[Congressional Record Volume 146, Number 102 (Wednesday, September 6, 2000)]
[Senate]
[Pages S8045-S8048]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                        SPRINTING TO THE FINISH

  Mr. DORGAN. Mr. President, yesterday I spoke briefly about the agenda 
that confronts this Congress in the next 5 weeks. This is literally a 
sprint to the finish. Much of what we will discuss and debate are the 
most important issues people worry about and are talking about around 
the supper table. They talk about the issues that affect them every 
day: Are our kids going to good schools? Are we proud of the schools we 
send our kids to? Do I have a good job? Does it provide retirement 
benefits, insurance, security? Will grandma and grandpa have adequate 
health care when they have serious health problems? Is our neighborhood 
a safe one in which to live? Can we afford the prescription drugs that 
the doctor prescribes and says we need to maintain a healthy lifestyle 
and to control a disease we may have?
  All of these things are the things that interest families who discuss 
what their lives are like these days and how they can be improved.
  I want to talk about the agenda and the issues with which we have to 
deal before this Congress adjourns. Before I do, as a way of 
introducing that, let me tell you about a television story that 
appeared on KFYR Television in Bismarck, ND, about 2 to 3 weeks ago. 
KFYR Television News did a piece about my Uncle Harold. My Uncle 
Harold, from Dickinson, ND, is now 80 years old, and he is a runner. 
There are not very many 80-year-old runners, so the television news did 
a story about him. The story showed him running down the street, with 
the gold medals he has won, and doing various things.
  Here is the story about my uncle. About 6 or 7 years ago, he and my 
aunt went to the Prairie Rose Games in Fargo, ND, where they have 
events for everybody in different age brackets. They decided to enter 
the bowling event because they bowl. Harold also saw that they had 
races for people who are 70 and above, so he decided to enter one at 
about age 71. He had never run before, but he decided to enter three 
races at the Prairie Rose Games, and he won all three easily. He said, 
``You know, I never knew I could run like that.'' So he started 
running. He went to Minnesota to run, and then to South Dakota, and 
Arizona.
  Pretty soon, Uncle Harold started specializing. Now he runs in the 
400 meter and 800 meter events. So I have this uncle who just turned 80 
running in races all over the country. He now has 45 gold medals. My 
aunt thinks he has had a stroke. She thinks it is as goofy as the devil 
that this 80-year-old man is running. Yet he discovered he is the 
fastest around in his age bracket. He is going to try out for the 
Senior Olympics and go one more time. He took fifth out of 200-some 
runners the last time. Now that he is 80 and at the bottom of a new age 
bracket, he thinks he will get a gold medal in the Olympics. My uncle 
is a fisherman, so I don't know whether this is true, but he said he 
runs the 400 meter race in 79 seconds. I run a little as well. One of 
these days I will figure out whether I can run it in 79 seconds.
  I should mention one other thing about Uncle Harold. He also golfs, 
and he is the strangest golfer I have ever golfed with. I went golfing 
with my uncle a couple of years ago. He takes a bag and only takes four 
or five clubs. He hits the ball and, because he is always in training 
for the Senior Olympics, he sprints on a dead run to the ball. It is a 
strange looking thing to see a guy who was 78 years old at the time hit 
a ball and go on a dead run to find out where it rested and then hit it 
again. In the meantime, my wife and I were driving a cart, and this 78-
year-old man is sprinting on the golf course. I have since decided I 
should never

[[Page S8046]]

drive a cart when golfing with my uncle.
  The point is, here is this 80-year-old guy jogging 3 miles a day, 
getting ready to try to qualify to go again to the National Senior 
Olympics. That is pretty remarkable when you think about it. Thirty 
years ago, that would not have happened. Usually, when you are 80, you 
find a chair someplace and relax. But these days people are living 
longer, healthier lives. My uncle, for example, is training for the 
Olympics. That is the result of a lot of things: lifestyle changes, 
nutrition changes, cultural changes, better health care, Medicare. A 
whole series of things are happening in this country that are pretty 
remarkable. That really all relates to the agenda that we have in the 
next 5 weeks in this Congress.
  Americans are living longer, living better, at a time when we are so 
blessed in this country. We have an agenda in the Congress that will 
have an impact on people's lives. Yes, for my uncle, but for 
everybody's aunts, uncles, brothers, and sisters--the agenda of health 
care and education and other things that mean so much to people's 
lives.
  Let me talk for a minute about what we need to do and why. First of 
all, one of the advancements that allows people to live longer and 
healthier lives is the increase in the use of prescription drugs. There 
are so many illnesses and diseases for which, 35 years ago when 
Medicare was developed by this Congress, there were no medicines. But 
now there are miracle drugs, prescription medicines. We have decided 
that it is important to add a prescription drug benefit to the Medicare 
program. Why? Because being able to afford the right prescription drugs 
can allow people to lead healthier lives and treat illnesses and stay 
out of a hospital, which is horribly expensive. It is, in the long run, 
a bargain for the American people to say let's have a prescription drug 
benefit in the Medicare program.
  Now, some say, well, we cannot afford it. The fact is that it will 
cost a lot more if we don't have it. People will get sick and go to 
hospitals and it will cost more. The issue of affordability applies 
more to senior citizens than to the Government. The reason we need this 
benefit is that too many senior citizens know they need a medicine, but 
they can't afford to buy it.
  A doctor in Dickinson, ND, testified at a hearing I held in 
Dickinson. He said he prescribed a drug to a senior citizen who had a 
mastectomy in order to treat her breast cancer. The doctor said to his 
patient: This is the drug I am going to prescribe for you because it 
will reduce the chances of a recurrence of your cancer. She said: What 
does it cost? He told her and she said: Doctor, I can't afford to take 
that drug. I will just have to take my chances.
  At every hearing I have held, I have heard testimony from people who 
say: We go to the back of the grocery store where the pharmacy is first 
because we have to buy our prescription drugs first; only then, will we 
know how much money we have left over to buy food.
  Spending on prescription drugs increased 16 percent last year in this 
country. Sixteen percent. Some of that is increased utilization and 
some is increased prices. But too many senior citizens know they need a 
prescription drug, and they can't afford it. We need to do two things: 
put on pressure to bring drug prices down and, No. 2, add an 
affordable, universal, voluntary prescription drug benefit to the 
Medicare program.
  Mr. President, with your permission, I want to show a couple of pill 
bottles. I ask unanimous consent to be allowed to do that.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. DORGAN. I will speak about the prices charged for prescription 
drugs in this country versus the prices charged elsewhere in the world 
for the identical medicine.
  These two bottles are slightly different but they contain the same 
pill. Both bottles are for a wonderful drug called Zocor, which is used 
to lower cholesterol in patients. It is a medication that a lot of 
people use. I commend all those who did the research to create these 
kind of drugs. But to those who decided the prices that ought to be 
charged for these medications to various citizens around the world, I 
don't say good job.
  Let me describe what has happened.
  In both bottles are the same pill, in the same dosage, made by the 
same company, perhaps made in the same manufacturing plant, approved by 
the FDA. Once the medicine is approved by the FDA, the FDA approves the 
manufacturing plants, and the company produces the drug for sale. This 
bottle they sent to Canada. They say to the Canadians: Do you want to 
buy some Zocor? It will lower your cholesterol. It is $1.82 per tablet.
  This other bottle they sent to Grand Forks or Minot, ND, or anywhere 
else in the U.S. To Americans they say: Do you want to buy some Zocor? 
Well, you will have to pay $3.82 per tablet. $1.82 and $3.82, why the 
difference? That is something we ought to ask the drug companies.
  I have taken a group of senior citizens to Canada to a little 
drugstore in Emerson, Manitoba. I stood in that one-room pharmacy, and 
I saw the prices charged there. I have seen the prices charged for the 
same medications in North Dakota. I know the drugstores on Main Streets 
in North Dakota are not charging higher prices because they want to 
overcharge. They are simply having to pay the drug companies an 
inflated price far above that which is charged in Canada, England, 
Germany, Italy, France, and in virtually every other country in the 
world because the pharmaceutical manufacturers impose that charge on 
them. This is not the fault of Main Street drugstores.
  Again, I ask the question--I have asked this many times--is there 
anyone in the Senate who wants to stand up and say: Count me in on 
supporting these prices; I really believe it is fair and right to 
charge the American consumer $3.82 for the exact same pill for which a 
Canadian is charged $1.82? Is there one Senator willing to say this? 
There hasn't been one in the last six weeks that I have asked this 
question. If there is not any Senator willing to stand up and say this, 
then will all of them join us to try to change this situation so that 
the American consumer who needs to purchase prescription drugs receives 
a fair price?
  The amendment that we passed in the Senate is now in conference. I am 
one of the conferees. What we are saying with this legislation is that 
pharmacists and drug wholesalers have the same right to reimport 
prescription drugs into this country that the drug companies already 
have, provided that the imported medications are FDA-approved and made 
in FDA-approved plants. It is very simple. We need to do that before 
this session of Congress ends.
  The prescription drug companies are working overtime, of course, to 
kill this provision. They say the issue is safety. It is not. It is 
profits. That is what the issue is--profits, not safety. These are 
pills made in FDA-approved plants. These are medicines approved by the 
FDA with a chain of custody that can be traced from the manufacturing 
plant to the drugstores. There is no safety issue at all.
  Adding a prescription drug benefit to the Medicare Program and 
enacting legislation that we passed on the floor with the bipartisan 
support of Senator Jeffords, Senator Gorton, myself, and many others 
who have worked on this are two things Congress must do before 
adjourning this year.
  The other thing we need to do is pass a Patients' Bill of Rights.
  I want to talk a few minutes about that today because we have 
Patients' Bill of Rights legislation that is in conference.
  What is the Patients' Bill of Rights? This legislation says let's 
even up the odds a little bit between people who are sick and their 
insurance companies. Let's even up the odds a little bit.
  In some cases what has been happening is that a person's medical care 
has become a function of their insurance company's profit. All too 
often doctors are not the ones making the decision about what kind of 
care is provided to a patient. It is an accountant in some insurance 
office thousands of miles away.
  Yesterday, I mentioned a young boy in Nevada. I want to mention him 
again because it seems to me that he illustrates, as with so many 
others, the problem. A young man named Christopher Roe died October 12 
last year. His mother came to a hearing that

[[Page S8047]]

Senator Reid and I co-chaired in Nevada. He died on October 12, 1999, 
on his 16th birthday. The official cause of his death was leukemia. But 
his mother tells us that the real reason he died was that his health 
care plan denied him the investigational chemotherapy drug that he 
needed. He needed a shot, a chance, and the bureaucracy of the managed 
care organization never gave him that chance. They just took forever to 
get to that point.
  Christopher Roe died, and Christopher Roe's mother came to our 
hearing. She held up a large picture of Christopher. She wept as she 
told us about her son who from his sickbed looked up at her, and said, 
``Mom, I just don't understand how they could do this to a kid?'' Good 
question? Christopher died.
  Or let me share another example. A woman fell off a cliff in the 
Shenandoah mountains. She was hauled into an emergency room unconscious 
with broken bones. She was treated. After a difficult period, she 
survived, and was then told by her managed care organization that they 
wouldn't cover her emergency room treatment because she didn't get 
prior approval. She was hauled in on a gurney unconscious, but the 
managed care organization said: You did not get prior approval for 
emergency room treatment.
  That is the kind of thing that is happening all too often in this 
country.
  Or, perhaps a better way to describe it is with the story of Ethan 
Bedrick, a young boy born with cerebral palsy resulting from a 
complicated delivery who was told that he had only a 50-percent chance 
of being able to walk by age 5. The managed care organization denied 
him the therapy he needed because they said a 50-percent chance of a 
young boy being able to walk by age 5 was insignificant. They 
considered it insignificant that a young boy had a 50-percent chance of 
being able to walk with the right kind of therapy.
  Is there a reason to question those who are making health care 
decisions in the sterile offices of managed care organizations 1,000 
miles away from where the doctor is seeing the patient and describing 
the medical treatment that is necessary for the patient's care? Yes. 
That is why I wanted to make this point.
  We had a debate on patients' care in the Senate a while back. We lost 
by one vote, effectively, because there were some Members missing. We 
may have turned the tide in the Senate based on that vote, in which 
case the Presiding Officer may very well have broken the tie. But a 
substitute Patients' Bill of Rights was offered by our colleague, 
Senator Nickles, when we offered the Patients' Bill of Rights.
  Dr. Greg Ganske, a Republican Member of the U.S. House, wrote a 
letter to all of us about that substitute. In fact, the local papers 
described the substitute that the Senate passed as the Patients' Bill 
of Rights. It was not a Patients' Bill of Rights. It was a ``patients' 
bill of goods.'' But the Senate passed it, and the papers wrote exactly 
what those who supported it had hoped they would: The Senate passed a 
Patients' Bill of Rights.
  Dr. Ganske, a Republican Member of Congress, said this Senate 
legislation virtually eliminates any meaningful remedy for most working 
Americans and their families against death and injury caused by HMOs.
  That is not a Democrat speaking. That is a Republican Member of the 
U.S. House, Dr. Ganske.
  Let me describe the legal analysis he sent around to every Member of 
the Senate:

       . . . The measure would appear to undo State law remedies 
     for medical injuries caused by managed care companies 
     treatment decisions and delays.
       . . . In the name of patient protection the Senate 
     legislation appears to eliminate virtually any meaningful 
     remedy for most working Americans and their families.
       . . . A vehicle for protecting managed care companies from 
     various forms of legal liability under current law.
       Viewed in this light, the congressional passage of the 
     Senate bill would be worse than were Congress to enact no 
     measure at all.

  I raise this because this is not a Democrat being critical of a 
Republican proposal. It is a Republican Member of Congress saying that 
the proposal passed by the Senate was worthless, just worthless.
  This is not partisan criticism, it is Dr. Ganske, a Republican Member 
of Congress, saying what the majority of the Senate claimed was a real 
Patients' Bill of Rights was worthless.
  Now we could, and should, and I hope will pass a real Patients' Bill 
of Rights. There is a commercial being run in a northeastern State on 
behalf of a Member of the Senate who voted for our Patients' Bill of 
Rights, the Norwood-Dingell Patients' Bill of Rights that was passed on 
a bipartisan basis by the House. A Member of the Senate who voted for 
that--a Republican; there were only a very few--is running a commercial 
paid for by the Republican Senatorial Campaign Committee that says this 
Senator voted for a real Patients' Bill of Rights--meaning ours.
  It is fascinating to me that we now have a circumstance where the 
Republican Campaign Committee is saying that the Patients' Bill of 
Rights we proposed was the ``real one.'' We will have more to say about 
that and have a more aggressive debate about that in the days ahead.
  My expectation is that there will be a tie vote when another vote 
occurs--and it will happen again; we fully intend it to happen again. 
Fortunately, we will have a Vice President to break that tie. The 
Patients' Bill of Rights issue is very important.
  Let me mention a couple of other issues, and then I will conclude.
  We also have a responsibility to deal with the farm crisis and we 
have not done so very well. We have a farm bill that doesn't work. The 
Freedom to Farm bill does not work. It has been a failure since it was 
enacted in 1996. The promise was: Produce what you want; we will sell 
it overseas and get rid of the farm program and things will be better 
off.
  Since that time, prices have collapsed and family farmers have had an 
awful time trying to make ends meet. In most cases, they are receiving 
far less now in real terms than they received during the Great 
Depression for their product. These are not people who are slothful. 
These are not people who aren't being productive. They are economic 
all-stars. They produce in prodigious quantity the food the world needs 
so desperately. Yet the market says: By the way, your food has no 
value.
  While people climb trees to pick leaves to eat in countries around 
the world where there is not enough food, family farmers driving a 2-
ton truck to a country elevator are told by the grain trader: Your food 
has no value.
  Something is wrong with that. What really has no value is the current 
farm program. It doesn't work. It is long past time to fix it. We are 
within three or four votes of doing that. I encourage help from the 
other side to give us the votes needed to pass a farm program that 
provides real assistance for family farmers.
  While we are on the subject of freedom, those who wrote the Freedom 
to Farm bill--I didn't, and I voted against it--should understand there 
is something called the freedom to sell. The freedom to sell means if 
you want to give family farmers the freedom to produce whatever, let's 
also give them the freedom to sell their products in markets such as 
Iran, Iraq, Cuba, North Korea, and others that have been off limits to 
them because this country has imposed economic sanctions against 
countries whose behavior we don't like. I am fine with economic 
sanctions. Slap them with sanctions. But don't ever include food as a 
part of those sanctions. Using food as a weapon is unbecoming to this 
country. A country as big and as good and as powerful and as important 
as this country ought never use food as a weapon.

  The freedom to sell is a pretty important principle which we ought to 
care a bit about. There is an amendment that I put in the 
appropriations bill now in conference, and I know there are a couple of 
House leaders who are intending to try to kill that as we get to 
conference. I am hoping with the bipartisan support we received in the 
Senate that we will prevail on this issue.
  Finally, one of the other important issues we face as we wrap up this 
Congress is trying to do something to strengthen the education system 
in our country. We have the opportunity to do that. It is just that we 
have all of this bickering back and forth. We have things that we know 
need to be done. Everybody here understands that if you are in a 
classroom of 15 people, there is more learning going on than if there 
is a classroom with 1 teacher and 30 kids. Class size matters. We have

[[Page S8048]]

proposals to reduce class size which will dramatically improve 
education.
  We also understand you cannot learn in schools that are in functional 
disrepair. No wonder there is disrepair in the schools. They were built 
50 or 60 years ago, after World War II, when we had soldiers coming 
back, having families, and building schools for their children all 
across the country. Many of these schools are still in use today and 
are in desperate need of repair and remodeling. If anyone doubts that, 
take a trip to the Ojibwa school on the Turtle Mountain Indian 
Reservation or the Cannon Ball Elementary School, south of Bismarck, 
ND. Take a look at those schools and ask yourself whether those schools 
need help.
  The third grader who walks through the classroom door in the Cannon 
Ball School ought to be able to expect the same opportunity for a good 
education as all kids in this country. Yet these children don't have 
the same opportunity. We know that. Yet legislation to improve and 
modernize our schools languish in this Senate because some people don't 
believe it is important, or some people believe they cannot do it 
because if they did, somebody would declare victory for a public policy 
that makes sense.
  Let's declare victory for a little common sense in all of these 
areas: Education, health care, agriculture. There are so many areas. 
The agenda in this Congress is the agenda we establish. If we are a 
Congress of underachievers, that is our fault, not something we blame 
on anybody else.
  I wish I were in the majority here, but I am not. The majority 
establishes a schedule; we don't. I accept that. We have a right, and 
insist on the right, between now and the 5 weeks when this Congress 
wraps up its business, to try to bring to the floor of the Senate once 
again a real Patients' Bill of Rights and have another vote. We have a 
right to try to push these policies to get them done. We have a right 
to try to push education policies that we think will enhance and 
improve education in this country. We have a right to try to push 
policies that say we want to add a prescription drug benefit to the 
Medicare program. We have a right to insist that the American consumer 
pay prices for prescription drugs that are fair--not the highest prices 
of anyone in the entire world.
  We have a right to address all of those issues, and we should. There 
is time. It is just a matter of will. Will the Members of the Senate 
who do the scheduling, who plan the agenda, exhibit the will to do what 
is right in the final 5 weeks and pass this kind of legislation?
  As I said when I started, when people sit down at the dinner table 
and talk about their lives, they are talking about things that matter 
to them. All of the things I have talked about are things that matter 
to them: Are our kids going to good schools? Do grandpa and grandma 
have the opportunity to get decent health care when they are sick? Are 
the neighborhoods safe? Do I have a decent job? Does it pay well? Does 
it have security? All of those are things that are important to the 
American people. All of those are things they should expect this 
Congress to address in the coming 5 weeks.
  I yield the floor.
  Mr. GRAMS. Mr. President, what is the order of business pending 
before the Senate?
  The PRESIDING OFFICER. The Senate is debating the motion to proceed 
on the permanent normal trade relations with China.
  Mr. GRAMS. Mr. President, I would like to talk about my support for 
H.R. 4444, but I just want to respond briefly to one comment of the 
Senator from North Dakota, Mr. Dorgan. I think he was bragging a little 
bit, maybe, about his uncle who is 80 years old and running in a 
marathon. I just congratulate him. How great that our senior citizens, 
because of the advances of medicine, can do that. I have a friend 
retiring at the age of 65. He wanted to retire to spend more time 
playing golf with his dad. Another is an uncle who was 85 last year who 
got his first hole-in-one, Ray Sandey. I just wanted to put that into 
the Record and congratulate them on their achievements.
  Mrs. LINCOLN. Mr. President, I wish to comment on the comments of my 
two colleagues who have spoken about the important issues facing our 
aging populations in this Nation. They both commented on the 83-year-
olds and the 84-year-olds. I think I have them beat. My husband's 
grandmother will turn 103 on the last day of this month.
  So the issues for the elderly in Arkansas are extremely important to 
us, a No. 1 priority, and something I hope we will address in the 
context of a prescription drug piece for the elderly, as well as 
reauthorizing the Older Americans Act, not to mention the importance of 
solidifying and preserving Social Security and Medicare.

                          ____________________