S5744 CONGRESSIONAL RECORD — SENATE April 27, 1995

Arkansas. It is a shame when you have

an organization with a lot of fine people in it that do abide by the law, that

do want to instill in people a respect

for guns and to teach them how to use

them legitimately, responsibly, and to

have an organization, then, taken over

by the likes of Wayne LaPierre, and to

really take what could otherwise be a

decent organization which could instill

in young people a healthy respect for

firearms and hunting, and to move that

organization, as he has done with this

kind of letter, into almost an organization that would be disrespectful of our

Constitution and disrespectful of the

United States of America, I know he

does not speak for the members of the

NRA that live in Iowa.

Mr. PRYOR. If I might say, I appreciate the Senator’s remarks.

The PRESIDING OFFICER. Under

the previous order, the Senator from

Iowa [Mr. HARKIN] is recognized to

speak for up to 10 minutes.

(The remarks of Mr. HARKIN pertaining to the introduction of legislation

are located in today’s RECORD under

‘‘Statements on Introduced Bills and

Joint Resolutions.’’)

Mr. FRIST. Mr. President, I ask

unanimous consent that I be permitted

to speak as in morning business for a

period of not more than 10 minutes

The PRESIDING OFFICER. Without

objection, it is so ordered.

MEDICARE TICKING TIME BOMB

Mr. FRIST. Mr. President, yesterday

fI began discussions on the pending insolvency of Medicare, predicted to

occur in the year 2002, just 7 years from

today.

I called Medicare a ticking time

bomb. I expressed my concern that this

body has not addressed that ticking

time bomb. We must act now to preserve Medicare, to protect it, to save

it, to disarm that ticking time bomb.

I will continue those discussions this

morning.

Congress and all Americans must realize that it is the Federal Government, through the Medicare program,

that is the purchaser of health care for

this country’s seniors and people with

disabilities. The same Government

that brought you $100 hammers is also

shopping for scalpels and stethoscopes.

The Federal Government spends more

money on health care than individuals,

and more than employers. But, it’s not

our money. If it were, we would likely

be more prudent consumers. We would

likely react more quickly and more responsibly to skyrocketing costs.

So whose money do we spend? For

the answer, we should revisit the creation of the program and remind ourselves of its intended role in our health

care system when it was created in

1965. Also it is time to understand the

shortfalls of the program.

Because the program was created to

increase seniors’ access to acute care,

Congress mandated participation for

hospital services, called Medicare part

A. After seniors pay for a relatively

low deductible—$716 in 1995, Medicare

fully covers expenses for 60 hospital

days. If a senior’s hospitalization exceeds the 60 days in 1 year, he or she is

responsible for a co-insurance fee—$179

per day for the 61st through 90th days,

and $358 per day beyond that.

Medicare part A comprises 63 percent

of all Medicare spending. It is funded

by the Medicare portion of the Social

Security payroll tax—a tax of 2.9 percent of all income—split evenly between employer and employee. Taxes

collected from today’s workers go directly to pay for services delivered to

today’s beneficiaries. It is important to

understand that contributions to Medicare do not actually sit in the hospital

insurance [HI] trust fund and wait for

you. Rather, they are paid out immediately to meet the needs of today’s

seniors and people with disabilities.

Beginning in 1997, the part A expenditures will exceed total income annually.

Medicare’s part B goes to pay doctor

bills and is voluntary. It is funded 30

percent from beneficiary premiums and

70 percent by automatic withdrawals

from Treasury general revenues.

Today, a senior opting for Medicare

part B pays $46.10 each month and is responsible for a $100 annual deductible

and 20 percent co-insurance for most

services. General revenues provide a 70

to 75 percent premium subsidy and

cover 80 percent of most services.

Theoretically, the funding arrangement for part A—the hospital insurance—would work fine if the demographics of the population were constant, if medical technology were constant, and if the growth of overall expenditures were constant. But, as we

all know, this is not the case.

First—and most importantly—the elderly population is growing much faster than the overall population. In 1990,

2.1 million Americans qualified for

Medicare. But in the year 2020, 3.9 million new enrollees will qualify—almost

twice as many new enrollees will be

qualifying that year. And who pays the

bill? The working generation, which is

not growing nearly as fast. When Medicare was created, two workers would

cover the costs of the Medicare beneficiary. By the time I qualify for the

program, it will take four workers to

cover the same cost.

Consider the consequences of delaying Medicare reform. I have three sons:

Bryan is 7 years old, Jonathan is 9, and

Harrison is 11. In the year 2020, they

will be 32, 34, and 36 years old. I will be

68 and eligible for Medicare benefits.

My sons and their generation will pay

for the services for my generation. It

will take the taxes of all my three sons

plus another individual just to pay for

my own Medicare benefits. It is intolerable to punish our children, the next

generation, with this inequity.

Second, medical breakthroughs are

allowing people to live healthier and

longer lives. Take my own field of

heart disease as an example. Thirty

years ago, there were few heart intensive care units in the country. Coronary artery bypass surgery had never

been performed. Cardiovascular drugs

were in their infancy. Heart transplants were but a dream for the future.

Today, because of advances in medical

science and technology, people who

used to die of their heart disease are

living 10, 20, or 30 years longer, and

those new technologies are expensive.

Back to my earlier question, ‘‘Whose

money is this?’’ Medicare is paid for by

three vehicles: a 2.9 percent payroll

tax, split by employers and employees;

general revenue tax dollars; and beneficiary premiums, copayments, and

deductibles.

I think it is safe to say that taxpaying workers are more watchful of

the money coming out of their pockets

than is the Federal Government. I

know the employers are. We have recently seen their impact on the health

care system as they have struggled

with increasing costs. I have witnessed

through my own parents that seniors

are prudent purchasers of health care

services. Since Medicare was not designed as a comprehensive insurance

program, seniors already shop for additional health care coverage. Most seniors today live within a fixed budget.

They are careful to judge the value of

their health care dollar.

By failing to mend this program, we

are failing all of these groups who will

suffer from our inattention in the

years to come. Yet, there is an ongoing

premise that the Federal Government

should not attempt to manage its

spending of the Medicare dollar. Every

other purchaser has to manage his or

her money. Why should the Federal

Government be exempt?

And, how does this country pay for

our failure to manage the Medicare

Program? First, employers pay in the

form of higher health care costs. For

the last 10 years, Congress has chosen

to repeatedly cut payments to physicians and hospitals for services delivered. This reduces program costs incrementally, but does little to reduce the

overall rate of growth of expenditures.

Lower Medicare payments, especially

when coupled with even lower Medicaid

payments, simply lead providers to

shift costs and to charge self-pay and

privately insured patients more. This

increases everyone’s insurance premiums. In east Tennessee, a recent survey of physician fees found that the

private sector is paying physicians, on

average, 220 percent above Medicare

rates. Depending on the specific procedure, these private plans are paying

anywhere from 43 to 461 percent above

Medicare rates. Without Medicare reform, private health insurance will

continue to climb even further out of

reach and all Americans will suffer reduced access and thus reduced overall

quality.

Second, the working generation pays

for our mismanagement of Medicare

through increased taxes. Over the last
April 27, 1995 CONGRESSIONAL RECORD — SENATE S5745

30 years, Congress has dramatically expanded both the tax base and the tax

rate supporting the Medicare trust

fund. Initially, Medicare relief on a 0.6-

percent payroll tax on the first $6,600

earned. Today, the program relies on

nearly a 3-percent payroll tax on all income earned. Next year for the first

time in its history, the trust fund will

begin spending more money than it is

taking in. Without reform, a tax increase is around the corner. And at

best, this tax increase would only prolong the program a few years.

Third, beneficiaries pay for Medicare’s failures. Skyrocketing costs of

the program force the same rate of

growth on the direct expenditures by

our seniors and disabled. Their out-ofpocket costs are directly related to

overall program costs. Medicare does

provide a generous subsidy, making it

a better deal than anything else out

there. But not all services are covered,

the coinsurance and deductibles are

substantial, and premiums are calculated to cover a defined amount of

program costs. Only 1 out of 10 or 11

percent of seniors rely solely on Medicare for their health care insurance.

Most seniors still purchase private supplemental medical coverage or have access to additional employer-sponsored

coverage. Beneficiary costs will continue to climb as the overall program

spending spins out of control.

Medicare is an entitlement. I do not

suggest we take away that concept.

However, I do ask us to remember what

it entitles us to. Quite simply, the entitlement was intended to provide access

to the private system. Our predecessors

did not create a system which limited

beneficiaries to public hospitals or

Government-employed physicians.

Rather, it provided financial access to

private physicians and hospitals, the

same providers Americans used before

they turned 65.

If we viewed the Medicare subsidy

today as it was originally intended—allowing beneficiaries to use it to access

private coverage—seniors would then

be able to choose health care plans

that better meet their needs. Today

they do not have that choice. We

should provide that choice to our seniors.

Mr. President, I will continue this

discussion over the next several days

as we look forward to better ways to

save, to preserve our Medicare Program.

I yield the floor.

EXTENSION OF MORNING

fBUSINESS

Mr. DODD. Mr. President, I ask unanimous consent that I be permitted to

speak for 15 minutes, and that a period

for morning business be extended accordingly.

The PRESIDING OFFICER. Is there

objection? Without objection, it is so

ordered.

LETTER FROM THE NATIONAL

RIFLE ASSOCIATION

fMr. DODD. Mr. President, earlier

today my colleague from Arkansas,

Senator PRYOR, spoke about a very dis- turbing letter circulated by the National Rifle Association [NRA]. I commend him for his remarks. I do not

want to get into a lengthy discussion

of this issue, but I urge all of my colleagues, regardless of where you stand

on the issue of gun control, to read this

letter, which was sent out by the NRA

under the signature of Mr. Wayne

LaPierre, the executive vice president.

I do not know of anyone here, no matter how strongly they feel about

the legitimate issue of what we do

about gun control, that would not be

offended by this letter and the language in it.

Again, I am not going to spend a great deal of time here this morning,

but there is language in the letter

which talks about:

. . . jack-booted government thugs [given] more power to take away our Constitutional

rights, break in our doors, seize our guns, destroy our property, and even injure or kill

us;

That is how the letter refers to our

Government and the hard-working

members of our Federal law-enforcement agencies. And the letter goes on,

in reference to the Clinton administration:

. . . if you have a badge, you have the Gov- ernment’s go ahead to harass, intimidate,

even murder law-abiding citizens;

And there is even more:

Waco and the Branch Davidians . . . Not

too long ago it was unthinkable for Federal

agents wearing Nazi bucket helmets and

black storm trooper uniforms to attack lawabiding citizens.

Law-abiding citizens? People who shot Federal agents, who burned their

own buildings, and killed their own

families and friends? I mean this is incredible.

And this is not a letter from some

fringe organization. It is a letter from

the NRA—a national organization that

usually has credibility. Quite simply,

the NRA ought to know better.

Please read this letter. It is five or

six pages. And if you are not as offended as I have been by reading it, I

will be surprised.

Someone needs to ask for a retraction of this letter. Put aside the tragic

events in Oklahoma for a moment, I do

not want to suggest that this letter is

linked to that terrible tragedy. I do not

want to cloud the issue. But someone

needs to apologize for this letter. It

goes way beyond the kind of rhetoric

that is appropriate on these issues.

Remember this letter went, apparently, to millions of homes. I have no

problem with people sending out fundraising letters and even using strong

language in those solicitations. But the

NRA’s letter goes way beyond the pale.

At first, I was so shocked, I thought it

might be a hoax. But apparently it was

not. I understand the NRA has confirmed that it sent the letter.

Again, I urge my colleagues to read

the letter and I ask unanimous consent

that this letter be printed in the

RECORD.

There being no objection, the letter

was ordered to be printed in the

RECORD, as follows:

NATIONAL RIFLE ASSOCIATION.

DEAR FELLOW AMERICANS: I’ve worn out a

lot of shoe leather walking the halls of Congress. I’ve met key leaders, I’ve talked with

old allies, I’ve met with the new Congressmen and many staff members.

What I’m hearing and seeing concerns me.

Many of our new Congressmen are ignoring

America’s 80 million gun owners. Some have

forgotten what we did to elect them. Others

say our demands to restore our Constitutional freedoms are ‘‘politically out of line.’’

Don’t get me wrong, not all of them are

like this. Senator Phil Gramm, House Speaker Newt Gingrich, and Congressmen Bill

McCollum, Bill Brewster and Harold Volkmer are all coming to our aid. But too many

others are not.

And without a major show of force by

America’s 80 million gun owners, America

will resume its long march down the road to

gun bans, destruction of the Constitution

and loss of every sacred freedom.

I want you to know I’m not looking for a

fight.

But when you consider the facts of our current situation, you too, will see we have no

other choice.

Fact No. 1: The Congress’ leading anti-gunners, Senators Dianne Feinstein, Ted Kennedy and Congressmen Charles Schumer and

Major Owens all survived their last elections.

They’ve pledged to fight us to the bitter

end for Brady II and its ammo taxes, licensing and registration schemes, gun rationing,

bureaucrats with the power to determine if

you ‘‘need’’ a gun and yes, the repeal of the

Second Amendment.

It doesn’t matter to them that the Brady

Law is a failure.

It doesn’t matter to them that the Brady

Law has become one more tool that government agents are using to deny the Constitutional rights of law abiding citizens.

It doesn’t matter to them that the semiauto ban gives jack-booted government

thugs more power to take away our Constitutional rights, break in our doors, seize

our guns, destroy our property, and even injure or kill us.

Schumer, Feinstein, Kennedy, Owens and

the rest of the anti-gunners want more and

more gun control.

It can be something small and subtle like

a regulation expanding the disqualification

criteria for the Brady Law. They’re fighting

for anything that makes it harder for you to

own a gun.

The gun banners simply don’t like you.

They don’t trust you. They don’t want you

to own a gun. And they’ll stop at nothing

until they’ve forced you to turn over your

guns to the government.

Fact No. 2: If the anti-gunners fail to

achieve their goals in Congress, they have a

fall-back position in Bill Clinton, the most

anti-gun President in American history.

In two short years, Bill Clinton launched

two successful attacks on the Constitution.

He signed two gun control bills into law. He

has sworn to veto any repeal of the semiauto ban and any restoration of our Constitutional rights.

His Interior and Agriculture Departments

have set their sights on closing hunting

lands.

And his Environmental Protection Agency

is attempting to take jurisdiction over existing uses of lead. This, of course, includes gun

ranges and spent shot.

What’s more, gun owners aren’t the only

ones Clinton’s EPA has set its sights on.