[Congressional Record Volume 148, Number 58 (Thursday, May 9, 2002)]
[Senate]
[Pages S4087-S4088]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           PRESCRIPTION DRUGS

  Ms. STABENOW. Madam President, I want to speak to an issue that 
relates to health care. I am so honored to join with our colleagues, 
particularly on this side of the aisle in the Democratic caucus, who 
continue to work very hard to bring a sense of urgency to the question 
of health care for our families, to health care insurance, and to 
affordability for our small businesses and family farmers and the 
larger business community.
  We know today that one of the major costs economically and from a 
business standpoint--and certainly for families, and particularly for 
our seniors--is the whole question of being able to provide health care 
and being able to afford health care for our families.
  We also know the major reason we are seeing health care costs rise 
relates to the uncontrollable increase in prescription drug coverage.
  Today, I once again come to the floor to speak about the need for 
real action now.
  I challenge and invite our colleagues on the other side of the aisle 
and those in the other Chamber who have come forward with principles--
the Speaker of the House and those who will be speaking today about a 
plan--to join with us in something that is real and tangible.
  Words are not going to buy prescriptions for seniors. We know there 
are seniors watching right now who are deciding today whether to pay 
that utility bill or eat supper tonight or do they do those other 
things which they need to do in order to have the quality of life we 
want for our parents and grandparents and older Americans of this 
country--or do they put all of their money into paying for lifesaving 
medications? That is not a good choice.

  Shame on us for having a situation where seniors have to make that 
choice. Yet when we come to the floor, we talk about the need for a 
real Medicare prescription drug benefit. And when we talk about the 
need to lower prices for all of our families and lower prices for 
everyone so we have health care available for everyone in this country, 
we get more words than we get actions.
  I am deeply concerned today as we look at what has been proposed by 
our colleagues on the other side of the Congress, our Republican 
colleagues in the House have said that they wish to lower the cost of 
prescription drugs now. Yet at the same time we see old proposals to do 
minimal kinds of discounts through discount cards and so on--things 
that are already available which folks want to take political credit 
for, maybe change the name or maybe put it under Medicare. But it 
doesn't do anything to actually lower the prices and make prescription 
drugs more available.
  I am very concerned when we come forward with proposals that will, in 
fact, lower prices that we are not yet seeing the support.
  We want that support to be there to be able to use more generic drugs 
when they are available after the patent has run out--the same drug and 
the same formulation--and at a lower price.
  We want to have the ability to open our borders so we can get the 
best price of American-made drugs regardless of where they are sold 
around the world.
  In Michigan, simply crossing the bridge to Canada, which is a 5-
minute drive, cuts the price in half on American-made drugs. It is not 
right. We think when we are talking about fair trade we should open the 
border to the one thing that we don't have fair and open trade on; that 
is, prescription drugs.
  We also know the fastest growing part of the cost of that 
prescription bottle is advertising costs, and that the top 11 Fortune 
500 companies, last year, spent 2\1/2\ times more on advertising than 
research.
  I was pleased to join with my colleagues earlier this week in 
introducing legislation to simply say: If you are doing more 
advertising than research, taxpayers are not going to subsidize it. We 
will allow you to deduct the amount of advertising and marketing that 
you do up to the level that you spend in research. We want more 
research. We want more innovative drugs. We do not want more market 
research; we want more medical research. So we propose items to lower 
costs to help everyone, right now, to lower those prices.
  We also come forward saying it is time to update Medicare for today's 
health care system. When Medicare was set up in 1965, it covered the 
way health care was provided in 1965. If you went into the hospital, 
maybe you had a little penicillin, or maybe you had an operation in the 
hospital, and Medicare covered it.
  Medicare is a great American success story. But health care 
treatments have changed. I have a constituent who showed me a pill he 
takes once a month that has stopped him from having to have open-heart 
surgery. It is a great thing: One pill a month. The pill costs $400. I 
said: I want to take a close look at that pill. I hope it is gold 
plated. But the reality is, that pill stops expensive open-heart 
surgery and allows this person to be able to continue living and 
enjoying a wonderful quality of life with his wife and family.
  If he went in for that surgery, Medicare would cover it. They don't 
cover the pill. So that is what we are talking about. But we need this 
to be comprehensive.
  When our colleagues come forward, and their second principle is 
guaranteeing all senior citizens prescription drug coverage, we say: 
Yes, come join with us. Let's make it real. But, unfortunately, when we 
run the numbers on what is being talked about--and the bill has not 
been introduced yet, but we have all kinds of information about what 
appears to be coming. From what we know, let me share with you some of 
the numbers.
  If you are a senior or if you are disabled and you have a $300-a-
month prescription drug bill, which is not uncommon, when you get all 
done with the copays and the premiums and the deductibles that they are 
talking about, you would end up, out of $3,600 worth of prescriptions, 
paying, out of pocket, $2,920. So less than 20 percent of your bill 
would be covered under Medicare.
  That is not what we are talking about. That is not comprehensive 
coverage under Medicare. That is really a hoax. That is a proposal 
being put forward to guarantee all seniors prescription drug coverage 
that is words, not actions. Again, words will not pay the bills. Words 
will not guarantee that seniors get one more prescription covered, that 
they will get that blood pressure medicine, that they will get that 
cholesterol medicine, or make sure they have that pill that stops them 
from having to have that open-heart surgery.
  So we come today to this Chamber to say: Yes, guarantee all seniors 
prescription drug coverage. But the proposal coming forward by the 
Speaker of the House, and those on the other side of this building, 
will not do it. Unfortunately, what is being talked about will add 
insult to injury because they are talking about paying for their less-
than-20-percent coverage by another cut to hospitals.
  I know the Presiding Officer from New York shares the same concern I 
have because I know hospitals in New York have been cut, hospitals in 
Michigan have been cut. My colleague from Florida is in the Chamber. I 
know he has the same stories--and our leader from Nevada. We know that 
whether it is rural hospitals or urban hospitals or suburban hospitals, 
they have had enough cuts under Medicare. It is unbelievable we would 
be talking about another cut for hospitals while they are proposing 
this minimal prescription drug benefit.
  The other thing I find incredible is that they are talking about a 
copay of $50 for home health visits. We already have seen dramatic 
cuts. We have had over 2,500 home health agencies close

[[Page S4088]]

across this country because of the excessive cuts in home health care 
payments since 1997. Many of us have been saying: Enough is enough.
  We cannot say that the home health help you need will cost more when 
we are trying to give a little bit of help with prescription drugs 
because it is the combination of home health care and prescription 
drugs that allows people to live at home when they have health care 
needs. It allows families to take care of mom or dad or grandpa or 
grandma, to make sure if someone is disabled and needs care at home, 
that they are not inappropriately placed into a nursing home or out-of-
home care. The combination of home health care and affordable 
prescription medications will help our families care for their loved 
ones and help people to live in dignity at home.
  So I find it incredible that you would have, first of all, a minimal 
proposal on prescription drugs coming forward, and then it would be 
coupled with the fact they are talking about cutting hospitals and 
copays for home health care to pay for it. This is an amazing situation 
to me.
  We need to be strengthening Medicare, not undermining it. Many of the 
other parts of this proposal would turn Medicare over to private 
insurance companies. It would basically create a situation where the 
drug companies or insurance companies may believe they benefit but at 
the expense of our seniors.
  I am going to yield a moment to my colleague from Florida, who I know 
cares deeply about this subject. I thank him for coming to the floor 
today to join me, as we rise to say to our Republican colleagues in the 
House of Representatives: Come join with us. Come join with us to make 
sure we can, in fact, put the words into action. Words are not enough. 
We need comprehensive Medicare prescription drug coverage. We need to 
lower prices now.
  I yield time to my colleague from Florida.
  The ACTING PRESIDENT pro tempore. The Senator from Florida.
  Mr. NELSON of Florida. I thank the Senator from Michigan for 
yielding. I want to underscore a number of the remarks the Senator from 
Michigan made--this issue of health care, home health care, and 
prescription drugs.
  I start my comments by saying, has the Bush administration taken 
leave of its senses with regard to a number of these proposals? What 
the Senator from Michigan has just said in relation to copayments for 
home health care, home health care is something we want to encourage. 
Home health care is certainly an alternative to being in a nursing home 
from a cost standpoint. It is certainly a cost incentive as an 
alternative to being in a hospital. But home health care, if it is the 
right kind of medical care, is also a lot better quality of life for 
the patient than having to be in a nursing home or a hospital, if that 
is the appropriate medical care, because they are surrounded by family 
in their home.
  The Bush administration now wants to propose a new copayment. 
Therefore, for senior citizens who are having difficulty paying medical 
bills as it is, because Medicare does not cover everything, now the 
Bush administration wants, in fact, them to pay more in order to be 
eligible for home health care? Have they taken leave of their senses?
  Take, for example, what the Senator mentioned on prescription drugs. 
The Bush administration is saying: Oh, we want a prescription drug 
benefit. Well, certainly all of us do. Why? Because Medicare was set up 
in 1965 when health care was organized around acute care in hospitals. 
But 37 years later, health care is a lot different. Thank the Good Lord 
for the miracles of modern medicine.
  So to provide those miracles of modern medicine--otherwise known as 
prescription drugs--to our senior citizens, we ought to be modernizing 
Medicare by adding a prescription drug benefit.
  The administration says: Yes, we want it. But they are saying, $190 
billion over 10 years. That is a drop in the bucket.
  The ACTING PRESIDENT pro tempore. Time for morning business has 
expired.
  Mr. NELSON of Florida. Madam President, I ask unanimous consent that 
I may proceed for 5 additional minutes.
  The ACTING PRESIDENT pro tempore. Is there objection?
  Mr. REID. Madam President, that would be fine. It may necessitate 
having the vote at 5 after rather than on the hour.
  Mr. LEAHY. I have no objection, provided we then still keep the 
period of time prior to the next vote the same amount of time and the 
vote will have to slip 5 minutes.
  Mr. REID. I say to my friend from Florida, I also got a nod from the 
minority that that is fine. We will ask that the vote be scheduled for 
5 after 11 and that the Senator from Florida be recognized for an 
additional 5 minutes--I am sorry, 11:35.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.
  The Senator from Florida.
  Mr. NELSON of Florida. I thank my colleagues. They are very generous 
with the time. I thank the Chair.
  I was talking about prescription drugs and providing a realistic 
prescription drug benefit by modernizing Medicare. We talked about a 
level in the last campaign. This was a primary topic of concern. In 
every television debate I had, this issue came up. The level we were 
talking about was in the range of $300 to $350 billion for a 
prescription drug benefit over a 10-year period.
  The fact is, the escalating cost of prescription drugs is going to be 
more than that. Of course, with a budget that now has no surplus--we 
had about 14 months ago an ample surplus for the next decade--it is 
going to be very difficult. But we are going to have to face that fact. 
And don't talk about window dressing of $190 billion over a decade 
because that is not going to cut it. For example, why don't we step up 
to the plate on Medicare reimbursement? Look at the doctors and the 
hospitals that are having difficulty making it because Medicare is not 
reimbursing on a realistic payment schedule. We are going to have to 
address that.
  I say to my colleague from the great State of Michigan, the fact is, 
eventually this country is going to have to face the fact of health 
care reform in a comprehensive way. What are we going to do about 44 
million people in this country who don't have health insurance? The 
fact is, they don't have health insurance, but they get health care. 
They get it at the most expensive place, at the most expensive time; 
that is, when they get sick. They end up in the emergency room, which 
is the most expensive place at the most expensive time because without 
preventative care, when the sniffles have turned into pneumonia, the 
consequence is that the costs are so much higher.
  Ms. STABENOW. Will my colleague be willing to yield for a moment?
  Mr. NELSON of Florida. Certainly.
  Ms. STABENOW. He raises such an important point about prevention. 
That is why I know we care so much about the issue of prescription 
drugs. By making prescription drugs available on the front end, that is 
part of that prevention, along with comprehensive care, making sure 
that people are able to receive the medicine they need before they get 
deathly sick and need to go into a hospital or need an operation.
  My colleague raises such an important point, and it is one of the 
reasons we are working so hard to make Medicare available with 
prescription drugs and to also lower the prices for everyone. Part of 
that prevention is making sure that seniors have access to the medicine 
they need to prevent more serious injuries and illnesses from 
happening.
  Mr. NELSON of Florida. And comprehensive health care reform has to 
deal with the 40-plus million who don't have health insurance by 
creating a system whereby they are covered. That then allows the 
principle of insurance to work for you because the principle of 
insurance is that you take the largest possible group to spread the 
health risk, and when you do that, you bring down the per-unit cost. 
Thus, any comprehensive plan is going to have to have pooling of larger 
groups. It is going to have to have consumer choice. It is going to 
have to have free market competition to get the most efficiency, and it 
is going to have to have universal coverage.
  I thank the Chair for the opportunity to join the debate on 
prescription drugs.




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