[Congressional Record (Bound Edition), Volume 146 (2000), Part 1]
[Senate]
[Pages 1414-1417]
[From the U.S. Government Publishing Office, www.gpo.gov]



                THE NEED FOR PRESCRIPTION DRUG COVERAGE

  Mr. DORGAN. Mr. President, this will be a session in Congress in 
which we will have plenty of challenges and opportunities to discuss 
issues. We live in a country where we are blessed with an economy that 
is growing, and with unemployment that is about as low as it has been 
in my adult lifetime. Inflation is down. We have had the blessings of a 
rising stock market; we recently had some adjustments there. But home 
ownership is up. Personal income is up. We have a lot of things that 
exist in our economy that represent good news for our country.
  I come from a farm State, and there is not such good news for family 
farmers. They are suffering through a very severe crisis with collapsed 
grain prices and other difficulties. But, generally speaking, our 
country has been doing quite well. Our economy is stronger than almost 
any other economy in the world. Economists now predict that we will 
have budget surpluses as far out as the eye can see. Of course, that is 
not very far; economists who can't remember their home address try to 
tell us what is going to happen with the economy three, five, and ten 
years from now.
  It is interesting to note, if you go back to the early 1990s, 
virtually all leading economists in America predicted that the 1990s 
would be a decade of slow, anemic economic growth. Of course, they were 
almost all wrong. So as we confront our challenges and opportunities in 
the future, I think it is wise for us in this Chamber not to be seduced 
by some who would say that if we are going to have continued budget 
surpluses, let's have a $1.3 trillion tax cut over 10 years. I think it 
is much wiser to provide some targeted tax cuts with some of the 
surplus, if it materializes, and use a fair amount of the expected 
surplus to reduce Federal indebtedness.
  Why? Because during tough economic times you need to use increased 
debt to help you through those tough times, and during good economic 
times it seems to me you would want to reduce indebtedness. So I hope 
that is what we do.
  However, even as we discuss all of those fiscal policy changes and 
challenges, it is important for us to evaluate what else is necessary 
to be done, and what investments should be made. One is education. 
Clearly, our future is our children, and clearly we all, Republics and 
Democrats, want the same thing for our children. We want every single 
young child in our country to walk through a classroom door and 
believe, as parents and as Americans and as legislators, that that 
classroom is one of which we are proud.
  That is a classroom in which that young child can learn, in which 
that young child may grow up to be a nuclear physicist, or to be a 
doctor, or a lawyer, or the best plumber, mathematician, carpenter--
whatever it is the talents of that young child allow it to be. That is 
what we want for our children in education.
  There are a range of other education challenges that we will debate 
and discuss this year. In the area of health care, there are challenges 
as well.
  I came to the floor to talk about one specific area which, it seems 
to me, we must work together to address, and

[[Page 1415]]

that is this: How do we respond to the increasing needs in Medicare, 
especially with respect to prescription drugs?
  Times have changed in this country. Many people are living longer and 
much more productive and healthy lives. I have talked before about my 
uncle, and I will not describe him again in great detail. But my uncle 
is 79 years old. My Uncle Harold is a runner. He didn't discover he 
could run until he was in his early 70s. Then he discovered quite by 
accident that he was a pretty good runner. My uncle is now 79 years 
old, and he has 39 gold medals from running in races all over the 
country. He runs in the 400 and the 800 in Senior Olympic events. My 
uncle is probably a perfect description of how things have changed in 
our country.
  It wasn't too many decades ago that when you reached 79, there was a 
special place for you. It was a big, easy chair where someone would 
serve you soft food--probably oatmeal. You were 79, you were old, 
relaxed, and you were retired, eating soft food. That is not true 
anymore. People are living longer, better, and healthier lives. My 
uncle, God bless him, is in Arizona today training for his next race at 
age 79.
  In this job, we all meet and confront wonderful and interesting 
people. I have met some senior citizens who now, reaching the 
retirement portion of their lives and facing diminished income because 
they are no longer working, are able to look forward to responding to 
some of the health challenges with lifesaving drugs and therapies. They 
weren't previously available to them. But medicine has marched forward 
with new procedures, surgeries, and medicines.
  A woman came to a town meeting one day and told me that she had two 
new knees, a new hip, and cataract surgery. She said she feels like a 
million dollars. I told her that it was a pretty big investment, but 
good for you.
  Forty years ago, if I had held a town meeting in that small 
community, she would have been there in a wheelchair--if she was there 
at all--with bad knees and cataracts. But now, with surgical advances, 
there are so many things happening that allow people to live longer, 
better, more productive and healthier lives. And a part of that is the 
medicine that allows people to deal with their difficulties. There are 
breakthroughs in medicine that are quite remarkable.
  One of the things we must do in this session of the Congress, in my 
judgment, is to try to attach some sort of prescription drug benefit to 
Medicare. What is happening to senior citizens in this country is that 
all too often they reach that portion of their lives when they have 
diminished income and they have an increased need for prescription 
drugs, and they can't afford them.
  Senior citizens are 12 percent of the population in America, and they 
consume one-third of the prescription drugs in our country. Let me say 
that again because it is important. Senior citizens are only 12 percent 
of our population, but they consume one-third of the prescription 
drugs. Why? Because they need them.
  In Dickinson, ND, a doctor said to me that one of his Medicare 
patients had breast cancer. She was being treated for breast cancer, 
first with surgery, and with some prescription drugs to reduce her 
chances of recurrence of breast cancer.
  The doctor told his patient that she needed to take these 
prescription drugs to reduce the chances of recurrence of breast 
cancer. This woman told the doctor that she couldn't afford those 
prescription drugs, and therefore couldn't take them. She told him that 
she couldn't afford them because she didn't have coverage to help her 
pay for them through insurance or Medicare. This woman told the doctor 
that she was just going to have to take her chances with the recurrence 
of breast cancer because she couldn't afford the prescription drug.
  What about the woman with heart disease and diabetes, in her 80s, 
living on several hundreds of dollars a month of income who is told 
that she needs several different kinds of expensive prescription drugs 
to manage her heart disease, her diabetes, and all the other health 
challenges that come from that? She said to me: ``Mr. Senator, I don't 
have the money to do that. I can't buy these prescription drugs because 
I cannot afford them. I buy prescriptions as much as I can, and I try 
to cut the pills in half and take a half a dose occasionally in order 
to try to make it stretch.''
  Doctors tell me that can actually exacerbate health problems. That is 
the difficulty.
  How do we respond to that? We respond to that by providing a 
thoughtful, sensible, affordable prescription drug benefit in the 
Medicare program. We can do that. To put this together is not rocket 
science. All of us together can do that, understanding that people are 
living longer. But when they reach diminished income, as senior 
citizens do, they need affordable prescription drugs to deal with their 
health care problems.
  I have held Democratic Policy Committee hearings in New York, 
Chicago, and North Dakota. We will be having future hearings in Atlanta 
and other places to talk about these issues and to take testimony from 
senior citizens about the issue of prescription drugs and Medicare. The 
testimony is so gripping.
  Senator Durbin and I held a hearing in Chicago. A woman came to 
testify who had a double lung transplant. She explained to us that the 
way the system works for her health care is it costs her $2,400 a month 
in prescription drug costs for the very expensive drugs to prevent the 
rejection of these organ transplants. She said she didn't have the 
money. She said that because she couldn't afford them, she could get 
them through Medicaid for 1 month. Then they stop coverage for a second 
month. So she described to me the circumstances.
  It is like every other testimony you hear all across this country 
from senior citizens. Lifesaving drugs can only save your life if you 
are able to afford to take them. If you do not have the money, and 
don't have access to the drug that you need for your health--especially 
senior citizens--you will discover their life is not so long and not so 
healthy.
  Mrs. BOXER. Mr. President, will my friend yield for a colloquy?
  Mr. DORGAN. Certainly.
  Mrs. BOXER. I am so happy Senator Dorgan took the time to come over 
here to discuss this. I thought it would be interesting to talk with 
him about some facts that came out in recent studies because he has 
been on this issue before a lot of folks. He was talking about the cost 
of prescription drugs. I think he would be a very good person for me to 
direct a few questions to, if he would be willing to do that.
  When he talked about a particular woman who came to him and told him 
that she essentially could not afford to take the correct number of 
pills for her condition and she was trying to figure it out--well, if I 
took a half a pill now and a quarter of a pill later--I wonder if the 
Senator is aware that this is a widespread situation. If the Senator 
could comment on it, one report found that one in eight seniors has to 
choose between buying food and buying medicine.
  If my friend could comment on how it makes him feel as someone who 
has always been a fighter for the average person. Here we have senior 
citizens in our country, one out of eight, after they have worked all 
their lives, have saved their money, have taken care of their family, 
having to choose between buying food and buying medicine. I wonder if 
my friend would comment on that.
  Mr. DORGAN. Senator Boxer raises the question that is raised in so 
many hearings. We had a woman testify at a hearing I held who said 
something you hear often. She goes to a grocery store that has a 
pharmacy in the back of the store, and she takes a number of 
prescription drugs.
  By the way, a lot of senior citizens will take three, five, or seven. 
I have had senior citizens tell me they are on ten different 
prescription drugs for a whole series of health challenges and 
problems. This woman told me that when she goes to the grocery store, 
she must first go to the back of the store, to the pharmacy, to buy her 
medicine. She said that she does this so she will

[[Page 1416]]

then know how much money she has left to purchase food. Only then will 
she know how much food she can buy.
  We hear that time and time again.
  Last year, spending on prescription drugs in America rose 16 percent. 
Some of that is price inflation; much of it is increased utilization.
  Let me talk just for a moment about the cost of these drugs because 
that is part of the other issue. A fellow named Alan Holmer, who 
represents the pharmaceutical manufacturing industry, wrote a letter to 
the newspapers in North Dakota because he was upset about prescription 
drugs.
  I have been putting pressure on the prescription drug industry to try 
to moderate prices. How much do we pay for prescription drugs? When we 
pay $1 for a drug, the same pill, in the same bottle, made by the same 
company, the Canadians pay 64 cents; we pay $1 for what the English pay 
65 cents for; we pay $1 for what the Swedish pay 68 cents for; we pay 
$1 for what the Italians pay 51 cents for. We pay the highest prices 
for prescription drugs for any consumer in the world.
  I want to show my colleagues four pill bottles which make the point 
better than I, and I ask unanimous consent to do so.
  The PRESIDING OFFICER (Mr. L. Chafee). Without objection, it is so 
ordered.
  Mr. DORGAN. This is a bottle of medicine called Cipro, used to treat 
infections. It is a commonly used medicine. This bottle contains pills 
made by the same company, from the same plant--the same pill, inspected 
by the Food and Drug Administration.
  The difference? There is no difference in the medicine, no difference 
in the bottle. The difference is in price. This bottle of 100, 500-
milligram tablets is sold for $399 to the U.S. consumer. This bottle--
same company, same medicine, same pill--that sells for $399 in the 
United States is sold for $171 in Canada.
  Why? Good question.
  This is a different bottle, same pill, same company. Everyone will 
recognize this drug called Claritin, 10 milligrams, 100 tablets. In 
North Dakota, this is purchased for $218. The same pill--same company, 
in plants inspected by the Food and Drug Administration, approved by 
the Food and Drug Administration, sold for $218 to the United States 
consumer--is sold for $61 in Canada.
  Why? Good question.
  The same is true with a whole list of drugs, especially the most 
commonly prescribed drugs for senior citizens. The drugs on this chart 
include Zocor, a cholesterol drug. Buy it in the United States, it 
costs $106; in Canada, $43; in Mexico, $47.
  The question is this: Why is the U.S. consumer required to pay the 
highest prices of anyone in the world for the exact same drug that is 
sold for a fraction of the cost in virtually every other country in the 
world?
  Mr. Holmer, who represents the pharmaceutical manufacturing industry, 
has written a critical letter to the editor, which is fine. It is a 
free country; he can do that. I want the drug companies to do well and 
be profitable. I want them to produce good products. I want them to do 
research to find new medicines. We do it at the Federal level; there is 
a lot of federally sponsored research. I also want fair pricing for the 
American consumer. Fair pricing gives us an opportunity to put a 
prescription drug benefit in the Medicare program. This is a very 
important issue for all Americans, especially senior citizens.
  Mrs. BOXER. If my friend will continue to yield, this is my next 
question. I am appreciative the Senator has gone in this direction.
  The General Accounting Office found United States drug prices for 
specific drugs were, on average, one-third higher than in Canada and 60 
percent higher than in the United Kingdom. When my friend shows charts, 
this has been borne out by studies of a Federal agency.
  The Federal Trade Commission has reported that drug manufacturers use 
a two-tiered pricing structure under which they charge higher prices to 
those without insurance. In other words, if I go to a pharmacy where my 
insurance is not accepted, it costs an arm and a leg. However, if I 
have coverage, then the cost to my insurance company is way less.
  I pivot to this question: Because the Federal Trade Commission has 
studied it, we know there is a two-tiered pricing insurance, for those 
who have insurance and those who do not, so does it not make sense, for 
all of our people whom we can possibly reach, particularly those in the 
older years where they need these drugs to survive, thrive, and live, 
that they get into some kind of system?
  In other words, does my friend agree that even though we don't have 
to get into the details of what system it would be, in unity there is 
strength? If we can walk away from the high-tiered pricing and get into 
a system where citizens can avail themselves of the better price, this 
is something we should fight for. If we don't fight for it here, I 
don't know whom we are representing.
  Would my friend comment?
  Mr. DORGAN. The Senator from California says it better than I. In the 
multiple-tiered pricing systems, we have preferred customers who get 
drugs at a fraction of the price if they are in the right system; 
others pay the highest price on Main Street because the local 
pharmacies are not able to access, in most cases, those less expensive 
drugs.
  We have several different problems with pricing. One is internal. A 
preferred customer gets one price; if one is not preferred, they get 
another price. Often, senior citizens are the ones who walk to the 
corner drugstore in their hometown. The corner drugstores buy from a 
distributor that does not give them the preferred prices, and senior 
citizens pay the highest prices.
  I took senior citizens to Emerson, Canada. Senator Wellstone and 
others are working with me on a piece of legislation that deals with 
the international pricing issues. Senator Wellstone has done the same 
with Minnesotans and talked about this issue. We went to Emerson, 
Canada, which is 5 miles north of the North Dakota border. The same 
drugs are being sold 5 miles north of the border at a fraction of the 
price as in Walhalla or Pembina, ND. Does anyone think the drug 
companies are selling in Emerson County at a loss? Of course not. A 
small drugstore--a little, one-room drugstore in Emerson County is 
making a profit, pricing at a fraction of what they charge 5 miles 
south.
  We have two issues. One is something called the International 
Prescription Drug Parity Act. If the global economy is good for 
everyone, make it work for everyone. Let the pharmacist go up to 
Winnipeg, Canada, and access the same drug for a fraction of the price 
and pass the savings on to the pharmacist customer. There is a Federal 
law now that prohibits that. We ought to pass the International 
Prescription Drug Parity Act that Senator Wellstone and I and others 
introduced.
  Also, this Congress ought to work, Republicans and Democrats 
together, to understand that after 35 years it is time to add a 
sensible, thoughtful, and affordable prescription drug benefit to the 
Medicare program. Let's help those folks who are in their declining 
income years be able to access lifesaving drugs that will allow them to 
continue to live healthy lives. That is our challenge.
  Mrs. BOXER. One last question. As with everything else, we have to 
make choices about what we will do to help people. There is a big 
debate across party lines about the surplus. We know it is reflected in 
the Presidential race, even within the parties.
  I raise the subject of the marriage tax penalty. We know there is a 
penalty in our Tax Code for married couples, and everyone in this 
Chamber wants to fix it. If we fix it in the wrong way, where we help, 
instead of Mrs. Jones or Mrs. Smith, Mrs. Trump or Mrs. Helmsley, then 
we won't have enough money to take care of the one third of the 
Medicare beneficiaries who do not have prescription drug benefits, 
resulting in the story the Senator told in a very poignant way about a 
woman chopping up her prescription pill that she needs to stay alive, 
stay healthy, be vibrant, and have those golden years, as we always say 
we promise our seniors.

[[Page 1417]]

  We do not have a bottomless cookie jar. We learned that lesson in the 
1980s. We have to make some tough choices. When we talk about a 
prescription drug benefit, we are not enacting it in a vacuum. We are 
not just coming down with a laundry list of everything we wanted to do 
with the surplus. We have thought it out.
  As the Republican Party decides where it is going to go with the 
surplus, I hope they will consider, since they run this place right 
now, that if you give it all away to the wealthiest people with 
benefits they do not need because they are doing just fine, that they 
will be forgetting these senior citizens who are living 5 miles to the 
north of North Dakota and going to Canada to buy their drugs. That, as 
you say, is dicey right now. It is not even allowed, unless they have a 
particular note.
  So my closing question is a global question. It is more of a larger 
issue. How do we make room for this and can we make room for this 
benefit?
  Mr. DORGAN. I should mention also, about the trip to Canada, the 
Customs folks will allow you to bring a small amount of prescription 
drugs back across the border for personal use.
  Mrs. BOXER. I see.
  Mr. DORGAN. They would not allow a pharmacist who runs a drug store 
in Grand Forks to go to Canada and purchase Claritin and bring it back 
and sell it to a consumer. That is the problem. We have a global 
economy that is apparently good for the global interests, but it 
doesn't work for the Main Street pharmacist or distributor who wants to 
access lower prescription drug prices in Canada, for example.
  But if you ask doctors where we go from here, they will tell you that 
if you have a senior citizen who has a series of health difficulties--
and often they do, perhaps diabetes, perhaps some cardiac problems, 
arthritis, a whole series of problems--the most expensive way to treat 
them is to wait until the problem is magnified because they cannot 
afford the prescription drugs they need. If they cannot afford them, 
they will just not get them, and that is the expensive way to solve 
medical problems. What will happen to that patient? He will end up in a 
hospital bed someplace. And what does it cost for a day in the 
hospital?
  It is less expensive way to say to those folks: Here are the 
opportunities for you to access the right kind of prescription 
medicines that you need to manage your disease, and to allow you to 
stay out of the hospital. That is the most thoughtful and the least 
expensive way to treat health problems.
  In some ways it is like the old argument about wellness. We have 
always, as a country, been willing to treat somebody who is desperately 
ill. The minute someone becomes ill, we want to help. But when it comes 
to preventing someone from becoming ill, we don't want to worry about 
that. We would never pay for that in an insurance policy. We will only 
pay for the higher cost treatments once you are admitted to a hospital 
somewhere.
  The same thing applies to providing prescription drug benefits to 
Medicare. It will promote wellness, in the sense that it will keep 
people out of the most expensive medical treatment--time in an acute 
care hospital bed. We can do this.
  The Senator from California asked the right question at the start of 
her last discussion: What are our priorities? John F. Kennedy used to 
say that every mother hopes her child might grow up to be President, as 
long as they don't have to be active in politics. But, of course, 
politics is the process by which we make choices in our country. We do 
not have an unlimited opportunity to make choices.
  I hope this economy continues in ways that provide significant budget 
surpluses. If we have those surpluses, then let's be sensible and 
thoughtful about what we do with them. Let's have some targeted tax 
cuts, and, especially, pay down the Federal debt. But, in addition, we 
should find ways to use some of that surplus to do important things in 
education and health care. Let's construct together, in this Chamber, a 
prescription drug benefit for Medicare that, in my judgment, has been 
needed for a long time and is an issue Congress has ignored. We can do 
this.
  We cannot do any of this--we cannot even begin to talk or think about 
it, if someone comes to the floor, gives us a bill, and says they would 
like a $1.3 trillion tax cut over 10 years. First of all, we don't have 
those surpluses; they are simply economic projections. Second, $1.3 
trillion means you are going to dip into the Social Security trust fund 
to give the tax cut, and it means nothing else can be discussed because 
you have given out all that money in tax cuts.
  At least one of the Presidential candidates out there has proposed 
the $1.3 trillion tax cut in a way that, as always, gives the bulk of 
the money to those who need it the least. These at the upper side of 
the income scale will get the preponderance of this money and it will 
foreclose the opportunity to do some other important things.
  Yes, let's have a targeted tax cut; yes, let's reduce the debt and 
pass some other measures that will help this country offer a 
prescription drug benefit, and then let's invest in an education for 
our children that we can be proud of as well.
  The PRESIDING OFFICER. The Senator from Minnesota.
  Mr. WELLSTONE. I ask the Senator from California, did she not intend 
to speak?
  Mrs. BOXER. No. I am done.
  Mr. WELLSTONE. Mr. President, first of all, very briefly, how much 
time do the Democrats have left?
  The PRESIDING OFFICER (Mr. Santorum). Until 10:45, 10 minutes.
  Mr. WELLSTONE. Mr. President, let me try to do this in 10 minutes. I 
might ask unanimous consent for a couple of more minutes but not much 
more.
  I thank my colleagues for their discussion about prescription drug 
costs. In the State of Minnesota, actually only one-third of senior 
citizens have any prescription drug coverage at all. Let me also point 
out that in the State of Minnesota, we have many seniors who cut their 
pills in half because they think they will save money and still will be 
able to help themselves and actually, doctors say, sometimes that can 
be more dangerous than not even taking the drug at all.
  The investment in prescription drug coverage cannot be done on the 
cheap. I am in complete agreement with my colleagues about the tradeoff 
between tax cuts, the vast majority of which benefit people at the top, 
and not having the money for this investment. But to be fair in a 
critique here, I think all of us, Democrats and Republicans, have to 
understand even if we provide a benefit but we are unwilling to spend 
too much money for fear of being called, I suppose, big spending 
liberals or whatever, if you set a cap and you say only $1,000 will be 
covered and no more than that, then I can tell you many of our senior 
citizens, and others who are the frailest and most sick, will bump up 
against that cap, and it will still not cover their catastrophic 
expenses. We have to be very careful people can afford it on the front 
side as well.
  So whether it be too high deductibles or caps that are set too low, 
we have to be very careful if we say we are going to have this coverage 
for people and security for people, that it will be there.

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