HEALTH CARE REFORM HEARINGS BEFORE THE SUBCOMMITTEE ON HEALTH OF THE COMMITTEE ON WAYS AND MEANS ONE HUNDRED THIRD CONGRESS FIRST SESSION VOLUME V Expansion of Medicare Benefits to Include Health Care Service Delivery Infrastructure in Implementation of a National Health Budget JULY 13, 1993 Serial 103-31 Printed for the use of the Committee on Ways and Means 71-717 CC U.S. GOVERNMENT PRINTING OFFICE WASHINGTON: 1993 For sale by the U.S. Government Printing Office Superintendent of Documents, Congressional Sales Office, Washington, DC 20402 COMMITTEE ON WAYS AND MEANS DAN ROSTENKOWSKI, Illinois, Chairman SAM M. GIBBONS, Florida CHARLES B. RANGEL, New York BARBARA B. KENNELLY, Connecticut RICHARD E. NEAL, Massachusetts WILLIAM J. JEFFERSON, Louisiana BILL ARCHER, Texas AMO HOUGHTON, New York CONTENTS U.S. Department of Health and Human Services, Hon. Bruce C. Vladeck, Administrator, Health Care Financing Administration Office of Technology Assessment, Judith L. Wagner, Ph.D., Senior Associate American Association of Retired Persons, Tess Canja Coalition for Consumer Access to Pharmaceutical Care, R. Timothy Webster Generic Pharmaceutical Industry Association, William F. Haddad National Committee to Preserve Social Security and Medicare, Martha Pharmaceutical Manufacturers Association, Gerald J. Mossinghoff Access and Affordability Monitoring Project, Boston University School of Pub- lic Health, Alan Sager, statement Aging, Special Committee on, Hon. David Pryor, Chairman and a U.S. Sen- ator from the State of Arkansas, statement Drug Policy Research Group, Harvard Medical School, Department of Social Medicine, Stephen B. Soumerai, Dennis Ross-Degnan, and Thomas |