[Congressional Record Volume 153, Number 62 (Wednesday, April 18, 2007)]
[Senate]
[Pages S4634-S4636]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
[[Page S4634]]
MEDICARE PRESCRIPTION DRUG PRICE NEGOTIATION ACT OF 2007--MOTION TO
PROCEED
The ACTING PRESIDENT pro tempore. Under the previous order, the
Senate will resume consideration of the motion to proceed to S. 3,
which the clerk will report.
The bill clerk read as follows:
Motion to proceed to calendar No. 118, S. 3, a bill to
amend part D of title XVIII of the Social Security Act to
provide for fair prescription drug prices for Medicare
beneficiaries.
cloture motion
The ACTING PRESIDENT pro tempore. Under the previous order and
pursuant to rule XXII, the clerk will report the motion to invoke
cloture.
The bill clerk read as follows:
Cloture Motion
We, the undersigned Senators, in accordance with the
provisions of rule XXII of the Standing Rules of the Senate,
do hereby move to bring to a close debate on the motion to
proceed to Calendar No. 118, S. 3, Prescription Drugs.
Dick Durbin, Amy Klobuchar, Ken Salazar, Edward Kennedy,
Mark Pryor, Blanche L. Lincoln, Daniel K. Inouye, Byron
L. Dorgan, Chuck Schumer, Max Baucus, Kent Conrad, Jeff
Bingaman, John F. Kerry, Ron Wyden, Debbie Stabenow,
Jay Rockefeller, Maria Cantwell, Harry Reid.
The ACTING PRESIDENT pro tempore. By unanimous consent, the mandatory
quorum call has been waived.
The question is, Is it the sense of the Senate that debate on the
motion to proceed to S. 3, a bill to amend part D of title XVIII of the
Social Security Act to provide for fair prescription drug prices for
Medicare beneficiaries, shall be brought to a close?
The yeas and nays are mandatory under the rule. The clerk will call
the roll.
The bill clerk called the roll.
Mr. DURBIN. I announce that the Senator from South Dakota (Mr.
Johnson) is necessarily absent
Mr. LOTT. The following Senators are necessarily absent: the Senator
from Kansas (Mr. Brownback) and the Senator from Arizona (Mr. McCain).
The ACTING PRESIDENT pro tempore. Are there any other
Senators in the chamber desiring to vote?
The yeas and nays resulted--yeas 55, nays 42, as follows:
[Rollcall Vote No. 132 Leg.]
YEAS--55
Akaka
Baucus
Bayh
Biden
Bingaman
Boxer
Brown
Byrd
Cantwell
Cardin
Carper
Casey
Clinton
Coleman
Collins
Conrad
Dodd
Dorgan
Durbin
Feingold
Feinstein
Hagel
Harkin
Inouye
Kennedy
Kerry
Klobuchar
Kohl
Landrieu
Lautenberg
Leahy
Levin
Lieberman
Lincoln
McCaskill
Menendez
Mikulski
Murray
Nelson (FL)
Nelson (NE)
Obama
Pryor
Reed
Rockefeller
Salazar
Sanders
Schumer
Smith
Snowe
Specter
Stabenow
Tester
Webb
Whitehouse
Wyden
NAYS--42
Alexander
Allard
Bennett
Bond
Bunning
Burr
Chambliss
Coburn
Cochran
Corker
Cornyn
Craig
Crapo
DeMint
Dole
Domenici
Ensign
Enzi
Graham
Grassley
Gregg
Hatch
Hutchison
Inhofe
Isakson
Kyl
Lott
Lugar
Martinez
McConnell
Murkowski
Reid
Roberts
Sessions
Shelby
Stevens
Sununu
Thomas
Thune
Vitter
Voinovich
Warner
NOT VOTING--3
Brownback
Johnson
McCain
The ACTING PRESIDENT pro tempore. On this vote, the yeas are 55, the
nays are 42. Three-fifths of the Senators duly chosen and sworn not
having voted in the affirmative, the motion is rejected.
The majority leader.
Mr. REID. Mr. President, I enter a motion to reconsider that vote.
The ACTING PRESIDENT pro tempore. The motion is entered.
Mr. OBAMA. Mr. President, I am extremely disappointed by the Senate's
failure to consider a bill that would have placed the needs of seniors
ahead of the profits of the health industry. Once again, a minority of
the Senate has allowed the power and the profits of the pharmaceutical
industry to trump good policy and the will of the American people.
We have a major crisis in this Nation, and that is the rising cost of
health care. Over the last century, the Nation has witnessed tremendous
advances in medical science and technology, and we now have treatments
and cures for diseases and conditions that were at one time surely
fatal.
Yet we are paying the price for this success. Health care,
particularly the cost of drugs, is becoming increasingly unaffordable.
Over the last decade the cost of drugs has quintupled, now totaling
almost $200 billion. In 2005, the drug companies' profit was 16 percent
of their revenues, compared to only 6 percent for all Fortune 500
firms. The total profit of the top 7 U.S. based drug companies was $34
billion in 2004, and, if you add it up, their CEOs were paid $91
million that same year. Clearly, the new drug benefit in Medicare has
been a tremendous boon for the drug companies, adding to these extreme
profits.
The growth in the cost of drugs has slowed in recent years, in part
because of greater use of generic drugs. But given the pricetag, and
the financial challenges of our health care system, we can--and must--
take additional steps to curb how much we are spending on drugs.
Allowing the Federal Government to negotiate for lower drug prices in
the Medicare Program would have been an important step forward in this
regard. When you look at the prices the Federal Government has
negotiated for our veterans and military men and women, it is clear
that the government can--and should--use its leverage to lower prices
for our seniors as well.
Drug negotiation is the smart thing to do and the right thing to do,
and it is unconscionable that we were not able to take up this bill
today.
Mr. WHITEHOUSE. Mr. President, I speak today in outrage that my
colleagues on the other side of the aisle have chosen to block S. 3,
the Medicare Prescription Drug Price Negotiation Act, from coming to
the floor.
You meet a lot of people when you campaign for a seat in this
esteemed body. You meet people of all ages, from all socioeconomic
levels, from all ethnic and cultural backgrounds, liberal and
conservative, rural and urban, healthy and ailing--you meet them all.
These individuals bring personal voices to national issues. They
educate us with their stories, and they trust us to be stewards of
their experiences. I am sure my fellow freshman Senators will agree
with me when I say that listening to these stories was the best part of
running for U.S. Senate.
Sometimes these stories are uplifting tales about the triumphs of
government: SCHIP providing health insurance to at-risk children,
AmeriCorps helping young people serve communities throughout the
Nation, The Family and Medical Leave Act allowing parents, spouses, and
children the time to care for loved ones. But sometimes these stories
are just the opposite--depressing, discouraging, disheartening tales of
how the government has failed in its duty to support and safeguard our
must vulnerable citizens.
I have hosted community dinners throughout my State. Some of the very
saddest stories that Rhode Islanders shared with me were about their
experiences with the Part D drug benefit. I would like to share with
you a particularly touching story from Travis, who came to one of my
community dinners in Woonsocket. Travis told me of his great-
grandmother, a woman over 90 who was living independently, in a second
or third story walk-up apartment building in Woonsocket. She, like
other women her age, had signed up for a Part D plan, and was taking a
number of prescription medications. One day, Travis's great-grandmother
arrived at the pharmacy, only to be told that she was in the donut
hole, that she would now be responsible for almost the entirety of her
drug bill. His great-grandmother called Travis in despair. She would no
longer be able to afford her apartment, or her independent lifestyle.
She was forced to choose between her spirit of self-reliance and her
health.
This is a tragedy. It is a human tragedy because no human being
should be forced to choose between her dignity and her life, and it is
a moral tragedy because this is a totally unnecessary choice. The
Congressional Budget Office concludes that the privatization of the
drug benefit--the choice not to simply add the drug program onto the
established Medicare benefit--costs almost $5 billion a year. The
Center for
[[Page S4635]]
Economic and Policy Research reveals that the combined cost of
privatization and failure to negotiate prices is more than $30 billion
a year. I do not know about you, Mr. President, but I cannot look
Travis in the eye and tell him that the reason his great-grandmother
cannot afford her apartment is that the government needed to give it to
pharmaceutical manufacturers, an industry that, in 2004, was three
times more profitable than the median for all Fortune 500 companies--an
industry that from 1995 to 2002 was the most profitable industry in the
entire country.
I was not in the Senate when the drug benefit was created. I was not
privy to the debates that went on here regarding the complexities and
particulars of the bill. But I have a very hard time understanding how,
with a successful Federal drug benefit model in place at the VA, this
body created a new program that pays, on average, 70 percent more for
drugs than the existing VA program, according to the Center for
Economic and Policy Research. I understand that there are fundamental
differences between the Veterans population and the senior population,
between the Veterans system and the Medicare system, but 70 percent?
This seems, to me, like a de-evolution of the policy making process. We
are creating new programs that function less effectively and less
efficiently than the ones we already had in place.
The real question is why. Have we gained something valuable for this
extra cost? Can we justify the expensive and byzantine architecture of
this program based on the promotion of other values? Some of my
colleagues argue that the Part D drug benefit maximizes choice, and
that choice is of fundamental importance in health insurance markets.
Indeed, the bill succeeds here. In 2006, there were nearly 1,500
prescription drug plans offered throughout the Nation. Beneficiaries in
46 States had over 40 plans to choose from. This year, seniors
everywhere in the country can choose between at least 45 plans. In my
small state of Rhode Island alone, there will be 51 plans available.
But study after study, survey after survey, has shown us that, beyond
a reasonable point, more plans do not add up to beneficiary or provider
satisfaction. In fact, 73 percent of seniors think the Medicare
prescription drug benefit is ``too complicated.'' Sixty percent agree
with the statement, ``Medicare should select a handful of plans that
meet certain standards, so seniors have an easier time choosing.''
Thirty-three percent think it is ``somewhat difficult'' or ``very
difficult'' to enroll in a plan. In addition, 91 percent of pharmacists
and 92 percent of doctors think the benefit is too complicated. It is
time to admit that a plethora of plans does not add value to the
program; it adds bewilderment and burden.
And do we have a system in place to deal with the confusion we have
caused? No. We have 1-800-Medicare, which is adequate at its best, and
inaccurate, unreliable, or altogether unreachable at its worst. But we
need not rely on anecdotal evidence. GAO itself placed 500 calls to the
Medicare help line in the middle of last year to make its own
determination about the usefulness of the feature. Eighteen percent of
calls received inaccurate responses, 8 percent of the responses were
inappropriate given the question posed, 5 percent of the calls ended in
disconnection, and 3 percent of responses were incomplete. In total,
one-third of calls placed by GAO in this study were handled in an
unacceptable fashion. Our mechanism to demystify the drug benefit for
the average consumer is furthering the confusion of one-third of
callers. This is a catastrophe.
A second value that some of my colleagues argue excuses the
convoluted and costly nature of the drug benefit, is expanded coverage.
More seniors have drug coverage now than they did before January 2006.
No one disputes this. But insurance is not insurance unless it is there
for you when you really need it. Our sicker seniors are reporting far
more problems getting their prescription drugs than our healthy seniors
are. Over 40 percent of seniors who describe themselves as in ``fair''
or ``poor'' health report problems filling a prescription under their
Part D coverage, while only 12 percent of seniors in ``excellent'' or
``very good'' health report a problem. If Part D is failing to help the
sick, it is failing to meet the basic definition of insurance.
Do I mean to say that providing some coverage is worse than being
uninsured? No. But that was not the option on the table in 2003. We had
the option to provide everyone with excellent coverage. We had the
option to care equally and comprehensively for every elderly person in
this country, healthy, sick, or in between. We did not. Instead, we
chose to write checks to the pharmaceutical industry, we chose to write
checks to private insurers, and we left our seniors to write their own.
What, then, can we do to fix this broken benefit? There is a lot we
can do, and today is the first step. Today, we can allow the Secretary
of Health and Human Services to negotiate directly with drug companies
to lower prices for consumers. We can require the collection of data
from prescription drug plans, so that our experts at CRS, at CBO, at
GAO, or at MedPAC can better understand the operations of this program.
We can require CBO to study whether or not market competition is truly
reducing prices, as was the intent of privatization. We can increase
transparency for our seniors, by making the prices of covered drugs
available to the public on the CMS website. We can pass S. 3--the only
thing standing in our way is Republican obstructionism.
I thank the majority leader and Senator Baucus for their commitment
to our Nation's seniors, and I hope that my colleagues on the other
side of the aisle will drop their obstructionist tactics and let us get
to work on this bill. As important as it is, it is only a first step to
fixing our Medicare Part D program. I hope we can soon take that step
and then move on to the broader issues, for I believe there is much,
much more to be done.
Mr. SPECTER. Mr. President, I voted for cloture to cut off debate on
the motion to proceed because I think that the Senate should proceed to
give full consideration to the proposed legislation which would
authorize the Secretary of Health and Human Services to negotiate with
the pharmaceutical companies under Medicare Part D coverage. In the
past, I have favored such proposals because of the argument that the
Secretary's bargaining power would result in lower negotiated prices.
In light of the conclusion by the Congressional Budget Office in a
letter dated April 10, 2007 from Director Peter R. Orszag to Chairman
Max Baucus that the new authority to the Secretary ``would have a
negligible effect on federal spending because we anticipate that under
the bill the Secretary would lack the leverage to negotiate prices
across the broad range of covered Part D drugs that are more favorable
than those obtained by PDPs [prescription drug plans] under current
law,'' I have reviewed the negotiation process under existing laws.
The underlying facts are that the pharmacy benefit managers who
negotiate prices for the prescription drug plans represent
substantially more people than the Secretary would under Part D. For
example, Medco represents 62 million people, Caremark represents 80
million and Wellpoint represents 30 million, contrasted to the 29
million people covered under Medicare Part D. Accordingly, it may be
that the pharmacy benefit managers have even greater leverage than the
Secretary would if the Secretary were authorized to negotiate prices.
That is not certain because the negotiations between the pharmacy
benefit managers and the pharmaceutical companies are conducted on a
confidential basis, so that it is not known with certainty that the
lowest prices are obtained or that the cost savings are all passed on
to the prescription drug plans.
The latest Congressional Budget Office estimate for Part D costs is
$388 billion below the original estimates, for the 10-year period from
fiscal year 2007 to fiscal year 2016. That suggests the current system
is working well.
Extended Senate floor deliberation would provide an opportunity to
debate these issues and obtain greater detail on the facts.
One of the additional arguments favoring giving the Secretary power
to negotiate was the analogy to the savings achieved through the
negotiating power of the Department of Veterans Affairs. In analyzing
the VA's bargaining power, it must be noted that the Veterans
Department represents 4.4
[[Page S4636]]
million veterans, a much smaller number than represented by the
pharmacy benefit managers. It is also important to note that among
brand-name drugs listed on the 300 most popular drugs for seniors, only
42 percent are available to the VA plan because the pharmaceutical
companies declined to provide some of the drugs because of their
unwillingness to meet the price determined unilaterally by the VA. On
the other hand, it is estimated that PDPs under Medicare Part D have
access to 97 percent of the brandname drugs among the most favored 300
drugs. The Medicare Part D beneficiaries have an opportunity to select
the prescription drug plans that best meet their prescription drug
needs, with the opportunity to select a new plan on an annual basis.
Notwithstanding these factors, there may be answers and compelling
arguments in support of the proposed legislation to give the Secretary
negotiating authorities. A full debate by the Senate on these important
issues would pose the opportunity to resolve these complicated
questions and come to a reasoned judgment. The Senate will doubtless
revisit this issue in the future. In the interim, I intend to inquire
further and consider these issues in greater depth to determine what
policies would best serve the interests of the beneficiaries of
Medicare Part D.
____________________