Congressional Record, Volume 148 Issue 85 (Monday, June 24, 2002)

[Congressional Record Volume 148, Number 85 (Monday, June 24, 2002)]
[House]
[Pages H3842-H3849]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

PRESCRIPTION DRUG BILL

The SPEAKER pro tempore. Under the Speaker's announced policy of
January 3, 2001, the gentleman from New Jersey (Mr. Pallone) is
recognized for 60 minutes as the designee of the minority leader.
Mr. PALLONE. Mr. Speaker, I am pleased to say that I will be joined
this evening by some of my Democratic colleagues as we discuss the need
for a real Medicare prescription drug benefit.
I have been on the floor many times in the evening during Special
Orders criticizing the Republican leadership in the House because of
their failure to address the issue of prescription drugs and even bring
a bill to the floor. So I want to start out by saying I hoped since
they have promised that they are going to bring up a prescription drug
bill to the floor of the House before the July 4 recess, which would be
by this Thursday or Friday, I am hopeful since they made that
commitment to do so that we will see some bill come to the floor, and
there will be a debate on the prescription drug issue by end of the
week.
I am still somewhat skeptical that we are going to see that from the
Republican leadership because initially they said this was going to
happen Wednesday, and now we hear Thursday and now we hear maybe even
Friday. So certainly if they do not bring up the bill at all, they
should be seriously chastised for doing that since they promised it for
2 months.
But even if they do bring it up, my great disappointment and that of
my Democratic colleagues is that it is a sham proposal. It is not a
bill that will provide any benefit or certainly any meaningful benefit
to any senior citizen. And let me just explain why and very briefly
raise two, I think, very major points. One is that the Republican bill
is not a Medicare proposal. We all know that for many years since the
mid-60's when Medicare was first signed into law that Medicare has been
a government program that has provided senior citizens, every senior,
with a guaranteed benefit for their hospital care and a guaranteed
benefit for their physician's care. The bottom line is it works. It is
a government program that works.
Well, the Democrats have been saying, if we have a program that works
like Medicare, then just expand it to include prescription drugs. And
our proposal is very much like part B right now that pays for the
doctor bills. There is a defined guaranteed benefit under Medicare.
Everyone gets it. There is a very small premium, $25 a month, a low
deductible of $100 a year, and 80 percent of the cost of the
prescription drugs are paid up to $2,000 out-of-pocket, in which case
100 percent of the prescription drug bills are paid.
We have a very effective cost-control pricing mechanism that says
that since there is now 30 to 40 million seniors under Medicare, that
the Secretary of Health and Human Services has a mandate to negotiate
lower prices on behalf of this large pool of senior citizens to bring
prices down.
The Republicans have gone just the opposite. Rather than provide a
Medicare benefit, rather than continuing and expanding the Medicare
program to include prescription drugs, all they are proposing, if it
even comes to the floor this week, is to throw some money to private
insurance companies hoping that these insurance companies will offer
some kind of drug policy to senior citizens. And we know that the
insurance companies are saying they are not going to provide these
kinds of drug policies because they have never existed before.
And even if they do, there is no guarantee seniors will be able to
buy one, what the premium is going to be, whether they will get certain
prescription drugs, nothing, and no mechanism in the Republican bill to
deal with the issue of price and trying to reduce costs. In fact, there
is actually language in the Republican bill that says that the
administrator of the program cannot interfere in any way and try to
reduce costs or reduce prices.
So we have here a sham proposal on the part of the Republicans. I
hope they bring it up. I hope we have a debate by the end of the week
on the prescription drug issue, because we have not had it for almost 2
years as this Congress draws to a close. But when they bring it up, we
are going to have to show there really is no benefit at all and no
proposal at all.
Mr. Speaker, I yield to my colleague from Ohio, the ranking member on
the commerce Subcommittee on Health, who has been an outstanding
spokesman on this issue and who has really fought very hard to make
sure that we get a real Medicare prescription drug proposal.
Mr. BROWN of Ohio. Mr. Speaker, I thank my friend from New Jersey,
who has been, as a member of the Subcommittee on Health has helped to
lead the charge on all these issues in the last couple of years as
Congress, some of us, have moved towards a real Medicare benefit.

[[Page H3843]]

I want to sort of build on what my colleague has just said. Our plan,
the Democratic plan, a Medicare prescription drug benefit, is
administered by a program that Americans have learned to trust in the
last 37 years, the Medicare program, while the Republican plan
subsidizes the insurance companies to set up a Medicare prescription
drug private insurance HMO plan. And we know how HMOs have treated
seniors throughout this country over the last 5 years. Our plan, again,
is a Medicare benefit. Their plan sets up drug company HMOs.

Now, let us for a moment again compare the two plans. The Democratic
plan has a $25 premium, the Republican plan, the premium is undefined.
The premium will be set by insurance companies. And if what has
happened in the States is any indication, the premium could be as high
as $70 or $80 or $90 a month. The Democratic plan has a $100
deductible. The Republican plan, again set by the insurance companies,
will have a deductible of at least $250. The Democratic plan, while
there is a 20 percent copay for the first $2,000, the Republican plan
has a 20 percent copay for the first $1,000 then a 50 percent out-of-
pocket cost copay for seniors the next $1,000. Then, at $2,000, the
Democratic plan will cover all drug costs from there on up. The
Republican plan covers no drug costs for the next $1,800. So if a
senior's drug bills are $4,000, $5,000, $6,000, they are out of pocket
thousands and thousands of dollars in the Republican plan.
But the ultimate comparison is look what has happened with this
issue. The Republican plan is written by the drug companies. It is
clear the drug companies are very happy with the Republican plan. In
fact, in The Washington Post last week, and I quote, ``A senior House
Republican leadership aide said the Republicans are working hard behind
the scenes on behalf of the drug industry to make sure that the party's
prescription drug plan for the elderly suits drug companies.
Republicans favor a private sector solution to lowering drug costs,''
and on and on. But I will say it again, a senior House Republican aide
said the Republicans are working behind the scenes to make sure the
plan, the drug plan for the elderly, suits the drug companies.
The Democratic plan was written with input from the AARP, from
consumer groups, from all kinds of senior citizen organizations that
want to see seniors benefit from this plan. The Republican plan was
written by the drug companies so that drug companies benefit.
The logical question then is, why would the Republicans do that?
Well, last week, as my colleague, the gentleman from New Jersey (Mr.
Pallone), saw as a member of our committee, right in the middle of the
markup, right in the middle of hearing amendments and working on this
legislation, the Republicans, on Wednesday evening at 5 p.m., and we
usually work much later than that when we are doing important pieces of
legislation, at 5 p.m. the Republicans adjourned the committee so they
could go off to a fundraiser underwritten by Glaxo-Wellcome, a British
pharmaceutical company, to the tune of $250,000 and supported by other
drug companies.
PhRMA, the trade association for the drug companies, committed
another $250,000; other drug companies put in $50,000, $100,000, and
$250,000. So that the drug industry was pumping literally well over $1
million into this fundraiser. And so we stopped working on the drug
bill at 5 p.m. and the Republicans went to this fundraiser underwritten
by America's drug companies, the world's drug companies, Glaxo-
Wellcome, Bayer, and others from outside the United States.
Then the next day the Republicans returned to the committee hearing
and voted consistently in support of the Republican prescription drug
plan programs and consistently in support of what corporate interests,
what the drug companies wanted.
As an example, I had an amendment that no Member of Congress should
get a better benefit than senior citizens; seniors should have the same
prescription drug benefit as Members of Congress. The drug companies
did not want that, so the Republicans voted down the line against that
amendment that says to the public senior citizens, sorry, your drug
benefit is not as good as a Member of Congress.
Other amendments, offered by the gentleman from New Jersey (Mr.
Pallone), by the gentleman from California (Mr. Waxman), by the
gentleman from Wisconsin (Mr. Barrett), by several on the committee, by
the gentlewoman from California (Mrs. Capps), also were voted down by
the Republican majority because the drug companies did not want them.
Anyone sitting in that committee with a scorecard could have written a
column that reflected senior position, drug company position, and every
single time the Republicans went with the drug company position. Every
amendment, on rural health, on how to control and bring down prices of
prescription drugs, on closing what is called the donut hole, or the
gap, where prescription drug benefits simply end in the Republican plan
at $2,000, one issue after another the Republicans checked the box on
whatever the drug companies wanted.
The kind of money that the Republicans raised from the drug companies
last week is scandalous. The kind of money Republicans raised from drug
companies and then turned around and voted the Republican line is
absolutely outrageous. Americans need to speak out, tell the
Republicans in this body how ashamed they are that they would take that
position and vote the drug company line after pocketing literally
millions of dollars from drug company interests.
Until the Republican leadership in this Congress gets its act
together and realizes this drug bill should be for seniors, not for
drug company interests, Americans are going to continue to see the kind
of stalemate here that has happened.
I just urge people in this country to understand where each party
sits. The drug companies and the Republicans are on one side, seniors
and Democrats are on the other side. And that is why this Thursday or
Friday, when we vote for this, it is important that this House pass the
Democratic substitute which gives a real benefit, which limits prices
that drug companies charge so they cannot continue to charge Americans
more than they charge the British and the Japanese and the Germans and
the French and the Canadians and the Israelis and everybody else on
Earth.
The fact is it is an industry that is the most profitable industry in
America. They pay the lowest tax rate of any industry in America, U.S.
taxpayers help to fund research and development, and the drug companies
turn around with their Republican friends in Congress and continue to
stick it to the American public.

{time} 1945

I thank the gentleman from New Jersey (Mr. Pallone) for the good work
the gentleman has done on this legislation.
Mr. PALLONE. Mr. Speaker, I thank the gentleman for his comments. He
articulates so well the price issue.
I have to say during that Committee on Energy and Commerce markup,
there were two things that we realized over and over again. One is the
Republicans were never going to put this program under Medicare because
they are ideologically opposed to Medicare because they see it as a
government thing, and they were not going to do anything to effect
price reductions.
Mr. BROWN of Ohio. Mr. Speaker, Republicans want Medicare to take a
right turn, and that right turn is to expand health maintenance
organizations, to deliver the prescription drug benefit through a
privatized HMO/insurance system. We want to see Medicare remain a
public program and deliver the drug benefit the way it delivers
hospital benefits and physician benefits. The Republicans want to put
Medicare back into a private insurance scheme just like HMOs and put
the prescription drug coverage into that same scheme to privatize the
greatest government program in history, Medicare.
Mr. PALLONE. Mr. Speaker, we know when Medicare began under President
Johnson it was because the private sector was not able to provide
health insurance that was affordable for most American seniors. That is
why the program was set up, not because we wanted a government program
or we thought a government program was superior, but because the
private sector was not providing any kind of affordable health
insurance that most seniors could buy.
I want to develop a little bit what the gentleman from Ohio (Mr.
Brown)

[[Page H3844]]

said on the pricing issue. The incredible thing about the prescription
drug industry is that they get so much money and help from the Federal
Government right now, and I have a lot of the pharmaceutical companies
headquartered in my district, and New Jersey as a whole, so I am not
saying that they should not be able to make a profit, but think about
the fact that this is an industry that get a tremendous amount of money
from the Federal Government through the National Institutes of Health
to do the research on prescription drugs. Then they have a patent
program where they get exclusivity for new drugs that are developed for
a long period of time and subsidize their patents through the
exclusivity program, and then they get a break on the advertising
through the Tax Code, and finally they have a situation where they
closed the border for importation of prescription drugs from other
countries because they know if that were to happen and we were able to
import prescription drugs from Canada or Europe, we would have a
situation that would bring the cost down.
So everything is being done by the Federal Government to make sure
that they get a nice profit, whether it is money for research, whether
it is preventing importation of foreign drugs, whether it is the patent
exclusivity that they get, or the advertising break that they get
through the Internal Revenue Code, and there are probably many other
things that I could mention as well.
On top of that in terms of tax breaks and money and exclusivity of
patents, even with all that help, they still want the American people,
they want to charge the American people the highest drug costs in the
entire world. That is not fair. That is why the Democrats are saying an
important part of this prescription drug plan that we should pass here
has to address the price issue. Otherwise, prescription drugs will be
unaffordable and the Federal Government will not be able to afford a
prescription drug plan that will actually help senior citizens.
I want to reiterate how important the price issue is. The Democrats
in our bill, because we have our prescription drug program under
Medicare, language that mandates that the Secretary of Health and Human
Services take the 30 or 40 million seniors that are now part of the
Medicare program and negotiate lower prices for them. He has the power
with all these seniors to do the type of negotiation that would reduce
prices because he can bargain. The Republicans not only have nothing
like that in their bill, they have a clause, and I want to mention it
briefly, in their bill called noninterference.
It specifically says that the person who administers the prescription
drug program under their legislation cannot in any way require or
institute a price structure for the reimbursement of covered outpatient
drugs or to interfere in any way with negotiations between these
private insurers and the drug manufacturers or wholesalers or other
suppliers of covered outpatient drugs.
So the Republicans, contrary to the Democrats, are so concerned that
under whatever program they have that somehow prices would be reduced,
that they actually put in language to say it is not possible for the
administrator of their prescription drug program to do anything to
bring costs down. It is unbelievable how much they are willing to do
the bidding of the drug industry because of the amount of money that
they get from the drug industry.

Mr. Speaker, I yield to the gentleman from Massachusetts (Mr. Lynch).
Mr. LYNCH. Mr. Speaker, I thank the gentleman from New Jersey (Mr.
Pallone) and also the gentleman from Ohio (Mr. Brown) for their great
work on this issue.
Mr. Speaker, I am new to this Congress and I must say I had a handful
of issues that I thought stood head and shoulders above all issues when
I came to Congress; and one of those issues, quite frankly, that I
think would greatly improve the quality of life for seniors in this
country, America's greatest generation, would be to create a reliable
and affordable drug benefit program under Medicare. That was my hope
when I came to this Congress, and that is my hope tonight.
However, I must admit to great disappointment in reviewing the
Republican plan for prescription drugs. I think that we need to start
from the very beginning. In 1965, when Medicare was created, I think
that back then there was a good-faith, bipartisan effort to develop a
plan that would indeed address the health concerns of a lot of our
seniors. However, in 1965, the model for health care for seniors at
that time, the paradigm, if you will, was for seniors to receive health
care. It meant hospitalization in a great many respects.
Nowadays, though, fast forwarding to go to what we have today, for
many seniors, in order to achieve the goals of Medicare, we need to
provide solid, reliable, affordable prescription drug coverage. Many
medical benefits accrue to seniors now because of recent discoveries
and developments by pharmaceutical companies who have done good work
with their research. We need to provide access to those prescription
drugs that offer a medical benefit. Today, to accomplish that, we need
to have a plan under Medicare that is available to all seniors.
Under the Republican plan, there are a number of problems. First of
all, a senior citizen would have to go out and find an insurance
company or a plan that would allow them to participate. There is an
obstacle at the very beginning. I think many seniors who have tried to
acquire Medigap insurance, things of that nature through a private
insurer, find out those insurers are few and far between, and the cost
is prohibitive. Also in this program there is a substantial premium for
seniors who would participate in what the Republicans are proposing
here.
There is at least a benchmark premium of $35 a month, which is $420 a
year, with a deductible of $250 a year. Under the Republican plan, the
seniors would pay 20 percent of the first $1,000 and then 50 percent of
the next $1,000. So if a senior has a regular and serious need for
prescription drugs, the very people we are trying to help in this,
there are substantial costs.
In fact, the out-of-pocket premiums continue until that senior
basically has reached the $3,800 a year mark. That is when the full
government benefit through their plan would begin. Again, that is not
under Medicare. So there are serious problems with that.
I think this plan, the Republican plan, allows the seniors to be
victims of low expectations. I think we can do better. I sit on the
Committee on Veterans Affairs, and under the VA proposal, the
pharmaceutical program under the VA, we have a straight $7 copay for
seniors, for our veterans who participate under that program. It is
indeed a model that we should use in providing the Medicaid
prescription drug program under Medicare.

Now, the way the VA does it, they use the collective weight of their
purchasing power and they negotiate in a tough and competitive way with
the drug companies. They end up getting a good deal for our veterans
through good, hard-nosed negotiations, and that is the type of
negotiations we should have with our drug companies on behalf of our
seniors under Medicare.
The very provision that the gentleman from New Jersey (Mr. Pallone)
has pointed out, there is a provision under this Republican bill that
actually requires the administrator not to interfere, not to go after
discounts, and not to upset what the market would otherwise charge. I
think that cuts the legs out from under this plan and under the
administrator and prevents us from actually achieving what we are
trying to do in this Congress.
Mr. Speaker, we owe it to our seniors to provide for this drug
benefit. This is what they need. We have a responsibility to provide
it, and we should let nothing come in between ourselves and that goal.
Mr. PALLONE. Mr. Speaker, I thank the gentleman for what he said. He
brought up many important points, but there are two I want to develop a
little more because I think the gentleman stated something so
important.
One, the gentleman is a member of the Committee on Veterans Affairs;
and how it works with the VA, the administrator, because he has all of
these veterans, he is authorized by Congress to negotiate prescription
drug prices for the VA. I guess it is pursuant to the Federal Supply
Schedule, and he is able to get huge discounts. I understand they are
30, 40 percent, sometimes more.

[[Page H3845]]

We actually had an amendment, the gentleman from Michigan (Mr.
Stupak) had an amendment in the Committee on Energy and Commerce that
was totally tied to the Federal Supply Schedule and that used the VA as
his example. In other words, he wanted to put language in his amendment
in the bill that would have said that the Secretary had to use the
Federal Supply Schedule and do the same thing that the VA administrator
did for all senior citizens.
Not only was that voted down strictly on partisan lines with all of
the Republicans voting against it, but they actually articulated that
they did not want that type of negotiating power for senior citizens. I
do not have the faintest idea why. There was some suggestion it was
okay to do it for the VA because they fought for the country, but
seniors should not be treated the same way.
I wanted to point out that a lot of those seniors were also veterans,
so that made no sense. Just to show how far they were willing to go to
say they did not want any kind of pricing mechanism in this bill, they
actually rejected an amendment by the gentleman from Michigan (Mr.
Stupak) that would have modeled itself on the VA, the way the gentleman
described it.
The other thing that the gentleman said that was so important is the
whole idea of prevention. In other words, the gentleman pointed out
when Medicare started out in the mid 1960s, the reason it was set up
was because most senior citizens had no health care. They could not buy
health insurance.
At that time, we primarily were providing through Medicare for
hospitalization; and then later we expanded it to under Part B to cover
doctor bills. But the reason we need this prescription drug benefit is
because things have changed so much over the last 30 years. Now the
prescription drug benefit is just as important as Part A for
hospitalization and Part B for doctors' bills.

{time} 2000

I would venture, and you pointed out, and I know that the gentlewoman
from Texas has said this before and the gentleman from Ohio has said
this before, that if you actually provide a generous prescription drug
plan under Medicare, where 80 percent of the costs are paid for by the
Federal Government, which is what the Democrats do, because it is
preventative, you will prevent the hospitalization, the nursing home
care, the having to go to the doctors.
We had a couple of our colleagues, the gentleman from Arkansas (Mr.
Ross) who owns a pharmacy company and the gentleman from Arkansas (Mr.
Berry) who is a pharmacist, two guys from Arkansas, they pointed out
that someone will come into their pharmacy like on a Monday or a
Tuesday morning and ask for a certain drug that has been prescribed by
their doctor and be told, Okay. Well, that is $350. The person says, I
can't afford it, walks out of the pharmacy; and because the town is so
small where they are in Arkansas, they actually see that person in the
hospital at the end of the week running up a bill for Medicare that is
10, $20,000. It makes no sense. We need to basically reform Medicare
and include a prescription drug benefit, not put it outside Medicare,
because we will save money if we do it. It is such a simple thing to
explain to our Republican colleagues; and they just reject it because
they do not like Medicare, and they certainly do not want any impact on
pricing.
Mr. LYNCH. I think you raise a great point. I think that there is
also a sad reality. I just met with about 50 senior citizens in my
district who are actually boarding a bus to go to Canada. There was a
woman, Mrs. Morgan, who had just fought off her second bout with breast
cancer and had been prescribed Tamoxifen, which if she bought it at her
local CVS in my district, in and around the neighborhoods of Boston, it
would have cost her about $1,500 per year. She was going to Canada to
buy in one visit a year supply of that Tamoxifen for $155.
There has got to be a better way. Even under the veterans plan, there
are hard-nosed negotiations going on between the VA on behalf of
veterans and the drug companies; and the drug companies while they are
not happy with the negotiations as hard-nosed, they are making a
profit. They are making a reasonable profit, however; and it allows the
research to continue, it allows drug companies to continue to pursue
what we will, I think, in a very short while see as really miraculous
developments in terms of prescription drugs for many very debilitating
diseases. We need to keep that initiative forward. But we also defeat
our purpose if we pass a drug prescription program that seniors cannot
afford, which is the great risk if the Republican plan prevails.
I thank the gentleman from New Jersey for his kindness in allowing me
to participate this evening.
Mr. PALLONE. I want to thank the gentleman. I appreciate his remarks.
I yield to my colleague from Texas who has been here so many times in
the evening, oftentimes late at night, to make the point about how
important it is that we have a prescription drug benefit that actually
means something for senior citizens.
Ms. JACKSON-LEE of Texas. I thank the distinguished gentlemen, first
of all, as I listened to my colleague from Massachusetts for
articulating so well what the obstacles and the crisis that we are in
and what we face in this debate this coming week. I was in another
meeting and I was called indicating that you were having this
discussion on the floor, and I thought of several points and as I came
in you were making some points that I would like to briefly pursue
because in my heart, this hurts me.
I want this benefit so much for our seniors. I do not want to seem as
if I am exaggerating. I really want us to bring closure in a positive
way to this issue because it has gone on for so long. I believe that so
many of us have been in our districts so closely involved with our
seniors who really have a personal crisis as relates to their
medication. There are a multitude of examples of seniors having to
leave the country. It is one thing to have to leave the State, but
having to leave the country in order to secure the drugs that they need
in order to live. Can I say that again? In order to secure the drugs
that they need to live. That is what we are talking about.
What I am concerned about is that there are those of us who believe
that there is value to the pharmaceutical research that is done in this
country, and I know the distinguished gentleman from New Jersey who
sits on the Committee on Energy and Commerce also recognizes that we
must have that kind of scientific research, pharmaceutical research,
drug research, new drug research. No one is discounting that.
One of the arguments being made by our friends in the pharmaceutical
industry is that you are cutting our profit and we cannot do any more,
if you will, far-reaching drug research to be creative in new drugs. I
want to respond to that, because there are answers to that point. First
of all, I think we should be concerned about senior citizens. I heard
my colleague from Connecticut last week call them the Greatest
Generation. But they have lived longer because of Medicare starting in
1965, in the mid-sixties.

We now can provide a crowning touch to that because what we are
seeing is that the life expectancy diminishes when they are not able to
get the drugs as prescribed by their physician. The key element that I
think is important about this particular provision of the Democrats is
that our provisions are not voluntary. It goes through the Medicare
trust fund. It provides 80 percent in Medicare coverage. It means that
every senior who needs it will have a definitive benefit which they can
utilize. And it will eliminate confusion and whether or not they have
to make choices.
This does not discriminate as far as I am concerned against our
pharmaceutical companies. Why? Because they will have to use those
drugs. And as was made very clear, and I think the gentleman from New
Jersey made this point and I am convinced that he is right, that since
this will be similar to part A and B or these provisions that come
under Medicare, we will have the ability to see the maintenance
decrease the cost of hospitalization that you do under A and B. And
that in fact as they secure the drugs prescribed by their physicians,
do the pharmaceutical companies not see a decided increase in
utilization, because they will then be able to use the drugs
prescribed.

[[Page H3846]]

My good friend knows that there is some rumoring and fear about
generic drugs. There are some prescriptions, quite a number of them,
that cannot be substituted by generic drugs. The physician wants the
patient to take that particular drug. We know that. I know from my own
parent, my own mom, that she takes drugs that are particularly
prescribed by a particular drug company, a name brand, if you will.
Look at the increase that will come with the ability to purchase and
purchase the quantity that you need and at the same time provide good
care for these seniors. Do our friends in the pharmaceutical industry
not see the benefit and the profit for allowing the Democratic plan
that has the higher percentage of value to go forward? And, by the way,
providing, if you will, the same kind of compensation to providers, the
hospitals and physicians, I think that should be noted, in the
Democratic substitute, but providing that benefit that is not mandatory
but it is part of the Medicare program which then gives them the
automatic right and the automatic compensation, if you will, or income
to be able to purchase those drugs. That is what I think is a point of
contention that really should be enlightened upon, because I have
always wanted us to come to the floor of the House with a bipartisan
proposal that really works.
It saddens me that we are now at a point where we are about to vote
on this and we are voting politically. We are voting simply to make
some group happy over here that needs to be happy and that is our
pharmaceutical friends who believe they cannot be happy with this plan
that provides the 80 percent coverage. I disagree with them. I wish
they would look closely at this plan because I cannot imagine when you
increase the population of purchasers how that does not increase the
profit margin if we have to talk about that. I only talk about that
because I do believe that the research of new drugs is important. None
of us want to deny that or diminish that, but we have got to be
realistic about the needs of our senior citizens. I do not believe a
voluntary program, which I was willing to look at, by the way, I need
to be very frank with the distinguished gentleman, wanted to look at it
because I wanted something to work. I would almost say that how do you
mesh them and make them work together? But the key is a voluntary
program is less able to provide the benefit than a program that is
under Medicare and provided by Medicare and funded by Medicare.

And for those naysayers about the cost, all we have to do is put a
moratorium or repeal the enormous tax cut that has really sent us into
the deficit, if you will, that we are in. I would much rather invest in
this particular plan because this plan has growth. It provides a
lifesaving component to senior citizens benefits for Medicare. You
cannot have health care and maintenance by physicians and they are not
able to take the prescribed drugs that they are given. This is a key
element. I hope that my colleagues will join us and vote almost in
unanimous manner on the substitute that I believe offers to all of us a
real chance to make a difference on prescription drug benefits.
Mr. PALLONE. I want to thank the gentlewoman not only for what you
said tonight but for being here so many nights as we try to literally
pressure the Republicans to bring up a prescription drug plan and have
it debated on the floor. You expressed with me how disappointed we are
if this actually does happen this week and they bring up a proposal,
that the proposal is such a sham that will not actually do anything to
help senior citizens.
I wanted to yield to the gentleman from Arkansas, but I just wanted
to say one point about what the gentlewoman from Texas said about the
drug research and the increased utilization, because that was so
important. We hear the pharmaceuticals saying, well, we need money for
research, and you cannot reduce our profit. But I had said before, it
is incredible to hear them say that because the Federal Government is
so much involved in rewarding them and making sure that they have
enough profit.
First of all, we provide a lot of money for basic research to the
drug companies through NIH and other Federal programs. Then you talked
about generics. It is true, of course, that there are many drugs for
which there is no generic alternative because of the patent
exclusivity. In other words, if you develop a new drug and you can get
it patented and we give you an exclusive right to sell that over a
period of time before a generic can come to market, that is a huge
amount of money that the Federal Government through its patent policy
is giving to the drug companies. You cannot have a generic under those
circumstances.
Then you think about the fact, and a previous speaker talked about,
because he is from Massachusetts, the buses going to Canada. We also
say you cannot import foreign drugs, so we are again through Federal
policy giving them another windfall because you do not have the option
of competition with the drugs that would come from Canada or overseas
in lower prices. Then we give them huge tax breaks for their
advertising. For them to complain about how they need money for
research is absurd.
I totally agree with you as well. I have never understood why they do
not see bringing in all these seniors, now millions of new people in to
be able to purchase prescription drugs, would simply increase their
profits even more because now a lot more people would be buying the
drugs. Their arguments are specious and make no sense. I just do not
understand where they are coming from.
Ms. JACKSON-LEE of Texas. If the gentleman would yield for just one
sentence on that point. It is such an important point and I end on this
particular point, that is the incentive and the response that the
government gives to the pharmaceutical companies. It gives them that
benefit. That is why you have the patent, in order to protect them for
a period of years so that there is no generic undercutting of the
investment that they made to produce the drug. That is why you provide
that patent and as well, many people disagree with that, but that is
why we have those kinds of restrictions in terms of importation of
drugs. Now people are, as I said, having to leave the country to save
their lives. So you would find those same people right here using that
Medicare benefit, that 80 percent Medicare benefit and buying those
drugs that they now leave the country to buy. I cannot understand why
there is not an understanding about that logic, but I hope we will have
a coming together of the minds and vote on a good bill this week, which
would be the Democratic substitute.
Mr. PALLONE. I thank the gentlewoman. I yield to the gentleman from
Arkansas. We already mentioned your name tonight in the context of
prevention, the person at the pharmacy that does not get the
prescription drug and ends up being hospitalized.
Mr. ROSS. I would like to thank the gentleman from New Jersey and the
gentlewoman from Texas. It seems like every week we are here on the
floor of the United States House of Representatives talking about the
need to truly modernize Medicare to include medicine for our seniors.
Yet it seems like the majority, the Republicans on the other side of
the aisle, only continue to give us rhetoric on this issue.
Let me tell you what I mean by that. Let me preface my remarks for
those who do not know me in this body. I want to make sure that they
clearly understand that I am a conservative Democrat. I have crossed
over and voted with the Republicans when I think they are right. On
this issue, they are dead wrong; and I believe it is time for some of
us to stand up for our seniors and say so.

{time} 2015

That is why I am proud to rise tonight in opposition to this prodrug
manufacturer prescription drug bill and in support of the Democratic
alternative, which I refer to as the prosenior bill, a bill that will
truly help our seniors.
Let me also say that I believe I understand this issue. I understand
it because my wife is a pharmacist. We together own a small-town family
pharmacy. I have seen seniors in our small town of Prescott, Arkansas,
with a population of 3,400 people. In that small town I have seen
seniors come through our door after they have been to the doctor.
Medicare paid for their doctor bill, Medicare paid for the tests that
were run on them, and Medicare will even pay for their hospital stay
and

[[Page H3847]]

surgeries, and yet Medicare does not cover their medicine. Too many
times I have seen seniors leave that pharmacy without any medicine
because they simply could not afford it.
Mr. Speaker, we hear a lot of talk about them having to choose
between their medicine and their rent and their home mortgage and their
utilities and their food. A lot of seniors in my district are getting
by from Social Security check to Social Security check; and I
understand that and I understand it clearly, because that is exactly
what my 91-year-old grandmother back home in Prescott, Arkansas, does.
She worked hard all of her life. Did not have a retirement at work. Her
Social Security check is her only source of income. If you get ill
later in the month, oftentimes you are not having to choose because you
have already paid out of your $500 Social Security check for those
other things: your rent, your utilities, your food. And there is
nothing left for your medicine.
Living in a small town, I would see a week or 10 days later so many
seniors end up in Hope, Arkansas, at the hospital, just 16 miles down
the road, running up a $10,000 or $20,000 Medicare bill or required to
have a surgery that could exceed $100,000, or diabetics who have legs
amputated or require a quarter of a million dollars worth of kidney
dialysis before they later died, simply because they could not afford
their medicine or could not afford to take it properly. So I am not
standing here tonight with a lot of rhetoric; I am standing here
tonight with real-life stories from our small-town family pharmacy in
Prescott, Arkansas.
Mr. Speaker, if we think about it, today's Medicare is designed for
yesterday's medical care. I have said this before, but I will say it
again because I think it makes a good point.
I recently ran into a senior, a woman who is a retired pharmacist in
Glenwood, Arkansas, who just happened to be a relief pharmacist in my
hometown when I was a small boy growing up. She said, you know, back in
those days, which was not that long ago, she said, I would see
prescriptions rarely exceed $5; and when I did see a prescription that
exceeded $5, I would go ahead and fill the next one while I built up
enough courage to go out and tell the patient that their medicine was
going to cost over $5. Today, it is nothing for a prescription to cost
$100.
I think health insurance companies are among the most greedy
corporations in America. Even they cover the cost of medicine. Why?
Because they know, as the gentleman talked about earlier tonight, they
know it holds down the cost of needless doctor visits, the cost of
needless hospital stays, and the cost of needless surgeries. All we are
trying to do here is pass a bill that will help our seniors get the
medicine that they so desperately need.
So why is the Republican bill a prodrug manufacturer bill? I do not
know. It is crafted by the drug industry for the drug industry. They
have been unwilling, the Republicans have been unwilling to work with
Democrats to develop a bipartisan bill; and I say to my friends on the
other side of the aisle, it is time that this Congress stop talking
about this issue and got to work. It is time we united in a bipartisan
fashion on the need to truly provide our seniors with the medicine they
need, just as we have united on this war against terrorism.
Now, the drug manufacturers are going to spend, actually through a
front group known as United Seniors Association, they are going to
spend $3 million on an ad campaign trying to convince seniors that this
Republican plan is good. Again, I have crossed that aisle and voted
with the Republicans many times; and when they are right, I will vote
with them. I am a conservative Democrat from south Arkansas, but I can
tell my colleagues this: on this issue, I understand this issue, and on
this issue they are dead wrong.
Mr. Speaker, this is a quote from the Washington Post: ``A senior
House GOP leadership aid said yesterday that Republicans are working
hard behind the scenes on behalf of PhRMA,'' that is the drug
manufacturers, ``to make sure that the party's prescription drug plan
for the elderly suits drug companies. Republicans favor a private
sector solution to lowering drug costs, one that requires seniors to
buy insurance for drugs from companies or through a managed care plan.
Democrats want the benefit, drug benefit to be a part of Medicare, a
change companies fear could drive down profits,'' Washington Post, June
18, 2002.

In the midst of the Republicans marking up this so-called
prescription drug plan for our seniors, first they had this crazy idea
of coming up with a discount card like it was some new concept. They
have been around for years. Seniors who have bought them know there is
no real meaningful discounts to a discount card.
When we created Medicare, thank God we did not say, here is a
discount card, go cut a deal for your doctor visit or surgery. This
should not be complicated. It is time for us to simply go into the
pharmacy and get the medicine that our seniors need, just like going to
the doctor and going to the hospital.
In the midst of the Republicans marking up, writing this prodrug
manufacturer bill, they did take a break. They took a break long
enough, and I am quoting here, and this is from The Washington Post,
June 19: ``Pharmaceutical companies are among 21 donors paying a
quarter of a million dollars each for red carpet treatment at tonight's
GOP fundraising gala 2 days after Republicans unveiled a prescription
drug plan the industry is backing, according to GOP officials.'' Again,
Washington Post, June 19, 2002.
I get angry when I look at statistics that tell me that PhRMA, the
drug manufacturers, have over 600 lobbyists on Capitol Hill promoting
their interests. Let me tell my colleagues what makes me angry about
that. Pharmaceutical company profits are nearly four times the average
of other Fortune 500 companies. The annual profit of the top 14
pharmaceutical companies is $38 billion, with a B, and the drug
industries' effective tax rate is half that of other major industries.
I could go on and on, but I will not.
But let me say this. The next time we see one of those slick ads on
TV trying to tell us which drug we need to tell our doctor you need,
have my colleagues ever thought about that? The next time my colleagues
see one of those ads, remember this: many drug manufacturers spend more
money day in and day out, year after year, on those slick TV ads trying
to sell their product than they do on research and development of drugs
that can save lives and help all of us to live healthier lifestyles.
Please, do not be confused by this ad campaign they are putting up
trying to pass this prodrug manufacturer Republican bill. It is H.R.
4954. It is nothing more than a Band-Aid, at best.
Our plan, the Democratic plan, the seniors' plan truly gives our
seniors the ability to go to the doctor, to go to the hospital and,
yes, to be able to go to the pharmacy and get the medicine that they so
desperately need. We treat the prescription benefit just like going to
the doctor and going to the hospital. No gimmicks, no tricks. It is
that simple.
Mr. Speaker, I am glad to yield to the gentleman from New Jersey (Mr.
Pallone).
Mr. PALLONE. Mr. Speaker, I want to yield to the gentleman from
Washington who has been out front on this issue for so long as well.
But I just wanted to comment, I was so glad the gentleman brought up
the statement, or the quotes, if you will, from The Washington Post
about this big dinner that the Republicans had the night of the
prescription drug markup in the Committee on Commerce. We actually had
to break at 5 o'clock so that they could go to the dinner.
I have people come up to me and say, Congressman, no one thinks that
anybody who is elected to this House has evil intentions. I mean,
whether they be Republican or Democrat, they are not elected here, and
they do not come here because they want to be evil. I really believe
that strongly. I am sure all of my colleagues believe that.
So my constituents will say, well, why is it that the Republicans do
not want to put the prescription drug benefit under Medicare if
Medicare is such a good program, and why is it that they do not want to
reduce prices, because that will save the Federal Government money? The
answer is the special interest prescription drug industry. That is
where we have the Republican aid very much saying that.
They do not want this to be a Medicare benefit. They want to give it
to

[[Page H3848]]

private insurance companies, because the drug companies are afraid that
if it is a Medicare benefit and guaranteed to anyone that somehow they
are going to lose money or not make as much profit. And they do not
want to reduce costs for the same reason. So what is happening is that
the Federal Government cannot save money and the seniors cannot save
money because the drug companies have to make a bigger profit. I do not
even believe it is true, because I think that if we have this program
of Medicare and if we have 30 or 40 million seniors getting it, that
the drug companies will make even more money. So I do not even buy
that.
But they are convinced that they are going to make less money, so
they put pressure on the Republicans to say, do not put this under
Medicare, do not reduce prices, do not have any pricing mechanism in
it. There is no other explanation for it because it does not make
sense. People are not doing things because they want to be bad and hurt
people; they are just doing it because they are getting the money from
the special interests.
Mr. ROSS. Mr. Speaker, if the gentleman will yield, if the gentleman
recalls, he and I were here on the floor while they were out at the
fundraiser with the big drug manufacturers talking about this very
issue.
Let me say that those on the other side of the aisle, the
Republicans, I am convinced, I know a lot of them, and I am convinced
that they love this country just as much as I do. It is not about that.
I think it is about being misinformed.
Mr. Speaker, when seniors cannot afford a quarter of a million-dollar
contribution to get into an event, it makes it difficult for them to
get their side of the story heard. So I challenge, I welcome, I
encourage my colleagues on the other side of the aisle to call seniors
in their district, to call their hometown family pharmacies and talk to
the pharmacist. They understand these issues, and they know they are
going to take a hit as a result of Medicare setting the price on
something they now set the price for. They are okay with that, as long
as the drug manufacturers share that hit. Do not forget, when one goes
into a pharmacy, every dollar we spend, 84 cents, is a direct result of
the drug manufacturer; 84 cents out of every dollar, a direct result of
the drug manufacturers.
I just think they are misinformed. I think they are well-intentioned.
I think they are good folks; they love this country like we do. This
just happens to be an issue that they do not understand. Seniors cannot
afford a quarter of a million-dollar ticket to get into a fundraiser in
the middle of writing a bill. So I would ask them to put politics
aside, get on the phone and call seniors, call your hometown family
pharmacist. Ask them what they think about the Republican bill and the
Democratic bill, again, the drug manufacturer bill versus the seniors'
bill that will truly modernize Medicare for our seniors.
Mr. PALLONE. Mr. Speaker, I thank the gentleman from Arkansas, and I
appreciate the fact that the gentleman from Washington is here, and I
apologize. I think there is about 7 minutes left, and I know that is
not a lot of time, and I yield to the gentleman.
Mr. McDERMOTT. Mr. Speaker, I appreciate the gentleman yielding to
me. I think that this is an issue where the question that if I were
sitting out there, I listen to all of these people tear this Republican
plan apart and ask themselves, why in the world are the Republicans
putting forward something that has so many defects in it? I think the
truth really is that Newt Gingrich was quite honest when he said once,
we expect Medicare to wither on the vine. They never liked the senior
health care plan we have in this country paid for through the
government. They have always thought it ought to be done by the private
sector. They have thought that for 38 years.
Now, the reason they have this prescription drug benefit out here is
like the old story about the Trojan horse. They came up to the gates of
Troy with this horse and everybody inside said, oh, what a beautiful
horse. People said, well, the Greeks have brought it over here. It is a
gift. So the people from Troy said, well, okay, open the gates and we
will bring it in. They brought the horse in and lo and behold, it was
hollow and filled with Greek soldiers who took over and captured and
destroyed Troy.
Now, that is what this whole issue of pharmaceuticals is about. The
Republicans want to destroy Medicare as we have always known it and
make it under the private insurance industry. What they have done in
this bill is to set up two bureaucracies. Right now we have one
bureaucracy; it used to be called HCFA, the Health Care Financing
Administration. They changed that, they call it CMS now, whatever that
is; and they have that over there for the fee-for-services. Then they
created something called the Management Benefit Administration over
here, and they put all of the HMOs under that; and they put the drug
benefit under that.

{time} 2030

They separate the two and they give these two agencies the
responsibility of managing competing ways of delivering health care,
but it is not fair. They did not level the playing field. They said to
these people over on the private side that they can hire anybody they
want at any amount they want to pay them, but over here in the public
side they have to use the civil service rules, so this will allow these
people to take the best people away, and the whole idea is to set up
this competing private sector delivery of health care.
I sat on the Medicare Commission for a year, and the whole time they
were trying to set up a private health care system. In those days, they
called it a voucher. What they were going to do was give everybody
$5,400 and send them out to find a health care plan, and then we would
not need this public program. We would just dole out the checks at the
beginning of every year to the old people, and they would go out into
the private sector and look for an insurance company that would give
them their health insurance for $5,400.
We said that will not work because there are people who are sick and
people who are healthy. Some people will get a good program, some will
get a terrible program, and what we want is a program for all senior
citizens that give all an opportunity to have good benefits. And they
said, no, let us just give them the money, and we will give them
choice.
This is that magic word they throw around, ``choice.'' My mother is
92, and I do not know but there are probably a few members of Congress
who have got an older parent. When one is 92 years old, they are not
much interested in choice. They just want something they can count on
that they know will be there.
But Republicans are determined. From Gingrich, for the last 10 years,
well, longer than that, 35 years, they have been trying to push us into
the private sector because they know how to manage things so well and
they are so kind and loving and they take care of us so well. Over the
last 3 or 4 years, we have tried to get people to go into managed care.
People went into managed care. What happens to them? They close down
the program. We have had millions of people lose their benefits in this
country.
So now it is not bad enough with HMOs. Let us do this to drugs. Let
us put the folks into the private sector and let them start out and get
a benefit and have it closed down, and then they will have to look
around for somebody else. They will not have a benefit because it will
not be a guaranteed Medicare benefit. It is a voucher. They are going
to give a voucher to people and tell them to find a drug company that
will take care of them. And the American people are not stupid. They
can see a Trojan horse for what it is. These people have been after
destroying Medicare for 35 years, and they are doing it today.
My view is that, if we allow that to happen, we will have given away
one of the most important programs in this country for economic
security. Most senior citizens feel comfortable knowing that they do
not have to go to their kids for health care benefits, they do not have
to go to their kids and beg to them and say please buy my medication.
My mother lives on a small Social Security pension. That is all she
has. She has got three boys and one girl. We will help her. But the
Republicans will not even count as paying for the drugs in their
program what the kids put into it. My mother has to pay it all out

[[Page H3849]]

of her checkbook. So we have got to go through some shenanigans. We
will slip the money to my mother and say, Mother, put this in your bank
account and then you go pay for your medications instead of just our
paying for it straight. We have to play games to protect our own
parents. That is wrong.

____________________