[Congressional Record Volume 140, Number 109 (Tuesday, August 9, 1994)]
[Senate]
[Page S]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: August 9, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
               HEALTH CARE REFORM AND PRESCRIPTION DRUGS

  Mr. DORGAN. Mr. President, yesterday I was in the chair when one of 
our colleagues brought to the floor a very large poster with a 
telephone number of how citizens could reach their Senator. It was a 
poster that only had 1-(202) and the telephone number of the Capitol 
switchboard. I was thinking, as I looked at that, that it is preemptive 
television. In fact, that poster has to compete with a lot of other 
things on television these days and probably will not compete very 
well.
  The person who was asking people to call the U.S. Senate wanted them 
to call us because they wanted citizens to tell Senators that we should 
delay responding to the issue of health care reform.
  As I said, that is preemptive television, just putting a chart on. It 
does not compete with the dizzying disorientation, as it is called, and 
future shock of what we now see in the pop culture.
  Walk outside this building and talk to the first person you see, and 
they will be conversing about things totally irrelevant to our lives 
but things that have become relevant by virtue of television. Ask them 
about Tonya Harding. Ask if they know the whole story. Ask them about 
Lorena Bobbitt and her husband and, they will know the whole story. 
They will know it from Peoria to the west coast. Ask them about O.J. 
Simpson and they can debate the whole story. Ask them about Joey 
Buttafuoco, or maybe the Menendez brothers.
  It is part of our pop culture. We are told kids go to school and 
graduate from high school these days and they have spent 12,000 hours 
in the classroom and watched television for 20,000 hours. They are much 
more a product of what they watched than what they read.
  Unfortunately, if you take a look at all the things we read, see, and 
hear and become fixated on with our periodicals and television sets, 
you get the feeling in this country we often treat the light far too 
seriously, and the serious far too lightly. That is why I want to talk 
today about the question of should we delay the debate on health care 
reform.
  Should we delay the debate on health care reform? We are told --in 
fact an amendment is offered; I think it is still pending before the 
Senate--that it is really in the country's best interest for us not to 
respond to the issue of health care reform. It is not necessary, they 
say; there is a better time to do this; we do not know enough; we are 
not ready.
  Let me try to think through just a little bit what has caused this. 
If you take a poll and ask people about health care, you will find that 
most Americans think health care costs too much and prices are too 
high. It is not just that they think that, that is the plain fact. We 
spend much more on health care in the United States than any other 
country in the world, by far. It is not even close. We spend over 14 
percent of gross domestic product--everything that we produce in goods 
and services in this country. We will spend over 14 percent of our GDP 
on health care this year. The next nearest country is Canada which 
spent 11 percent, and no other country in the industrialized world 
spends more than 10.
  The point is, we spend far more than any other country, by far more 
than any other country. And the American people know it because they 
are paying the bill.
  The other point is--the American people well know this--health care 
prices are increasing, double and triple the rate of inflation. They 
have come down a little in the last year or so, but that is because 
there is a threat of health care reform. That is double or triple the 
rate of inflation for every year, for something that is not a luxury, 
but something that is a necessity.
  It is not unusual these days for peoples' monthly insurance payments 
to be twice as much as their car payment--$400, $450, $500 a month for 
a family policy is not that unusual in my part of the country. And that 
is what has driven middle American families to say to the Congress: Do 
something, do something because health care prices are out of control.
  In the rest of our economy, we have something called competition. And 
in competition, prices are a competitive regulator. In health care, it 
is not. At least not in my State. I represent a State of 640,000 
people. Guess what. We have six separate locations where you can get 
open-heart surgery in my State. Do we need six? Of course not. Is that 
competition? One hospital does it, the other wants to do it. One gets 
an MRI, the other hospital wants an MRI. One has a cardiac surgical 
unit, the other wants a cardiac surgical unit.
  Duplication? Waste of money? Of course it is, but it is competition.
  In health care, competition means duplication and higher prices, and 
that is a sad fact. Competition simply has not worked to bring down 
prices in health care.
  Lest anyone wonder where we are and where we are going, here is what 
happened to health care prices in the United States, and here is what 
is going to happen.
  You can see this bar graph, and it is alarming. What has happened is 
health care prices have risen out of control. It has devastated the 
Federal budget because we have a heavy amount of spending in Medicare 
and Medicaid. But more than the Federal budget, State and local 
budgets, and more than that, family budgets and business budgets, 
especially, have been devastated by the increasing cost of health care 
every single year.
  To those who say we should do nothing, let us delay, let us wait, it 
is not the time, I say what about this? How do you address this? It is 
one thing to say let us not do anything, but we have an obligation on 
behalf of American families to address this.
  What do we do about prices running out of control? Let me take just 
one aspect of prices, and I do this recognizing the Senator in the 
chair currently, Senator Pryor from Arkansas, has done an enormous 
amount of work on this. He will know these charts easily because these 
charts describe a problem he has discussed for years.
  To those who say let us do nothing, I say to them, take a look at 
this chart, if you will. I have taken the price of prescription drugs, 
one part of health care, an expensive part, and shown what they cost.
  The same manufacturer of the same drug puts the same pill in the same 
bottle, seals it up and sells it. They sell it in the United States, 
Canada, England and Sweden.
  Here is a drug called Premarin. This is the number one selling drug 
in the United States. It is used for estrogen replacement. The same 
drug put in the same bottle sealed up by the same manufacturer is sold 
in Sweden for $93. They sell it in the United Kingdom for $100 and $113 
in Canada. Guess what they charge the U.S. consumer for it--$297.
  To those who say let us wait, I say justify this. You tell me how you 
can justify asking a 60-, 70-year-old American who buys Premarin to pay 
that kind of overcharge.
  I just brought a couple of these charts about what happens with a 
range of drugs.
  Zantac, a drug for the treatment of ulcers. There are probably plenty 
of uses for ulcer drugs in the United States Senate these days as we 
fix to confront health care; $64 in Sweden, $84 in England, $102 in 
Canada and $133 in the United States.
  By what justification do they say to the United States consumer, 
``Here is the identical pill. We will charge you twice as much for it 
as we charge the Swedes.''
  Xanax, for anxiety: $10 in Sweden, $56 in the United States.
  Here is one well recognizable. This country consumes a lot of this. 
It is Valium, another drug used for anxiety.
  Guess how they charge Valium?--$4 for Sweden, $4 for the United 
Kingdom, $9 for Canada, and $49 in the United States. So to those who 
say, ``Let's wait. What's the hurry? There is no problem here,'' just 
take this small sliver of health care cost, just this, and justify it 
for me. Tell me the market system works. Tell me it is fair and 
reasonable to do this to the American consumer.
  Well, we are going to discuss health care now at some great length. 
We are going to discuss policy, and we are going to discuss terms that 
a lot of people probably will not understand very easily. It may best 
be described, however, in more human terms. And let me describe just a 
few of the people I have been around.
  A woman in central North Dakota in her mideighties has diabetes and 
heart trouble, and her doctor prescribes medicine for her to take for 
her diabetes and heart trouble. But this woman, like a lot of women, is 
living alone and has very little money, lives only on her Social 
Security check. She says, ``I can't afford the prescription drugs, so 
you know what I do?'' A woman in her mideighties takes half the dose 
her doctor prescribes, and that is the only way she can afford the 
prescription drugs that are necessary to keep her alive.
  Or a woman from Texas who testified before a committee I was on some 
while ago, a woman from Texas who was pregnant and broke, no money. She 
was going to have her neighbor help deliver the baby because she did 
not have money to go to a hospital. During the delivery, it turns out 
to be a difficult delivery, and they discover this is going to be much 
more trouble than they can deal with.
  They put her in a car, take her to a hospital, and the hospital says, 
``Do you have insurance?''
  ``No.''
  ``Do you have money?''
  ``No.''
  ``Well, we are sorry; you cannot be admitted.''
  Two hospitals during delivery denied admission. The baby was born at 
the third and the baby had the umbilical cord wrapped around its neck. 
The baby is alive, but the baby will be institutionalized the rest of 
the baby's life, damaged from that difficult pregnancy because this 
woman did not have money.
  I mentioned the other day I was in Minot, ND, a week or so ago, and a 
waitress at a place I was eating said, ``I know I shouldn't do this to 
interrupt your meal, but,'' she said, ``I want you to know I am 23 
years old and I have seizures occasionally. And you are going to hear 
from a lot of big interests, a lot of insurance companies, doctors, and 
others when you talk about health care. But will you just understand 
when you deliberate about health care, I am 23 years old and can't get 
insurance and can't find a job that pays benefits? So I walk around 
with no insurance not because I want it that way, but because I simply 
do not have the opportunity to get insurance and be covered for health 
care.''
  Now, in my home State right now there is a blitz of advertising. They 
have had television commercials. We have had radio commercials. We have 
had overlapping commercials by different interests. And the disclaimer 
on the commercials is always some innocuous title like ``Paid for by 
Americans for Decent Health Care'' or ``Paid for by Americans for'' 
this, that or the other thing.
  It is interesting; I had a call from a woman in North Dakota who 
called me because there is one organization that is advertising in 
North Dakota that is partially funded by the pharmaceutical industry, 
and they invite the person, once they have given their 30-second ad on 
radio to call this number, the 1-800 number and then they transfer the 
call to my Senate office. So this woman was calling my Senate office as 
a result of the radio ad that she heard. She did not have the foggiest 
idea that she had been asked by a pharmaceutical manufacturer in effect 
to lobby on their behalf for health care reform. That is just a plain 
fact.
  There is a complete disconnection these days because the biggest 
economic interests are able to spend an enormous amount of money to 
affect this debate.
  I have had senior citizens say to me, ``As a result of the ads 
running in North Dakota, we don't think the Government ought to be 
involved in health care in any way.'' These are people on Medicare, 
people on the Medicare Program. I had a fellow in his midseventies 
stand up and talk about what an awful health care system we have and 
how terrible it would be if Government were involved and how much money 
the Congress spends. And it turns out he just had open heart surgery 
paid for with Medicare.
  There is somehow a complete disconnection. Those same interests are 
now spending millions of dollars, and they have spent at least, as I 
understand it, some $100 million in concert in an attempt to influence 
this health care debate.
  From Ed Raymond, in the Gadfly--he writes a column in the Midweek 
Eagle, a tiny newspaper--let me read a couple excerpts. I thought he 
got it right. He does not have anything good to say about Congress, I 
might add, but he says of these interests that are spending all this 
money that this is the same crowd that is trying to hide the fact that 
the average salary for doctors is now near $180,000 a year against a 
per capita income of $22,000.
  It is the same crowd, he says, that pays its executives millions of 
dollars in annual salaries topped by one insurance company he names who 
has a CEO paid $52.8 million.
  He says that, of course, if they can defeat health care reform, that 
CEO will be worth every cent they pay him. This is the same crowd that 
paid one fellow from another health care institution, a private 
company, $12.7 million when that same company said that 37 million 
Americans do not need health insurance because the system just cannot 
afford it.
  This is the same crowd that, he says, charges patients $40 for 15 
milliliters of atropine sulfate that it gets wholesale for $1.12.
  This is the same crowd that bought more MRI's for Atlanta, GA, than 
exist in all of Canada.
  This is the same crowd that thinks it is fine for private health 
insurance companies to take 20 percent of the premiums for 
administrative costs, but then yells that Medicare administrative costs 
of 2 to 4 percent are wasteful.
  Finally, he says that this is the same crowd that charged my daughter 
$300 for three stitches in her index finger.
  ``Yup, it sure would be disastrous to have the government involved in 
health care,'' he concludes.
  Well, I am not standing here today as part of a forum or a caucus. I 
am not part of a mainstream group or upstream group. I did not sponsor 
the Clinton health care plan because I had some concerns about it. But 
I do not believe that this is the time for us to decide we should not 
address health care. This is exactly the time for us to be dealing with 
health care reform issues.
  I would hope that in the next couple of weeks we find a way to build 
a bridge across this Chamber and decide that this is not and cannot be 
a partisan issue and the question of whether some young child who is 
sick gets health care is not answered differently by Republicans or 
Democrats or Conservatives or Liberals. I would hope that will be the 
case.
  Likely, it will not start out that way, but who knows where we end 
up.
  We have people who come to the floor and say, ``Don't worry; be 
happy; no problems; do nothing.''
  I wish to tell just a brief story that I may have mentioned before 
that reminded me for the first time of part of our heritage.
  I was on a helicopter that ran out of gas in Nicaragua one day some 
years ago, and I discovered when you run out of gas in a flying 
machine, you are going to be landing right soon. And we did, and we 
were not injured, fortunately. But a lot of campesinos came up in the 
mountains through the jungle to talk to us as we were stranded out 
there, and one of the things that impressed me, talking to a young 
woman, perhaps in her midtwenties, through an interpreter who was with 
me on the helicopter, I said, ``How many children do you have?''
  She just came from a campesino family somewhere in the mountains of 
Nicaragua, had never seen anybody from the United States. She said, 
``Only four,'' in a disappointed way.
  Later, I asked the interpreter, ``Why would she be disappointed, 
having only four?'' She was in her midtwenties.
  He said, ``You don't understand the culture. They don't have any 
Social Security System in Central America. There is no Social Security 
Program. In a circumstance like that, it is not unusual to believe that 
you ought to have as many children as you can have during childbearing 
years, hoping that if you are lucky enough to live a long life, that 
some kids will survive and be of help to you in your old age as Social 
Security.''
  It was really the first time out in the jungle of Nicaragua that I 
understood what we took for granted. We take Social Security for 
granted. It adds such an enormous amount of strength to this country. 
We just take it for granted. You go back to the 1930's and take a look 
at that debate on Social Security, and you will find that we will 
replay that debate in the next 2 weeks. Then skip ahead. Skip ahead to 
Medicare, and review that debate in the early 1960's and mid-1960's. We 
are going to replay that debate again.
  There were people then in the 1930's who said Social Security would 
ruin this country. It will be the ruin of this country's economy. We 
were told in the 1960's that Medicare would be a disaster for America. 
The fact is we have always had people willing to say no. There is the 
story about a radio announcer who interviewed one day an 80-year-old 
man, and said to the man, ``You know, I bet you have seen a lot of 
changes in your life.'' He said, ``Yep, and I been against every one of 
them.'' We have people like that in this Chamber, and people who serve 
in public life. I say to them, look to the challenge of what to do 
about this problem.
  No one can possibly stand on the floor of this Senate and say that 
health care prices are not a problem. Health care prices have increased 
so substantially that it has raised the price of health care above the 
reach of far too many Americans. And for those who are still hanging on 
to their policies, as I have said before, they are paying in some cases 
double their car payment. And they simply cannot afford it. They want 
us to do something about it.
  We have been treated in this debate to a massive amount of 
institutional money that is put on television and radio to try to 
change the focus of the debate. We now have a circumstance in which I 
saw a poll yesterday that two-thirds of the American people say let us 
wait. Well, in the second question the poll, as I understand it from a 
colleague of mine who saw it, exactly the opposite was achieved. What 
if Congress did nothing about health care. Do you think they should act 
or do nothing? The answer is we do not want them to do nothing. The 
question is, then do what?
  I have been watching Harry and Louise now until I am just tired of 
Harry and Louise. It is interesting that it sort of reduces to 
theatrics. Harry and Louise are not really Harry and Louise. We all 
understand that. They are paid actors by the insurance industry to send 
us a message on behalf of the insurance industry. Since when has the 
insurance industry been an institution that most families can rely on 
to hold down prices? The fact is they are responding to prices. The 
providers are passing them on with their profit, and the little guy 
always gets stuck.
  I would say, if I could, to Harry and Louise that they become the 
symbol, I guess, of everything that is wrong with what is currently 
being proposed. And they I suppose are probably the symbol of that 
which says call your Senator and tell them to do nothing.
  I would ask Harry and Louise, if I could, Well, Harry and Louise, do 
you think we should do nothing about escalating prices in health care? 
Nothing? Or do you think we ought to address escalating prices that 
price something this essential out of the reach of the American family?
  I would ask Harry and Louise, What do you think of this? Why do you 
think an American consumer should be charged 10 times the price for the 
same drug in the same bottle by the same manufacturer as the consumer 
in Sweden or Canada or the United Kingdom?
  It seems to me, as we start this evening on the eve of this health 
care debate, that what we ought to try to find a way to do is join 
together in a bipartisan effort and fix these problems.
  I am reminded of a fellow from North Dakota as I conclude, Mr. 
President, who came to see me some while ago. He is an astronaut, a 
young, handsome man. His name is Rick Heib. In fact, he had just 
finished the latest flight, and was up over 2 weeks. He is from 
Jamestown, ND. After he had finished his previous flight in space on 
the Shuttle Endeavor, he came to see me.
  The reason I was kind of interested was that he had been up on the 
Shuttle Endeavor. And they were trying to fix the Intel satellite which 
needed repair. They pulled it into the bay, as I recall, or got it into 
the shuttle bay. It had stuck with some arm and they could not figure 
out how to get it loose. They went out to try to get it loose. They 
could not. They came back in, and it was trumpeted as a big failure.
  The second day they went back out with the procedure, sort of on a 
basis of, if they could not get it the first time, they would set up 
procedures they had never practiced, and they would do it another way. 
They went back out in space, and the world watched them. They were 
unable to solve that problem. They went back in that shuttle and 
continued to circle the Earth. Then they went back out a third time 
about a day and a half later to try to do something they had never 
practiced before.
  This is a 10,000-pound satellite up in a weightless environment. 
Three astronauts traveling 16,000 miles an hour went out for the third 
time, having failed the first two, to try something that had never been 
tried before, to unlatch and fix this satellite.
  I remember watching at home sitting on the davenport as I watched 
Rick, this young man from Jamestown, and his two friends, standing out 
there outside that shuttle bay holding that Intel satellite, and then 
trying to work on it to see if they could get it loose. It took them 5 
hours. They solved their problem.
  They came to see me a few weeks later after they landed, and 
confident. I said, ``Were you worried when you went back out?'' They 
said, ``Of course. We had no idea we could do it. We never tried that 
before, never practiced it. It was not in our plan. But we were up 
there in space, and we had to try to figure out how we were going to 
deal with this.''
  Think of it. If they failed the third time, guess what? We would have 
trumpeted their failure on the front page. But the failure in my 
judgment, and I think in this young man Rick Heib's judgment, would 
have been the failure to try.
  There is no disgrace in trying and failing. But there is certainly 
disgrace in my judgment in failing to try when you know something ought 
to get done. Everybody in this Chamber ought to understand that we need 
to do something about prices in health care, and also about access 
because prices are too high. It would be a failure, in my judgment, for 
us to not to address that at this point.
  Those who want to certainly call, I respect your opinion. Do you want 
to call based on the chart and say delay this, do not do this? 
Everybody has every right to waive on this question. But in my 
judgment, we ought to join together, and not to construct a big 
Government solution, but to construct a solution to make health care 
available at an affordable price in a quality way to every single 
American who needs it, day or night, anytime throughout the year. That 
is what we ought to have in this country.
  I hope that as we begin this evening this important debate that we 
can drive to a conclusion at the end of which would be some sort of 
celebration that finally, finally, after month after month after month 
we could have achieved something in a bipartisan spirit that we think 
makes sense for this country's future.
  Mr. President, I yield the floor.

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