[Congressional Record Volume 149, Number 101 (Thursday, July 10, 2003)]
[House]
[Pages H6592-H6595]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
LOWERING PRESCRIPTION DRUG PRICES FOR SENIORS
The SPEAKER pro tempore. Under the Speaker's announced policy of
January 7, 2003, the gentleman from Illinois (Mr. Emanuel) is
recognized for 45 minutes as the designee of the minority leader.
Mr. EMANUEL. Mr. Speaker, before I begin, I want to thank my
colleague from Texas not only for his generosity of providing this
time, but for the passion that he brings to education and to working
families of all ilks, and the eloquence he brought to the words about
the importance of education as the stepladder to the American dream.
So I want to thank him now for the generosity he provided so I can be
with my family this evening and catch the last flight, and for his
passion and tireless work on behalf of all Americans. Texas is lucky to
have you as a Representative and a voice; not only a vote, but a voice
for their values.
Mr. Speaker, about 2 weeks ago a number of us came to the floor to
speak on market access, and that is the ability of Americans to
purchase medications anywhere in Canada, Ireland, England, France,
Germany, Italy, wherever they get the cheapest price.
{time} 2000
Since the last time that my good friend from Minnesota and I were
here, there was a report yesterday by Families USA that ABC news
covered and the Wall Street Journal covered, and I would like to bring
that statistic to the attention of the American people. It reaffirmed a
disturbing trend about skyrocketing prescription drug prices in the
United States.
On average, the prices of the 50 drugs most commonly prescribed to
seniors increased at a three-and-a-half times rate of inflation. The
total spending of senior citizens on prescription drugs rose an
estimated 44 percent from 2000 to 2003, when inflation was only running
at collectively over those periods of time of 6 percent. Now we are
projected to spend over the next 10 years $1.8 trillion by our seniors
on their medications, and yet when we think about those dollars, the
American elderly spend somewhere between 30 to 300 percent higher in
prices than the senior citizens of France, England, Germany, Canada,
Denmark, any of the G-8 countries and our colleagues in Europe.
My good friend from Minnesota has brought a bill into play that
allows our American consumer, our American elderly, our businesses and,
most importantly, our taxpayers to get the use of market forces to
reduce those prices, bring real competition and the close market that
our pharmaceutical companies have brought and bring competition that
would save billions of dollars to the consumer and, most importantly,
to the taxpayer.
To me, if we are going to have the largest expansion of an
entitlement in 40 years, spend $400 billion, you would think you would
want to get the taxpayer the best price, but the pharmaceutical
companies have done a pretty good job of playing the political system
to their benefit, and they have tried to prevent us from getting this
bill to the floor, because if we got the bill to the floor, they would
know what happens.
In my view, this is not only good for the seniors, they would get
good prices, but it would be fair to the taxpayers who are going to be
asked to pay this bill.
So my friend from Minnesota has a wonderful bill. I think he has been
here many times to explain his chart about
[[Page H6593]]
comparative prices. I would like to yield now some time to him to talk,
and then I would like to ask some questions, if he does not mind.
Mr. GUTKNECHT. Mr. Speaker, will the gentleman yield?
Mr. EMANUEL. I yield to the gentleman from Minnesota.
Mr. GUTKNECHT. Mr. Speaker, I want to thank the gentleman from
Illinois, and I want to make a special point. This is time on the
Democrats today. We have Democrats and Republicans that are agreed on
this because, as I said in the past, this is not a matter of right
versus left. It is a matter of right versus wrong, and it is simply
wrong to require that Americans pay the world's highest prices for
prescription drugs, even though we are the world's best customers.
In virtually every other area that you can imagine, the best
customers get the best prices, but that is not true in prescription
drugs, and I began to research this story about 5 years ago, and the
more I learned, the more upsetting and compelling this story really is.
The story is that Americans are really held captive, and anytime you
have a captive market, it is absolutely predictable that you are going
to see the world's highest prices.
I want to give you a few examples from this chart. I apologize, this
chart is kind of hard to read, but I will show you some of the
examples, and I will give you the total, because I was in Germany 2
months ago, and we bought 10 of the most commonly prescribed
prescription drugs. What you see here on the chart is the prices that
we paid in Munich, Germany, and what those prices would be for the same
drugs, same quantities, same milligrams, here in the United States. Let
me give you a few of those examples.
This is a drug called Coumadin. It is a blood thinner, actually
developed at the University of Wisconsin veterinarian schools, and
actually originally developed as a rat poison, but in the United
States, this box of drugs would sell for $89.95. In Germany we bought
the drug for $21.
Here is another drug, Glucophage, made by Merck. It is a very
effective drug for diabetes. A 30-tablet, 850-milligram package in the
United States, $29.95. You can buy that same package, this package of
drugs we bought in Munich, Germany, for $5.
The story goes on. Zocor, commonly prescribed drug, a very effective
drug, the United States price, $89.95. You can buy that drug in Germany
for $41.20.
The grand total of these 10 drugs in Germany was $373.30 American,
but if we went down to buy them here in Washington, D.C., or almost any
city in America, the price would be $1,039.65.
Mr. EMANUEL. Those are the same drugs? I did not mean to interrupt my
colleague. Same medication, nothing different?
Mr. GUTKNECHT. In fact, in many of the cases, I believe these drugs
were made in the same plants, and they are shipped around the world.
All we really are saying in our bill is let us do with prescription
drugs essentially what we do with every other product, and that is
allow market forces to work to make certain that Americans are not held
captive, and as I have said, I think Americans should pay their fair
share, but I do not think we should be required to subsidize the
starving Swiss.
We also have a colleague with us tonight, my good friend from North
Carolina (Mr. Jones) who has joined us tonight, and he has been a
strong proponent of opening markets and finding ways to get cheaper
prescription drugs not just for senior citizens, but for all Americans.
Ultimately we are going to have a prescription drug benefit for the
taxpayers as well, and I would yield, if I could, a few minutes to the
gentleman from North Carolina.
Mr. JONES of North Carolina. Mr. Speaker, will the gentleman yield?
Mr. EMANUEL. I yield to the gentleman from North Carolina.
(Mr. JONES of North Carolina asked and was given permission to revise
and extend his remarks, and include extraneous material.)
Mr. JONES of North Carolina. Mr. Speaker, I want to thank the
gentleman from Minnesota (Mr. Gutknecht) and the gentleman from
Illinois (Mr. Emanuel) for being on the floor tonight and allowing me
to be part of this because I think, as both have said, this is not a
political partisan issue, because we have on my colleague's bill
numerous Republicans and Democrats who have joined to open markets up
to the citizens, not just senior citizens, but they are the first in
our mind, but citizens that can buy drugs at a much cheaper price and
still have the same quality.
I must tell my colleagues, I represent the 3rd Congressional District
of North Carolina. It is a great district for me to represent, and
every time I do a town meeting, I am not kidding you, for the last 3
years they have said to me, Congressman, what are y'all going to do in
Washington to help bring the costs down? I am talking about senior
citizens who are 65 and 70 and 80, and many of these people truthfully
are living on a very small amount of money, Social Security and what
they might receive from Medicare.
It bothers me to know that we who are sent here by the people, and
they trust us to do what is right, and many times politics gets such
that we have people that participate in the process, which is good that
we do, not just voting, but also contributing to candidates and to
parties, and I am afraid that this issue really has gotten bottled up
into an area that concerns me greatly.
If I might take just a moment, and then I will yield back to the
gentleman from Illinois. We have a dear friend that came with us in
1994. That was the year that the Republicans took over the House. His
name is Tom Coburn. He is an M.D., and Tom retired 3 or 4 years ago,
and quite frankly, we miss him if he should be watching tonight. We
miss him in many ways.
But as my colleagues well know, both you gentlemen know that certain
prolife groups have gotten involved in this issue who are opposed to
your legislation, and I hate to say it, but I am afraid there might be
some outside group helping them fight your legislation. I will let you
and the gentleman from Illinois maybe pick up on that in a minute, but
let me read, and I will submit this entire letter for the Record, but I
want to read two paragraphs very quickly.
This is to the gentleman from Minnesota (Mr. Gutknecht). It says:
``Dear Gil: I was shocked to learn that some opponents of free-market
access for prescription drugs have begun arguing that your legislation,
H.R. 2427, the `Pharmaceutical Market Access Act of 2003,' somehow
promotes abortion and, more specifically, the availability of abortion
drugs such as RU-486.''
Second paragraph and last one, ``As you may recall, while in the
House I was the author of not only provisions to permit the
reimportation of FDA-approved drugs, but also the author of the House-
approved proposal to block FDA approval of RU-486.''
Tom Coburn again, ``As a prolife practicing physician who earned a
100 percent prolife voting record while serving in Congress, I find it
ludicrous that those who oppose your legislation would resort to ad
hominem attacks with no basis in reality.''
I will insert the entire letter at this point.
July 10, 2003.
Hon. Gil Gutknecht,
Cannon House Office Building,
Washington, DC.
Dear Gil: I was shocked to learn that some opponents of
free-market access for prescription drugs have begun arguing
that your legislation, H.R. 2427, the ``Pharmaceutical Market
Access Act of 2003'' somehow promotes abortion and, more
specifically, the availability of abortion drugs such as RU-
486.
As you may recall, while in the House I was the author of
not only provisions to permit the reimportation of FDA-
approved drugs, but also the author of the House-approved
proposal to block FDA approval of RU-486. As a pro-life
practicing physician who earned a 100 percent pro-life voting
record while serving in Congress, I find it ludicrous that
those who oppose your legislation would resort to ad hominem
attacks with no basis in reality.
I can state unequivocally that your legislation in no way,
shape, or form promotes abortion. (Many pro-life members are
original cosponsors of your legislation and, quite obviously,
do not believe your bill violates their deeply held
convictions about the sanctity of life.) Those who argue that
your legislation makes abortion drugs more accessible by
lowering overall drug prices necessitate the conclusion that
in order to be pro-life one must be in favor of increasing
all drug costs. I suppose the argument would be the higher
the drug costs the more fervent your pro-life beliefs.
In Washington, it was always sad to see organizations drift
from their core principles
[[Page H6594]]
and take positions that defied common sense and logic. Any
organization that links your legislation with the abortion
debate will, in the long-term, undermine their credibility
and relevancy in Washington. While the pharmaceutical
industry has produced many wonderful life-saving drugs, it
would be unwise for anyone to believe that the industry that
developed and fought for FDA approval of RU-486 is now
motivated by a passion for the pro-life cause.
The fact that opponents of your legislation have resorted
to these attacks is shameful, yet the obtuseness of their
logic ultimately serves to highlight the soundness of your
argument.
Sincerely yours,
Tom A. Coburn, M.D.,
Former Member of Congress.
I want to share that with you and Mr. Emanuel just to say that this
is a very critical, vital issue to the senior citizens and also the
people of this country who must have drugs to have a quality of life.
Mr. EMANUEL. Mr. Speaker, reclaiming my time, you should take a
little solace in the fact that they have decided to go to scare tactics
because they know this is not about price controls. This is about
letting the market determine the price that we can pay, and they are
scared of the free market. This is a large company that has a captive
market and is scared of the forces of the free market to determine the
best price. So they have decided to through a few Members try to play
the worst and ugliest of politics because on the merits they cannot win
it, and I compliment you for having the courage to stand by your
principles.
I would like to make a note to something earlier that our good friend
the gentleman from Minnesota (Mr. Gutknecht) said which deals with the
fact that we are Democrats and Republicans here. We give different
views on different subjects, but the fact is what has brought us here
is our common principles and our common values, and this is a
bipartisan issue because we jointly think that our seniors should not
be paying the highest price, and our taxpayers should not be asked to
pay the highest price when you can get lower prices.
As our colleague from Minnesota showed with that chart, although
people cannot see the specific numbers, they get the basic gist that
there is a 700-buck spread for the same drugs you buy in Germany versus
what we buy here.
You do not have to have a party difference to understand it is
fundamentally wrong. It is not right, and we cannot ask the taxpayers
as we embark maybe on the largest expansion of an entitlement program
in 40 years to foot a bill that would be, in my view, the greatest,
largest fleecing of America in front of the naked eye.
So the pharmaceutical companies have decided to engage in this scare
tactic because on the merits and on the ground they cannot win this.
I would like to ask one question because they are engaged in one
other subject up here. If the gentleman from Minnesota (Mr. Gutknecht)
could walk the folks through that are watching the notion of safety,
just to walk them through this, because that is another scare tactic.
This is the first of many salvos. We are not done with their attacks,
if you do not mind me interrupting, but I would like you to walk the
public through the issue of safety.
Mr. GUTKNECHT. Mr. Speaker, if the gentleman would continue to yield,
I thank the gentleman from Illinois, and I thank my colleague from
North Carolina as well.
One of the arguments that they are making is this is not safe, you
cannot be reimporting or importing or opening markets to these drugs.
And once again, let me say, first of all, we are only talking about
FDA-approved drugs from FDA-approved facilities, number one.
Number two, what more and more of the companies are coming out with,
and we require in our legislation, and that is, they begin to develop
counterfeit-proof packaging, tamper-proof, counterfeit-proof packaging.
The other thing people need to understand is we are not saying people
have to do this. This is their option. We want to make certain that
they are not treated like common criminals, because right now seniors
are doing this. There was a study done by a University of Texas
professor. A million Americans right now are crossing the border to buy
their prescription drugs, and they have no assurance, no tamper-proof
packaging, and worse than that, they are treated like common criminals
by their own government.
So we want to make it safer. We actually want to put in a regimen, a
plan, so that people can do this and their pharmacists can do this,
because my vision is people ought to be able to go to the local
pharmacist, and he ought to be able to shop for the best price on the
best drugs. It is called parallel trading. That is what they do in
Europe, and it is why they get cheaper prices than we do here in the
United States.
We are concerned about safety, too. I do not want people dying from
taking contaminated drugs, but remember this: Every day we import
thousands of tons of food. Last year we imported 318,000 tons of
plantains, and so if someone wants to tamper with things that go into
people's mouths, they are more likely to do it with food products than
they are with something that comes in a tamper-proof, counterfeit-proof
package.
Mr. EMANUEL. Mr. Speaker, I appreciate that. So what you are saying
is that unless it is FDA-approved, it cannot come in, and it is FDA-
approved, meaning the Food and Drug Administration, which is the
overseer, the czar of what is safe, approves it, then it can be
purchased through the Internet or overseas and brought into the United
States, because, as you said earlier, it is manufactured at the same
facilities. So there is really no pricing differences except they get
price differences there than here. So they are FDA-approved.
Mr. GUTKNECHT. We are only talking about FDA drugs, and more
importantly than that, you are correct. There are only, as I am told,
about 600 facilities in the world that can produce FDA-approved drugs,
and so that is the only drugs that we would permit, and we believe that
a program can be established very easily using modern technology so
that we can be as certain that these drugs are, in fact, Coumadin or
Glucophage from an FDA-approved facility.
{time} 2015
We can be just as assured of that even if we get the drugs from
Geneva, Switzerland, or from right down the street. We want safe drugs.
We want seniors to be safe. And I think we have the plan that will do
that.
Mr. EMANUEL. Mr. Speaker, both of my colleagues we were talking a
little earlier; and perhaps you could address the question, what do you
think, given they have projected, I think it is $1.8 trillion over the
next 10 years that seniors will be spending on medications, but if we
had access to this bill and it was in place, what would be the savings
to both the elderly as well as to the taxpayer, projected?
Mr. GUTKNECHT. Mr. Speaker, the gentleman is correct. The
Congressional Budget Office, which are our official bean counters, if
you will, have estimated that seniors in the United States over the
next 10 years will spend $1.8 trillion on prescription drugs. We can
see by this chart, and I think we were very conservative, we estimate
that if we simply open markets, as we do with plantains and with prunes
and with pork bellies, if we just open up the markets as we do with
everything else, we will see prices in the United States drop by at
least 35 percent. Well, 35 percent of $1.8 trillion is $630 billion
that we will save American consumers and/or taxpayers.
If I can give just one more example. We had an Inspector General who
testified before the Committee on the Budget just yesterday, her name
was Dara Corrigan, and she estimated, and these are her numbers not
mine, but her numbers were that last year Medicare through the
hospitals bought $8.2 billion worth of prescription drugs. If they
could have bought those drugs at the same price that the VA buys those
drugs, her estimate was that taxpayers would have saved $1.9 billion
last year.
Now, my assertion is that if we open up the markets, we are going to
save the VA, we are going to save Medicare, we are going to save
Medicaid, we are going to save consumers, we are going to save
corporations.
Last year, General Motors spent $1.3 billion on prescription drugs.
Imagine how much they could save if they had access to world market
prices.
Mr. EMANUEL. The truth is, Mr. Speaker, that we had an original bill
that was going to use market forces to
[[Page H6595]]
bring competition between generic medications versus name-brand
medications. That was projected to save the taxpayers and the consumers
and the elderly $65 billion over 10 years. This concept, following that
same principle of competition as the price reducer, let the market
determine best price, would bring, I think the gentleman just said, a
little over a half trillion dollars to the consumers, the elderly, over
the next 10 years. It is using market forces.
Bringing that competition to bear on the market, that would bring
prices down, and no longer would the American elderly and the American
taxpayer be seen as the profit guinea pig for our pharmaceutical
companies. They are making up the difference where they cannot get it
in Germany or in England. They are making it up, the price difference,
their profit margins, on our elderly. Therefore, our taxpayers are
being asked to foot the bill in one of the largest fleecings of the
American people we will ever see.
The principles of competition will bring prices down, I think.
Pharmaceutical companies have gamed the system from the patent laws,
the laws as it relates to competition and globalization, and through
the tax laws. As my colleagues know, we had a provision which was to
allow the NIH to recoup 10 percent on any drug that was developed and
brought to market through NIH dollars. My view is anything below 30
percent in the private market is considered dumb money. The taxpayers,
all the cancer drugs, all the AIDS drugs on the market were developed
with taxpayer-based research. We should be recouping a minimum of 10
percent to the taxpayers. The NIH would be a self-funded agency in 10
years.
But the core of what we have, the biggest dollar saver is the
gentleman's amendment that we are honored to be cosponsors of. Again,
this is not price control; it is choice. If you bring choice to bear in
the market, consumers will flock to the lowest price, and I think that
is the basic principle why you have Democrats and Republicans ready to
vote for this, if we could get it to the floor.
Mr. GUTKNECHT. I would just simply say that I hope we can have a
vote. This is the people's House. Vox popolurum est vox dei, the voice
of the people is the voice of God. There is where the people's business
should be done. Occasionally we have partisan differences and we vote
differently, but this is one that crosses party lines. It is not a
matter of right versus left; it is right versus wrong. It is wrong for
Americans to be held captive.
Mr. JONES of North Carolina. Mr. Speaker, if my colleagues will
yield, I would say that the comments of both these gentlemen are
correct. Free markets are more powerful than armies, and I think my
colleague's quote from former President Ronald Reagan, and everything
else that has been said tonight by my friend, is so true. The whole
thing is that this is a critical issue to so many people throughout
this country and we need to do what is right. The right thing to do is
to look at the gentleman's bill, put this bill on the floor, let it be
debated, let it pass or fail, but do not bottle this bill up. Too many
people throughout this country need this relief.
And so, Mr. Speaker, I want to thank my colleagues, and I yield back
to the gentleman from Illinois.
Mr. EMANUEL. Well, Mr. Speaker, before I try to catch that last
flight, when I was running for office and I was in Six Corners Jewel,
which is our big grocery store with the Osco, on Irving and Organza,
seniors would come out and show me what they were paying and they told
me the stories about how they cut their medications in half, or a
husband would skip a month so his spouse could take her medications.
And the first thing they said is, you have to make this affordable. I
have to be able to pay for this. They would talk about that, and ask me
to make sure that whatever we did, we did not mess with their private
plans. But then they would say, please, add a prescription drug benefit
to Medicare.
In my view, if we are on the doorstep of adding that benefit, let us
ensure, because it is the first thing they have all said to every one
of us who has gone to meet with them, we have to make these drugs
affordable. They cannot afford these prices. They would tell me, look,
somehow last month my month's supply was $70 and this month it is $96,
and nothing has changed. Nothing. If we brought competition, something
would change.
Mr. GUTKNECHT. Absolutely. I know the gentleman wants to catch his
plane, but I just want to say this. Regardless of what happens in the
next week or two, we are not going to go away. This issue will not go
away. We will stay here, on a bipartisan basis, every night for the
next 6 months, 9 months, 3 years. We are not going away. The issue is
not going to go away.
There is no way that our leadership, the administration, the FDA, the
drug companies can defend a situation where Americans pay two and a
half times more for the same drugs than our counterparts in Germany. I
am not going to give up, my colleagues here tonight are not going to
give up, and God bless you all.
____________________