OpEd: Medicare Part D is largest entitlement in 40 years

We got Medicare reform done

BUSH: If they’re safe, they’re coming. I want to remind you that it wasn’t just my administration that made the decision on safety. Clinton did the same thing because we have an obligation to protect you. Kerry’s been in the US Senate 20 years. Show me one accomplishment toward Medicare that he accomplished. I’ve been in Washington 3-1/2 years and led the Congress to reform Medicare so our seniors have got a modern health care system.

KERRY: In 1997 we fixed Medicare, and I was one of the people involved in it. We not only fixed Medicare and took it way out into the future; we did something that you don’t know how to do, we balanced the budget.

Medicare bill uses market-based solutions to reduce costs

The Bush approach was to use elegantly simple market-based solutions to reduce costs. Under the old Medicare, there was no preventative care. Now when you are a senior and turn sixty-five, you will get a physical. Medicare can identify problems rather than waiting until you are seventy-five and they are more serious. And how could anyone be against giving the elderly prescription drugs that they did not have before?

Medicare Rx plan: immediate help, then senior choice

BUSH: I’ve got a plan on Medicare that’s a two-stage plan that says we’re going to have immediate help for seniors in what I call “Immediate Helping Hand,” a $48 billion program. [Then,] seniors are going to have not only a Medicare plan where the poor seniors will have their prescriptions paid for, but there will be a variety of options. My plan not only trusts seniors with options, my plan sets aside $3.4 trillion for Medicare over the next 10 years.

Cap senior prescription costs at $6,000 per year

$158B for Medicare prescriptions & subsidized premiums

Choice of Medicare, free equivalent, or adding own $

Second bill to Congress: $48B for immediate Rx help

All seniors entitled to Medicare; poor seniors subsidized

Here is my plan:
• We will keep the guarantee of health care security. Every senior 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.
• Every health plan that participates in Medicare must also offer a policy that includes prescription drugs.
• 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.
• All seniors will get help with at least 25% of their premiums for prescription drug coverage.
• All Medicare policies will be approved by the federal government, to ensure that the proper benefits are offered.
• No age increase. No tax increase. That is my commitment to the American people.

$7.4B for nursing home insurance via tax deductions

Bush wants to provide an income tax deduction to anyone buying long-term care insurance. The deduction, now available only to people who itemize and have big medical expenses, would apply to everyone except those on employer-subsidized long-term care plans. The campaign estimated the cost of that portion of Bush’s proposal at $5.1 billion.

Also, Bush proposed an additional tax exemption for elderly spouses, parents, or other relatives cared for in one’s home. That exemption is currently $2,750 a year. The campaign estimated the cost of that second proposal at $2.3 billion over 5 years.

Replace 132,000-page Medicare document with senior choice

Supports passage of Patient’s Bill of Rights

Patient Rights: No gatekeepers for gynecologists

And you can sue an HMO for denying you proper coverage. Now, there’s what’s called an Independent Review Organization that you have to go through first. If you’ve got a complaint with your insurance company, you can take your complaint to an objective body. If they rule on your behalf, the insurance company must follow those rules, or that becomes a cause of action in a court of law.

Give seniors choice, not bureaucrats; give incentives too

What will be the real world results for seniors?
• Seniors can stay in the current Medicare system, or choose another basic plan, for no cost at all. Or they can choose to pay a little more for a plan with additional benefits.
• If seniors are not happy with the service they receive, they can simply change their policy. This is the best way to make a health bureaucracy responsive - by giving customers the freedom to choose.
• 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.
• This plan will mean that every low to moderate income senior in America will be able to afford prescription benefits. Every single one.
• This modernization will make Medicare economically stable in the future - strengthening the program for current seniors and preserving it for the next generation.

Health care access via empowerment, not nationalizing

I believe we can help low-income Americans have access to high-quality health care.
• We can start by making a basic health plan more affordable, via a “Family Health Credit.”
• Second, we will increase the number of good, lower-cost plans available to workers.
• Third, I support increasing the number of community health centers across America.
• Finally, I am proposing a Healthy Community Innovation Fund-an extra source of federal support for health care in underserved communities. This initiative would support pilot programs for targeted purposes, such as AIDS education or mental health awareness.

Private alternatives & state reforms come first

• Strengthen Medicare by providing more choice and more private sector alternatives for the elderly
• Supports a prescription drug benefit to Medicare recipients through more options and greater choice of plans; also supports giving financial assistance to poor seniors to help pay for the plans
• Supports medical savings accounts as a health insurance option
• Opposes legislation that would supersede reforms already enacted by states

HMOs should cover emergency room; & gynecology directly

Create Review Board to hear HMO complaints

2000: market-based program for Medicare Rx drugs

Bush wanted to use free market forces to shape a Medicare prescription drug program that would be responsive to consumers, cost less than federal entitlements typically do, and provide seniors with a wide range of choices that would evolve over time to meet changing needs. He had run on creating a market-based--not government-run--program in the 2000 campaign.

But creating one was not a universally popular thing to do among Republicans. Some GOP members of Congress opposed the drug program because they believed it enlarged the welfare state.

FactCheck: Bush opposed drug reimports, but so did Clinton

CNN FACT CHECK:Bush did oppose a measure to import inexpensive prescription drugs from Canada, but Clinton killed a similar measure. Clinton signed a Canadian drug reimportation bill in Oct. 2000, but cited various problems including safety concerns. Two months later, the Clinton administration invoked a provision in the law to kill the program entirely. In the second presidential debate this year, Bush explained his position: “When a drug comes in from Canada, I want to make sure it cures you and doesn’t kill you.” However, in the 2000 presidential debates, Bush did indicate support for drug reimportation: “To allow for drugs that were sold overseas to come back into the US-that makes sense.”

FactCheck: Only 19% of poor seniors use Drug Discount cards

FACT CHECK: In fact they’re not working nearly as well as originally advertised. Seniors complain the cards are confusing, and healthcare advocates fault the Department of Health and Human Services for failing to effectively publicize the program. The Associated Press reported that of the 7 million poor seniors who are eligible for the card and a $600 subsidy, only 1.3 million (19%) have actually signed up to receive the discount. And as widely reported, total enrollment-counting both poor and non-poor-is at 4.4 million, and over half of those were enrolled automatically by health maintenance organizations. The overall total is still 3 million shy of the number the administration predicted would be enrolled by the end of 2004.

Make sure the drugs from Canada cure and don’t kill you

A: I just want to make sure they’re safe. When a drug comes in from Canada, I want to make sure it cures you and doesn’t kill you. And that’s why the FDA and that’s why the surgeon general are looking very carefully to make sure it can be done in a safe way. I’ve got an obligation to make sure our government does everything we can to protect you. And my worry is is that, you know, it looks like it’s from Canada; it might be from a Third World. We’ve just got to make sure before somebody thinks they’re buying a product that it works. And that’s why we’re doing what we’re doing. Now, it may very well be here in December you hear me say I think there’s a safe way to do it. Other ways to make sure drugs are cheaper. One is to speed up generic drugs to the marketplace quicker. Pharmaceuticals were using loopholes to keep brand drugs in place, and generics are much less expensive than brand drugs.

Senior Rx coverage without government dictates

• Prescription drug coverage that enables seniors to get the medicines they need, without the government dictating their drug choices.
• Choice of an individual health care plan that best fits their needs just like Members of Congress and other federal employees enjoy today.
• Choice of the doctor, hospital, or place they want for the treatment and care they need.
• Full coverage for disease prevention such as screenings for cancer, diabetes and osteoporosis.

Give states money to help poor seniors buy medicine

BUSH: Step one is to reform the Medicare system. I want to call upon Republicans and Democrats to take care of a senior prescription drug program. I think it’s important to have what’s called Immediate Helping Hand, which is direct money to states so seniors don’t have to chose between food and medicine.

GORE: I have never been afraid to take on the big drug companies. They are now spending more money on advertising than they are on research. They’re trying to artificially extend the monopoly so they can keep charging high prices. I want to streamline the approval of generic drugs so that we bring the price down. I proposed a prescription drug benefit under Medicare. You pick your own doctor and the doctor chooses the prescription and nobody can overrule your doctor. You go to your own pharmacy and Medicare pays half. If you’re poor, they pay all of it. If you have extraordinarily high costs, then they pay all over $4,000 out of pocket.

Medicare Rx drug coverage for low-income seniors

Flu vaccine shortage from litigation worries

A: We’re working with Canada to help us [get] the vaccine necessary to make sure our citizens have got flu vaccinations during this upcoming season. If you’re healthy, if you’re younger, don’t get a flu shot this year. Help us prioritize those who need to get the flu shot, the elderly and the young. We have a problem with litigation in the US. Vaccine manufacturers are worried about getting sued and so therefore they have backed off from providing this kind of vaccine. One of the reasons I’m such a strong believer in legal reform is so that people aren’t afraid of producing a product that is necessary for the health of our citizens and then end up getting sued in a court of law.

Lack of market forces and lawsuits increase healthcare costs

A: There’s a systemic problem. Health-care costs are on the rise because the consumers are not involved in the decision-making process. Most health-care costs are covered by third parties. And therefore, the actual user of health care is not the purchaser of health care. And there’s no market forces involved with health care. Secondly, I do believe the lawsuits are causing health-care costs to rise in America. That’s why I’m such a strong believer in medical liability reform. The defensive practice of medicine costs the federal government some $28 billion a year and costs our society between $60 billion and $100 billion a year. Thirdly, one of the reasons why there’s still high cost in medicine is they don’t use any information technology. It’s the equivalent of the buggy and horse days, compared to other industries here in America. And finally, moving generic drugs to the market quicker.

FactCheck: Frivolous lawsuits do not cost government $28B

FACT CHECK: Bush recycled his claim that lawsuits force physicians to practice “defensive medicine” that adds substantially to medical costs, and increases federal spending for health-care programs by $28 billion a year. We de-bunked that one back in January. The non-partisan GAO and CBO agencies criticize the study the Bush administration uses as their main support for that claim. These agencies suggest savings from passage of limits on malpractice damages-if there are any savings at all-would be relatively small. Bush’s claim rests mainly on a single 1996 study by two Stanford economists who said caps on damage awards could hold down overall medical costs by 5% to 9%. The CBO found “no evidence that restrictions on tort liability reduce medical spending.”

Pass medical liability reform to make health care affordable

Lower care costs; reform taxes; limit lawsuits

Bush supports the following principles regarding health issues:
• Ensure access to basic health care, through managed care, insurance reforms, or state funded care
• Limit damages that can be awarded in medical malpractice lawsuits
• Require HMOs to give patients complete doctor choice
• Bush says, “To improve access to basic health care, we need to bring down health care costs, reform tax laws, limit frivolous lawsuits, and allow medical savings accounts.”

Voted NO on adding 2 to 4 million children to SCHIP eligibility.

Proponents support voting YES because:

Rep. DINGELL: This is not a perfect bill, but it is an excellent bipartisan compromise. The bill provides health coverage for 3.9 million children who are eligible, yet remain uninsured. It meets the concerns expressed in the President's veto message [from HR976]:

1. It terminates the coverage of childless adults.
2. It targets bonus payments only to States that increase enrollments of the poorest uninsured children, and it prohibits States from covering families with incomes above $51,000.
3. It contains adequate enforcement to ensure that only US citizens are covered.

Opponents recommend voting NO because:

Rep. DEAL: This bill [fails to] fix the previous legislation that has been vetoed:

• On illegal immigration: Would the verification system prevent an illegal alien from fraudulently using another person's name to obtain SCHIP benefits? No.
• On adults in SCHIP: Up to 10% of the enrollees in SCHIP will be adults, not children, in the next 5 years, and money for poor children shouldn't go to cover adults.
• On crowd-out: The CBO still estimates there will be some 2 million people who will lose their private health insurance coverage and become enrolled in a government-run program.

Veto message from President Bush:

Like its predecessor, HR976, this bill does not put poor children first and it moves our country's health care system in the wrong direction. Ultimately, our goal should be to move children who have no health insurance to private coverage--not to move children who already have private health insurance to government coverage. As a result, I cannot sign this legislation.

Protect state tobacco settlement funds from federal seizure.

As you know, preserving and protecting the state tobacco settlement funds is the nation’s Governors’ highest priority. We strongly urge you to reach final agreement and pass the conference report on the emergency supplemental appropriations bill soon, and to retain the Senate provision that protects our settlement funds from federal seizure.

Many of our state legislatures are currently in session, and some have already completed work on their budgets. Therefore, it is critical that conferees reach agreement quickly on this issue. Governors are unified in their commitment to ensuring that the funds remain in the states and that there be no restrictions on states’ ability to tailor spending to meet the needs of their citizens.

We offer our strongest support for conferees to recede to the Senate version of the bill containing the Hutchison/Graham bipartisan tobacco recoupment protection legislation.