[Congressional Record (Bound Edition), Volume 155 (2009), Part 12]
[Senate]
[Pages 15799-15802]
[From the U.S. Government Publishing Office, www.gpo.gov]




                              HEALTH CARE

  Mr. DORGAN. Mr. President, as this country tries to pull itself out 
of a very significant economic crisis in which millions of Americans 
have lost their jobs, lost their homes, lost hope, there are a number 
of things we have to do that also threaten the future of this country, 
in addition to trying to restore some economic health, and those 
include health care to be sure--we are working on this issue of health 
care; the second is an energy policy that makes us less dependent on 
foreign oil, where we are far too vulnerable and far too dependent; and 
the third is the relentless march of increased Federal budget deficits. 
All three of these issues, in my judgment, threaten our country's 
future. I wish to speak about them in the coming days. Today, I wish to 
talk about health care specifically.
  Let me again say, I do that with the understanding that first and 
foremost we have to pull this country out of the difficulties we are in 
with the general economy and try to find ways to promote economic 
growth and put people back to work with jobs that pay well and give 
them the opportunity to care for their families. That is what gets 
America moving again. But when we do that, when we begin to restore 
this economy to economic health, the vulnerabilities that will remain 
are health care, energy, and the Federal budget deficits far into the 
future. So let me talk about health care just a bit.
  I know there is a lot of discussion in the committees, the two 
relevant committees, the Finance Committee and

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the so-called HELP Committee, both of which are writing pieces of the 
health care reform bill.
  It is true that increased health care costs--the increased cost of 
insurance for families, businesses, and governments--are on the march. 
Now it consumes over 17 percent of the domestic product of this 
country. Of all the goods and services we produce, over 17 percent of 
that is consumed by health care. And the rate of increase is 
unsustainable. Families will not be able to pay the extra cost year 
after year after year. We are told that nationally it now costs about 
$12,000 for a family health insurance policy.
  So what do we do about this? Well, we hear a lot of discussion on the 
floor of the Senate, when we start talking about health care, where 
people will say: Well, now you are talking about a government-run 
health care system in which a bureaucrat is going to make decisions 
about how much treatment your doctor can provide to you personally.
  That is just absurd. That is not what this discussion is about. But 
if we can get back to some thoughtful discussion rather than 
thoughtless discussion on health care, maybe we can all reach an 
agreement of how to improve this system. I personally think this system 
needs improving. Let me describe some things I think we should do.
  First of all, we do not have a health care system so much as we have 
a sick care system. We do not pay any attention in this country to the 
things that can keep you from being sick or getting sick; we just pay a 
lot of money to put you into acute-care beds once you have gotten sick. 
That makes no sense at all. We ought to change the entire model to say 
it is much, much less costly to do the preventive things than it is to 
pay for acute-care beds in a hospital once someone gets sick.
  This is all about behavior in many respects, and nobody wants to talk 
much about that. But behavior is a very important part of this. We are 
told that two-thirds of the American people are overweight and one-
third are obese. Just that alone imposes unbelievable costs on this 
health care system of ours.
  By the way, attendant to that issue of obesity and being overweight 
is the march of diabetes. The incidence of diabetes in this country is 
unbelievable. It just ratchets up and up and up every year.
  Now, you wonder about that, wonder about America's children and the 
number of children who are overweight and obese. Walk into a school and 
then find out that in a number of schools in our country, they have 
decided to make money by allowing the soda machines, the pop machines, 
from the largest manufacturers in this country to sell Coke and Pepsi 
and other soft drinks in the school hallways. You can buy not only a 
soft drink full of sugar, you can then buy, perhaps, a bag of Doritos 
to go with it in the middle of the afternoon at school. So what kind of 
message is that in a country in which a substantial number of the 
people--especially children--are vastly overweight and in which we, by 
the way, minimize physical fitness in our schools because we have 
become very obsessed--and necessarily so--we care now more about math 
and sciences and getting out of our school system more engineers, more 
people steeped in the maths and sciences. But should that be at the 
expense of physical fitness? What kind of a brain is walking around 
without a physical being to propel it? How about some physical fitness 
in our schools? How about moving soda machines or the soft drink 
machines and the Doritos and Cheetos out of the school hallways? Those 
things are just common sense. It is about personal behavior, and it is 
about what we do in this country.
  By the way, the reason those machines are there is, if they can put 
machines in the hallways of schools, the companies will provide money 
to the schools. So that is how we are going to fund our school system 
these days--through soft drinks and chips? It does not make much sense 
to me.
  With respect to this issue of personal responsibility and behavior, 
let me describe a meeting we held about a week and a half ago with the 
CEO of Safeway corporation. I know he has met with groups of 
Republicans and Democrats here in the Congress. He said something very 
interesting, and I am using numbers that I think approximate what he 
said. They may not be precise, but I believe he told us there are 
between 40,000 and 50,000 employees at Safeway corporation who are 
nonunion. He began a project with those 40,000 and 50,000 people in 
health care, and now he is beginning to try to move that into the union 
contracts.
  Here is the project. That company says to its employees: I want 
responsibility for four areas in exchange for lower cost health 
insurance. We believe behavior is an important part of controlling 
health care costs. No. 1, if you have high blood pressure, we want you 
taking medicine to control your high blood pressure. No. 2, if you have 
high cholesterol, we want you taking medicine to control your high 
cholesterol. And I believe he said the company is paying for that. No. 
3, if you are smoking, you have to have stopped or be on a program to 
stop. No. 4, if you are overweight, you have to be on a program to deal 
with that issue.
  Cholesterol, high blood pressure, weight, and smoking--in each case, 
from a baseline of the cost of health insurance policies, those who are 
engaged in behavior that addresses these four issues have gradations of 
lesser costs for their health insurance premiums. In other words, it is 
about personal behavior and taking responsibility for addressing the 
things that can keep you healthy.
  He indicated to us that they have had flat costs for 5 years in that 
body of employees dealing with this criteria in health care. That is a 
success. If that is the model he is using, saying: You have a 
responsibility.
  By the way, even in their cafeteria, where they have partially 
subsidized company food during the lunch hours, just as an example, he 
said: We still serve unhealthy things. But we charge much, much more 
for it--once again trying to induce the behavior to take a healthy 
alternative.
  So I think what Steve Burd, the CEO of Safeway, has suggested 
represents something we need to consider as we write our health care 
legislation.
  There is another element that was brought to my attention recently 
and I think has been brought to the President's attention and Members 
of the Congress, and that is a New Yorker article written by Atul 
Gawande, a doctor from Harvard. He visited McAllen, TX, and El Paso, 
TX, and wondered why in one city you have the highest costs per capita 
for health care and why the other city is just average. What caused 
this? He has a lot of conclusions, and I think very interesting 
conclusions, about overutilization in health care, and the movement of 
doctors' ownership with respect to the business side of health care. 
The doctors' ownership in a cancer clinic, ownership in a new heart 
clinic, those kinds of things that he suggests promote substantial 
overutilization.
  The fact is, in our part of the country, where it is reasonably 
sparsely populated--the northern Great Plains--almost every hospital of 
any size wants to have a cardiac surgical unit so they can do open-
heart surgery. They do not all need to do that. In fact, it duplicates 
services, which then ends up costing more because you are duplicating 
services. But every hospital wants it. So many of our States have more 
than is necessary of cardiac surgical suites.
  This weekend, I was reading about two hospital groups merging, and 
one of them indicated that one of the advantages would be they would be 
able to then perform perhaps procedures they do not now perform, citing 
especially heart transplants. Why would we want duplication of a lot of 
facilities doing heart transplants? It does not seem to make sense to 
me. There are not so many done in the United States that we should not 
at least try to suggest that you do not need too many heart transplant 
centers.
  Some say: Well, then who should tell them they cannot do that?
  Well, if you just decide that overutilization is all right; whatever 
it costs, it costs; whatever it pays, it pays, I think I can tell you 
that you

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cannot solve this issue. Again, I am not suggesting government-run 
health care, but I am saying we ought to be reasonably smart about what 
we are doing, and that has not always been the case.
  I wish to talk about one of the fastest rising areas of health care 
costs for a moment; that is, the issue of prescription drugs.
  By the way, maybe they ought to tone down some of this advertising or 
knock it off. You get up in the morning and brush your teeth. If you 
have a television set near and have it on just for listening purposes, 
you are no doubt going to hear a commercial that says: Do you know 
what, you should go ask your doctor whether the purple pill is right 
for you. I do not know what a purple pill is, but they have described a 
purple pill that is going to do something for you, and they ask you to 
go ask your doctor if you should be taking the purple pill because you 
cannot get it unless a doctor thinks you need it.
  We have massive amounts of advertising on prescription drugs in this 
country. In fact, some have indicated that the promotion and 
advertising and marketing of prescription drugs exceed research and 
development by the companies that manufacture prescription drugs. 
Frankly, for anything that is prescribed only by a doctor and capable 
of being prescribed only by a doctor, why do you have direct-to-
consumer advertising? Most nations like ours do not allow it. I believe 
there is only one other of the industrialized nations that does--
something to consider about perhaps reducing health care costs.
  But I want to talk about the other side of prescription drugs.
  Mr. President, if I might by unanimous consent show these two 
bottles.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.
  Mr. DORGAN. Lipitor is one of the most popular prescription drugs in 
the United States, I believe, for lowering cholesterol. These bottles 
are identical. One is blue and one is red. They look identical because 
they are produced by the same company. It is produced in Ireland. 
Lipitor is produced in Ireland and shipped around the world. The 
difference between these two bottles is not the medicine inside. It is 
the same pill, made by the same company, in the same place. The 
difference is it is shipped to different places. This one is shipped to 
Canada, and this one is shipped to the United States. The U.S. consumer 
has the pleasure of paying twice the cost as the Canadian consumer. But 
it is not just Canadian. It is French. It is Italian. It is British. It 
is that almost every other industrialized country pays a fraction of 
the price we do. Why should the American consumer be charged the 
highest price in the world for this prescription drug? Because those 
who apply the price have the ability to do it.
  Some of us--Senator McCain, myself, Senator Kennedy, Senator 
Grassley--Republicans and Democrats--Senator Snowe, especially, my 
cosponsor on the importation of prescription drug legislation--some of 
us believe the American people ought to have the ability and the 
advantage of the world marketplace to purchase that identical 
prescription drug--FDA approved, produced in an FDA-inspected plant--to 
be able to purchase it from anywhere in the world at a fraction of the 
price.
  We put together legislation that dramatically improves the safety of 
our domestic prescription drug supply and the drugs coming in.
  By the way, a lot of the prescription drugs we take are imported. 
Lipitor is imported into this country. The pharmaceutical industry--
which has always opposed our legislation because they want to charge 
the highest prices in the world to the U.S. consumers--they say: Well, 
if you do this, if you allow Americans to import FDA-approved drugs, 
there is a greater possibility of counterfeiting. Our legislation 
actually will dramatically improve safety because we require pedigree--
we do all kinds of safety mechanisms that do not now exist with respect 
to our prescription drug supply.
  So my point is, this is not rocket science. Do you want to reduce 
health care costs? I would say to the Finance Committee, and the HELP 
Committee, make sure you put this piece in your legislation because 
some of the fastest rising costs in this country are prescription 
drugs, and we know how to solve that. If we pass the legislation 
Senator Snowe and I have introduced, with broad bipartisan support, 
that allows the importation of FDA-approved prescription drugs by 
American consumers, it will require the pharmaceutical industry to 
reprice their drugs and allow our consumers to have fair prices for the 
prescription drugs they take.
  By the way, our legislation is actually a winner. It is $50 billion 
dollars in cost savings and deficit reduction, according to the CBO 
evaluation.
  So the fact is, there are a lot of things we can do and a lot of 
things that represent common sense. I know some will want to put 
together a health care proposal that would look like a Rubik's Cube 
with all kinds of moving pieces. It need not be that complicated. I 
just described some of the things we can do that represent common 
sense.
  Let me make one more point. Medicare has been a very successful 
program. When Medicare was started, the fact is, they established a 
base funding for Medicare that represented the cost for health care 
delivery at that time from that place. The result is, those areas with 
the highest costs got the biggest reimbursements. And it is still true 
today that some of the States--including my State--measured with some 
of the highest quality of health care in this country get the lowest 
reimbursement because they are the most efficient. That is 
preposterous. Whatever we do on health care, it has to address that 
issue. Let us at least, after nearly 40 years, begin to decide we will 
not reward inefficiency and we will not reward higher costs.
  I am not suggesting this is unbelievably simple; it is not. In many 
ways, I kind of wish we could hearken back to the old days, but in the 
old days we didn't have the medical miracles and the medicine we have 
now. In my hometown of 300 people--a small town--we did have a doctor. 
He came as a young man and stayed until he died, and he provided health 
care. There was no Medicare. He provided health care to anybody who 
needed it, and if they couldn't pay him, he would take some chickens or 
a hog or a side of beef. If he was out on a ranch or a farm and 
delivered a baby and they didn't have any money, and somebody else had 
money, he would charge a little extra to make up for the people who 
couldn't pay, so he administered his own health care system.
  Then we couldn't look inside the human body. We didn't have the 
miracle medicines through the NIH and PhRMA and others that allow us to 
stay out of an acute care bed. We didn't have all of those things. So 
now health care has become much more complicated. According to the New 
Yorker magazine article, which I recommend to everybody, when we have 
decided to make health care a ``business proposition'' where you can 
get several doctors together and open a cancer center, that becomes 
something in which you promote overutilization. And it is happening in 
parts of our country. We need to be concerned about that and try to 
evaluate what can we do together to deal with it.
  One final point. Some of my colleagues march to the floor every 
single day and allege that a bill that doesn't yet exist is going to be 
a government takeover of health care. Well, apparently they are 
clairvoyant, because we don't yet have a bill. When that bill exists, 
they have every right to come to the floor and describe the facts about 
the bill. One would hope in this debate we could stick to those facts, 
but there is not yet a fact that allows somebody to say there is a 
government takeover of health care, because there is not yet a bill out 
of either of our committees. There have been some introductions of 
topics and legislative proposals, but that is far different than a bill 
from a committee. We will have undoubtedly a robust debate on this, and 
we should. Health care is a very important element in this country's 
economy. It is growing, and growing too fast, and we need to deal with 
it to make sure all Americans have access to health care.

[[Page 15802]]

A sick child should not have to wonder whether they get to see a doctor 
depending on how much money their parents have in their wallet or their 
bank account. That is not what health care ought to be in this country. 
So we can and will do much better.
  I indicated I wish to talk about the future threats to this country, 
one of which is the march of health care costs. The second, in my 
judgment, is our unbelievable vulnerability on foreign oil and energy. 
The third is deficits. I will talk about the following two in the 
coming days as well.
  Mr. President, I yield the floor.
  The ACTING PRESIDENT pro tempore. The Senator from Texas.
  Mr. CORNYN. Mr. President, the Presiding Officer wishes to speak for 
5 minutes. I would be glad to speak after that. I ask unanimous consent 
that following the Senator from Virginia being recognized to speak for 
up to 5 minutes, then I be recognized to speak.
  The PRESIDING OFFICER (Mr. Dorgan). Without objection, it is so 
ordered.
  The Senator from Virginia is recognized.
  Mr. WARNER. Mr. President, I am not sure whether we are in a quorum 
call.
  The PRESIDING OFFICER. We are not.

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