[Congressional Record (Bound Edition), Volume 149 (2003), Part 12]
[Senate]
[Pages 16864-16866]
[From the U.S. Government Publishing Office, www.gpo.gov]




                THE HOPE-FILLED SENATOR FROM NEW MEXICO

  Mr. DOMENICI. Mr. President, I was in my office and I regret that I 
was unable to be in the Chamber when the distinguished majority leader, 
Dr. Bill Frist, gave a rather elaborate, detailed, and enlightened 
discussion regarding illnesses, ailments, cures, and the evolution of 
diseases in this country and in the world.
  I commend him for that. Had I been in the Chamber at that time, I 
would have taken the opportunity to present him with the first document 
that the Senator from New Mexico is having printed. It will be 
something that I choose to call ``The Hope-filled Senator.'' The hope-
filled Senator is the story of America's future in terms of diseases, 
prescriptions, and cures. It is my own story of what I believe is going 
to happen to prescription drugs, to the medical profession, and to the 
delivery of health care over the next 30 to 40 years.
  I am hoping that this very brief summary of the hope-filled Senator's 
thoughts will be of some help to Senators and people who are so worried 
about the costs of prescription drugs. Will it really work; will we 
really have enough money to do it or not?
  Today, I will not repeat the contents of this hope-filled statement 
that I delivered as the Senator from New Mexico, calling myself a hope-
filled Senator.
  Suffice it to say that when one discusses a program of the magnitude 
of this prescription drug program, that it is absolutely imperative 
that it is looked at from more than one vantage point. One vantage 
point is to look at it as Senators did on the Senate floor, in the back 
rooms and in caucuses. We talked about the specifics of who is going to 
get the drugs, how much is it going to cost, will we have enough money, 
and are we going to be able to pay for it? We asked will America go 
bankrupt? Will Medicare really survive and will it be competitive? Are 
we really building into the system? We examined the ingredients that 
are so well known for bringing prices down. We examined competition for 
delivery and competition for business. All of that is one way to look 
at it.
  One must look at it that way, but another way to look at it is to try 
to think of what is going to happen to health delivery and medical care 
during the ensuing 10, 20, 30, or 40 years. The hope-filled Senator is 
talking about those things as he looks at the next four decades.
  By way of recapitulation of what was in my statement of a hope-filled 
Senator, there are three or four big things. We finished mapping the 
chromosomes of the human anatomy. We call that the genome system. That 
means that after years of mankind researching to try to find where in 
the chromosome of the human body was the aberration that caused 
multiple sclerosis, and years of research at various institutions to 
locate the gene, or the number of genes that caused, perhaps, 
schizophrenia--what we finally did in a record period was to take them 
all, map them and index them. We can say we know where they all are. We 
do not have to go looking for them anymore.
  I do not mean to make this a big thing, because people sometimes 
think they do not have to worry about it. But this is a big thing. For 
years, even in our lifetime, we can remember reading a story that would 
leave the medical journals and be big enough to hit the newspapers. The 
story would say, ``Michigan State group of researchers discover the 
location on the genome system of a multiple sclerosis gene.'' Remember 
that? Boy, that was big time.
  Soon, I am going to hand to the majority leader the first copy of a 
document called ``The Hope-filled Senator.'' I am going to have it 
encapsulated with gold print. It is the hope-filled Senator's other 
side of the story. It is the story of the delivery system of health 
care during the next 40 or 50 years as it most assuredly will impact on 
this prescription drug system.
  I did not go bother a bunch of scientists in putting this document 
together. So, they may find this document lacking. But what I did, and 
I repeat it now because our leader is in the Chamber, I used four or 
five big things that are going to change. I started with the genome 
mapping, indicating that we have now located the aberrations on the 
chromosome system of the anatomy of every known disease from which 
mankind suffers.
  Why is that important in the hope-filled Senator's dissertation 
regarding prescription drugs? Because there is no question during the 
delivery system that we tried so valiantly to find out how much it is 
going to cost. During that time many diseases for which we are spending 
huge amounts of money in prescriptions are going to be cured. 
Researchers will know where the illnesses are and they will be able to 
research how to fix them. And, they are going to fix many of them.
  What does that mean? That means many of the expected costs that the 
Congressional Budget Office plugged into their estimates are going to 
be different. Indeed, there are going to be prescription drug 
breakthroughs that come from this genome mapping that are going to 
clearly indicate that there are different ways to do what we are doing 
today. We can achieve better results. So, as I said this will 
dramatically change the delivery system of health care.
  I was foolish enough, as a hope-filled Senator, to predict that 
before the turn of 40 years the hospitals in America will not be the 
hospitals of today. I predicted that we would have hospitals that are 
going to be more concerned with genetics than with the individual 
curing of an ailment.
  I did not dream that up. When I first started working on genomes, I 
had a magnificent, wonderful doctor who egged me on, and he was the 
inventor of Tylenol. He used to sit in my office and talk with me. He 
used to draw

[[Page 16865]]

what he thought a hospital might look like in 30 or 40 years. I used to 
laugh and throw the drawings away. He drew a center where you would 
check your gene system and they would tell you, as you left, what was 
wrong with you and how they would fix you. Or if you got sick, that is 
what they would plug in. That would be the hospital.
  He is still alive; he is currently practicing as a very old doctor. 
He joined up with doctors who are down in the South delivering health 
care to poor people free. He does this just because he wants to keep on 
being a doctor. He was so thrilled that he hooked me on this concept 
that we never lost contact.
  In this hope-filled sermon, we start with that.
  Then I said, the American economy is going to change so rapidly in 
terms of its productivity and, at the same time, produce new things 
because of nanoscience. I defined nanoscience as the newest science 
that is so unique, and so way out, that today's scientists are saying 
we will not recognize the products that humanity will be using because 
of nanoscience. They are practicing a science of changing the molecules 
that make up a substance. Imagine, compare that with making zinc by 
adding a couple of compounds. That science is today's industry. They 
will be changing the molecular makeup so things change and become 
something different.
  It is predicted with the five centers that exist in America today on 
nanoscience, and many more to come, that the breakthroughs, once they 
start, will occur with such rapidity that the productivity in America 
and in the world will change. That means those who make medicine and 
cures will be part of picking up that change and those breakthroughs 
also.
  The third that I am aware of, and there are probably some I am 
missing, is a most incredible science. For lack of better terminology 
it is called microengineering or the production of microengines.
  I visited the Sandia National Laboratory in New Mexico. They wanted 
to show me microengines. I thought, you have to be kidding; what kind 
of engines could there be that are so small they have now reached this 
level? They showed me. Microengines are so small. Now we have in the 
computer business a chip, and on the surface of the chip we can put 
these different things, and that is how we get these millions of 
megabytes. Now it is trillions and numbers we did not even used to use. 
They actually create engines that are so small they put them on a chip, 
but they can be synchronized and organized as engines on that little 
chip.
  The engines look to me something like an oil patch when you see the 
drilling wells with the pumps. They are so small you could never see 
them unless you used an extremely powerful microscope.
  What will happen with these engines? We do not know. But, they have a 
hypothesis. It is entirely possible that one of the first things we 
will do with these engines is organize them so well that we will be 
able to inject them in the human body. They will be directed to do some 
work, and they will do it like they are told. And, believe it or not, 
they possibly will go in and eat what you want them to eat. They will 
be able to go into the heart system to open up areas we worry are 
clogged. These little microengines will dissolve those clogs for you.
  Those are engineers that can do that work. We will not even have to 
send patients over to Vanderbilt University to a bunch of scientists or 
heart specialists.
  There will be huge numbers of breakthroughs if we add those three 
things to a vibrant American economy. We must not mess up by causing 
the American economic system to go to sleep. We must keep the economy 
vibrant, by doing the right things in terms of taxing the right things 
and not the wrong things. If we continue to fund the right research 
instead of the wrong things, and we keep on funding NIH but maybe we 
reach the point where 10 percent a year might be enough and maybe we 
move over and fund some physical science like the Energy Department and 
a few other institutions of our Government that are doing basic science 
so physical science can catch up with the biological sciences. There 
will be huge numbers of breakthroughs.
  My hope-filled delivery dissertation says: Don't be so worried about 
whether we will be able to deliver on what we promise. We may be able 
to deliver even more than we think we are going to deliver. And let's 
just watch out that in putting the system together--and I know the 
majority leader has been worried about this--that we don't just put 
bureaucracy in place where it inhibits the injection of these new 
things into the delivery system.
  That is why HCFA, which this Senator personally as a young Senator 
found was such a terrible inhibitor to delivering appropriate care had 
to be changed. The management tool had grown so big that all we heard 
as Senators when we went home to our hospitals, to our doctors, to our 
clinics, to those centers that were taking care of people in shelters, 
all we heard was HCFA is messed up so badly that we are doing worse 
with their rules than if we did not have any rules. It was so bad once 
that I thought I would come back here and introduce a bill that 
recommended we experiment with 100 places where we will treat seniors 
with no regulations. We would look at them once every 6 months. And 
take a chance and see if they are not better run and the people taken 
care of better and cheaper than those who have to have someone checking 
off every time an apple was delivered to a senior that happened to have 
been decayed, if it was brown and faulty. At one time, you had to note 
that you delivered a bad apple, literally, to a senior.
  Now, frankly, I know a lot about fiscal policy.
  I know a lot of experts on this bill who are worried about whether we 
are going to have enough money to deliver under this system. But I 
chose to go over it and spend a little bit of time on it. Once I 
decided we were going to try this and to talk about this, I say to my 
friend, the majority leader--yesterday afternoon while he was still 
burdened, I sat down and wrote on a piece of paper what the score would 
be at whatever hour we voted last night. What I wrote down was the vote 
would be 78 yes, and 22 no. The vote turned out to be 76-21. I think I 
know what happened to one of them who would have made it 77, the 
Senator from Pennsylvania. But I think it became pretty clear to people 
like me that the Senate was ready. I had a hope they were ready, 
because even if they weren't, I had a hunch they had some hope we could 
get this done.
  Mr. FRIST. Mr. President, will the Senator yield?
  Mr. DOMENICI. I am pleased to yield.
  Mr. FRIST. Mr. President, just about 30 minutes ago I sat down and 
wanted to review a little bit about the last 6 months. As I did that 
and came to the floor and cited some of the legislation we have done, I 
so much appreciate the comments of the Senator from New Mexico because 
they fit with the hope which I translate into maybe additional dreams 
and hopes, but reality.
  I have been blessed to be in this body for the last 8 years, but 
prior to that, 20 years in the scientific field and spending hours and 
nights in laboratories thinking and trying to hypothesize about what 
would occur 6 months later; or why a capillary muscle relaxed in a way 
based on the metabolic environment and doing my best to figure it out 
and doing the experiments; but then 6 months later because of the work 
of other people in maybe unrelated fields, having that hypothesis 
changed and productivity to increase to the point that my idea was 
solved--not the way I wanted to, but because of investment with 
science. I would run over from the laboratory to the clinical arena and 
work in a health care system that was beautiful, which was delivering 
the very best quality of care but looking at it through really a 
Medicare system at the time that was so rigid and inflexible because of 
the 130,000 pages of regulations from HCFA--the Health Care Financing 
Administration--which had evolved over a period of 30 years with good 
intentions but which so micromanaged and so

[[Page 16866]]

straitjacketed the physicians, the scientists, the researchers, the 
patients, governing the doctor-patient interaction--130,000 pages of 
governing which meant you could not capture whether it is the 
nanotechnology or the 3 billion bits of information out of the human 
genome project today, with the micromanaging that the Senator was 
talking about--that can't be assimilated into the system of health care 
delivery at a rate which the American people deserve.
  I mention that because as I was going through this legislation, I was 
thinking of AIDS/HIV, a huge problem with 23 million people dead and 40 
million people infected, and there is no cure. Another 60 million 
people will die. Thus, we need to encourage that innovation, invent 
that vaccine, engage in that science. Right now we don't know what the 
hypothesis is. But it is there, and we are going to see it in our 
lifetime, because in part, just as the Senator from New Mexico led the 
support in the human genome at the time, at the time nobody really knew 
what was going to happen, he was out here 15 years ago leading on the 
human genome project, for a shorter period of time we had that phone 
book of 3 billion bits of information which is there. It is the phone 
book, as he said. Now it can be applied.
  I mention that because 12 hours ago on this floor we passed a piece 
of legislation that delivers prescription drugs in an unprecedented way 
for the first time in the history of the Medicare program. We are 
helping seniors with prescription drugs. But at the same time it 
modernizes Medicare to get rid of the unnecessary bureaucracy, the red 
tape, the straitjacket, the micromanagement, building in the 
flexibility where those new ideas, the dynamism from the marketplace, 
the innovation in the marketplace can be assimilated and speed up the 
process where we can address this huge unfunded liability which we know 
occurs in Medicare today because of what our seniors deserve. But we 
have a doubling of the number of seniors.
  At the same time we offer the prescription drug package, we modernize 
Medicare in such a way that it is flexible. These new ideas will be 
incorporated in a rapid fashion.
  Heart transplantation. At the time I first started heart transplants, 
it was very rare. Lung transplants had never been done successfully. I 
am not that old. But I had the opportunity to be involved in heart 
transplants. It took about 5 years after I was doing them routinely in 
the private sector for Medicare to allow any reimbursement for our 
seniors--5 years because of bureaucrats. It is the way Government 
works. It takes a long time. That is just one procedure.
  The optimism which the Senator talked about, I think so realistically 
and eloquently, is there. There is no question.
  When we talk about 14 years out trying to predict essentially a 
static system moving ahead, and it is not going to happen--the advances 
in technology are just like that. The half-life of science has gone 
from 10 to 7 to probably 4 years now, and it is going to be down to 2 
years. It is the same way with the health care delivery systems, and 
the old fee-for-service.
  My dad practiced medicine for 55 years. As the Senator was talking 
about the genetic testing that is going to be available, the 
appropriate response and how we are going to be able to develop cures, 
I was sitting there thinking of my dad with his black bag in the 1940s, 
1950s, and 1960s. He didn't have any medicines. He had none. He had 
antibiotics after 1945, but none before that.
  But the revolution I have seen when I was doing heart transplants and 
lifting people's hearts out and putting them in was made possible 
because of one drug--cyclosporine. If the pharmaceutical companies had 
not invested to get that drug, we would not have been able to do heart 
and lung transplants.
  The advances we went through in that 20 or 25 years--and now I see 
because of the work like the human genome projects and nanotechnology--
that combination--once we allow that to marry with our health care and 
government-sponsored programs, the sky is the limit. Productivity will 
increase. The advances can be assimilated. We will be able to think 
more in terms of, yes, longevity, but also quality of life.
  It does come down to hope. I very much appreciate the Senator 
articulating the big vision, because every day we are here, in the back 
of my mind I am thinking the same thing. Prescription drugs are 
important, but at the same time to develop a system that can capture 
that technology and at the same time look at HIV/AIDS and make sure 
there is a vaccine bill, and that we keep trying. We are all trying to 
get it through.
  But right now, because of the medical liability issues which we are 
going to address in July, when you have predatory trial lawyers--not 
all are predatory--who are really going to come in and say that vaccine 
has certain side effects, there is going to be a lawsuit, and there 
will be a lot of frivolous lawsuits that drive up the cost of health 
care and drive people to the ranks of the uninsured.
  One last issue which I didn't mention earlier but which we addressed 
on the floor goes into this--medical safety in the hospital.
  The Institute of Medicine report said there are 100,000 people who 
die every year because of medical errors in the hospital. Most of that 
is cross-reaction from drugs and the like. The best way to approach 
that is to have information voluntarily shared by physicians and by 
nurses to learn in an ongoing, continuous quality management program 
and to have that information available, which is correct, and which is 
self-correcting. But if you have predatory trial lawyers all the way 
around, and you have incentives not to share that information, we are 
never going to make this system better.
  So it all fits together: the science, the technology, the framework 
which the Senator explained so well. What we are doing in Medicare, the 
access to prescription drugs, global HIV/AIDS--you put all that 
together. If we keep moving things, as we have in the last, I would 
say, 6 months, I am absolutely--absolutely--convinced we are going to 
be able to capture those hopes.
  In many ways, people say: You're dreaming. You describe them as 
hopes. Having seen science and technology in my own life, they may have 
started as dreams, and they may be hopes now, but in our lifetimes they 
are going to be reality.
  Mr. DOMENICI. Thank you so much for your comments. I was very pleased 
to yield.
  I just want to say, without hopes and dreams in these fields, there 
is no question we are overwhelmed. It is hopes and hope-filled ideas 
that keep us energized. But it does not mean we do not have a big job 
because, as a matter of fact, the hopes can truly be deenergized by 
systems that do not let it work. That is what we have to worry about.
  In my opinion, the breakthroughs are going to be so rapid that the 
bureaucracy that manages the change is going to have to be looked at 
all the time by people who really know. The breakthroughs will occur, 
and it will make your 5-year example--of how long it took for the heart 
to go from being done to being accepted--it will make that example pale 
as compared to the breakthroughs that are going to be over and over and 
around here and over there. We think the new bureaucracy--which the 
Senator and others helped put together--will make that work better.
  I do want to hold the floor. I thank the Senator.
  The PRESIDING OFFICER (Mr. Bennett). The Senator from New Mexico.

                          ____________________