Congressional Record, Volume 146 Issue 108 (Thursday, September 14, 2000)

[Congressional Record Volume 146, Number 108 (Thursday, September 14, 2000)]
[Senate]
[Pages S8600-S8604]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

PRESCRIPTION DRUG BENEFIT

Mr. DORGAN. Mr. President, my colleague from Nevada, Senator Reid,
and I were discussing some dialog that had taken place on the floor of
the Senate earlier today, and we wanted to visit a bit about the issue
of a prescription drug benefit for the Medicare program.
We are in session in this 106th Congress perhaps only another 4 or 5
weeks at the outset, and much is left to be done prior to the
adjournment of this Congress.
One of the issues that most people think is very important to the
American people is for this Congress to add a prescription drug benefit
to the Medicare program. Almost everyone in this country now
understands that the price of prescription drugs is moving up very
quickly. Last year, the price of prescription drugs increased very
rapidly. In fact, the cost of prescription drugs last year alone,
because of increased utilization, price inflation and other things,
increased 16 percent.
The senior citizens in this country are 12 percent of our country's
population but consume one-third of all the prescription drugs in
America. Senior citizens are at a point in their lives where they have
reached declining and diminished income years and they are least able,
in many cases, to be able to afford to pay increasing prescription drug
prices.
There are a range of issues with prescription drugs. I talked about
some of these in this Chamber before. There are wild price variations.
The same drug in the same bottle made by the same company is being sold
in Canada for a tenth of the price that it is sold to a consumer in the
United States.
The other day I held up two pill bottles of medicine on the floor of
the Senate--exact same medicine, made by the same company, put in the
same bottle, shipped to two different pharmacies, one in the U.S. and
one in Canada. One was priced three times higher than the other. Guess
which. The U.S. consumer was asked to pay three times more than the
Canadian consumer for the same prescription drug. That is one issue.
There is a second issue changing or altering the Medicare program to
add a prescription drug benefit to the Medicare program. There is no
question that if the Medicare program were being written today instead
of the

[[Page S8601]]

early 1960s it would include a benefit for prescription drugs. Many of
the lifesaving prescription drugs that are now available were not
available then.
We clearly should add a prescription drug benefit to the Medicare
program. We have proposed, the President has proposed, and the Vice
President has proposed a plan that would provide an optional and an
affordable prescription drug benefit available to senior citizens to
try to help them cover the cost of their needed prescription drugs.
Earlier today we had Members of the Senate talk about this being a
big Government scheme. It is no more a scheme than the Medicare
program. The Medicare program is not a scheme at all. It is something
this Congress did over the objections of those who always object to
anything that is new. We have a few in this Chamber. It has been done
for two centuries. No matter what it is, they say: We object.
The Medicare program was developed in the early 1960s at a time when
one-half of the senior citizens in America had no health care coverage
at all. We proposed a Medicare program. Now 99 percent of the senior
citizens have health care coverage.
Do you know of any insurance companies that are going around America
saying: You know what we would like to do is provide unlimited health
care insurance to people who have reached the retirement years? We
think it is going to be a good business proposition to find those who
are in their 60s, 70s, and 80s and provide health insurance because we
think that is really going to be profitable. It is not the case.
That is why 40 years ago half the senior citizens couldn't afford to
buy health insurance. That is why there was a need for the Medicare
program. We not only have a Medicare program, and one that works, but
we now need to improve it by offering a prescription drug benefit. When
we do, the same tired, hollow voices of the past emerge in this Chamber
to say: You know what they are proposing is some sort of Government
scheme.
It is not a scheme. It is not a scheme at all. It is an attempt to
strengthen a program that every senior citizen in this country knows is
valuable to them and their neighbors. That is what this is.
Most Members of the Senate understand that we ought to do this. Some
who understand it ought to be done, don't want to do it through the
Medicare program and are proposing we provide some stimulus for the
private insurance companies to offer some sort of prescription drug
benefit. But the private insurance companies come to our office and
say: We won't be able to offer this benefit; we would be required to
charge senior citizens $1,100 for $1,000 worth of benefit for
prescription drugs. They say: We are not going to offer it; it doesn't
add up; we won't do it. That is what the U.S. executives say.
I am happy to bring out a chart, as I did the other day, to quote the
head of the Health Insurance Association and others who say it won't
work--I am talking about the plan proposed by the majority party--it
doesn't work at all. But to have them come to the floor of the Senate
calling our desire to add an optional prescription drug benefit to the
Medicare program some sort of Government scheme doesn't wash. We are
trying to do something that we think is thoughtful, we think is
necessary, and we think most senior citizens will take advantage of on
an optional basis because they understand the price of prescription
drugs continues its relentless increase year after year after year.
We have people who have never supported the Medicare program. They
don't talk about it, but they have never supported it, never liked it.
It is the same people who don't like to add a prescription drug benefit
to the program. They say: Gee, we have financial problems with
Medicare.
Do you know what our problems are with Medicare and Social Security?
Our problems are success. People are living longer. In the year 1900,
people in this country were expected to live to be 48 years of age; a
century later, people are expected to live to almost 78 years of age.
In one century, we have increased the life expectancy nearly 30 years.
That is success.
Does that put some strains on the Medicare program and Social
Security program because people are living longer? Yes. But of course
that strain is born of success. This isn't something to be concerned
about; it is something to be proud of. People are living longer and
better lives, and part of that is because of the Medicare program. We
ought to improve that program by adding the prescription drug benefit
to that program now, in this Congress, in the remaining 4 weeks.
I am happy to yield to my colleague from the State of Nevada.
Mr. REID. I say to my friend from North Dakota that I, along with my
constituents from the State of Nevada, appreciate the Senator being
able to articulate the problems with the cost of prescription drugs.
The Senator has been on this floor with visual aids showing how much a
drug costs, the cost of a prescription being filled in Canada and the
cost in America. There is a 300- to 400-percent difference in some of
those medications. These are lifesaving drugs, drugs that make lives
more comfortable. It makes people's live bearable.
No one in the Congress has done a better job of suggesting and
showing the American people how unfair it is that the United States--
the inventor, the manufacturer, the developer of these prescription
drugs--why in the world do we, the country that developed the drugs,
why do the people from Nevada and North Dakota and every place in
between, why do we pay more than the people in Canada, Mexico, and
other places in the world?
We don't have an answer to that, do we?
Mr. DORGAN. I say to my colleague from Nevada, we do not have an
answer, except I presume it is probably fairly simple: It is about
profits. The companies that manufacture prescription drugs have a
manufacturing plant, and they produce those drugs in the plant, and
they put them in a bottle and put a piece of cotton on top, and they
seal it up, and they ship it off. They will ship a bottle to Grand
Forks, ND; they will ship a bottle to Reno, NV; and they will ship a
bottle to Pittsburgh, PA. Then they will ship a bottle to Winnipeg,
Canada, and into Brussels or Paris, and they price it.

They say the U.S. consumers will pay the highest prices of anybody in
the world for the same pill in the same bottle; we will charge the
American consumer triple, in some cases 10 times, what we charge
others. Why? Because they can. Why? Because they want to.
The pharmaceutical industry has profits the Wall Street Journal says
are the ``envy of the world.'' I want them to succeed. I appreciate the
work in developing new drugs. But a lot of work in the development of
new drugs is publicly funded by us, through the National Institutes of
Health and other scientific research.
I want them to be successful. I don't, however, want a pricing policy
that says to the U.S. consumer, you pay the highest prices for drugs of
anybody in the world. It is not fair. And too many of our consumers--
especially senior citizens--have reached that stage in life where, with
a diminished income, they cannot afford it.
One of the results of the unfairness of all of this and one of the
results of not having a prescription drug benefit in the Medicare
program is this: Three women who suffer from breast cancer are all
seeing the same doctor and the doctor prescribes tamoxifen. Two of the
women say: I can't possibly afford it; I have no money. The third, who
can, says: I will purchase my dose of tamoxifen, and we will divide it
into three, and we will each take a third of a dose.
Or the woman, a senior citizen in Dickinson, the doctor testified
before a hearing, suffered breast cancer, had a mastectomy. The doctor
said: Here's the prescription drug you must take in order to reduce
your chances of a recurrence of breast cancer. The woman said: Doctor,
I can't possibly do that; I can't possibly afford that prescription
drug. I will just take my chances with the recurrence of breast cancer.
The point is that senior citizens across this country understand,
because their doctor has told them the drugs they need to try to deal
with their disease and try to improve their lives, all too often they
cannot afford it.
In hearing after hearing I have held, I have heard from senior
citizens who say: My druggist is in my grocery store. The pharmacy is
in the back of the store. When I go to the grocery store, I must go to
the back of the

[[Page S8602]]

store first because that is where I buy my prescription drug. Only then
do I know how much I have left for food.
In State after State, I heard that message. It is not unusual.
That is why this is such an important issue, both with respect to
international pricing and the unfairness of asking the American
consumer to pay the highest prices in the world for these prescription
drugs, but also in terms of whether we add a prescription drug benefit
to the Medicare program.
We have proposed that. What has happened is we have people dragging
their feet here in the Congress. While they don't want to be against
it, they understand we should do it; neither do they really want to do
it in the Medicare program, because they have never believed that was a
very good program and it was a program pretty much resisted by those
would resist everything, as I said.
Mr. REID. Will the Senator yield?
Mr. DORGAN. I yield.
Mr. REID. I carry in my wallet, and I have pulled it out on
occasion--it is pretty worn and tattered--some quotes just confirming
what my friend from North Dakota said about how people on the majority
feel about Medicare.
Let me read some direct quotes: ``I was there fighting the fight, 1
of 12, voting against Medicare because we knew it wouldn't work in
1965.'' Senator Robert Dole. He, as one of the leaders of the
Republican Party, opposed it in 1965. I am sure he still opposes it.

We don't have to look at Senator Dole, even though I think he is one
of the patriarchs of the Republican Party. Let's look at one of the
present leaders, Dick Armey: ``Medicare has no place in a free world.
Social Security is a rotten trick, and I think we are going to have to
bite the bullet on Social Security and phase it out over time.'' This
is the House majority leader, Dick Armey.
What my friend from North Dakota has said is right: The majority has
never felt good about Medicare.
As my friend has said, in 1965 when Medicare came into being, there
really wasn't a need for prescription drugs because prescription drugs
were in their infancy and it didn't matter the vast majority of the
time whether someone was going to live or die, be comfortable or not.
Now, how can we, the only superpower in the world, a nation that is
leading the world in research and medical products, how can we have a
Medicare program, a program for health care for senior citizens, that
does not include the prescription drug benefit? We can't do that.
I also say to my friend, the reason we are here is this morning a
Senator came over and gave this presentation and said what my friend
from North Dakota said: Sure, we want to do something about Medicare,
but I have gotten letters from my constituents saying ``I'm against the
big government plan.''
This is exactly what we hear on the radio advertisements and the
television advertisements that are paid for by the health care
industry. They want the American people to think that the program the
Democrats are propounding is a big government plan. There could be
nothing further from the truth.
What does this have to do with big government? A woman by the name of
Gail Rattigan, from Henderson, NV writes:

I am a registered nurse who recently cared for an 82-year-
old woman who tried to commit suicide because she couldn't
afford the medications her doctor told her were necessary to
prevent a stroke. It would be much more cost effective for
the Government to pay for medications that prevent more
serious illnesses and expensive hospitalizations. These
include but are not limited to blood pressure medications,
anti-stroke anticoagulants, and cholesterol medications. The
government's current policy of paying for medications only in
the hospital is backward. Get into health promotion and
disease promotion and save money.

This is a registered nurse from Henderson, NV.
I want everyone on the majority side to know they are not going to be
able to come over and make these statements as if there is no
opposition to it. What my friend from Tennessee says is wrong. He
states he has gotten all of these letters saying: I am against the big
government plan.
That is because of the radio and TV advertisements from the powerful
health insurance industry. But the real people are like the 82-year-old
woman who wanted to commit suicide because she couldn't get medication.
Also, I want to spread across this record that my friend from
Tennessee, who came and said, ``We need the Republican plan,'' makes
the statement that he wants to involve Senator Breaux in this.
The majority can't have it both ways. They either support the Bush
plan, the plan of the person running for the President of the United
States on the Republican ticket, or they don't support the nominee. It
appears what my friend from Tennessee is doing is trying to have it
both ways because the Senator from Louisiana does not support Governor
Bush's plan.
The majority realizes that their medicare plan simply can not work
because of their nominee's $1.6 trillion tax cut proposal. Senator
Breaux pointed this out quite clearly today.
My point is, I say to my friend from North Dakota, people who come
here and make statements on the floor need to have substantiation. I
say the Senator from Louisiana does not support the Bush Medicare plan.
I also say the majority has introduced a proposal--so we understand
it, but it is a Medicare prescription drug benefit in name only. A New
York Times writer states:

. . . all indications are that this plan is a non-starter.
Insurance companies themselves are very skeptical; there
haven't been many cases in which an industry's own lobbyists
tell Congress that they don't want a subsidy, but this is one
of them.

I take just another minute or two of my friend's time.

The GOP plan subsidizes insurance companies, not Medicare
beneficiaries. Health insurance companies continue to say the
Republican plan is unworkable.

The majority tries to give this to the insurance industry, but the
insurance industry doesn't want it because it won't work.
Charles Kahn, President of the Health Insurance Association of
America, has stated:

. . . we continue to believe the concept of the so-called
drug-only private insurance simply would not work in
practice.
I don't know of an insurance company that would offer a
drug-only policy like that or even consider it.

Mr. President, I say to my friend from North Dakota, we know there
needs to be something done about the high cost of prescription drugs.
No. 2, we know there has to be something done with Medicare to help
senior citizens of this country be able to afford prescription drugs.
That is all we are saying. And we want everyone to know the program put
forth by the minority is a program that helps senior citizens. It is
not something that is means tested, but a program that helps all senior
citizens, not people who make less than $12,000 a year. It is a program
that is essential. It is essential because people, as we speak, such as
Gail Rattigan, who is a registered nurse, who wrote to me, write that
people are considering suicide. If they are to take one pill a day,
they are splitting them in two; they are asking if they can get half a
prescription filled because they simply can't afford it. We need to
change that.
Mr. DORGAN. Mr. President, some weeks ago I was attending a meeting
in North Dakota dealing with farm issues. An elderly woman came to the
meeting. She sat quietly, said nothing. At the end of the meeting,
after everyone else had pretty much left, we had shaken hands with a
number of them, she came over to me. She was very quiet. She grabbed my
arm and she said:

I just want to talk to you for a moment about prescription
drug prices.

I am guessing she was in her mid to late seventies. She said she had
serious health problems and she just couldn't afford to buy the
prescription drugs her doctor said she needed.
As she began talking about this, her eyes began brimming with tears
and then tears began running down her cheeks and her chin began to
quiver and this woman began to cry about this issue, saying:

I just can't afford to buy the prescription drugs my doctor
says I need.

This repeats itself all over this country. If it is no longer a
question of whether we ought to do this--and perhaps that is the case
because we hear almost everyone saying we ought to do this--then the
question remaining is: How do we do it?

[[Page S8603]]

We say we have a program that works. The Medicare program works. It
has worked for nearly four decades. We know nearly 99 percent of
America's senior citizens are covered by that Medicare program. And we
say let's provide an optional prescription drug benefit that senior
citizens, with a small copayment, can access.
Others say let's not do that. That is big government. Medicare is big
government, they say. They say what we want to do is have the private
insurance companies somehow write policies that would provide
prescription drug coverage.
Is that big insurance? If one is big government, are they saying we
don't want big government, we want big insurance to do this?
But if it is big insurance--and it is--let's hear what the insurance
folks have to say about it. My colleague just mentioned it. Here is a
chart.
Mr. Charles Kahn, President of the Health Insurance Association of
America, says:

We continue to believe the concept of the so-called drug-
only private insurance simply would not work in practice.

It simply would not work in practice.
I have had two CEOs of health insurance companies come to my office
and say to me: Senator, those who are proposing a prescription drug
benefit by private insurance company policy, I want to tell you as a
President of a company, it will not work. We will not offer such a
policy. And if we did, we would have to charge $1,100 for a policy that
pays $1,000 worth of benefits.
That is Charles Kahn, again, from the Health Insurance Association of
America.
Private drug-insurance policies are doomed from the start. The idea
sounds good, but it cannot succeed in the real world.

I don't know of an insurance company that would offer a
drug-only policy like that or even consider it.

That is from the insurance industry itself. Let me just for a moment
ask this question.
If the insurance industry would have been able to offer a policy for
prescription drugs that was affordable and practical and usable, would
they not already have done so? Ask yourself: If in 1960 it would have
been profitable for health insurance companies to say, Our marketing
strategy is to try to find the oldest Americans, those who are nearest
the time when they will have a maximum call for needs in the health
care industry, to find those people and see if we can insure them--if
that were the case, would there have been a need for the Medicare
program? No, there would not have.
Of course, that is not the case. In the private sector, these
companies are after profits. How do you find profits in health
insurance? Find some young, strapping man or woman who is 20 years old,
healthy as a horse, is not going to get sick for 40 years, and sell
them a health insurance policy and not have them see a doctor in 40
years, and all the premium is profit. Good for them, good for the
company, and good for the healthy person.
But they do not make money by seeking out someone who is 70 years old
and probably 5 or 10 years away from the serious illness that is going
to have a claim on that health insurance policy, and that is why, in
1960, senior citizens could not afford to buy health insurance. Half of
American senior citizens did not have it. The Federal Government said,
we have to do something about it. Even when there were those who were
pulling the rope uphill, trying to do the positive things, we had
people here with their foot stuck in the ground saying: No, we will not
go; no, it will not work; it is big government; no, it is a scheme.
We have such people on every single issue in this Chamber. There is a
story about the old codger, 85 years old, who was interviewed by a
radio announcer. The radio announcer said to him: You must have seen a
lot of changes in your life, old timer. The guy said: Yep, and I've
been against every one.
We know people like that. There are a lot of them in politics. I can
tell you about people who are against everything new. Then, of course,
we do it because it is important to do it; it makes life in this
country better.
About 10 years later, guess what. They said: Yes, I started that; I
was for that. Of course, they were not.
This is not about Republicans or Democrats at this moment. There is
no Republican way or Democratic way to get sick; you just get sick.
There is no Democratic or Republican way to put together a program like
that.
My point is there are some, Governor Bush and others, who have a
proposition with respect to prescription drugs that will not work
because those on whom they rely to offer a policy say they cannot offer
it; it will not work; it cannot be done.
If that is the case, and if they believe, as we do, that we ought to
put a prescription drug plan in the Medicare program, then I say join
us and help us and work with us over the next 4 weeks and get this
done.
The question is not whether, it is how, and the answer to the how is
here. You cannot do it the way you say you want to do it. You cannot
pretend to the American people you have a plan that will work when the
industry you say will do it says it is unworkable.
I did not come here to cast aspersions on anybody or any group. This
is one of those issues of perhaps three or four at the end of this
106th Congress that we owe to the American people to do, and the only
way we are going to get this done is if those who say they favor a
prescription drug benefit in the Medicare program will stop coming to
the floor and calling the Medicare program some giant Government
scheme. Those who do that understand they are calling a program that
has worked for 40 years, that has made life better for a lot of folks
in this country, a scheme.
Let's work together. Let's decide we will embrace those things we
know will work and help people. That is why I am pleased the Senator
from Nevada has joined me today.

I will not go on at length, but the other issue--and at some point I
want to visit with the Senator from Nevada about the other issue--is a
Patients' Bill of Rights. We held a hearing in his State on that issue.
Sometime I want to talk on the floor of the Senate about that hearing.
That is another health issue we ought to do in this 4-week period. We
owe it to the American people to do it. It is so important.
Mr. REID. Will the Senator yield?
Mr. DORGAN. I will be happy to yield.
Mr. REID. We do need to talk about that hearing in Las Vegas. There
is not anyone who could watch that and listen to that and not shed a
tear.
I want to take off on something my friend from North Dakota said.
During that hearing--those sick people and the mother who lost her
son--there was not a question about whether or not they were Democrat
or Republican. There was not a single word about that. Democrats get
sick, and Republicans get sick. That is why I underscore what the
Senator from North Dakota has stated today: That we need to come up
with a plan that will work. We know the private insurance plan will not
work. We do not have to have politicians tell us. The people the
majority is trying to help tell us it will not work.
Mr. DORGAN. Mr. President, the Senator is right. I end by saying this
is not about politics; it is about solutions to real problems. We
understand this is a problem. Prescription drug prices are too high.
They are going up too rapidly. Senior citizens cannot afford them.
We have a serious problem in this country in this area. We understand
we have a responsibility to do something about it. What? There are two
choices. One does not work, and one we know will. This is not rocket
science. We know what works. All we need to do is get enough votes in
this Congress to decide we will do what works to put a prescription
drug benefit in the Medicare program which is available to senior
citizens across this country. Six or eight weeks from now, it can be
done. We will have it in the Medicare program, and there will be a lot
of senior citizens advantaged because of it.
We will have more to say about this, but because others wanted to
come to the floor today and talk about schemes and other things, I
thought it was important--and the Senator from Nevada did as well--to
provide the perspective about what this issue is.
A lot of people speak with a lot of authority. Some are not always
right but never in doubt. Some old codger said to me one day: There are
a lot of smart people in Washington and some ain't so smart; it's hard
to tell the difference.
He is right about that. The currency in Congress is a good idea to
address a

[[Page S8604]]

real problem that needs addressing. We have a real problem that needs
addressing now, and a good idea to address this problem of prescription
drugs is to put in the Medicare program an optional program which is
affordable, with a small copay that will give senior citizens who need
it an opportunity to get the prescription drugs they need to improve
their lives.
Mr. President, I yield the floor.
The PRESIDING OFFICER. The Senator from Ohio.

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