Thomas Coburn

Mr. COBURN

Mr. COBURN. If the gentleman will continue to yield, is the gentleman saying that people are not held accountable for confidentiality otherwise?

Mr. COBURN

Mr. COBURN. Mr. Speaker, I thank the gentleman from Texas (Mr. Armey), the majority leader. I would make one other comment, HCFA, which stands for the Health Care Financing Administration, in the words, their own director says nobody in HCFA understands the details of HCFA. It is so convoluted. And having practiced in the medical field, understanding the regulations, understanding the results, understanding the lack of common sense that comes out of this organization in terms of how we impact with our patients and how our patients are cared for, to take $300 billion swiped out of Medicare over 10 years and let those people handle it is the last thing we should do. Mr. Speaker, there should not be an expansion of the responsibility within the Health Care Financing Administration. Mr. Speaker, I yield to the gentleman from Texas (Mr. Sessions).

Mr. COBURN. I thank the gentleman. I want to make two points just for the Record to those that might be watching this. Medicare did a prescription drug benefit in 1988. The estimated cost was $4.7 billion. The actual costs, the 1 year that that was in place was $11.7 billion; that is how well we estimated the costs. So when we saw up here a cost of $353 billion over 10 years, we know at least it is double that, just by the track records. The other thing that I would make is the GAO has already stated, our accounting agency, that Medicare is not going to make it, unless we do some significant changes in terms of incentives and payments. How do we do that? We do not do that by adding significantly more costs to an already bankrupt program. Mr. Speaker, I yield to the gentleman from Arizona (Mr. Shadegg), a close friend of mine and somebody I respect a great deal.

Mr. COBURN. That is the same principle as we have today in Medicare. There is no choice; if one is over a certain age, they will participate, unless one chooses not to participate at 64.5 years. Once they choose not to participate, they will never be eligible.

Mr. COBURN. It is called poll through demand.

Mr. COBURN. That is accurate. I think the other thing to remember is one of our problems in health care in this country, especially in terms related to HMOs, is that we have lost a considerable amount of freedom. When one does not have the right to choose their doctor in this country, they have lost a significant amount of freedom. Now what we are going to see is you are not going to have the right to choose whether you get the best drug for you or one that a bureaucrat in Washington has decided is the cheapest and least expensive and may not be as effective, you are not going to get to make that choice. So it is a great political tool to say we are going to have something for everybody, even though our grandchildren are going to have to pay for it and have a lower standard of living; but to not be honest about the loss of freedom associated with that I think is disingenuous.

Mr. COBURN. There is a good example. There is a drug on the market known as Trazadone. The brand name is Desyrel. I use that drug a lot. I use the generic as a sleep-inducing aid for senior citizens, but I never use the generic for an antidepressant because it is not as effective. If we have this system, I will not be able to do that. So I will not be able to use a drug that there is significant difference in efficacy for treating depression, I will not be able to use that because we are going to use the generic. So, therefore, I will not be able to use that so I will not be able to give the care and nor will I have the confidence that my patient is going to get what they want. So the loss of choice is an implied loss of freedom, but it is also a decline in care.

Mr. COBURN. I cannot answer that. I do not know, but I can say in other government-run health programs, title X clinics, title XI clinics, it is not doctors that make decisions. It is an extension of the doctors, somebody that is abstract making those decisions. That is felt to be efficient, even though the care sometimes might be substandard.

Mr. COBURN. I would like for us to ask the gentleman from Minnesota (Mr. Gutknecht) to stand up and join with us, because one of the issues that we raised, that this whole plan totally ignores, is enhancing of competition. What the Gore plan will do is cost shift the cost savings that might come about through Medicare on to the private sector, which will then raise everybody else's costs for prescription drugs. It will raise the State's cost in terms of Medicaid. It will raise the company's cost that pays for your insurance. If you pay your insurance yourself, it will raise. If you have no insurance, it will raise. The problem that we have today, the reason we are even addressing this issue, is because price has become predominant. We had a 17.4 percent rise in the cost of prescription drugs in this country last year, when inflation was under 3 percent. There has to be something wrong here, and I think the gentleman from Minnesota (Mr. Gutknecht) has a solution to that and has been very vocal on how we enhance competition in this country, and I would welcome him to the debate.

Mr. COBURN. Call a doctor.

Mr. COBURN. Or call your hospital.

Mr. COBURN. More powerful.

Mr. COBURN. Mr. Speaker, let me interject with the gentleman if I could for a minute. I think it is important for people to know that essentially Americans are subsidizing the drugs of everybody else in the world, number one, through our research, through the National Institutes of Health; and number two, through the prices that we pay. In fact, even if the gentleman's statement about reimporting price controls were true, what that would do is put a higher pressure on the negotiated price to the other countries and, therefore, Americans would not shoulder the absolute high cost of drugs compared to everybody else, and we would see a shift of that cost, an appropriate shift of that cost, to the others. Remember, these are all made in the same plants, shipped all over the world, and charged at significantly different prices. It is important to note that one way to do that is to allow reimportation at the wholesale pharmacy and at the pharmacy level of the identical drug from other countries. If we do that, we will drive some prices. The other point that I think is important that ought to be made is that this year $6 billion out of a $115 billion market for prescription drugs is going to be associated with television advertising for drugs that one cannot get unless a physician writes a prescription. The average consumer sees 10 of those ads a day. Now, who is paying for that? We are going to pay in America an extra $6 billion so we can see a commercial to tell us to go ask a doctor for a medicine when, in fact, what we should be saying is, Doctor, here is the problem I have, what is the best medicine? One of the subtle things that people do not realize is that when somebody comes to me thinking they need a certain medicine, it increases the cost of care, because if they do not really need that medicine, not only do I have to take their history and examine them, then I have to spend time explaining why they do not need the medicine that the ad just sold them and why they need this medicine that is cheaper, better and more effective. So, in essence, it is raising the total cost of medicine far beyond the $6 billion this year, the $9 billion that they are planning on spending next year, just on television advertising.

Mr. COBURN. And, we are the only country in the world that allows it.

Mr. COBURN. Through television.

Mr. COBURN. If the gentleman will yield, they are just about to become GlaxoWellcome SmithKline Beecham.

Mr. COBURN. Mr. Speaker, we are just about out of time and I want to make just kind of a summary statement. The best way to allocate any resource in this country, any resource, is competition. I see the gentleman from New York (Mr. Crowley), very influential in our ability to try to reimport wholesale prescription drugs into this country. He understands that. The idea is to allocate resources with competition. That is one of the things we need to do. The last thing we need is another mandatory, government-run health care program that is already proving to be inefficient, has been tried once and was so expensive they dropped it; and number three, will discourage research, will discourage new drugs, and will cost-shift, and does no benefit for anybody except a senior. Everybody else is going to have a lower benefit, less access to health care through that plan. I yield the balance of the time to the gentleman from Arizona.

Mr. COBURN. Mr. Speaker, I thank my colleagues for participating in this special order with me.

Mr. COBURN. Monday.

Mr. COBURN. Mr. Speaker, I would like to spend a little time this afternoon on a subject that we hear across all the airways and we read in all the newspapers and it is what all the politicians in the country are running around talking about. It is called prescription drug plans. It is amazing how interested we are in this now that we have gotten into an election year. But the problem has been occurring for the last 3 years essentially. There is no question in this country that, as the percentage of health care costs rise, an increasing proportion of that is prescription drugs. And there is no question that in our country, all of us, seniors, people in insured plans, people with no insurance, people on Medicaid, are having a more and more difficult time accessing the pharmaceuticals that we need to both succeed in treating the illnesses that we face and prevent illnesses that we could face. My experience is I have been a physician for almost 20 years. I continue to practice on the weekends and on Fridays when we are not in session and on Monday mornings. What I want to spend time today talking about is the direction of the Congress with this issue. I want to compare what we have heard President Clinton say and Vice President Gore say about their solution for this problem. I have 18,000 square miles in Oklahoma that I am fortunate enough to represent. I will be going home when this session of Congress is over, and I will not be returning because I chose to limit my terms. But as we travel around and I talk to seniors, which have been the major topic that we have seen discussed in this potential to began a political advantage, this bidding war on prescription drugs, if we ask the question, do you need help with prescription drugs, many will say yes. There is no question. But if we ask the question putting with it the caveat of who is going to pay for it, the answers are totally different. If we ask seniors, do you want a prescription drug plan and do you want one that is going to lower the standard of living of your grandchildren, we never ask that, but that is implied in the question. For historical purposes, when Medicare began, the estimated cost for Medicare in 1990 was $12 billion in 1990. That is what the best accountants, the best people that we could have said that is what it was going to cost. And there are a couple of reasons why they missed it a thousand percent. It cost $120 billion in 1990. There are two reasons they missed it. Number one is it is hard to estimate; and number two, the politicians in Washington, if they do not have to be responsible for the cost of it, are going to add an additional benefit. That is a natural human response, whether one is a politician or otherwise, is to give somebody else's money away if in fact it helps them accomplish their purpose. Well, we now have a drug proposal before us that is supposed to cost about $100 billion over 10 years. And if we think about the track record for the Health Care Financing Administration and the CBO, the Congressional Budget Office, and the Government Accounting Office, all of which totally missed the cost to Medicare, what it is really going to cost is probably a trillion dollars over the next 10 years. That is where we are at. Now, where are we going to get money to pay for that? We are going to delay the funding of it. We are going to borrow it. And we are going to eventually ask our children to pay for it and our grandchildren. There is a lot of baby boomers out there, which I am one of them. There are 77 million of us that are baby boomers, and it will not be long that we will be eligible for the benefits under Medicare. And as we become eligible, the one thing we do know is that the cost of the Medicare program is going to skyrocket. The second point that I want to make is, what is the real problem in our country in terms of people being able to get prescription drugs? What is the difficulty? It is not the quality of the drug. It is not the availability of the drug. It is not the research that brings the drugs forward. What is the real problem? The problem is price. If we do not address the competitive issue in this solution to this problem, then all we are going to do is lower the cost for some seniors and transfer it to everybody else in the country. Unless we establish and make sure that that marketplace is as efficient as it can be, we will do wonders for seniors and harm to everybody else, let alone the cost. I have one chart I would like to spend some time on. This chart is actually Social Security. But if we move it over to 2011, the numbers are exactly the same in terms of the ratio of positive cash flow into the Social Security or Medicare fund versus outflow. In 2011 under the spending we have now without a drug program, Medicare starts running a negative cash flow. It would not do that well if we had not taken two or three components out of the Medicare trust fund and put them to the regular budget. So we essentially have improved the life of Medicare both by manipulations here and the fact that we have had a wonderful economy with a lot of people paying in a lot of money on Medicare. But what is going to happen, starting in 2011, is we are going to have to run this tremendous deficit, without a prescription drug benefit. So if we decide that a big government program is the answer and that the President and Vice President Gore is the answer, then what you need to do is just about double or triple the red on this chart. The implication being, is that your children and your grandchildren because we are going to fix the wrong problem, lack of competition, are going to have a much lower standard of living. I have a chart that compares FICA earnings and estimated taxes just on Social Security. The reason I want to use Social Security is because the same numbers reflect on Social Security the baby boomers. What you can see is right now we all pay about 6 percent of every dollar we earn in a FICA tax and our employer matches that. But I want you to notice this graph. That does not have anything to do with the 1.45 percent that you pay in Medicare and that your employer pays. But if you just follow this graph in terms of the introduction of the new people coming into Medicare and Social Security, what you can see is the tax rate just to meet the cash flow requirements, without a prescription drug benefit, goes up to almost 20 percent. If you extrapolate that same rate from Social Security to Medicare, instead of 1.45 percent, we are going to be paying 3 percent individually and 3 percent by your employer. So we are going to double the cost of the tax when you work just to cover the Clinton-Gore drug plan. I am not known as a partisan, and I was not real happy with the Republicans' drug plan, either; but what I do know is that the plan that is outlined by the President and Vice President Gore concentrates more power in Washington, concentrates more decision-making in Washington, and concentrates bankruptcy for Medicare in the future. I yield to the gentleman from Texas (Mr. Armey), the majority leader in the House.

Mr. COBURN

Mr. COBURN. Mr. Speaker, I yield myself such time as I may consume. Mr. Speaker, I would like to respond. The awareness of the sexually transmitted disease epidemic is one of the things that I think that I have brought to this body. It was denied, obscured and covered up over the last 6 years. The fact is, as a postcoital morning-after pill, administration does nothing to prevent sexually transmitted diseases. The other thing is the gentlewoman who just talked has been against informing people of the fact that a condom does not prevent someone from getting the largest incurable, sexually transmitted disease that we have, that will infect 6 million people this year. So if we want to talk accurately about the medical facts, I will; but this issue is when a child at school cannot get an aspirin without a parent being involved, but we can give them a prescription pill that will have a long-term impact on them. I think we need to have a full and fair discussion on that. Mr. Speaker, I yield 2 minutes to the gentlewoman from North Carolina (Mrs. Myrick).

Mr. COBURN. Mr. Speaker, I yield 1 minute to the gentleman from Maryland (Mr. Bartlett). (Mr. BARTLETT of Maryland asked and was given permission to revise and extend his remarks.)

Mr. COBURN. Mr. Speaker, I yield myself such time as I may consume. Mr. Speaker, number one, I would thank the gentleman from Illinois (Mr. Porter), I wished the gentleman would have given me the idea 2 months ago or 3 months ago, and I would have been happy to put that in the bill. Number two, I find it somewhat ironic. I want to stay on the issue. I find it somewhat ironic that we cannot use direction in terms of spending with the motion to commit, but yet we are funding hundreds and hundreds and hundreds of millions of dollars of programs that never have been authorized by any of the authorizing committees. What I would ask the gentleman is, does he believe it is right that a 12-year old should get a morning after pill in a school clinic and a parent never know anything about it. I mean, that is what this issue is about. Whether or not we are going to give a prescription drug to a young adolescent female without her parents ever knowing in school; that is what the objection is. That is why this rider is there. The Senate passed this 54-41. This is not a pro-life, pro-abortion debate. This is a debate about parents being involved. As we look at the young people in our country today, the one problem we are seeing and we are trying to solve in many of the programs that the gentleman has graciously funded through his appropriation to re-empower parents. This bill tears them down. This bill separates by not having this. So the Senate did want this. They voted it. All we are asking is for the committee, should the House accept this motion to instruct, to follow that and give parents back some of their power. Mr. Speaker, I reserve the balance of my time.

Mr. COBURN. Mr. Speaker, I yield myself 30 seconds. Mr. Speaker, I just say in response to the gentleman from Wisconsin (Mr. Obey), there are 4,000 clinics, outside of school clinics, where you can get this done with Federal funds, what we are saying is, is this should not be happening in a middle school. There is plenty of places that if you want this service, you can get it, but it should not be occurring in the seventh and eighth grades in this country without a parent involved. Mr. Speaker, I reserve the balance of my time.

Mr. COBURN. Mr. Speaker, I would not have any problem; that is their individual choice. I have a problem in destroying the life of an unborn baby; that is a different topic. But if, in fact, a parent is involved, but under the auspices of the HCSC planning guidelines and under the auspices of title 10, there is no obligation to inform the parents whatsoever.