S5686 CONGRESSIONAL RECORD — SENATE April 26, 1995

good for the country?’’ And we follow

that. DAVE PRYOR really has done that.

He has been just a distinguished

Member of this body in addition to

being a friend of all of us. It has been

a real privilege to serve with him in

the U.S. Senate. He has served Arkansas well, but I think more important

than that, he has served the United

States of America well. I am proud to

have him as a colleague here in the

Senate.

Mr. GORTON. Will the Senator from

Illinois yield?

Mr. SIMON. I will be pleased to yield

to my friend from Washington.

Mr. GORTON. I enjoyed the description by the Senator from Illinois of the

Senator from Arkansas. I agree with it.

I may also say I believe the Senator

from Illinois has described himself.

Mr. SIMON. My friend from Washington has been too generous in that remark, but I thank him anyway.

Mr. President, if no one else seeks

the floor—I see my colleague from Colorado does not look as if he is quite

ready. He is still making notes.

Mr. President, I suggest the absence

of a quorum.

The PRESIDING OFFICER. The

clerk will call the roll.

The assistant legislative clerk proceeded to call the roll.

Mr. FRIST. Mr. President, I ask

unanimous consent that the order for

the quorum call be rescinded.

The PRESIDING OFFICER. Without

objection, it is so ordered.

The Senator from Tennessee.

Mr. FRIST. Mr. President, I ask

unanimous consent that I be permitted

to speak as if in morning business for a

period of not more than 10 minutes.

The PRESIDING OFFICER. Without

objection, it is so ordered.

MEDICARE: THE TICKING TIME

fBOMB

Mr. FRIST. Mr. President, I rise to

discuss the approaching insolvency of

our Medicare Program.

The Clinton administration has confirmed that Medicare is going bankrupt. We must act now to save it. We

must reform Medicare to protect it, to

preserve it, and to improve it.

Next year, for the first time in its 30-

year history, the program will begin

deficit spending. And on April 3, the

Medicare Board of Trustees announced

that Medicare will go bankrupt by the

year 2002. In 7 years—well before I will

be eligible for benefits—the program

will have exhausted all of its resources

and will cease to exist in its current

form. We must act now.

This is not new information—Congress has been warned repeatedly of the

Medicare time bomb. Mr. President,

the clock is ticking—we must take action this Congress to save this vital

program. I come before you today to

discuss the successes and failures of

this program, and to begin to look for

ways to protect and preserve its longterm health.

What is Medicare? It is a Government

program which gives 32 million older

Americans and 4 million individuals

with disabilities access to the private

health care system. Medicare is actually made up to two entirely different

programs: A hospital insurance program, which is compulsory for seniors,

and a physician insurance program,

which is voluntary, with 96 percent of

all seniors participating in this voluntary insurance program.

Medicare’s hospital insurance program—part A—is funded by a payroll

tax on working citizens, a tax which

entitles them to future benefits.

The physician insurance program,

part B, in contrast, is funded by a combination of general tax revenues and

premiums paid by the beneficiary.

Medicare has been very successful,

successful in providing access to quality care. More than 37 million Americans today are covered by the program.

Today’s elderly live longer, live

healthier lives, and enjoy a better quality of life than ever before. Medicare

participants are extremely satisfied

with the overall care they receive. Yet,

Medicare has become a victim of its

own success. All will be lost if we do

not act to save Medicare.

Over the years, many have found

fault with the program: it does not

cover comprehensive benefits; it does

not protect out-of-pocket costs; it does

not really provide incentives for consumers to maintain cost-conscious behavior; it does not reward providers

with keeping people healthy; and its

costs clearly are growing out of control

faster than the Nation’s economy, faster than the budget as a whole, and faster than twice the rate of inflation.

Medicare spending rose by 11 percent

last year, while private sector health

care spending rose by only 4 percent.

Thus, each of us comes to the Medicare Program with the hope of addressing one or more of these problems. As

a citizen legislator, one who comes to

the Senate directly from the private

sector, I approach this challenge wearing many hats. I come to the table as

a health care provider, a physician who

on a daily basis has served the personal

health care needs of thousands of Medicare patients. I come to the table as

the son of two active parents, both of

whom are 84 years of age. They have

been beneficiaries of Medicare as they

were treated for heart attacks, colon

cancer, pulmonary edema, a fractured

neck, bleeding ulcers, kidney failure, a

broken arm, phlebitis, and a stroke. I

come to the table as a father of three

boys whose generation will be working

to the pay the bills for my generation.

And I come to the table as a legislator

who sees the looming crisis of Medicare

staring us straight in the face.

When Medicare was designed in 1965,

the goal very clearly was to provide

senior citizens with greater access to

our country’s health care system. Medicare at that time was structured to

mirror the private system of the time

which in 1965 was primarily Blue Cross

and Blue Shield fee for service. That

means Congress paid providers based

solely on the cost of the care delivered.

There was no fee schedule of negotiated

rates with providers. There was no real

justification of costs. Furthermore, at

that time Medicare insulated providers

from the Government by allowing them

to work through fiscal intermediaries

and carriers, similar to private insurance.

Now, Medicare is an insurance program that pays for private services.

Great Britain took quite a different approach. I spent almost a year as a physician in England, and I as a physician

worked directly for the English Government receiving a salary from the

English Government as an employee of

the National Health Service. The English have replaced their national insurance program and moved directly into

Government provision of services.

Whereas our country relies on the private sector for control and direction,

England relies on direct Government

intervention. This underlying philosophy is fundamental to our understanding of Medicare. Medicare was established to give seniors access to the very

same health care system available to

all other Americans.

But as the American medicine delivery systems have changed over the last

30 years, and matured and diversified,

Medicare has remained stagnant. Medicare fails to give seniors access to the

full range of plans currently available

to all other Americans. The private

system has evolved and Medicare has

failed to keep up. Changes and improvements are required today before

seniors and the disabled fall even further behind.

Managed care illustrates that point.

Today, 63 percent of working Americans obtain their care through some

type of managed care program. In contrast, only 9 percent of seniors are enrolled in some type of managed care.

Yet, it is important for people to understand managed care is only one of

the options in the private system

today. There are many others. And reasoned Medicare reform would open the

Medicare Program broadly to the many

options that are available to all other

Americans in our private system

today. It would allow seniors the freedom to direct their Medicare money to

the plan of their choice. For some, that

would mean an employer-sponsored

plan. For others, it would mean an indemnity-type plan, and for still others

a looser form of managed care. But the

bottom line is that the Government

should no longer restrict a senior’s

choice of health plans.

New to this body, I find it hard to understand why Congress has failed to

pay attention to the ticking time

bomb—Medicare. By failing to address

the issue head on, we only delay the inevitable and make it more difficult for

our successors. If we choose not to preserve Medicare’s integrity, we resign

ourselves to either substantial benefit

reductions for seniors or repetitive tax
April 26, 1995 CONGRESSIONAL RECORD — SENATE S5687

increases. We must act now. Either my

generation, the children of today’s

Medicare beneficiaries, will have greatly reduced opinions in the future, or

our children will incur unprecedented

tax increases.

Now, the President of the United

States has failed to address this imminent financial crisis. In fact, the Clinton administration predicts Medicare

expenditures will grow by a staggering

66 percent over the next 5 years. Yet,

despite this forecast and despite the

findings of the Medicare trustees and

the entitlement commission, the President failed in his fiscal year 1996 budget to recommend even one measure to

save Medicare.

We must act now. I expect that the

President will rely simply on tax increases to maintain the program in the

future, and that will work only for a

short time, because it fails to address

the underlying cause of the crisis. If

nothing is done, the Medicare portion

of FICA taxes would have to be raised

by 125 percent. That is more than $700

taken out of a $40,000 salary. That is intolerable. Structural improvement is

necessary if we are to protect and preserve Medicare in the long run. We can

and will protect and save Medicare if

we act now.

I will be taking time over the next

several days to come back to the floor

to continue this discussion of how best

this Congress is to save Medicare.

I yield the floor.

Mr. BRYAN addressed the Chair.

The PRESIDING OFFICER. The Senator from Nevada.

Mr. BRYAN. I thank the Chair.

Mr. President, I ask unanimous consent I be allowed to speak for a period

of time not to exceed 15 minutes as if

in morning business.

The PRESIDING OFFICER. Without

objection, it is so ordered.

Mr. BRYAN. Mr. President, we are

Mr. BRYAN. I thank the Chair.

WELFARE REFORM

fabout to be engaged in a debate in this

Chamber on welfare reform, an issue

which has failed the recipients, has

failed the American taxpayer, and on

which I think men and women of good

will on both sides of the political aisle

agree we must undertake some major

structural reforms. I think that we can

do so in a bipartisan fashion.

It was in this context during the recent April recess that I spent an entire

morning at one of the busiest welfare

offices in Las Vegas, the West Owens

District Welfare Office. May I say, Mr.

President, to my colleagues, it was an

educational opportunity, and if my colleagues have not previously done so, I

would urge each of them to avail themselves of this opportunity.

I first sat in on a welfare eligibility

interview, a process that lasts for approximately 1 hour. I observed this

process from the beginning to its conclusion.

In the Owens Welfare Office, eligibility workers sit in very small interview rooms, somewhat affectionately

referred to as the ‘‘chutes.’’ The eligibility worker has a desk literally surrounded on all sides with shelves full of

various forms and regulations that deal

with the nearly 20 different programs a

person in need of welfare assistance

may be eligible to receive. The client

comes into the interview room from

the reception area, sits across from the

eligibility worker’s desk, and the interview process begins.

Now the interview I observed, contrary to some of the stereotypical images that are often projected, was of a

young Caucasian woman. She was married, living with her husband and two

children. Her situation represents the

prototype of the kind of problem that

many people in America face who seek

welfare assistance.

She and her husband had moved to

Nevada from California, and currently

both are working. Although their jobs

pay above the minimum wage, they are

still unable to provide for their family

of four. Her employer structures her

workweek so that her hours do not exceed 20 hours per week, and so she is

ineligible for the medical benefits

which her employer pays for those who

work full time. One of her children has

a preexisting medical condition, so

medical care is a necessity. Her husband’s employer provides no medical

insurance. She also needs to pay for

the cost of child care, and her child

care cost is more than 50 percent of the

gross hourly wage that she makes each

hour.

Following this eligibility determination interview, I sat down to a very

frank discussion with eligibility workers concerning the areas of the welfare

system that they believe need reforming.

Let me say, Mr. President, I had anticipated the thrust of the comments

would be that you all in the Congress

need to provide more money; the system works. In effect, I thought I might

be hearing a defense of the status quo,

because these are eligibility workers,

the committed and dedicated people

who choose, in terms of their own educational background and their work experience, to provide care to others. So

these are highly compassionate, sensitive people who see the travail of life

before them every day.

To my great surprise, they are as enraged and as frustrated and as angry as

are the American people and each of us

who, as Members of Congress, have had

a chance to look at this system that

has failed so abysmally. Their suggestions and comments to us, I think, are

extremely worthwhile for us to consider. They are the people that are on

the front lines. They know the nuances

of the system. They know how the system is ripped off. And they also know

of its shortcomings in providing help to

those who all of us in this body would

acknowledge are in genuine need of

help.

As one of the underpinnings of the

welfare system, I think all of us can

agree, whether we position ourselves in

the political spectrum to the left of

center, to the right of center, or in the

middle, that we want a system that encourages people to work.

Most of us in America have a work

ethic that is part of our background. It

is part of what our parents shared with

us. And, for whatever measure of success we may have achieved in life, it is

the presence of that work ethic that

contributed to that success.

But a person who is on welfare, who

gets a job, who achieves that first rung

on the job ladder, oftentimes is confronted with a horrific choice. Immediately that individual may be cut off

from all medical care, all child care assistance, and that individual may, in

fact, find herself in a more disadvantageous position than before she attained

employment.

That part of our system, it seems to

me, ought to be fundamentally

changed. We ought to be encouraging

and rewarding those people like the

young applicant whose interview I observed, who is going out, getting a job,

and trying to help herself and her family.

Our present system provides all of

the disincentives by not providing

transitional help for her, so she can get

a little better job, that pays a little bit

more, so that she is able to provide for

herself and her family. That, it seems

to me, ought to be one of the structural incentives that any welfare reform ought to encourage.

The welfare system is replete with

conflicts, both indefensible and maddening. It is the sort of thing that encourages the American public to react

as it does when the word ‘‘welfare’’ is

mentioned.

I would like to talk about a few of

those, if I may, Mr. President.

One of the key policy problem areas

the eligibility workers brought to my

attention is how the term ‘‘household’’

is defined for determining the eligibility of individuals living together at

one residence for different welfare assistance programs.

One of the most egregious examples

of how policy and effect conflict is the

Food Stamp Program definition of

‘‘household.’’ Assume with me for the

moment that two families have the

same number of family members, and

the same income. Applying the ‘‘household’’ definition can mean a family

where everyone is a legal citizen is ineligible for food stamps, while a similar family with one member, who is an

illegal alien, is eligible for such assistance.

Let me be more specific.

Let us assume family A and family B

both have a total monthly household

income of $1,200, and each parent individually earns $600. Family A’s two

working parents are both legal citizens. Family B also has two working

parents, but one is an illegal alien.