[Congressional Record (Bound Edition), Volume 148 (2002), Part 8]
[Senate]
[Pages 10894-10897]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           PRESCRIPTION DRUGS

  Mr. GRAHAM. Mr. President, since its creation in 1965, the Medicare 
Program has helped millions of the Nation's elderly and disabled when 
they were in desperate need, after they had become sick enough to 
require a physician's assistance or hospitalization. Thirty-seven years 
after its creation, it is time for change.
  A prescription drug benefit is the most fundamental reform we can 
make to the Medicare Program. Why? If we want to truly reform Medicare, 
we must change its basic approach from one that is oriented toward 
intervention after sickness to one that focuses on maintaining wellness 
and the highest quality of life. This prevention approach will require 
in almost every instance a significant use of prescription drugs.

[[Page 10895]]

  An example of how the use of prescription drugs has changed medicine 
was made by Dr. Howard Forman, a congressional fellow in my office, who 
is a doctor and professor at the Yale Medical School. Dr. Forman 
remarked to me that none of his students had ever seen ulcer surgery. 
Why? Because we now give patients prescription drugs to care for this 
ailment which previously was dealt with through surgery. This is just 
one of many examples of where modern medicine has fundamentally been 
altered by prescription drugs; notably, by improving the quality of 
people's lives, ending the need for many surgeries and long recovery 
periods.
  A side benefit of this change would be that the cost to the Medicare 
Program could be lowered by utilizing these expensive but less 
expensive prescription procedures as opposed to traditional surgery.
  The prescription drug legislation I am sponsoring, with my friends, 
Senator Zell Miller of Georgia and Senator Ted Kennedy of 
Massachusetts, would improve the Medicare Program and give seniors a 
real, a meaningful, a sustainable drug benefit. With a $25 monthly 
premium, no deductible, and a simple copayment of $10 for generic 
drugs, $40 for medically necessary, standard brand name drugs, and $60 
for other brand name drugs, and a maximum of $4,000 in out-of-pocket 
expenses, our plan would give seniors the universal, affordable, 
accessible, and comprehensive drug coverage which they want and need.
  Our plan would help 80-year-old Freda Moss of Tampa, FL. She has no 
prescription drug coverage. Today, she pays nearly $8,000 a year for 
the drugs she needs to keep her healthy. This does not include a new 
prescription for Actos, an oral diabetes drug that costs $143.68 every 
month. Freda has not had this prescription filled because it is so 
expensive.
  Under the Graham-Miller-Kennedy plan, she would pay just over 
$2,900--saving $5,100 each year. Under the House Republican plan, 
Freda's drug costs would be at least $4,220 a year. Why would the House 
plan cost Freda $1,320 more per year?
  There are many reasons, including a higher monthly premium and a $250 
deductible. But the single biggest reason is the ``donut.''
  What is the donut, Mr. President? We are all familiar with donuts. 
They are round; they taste good; often, they have powdered sugar on 
them; they are tasty at the edges. But when you get into the middle, 
there is nothing there. That describes the benefit structure of the 
House Republican plan.
  Let's look at how this plan would have affected Freda and her 
husband, Coleman. After having paid a $250 annual deductible, Freda and 
her husband would pay 20 percent of the cost of each specific 
prescription up to $1,000. From $1,001 to $2,000, she would pay 50 
percent of each prescription. And then she hits the hole in the donut. 
Freda is on her own until she reaches the catastrophic limit of $4,900 
in total drug costs.
  While she is struggling through this hole in the middle of the donut, 
she would be responsible for continuing to pay her monthly premiums of 
about $34, for which she would receive nothing, no benefit.
  Mr. President, there is no comparable donut in private health care 
plans. The kind of plan which probably covered Freda and Coleman before 
she came on to Medicare did not have this approach; it has, as we do, 
continuous protection. One of the things our older citizens want is 
certainty and security. Our plan gives them that.
  The House Republican plan converts them into guinea pigs, 
experimenting with untested health care policies and a ``gotcha'' of an 
unexpected hole in the middle of their benefit--a hole which runs from 
$2,001 all the way to $4,900 of expenditures. We are not going to make 
39 million senior Americans into laboratory experiments.
  Under our plan, Freda would pay no deductible, receiving coverage 
from her first prescription. She would pay a simple copay for each 
prescription. There are no donut holes. Instead of gaps, we give 
American seniors a plan that mirrors the copay system that they had in 
their working lives.
  Mr. President, as my colleague, Senator Miller, says with such 
conviction and passion: This is the year for action, not just talk, on 
prescription drugs.
  I don't want to go back to Tampa, FL, and tell Freda we had a very 
strong debate about this issue. I want to tell Freda she can start 
going to the drugstore and from her first prescription begin to get 
real assistance. We all will come to the floor this week, and in the 
following weeks, to remind our colleagues about the importance of 
passing a prescription drug benefit before the August recess, and to 
have that benefit in law before the end of this session of Congress.
  The ACTING PRESIDENT pro tempore. The Senator from Georgia is 
recognized.
  Mr. MILLER. Mr. President, I, too, rise to talk about prescription 
drugs and the struggle our seniors face every day.
  Since April, I have been coming down to this Chamber on a regular 
basis to speak about the urgency of passing a prescription drug benefit 
before the August recess. I have spoken about how we have kept our 
seniors waiting in line for years and how we have bumped them time and 
time again to debate other issues--other important issues but other 
issues.
  Our majority leader, Senator Daschle, has said we will bring up 
prescription drugs on the Senate floor before the August recess. I and 
many others are very grateful.
  As of today, we now have three bills in Congress to add a 
prescription drug benefit to Medicare--two in the House and one in the 
Senate--the one I am a cosponsor of, along with Senator Graham of 
Florida, Senator Kennedy, Senator Daschle, and about 28 other Senators.
  This issue is now where it should be; it is front and center. It has 
more momentum today than it has had in all the years we have been 
talking about it. Our seniors have finally reached the front of the 
line. Now it is time to get down to business and have a real debate on 
the details of these proposals.
  Make no mistake about it, there are real differences among them. 
Let's debate those differences. If we can, let's find some common 
ground. And then let's get something passed because if we fail to do 
something now, if we just criticize each other's bills for the sake of 
criticizing, and dig in our heels and refuse to compromise and work 
something out, our seniors are never going to let us forget it come 
November.
  After years of wandering in the wilderness, our seniors are now 
inside of the promised land. Both political parties have brought them 
there and have given them a glimpse. We cannot send them away to wander 
in the desert for another election cycle or who knows how many more 
years.
  I urge my colleagues to let us have a healthy debate on these bills. 
Let us point out the strengths and weaknesses of each proposal, but 
never lose sight of the big picture, as Senator Graham just said at the 
end of his remarks.
  This should not be viewed as just an issue for the next election 
campaign. I urge my colleagues not to look at it in that way. Our goal 
should be to pass a prescription drug benefit. I will work hard to see 
that the bill we pass in the Senate offers real help for our seniors, 
especially for our neediest seniors.
  As Senator Kennedy said so eloquently last week: The state of a 
family's health should not be determined by the size of a family's 
wealth.
  One way to help our seniors, including the neediest, with 
prescription drugs is to pass a bill that has no gap in coverage and 
that places a reasonable cap on out-of-pocket expenses.
  The Graham-Miller-Kennedy bill offers just that. There is no gap in 
coverage, and the out-of-pocket maximum is set at $4,000 a year. After 
$4,000, Medicare would pick up 100 percent of the cost of prescriptions 
under our bill. But the House Republican bill provides no coverage from 
the time a senior's total drug costs reach $2,000 to the time they 
reach $4,900. That is that ``hole in the donut'' Senator Graham was 
talking about that is so obvious.
  Who will it hurt the most? The ones who can afford it the least--the 
low-income seniors. To add insult to injury,

[[Page 10896]]

the House bill requires seniors to continue paying monthly premiums 
during this gap, even though they are not receiving a single penny of 
benefit. Even the neediest seniors would have to pay these premiums 
during this gap. That is not right; that is just plain unacceptable.
  I look forward to debating this provision, and many others, when we 
take up prescription drugs in the next few weeks. I urge my colleagues 
in both Houses and in both parties to keep the big picture in mind. Our 
duty to seniors is not just to debate a bill, it is to pass a bill.
  The final product won't be perfect. It won't include everything that 
I want, and it won't include everything that some of my colleagues may 
want. But it will be better than what our seniors have now. And what 
our seniors have now is nothing.
  The ACTING PRESIDENT pro tempore. The Senator from Massachusetts is 
recognized.
  Mr. KENNEDY. Mr. President, first of all, I want to commend our 
colleagues, Senator Miller and Senator Graham, for their leadership in 
this area, which is of such enormous importance and consequence to 
people in my State of Massachusetts and across the country.
  I hope the American people are going to pay close attention to these 
presentations that are made today by both of these leaders, as well as 
my friend from Michigan, Debbie Stabenow, as they continue to help the 
American people understand what is really at stake.
  Medicare is a solemn promise between the government and the American 
people and between the generations. It says ``Play by the rules, 
contribute to the system during your working years, and you will be 
guaranteed health security in your retirement years.'' Because of 
Medicare, the elderly have long had insurance for their hospital bills 
and doctor bills. But the promise of health security at the core of 
Medicare is broken every day because Medicare does not cover the 
soaring price of prescription drugs.
  Too many elderly citizens must choose between food on the table and 
the medicine their doctors prescribe. Too many elderly are taking half 
the drugs their doctors prescribe--or none at all--because they can't 
afford them. The average senior citizen has an income of $15,000 and 
prescription drug costs of $2,100. Some must pay much more.
  I want to pick up on the issue of comparing the different bills. 
Hopefully, as we come to debate these issues and questions, we will 
begin to understand the importance of the differences in the Democratic 
and Republican bills. They are enormously different.
  The administration's first bill did not even pass the laugh test, and 
the bill that is being considered now by the Republicans in the House 
of Representatives does not pass the truth-in-advertising test. The 
administration allocated $190 billion. Senior citizens are going to 
spend $1.8 trillion for prescription drugs. So they get about 10 cents 
on the dollar to assist them, and there are still a lot of gimmicks 
they have to go through to get even that.
  Listen to the Republican proposal. The House Republicans have a 
proposal that says: If you have an income below 150 percent of poverty, 
you are not going to have to worry about your premiums, copayments, or 
deductibles. Doesn't that sound reasonable for low-income people? 
Except there is an assets test which the Miller-Graham proposal does 
not have.
  This is basically a hoax on the low-income people. To qualify for 
low-income subsidies under the Republican plan a senior cannot have 
$2,000 in savings. They cannot have $2,000 in furniture or property, 
they cannot have a car that is worth $4,500 or a burial plot that is 
worth $1,500. Any one of these assets disqualifies one from the 
Republican plan. Do they mention that? No. Do you read about it? No. Is 
it there? Yes. Effectively this writes off, writes out millions of low-
income seniors.
  This group of seniors is seeing a fraud perpetrated on them. The 
Miller-Graham bill has rejected that concept. If we in the Senate are 
going to be true to our word, we will reject it, too. This will be an 
important battle.
  The second group of seniors is those with moderate incomes who are 
going to pay the $420 annual premium and the additional $250 
deductible. We know they are going to get very little in return. They 
will pay up to $670 in premiums and deductibles before they are going 
to get any assistance at all. Those with prescription drug spending of 
$250 or less will pay $670 and receive no benefit. Seniors who have 
drug costs between $250 and $1,000 annually will spend up to $820 in 
annual costs but only receive up to $600 in benefits. Those seniors 
with prescription drug costs falling between $1,000 and $2,000 a year 
will pay premiums, deductibles, and copayments totaling up to $1,320 in 
return for benefits of up to only $1,100. Seniors ought to know just 
what help the Republicans are offering in their proposal.
  Finally there is the last group, individuals who still have a very 
modest income, but have prescription drug costs over $2,000. They are 
going to fall into the hole, as Senator Graham has pointed out. They 
will get no assistance for their drug costs once they reach $2,000.
  It is important to understand, as we begin this debate, who is going 
to be helped and who is not going to be helped. The Republican program 
fails to explain that either to their membership or to the American 
public.
  In each of these areas, the Miller-Graham bill rejects those 
artificial barriers and assists each and every citizen all the way 
through. That is a major difference. This is one of the important 
differences we ought to recognize.
  Here's another important difference. Rather than the safe, dependable 
Medicare system that senior citizens understand, the Republican plan is 
run through private insurance companies--pharmaceutical HMOs. They are 
allowed to set premiums at whatever the traffic will bear. And there is 
no guarantee that benefits will actually be available if private 
insurance companies decide they don't want to participate. Senior 
citizens have seen what has happened to HMOs in the regular Medicare 
program--cutbacks in benefits, withdrawal of services. They don't need 
that for lifesaving prescription drug coverage.
  And to complete this dishonor roll of the Republican plan, it does 
not even start until 2005. The Republican prescription for senior 
citizens: take two aspirin and call the pharmacy in two and a half 
years.
  Senior citizens and their children and their grandchildren understand 
that affordable, comprehensive prescription drug coverage under 
Medicare should be a priority. Let's listen to their voices instead of 
those of the powerful special interests. Let's pass a Medicare 
prescription drug benefit worthy of the name.
  The ACTING PRESIDENT pro tempore. The Senator from Michigan.
  Ms. STABENOW. Mr. President, I rise today to join my colleagues in 
supporting the Graham-Miller-Kennedy bill of which I am very pleased to 
be a cosponsor, which will provide a voluntary comprehensive Medicare 
prescription drug benefit. This is long overdue.
  I also rise today to express great concern about what is being done 
in the House of Representatives. We know that in the end we need to 
come together with a bipartisan bill. We welcome that and want to work 
with our colleagues, but it has to be something real, it has to be 
something that provides more than 20 percent of the cost of 
prescription drugs--only 20 percent help--leaving our seniors to pay 80 
percent and, in some cases more, for their prescriptions. It is just 
not good enough.
  I wish to share some portions of a letter I received yesterday from 
the Kroger Company of Michigan that was written to me concerning the 
legislation that is being drafted and passed by our Republican 
colleagues in the House. It says:

       Dear Senator Stabenow: As president of the Michigan Kroger 
     stores, I am writing to advise you that our stores oppose the 
     Thomas-Tauzin medicare bill.

  The Republican bill in the House.

       Passage of this bill will hurt Michigan senior citizens by 
     confining their freedom in

[[Page 10897]]

     choosing generic over brand name medications and restricting 
     their pharmacy choices. Furthermore, the viability of 
     community pharmacies is of significant concern, especially in 
     rural areas where inadequate reimbursement rates could force 
     many community pharmacies out of business, further 
     restricting seniors' choices.

  There is great concern not only from the senior groups, those that 
represent consumers in our country. I appreciate the president of 
Kroger expressing great concern about this as well. We can do better. 
The question is, To whom are we going to listen?
  I am asking, as are my colleagues, that we listen to not only seniors 
but businessowners and others who are experiencing an explosion in the 
prices of prescription drugs, and that we act and do so now. It is long 
overdue.
  A few weeks ago, I invited people to come to my Web site. We have set 
up the prescription drug people's lobby in Michigan. We are tying it to 
a Web site that has been set up nationally, fairdrugprices.org, and I 
have been asking people to share their concerns, their experiences with 
the high prescription drug prices we are seeing across the country.
  Once again, I wish to share a story from one of those citizens in 
Michigan who has signed up to be a part of our prescription drug 
people's lobby.
  This is from Molly A. Moons, who is 44 years old in Pontiac, MI. She 
says:

       Senior citizens are not the only people suffering from the 
     high cost of prescription drugs. I am the sole employee of a 
     small business and not eligible for any health care plans 
     that cover the cost of prescription drugs. I have four 
     prescriptions that need filling each month, and the cost is 
     in excess of $300 a month--a real financial burden. At the 
     invitation of some senior citizen friends, I was invited to 
     take a ``drug run'' to Canada.

  Mr. President, a number of us have done this to demonstrate the 
differences in prices.

       These ladies were all widows/retirees on fixed incomes that 
     were having trouble paying for their medications, so I joined 
     them to buy our prescriptions in Canada.
       . . . I am able to get a 3-month supply of medication for 
     what it costs me for a 1-month supply in the United States.

  A 3-month supply in Canada for a 1-month supply in the United States.

       I find that shameful.
       While I believe that everyone has a right to make a 
     profitable living, the gouging of the pharmaceutical 
     companies is sickening. Additionally, the loopholes that 
     these companies use to keep drugs from generic manufacturers 
     are also criminal. Please help make this stop.

  I thank Molly Moons for sharing her story as a small businessowner 
and sharing her concern about the senior citizens who were on that bus 
going to Canada. Shame on us. She is right, ``I find it shameful,'' and 
it is shameful. We are saying we can do something about it. We can do 
something about it by passing the Graham-Miller-Kennedy bill that will 
provide a comprehensive Medicare prescription drug benefit, and we can 
further do it by passing other legislation to lower prices through 
expanded use of generics, opening the border to Canada and other 
policies that will lower prices. We can do that, and we need to do 
that.
  Why has this not been done? Why has this not happened? We have been 
talking about it. I talked about it as a Member of the House of 
Representatives. We tried to pass something then. Colleagues of mine 
have talked about it. Presidential candidates have talked about it. As 
the Senator from Georgia said earlier, it is time to stop talking about 
it and get something done.
  Why has that not happened? Unfortunately, we have seen too much 
influence and too many voices trying to stop this, and not enough of 
the people's voice in this process, which is what we are trying to do 
right now.
  We have a Web site that I have invited people to go to that is called 
fairdrugprices.org. We are inviting people to sign a petition to urge 
Congress to act right now, to urge Congress to pass a comprehensive 
Medicare prescription drug benefit, and to pass other efforts to lower 
prices. We urge people to go to this Web site and share their story. We 
will share those stories on the floor of the Senate.
  Why is that important? It is important because, according to our 
numbers, there are about six drug company lobbyists for every Member of 
the Senate. Their voice is being heard. This is about making the 
people's voice heard through their Representatives and their Senators.
  Unfortunately, there are other ways in which voices are heard. I 
found it unfortunate that yesterday, while in the midst of debating a 
Medicare bill, which has been viewed by colleagues and quoted in the 
paper from House Republican staff as being a bill they are very 
concerned about having reflect the needs of the drug companies, but at 
the same time we do not have the concerns of our seniors and our 
families being voiced as a part of that process, that last evening 
there was a major fundraiser. Our colleagues on the other side of the 
aisle and the House of Representatives had a major Republican 
fundraiser and we saw a number of pharmaceutical companies playing a 
major role.
  We saw Glaxo Smith Klein, according to the newspaper, contributing 
about $250,000 to that fundraising effort; PHRMA, which is the trade 
organization for the companies, contributing about $250,000 to that 
fundraiser; Pfizer, about $100,000, and other companies as well. So 
there are those that are not only here as lobbyists but contributing 
dollars to fundraisers, certainly wanting to make their voice heard.
  The PRESIDING OFFICER (Mr. Miller). The Senator's time has expired.
  Ms. STABENOW. Mr. President, I ask unanimous consent for 2 additional 
minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Ms. STABENOW. In conclusion, we know the lobbyists' voices are heard 
on this issue, the drug companies' voices are heard in a multitude of 
ways. Now is the time for the people's voice to be heard on this 
subject, and I urge those who are watching today to get involved 
through fairdrugprices.org, by showing support for a bill that will be 
brought up in July and will be voted on in this Senate to provide real 
help for seniors and those with disabilities in our country.
  We will bring forward other legislation to lower prices for everyone, 
for the small businessowner, the manufacturer in Michigan, the farmer, 
those who are paying high prices through their insurance premium or at 
the pharmaceutical counter. The time has come to act. We know what to 
do. Now it is time to do it.
  The PRESIDING OFFICER. The Senator from Pennsylvania.

                          ____________________