[Congressional Record Volume 146, Number 35 (Monday, March 27, 2000)]
[Senate]
[Pages S1698-S1700]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




               NEED FOR ACTION ON PRESSING HEALTH ISSUES

  Mr. DORGAN. Mr. President, I want to talk about two issues we must 
address in this Congress before the end of the year, both dealing with 
health care. I will describe very briefly why these are important and 
why many have been pushing for some long while to try to get the Senate 
to act on this issue.
  First is prescription drugs and Medicare. On Friday of the past week, 
I was in New York City with Senator Chuck Schumer holding a hearing on 
the issue of prescription drugs and Medicare. I have held similar 
hearings in Chicago, in Minneapolis, and various places around the 
country as the chairman of the Democratic Policy Committee. We have had 
virtually identical testimony no matter what part of the country we 
were in. Senior citizens say drug prices are very high. When they reach 
their senior years, living on fixed incomes, they are not able to 
access prescription drugs that they need.
  In Dickinson, ND, a doctor told me of a patient of his who had breast 
cancer.
  He told the woman after her surgery that she was going to have to 
take some prescription drugs in order to reduce the chances of the 
recurrence of breast cancer. When she found out what the cost of the 
prescription was, she said: I can't afford to take these drugs.
  The doctor said: Taking them will reduce the risk of recurrence of 
breast cancer.
  The woman said: I will just have to take my chances.
  Why did she say that? Because there is no coverage in the Medicare 
program for prescription drugs and because many of these prescription 
drugs cost a significant amount of money. Senior citizens in this 
country are 12 percent of America's population, but they consume 33 
percent of the prescription drugs in our country.
  Last year, spending on prescription drugs in the United States 
increased 16 percent in 1 year. Part of this increase is the increase 
in drug prices and part is greater utilization of prescription drugs.
  What does that mean? It means that everyone has a rough time paying 
for prescription drugs, especially senior citizens who live on fixed 
incomes. Many of us believe that were we to create a Medicare program 
today in the Congress, there is no question we would have a 
prescription drug benefit in that program.
  Most of these lifesaving prescriptions were not available in the 
sixties when Medicare was created. But a lifesaving prescription drug 
can only save a life if those who need it can afford to access it. That 
is the point. That is why many of us want to include in the Medicare 
program a benefit for prescription drugs. We do not want to break the 
bank. We want to do it in a thoughtful way. We would have a copayment. 
We would have it developed in a manner that allows senior citizens to 
choose to access it or not. They could either participate in this 
Medicare prescription drug program or they could decide not to do it.
  In any event, we ought to do something on this subject. Those of us 
who have come to the floor over and over again saying this is a 
priority believe with all our hearts this is something we should do for 
our country.
  I will take a moment to describe part of the pricing problem with 
prescription drugs. The U.S. consumer pays the highest price for 
prescription drugs of anyone else in the world.
  I ask unanimous consent to show a couple of pill bottles on the floor 
of the Senate.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. DORGAN. Mr. President, these are two pill bottles. They are a 
different shape, but they contain the same pill made in the same 
factory, made by the same company.
  This happens to be a pill most of us will recognize. It is called 
Claritin. It is commonly used for allergies. This bottle of 100 
tablets, 10 milligrams each, is sold in the United States for $218. 
That is the price to the customer in the United States. This pill 
bottle is sold in Canada. It is the same pill made by the same company, 
in the same number of tablets and the same strength, but this bottle 
costs only $61. The same bottle of pills is $218 to the U.S. consumer; 
to the Canadian consumer, $61. By the way, the Canadian price has been 
converted into U.S. dollars.
  One must ask the question: Do you think the pharmaceutical 
manufacturers are losing money in Canada selling it for $61? I 
guarantee you they would not sell it there if they were losing money, 
but they charge 358 percent more to the U.S. consumer. I will 
demonstrate another drug.
  These two bottles contain Cipro. It is a common medicine to treat 
infection. This time, the drug is actually packaged in the same type of 
bottle, with the same marking, same coloring, and containing the same 
pills made by the same company. Incidentally, both were from facilities 
inspected by the FDA in the United States. Cipro, purchased in the 
United States, 500 milligram tablets, 100 tablets, costs $399. If one 
buys the pills in the same bottle in Canada, it is $171. The U.S. 
consumer is charged 233 percent more.

  We need to do something about two issues: One, we need to put some 
downward pressure on pharmaceutical drug prices and to ask the 
legitimate question: Why should the American consumer pay higher 
prescription drug

[[Page S1699]]

prices than anyone else in the world? Is that fair? The answer, of 
course, is no.
  What does it mean to those who can least afford it? It means 
lifesaving medicine is often not available to those who cannot afford 
access to it. I can tell my colleagues story after story of folks who 
came to hearings I held in Chicago, New York, and all around the 
country describing their dilemma. There were people who had double lung 
transplants, heart transplants and cancers, talking about $2,000 a 
month in prescription drug costs.
  This is serious, and this is trouble for a lot of folks. We need to 
do something about putting downward pressure on prescription drug 
prices.
  I have a solution for that, and that is to allow US pharmacists and 
distributors access to the same drugs in Canada and to bring it down 
and pass the savings along to the US consumers. We have to pass a law 
to do that. We are having a little trouble passing that bill.
  Second, we need to add a prescription drug benefit to the Medicare 
program.
  I will now turn to the Patients' Bill of Rights, which is the second 
piece of legislation we ought to get done. The Senate has passed a 
bill, some call it the ``Patients' Bill of Goods'' because it did not 
do much and it covered few people. The House passed a bipartisan bill, 
the Dingell-Norwood bill. Democrats and Republicans joined to pass this 
bill. It is a good bill.
  The Senate and House bills are in conference. The House appointed 
conferees who voted against the House bill because the House leadership 
does not support the bipartisan bill that passed the House. We have a 
paradox of conferees from the House who, by and large, do not support 
the House bill, which is the only good bill called the Patients' Bill 
of Rights.
  I will describe a couple of the elements of the Patients' Bill of 
Rights, which are so important.
  First is the situation with Ethan Bedrick. One might say: You have 
done that before; that is unfair. It is not unfair. Health care denied 
to individuals is a very personal issue. When we have a framework for 
health care delivery in this country that denies basic health care 
services under certain HMOs and certain policies to people who need it, 
it is perfectly fair to talk to people in the Senate about the need to 
change public policy.
  This is little Ethan Bedrick from Raleigh, NC. When he was born, his 
delivery was very complicated. It resulted in severe cerebral palsy and 
impaired the motor functions in his limbs. As you can see, he has 
bright eyes and a wonderful smile. When he was 14 months old, his 
insurance company curtailed his physical therapy. Why? Because they 
said he only had a 50-percent chance of walking by age 5. A 50-percent 
chance of walking by age 5 is not enough, they said. This is a matter 
of dollars and cents, so Ethan shall not get his physical therapy.
  Is it fair to raise these questions? Of course it is. Should someone 
like Ethan with a 50-percent chance of walking by age 5 have an 
opportunity for the physical therapy he needs? You bet. Should we have 
a Patients' Bill of Rights that will guarantee him that access under an 
HMO contract? You bet.
  We have in the House of Representatives Dr. Greg Ganske, a 
Republican, and very courageous fellow, I might add. He is one of the 
key sponsors of the Patients' Bill of Rights in the House of 
Representatives. Dr. Ganske is also someone who has done a substantial 
amount of reconstructive surgery.
  He used this photograph, which is quite a dramatic photograph showing 
a baby born with a very serious defect, a cleft lip shown in this 
picture. Dr. Ganske was a reconstructive surgeon before he came to 
Congress. He said he routinely saw HMOs turn down treatment for 
children with this kind of defect because they said it was not 
medically necessary.
  I thought when I heard Dr. Ganske make that presentation the first 
time: How can anyone say correcting this is not medically necessary?
  Then Dr. Ganske used a picture which showed what a correction looks 
like when reconstructive surgery is done. Isn't it wonderful what can 
happen with good medicine? But it can only happen if that child has 
access to that reconstructive surgery.
  Is it a medical necessity? Is it fair for us to discuss and debate 
the Republican policy? The answer is clearly yes.
  Let me also mention a case I have discussed before on the floor of 
the Senate, young Jimmy Adams. Jimmy is now 5. When he was 6 months 
old, he developed a 105-degree fever. When his mother called the 
family's HMO, they were told they should bring James to an HMO-
participating hospital 42 miles away, even though there were emergency 
rooms much closer.
  On that long trip to the hospital, this young boy suffered cardiac 
and respiratory arrest and lost consciousness. Upon arrival, the 
doctors were able to revive him, but the circulation in his hands and 
feet had been cut off. As you can see, he lost his hands and feet.
  Why didn't they stop at the first emergency room or the second 
emergency room that was closer? Because the HMO said: We will only 
reimburse you if you stop at the emergency room we sanction. So 42 
miles later, this young boy had these very serious problems and lost 
his hands and feet.
  What are we to make of all this? We have very significant differences 
in the Patients' Bill of Rights between the House and the Senate. The 
differences in the bill of rights in the House and the Senate are the 
differences dealing with medical necessity. As used in HMO contracts:

       Medical necessity means the shortest, least expensive or 
     least intense level of treatment, care or service rendered or 
     provided, as determined by us.

  The fact is, health care ought not be a function of someone's bottom 
line. Young Ethan, young Jimmy, or the young person born with a severe 
birth defect, like the cleft palate defect of the type I described, 
ought not be a function of some insurance company's evaluation of 
whether their profit or loss margin will suffer by providing treatment 
to these patients.
  A woman fell off a cliff in Virginia, dropped 40 feet and was 
rendered unconscious. She went into a coma and was brought into an 
emergency room and treated for broken bones and a concussion. They 
wheeled her into the emergency room on a gurney, while unconscious, yet 
the HMO later, after she survived, said: We will not pay for your 
emergency room treatment because you did not have prior approval.
  This is a woman, unconscious, in a coma, wheeled into an emergency 
room, but she did not get prior approval. That is the sort of thing 
that goes on too often in this country in health care. It ought to be 
stopped. It can be stopped if we pass a Patients' Bill of Rights. Not 
if we pass a patients' bill of goods that someone tries to misname to 
tell their constituents they have done something when, in fact, they 
stood up with the insurance companies, rather than with patients. We 
need a Patients' Bill of Rights that really digs in on these issues: 
What is a medical necessity? Do patients have a right to know all of 
their options for treatment, not just the cheapest? Do they have those 
rights?
  The piece of legislation that was passed in the House gives patients 
those rights. The piece of legislation the majority passed in the 
Senate does not. We are going to continue to fight to try to get 
something out of this conference committee that medical patients in 
this country, that the American people can believe will give them some 
basic protection, some basic rights, so that the kinds of circumstances 
I have described will not continue to exist in this country.
  Health care ought not be a function of someone's profit and loss 
statement. People who need lifesaving treatment ought to be able to get 
it. The ability to access an emergency room during an emergency ought 
not be something that is debatable between a patient and an HMO.
  Those are the issues we need to deal with in the coming couple of 
months--both of them health care issues, both of them important to the 
American people. I hope that as this debate unfolds, we will have some 
bipartisan help in trying to address prescription drugs in Medicare, 
No. 1, and, No. 2, passing a real Patients' Bill of Rights, to give 
real help to the American people.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from South Dakota.
  Mr. JOHNSON. Mr. President, I ask unanimous consent I be able to 
proceed in morning business for a period of 12 minutes.

[[Page S1700]]

  The PRESIDING OFFICER. Without objection, it is so ordered.

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