Byron Dorgan

Mr. DORGAN

Mr. DORGAN. Mr. President, I joined my colleague earlier on the third floor of the Capitol at a press conference to talk about the generic bill. That bill is very important and one about which I have held a hearing. In terms of prescription drugs, we need to do two things that are important. We need to have a prescription drug benefit, and we need to do something that puts some downward pressure on prescription drug prices. We must find a way to put a prescription drug plan in the Medicare Program, one that works, works for all beneficiaries, and provides them with the ability to access the medicine they need when they need it. I said earlier that there is nothing lifesaving about drugs if you cannot afford them. There are no miracles in miracle drugs if you can't afford them. I just heard my colleague talk about those people who helped build this country. Tom Brokaw's book described some of them who went to war in the Second World War as ``the greatest generation.'' I had a fellow come to a meeting a while back, who is a member of the greatest generation. He served in the Air Corps in the Second World War. He was in his late seventies and he needed new teeth and didn't have any money for them. I arranged for a dentist and I also helped him get some teeth. Here is a fellow who fought in the Second World War, who ends up with nothing, who needs a new set of teeth and has to come nearly begging people to help him get his new teeth. Senator Kennedy is right. We have a lot of people in this country who have needs. They reach their declining income years, their retirement years, and they discover the things they need such as new teeth or prescription drugs, cost a fortune. Senior citizens are 12 percent of America's population and they consume one-third of all prescription drugs. Is it because they want to be sick? Is it because they like to take prescription drugs? I think not. You meet them at town meetings and various locations around the State, and they come up to you and say: You know, Mr. Senator, I am 80 years old and I have diabetes. I have heart trouble. I have to take seven different prescription medicines. Mr. Senator, I can't afford it. I don't have the money. I wish I didn't have to take the drugs, but I need them and can't afford them. A doctor in Dickensin, ND, told me one day about a cancer patient who had breast cancer, a senior citizen. After the surgical removal of her breast he told her about the drugs she was going to have to take to try to minimize the chance of recurrence of her cancer. He said she looked at me and said: Doctor, what will these prescription drugs cost? And when he told her what they would cost, she said: Doctor, I couldn't possibly afford those prescription drugs. I don't have the money. I'll just have to take my chances. I'll just have to take my chances. We can do better than that. We need to put a prescription drug plan in the Medicare Program, one that works--one that really works. At the same time as we do that, it has to be complemented by a couple of other provisions we--the generic bill offered by my colleague, Senator Schumer and the Canadian reimportation bill, both of which will put downward pressure on prices. If we do not do that, we just break the bank. I am not interested in breaking the bank, hooking a hose up to the tank and just sucking all the money out. We can't do that. I am interested in making sure we have a prescription drug benefit plan that works. No, not some sliver of a plan, that says to a poor person: By the way, spend a lot of your money first, and then we'll give you a little help. No. 1, let's have a plan that works; No. 2, a plan that includes in it downward pressure on prices, not just for senior citizens but for all Americans. That is why this is so important. I imagine some members of this body could come up with a dozen reasons not to do this. In fact, the negative side of the debate is always the easiest. I think it was Mark Twain who was asked if he would engage in a debate of some sort. He said: Of course, as long as I can take the negative side. When it was pointed out to him that he hadn't been told the subject of the debate, he said: It doesn't matter. The negative side takes no preparation. It is easy to take the negative side. It is much more difficult to come up with a positive approach. That is what we are trying to do here. Yesterday, 52 Senators in a very important vote, for the first time in over 40 years, said we would like to put a prescription drug benefit in the Medicare Program. Fifty-two Senators said that. It takes 60 votes. The question now is, Will the minority of the Senate block it in the next couple of days? The answer is, I hope not. I hope all Members of the Senate understand this is not just some run-of-the-mill issue. This is not just some issue of convenience. This is life or death issue for those who have reached their declining income years. Those who in many cases are living in or near poverty and who are told by their doctor they must take five or seven different kinds of prescription drugs. And they do not have the ability to pay for those drugs. That is why this issue is important. Let's do this and let's do it right. Let's not take slivers of policy here or there and pretend that we have constructed something meaningful. Let's put a real plan together, one that adds up, one that makes sense, and one that provides real benefits.

Mr. DORGAN. I am happy to yield.

Mr. DORGAN

Mr. DORGAN. Some say, when you talk of prescription drug prices, let the market decide. There is, after all, an open, free market; let the market decide. Is it not the case that there is no free market for prescription drugs in this country? There are price controls in the United States but the prices are controlled by the pharmaceutical industry, and they like that. I understand that. Most other countries have price controls in which the governing authority sets the price, including profit, and the drug manufactures market those drugs in those countries under those conditions. In this country, there are no such limitations. So in this country, you can charge whatever you like. The problem is, what if you charge too much for tamoxifen? What if you charge 10 times more than you should for tamoxifen, and they can actually buy it for one-tenth the price in Winnipeg, Canada? What prevents the consumer from voting with their feet and going to Canada? What prevents it is a perversion of the free market, and that is a law that says the pharmacist at the Main Street drugstore, the distributor cannot access drugs and bring them back. There is a law that creates an artificial barrier against the free market working. When we try to change that, people say they are worried about bioterrorism, poppy seeds in Afghanistan, or they are worried the Moon is made of blue cheese--the most Byzantine arguments I have heard since I have been in the Senate. Is it not the case that to say let the market decide, the free market is not a free market with respect to drug pricing in the United States?

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

Mr. DORGAN. I would like to ask a question of the Senator from Michigan. It is true that yesterday we had 52 votes for a prescription drug plan in the Medicare Program. It is also true that we desperately need it. Medicare is now roughly 40 years old. Had we had these lifesaving and miracle drugs available when Medicare was created, there is no question that we would have had a prescription drug benefit in the Medicare Program. Our task now is to put a prescription drug benefit in the Medicare Program and do it in a way that does not break the bank. Both goals are important. Yesterday, we had 52 votes for a prescription drug plan in the Medicare Program, but we need 60. It is also true that although a majority of the Senate have now expressed themselves that they want this prescription drug plan in the Medicare Program, a minority of the Senate can block it. My hope is we will find a way now to reach 60 votes put a prescription drug plan in the Medicare Program in a thoughtful, responsible manner, that is helpful to senior citizens. At the same time we must put downward pressure on prescription drug prices. Both approaches are necessary. I ask the Senator from Michigan if it is not the case that although we had 52 votes and the Senate has already said, yes, let us do it, a minority can block it? The question is, over the next 48 hours, Will a minority in the Senate block the majority's efforts to pass this bill? Is that not where we stand at this point?

Mr. DORGAN. Mr. President, the Senator from Michigan knows that one issue with respect to this bill is adding a prescription drug benefit to the Medicare Program, but that is not the only issue concerning prescription drugs in this country. The other issue is that all Americans who get sick, who have a disease or an illness and who need prescription drugs need to be able to afford and have access to these medicines. Miracle drugs provide no miracles, lifesaving drugs save no lives for those who cannot afford them. So we are trying to find a way to put some downward pressure on prescription drug prices. The fact is that American people are charged the highest prices in the world for prescription drugs. Virtually everyone else in the world buys the same pill, put in the same bottle, made by the same company, and pays a much lower price. There is no Republican or Democratic way to get sick. There is no Republican version of Celebrex, Zocor, or tamoxifen, and there is no Democratic version of Celebrex, Zocor, or tamoxifen. There is just sickness, medicine, and need. I want the drug companies to do well. I want them to invest in research, experimentation, and finding drugs. We are doing that in the public sector, doubling the amount we are spending on the National Institutes of Health searching for cures for these diseases. By the same token, I want what we reap from all this research to be affordable by the American people who need them when they get sick. Regrettably, what has happened is every year the cost of prescription drugs is going up--18 percent last year, 16 percent the year before, 17 percent the year before that. There is this relentless increase in the cost of prescription drugs, and the fact is a lot of vulnerable people in this country desperately need those drugs and cannot possibly afford them. Yes, it is important we do a prescription drug benefit in the Medicare Program. Fifty-two Senators have already said yes. The question is, Will a minority block us in the next day or two from getting this done? We also need to find a way to put downward pressure on prices. One way we have worked on--and the Senator from Michigan has been a leader--is the reimportation of prescription drugs from Canada. The same drug, put in the same bottle, made by the same company, is sold in Canada at a fraction of the cost that the American consumer is charged. To use one example, someone suffering from breast cancer who needs to take the drug tamoxifen is going to pay $100 for that which they could buy for $10 in Canada, the same medicine made by the same company, FDA approved, similar bottle, different price. The U.S. consumer is charged 10 times more than the Canadian consumer. It is wrong, it is unfair, and it ought to stop. These are the things on which we are working.

Mr. DORGAN. We do not have perfect solutions, but we must in the next day or two make progress to get this bill completed so that we can go to conference with the House and make prescription drugs available to senior citizens, especially in the Medicare Program, and also begin to find a way to bring prescription drug prices down for all of us. I appreciate the work the Senator from Michigan has done. She has done in her leadership position a lot of work on this issue, and I deeply appreciate it.

Mr. DORGAN

Mr. DORGAN. The Senator will have ample time to answer the question. I will inquire when he does so. In the minute or so I have remaining, let me say this: This is life or death for a lot of people, this issue of prescription drug pricing. Yes, we need to put a prescription drug benefit in the Medicare Program. I support that strongly. But if we do not do something to put downward pressure on prescription drug prices, we will simply break the bank, in my judgment. That is why we need reimportation. And we need the generic amendment--the base bill. We need to do both of these things. I am not interested in compromising safety under any condition or any circumstance. This amendment is very simple. It says, in part, that the Secretary of Health and Human Services can suspend and will suspend and shall suspend the implementation of this reimportation if, in fact, there is a counterfeiting problem, or other problems such as terrorism. The issue of counterfeit drugs that had been raised, the issue of terrorism, has nothing at all to do with this amendment. We are talking about licensed pharmacists, licensed distributors, FDA-approved drugs, FDA-approved plants--a system in which those from the U.S. who are licensed to do so can get the exact same prescription drug safely from Canada at much cheaper prices and pass those savings along to customers. I understand we will have another amendment following the vote on this amendment. That amendment will have the effect of essentially making this provision unworkable. We will have to debate that at that time. How much time remains?

Mr. DORGAN. Is that total time?

Mr. DORGAN. I yield 3 minutes to the Senator from Vermont.

Mr. DORGAN. But is it not then the case that they are not FDA- approved drugs and therefore our amendment deals with that?

Mr. DORGAN. If the Senator will yield for one additional question, the Senator is aware, I am sure, that today pharmaceutical manufacturers reimport a substantial amount of prescription drugs from Canada. What is to prevent the circumstance you just described from occurring now, with respect to current law?

Mr. DORGAN. I appreciate the courtesy. The amendment deals with FDA drugs, so the condition under which that drug from Canada would come into this country would be it was purchased at a Canadian-licensed pharmacy or distributer by a licensed facility or distributor in this country, and therefore it must be FDA approved and produced in an FDA- approved plant. Is that not the case?

Mr. DORGAN. The Senator from Pennsylvania was speaking about advertising costs and so on. Toward the end of his speech, I know the Senator from Michigan wanted to be yielded to. I yield to her for a question at this point.

Mr. DORGAN. Mr. President, I have heard a generous and interesting presentation for 45 minutes or so--in fact, I think it was the most effective discourse I have heard for some while on behalf of the pharmaceutical industry and their pricing policies. Of course, I disagree with it very strongly. Nonetheless, I think it was a good representation of what the pharmaceutical industry believes about pricing strategies. As I listened to the back and forth, it reminded me of a small grease fire in a small restaurant; a lot is going on, but nothing real urgent. Let me react to some of the statements made recently. Statement: ``Some people in the Senate don't like anybody who makes any money.'' That is absurd, but obviously in the Senate we can say those things, I guess. I would like to see one Member stand up and say: All right, here is what I stand for. I stand for a pricing strategy by which the American consumer is charged the highest prices for prescription drugs of anybody in the world. I want to see one Senator stand and say that I stand with the pharmaceutical industry and the pricing strategy, and I want the American consumer to pay the highest prices in the world. Nobody will stand and say that. Instead, they will use metaphors that mean something different. We are told, for example, the problem is that, if we don't pay those high prices, we don't get the R&D. The information that was used was, of course, incorrect. Actually, more money is spent in Europe on R&D than in the United States 37% versus 36%--not a lot more, but more--and in every country in Europe their consumers pay far lower prices for prescription drugs. How does that figure add up? We just heard our colleague say to us that if you don't pay the highest prices for prescription drugs, you don't get the R&D. Tell us about the Europeans.

Mr. DORGAN. Will the Senator yield for a question?

Mr. DORGAN. If the Senator will let me finish my statement first--I listened for 45 minutes to the great case the Senator made on behalf of the pharmaceutical industry--I will be happy to yield when I finish. The point is this: We are told that the pricing strategy by which Americans are charged the highest prices is fair and is necessary--fair because it is the only way we will get the R&D, and it is necessary because nobody else will pay those prices. So we need to accumulate that cash from the American consumer in order to pay for the R&D. There are a couple things wrong with that. One, we spend a substantial amount of taxpayers' money at the National Institutes of Health. We have gone from $12 billion to $24 billion. I supported that. It was bipartisan in the Senate. We doubled the amount of money for the National Institutes of Health for health and research, and the pharmaceutical industry benefits from that as well because they take that accumulated research and use it to create new and miracle medicine. Yes, they do research as well, and I commend them for that. My point is, we do a lot in public policy, such as research at the NIH. We passed a tax credit--I assume my colleague from Pennsylvania supports that, as I do--to say we will give you a tax credit for research and development. This country gives a very substantial tax credit for research and development, and I support that. I voted for it for two dozen years. I bet my colleague did as well. This is not about research and development, it is about a pricing policy, that says that we will do more research in Europe and charge them lower prices then the American consumer, and, oh, by the way, when someone wants to raise questions about that, we will say: No, you cannot raise questions about that; this is a pricing strategy that is fair to the American people. Not where I come from, and I come from a much smaller town, I am sure, than some others here, a town of 400 people. We had a drugstore. We had a fellow who came to my town when he was just out of medical school. His name was Doc Hill. He was the doctor and ran the drugstore in town. He knew everything about everything. There was not anything he could not treat or any diagnosis he could not make. He was just a wonderful guy. I grew up with that kind of medicine in a small town. In my small town, if someone said: We have a little deal here in the county--we have three towns--Mott, Regent, and New England. Regent is mine, by the way. We have a policy. What we would like to do is charge you folks in Regent 10 times as much for tamoxifen. If you women have breast cancer and are using tamoxifen, we are going to charge you 10 times as much as we are going to charge the people in New England and Mott. Do you know what the people in Regent would say about that? Are you nuts? Are you stark raving mad? For God's sake, what kind of a pricing policy is that? It is fundamentally unfair, they would say. Let's take that globally. We are told this is a global economy, after all, and just as it would be for my county, we are told by the pharmaceutical manufacturers that with tamoxifen, Premarin, Zocor, Lipitor, or dozens of other medicines, we should ask the American consumer to pay much more than others. I understood there are people here who represent the interests of those who want higher prices. That is not the President's position, by the way. This is the President's position. The third Presidential debate in St. Louis, from George W. Bush, now President Bush: Allowing the new bill passed in Congress, you know, for drugs that were sold overseas to come back into the United States, that makes sense. That is President George W. Bush. That is called reimportation. That is President George W. Bush in 2000 saying it makes sense. Sure, it makes sense. It does not make sense to the pharmaceutical industry, and I understand why. They have price controls. They control the price. People say we do not have price controls in America. Yes, we do; of course, we have price controls. The pharmaceutical industry controls the price. With respect to this global economy, it is interesting, my colleague said: In effect, you are going to import price controls from Canada. Canada has price controls on prescription drugs. Yes, that is true. Canada has price controls on prescription drugs. So do many other countries. We reimport a lot of products from other countries. That is one of the factors that makes the global economy interesting. If my friend the Senator from Pennsylvania has a necktie that is made in China today--and I do not know if he does or not, but there is a pretty good likelihood many of us are wearing neckties made in China--then one might make the case that the price of that necktie supports the salary of the leader of a Communist government. Does that make it tighter around our necks? I do not think so. It is the global economy. Do I like to buy something from a country that perhaps supports a Communist government? No, no, no, but a global economy means we move products back and forth, and sometimes we inherit policies we may not like. But inheriting the capability through reimportation to allow the American consumer to pay less for prescription drugs than they would otherwise pay is good public policy and makes good sense for our citizens. The Capitol is full of people who care a lot about drug prices, and they are very concerned about this--they are lobbying this issue on behalf of the pharmaceutical industry. They have every right to do that. I talked about a woman named Elizabeth earlier. I know there was some chiding about that, the teary stories about individuals. But I am wondering if Elizabeth has anyone who is going to grab somebody by the arm before they vote and say: You know, it is very important that you cast your vote the right way. Remember, Elizabeth is a farm wife who is 74 years old who drove a tractor until 2 years ago when she lost her husband and her lungs got worse. She has scleroderma and was diagnosed at Mayo. She talks about how she has been on oxygen for 2 years. She talks about the one new pill that would cost $3,600 or more a year. She cannot afford it. But I ask: If there is anybody in the Capitol Building today who is representing Elizabeth today? There are plenty who represent those who want to keep the current pricing strategy. Or Velma: I am 86 years old. I can't work. That is pretty reasonable. She is 86 years old and says: I can't work. I get $303 in Social Security each month, and I pay $400 a month for medicines. She has had heart surgery and osteoporosis. Sylvia Miller, 70 years old, diabetes, heart problems, emphysema. She went with me to Emerson, Canada, to buy prescription drugs. In recent years, she has spent $4,900 on her medicines. It was up $1,000 from the previous year. The point is, this is a very important issue. This is a tripartisan bill that is supported by Senator Jeffords and many on both sides of the aisle. There is no one advocating reimportation who wants in any way ever to diminish the safety standards that exist that allow the American people to access a safe supply of prescription drugs. An important point is this: Prescription drugs are lifesaving and miracle drugs only to those who can afford them when they need them. They save no lives when those who need drugs cannot have access to them. These prices are unfair, and reimportation will help put downward pressure on prices. I say to those who oppose reimportation, what approach do you have to put downward pressure on prescription drugs prices, or is it simply Katie bar the door? Is there another approach? I am willing to embrace almost any approach that attempts to put downward pressure on drug prices. The Cochran amendment is offered, I know, to try to effectively scuttle the issue of reimportation because it was effective in doing so to the bill we passed 2 years ago. At the time we did not know it would scuttle that legislation, but it did, with two Secretaries. I think those who bank on the Cochran amendment effectively killing this legislation this time are wrong. We have changed the reimportation amendment this year. Our legislation now does not permit reimportation of medicines from Mexico. It does not allow for the reimportation of medicine from Bangladesh. It does not allow for the reimportation of medicines from China or Taiwan or South Korea. It allows for the reimportation of medicines from one country, Canada, a country that has a nearly identical chain of supply to this country. It will be, in my judgment, nearly impossible for a secretary to assert that there is additional risk by allowing the reimportation of prescription drugs from a country that has a nearly identical chain of supply, a country that is our nearest neighbor, a country that is our largest trading partner. I do not believe the Cochran amendment is effectively going to kill reimportation. I know some believe this is a great way on behalf of the pharmaceutical industry to do that, but I do not think so. As a matter of fact, I think the Cochran amendment will not have the impact it had 2 years ago because the bill 2 years ago was not country specific. This bill is limited and deals only with the country of Canada. The Senator from Pennsylvania answered a question I did not ask, so let me ask the real question and then answer that. I was asked a question: Why are prices higher here than in Canada? That is not the question I asked. I asked the question I have asked a dozen times, which is: Who here believes that an American citizen ought to have to go to Canada to get a fair price on prescription drugs made in the United States? That is the question I asked. That still has not been answered, and I do not believe it will be answered. If I were to try to answer the question the Senator has asked--why are prescription drugs higher priced in the United States than in Canada?--the answer is fairly simple on two fronts. One, it is true that Canada does have price controls and we do not. Second, I have held a couple of hearing on this subject, and the answer as to why drug costs in the U.S. are so high for prescription drugs is because the charges are set in this country at whatever the consumer will bear. That was essentially what the pharmaceutical manufacturers told us. My feeling is that it is not a fair pricing system, and on behalf of a lot of Americans, not just senior citizens who have to find a way to access these prescription drugs to deal with their serious medical problems, I think we need to find ways to put downward pressure on prescription drug prices. I do not want people going to Canada to access prescription drugs. That is not the goal of this amendment. Our goal is to allow pharmacists and distributors to bring them back, pass the savings along, and that will force the pharmaceutical industry to reprice those prescription drugs in this country. That is our goal. I finish with this point. It is interesting to me that some on the other side say those of us who want reimportation are saying the pharmaceutical industry is a big, bad industry; shame on them for making profits. I have heard none of that rhetoric today. I certainly have not taken part in that myself. I have said repeatedly, the pharmaceutical industry is a big industry, a profitable industry. It has done some terrific things. I commend it. I want them to do well. I wish them well. Their pricing strategy is wrong, and I want them to change it. They will not change it voluntarily, and I fully understand that. If that is the industry I worked for, I would not change it voluntarily, I suppose, because their responsibility to the stockholders is to maximize profits. Since they have the ability to control prices in this country and maximize profits for their stockholders, that is exactly what they do. But if we are going to put a prescription drug benefit in the Medicare program and if we are going to care about the needs of all Americans, not just senior citizens, who can't afford prescription drugs, then we have to do more. We have to employ ways to put downward pressure on prescription drug prices. We have to do that. Failing to do so means we will break the bank, and I am not prepared to allow that to happen. So that is why we offer this, not to tarnish the prescription drug industry and the pharmaceutical manufacturers. I trust the Main Street pharmacists. I trust those distributors. I trust the Canadian system which is nearly identical to ours. I have heard this bizarre argument about counterterrorism and counterfeit drugs. In fact, one of my colleagues brought some yellow paint, I guess yellow cement paint, and some other devices, none of which came from Canada. Isn't that interesting? Maybe I could have brought some kangaroos to the floor of the Senate and watched them jump. Wouldn't that be interesting? Sure, it is all interesting, but it has no relevance to the discussion. So we can be interesting but maybe what we should do is care a little more about pricing of pharmaceuticals in this country in a manner that is fair to the American people. That is all we are trying to do with this amendment. We are not trying to tarnish anybody. We are saying, give the American people a fair break. If 10 cents is going to be charged for a breast cancer drug in Canada, then do not charge a dollar for it to a woman with breast cancer in the United States. Do not do that. It is not fair to the American consumer. That is all we are saying. I yield the floor.

Mr. DORGAN. Mr. President, I ask for the yeas and nays.

Mr. DORGAN. I yield back my time.

Mr. DORGAN. It is correct.

Mr. DORGAN. I have very limited time. I am sorry.

Mr. DORGAN. Mr. President it is unusual we have a real debate on the floor of the Senate. I think it is interesting to do so. It is also interesting to listen to the debate and see the tactics we have heard about terrorists, terrorism, heart surgery in Tijuana, everything but poppy seeds from Afghanistan--yellow highway paint from somewhere around the world. He is not sure where it comes from. Well, he just won a debate no one is having. It is the easiest debate in the world to win. Congratulations. The real subject, however, is vastly different than the presentation you just heard. This is about FDA-approved drugs, only FDA-approved drugs produced in FDA-approved manufacturing plants, moved across the border by licensed pharmacists and licensed distributors, and only those. Apparently--obviously--the pharmaceutical industry does not like what we are doing here. I understand that. And I understand why people stand up and say the pharmaceutical industry does not want this to happen. But what they are saying is, it is OK for the manufacturers to move prescription drugs back and forth across the border--and they do; they do a lot of it every day--but it is not appropriate for licensed pharmacists or distributors to do so. Why is it we trust the manufacturers so much more than the Main Street pharmacists? Tell me about that, if you will. Why is one trustworthy and the other untrustworthy. And is it not the case that there might be a price differential, I say to my colleague from Louisiana, between the United States and Canada? It is a fact that there is a very substantial price differential, and that the American consumer is charged the highest prices in the world for the identical prescription drug. There is a lot of fog in this debate and very little light. We are talking about something very simple. We are not talking about counterfeit drugs or adulterated drugs. We are not talking about terrorism. We are talking about very careful circumstances under which a licensed pharmacist or distributor goes to Canada, which has a chain of custody that is similar to ours, accesses the identical prescription drugs that are FDA approved, brings them back across the border, and passes the savings along to the American consumer. Why don't the pharmaceutical companies like that? Because it will force them to reprice their drugs in this country. It will force down drug prices to the U.S. consumer. That is why they do not like that. I renew the question I have asked time and time again, for which no one in this Chamber has an answer--no one. Why should American citizens have to go to Canada to get a fair price on a prescription drug that was manufactured in the United States? There is no answer to that in this Chamber. No one has attempted an answer. What we have seen is a discussion about---- Mr. SANTORUM Will the Senator from North Dakota yield for an answer?

Mr. DORGAN

Mr. DORGAN. Mr. President, the amendment we are now considering, a first- and second-degree amendment, I have offered for myself, Mr. Wellstone, Mr. Jeffords, Ms. Stabenow, Ms. Collins, Mr. Levin, Mr. Johnson, Mr. Miller, Mr. Durbin, Mr. Feingold, and Ms. Snowe. It is a bipartisan amendment. It is a very important amendment--one that addresses a part of that which we are here to consider on the floor of the Senate on the issue of prescription drugs. Let me describe what the problems are. One, we don't have a prescription drug benefit in the Medicare Program, and we need to change that. We need to add a prescription drug benefit to the Medicare Program. Why do we need to do that? Because when Medicare was created, many of the lifesaving miracle drugs that exist now that allow senior citizens to live a longer and healthier life did not exist. So Medicare was basically an opportunity to provide health insurance coverage for doctors and hospitals but no prescription drug coverage. That was back in the 1960s. Things have changed. Were we to write a Medicare Program today, we would clearly include prescription drug coverage in that Medicare Program. I mentioned senior citizens especially because that is who benefits from the Medicare Program. They represent about 12 percent of the population of our country, and they consume one-third of all prescription drugs. It is not unusual at all to talk to a senior citizen who has a series of health issues, as they have reached the later stages of their lives, and they have to take 4, 5, 10, and in some cases 12 different prescription medicines every day in order to deal with their health issues. The problem is, when senior citizens reach that time of their lives where they have retired and have a lower income, they have less ability to be able to afford those prescription drugs. With the cost and spending increasing substantially, senior citizens are finding all too often that the prescription drugs they need to take are simply out of reach. Let me describe some of the consequences that result. I talked yesterday about the woman who came up to me--and all of us have had this experience--she grabbed me by the elbow and said: Senator Dorgan, can you help me? I said: What is wrong? She said: Well, I have very serious health problems and my doctor prescribed prescription drugs that I must take, but they are too expensive. I don't have the money to be able to afford them. Her eyes welled up with tears and her chin began to quiver and she began to cry. She said: Can you help me, please? This happens all across the country every day. Let me just read some letters. This is from a North Dakotan who wrote me some while ago, about 2 months ago: Dear Senator Dorgan: I just returned from a drug store, where I happened to witness a very pathetic situation that brought tears to my eyes. Standing in front of me at the counter was an elderly gentleman about 80 years of age. He handed 2 prescriptions to the pharmacist. He said, ``Before you fill these, can you tell me what the price is?'' The pharmacist checked the price through her computer and told the elderly man, ``The first prescription is $94.76. The next prescription is $49.88. Do you want me to fill them for you?'' The old man looked around and was deep in thought and said, ``No, I guess not. I haven't bought Christmas presents for my wife and grandchildren. I will just put up with the pain.'' Using his cane, he walked away. ``God bless America,'' she writes. ``I just thought,'' she said, ``you and your Senate colleagues who have reservations about the need for lower priced prescription drugs ought to understand that this is going on in our country.'' A North Dakotan wrote to me and said: I am 86 years old, so I cannot work. Her first thought, of course, would be to work. I am 86 years old, so I cannot work. I am writing in regard to the medication I take. I get $303 in Social Security every month. I have never worked out of my home. I pay $400 a month for my medication. I have had heart surgery and have osteoporosis of the bones. The medicines are very high priced. We need help. We are using all of our savings. I am 86 years old, so I cannot work. Another woman from my State says: I am a person with scleroderma, diagnosed at the Mayo 24 years ago. While this disease attacks different parts of my body, it's mainly my lungs. I have been on oxygen for 2 years now. A new medication is out named Tracleer. One pill a day is $3,600 a year. I called Medicare to see if there was an insurance I can buy for medications. I was told I could not do that. I am a farm wife, 74 years old, who drove a tractor until 2 years ago when I lost my husband and then my lungs got worse. She goes on at some great length. I recall a snowy North Dakota day in January, in a small van going to Canada with some senior citizens from my State. Among the people who traveled to a little one-room drugstore in Emerson, Canada, that snowy day was Silvia Miller, a 70-year-old Medicare beneficiary from Fargo, ND, with no prescription drug coverage. She has diabetes, heart problems, and emphysema. She takes 10 to 12 medications every day. In 1999, she spent more than $4,900 for her medications. Well, Silvia Miller, like a lot of others, struggles to try to make do and deal with very serious health problems and tries to catch an increased price every year--increased costs of prescription drugs. Of course, she cannot catch that. It is moving out of sight. Last year, there was a 17- to 18-percent cost increase for prescription drugs. The year before that, it was about 16 percent. The year behalf that, it was about 17 percent. So year after year after year, there are relentless increases in the cost of prescription drugs. This trend continues. What can we do about it? Well, the point we make with this amendment is this: We support fully putting a prescription drug benefit in the Medicare Program. That ought to be done. I hope it will be done. But if that is all we do--if we do nothing to try to dampen down prices, put some downward pressure on prescription drug prices, we will have done nothing but hook up a hose to the Federal trough and we will suck it dry. The American taxpayer beware. If we don't do something to try to put some downward pressure on prescription drug prices, we cannot afford putting a prescription drug benefit in the Medicare Program. We must do both, in my judgment. Let's put the benefit in the Medicare Program, make it optional, make it good, and at the same time let's do some things that put downward pressure on prescription drug prices. I mentioned that I went to Canada with a group of North Dakota senior citizens. More recently, the Alliance For Retired Americans arranged 16 bus trips to Canada between May and June of this year to highlight the enormous price differences that exist for the identical prescription drugs between the United States and Canada. Participants in those 16 trips saved $506,000, or $1,340 per person. I think it is important that we talk about policy in theory in the U.S. Senate, but let me do something a bit more than that, if I can. I ask unanimous consent to show some prescription drug bottles that describe the real problem.

Mr. DORGAN. Mr. President, if I might go through a few of these, it will be useful for people to understand what senior citizens are discovering with respect to pricing. This prescription drug is Celebrex, quite a remarkable drug for pain. It is sold both in the United States and Canada bottles that are essentially identical. The U.S. consumer is charged $2.22 per tablet. The Canadian consumer is charged 79 cents per tablet. Same drug, same bottle, made by the same company; the difference is the American consumer is charged dramatically more for the same prescription drug. Mr. President, Paxil is a prescription drug used to treat depression. As you can see, these two pill bottles are identical. The cost is $2.22 per tablet to the U.S. consumer; for the Canadians, for the same drug, it is 97 cents. Again, it is $2.22 for the American purchaser and 97 cents for the Canadian purchaser. One might ask, as you go through this--and I have a couple more examples--why the difference in pricing? Well, that is a good question. We have had hearings on this and it is not that there is a difference in the tablets in the bottles. This is Zocor. A famous football coach talks about Zocor on television every day. He says he takes this prescription drug and recommends it to others who need it. Zocor is sold in the United States in this bottle. It is $3.33 cents per tablet in the United States, and it is $1.12 per tablet in Canada. Finally, this is a prescription drug called Prevacid. As one can see, this prescription drug, like the others, is marketed in an identical bottle in the U.S. and Canada. This is used for ulcers. It has a label that is of a slightly different color, but the bottle is identical-- same pill, same bottle, made by the same company. In the United States, a purchaser pays $3.58 per tablet; in Canada, it is $1.26 per tablet. I have more.

Mr. DORGAN. I will be happy to yield.