[Congressional Record Volume 146, Number 5 (Monday, January 31, 2000)]
[Senate]
[Pages S132-S134]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                A PRESCRIPTION DRUG BENEFIT FOR MEDICARE

  Mr. DORGAN. Mr. President, I would like to speak for a few moments 
today about the call in the State of the Union Address for a 
prescription drug benefit to be added to the Medicare program.
  In all of the discussions about the State of the Union and what is 
happening to the health of the American people, one of the underlying 
issues is that people are living longer and better lives. When people 
live longer and better lives, it means we have more strain on Medicare 
and on Social Security. But, of course, all of that is born of good 
news: People are living longer. At the start of the last century, 
citizens of the United States were expected to live, on average, to 
about 48 years of age. One hundred years later, in the year 2000, you 
are expected to live to be about 78 years of age--a 30-year increase in 
life expectancy. That is really quite remarkable.
  What are the reasons for that? There are a lot of reasons: Better 
nutrition, new medical technologies, and life-saving prescription 
medicines that have been developed to extend life. There are a lot of 
reasons for the increased longevity.
  In 1965, we created a Medicare program that has contributed 
substantially to the increase in longevity in this country. Prior to 
that time, 50 percent of senior citizens had no health care coverage at 
all--none. Medicare provided health care coverage to all senior 
citizens, and now 99 percent of older Americans in this country have 
basic health care protection through Medicare. That clearly has 
extended life and has allowed people to live longer and better lives. 
But in 1965 when Medicare was created, many of the prescription drugs 
that now exist for extending life simply weren't available. There was 
not, therefore, a need for a prescription drug benefit in Medicare.
  The call now by the President and by Members of Congress, myself 
included,

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Democrats and Republicans alike, is for a prescription drug benefit for 
the Medicare program. Why? Because senior citizens in this country 
comprise 12 percent of our population and consume 33 percent of the 
prescription drugs in our country.
  Let me repeat that because it is important.
  Twelve percent of our population are senior citizens, but yet they 
consume one-third of the prescription drugs.
  The cost of prescription drugs last year increased nearly 16 
percent--last year alone. Part of the reason for that increase was 
price inflation, and part of it was a dramatic increase in utilization. 
But we should, it seems to me, be especially concerned about senior 
citizens having access to the prescription drugs they need to extend 
and improve their lives.
  As chairman of the Democratic Policy Committee, I have been holding 
hearings in various parts of the country on this very subject. For 
instance, I held a hearing with Senator Schumer in Westchester, NY, and 
a hearing recently with Senator Durbin in Chicago. I guess I have held 
perhaps six or eight hearings on this subject.
  It is heartbreaking sometimes to hear the stories told at these 
hearings. An oncologist came to a hearing I held. He told of one of his 
patients who was a senior citizen, a woman who had breast cancer. And 
he said: There is a medicine she needs to take following her surgery, 
chemotherapy, and radiation that will reduce the chances that she will 
have a recurrence of breast cancer. When I described this medicine to 
her, she said: What does it cost? The doctor told her what it cost. And 
she said: There isn't any way I can afford that medicine. I will just 
have to take my chances. I will just have to take my chances of the 
breast cancer recurring because I can't afford the medicine.
  It breaks your heart to hear that.
  Or to hear a senior citizen who said: When I go into the grocery 
store where I purchase my medications, the first stop for me must be 
the pharmacy counter because I must get my prescriptions filled, so 
then I will know how much money I have left for food. Only then will I 
know how much food I can buy.
  Senior citizens will find in some circumstances that they take 4, 6, 
or 8, and in some cases 10 and 12, different kinds of medicines at the 
same time. Some of them are horribly expensive. Yet most older 
Americans have very little prescription drug coverage.
  I would like to show some charts that describe these circumstances 
graphically, especially for senior citizens.
  This chart shows that nearly a third of senior citizens spend $1,500 
a year on prescription drugs. These are people who are living on fixed 
incomes, and 70 percent of them have incomes of $15,000 or less.
  This chart shows that nearly 75 percent of Medicare beneficiaries 
have inadequate prescription drug coverage. In fact, 34 percent have no 
drug coverage at all--none, zero. So they must go to the drugstore to 
buy their prescription drugs, living on a fixed income, trying to 
balance the need to pay heat and light and rent and food, and then try 
to figure out how to pay for increasingly expensive prescription drugs. 
Many of them find they can't do it.
  They tell me at these hearings some of the measures they are forced 
to take: I have heart trouble, or I have diabetes, they tell me, and 
what I do is buy the prescription drugs that the doctor says I must 
have, and cut the pills in half and take half the dose so it lasts 
twice as long. And they hope somehow that they will avoid medical 
problems by doing it. It breaks your heart to hear someone 85 years of 
age who knows he has to take medicine to deal with his heart disease 
and diabetes, but who says: I can't afford it so I don't take the 
medicine.

  As this chart shows, this is especially a problem for older women. As 
you can see, the majority of women have no prescription drug coverage 
at all. That is a very serious problem.
  This chart illustrates that rural beneficiaries are less likely to 
have prescription drug coverage across all income groups. I represent a 
rural State and the many hearings I have held in North Dakota confirm 
this fact.
  We are going to be confronted in this Congress with the question of 
whether we should add a prescription drug benefit to the Medicare 
program. When I was in New York with Senator Schumer, Connie Pennucci, 
77 years old, said she has no prescription drug benefits and pays $200 
a month out of pocket for the medications she needs to treat her 
arthritis and osteoporosis.
  In Illinois about 2 weeks ago, a woman named Anita Milton told 
Senator Durbin and I that she had a double lung transplant. Because of 
the way Medicaid works, she gets help to pay for her prescription drugs 
one month, but then the next month she has no drug benefits at all. I 
think she told us that her prescription drugs to prevent the rejection 
of her new lungs cost $2,500 a month. Think of that, $2,500 a month.
  At that same hearing, this wonderful woman who had a double lung 
transplant was joined by two people who had heart transplants. They 
told us the cost of their prescription drugs that are necessary to 
prevent rejection of their transplanted hearts. Is all of this miracle 
medicine? Of course it is. But it is only miraculous if you can afford 
the prescription drugs that must be taken on a daily basis to ward off 
the rejection of the transplanted organ.
  There is an urgent requirement, in my judgment, for all of us in 
Congress to join together to find a way to add a prescription drug 
benefit to Medicare. We should do it in a way that is voluntary for 
senior citizens. We should do it in a way that doesn't break the 
Treasury, and pharmaceutical prices should be affordable. But we can do 
that. I hope Republicans and Democrats together will recognize the 
urgent need to do this.
  I would like to address one other issue, and that is the issue of the 
price of prescription drugs. Why do prescription drugs cost so much, 
and what can we do about it? Let me say at the outset, I want the 
pharmaceutical industry to be successful. I want the drug companies to 
be successful. I want them to be profitable. I want them to continue to 
invest in new research and development to help discover new lifesaving 
medicines and drugs. As you know, the federal government provides a 
substantial investment in pharmaceutical research and development 
through the National Institutes of Health and tax credits. A 
substantial amount of research and development for new medicines is 
publicly funded. But the pharmaceutical industry does private research 
and development.
  I want them to be successful. But I also want them to price 
pharmaceutical drugs fairly for all of the American people. In 
virtually every other country in which you purchase a prescription drug 
made by a pharmaceutical company in a plant inspected by the Food and 
Drug Administration, the same pill in the same bottle made by the same 
company costs double, sometimes triple the amount in the United States 
than in virtually any other country in the world. I will give you some 
examples.
  Let me go back to some of the medications most frequently used by 
older Americans who consume a third of the prescription drugs in our 
country. If they take Zocor, a cholesterol-reducing drug, the same drug 
in the same dosage and quantity costs $106 in the United States, and 
only $43 in Canada, $47 in Mexico. These prices have been converted to 
U.S. dollars.
  Or Prilosec, a drug for ulcers costs $105 in the U.S., $53 in Canada, 
and $29 in Mexico.

  Zoloft, a drug for depression, costs $195 in America, $124 in Canada, 
and $155 in Mexico. The list goes on.
  This chart shows it better. How much do we pay for prescription 
drugs? For every $1 that American consumers pay for a prescription 
drug, that same drug would cost much less in other nations. For every 
dollar Americans spend for prescription medications, Canadian consumers 
pay 64 cents, the English pay 65 cents, the Swedes pay $68 cents, and 
the Italians pay 51 cents.
  Why do U.S. consumers pay the highest prices in the world for 
prescription drugs? The answer is because the pharmaceutical industry 
can charge as much as they want if they choose to do so --and they do.
  I took a small group of senior citizens to Emerson, Canada, recently. 
They purchased prescription drugs at the pharmacy in Emerson. These are 
senior citizens with heart disease, osteoporosis, diabetes, and other 
illnesses. Guess what. We went 5 miles

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across the border into Canada and there they could buy the same 
prescription drugs at a small percentage of the price of the 
prescription drugs in this country. These are the same pills, made by 
the same company, often actually made in the United States and then 
shipped 5 miles north into Canada. Yet, if U.S. consumers were to buy 
them in the United States, they are charged much higher prices.
  Is that fair? No. If this is truly a global economy, then it seems to 
me that pharmacists in this country ought to be able to access those 
same drugs in any market in the world and pass the savings on to their 
customers. That would, in my judgment, force the pharmaceutical 
industry to reprice their products in the United States.
  As I said when I started, I want the pharmaceutical industry to make 
money. I want them to do good pharmaceutical. The Wall Street Journal 
calls the profits of the pharmaceutical industry ``the envy of the 
corporate world.'' Why? At least in part, it seems to me, it is because 
the U.S. consumer is charged very, very high prices for the same drug 
that is marketed in the rest of the world at a much lower cost. I have 
introduced a piece of legislation, the International Prescription Drug 
Parity Act, that I and a bipartisan group of cosponsors are going to 
try to get passed in this Congress to address this problem.
  These issues of pharmaceutical drug costs and a prescription drug 
benefit in Medicare are very important issues. Lifesaving medicine is 
only able to save lives if people can afford to have access to that 
medicine. Too many Americans find these prices are out of their reach. 
Too many senior citizens living on fixed incomes are finding they are 
not able to afford the medicines that are necessary for them to prolong 
their lives, to improve their lives, and to treat their diseases or 
illness. We in Congress can do something about that. But I would say 
this. Even as we try to add a prescription drug benefit to Medicare, we 
must find a way to put some downward pressure on prescription drug 
prices and provide some fairness relative to what the rest of the world 
pays for the same prescription drugs.
  Mr. President, I again thank the Senator from Iowa for the courtesy. 
I know the bankruptcy bill is on the floor.
  I yield the floor.
  Mr. SPECTER. Mr. President, parliamentary inquiry: Are we still in 
morning business?

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