Thomas Coburn

Mr. COBURN

Mr. COBURN. Mr. Speaker, I yield myself 30 seconds. Mr. Speaker, just a couple of points on the points that the gentleman from Ohio (Mr. Brown) made. We also are not allowed by the rule and by the powers that be with an ability to limit the direct consumer advertising that should be a part of this, that consumed $1.9 billion last year, will consume $3.8 billion this year and will consume $7.6 billion a year from now, all of which has no benefit for the American consumer except the American consumer is paying for it. Mr. Speaker, I yield 2\1/2\ minutes to the gentleman from Florida (Mr. Miller).

Mr. COBURN. Mr. Speaker, I yield 3 minutes to the gentleman from Minnesota (Mr. Gutknecht).

Mr. COBURN. Mr. Speaker, I yield myself 2\1/2\ minutes. Mr. Speakers, one of the ironic things about today's debate is the debate was about whose prescription drug bill would do the problem. We had a debate about the wrong problem. The problem is the lack of price competition in the pharmaceutical industry. For if prices were not rising, seniors would not be screaming, and we would not be addressing this issue at all, putting the risk of the Medicare program and its viability in the future on the line. It is interesting to note that we have a President that is screaming for a prescription drug bill, and his own Justice Department will not even answer letters requesting an investigation into the antitrust activities of the pharmaceutical industry. It is interesting to note that politics has reigned supreme in the debate about pharmaceutical and Medicare drug benefit when, in fact, we can accomplish a limitation on advertising, we can accomplish setting in force of motion of the very administrative agencies that are already in place to assure the American people that we do not have monopolies and we do not have price gouging and we do not have price fixing. It is to be noted that the FTC has already received two consent decrees from two large pharmaceuticals manufacturers, one of which was paying $60 million a year to another pharmaceutical company not to bring a drug to market, consequently costing American consumers for $250 million for that drug alone. That drug was a calcium channel blocker known as diltiazen. Another one, Hytrin, used for prostatic hypertrophy and hypertension, same thing, $15 million a month paid to another pharmaceutical company so they will not bring a drug to market. We have collusion, and we have lack of competition. Until we address that, we will not be good stewards of the Medicare program. We will not be good stewards, whatever drug benefit we offer. The other point that I would make, as we have done in every other area of Medicare, because we have not been good stewards, we are going to cost shift. We are going to lower the prices. Under the Democrat plan or the Republican plan, the prices for Medicare seniors will go down. But that price, if we do not work on the industry, will cost shift to the private sector. So we are going to raise taxes on everybody else, their cost of health care, to supplant the lack of the proper benefits in Medicare. Mr. Speaker, I reserve the balance of my time.

Mr. COBURN. Mr. Speaker, I yield 3\1/2\ minutes to the gentleman from Minnesota (Mr. Gutknecht).

Mr. COBURN. Mr. Speaker, I yield myself such time as I may consume. Mr. Speaker, I would just like to make note of the fact that the wonderful Food and Drug Administration bureaucracy that we have seen built over the last 40 years, the average price to get a drug through that organization is $450 million, of which only $50 million is allocated for safety, $400 million for efficacy for a Food and Drug Administration to tell somebody where to put a bathroom in a plant, and bureaucratic overregulation. So when we talk about how effective it is, it is important to know what portion of the costs are really on safety and that portion which is not associated with safety. Mr. Speaker, I yield 3 minutes to the gentleman from Montana (Mr. Hill).

Mr. COBURN. Could I inquire of the Chair the time remaining.

Mr. COBURN. Mr. Speaker, I yield myself such time as I may consume. Mr. Speaker, I would like to add to what the gentleman from Arkansas had to say. Mr. Speaker, $5.9 billion of Claritin were sold last year. There are four other drugs with similar chemical moieties that have been approved by the FDA. Guess what, they are all priced the same. Why is that? Because there is not price competition in the pharmaceutical industry. Mr. Speaker, I yield 2 minutes to the gentleman from Michigan (Mr. Hoekstra).

Mr. COBURN. Mr. Speaker, I yield 2\1/2\ minutes to the gentlewoman from Idaho (Mrs. Chenoweth-Hage).

Mr. COBURN

Mr. COBURN. Mr. Speaker, we are having a debate today; and we have heard a lot of partisan bickering back and forth, and it is because what we are doing is the wrong thing, and the politics of Washington is claiming to fix a problem that is very real, but it is fixing the wrong problem. The problem is, there is no competition within the pharmaceutical industry and what is there is limited in its base. As we seek to solve the problem for the very seniors that need our help, if we do not solve the problem on competition, then we will, in fact, have wasted Medicare dollars and cost-shifted another large cost of health care to the private sector. I would like to introduce into the Record the FTC Web site showing four pharmaceutical companies who have been paying their competitors not to bring drugs to market, costing the American consumers over $250 million a year. I would also enter into the Record various portions of the paper talking about the pricing of prescription drugs, not the availability but the pricing. If we fail to address that, we have shirked our duty completely. Neither the Republican or the Democrat bill does that. Why the High Cost of Prescription Drugs Is a Problem We Can't Afford to Ignore Spending on prescriptions rose a record 17.4% last year. Elderly patients saw the largest increases, with average prescription prices increasing 18% for women aged 70-79 and 20% for women 80 and older. Men in the same age groups fared a bit better, experiencing 9% and 11% increases, respectively. For all Americans, prescription spending averaged $387.09 per person in 1999, up from $329.83 in 1998.--Study by Express Scripts, a St. Louis-based pharmacy benefits manager, which examined claims data from more than 9 million patients, reflecting average wholesale prices, June 27, 2000. Express Scripts projects that spending on prescription drugs will nearly double over the next five years, reaching $758.81 per person in 2004.--Wall Street Journal, June 27, 2000. The history of Medicare shows that the federal government has seriously underestimated the future growth of the program. In 1964, the Johnson administration projected that Medicare in 1990 would cost about $12 billion (with an adjustment for inflation); the actual cost was $110 billion-- almost a 1,000% cost underestimate. How much of a cost underestimate can we afford for prescription drugs?--The Origins of Medicare by Robert B. Helms, American Enterprise Institute, April 1999. Express Scripts noted that the introduction of new drugs, such as the arthritis medicines Vioxx and Celebrex, contributed significantly to the rise in spending last year. However, roughly half of the total increase in drug spending was due to higher prescription costs.--New York Times, June 27, 2000. Of the 50 top selling drugs for seniors in 1999; 11 increased at least 5 times the rate of inflation; 16 increased at least 3 times the rate of inflation; 33 increased at least 1.5 times the rate of inflation, and only 12 increased slower than the rate of inflation.--Families USA, April 2000. Of the 50 top selling drugs for seniors between 1994 and 2000, 39 of which were marketed for all six years, 6 increased at least 5 times the rate of inflation; 11 increased at least three times the rate of inflation; 22 increased at least 2 times the rate of inflation; 30 increased at least 1.5 times the rate of inflation, and 37 increased faster than inflation.--Families USA, April 2000. While prescription drugs accounted for about 5% of overall health care spending in 1992, some experts have predicted that that figure could rise to about 15% within 10 years.-- Los Angeles Times, May 29, 2000. Drug spending is increasing 15% to 20% a year even in well- run private health plans.--New York Times, May 15, 2000. For 1999, drug spending is projected to have risen 14% to 18%, according to HCFA. A recent study by Families USA, a health-care advocacy group, said the average cost of the 50 drugs most used by the elderly rose 3.9% last year, outpacing the 2.2% inflation rate, and the prices of some medications jumped as much as 10%.--Wall Street Journal, May 11, 2000. Pharmacia Corp., which markets a generic version of the drug called Toposar, reported a price of $157.65 for a 20- milligram dose in the 1999 industry guide. But the actual average wholesale price is $9.70, according to a government price list.--Wall Street Journal, June 2, 2000. Today, federal and state investigators are threatening civil litigation against pharmaceutical makers that authorities believe have induced Medicare and Medicaid to overpay for prescription drugs by $1 billion or more a year.--Wall Street Journal, May 12, 2000. In 1997, Zachary Bentley, an employee of a Florida company called Ven-A-Care that offered patients the option of receiving intravenous drugs in their homes rather than at a hospital, sent a toilet seat and an overpriced drug to HCFA. Bentley noted that Medicare was paying providers almost $428 a day for a product that could be bought for $49--proof, in Bentley's view, that the agency was wasting tax dollars as the Pentagon did with its high-priced toilet seats in the 1980s.--Wall Street Journal, May 12, 2000.

Mr. COBURN

Mr. COBURN. Mr. Speaker, I just want to take 30 seconds to respond to the gentleman from Massachusetts (Mr. Frank). There is no one more cantankerous or contrary with our leadership than I am, and we have never been stifled in our conversation and we have never been limited in terms of our ability to express our viewpoint.

Mr. COBURN

Mr. COBURN. Mr. Chairman, I yield myself such time as I may consume. Mr. Chairman, I want to thank the gentleman from Florida (Mr. Boyd) for bringing up this issue because the American public needs to be informed on how we are operating. What the gentleman from Florida is really saying is we are playing a smoke and mirrors game as far as emergency funding in this country, and that, in fact, we have spent more than $2.7 billion each of the last 5 years on emergency, yet we fail to plan for the rainy days for the constituencies that we have in this country and for the emergencies that they face. His point is a good one. We should, in fact, be budgeting within the 302(b)s and within the budget of this Congress. Now, let us talk about why it is not. The reason it is not in there is because when we are all said, done, and through this year, we will reach back into year 2000 money and pay for emergency spending and not have to account for it. Until we get new updates, what we will really be taking that money from is Medicare. That money will come from Medicare. So I want to commend the gentleman from Florida. I think his point is right on. We need to be budgeting as a part of the budget process, and we need to be appropriating yearly this amount of money. It comes with being part of the fiscal discipline and the budgetary process that is open and honest. This one is not. What we are going to do with FEMA and how we are going to fund it to you, we all know we will fund it, the question is will we fund it honestly or will we reach back and claim the surplus last year and then steal the money, not tell the American public that the money that is going to be spent in fiscal 2001 is actually their 2000 that we, at one time, called a surplus. Mr. Chairman, I reserve the balance of my time.

Mr. COBURN. Mr. Chairman, I yield myself such time as I may consume. Mr. Chairman, I would just make one final point. If in fact we need $2.9 billion and there is $2 billion in the pipeline, then $900 million out of this appropriation bill should have been set aside, appropriated for that purpose, and it was not. It was not because we know we can reach back. It is easier to spend your money, Mr. Taxpayer, Mrs. Taxpayer, than it is to not spend it. That is why, in fact, it is not. Mr. Chairman, I yield back the balance of my time.

Mr. COBURN. Mr. Chairman, I make a point of order that on page 67, lines 4 through 14 constitute legislating on an appropriation bill in violation of clause 2 of rule XXI. I ask for a ruling from the Chair in that regard.

Mr. COBURN. Mr. Chairman, I ask unanimous consent to claim the time in opposition to the amendment.

Mr. COBURN. Mr. Chairman, I yield such time as he may consume to the gentleman from New York (Mr. Walsh).

Mr. COBURN

Mr. COBURN. Mr. Chairman, I move to strike the last word. Mr. Chairman, I assure Members that I will return that. I just wanted to make a statement. We have another appropriations bill on the floor, and I want to compliment the chairman, the gentleman from Ohio (Mr. Regula), and the ranking member, the gentleman from Washington (Mr. Dicks). There are no games played in this bill. The American public is going to be able to see exactly what is in there. There is no sneaking in of advanced funding. There is no sneaking of emergency funding that comes right out of Medicare. This committee should be recognized for setting the example of what the agreement was when we finished the budget in this year. And I wanted to tell Members how much I appreciated it, and I know that there are several other Members in the House that appreciate it. And we would like to see more of it.

Mr. COBURN

Mr. COBURN. Mr. Chairman, I make a point of order.

Mr. COBURN. Mr. Chairman, on page 44, beginning on line 4 with the word ``provided'' and continuing through the colon on line 14, constitutes legislating on an appropriation and is, therefore, a violation of clause 2 of rule XXI. I ask for a ruling from the Chair.

Mr. COBURN. Mr. Chairman, will the gentleman yield?

Mr. COBURN

Mr. COBURN. I thank the gentlewoman for yielding me this time. Mr. Speaker, in about 6 months from now, I will be back in my medical practice in Oklahoma. The one thing I will not miss is a lack of integrity and straightforwardness about when we discuss these issues. Everybody in this House knows that the funding in Labor-HHS bills have climbed faster than in any other thing that we have funded in this House under Republican control. We are $40 billion more under this appropriation bill than we were in 1995. There is $14.3 billion more for children, for health, for education to be available, to be spent in 2001 than was available last year. And for anyone to come to the House floor and to say that there is a cut in programs, it is not only untrue but it smirches the integrity of this entire House. We have a bill that spends much more than I want to spend on many of these programs because the accountability is not there, but we are going to spend the money to fulfill the needs even though the accountability is not there. It is important for us to make sure when we talk about priorities that what we are really talking about is a difference in the amount of increase in spending in priorities, not in cutting any major program. My heart aches for my grandchildren, because if we progress in this House with statements of untruth for political demagoguery purposes, we do neither party any positive benefit and we undermine the very value of this institution. So I would beg that as we debate this bill the next 16 hours, to tell the Members of the House and tell the people in the country the same thing you would tell your grandchildren. Would you lie to your grandchildren? Would you be untruthful about what is really going on? We can have an honest debate about the differences in priorities. But I beg you, do not undermine the integrity of this House by baseless claims of cuts in spending.

Mr. COBURN

Mr. COBURN. Mr. Chairman, I thank the gentleman for yielding me this time, and I listened with great care to what the gentleman from Indiana (Mr. Buyer) had to say to warn us about the emotional side of being inaccurate in this, but I am not running for reelection. This speech gives me nothing. I want to tell my colleagues what I learned when I first ran for office 6 years ago, and that is that we have lied and cheated our veterans and our retired military in terms of their health care. It is too common a complaint. It is too real. I saw it. I saw it at Tinker Hospital in Oklahoma City. They cannot even handle the people that are there now that are active duty. They send the people off. So the question is, yes, have we met our need? We all agree we are trying to do that whether we do the Buyer amendment to this amendment or not. The question that was raised is, is it cost effective? I do not care if it is cost effective. Because if it is cost effective or not, if the first principle of not keeping our word is not met, it does not matter. It does not matter. We will not be able to ever man an army when we need to man a geared- up army if that population believes that we will not keep our word. And that is exactly what they believe today. The final thing is that it is a crippled program. The only reason it is crippled is because we have not thought outside of the box. If we make the commitment to retired military that we are going to promise them health care, then give them a card, a new card, that lets them get it at a military hospital, at a VA hospital, at any hospital they want. But, by dingy, keep that commitment.

Mr. COBURN

Mr. COBURN. Mr. Speaker, I thank the gentleman from Iowa for yielding me this time. I thank the committee for the manner in which they worked with us. For $4 a baby, we can prevent HIV infection in Africa, $4. That is all it takes, one dose of nevirapine, and the pregnant woman who has HIV for her child not to become infected. That is the minimal that we can do. This bill brings forward the first of many challenges that the world is going to face in terms of HIV. About 3 months ago, I met with directors, AIDS directors of 21 African countries and visited with them about what they were doing. My hope is, as we pass this bill and we assess the success that I know that is going to take place in Africa, because we have already seen major changes in two countries, Uganda and Senegal, my hope is that, as we vote for this, that we will apply the same common sense to the AIDS epidemic in America. See, the same women, African-American women are being unduly hit by this disease. The same children, African-American children in America are five times more likely to contract this disease than a white child. An Hispanic child is three times more likely to contract this disease. So as we vote to help Africa in this dreaded disease, and this will be great help, it will make a tremendous difference, we will have not ever spent $100 million more effectively than the money that is going to be authorized in this program, please look at how we handle HIV in this country, and let us not let another baby get infected in this country, the wealthiest country in the world. Let us not allow people to continue to be ignorant about HIV and this infection. I thank the gentleman from Iowa (Mr. Leach), chairman, and the gentleman from New York (Mr. LaFalce), ranking member, for this bill. It has my wholehearted endorsement.

Mr. COBURN

Mr. COBURN. Mr. Speaker, first of all, I would like to pay tribute to the gentlewoman from California (Ms. Eshoo) and to the gentleman from New York (Mr. Lazio) for their work on this bill. I do not think it would have come about without their efforts. And I do not believe this has anything to do with partisan politics, and I am sorry that that has been raised as a part of this. The human papilloma virus, breast cancer, does not care what one's political affiliation is. It just is coming after us. I also want to make clear the statements by the gentleman from California are erroneous. The number one sexually transmitted disease in this country today, that claims 15,000 lives, more lives than AIDS, is human papilloma virus. And for the American College of Obstetricians and Gynecologists to stick their head in the sands and say they do not really care about women because they do not want them educated about the number one risk factor for them developing cervical cancer. It is true that 15,000 women will be diagnosed with cervical cancer this year. Fifteen thousand women will die. But hundreds of thousands of women will be treated for precancer dysplasia because we, as a government and health policy, have decided we are not going to let everybody know about the most dangerous sexually transmitted disease out there. This bill moves a long way toward that, of informing women of the actual method of transmission and the fact that prophylactic use of condoms will not prevent this disease. ACOG did not dispute the facts. They just said they did not want the public to know. I think it is highly ironic in this day and time of advances in health care that those that control the power over the medical institutions have chosen to go against knowledge, against informing women. If they were to apply the same logic to breast cancer, they would not tell women about annual screening with mammograms, they would not tell women about how important it is for them to get a report back on their mammogram or to have a follow-up doctor visit or to do annual self-breast exams. So I find it very ironic that, number one, this bill can be claimed to be partisan. It is not. The gentlewoman from Missouri (Ms. Danner), the gentlewoman from California (Ms. Eshoo), and many others in this Chamber have worked hard to see that this bill came to fruition, including the ranking minority member of this subcommittee. Let us not let it be partisan. Number two, let us not deny scientific truth. Let us let people know what they are at risk for. That is all this is about, to inform the public of the risks that are out there in terms of a disease that causes more deaths than AIDS in this country, and it is preventable. And, Mr. Speaker, I am providing for insertion into the Record a letter from the Medical Institute on Human Papilloma Virus. The Medical Institute, Austin, TX, May 9, 2000. Press Release house to decide whether americans should be told the truth about the most common std, human papilloma virus (hpv) Austin, Texas (May 9, 2000).--Today the House of Representatives will consider the Breast and Cervical Treatment Act legislation (H.R. 4386). This important legislation has the potential to dramatically decrease the number of lives shortened each year by cervical cancer, which results from the most common STD, human papilloma virus (HPV). H.R. 4386 would make HPV and cervical cancer prevention a new public health priority. The bill directs the CDC to determine the prevalence of HPV, and to develop and disseminate educational materials for the public and for health care providers regarding the impact and prevention of HPV. In addition, condom labels and government sponsored informational materials would be required to state that condoms do not prevent the transmission of HPV and that HPV can cause cervical cancer. This bill is particularly significant in that it would make HPV a reportable disease to the Centers for Disease Control and Prevention. This action would make it possible to accurately assess how many individuals are hurt by the disease each year. Current estimates suggest that 75 percent of all sexually active adults currently have, or previously had, an HPV infection--that's over 80 million Americans between the ages of 15 and 49. Current labeling on condom packages suggests that condoms protect users from HIV and other sexually transmitted diseases, including HPV. This bill would require condom packaging and public health messages to warn the public that condoms do not provide adequate protection for HPV transmission, which can lead to cervical cancer. Most Americans--including American health care professionals--are currently unaware of HPV's dramatic prevalence. HPV is the most common viral STD in the United States. Current estimates suggest that 5.5 million Americans acquire the infection each year. HPV is the virus present in over 93 percent of all cervical cancers (according to a 1995 study in the Journal of the National Cancer Institute). More women die from cervical cancer than die from AIDS each year in the U.S. In addition to cervical cancer, HPV can lead to vaginal, vulvar, penile, anal and oral cancer. According to the National Cancer Institute, the evidence that condoms do not protect against HPV is so definitive that ``additional research efforts by NCI on the effectiveness of condoms in preventing HPV transmission is not warranted.'' Dr. Richard Klausner of the National Cancer Institute has stated, ``condoms are ineffective against HPV because the virus is prevalent not only in mucosal tissue, but also on dry skin of the surrounding abdomen and groin, and can migrate from those areas into the vagina and cervix.'' Despite these findings, The American College of Obstetricians and Gynecologists (ACOG) does not support this legislation. In a letter sent to the members of the House, the College states, ``We believe that the HPV language included in H.R. 4386 is not medically appropriate. Indeed, we feel the language, if passed, would discourage condom use although condoms are effective in preventing other serious STDs such as HIV/AIDS.'' This statement indicates that ACOG has abandoned its responsibility to inform the American public about the truth: condoms don't protect against the transmission of the most common STD--HPV. It's worth noting that ACOG is not questioning the medical accuracy of the legislation. They are simply fearful that the data might discourage condom usage (although there is no scientific or anecdotal evidence to support this conclusion). H.R. 4386 must be passed to protect the future health of Americans. Americans have a right to know the truth about human papilloma virus (HPV). It is only when individuals know the facts that they can make informed decisions that impact their personal health and future happiness. The Medical Institute applauds the House for addressing this important issue. The Medical Institute is a nonprofit medical organization founded in 1992 to confront the worldwide epidemics of nonmartial pregnancy and sexually transmitted infection with incisive health care data.

Mr. COBURN

Mr. COBURN. The same drug?

Mr. COBURN. Mr. Speaker, I wanted to address the American public and Members of the House tonight. I find myself in a minority in Washington, both among the Republicans and the Democrats. I am a practicing physician that normally practices and sees patients on Mondays and Fridays when I am not in Washington, and I see before us a situation much like a patient who would come to me with a fever, chills and night sweats, and the treatment we are about to give to that patient is to tell them to take an aspirin and cover up in a blanket and go home and they will get better, when the underlying problem is that they have pneumonia. Without totally diagnosing their disease, what I have done is committed inappropriate care and have actually harmed the patient. If one is a senior citizen tonight, I want them to listen very carefully to what I am going to explain to them about Medicare, and the tack that I am going to take is not necessarily going to be appreciated by most of the Members of this body. I also happen to be a term-limited Member of Congress. I am not running for reelection, and I want to say that in my heart, knowing how severe the problems are for my patients with prescription drugs, the worst thing we can do for seniors is to add a costly prescription benefit drug to the Medicare program. I am going to spend the next hour outlining why that is the case and why it ignores what the real problems are in the drug industry and the physician practices that now many of our seniors find themselves involved with. I also want everyone to know that Medicare has been abused by the Members of this body, the other body and previous Presidents, because most workers in this country, as a matter of fact all workers in this country except if they are a Federal employee, are paying 1.45 cents out of every dollar they earn, no matter how much money they earn, into the Medicare part A trust fund. As they pay that 1.45 cents, so does their employer. So that is almost 3 cents out of every dollar that is earned by every employee is paid into the Medicare part A trust fund. The Congress, with the consent of the Presidents over the last 20 years, have stolen $166 billion of that money. What they have done is they have put an IOU in there and said we will pay this back some day in the future, but they took that money and spent it on other programs. They did not say we need to raise taxes to do this good program. They did not say we are going to take the Medicare money and spend it on this program. They just very quietly took $166 billion out of that trust fund for a hospital trust fund and spent it on other programs. Now that is not a partisan statement. That is Republicans and Democrats alike. So we now find that as of 2 weeks ago, that trust fund is going to be totally bankrupt by the year 2015. Now we had some good news this last week. That has advanced to 2023; that is, if we do not do anything with Medicare. We know that at least 17 cents out of every dollar that is paid out for Medicare is inappropriate. Where is the reform for Medicare? Where is the fix to the very program that is supposed to be supplying the needs of our seniors? I see every day that I am in practice seniors who have a difficult time accomplishing what I want them to do as far as their drugs. I see seniors, and we have had described tonight, that have to make a choice between whether they are going to eat a meal or take a medicine. That is not all because there is not a prescription drug benefit because of Medicare, and what I want to outline is some of the deeper problems that are associated with the pricing of drugs in this country, the overprescribing of drugs in this country, the lack of review of drugs that seniors are taking in this country, and what we can do about it to fix it before we ever start adding another program. The reason that that is important, because if we add another benefit now the people who are going to pay for that is our grandchildren. It is not going to be 3 cents out of every dollar. It is going to be 9 cents out of every dollar, and what is really being said is the grandchildren's standard of living, if we establish a Medicare drug benefit, because that is who is going to pay for it because it is going to start in the year 2023 and there is going to be a significant price to pay, and that price is going to be manifested in the fact that their standard of living is going to be far less. They will not buy a new home because they are going to be paying 6 percent additional out of their income for a Medicare program. What can we do today to change the current climate as far as prescription drugs in this country? I say there is a lot we can do. The first thing we can do is we can ask the President to instruct the FDA to get on the ball as far as generic drugs. The gentlewoman from Michigan mentioned that she had somebody write in and say she was taking Premarin. For 5 years there has been an application pending for an identical drug to Premarin that the vast majority of women over 50 years of age in this country are taking that will sell for one-sixth the cost that Premarin presently sells for. Premarin sells for, a month, about $30 average in this country. The same drug made in the same plant in Europe, not Canada and Mexico because they have price controls, in Europe sells for $6.95. How is it that we are subsidizing the drug consumption of the rest of the world? There is something wrong with the market. So it is not a nonconservative position to ask that competition be restored. The first thing we do is we get the FDA to approve more generic drugs. I might also note that there was a recent release March 16 on four drug companies where the FTC found that two drug companies had paid two other drug companies to delay the release of their generics. In other words, they fixed prices. What that says to us is the Justice Department in this country ought to have an aggressive policy that is going to attack anticompetitive practices in the drug industry. If we do not fix that and we create a Medicare drug benefit, what we are going to do is waste money in Medicare, besides supplying the need for our seniors which is very real. I do not deny that. If we do not fix that underlying pneumonia in this program and in the drug industry, all we are going to do is pay more money for it. Those companies, and this can be found on the FTC Web site as of March 16, 2000, if anyone is interested in knowing, clear evidence that there is price fixing that is ongoing in the drug industry today; clear evidence that the Justice Department is not doing its job to make sure that there is competition among the drug industry. The other thing that is important is 2 years ago, which I voted against and very few of us did, this Congress and this President passed FDA reform which allowed prescription drug companies to advertise prescription-only medicines on television. This year they will spend $1.9 billion on television advertising for medicines that can only be gotten if a doctor writes a prescription for someone. Who is paying for that? We are paying for it. It is not necessarily more effective for the patient. It does not necessarily make us healthier. It just creates a brand name under which that drug company can sell more of a particular brand of drug without necessarily inuring any health benefit to us as a Nation. We ought to reverse that. There is no reason to advertise prescription drugs on television. That is $1.9 billion that would drop out of the price of drugs tomorrow. That is expected to go to $5 billion next year. So we can take $5 billion next year out of the cost of drugs. This year, the average wholesale price of existing drugs in this country rose 12 percent. That is the year 1999. Not new drugs, drugs that were already out there. The costs associated to those drug companies for those was 1.8 percent. So they had a six-fold increase in price for existing drugs with a 1.8 percent increase in price. That to me tells us that there is no competition in the drug industry. When the average cost of living was less, the increases all across the board were 3 percent, and prescription drugs, not new drugs, not new benefits, not things that were breakthroughs, increased four times the rate of inflation, we have to ask the question, what is going on in the drug industry? Do not get me wrong. I believe in the free enterprise system. I believe in competition. I believe competition allocates scarce resources very effectively. But we do not have competition in the drug industry today. A third thing that can happen is we ought to put a freeze, no additional mergers in the drug industry until there is a blue ribbon panel that says there is, in fact, competition to make sure that there is true competition. A drug was recently introduced that competes with a drug that is on TV, everybody knows it as the purple pill. It is called Prilosec. A new drug, does the same thing slightly different, one would think they would want to get market share. One would think they would want to introduce that new drug at a price lower so that people might switch to that one to use it. Guess what the average wholesale price? Exactly the same as Prilosec. Why is that? Because there is no competition in the drug industry. Now, the statements I am making on the floor tonight will be met with hard-ball politics tomorrow by the drug industry, my colleagues can bet it. But unless America wakes up and does not go to sleep saying the problem to solve drugs for our seniors is to create a new program on a bankrupt program and charge it to our grandchildren, we will never solve the problems. The problems are severe. There is another thing that could happen tomorrow that would help almost every person that has been mentioned in the hour before I started speaking. Almost every drug company in this country has an indigent drug program. They will give drugs free to indigent seniors, but it takes a little work. The doctor has to fill out something. It has to be mailed to the drug company. They will mail them a 30-day supply. One has to keep doing it if one wants them to keep getting it. The drug companies are willing to do that, but the physicians in this country, because they are already overworked because of the overburdened system of managed care, do not really have the time to take advantage of that. So here we have a benefit that would lower the cost, would make available drugs to many of our seniors, but it is not being utilized because of the mandated system and lack of competition and the lack of freedom associated with the health care system that we have. There is still another thing that we could do, and this one my physician friends are not going to like. But we heard comments that a senior was on 17 medicines. Well, I will tell my colleagues any person in this country on 17 medicines is not feeling well. One of the reasons they are not feeling well is the medicines are making them not feel well. Most good doctors were trained to do a medicine review at least every couple of months on somebody taking 17 medicines. One of the things that makes me happiest when I see seniors, they come to see me, and I look at the medicines they are on, if they are a new patient, the first thing I do is take them off three or four, and they think I am a hero. I am not a great doctor. It is just common sense that if one is on too many medicines, one is not going to feel good. The second thing is, if one is on 17 medicines, one is not going to be taking them right. So they are not going to be effective. The third thing is doctors have to pay attention to what medicines cost. Guess what? Most physicians are not doing that. They are writing a prescription. Our goal ought to be, as physicians, is if we are going to help somebody get well, we ought to make sure we can give them a prescription for a drug they can afford to take. Now, that may not always be the best drug. It may be one that works 95 percent as well. But if they are taking the one that costs $5 that works 95 percent as well compared to the one that costs four or five times as much and worked 99 percent instead of 95, which would one rather have one's mother and father on. I would rather have them on the one they are going to take. So I think there are a lot of common sense things that ought to be approached before we ever start talking about sacrificing the future of our grandchildren by expanding a new Medicare program. Now, let me give my colleagues a little history on Medicare. We talked about all the things. The closest the Federal Government, the best the Federal Government has ever done in estimating the cost of a new Medicare benefit they missed by 700 percent. So when my colleagues hear a new drug program is going to cost $40 billion, it is going to cost $280 billion at the least, $280 billion. Instead of this program being bankrupt in 2023, it is going to be bankrupt in 2007, 2008. Now, politically, if one is running for office, it does not take much courage to say one will vote for a Medicare benefit. But it takes a whole lot of courage to say, I do not think that is the best thing for all of us as a society as a whole. Why do we not fix the real problems associated with the delivery of medicine and drugs and competition within the health care industry. By ignoring it, that patient I talked about that had pneumonia is going to die, and that is what is going to happen to Medicare. We will not let it die because the career politicians do not have the courage to challenge the system. It was last year that we finally got the Congress to stop touching Social Security money. But this year, if you will notice these charts, you can see how the Medicare money comes in. Medicare trust money comes in, it goes to the Federal Government. They use it, the excess money they put an IOU in there and the IOU is credited to the Medicare trust fund. Here is what is going to happen for the next 2 years. These are not my numbers. These are Congressional Budget numbers as of 2 weeks ago. This year, the surplus in the Medicare part A trust fund is $22 billion. The surplus in the fiscal year 2000, right now, as estimated by the CBO is $23 billion. So $22 billion of the $23 billion that the politicians in Washington are going to call surplus is actually coming from Medicare trust fund. Mr. Speaker, how about us not touching that? How about us not spending that on something else? How about us retiring outside debt, so that when it comes time for us to use that, we will have the money, that we will not have to go borrow it from our children and grandchildren. Year 2001, the same thing, $22 billion of the surplus which is projected right now at $22 billion, it is all Medicare part A money. So we can claim we have a surplus, but we have to wink and nod at you and say, well, it really is part A trust fund money, but we are going to borrow it, because we cannot control the appetite of the Federal bureaucracies. We cannot make them efficient to do what they need to do it, and we cannot meet the needs of the commitments that we have made to the rest of America by making sure government is at least as efficient as the private sector, what we are going to do is we are going to steal the money. Instead of $166 billion that we owe, we are going to go to $189 billion this year, and then we are going to go to $211 billion next year. And then pretty soon, it is going to tail right back off, because as we add a drug program, the numbers are going to be uncontrollable. So we have major problems ahead of us, and they are confused because the only thing that the people in Washington want to talk about is answering the easy political problem. A senior has problem buying drugs, so, therefore, we create a Federal program that buys drugs. That is not the answer that our children deserve. That is not the answer that you deserve when you elect people to come up here. We need to make the hard choices, even if it means we do not get reelected, we need to make the hard choices to fix the programs so they work effectively. I notice a friend of mine has shown up, the gentleman from Minnesota (Mr. Gutknecht), and I would welcome him and recognize him now and yield to him.