Byron Dorgan

Mr. DORGAN

Mr. DORGAN. Mr. President, I was interested in the statement by the majority leader. This, of course, is not the amendment the Senate previously considered. It is not the amendment to which the Senate previously agreed. It is not the provision of law that the Secretary of Health and Human Services has refused to implement in two administrations. It is not that at all. First, we will sort out the facts. Let me make a case for the amendment itself. My colleague just won a debate we weren't having. His debate is about a piece of legislation the Senate passed a couple of years ago. I supported that, and I believe the Health and Human Services Secretary and the FDA made a mistake in not implementing it. Nonetheless, that was all a couple of years ago. Yes, this particular amendment we offered deals with the reimportation of prescription drugs, but it deals only with the reimportation of prescription drugs from the country of Canada--only from the country of Canada. The Senate previously addressed this issue of reimportation in 2000 by saying reimportation from other countries--as long as it was an FDA- approved drug and brought here under conditions of safety--would be appropriate. We have already said the HHS and FDA did not implement the previous legislation. But now, we will narrow this legislation very dramatically and provide reimportation only from the country of Canada. I will explain why that is important. First, miracle drugs offer no miracles to those who cannot afford them. If we don't do something to make drugs more affordable, seniors in the country lose, and others who need prescription drugs and can't afford them lose. We should and must put some downward pressure on drug prices. I understand the pharmaceutical manufacturers do not like that. I understand why they resist it. If I were in their position, I would certainly resist it as well. I don't try to paint with a dark brush all of those who are on the other side of the issue. I think the pharmaceutical industry does many good things. They do a lot of very important research, some of which is original and some of which they take from the National Institutes of Health. They create medicines that are very important for the American people. I also said the other day that some of the pharmaceutical companies have been providing free and discounted drugs to the lowest income Americans. Five and a half million people have benefitted from free medicines from American drug companies. I commend those companies. I don't have the names of all the companies. Good for them. It is a step in the right direction. They ought to be commended and saluted for their program to help the lowest income Americans. But the other issue is the larger one of the price of prescription drugs. The fact is, we need to try to do something that puts some downward pressure on prices. Let me describe, if I might, what the problem is. Let me do it with some bottles of medicine. I ask unanimous consent to be able to show some bottles of medicine on the Senate floor. These are empty bottles.

Mr. DORGAN. I ask unanimous consent the reading of the amendment be dispensed with.

Mr. DORGAN. Well, Mr. President, the second-degree amendment that was attached then dealt with safety and so on. What happened was, the Department of Health and Human Services and the FDA indicated they would not implement the law, so it was not implemented. But it is important to point out that this piece of legislation dealt with the importation of prescription drugs from many other countries. We have narrowed this amendment to the country of Canada, to allow the reimportation of drugs only from Canada. And because Canada has an identical chain of custody to this country, there can be no question as to the safety of allowing licensed distributors and pharmacists to be able to access, from a licensed pharmacy in Canada, FDA-approved prescription drugs. So that is why I do not have a problem accepting the second-degree amendment offered by the Senator from Mississippi. I cannot think of anybody at HHS or the FDA who can make a credible case that there is a safety issue by allowing a licensed American pharmacist to access prescription drugs from a licensed pharmacy in Canada. There is no safety issue there. It is gone, finished. So we, I hope, will adopt this. I believe there is no justification for HHS or the Food and Drug Administration to fail to implement this legislation.

Mr. DORGAN. I am happy to yield.

Mr. DORGAN. I believe that is the case. I don't have the numbers in front of me. I believe Senator Stabenow referred to that earlier. My understanding is that the expenditures on advertising and promotion exceed the expenditures on research. Let me make two additional points and then yield the floor. I support research and development, R&D, tax credits for industries, including for the pharmaceutical industry. They benefit greatly from them. I have always supported those tax credits. I think it makes sense to provide credits and incentives for the development of new drugs. Second, when these drugs are produced and then sold, I don't think we ought to pay the highest prices in the world. Let me give one more example, if I might. A woman with breast cancer needs Tamoxifen. With a prescription to go buy Tamoxifen, you have one of two choices, if you live near the border. You can pay $10 for a supply of Tamoxifen in the United States, or you can go to Canada and buy exactly the same amount of Tamoxifen for $1--$10 or $1. Why should you have to fight breast cancer and fight these pricing policies at the same time? It is not fair. It doesn't make sense that we should pay the highest prices in the world. Again, the majority leader started off by saying we have passed this before and it doesn't work. Let me correct it again to say: Legislation limited to Canada has not been enacted before. We passed something else before. You are right, it was not implemented. It was reimportation from other countries in the world, provided it was an FDA-approved drug. That was not implemented. This will be reimportation from Canada, so the legislation has been dramatically narrowed to a country that has an identical chain of supply for which there can be no safety concerns about unsafe drugs. We are only talking about having licensed pharmacists and licensed distributors accessing those drugs from licensed pharmacists or distributors in Canada. I am not interested in any way ever compromising the supply of pharmaceutical drugs in America. I wouldn't offer this in a million years if I felt it did that. I know it doesn't. There isn't any way anyone in this Chamber can demonstrate that there is a safety issue with respect to the medicines sold in Canada. You might be able to demonstrate there is a safety issue dealing with Bali or Honduras or Guatemala or Zaire, but you can't do it with Canada. You just can't. And so that is why I have no difficulty accepting the second-degree amendment offered by my colleague from Mississippi. There is not a safety issue with respect to this narrow amendment. There is only this issue: Shall the American people be able to see a repricing of prescription drugs that results in price fairness with respect to what U.S. and Canadian consumers are charged for identical drugs put in identical bottles produced by the same company?

Mr. DORGAN. Yes. As I indicated in one of the charts I presented, the Canadian official said that any drug that crosses into Canada is treated just the same as the drugs that enter the United States. As you know, there are many drugs that are imported into this country. Just as is the case for the importation of drugs into the United States by the drug manufacturers, drugs that are imported into Canada from other sources of production are certified as safe by the Canadians--just as ours are certified by the FDA.

Mr. DORGAN. I am happy to yield.

Mr. DORGAN. First of all, the only way they can be reimported into the United States would be if a licensed pharmacist or a licensed distributor in the United States purchases them from a licensed pharmacist or distributor in Canada. So at that point, they have entered the stream of prescription drugs in the Canadian system. At that point, the Canadians say: We assure the safety of the chain of custody of those prescription drugs just as you do in the United States. I find this debate interesting because I was up on the border of Canada one day. This was before mad cow disease occurred in Canada. My heart goes out to the Canadian ranchers for having discovered one instance of mad cow disease. Do you know what we do with Canada with respect to meat. We say: We have reciprocal inspection procedures for meat. You inspect it and that is good enough for us. What we want you to do is cut one little strip off the meat and lay it in the back of the truck, and we will open the back of the truck and see if it looks decent and smells all right, and then you just run the truck through. Why? Because we have reciprocal inspections. We say: If it is good enough for you, it is good enough for us. We have identical chains of custody for prescription drugs in Canada and the U.S., but we won't say: If it is good enough for Canada with an identical chain of custody for prescription drugs, it is good enough for us. That doesn't make sense to me. There is only one reason we won't say that. That is because some are willing to support the notion that the U.S. customer, the U.S. citizen, should pay the highest prices for prescription drugs. I happen to think that is wrong. I believe our citizens ought to pay a good price. Miracle medicines are not cheap. We ought to pay a good price and a fair price. Should we pay the highest price in the world? I don't believe so.

Mr. DORGAN. Mr. President, let me say I will not put this entire report in the record, but we asked the Congressional Research Service, the CRS, to do a comparison of U.S. and Canadian requirements for approving and distributing prescription drugs. This is by the nonpartisan Congressional Research Service. They prepared a memorandum comparing the U.S. and Canadian systems for both approving and distributing prescription drugs. Essentially this report affirms that, in all aspects of the U.S. and Canadian drug systems, drug approval, drug manufacturing, drug labeling, drug distribution, the U.S. and the Canadian systems are similar in all respects. There just is not a circumstance here where someone can say the U.S. system is terrific and the Canadian system is not. Both countries have chains of custody that I think give people in Canada and the U.S. assurance of safety. Perhaps before I give up the floor, I should mention this has been something Republicans and Democrats have worked on over a period of time. We have debated these issues before, but not this amendment because this is narrowed to Canada. I would be remiss if I didn't mention our late colleague, Paul Wellstone. If he were in the Chamber, he would be sitting in that back seat, and he either would have offered the amendment, perhaps, or be waiting to be among the first to speak. He, like many others of us--particularly in northern States--felt strongly that the reimportation of prescription drugs was a way for senior citizens, yes, but all Americans, to access the same prescription drugs at a fairer price. My expectation is that when we finish this debate and have a vote--I believe we will vote on this tomorrow--this amendment will be further amended by the second-degree amendment of Senator Cochran, which I indicated I would accept. I don't believe there is a need to vote on that. I believe that amendment will be subject to a recorded vote tomorrow. I hope my colleagues will do as we have done previously on broader legislation. At least with this narrower bill, let's decide to pass this and see if this can help provide some downward pressure on prescription drug prices.

Mr. DORGAN. Yes, I am happy to yield for a question.

Mr. DORGAN. Yes, we have free trade with Canada. It actually isn't free trade. We could spend a long time talking about wheat and other issues. We have a free trade agreement with Canada, but it excludes prescription drugs. Why? Because a piece of legislation was passed a decade and a half ago that said the only entity that will be allowed to reimport prescription drugs into the United States is the manufacturer of that prescription drug. That is what perverts the market. If you assume that you have a safe supply of drugs in both countries, why then would consumers simply not decide where to purchase the drug in whatever represents their best interests? Why would they not be able to make their own choice under a free trade agreement? It is perverted by this previous legislation that prohibits the reimportation except by the manufacturer. What we are saying now is, we would allow the reimportation by the licensed pharmacies. We are not talking about somebody shuffling around in a T-shirt who knows nothing about prescription drugs. We are talking about a licensed pharmacist or a licensed distributor who does this for a living. We are saying they have the ability to go to Canada and access medicines from a licensed pharmacist or a licensed distributor. I would love to have somebody make a persuasive case that somehow that compromises safety. I don't think the case exists.

Mr. DORGAN. This is Zocor. A very famous football coach advertises this at halftime at football games. He says he takes Zocor. It is quite a good medicine, I am sure. These are two bottles for Zocor--one from the United States and one from Canada. The same pill is put in the same bottle, manufactured in the same place, by the same company. In both bottles is an FDA-approved drug. The only difference is, when that medicine is sold in the United States to U.S. consumers, it costs $3.03 per tablet. In Canada, the same pill, in the same bottle, made by the same company, cost $1.12 cents per tablet--$3 versus $1. The same pill, same company, different countries. That is Zocor. This is a drug called Lipitor. It has the same purpose as Zocor--to reduce cholesterol. You can see that it is sold in the United States and in Canada. These are bottles from each country. They are identical bottles, made by the same company, again only the cost is different--$1 per tablet for the Canadians, and $1.86 for the U.S. consumer. The same drug, same pill, manufactured in the same FDA-approved plant, put in the same bottle, but different prices. This is Vioxx used for arthritis. As you can see, same pill, made by the same company, put in identical bottles. The difference? It costs $2.20 if you buy it in the United States. If you are a Canadian customer, it costs 78 cents for the same tablet--$2.20 versus 78 cents for the same medicine. Let me use one more example, if I might. This is Prevacid: Those who are afflicted with ulcers would take this drug. As you can see, once again, the same bottle, identical shape. The difference? It costs $3.58 for the American consumer, and $1.26 for the Canadian consumer--same pill, same bottle, same company, but a different price. Let me tell you about being in a little one-room drugstore in Emerson, Canada, 5 miles north of the United States. Just 5 miles north of the Canadian border, there is a drugstore. I accompanied a group of seniors to the one-room drugstore in Emerson, Canada, just to make a point. The point was very simple. The medicines those seniors purchased in Canada--the identical medicines to what they buy in the United States and for which there is no safety concern or issue because the chain of custody is identical in Canada--cost much less. It begs the question. Why not let the market system resolve these issues? As long as you have the safety of supply and the closed chain of custody which you can be confident in--and you certainly do with Canada because their system is very comparable to ours--allow people to decide where they want to purchase their prescription drugs. If they decided they would purchase their prescription drugs where they are less expensive, it forces repricing of prescription drugs in this country. Let me use some charts to show what is happening. How much more does the U.S. consumer pay? More than everyone else in the world by far. If we pay $1 for a pharmaceutical product, that same product is 62 cents in Canada. You can see what it is around the globe in different countries--in England, 69 cents, Germany, 65 cents, France, 55 cents, and Italy, 52 cents. Let me show a chart with specific medications. I just showed these: U.S. price versus Canadian price for Prevacid, Zocor, Paxil--all heavily used drugs and costing nearly 40 percent more in the United States than in Canada. Now let me quote, if I might, President George W. Bush during the third Presidential debate in St. Louis, MO. During the Presidential debates, President Bush was asked about this. Here is what he said: Allowing the new bill that was passed in the Congress made sense to allow for, you know, drugs that were sold overseas to come back and other countries to come back into the United States. That makes sense. What he was saying there is that the reimportation of prescription drugs makes sense. That is what he said in the third Presidential debate. I am not making this up. These are the President's words from the debate--prescription drugs coming back into the country would make sense. If I could put words in his mouth, I would believe, of course, that he would say it makes sense, if this is safe. But, nonetheless, this President, in a debate, said reimportation makes sense.

Mr. DORGAN. Mr. President, let me conclude quickly and quote what Health Canada's Associate Director General said: As soon as any drug crosses the border into Canada, it has to meet all the regulations of our laws. . . . What they are saying in Canada, with that statement, is that they do not have drugs ricocheting around their country that are counterfeit drugs or non-approved drugs. They have a drug safety system very much like ours, in which drugs that go from an inspected plant into this system, all the way through to the local licensed pharmacy, so that you have a safety circumstance that everyone understands. Let me continue. It was referenced a bit ago that all of the FDA--or virtually all--of the former FDA Commissioners, oppose this. Let me tell you what former FDA Commissioner David Kessler said: I believe the importation of these products could be done without causing a greater health risk to American consumers than currently exists. That is David Kessler, former FDA Commissioner. Let me continue. William Hubbard, FDA Senior Associate Commissioner, September 5, 2001, in a hearing that I chaired before the Senate Commerce Subcommittee on Consumer Affairs said: I think as a potential patient, were I to be ill and purchase a drug from Canada, I think I would have a relatively high degree of confidence in Canadian drugs. . . . Simple and easy to understand, I think. Finally, let me describe the systems in the United States and Canada. Drugs must be proven to be safe and effective. We are talking only about FDA-approved drugs. There are good manufacturing practices required in both countries. There is appropriate labeling required in both countries. There is the inspection of manufacturers, pharmacies, and drug wholesalers in both countries. Pharmacists and wholesalers must be licensed in both countries. And there is a chain of custody required between the pharmacist, the wholesaler, and the drug manufacturers in both countries. There is a regulatory requirement for postmarketing surveillance required in both countries. And a national mechanism for drug recall exists in both countries. This is a chart that shows the same thing: The regulation in the United States and the regulation in Canada, from the production of the drug to the licensing of the pharmacist, are the same. There isn't any way, in my judgment, that restricting reimportation to medicines from Canada will allow the HHS or FDA folks to say this does not work. Of course, it works. Of course, it will not compromise the safety of the American consumer. The question is, Will we be able to have a circumstance where the American consumer can access lower cost prescription drugs? It is not my intention--and it has never been my intention--to force U.S. consumers to go outside of this country to access a supply of prescription drugs. It is my intention to find ways to put downward pressure on these prices by injecting competition that will force a re- pricing of drugs in this country. Now, every year, spending on prescription drugs in this country is increasing 15 percent, 16 percent, 18 percent, every year. Just about every year, there are double-digit increases in the cost of prescription drugs. If we do not do something about this, we will hook a hose up to the Federal tank and suck this tank dry. I guarantee it. Now, let me end as I began. If I were representing the pharmaceutical industry, I would fight like the dickens to price drugs however I wished to price them. That is in their interest. It is in their stockholders' interest. I understand that. It is in their company's interest. But there is a limit. This increase every year--15, 16, 18 percent--comes from two main factors: one is increased utilization, the other is price inflation. The fact is, if we do not find some way to moderate these price increases, this system of ours isn't going to work. I started by saying that I think the prescription drug industry, the pharmaceutical manufacturers in this country, provide a significant service to the American people by doing the research and providing prescription drugs that are, in many cases, breakthrough drugs. I might say at least a fair amount of that which they do comes from National Institutes of Health research which is financed by the U.S. taxpayer. I do not complain about that. Good for them. And I want those companies out there. I want the NIH and the pharmaceutical manufacturers searching for the cure for diabetes and for cures for cancer and searching for new pharmaceutical products that can help the American people. I want that to happen. I do not want to shut off research. The argument is made that if somehow the American people do not pay the highest prices in the world, it will shut down research on new drugs. That is not true. The fact is, European drug companies spend more on research on drugs than companies do in the United States. There is more research on drugs that occurs in Europe than in the United States, and prices are lower in Europe than in the United States. I just do not think it is right. I do not think it is right for the U.S. citizen to pay the highest prices for prescription drugs in the entire world. I just do not believe that is right. Now, I understand all the arguments that are going to be raised by my colleagues who oppose this and I would just ask them, what happened to your faith in the market system? I hear a lot about this market system: Let the market system work. As long as you have the safety of the drug supply, and a protected chain of custody--and that exists in Canada; no one can come to this floor and say it does not--why not let the market system work?

Mr. DORGAN. I would be happy to yield.

Mr. DORGAN. I was yielding for the purpose of a question.

Mr. DORGAN. Of course. I am happy to yield.

Mr. DORGAN. Mr. President, Senator Stabenow has done a service by pointing out something in the amendment I did not point out. The other change is that this would be a 1-year pilot program, when approved by the Senate. The certification will still be that this is safe because, clearly, we have identical systems in the U.S. and Canada. In addition, after a 1-year pilot project, there will be a 6-month period in which the Secretary of Health and Human Services will certify if there is a problem, if in fact there is one. I expect there will not be. At that point, this program will continue. At least it creates a specific 1-year pilot project and an evaluation, so there is a fail- safe system if there would be any problem at all. I would not expect a problem--particularly because we have narrowed this--with respect to Canadian drugs.

Mr. DORGAN

Mr. DORGAN. Mr. President, will the Senator from Iowa yield for a question?

Mr. DORGAN

Mr. DORGAN. Madam President, for almost a half century a Catholic priest in North Dakota has lived a remarkable double life. In one guise, Father Bill Sherman is a holy man, the kind of warm and perfect parish priest who would have once been played by Spencer Tracy. But in his other role, he is the talented scholar and painstakingly diligent chronicler who, like no other authority, commands the ethnic history of North Dakota. Because Father Sherman is retiring this month from the religious vineyards, I want to take note of his remarkable alter ego--that of the State's most eminent ethnic historian. He has been a key player over the last 20 years in producing four impressive volumes on the subject--``Plain Folks: North Dakota's Ethnic History,'' ``Prairie Mosaic: An Ethnic Atlas of Rural North Dakota,'' ``African Americans in North Dakota,'' and the most recent book, ``Prairie Peddlers: Syrian-Lebanese in North Dakota,'' which is now coming off the presses. In addition, he was also one of the authors of ``Scattered Steeples, The Fargo Diocese, A Written Celebration of Its Centennial.'' His volumes on the State's ethnic heritage are extraordinary works-- painstakingly researched, rich with thoughtful analysis, brightly written, and handsomely designed. They are works of careful scholarship of a high order and a real treasure for anyone intrigued with the marvelous ethnic diversity of America. Born in Detroit in 1927, Father Sherman grew up in North Carolina and Oregon before his family moved to Lidgerwood, ND. After high school, he joined the Army, serving in the Philippines and Japan at the end of World War II. He graduated from St. John's University in Collegeville, MN, got a bachelor's degree from North Dakota State University and a master's degree from the University of North Dakota and became a priest in 1955. He has served the parishes of the Cathedral of St. Mary in Fargo from 1955 to 1962, the Newman Center at the University of North Dakota from 1962 to 1964, St. Raphael's in Verona from 1964 to 1965, the Newman Center at NDSU from 1965 to 1975, St. Patrick's in Enderlin from 1975 to 1976 and finally the diocese's largest parish, the 5,000-member strong St. Michael's of Grand Forks for 27 years. At UND, he taught religion and, at NDSU, where he is now professor emeritus, he taught sociology of religion and sociology of the Great Plains. He has received numerous awards, most recently an honorary doctorate of leadership degree from the University of Maryland. In a profile of Father Sherman this month, the Grand Forks Herald said, ``Sherman's style, of being a sometimes gruff, no-nonsense defender of old-fashioned, blue-collar Catholicism, while being genial good company to anyone, and wearing his academic accomplishments lightly, attracted many to the parish. It's difficult, if not impossible, to find a discouraging word said about Sherman, a fairly remarkable fact about any member of the clergy who stays in one spot a long time.'' And a few days later, the editor of the newspaper called Father Sherman ``a remarkable man--a priest first and foremost, a man of old- fashioned faith, but also a scholar, a witty conversationalist, a polished orator, an able administrator, a distinguished patriot, a community builder, a cool head in a crisis, a giver and an excellent friend to many thousands of people both within and outside his church.'' Father Sherman is also a survivor. During the disastrous Red River flood of 1997, one of the worst to ever strike an American community, his parish was completed flooded and his church, school and rectory suffered heavy damage. Among the most painful losses was Father Sherman's collection of North Dakota history, a singular treasury of volumes on the State's heritage. But the indomitable cleric is now busy rebuilding that library and at work writing several more books, one on the transfer of Eastern European architecture to the Great Plains at the time of settlement and a second on another remarkable North Dakota priest who served during World War II with the Polish resistance. It is clear that retirement to Father Sherman means something different than it does to the rest of us. Not only will he still minister on a part-time basis to Roman Catholics, but he will continue to energetically research and write about intriguing aspects of North Dakota's ethic legacy. Although he has already provided a valuable and outstanding body of work on ethnic heritage, North Dakotans are grateful for his continued interest in the field. He is a scholar of the first order, a priest of the classic and finest model, and an exemplary citizen indeed.

Mr. DORGAN

Mr. DORGAN. Mr. President, before Senator Grassley leaves the floor, I want to tell him that one piece of this legislation that I think is particularly important are the provisions dealing with Medicare reimbursement for rural hospitals and other rural health care providers. I know he talked about how this Senate has dealt with this concern before, and we have. In fact, we had a very strong vote on it. But at this point, significant legislation has not been signed into law. The fact is, his constituents in Iowa and mine in North Dakota pay the same payroll tax out of our paychecks as everybody else in the country, except we do not get the same reimbursement for much of what our providers do. And the result is, some very important health care facilities in smaller rural States, in smaller communities, are struggling and having an awfully difficult time making it because the provider reimbursement system is not fair. I want to compliment my colleague from Iowa and others who have worked on this. I have been pleased to work on it some, but his leadership is very important in this area. That is one piece of this legislation to which I think we need to pay some attention. I will be pleased when the President signs a bill that includes these provisions, and so will many of our rural health care providers who have waited a long while for it. Having said that, let me make a couple of comments about the broader piece of legislation and why we are here. I think Medicare has been an excellent program for this country. Prior to the creation of the Medicare program, over one-half of the senior citizens in America had no health insurance coverage. They reached their retirement years--having worked all their lives, in most cases--and discovered that when they were in their sixties, seventies, and eighties there was not a traffic jam of insurance agents or insurance companies wanting to see if they could fully cover their health insurance needs once they have reached 70 and 80 years of age. What they discovered was that at that age the cost of a health insurance policy was almost prohibitive. The result, back in the early 1960s, is that over half of the senior citizens in our country had no health insurance coverage at all. So the Congress passed a Medicare program, which has been a remarkably successful program. The Medicare program has meant that now 99 percent of America's senior citizens are covered under Medicare. They do not have to live with the fear of not having some basic health care coverage when they reach retirement age. When they reach their declining income years, Medicare is there. It has been there, and will be there. It has been a remarkably successful program. Some say: But there have been financing problems with Medicare. Yes, that is true, and they are all borne of success. By that I mean people are living longer and better lives. As a result of that, there have been some financing issues and some financing difficulties with Medicare. We would not have any financing issues at all if we just went back to the old life expectancy, but people are living longer, better, more productive lives. The result is that we continue to talk about how we finance Medicare. An example of that: My brother was telling me about a friend of his a while back who, at age 89, bought a new car. She, at 89 years old, bought a new car. He said she financed it with a 5-year loan. I guess that is optimism. But what a wonderful thing, an 89-year-old person buying a new car and getting a 5-year loan. There was a story in the North Dakota papers some long while ago about a man who was 99 years old and still farming. They had a picture of this old 99-year-old codger. He was getting on his tractor. And the article talked about his son. His son was in the Army during the Second World War, and he came back and decided he would work with his dad until his dad retired. The son was about 74 years old, and his dad was 99 years old, and still farming. It did not work out the way the son thought. The story was about this 99-year-old still driving a tractor. I have often mentioned my uncle who is in his early eighties. I believe he is 81 or 82 years old now. He discovered in his early seventies that he was a runner. He ran faster than most people his age. He started entering the Senior Olympics. My uncle runs the 400 and the 800 meter. He now has 43 gold medals. He has been running in California and Arizona and Minnesota. My aunt thinks he is about half goofy for an 80-year-old. What a wonderful thing: An 89-year-old buying a car; a 99-year-old still farming; an 81-year-old running in the 400 and the 800 races in the Senior Olympics. People are living longer. That is a good thing. However, Medicare, as it was developed in the 1960s, is basically for acute care or hospital care. If you get sick, you go to a hospital, and they help you. The medical model has changed dramatically since then and so must Medicare. That is what brings us to the Senate floor. We recognize that the prescription drugs now available that keep people out of the hospital, that allow them to control some of their health conditions and continue to lead productive lives, were not available in the early 1960s when Medicare was developed. We come to the floor with a proposal that says: Over 30 years has elapsed since the writing of the Medicare program. It is now time to put a prescription drug benefit in the program. Let me describe what that means in my State. We have 103,000 people who are on Medicare in the State of North Dakota. North Dakota is a relatively small State in terms of its population. It is large geographically, 10 times the size of Massachusetts in land mass, but it has only 645,000 people. We have 103,000 on Medicare. The people who are on the Medicare program paid payroll taxes all of their working lives, beginning back in the mid 1960s, and that money is what provides the capability of their being able to access the Medicare program. Senior citizens, although they are 12 percent of America's population, consume one-third of all the prescription drugs in this country. It is probably pretty obvious to anyone who has been around senior citizens that they often take multiple prescription drugs. It is not unusual to talk to a senior citizen who takes 5 and in some cases 10, 12, or more different prescription drugs every day. The fact is, many of them simply cannot afford to pay for these drugs. Many of them do not have prescription drug coverage through any kind of insurance plan. Because of that need, because so many of them can't afford their medicines, we propose giving Medicare beneficiaries a prescription drug benefit. A woman came up to me at the end of a town meeting in northern North Dakota one day. She was perhaps in her late 70s or early 80s. She grabbed me by the elbow and said: Mr. Senator, I want to talk to you a moment. My doctor tells me that I must take a range of prescription drugs to control diabetes and heart trouble. The problem is, I can't afford to take them and can't afford to buy them. Can you help me? As she began talking about it, her eyes welled up with tears. This woman, perhaps 80 years old, was stranded. The doctor said: You have serious health problems, diabetes, heart trouble, and more. Here is what you have to take. These prescription drugs will control your health issues. She said: I don't have the money. A widow, living on a small Social Security payment, she does not have the capability of going in to a pharmacy and paying the very high cost for prescription drugs. Let me say there are some things that have happened we should mention. I know the pharmaceutical industry sometimes takes a look at me and thinks I am always on the floor trying to put downward pressure on prescription drug prices. That is true. It is because I believe so strongly that we need to make sure that miracle drugs can provide miracles for those who need them. Miracle drugs cannot provide miracles for those who cannot afford them. I want to say this about the industry. First, a number of pharmaceutical industry companies have stepped up to the plate since we last debated this subject. They offer programs to provide some free medicine to low-income patients and medicine discount cards for Medicare beneficiaries who don't have drug coverage. In 2002, we are told, the American pharmaceutical companies provided free medicine to 5.5 million patients. There are several programs of this type. Pfizer, Eli Lilly, and many others have these programs. We ought to recognize that is a good thing. We ought to say to them: Good job. Frankly, that is a positive step. But these programs are no substitute for offering a prescription drug benefit to all Medicare beneficiaries. The pharmaceutical companies, although I have significant disagreements with them about pricing issues, ought to be commended for stepping forward and providing some approaches to help those very low-income seniors who have no recourse, no other alternatives. They have helped 5.5 million patients in the United States. But that is not a substitute for offering this legislation to put a prescription drug benefit in the Medicare program. We are going to offer some amendments to the bill before us. I will offer an amendment or two. Some of my colleagues will offer amendments in the coming week and a half with the expectation that by the end of next week the Senate will finish its work on this bill. We will have passed legislation that for the first time since the early 1960s, when Medicare was created, will substantially improve the capability of Medicare to maintain the good health of senior citizens by adding a prescription drug benefit. There are some weaknesses in the legislation that came out of the Finance Committee. My hope is we can address them and improve them. The legislation that came out of committee has a coverage gap that is pretty difficult. We need to fix that. There are periods where, even though beneficiaries will be paying premiums, their purchases of prescription drugs will not be covered. Those periods are, of course, first with the deductible. For the first $275 in drug expenses there would be no coverage. And then in addition, when seniors reach $4,500 in drug spending, their prescription drug coverage stops. Then catastrophic coverage will kick in when their drug spending reaches $5,800. During that $1,300 stretch between $4,500 and $5,800 in expenses, there will be no coverage at all. So senior citizens will be paying premiums during those months but have no coverage for the prescription drugs they are purchasing. That coverage gap needs to be fixed. The legislation has no defined benefit or premium. We need to fix that if we can. We don't know what kind of charges would be set by the insurance companies, what the actual premium would be, exactly how would they define the benefits, and would they change or differ from region to region. I am particularly concerned that rural Medicare beneficiaries, those in smaller States, will be charged higher premiums than urban beneficiaries. We need to be very careful about that. I hope we can address some of it in amendments. Reducing drug costs is another issue. Having just complimented the pharmaceutical industry, let me also say I believe we ought to pass the generic legislation that will tend to put some downward pressure on prescription drug expenditures. I also believe we ought to, as do some of my colleagues who have worked with me, have the global market system work for prescription drug consumers. The way the system could work, not just for Medicare but for all prescription drug consumers, is to allow those consumers to purchase the identical drug put in the same bottle made by the same manufacturing company from Canada, provided that you have a safe chain of custody. In Canada, the same medicines that are available in the United States are sold for a fraction of the price. A pharmacist in Pembina, ND, is prohibited from going to Emerson, Canada 5 miles north and buying a prescription drug such as Tamoxifen for a fraction of the price. That pharmacist cannot now bring that Tamoxifen back and pass the savings along to a woman who has breast cancer in Pembina, ND. I frankly think they should be allowed to do that. That is another way by which we can put downward pressure on prescription drug prices. Well, those are some of the issues we are going to be dealing with this week. Again, my fervent hope is at the end of this process we will, with a bipartisan piece of legislation, get the best of what all have to offer in this Chamber. We so often see legislation come to the floor of the Senate that has a pretty significant partisan split, and we often end up getting the worst of what can be provided rather than the best. I hope in this legislation on the issue of prescription drugs and Medicare we all recognize a couple of points. One, it is long past time to do this. Were we to create the Medicare Program today, there is no question but that it would have a prescription drug benefit in it. Most of the lifesaving prescription drugs have become available since Medicare was originally written. That is No. 1. I think we are at that point where virtually everybody in this Chamber understands we ought to do this, and we ought to do it now. The second and most important issue is we ought to do it right. There is a right way and a wrong way to do this. First of all, the benefit ought to be reasonably simple, understandable, affordable, and provide significant benefits to the senior citizens of the country who need prescription drugs. That means simplifying this bill, trying to solve the coverage gap, and trying to put some downward pressure on prices. I yield the floor.

Mr. DORGAN

Mr. DORGAN. Mr. President, the American Association of Airport Executives and the Air Transport Association, and others, have told us it is unlikely we would see the security investment--after all, this is national security--we would not see the security investment in airport improvement and safety with this money if we did not waive the local match. I continue to believe we ought to make this habit forming. The value expressed by the Senator from Mississippi is on the mark in many cases. I appreciate very much the ability to work this out and be able to move this amendment. If appropriate, I think it has been agreed to by both sides. I ask if we can have the amendment considered at this point.

Mr. DORGAN. I have.

Mr. DORGAN. Mr. President, let me ask the Senator to yield for a moment. I think there is great merit in local matching, by and large, because you need local support. We ought not just create pools of money here in the Congress to send out around the country unless there is evidence of local support. The Senator from Mississippi made the point, and I think it is an important point. First, I ask unanimous consent that a letter from the American Association of Airport Executives, and a letter from the Air Transport Association be printed in the Record.

Mr. DORGAN. Mr. President, I have explained my amendment already. What I would like to do is work with my colleagues, Senator McCain, Senator Lott, Senator Hollings, and others. I think this is an important amendment. I am not suggesting this be a precedent forever, for all time. At this moment, in this place, for this reason, I believe if we want to invest $500 million in aviation security in this country, it is likely the only way that will be invested is to eliminate the State and local match. I think there are good reasons to do that. So if I can work with my colleagues in the next several hours, I hope we can make some progress on this amendment. I do want to make one final point. It is not my intention in any way to hold up this bill. I do not expect this would be a lengthy debate, in any event. I would agree to a short time agreement. But my hope is perhaps we could support this by a voice vote at some point. I yield the floor.

Mr. DORGAN

Mr. DORGAN. If the Senator will yield, my understanding from the majority leader is that it is not the relevancy determined by the Parliamentarian, but they must be related to the subject of energy, which is infinitely a broader definition. That is my understanding.