That is the record of the last eight years: old politics, causing the same old stalemate. Failed leadership and wasted opportunities. Vice President Gore talks about the “people” versus the “powerful.” For eight years, he has been the powerful – and, on health care, he has little to show for it.
The Vice President said he has been involved with every decision for the past eight years. And after 8 years of his active involvement, 8 million more Americans are left without health insurance than in 1993 – a 20 percent increase.
44 million Americans now have no health insurance. 2.4 million more children have no health insurance. And nothing has been done to reform Medicare or provide prescription drug coverage
Now the Vice President has adopted the President’s prescription drug proposal, and has challenged America to compare our plans. I welcome the comparison , because there is a lot Vice President Gore isn’t telling you.
The Vice President calls for a new, access fee for prescription drugs. If you make as little as $12,500 a year, you will pay an additional $24 a month, rising to $50 a month by 2008. This is on top of the premiums, deductibles and co-payments you already pay for Medicare. In return, the government would pay no more than half of the costs of your prescription drugs.
Here are the practical problems with Al Gore’s plan:
The Gore plan forces seniors into a government chosen HMO for their drugs – and if you don’t like the plan the Washington bureaucracy puts you into, too bad. You have no other options. For the majority of seniors, those who use less than $576 in prescription drugs a year, you will actually lose on the Gore plan – the combination of additional premiums and a high co-pay will force you to pay- more than you get back in benefits. Some seniors may wan different options – a higher deductible on drugs, say, in exchange for vision coverage. Under the Gore plan,you’re out of luck. You have only one choice – the one that government makes for you. The Gore plan gives seniors just one chance to buy into drug coverage – at age 64 and a half. If you want coverage at age 67, or you change your mind, you’re again, out of luck. It’s the Gore plan for life, or nothing at all. Even if the Gore plan passes, no one will get the full drug benefit for eight years. That’s a detail you don’t hear much in the Vice President’s speeches. By making government agents the largest purchaser of prescription drugs in America – by making Washington the nation’s pharmacist – the Gore plan puts us well on the way to price controls for drugs. As costs rise, the government will be pressured to impose controls – as it already does in other parts of Medicare. A hostile government takeover of the drug industry would actually dry up the supply of new miracle drugs. And this would undermine the health, not just of seniors, but of every single American. There are about 7,500 new drugs in the research pipeline for seniors. One of them could be a cure for Alzheimers. Or one of them could be a cure for Parkinson’s. We should not stifle this innovation. Finally, the Gore plan doesn’t modernize the broader Medicare program at all. It doesn’t solve its long-term financial problems or save this vital program for the future. It just adds resources without reform. And that, says Senator Breaux, a proud Democrat, is “like putting new gas in an old car. It’s still going to run like an old car. Medicare today is running like a ’65 Chevy.”
It was on the lot when Al Gore ran in 1992. It was still on the lot when Al Gore ran for re-election in 1996. And it’s still on the lot in the year 2000. They may have changed the odometer, but it’s still not running – and Medicare needs an overhaul.
I support new resources for Medicare. My budget will double funding for Medicare– from $216 billion to $441 billion – over the next ten years. And I support additional spending, above that amount, as I’ll detail in a moment. Yet, as I announced in May of this year, I want to seize this moment to modernize Medicare. To increase, not just funding, but choices, and quality, and security. To provide a prescription drug benefit.
And to place Medicare on firm financial ground.
Here is my plan:
We will keep the guarantee of health care security. Every senior, without exception, will be entitled to the current set of Medicare benefits.
We will give all seniors a number of additional options, so they can choose a better policy that meets their indvidual needs, including benefits like preventive care, vision care and dental care. Some new benefits packages will be traditional fee for service. Others may be networks run by doctors. All must offer the minimum Medicare benefits, and can add additional services to compete for customers. You can choose to keep your current Medicare benefit, exactly the way it is, or you can add to and improve it.
Every health plan that participates in Medicare must also offer a policy that includes prescription drugs. And every senior will get assistance to make that coverage affordable.
Seniors with incomes less than $11,300 – couples making less than $15,200 – will pay no premium for their medical insurance, and will get prescription drug coverage at no cost. Those just above that income level will get a substantial subsidy to help them afford prescription coverage. Twelve million low to moderate income seniors will have a strong insurance plan, including a prescription drug benefit.
And all seniors, at every income level, will get help with at least 25 percent of their premiums for prescription drug coverage.
All the policies available through Medicare will be approved by the federal government, to ensure that the proper benefits are offered, and to provide seniors with clear information to compare the plans. And these reforms will be made without increasing the eligibility age for Medicare or increasing the payroll tax. My position is clear.
No age increase. No tax increase. That is my commitment to the American people.
What will be the real world results for seniors?
First, they will have a system with a proven track record. Nine million federal employees already have a similar plan, and they report one of the highest levels of satisfaction of any health care system in the country. Like federal employees – including members of the House and Senate – seniors will get a book each year, just like this one. It will list all the health plans, and compare their benefits. Seniors can stay in the current Medicare system, with no changes.
They can choose another basic plan, for no cost at all. Or they can choose to pay a little more for a plan with additional benefits. And every low income senior will get a high-option plan for free.
Second, if seniors are not happy with the service they receive, they can do what federal workers do. They can do what members of Congress do. They can simply change their policy. This is the best way to make a health bureaucracy responsive – by giving customers the freedom to choose.
Third, government regulators will no longer be making decisions about health coverage, which slows the adoption of new medical technologies.
So seniors will see medical advances covered by their insurance more quickly.
Fourth, this plan will mean that every low to moderate income senior in America will be able to afford prescription benefits. Every single one.
Finally, this modernization will make Medicare economically stable in the future – strengthening the program for current seniors and preserving it for the next generation.
This is the path to bipartisan, long-term reform.
Yet there is also a short-term crisis, demanding an immediate response. For many seniors, as we speak, prescription drugs are a daily need, and affording them is a daily struggle. Medigap coverage is costly. Medicare HMOs, important to so many seniors here in Pennsylvania, have been crippled by this administration. And some seniors are left with constant worries and few options, except to skip pills, or break them in half, or go without.
Consider the case of an 80-year-old widow from Johnstown, Pennsylvania. With an income less than $11,000, she needs prescription drugs that cost $2,500 a year. With bills like that, she was facing the prospect of selling her home to buy her medicine.
These are the cruel choices some seniors face:
Heat or medicine. Food or pills. In a wealthy nation, this is a scandal. In a compassionate nation, it is a call to action.
Because there is no prescription drug benefit in Medicare, 23 states have now established state drug assistance programs – programs that pay drug costs for low-income seniors. Here in Pennsylvania, that widow in Johnstown was helped by just this kind of program. Without it, she says, she would have “lost her dignity and her life.” Her story had a happy ending. And we can multiply it by millions.
We will modernize Medicare. But we will not wait to help seniors afford prescription drugs. We will give them direct aid now, by expanding state assistance programs. Today I am announcing an initiative called “An Immediate Helping Hand.”
For four years – during the transition to better Medicare coverage – we will provide $12 billion a year in direct aid to low-income seniors in all 50 states.
Every senior with an income less than $11,300 – $15,200 for a couple – will have the entire cost of their prescription drugs covered. For seniors with incomes less than $14,600 – $19,700 for couples – there will be a partial subsidy. With these large buying pools, states will be able to negotiate for significant discounts on drugs. In addition, we will set a cap, a maximum limit, on out-of-pocket drug costs of $6,000 a year for all seniors – the same limit we will set for all Medicare costs in broader Medicare modernization.
My plan sets aside $158 billion additional dollars for Medicare over the next ten years.
Four years to provide “An Immediate Helping Hand,” and an additional $110 billion for Medicare modernization.
In the past, I have said that education reform will be my first priority as president – the first bill I propose to Congress. The measure I am proposing today – immediate prescription drugs for seniors – will be my second bill. And this plan will help seniors much sooner than anything proposed by Vice President Gore.
Eight years ago, Bill Clinton and Al Gore promised Medicare reform. Four years ago, they did the same. This is a patient country, but our patience is wearing thin. This is not a time for third chances, it is a time for new beginnings, and new leadership.
On health care, my opponent offers the same tired, partisan ideas that have led our country nowhere. His is the path of politics, the path of posturing, the path of least resistance. But it is not the path of leadership.
Modernizing Medicare will be bipartisan – or it will not happen at all. Only by working together will we strengthen Medicare, and get prescription drugs to seniors who need them.
This administration has shown what it thinks of bipartisanship – by frustrating it. I will take a different road. I will join a rising generation of reformers – Democrats and Republicans – who want to move beyond the old politics to get results Leaders like Senators Bob Kerrey, John Breaux and Bill Frist. I agree with the Progressive Policy Institute – the think tank of Joe Lieberman’s Democratic Leadership Council – when it calls on leaders to “seize this opportunity to push for a bipartisan agreement that uses the Breaux approach as the basic blueprint for Medicare reform.”
As president, my message to Congress will be clear:
Instead of seeking advantage, let us set common goals.
Instead of polarizing this country, let us honor our common commitment to elderly Americans.
Instead of pointing the finger of blame for failure, let us share the credit for success.
This is the way to fulfill the promise of Medicare. And this is the way to serve the seniors of our country.