[Congressional Record Volume 146, Number 23 (Monday, March 6, 2000)]
[Senate]
[Pages S1188-S1191]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




       PRESCRIPTION DRUG COVERAGE--A LIFELINE, NOT A POISON PILL

  Mr. DURBIN. Madam President, I rise to express my disappointment that 
the Congress has been unable to move forward on a bipartisan basis on 
the prescription drug benefit under Medicare. There is a lot of talk 
with our surplus about potential tax breaks for businesses and families 
and individuals. In fact, it appears one of the proposals is going to 
be virtually unanimous, and that is the suggestion we take the cap off 
income for those who are under Social Security so people between the 
ages of 65 and 70 can work without penalty. That is encouraging. We 
should move on that and move quickly.
  Another element of some debate but some agreement as well is the so-
called marriage penalty. This is a feature of our Tax Code that was 
probably not there by design, but it reads that if two individuals 
making a certain amount of money should get married and their combined 
income puts them in a different and higher income tax category, they 
face a penalty.
  Some have argued, with very little evidence, that many people do not 
get married because of this. I have my doubts about it. I do not know 
how many people visit their accountant before they buy the engagement 
ring, but I suppose it happens.
  I do believe we can, on a bipartisan basis, come to an agreement that 
we will remove the so-called marriage penalty and do it in a way that 
is not unreasonable so we benefit those who would otherwise be 
disadvantaged.
  There is an irony to this as well, of course, in that when many 
people get married, their combined income puts them in a lower tax 
bracket. This is, I guess, a marriage bonus, if you want to use the 
term. We certainly believe that should continue and that it should not 
be changed. I hope we can move in that direction.
  Unfortunately, the House of Representatives recently passed a package 
on the marriage penalty that was really quite different than what I 
have described. First of all, as with so many other tax bills that have 
come from the other party over the years, the vast majority--two-thirds 
of the benefits of this so-called marriage penalty tax bill coming from 
the House--goes to higher-income couples; that is, couples making over 
$75,000 a year. These higher-income couples get an average tax cut of 
close to $1,000. Couples who earn less than $50,000 receive an average 
of $149. That is a very small percentage of the amount that goes to 
those in higher-income categories.
  The price tag for the Republican marriage penalty bill coming out of 
the House--well, it's a whopping $182 million, and almost half the 
benefits go to couples who do not face the marriage penalty in their 
taxes. In this process, this huge expense, mostly going to high-income 
families, crowds out a lot of very important priorities.
  I hope we all can agree that if our goal is to eliminate the marriage 
penalty, it can be done for a fraction of what the House of 
Representatives did in their tax relief bill. There are other deserving 
tax benefit suggestions we should consider. At the top of these 
priorities is a prescription drug benefit for senior citizens.
  On the Democratic side, our party believes we can address both the 
marriage penalty and the prescription drug benefit. The prescription 
drug coverage for our seniors is a lifeline. One of the leaders in the 
House of Representatives on the other side of the aisle said if we put 
the prescription drug benefit in his bill, he will consider it a 
``legislative poison pill.''

  For the seniors with whom I speak in Illinois and from across the 
Nation, prescription drug coverage is a lifeline, not a poison pill. 
House Majority Leader Dick Armey and other House Republicans who called 
it a poison pill illustrate the flaws in their priorities.
  I hope we can come together. I hope my friends on the Republican 
side, particularly in the House of Representatives, will learn, as I 
have, about the skyrocketing costs of prescription drugs.
  Prescription drug prices have been rising at an almost double-digit 
rate for the last 20 years. A Families USA study shows these prices 
rising at four times the rate of inflation. Medicare beneficiaries' 
annual out-of-pocket drug costs tell the story: 38 percent of Medicare 
beneficiaries are spending more than $1,000 a year on their 
prescription drugs. Many of them are on tight, fixed incomes. Eighteen 
percent of Medicare beneficiaries spend between $500 and $1,000, and 31 
percent are paying out up to $500.
  For some people stepping back and saying $1,000 a year should not 
mean much, I can tell them that for a person on a fixed income of $600 
or $800 a month under Social Security, $100 a month can mean a real 
sacrifice, and many senior citizens have to face those sacrifices on a 
regular basis.
  When we held a hearing in Chicago on the prescription drug situation, 
there were seniors who told us that when they visited large 
supermarkets in the Chicagoland area that had prescription drug 
counters, first they would have to find out what their drugs would cost 
and then calculate what was left over for the groceries they needed to 
buy to fill their refrigerators and feed themselves in the days ahead.
  That is a tough sacrifice and choice for anyone to make, certainly 
for one to decide between health and the basic necessities of life. One 
study showed fully 1 in 8 seniors faces this choice between food and 
medicine. That is unacceptable.
  Addressing this problem is certainly not a poison pill, in Mr. 
Armey's words. Time and again, in each of my town meetings around the 
State, I heard how much money seniors have to spend to remain healthy. 
It was not unusual in any senior citizen setting to find someone 
spending $200, $300, $400 a month or even more.
  In Illinois, my constituents tell me they are having a tough time 
paying for their own drugs. Many are worried about whether their 
parents can afford the drugs they need to stay healthy.
  I had a town meeting in Chicago recently. Julie Garcia told me of her 
concerns about her mother's health care needs. This was not an uncommon 
story. Many children are concerned about a parent who has been ill. 
They want to make certain their parents have access to prescription 
drugs to stay healthy.
  Julie Garcia's mother was diagnosed with cancer 11 years ago and must 
still see her oncologist for routine visits every 2 or 3 months. 
Because of her cancer, Julie Garcia's mother was unable to buy 
individual insurance. When she was going through her cancer treatment, 
she was on what is known as a spend-down program through Medicaid. This 
paid for a large portion of her hospital bill, but she still incurred 
thousands of dollars in bills for which she was held liable. A great 
many of those thousands of dollars were for the cost of prescription 
drugs she needed.
  So many seniors who are concerned about their health are often faced 
with

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these terrible choices. I have run into seniors who do not fill 
prescriptions given to them by doctors. Some fill the prescription and 
take it every other day. Some will try to stretch the prescription out 
in other ways. Little do they know they may be losing all of the 
beneficial impact of the prescription drug itself.
  One lady in particular had a double lung transplant. She found it was 
going to cost $2,500 a month for her to deal with the antirejection 
drugs and other things necessary to stay healthy after this transplant 
surgery. She came to the conclusion she could not afford it. She 
decided, on her own, to cut back on the prescription drugs she would 
take. As a result of that decision--a monetary decision--she lost one-
third of her lung capacity permanently, irreparable harm which could 
damage her for years to come--a money decision that resulted in a 
health disaster.
  Those are the choices people are making every single day. It is not 
just the seniors, of course. Under Medicare, many who are disabled find 
themselves in the same predicament: Cutting back, mainly on drugs, 
sometimes because of large price increases. Over the last couple of 
years, it has gone from bad to worse. As I mentioned before, one study 
shows that one senior in eight is forced to choose between food and 
medicine.
  What kind of drug price increases are we talking about?
  In 1992, the average cost of a prescription drug was $30. Six years 
later, in 1998, it had more than doubled to an average of $78. Drug 
prices are increasing much more quickly than the pace of inflation.
  A study by Families USA, a national health care consumer group, 
examined the prices of 50 drugs most often used by seniors. They tested 
the period between January 1, 1998, and January 1, 1999. Here is what 
they found.
  For the 50 most popular drugs used by seniors, 36 out of those 50 
drugs increased two or more times faster than the rate of inflation. 
More than a third of these drugs--17 out of 50--increased four times 
the rate of inflation.
  Pharmacists in my State tell me that in the past they used to get a 
price increase once or twice a year. Now many of them face price 
increases on drugs on a weekly or monthly basis. The curiosity about 
this is the relative expense of these drugs.
  We understand the pharmaceutical companies are in business to make a 
profit. If they did not, their shareholders would turn on the 
management and oust them and find someone who could make a profit. That 
happens all the time. That is the nature of capitalism, the nature of 
our free market, and the nature of business.

  We also understand that pharmaceutical companies need to make enough 
money so they can invest in future research, to find the next cure, the 
next drug on which they can make a profit. We want them to do that. Of 
course, success in doing that moves us closer to the day when we start 
eradicating many of the worrisome diseases Americans face.
  Having said that--that we are going to concede the profit motive, we 
are going to concede the amount of money needed for research--I think 
there are still serious questions to be raised about the pharmaceutical 
industry, particularly when you compare the cost of these drugs in the 
United States to the cost of these drugs in other places.
  There are several people now who live in the border States in the 
northern part of our United States who take buses, on a regular basis, 
into Canada. Senior citizens get on these buses for a daily excursion 
and make a trip across the border to buy prescription drugs.
  Why would somebody want to leave the United States to go to Canada to 
buy drugs? Frankly, because the drugs are cheaper. For every dollar 
Americans spend on prescription drugs, that same drug costs 64 cents 
across the border--64 percent of what it costs in the United States--in 
England, 65 percent; in Italy, 51 percent; in Germany, 71 percent.
  You ask yourself, are they different drugs? The answer is no; they 
are exactly the same drugs. Exactly the same thing sold in the United 
States--made by an American company, inspected by the Food and Drug 
Administration, approved for sale here--when it crosses that invisible 
border between the United States and Canada becomes a bargain.
  A lot of these seniors from the northern States in our country have 
decided to go to Canada to fill their prescriptions to save money.
  Why in the world would these same drugs cost less in Canada? Frankly, 
because the Canadian Government has said to the drug companies that if 
they want to sell the drugs in Canada, in the national health care 
system, they have to reduce the price. They take an average of the 
price increases around the world and say to the drug companies: This is 
as far as you can go. The same thing happens in Mexico. The same thing 
happens in virtually every other industrialized country in the world.
  American drugs--developed in this country, sold to Americans--are 
sold at a fraction of the cost in other countries.
  Let me say, that is not the only case where the American drug 
companies sell at a discount. They sell at a discount to the Federal 
Government for the Veterans' Administration, for example, and for the 
Indian Health Service. They bargain with them. The Veterans' 
Administration, at our hospitals, says to drug companies: If you want 
to sell these drugs, we demand that you give a discount for the 
veterans and thereby save the Federal taxpayers a few dollars. The same 
thing is true with the Indian Health Service.
  It is also true that insurance companies, HMOs, and managed care 
companies bargain, as well. They will go to a drug company and say: If 
you want your drug to be on the formulary, the list of drugs that can 
be prescribed by the doctors in our plan, then you have to sell at a 
discount to this insurance company and these doctors. Of course, the 
insurance company makes out well in that decision, and the patient 
still gets the drugs, and the discount is there.

  There is only one group who cannot bargain. It is the largest group 
in America when it comes to buying drugs--the Medicare beneficiaries. 
For what is supposed to be a free market system, the only place where 
it is a so-called ``free market'' is when it comes to seniors in 
America.
  Isn't it ironic that these American drug companies charge the highest 
prices, for the drugs that they sell, to the elderly and disabled in 
our own country? We are a country which, through the National 
Institutes of Health, has generated research which has led to the 
discovery of these drugs. We are a country which, through its Federal 
agencies, such as the FDA, inspects and approves the manufacturing of 
these drugs to make sure they are of the highest quality. And with all 
of the benefits given to pharmaceutical companies under our Tax Code to 
reduce their tax burden and to increase the profitability of these 
companies in America, the one group they target to charge the highest 
prices turns out to be our seniors and our disabled in America. I do 
not think that is fair. I think it should change.
  For example, Ciperal is a drug that is used to treat infections. The 
exact same bottle, the exact same pill, the same amount, made in the 
same manufacturing plant, costs $171 in Canada but costs $399 in the 
United States--more than twice as much.
  What about the drug called Claritin? It is the same company, 
Schering-Plough. The shape of the bottle in which the pills are sold is 
different in Canada as compared to the United States, but it is still 
the same pill, made in the same facility, subject to the same Federal 
inspection. For a bottle of this pill, Claritin, in Canada, they charge 
$61; in the United States, at your local pharmacy, $218--more than 
three times the cost of the drug in Canada.
  The bottom line is this. The rest of the world gets better deals, and 
Americans pay far more. This is keeping Medicare beneficiaries from 
being able to afford prescription drugs. It is just plain unacceptable.
  If we were to decide this year in Congress to pass a prescription 
drug benefit under Medicare, I am sure we could devise a system that 
might work to provide benefits and access to drugs for a lot of seniors 
and disabled people across our country. If we were to create this 
benefit package and not address the underlying challenge of the 
increase in prices each year, each month, sometimes each week, and the

[[Page S1190]]

differential in prices between the United States and Canada, any 
prescription drug benefit program we devise would be bankrupted in no 
time flat.

  The Medicare program, as we know, does not include a prescription 
drug benefit. The reason for this is, of course, when it was enacted in 
1965, prescription drugs just didn't play that large a role in health 
care. But the world has changed. There are so many drugs now that 
maintain quality of life for people across America that we couldn't 
have dreamed up 35 years ago. Isn't it ironic that we don't pay for 
prescription drugs but if a person doesn't take his medicine and gets 
sick and goes into a hospital, Medicare will pay for the 
hospitalization. Wouldn't we want to invest a few pennies in prevention 
rather than spend hundreds of dollars in a cure that might involve some 
hospitalization? It seems obvious to me.
  Too many seniors find it virtually impossible to comply with their 
doctor's orders. As we know, they have to make tough choices between 
what their doctor tells them is good for them and what they can afford, 
a choice no one should have to make. According to a report prepared for 
the Department of Health and Human Services, three out of four Medicare 
beneficiaries do not have dependable private drug coverage. Some folks 
on Capitol Hill, in the House and Senate, have suggested this isn't 
really a problem; they believe that many people have prescription drug 
coverage. They ought to get out of this Capitol Building into the real 
world.
  I think what they will find is this: About a third of the people in 
the United States have exceptionally good drug coverage in their 
retirement. I found a lot of them in Illinois. Some of them are retired 
union workers and their families. Others have benefited from a great 
plan that takes care of their prescription drugs. They are the 
exception rather than the rule.
  A third of the people have prescription drug coverage which is anemic 
at best; it barely pays the most basic bills and, of course, with large 
expenses, provides no relief to the seniors who turn to them.
  Then a third are on their own. Those are the sorriest stories of all, 
where people are faced with actually paying out of pocket for every 
single thing they need when it comes to prescription drugs. That tells 
you, if we rely on the current system without looking to a new benefit, 
we will leave two-thirds of America behind. Those are the underinsured, 
when it comes to prescription drugs, and those who are basically 
uninsured.
  Incidentally, those who have some sort of prescription drug benefit 
under HMOs in Illinois tell me over and over again that the copays and 
deductibles keep going up. Their coverage is virtually evaporating.
  I met a woman in Chicago, Anita Milton of Morris, IL, who became 
disabled in 1995 and, in 1996, had a bilateral lung transplant. Her 
prescription drug costs are $2,500 a month. Now on Medicaid, she has to 
pay a certain amount each month out of pocket on drugs before she gets 
the first dollar in coverage. She has an income of $960 a month. That 
is her only income. She pays up to $638 a month out of pocket for the 
drugs she needs. Somehow she is supposed to survive on $251 a month.
  For many elderly people in that circumstance, they have little or no 
recourse but to move in with their children and try to survive. On a 
month when her drugs aren't covered, she doesn't meet her spending 
requirement, so she loses coverage for a full month. In other words, 
she only receives coverage every other month.

  This story sounds bizarre, but it is not. It is virtually commonplace 
to see in America people who have lived a good life, raised their 
families, contributed so much to this country, paid their taxes, obeyed 
the laws, and now find themselves captives of a situation they cannot 
control. A pharmacist in Illinois told me what they are faced with--
telling seniors the problems of prescription drug costs is really 
difficult to deal with. A pharmacist, Linda Esposito, came to my 
meeting in Chicago and said:

       Virtually every day pharmacists are faced with older 
     Americans who have assumed that their medications, the 
     prescription that their physician has written for them, is 
     covered by their supplemental Medicare benefits or Medicare 
     itself. All too often they find the insurance isn't there 
     when they really need it to be there.

  Men and women who want to stay healthy, who want to stay independent, 
and want to stay out of the hospital find they cannot afford the 
medications to make that happen. That is why it is important we move 
forward with a comprehensive drug benefit to the Medicare program for 
all beneficiaries. America's seniors shouldn't have to pay more than 
everyone else for prescription drugs. As I have heard from Illinois 
senior citizens, prescription drug coverage offers a lifeline to them 
and not a poison bill. Congress must work to offer our seniors this 
lifeline this year.
  The record of this Congress over the last several years has been 
scant, to say the least. There is just very little we even take 
seriously around here and consider by way of addressing problems that 
American families face.
  It has been a frustration to me, as a Senator from the State of 
Illinois, to go home repeatedly and hear the people I represent raise 
issues they are concerned with, issues about education, what are we 
going to do in Washington to help improve schools in America. A bill we 
passed last week will have virtually no impact whatsoever on education 
in this country. We have not addressed the most basic requirements to 
make sure our teachers are well trained and qualified to teach, held 
accountable for their own standards in their classroom; that kids are 
held accountable to make certain when they graduate, they can be 
promoted to another grade and succeed rather than just be pushed along; 
to try to upgrade and modernize the schools our kids attend so they can 
deal with modern technology. Has this Congress done anything to address 
that over the last 3 years? Sadly, the answer is no.
  The President has proposed these things. This Congress has ignored 
them.
  On the issue of health care, whether it is prescription drugs or a 
Patient's Bill of Rights, I am afraid the drug companies and the 
insurance companies have really ruled the agenda. We are trying our 
best to move this issue to the forefront, and those forces are trying 
their best to keep it out.
  On the issue of peace and tranquility in our communities, we find 
people asking whether this Congress can respond with sensible gun 
control. The honest answer is, it is not likely. The President is 
holding a summit this week--I am glad he is--bringing in the leaders 
from Congress and challenging them to look anew at this issue of gun 
control.

  When we have reached the point in America where first graders are 
killing other first graders with guns, we are dealing with a gun 
crisis. For those who blithely say we have all the laws we need, there 
is not an idea we should consider, we have everything taken care of, 
pick up any morning paper and tell me we have everything taken care of. 
I don't believe that is the case at all.
  On issue after issue, whether it is education, health care, or 
sensible gun control, this Congress sits on its hands. The people 
across America ask of us, the world's so-called greatest deliberative 
body, when are you going to deliberate? What are you going to do? 
Sadly, the answer for the last 3 years is little or nothing.
  I think that is what elections are all about. This coming election in 
November, the people across America can really issue their own report 
card on this do-nothing Congress. They can take a look back and see at 
the end of our work this calendar year what we have achieved. If we 
leave town without addressing the needs of education, if we leave town 
without creating a prescription drug benefit under Medicare, if we 
leave town without increasing the minimum wage from $5.15 an hour to 
something that is more humane and more livable, if we don't do anything 
to cope with the health care crisis that has been generated because of 
HMOs and managed care, if we don't do something about sensible gun 
control, this Congress will rightly deserve a failing grade.
  I think it is important we try to come together. For those who say 
there is no intention on this side of the aisle, the Democratic side, 
to really find solutions, I think the challenge is on the table to come 
forward and try

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on a bipartisan basis. I will be there, and I think many on my side 
will as well, to make certain this Congress adjourns this year with not 
only a record of accomplishment but a record of response for American 
families.
  I yield the floor.

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