Colin Roskey

SUSAN DENTZER:

Why do you think this year, of all years, Medicare is playing such a role in the election campaign, in the race for President?

COLIN ROSKEY:

Because this year, this President has achieved more on Medicare than any President in, in history. In 35 years of the program's history, this President has brought modernized, enhanced benefits to and age-old table, and any time there's change of that magnitude, there's bound to be controversy and discussion and that, that is what we're essentially seeing here on the campaign trail, is that Senator Kerry who was wildly absent from the discussion and the debate on Medicare reform and prescription drugs in the United States Senate, is now critical of the very benefits that the President has brought forward in the way of prescription drugs and new enhanced benefit and choices for senior citizens.

SUSAN DENTZER:

Despite all of that, though, the polls seem to indicate that the majority of Medicare beneficiaries are dubious about the law. They're skeptical that their costs are going to be paid for. They think that drug costs are exploding, and, on balance, more of them than not seem to think that the law needs substantial improvements.

COLIN ROSKEY:

I think any time, like I said, that you make a change of this magnitude, there are bound to be skeptics, critics, and those who are caught in between. We just don't know what to make of something this big. This is a massive new entitlement expansion that has something in it for virtually everyone who has a Medicare card.

Does it mean that virtually everyone who has a Medicare card will be perfect and will be well-off, at a 100 percent level? The answer is probably no, right away. There needs to be more education, there needs to be more understanding at the beneficiary level over the next year and a half before the drug benefits and the benefit enhancements become live and on line, and over that time I think it's incumbent upon stakeholders who are going to be providing the benefits, the drug plans, and the hospitals and health systems who will be taking care of our senior citizens, to be explaining exactly how they're going to be going about doing it, and right now that work is happening, it's underway, through the regulatory process at the Department of Health and Human Services, has already begun to make this drug bill happen by 2006.

SUSAN DENTZER:

One of the aspects of the bill that's gotten a lot of controversy and that Senator Kerry mentions all the time is "the donut hole," and it's fueling beneficiaries' beliefs that not much of their drug costs are going to be covered.

COLIN ROSKEY:

The donut hole is really a bogus argument that comes out of left field, almost nowhere, a, a result of really a scoring and budget, budget device that forced the Congress to set up a benefit design based on strictures that do not exist in reality and will not exist in the actual benefits and actual pocketbooks of senior citizens on Medicare who are eligible for this benefit.

The donut hole will not exist in the reality of the competitive marketplace where prescription drug plans are going to be competing for the lives of senior citizens to come and take care of their drug expenses. They're not going to sell their plans on the basis of a donut hole. They're going to make, and will have freedom to, under the guidance that the Department of Health and Human Services has already issued, will have freedom to design benefit packages that look better than one that would look, in some ways, like a hole, or one that has a donut in–inside of it in some way.

I think we, we are bound to see a lot less and a lot fewer pac–benefit packages with donut holes and more comprehensive benefits that look more like traditional employer-sponsored insurance we see in the marketplace today.

SUSAN DENTZER:

Another aspect of the Medicare law that the senator zeroes in on are the large subsidies in that law to Medicare Advantage plans and he describes them as give-aways to insurance companies.

COLIN ROSKEY:

Medicare Advantage is a new program that is going to become part of the Medicare option plate in 2006, that will provide open network, PPO plans, to senior citizens, much like those that we have in the employer insurance marketplace today. We have open provider panels, we have open provider directories that we access to, to find the care we need.

We have preferred provider organizations. Medicare, however, has never had a preferred provider organization option. They have played with and toyed with HMO options but have never had preferred provider organization options.Setting that option up and ensuring its strength and vitality across every state in the country has cost some amount of money in the overall benefit package that Congress approved as part of the roughly $400 billion package last year, in 2003.

I won't call it a give-away. Senator Kerry will. He, however, was absent from most of the debate on Medicare reform, modernization and prescription drugs, but at the same time, as a Senate finance committee member, was a very vocal supporter of payments, enhanced payments to private health plans…[M]any private health plans, encouraged Senator Kerry himself to support enhanced payments for private health plans as part of Medicare reform and prescription drug improvements.

SUSAN DENTZER:

So you're saying Senator Kerry supported those same subsidies to health plans?

COLIN ROSKEY:

He has supported improved payments to Medicare Advantage plans as part of Medicare reform, although he did not vote for the bill on final passage.

SUSAN DENTZER:

And the documentation you have of his support for that is…?

COLIN ROSKEY:

He has signed numerous letters in his role as the senator from Massachusetts in support of enhanced payments to private health plans. There are many private health plans in Massachusetts who took part in the Medicare+Choice program. Those health plans had suffered by, by their own accounts, for–by improper and, and low-level reimbursement.

He, among others in the Senate, including others in the Democratic Caucus from the Northeast states, made, made it their cause to ensure that improved payments would come to the HMOs that serve their constituents.

SUSAN DENTZER:

Are you saying the senator is being hypocritical about this?

COLIN ROSKEY:

I'm not calling anybody a hypocrite. I'm talking about what the facts of the matter are, and if the facts of the matter are that he's complaining about enhanced payments to private health plans but at the same time he himself supported those same enhanced payments for his own constituents when it mattered most.

SUSAN DENTZER:

Let's talk about another point that the senator brings up all the time, which is the fact that the Medicare Modernization Act in fact prohibited the government from carrying on direct negotiations with pharmaceutical companies over drug prices, that this is something that needs to be rectified, so that the government in effect could negotiate prices directly with pharmaceutical companies, and also that the American people need another drug price safety valve which would be importation of drugs from Canada.

Let's talk about those two things now.

On the question of the government being proscribed, the secretary [of Health and Human Services] being proscribed from negotiating with pharmaceutical companies, Senator Kerry says this is a give-away to the pharmaceutical companies.

COLIN ROSKEY:

It's not a give-away to the pharmaceutical companies at all. It's, it is a logical means by which the private market will work. It is a logical policy that sets in place a vibrant and workable private health plan marketplace to deliver prescription drug benefits.

It gives that private marketplace a fighting chance to obtain and secure critical competitive discounts for drug prices on behalf of the American people.

I might point out that Senate Democrats, including Senator Daschle, supported similar Medicare reform prescription drug legislation in previous Congresses, that included the same prohibition on interference in negotiation between the department and the competitive marketplace.

The question is:

Are you going to let the competition marketplace deliver the lowest possible price for seniors or not? And our answer was we absolutely will.

On the question of importation, let me say that there have been numerous concerns that have been spoken by members of the United States Senate Republican Caucus, chiefly Senator Frist, and others who are concerned about safety of, of imported prescription drugs. There is simply no way that an administration–and it has been tried by Democratic and Republican secretaries of HHS–there is no way that secretaries can ensure the safety and efficacy of prescription medicines that are reimported from other countries including Canada.

Until the secretaries, until the Congress are able to sit down and truly and fully develop a plan for ensuring the safety and efficacy of prescription drugs, there will not be and there should not be importation of prescription drug products from other countries, including Canada.

SUSAN DENTZER:

Let's move on to discussion now about the Part B premium increase for next year. As you know Part, the Part B premium is now scheduled to rise by 17.4 percent, the largest jump, in percentage terms, in, in history. Senator Kerry argues that this is a misstep on the part of the administration and that the, the President has moved to hike these premiums to the detriment of beneficiaries.

What's the campaign's response to that?

COLIN ROSKEY:

The President has not moved to hike any premiums himself, one way, shape or form. These premium hikes are the result of statutory formulas that began in 1997, statutory formulas that I might add, Senator Kerry voted for as part of comprehensive budget reform in 1997.

The mandates by which these formulas became calculated were voted on and approved by Senator Kerry, not just in 1997 but in multiple budget bills after that, when the premium calculation became modified, however slightly.

Let me also say that the increase in the premium that's being talked about right now is not the result of somebody's single stroke of a pen. It's a result of an improved benefit package of benefit enhancements and rising costs for Medicare in doctor payments, in payments to some of those managed care constituents that Senator Kerry's concerned about, and in payment and benefit improvements like new preventive care options in Medicare, like a new free initial screening physical that is now part of the Medicare basic benefit package, and other of the benefit modernizations that were included in the overall basic benefit bill, in addition to prescription drugs.

Those are additive benefits that cost money and contributed to and will continue to contribute to a, a broader growth in premiums that, that beneficiaries are going to have to absorb.

SUSAN DENTZER:

But it's also the case, is it not, that part of the premium increase is going in effect to cover some of the costs of the higher subsidies to private plans. You mentioned the higher payments to physicians. Those aren't going to directly benefit Medicare beneficiaries but they're paying the bill for them.

COLIN ROSKEY:

And they're paying for the network and the fabric of care that surrounds and supports our beneficiaries, and whether that fabric and network is in the form of a health plan, a local health plan that's doing chronic disease management for a diabetic population or whether it's in the form of a family doctor who is seeing somebody for a preventive physical, it still costs money and those costs are continuing to go up.

They're going up on their own as a natural aspect of medical inflation and they're going up as part of the statutory formulas that Senator Kerry himself supported.

SUSAN DENTZER:

So what's the Bush campaign's response to beneficiaries? Basically, 'You're stuck'?

COLIN ROSKEY:

The Bush campaign is concerned about the continuing growth in medical expenses for both Medicare and non-Medicare beneficiaries and is going to be looking at and working with members of Congress and others to try to find ways to help seniors absorb the rising costs of insurance, be, be it medical insurance provided by the Medicare program or other insurance provided by an employer-sponsored arrangement.

SUSAN DENTZER:

Let's also talk about the long-term projections now for total out-of-pocket costs for Medicare beneficiaries as a share of Social Security benefits. The actuary at the centers for Medicare and Medicaid Services did make available, once again, this year, projections that show that those costs are going to be quite substantial as a share of Social Security benefits over time.

Senator Kerry now has said this is another aspect of the mismanagement of Medicare program which is resulting in huge, huge costs for seniors.

COLIN ROSKEY:

I would respond that it's not really, in our view, about mismanagement of Medicare. It is about the rising costs of health care generally, and what are we doing to curb and contain it? And are there things that can be done over, over future years, in our future generations, to help seniors absorb a broader out-of-pocket cost as a percentage of their Social Security income?

The administration is concerned about the rising costs of health care, not just for Medicare beneficiaries who are on fixed incomes, but for everybody else as well, and so it'll be part of a larger effort to ensure that, that rising health care costs are, in some ways, curbed, monitored and contained, and with respect to the percentage of costs that are, that are coming out of a beneficiary's Social Security income, should there be discussion and, and debate in the Congress about how best to control and contain that cost growth?

I'm sure that there should and I'm sure that there will be.

SUSAN DENTZER:

How do you think the President will do with this large block of voters, 42 million elderly and disabled Medicare beneficiaries? The polls again, as we've discussed, suggest a lot of suspicion, a lot of doubt about the expansion of Medicare last year.

How do you think, in the end, the President will do with these voters?

COLIN ROSKEY:

In the end, this President has done more for these voters than any other President in history. This President has taken a 35-year-old program that was doing great but was sagging, in many ways, by its own weight and was looking more like a benefit package like full of Swiss cheese than full of, of basic employer-sponsored style benefits, comprehensive benefits, and turned the program around, has brought the program into the 21st Century by adding prescription drugs, by adding coordinated and improved disease management options, and making the program look more like the kinds of private prescription that we all enjoy today in the workplace and less like an age-old one-size-fits all, government fits all program, with only one way in and one way out.

SUSAN DENTZER:

How much of the, of the problem that the President has this year on this issue is due to the fact that the drug benefits are not yet in effect, and so far what people have is a prescription drug discount card which they find very confusing?

COLIN ROSKEY:

Well, first of all, I would like to say that I don't think the President has a problem on this issue this year. Let me start with that. The President has delivered a prescription drug benefit to seniors that is starting right now, already, in the form of a prescription drug discount card and is working towards a final and comprehensive passage of a full and total benefit beginning in 2006.

So no, I don't see that there is a problem here at all. Where I see a problem is in Senator Kerry, and Senator Kerry missing 36 of 38 votes on Medicare reform and prescription drugs, totally absent from the Senate Finance Committee discussion and debate on prescription drugs and modernizing the Medicare program.

If he cares so much about it now, as he appears to in discussions with us, and with you in the past, why was he absent from final passage? Why was he absent from 36 of the 38 votes that led towards that final passage?

I don't think there's a problem here for the President at all. The President has delivered a prescription drug benefit for the first time in the program's 35 year history.