Thomas Coburn

Mr. COBURN

Mr. COBURN. Mr. Speaker, I continue to reserve my time.

Mr. COBURN. Mr. Speaker, I move to suspend the rules and pass the bill (H.R. 4807) to amend the Public Health Service Act to revise and extend programs established under the Ryan White Comprehensive AIDS Resources Emergency Act of 1990, and for other purposes, as amended.

Mr. COBURN. Mr. Speaker, I yield myself such time as I may consume. Mr. Speaker, I want to make a statement. We are getting ready to talk a bill that will spend $7.1 billion over the next 5 years. We have 32 minutes to do it in; that is about $215 million a minute as we talk. I think it is unconscionable that we are doing this at this time at night, where the American public cannot see the extent of this epidemic and the problems we have facing it, the way the epidemic has moved into our minority communities, unfortunately, and in a greater rate than in any other communities, and that we are not going to put the resources that are necessarily needed to address that. Mr. Speaker, I would just make that point; that this is the wrong time of the evening for us to be doing this. I stand here embarrassed that we are not going to be able to have an opportunity to educate the American public about the needs that are addressed in this bill. Mr. Speaker, first of all, we need to recognize Jeanne White and the loss that she had and her vigor and desire to bring forward a bill to care for people with HIV. We have spent a lot of money in this country already, some of it very successfully, some of it not very successfully; but we have with this bill made some very significant major changes in this legislation. In 1988, a Presidential commission made recommendations to the Congress and to the Government on what we should do. One of the things that they described in that report is the importance that should be placed on prevention. We have heard our grandmoms tell us for years that an ounce of prevention is worth a pound of cure. We know that. And I am very thankful for the gentleman from California (Mr. Waxman) and his staff as we have been able to work together and with others on the other side of the aisle to bring to the body this bill. Again, I think it is very unfortunate that we, in fact, are doing this at this time. There are several other components to the bill that we will discuss as we proceed through it. Mr. Speaker, I include the report referred to earlier. Report of The Presidential Commission on the Human Immunodeficiency Virus Epidemic Submitted to The President of the United States, June 24, 1988 Commissioners: Admiral James D. Watkins, Chairman, United States Navy (Retired); Colleen Conway-Welch, Ph.D.; John J. Creedon; Theresa L. Crenshaw, M.D.; Richard M. Devos; Kristine M. Gebbie, R.N., M.N.; Burton James Lee III, M.D.; Frank Lilly, Ph.D.; His Eminence John Cardinal O'Connor; Beny J. Primm, M.D.; Representative Penny Pullen; Cory Servaas, M.D.; William B. Walsh, M.D. executive summary The Human Immunodeficiency Virus (HIV) epidemic will be a challenging factor in American life for years to come and should be a concern to all Americans. Recent estimates suggest that almost 500,000 Americans will have died or progressed to later stages of the disease by 1992. Even this incredible number, however, does not reflect the current gravity of the problem. One to 1.5 million Americans are believed to be infected with the human immunodeficiency virus but are not yet ill enough to realize it. The recommendations of the Commission seek to strike a proper balance between our obligation as a society toward those members of society who have HIV and those members of society who do not have the virus. To slow or stop the spread of the virus, to provide proper medical care for those who have contracted the virus, and to protect the rights of both infected and non-infected persons requires a careful balancing of interests in a highly complex society. Knowledge is a critical weapon against HIV--knowledge about the virus and how it is transmitted, knowledge of how to maintain one's health, knowledge of one's own infection status. It is critical too that knowledge lead to responsibility toward oneself and others. It is the responsibility of all Americans to become educated about HIV. It is the responsibility of those infected not to infect others. It is the responsibility of all citizens to treat those infected with HIV with respect and compassion. All individuals should be responsible for their actions and the consequences of those actions. The urgency and breadth of the nation's HIV research effort is without precedent in the history of the Federal Government's response to an infectious disease crisis. However, we are a long way from all the answers. The directing of more resources toward managing this epidemic is critical; equally important is the judicious use of those resources. The term ``AIDS'' is obsolete. ``HIV infection'' more correctly defines the problem. The medical, public health, political, and community leadership must focus on the full course of HIV infection rather than concentrating on later stages of the disease (ARC and AIDS). Continual focus on AIDS rather than the entire spectrum of HIV disease has left our nation unable to deal adequately with the epidemic. Federal and state data collection efforts must now be focused on early HIV reports, while still collecting data on symptomatic disease. Early diagnosis of HIV infection is essential, not only for proper medical treatment and counseling of the infected person but also for proper follow-up by the public health authorities. HIV infection, like other chronic conditions-- heart disease, high blood pressure, diabetes, cancer--can be treated more effectively when detected early. Therefore, HIV tests should be offered regularly by health care providers in order to increase the currently small percentage of those infected who are aware of the fact and under appropriate care. Since many manifestations of HIV are treatable, those infected should have ready access to treatment for the opportunistic infections which often prove fatal for those with HIV. Better understanding of the true incidence and prevalence of HIV infection is critical and can be developed only through careful accumulation of data from greatly increased testing. Quality assured testing should be easily accessible, confidential, voluntary, and associated with appropriate counseling and care services. At the present time, a relatively small percentage of those infected with HIV are aware of their infected status. Some preventive measures must be undertaken immediately. Public health authorities across the United States must begin immediately to institute confidential partner notification, the system by which intimate contacts of persons carrying sexually transmitted diseases, including HIV, are warned of their exposure. The HIV epidemic has highlighted several ethical considerations and responsibilities, including: the responsibility of those who are HIV-infected not to infect others; the responsibility of the health care community to offer comprehensive and compassionate care to all HIV-infected persons; and the responsibility of all citizens to treat HIV infected persons with respect and compassion. The Commission believes that if the recommendations in this report are fully implemented, we will have achieved the delicate balance between the complex needs and responsibilities encountered throughout our society when responding to the HIV epidemic. Modeling HIV Infection Disease surveillance began early in the epidemic, before the human immunodeficiency virus (HIV) had been identified or isolated, and before it was known that there could be a lengthy period of infection prior to illness. Because at that time it was possible to identify only those individuals in whom disease are far enough advanced to be symptomatic, monitoring the epidemic meant monitoring disease, rather than monitoring infection. The early concentration on the clinical manifestation of AIDS has had the unintended effect of misleading the public as to the extent of the infection in the population, from initial infection to sero-conversion, to an antibody positive asymptomatic stage to initial indicative symptoms to full-blown AIDS. Continued emphasis on AIDS has also impeded long-term planning efforts necessary to effectively allocate resources for prevention and health care. Decisions on who will receive care, and whose costs will be covered, focused only on those most seriously ill. Continuing to use only the term ``AIDS'' to make treatment, reimbursement, or prevention program decisions is anachronistic and a policy we can no longer afford. While it is of value to continue monitoring diagnosed AIDS cases, public policy and prevention efforts should be based on an understanding of the extent and distribution of HIV in the population and on the rate at which new infections occur. This is especially critical in dealing with HIV, for which the average length of time between infection and diagnosis is at least eight years, according to the Institute of Medicine. It is critical that CDC begin now to collect HIV infection data from the states, not just case reports. The success of any disease or infection surveillance effort is dependent upon coordination at the national, state, and local levels and the sharing of resources and expenses. The public health profession has a long tradition of respectful, confidential handling of sensitive data and of affected persons; those currently holding public health posts and should be striving to build public confidence by stressing the profession's traditional adherence to this standard. Until CDC changes the focus of data collection from diagnosed AIDS cases to HIV infections, effectiveness of planning and intervention will be limited. As of March 1988, CDC acknowledged that a precise statement of the prevalence and rate of spread of HIV infection in the general population is still not available. Most analysts concur with CDC that, based on presently available data, the best estimate of seroprevalence is one million, with a range of up to 1.5 million. Repeatedly, witnesses before the Commission agreed that every reasonable effort should be made to increase the precision of this number, and of the rate of infection within specific population groups. obstacles to progress The Commission has identified the following obstacles to a nationwide effort to improve the public's response to and participation in programs designed to quantify the HIV epidemic at the federal, state and local levels: Continued focus on the label ``AIDS,'' contributing to lack of understanding of the importance of HIV infection as the more significant element for taking control of the epidemic. Lack of strong CDD leadership in the public health community for obtaining and coordinating HIV infection data. Inadequate counseling resources to assist those tested makes many support and interest groups reluctant to recommend widespread HIV testing. recommendations To respond to these obstacles, the Commission recommends the following: The Centers for Disease Control must provide clear direction for expanded and improved surveillance, including endorsement and support by national leaders, other federal agencies, and state and local leaders. States should require reporting of HIV infections. This information should be given to the Centers for Disease Control in appropriate form for statistical analysis, without identifiers. women with HIV infection With little exception, HIV research and programs have focused exclusively on homosexual men and intravenous drug users. As a result, there is limited information about the course of HIV infection in women. Diagnosis of AIDS in women may be late or less accurate because the natural history of infection in women is so poorly understood to date. There is some evidence to suggest that it differs from men. The problem of women with HIV infection is particularly important because it is directly linked to the rapid growth of the pediatric AIDS population. The greatest number of AIDS cases among women occur in the black and Hispanic populations. Of all cases of AIDS in women, 51 percent are black, and 20 percent are Hispanic. The routes of viral transmission are the same for women as for men, but in women, HIV infection occurring directly from intravenous drug use, and through heterosexual contact with an infected man rank first and second, respectively. One of the most serious problems facing the HIV-infected mother is the guilt she may feel after giving birth to an infected child, her despair as she watches that child die, or her anguish, knowing that after her own imminent death, she will leave children behind. minorities The impact of HIV infection on black and Hispanic communities has been felt very strongly; individuals from these groups comprise about 40 percent of all persons with symptomatic HIV infection. Leadership is critically needed from major national minority organizations and from churches in minority communities. partner notification Both public health practice and case law makes clear that persons put at risk of exposure to an infectious disease should be alerted to their exposure. The Commission believes that there should be a process in place in every state by which the official state health agency is responsible for assuring that those persons put unsuspectingly at risk for HIV infection are notified of that exposure. Such a process will enable that agency to work with the infected individual and the patient's primary health care provider to assure that contacts are notified of their exposure and urged to take advantage of the opportunity for testing and counseling. When interviewed appropriately, any person infected should be able to identify one or more persons from whom the infection may have come or to whom it may have been given. There are options for contacting those persons and ensuring that they, too, are aware of their risks. Those options include patient-managed referral and professional-assisted referral (with notification by an individual's health care provider or with notification by the health department). As an example, consider the women who has been married for 30 years to a man who, unknown to her, is a bisexual, or the person who believes he or she is involved in a completely monogamous marriage when, in fact, his or her spouse has been having sex with others. These people are completely ignorant of their exposure to the virus and would probably remain so until either their spouse, their child, or they, themselves, developed the clinical symptoms of AIDS. The Commission firmly believes in these individuals' right to be notified of their possible exposure so that they can seek prompt medical attention and avoid potentially exposing others. recommendations The public health department has an obligation to ensure that any partners are aware of their exposure to the virus. Mr. Speaker, I reserve the balance of my time. Parliamentary Inquiry

Mr. COBURN. Mr. Speaker, I ask unanimous consent that all Members may have 5 legislative days within which to revise and extend their remarks and insert extraneous material on H.R. 4807, as amended.

Mr. COBURN

Mr. COBURN. Mr. Speaker, I come to the floor to strongly support this, and I understand that our job is to set priorities for the administration. There is no question in the debate that this has not been a priority for the administration. They have said that this has not been a priority, and no matter how much money we send to the Department of Justice, it behooves us to direct the spending of that money in this area. Mr. Speaker, I want to relate a couple of things to my colleagues. I delivered a 9-year-old child of a baby, 9 years old, pregnant and delivering her. I want to tell my colleagues that that is never going to be and never will be a positive circumstance. The kind of actions that brought about that situation are the very actions that we are trying to get the Justice Department to look at, to follow the law and to prosecute the law. The problem is much greater than we would say, because if, in fact, we look on the Internet today, under stop AIDS, we will find information under that category that is funded by our own CDC that lists how you participate in S&M sex. Also in that same area, it shows the same type of obscenity that we are paying for with our tax dollars to do that. So the question is, this bill does not go near far enough. This should just be the first step as we attack this attack on our children. The other point that I would like to make, if this is an addictive procedure, we are big about protecting our children from tobacco, we are big about protecting our children from alcohol, we are big about protecting our children from drugs, we are big about talking about the violence that our children are seeing, but we are not big when it comes to one of the things that can undermine their future more than any other thing. So where is our priority? If we are really concerned about our children, then we ought to be concerned about every aspect that will undermine their future. This is one of, if not, the largest threat facing our children today, and I would hope that we would all support this legislation.

Mr. COBURN

Mr. COBURN. Madam Speaker, here we are again debating a question of life, and I am really saddened that we even have to be here. I think the gentleman from New York (Mr. LaFalce) raises a great question. What is the nexus? But there is an even greater question. What is the nexus that the Supreme Court used to say that innocent life has no value if, in fact, a mother says it has no value? So the question of nexus has tremendous precedent, as set by the Court, in overruling laws in my State that said innocent life should be protected beyond any shadow of a doubt. The second point which I think is very obvious to us is that it is right, nobody would come to the floor to say that this is not a proper thing to do. What a shame it is that a potential next leader of our country was confused on this issue. What that tells me is there is a rudder lacking in our moral integrity and foundation in this country and it was very well exhibited by that gentleman's statements. There is no question in this country that we are paying a tremendous moral price for the convenience of abortion. This bill is on the floor because we still have a tremendous moral wrong in this country. Any way that that issue can be discussed and talked about is a bona fide actuality on the floor of this House. We may not like it, but the truth matters; and the truth is that our Founders said that we are all equal, that we all have the right to the pursuit of life, liberty and happiness. Our country is in a sad state of affairs when we fail to recognize unborn life. This is just one of the symptoms of that. The gentleman from New York (Mr. LaFalce), I grant him, I do not like the politicization of this issue. But the realistic facts are we are here today because innocent life is being torn from the foundation of what would make us a great country.

Mr. COBURN

Mr. COBURN. Mr. Chairman, I do not want to offend anybody in this body, but I think we ought to really characterize what this debate is about, and that is whether or not we are going to use taxpayer dollars to allow a woman to kill her unborn baby. I mean, we can say that is not a politically correct statement; but that is what abortion is, is an unborn human being, a child, is being killed. Now, we can say, no, that is not it; it has no standing, but the fact is the Supreme Court recognizes that death in this country only occurs when there is an absence of brain waves and heartbeat. At 19 days post-conception, infants, children in their mother's womb, meet that. The other contention that I think we ought to talk about, very frankly, is whether or not killing an unborn child is health care. Who is that health care for, and should we ask the taxpayers of this country to subsidize the taking of unborn life? The fact is the vast majority of Americans today do not believe that abortion is the right thing to do, by far. It is growing every day as they see the truth about abortion. The fact is that we do not consider the rights of the unborn child, except if the child is injured unintentionally in a car wreck or injured in some other way. Then it has standing. But if it has standing at those times, we are going to say the rest of the time it has no standing. Mark my words, our country will change this. We can all disagree about whether or not this is a right or a wrong thing to do, but the fact that we should not subsidize it and the fact that the American people, by a large majority, do not want us subsidizing it, speaks very plainly to the fact that they know what the truth is: abortion is not health care. Abortion is taking the life of an unborn human being that is unique, has never been here before, never been created before, is totally unique, has the attributes of life, a beating heart, active brain waves. We can deny that because it is convenient to rationalize our moral choice for an inadvertent sexual activity. This amendment would pretend that rape, incest and the life of the woman does not exist. They are excepted in this. So the fact is we are protecting the true health of the woman in recognizing the right under our constitution of this unborn child.

Mr. COBURN. Mr. Chairman, I would just like to say that I have the utmost respect for the gentlewoman from Florida (Mrs. Meek), but the statement she just made ignores one person's rights, and that is the rights of the unborn. Read our Declaration of Independence. Read our Constitution. Regardless of what the law is, in the scheme of the long- term measure of us as a society, it is going to be said that we did the wrong thing. Legally, we have the right to abortion in this country. We are not disputing that. That is the law. I would just state that the fact is the judgment in history on our society is not going to be whether or not we recognize the woman's right to choose. It is going to be whether we recognize the innocent's right to life.

Mr. COBURN

Mr. COBURN. Mr. Chairman, I yield myself the remainder of my time. Mr. Chairman, I would make some points. First of all, the American people should look at the national debt clock. We are doing so well that the debt is going to rise this year. So if we want to measure whether or not we are balanced and whether we are in surplus, just look at how much debt we are going to leave for our children because it is going to be higher at the end of this year than it was at the end of last year. That is number one. Number two, in 1960, the Federal employee contributions provided 84.8 percent of the benefit outlets. In 1995, that went down to 12.5 percent, and in the next 10 years it is to be below 10 percent, so that the fact is for the benefits as they rise, the Federal employees' share are at a decreasing and decreasing amount. What does that mean? That means that our grandchildren's level and share is at an increasing amount. The point is that we still have a marked differential. Let the record show, there is a thrift savings plan that most employers do not offer to their employees that Federal employees have. The comparisons that he made in terms of employees are based on professional employees, not bureaucrats, not midlevel employees. It is based on professional. So although I think the gentleman is right in his position to defend those that are his constituents, I still stand with my position that we are not prudent for our grandchildren; we are not prudent for the investment of the future; we are not prudent for their standard of living because what we are going to do is leave them a legacy of debt. Although we talk about retiring debt, we are talking about retiring publicly held debt. We are not retiring total debt. We still have the obligations, and the only thing it changes is our cash flow, not our actual amount of money costed in interest. So I understand the rhetoric in Washington about the debt and about the balanced budget, and I respect that that is the way it has been talked about; but in terms of an accounting standpoint, it is baloney. We are not in a budget surplus yet, even though we are calling it a surplus because we have a consolidated accounting that does not recognize our obligations. Mr. Chairman, I reserve the balance of my time.

Mr. COBURN. Mr. Chairman, I yield myself the balance of my time. Mr. Chairman, I would state that anything that is backed by the Federal Government is actuarially sound even through we know Medicare is not, we know Social Security is not, and we know that the Federal Employee Retirement System is not as well. Mr. Chairman, I ask unanimous consent to withdraw the amendment.

Mr. COBURN. Mr. Chairman, I yield myself such time as I may consume. Mr. Chairman, under agreement with the gentleman from Maryland (Mr. Hoyer), the ranking member, and the gentleman from Arizona (Mr. Kolbe), the chairman of the committee, I have chosen to later withdraw this amendment during this discussion. But I think it is very important that the American public know what we have done in this bill, and the reason I am offering it is to describe once again the tendency of us as a body, well-intentioned as we are, to think in the short term. In 1995, we passed a budget out of this House that said we would change the contribution of Federal employees for their retirement. We did that again in 1996. The agreement with the President in 1997 was the same. In 1997, we had a 5-year moratorium to bring that up to 7.5 percent participation rate. What the committee did in trying to benefit Federal employees is to rescind the next few years of that agreement. Although, I hold no malice towards our Federal employees, I think we ought to be very frank about what we are doing. We are spending $1.3 billion of Federal monies that we had previously agreed that we will not spend, so we reversed, once again, a commitment we made to the American public with the administration about how we would fix the finances of our country. We do have a better revenue stream. There is no question about that, but our children do not have a better revenue stream. If we look at the unfunded obligations for Medicare and Social Security, unless we think about the future, instead of about today, we are going to put them in a tremendous financial box. We all know that; that is why we are all grappling with ways to fix Medicare and Social Security. But under the Federal pension benefit, we have an unfunded liability of three-quarters of a trillion dollars, a very high number equating close to one of these other two that I have mentioned. Mr. Chairman, I want to make a case so that the American people know that if you compare to the top 800 corporations in this country defined benefits in terms of retirement, the Federal employees on average have 40 percent better benefits than the top 800 corporations for the same wages. They also have rising COLAs every year which those benefits they do not have in the private sector. They are going to be paying with this past the same level of contribution for a much expanded benefit as they paid in 1969, where those in the private sector have had significant increases in terms of 30 percent or 40 percent. So although I hold no malice towards our Federal employees, I do hold malice on our judgment for going back on our long-term commitments to protect the future for our children and look honestly about what we need to be doing in terms of addressing this need. How are we going to pay for the retirement of the Federal employees? Nobody has a plan out there. It is an unfunded liability of three- quarters of a trillion dollars, $763 billion today; this is going to add $1.3 billion to that and that we are going to take and assume. I offer this amendment so that we can discuss this and understand what we are doing as we do this, and I have every intention of withdrawing it. Mr. Chairman, I reserve the balance of my time.

Mr. COBURN. Mr. Chairman, I offer an amendment.

Mr. COBURN

Mr. COBURN. Mr. Chairman, I thank the chairman for yielding. Mr. Chairman, if possible, I would like to enter into a colloquy with the chairman to discuss an area that I think in our foreign policy that we overlooked, and that is the funding for the former Yugoslav Republic of Macedonia. This is a country that of all the countries in the Balkans has achieved what none of the others have. And, in fact, what we have is a multiethnic society that has democracy, a functioning parliament that we, through our foreign policy, have not kept our agreements with, and specifically, the agreement that we signed that, if we were there longer than 5 days, we would renegotiate our agreements for the utilization of that society during the war in Kosovo. The toll on Macedonia has been tremendous. They had an influx of 350,000 refugees in a country of 2 million people. That would be like us taking 45 million people in. The agreements that were made are not being kept with the Macedonian people. In this time of instability in the Balkans and the need for stabilization, it is, I believe, imperative that, number one, we go back and reemphasize our effort for support for that democracy; and, number two, we keep the agreement that the administration made. I would like to enter into the Record the statements by Ambassador Holbrooke, the fact that the administration had asked for more money for Macedonia; and, in fact, their request was not for an increase in money for Macedonia and to make that a part of the Record. The second area that I think that we need to talk about is the infrastructure damage that has been done by both the KFOR force and the European force to their roads and highways which is handicapping their ability to rebuild their democracy and their economics. My question would be to the gentleman that if he would he take another look at this prior to going to conference to see if in fact we cannot live up to our obligations that were promised, number one, and number two, invest in a country that has chosen peace instead of conflict and is demonstrating that a multiethnic parliament and democracy can work in that area.

Mr. COBURN

Mr. COBURN. Mr. Chairman, I demand a recorded vote, and pending that, I make the point of order that a quorum is not present.

Mr. COBURN. I yield to the gentlewoman from Ohio.

Mr. COBURN. Mr. Chairman, I yield myself such time as I may consume.

Mr. COBURN. Mr. Chairman, I ask unanimous consent that time for debate on this amendment be limited to 10 minutes in opposition and 10 minutes in favor.

Mr. COBURN. Mr. Chairman, I am happy to address those issues. Number one, we cannot manufacture a drug that comes into this country unless we are manufacturing it in an FDA-approved facility. That is number one. So safety is not a concern, and they can do whatever they want if it is not manufactured in an FDA-approved facility. Number two, it does not apply to a drug that is not approved in this country. So as far as the drugs that are approved in this country, those are the ones that are manufactured in an FDA-approved facility that will come in safe. All we are saying is, since NAFTA is here, and I would have voted against had I been a Member of Congress at that time, but since it is here, let us use it. Let us get some benefit out of it besides stealing some of our jobs. So let us utilize NAFTA. This will not hamper the FDA.

Mr. COBURN. Mr. Chairman, reclaiming my time, I want to discuss a little bit about this problem. We spent 2 weeks ago talking about the crisis in the pharmaceutical industry as far as our seniors in getting drugs. It is not just our seniors; it is everybody in this country is paying too much for drugs. There are five things that could happen tomorrow to lower the price for prescription drugs in this country. This is a small step that would help. It is not even one of the major ones. The number one thing is to have a competitive market for prices in this country. We believe in free enterprise; there is not free enterprise in the pharmaceutical industry right now. All one has to do is look at the FTC Web site. There is documented collusion. We need to address that. Number two, our President needs to stand up and bully pulpit the pharmaceutical industry's prices. We do not need price controls. We need competition. Competition allocates scarce resources better than any type of price control ever will. What we need is real competition. Ms. Reno has received a letter signed by me asking for an investigation of which as of today, now, 4 weeks later, there has been no response on the documented areas of collusion within the drug industry. Number three, doctors need to do a better job giving generics to seniors, and they are not. Finally, number four, the pharmaceutical companies are not all bad. They do a lot of good things. There are private, indigent programs in the pharmaceutical industry that the health professions need to utilize. They will supply their drugs. Mr. Chairman, I yield the balance of my time to the gentleman from Maine (Mr. Baldacci).

Mr. COBURN. Mr. Chairman, I yield such time as he may consume to the gentleman from New Hampshire (Mr. Bass). (Mr. BASS asked and was given permission to revise and extend his remarks.)

Mr. COBURN. Mr. Chairman, I yield 5 minutes to the gentleman from Maine (Mr. Baldacci).

Mr. COBURN. Mr. Chairman, I yield myself 3 minutes. Mr. Chairman, first of all I want to thank the gentleman from Maine (Mr. Baldacci), the gentleman from Minnesota (Mr. Gutknecht), and several others for their work in this area. All this bill says is we are not going to intimidate seniors who are following the law, following NAFTA, and bringing drugs into this country from Canada or Mexico, as long as those are approved drugs and they have been manufactured in FDA-approved facilities. Mr. Chairman, we have debated this issue to a great extent. All this amendment will do is say ``hands off, FDA'' on legal and qualified manufactured products. It does not have anything to do with limiting their ability on safety; it does not apply to anything but a legal drug. So that means my patients who now are trying to get their drugs from Canada, from Oklahoma, can in fact have a prescription mailed to Canada or Mexico and have it filled and shipped across the border, and the FDA cannot intimidate them and say they cannot do that. That is all we are talking about, drugs that are manufactured in this country and manufactured in FDA-approved facilities that are legal drugs. Mr. Chairman, I reserve the balance of my time.

Mr. COBURN. Mr. Chairman, I offer an amendment.

Mr. COBURN. I move to strike the last word, Mr. Chairman. Mr. Chairman, I rise in strong support for this amendment. I believe the gentleman from New York has hit on an issue that we talked about during the prescription drug debate. I want to carry it a little further. The drug that he utilized, one of those, is Prilosec. There are three drugs on the market to compete with that in the United States. They all do essentially the same thing. Prilosec is about to go off patent. It is a $5.9 billion per year drug, per year. Of the two drugs that have come to market to compete with it, they are priced exactly the same. To me, that smells like no competition, it smells like a wink and a nod. Why, in a market that is a $6 billion market, would there not be any price competition for a drug that does essentially the same thing? I believe there may be some legitimate concerns about minimal packaging or safety, but the thing we need to remember is that this amendment is directed towards drugs made in this country, shipped to Canada and then come back, or into Mexico and then come back. So these are drugs that have already been licensed, they have been manufactured in an FDA facility, and in fact they should be, under NAFTA, readily coming across our border without any inhibition whatever if there is a bona fide prescription for that drug in this country. We have a crisis in prescription drugs, but it is not a crisis in Medicare, it is a crisis in price. The reason we have the crisis in price is there is not adequate competition in the pharmaceutical industry. I would direct the Members of this body to go to the FTC's website where they have identified four manufacturers over the last year raising the cost for prescription drugs close to $1 billion on four separate drugs because they colluded with people to not bring other drugs to market. They were actually paying their competitors not to bring drugs to market. So I believe the gentleman from New York has a wonderful idea. I believe it is an appropriate idea. I think the safety concerns are a red herring. There are not the safety concerns because they are actually manufactured in this country. The FDA will not have any limitations on it. As far as traceability, we are going to be able to trace these drugs like any other drug. They are not going to be allowed to be sold in Canada with a prescription unless we can trace it and keep a record, just as in this country. There will be completely the same types of regulations in terms of pharmaceuticals. As a practicing physician that sees that people cannot afford their medicines today, we have to do something. The first thing we need to do is to start competition. If the Justice Department is not going to investigate the pharmaceutical industry, we should be doing this and passing this amendment.

Mr. COBURN. Mr. Chairman, reclaiming my time, the drugs that are produced in FDA-approved facilities, they do assure at this time that they are made to the same standard as the drugs that are made in this country. Otherwise, they would not have their approved labeling from the FDA, and that is true in all FDA-approved facilities.