[Congressional Record Volume 155, Number 154 (Thursday, October 22, 2009)]
[Senate]
[Pages S10687-S10690]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           HEALTH CARE REFORM

  Mr. DORGAN. Mr. President, as the Senate continues to discuss in 
various ways the issue of health care, I wanted to comment once again 
on the need, when the health care bill is finally brought to the floor, 
open for debate and amendment, to offer an amendment, which I and 
others will do, to address the cost of prescription drugs. One of the 
significant areas of cost increases for medicine is in prescription 
drugs.
  Prescription drugs are unbelievably important. Many people manage 
their diseases with prescription drugs that were not available years or 
decades ago. Those people who are able to access prescription drugs for 
disease management are able to keep out of the hospital and avoid being 
in an acute-care bed, which is the costliest form of health care.
  I understand the importance of prescription drugs in the health care 
system. I want us to continue to incentivize the development of new 
drugs, research and development. We do a lot of that through the 
National Institutes of Health, and so, too, do the pharmaceutical 
companies engage in research and development. But even as we do all of 
that to try to incentivize development of additional drugs and make 
them available for disease management, it is important to understand 
that part of the process of trying to put some downward pressure on 
health care costs is to put some downward pressure on the price of 
prescription drugs. It is a fact that we pay the highest prices in the 
world for brand-name prescription drugs. That is just a fact. In my 
judgment, it is not fair.
  When a bill does come to the floor, I and a number of my colleagues--
there are over 30 who have cosponsored legislation on prescription 
drugs--will offer as an amendment the legislation we have drafted 
together. It has significant safety provisions in it. It would

[[Page S10688]]

make the drug supply eminently safer than now exists, requiring 
pedigrees and batch lot numbers on everything that is produced and 
distributed so that we can track it. It would be a much more effective 
way of addressing the issue of counterfeit drugs.
  Essentially what we propose is to put downward pressure on 
prescription drug prices by allowing the American people the freedom to 
access that identical prescription drug wherever it is sold, if it is 
FDA-approved, access it wherever it is sold for a fraction of the price 
that is charged here in the United States.
  I have in my desk two pill bottles. They contain the medicine called 
Lipitor. I have used them many times and ask unanimous consent that I 
be allowed to use them on the floor.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. DORGAN. These bottles are bottles that contain medicine produced 
in the exact same manufacturing plant. This plant happens to be in 
Ireland, and Lipitor happens to be the most prescribed prescription 
drug for the lowering of cholesterol anywhere in the world. More people 
take this for the lowering of cholesterol than anything else. I am not 
standing here advertising for it. I am making the point that this is 
made in Ireland. It is shipped all over the world.
  As we can see, these are two bottles that look identical. They 
contain the same pill in the same bottle made by the same company made 
in the same plant. This bottle was shipped to Canada. This bottle was 
shipped to the United States. This is 90 tablets at 20 milligrams. 
Canadians are required to pay $1.83 per tablet for this drug. 
Americans--same pill, put in the same bottle, made in the same place, 
in an FDA-approved plant--pay $4.48 a pill. So it is $1.83 if you buy 
it north of here, $4.48 if you are an American citizen buying it in the 
United States.
  Is that fair? It is not, in my judgment. It is not only Lipitor; it 
is brand-name drug after brand-name drug. How does that happen, and how 
can they make this stick? They do it because under current law the only 
entity that can import a prescription drug is the manufacturer of the 
drug. Therefore, if this prescription drug is sold in Italy or Spain or 
France or Canada--any number of countries--for a fraction of the price, 
the American people are prohibited from accessing that identical, FDA-
approved drug that is sold at half or one-third of the cost in the 
United States.
  With our legislation, we aim to give the American people some 
freedom--the freedom to access that drug. We establish a system by 
which they are able to access that FDA-approved drug from a chain of 
custody that is as safe as the American chain of custody and allow them 
to import that drug into this country by paying a fraction of the 
price. This is about freedom. Why would we not want to give the 
American people the freedom and the advantage of the system of trading?
  Some say: You can't do that without limiting the opportunity for 
counterfeiting. They have been doing it in Europe for 20 years. If you 
are in Spain and want to buy a prescription drug from France, good for 
you; it is easy to do under something called parallel trading. If you 
are in Italy and want to buy a prescription drug from Germany, it is 
not a problem; they have something called parallel trading. They have 
been doing it for two decades without any safety issue at all. Yet they 
say we can't do it here in America? We can't manage something the 
Europeans have managed routinely for two decades? I think we can. Of 
course we can.
  It is not just Lipitor. I mentioned previously that I was at a 
farmyard for a farm meeting some while ago. People were sitting around 
on bales of straw talking, and there was an old codger there. The 
subject of health care came up.
  He said: I am near 80 years old. My wife is about 2 years younger, 
near 80. She just suffered breast cancer. She has been fighting a 
battle with breast cancer in the last 3 years.
  This, by the way, was in the southern part of North Dakota.
  He said: We drove to the Canadian border and then drove across the 
border every 3 months to buy Tamoxifen for my wife to fight her breast 
cancer. And the reason we did that is because we couldn't afford it 
here. We paid about 20 cents for what we would pay a dollar for in the 
United States for the Tamoxifen my wife needed. We had to drive to the 
Canadian border and across to buy it.
  The fact is, he was allowed to do that because on an informal basis 
they allow you to bring across on your own person about 90 days' worth 
of prescription drugs. But for the most part, Americans are not allowed 
to access those lower cost prescription drugs. They are just not 
allowed.
  Why not give the American people the freedom to access the same drug, 
put in the same bottle, made by the same company? If that company plant 
is inspected by the FDA, and the drug itself is FDA approved, why would 
you prevent the American people from having access to the very 
marketplace that everybody boasts about as being the free market?
  I hear all my colleagues come to the floor all the time and talk 
about freedom. Yet I have seen some of them vote against the bill that 
would give the consumer the freedom to access these same drugs in 
places in the world where it is sold for a fraction of what the 
American people are charged.
  There are 30 of us who have come together to write this legislation. 
It is a Dorgan-Snowe bill. Myself and my colleague, Senator Snowe from 
Maine, have worked on this legislation for a long time, as have other 
colleagues. The late Senator Kennedy was a cosponsor of this 
legislation. Senator John McCain is a cosponsor of this legislation. 
Last year, when Barack Obama was a Senator, he was a cosponsor of my 
bill. So this is a very wide coalition. Senator Grassley from Iowa 
asked me about this legislation when we came over for the last vote.
  This is a very wide coalition of Republicans and Democrats who 
believe the American people ought to be given the freedom to access 
these identical prescription drugs that are sold at a fraction of the 
price in all the rest of the world at a time when the highest prices 
are charged to the American consumer.
  If the goal of health care is twofold--one, to try to put some 
downward pressure on these relentless cost increases for health care; 
and, No. 2, to extend coverage to those who do not have it--how could 
we possibly bring a health care bill to the floor of the Senate and 
avoid the issue of whether we are going to do something about the 
relentless increasing march of prescription drug prices? How could we 
walk off the floor having done health care and say, ``Yes, we did not 
do anything, however, about prescription drug prices. Yes, we 
understand it is ratcheting up, up, up, and up, way out of the reach of 
some folks, but we did nothing about it.''
  Some will say: Well, except that there was a deal made in which the 
White House announced an $80 billion deal with the pharmaceutical 
industry, and so on, that would have senior citizens buying brand-name 
prescription drugs in a manner that filled half of the doughnut hole--
that is all Washington jargon--so, therefore, it becomes something that 
the pharmaceutical industry has contributed to the well-being of senior 
citizens.
  I do not know about all that. I think it was Russell Long who said: 
I'm not for any deal that I was not a part of. Well, I do not know 
about what this deal is. I called the White House when it was 
represented by the pharmaceutical industry that this deal also included 
the White House's agreement to oppose the legislation I and others are 
talking about here. I called the White House. Actually, I did not call 
the physical structure. I called a high official in the White House and 
asked the question: Was there a deal made by which they would oppose 
this? And the answer was no, no such deal was made.
  So there is a bipartisan group of us who will be here to offer this 
amendment. I fully expect in the consideration of deciding how to put 
some downward pressure on the costs of health care, our colleagues will 
join me and Senator Snowe and so many others in adopting this 
amendment. At last--at long last--having been fighting this issue for 
many years, I believe, as we consider the health care bill on the floor 
of the Senate, we will include something that puts some pressure to 
bend down or at least to limit the kind of price increases we see every 
single year on these brand-name prescription drugs.

[[Page S10689]]

  Let me say again, I have great respect for the pharmaceutical 
industry. It is looking after its own interests. Good for them. They 
should. They produce in some cases some miracle drugs, some of it with 
public funding through the National Institutes of Health, but, however, 
some of it, perhaps--not ``perhaps''--some of it with their own 
research and development. I do not want to do anything that interrupts 
our opportunity to produce these new medicines that will be helpful to 
the American people.
  But I know what will happen. The minute we offer this amendment, we 
will have people popping up here on the floor of the Senate, and they 
will say: Aha, what you are going to do is shut down research and 
development for new drugs. That is what you are doing. You are going to 
shut down R&D that is going to develop the next miracle drug for 
Alzheimer's or Parkinson's, and so on.
  I say, no, that is not the case at all. It is just not the case. In 
fact, they pay a much lower price for the brand-name drugs, the same 
drugs we pay for. They pay much lower prices in Europe and do more 
research and development in Europe than we do here in the United 
States. So go figure.
  It is also the case that the industry spends more for marketing, 
advertising, and promotion than they do on research and development. If 
you doubt me, turn on your television set tomorrow morning when you are 
brushing your teeth and listen to the advertisements. The 
advertisements say: Go ask your doctor today. Run down to your doctor 
and ask whether the purple pill is right for you. Or: Didn't you wake 
up this morning thinking you needed some Flomax? Go talk to your 
doctor; you must need Flomax--whatever Flomax is.
  My point is, they relentlessly push these medicines at you with 
unbelievable amounts of advertising. So I would say, how about knocking 
off a little of that, maybe pumping some of that money back into 
research? The fact is, the way you can get a prescription drug is if a 
doctor thinks you need it. That maybe is where the decision ought to be 
made, not while you are brushing your teeth watching a commercial on 
television, whether the purple pill would enhance your lifestyle.
  So I only say that because I know the pushback when we offer this 
amendment will be to say: This will injure somehow the opportunity to 
do research and development. Nothing could be further from the truth. 
It will not. I want the pharmaceutical industry to succeed. This 
amendment is not punitive at all. I want them to charge prices that 
allow them to make profits. I just do not want them to charge the 
highest prices in the world to the American consumer--to do it over and 
over. Why? Because they can. Because the American consumer does not 
have the freedom to access those lower priced prescription drugs in the 
world economy.
  Let me mention something, finally, about the larger area of health 
care. I held a lot of meetings in August, as most of my colleagues did, 
I am sure. I had standing room only at every single meeting, and I had 
people allege that whatever is done with health care will be a bill 
that will cover health care for illegal aliens, it will be a bill that 
pays for health care costs for abortions, it will be a piece of 
legislation that does this and that. It is unbelievable the allegations 
out there, which have no basis in truth at all.
  I am not going to vote for a bill that does the five or six things 
that most people are alleging the bill would do. But that is not going 
to be in legislation. This legislation we will consider I hope will 
be--and if it is not, I will offer to amend it; and if I cannot amend 
it and cannot fix it, I will not support it. But I believe legislation 
that will be supported by a good many--perhaps including myself if it 
is the right kind of legislation--will be legislation that is a serious 
attempt to try to address the issue of increasing costs of health care.
  We spend much more than anybody else in the world on health care. Yet 
we do not have the results. We rank, according to CIA data, which keeps 
information on all the countries, 50th in life expectancy. So we spend 
much more than anybody else in the world and rank 50th in life 
expectancy. Go figure. There is something wrong with that picture.
  The other issue is, a lot of people do not have health insurance 
because the increased cost of health insurance is running out of 
people's ability to pay for it.
  One other important point is most people who do have health insurance 
believe: Well, I am set. I am fully insured. In most cases, they are 
not. In most cases, they are one serious illness away from bankruptcy.

  I met a woman in a community recently who is a quadriplegic. About 10 
years ago, she had $600,000 in the bank. She lived in a home and had 
home equity. She had a job and insurance. Ten years later, it is all 
gone. She is a quadriplegic who has unbelievable needs. She suffered a 
very serious illness that continues. She has reached the cap on her 
insurance policy. She is one of those who is a demonstration of being 
one serious illness away from bankruptcy, even if you have insurance. 
This country is a better country than to decide that does not matter.
  One-half of the bankruptcies in this country are bankruptcies as a 
result of health care costs. Every single Member of this Chamber goes 
around their State and discovers there is a benefit being held 
someplace for somebody who needs a new kidney or somebody who has some 
other medical difficulty, and they are doing some sort of fundraiser 
for the community to see. Can they raise enough money for this surgery 
so this person can get health care because that is the only way they 
can get this surgery? So they need donations from neighbors. We can do 
better than that. That is the reason there is an interest in trying to 
find some way to address this health care issue.
  I want to mention one additional point, and that is last evening 
there was a vote on what is called commonly here the doctors fix. It 
deals with physician reimbursements. A reporter asked me, as I left 
last evening: Wasn't this some significant rejection of the health care 
piece? The answer was no. That vote last evening was not a harbinger of 
anything. The vote last evening was on the issue of fixing physician 
reimbursements, but it was done in a way that was not paid for, and a 
good many Members of the Senate felt that is not the way to do it.
  We should--and will, in my judgment--fix this physician reimbursement 
issue. We must. We cannot have a circumstance where physicians are 
told: Oh, by the way, in 2 or 3 years from now, your reimbursements are 
going to drop off a cliff 25 or 35 percent and then we will see you 
decide not to treat Medicare patients. That will not work. So we have 
to fix this. But we are in the middle of a very deep hole with very 
significant budget deficits, the most significant recession since the 
Great Depression. In my judgment, we cannot just add $240 billion to 
the Federal budget deficit.
  So we will, in my judgment, address legislation with the physician 
payment issue and fix that issue because we have to, but we have to do 
it the right way. That is all that vote was. That vote was not a 
harbinger about how health care reform might be dealt with today, 
tomorrow, or yesterday. It was just a vote on that issue with respect 
to the deficit, and a lot of Members of Congress decided, do you know 
what, let's come back and do it in a different way.
  Let me make one final point. The majority leader of the Senate is 
working, along with many others, to try to combine the best of several 
pieces of legislation. It is not an easy job. But the fact is, he will 
bring a piece of legislation to the floor of the Senate. It will be 
wide open for amendment, and we will have a lot of the best ideas that 
come to the floor in the form of amendments about how to improve the 
bill. And that is exactly the way this process will work. I do not 
think we ought to get ahead of the process alleging this or that. Let's 
take a look at what this bill does and says and provides. Let's offer 
improvements where improvements can be made. We will have votes on all 
of those issues and see if we can do something good for the American 
people. The American people deserve that.
  This has been a tough time with a very deep economic hole we have 
been going through. Part of the economic distress in this country is to 
try to decide at the end of the day, the month, or the year: How do I 
pay this unbelievable increase in my health insurance

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cost because I know that and my kids and my family and I need to have 
health insurance? When you are losing your job and losing your home and 
losing hope in the middle of a great economic downturn, it is pretty 
troublesome to discover, do you know what, we probably cannot even 
insure our family against illness and disease.
  We are a better country than that. We can do something here. I 
understand a lot of people would like to say they want to do something 
but in reality do not want to do anything. And it is always easier to 
criticize. It is always easier to take the negative side. But the 
question is: Can we come together with something positive that advances 
the interests of this country? I hope we can. And I believe we can if 
we are thoughtful and work together. So that will be my hope at the end 
of the day.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Delaware.

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