[Congressional Record (Bound Edition), Volume 146 (2000), Part 13]
[House]
[Pages 18636-18643]
[From the U.S. Government Publishing Office, www.gpo.gov]



                        PRESCRIPTION DRUG PLANS

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 6, 1999, the gentleman from Oklahoma (Mr. Coburn) is recognized 
for 60 minutes as the designee of the majority leader.
  Mr. COBURN. Mr. Speaker, I would like to spend a little time this 
afternoon on a subject that we hear across all the airways and we read 
in all the newspapers and it is what all the politicians in the country 
are running around talking about. It is called prescription drug plans.
  It is amazing how interested we are in this now that we have gotten 
into an election year. But the problem has been occurring for the last 
3 years essentially.
  There is no question in this country that, as the percentage of 
health care costs rise, an increasing proportion of that is 
prescription drugs. And there is no question that in our country, all 
of us, seniors, people in insured plans, people with no insurance, 
people on Medicaid, are having a more and more difficult time accessing 
the pharmaceuticals that we need to both succeed in treating the 
illnesses that we face and prevent illnesses that we could face.
  My experience is I have been a physician for almost 20 years. I 
continue to practice on the weekends and on Fridays when we are not in 
session and on Monday mornings.
  What I want to spend time today talking about is the direction of the 
Congress with this issue. I want to compare what we have heard 
President Clinton say and Vice President Gore say about their solution 
for this problem.
  I have 18,000 square miles in Oklahoma that I am fortunate enough to 
represent. I will be going home when this session of Congress is over, 
and I will not be returning because I chose to limit my terms. But as 
we travel around and I talk to seniors, which have been the major topic 
that we have seen discussed in this potential to began a political 
advantage, this bidding war on prescription drugs, if we ask the 
question, do you need help with prescription drugs, many will say yes. 
There is no question.
  But if we ask the question putting with it the caveat of who is going 
to pay for it, the answers are totally different. If we ask seniors, do 
you want a prescription drug plan and do you want one that is going to 
lower the standard of living of your grandchildren, we never ask that, 
but that is implied in the question.
  For historical purposes, when Medicare began, the estimated cost for 
Medicare in 1990 was $12 billion in 1990. That is what the best 
accountants, the best people that we could have said that is what it 
was going to cost. And there are a couple of reasons why they missed it 
a thousand percent. It cost $120 billion in 1990. There are two reasons 
they missed it.
  Number one is it is hard to estimate; and number two, the politicians 
in Washington, if they do not have to be responsible for the cost of 
it, are going to add an additional benefit. That is a natural human 
response, whether one is a politician or otherwise, is to give somebody 
else's money away if in fact it helps them accomplish their purpose.
  Well, we now have a drug proposal before us that is supposed to cost 
about $100 billion over 10 years. And if we think about the track 
record for the Health Care Financing Administration and the CBO, the 
Congressional Budget Office, and the Government Accounting Office, all 
of which totally missed the cost to Medicare, what it is really going 
to cost is probably a trillion dollars over the next 10 years. That is 
where we are at.
  Now, where are we going to get money to pay for that? We are going to 
delay the funding of it. We are going to borrow it. And we are going to 
eventually ask our children to pay for it and our grandchildren.
  There is a lot of baby boomers out there, which I am one of them. 
There are 77 million of us that are baby boomers, and it will not be 
long that we will be eligible for the benefits under Medicare. And as 
we become eligible, the one thing we do know is that the cost of the 
Medicare program is going to skyrocket.
  The second point that I want to make is, what is the real problem in 
our country in terms of people being able to get prescription drugs? 
What is the difficulty? It is not the quality of the drug. It is not 
the availability of the drug. It is not the research that brings the 
drugs forward. What is the real problem? The problem is price.
  If we do not address the competitive issue in this solution to this 
problem, then all we are going to do is lower the cost for some seniors 
and transfer it to everybody else in the country. Unless we establish 
and make sure that that

[[Page 18637]]

marketplace is as efficient as it can be, we will do wonders for 
seniors and harm to everybody else, let alone the cost.
  I have one chart I would like to spend some time on. This chart is 
actually Social Security. But if we move it over to 2011, the numbers 
are exactly the same in terms of the ratio of positive cash flow into 
the Social Security or Medicare fund versus outflow.

                              {time}  1500

  In 2011 under the spending we have now without a drug program, 
Medicare starts running a negative cash flow. It would not do that well 
if we had not taken two or three components out of the Medicare trust 
fund and put them to the regular budget. So we essentially have 
improved the life of Medicare both by manipulations here and the fact 
that we have had a wonderful economy with a lot of people paying in a 
lot of money on Medicare.
  But what is going to happen, starting in 2011, is we are going to 
have to run this tremendous deficit, without a prescription drug 
benefit. So if we decide that a big government program is the answer 
and that the President and Vice President Gore is the answer, then what 
you need to do is just about double or triple the red on this chart. 
The implication being, is that your children and your grandchildren 
because we are going to fix the wrong problem, lack of competition, are 
going to have a much lower standard of living.
  I have a chart that compares FICA earnings and estimated taxes just 
on Social Security. The reason I want to use Social Security is because 
the same numbers reflect on Social Security the baby boomers. What you 
can see is right now we all pay about 6 percent of every dollar we earn 
in a FICA tax and our employer matches that. But I want you to notice 
this graph. That does not have anything to do with the 1.45 percent 
that you pay in Medicare and that your employer pays. But if you just 
follow this graph in terms of the introduction of the new people coming 
into Medicare and Social Security, what you can see is the tax rate 
just to meet the cash flow requirements, without a prescription drug 
benefit, goes up to almost 20 percent. If you extrapolate that same 
rate from Social Security to Medicare, instead of 1.45 percent, we are 
going to be paying 3 percent individually and 3 percent by your 
employer. So we are going to double the cost of the tax when you work 
just to cover the Clinton-Gore drug plan.
  I am not known as a partisan, and I was not real happy with the 
Republicans' drug plan, either; but what I do know is that the plan 
that is outlined by the President and Vice President Gore concentrates 
more power in Washington, concentrates more decision-making in 
Washington, and concentrates bankruptcy for Medicare in the future.
  I yield to the gentleman from Texas (Mr. Armey), the majority leader 
in the House.
  Mr. ARMEY. Mr. Speaker, I want to thank the gentleman from Oklahoma 
for recognizing me. I want to thank also the gentleman from Oklahoma 
for taking this special order on this special topic. It is a matter 
that of course is of great interest and, frankly, considerable concern 
to the American people. I am proud to be included in his special order.
  Mr. Speaker, I have worked very hard on these comments, and I will 
read my comments because this is a complex subject, and we want to make 
sure we get it exactly right.
  I would like to take a moment just to discuss the prescription drug 
issue. Vice President Gore and Governor Bush are engaged in a heated 
debate over this matter and how best to help seniors afford drugs.
  Everyone agrees that Medicare coverage has failed to keep up with 
medical progress and that one-third of seniors today lack drug coverage 
and need immediate help to better afford the medications they need and 
upon which they rely. But as with anything, there is a right way and a 
wrong way to go about doing it. I might say, if this is worth doing, 
and I believe it is, it is worth doing right. Sadly, Mr. Speaker, the 
Vice President has chosen the wrong way.
  Six years ago, he and President Clinton tried to force all Americans 
into a government-run health care plan. Thankfully their plan was 
rejected by the public and by Congress. I am proud to have been a part 
of the effort to defeat the Clinton-Gore health care plan. I thought 
forcing people into government-run, government-chosen HMOs was wrong 
then; and, Mr. Speaker, I think it is wrong now. Back then, to 
illustrate what the Clinton care plan really entailed, I drew up a 
chart showing all its amazing complexities and absurdities. I called 
that chart ``Simplicity Defined.'' It looks an awful lot like this 
chart we are seeing right here. This one I call ``Nightmare on Gore 
Street.'' You see, this risky big-government drug scheme of the Vice 
President's is really the sequel to that 1994 horror film we had hoped 
we would never see again, the one called ``Clinton Care.''
  Alas, like the unrepentant Freddy Krueger, Mr. Gore is back trying to 
do for drugs what he failed to do for health care, put the government 
in charge of all of it. Ira Magaziner and Rube Goldberg would be hard 
pressed to devise so nightmarish a scheme. This frightening tangle of 
chutes and ladders is the product of no less than 412 new government 
mandates contained in the Gore plan.
  If this horrifying picture is not enough, allow me to recount just a 
few of the reasons why the Gore government-run drug plan is bad for 
seniors and all other Americans as well.
  First, it forces all seniors into a government-chosen HMO for drugs. 
If you do not like the plan the bureaucrats put you in, it is just too 
bad. You have no other options.
  Second, it is not really voluntary as Mr. Gore claims. You will have 
just one chance to buy into it at the age of 64\1/2\. If you do not 
want to join at that time or change your mind later, you are out of 
luck. It is the Gore plan. Life his way or nothing at all.
  Mr. Speaker, I must say, that bothers me especially because it sounds 
like an ultimatum. Just at that time in your life when you come to 
terms with the things that you do, retiring from your job, starting to 
contemplate a new life, worrying through what might be my options, how 
might I provide for myself and my family in this critical area of 
health care, Vice President Gore says, ``We will give you an ultimatum. 
Make up your mind, right now. Do it my way or not at all.'' That is not 
right, and even worse, it is not fair. If you do not believe me, just 
look at today's part B of Medicare. That part is called voluntary, too. 
Just try escaping it. I dare you.
  Third, government bureaucrats will decide which drugs are and are not 
covered. If they decide the drug you need is too expensive, they can 
force you to switch to a cheaper, less effective one.
  Fourth, seniors will lose their existing private sector coverage 
whether they participate or not. Experience shows employers drop 
coverage as soon as the government begins providing it. So if you are 
one of the two-thirds of seniors who enjoy private sector drug coverage 
today, prepare to kiss it good-bye.
  Fifth, no one will get the drug benefit until the year 2008, 8 years 
from now.
  Sixth, it is a bad deal for most seniors. The average senior will get 
just 13 cents a day of actual benefit. And if you are one of the 
majority of seniors who use less than $576 in prescription drugs each 
year, you actually lose under the Gore plan. The combination of 
additional and a high copay force you to pay more than you would get 
back in benefits. For example, if you were to incur $500 in drug costs, 
under Gore's plan you would have to pay $550 for that privilege. That 
is because $300 in premiums plus $250 in copayments equals $550, more 
than the benefit is worth. Incidentally, these costs are on top of your 
existing part A, part B, and supplemental coverage costs. And the 
premiums for the drug coverage plan? They come directly out of your 
Social Security check, whether you want to pay that way or not.
  Seventh, the Gore plan threatens the physical health not just of 
every senior but of every single American. Despite

[[Page 18638]]

Mr. Gore's strenuous denials, his plan must and does rely on government 
price controls to control its massive costs. These price controls will 
make it unprofitable to develop new miracle drugs, and this will kill 
innovation. Right now there are about 7,500 new drugs just for seniors 
in the research pipeline. Some of them could be cures for Alzheimer's, 
Parkinson's, diabetes or cancer. If the Gore plan is enacted, these 
innovations may never make it to the market.
  The eighth problem with the Gore plan is that it relies on that old 
Democrat Party favorite, bureaucracy. Those few drugs that do get 
invented and make it through the FDA bureaucracy will under the Gore 
plan have to wind their way through the Medicare bureaucracy as well. 
It currently takes Medicare 15 months to 5 years to provide a new 
medical device or technology. For instance, Medicare still does not 
cover the tumor-detecting PET scan technology that has been covered by 
private health insurance for 10 years. Medicare regulations currently 
fill 132,000 pages, more than the tax code. Imagine how many pages of 
regulations will stand between seniors and new miracle drug cures under 
the risky Gore drug scheme.
  Finally, the Gore plan actually endangers the Medicare program. As 
everyone knows, Medicare is insolvent, heading toward bankruptcy in the 
year 2025, possibly sooner. The Gore plan would pile a huge new 
government entitlement on top of the existing, rickety Medicare with 
absolutely no modernization. That is dangerous and irresponsible, like 
adding a second story to your house when the foundation is cracked. And 
it is a terrible disservice to seniors.
  Mr. Speaker, let us not be discouraged. There is a better way. 
Americans want and deserve and we Republicans are working hard to pass 
a Medicare drug plan that keeps Washington out of your medicine 
cabinets and puts choice and control in the hands of our own seniors. 
Last July, we in the House passed such a plan. It was drafted by a task 
force of Members led by our colleagues, the gentleman from California 
(Mr. Thomas), the gentleman from North Carolina (Mr. Burr), and chaired 
by the Speaker. It is a good plan that shows seniors enough respect to 
give them choices.
  I am proud that Governor Bush has proposed a plan similar to our 
congressional plan, based on the same principles. Like our plan, the 
Bush plan is truly voluntary. You decide whether or not to participate. 
It lets you keep your existing private sector coverage if you want to. 
It does not let bureaucrats restrict your access to drugs. It lets you 
pick your own plan and tailor the benefits to suit your own needs. It 
holds down drug costs by helping seniors band together in groups to 
bargain for better prices, not through innovation-killing government 
price controls. And it modernizes, improves and strengthens Medicare 
for the long term. And one more thing: the Bush plan takes effect right 
away, next year, not the year 2008 like the Gore plan.
  Mr. Speaker, here is the issue. The Gore plan puts choice and control 
in the hands of the government and it endangers Medicare. The 
Republican plan puts choice and control in the hands of seniors and 
strengthens Medicare. That is the whole choice before us in this 
election. I think when the American people understand the profound 
differences between these two approaches, they will overwhelmingly 
favor our approach and oppose the Democrats' risky big-government 
scheme, just as they did in 1994.
  Mr. Speaker, I am going to ask that we put that original chart up 
here for just a moment. Take a look at this chart. Each and every one 
of these dots, segments in this snaky chart, is a separate government 
mandate. Why does it have to be so complex? Because we have to cut all 
the bureaucrats in on the deal. Why does it take till the year 2008 to 
implement it? It will take them till the year 2008 for them to decide 
what they want you to have.

                              {time}  1515

  Why can Governor Bush implement his right away? Because he knows we 
already know what we would like to have, and we do not have to have 8 
years for a decision regarding somebody else's business.
  If we think the government can get this right better than you can, 
Mr. Speaker, when was the last time the gentleman bought his wife the 
right Christmas present?
  Mr. COBURN. Mr. Speaker, I thank the gentleman from Texas (Mr. 
Armey), the majority leader.
  I would make one other comment, HCFA, which stands for the Health 
Care Financing Administration, in the words, their own director says 
nobody in HCFA understands the details of HCFA. It is so convoluted. 
And having practiced in the medical field, understanding the 
regulations, understanding the results, understanding the lack of 
common sense that comes out of this organization in terms of how we 
impact with our patients and how our patients are cared for, to take 
$300 billion swiped out of Medicare over 10 years and let those people 
handle it is the last thing we should do.
  Mr. Speaker, there should not be an expansion of the responsibility 
within the Health Care Financing Administration.
  Mr. Speaker, I yield to the gentleman from Texas (Mr. Sessions).
  Mr. SESSIONS. Mr. Speaker, I thank the gentleman from Oklahoma (Mr. 
Coburn) for not only securing this time from the gentleman from Texas 
(Mr. Armey), the majority leader, but also for joining with the 
gentleman from Texas, the majority leader, today to talk about this 
important issue.
  Each Member of Congress is confronted not only in Washington, D.C., 
but around our own tables, in talking to our own parents, and certainly 
back home where we talk about how important it is for us to address the 
important public policy issue of prescription drugs.
  What I would like to do is to spend my brief minutes here today in 
talking about the importance of not only what the Republican party is 
doing and our plan that my colleagues have heard the gentleman from 
Texas, the leader talk about, George Bush's plan, but also to go back 
and to talk with my colleagues about the importance of what we have 
already done.
  We had an opportunity in this Congress back in July to pass a 
prescription drug plan, and we had the opportunity to look at several 
plans that were presented and certainly there was vigorous debate on 
the floor of the House of Representatives. And what happened was there 
was one plan that was raised and supported by the Democratic party, 
which would have arbitrarily been a decision that would be taken over 
by the Federal Government by Medicare, to make a decision about every 
single part of what a senior's health care would be decided by with 
prescription drugs by the Federal Government. I call it the same or 
similar to what we have known as Hillary Care for Health Care, the same 
thing is true for prescription drugs.
  The second thing is, it would have required participation by every 
single senior. Every single senior would have to make the decision are 
you getting in or are you getting out?
  Thirdly, it would be a decision about whether you were going to have 
a prescription drug plan that would really begin kicking in in 2005, 
now we have heard 2008.
  The decision that this body made was overwhelming, and it was 
overwhelming because it was a bipartisan support, and pro-business 
Democrats made a decision that they would vote against the Democrat 
plan.
  They did not want to take over the prescription drug industry. They 
did want price controls on the prescription drug industry, because they 
recognize that in a free enterprise system that we have here in America 
that we want these drug companies to keep developing, not only newer 
and more innovative prescription drugs, but the opportunity for us to 
continue what we have today, provide them to all of our senior 
citizens.
  That plan failed, the Democrat party could not even pass their own 
plan, not because of the Republican party, but because they could not 
get enough Democrats to vote for the Democrat

[[Page 18639]]

plan. And so Republicans were joined by about 10 pro-business 
Democrats. And we passed a prescription drug plan here in the House of 
Representatives that aims directly at the problem.
  The problem is not every senior citizen, about two-thirds of our 
seniors, two-thirds of our seniors are without a prescription drug 
coverage or a plan today, and so that is why we aimed it at that.
  We, our plan, the Republican plan, that has passed this House of 
Representatives would find that those that are at 135 percent or less 
of poverty, which equals 11,124 for a single person, that they would 
have an opportunity to receive without any cost any prescription drug 
that their physician decided that they needed.
  Now, why is this important? I receive questions across my district 
all the time. Why would we want theFederal Government to begin imposing 
this plan for senior citizens? Well, it is simple. The fact of the 
matter is, is that Medicare today offers the coverage for health care 
for senior citizens.
  Prescription drugs today can cure many, many more ills than it used 
to just a year ago, and in the future it will cure many more ills in 
the future, but doctors, when they write a prescription or when they 
utilize prescription drugs, they need that as part of the medical 
treatment for patients, putting a patient in the hospital is not always 
the answer.
  Sometimes it is a prescription drug, so people who make less than 
$11,124, and it is on a sliding scale with a slight copay above that, 
they would receive exactly what the prescription was that the doctor 
ordered, exactly the way the doctor wrote it. They would be given this 
at no cost.
  We are aiming at the poorest Americans. We are trying to help those 
that need help the most. That is what this prescription drug plan did.
  Now, the question is in Washington, as it always has been, not only 
about prescription drugs or about health care, about taxes, about the 
things we do, why would we want the government to be involved? We have 
done this to help senior citizens. The Democrat plan on the other hand 
is one that we oppose, because we recognize that money equals power.
  It always has, and unfortunately probably always will, money equals 
power. And they want to control the lives and the prescriptions that 
are written by the individual doctor, because they want to make 
decisions.
  I became very interested in an article that appeared in the Dallas 
Morning News, which is a paper of high standing, my local newspaper in 
Dallas, Texas, and it is dated September the 9th, just a few weeks ago 
and it says ``administration halts plan to cut Medicare payments for 
cancer drugs.''
  Mr. Speaker, it is this bureaucrat, the government, that is making a 
decision about live-saving drugs for many times our parents and 
grandparents, and based upon a number of Members of Congress, they 
state in here, at least 121 Members of Congress, 70 Republicans and at 
least 51 Democrats, signed a letter to Donna Shalala, head of the 
Health and Human Services, please do not cut Medicare payments. You 
already control seniors health care. Let me state the administration 
backed off cutting that.
  Further, in the article it says, and I quote from the Dallas Morning 
News, September 9, Terry S. Coleman, former chief counsel of the 
Medicare program said, ``the reimbursement methodology is so 
complicated, you can't just go in and adjust a few billing codes. The 
same methodology is used for all physician specialties, not just 
oncology.''
  Well, I would suggest that the majority leader is right. We should 
not allow this government to control the decision that is made by 
physicians on our prescription drugs. It even gets better, and I quote 
further, ``while putting off cuts in payment for cancer drugs, Medicare 
officials said they would cut payments for drugs used at kidney 
dialysis centers and in the treatment of emphysema and other lung 
diseases starting January 1.''
  Mr. Speaker, I would suggest that not only is money power, but the 
ultimate power through rules and regulations, where we are required by 
the Federal Government to have Medicare to be the final decision-maker 
for prescription drugs in this country is not only a bad program and 
one that would not start with a Democrat plan until we find that kick 
in 2008 but, in fact, would control our lives and our freedom.
  The reason why the Republican party and these Members are standing up 
here today is to make sure that all the Members are fully aware of what 
this debate is about and what the ramifications are.
  It is about whether we will once against give up, as the debate in 
this country was in 1994, whether we will give up on the prescription 
drug industry and say we do not trust the free market, we want somebody 
else to do it for us, and when we do that, we lose pieces of our 
freedom, the opportunity for us to make a decision about the 
prescription drugs that we will put and count on for our health.
  We need a plan where we empower the physician and the patient to make 
a decision. We need to make sure that prescription drugs are not only 
available, but that they are what the doctor ordered. And I will tell 
my colleagues that the plan that we have voted for is exactly what the 
doctor ordered.
  Mr. Speaker, I appreciate the opportunity to be here with the 
gentleman today. I applaud what the gentleman has done; what the 
gentleman from Arizona (Mr. Shadegg) is doing; the gentleman from Texas 
(Mr. Armey), the majority leader; and also the gentleman from Minnesota 
(Mr. Gutknecht) to make sure that our colleagues are not only updated 
on this issue, but that we continue to talkabout the importance of 
allowing physicians and patients to decide their own future.
  See money is not only power, but freedom is power, too.
  Mr. COBURN. I thank the gentleman. I want to make two points just for 
the Record to those that might be watching this. Medicare did a 
prescription drug benefit in 1988. The estimated cost was $4.7 billion. 
The actual costs, the 1 year that that was in place was $11.7 billion; 
that is how well we estimated the costs.
  So when we saw up here a cost of $353 billion over 10 years, we know 
at least it is double that, just by the track records.
  The other thing that I would make is the GAO has already stated, our 
accounting agency, that Medicare is not going to make it, unless we do 
some significant changes in terms of incentives and payments. How do we 
do that? We do not do that by adding significantly more costs to an 
already bankrupt program.
  Mr. Speaker, I yield to the gentleman from Arizona (Mr. Shadegg), a 
close friend of mine and somebody I respect a great deal.
  Mr. SHADEGG. Mr. Speaker, I thank the gentleman from Oklahoma (Mr. 
Coburn) for yielding to me, and I appreciate the opportunity to 
participate in this debate.
  Mr. Speaker, I actually would like to engage the gentleman in a 
colloquy about a number of the aspects of the Clinton-Gore plan that I 
think are of concern and that may need to be repeated here so they 
understand.


                         Parliamentary Inquiry

  Mr. SHADEGG. Mr. Speaker, I would like to make a parliamentary 
inquiry. One of our colleagues, I think it was the gentleman from Texas 
(Mr. Armey), our majority leader, just referred to the fact that it is 
very important to be accurate in the facts in this debate, and that as 
we debate this critically important issue, we should be precise, and I 
believe the gentleman said that he, in fact, would read his statement 
so that he could be precise about, for example, the number of 
bureaucratic steps on the chart.
  I believe in the remarks of the gentleman, he indicated that it was 
very important in this complicated debate that we be precise in what we 
say and in the facts we use and marshal in support of our position in 
this debate.
  The question I want to ask is, is it true that under the rules of the 
House, I cannot refer to the fact that the Vice President in a speech 
in Florida on this issue, just a week or two ago, made up

[[Page 18640]]

certain facts about the costs of prescription drugs imposed upon his 
mother-in-law, that those were not, in fact, the actual costs, that he 
made up some facts regarding the dosage of the drug taken by his 
mother-in-law and the dosage of the drug taken by his dog, and that he 
also made up the facts with regard to the overall costs of these 
prescriptions to his family? Am I correct that that cannot be referred 
to on the floor of the House?
  The SPEAKER pro tempore (Mr. Gilchrest). The general rule is that the 
gentleman cannot engage in personality attacks against the Vice 
President, but the gentleman can criticize the Vice President's 
policies and his candidacy.

                              {time}  1530

  Mr. SHADEGG. Let me ask for a further clarification, if I might. On 
the screen here on the board, there are two stories, one from the 
Boston Globe and one from the Washington Times. I know the Times story 
appeared yesterday. The Boston Globe story, I believe, appeared the day 
before yesterday.
  Mr. COBURN. Monday.
  Mr. SHADEGG. It appeared Monday. Both of those stories report that, 
in fact, the Vice President did make up these facts; the cost of the 
drug that his mother-in-law allegedly paid, the dosages taken by his 
mother-in-law versus the dosages taken by his dog. He, in fact, made up 
also the overall cost and did not relate whether or not his mother-in-
law was paying for these drugs or whether they were, in fact, paid for 
by insurance and that now the Gore campaign will not relate whether or 
not she is insured or not.
  My question is, is it also true that that cannot be referred to and 
those articles cannot be read here on the floor?
  The SPEAKER pro tempore (Mr. Gilchrest). The gentleman can criticize 
the Vice President in his actions as a candidate, but the gentleman 
cannot get personal in his criticism of the Vice President.
  Mr. SHADEGG. I have no desire to be personal. I do think, as I stated 
and as I believe the majority leader stated and as the gentleman from 
Oklahoma (Mr. Coburn) stated at the outset of this debate, that if we 
are going to debate important public policy, it is critical that we all 
be accurate; and I would commend to my colleagues here in the Congress 
both of these articles which relate that, in fact, facts were 
fabricated by the Vice President in the course of his campaign to win 
support on this issue.
  I would urge my colleagues that it is critical that we be truthful. 
It is critical that in this kind of important debate before the public 
that we do not make up facts or figures; that we do not mislead the 
American public on these issues; that we do not relate allegedly 
truthful stories about this issue, about family members, when we ought 
to know the facts, in a way which is untruthful, and that that is a 
discredit to this institution and a discredit to the campaign.
  I think it is also important that we, in the course of this debate, 
not allow the ends, in this case winning the debate over how do we best 
take care of these serious prescription drug needs of America's elderly 
population, we do not allow the end of winning that debate to justify 
means which are clearly improper, such as making up facts which are not 
true; being untruthful; or in other ways telling stories which are not 
accurate and honest with the America people, just to win support for 
our position in the debate. I think that is a point that is truly worth 
stressing.
  I would like to just go over with the gentleman from Oklahoma (Mr. 
Coburn), if we might, in a dialogue form some of the points that have 
been made already here to make sure that we understand. First, I want 
to ask the gentleman, is it his understanding of what is being proposed 
by the other side on this issue, by our Democratic colleagues, by the 
Clinton-Gore administration, that that plan would, for example, provide 
a subsidy for prescription drugs for people regardless of their income 
and therefore would provide a subsidy to perhaps Ross Perot, Donald 
Trump or anyone else in that income bracket?
  Mr. COBURN. That is the same principle as we have today in Medicare. 
There is no choice; if one is over a certain age, they will 
participate, unless one chooses not to participate at 64.5 years. Once 
they choose not to participate, they will never be eligible.
  Mr. SHADEGG. The gentleman used the word ``choice'' and talked about 
once one chooses not to participate or to participate. I think that is 
important. As the gentleman understands the proposal being offered by 
Republicans, one of the key features is choice. That is, we allow 
people to pick from amongst a variety of plans that meet their own 
needs; and in addition at least it is my understanding that as the bill 
we passed and the legislation we are proposing and indeed the 
legislation being proposed by Governor Bush would give seniors the 
right to not only choose amongst various plans when they join but to 
make choices again down the line. If they are unhappy with the plan 
they pick, they could make a choice at a later point to switch plans. 
Is that not a feature?
  Mr. COBURN. That is accurate. I think the other thing to remember is 
one of our problems in health care in this country, especially in terms 
related to HMOs, is that we have lost a considerable amount of freedom. 
When one does not have the right to choose their doctor in this 
country, they have lost a significant amount of freedom. Now what we 
are going to see is you are not going to have the right to choose 
whether you get the best drug for you or one that a bureaucrat in 
Washington has decided is the cheapest and least expensive and may not 
be as effective, you are not going to get to make that choice. So it is 
a great political tool to say we are going to have something for 
everybody, even though our grandchildren are going to have to pay for 
it and have a lower standard of living; but to not be honest about the 
loss of freedom associated with that I think is disingenuous.
  Mr. SHADEGG. I think you just touched upon another key point that I 
wanted to bring out at least in part of this important discussion. 
Arizona has many senior citizens. It is a great place to retire to. I 
hope more people retire there. But I think one of the keys that the 
gentleman just mentioned is we often talk about choice in the abstract. 
It is important, I think, for people to understand that not only under 
the Clinton-Gore plan do you make one choice at the outset, you either 
opt in or opt out and that decision is binding for life, but the second 
point is the one that you just mentioned and that is that if you choose 
to participate in the plan which the Clinton-Gore team is proposing, 
you are, in fact, giving away your choice, your right to choose the 
drug that is best for you, to a Federal bureaucrat.
  I know many people that work as government employees. I worked as a 
government employee in the past part of my life in an unelected 
capacity. I think they are genuine, honest and sincere; but under the 
Gore plan the schedule of committed drugs would be decided by someone 
deep in the bowels of the Federal bureaucracy. It would take choice 
about which drug is right for you, which drug is right for your wife or 
your father or your mother or your grandfather or grandmother, it would 
take that choice away from them as individuals and vest it in a group 
of, quite frankly, Federal bureaucrats who would decide which drugs are 
appropriate and which drugs are not, taking that power not only away 
from you but away from your doctor as well. Is not that correct?
  Mr. COBURN. There is a good example. There is a drug on the market 
known as Trazadone. The brand name is Desyrel. I use that drug a lot. I 
use the generic as a sleep-inducing aid for senior citizens, but I 
never use the generic for an antidepressant because it is not as 
effective. If we have this system, I will not be able to do that. So I 
will not be able to use a drug that there is significant difference in 
efficacy for treating depression, I will not be able to use that 
because we are going to use the generic. So, therefore, I will not be 
able to use that so I will not be able to give the care and nor will I 
have the confidence that my patient is going to get what they want.

[[Page 18641]]

  So the loss of choice is an implied loss of freedom, but it is also a 
decline in care.
  Mr. SHADEGG. Ultimately, as a medical doctor trying to tailor the 
best care for your patient, you would be at the mercy of a Federal 
bureaucrat who would decide which drugs can be used for which purposes.
  Let me ask this question: let us say someone is sitting home and 
saying we have to make certain trade-offs. Maybe that has to happen. 
Somebody has to ultimately decide. Maybe we cannot afford to allow 
patients to consult with their doctors and decide which drug is right.
  Do we have any assurance, if the gentleman knows the answer to this 
question, do we have any assurance that under the Clinton-Gore plan 
that at least it would be medical doctors as opposed to nondoctor 
personnel that would be deciding these issues under the Gore plan?
  Mr. COBURN. I cannot answer that. I do not know, but I can say in 
other government-run health programs, title X clinics, title XI 
clinics, it is not doctors that make decisions. It is an extension of 
the doctors, somebody that is abstract making those decisions. Thatis 
felt to be efficient, even though the care sometimes might be 
substandard.
  Mr. SHADEGG. The gentleman and I have worked on health care reform a 
great deal over the last 6 years, and particularly over the last 2 
years. I hope that the medical profession is aware that this results in 
a surrendering of their ability to pick the right prescription drug for 
their patient and a tremendous loss of choice, not just for patients 
but for doctors and a diminution in the quality of care.
  Mr. COBURN. I would like for us to ask the gentleman from Minnesota 
(Mr. Gutknecht) to stand up and join with us, because one of the issues 
that we raised, that this whole plan totally ignores, is enhancing of 
competition. What the Gore plan will do is cost shift the cost savings 
that might come about through Medicare on to the private sector, which 
will then raise everybody else's costs for prescription drugs. It will 
raise the State's cost in terms of Medicaid. It will raise the 
company's cost that pays for your insurance. If you pay your insurance 
yourself, it will raise. If you have no insurance, it will raise.
  The problem that we have today, the reason we are even addressing 
this issue, is because price has become predominant. We had a 17.4 
percent rise in the cost of prescription drugs in this country last 
year, when inflation was under 3 percent. There has to be something 
wrong here, and I think the gentleman from Minnesota (Mr. Gutknecht) 
has a solution to that and has been very vocal on how we enhance 
competition in this country, and I would welcome him to the debate.
  Mr. SHADEGG. Just let me stress the point of everyone is concerned 
about the cost of prescription drugs. I have, as I said, many seniors 
in Arizona that I am deeply concerned about. My question is: How do we 
solve the problem, and how do we do it in a way that helps people 
rather than hurts them? I welcome the gentleman to the debate.
  Mr. GUTKNECHT. I would like to thank my colleagues, and particularly 
the gentleman from Oklahoma (Mr. Coburn), and let me just say publicly 
we are going to miss him a lot in the next Congress. He has been a 
fearless advocate for real reform of our health care delivery system.
  I would just like to mention before we get into the price, people 
need to understand and they do not have to take our word for it and I 
want to thank my colleague, the gentleman from Arizona (Mr. Shadegg), 
for bringing up this whole issue about, let us at least deal with the 
facts, and everything I am going to say today I do not want people to 
take my word for it. The first thing I am going to say is anyone who 
believes that we ought to make the Health Care Financing Administration 
even bigger and stronger, just pick up the phone and call your local 
nursing home, call a registered nurse who happens to work in that 
nursing home.
  Mr. COBURN. Call a doctor.
  Mr. GUTKNECHT. Call anybody; call your doctor.
  Mr. COBURN. Or call your hospital.
  Mr. GUTKNECHT. Call anybody who is involved with hospital 
administration. Just go ahead and ask them do you think it is a good 
idea to make the Health Care Financing Administration even bigger and 
stronger?
  Mr. COBURN. More powerful.
  Mr. GUTKNECHT. Now, you might want to hold the phone back aways 
because you are going to get an earful of how the cow ate the cabbage. 
I mean, the people who deal with this powerful bureaucracy today will 
say the last thing they want to do is make it even more powerful.
  The other thing I want to say about this, and again do not take my 
word for it, do a little research, I think the best thing about the 
program that we are offering, and I am not going to say it is perfect, 
but there are three very important principles about our program that 
everyone needs to understand. First of all, it is going to be available 
to all. Secondly, it is going to be affordable for all. But, third, and 
I think the most important ingredient, is that it is going to be 
voluntary.
  Now, I am very fortunate. My parents are both on Medicare and because 
of the company that my dad worked for and the union contract that they 
had, he qualifies for a medical benefit now. So in many respects, they 
are in great shape. But if you ask the people who currently have 
coverage like that do you want to give it up for a program that is run 
by the Federal bureaucracy, the answer from most of those people is no. 
They like the program that they have today, and under the Clinton-Gore 
proposal they would lose the ability to choose the program that they 
currently have.
  I do want to talk about price, because many of us have been having a 
lot of town hall meetings over the last several years. I was first 
alerted to this problem a couple of years ago at a town hall meeting in 
Faribault, Minnesota. Some of the seniors stood up and they started 
talking about the differences between whatthey pay for drugs here in 
the United States as opposed to what people can buy those same drugs 
for, whether it is Canada or Mexico or Europe.
  I sometimes feel like that little boy who came in and asked his 
mother a question and his mother was kind of busy and she said, go ask 
your dad, and the little boy said well, I did not want to know that 
much about it. I feel a little bit like that little boy because the 
more I learn about this, sometimes I just say to myself I did not want 
to know that much about it.
  Let me just show this chart. Everywhere I have gone, and we have 
taken this to county fairs and town hall meetings, and the people who 
have seen this bear out these facts. Now, interesting, this chart now 
is about a year and a half old, and this is not just Canada or Mexico. 
This is about Europe. Again, I will come back to my father, 83 years 
old, he takes a drug called Coumadin. Now, he has prescription drug 
coverage. He does not pay full retail, but the truth of the matter is 
the average price for that Coumadin, it is a very commonly prescribed 
blood thinner, the average price about a year and a half ago in the 
United States for a 30-day supply of Coumadin was $30.25. That same 
drug, made in the same plant under the same FDA approval, was selling 
in Switzerland for $2.85.
  Now, one sweet lady at one of my town hall meetings came up to me and 
she said, if you think drugs are expensive today, just wait until the 
government provides for them free. And we need to think about that, 
because the answer to our problem, and let us go back to the big 
problem, and I think this was alluded to, the big problem is 
affordability. For an awful lot of seniors, if they could buy Prilosec, 
for example, instead at the average price in the United States which I 
now understand has gone up dramatically from this $109 figure for a 30-
day supply, the average price in Europe at the time this chart was put 
together was about $39, I am told that even today you can buy it in 
Mexico, again the same drug made by the same company, for less than 
$20. Now, if seniors had access to some of these world market prices, 
it would go a long ways to solving this

[[Page 18642]]

problem because seniors who are taking two or three prescriptions they 
might be able to afford easily $30 or $40 per month, but when that same 
prescription, that same drug, sells in the United States for say $200, 
as a matter of fact we had a gentleman at one of my town hall meetings 
in Winona, he came up to this chart, he pointed at two drugs and it 
added up to $149; and he said if I could buy those drugs at European 
prices, and he said that was about what I pay, but he said if I could 
buy them in Europe it is less than $50.

                              {time}  1545

  Now, he said, $150 really stretches my retirement and Social Security 
budget. But $50 I could probably afford that a whole lot more.
  The real issue, though, that we need to talk about is what do we need 
to do to bring down prescription drug prices to a world market level. 
The answer, I want to make it clear, I do not support price controls, 
and it is honest to say some countries in Europe and the Canadians and 
the other countries do employ various forms of price controls.
  Mr. Speaker, I have wrestled with this question. In some respects, 
some people say if you go to an open market system and you allow 
people, particularly our local pharmacists to buy from other countries, 
are you not just importing price controls? I have to admit, to some 
degree, that is correct. But we also have to step back and say, wait a 
second. These are the same drugs. We are the world's best customers. We 
should not be required to pay the world's highest prices.
  Mr. COBURN. Mr. Speaker, let me interject with the gentleman if I 
could for a minute. I think it is important for people to know that 
essentially Americans are subsidizing the drugs of everybody else in 
the world, number one, through our research, through the National 
Institutes of Health; and number two, through the prices that we pay. 
In fact, even if the gentleman's statement about reimporting price 
controls were true, what that would do is put a higher pressure on the 
negotiated price to the other countries and, therefore, Americans would 
not shoulder the absolute high cost of drugs compared to everybody 
else, and we would see a shift of that cost, an appropriate shift of 
that cost, to the others. Remember, these are all made in the same 
plants, shipped all over the world, and charged at significantly 
different prices. It is important to note that one way to do that is to 
allow reimportation at the wholesale pharmacy and at the pharmacy level 
of the identical drug from other countries. If we do that, we will 
drive some prices.
  The other point that I think is important that ought to be made is 
that this year $6 billion out of a $115 billion market for prescription 
drugs is going to be associated with television advertising for drugs 
that one cannot get unless a physician writes a prescription. The 
average consumer sees 10 of those ads a day. Now, who is paying for 
that? We are going to pay in America an extra $6 billion so we can see 
a commercial to tell us to go ask a doctor for a medicine when, in 
fact, what we should be saying is, Doctor, here is the problem I have, 
what is the best medicine? One of the subtle things that people do not 
realize is that when somebody comes to me thinking they need a certain 
medicine, it increases the cost of care, because if they do not really 
need that medicine, not only do I have to take their history and 
examine them, then I have to spend time explaining why they do not need 
the medicine that the ad just sold them and why they need this medicine 
that is cheaper, better and more effective. So, in essence, it is 
raising the total cost of medicine far beyond the $6 billion this year, 
the $9 billion that they are planning on spending next year, just on 
television advertising.
  Mr. SHADEGG. Mr. Speaker, if the gentleman will yield, I just want to 
make sure that the American public and that our colleagues understand 
that point. This is demand? Is there a technical term?
  Mr. COBURN. It is called poll through demand.
  Mr. SHADEGG. Poll through demand. We advertise to the American public 
a prescription drug, a drug that they can only get with a prescription, 
the goal being those of us sitting at home feeling some of those 
conditions will go to our doctor and demand that particular drug, and 
we see these advertisements all the time. The gentleman and I are 
paying for the cost of that advertising, we are paying for the cost of 
that doctor's visit, and we are paying for the doctor to say to us, no, 
you really do not need that drug, it is not right for your condition.
  Mr. COBURN. And, we are the only country in the world that allows it.
  Mr. SHADEGG. The only country in the world that allows demand driven 
advertising.
  Mr. COBURN. Through television.
  Mr. SHADEGG. Through television.
  Mr. Speaker, I would also like to ask my colleague from Minnesota who 
is, in fact, one of the experts in the Congress on this issue; his 
State borders Canada, my State borders Mexico. We have the same 
problem. I have people in my State of Arizona who go across the border 
into Mexico and get their prescription drugs at a fraction of the cost 
in the United States. It is shameful that they have to do that. It is 
particularly true that they have to do that in rural Arizona where they 
cannot take advantage of Medicare+Choice, where they get a drug 
benefit.
  I think it is important, and the gentleman deserves to be 
complimented for the work he has done to stop the FDA from sending 
threatening letters to these people. Iwould like the gentleman to 
explain that. I would also like the gentleman to address the issue of 
how will government subsidization of all drug prices in America, 
including the drugs for Ross Perot, for example, or Donald Trump, how 
will that somehow bring down the cost of drugs for the rest of us, or 
even for seniors?
  Mr. GUTKNECHT. Mr. Speaker, I think it will only make matters worse. 
If we were to pursue the Clinton-Gore formula, I think long term, it 
would drive the price of drugs even higher, even though they are trying 
to impose a modified form of price controls.
  I think the gentleman's question is a good one. We have been aware of 
this for several years now, that there are huge differences between 
Canada and Mexico, Europe, Japan, and what we pay in the United States.
  Now, I want to come back to something that the good doctor said. He 
said, we subsidize the pharmaceutical industry in several ways. One, 
through what we do with the NIH, the National Institutes of Health. We 
spend about $18 billion a year in basic research, much of which 
ultimately benefits the pharmaceutical industry. We also subsidize them 
through the price that we pay for those drugs. But there is a very 
important component that we sometimes forget. We also subsidize basic 
research through the pharmaceutical industries with a very generous 
research and development tax credit. So they are really getting 
subsidies three different ways from the American consumers.
  Mr. Speaker, I am not here to beat up on the pharmaceutical industry. 
They have provided us with miracle drugs. We in the United States and 
people around the world live better and longer because of the 
pharmaceutical industry.
  Mr. SHADEGG. But it is fair to ask, is one more subsidy going to 
solve the problem.
  Mr. GUTKNECHT. Right. I think we want to come back to this. We have 
known for a long time, and certainly the FDA has known for a long time, 
that there are differentials, so what consumers have done to try and 
save some money, and sometimes we are talking about thousands of 
dollars, they have gone to other countries.
  So what has this administration done about it? Well, they have done 
two things, and both of them, in my opinion, have made a bad situation 
worse. First, they have allowed some of the large pharmaceutical 
companies, Glaxo and Wellcome, used to be two very large pharmaceutical 
companies, today they are one. They have allowed these mergers to go on 
basically unabated.
  Mr. COBURN. If the gentleman will yield, they are just about to 
become GlaxoWellcome SmithKline Beecham.

[[Page 18643]]


  Mr. GUTKNECHT. We will have taken four huge pharmaceutical companies, 
and now we will have one. The net result is they will have greater 
control over markets and products, and we will see even higher prices. 
They have made a bad situation worse.
  Mr. Speaker, let me just talk about these letters. This is a 
threatening letter. They have sent literally thousands, I have heard 
estimates as high as 300,000 of these letters have gone to seniors who 
are threatening them through their own FDA because they tried to save a 
few bucks by going to Canada or Mexico or Europe to buy prescription 
drugs.
  Mr. COBURN. Mr. Speaker, we are just about out of time and I want to 
make just kind of a summary statement. The best way to allocate any 
resource in this country, any resource, is competition. I see the 
gentleman from New York (Mr. Crowley), very influential in our ability 
to try to reimport wholesale prescription drugs into this country. He 
understands that. The idea is to allocate resources with competition. 
That is one of the things we need to do.
  The last thing we need is another mandatory, government-run health 
care program that is already proving to be inefficient, has been tried 
once and was so expensive they dropped it; and number three, will 
discourage research, will discourage new drugs, and will cost-shift, 
and does no benefit for anybody except a senior. Everybody else is 
going to have a lower benefit, less access to health care through that 
plan.
  I yield the balance of the time to the gentleman from Arizona.
  Mr. SHADEGG. Mr. Speaker, I simply want to thank my colleagues for 
participating in this debate. The letters that my colleague from 
Minnesota has pointed out have gone to people in my home State of 
Arizona for just having the temerity to cross the border into Mexico 
and buy drugs at a fraction of the cost here in the United States.
  I think we need to force competition on the drug companies, I think 
we need to put them in a position where we force them to bring down the 
prices. I think we need to force them to quit forcing us to subsidize 
drugs in other countries. I certainly do not believe, and I compliment 
the gentleman for the facts that he has brought to this debate, I do 
not believe we should make up facts, I do not believe we should use 
false information, but I do believe that we should make it clear that a 
government subsidy, a program the likes of which is being proposed by 
the Clinton-Gore administration which says you get one chance to opt in 
or opt out and that is binding on you for a lifetime, and you hand 
over, by opting in, the right to choose your drugs to a bureaucrat, not 
a doctor; take it away from yourself, take it away from your family, 
take it away from your physician and give it to a bureaucrat. I cannot 
believe that is the best public policy Congress can come up with. I 
think there are better plans out there. I think the plan that we voted 
on, while not perfect, is a step in the right direction.
  Mr. Speaker, perhaps we should conclude by pointing out that this is 
an issue that is important and we will not rest until we address this 
problem for the American people.
  Mr. COBURN. Mr. Speaker, I thank my colleagues for participating in 
this special order with me.

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