[Congressional Record Volume 153, Number 6 (Thursday, January 11, 2007)]
[House]
[Pages H412-H418]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




               MEDICARE PART D PRESCRIPTION DRUG PROGRAM

  The SPEAKER pro tempore (Mr. Perlmutter). The gentleman from Georgia 
(Mr. Gingrey) is recognized for 60 minutes.
  Mr. GINGREY. Mr. Speaker, this opportunity for the minority party 
during this hour is dedicated to the subject of what we are going to be 
dealing with tomorrow, H.R. 5, and that regards the Medicare Part D 
prescription drug, allowing or, in fact, requiring the Secretary to 
negotiate prices. And this is a hugely important issue.
  But I want to take just a minute to respond to my colleagues on the 
other side of the aisle that just spent their hour with the Out of Iraq 
Caucus. In fact, they asked me for permission for an additional 5 
minutes because they had some very passionate Members that had not had 
an opportunity to speak.
  I gladly granted them that opportunity. That is what makes this 
Congress great. That is what makes this country great, the willingness 
to listen to diverse opinions.
  But I want to say, and I want to take just a few minutes before we 
get into the discussion of Medicare Part D, how diametrically opposed I 
am to what the Out of Iraq group just had to say during this last hour, 
and, indeed, Mr. Speaker, hour and 5 minutes.
  I don't object to their right to have that opinion. I do certainly 
take exception, Mr. Speaker, and my colleagues, when folks stand up 
here, and I am not talking about new Members of this body. In fact, 
there was one new Member from Illinois, the gentleman from Illinois, 
who is going to be part of the Out of Iraq Caucus. I am talking about 
very senior, thoughtful Members. To stand up and suggest that the 
President lied to the American people, I think, is really not, in fact, 
even close to being the truth.
  The President, I think, is an honest man. And last night, Mr. 
Speaker, in his presentation to the American people, I thought he did 
an excellent job of explaining why it is so important for us to try to 
apply, if not a knock out blow to the insurgence and the terrorism, the 
sectarian violence that is

[[Page H413]]

going on in and around Baghdad, certainly, to strike a blow that would 
put them on the ropes, would get us off the ropes and put them on the 
ropes. And yet, we hear from the majority party wanting to tie the 
President's hands behind his back and our great military.
  I think we have got a wonderful opportunity. Mistakes have been made. 
Absolutely. There is no question about that. I think the President 
acknowledged that last night in his 20-minute speech to the Nation. But 
we have an opportunity.
  And this is really, I want my colleagues to think about this. This is 
not about the President's legacy. This is not about the legacy of 
Donald Rumsfeld, or General Abizaid or even our new Secretary of 
Defense, Robert Gates, who we just heard from in a 3-hour hearing at 
the House Armed Services Committee, or our Chairman of the Joint Chiefs 
of Staff, Peter Pace, or General Petraeus. This is about 23 million 
Iraqi people. This is about the citizens of the United States of 
America. This is about the entire Middle East. In fact, this is about 6 
billion people on this planet. And we have to, in my opinion, we have 
to support the plan. If we don't, even if our colleagues in the Out of 
Iraq Caucus absolutely abhor this President and would like to see his 
legacy be one of failure, surely, surely, they are with the American 
people. And I think they are. I think deep down within their heart, 
they are.
  But I am absolutely convinced that they have not thought about the 
consequences of, all of a sudden, I mean, almost instantaneously 
pulling our troops out of Iraq, as they say. And I have heard many of 
them say that, Mr. Speaker, and my colleagues. And the fact that, if 
that would happen, I think you would, indeed, have another Vietnam. You 
would, indeed, have a total bedlam and sectarian violence in the 
country of Iraq. You would have Syria and Iran taking over the Middle 
East.
  And I just wonder how much longer the country of 7 million people in 
Israel would last. I mean, they have already pledged, Ahmadinejad and 
others, to drive them into the sea. And what respect, Mr. Speaker, 
would the world have for the United States of America if we, indeed, 
cut and run?
  I am not suggesting that that is what they are saying. But I think 
that is a perception that the rest of the world would have. You cannot 
depend on the United States. And those terrorists would be back after 
us again.
  We haven't had another 9/11 or any kind of a terrorist attack on this 
soil in 5\1/2\ years. But if we follow the recommendation of the Out of 
Iraq Caucus in this Congress, that is exactly what will happen. It will 
be far worse than 3,000 lost lives, of innocent people.
  Certainly, the gentleman from Illinois, the new Member, I have great 
respect for all of the new Members, Mr. Speaker. And he talked about 
Martin Luther King, a man of peace. We need people, like Martin Luther 
King, that pray for world peace. I pray for world peace every day, and 
I know all of my colleagues do.

  But we also need fighting men and women. We need a strong military 
when we get attacked, an unprovoked attack, when those prayers are not 
working so that we can defend this Nation.
  So I am glad to give them an extra 5 minutes so it gives me an 
opportunity to refute most of what was said here in the last hour.
  With that, Mr. Speaker, I will turn to the subject of the hour, and 
that, of course, is what is going to be on this floor tomorrow as part 
of the new Democratic majority's 100 hours. This will be H.R. 4.
  We have had three bills this week. We have had the so-called 9/11, 
completion of the recommendations of the 9/11 Commission. We had the 
minimum wage bill and then today of course the stem cell research 
issue.
  And tomorrow what the Democratic majority wants to do is require the 
Secretary of Health and Human Services to negotiate prescription drug 
prices. Government price control; put the government in the medicine 
cabinet of 42 million seniors and disabled folks who are part of the 
Medicare program and prescription drug Part D. And they want to do 
that, just as they have done with these other three bills this week, 
with absolutely no opportunity, no opportunity for the minority party 
or even members of the majority, maybe the rank and file, as many of us 
refer to ourselves, to bring amendments, to have an opportunity to go 
before the Rules Committee and say, you know, I think we can improve on 
this bill a little bit. There are certain things I have been thinking 
about it. I am a doctor. I am a nurse. I am a health care worker, and I 
think we can make this a little bit better.
  But, no. No, no. This new Democratic majority that railed for the 
last 2 years almost every day that their rights were being trampled 
upon and their amendments were not made in order, and here we are with 
four bills this week.
  We are not talking, Mr. Speaker, about naming Post Offices here. We 
are talking about hugely important pieces of legislation, legislation 
that is controversial. This issue today on stem cell research, and we 
are talking about the destruction of what I feel, as a strong pro-life 
physician, is a little human life. And the proof of the pudding of 
course is the snowflake babies, literally thousands of them. And to 
suggest that those little embryos are just extra and throwaway, and we 
don't need them, and why waste them? We didn't get an opportunity to 
offer a single amendment. And this same thing in regard to this 
Medicare Part D issue which will be debated on the floor tomorrow.
  Mr. Speaker, and my colleagues, if there is ever an issue of the old 
adage, ``If it ain't broke, don't try to fix it,'' it is this one, 
because this law that was passed in November of 2003 went into effect 
January 1 of 2005, the bill, the benefit, the optional benefit of 
prescription drugs under Medicare has only been in place for 1 year. 
And the success is unbelievable. I mean, it is far beyond anybody's 
expectations. It has an 80 percent approval when you poll seniors 
because they are getting their prescriptions, those who are having to 
pay for them, are getting them at a much lower price. The average 
savings is $1,100 a year for those who are paying their monthly premium 
and their deductible and their copay. And for those who, because of 
their low-income status, are virtually paying nothing but a dollar or 
maybe $3 to $5 for a brand name drug, if that is covered by the 
supplement because of low income, then they are saving at least $2,400 
a year.
  And so, Mr. Speaker, to try to improve upon something that is working 
so well, I think, is a grave mistake. And I think, as the expression 
goes, they are going to gum up the works.
  Now, let me tell you how setting price controls works and how poorly 
it works for that matter. When we were debating this bill in 2003 in 
the committee on the House side, a Democratic Member, I think it was 
Representative Strickland, now Governor of Ohio, a very good Member of 
this body, suggested, had an amendment and said look, let's set the 
monthly premium at $35. Let's require that the monthly premium be $35, 
I guess, over concern that it could be higher than that.

                              {time}  1815

  Let us set it at $35. The same bill was introduced on the Senate 
side, and I am not sure which Senator, which Democratic Senator, 
introduced the bill on the Senate side.
  But, again, to set that premium. Well, had we done that, then our 
seniors today would not be enjoying an average monthly premium of $24 a 
month, $24 a month, because the market, the competition between the 
multitude of prescription drug plans that are out there competing for 
business allowed that to happen as they brought down the price of drugs 
as they compete with one another.
  I will give you another example in regard to the Medicaid program. 
You know, the States each have their own Medicaid program, and they can 
cover prescription drugs if they want to. They don't have to. Most do, 
and they set prices. The State governments do that to try to save 
money. They set prices.
  Well, people who are eligible for both Medicaid, because of their low 
income, and Medicare, because of their age or disability, now these 
dual eligibles, the prescription drugs are paid for by the Medicare 
part D program as the first payer. Well, our community pharmacists are 
so upset because they were getting a higher price for prescription 
drugs under the Medicaid program than they are under this new Medicare 
part

[[Page H414]]

D program which has forced those prices down. Obviously, the 
neighborhood druggists, the community pharmacists are making less 
money, and they are upset. I can understand that.
  But this just goes to show you once again, when the government sets 
the price, it is just as likely, if not more likely, that they set the 
price too high. The bureaucrats are notorious for that. The marketplace 
would never let that happen because of competition.
  This opportunity to talk about this subject tonight is a very, very 
important issue at an important time. We will talk about it on the 
floor tomorrow and try to proffer these same arguments against 
requiring the Secretary of HHS to set prices. It is the first step down 
the road toward a national health insurance program, a single-payer 
program, or, if you like, Hillary Care. I don't think the country liked 
Hillary Care when it was offered back in 1994, and President Clinton 
paid a price for that, a dear price.
  It is just really surprising to me that the Democratic majority would 
come back with this type of issue.
  I think what is driving it is the success of this program is so 
resounding, and they, my good friends and colleagues on the other side 
of the aisle, that resisted this program every step of the way, fought 
it every step of the way, now I think they kind of want to get on the 
bandwagon and get a little credit for something.
  But I warn them, I warn them, what I frequently hear them and others 
say, when you are in a ditch, when you are deep in a hole, the first 
thing you need to do is stop digging. I think they are digging 
themselves a bigger hole. And, politically, that is good for us. That 
is good for the Republican minority. That will help us regain the 
majority. But it is not good for the American people. It is not good 
for our needy seniors, and that is why I am so opposed to it.
  I am very happy to have with me tonight a couple of my Republican 
colleagues, great Members, not just Republican Members that don't have 
special knowledge on this issue, but I am talking about a couple of our 
physician Members.
  At this time I would like to yield to the gentleman from Texas (Mr. 
Burgess), a fellow OB/GYN physician.
  Mr. BURGESS. I thank the Chair for the recognition and I thank the 
gentleman from Georgia yielding. I do want to thank the gentleman from 
Georgia for taking an extra minute to talk about the issues that 
concluded the last hour. I think it was important, and it needed to be 
done, and the American people do need to hear that debate as well.
  In the process of the first 100 hours, and I don't know where we are 
now, in my count it is about 44 hours into it, but it is a funny kind 
of timekeeping. We started this Special Order hour at about 6:00 in the 
evening, that is 5:00 back home in Texas. That means we will conclude 
the House business for the day in 2 hours; that is 7:00 back in Texas.
  That is not really an onerous work schedule that we are under. We 
have just managed to spread it out, do a little less work and spread it 
out over more days to look like we are doing more.
  But my purpose here this evening is to offer, really, a public 
service, a little bit of education, a little bit of history. Because 
many Members in the House are new, they were not here when we went 
through the Medicare Modernization Act of 2003. In fact, some of this 
story goes back even before Dr. Gingrey and I started here in 2003.
  So let us take a step back to just a little while earlier in the 
decade and visit with one of the President's press releases when they 
talked about his vision for a new Medicare prescription drug benefit. 
It rolled out with a good deal of fanfare one day, that the benefit 
would be voluntary, accessible to all beneficiaries, designed to 
provide meaningful protection and bargaining power for seniors, 
affordable to all beneficiaries for the program and administered using 
competitive purchasing techniques consistent with broader Medicare 
reform.
  That was the message that the President delivered at that time to the 
Senate to deal with major Medicare reform to provide a prescription 
drug benefit.
  Let us go over it again, because it is important. Voluntary Medicare 
beneficiaries who now have dependable, affordable coverage should have 
the option of keeping that coverage, accessible to all beneficiaries. 
All seniors and individuals with disabilities, including those in 
traditional Medicare, should have access to a reliable benefit, 
designed to give beneficiaries meaningful protection and bargaining 
power.
  A Medicare drug benefit should help seniors and help the disabled 
with the high cost of their prescription drugs and protect against 
excessive out-of-pocket costs. It should give beneficiaries bargaining 
power that they lack today and include a defined benefit, assuring 
access to medically necessary drugs.

  Under the administrative part of the communication to the Senate, it 
says very specifically, discounts should be achieved through 
competition, not regulation, not price controls, and private 
organizations should negotiate prices with drug manufacturers and 
handle the day-to-day administrative responsibilities of the benefit.
  The press release goes on to talk about some other things. The 
President urges the Congress to act now.
  It is instructive that this press release was issued March 9, cherry 
blossom time here in Washington D.C., March 9, the year 2000. This was 
a press release issued by then-President William Jefferson Clinton to 
Senator Tom Daschle with Clinton's instructions as to how he wanted 
this drug benefit drawn.
  Well, I think its instructive to remember the past because there are 
some inherent dangers with tinkering with the program that is already 
working well.
  But the real central question in front of us is, does ideological 
purity trump sound public policy? We all know it should not, but 
unfortunately it appears we are on the threshold of profound changes to 
the part D program. These changes are not being proposed because of any 
weakness, because of any defect in the program. The changes are being 
proposed because a viable program lacks the proper partisan branding.
  Since the inception of the part D program, America's seniors have had 
access to greater coverage, lower cost, than anytime since the 
inception of Medicare over 40 years ago. Indeed, over the past year, 
saving lives and saving money has not just been a catchy slogan. It has 
been a welcome reality for the millions of American seniors and those 
with disabilities who previously lack prescription drug coverage.
  Under the guise of negotiation, their proposals now are to enact 
draconian price controls on pharmaceutical products. The claim is 
billions of dollars in savings, but experts in the Congressional Budget 
Office, as evidenced in The Washington Post just today, deny that the 
promised savings will actually materialize.
  The reality is competition has brought significant cost savings to 
the program just as envisioned by President William Jefferson Clinton 
and enacted by President Bush. Competition has brought significant cost 
savings to the program and subsequently to the seniors who are actively 
using the program today.
  Consider that the enrollment of the part D program began in January 
of 2006, just a little over a year ago, and has proven to be a success. 
CMS reports that approximately 38 million people, 90 percent of all 
Medicare beneficiaries, are receiving comprehensive coverage, either 
through part D, an employer-sponsored retiree health plan, or other 
credible coverage.
  Going back to the press release of 2000, there was concern because 
that credible retiree prescription drug coverage was leaving at a rate 
of about 10 percent per year. That was arrested with the enactment of 
the Medicare Modernization Act. Ninety-two percent of Medicare 
beneficiaries will not enter into the Medicare benefits drug coverage 
gap because they will not be exposed to the gap, or they have 
prescription drug coverage from plans outside of Medicare part D, or 
their plan coverage of the so-called gap, an important point as seniors 
go for their reenrollment, which they have just come through to make 
sure that their drugs, in fact, are covered in the coverage gap.
  In the State of the Texas, there are five plans that will cover drugs 
in the

[[Page H415]]

so-called coverage gap. Eighty percent of the Medicare drug plan 
enrollees are satisfied with their coverage, and a similar percentage 
says that out-of-pocket costs have decreased. Think of it, a Federal 
program, a program administered by a Federal agency with an 80 percent 
satisfaction rate, on time, under budget. When have you ever heard of a 
Federal agency delivering a program that was on time or under budget?
  Again, consider, under the cloak of negotiation, the reality is that 
Federal price controls could have an extremely pernicious effect on the 
price, on the availability of current pharmaceuticals and those 
products that may be available to treat future patients. It is 
ideological branding so critical that it trumps providing basic 
coverage to our senior citizens.
  Thus the challenge, would it not be better to continue a program that 
empowers the individual rather than create a new scheme which seeks to 
reward the supremacy of the State?
  I see we have several speakers lined up, and I don't want to 
monopolize too much more time, but let me just go on with one other 
point. The American health care system in general, the Federal Medicaid 
program in particular, there is no shortage of critics both at home 
here and abroad. But remember it is the American system that stands at 
the forefront of new innovation and technology, precisely the types of 
system-wide changes that are going to be necessary to efficiently and 
effectively provide care for America's seniors in the future.
  I don't normally read The New York Times, but someone brought this 
article to my attention, published October 5, 2006 by Tyler Cowan, who 
writes from The New York Times: ``When it comes to medical innovation, 
the United States is the world leader. In the past 10 years, for 
instance, 12 Nobel Prizes in medicine have gone to American-born 
scientists working in the United States. Three have gone to foreign-
born scientists working in the United States, and just seven have gone 
to researchers outside the country.''
  That is American exceptionalism. Mr. Cowan goes on to point out that 
five of the six most important medical innovations of the past 25 years 
have been developed within and because of the American system. 
Comparisons with other Federal programs such as the VA system are 
frequently mentioned.
  It must be pointed out that a restrictive formulary such as employed 
by the VA system would likely meet significant public resistance 
because of the near-universal access of the most commonly prescribed 
medications under the current Medicare prescription drug plan. Some 
studies have estimated that nearly one-quarter of the medications 
available under the current Medicare plan would disappear under that 
restrictive formulary system.
  The fact is the United States is not Europe; we shouldn't try to 
pretend we are Europe. In fact, most of us don't want to be Europe. 
American patients are accustomed to wide choices when it comes to 
hospitals. They are accustomed to wide choices in physicians and to 
wide choices in their pharmaceuticals. Because our experience is unique 
and different from that of other countries, this difference should be 
acknowledged when reforming either the public or the private health 
insurance programs.
  The irony of the situation is that after 40 years, many Congresses, 
many Presidents have tried to add a prescription drug benefit. When 
Medicare was first rolled out, it was kind of an inconvenience if they 
didn't cover prescription drugs. But they only had penicillin and 
cortizone, and those were interchangeable, so it didn't really matter.

                              {time}  1830

  But over the years, as American medicine advanced, it became a 
critical, a glaring lack of having the prescription drug benefit 
covered. That is why it is ironic that a Republican president working 
with a Republican Congress, Republican House, Republican Senate passed 
meaningful and needed Medicare reform that included the prescription 
drug benefit, and it happened on the floor of this House at 5:30 in the 
morning, November 22, 2003. Dr. Gingrey and I were here and very proud 
to have been part of that.
  One last thing I need to mention, and it is a public service, it is a 
safety tip from someone who has been here only a short time. But I want 
to remind my colleagues that recently The Third Way, a leading 
progressive policy think tank has circulated a memo warning those 
seeking to make changes in how Medicare pays for prescription drugs 
provided under part D of the program do so with an abundance of 
caution.
  I might remind my colleagues, back in 1988, when the then chairman of 
the Ways and Means Committee, Dan Rostenkowski, enacted a significant 
long-term care benefit that cost seniors a great deal of money. He was 
met with concern and consternation and in fact could not drive his car 
away from the town hall meeting that he convened shortly after costing 
seniors so much money with that benefit.
  The important thing, and I want to speak specifically to the new 
Members who are here on the other side of the aisle, don't let this 
happen to you. Don't try to improve on a Medicare program that is 
popular with the seniors and meeting their health needs. Seniors will 
resent having fewer choices that cost more under Medicare part D merely 
to score political points with your new Speaker by repealing Medicare's 
noninterference clause.
  Mr. GINGREY. Dr. Burgess, thank you very much for that most 
enlightening discussion.
  We have two other speakers, and again I mentioned at the outset Dr. 
Charles Boustany from the great State of Louisiana, a cardiovascular 
surgeon. And Dr. Boustany, we thank you for being with us tonight, and 
we want to turn it over to you at this time.
  Mr. BOUSTANY. Mr. Speaker, I thank my colleague from Georgia for 
organizing this hour and for all the work he has done on this issue.
  Let me start by saying that, as a heart and lung surgeon, I have 
often seen patients whose illness did not respond to a particular drug, 
and I have seen the frustration and the anxiety among family members 
and among patients when a government bureaucrat or an HMO tried to save 
money by denying access to a more effective medication. In fact, Mr. 
Speaker, I once operated on a Vietnam veteran; I performed heart 
surgery on this gentleman, and afterwards he needed several very 
important medications to maintain his condition, but the VA program was 
going to make him wait between 2 and 3 weeks before he could get his 
medication. That is just simply unacceptable. This poor man had no 
choice but to pay out of pocket hundreds of dollars to get medication. 
This is something that we don't want to do for our seniors.
  Now, Secretary Leavitt has warned that H.R. 4 will result clearly in 
fewer choices and less consumer satisfaction. And we all know that we 
have had a tremendous success with this program in just 1 year, 80 
percent satisfaction, premium prices dropping from $37 down to $22. 
Let's face it, government rationing harms patients, and calling it 
negotiation won't make it any less dangerous.
  The American people did not give Congress a mandate to force HHS to 
make unspecified cuts to Medicare.
  I also know that the idea of government negotiation is a joke. In 
fact, according to a Democratic polling group, 8 in 10 voters agree 
that government negotiation would limit access to prescription drugs 
and to life-saving medications.
  Let's face it, aggressive negotiation through the marketplace is 
already working, and it is driving down the prices of premiums as I 
mentioned earlier.
  Let me just say this. If the market is good enough for Members of 
Congress, why would we take that away from our seniors? I find it to be 
a profound irony that supporters of this bill, the Democratic 
leadership in the House, they are pushing for this government 
negotiation, this so-called government negotiation, but they won't 
allow that for their own medicine cabinets. There is a profound irony 
in this.
  Why doesn't a proposal that would limit the medical care of tens of 
millions of seniors deserve a fair hearing? I say it is reckless on the 
part of the Democratic leadership of the House to force the Federal 
Government to cut Medicare without specifying, where are we going to 
achieve those additional

[[Page H416]]

savings? How is this so-called negotiation going to take place? And 
before rushing into this bill, I think Speaker Pelosi has an ethical 
obligation to detail how the Federal Government would achieve 
additional savings without limiting seniors' access to medicines, 
hurting community pharmacies and increasing prices for our veterans.
  We know what the outcome of a recent CBO study showed, that the 
Secretary will be unable to negotiate prices that are more favorable 
than those under the current law. In fact, a Senate hearing was held on 
this. The Senate Finance Committee held a hearing, and the Democratic 
chairman of the Senate Finance Committee is questioning whether there 
are savings to be achieved by direct negotiation.
  Furthermore, I have letters that I have received from community 
pharmacists throughout my district. I want to read from one of these. 
It is addressed to me and says, ``There will be a vote in Congress on 
Friday, January 12, which could dismantle the very important Medicare 
part D program. I am joining former U.S. Senator John Breaux,'' a 
Democrat, a former prominent Democrat on the Senate Finance Committee 
and a member of the Senate who worked on this Medicare part D program 
when it was put into law. He says, ``I am joining former Senator John 
Breaux and the Louisiana Medicare Prescription Access Network and more 
than 700 supporting member organizations in our State in asking you to 
vote against H.R. 4 on Friday, January 12.''
  Price controls are not in the interest of our seniors. This is not 
something that we want to do. If we are going to reform our entitlement 
programs where costs are burgeoning, we need to introduce market 
forces; and lo and behold, in one year of operation we have a program 
where we introduced market forces to drive down premiums for our 
seniors, and it is working.
  It is too premature to change this. It is wrong to change this, and I 
urge all of my colleagues to listen to this and do what is right for 
seniors. And I will end by just asking one question: Why would the 
Democratic leadership in the House want to hurt our seniors? I think 
the American public and our seniors deserve an answer to that question.
  Mr. GINGREY. Mr. Speaker, I want to thank the gentleman from 
Louisiana, the cardiothoracic surgeon who is doing such a great job now 
in his second term.
  At this point, I want to turn the program over to my colleague from 
Georgia. Not only do we represent part of the same county, but we are 
both physician Members, and Dr. Price is an outstanding orthopedic 
surgeon, an outstanding Member of this Congress. In fact, I was at a 
very important press conference earlier this afternoon on this issue, 
and I heard Dr. Price, he may want to say it again; I don't mean to 
preempt him. But I heard Dr. Price say this looks like a solution in 
desperate search of a problem. And that kind of goes along with what I 
said earlier: If it ain't broke, don't fix it. And if the Democrats 
find themselves in a hole, they need to stop digging. So with that, I 
will turn it over to Dr. Price.

  Mr. PRICE of Georgia. I thank you so much, Dr. Gingrey. It is a great 
pleasure to share the floor with you once again and talk about an issue 
that is so very, very important, not just to seniors but to all 
Americans. And I appreciate, as has been said, your leadership on this 
issue. It has been wonderful and greatly appreciated. You are serving 
extremely well in this area, and I appreciate that.
  I also want to point out to the Speaker, as I know he knows, and to 
other Members of Congress that I think it is instructive to note that 
the individuals who have come to the floor tonight to talk about this 
issue are physicians or at least were physicians in their former lives. 
And I think that is helpful to think about, because the individuals who 
are charged with caring for the health of this Nation, the physicians 
all across this Nation understand and appreciate that the consequences 
of government decisions can oftentimes be huge in their effect on the 
ability to provide quality care for the patients of this Nation.
  So we come down here tonight and talk about an issue that is of just 
most importance to American people and to all seniors who participate 
in the Medicare program, and we do so because we have been on the other 
side, the other end of these decisions. And when decisions are made in 
Washington that provide for greater control of health care by 
Washington, I would suggest, Mr. Speaker, that always, always, by and 
large, results in a decrease in the quality of care that is able to be 
provided.
  I would also wish to point out, Mr. Speaker, that I think this is an 
issue that really is part of a bigger question. And the bigger question 
is, who is it that ought to be making fundamental personal health care 
decisions? And it appears that we in this body have a philosophical 
difference about who that ought to be. My colleagues on the Republican 
side of the aisle tend to believe that the decisionmaking authority in 
those personal health care decisions ought to rest with patients and 
with physicians, that that is where those decisions ought to be. And I 
know that my colleagues who are here this evening would concur with 
that, because we know how difficult it is when somebody else, 
especially a nonmedical person, is making those kinds of decisions and 
it most often adversely affects the health care of that patient. So we 
believe as a matter of principle that patients and physicians ought to 
be making health care decisions, including which medication to utilize, 
because patients and physicians are the ones that know best which 
medication that ought to be utilized.
  Our good friends on the other side of the aisle it appears believe as 
a matter of principle that government ought to be making those 
decisions, that government bureaucrats, Washington bureaucrats who may 
or may not have any fundamental knowledge about, in this instance, 
personal health care issues, that government ought to be making those 
decisions.
  So I think it is important for people to appreciate, Mr. Speaker, 
that that really is one of the fundamental principles that we are 
talking about here: Who ought to be making health care decisions? 
Should it be patients and physicians, or should it be the government?
  My good friend mentioned that this was a solution in search of a 
problem, as I had said before, and it really is. And so when you have 
an issue like that, I think it is also important, Mr. Speaker, to look 
at why is it that the Democrat majority is even attempting to solve 
this problem that I would suggest doesn't exist? And I would use as 
rationale for the fact that there is no problem to solve so many issues 
that have been brought up here on the floor already and in this debate.
  The cost of the benefit to seniors all across this Nation in 2006 are 
30 percent lower, 30 percent lower, $13 billion lower in 2006 than were 
projected. The projected costs over 10 years are down over 21 percent 
which equals $197 billion. The premiums are down over 40 percent over 
that that was projected. And in fact, if you think about the last time 
that the majority party, the now majority party tried to effect this 
program, one of their proposals was to mandate, was to dictate, was to 
make certain, was to guarantee that the premium per month for each and 
every senior would be $35, $35 a month. They wanted to make certain 
that it would be absolutely that amount and not a penny less. And in 
fact, what we have seen is that the current premium per month is about 
$22 or $23.

                              {time}  1845

  So if the other side had had its ways 2 years ago, 3 years ago, when 
this was adopted, seniors all across this Nation would be paying $12 to 
$13 a month more, more on top of the premium that they are already 
paying, if the other side had had their way. So I think it is important 
to think about and to appreciate what they have had in mind all along. 
Why they want to do that is beyond me, but I would suggest to you that 
it has something to do with whom they want to be in control of these 
health care decisions.
  And finally, Mr. Speaker, I would tell you, looking at this issue, 
that it really is a solution in search of a problem. The Medicare 
beneficiaries all across this Nation, over 80 percent of them are 
pleased with this program, are happy with the program, believe that it 
helps them greatly in caring for their health. And that is in a program 
that has over 90 percent of those who are eligible to participate 
involved. So 80 percent of those participating are

[[Page H417]]

pleased with it. So you have got to ask, why? What kind of problem are 
we trying to solve?
  It is also important, I think, Mr. Speaker and colleagues, to ask the 
question, if the program is working so well, why is it working so well? 
And as has already been mentioned, there is this big kind of proposal 
that is being put forward now that would say that the government ought 
to be able to negotiate, that nobody is negotiating drug prices. Well, 
in fact, as you well know, Mr. Speaker, the plans themselves right now 
are negotiating and negotiating extremely well. Otherwise, you wouldn't 
see the kind of savings that we have already seen in just a year's 
history of the program. Plans are negotiating with both pharmaceutical 
companies and with pharmacists, and, in fact, that is what is resulting 
in the decrease in premiums that seniors all across this Nation are 
seeing. So the system is truly working extremely well in spite of all 
the naysayers on the other side.
  I want to bring up again what happens when the government gets 
involved, and my good friend has a poster down there about government-
negotiated prices on certain drugs and the actual cost. And the numbers 
are striking. They truly are. And the reason that it is important to 
look at what happens when the government gets involved with a 
negotiation is to remember what negotiators have to be able to do. The 
individual doing the negotiating has to, in this instance, be able to 
say to the drug company: If you won't meet my price, then I am not 
going to put your drug on the formulary, on the list of drugs that are 
available for patients. However, when the government is doing all the 
negotiating, what will happen is that they will say: If you don't meet 
my price, you won't be able to have your drug on this formulary, and 
the consequence of that is that your drug will not be available to 
seniors or physicians who are trying to make those personal health care 
decisions. What that means, Mr. Speaker, is that there will be fewer 
drugs available. Fewer drugs available. That is what happens when the 
government gets involved in the process. So the price may be lower for 
a period of time. I do not believe that is the case, as we have had 
good examples and quotes from very learned individuals in the economic 
system that will tell you that the government cannot dictate a lower 
price in this instance, but what certainly will happen is that there 
will be fewer drugs available.
  Somebody may say that is just conjecture; that is just somebody 
dreaming about what might happen. But if we look at a program that the 
government did affect relatively recently and see what happened, we can 
see exactly by example what happens when the government gets involved. 
And the program I would cite is a program called the Vaccine for 
Children's program, and, Mr. Speaker, folks all across this Nation may 
remember that there was a very robust vaccine industry in our country 
not too long ago, in fact, about 12 or 13 years ago, and then the 
government got a bright idea and said, oh, but the price for those 
vaccines is a little too high. In some instances they believed it was a 
lot too high. So instead of working on how to assist individuals who 
didn't have the resources with which to purchase those vaccines, what 
the government did was come in and say, all right, you can only charge 
this amount of money for that vaccine. And what happened was that we 
saw a huge decrease in the number of companies that now provide 
vaccines. In fact, it went from about 30 companies that made and did 
research and development on vaccines, and now in this Nation, Mr. 
Speaker, we only have three, three, in about 12 years. That is what 
happens when the government gets involved in a program. Price fixing 
occurs and a decrease in the quality of health care that is provided 
occurs, and certainly a decrease in the number of medications 
available. Everybody across this Nation knows that that is what 
happened with the vaccine program. Fewer innovations, fewer new 
vaccines, shortages of vaccines, and less access to vaccines.
  So, Mr. Speaker, I just want to close and finally talk about, just to 
reiterate, the issue of who is making health care decisions. When I go 
home and I talk to my constituents at home, and I know that is true for 
Congressman Gingrey and Congressman Boustany and certainly when we see 
our former patients in the post office or at a restaurant or a church, 
I know that what they tell me is, please, please don't let the 
government get more involved in health care. And so I would suggest to 
you, Mr. Speaker, that where health care decisions are made between the 
physician and the patient is something that is extremely important to 
men and women and children all across this Nation. And this issue is 
one of those issues that will strike a cord among people all across 
this Nation if the government gets involved and says, no, you may not 
have that drug, you may not have that medication because the price is 
too much.
  So, Mr. Speaker and my colleagues, I will tell you that if what is on 
the floor tomorrow is adopted, we will see a lower quality of health 
care, a decrease in access to health care, and I believe strongly that 
we will see patients across this Nation harmed. I know that is not what 
my colleagues on the other side of the aisle want to do. At least I 
hope that is not what they want to do. But I will tell you that that 
will be the consequence of this bill if it passes tomorrow.
  So I am very hopeful that our friends on the other side of the aisle 
will recognize the consequences of decisions that they are about to 
make and will appreciate that, indeed, what they must do, if they truly 
believe in looking out for the best interest of their constituents and 
our former patients, is to make certain that health care decisions 
remain in the hands of physicians and patients.
  And with that, I thank my friend and colleague from Georgia once 
again for his leadership on this issue and for the opportunity to 
participate in this message tonight.
  Mr. GINGREY. Mr. Speaker, I thank Dr. Price and Dr. Boustany for 
their very informative contribution to this hour.
  Mr. Speaker, in the few minutes that we have remaining and as we move 
toward wrapping up this hour, I want to just read a couple of quotes to 
my colleagues from former President Bill Clinton, who remains their 
rock star and who certainly tried to do some things on health care, 
unfortunately for him, unsuccessfully. But will listen to what 
President Clinton said in 1999 on his idea of a Medicare modernization 
proposal, which, as I say, was not passed: ``Under this proposal 
Medicare would not set prices for drugs. Prices would be determined 
through negotiations between the private benefit administrators and the 
drug manufacturers. Thus, the proposal differs from the Medicaid 
program in that a rebate would not be required and from the Veterans' 
Administration program in that no fee schedule for drugs will be 
developed. Instead, the competitive bidding process would be used to 
yield the best possible drug prices and coverage, just as it is used by 
large private employers and the Federal Employees Health Benefit Plan 
today.'' That was July 5, 1999.

  And the then Secretary of Health and Human Services, Donna Shalala, 
Secretary Shalala, on this same Clinton proposal said: ``Private 
pharmacy benefit management firms will administer prescription drug 
coverage for beneficiaries in original fee-for-service Medicare. These 
firms will bid competitively for regional contracts to provide the 
service. They, not the government, will continue to negotiate 
discounted rates with drug manufacturers, and beneficiaries will 
receive these discounted rates even after they exhaust the Medicare 
benefit coverage.''
  You know, Mr. Speaker, again, I said at the outset of the hour, why 
are the Democrats doing this? I know that when this bill was first 
passed, like anything, there was concern. Well, you know, is this going 
to work? Is it going to be successful? And, of course, they all opposed 
it. I think there were just maybe a handful of Democrats that 
ultimately voted for Medicare modernization, the prescription drug act 
of 2003. And they were asking their constituents and seniors to tear up 
their AARP card. Some of them symbolically did that from the lectern 
here in this Chamber. They were just outraged that a senior 
organization could support a Republican proposal, which, of course, 
they did. And when it passed and then over the last year of the 
program, it has been so successful that

[[Page H418]]

they want to get in on it, even though that was such a bad idea, as 
Bill Clinton and as the Congressional Budget Office have said, in 
response to Dr. Frist's request back in 2004, that allowing the 
Secretary of Health and Human Services to negotiate prices would not 
save any money. The program is working so well.
  Every one of these bills that have been brought up this week under 
this special rule of no rule, no opportunity to meet in the Rules 
Committee and no amendments, all these issues, minimum wage and 
completing the recommendations of the 9/11 Commission and stem cell 
expansion, poll really high. Yet this particular issue is just the 
reverse of the information they have got. It is an 80 percent positive 
issue for us. So I can only presume that they still want a little skin 
in the game. They want to get on the bandwagon.
  Well, I am going to tell you, what is going to happen is our seniors 
are going to get skinned because they are about to ruin a good program. 
A program that is working well, that 80 percent of our seniors are in 
favor of. It has brought down prices of prescription drugs. It has come 
in now at $22 a month average monthly premium and this is great 
satisfaction. And they want to try to improve on that by letting the 
government negotiate prices. It is going to be a disaster for them. And 
I hope some of their Members, if they are smart, from these districts 
that they won from our Members in these elections in November, in these 
marginal districts, they had better talk to their folks back home 
before they follow the lead of their leadership and vote for this 
atrocious piece of legislation.
  I railed at the outset, Mr. Speaker, about the fact that the new 
minority has been given no opportunity for amendments on any of these 
first four bills that are brought up during their 100 hours, and I do 
think it is an atrocity. But they may be doing us a favor inadvertently 
by not allowing us to amend this piece of legislation, which can't be 
amended. It needs to be killed. We need to kill this sucker dead. And I 
think every Member on our side of the aisle will vote against it, and 
the smart ones on their side of the aisle will vote against it.

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