[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.

                          ____________________