[Congressional Record (Bound Edition), Volume 149 (2003), Part 13]
[House]
[Pages 17592-17596]
[From the U.S. Government Publishing Office, www.gpo.gov]




             LOWERING PRESCRIPTION DRUG PRICES FOR SENIORS

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 7, 2003, the gentleman from Illinois (Mr. Emanuel) is 
recognized for 45 minutes as the designee of the minority leader.
  Mr. EMANUEL. Mr. Speaker, before I begin, I want to thank my 
colleague from Texas not only for his generosity of providing this 
time, but for the passion that he brings to education and to

[[Page 17593]]

working families of all ilks, and the eloquence he brought to the words 
about the importance of education as the stepladder to the American 
dream.
  So I want to thank him now for the generosity he provided so I can be 
with my family this evening and catch the last flight, and for his 
passion and tireless work on behalf of all Americans. Texas is lucky to 
have you as a Representative and a voice; not only a vote, but a voice 
for their values.
  Mr. Speaker, about 2 weeks ago a number of us came to the floor to 
speak on market access, and that is the ability of Americans to 
purchase medications anywhere in Canada, Ireland, England, France, 
Germany, Italy, wherever they get the cheapest price.

                              {time}  2000

  Since the last time that my good friend from Minnesota and I were 
here, there was a report yesterday by Families USA that ABC news 
covered and the Wall Street Journal covered, and I would like to bring 
that statistic to the attention of the American people. It reaffirmed a 
disturbing trend about skyrocketing prescription drug prices in the 
United States.
  On average, the prices of the 50 drugs most commonly prescribed to 
seniors increased at a three-and-a-half times rate of inflation. The 
total spending of senior citizens on prescription drugs rose an 
estimated 44 percent from 2000 to 2003, when inflation was only running 
at collectively over those periods of time of 6 percent. Now we are 
projected to spend over the next 10 years $1.8 trillion by our seniors 
on their medications, and yet when we think about those dollars, the 
American elderly spend somewhere between 30 to 300 percent higher in 
prices than the senior citizens of France, England, Germany, Canada, 
Denmark, any of the G-8 countries and our colleagues in Europe.
  My good friend from Minnesota has brought a bill into play that 
allows our American consumer, our American elderly, our businesses and, 
most importantly, our taxpayers to get the use of market forces to 
reduce those prices, bring real competition and the close market that 
our pharmaceutical companies have brought and bring competition that 
would save billions of dollars to the consumer and, most importantly, 
to the taxpayer.
  To me, if we are going to have the largest expansion of an 
entitlement in 40 years, spend $400 billion, you would think you would 
want to get the taxpayer the best price, but the pharmaceutical 
companies have done a pretty good job of playing the political system 
to their benefit, and they have tried to prevent us from getting this 
bill to the floor, because if we got the bill to the floor, they would 
know what happens.
  In my view, this is not only good for the seniors, they would get 
good prices, but it would be fair to the taxpayers who are going to be 
asked to pay this bill.
  So my friend from Minnesota has a wonderful bill. I think he has been 
here many times to explain his chart about comparative prices. I would 
like to yield now some time to him to talk, and then I would like to 
ask some questions, if he does not mind.
  Mr. GUTKNECHT. Mr. Speaker, will the gentleman yield?
  Mr. EMANUEL. I yield to the gentleman from Minnesota.
  Mr. GUTKNECHT. Mr. Speaker, I want to thank the gentleman from 
Illinois, and I want to make a special point. This is time on the 
Democrats today. We have Democrats and Republicans that are agreed on 
this because, as I said in the past, this is not a matter of right 
versus left. It is a matter of right versus wrong, and it is simply 
wrong to require that Americans pay the world's highest prices for 
prescription drugs, even though we are the world's best customers.
  In virtually every other area that you can imagine, the best 
customers get the best prices, but that is not true in prescription 
drugs, and I began to research this story about 5 years ago, and the 
more I learned, the more upsetting and compelling this story really is.
  The story is that Americans are really held captive, and anytime you 
have a captive market, it is absolutely predictable that you are going 
to see the world's highest prices.
  I want to give you a few examples from this chart. I apologize, this 
chart is kind of hard to read, but I will show you some of the 
examples, and I will give you the total, because I was in Germany 2 
months ago, and we bought 10 of the most commonly prescribed 
prescription drugs. What you see here on the chart is the prices that 
we paid in Munich, Germany, and what those prices would be for the same 
drugs, same quantities, same milligrams, here in the United States. Let 
me give you a few of those examples.
  This is a drug called Coumadin. It is a blood thinner, actually 
developed at the University of Wisconsin veterinarian schools, and 
actually originally developed as a rat poison, but in the United 
States, this box of drugs would sell for $89.95. In Germany we bought 
the drug for $21.
  Here is another drug, Glucophage, made by Merck. It is a very 
effective drug for diabetes. A 30-tablet, 850-milligram package in the 
United States, $29.95. You can buy that same package, this package of 
drugs we bought in Munich, Germany, for $5.
  The story goes on. Zocor, commonly prescribed drug, a very effective 
drug, the United States price, $89.95. You can buy that drug in Germany 
for $41.20.
  The grand total of these 10 drugs in Germany was $373.30 American, 
but if we went down to buy them here in Washington, D.C., or almost any 
city in America, the price would be $1,039.65.
  Mr. EMANUEL. Those are the same drugs? I did not mean to interrupt my 
colleague. Same medication, nothing different?
  Mr. GUTKNECHT. In fact, in many of the cases, I believe these drugs 
were made in the same plants, and they are shipped around the world.
  All we really are saying in our bill is let us do with prescription 
drugs essentially what we do with every other product, and that is 
allow market forces to work to make certain that Americans are not held 
captive, and as I have said, I think Americans should pay their fair 
share, but I do not think we should be required to subsidize the 
starving Swiss.
  We also have a colleague with us tonight, my good friend from North 
Carolina (Mr. Jones) who has joined us tonight, and he has been a 
strong proponent of opening markets and finding ways to get cheaper 
prescription drugs not just for senior citizens, but for all Americans. 
Ultimately we are going to have a prescription drug benefit for the 
taxpayers as well, and I would yield, if I could, a few minutes to the 
gentleman from North Carolina.
  Mr. JONES of North Carolina. Mr. Speaker, will the gentleman yield?
  Mr. EMANUEL. I yield to the gentleman from North Carolina.
  Mr. JONES of North Carolina. Mr. Speaker, I want to thank the 
gentleman from Minnesota (Mr. Gutknecht) and the gentleman from 
Illinois (Mr. Emanuel) for being on the floor tonight and allowing me 
to be part of this because I think, as both have said, this is not a 
political partisan issue, because we have on my colleague's bill 
numerous Republicans and Democrats who have joined to open markets up 
to the citizens, not just senior citizens, but they are the first in 
our mind, but citizens that can buy drugs at a much cheaper price and 
still have the same quality.
  I must tell my colleagues, I represent the 3rd Congressional District 
of North Carolina. It is a great district for me to represent, and 
every time I do a town meeting, I am not kidding you, for the last 3 
years they have said to me, Congressman, what are y'all going to do in 
Washington to help bring the costs down? I am talking about senior 
citizens who are 65 and 70 and 80, and many of these people truthfully 
are living on a very small amount of money, Social Security and what 
they might receive from Medicare.
  It bothers me to know that we who are sent here by the people, and 
they trust us to do what is right, and many times politics gets such 
that we have people that participate in the process, which is good that 
we do, not just voting, but also contributing to candidates and to 
parties, and I am afraid

[[Page 17594]]

that this issue really has gotten bottled up into an area that concerns 
me greatly.
  If I might take just a moment, and then I will yield back to the 
gentleman from Illinois. We have a dear friend that came with us in 
1994. That was the year that the Republicans took over the House. His 
name is Tom Coburn. He is an M.D., and Tom retired 3 or 4 years ago, 
and quite frankly, we miss him if he should be watching tonight. We 
miss him in many ways.
  But as my colleagues well know, both you gentlemen know that certain 
prolife groups have gotten involved in this issue who are opposed to 
your legislation, and I hate to say it, but I am afraid there might be 
some outside group helping them fight your legislation. I will let you 
and the gentleman from Illinois maybe pick up on that in a minute, but 
let me read, and I will submit this entire letter for the Record, but I 
want to read two paragraphs very quickly.
  This is to the gentleman from Minnesota (Mr. Gutknecht). It says: 
``Dear Gil: I was shocked to learn that some opponents of free-market 
access for prescription drugs have begun arguing that your legislation, 
H.R. 2427, the `Pharmaceutical Market Access Act of 2003,' somehow 
promotes abortion and, more specifically, the availability of abortion 
drugs such as RU-486.''
  Second paragraph and last one, ``As you may recall, while in the 
House I was the author of not only provisions to permit the 
reimportation of FDA-approved drugs, but also the author of the House-
approved proposal to block FDA approval of RU-486.''
  Tom Coburn again, ``As a prolife practicing physician who earned a 
100 percent prolife voting record while serving in Congress, I find it 
ludicrous that those who oppose your legislation would resort to ad 
hominem attacks with no basis in reality.''
  I will insert the entire letter at this point.

                                                    July 10, 2003.
     Hon. Gil Gutknecht,
     Cannon House Office Building,
     Washington, DC.
       Dear Gil: I was shocked to learn that some opponents of 
     free-market access for prescription drugs have begun arguing 
     that your legislation, H.R. 2427, the ``Pharmaceutical Market 
     Access Act of 2003'' somehow promotes abortion and, more 
     specifically, the availability of abortion drugs such as RU-
     486.
       As you may recall, while in the House I was the author of 
     not only provisions to permit the reimportation of FDA-
     approved drugs, but also the author of the House-approved 
     proposal to block FDA approval of RU-486. As a pro-life 
     practicing physician who earned a 100 percent pro-life voting 
     record while serving in Congress, I find it ludicrous that 
     those who oppose your legislation would resort to ad hominem 
     attacks with no basis in reality.
       I can state unequivocally that your legislation in no way, 
     shape, or form promotes abortion. (Many pro-life members are 
     original cosponsors of your legislation and, quite obviously, 
     do not believe your bill violates their deeply held 
     convictions about the sanctity of life.) Those who argue that 
     your legislation makes abortion drugs more accessible by 
     lowering overall drug prices necessitate the conclusion that 
     in order to be pro-life one must be in favor of increasing 
     all drug costs. I suppose the argument would be the higher 
     the drug costs the more fervent your pro-life beliefs.
       In Washington, it was always sad to see organizations drift 
     from their core principles and take positions that defied 
     common sense and logic. Any organization that links your 
     legislation with the abortion debate will, in the long-term, 
     undermine their credibility and relevancy in Washington. 
     While the pharmaceutical industry has produced many wonderful 
     life-saving drugs, it would be unwise for anyone to believe 
     that the industry that developed and fought for FDA approval 
     of RU-486 is now motivated by a passion for the pro-life 
     cause.
       The fact that opponents of your legislation have resorted 
     to these attacks is shameful, yet the obtuseness of their 
     logic ultimately serves to highlight the soundness of your 
     argument.
           Sincerely yours,
                                              Tom A. Coburn, M.D.,
                                        Former Member of Congress.

  I want to share that with you and Mr. Emanuel just to say that this 
is a very critical, vital issue to the senior citizens and also the 
people of this country who must have drugs to have a quality of life.
  Mr. EMANUEL. Mr. Speaker, reclaiming my time, you should take a 
little solace in the fact that they have decided to go to scare tactics 
because they know this is not about price controls. This is about 
letting the market determine the price that we can pay, and they are 
scared of the free market. This is a large company that has a captive 
market and is scared of the forces of the free market to determine the 
best price. So they have decided to through a few Members try to play 
the worst and ugliest of politics because on the merits they cannot win 
it, and I compliment you for having the courage to stand by your 
principles.
  I would like to make a note to something earlier that our good friend 
the gentleman from Minnesota (Mr. Gutknecht) said which deals with the 
fact that we are Democrats and Republicans here. We give different 
views on different subjects, but the fact is what has brought us here 
is our common principles and our common values, and this is a 
bipartisan issue because we jointly think that our seniors should not 
be paying the highest price, and our taxpayers should not be asked to 
pay the highest price when you can get lower prices.
  As our colleague from Minnesota showed with that chart, although 
people cannot see the specific numbers, they get the basic gist that 
there is a 700-buck spread for the same drugs you buy in Germany versus 
what we buy here.
  You do not have to have a party difference to understand it is 
fundamentally wrong. It is not right, and we cannot ask the taxpayers 
as we embark maybe on the largest expansion of an entitlement program 
in 40 years to foot a bill that would be, in my view, the greatest, 
largest fleecing of America in front of the naked eye.
  So the pharmaceutical companies have decided to engage in this scare 
tactic because on the merits and on the ground they cannot win this.
  I would like to ask one question because they are engaged in one 
other subject up here. If the gentleman from Minnesota (Mr. Gutknecht) 
could walk the folks through that are watching the notion of safety, 
just to walk them through this, because that is another scare tactic. 
This is the first of many salvos. We are not done with their attacks, 
if you do not mind me interrupting, but I would like you to walk the 
public through the issue of safety.
  Mr. GUTKNECHT. Mr. Speaker, if the gentleman would continue to yield, 
I thank the gentleman from Illinois, and I thank my colleague from 
North Carolina as well.
  One of the arguments that they are making is this is not safe, you 
cannot be reimporting or importing or opening markets to these drugs. 
And once again, let me say, first of all, we are only talking about 
FDA-approved drugs from FDA-approved facilities, number one.
  Number two, what more and more of the companies are coming out with, 
and we require in our legislation, and that is, they begin to develop 
counterfeit-proof packaging, tamper-proof, counterfeit-proof packaging.
  The other thing people need to understand is we are not saying people 
have to do this. This is their option. We want to make certain that 
they are not treated like common criminals, because right now seniors 
are doing this. There was a study done by a University of Texas 
professor. A million Americans right now are crossing the border to buy 
their prescription drugs, and they have no assurance, no tamper-proof 
packaging, and worse than that, they are treated like common criminals 
by their own government.
  So we want to make it safer. We actually want to put in a regimen, a 
plan, so that people can do this and their pharmacists can do this, 
because my vision is people ought to be able to go to the local 
pharmacist, and he ought to be able to shop for the best price on the 
best drugs. It is called parallel trading. That is what they do in 
Europe, and it is why they get cheaper prices than we do here in the 
United States.
  We are concerned about safety, too. I do not want people dying from 
taking contaminated drugs, but remember this: Every day we import 
thousands of tons of food. Last year we imported 318,000 tons of 
plantains, and so if someone wants to tamper with things

[[Page 17595]]

that go into people's mouths, they are more likely to do it with food 
products than they are with something that comes in a tamper-proof, 
counterfeit-proof package.
  Mr. EMANUEL. Mr. Speaker, I appreciate that. So what you are saying 
is that unless it is FDA-approved, it cannot come in, and it is FDA-
approved, meaning the Food and Drug Administration, which is the 
overseer, the czar of what is safe, approves it, then it can be 
purchased through the Internet or overseas and brought into the United 
States, because, as you said earlier, it is manufactured at the same 
facilities. So there is really no pricing differences except they get 
price differences there than here. So they are FDA-approved.
  Mr. GUTKNECHT. We are only talking about FDA drugs, and more 
importantly than that, you are correct. There are only, as I am told, 
about 600 facilities in the world that can produce FDA-approved drugs, 
and so that is the only drugs that we would permit, and we believe that 
a program can be established very easily using modern technology so 
that we can be as certain that these drugs are, in fact, Coumadin or 
Glucophage from an FDA-approved facility.

                              {time}  2015

   We can be just as assured of that even if we get the drugs from 
Geneva, Switzerland, or from right down the street. We want safe drugs. 
We want seniors to be safe. And I think we have the plan that will do 
that.
  Mr. EMANUEL. Mr. Speaker, both of my colleagues we were talking a 
little earlier; and perhaps you could address the question, what do you 
think, given they have projected, I think it is $1.8 trillion over the 
next 10 years that seniors will be spending on medications, but if we 
had access to this bill and it was in place, what would be the savings 
to both the elderly as well as to the taxpayer, projected?
  Mr. GUTKNECHT. Mr. Speaker, the gentleman is correct. The 
Congressional Budget Office, which are our official bean counters, if 
you will, have estimated that seniors in the United States over the 
next 10 years will spend $1.8 trillion on prescription drugs. We can 
see by this chart, and I think we were very conservative, we estimate 
that if we simply open markets, as we do with plantains and with prunes 
and with pork bellies, if we just open up the markets as we do with 
everything else, we will see prices in the United States drop by at 
least 35 percent. Well, 35 percent of $1.8 trillion is $630 billion 
that we will save American consumers and/or taxpayers.
  If I can give just one more example. We had an Inspector General who 
testified before the Committee on the Budget just yesterday, her name 
was Dara Corrigan, and she estimated, and these are her numbers not 
mine, but her numbers were that last year Medicare through the 
hospitals bought $8.2 billion worth of prescription drugs. If they 
could have bought those drugs at the same price that the VA buys those 
drugs, her estimate was that taxpayers would have saved $1.9 billion 
last year.
  Now, my assertion is that if we open up the markets, we are going to 
save the VA, we are going to save Medicare, we are going to save 
Medicaid, we are going to save consumers, we are going to save 
corporations.
  Last year, General Motors spent $1.3 billion on prescription drugs. 
Imagine how much they could save if they had access to world market 
prices.
  Mr. EMANUEL. The truth is, Mr. Speaker, that we had an original bill 
that was going to use market forces to bring competition between 
generic medications versus name-brand medications. That was projected 
to save the taxpayers and the consumers and the elderly $65 billion 
over 10 years. This concept, following that same principle of 
competition as the price reducer, let the market determine best price, 
would bring, I think the gentleman just said, a little over a half 
trillion dollars to the consumers, the elderly, over the next 10 years. 
It is using market forces.
  Bringing that competition to bear on the market, that would bring 
prices down, and no longer would the American elderly and the American 
taxpayer be seen as the profit guinea pig for our pharmaceutical 
companies. They are making up the difference where they cannot get it 
in Germany or in England. They are making it up, the price difference, 
their profit margins, on our elderly. Therefore, our taxpayers are 
being asked to foot the bill in one of the largest fleecings of the 
American people we will ever see.
  The principles of competition will bring prices down, I think. 
Pharmaceutical companies have gamed the system from the patent laws, 
the laws as it relates to competition and globalization, and through 
the tax laws. As my colleagues know, we had a provision which was to 
allow the NIH to recoup 10 percent on any drug that was developed and 
brought to market through NIH dollars. My view is anything below 30 
percent in the private market is considered dumb money. The taxpayers, 
all the cancer drugs, all the AIDS drugs on the market were developed 
with taxpayer-based research. We should be recouping a minimum of 10 
percent to the taxpayers. The NIH would be a self-funded agency in 10 
years.
  But the core of what we have, the biggest dollar saver is the 
gentleman's amendment that we are honored to be cosponsors of. Again, 
this is not price control; it is choice. If you bring choice to bear in 
the market, consumers will flock to the lowest price, and I think that 
is the basic principle why you have Democrats and Republicans ready to 
vote for this, if we could get it to the floor.
  Mr. GUTKNECHT. I would just simply say that I hope we can have a 
vote. This is the people's House. Vox popolurum est vox dei, the voice 
of the people is the voice of God. There is where the people's business 
should be done. Occasionally we have partisan differences and we vote 
differently, but this is one that crosses party lines. It is not a 
matter of right versus left; it is right versus wrong. It is wrong for 
Americans to be held captive.
  Mr. JONES of North Carolina. Mr. Speaker, if my colleagues will 
yield, I would say that the comments of both these gentlemen are 
correct. Free markets are more powerful than armies, and I think my 
colleague's quote from former President Ronald Reagan, and everything 
else that has been said tonight by my friend, is so true. The whole 
thing is that this is a critical issue to so many people throughout 
this country and we need to do what is right. The right thing to do is 
to look at the gentleman's bill, put this bill on the floor, let it be 
debated, let it pass or fail, but do not bottle this bill up. Too many 
people throughout this country need this relief.
  And so, Mr. Speaker, I want to thank my colleagues, and I yield back 
to the gentleman from Illinois.
  Mr. EMANUEL. Well, Mr. Speaker, before I try to catch that last 
flight, when I was running for office and I was in Six Corners Jewel, 
which is our big grocery store with the Osco, on Irving and Organza, 
seniors would come out and show me what they were paying and they told 
me the stories about how they cut their medications in half, or a 
husband would skip a month so his spouse could take her medications. 
And the first thing they said is, you have to make this affordable. I 
have to be able to pay for this. They would talk about that, and ask me 
to make sure that whatever we did, we did not mess with their private 
plans. But then they would say, please, add a prescription drug benefit 
to Medicare.
  In my view, if we are on the doorstep of adding that benefit, let us 
ensure, because it is the first thing they have all said to every one 
of us who has gone to meet with them, we have to make these drugs 
affordable. They cannot afford these prices. They would tell me, look, 
somehow last month my month's supply was $70 and this month it is $96, 
and nothing has changed. Nothing. If we brought competition, something 
would change.
  Mr. GUTKNECHT. Absolutely. I know the gentleman wants to catch his 
plane, but I just want to say this. Regardless of what happens in the 
next week or two, we are not going to go away. This issue will not go 
away. We will stay here, on a bipartisan basis, every night for the 
next 6 months, 9 months, 3 years. We are not going

[[Page 17596]]

away. The issue is not going to go away.
  There is no way that our leadership, the administration, the FDA, the 
drug companies can defend a situation where Americans pay two and a 
half times more for the same drugs than our counterparts in Germany. I 
am not going to give up, my colleagues here tonight are not going to 
give up, and God bless you all.

                          ____________________