[Congressional Record Volume 146, Number 112 (Wednesday, September 20, 2000)]
[House]
[Pages H7902-H7909]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
PRESCRIPTION DRUG PLANS
The SPEAKER pro tempore. Under the Speaker's announced policy of
January 6, 1999, the gentleman from Oklahoma (Mr. Coburn) is recognized
for 60 minutes as the designee of the majority leader.
Mr. COBURN. Mr. Speaker, I would like to spend a little time this
afternoon on a subject that we hear across all the airways and we read
in all the newspapers and it is what all the politicians in the country
are running around talking about. It is called prescription drug plans.
It is amazing how interested we are in this now that we have gotten
into an election year. But the problem has been occurring for the last
3 years essentially.
There is no question in this country that, as the percentage of
health care costs rise, an increasing proportion of that is
prescription drugs. And there is no question that in our country, all
of us, seniors, people in insured plans, people with no insurance,
people on Medicaid, are having a more and more difficult time accessing
the pharmaceuticals that we need to both succeed in treating the
illnesses that we face and prevent illnesses that we could face.
My experience is I have been a physician for almost 20 years. I
continue to practice on the weekends and on Fridays when we are not in
session and on Monday mornings.
What I want to spend time today talking about is the direction of the
Congress with this issue. I want to compare what we have heard
President Clinton say and Vice President Gore say about their solution
for this problem.
[[Page H7903]]
I have 18,000 square miles in Oklahoma that I am fortunate enough to
represent. I will be going home when this session of Congress is over,
and I will not be returning because I chose to limit my terms. But as
we travel around and I talk to seniors, which have been the major topic
that we have seen discussed in this potential to began a political
advantage, this bidding war on prescription drugs, if we ask the
question, do you need help with prescription drugs, many will say yes.
There is no question.
But if we ask the question putting with it the caveat of who is going
to pay for it, the answers are totally different. If we ask seniors, do
you want a prescription drug plan and do you want one that is going to
lower the standard of living of your grandchildren, we never ask that,
but that is implied in the question.
For historical purposes, when Medicare began, the estimated cost for
Medicare in 1990 was $12 billion in 1990. That is what the best
accountants, the best people that we could have said that is what it
was going to cost. And there are a couple of reasons why they missed it
a thousand percent. It cost $120 billion in 1990. There are two reasons
they missed it.
Number one is it is hard to estimate; and number two, the politicians
in Washington, if they do not have to be responsible for the cost of
it, are going to add an additional benefit. That is a natural human
response, whether one is a politician or otherwise, is to give somebody
else's money away if in fact it helps them accomplish their purpose.
Well, we now have a drug proposal before us that is supposed to cost
about $100 billion over 10 years. And if we think about the track
record for the Health Care Financing Administration and the CBO, the
Congressional Budget Office, and the Government Accounting Office, all
of which totally missed the cost to Medicare, what it is really going
to cost is probably a trillion dollars over the next 10 years. That is
where we are at.
Now, where are we going to get money to pay for that? We are going to
delay the funding of it. We are going to borrow it. And we are going to
eventually ask our children to pay for it and our grandchildren.
There is a lot of baby boomers out there, which I am one of them.
There are 77 million of us that are baby boomers, and it will not be
long that we will be eligible for the benefits under Medicare. And as
we become eligible, the one thing we do know is that the cost of the
Medicare program is going to skyrocket.
The second point that I want to make is, what is the real problem in
our country in terms of people being able to get prescription drugs?
What is the difficulty? It is not the quality of the drug. It is not
the availability of the drug. It is not the research that brings the
drugs forward. What is the real problem? The problem is price.
If we do not address the competitive issue in this solution to this
problem, then all we are going to do is lower the cost for some seniors
and transfer it to everybody else in the country. Unless we establish
and make sure that that marketplace is as efficient as it can be, we
will do wonders for seniors and harm to everybody else, let alone the
cost.
I have one chart I would like to spend some time on. This chart is
actually Social Security. But if we move it over to 2011, the numbers
are exactly the same in terms of the ratio of positive cash flow into
the Social Security or Medicare fund versus outflow.
{time} 1500
In 2011 under the spending we have now without a drug program,
Medicare starts running a negative cash flow. It would not do that well
if we had not taken two or three components out of the Medicare trust
fund and put them to the regular budget. So we essentially have
improved the life of Medicare both by manipulations here and the fact
that we have had a wonderful economy with a lot of people paying in a
lot of money on Medicare.
But what is going to happen, starting in 2011, is we are going to
have to run this tremendous deficit, without a prescription drug
benefit. So if we decide that a big government program is the answer
and that the President and Vice President Gore is the answer, then what
you need to do is just about double or triple the red on this chart.
The implication being, is that your children and your grandchildren
because we are going to fix the wrong problem, lack of competition, are
going to have a much lower standard of living.
I have a chart that compares FICA earnings and estimated taxes just
on Social Security. The reason I want to use Social Security is because
the same numbers reflect on Social Security the baby boomers. What you
can see is right now we all pay about 6 percent of every dollar we earn
in a FICA tax and our employer matches that. But I want you to notice
this graph. That does not have anything to do with the 1.45 percent
that you pay in Medicare and that your employer pays. But if you just
follow this graph in terms of the introduction of the new people coming
into Medicare and Social Security, what you can see is the tax rate
just to meet the cash flow requirements, without a prescription drug
benefit, goes up to almost 20 percent. If you extrapolate that same
rate from Social Security to Medicare, instead of 1.45 percent, we are
going to be paying 3 percent individually and 3 percent by your
employer. So we are going to double the cost of the tax when you work
just to cover the Clinton-Gore drug plan.
I am not known as a partisan, and I was not real happy with the
Republicans' drug plan, either; but what I do know is that the plan
that is outlined by the President and Vice President Gore concentrates
more power in Washington, concentrates more decision-making in
Washington, and concentrates bankruptcy for Medicare in the future.
I yield to the gentleman from Texas (Mr. Armey), the majority leader
in the House.
Mr. ARMEY. Mr. Speaker, I want to thank the gentleman from Oklahoma
for recognizing me. I want to thank also the gentleman from Oklahoma
for taking this special order on this special topic. It is a matter
that of course is of great interest and, frankly, considerable concern
to the American people. I am proud to be included in his special order.
Mr. Speaker, I have worked very hard on these comments, and I will
read my comments because this is a complex subject, and we want to make
sure we get it exactly right.
I would like to take a moment just to discuss the prescription drug
issue. Vice President Gore and Governor Bush are engaged in a heated
debate over this matter and how best to help seniors afford drugs.
Everyone agrees that Medicare coverage has failed to keep up with
medical progress and that one-third of seniors today lack drug coverage
and need immediate help to better afford the medications they need and
upon which they rely. But as with anything, there is a right way and a
wrong way to go about doing it. I might say, if this is worth doing,
and I believe it is, it is worth doing right. Sadly, Mr. Speaker, the
Vice President has chosen the wrong way.
Six years ago, he and President Clinton tried to force all Americans
into a government-run health care plan. Thankfully their plan was
rejected by the public and by Congress. I am proud to have been a part
of the effort to defeat the Clinton-Gore health care plan. I thought
forcing people into government-run, government-chosen HMOs was wrong
then; and, Mr. Speaker, I think it is wrong now. Back then, to
illustrate what the Clinton care plan really entailed, I drew up a
chart showing all its amazing complexities and absurdities. I called
that chart ``Simplicity Defined.'' It looks an awful lot like this
chart we are seeing right here. This one I call ``Nightmare on Gore
Street.'' You see, this risky big-government drug scheme of the Vice
President's is really the sequel to that 1994 horror film we had hoped
we would never see again, the one called ``Clinton Care.''
Alas, like the unrepentant Freddy Krueger, Mr. Gore is back trying to
do for drugs what he failed to do for health care, put the government
in charge of all of it. Ira Magaziner and Rube Goldberg would be hard
pressed to devise so nightmarish a scheme. This frightening tangle of
chutes and ladders is the product of no less than 412 new government
mandates contained in the Gore plan.
If this horrifying picture is not enough, allow me to recount just a
few
[[Page H7904]]
of the reasons why the Gore government-run drug plan is bad for seniors
and all other Americans as well.
First, it forces all seniors into a government-chosen HMO for drugs.
If you do not like the plan the bureaucrats put you in, it is just too
bad. You have no other options.
Second, it is not really voluntary as Mr. Gore claims. You will have
just one chance to buy into it at the age of 64\1/2\. If you do not
want to join at that time or change your mind later, you are out of
luck. It is the Gore plan. Life his way or nothing at all.
Mr. Speaker, I must say, that bothers me especially because it sounds
like an ultimatum. Just at that time in your life when you come to
terms with the things that you do, retiring from your job, starting to
contemplate a new life, worrying through what might be my options, how
might I provide for myself and my family in this critical area of
health care, Vice President Gore says, ``We will give you an ultimatum.
Make up your mind, right now. Do it my way or not at all.'' That is not
right, and even worse, it is not fair. If you do not believe me, just
look at today's part B of Medicare. That part is called voluntary, too.
Just try escaping it. I dare you.
Third, government bureaucrats will decide which drugs are and are not
covered. If they decide the drug you need is too expensive, they can
force you to switch to a cheaper, less effective one.
Fourth, seniors will lose their existing private sector coverage
whether they participate or not. Experience shows employers drop
coverage as soon as the government begins providing it. So if you are
one of the two-thirds of seniors who enjoy private sector drug coverage
today, prepare to kiss it good-bye.
Fifth, no one will get the drug benefit until the year 2008, 8 years
from now.
Sixth, it is a bad deal for most seniors. The average senior will get
just 13 cents a day of actual benefit. And if you are one of the
majority of seniors who use less than $576 in prescription drugs each
year, you actually lose under the Gore plan. The combination of
additional and a high copay force you to pay more than you would get
back in benefits. For example, if you were to incur $500 in drug costs,
under Gore's plan you would have to pay $550 for that privilege. That
is because $300 in premiums plus $250 in copayments equals $550, more
than the benefit is worth. Incidentally, these costs are on top of your
existing part A, part B, and supplemental coverage costs. And the
premiums for the drug coverage plan? They come directly out of your
Social Security check, whether you want to pay that way or not.
Seventh, the Gore plan threatens the physical health not just of
every senior but of every single American. Despite Mr. Gore's strenuous
denials, his plan must and does rely on government price controls to
control its massive costs. These price controls will make it
unprofitable to develop new miracle drugs, and this will kill
innovation. Right now there are about 7,500 new drugs just for seniors
in the research pipeline. Some of them could be cures for Alzheimer's,
Parkinson's, diabetes or cancer. If the Gore plan is enacted, these
innovations may never make it to the market.
The eighth problem with the Gore plan is that it relies on that old
Democrat Party favorite, bureaucracy. Those few drugs that do get
invented and make it through the FDA bureaucracy will under the Gore
plan have to wind their way through the Medicare bureaucracy as well.
It currently takes Medicare 15 months to 5 years to provide a new
medical device or technology. For instance, Medicare still does not
cover the tumor-detecting PET scan technology that has been covered by
private health insurance for 10 years. Medicare regulations currently
fill 132,000 pages, more than the tax code. Imagine how many pages of
regulations will stand between seniors and new miracle drug cures under
the risky Gore drug scheme.
Finally, the Gore plan actually endangers the Medicare program. As
everyone knows, Medicare is insolvent, heading toward bankruptcy in the
year 2025, possibly sooner. The Gore plan would pile a huge new
government entitlement on top of the existing, rickety Medicare with
absolutely no modernization. That is dangerous and irresponsible, like
adding a second story to your house when the foundation is cracked. And
it is a terrible disservice to seniors.
Mr. Speaker, let us not be discouraged. There is a better way.
Americans want and deserve and we Republicans are working hard to pass
a Medicare drug plan that keeps Washington out of your medicine
cabinets and puts choice and control in the hands of our own seniors.
Last July, we in the House passed such a plan. It was drafted by a task
force of Members led by our colleagues, the gentleman from California
(Mr. Thomas), the gentleman from North Carolina (Mr. Burr), and chaired
by the Speaker. It is a good plan that shows seniors enough respect to
give them choices.
I am proud that Governor Bush has proposed a plan similar to our
congressional plan, based on the same principles. Like our plan, the
Bush plan is truly voluntary. You decide whether or not to participate.
It lets you keep your existing private sector coverage if you want to.
It does not let bureaucrats restrict your access to drugs. It lets you
pick your own plan and tailor the benefits to suit your own needs. It
holds down drug costs by helping seniors band together in groups to
bargain for better prices, not through innovation-killing government
price controls. And it modernizes, improves and strengthens Medicare
for the long term. And one more thing: the Bush plan takes effect right
away, next year, not the year 2008 like the Gore plan.
Mr. Speaker, here is the issue. The Gore plan puts choice and control
in the hands of the government and it endangers Medicare. The
Republican plan puts choice and control in the hands of seniors and
strengthens Medicare. That is the whole choice before us in this
election. I think when the American people understand the profound
differences between these two approaches, they will overwhelmingly
favor our approach and oppose the Democrats' risky big-government
scheme, just as they did in 1994.
Mr. Speaker, I am going to ask that we put that original chart up
here for just a moment. Take a look at this chart. Each and every one
of these dots, segments in this snaky chart, is a separate government
mandate. Why does it have to be so complex? Because we have to cut all
the bureaucrats in on the deal. Why does it take till the year 2008 to
implement it? It will take them till the year 2008 for them to decide
what they want you to have.
{time} 1515
Why can Governor Bush implement his right away? Because he knows we
already know what we would like to have, and we do not have to have 8
years for a decision regarding somebody else's business.
If we think the government can get this right better than you can,
Mr. Speaker, when was the last time the gentleman bought his wife the
right Christmas present?
Mr. COBURN. Mr. Speaker, I thank the gentleman from Texas (Mr.
Armey), the majority leader.
I would make one other comment, HCFA, which stands for the Health
Care Financing Administration, in the words, their own director says
nobody in HCFA understands the details of HCFA. It is so convoluted.
And having practiced in the medical field, understanding the
regulations, understanding the results, understanding the lack of
common sense that comes out of this organization in terms of how we
impact with our patients and how our patients are cared for, to take
$300 billion swiped out of Medicare over 10 years and let those people
handle it is the last thing we should do.
Mr. Speaker, there should not be an expansion of the responsibility
within the Health Care Financing Administration.
Mr. Speaker, I yield to the gentleman from Texas (Mr. Sessions).
Mr. SESSIONS. Mr. Speaker, I thank the gentleman from Oklahoma (Mr.
Coburn) for not only securing this time from the gentleman from Texas
(Mr. Armey), the majority leader, but also for joining with the
gentleman from Texas, the majority leader, today to talk about this
important issue.
Each Member of Congress is confronted not only in Washington, D.C.,
but around our own tables, in talking to our own parents, and certainly
back home where we talk about how important it is for us to address the
important public policy issue of prescription drugs.
[[Page H7905]]
What I would like to do is to spend my brief minutes here today in
talking about the importance of not only what the Republican party is
doing and our plan that my colleagues have heard the gentleman from
Texas, the leader talk about, George Bush's plan, but also to go back
and to talk with my colleagues about the importance of what we have
already done.
We had an opportunity in this Congress back in July to pass a
prescription drug plan, and we had the opportunity to look at several
plans that were presented and certainly there was vigorous debate on
the floor of the House of Representatives. And what happened was there
was one plan that was raised and supported by the Democratic party,
which would have arbitrarily been a decision that would be taken over
by the Federal Government by Medicare, to make a decision about every
single part of what a senior's health care would be decided by with
prescription drugs by the Federal Government. I call it the same or
similar to what we have known as Hillary Care for Health Care, the same
thing is true for prescription drugs.
The second thing is, it would have required participation by every
single senior. Every single senior would have to make the decision are
you getting in or are you getting out?
Thirdly, it would be a decision about whether you were going to have
a prescription drug plan that would really begin kicking in in 2005,
now we have heard 2008.
The decision that this body made was overwhelming, and it was
overwhelming because it was a bipartisan support, and pro-business
Democrats made a decision that they would vote against the Democrat
plan.
They did not want to take over the prescription drug industry. They
did want price controls on the prescription drug industry, because they
recognize that in a free enterprise system that we have here in America
that we want these drug companies to keep developing, not only newer
and more innovative prescription drugs, but the opportunity for us to
continue what we have today, provide them to all of our senior
citizens.
That plan failed, the Democrat party could not even pass their own
plan, not because of the Republican party, but because they could not
get enough Democrats to vote for the Democrat plan. And so Republicans
were joined by about 10 pro-business Democrats. And we passed a
prescription drug plan here in the House of Representatives that aims
directly at the problem.
The problem is not every senior citizen, about two-thirds of our
seniors, two-thirds of our seniors are without a prescription drug
coverage or a plan today, and so that is why we aimed it at that.
We, our plan, the Republican plan, that has passed this House of
Representatives would find that those that are at 135 percent or less
of poverty, which equals 11,124 for a single person, that they would
have an opportunity to receive without any cost any prescription drug
that their physician decided that they needed.
Now, why is this important? I receive questions across my district
all the time. Why would we want the Federal Government to begin
imposing this plan for senior citizens? Well, it is simple. The fact of
the matter is, is that Medicare today offers the coverage for health
care for senior citizens.
Prescription drugs today can cure many, many more ills than it used
to just a year ago, and in the future it will cure many more ills in
the future, but doctors, when they write a prescription or when they
utilize prescription drugs, they need that as part of the medical
treatment for patients, putting a patient in the hospital is not always
the answer.
Sometimes it is a prescription drug, so people who make less than
$11,124, and it is on a sliding scale with a slight copay above that,
they would receive exactly what the prescription was that the doctor
ordered, exactly the way the doctor wrote it. They would be given this
at no cost.
We are aiming at the poorest Americans. We are trying to help those
that need help the most. That is what this prescription drug plan did.
Now, the question is in Washington, as it always has been, not only
about prescription drugs or about health care, about taxes, about the
things we do, why would we want the government to be involved? We have
done this to help senior citizens. The Democrat plan on the other hand
is one that we oppose, because we recognize that money equals power.
It always has, and unfortunately probably always will, money equals
power. And they want to control the lives and the prescriptions that
are written by the individual doctor, because they want to make
decisions.
I became very interested in an article that appeared in the Dallas
Morning News, which is a paper of high standing, my local newspaper in
Dallas, Texas, and it is dated September the 9th, just a few weeks ago
and it says ``administration halts plan to cut Medicare payments for
cancer drugs.''
Mr. Speaker, it is this bureaucrat, the government, that is making a
decision about live-saving drugs for many times our parents and
grandparents, and based upon a number of Members of Congress, they
state in here, at least 121 Members of Congress, 70 Republicans and at
least 51 Democrats, signed a letter to Donna Shalala, head of the
Health and Human Services, please do not cut Medicare payments. You
already control seniors health care. Let me state the administration
backed off cutting that.
Further, in the article it says, and I quote from the Dallas Morning
News, September 9, Terry S. Coleman, former chief counsel of the
Medicare program said, ``the reimbursement methodology is so
complicated, you can't just go in and adjust a few billing codes. The
same methodology is used for all physician specialties, not just
oncology.''
Well, I would suggest that the majority leader is right. We should
not allow this government to control the decision that is made by
physicians on our prescription drugs. It even gets better, and I quote
further, ``while putting off cuts in payment for cancer drugs, Medicare
officials said they would cut payments for drugs used at kidney
dialysis centers and in the treatment of emphysema and other lung
diseases starting January 1.''
Mr. Speaker, I would suggest that not only is money power, but the
ultimate power through rules and regulations, where we are required by
the Federal Government to have Medicare to be the final decision-maker
for prescription drugs in this country is not only a bad program and
one that would not start with a Democrat plan until we find that kick
in 2008 but, in fact, would control our lives and our freedom.
The reason why the Republican party and these Members are standing up
here today is to make sure that all the Members are fully aware of what
this debate is about and what the ramifications are.
It is about whether we will once against give up, as the debate in
this country was in 1994, whether we will give up on the prescription
drug industry and say we do not trust the free market, we want somebody
else to do it for us, and when we do that, we lose pieces of our
freedom, the opportunity for us to make a decision about the
prescription drugs that we will put and count on for our health.
We need a plan where we empower the physician and the patient to make
a decision. We need to make sure that prescription drugs are not only
available, but that they are what the doctor ordered. And I will tell
my colleagues that the plan that we have voted for is exactly what the
doctor ordered.
Mr. Speaker, I appreciate the opportunity to be here with the
gentleman today. I applaud what the gentleman has done; what the
gentleman from Arizona (Mr. Shadegg) is doing; the gentleman from Texas
(Mr. Armey), the majority leader; and also the gentleman from Minnesota
(Mr. Gutknecht) to make sure that our colleagues are not only updated
on this issue, but that we continue to talk about the importance of
allowing physicians and patients to decide their own future.
See money is not only power, but freedom is power, too.
Mr. COBURN. I thank the gentleman. I want to make two points just for
the Record to those that might be watching this. Medicare did a
prescription drug benefit in 1988. The estimated cost was $4.7 billion.
The actual costs, the 1 year that that was in place was $11.7 billion;
that is how well we estimated the costs.
[[Page H7906]]
So when we saw up here a cost of $353 billion over 10 years, we know
at least it is double that, just by the track records.
The other thing that I would make is the GAO has already stated, our
accounting agency, that Medicare is not going to make it, unless we do
some significant changes in terms of incentives and payments. How do we
do that? We do not do that by adding significantly more costs to an
already bankrupt program.
Mr. Speaker, I yield to the gentleman from Arizona (Mr. Shadegg), a
close friend of mine and somebody I respect a great deal.
Mr. SHADEGG. Mr. Speaker, I thank the gentleman from Oklahoma (Mr.
Coburn) for yielding to me, and I appreciate the opportunity to
participate in this debate.
Mr. Speaker, I actually would like to engage the gentleman in a
colloquy about a number of the aspects of the Clinton-Gore plan that I
think are of concern and that may need to be repeated here so they
understand.
Parliamentary Inquiry
Mr. SHADEGG. Mr. Speaker, I would like to make a parliamentary
inquiry. One of our colleagues, I think it was the gentleman from Texas
(Mr. Armey), our majority leader, just referred to the fact that it is
very important to be accurate in the facts in this debate, and that as
we debate this critically important issue, we should be precise, and I
believe the gentleman said that he, in fact, would read his statement
so that he could be precise about, for example, the number of
bureaucratic steps on the chart.
I believe in the remarks of the gentleman, he indicated that it was
very important in this complicated debate that we be precise in what we
say and in the facts we use and marshal in support of our position in
this debate.
The question I want to ask is, is it true that under the rules of the
House, I cannot refer to the fact that the Vice President in a speech
in Florida on this issue, just a week or two ago, made up certain facts
about the costs of prescription drugs imposed upon his mother-in-law,
that those were not, in fact, the actual costs, that he made up some
facts regarding the dosage of the drug taken by his mother-in-law and
the dosage of the drug taken by his dog, and that he also made up the
facts with regard to the overall costs of these prescriptions to his
family? Am I correct that that cannot be referred to on the floor of
the House?
The SPEAKER pro tempore (Mr. Gilchrest). The general rule is that the
gentleman cannot engage in personality attacks against the Vice
President, but the gentleman can criticize the Vice President's
policies and his candidacy.
{time} 1530
Mr. SHADEGG. Let me ask for a further clarification, if I might. On
the screen here on the board, there are two stories, one from the
Boston Globe and one from the Washington Times. I know the Times story
appeared yesterday. The Boston Globe story, I believe, appeared the day
before yesterday.
Mr. COBURN. Monday.
Mr. SHADEGG. It appeared Monday. Both of those stories report that,
in fact, the Vice President did make up these facts; the cost of the
drug that his mother-in-law allegedly paid, the dosages taken by his
mother-in-law versus the dosages taken by his dog. He, in fact, made up
also the overall cost and did not relate whether or not his mother-in-
law was paying for these drugs or whether they were, in fact, paid for
by insurance and that now the Gore campaign will not relate whether or
not she is insured or not.
My question is, is it also true that that cannot be referred to and
those articles cannot be read here on the floor?
The SPEAKER pro tempore (Mr. Gilchrest). The gentleman can criticize
the Vice President in his actions as a candidate, but the gentleman
cannot get personal in his criticism of the Vice President.
Mr. SHADEGG. I have no desire to be personal. I do think, as I stated
and as I believe the majority leader stated and as the gentleman from
Oklahoma (Mr. Coburn) stated at the outset of this debate, that if we
are going to debate important public policy, it is critical that we all
be accurate; and I would commend to my colleagues here in the Congress
both of these articles which relate that, in fact, facts were
fabricated by the Vice President in the course of his campaign to win
support on this issue.
I would urge my colleagues that it is critical that we be truthful.
It is critical that in this kind of important debate before the public
that we do not make up facts or figures; that we do not mislead the
American public on these issues; that we do not relate allegedly
truthful stories about this issue, about family members, when we ought
to know the facts, in a way which is untruthful, and that that is a
discredit to this institution and a discredit to the campaign.
I think it is also important that we, in the course of this debate,
not allow the ends, in this case winning the debate over how do we best
take care of these serious prescription drug needs of America's elderly
population, we do not allow the end of winning that debate to justify
means which are clearly improper, such as making up facts which are not
true; being untruthful; or in other ways telling stories which are not
accurate and honest with the America people, just to win support for
our position in the debate. I think that is a point that is truly worth
stressing.
I would like to just go over with the gentleman from Oklahoma (Mr.
Coburn), if we might, in a dialogue form some of the points that have
been made already here to make sure that we understand. First, I want
to ask the gentleman, is it his understanding of what is being proposed
by the other side on this issue, by our Democratic colleagues, by the
Clinton-Gore administration, that that plan would, for example, provide
a subsidy for prescription drugs for people regardless of their income
and therefore would provide a subsidy to perhaps Ross Perot, Donald
Trump or anyone else in that income bracket?
Mr. COBURN. That is the same principle as we have today in Medicare.
There is no choice; if one is over a certain age, they will
participate, unless one chooses not to participate at 64.5 years. Once
they choose not to participate, they will never be eligible.
Mr. SHADEGG. The gentleman used the word ``choice'' and talked about
once one chooses not to participate or to participate. I think that is
important. As the gentleman understands the proposal being offered by
Republicans, one of the key features is choice. That is, we allow
people to pick from amongst a variety of plans that meet their own
needs; and in addition at least it is my understanding that as the bill
we passed and the legislation we are proposing and indeed the
legislation being proposed by Governor Bush would give seniors the
right to not only choose amongst various plans when they join but to
make choices again down the line. If they are unhappy with the plan
they pick, they could make a choice at a later point to switch plans.
Is that not a feature?
Mr. COBURN. That is accurate. I think the other thing to remember is
one of our problems in health care in this country, especially in terms
related to HMOs, is that we have lost a considerable amount of freedom.
When one does not have the right to choose their doctor in this
country, they have lost a significant amount of freedom. Now what we
are going to see is you are not going to have the right to choose
whether you get the best drug for you or one that a bureaucrat in
Washington has decided is the cheapest and least expensive and may not
be as effective, you are not going to get to make that choice. So it is
a great political tool to say we are going to have something for
everybody, even though our grandchildren are going to have to pay for
it and have a lower standard of living; but to not be honest about the
loss of freedom associated with that I think is disingenuous.
Mr. SHADEGG. I think you just touched upon another key point that I
wanted to bring out at least in part of this important discussion.
Arizona has many senior citizens. It is a great place to retire to. I
hope more people retire there. But I think one of the keys that the
gentleman just mentioned is we often talk about choice in the abstract.
It is important, I think, for people to understand that not only under
the Clinton-Gore plan do you make one choice at the outset, you either
opt in or opt out and that decision is binding for life, but the second
point is the one that you just mentioned and that is
[[Page H7907]]
that if you choose to participate in the plan which the Clinton-Gore
team is proposing, you are, in fact, giving away your choice, your
right to choose the drug that is best for you, to a Federal bureaucrat.
I know many people that work as government employees. I worked as a
government employee in the past part of my life in an unelected
capacity. I think they are genuine, honest and sincere; but under the
Gore plan the schedule of committed drugs would be decided by someone
deep in the bowels of the Federal bureaucracy. It would take choice
about which drug is right for you, which drug is right for your wife or
your father or your mother or your grandfather or grandmother, it would
take that choice away from them as individuals and vest it in a group
of, quite frankly, Federal bureaucrats who would decide which drugs are
appropriate and which drugs are not, taking that power not only away
from you but away from your doctor as well. Is not that correct?
Mr. COBURN. There is a good example. There is a drug on the market
known as Trazadone. The brand name is Desyrel. I use that drug a lot. I
use the generic as a sleep-inducing aid for senior citizens, but I
never use the generic for an antidepressant because it is not as
effective. If we have this system, I will not be able to do that. So I
will not be able to use a drug that there is significant difference in
efficacy for treating depression, I will not be able to use that
because we are going to use the generic. So, therefore, I will not be
able to use that so I will not be able to give the care and nor will I
have the confidence that my patient is going to get what they want.
So the loss of choice is an implied loss of freedom, but it is also a
decline in care.
Mr. SHADEGG. Ultimately, as a medical doctor trying to tailor the
best care for your patient, you would be at the mercy of a Federal
bureaucrat who would decide which drugs can be used for which purposes.
Let me ask this question: let us say someone is sitting home and
saying we have to make certain trade-offs. Maybe that has to happen.
Somebody has to ultimately decide. Maybe we cannot afford to allow
patients to consult with their doctors and decide which drug is right.
Do we have any assurance, if the gentleman knows the answer to this
question, do we have any assurance that under the Clinton-Gore plan
that at least it would be medical doctors as opposed to nondoctor
personnel that would be deciding these issues under the Gore plan?
Mr. COBURN. I cannot answer that. I do not know, but I can say in
other government-run health programs, title X clinics, title XI
clinics, it is not doctors that make decisions. It is an extension of
the doctors, somebody that is abstract making those decisions. That is
felt to be efficient, even though the care sometimes might be
substandard.
Mr. SHADEGG. The gentleman and I have worked on health care reform a
great deal over the last 6 years, and particularly over the last 2
years. I hope that the medical profession is aware that this results in
a surrendering of their ability to pick the right prescription drug for
their patient and a tremendous loss of choice, not just for patients
but for doctors and a diminution in the quality of care.
Mr. COBURN. I would like for us to ask the gentleman from Minnesota
(Mr. Gutknecht) to stand up and join with us, because one of the issues
that we raised, that this whole plan totally ignores, is enhancing of
competition. What the Gore plan will do is cost shift the cost savings
that might come about through Medicare on to the private sector, which
will then raise everybody else's costs for prescription drugs. It will
raise the State's cost in terms of Medicaid. It will raise the
company's cost that pays for your insurance. If you pay your insurance
yourself, it will raise. If you have no insurance, it will raise.
The problem that we have today, the reason we are even addressing
this issue, is because price has become predominant. We had a 17.4
percent rise in the cost of prescription drugs in this country last
year, when inflation was under 3 percent. There has to be something
wrong here, and I think the gentleman from Minnesota (Mr. Gutknecht)
has a solution to that and has been very vocal on how we enhance
competition in this country, and I would welcome him to the debate.
Mr. SHADEGG. Just let me stress the point of everyone is concerned
about the cost of prescription drugs. I have, as I said, many seniors
in Arizona that I am deeply concerned about. My question is: How do we
solve the problem, and how do we do it in a way that helps people
rather than hurts them? I welcome the gentleman to the debate.
Mr. GUTKNECHT. I would like to thank my colleagues, and particularly
the gentleman from Oklahoma (Mr. Coburn), and let me just say publicly
we are going to miss him a lot in the next Congress. He has been a
fearless advocate for real reform of our health care delivery system.
I would just like to mention before we get into the price, people
need to understand and they do not have to take our word for it and I
want to thank my colleague, the gentleman from Arizona (Mr. Shadegg),
for bringing up this whole issue about, let us at least deal with the
facts, and everything I am going to say today I do not want people to
take my word for it. The first thing I am going to say is anyone who
believes that we ought to make the Health Care Financing Administration
even bigger and stronger, just pick up the phone and call your local
nursing home, call a registered nurse who happens to work in that
nursing home.
Mr. COBURN. Call a doctor.
Mr. GUTKNECHT. Call anybody; call your doctor.
Mr. COBURN. Or call your hospital.
Mr. GUTKNECHT. Call anybody who is involved with hospital
administration. Just go ahead and ask them do you think it is a good
idea to make the Health Care Financing Administration even bigger and
stronger?
Mr. COBURN. More powerful.
Mr. GUTKNECHT. Now, you might want to hold the phone back aways
because you are going to get an earful of how the cow ate the cabbage.
I mean, the people who deal with this powerful bureaucracy today will
say the last thing they want to do is make it even more powerful.
The other thing I want to say about this, and again do not take my
word for it, do a little research, I think the best thing about the
program that we are offering, and I am not going to say it is perfect,
but there are three very important principles about our program that
everyone needs to understand. First of all, it is going to be available
to all. Secondly, it is going to be affordable for all. But, third, and
I think the most important ingredient, is that it is going to be
voluntary.
Now, I am very fortunate. My parents are both on Medicare and because
of the company that my dad worked for and the union contract that they
had, he qualifies for a medical benefit now. So in many respects, they
are in great shape. But if you ask the people who currently have
coverage like that do you want to give it up for a program that is run
by the Federal bureaucracy, the answer from most of those people is no.
They like the program that they have today, and under the Clinton-Gore
proposal they would lose the ability to choose the program that they
currently have.
I do want to talk about price, because many of us have been having a
lot of town hall meetings over the last several years. I was first
alerted to this problem a couple of years ago at a town hall meeting in
Faribault, Minnesota. Some of the seniors stood up and they started
talking about the differences between what they pay for drugs here in
the United States as opposed to what people can buy those same drugs
for, whether it is Canada or Mexico or Europe.
I sometimes feel like that little boy who came in and asked his
mother a question and his mother was kind of busy and she said, go ask
your dad, and the little boy said well, I did not want to know that
much about it. I feel a little bit like that little boy because the
more I learn about this, sometimes I just say to myself I did not want
to know that much about it.
Let me just show this chart. Everywhere I have gone, and we have
taken this to county fairs and town hall meetings, and the people who
have seen this bear out these facts. Now, interesting, this chart now
is about a year and a half old, and this is not just Canada or Mexico.
This is about Europe.
[[Page H7908]]
Again, I will come back to my father, 83 years old, he takes a drug
called Coumadin. Now, he has prescription drug coverage. He does not
pay full retail, but the truth of the matter is the average price for
that Coumadin, it is a very commonly prescribed blood thinner, the
average price about a year and a half ago in the United States for a
30-day supply of Coumadin was $30.25. That same drug, made in the same
plant under the same FDA approval, was selling in Switzerland for
$2.85.
Now, one sweet lady at one of my town hall meetings came up to me and
she said, if you think drugs are expensive today, just wait until the
government provides for them free. And we need to think about that,
because the answer to our problem, and let us go back to the big
problem, and I think this was alluded to, the big problem is
affordability. For an awful lot of seniors, if they could buy Prilosec,
for example, instead at the average price in the United States which I
now understand has gone up dramatically from this $109 figure for a 30-
day supply, the average price in Europe at the time this chart was put
together was about $39, I am told that even today you can buy it in
Mexico, again the same drug made by the same company, for less than
$20. Now, if seniors had access to some of these world market prices,
it would go a long ways to solving this problem because seniors who are
taking two or three prescriptions they might be able to afford easily
$30 or $40 per month, but when that same prescription, that same drug,
sells in the United States for say $200, as a matter of fact we had a
gentleman at one of my town hall meetings in Winona, he came up to this
chart, he pointed at two drugs and it added up to $149; and he said if
I could buy those drugs at European prices, and he said that was about
what I pay, but he said if I could buy them in Europe it is less than
$50.
{time} 1545
Now, he said, $150 really stretches my retirement and Social Security
budget. But $50 I could probably afford that a whole lot more.
The real issue, though, that we need to talk about is what do we need
to do to bring down prescription drug prices to a world market level.
The answer, I want to make it clear, I do not support price controls,
and it is honest to say some countries in Europe and the Canadians and
the other countries do employ various forms of price controls.
Mr. Speaker, I have wrestled with this question. In some respects,
some people say if you go to an open market system and you allow
people, particularly our local pharmacists to buy from other countries,
are you not just importing price controls? I have to admit, to some
degree, that is correct. But we also have to step back and say, wait a
second. These are the same drugs. We are the world's best customers. We
should not be required to pay the world's highest prices.
Mr. COBURN. Mr. Speaker, let me interject with the gentleman if I
could for a minute. I think it is important for people to know that
essentially Americans are subsidizing the drugs of everybody else in
the world, number one, through our research, through the National
Institutes of Health; and number two, through the prices that we pay.
In fact, even if the gentleman's statement about reimporting price
controls were true, what that would do is put a higher pressure on the
negotiated price to the other countries and, therefore, Americans would
not shoulder the absolute high cost of drugs compared to everybody
else, and we would see a shift of that cost, an appropriate shift of
that cost, to the others. Remember, these are all made in the same
plants, shipped all over the world, and charged at significantly
different prices. It is important to note that one way to do that is to
allow reimportation at the wholesale pharmacy and at the pharmacy level
of the identical drug from other countries. If we do that, we will
drive some prices.
The other point that I think is important that ought to be made is
that this year $6 billion out of a $115 billion market for prescription
drugs is going to be associated with television advertising for drugs
that one cannot get unless a physician writes a prescription. The
average consumer sees 10 of those ads a day. Now, who is paying for
that? We are going to pay in America an extra $6 billion so we can see
a commercial to tell us to go ask a doctor for a medicine when, in
fact, what we should be saying is, Doctor, here is the problem I have,
what is the best medicine? One of the subtle things that people do not
realize is that when somebody comes to me thinking they need a certain
medicine, it increases the cost of care, because if they do not really
need that medicine, not only do I have to take their history and
examine them, then I have to spend time explaining why they do not need
the medicine that the ad just sold them and why they need this medicine
that is cheaper, better and more effective. So, in essence, it is
raising the total cost of medicine far beyond the $6 billion this year,
the $9 billion that they are planning on spending next year, just on
television advertising.
Mr. SHADEGG. Mr. Speaker, if the gentleman will yield, I just want to
make sure that the American public and that our colleagues understand
that point. This is demand? Is there a technical term?
Mr. COBURN. It is called poll through demand.
Mr. SHADEGG. Poll through demand. We advertise to the American public
a prescription drug, a drug that they can only get with a prescription,
the goal being those of us sitting at home feeling some of those
conditions will go to our doctor and demand that particular drug, and
we see these advertisements all the time. The gentleman and I are
paying for the cost of that advertising, we are paying for the cost of
that doctor's visit, and we are paying for the doctor to say to us, no,
you really do not need that drug, it is not right for your condition.
Mr. COBURN. And, we are the only country in the world that allows it.
Mr. SHADEGG. The only country in the world that allows demand driven
advertising.
Mr. COBURN. Through television.
Mr. SHADEGG. Through television.
Mr. Speaker, I would also like to ask my colleague from Minnesota who
is, in fact, one of the experts in the Congress on this issue; his
State borders Canada, my State borders Mexico. We have the same
problem. I have people in my State of Arizona who go across the border
into Mexico and get their prescription drugs at a fraction of the cost
in the United States. It is shameful that they have to do that. It is
particularly true that they have to do that in rural Arizona where they
cannot take advantage of Medicare+Choice, where they get a drug
benefit.
I think it is important, and the gentleman deserves to be
complimented for the work he has done to stop the FDA from sending
threatening letters to these people. I would like the gentleman to
explain that. I would also like the gentleman to address the issue of
how will government subsidization of all drug prices in America,
including the drugs for Ross Perot, for example, or Donald Trump, how
will that somehow bring down the cost of drugs for the rest of us, or
even for seniors?
Mr. GUTKNECHT. Mr. Speaker, I think it will only make matters worse.
If we were to pursue the Clinton-Gore formula, I think long term, it
would drive the price of drugs even higher, even though they are trying
to impose a modified form of price controls.
I think the gentleman's question is a good one. We have been aware of
this for several years now, that there are huge differences between
Canada and Mexico, Europe, Japan, and what we pay in the United States.
Now, I want to come back to something that the good doctor said. He
said, we subsidize the pharmaceutical industry in several ways. One,
through what we do with the NIH, the National Institutes of Health. We
spend about $18 billion a year in basic research, much of which
ultimately benefits the pharmaceutical industry. We also subsidize them
through the price that we pay for those drugs. But there is a very
important component that we sometimes forget. We also subsidize basic
research through the pharmaceutical industries with a very generous
research and development tax credit. So they are really getting
subsidies three different ways from the American consumers.
Mr. Speaker, I am not here to beat up on the pharmaceutical industry.
They have provided us with miracle drugs. We in the United States and
people around the world live better and longer because of the
pharmaceutical industry.
[[Page H7909]]
Mr. SHADEGG. But it is fair to ask, is one more subsidy going to
solve the problem.
Mr. GUTKNECHT. Right. I think we want to come back to this. We have
known for a long time, and certainly the FDA has known for a long time,
that there are differentials, so what consumers have done to try and
save some money, and sometimes we are talking about thousands of
dollars, they have gone to other countries.
So what has this administration done about it? Well, they have done
two things, and both of them, in my opinion, have made a bad situation
worse. First, they have allowed some of the large pharmaceutical
companies, Glaxo and Wellcome, used to be two very large pharmaceutical
companies, today they are one. They have allowed these mergers to go on
basically unabated.
Mr. COBURN. If the gentleman will yield, they are just about to
become GlaxoWellcome SmithKline Beecham.
Mr. GUTKNECHT. We will have taken four huge pharmaceutical companies,
and now we will have one. The net result is they will have greater
control over markets and products, and we will see even higher prices.
They have made a bad situation worse.
Mr. Speaker, let me just talk about these letters. This is a
threatening letter. They have sent literally thousands, I have heard
estimates as high as 300,000 of these letters have gone to seniors who
are threatening them through their own FDA because they tried to save a
few bucks by going to Canada or Mexico or Europe to buy prescription
drugs.
Mr. COBURN. Mr. Speaker, we are just about out of time and I want to
make just kind of a summary statement. The best way to allocate any
resource in this country, any resource, is competition. I see the
gentleman from New York (Mr. Crowley), very influential in our ability
to try to reimport wholesale prescription drugs into this country. He
understands that. The idea is to allocate resources with competition.
That is one of the things we need to do.
The last thing we need is another mandatory, government-run health
care program that is already proving to be inefficient, has been tried
once and was so expensive they dropped it; and number three, will
discourage research, will discourage new drugs, and will cost-shift,
and does no benefit for anybody except a senior. Everybody else is
going to have a lower benefit, less access to health care through that
plan.
I yield the balance of the time to the gentleman from Arizona.
Mr. SHADEGG. Mr. Speaker, I simply want to thank my colleagues for
participating in this debate. The letters that my colleague from
Minnesota has pointed out have gone to people in my home State of
Arizona for just having the temerity to cross the border into Mexico
and buy drugs at a fraction of the cost here in the United States.
I think we need to force competition on the drug companies, I think
we need to put them in a position where we force them to bring down the
prices. I think we need to force them to quit forcing us to subsidize
drugs in other countries. I certainly do not believe, and I compliment
the gentleman for the facts that he has brought to this debate, I do
not believe we should make up facts, I do not believe we should use
false information, but I do believe that we should make it clear that a
government subsidy, a program the likes of which is being proposed by
the Clinton-Gore administration which says you get one chance to opt in
or opt out and that is binding on you for a lifetime, and you hand
over, by opting in, the right to choose your drugs to a bureaucrat, not
a doctor; take it away from yourself, take it away from your family,
take it away from your physician and give it to a bureaucrat. I cannot
believe that is the best public policy Congress can come up with. I
think there are better plans out there. I think the plan that we voted
on, while not perfect, is a step in the right direction.
Mr. Speaker, perhaps we should conclude by pointing out that this is
an issue that is important and we will not rest until we address this
problem for the American people.
Mr. COBURN. Mr. Speaker, I thank my colleagues for participating in
this special order with me.
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