[Congressional Record (Bound Edition), Volume 148 (2002), Part 8]
[House]
[Pages 11464-11471]
[From the U.S. Government Publishing Office, www.gpo.gov]




         THE SKYROCKETING COST OF PRESCRIPTION DRUGS IN AMERICA

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 3, 2001, the gentlewoman from Florida (Mrs. Thurman) is 
recognized for 60 minutes as the designee of the minority leader.
  Mrs. THURMAN. Mr. Speaker, tonight we have a group of women here who 
are very concerned about the prescription drug benefit that we may be 
voting on this week and with some particular interest in the high cost 
and

[[Page 11465]]

skyrocketing cost of prescription drugs in this country.
  Mr. Speaker, I yield to the gentlewoman from Illinois (Ms. 
Schakowsky), who is a valuable member to our caucus and has been 
actively involved in the area of prescription drugs.
  Ms. SCHAKOWSKY. Mr. Speaker, I thank the gentlewoman from Florida for 
yielding to me, who has been such a great leader on an issue that is so 
important to the 39 million people who are on Medicare. Those are the 
elderly and persons with disabilities.
  A lot of times we come to the floor and we talk about people that are 
in our districts or people that we have heard about or issues that 
affect some segment of our society, but not so often do we come to the 
floor and talk about a problem that affects so many people that also 
directly impacts our own families.
  The issue of the high cost of prescription drugs is hard to escape 
from, regardless of the income or the position of one's family. I 
found, much to my surprise, sometime ago that my family was not immune 
from this particular crisis.
  One day I got an e-mail from a cousin of mine that said, ``The reason 
I am writing you today, I saw you on C-SPAN giving a speech on 
prescription drugs.'' He said, ``I thought you would be interested in 
my mom's story.'' This is also my cousin, his mother.
  ``The last couple of years of my dad's life, he was relying heavily 
on all sorts of heart medication and other prescription drugs to keep 
him going and maintain a quality of life.''

                              {time}  1930

  Well, Mom kept on putting those drugs on their credit cards. How else 
were they going to pay for them? With Social Security? I do not think 
so.
  Well, anyway Mom did everything she could to make sure Dad got his 
meds. When Dad passed away in January 1998, Mom was left with a 
mountain of credit card debt. The Tuesday after his funeral, she had to 
declare bankruptcy. It just does not seem fair. But if you ask Mom, she 
would do it all over again to have a few more days with Dad.
  As we the baby boomers get older and the cost of prescription drugs 
is skyrocketing, something needs to be done to curb the drug companies. 
It cannot all be for recouping R and D. Somebody is gouging somebody.
  This e-mail was sent to me almost exactly 2 years ago today. And at 
that time there was not a candidate running for office, particularly 
for Federal office, who was not promising that something was going to 
be done about that high cost of prescription drugs. Oh, yes, elect me 
and I will go to the White House or I will go to the Congress and I 
will pass a prescription drug benefit for senior citizens. Do not 
worry, seniors. Vote for me and I will get you a prescription drug 
benefit. There was not anybody running for any office at the Federal 
level that did not say that.
  Well, those seniors, people in our own families, are still waiting in 
line for that prescription drug benefit. We are almost through an 
entire session of Congress, and there still is not a prescription drug 
benefit. They have been bumped out of their place in line by the 
airlines who we bailed out a very short time after September 11. They 
have been displaced from their place in line by a very few rich dead 
people when we excused them from the estate tax. And now as the front 
of the line appears closer and closer, maybe they are getting there, 
what they are offered up by the Republicans is a sham and not a plan, a 
bill that was written by the drug companies and for the drug companies 
that does nothing to control the high cost of prescription drugs, 
provides no guaranteed benefit, there is no predictable premium or 
copayment, no guarantee even that any insurance company will even offer 
them the chance to purchase a plan.
  A former member, Bill Gradison, who was president of the Health 
Insurance Association of America from 1993 to 1998, criticized the GOP 
private market approach to prescription drug coverage saying, ``I am 
very skeptical that `drug only' private plans would develop.''
  So even those people who are associated with the insurance industry 
think that there is not going to be such a plan available. That is what 
the Republicans have offered up.
  The Democrats on the other hand, we have a plan that does provide a 
guaranteed benefit, that is absolutely going to lower the cost of 
prescription drugs, will lower the cost by enabling the Secretary of 
Health and Human Services to negotiate a lower price for senior 
citizens, that says that all the beneficiaries of Medicare, our group 
just like an HMO or the Veterans Administration, and they will 
negotiate a lower price for senior citizens, and lower the amount of 
out-of-pocket costs.
  But women, women are the ones who are most affected, that are most 
hurt by the high cost of prescription drugs just like my cousin was who 
had to declare bankruptcy. Out-of-pocket spending on prescription drugs 
by seniors is the single largest out-of-pocket health care component 
after premium payments.
  Older women spend more out of pocket on prescription drugs on average 
than do older men regardless of the type of supplemental insurance 
coverage they have. Women on Medicare without supplemental benefits 
spend almost 40 percent more on prescription drugs than men, and men 
are spending too much. Older women are less likely than men to have 
employer-sponsored prescription drug coverage. Women without drug 
coverage spend more out of pocket on drugs than men. On average older 
women fill more prescriptions than men each year regardless of whether 
they have prescription drug coverage. Older women without prescription 
drug coverage on average have 18 prescriptions filled in 1 year 
compared to 14 for men.
  So this is a problem that impacts all Medicare beneficiaries, all 
old, every American, but particularly falls the hardest on women. And I 
know that my colleagues here, the women here, today are going to talk 
about how the Democratic plan is going to directly address the needs of 
the elderly, and particularly elderly women; and we will go into that.
  But I would just like to say that if anybody thinks that their 
families, their own relatives, their own parents or grandparents and 
aunts and uncles and cousins are immune from the runaway costs of 
prescription drugs, think again. If my cousin had not sent me this e-
mail telling me about the bankruptcy in my own family, I would not have 
known because my cousin was too proud to tell anyone in the family that 
this is what was going on.
  So I am just happy to be part of a great group of women who are here 
today to stick up for and to go to bat for all of the women who really 
need our help with the true prescription drug benefit under Medicare. I 
thank the gentlewoman for yielding to me.
  Mrs. THURMAN. Mr. Speaker, I thank the gentlewoman and certainly 
appreciate the story that you told about your cousins because there are 
hundreds and thousands of stories like that throughout this country, 
and it puts a face on why this issue becomes so important to us in this 
Congress.
  At this time, I yield to the gentlewoman from Nevada (Ms. Berkley) 
who has been a continued voice of reason from her experience and the 
experience from her own State, and we are certainly glad that she is 
here to engage us and give us some idea of what has been happening and 
happened and why some of these plans just will not work.
  Ms. BERKLEY. Mr. Speaker, I thank the gentlewoman from Florida (Mrs. 
Thurman) and the gentlewoman from California (Ms. Millender-McDonald), 
the cochair of the Women's Caucus for organizing this Special Order.
  I am here to discuss an issue that is absolutely crucial to seniors 
across America, Medicare coverage for prescription drugs. This is one 
of the most important issues that Congress will work on this year. This 
is a defining issue. Who exactly do we represent in this body? Do we 
represent millions of older Americans or do we represent the CEOs of 
the pharmaceutical companies? Seniors have the greatest need for 
prescription drugs. In many cases medicine is the most effective, 
perhaps

[[Page 11466]]

the only, treatment for illness; and yet one-third of senior citizens 
do not have any prescription drug coverage at all.
  This means that millions of seniors in our country have no 
prescription drug insurance, and soaring drug prices are putting 
necessary medications out of their reach. They simply cannot afford 
them. Nowhere is this problem more apparent than in my district in 
southern Nevada.
  Southern Nevada has the fastest growing senior population in the 
United States. When I go home every weekend, my seniors tell me about 
the drugs they are taking, the medications they need. They tell me how 
much they cost, and they tell me how difficult it is and what difficult 
choices they have to make. Do they cut the prescribed doses to make the 
medicine last longer? Do they take their medicine every day? Every 
other day? Do they pay their rent? Do they pay their electric bills? Do 
they buy groceries, or do they buy medicine?
  We have to do better as a Nation. We have to do better. We must enact 
the prescription drug benefit under Medicare. Our seniors are demanding 
it. Our seniors deserve it from their elected representatives. They are 
counting on us to honor our promises, our campaign promises to provide 
affordable prescription medication under Medicare, where it belongs, to 
older Americans.
  This legislation, the legislation that the Republican majority is 
sponsoring is a sham. It is not a prescription medication benefit. It 
is a press release, and it is a campaign ad. Their so-called benefit is 
complicated, and it is not guaranteed. There are gaps in the coverage 
and it will do nothing, absolutely nothing to lower the prices of 
prescription drugs. Their plan will not get the job done for our 
seniors.
  The majority bill also does a terrible disservice to our Nation's 
Medicare providers. If the Republican majority cared one wit for 
Medicare patients, for their doctors, we would pass a freestanding bill 
to restore Medicare reimbursements to doctors and other health care 
providers. Our doctors and health care providers, our nurses, our 
hospitals, other health care providers, are being deceived and they are 
being hurt by being thrown into the middle of this divisive issue. By 
attaching the Medicare reimbursement to a useless sham of an insurance 
based prescription bill, the Republicans have unfortunately doomed 
both.
  I am for a prescription drug benefit that is comprehensive, 
affordable and guaranteed. I am for a benefit that will provide uniform 
coverage for every senior in America no matter where they live or what 
their income. It does not matter if they live in the State of Nevada 
where we have a State program. It matters that all seniors are covered 
throughout the United States.
  America's seniors are depending on us to give them a benefit, the 
right benefit. Let us act responsibly and give them what they need, 
what they deserve, what they are counting on.
  Our Nation is depending on us. They are looking to us to do the right 
thing, and it is time for us to step up to the plate, fulfill our 
campaign promises and improve the lives of older Americans in this 
country.
  I thank the gentlewoman, and I appreciate the opportunity.
  Mrs. THURMAN. Mr. Speaker, I appreciate the gentlewoman's concern and 
her participation in tonight's Special Order.
  It is now my privilege to yield to the gentlewoman from North 
Carolina (Mrs. Clayton), someone who I have valued over the last 10 
years, somebody who came in with me, and somebody I served with on the 
Committee on Agriculture, and someone all of us in this House respect 
for the work that she has done. We are all very sad that she has made a 
choice to go home, but I have met her husband T.T., and I certainly 
understand. I am glad to have the gentlewoman here today.
  Mrs. CLAYTON. Mr. Speaker, I thank the gentlewoman for her 
leadership, and I thank her for yielding and her remarks.
  Mr. Speaker, I rise today to remind my colleagues of a promise made 
by Members and the Presidential candidates of both parties only a 
little less than 2 years ago. We all agreed that the rising costs of 
prescription drugs had reached critical mass and that it was forcing 
many Americans, particularly our senior citizens, to make choices they 
should not, in their golden years, be forced to make.
  But I also would like to point out that what the Republican 
leadership is just now getting around to offering is a choice that 
really is no choice. They have tied two issues that really should be 
dealt with separately. One is the prescription drug plan that is 
deficient at best and probably is dead on arrival in the Senate. The 
second matter is increasing reimbursements to rural hospitals and 
medical facilities by Medicare to better reflect the costs of providing 
a better service which I support but not in this bill. And especially 
as a co-chair of the Rural Caucus and the member of the Rural Health 
Caucus, we know the devastation that rural hospitals are suffering. So 
they need this reimbursement.
  So they have tied these two issues together with their Medicare 
Modernization and Prescription Drug Bill. The Republican leadership 
pits struggling health care facilities against struggling seniors. In 
this, the majority party shows us the height of their cynicism and the 
depth of their partisan politics at the same time. That is quite a 
feat, unfortunately. It would do nothing serious to help solve our 
seniors' problems relating to access and affordability when we 
understand what they have provided.
  Now, it does do something, I have to say, in terms of the hospital. 
But it will not be enough to solve the financial crises being 
experienced by our hospitals and our clinics, particularly in rural 
areas, and as a result of inadequate Medicare payments.
  The choices too many of our seniors are forced to make result in the 
difference between life and death in a struggle to juggle the very 
basics of their life such as rent, utilities, food, medicine and having 
those conditions that senior citizens have to juggle each time to make 
sure they are living.
  Disproportionately to men, this is the common quandary in which 
senior women find themselves. Senior women find themselves far greater 
in the quagmire. First of all, women live longer than men.

                              {time}  1945

  It is also a fact that cardiovascular disease is the leading cause of 
disability and death for women. Women have the highest incidence of 
diabetes, stroke, high blood pressure and cholesterol problems. There 
are also maladies like Parkinson's and Alzheimer's disease, breast 
cancer, arthritis and others, all of these requiring a lot of 
medication.
  As a result of years of gender pay inequity and other factors, older 
women are poorer than older men. Seventy-five percent of all elderly 
poor are women. Older women are twice as likely as older men to have 
incomes below $10,000. Sixty percent of all Medicaid beneficiaries are 
women, many widowed; and among Medicare beneficiaries of all ages with 
incomes below the poverty level, nearly 70 percent of them are women.
  Women are living longer than men with less money, usually on fixed 
income and with more medical problems to deal with, therefore requiring 
more prescription drugs, but prices for these drugs are increasing at 
triple the rate of inflation.
  According to a recent study by Families USA, which analyzed price 
increases for the 50 most commonly prescribed drugs for seniors over 
the last year, for the last year, nearly three-quarters of these drugs 
rose at least 1\1/2\ times the rate of inflation and over one-third 
rose three or more times the rate of inflation.
  Ten of the 50 most prescribed drugs for seniors are generics, only 10 
of them. The average price for generic drugs is only about $375. 
However, the average price for the 40 that are not generically 
available is $1,103, three times that.
  So women who have less money, less income, more health problems, find 
themselves having to rely on drugs that are four and five times the 
cost of generics or they are not available.

[[Page 11467]]

  Helping our hospitals by modernizing the payment schedule for medical 
services provided under Medicare and helping our seniors cope with the 
costs of life-sustaining medicines that are spiraling out of control 
are both worthy causes. We should be doing both but differently. They 
have different objectives, and they should be separated in different 
bills. These two issues should be debated separately in order to spare 
the people affected a divisive fight they did not pick.
  I have my rural hospital calling me right now to tell me to vote for 
this bill, and they know that I understand their plight. I also have my 
senior citizens calling me that this is insufficient.
  We should not be having these divisive fights by struggling rural 
hospitals and struggling rural citizens. We are pitting them together.
  The leadership knows what it is doing. It is putting together a 
poison pill for us to swallow. This is no choice because, indeed, my 
senior citizens should not indeed have to do this.
  We can do better, and we should do better, and the Republican 
leadership knows this is indeed only a fight of ideology, not really a 
worthy fight of principle.
  I thank the gentlewoman from Florida as well as the gentlewoman from 
California for having allowed me to participate in this special order 
on this very special subject.
  Mrs. THURMAN. Mr. Speaker, I thank the gentlewoman from North 
Carolina for her participation and her wonderful information that she 
has shared with us here tonight.
  I would like to now take some time to ask the gentlewoman from 
California (Ms. Millender-McDonald) to speak. I know she has some 
words. She has been a great leader on this, and she has worked so well 
with the Women's Caucus in trying to bring the issues and make sense of 
some of these things that we are hearing about in potential bills. I 
know tonight that we had especially one Republican Member of their 
caucus that got up and kind of talked about some issues that really 
kind of go to the essence of part of our message here tonight. So I 
would love to yield to the gentlewoman from California.
  Ms. MILLENDER-McDONALD. Mr. Speaker, I thank the gentlewoman from 
Florida for her leadership on this issue. She has been absolutely front 
and center with us on this very critical issue, an issue that is 
absolutely critical and important to women, senior women, seniors, and 
women as a whole.
  I was struck tonight by one of my Republican colleagues who came to 
the floor, the gentleman from Minnesota (Mr. Gutknecht), and he said 
something to the effect that we know the bill has problems, he says, 
about his Republican bill. He also said we must do something serious 
about this critical issue. It was amazing that he admitted to the fact 
that the Republican bill has problems, but I want to turn our attention 
to this chart I have behind me, because this chart speaks volumes to 
the experts who have also spoken about their concerns about the 
Republican drug bill.
  Bill Gradison, the former president of the Health Insurance 
Association of America, says, I am very skeptical that drug-only 
private plans would develop.
  Then we have John Rother, the policy director of AARP, and he says, 
There is a risk of repeating the HMO experience.
  These experts are talking about this Republican drug bill.
  Then we have Richard A. Barasch, chairman of Universal America 
Financial Corporation, and he says, I do not think it is impossible but 
the odds are against it, insurance participation. In fact, he is 
talking about the insurance company's participation.
  Then we have Thomas Boudreau, the senior vice-president and general 
counsel of Express Scrips, and he says, We are not enthusiastic about 
that approach.
  When we have these four to five experts that are experts in 
prescription drugs and Medicare and they are saying they have a problem 
with this Republican drug bill, then it solidifies just what we 
Democrats have said all along. This bill is flawed. This bill does not 
speak to what the Democrats have in our plan that we call the Medicare 
Modernization and Prescription Drug Act of 2002. This is a plan that is 
universal, affordable, dependable and accessible, and in spite of all 
of those fake things the Democratic plan has, it is voluntary.
  When the gentlewoman from Florida (Mrs. Thurman) talks about that, I 
am happy to join her and the other Members who have now come to the 
floor so that we can talk about some of the stories that we have, that 
we can bring to the American people about the difference between the 
Democratic prescription drug plan and the Republican prescription drug 
plan. So I will turn it back to her. Then, of course, she will 
introduce the other two ladies, and we will get started on what the 
people are telling us about the difference.
  Mrs. THURMAN. Mr. Speaker, reclaiming my time, before we move on to 
that, because I think the gentlewoman's poster says what the experts 
are saying about the Republican drug plan, one of the big differences 
that we all need to recognize is that, under the Democratic plan, 
seniors would have a new benefit under Medicare.
  Let me repeat that, under Medicare, and that would look and operate 
like the benefits they already get such as hospitalization and 
physician care because we would use those same providers that we use 
today. However, very interesting, the Republican bill can only 
guarantee private HMO-like drug plans and will participate in every 
area we think almost by bribing the taxpayer, because this is what they 
do. This goes directly to my colleague's poster, directly to her 
poster. To entice plans to participate, the Republicans allow a 
giveaway to the private insurers of up to 99.99 percent of the risk 
they would incur. In other words, in areas of the country where private 
plans are worried they might not make a profit, the government would 
guarantee at least a minimal profit to the private insurers at 
taxpayers' expense.
  The GOP plan does not require that the HMO-like insurers pass on the 
subsidies to the beneficiaries, directly to what they are saying.
  First of all, we do not know that there would even be a plan that 
would be offered. If there is not one, they are going to actually 
entice them at taxpayers' funding, similar to what we have done under 
Medicare Choice programs that have created all kinds of problems for us 
and, just as importantly, in this plan we still do not give the 
authority of the Secretary to, in fact, negotiate and use the power of 
40 million Medicare beneficiaries to achieve greater discounts for 
seniors.
  Guess what? This is proven. Look at the programs that we talk about 
up here. The gentlewoman from Florida (Ms. Brown) can tell us. She is a 
member of the Committee on Veterans Affairs. She has been an outspoken 
member on the Committee on Veterans Affairs and, in particular, dealing 
with prescription drugs both at the VA level and for our military 
retirees that we have offered. She can tell my colleagues that the 
power of people, and when we put a number like 40 million people into 
the risk pool, the costs are reduced.
  She has done a fabulous job in this area, and I would love to hear 
some of her maybe comments and experiences that she has even had in 
that realm, showing why it is so important that this goes under 
Medicare and not to private insurers. We are so glad she is here 
tonight, and we really do appreciate her leadership on this issue.
  Ms. BROWN of Florida. Mr. Speaker, let me just say that I want to 
thank the gentlewoman for yielding, but I want to also thank her for 
her leadership on this matter. We both share the great State of 
Florida, and we also share the many problems. Being one of the oldest 
aging populations, we understand what our seniors are going through, 
and we know we have got to bring some relief from the Federal 
Government, because clearly both of us serve, she served in the Senate 
and I served in the House, we know that in Florida, just as in 
Washington, the only thing that is going on is tax breaks, tax breaks, 
tax breaks, and not addressing the problems that our senior citizens 
are experiencing.

[[Page 11468]]

  Let me just tell my colleagues about my experience. When we had our 
little break in March, I went home. Just like all of us when we go 
home, we are going to do what we can to help out with our family; and 
so I am going to go to pick up my grandmother's prescription. Of 
course, I went there, and I am ready with my money, and I am waiting 
for the prescription. I know she pays this bill every month, $53, so 
that she can get a reduction and with an HMO. So I thought it would be 
a $10 or $15 co-payment, just like we have a co-payment of a small 
amount.
  The amount of the bill was $91 for one prescription. I could not 
believe it, $91. I talked to the doctor, and I wanted to know, I talked 
to the pharmacist, what is the problem, and what they told me was that 
her benefit had run out. We are talking about March. Three months with 
this HMO, and her benefits had run out.
  So when I think about my grandmother, who I could write a check for 
$91, I think about all the other grandmothers. We have a responsibility 
to look out for the grandmothers who cannot afford $91 a month for one 
prescription, and most people are taking four and five. It does not 
make any sense.
  During the last election, and my colleagues know the kind of hanky-
panky that went on in Florida, but one thing we do know for sure, that 
all of the candidates were saying that, if elected, I will provide a 
prescription benefit for the seniors.

                              {time}  2000

  Well, let me tell everyone something. We have been waiting 2 years 
for that promise to be kept, and in the meantime we have had constant 
tax cuts. We have had the terrorists operate; and if we are not 
careful, the seniors who cannot afford it will be the ones who are left 
out in the cold.
  Mrs. THURMAN. Mr. Speaker, I want to talk about that for just a 
second and what the gentlewoman from Florida (Ms. Brown) talked about 
in the benefit plan and particularly because it was under probably a 
Medicare Choice program of some sort; and by the way, the Medicare 
Choice plans would be covered under the Democratic plan. There has been 
some conversation on this floor over the last couple of days saying 
they would not be able to keep what they already have. That is not 
true. That is number one.
  Number two, though, the gentlewoman from Florida (Ms. Brown) 
mentioned a couple things that I think are extremely important to point 
out. Number one, under the Democratic plan it is a guaranteed minimum 
benefit, that is guaranteed; and under the Republican plan it is not. 
Guaranteed lower drug prices, for Democrats the answer is yes. For 
Republicans, it is no. Guaranteed monthly premium, that is a good 
thing. We think that is wonderful. Ours would be $25 set in the bill. 
It says $25. In the Republican plan we have no guaranteed monthly 
premium.
  What we have is a CBO estimate that it might be on an average premium 
of $34, not set in the bill. Annual deductible, again a most important 
part. The gentlewoman from Florida (Ms. Brown) talked about her 
grandmother in March. Well, under the Democratic plan it says $100 
deductible, period. Under the Republican plan it says $250 or an amount 
that makes benefit actuarially equivalent. I am not an actuary; so I am 
not sure what that means, but somebody will explain it. Co-insurance 
paid by beneficiary per year, 20 percent under the Democratic plan 
until out-of-pocket cost is $2,000. Under the Republican bill, listen 
because we have got to make this difficult, 20 percent for $251 to 
$1,000; 50 percent for $1,001 to $2,000; 100 percent of above $2,000 
until out-of-pocket cost is $3,800.
  Ms. BROWN of Florida. Mr. Speaker, would the gentlewoman yield?
  Mrs. THURMAN. I yield to the gentlewoman from Florida (Ms. Brown).
  Ms. BROWN of Florida. Mr. Speaker, I just want my colleagues to know 
that my grandmother cannot afford $3,800 a year. She is 96 years old. 
She does not have $3,800; and there lies the problem because our 
seniors just do not have it, and I do not understand why these other 
people do not get it. They are deciding. They have to pay their rent, 
they have to pay their mortgage, they have to buy food, and they just 
do not have this kind of money. I do not understand. Since the 
Republicans have taken over, what they practice is what I call reverse 
Robin Hood, reverse Robin Hood. When I was coming up, I used to watch 
Robin Hood. Reverse, stealing from the poor and working people, and now 
our frail elderly, to give tax breaks to the rich.
  Ms. MILLENDER-McDONALD. Mr. Speaker, if the gentlewoman from Florida 
(Mrs. Thurman) will yield, if I can just show this chart. As the 
gentlewoman from Florida (Mrs. Thurman) laid out, the actual premiums 
and the comparison of the two bills showing that the Democratic plan is 
the better plan, this is how much the average senior will save. The 
Republican plan, only 22 percent, compared to the Democratic plan that 
they will save 68 percent; and this is according to the CBO, the 
average senior will spend $3,059 on prescription medicine in 2005, the 
first year of any Medicare drug benefit. This right here absolutely 
outlines by the Congressional Budget Office that the comparisons are so 
stark that we can see that the Democratic plan absolutely gives a 
better benefit to seniors than that of the Republican plan.
  Mrs. THURMAN. Mr. Speaker, one other issue that the gentlewoman from 
Florida (Ms. Brown) brought up that I also think is very important in 
this debate and quite frankly it is an issue that our Republican 
colleagues are having, I can say from CongressDaily today, one is the 
cost issue. They are concerned about it. The gentleman from Minnesota 
(Mr. Gutknecht) came on the floor and showed the comparison of what we 
do in this country as compared to the same cost of that drug in another 
country, an industrialized country which is important to appreciate and 
understand and the price issue but it is the pharmacist issue.
  Let me tell a little story that I think makes a really good point. A 
couple of years ago, my mother, who lived with me, and I took care of 
her when she was sick and she was in Florida with me during one of my 
breaks, she had been at one of our teaching hospitals, Shands. I had 
brought her home after she had been in the hospital for a couple of 
days, and they had said to me, You know, Karen, we think these are some 
of the things we think are wrong, and what we want to do is go ahead 
and put her on some medications, but we would like you to bring her 
back in about 10 days to see how she is doing.'' I said, okay.
  So I go to the pharmacist, and I pick up the medicines. And I am not 
even going to speak to the cost of the medicines, but my dad was 
military, so my mother had always had the opportunity to go to the 
bases to get her medicines and she was in sticker shock, I think, for 
the very first time to see what the real cost of medicines were for 
other folks, or for her friends.
  But listen to how important this was. Just leaving the pharmacist out 
of this equation, which is another thing they do in this bill 
basically, because they do not have to include the pharmacist, our 
local pharmacies, my pharmacist said to me, You know, Karen, I can give 
you the full month's prescription on this, and it will cost you X 
amount of dollars, he said, but when does your mom go back to the 
doctor to get a checkup? And I said, Well, in about 10 days we will 
take her back to see how things are going. He said to me, You know 
what. I will just give you a 10- or 11-day supply. Why should I make 
you pay for 30 days when they may end up changing her medication 
because it may not be doing what it is supposed to be doing.
  That 10-day supply was something that cost me less, cost my mother 
less; and more importantly, when she went to the doctor in 10 days, 
guess what, they in fact did change and prescribe something different. 
And I just have to say that that kind of a story is so important to why 
the local pharmacists need to be involved in this issue, because we 
depend on them.
  Ms. BROWN of Florida. Mr. Speaker, if the gentlewoman will yield on 
that point. I had the Committee on Government Reform do a study in my 
district, and we compared what the seniors in

[[Page 11469]]

the Third Congressional District of Florida pay. We pay 131 percent 
more for a brand-name prescription than other consumers and 98 percent 
more than consumers in Canada and Mexico.
  Mrs. THURMAN. Reclaiming my time, Mr. Speaker, I want to get back to 
that issue, because I want to talk about an amendment that we offered 
to try to bring the cost down.
  But at this time I would like to take the opportunity to invite the 
gentlewoman from Texas (Ms. Jackson-Lee), a valued Member of this body, 
who has been actively involved in this issue and who I think has some 
information that we might have skipped over. So I would like to invite 
her into this discussion.
  Ms. JACKSON-LEE of Texas. Mr. Speaker, I thank the distinguished 
gentlewoman from Florida (Mrs. Thurman), and might I acknowledge my 
other colleagues, the gentlewoman from California and, of course, the 
gentlewoman from Florida (Ms. Brown) for their leadership, and 
particularly the areas of expertise that they all generate.
  I thought it would be helpful, as I was listening to my colleagues, 
to come to the floor and share some of the messages and the concerns 
that I bring back from Texas, but also the history of the Medicare 
legislation that many of my colleagues are familiar with.
  I would like to, as I show them some very important facts in pictures 
tonight, I would like to hold up a picture of President Johnson signing 
this legislation in 1965. If we were to track the aging of America, we 
would determine that post-1965 our senior citizens have lived longer 
because of the implementation of Medicare. And what we talk about 
tonight is the component that will add to the life of seniors today who 
are losing ground because so many of them now do not have a 
prescription drug benefit. That is what we are talking about with the 
Democratic plan, a benefit. That is quite the contrary from a voluntary 
optional program which an individual can choose to participate in.
  Now, many of my friends have said, and as many of my colleagues know, 
particularly the gentlewoman from Florida (Mrs. Thurman), we have been 
on this issue now for at least, I guess in our life, two or three 
terms, but 6 years or more, and some even longer; and for many times 
during that time frame, we budgeted very responsibly, meaning 
Democrats, in preparing ourselves for the expenditure. In fact, I want 
to cite for the record that last year, March 2001, we had about $5.6 
trillion in our surplus. We were prepared for what this might cost.
  I listened to the gentlewoman from Florida (Ms. Brown) discussing her 
grandmother, and I took a tour of my senior citizen centers and asked 
couples and singles how many of them are cutting their prescription 
drugs, and hands went up; and how many of them are not taking the drugs 
or not taking them in the right amount, and hands went up. There, right 
in front of my eyes, was the undermining of their health.
  In addition, about 2 years or so ago, I was running around my 
district in a panic because my seniors were in a panic. We were trying 
to answer concerns, because what had happened in Texas was that HMOs 
had shut their doors, literally shut their doors. We had seniors in 
Harris County who had become reliably comfortable with HMOs, between 3 
and 4 million people. Many of us, elected persons and others, begged 
HMOs either to come back or to stay. I remember us getting into 
negotiations where we asked if they could stay an extra 90 days. My 
senior citizens know what I am talking about. Their HMOs shut down on 
them.
  My fear with the Republican plan, this plan that is a card or some 
kind of membership, is that when we get to a point and we find that it 
is not profitable, and when I say ``we'' I mean those who are engaged 
in this plan, when they find it is not profitable, am I to expect that 
those pharmaceuticals will shut their plan down?
  So I wanted to show another picture to say why this can be done and 
why it is imperative that we do this. Because imagine becoming 
dependent on this voluntary card, imagine seniors having accepted it, 
having become comfortable with it, that is, if it even works, and they 
get a few dollars off from it, and they hold this card in their hand 
and, all of a sudden there is some analyst locked up in a room 
somewhere in corporate headquarters that says, you know what, they are 
not making any money in Jacksonville, they are not making any money 
near Orlando or Houston, Texas, so shut it down. Then I have got 
thousands of seniors without the ability to secure their medicine.
  I want the American public to understand that this is a well thought-
out process; and we believe, many of us, that when we look responsibly 
at the tax cut, and I know there are many shades to the tax cut, but if 
we look responsibly, and we are talking about that major one that 
really just focused in on 1 percent of the population, there were other 
side-bar tax cuts, but it is that big one, and we believe when we look 
at that seriously we can find 64 percent of the people that would not 
be opposed to rolling back the tax cut that Congress passed last year 
and using that money to provide a prescription drug benefit under 
Medicare for seniors.
  So this dialogue tonight, and I thank the gentlewoman from Florida 
for it, this dialogue tonight is not reckless, it is not an attempt to 
use what we do not have. It is, frankly, a recognition of really the 
concern we all have. And I want to be responsible, but sometimes I 
visit my seniors and there is panic. And I use that word only because I 
have seen it, the panic they might face by going one more month, one 
more day without a real drug benefit.

                              {time}  2015

  Mr. Speaker, I simply say in closing that I know the other body is 
discussing this issue. We have to recognize the other body. Why pass 
legislation in the House that has absolutely limited chance in a 
compromise effort in the other body? We are trying to get legislation 
that is realistic and will answer the concerns of all seniors.
  I am disappointed that we cannot come to a conclusion on something 
that deals realistically with a guaranteed benefit, and I might say 
protection of our rural hospitals and urban hospitals, taking care of 
some of the formula problems that we have, there seems to be no reason 
why we cannot do this. I thank the gentlewoman from Florida (Mrs. 
Thurman) for her leadership.
  I smile because lawyers have more than one closing, but this is a 
closing. Women, I have been hearing this all day long, have a greater 
use and/or need for Medicare drug benefit, not diminishing the men, but 
we are finding out that many older women are living longer, and we are 
going to help with research to help men, living as widows without 
income, they are really suffering. I think we can do better.
  Mrs. THURMAN. Mr. Speaker, I thank the gentlewoman from Texas (Ms. 
Jackson-Lee) and her concern for her constituents and the stories that 
they have told the gentlewoman.
  I do want to say one other thing. We are getting phone banked in our 
offices right now. I had a conversation with my staff this afternoon 
about this phone banking. I asked what are they saying.
  They said, first of all, we get this phone call, and then all of a 
sudden there is a click and somebody is on the phone. We say, this is 
the office of Mrs. Thurman; and they say, I want you to vote for 
whatever the bill number is on this piece of legislation.
  My answer is, I will be glad to vote on a Medicare prescription drug 
benefit but not one that is privatized. They say, that is exactly what 
I want you to do.
  Just remember, all of us standing here tonight are for a prescription 
drug benefit that is under Medicare.
  Mr. Speaker, I yield to the gentlewoman from California (Ms. Watson), 
former ambassador, as well as a State legislator, who has dealt with 
State health issues in California and I know had some very difficult 
times after some propositions out there.
  Ms. WATSON of California. Mr. Speaker, I thank the gentlewoman

[[Page 11470]]

from Florida (Mrs. Thurman). I thank all Members who are making the 
case for our seniors and particularly those who are women, because they 
rely more heavily on prescription drugs than the average American. 
Although they represent just 13 percent of the population, they consume 
more than one-third of all prescriptions. Not only do seniors use more 
drugs, they also rely on more costly medications. Drug expenditures for 
seniors constitute 42 percent of the Nation's total. Seniors with 
health insurance find themselves without coverage for prescription 
drugs more often than not.
  More than 10 million Medicare beneficiaries lack coverage, and 
millions more have inadequate and unreliable drug plans. Part of the 
solution to our current problem is the enactment of a meaningful drug 
benefit within the Medicare program.
  I am from California, and I know some Members did not really 
understand what our substitute Democratic proposal had in it. They said 
it will hurt California. The only reason that perception was out there 
is because California has an excellent MediCal program where we offer 
about 32 to 35 more benefits than are required under Medicaid. That 
accrues to the Medicare program as well. This proposal that is a 
substitute proposal or a supplemental proposal will only benefit our 
seniors in California, not hurt them.
  Republicans have proposed a bill to address the problem that is just 
plain bogus. The American public must filter out the rhetoric and see 
the Republican plan and the Democratic substitute for what they really 
are. The phone calls that the gentlewoman is getting are people who 
have been deceived and misled. We need to clarify so they will know. I 
want to spend a second clarifying.
  The Republican bill covers less than one-fourth of Medicare drug 
costs over the next 10 years. The Republican bill does not help with 
any drug cost between $2,000 and $5,600. The Republican drug benefit is 
vague. They offer a standard suggestion for what private plans might 
offer. In addition, their bill does not guarantee that seniors will 
have affordable, and that is the keyword, affordable drug coverage.
  The House Democratic proposal adds a new Part D in Medicare that 
provides voluntary prescription drug coverage for all Medicare 
beneficiaries beginning in the year 2005. The Democratic proposal 
authorizes Medicare contractors to obtain guaranteed reductions in 
prices.
  The Secretary of Health will have the authority to use the collective 
bargaining power of Medicare's 40 million members to negotiate prices 
on particular drugs. The basics are: $25 a month premium, $100 a year 
deductible; and beneficiaries pay 20 percent, Medicare pays 80 percent 
and a copay; and a $2,000 out-of-pocket limit per member per year. 
That, Mr. Speaker, is the Democratic plan. That is not a Republican 
maybe plan.
  Yes, it has a price tag. But the Republican $1.6 trillion tax cut 
would pay for this program several times over. Just do the math.
  Members should be able to respect older Americans, and we need to be 
able to give aid to New Yorkers post 9-11 and fight the terrorist 
threat at the same time. We can do it all if we were not foolishly led 
to support a $1.6 trillion give-back to the wealthiest Americans.
  Mrs. THURMAN. Mr. Speaker, I thank the gentlewoman.
  Mr. Speaker, it is my privilege to introduce the gentlewoman from 
California (Mrs. Davis) who is a freshman, who was one of those out on 
the campaign trail when everybody was saying we have got to have a 
prescription drug benefit. We are so pleased that the gentlewoman is 
here and is such an active voice on this issue.
  Mrs. DAVIS of California. Mr. Speaker, it is true when I was out on 
the campaign trail we talked a lot about health care. That is why it 
was so interesting to me a few months ago when I was in Costco on the 
weekend with my husband doing some shopping and I noticed that people 
were following me around the store. I started getting a little nervous 
and finally stopped long enough for them to approach me.
  Basically what they said is that they know that Congress has got to 
focus on the war on terrorism, that that is our priority, and I support 
the President in his efforts. Then they said, we understand that, but 
when is Congress going to get back to talking about health care? They 
proceeded to tell me about the difficulty that they are having with 
their mother and her prescription drug costs.
  I know that Members get e-mails and letters daily. I have one here. 
``Dear Congresswoman Davis: I have only one request. That is to help 
us, families with members who suffer from Alzheimer's disease. Medicare 
does not cover my mother's prescriptions, which is very costly, around 
$140 for 30 tablets that she must take. Taking care of her is really 
hard. Where are we going to end with medication and treatment for this 
disease? We need your help soon.''
  And another letter, ``As retired people and getting up in years, my 
wife and I are spending an increasing share of our income on medicine. 
I hope you can find a way to help us with that problem.''
  Well, we are talking about that now, and that is a good thing. The 
reason we are here tonight is to talk about the impact that this has 
particularly on women. It is all about our priorities, what is 
important to us and what do we choose to fund.
  We know that in America today over a quarter of women on Medicare, 
nearly 6 million women, lack any prescription drug coverage at all. The 
average woman, age 65 and older, lives nearly 7 years longer than the 
average man, and she is typically widowed, living alone and struggling 
to make ends meet on an annual income of $15,615, compared to over 
$29,171 for men. It is nearly half of that for men.
  So that is why we come before the House today to talk about how this 
impacts women. We know that two-thirds of Medicare beneficiaries with 
annual incomes below the poverty level are women and that a woman 
spends 20 percent of her income each year on out-of-pocket health care 
costs.
  I am committed, as I know Members here today are committed, to a fair 
prescription drug plan under Medicare that does not stifle innovation 
or eliminate choice in coverage. I want to help seniors afford the 
increasingly expensive prescription drugs that they need to treat or 
prevent illness.
  We know what is going to be before us does not have the access, has 
geographic inequalities that do not work, and has premium concerns that 
will not work for our seniors. We need to develop the best 
comprehensive plan. We need to develop a prescription drug plan that 
provides our seniors with real benefits. An alternative does exist, and 
I hope that there will be an opportunity to bring that to the House 
floor for discussion.
  I thank the gentlewoman for bringing these issues before us today.
  Ms. BROWN of Florida. Mr. Speaker, I understand the family of the 
gentleman from Indiana (Mr. Kerns) is visiting with us in Washington 
here today, and I know that they are very, very proud of you being the 
Speaker. I want to thank the gentleman for being here tonight as we 
conduct this very important debate.
  Mrs. MALONEY of New York. Mr. Speaker, I thank you, Congresswoman 
Thurman for organizing this important special order on the need for 
prescription drug coverage.
  Medicare provides health care coverage to forty million retired and 
disabled Americans.
  For decades, Medicare has worked to provide needed, lifesaving health 
care to millions, but it is missing a fundamental component: a 
prescription drug benefit.
  If we have courage, this Congress can make history and give our 
nation's seniors what they desperately need: a real, and meaningful 
prescription drug plan.
  I am proud to joint my Democratic Colleagues, lead by Mr. Dingell, 
Mr. Rangel, Mr. Stark and Mr. Brown, as an original cosponsor of the 
``Medicare Prescription Drug Benefit and Discount Act.''
  I come to the floor this evening to discuss two points:
  Number 1: unlike the Republican drug plan, the Democratic plan is 
simple because it builds upon a proven model--Medicare.
  Just like seniors pay a Part B premium today for doctor visits, under 
our plan, seniors would pay a voluntary Part D premium of $25

[[Page 11471]]

per month for drug coverage. For that, Medicare or the government will 
pay 80 percent of drug costs after a $100 deductible. And NO senior 
will have to pay more than $2,000 in costs per year.
  There is an urgent need for this plan. The most recent data indicates 
that almost 40 percent of serniors--an estimated 11 million--have no 
drug coverage. Problems are particularly acute for low income seniors 
and seniors over the age of 85 (the majority whom are women). 
Additionally, those older Americans who do have coverage find that 
their coverage is often inadequate for their needs.
  The Democratic plan is a real plan with real numbers, not estimates.
  Point 2: the Republican Plan does nothing to bring down the cost of 
prescription drugs. The Democratic plan is the only plan that provides 
real Medicare prescription drug coverage for our seniors by stopping 
soaring drug costs.
  Under the buying power of Medicare, through competition and 
bargaining we can rein in drug costs. Prescription drug costs are too 
high for our older Americans. They need help now!
  For instance, look at Prevacid. Prevacid is an unclear medication, 
and the second most widely used drug by American seniors. The cost for 
this prescription is on average $137.54 per month in New York City--cut 
only $45.02 in the United Kingdom, a price different of 200 percent.
  Or look at Celebrex, a popular arthritis medication and a drug needed 
by many older women, especially, since older women are stricken more 
often than men by arthritis. According to a Government Reform Committee 
report released by Mr. Weiner and myself, a monthly supply of this drug 
costs $86.26 in New York City. In France, a monthly supply of Celebrex 
costs only $30.60. This is a price differental of 182 percent. Seniors 
in New York City without drug coverage must pay almost three times as 
much as purchasers in France.
  Prices for prescriptions have risen 10 percent per years for the last 
several years, leading to over $37 billion in profits last year for the 
giant drug companies. While these corporations wallow in their spoils, 
seniors suffer without coverage.
  Unfortunately, the brunt of the problem falls squarely on our 
nation's olderly women, who are nearly sixty percent of our senior 
citizens. We need to take care of America's older women, we need to 
help all of our senior citizens.
  Mr. Speaker, we must pass the Democratic prescription drug plan 
without delay. It is built on a proven model medicare. The Republican 
plan only offers gap-ridden coverage. The Republican bill is about 
privatization. The Republican plan is all about election year politics.
  For the sake of our seniors, we must pass the democratic plan, and we 
must pass it now.

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