Congressional Record, Volume 148 Issue 96 (Tuesday, July 16, 2002)

[Congressional Record Volume 148, Number 96 (Tuesday, July 16, 2002)]
[Senate]
[Pages S6854-S6856]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

MORNING BUSINESS

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MEDICARE PRESCRIPTION DRUG BENEFIT

Ms. STABENOW. Madam President, it is difficult to know where to begin
at this point. I feel compelled to respond to my colleague and friend
from Pennsylvania, who has spoken at some length. As I listened to him
on a variety of subjects, I have changed what I was going to say a
number of times.
Let me just start by addressing the last issue he raised about
knowing the whole story because I believe it is incredibly important.
We have been trying, now, since Friday--or certainly we have been
trying since yesterday--to move to this legislation which is so
critical to lower prices of prescription drugs for everyone and also
provide a Medicare prescription drug benefit that is beneficial. As we
finally move to the bill, it is important that we understand the whole
story of how the industry operates today and our role as taxpayers.
I think we need to understand that we start with basic research. This
year, we as taxpayers are spending $23.5 billion that we give to the
National Institutes of Health for basic research. I support that. I
would support doing more. I think it is critical. But we do that, and
companies take the information and then move it to the next level after
we have subsidized or paid for the research.
They move to the next level and do research and development
themselves, which is also very important. We subsidize that as well
through tax writeoffs on research and development as well as
advertising and business costs and so on. So we participate through tax
deductions and credits.
We then allow companies that bring a product to market to have up to
a 20-year patent. That patent, then, allows them to have exclusive
rights, without competition, so they can recover their costs, their
research costs. It does cost a tremendous amount of money to bring new
drugs to the market. We know that. We as Americans have built in a
system to make sure that that innovation is recognized. We allow
companies to recoup their costs, and they are then able to bring these
lifesaving drugs to market.
We then get to the end of that process, and then something else is
supposed to happen. The formula is supposed to be available for generic
companies to be able to, in turn, manufacture the drugs and reduce the
prices.
What happens today? Unfortunately, this industry, that has been
supported and subsidized and is making 18-percent to 20-percent profit
a year, fights every possible venue for competition. They fight
everything. They fight generics going on the market. Sometimes they buy
up the companies. Sometimes they just sue them to keep them off the
market. They fight opening the borders to Canada which would create
more competition. They fight real Medicare prescription drug coverage
that would allow 40 million seniors and those with disabilities to be
under one insurance plan and be able to have the clout to get a group
discount. They fight everything.
That is the real story: Why we are here, seeing delay after delay
after delay, because we see the lobbyists in that industry looking for
every opportunity to stop us from going forward.
My colleague also said we should have brought this up in the Finance
Committee. One of the things I learned is that if you are wrong on
substance, you bring up process arguments. So we had a lot of process
arguments. Unfortunately, not one of those process arguments would buy
one prescription for one senior.

We have heard arguments about the Finance Committee. I ask my
colleagues: It is my understanding there has been a bill in the Finance
Committee for 5 years. How long is long enough? How long is long
enough? How long do seniors in the country have to wait for Medicare
coverage? How long is long enough?
We debate on the floor skipping the Finance Committee. How about the
senior who is skipping supper right now? Frankly, I am more concerned
about that person right now. How long do people have to wait? How many
Presidential debates and campaigns? How many congressional campaigns?
How long?
Now is the time to stop talking about process and start talking about
real Medicare coverage and lowering prices for everyone, so the next
group of employees do not have to be told their pay is frozen so the
employer can pay the health care benefit; so the next round of small
businesses do not see their premiums jump 30 percent, 40 percent, and
they have to consider dropping insurance coverage for their employees--
predominantly because of the driving costs of prescription drugs; so
the manufacturers in my State do not have to struggle with this issue.
How long? I would suggest too long. And now is the time to do it. Now
is the time to act. If we are operating as people of good will, we can
work out the process, we can work out the details. There are
philosophical differences--no question--about how to proceed. But if
people of good will want to make something happen, I believe we can and
we will.
I will have a lot more to say about the differences in the Medicare
plans and other differences tomorrow, as we move through this debate.
But this evening I would like to remind Senators, again, what we are
supposed to be focusing on. I hope, anyway, with all due respect to
colleagues, that we pay attention to what is really at stake. I have
set up a prescription drugs people's lobby through my Web site and
asked people to share with me their stories.
I close with two descriptions of real-life situations that are
happening right now. One is from Rochelle Dodgson of Oak Park, MI. I
want to thank her very much. I have shared this before, but I want to
bring us back to what this is about. She writes:

My mother is currently insured under COBRA after losing her
job in August of 2001. While she has her basic Medicare
coverage, she will lose her supplemental medical coverage in
January 2003. She has recently been diagnosed with multiple
myeloma and will require treatment for this blood disorder
the rest of her life. The medication she was taking before
this new illness costs over $500 retail on a monthly basis. I
have not checked the prices of the `chemo' she takes monthly
nor the cost of the Procrit she takes weekly. I expect her
monthly out of pocket expenses to be around $700 a month. Her
Social Security is just over $800 a month.

Her monthly out of pocket expenses are $700; her Social Security is
around $800.

I can't imagine having to budget food and housing expenses
along with medication on that kind of income. My husband and
I will try to find a way to budget some of her medical costs
into our own expenses. . . .

Many families are doing this across America.

. . . but we also care for my husband's mother.
My mother is still a viable part of society. She doesn't
deserve to struggle just because she has chronic illness.

That is what this is about. It is not about procedures, and 60 votes
versus 51 votes, and all of the other processes, objecting to
proceeding with bills. This is what this is about.
Let me just share one other story. This is actually from Austin, TX.
Jackie Smith wrote through my e-mail. I am sure she shared it with
other colleagues as well. I appreciate it. She says:

My prescriptions will cost $3,850 a month beginning August
15 [of this year].

Madam President, $3,850 a month for prescriptions.

That is when my COBRA benefits--which allowed me to
continue my health care coverage through my employer--will
run out. I will then qualify for Medicare with no
prescription drug coverage.
Between my disability policy benefits and Social Security
disability my fixed income is

[[Page S6855]]

$2,000 a month. I have no idea where to turn for help.

Madam President, $2,000 a month in income, $3,850 a month in
prescription drug costs. She describes her situation and ends by
saying:

Thank you so much for working for a meaningful drug
benefit.
That is what this is about. If we want to fix it, we will. We don't
need another campaign issue. This is about getting it done. We can do
that if we want to do that. We are here thanks to the leadership of our
majority leader who understands that it needs to be done and allocated
2 weeks in a schedule with a lot that needs to happen. Because of the
importance of this issue, he said we will take 2 full weeks on this and
work through it. Instead of doing it on Monday or on Tuesday, it will
be tomorrow--Wednesday--before we start. OK. But let us get started.
Let us get it done. If we want to do it--we have bright people on both
sides of the aisle--we can do it. If we want to just argue process, we
can argue process. But this is a bill which for 5 years has been under
consideration by the Finance Committee. If it is not possible to get a
meaningful, real Medicare benefit, and we instead do it on the floor--I
have only been here for 1\1/2\ years; I have seen an awful lot of bills
not go through committee and go directly to the floor, an awful lot of
them on both sides of the aisle with both leaders of different parties.
The reality is that when you are not able to do what you believe needs
to happen it frequently goes to the floor.
The issue is how we are going to get it done. Are we going to do what
is long, long overdue? I believe the American people are getting tired
of hearing us talk. They want us to get it done. I hope we will.
I yield the floor.
The PRESIDING OFFICER. The Senator from Arkansas is recognized.
Mr. HUTCHINSON. Madam President, I wish to take a moment to respond
to some of the comments by my distinguished colleague from Michigan
regarding the process. I agree that the process in many cases does not
matter. Normally, the American people do not care about process.
Instead, they care about results. They care about their pains and their
families' pains, and they are concerned about the future.
But if you have a process that is a prescription for failure, then
process matters. If you have a process that is set up to ensure there
is no result, then process matters.
I say to my distinguished colleague from Michigan that it is easy to
ridicule concerns about the process, but when the process results in 60
votes needed for passage instead of 51 votes--a process which is going
to guarantee that we don't get a prescription drug benefit for our
seniors, and that is exactly the situation--then process matters. If
the fact that we didn't go through the Finance Committee, and the fact
that we didn't have a markup in the Finance Committee results in a
point of order that sets the bar so high that we are not going to get a
bill through, then it matters. If the process ensures that we are going
to pass a bill with a pricetag that CBO has not even given us yet,
perhaps in the range of $800 billion, and we send it to conference with
the House bill that is much, much smaller, and it assures we are not
going to have a result, then process matters.
I would suggest that the process we have been given--for legislation
that provides for an enormous change in policy and the most significant
legislation that some of us will vote on and many of us will debate in
our entire careers--is less than adequate because we are being given a
bill that has not had the benefit of a markup in committee.

As an Arkansan, I have colleagues in this body who serve on the
Finance committee who are being denied their right to have input into
the product that comes out. It is my understanding that members of the
Finance Committee are ready to vote on a prescription drug bill, and
the votes are there; that we could send a product to the Senate floor
right now that we could debate and use as our vehicle. But instead we
are going to have a bill presented that no one on this side has had the
opportunity to read and that has not yet been scored by the
Congressional Budget Office. It is a moving target. That is no way for
us to do significant and important legislation.
My colleague from Pennsylvania said he has the second highest per
capita senior population in the Nation. He is accurate in that, I am
sure. But I would point out to him that in my home State,
unfortunately, we have one of the highest percentages of low-income
seniors per capita. This is an issue that is very important to seniors
in Arkansas. And it is important not so we have a political issue for
the campaigns that are less than 4 months off. It is important because
there are millions of seniors who are making do with a Medicare system
that is out of date and that is headed towards obsolescence.
Medicare today was a wonderful system when it was developed in the
1960s. But health care has changed. Insurance has changed. It would be
like going back to a 1960 model automobile. Prescription medicines
today are an integral part of patient care. Medicare denies seniors
those needed drugs. These are drugs to ease the symptoms of
Parkinson's, Alzheimer's, and arthritis--drugs to control cholesterol,
blood pressure, and to fight other life-threatening diseases such as
cancer. Many seniors, even though they are prescribed these drugs,
simply go without because they cannot afford them.
My colleague from Michigan is right about that. Seniors are what this
debate is about. It is not whether or not at the end of next week, when
all the dust has settled, we can campaign on an issue as we go into the
election season. It is about whether or not millions of seniors are
going to get the help they need.
Mary McDaniel from Crossett, AR, wrote and said:
I am in favor of a program that promises affordable medication to all
senior citizens but not a Medicare pharmacy policy that may take away
my rights to choose my pharmacy and one that offers false promises. I
want to be able to get the medication my doctor prescribes and not
something the Government says I can have.
The fact is that prescription drugs improve lives and in many cases
they save lives. Coverage for prescription drugs needs to be a part of
our Medicare system.
The 21st Century Medicare Act--called the tripartisan bill--creates a
prescription drug benefit which is permanent, available to all seniors,
and does not jeopardize the stability of Medicare for future
generations. That is so important.
What benefit are we giving our seniors if we pass a prescription drug
benefit that is so expensive that it is like a barnacle on the ship
that is the Medicare system, dragging it down to bankruptcy? A
responsible benefit must be one that does not jeopardize the stability
of the system for future generations.
Seniors will be able, under the tripartisan bill, to voluntarily sign
up for this prescription drug benefit, which has an affordable monthly
premium of $24, the lowest premium of any of the prescription drug
bills introduced so far.
For low-income seniors, the bill provides additional support. Madam
President, 11.7 million lower income beneficiaries with incomes below
150 percent of poverty will receive a generous subsidy for their
prescription drug costs. Those below 135 percent of poverty will have
80 to 98 percent of their drug costs covered with no premium at all.
For the State of Arkansas, that means for those beneficiaries under 135
percent of poverty--there are 179,378 such seniors in Arkansas out of
453,598 total Medicare beneficiaries--these seniors will have their
entire premiums paid for and most of their drug costs covered as well.
This legislation also provides catastrophic coverage to protect
seniors against extremely high out-of-pocket drug costs that exceed
$3,700 per year.
The 21st Century Medicare Act also seeks to modernize Medicare
benefits by allowing seniors to choose a new, enhanced benefit called
Medicare Part E. This new benefit eliminates copays for important
preventative health benefits such as mammograms, prostate cancer
screenings, bone mass measurements, and medical nutrition therapy. It
also streamlines hospital benefits, eliminating per-day copays and
other limits.
If seniors do not like this option, they can always stick with
traditional Medicare. This bill does not weaken

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traditional Medicare, but it makes it better and stronger. It does not
make it more expensive. It does not make it less accessible.

To further ensure that seniors have choices, the 21st Century
Medicare Act requires qualified providers of the prescription drug
benefit to have ``bricks and mortar'' pharmacies in their network.
Let me pause here to tell you just how important our Nation's
pharmacies are to seniors and to all Americans. You can give seniors
prescription drugs, but if they don't know how to use them, they don't
get any benefit.
Pharmacists play a critical role in counseling seniors and other
patients about drug interactions and medication use in general. During
the debate on how to structure a Medicare prescription drug benefit, we
cannot forget that pharmacists will play, and must play, a critical
role in making this a quality benefit.
So I am very pleased to be one of the cosponsors of the 21st Century
Medicare Act. I intend to work to enhance the bill in regard to the
role of pharmacists in the future.
I have received, as I am sure we all have, many examples of those who
have written to express their support for a Medicare prescription drug
benefit. I have also heard this sentiment expressed in town meetings
across the State of Arkansas. During the Fourth of July recess, there
was no issue more on the minds of my constituents than the rising cost
of prescription drugs and how Congress is going to deal with it.
Ruth Blair, from Rogers, AR, writes:

Please vote for help with prescription drugs for senior
citizens. We either eat or take medicine. It's a tradeoff.

That is the sad situation for millions of Americans and tens of
thousands of Arkansans on Medicare.
In 2001, more than 15 million Medicare beneficiaries had no
prescription drug coverage at all, according to the Kaiser Family
Foundation. Almost 400 new drugs have been developed in the last decade
alone to fight diseases such as cancer, arthritis, heart disease, and
diabetes. While 98 percent of employer health plans offer coverage of
these often lifesaving therapies, Medicare does not. That is the issue
before us. That is what we must address.
Dorothy Adams from England, AR, writes:

Please support a prescription drug benefit. My husband and
I have $300 to $400 drug bills every month.

That adds up to $3,600 or $4,800 per year. Under the tripartisan
bill, the Adams family would have 90 percent of their drug costs
covered after reaching $3,700 in drug costs. That is the kind of help
we can give.
We have this phantom bill that is going to be brought to the floor by
the Senate Democrats. It has not been scored by the Congressional
Budget Office. We do not know what the pricetag is going to be. And
there are different estimates out there as to what it is going to cost.
The original Graham-Miller-Daschle-Kennedy bill, the temporary
benefit bill that was introduced, has a sunset provision. So you have a
benefit that is truly an illusion. It starts late and ends early.
The Graham-Miller bill, which is the only bill we have to analyze
right now, establishes a prescription drug benefit for seniors, and
then it takes it away by terminating the benefit in 2010. That is the
cruelest of all hoaxes. That is the ultimate use of a sensitive issue
for vulnerable people for political purposes. And it is no way to
fulfill our promise to America's seniors. They do not need a benefit
that will disappear a few years after they sign up.

This gimmick is intended for one reason, and that is to reduce the
price tag of the Democrat proposal.
AARP has said that a prescription drug benefit should be ``a
permanent and stable part of Medicare.'' The key word is ``permanent.''
The benefit created under Graham-Miller bill is neither permanent nor a
stable part of Medicare.
The Graham-Miller bill supposedly costs $450 billion over 7 years,
according to the bill's sponsors. But by others' calculations, the bill
could cost as much as $600 billion or, without the sunset, easily $1
trillion.
A benefit that costs $600 billion over the next 10 years would
require cutting 10 percent of all Government programs other than
Medicare. That includes education, health care, and national security
programs. That is not responsible.
If we want a bipartisan bill, if we want a bill that Republicans and
Democrats have worked together on and have consulted on and cooperated
on--then we have a tri-partisan bill that we can vote out, and we have
the prospect of actually having a responsible, realistic, achievable
prescription drug bill to give the President this year.
But if the House passes a partisan bill, and if the Senate leadership
insists that we are going to bypass the Finance Committee and bring a
purely partisan bill to the floor of the Senate, it is a prescription
for doing nothing this year. I suggest that in fact--though it will
never be admitted--such failure is exactly what some people want to
happen.
The Graham-Miller bill is partisan and does not currently have the
support of Finance Committee Chairman Max Baucus. It is apparent that
the Graham-Miller bill could not pass out of the Finance Committee, and
I would suggest that may be why the Finance Committee was not allowed
to mark up a bill.
If the majority leader were serious about getting a prescription drug
bill enacted into law this year, I would suggest that he would not
bypass the Finance Committee. Is it a real accomplishment, achievement,
that we want, or is it an election issue for November that is sought?
The majority leader has, I believe, turned a blind eye to the fact
that there is in fact a bipartisan bill--a tripartisan bill as it is
being called; it was introduced on Monday by Senators Grassley,
Jeffords, Breaux, Snowe, and Hatch--which I have cosponsored. It could
pass out of the Finance Committee today if the committee were allowed
to bring it up.
If Democrats and Republicans are willing to work together, we could
make meaningful progress for our seniors.
In 1999, Republicans supported legislation based on the bipartisan
Breaux-Thomas proposal which would have spent $60 billion over 10 years
on a Medicare prescription drug benefit. That was 1999. But Democrats
rejected this proposal and offered a $111 billion proposal. That was in
1999.
In 2000, Republicans proposed a drug benefit that would have spent
$140 billion over 10 years on a Medicare prescription drug benefit, but
Democrats again rejected this proposal as inadequate and offered a $338
billion proposal. That was in the year 2000.
In 2001, Republicans and Democrats agreed on a budget resolution
which provided $300 billion for a Medicare prescription drug benefit.
The House of Representatives has passed a $350 billion proposal, and
there is a bipartisan bill in the Senate which is a $370 billion
proposal. Yet the other side now says that is not enough.
I suggest that nothing will be enough because they do not want an
accomplishment, they do not want an achievement, they do not want a
prescription drug benefit this year. They want a campaign issue.
If we are serious about providing seniors with a Medicare
prescription drug benefit, in the days ahead we should look at the only
truly bipartisan bill that has a majority of support. Senator Grassley,
Senator Breaux, Senator Jeffords, and others, who I have now joined as
a cosponsor, have crafted a responsible, achievable, doable
prescription drug benefit that can be conferenced, passed, and sent to
the President.
So if we really mean it--when we say that the issue is not process,
but our seniors--then the time to act, on a bipartisan basis, is now,
instead of going down the road of a purely partisan political exercise.
I yield the floor and suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The assistant legislative clerk proceeded to call the roll.
Mr. GRASSLEY. Madam President, I ask unanimous consent that the order
for the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.

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