John Breaux and Bill Frist

Excerpts from a Monitor breakfast on Medicare reform

Sens. John Breaux (D), of Louisiana, and Bill Frist (R), of Tennessee, were Friday's guests.

Senator John Breaux graduated from the University of Southwestern Louisiana and then from Louisiana State School of Law. In 1972, at the age of 28, he was elected to Congress, becoming its youngest member. He moved to the Senate in 1986, taking the seat vacated by Russell Long.

Bill Frist followed a less-direct path to the Senate. He is a graduate of Montgomery Bell Academy, Princeton University, and Harvard Medical School. Dr. Frist was senior fellow and chief resident at Stanford University School of Medicine.

Dr. Frist won election to the Senate in 1994, becoming the first doctor to serve there since 1928. He won reelection in 2000 by the widest margin in a statewide contest in Tennessee history.

Last year he was elected majority leader, having served fewer years in Congress than any previous majority leader in history.

Here are excerpts from their remarks:

On the importance of providing a prescription drug benefit:

(Frist) "The question of fiscal responsibility and healthcare security both have to be addressed... In the bill we addressed both ... the purpose, the goal, what is at the top is healthcare security for seniors ... your fundamental responsibility for those 40 million seniors and probably the ones who are coming up over the next several years is to inject prescription drugs because prescription drugs are the most important part of healthcare today - more important than the surgeon's knife, more important than the acute hospital bed, more important than the hospital. Today, unlike five years ago, unlike ten years ago, unlike 15 years ago. So the mission is healthcare security, therefore the response needs to be to have a benefit structure that responds... to provide that, your responsibility is do it in a way that is fiscally responsible..."

On criticism that the Medicare legislation should have more provisions aimed at improving the financial health of Medicare:

(Breaux) "One of the editorials you mentioned talked about why didn't we do the obvious things to restore financial stability. If someone told me what those obvious steps were we would do them right away. There are none.

The easiest choices are to increase taxes to help pay for it or to reduce the benefits for seniors. Try either one of those and you will see what kind of political headache we will inherit overnight...

Used properly, pharmaceuticals will keep people out of hospitals and make their hospital stay when they have to go a shorter period of time because of the proper use of prescription drugs which in many cases are not available today."

On testing market-based approaches to providing healthcare for seniors as a way to control costs:

(Frist) "The whole idea of innovating now with careful protection for people who are in the program itself is to see if the marketplace will work. If our model works and competition, true competition, comes to the table where individuals are empowered to consume, to make smart choices outside of price fixing, it may well be that we don't have to do anything in terms of raising taxes in the future.

If we use the traditional model, the 1965 model, of benefits that are micromanaged by congressmen, senators actually sitting here and setting prices, not having preventative medicine, not having coordinated care, not having disease management, then absolutely - if we are not going to change, as this bill begins to change, you would have to cut benefits or raise taxes. If this model works, you would not have to."

On the need to fix or repeal the Medicare legislation next year:

(Frist) "I predict it will not be the case, because it is voluntary. These are new benefits that are on the table that seniors do not otherwise have access to ... we are talking about drugs, something that is of value to people that they are going to be getting in eight months that they don't have access to now."

(Breaux) "I think it is a good program. If we can't sell it, we should do something else."

On the choice Democrats face of whether to support the legislation:

(Breaux) "This bill has Democratic principles in it because of Senator Max Baucus fighting very hard for this ... there are things that are good for low-income seniors ... I would want to say we were part of that process. I would not want to see a Medicare reform bill that contains prescription drugs not pass with Democratic support. Democrats have to recognize that while this is not perhaps a perfect bill, it is one that deserves our support. We ought to jump on the bandwagon and be part of the parade because we have helped influence the final product. "

On charges by critics that the Medicare bill capitulates to drug companies by forbidding the government from negotiating for volume discounts:

(Frist) "The problem is 24 million seniors do not have appropriate plans to cover drugs and so they are not getting drugs for their cancer therapy, for their hypertension, for their Alzheimers, for their Parkinsons. The fact that we are opening up that market so they can get healthcare ... means that the market is greatly expanded. And in that sense if you are in the business of selling drugs, that is very positive, it is a larger market.

Long term, the purpose of having competition, of having transparency, of having consumer choice, of having competitive bidding which is injected in this bill which does not exist in Medicare today at all for anything. For the first time, we are going to have a private healthcare plan bidding against a private healthcare plan. ...That is the first time that has ever existed in this huge entitlement program of Medicare today.

If you believe in the marketplace, if you believe in competition, and some people don't, if you believe in market forces and the power of market forces, I find it hard to argue that there is not going to be an effect both on prices as well as quality because you have the transparency to measure it as we go forth..."

On Democrats being excluded from the House-Senate negotiations on the Medicare bill, except for himself and Senator Max Baucus:

(Breaux) "Now members are excluded only because of who they are and what they feel ... it is most unfortunate as far as process is concerned. And that is why I said unnecessary partisan politics is destroying this institution's [the Senate's] ability to get things done. ...I had a choice of not being in the room or being in the room and helping design and produce a better product. I think the choice was clear.

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