Byron Dorgan

Mr. DORGAN

Mr. DORGAN. I ask unanimous consent that the order for the quorum call be rescinded.

Mr. DORGAN. Madam President, I have listened this afternoon to some of the opposition to the legislation, the amendment we have offered trying to deal with the increasing price of prescription drugs. Those who are opposed apparently are oblivious to the question of the dramatic runup in prices for prescription drugs. They talk about counterfeiting and their worry about that. I wish to talk about that. Because if you are worried about counterfeiting--and, by the way, there is a counterfeiting issue with respect to prescription drugs in this country and several of my colleagues have described that issue--if you are worried about that, then you have to support the amendment I and Senator McCain and others have offered that provides the only basis for getting to things such as pedigrees on prescription drugs, batch lots, and tracers. The only mechanism to do that is in this amendment, which will make the domestic drug supply safer, allow us to track back drugs to their origin, and will certainly allow us to import FDA-approved drugs when they are sold in other countries for a fraction of the price. Let me describe what brings us to the floor of the Senate. To those who are opposed to this amendment, if one wants to be oblivious, I guess, fine, but the consumers will certainly notice. You want to buy some Nexium, guess what. Nexium is going to cost you $424 in this country. But if you buy it in Great Britain, it is $41 dollars; Spain, $36; Canada, $65; Germany $37. Once again, the American consumer gets to pay $424 for an equivalent amount, 10 times the cost of what it costs in Great Britain. Is that fair? To me, it is not. It is not fair to me that the American consumer is charged the highest prices in the world. Plavix, you can see what is happening here, $133; $59 in Britain; $58 in Spain. The American consumer gets to pay $133 for the equivalent amount. Lipitor, the popular cholesterol-lowering drug, for an equivalent amount of Lipitor, the American consumer pays $125. In Great Britain, they pay $40. In Spain, they pay $32. In Germany, they pay $48. Again, the American consumer is told: You get to pay $125. I have described, over and over again, the two bottles of Lipitor, empty bottles made in Ireland by an American corporation and distributed all across the world, the most popular cholesterol-lowering drug. Same pill put in the same bottle made by the same company, FDA approved. Only difference is this one has a blue label and this one has a red one. This one went to Canada and this one to the United States. The U.S. consumer got to pay nearly triple the price. Is that fair? Not where I come from. By the way, my colleague from Maine, who spoke moments ago, talked about a nearly 10-percent increase in the price for brand-name prescription drugs just this year. This chart shows what is happening. You take the arthritis drug Enbrel; you got a 12-percent increase this year. Singular, for asthma, this year you got a 12-percent increase. Boniva, for osteoporosis, an 18-percent increase this year in drug cost. The list goes on. Plavix, 8 percent up this year. In fact, I have a chart that shows what has happened year after year after year. The price of brand-name prescription drugs in the United States is way above the rate of inflation in every single year. In fact, during this year, the rate of inflation has dropped down here and the price of prescription drugs has gone up 9.3 percent. Several of my colleagues, at least a couple of my colleagues have talked about the issue of counterfeit drugs. I am concerned about counterfeit drugs as well. In fact, there were proposals in the Congress that would have done what we should have done long ago with respect to ensuring a safe drug supply: attaching pedigrees to drugs, batch lots so you can trace them all the way back to their origin and trace them all the way through the chain of custody. That has never been done, and it should be done. It is in our amendment. That is the only way we will have a totally safe drug supply. A couple of my colleagues have talked about circumstances where there have been counterfeit drugs in this country. That is true. Those were domestic drugs, drugs inside the country. By the way, how does some of that happen when you have not only counterfeit drugs but contaminated drugs? Forty percent of the active ingredients in prescription drugs for the United States comes from India and China. Think of that: 40 percent of the active ingredients of all the prescription drugs consumed in our country comes from India or China. I described earlier today the Wall Street Journal investigative report which shows the circumstances with the active ingredient for Heparin, the production of Heparin in a building in China. This shows the development of pig intestines for the production of Heparin. You will see this in the Wall Street Journal articles and the expose. Here is a man in this building in China who is producing Heparin, stirring a rusty old pot with what appears to be a twig from a tree, clearly unsanitary conditions. That becomes ingredients for America's prescription drug supply; 40 percent of our active ingredients comes from circumstances in which there is virtually no inspection or very few inspections of those kind of places where those prescription drugs are developed. By the way, there was a drug called Epogen produced by a pharmaceutical company, a very reputable one. There is a wonderful book written called dangerous doses by Katherine Eban. She traced this drug to a 16-year-old boy named Timothy Fagan, whose health was dramatically affected by what has happened here. This drug found its way all the way through these places, including a strip joint in Miami, a cooler in the back of a strip joint in Miami, in the trunks of automobiles, distributed through all sorts of strange and unusual places, and gets to a 16-year-old boy with devastating results because this drug had one-twentieth the strength that was supposed to have been given to this young boy for his disease. Does anybody have the capability to understand where all this happened, how it got tracked? A journalist did the investigative work to find this out. Fortunately for us, we now have a track on this one drug that affected this young boy in a devastating way. That was not importation. That was the domestic drug supply. How can this happen? Because we don't have batch lots and pedigrees and tracers and the capability to find out where a drug is produced and where it goes from that production to the final user in every single circumstance. We have that in our amendment. It is the only way it will happen if we pass this amendment. It is interesting to me. There was a man named Dr. Peter Rost. He was the former vice president of marketing for Pfizer Corporation. By the way, Dr. Rost also worked in Europe in the parallel trade area for 20- some years. They do this in Europe routinely. They actually have parallel trading where you can purchase drugs, one country to another, no problem. Here is what he says: The biggest argument against reimportation is safety. What everyone has conveniently forgotten to tell you is that in Europe reimportation has been in place for 20 years. They say this is going to be unsafe, you can't do it. Europe has been doing it for 20 years. Don't tell me we don't have the capability if Europe can do it. Why would we do it? Because it is unfair to the American people to be paying double, triple or quadruple or 10 times the cost of prescription drugs that are being paid for by people in the rest of the world. That is unfair. It doesn't make any sense to me. We offer an amendment. It is one of the few amendments in the Senate, in recent days and weeks, that is bipartisan. Most of the things offered are not bipartisan. This is an amendment, Dorgan-Snowe. We offer it with broad support. The late Ted Kennedy, bless his soul, sat right over there. He was a cosponsor of our amendment. John McCain is a cosponsor of our amendment. Senator Grassley and Senator Stabenow are cosponsors.

Mr. DORGAN. I ask unanimous consent for 5 additional minutes.

Mr. DORGAN. This is broadly bipartisan. It is one of the few bipartisan amendments. My expectation is, we will have a vote on the Crapo motion. He offered his last evening and I offered mine last evening. My expectation is we will have a vote on the Crapo motion and then a vote on this amendment and move on. I would hope we will have the votes on this. It is the only thing in any health care proposal in the House or the Senate that starts to put the breaks on the escalating prices of prescription drugs. It is the only thing. Without this, we will pass health care reform, if, in fact, it passes and if someone says to you: What have you done to try to put the brakes on the fact that prescription drugs are increasing at 9 and 10 percent? What have you done about that? The answer is going to be, we didn't do anything. We just couldn't do that. The fact is, a whole lot of people in this country use prescription drugs regularly to control their cholesterol, their blood pressure, and otherwise manage diseases. It keeps them out of the hospital. The fact is, many of these prescription drugs are very important in the lives of people. The question for us is, if we are allowing these drugs to be priced out of the reach of people, what does that say about the value of the drugs? We need to have fair pricing for the American people. We must insist on fair pricing for prescription drugs for the American people. It is that simple. This notion of there being any kind of a safety issue is a total canard by those who ignore the very provisions of the bill that establish the most rigorous regime of safety ever established for the domestic drug supply and for the reimportation of prescription drugs. That is just a fact. My hope is, in very short order, we will have an opportunity to have the Members of the Senate cast their votes on this and, at long last, Senator Snowe and I, having been at this, I think, now for 8 or 10 years, will have at the right time--and that is health care, when you are considering health care, when is a more important or more appropriate time to consider the questioning of prescription drugs--and in the right place, the ability to pass the legislation. We offer a bill as an amendment. Thirty Senators having cosponsored it, Republican and Democrats, conservatives and liberals and moderates having cosponsored it. It is my expectation, we will have this vote and at long last be successful in doing something for the American people. The question is, does the pharmaceutical industry have a lot of clout? The answer is, they sure do. As I said many times, I have no beef against that industry. I want them to succeed and earn profits. I think their pricing strategy is unfair to the American consumer. Do they have a lot of clout. Yes, they do. But it is my hope that when it comes time for a vote, the American people and the interests of the American consumers will have as much clout in this Chamber, based on the facts, facts that suggest the American people ought to be treated fairly. This amendment is all about freedom, giving the American people the freedom to do what everybody else can do and that is participate in the global marketplace. When the medicine they need that is FDA-approved is available somewhere else for half price or for an 80-percent reduction, why on Earth should they not be able to acquire that lower priced drug that is FDA-approved? The answer is, they should have the freedom to do that. The only way that freedom will exist is if we pass this amendment. That is just a fact. I yield the floor.

Mr. DORGAN

Mr. DORGAN. Madam President, will the Senator from Texas yield for a unanimous consent request?

Mr. DORGAN. Madam President, I ask unanimous consent that following the presentation by the Senator from Texas that I be recognized to offer an amendment, and following that Senator Crapo be recognized to offer an amendment, and Senator Crapo, I believe, wishes to speak 2 or 3 minutes, and following that then I would be recognized as well for a presentation on the amendment I have offered, and following my presentation, the Senator from Minnesota, Ms. Klobuchar, would be recognized, and Senator Kaufman would be recognized as part of the colloquy with Senator Klobuchar.

Mr. DORGAN. Madam President, I call up amendment No. 2793, as modified, and ask for its immediate consideration.

Mr. DORGAN. Madam President, I ask unanimous consent that the reading of the amendment be dispensed with.

Mr. DORGAN. Madam President, my understanding is that the Senator from Idaho is to be recognized next for laying down an amendment.

Mr. DORGAN. Madam President, the amendment I have offered with many colleagues--over 30 colleagues, Republicans and Democrats, a bipartisan legislation--deals with the issue of prescription drugs; specifically, the importation of FDA-approved drugs that the American people would be able to access for a fraction of the price they are charged in this country. The American people are paying the highest prices in the world for brand-name prescription drugs. It is not even close. Let me just show the first chart. I have many. I will show the first one to describe what brings me to the floor of the Senate. Here are prices for Lipitor. There are so many people who take Lipitor that they probably ought to put it in the water supply--the most popular cholesterol-lowering drug in America, perhaps in the world. Here is what the American people pay for an equivalent quantity: $125. The same quantity costs $40 in Britain, $32 in Spain, $63 in the Netherlands, $48 in Germany, $53 in France, and $33 in Canada. Once again, it is $125 to the American consumer. Here are the two bottles for Lipitor. It is made in Ireland by an American company and then sent around the world. This happened to go to Canada, and this went to the United States. It is the same pill, same bottle, same company, made at the same manufacturing plant, and it is FDA approved. Difference? The American consumer gets to pay three to four times higher cost. Fair? Not for me. That is what this amendment is about. This amendment is about freedom, giving the American people the freedom in the global economy to buy the same FDA-approved drug from those countries that have an identical chain of custody as we do in this country, so an FDA-approved drug sold for a fraction of the price--why should we prevent the American people from being able to exercise and see the same savings every other consumer in the world sees? Let me see whether anybody recognizes this. Prescription drugs are a significant part of our lives. We are bombarded with ads every single day. Let me show a demonstration of the push for consumption of prescription drugs at the highest brand-name prices in the world. On television, Sally Field says to us--and I have seen it many mornings when I am brushing my teeth--she says this: I always thought calcium, vitamin D, and exercise would keep my bones healthy. But I got osteoporosis anyway, so my doctor started me on once-a-month Boniva. And he told me something important: Boniva works with your body to help stop and reverse bone loss. My test results proved I was able to stop and reverse my bone loss with Boniva. And studies show that after one year, 9 out of 10 women did, too. I've got this one body and this one life, so I wanted to stop my bone loss. But I did more than that; I reversed it with Boniva. Ask your doctor if Boniva is right for you. Here is another one: Some of us need help falling asleep. Some of us need help staying asleep. A good night's sleep doesn't have to be an on/off thing anymore. From the makers of the most prescribed name in sleep medicine comes controlled release Ambien CR. It's the only one with two layers of sleep relief. Ambien CR is a treatment you and your doctor can consider along with lifestyle changes and can be taken for as long as your health care provider recommends. So ask your health care provider about Ambien CR, for a good night's sleep from start to finish. Here is another one: Does your restless mind keep you from sleeping? Do you lie awake exhausted? Well, maybe it's time to ask whether Lunesta is right for you. For a limited time, you're invited to take the 7-night Lunesta challenge. Ask your doctor how to get 7 nights of Lunesta free and see if it's the sleep aid you've been looking for. Get your coupon at Lunesta.com and ask your doctor today. Here is another one: They're running the men's room marathon, with lots of guys going over and over. And here's the dash to the men's room with lots of guys going urgently. Then there's a night game waking up to go. These guys should be in a race to see their doctors. Those symptoms could be signs of BPH or enlarged prostate. Waking up to go, starting and stopping, going urgently, incomplete emptying, weak stream, going over and over, straining. For many guys, prescription Flomax reduces urinary symptoms associated with BPH in one week. Only a doctor can tell if you have BPH and not a more serious condition like prostate cancer. Call 1-877-FLOMAX to see if Flomax works for you and to see if you qualify for $40 off your prescription. For many men, Flomax can make a difference in one week. Here is another one: There are moments you look forward to, and you shouldn't have to miss out on them. Sometimes a bladder control problem can cause unwanted interruptions. It doesn't have to be that way. Overactive bladder is a treatable medical condition. Enablex is a medication that can help reduce bladder leaks and accidents for a full 24 hours. Ask your doctor about Enablex. Well, I have a couple dozen more. Most people understand what this is because they have heard them all--things like: Go ask your doctor if the purple pill is right for you. They don't have the foggiest idea what a purple pill is for. They think that with all these scenes of trees and green grass and convertible cars and pillow clouds in the sky, if life is like that when you are on the purple pill, give me some purple pills. I mean, that is what this advertising is all about. I don't mean to make light or fun of all of it. Prescription drugs are important in people's lives. I understand that. But you know what, you can only get a prescription drug if your doctor prescribes it and believes you need it. These advertisements are telling people sitting at home watching a television program tonight that you need to get up and go talk to your doctor and see if you don't need some of these pills. It is trying to create consumer demand for something you can get only because a doctor believes you should have it. Well, that is where we are now with prescription drugs in our country. A lot of people are taking prescription drugs. A lot of these drugs are miracle drugs, and they allow people to stay out of a hospital. They don't have to be in an acute-care hospital bed if they manage the disease--whether it is high blood pressure, high cholesterol--with medicine. That is good, and I understand that. But this consumer demand-driven urge for prescription drugs is pretty unbelievable. Go talk to a doctor and ask that doctor what happens every single day in the doctor's office. Somebody is coming in and saying: I wonder if I shouldn't be taking some of this medicine. I read about it or saw the advertisement about this. I wonder if I shouldn't be taking some of it. It is quite a deal. You produce all of this demand with dramatic amounts of marketing, promotion, and advertising, and then you jack up the price and keep it up. The question is, Who can afford these prescription drugs? Who can afford them? So that is what brings me to the floor of the Senate today saying that when the American people are charged the highest prices for brand- name drugs--and this year, it goes up close to 10 percent once again in price--at a time when we have almost no inflation, isn't that pricing prescription drugs out of the reach of too many Americans? We are now talking about health care reform. There is nothing in any of this legislation in the House or the Senate that addresses this question of the steep and relentless price increases on prescription drugs. There is nothing in any of this legislation that does that. The question is, Shouldn't we be addressing this as well? I talked about Lipitor. Let me show you Plavix. Do you see the U.S. price? The U.S. consumer pays the highest prices in the world. Here is Nexium. If you want to buy that, you get to pay $424 in the United States, and it is $41--one-tenth the price--in England, $36 in Spain, and $37 in Germany. The question is this: If Nexium is an FDA- approved drug--and it is--made in plants approved by our FDA--and it is--why should an American citizen not be able to access this drug from here, from here, and from here? It is because the pharmaceutical industry doesn't want them to. They have had enough friends here to keep in place a law that prevents the American people from reimporting these drugs. That is why. That is what this amendment is about. This amendment says: Give the American people the freedom to access FDA-approved drugs where they are sold at a fraction of the price. Madam President, there is a lot to talk about, and I will describe a number of circumstances that have brought us to this point. This is the place for this amendment--not some other place; this is the place. It is about health care. We have been told over and over again that our problem is that health care is consuming too large a portion of the GDP of this country--roughly 17.3 percent, I believe. All right, part of health care--not the largest part but one of the fastest growing parts is prescription drugs. So if the issue is that health care is rising in cost relentlessly and consuming too large a portion of our GDP because we spend much more on health care than anybody else in the world by far--it is not even close--if that is the case and if one of the fastest rising areas of health care is drug costs, then why would legislation that leaves this Chamber or the House of Representatives not include something that addresses these unbelievable price increases for prescription drugs? How is it that we would allow that to happen? I don't know how we got to this point without having it in the bill, but I aim to try to put it in. I understand, by the way, that there is tremendous pushback by the pharmaceutical industry. If I had the sweetheart deal they have, I would fight to the finish to try to keep it. I understand that. By the way, let me just say, as I have always said and nobody hears it very much--certainly the pharmaceutical industry will never hear this--that some of the things the pharmaceutical industry does for this country are laudable. I say, good for you. They talk about the prescription drugs they produce. Good for them. A substantial portion of that comes from research we have done and paid for at the National Institutes of Health with taxpayer funds. But that doesn't matter to me. That information ought to be available to the pharmaceutical industry--and it is--so they can produce these new miracle drugs. I commend them. My beef is not that they produce pharmaceutical drugs that help people. I am all for that. My beef is the way they price those drugs, saying to the American people: You will pay the highest prices in the world, and there is nothing you can do about it. It is their pricing policy. It is just not fair. How many in this Chamber have visited with somebody at a town meeting someplace--I have--and they come up to you--in this case, an elderly woman who was close to 80 touched me gently on the elbow and said, ``Senator Dorgan, can you help me?'' She was talking about how many prescription drugs she had to take, how little money she had to pay for them, and how she always had to try to determine what her rent cost was and how much groceries she could buy to determine how much she had left to pay for prescription drugs. How many people have said to you: Yes, I take the drugs my doctor asks me to take, but I cut them in half because I cannot afford the whole dose. We have all heard that. So the question is, Are we going to do something about it? This is a chart that shows price increases in 2009. Enbrel, for arthritis, is up 12 percent. Singulair, for asthma, is up 12 percent. Boniva is up 18 percent. Nexium is up 7 percent. I want to talk a bit about the issue of drug prices versus inflation. This chart shows what has happened to the price of prescription drugs, the red line, and the inflation rate in this country, the yellow line. It describes why it is urgent that we do something, why we cannot allow a health reform bill to leave this Chamber and do nothing about the issue of prescription drugs. We must at least address this question of whether the American people should not have the freedom to access these identical drugs where they are sold elsewhere for a fraction of the price. This year, there was a 9.3-percent increase in brand-name prescription drug prices, at a time when inflation is going down. We have had deflation. That is not justifiable. Madam President, I know we are going to have a lot of debate here in the Chamber about a lot of things. I will describe tomorrow morning, when I speak, that 40 percent of the active ingredients in U.S. prescription drugs currently come from India and China. And they are worried about somebody from Sioux Falls, SD, buying prescription drugs from Winnipeg. Are you kidding me? Again, 40 percent of the active ingredients in U.S. prescription drugs currently come from India and China. In most cases, the places those active ingredients come from have never been inspected. I will talk about that, but I am not going to go into it tonight. I will talk about a number of issues related to drug safety of the existing drug supply and how what we have included in this legislation with respect to pedigree, batch lots and track and trace will dramatically improve the existing drug supply in our country and make certain we prevent safety problems coming from the importation of drugs. I am going to speak about this at some length tomorrow. But I just received a letter from the head of the FDA, Margaret Hamburg, who raises some questions about the amendment. I am not going to read the letter into the Record. I will talk more about it tomorrow. I must say, I am in some ways surprised by the letter and in some ways not surprised at all. Surprised, because this administration, President Obama, was a cosponsor of this legislation last year in the Senate--a cosponsor of my legislation. He was part of a bipartisan group that believed the American people ought to have this right and believed we could put together a piece of legislation that has sufficient safety capabilities and, in fact, dramatically enhances the safety of our existing drug supply. I am going to show tomorrow that the existing drug supply has all kinds of issues. I will show batch lots of existing drugs that have gone through strip joints, in the back room in coolers, and distributed out of strip joints. I am going to talk about that. But, first, I wish to say I was surprised to get this letter because both the President and the Chief of Staff at the White House were a cosponsor in the Senate and a leader in the House for reimportation of prescription drugs. I called the head of the FDA yesterday afternoon about this time and said: I have heard rumors that there was a letter coming to Capitol Hill on this issue. She told me she was not aware of such a letter. Twenty-four hours later, apparently she is aware of that letter because she signed it. I am interested in where it was written, but that is another subject I will save for tomorrow as well. We will be told, as we have been so often, that if you allow the American people to buy prescription drugs that are FDA approved from elsewhere, it will be somehow unsafe. The implication is, we are not smart enough and we are not capable enough of putting together a system that the Europeans have had together for 20 years. In Europe, they do this routinely. For 20 years, they have had something called parallel trading. You are in Germany and want to buy a prescription drug from Spain? No problem. You are in Italy and want to buy a prescription drug from France? No problem. They have a specific parallel trading system, and it works and works well. I am going to describe, in the words of someone who has been involved in that system for many years, that the Europeans can do, have done it, do it today with no problems at all. Are people saying they can do it, they are smart enough, they are capable enough, but we are not? Give me a break. That makes no sense to me at all. Of course, we can do this. It is just that those who do not want to do it have decided this current ``deal,'' which allows the pharmaceutical industry to price as they wish in this country and make certain the American people cannot do anything to get the lesser prices in other countries, lower prices for the identical drug, it means they will price this year up 9.3 percent, just this year alone. They will do whatever they want to price those prescription drugs and too often will price them out of reach of the American people. It is not fair to me. It does not make any sense to me. I know some will view this as just an attack on the pharmaceutical industry. It is not intended to be that. As I said, I don't have a grievance against that industry at all. The only problem I have is the way they price their product, and I think it is not fair to the American people. We are dealing with health care, which is a big issue and an unbelievably controversial issue. This is one piece of it--not even the biggest piece--but it is an important piece. I have a lot to say tomorrow morning, and I will take substantial time. I know there are others who want to speak tonight. I wish to say this. I have watched and listened in this Chamber now for some while. I have not spoken a lot on health care. I have been pretty distressed about some of what has been said on the floor of the Senate. I especially have been distressed with the television ads that have been running that are unbelievably dishonest with respect to the facts. The first amendment allows all that. I would be the last to suggest we ought to alter the first amendment. This is a great country in which we live. Over the last century, for example, we have made a lot of changes, and in most every case--in most every single case--the changes have been unbelievably painful. I think of the Presiding Officer and think of the period in which the women in this country wanted the right to vote and were taken to the Occoquan Prison and beaten. Lucy Byrne and Alice Paul, they nearly choked to death one of them; the other hung with a chain from a prison door all night long with blood running down her arms. Why? Because they wanted the right to vote. Think of the pain of that. Now we look back and say: How could anybody have decided we are all Americans except women do not have full participation because they cannot vote? Think of that. You can go right up the line. Social Security: a Communist socialist plot. Medicare: What are you thinking about? A takeover of health care for senior citizens. I bet there is not--I was going to say I bet there is not one. I shouldn't say that. I bet there are not more than two or three people in this Chamber, if we said: Let's get rid of Medicare, who would say: Yes, let's do that. Almost everybody believes that providing health care for senior citizens was the right thing to do. There were no insurance companies in the fifties and early sixties that said: Here is our business strategy. Our business strategy is to go look for old people and see if we can't sell them health insurance because we think that would be a very good deal. They were not doing that. They would not even make health insurance available to a lot of old folks because they know, somewhere toward the end of their lives, they were going to need a lot of health care. One-half of the senior citizens in America had no access to health care. Think of that--lie down on your pillow at night frightened that tomorrow might be the day you have this dreaded disease and you have no coverage to see a doctor or go to a hospital. It is unbelievable. So some people in this Chamber said: Let's do Medicare. Man, that was radical. People said: Socialist plot, government takeover. But we did it. I was not here. They did it--God bless the ones who did it--and it enriched this country, to say all those who lived their lives and built the roads and built the schools and built the communities and left a better place for us: You are not going to have to lay awake at night frightened about your health care; we are going to provide health care for you. All these issues have been difficult, draining, wrenching issues, and they have all provoked great criticism and great anger, in many cases. This issue of health care brought to the floor of the Senate--I, perhaps, would have a different view of what is the priority. I have spent most of my time saying: The economic engine, restart the engine, get people back to work. But that does not mean health care is not important. It is. Health care continues to gobble up more and more of this country's economy. At some point, somebody has to say: How do we stop that? If we are spending much more than anybody else, how do we fix this? That is what this is about. It is going to take some courage to do it. One piece of it is this issue of prescription drugs and pricing. Some of us have been working on this for a long time. The breadth of the support of this issue in this Chamber extends from the late Senator Ted Kennedy, who sat in that seat back there--and God bless his memory--to John McCain over there; it extends to Senator Chuck Grassley, Debbie Stabenow, Amy Klobuchar--a whole series of Republicans and Democrats who have come together to say: You know what, let's make sure there is fair pricing of prescription drugs for the American people. We are not asking for anything other than fair pricing. How do you get it? My goal is not to ask the American people to buy their prescription drugs overseas. My goal is to say, if we allow the American people the freedom to do that, the pharmaceutical industry will be required to reprice their drugs in this country. It is as simple as that. I know others wish to speak. As I said, I have a lot to say tomorrow. I am going to go home kind of upset about this letter today from the FDA, which is, in my judgment, completely bogus. I will read it tomorrow. I am not surprised. I expected this. I heard rumors about it. Tomorrow my hope is with my colleagues--Republicans and Democrats--we will pass this legislation at last, at long last. Many of us have been working on this issue 6, 8, 10 years. We will pass this legislation. Why? Because this is the place for it. This is the bill that should be amended. This is the time to do this. We cannot walk out of this Chamber and say something happened in that Chamber to deal with health care. But did you do something about prescription drugs? No, no, we couldn't do that, couldn't do that. This is not the way I want this to end, and it is not the way it has to end if enough of us have the courage to take on this fight. As I said, I will have a lot more to say tomorrow morning. I appreciate the indulgence of my colleagues to listen tonight about why we have offered this legislation. I started and let me finish by saying this is broadly bipartisan. It is, first and foremost, a Dorgan-Snowe bill. Senator Dorgan--myself-- and Senator Snowe from the State of Maine, but many others--my colleague, Senator Grassley, who is on the floor, Senator McCain, who spent a lot of time on this issue--Republicans and Democrats have come together. By the way, this has not happened very often on this bill. But this is a bipartisan bill with Republicans and Democrats pulling their oars together to try to get this done. I yield the floor.

Mr. DORGAN. Madam President, I say to the Senator from Iowa, that and Cohiba cigars from Cuba, I reckon. We have a special embargo with respect to Cuba. With that exception, I don't think there is a legal product the American consumer cannot access anywhere else in the world. This is about giving the American consumer the freedom that the global economy should offer everybody. The big shots got it. The big interests can do it. How about the American people having the opportunity to shop around the world for the same product and pay a fraction of the price of the charges that are imposed on them in the United States.

Mr. DORGAN

Mr. DORGAN. Mr. President, I would like to announce that the Committee on Indian Affairs will meet on Wednesday, December 9, 2009, at 9:30 a.m. in room 628 of the Dirksen Senate Office Building to conduct a business meeting on pending committee issues, to be followed immediately by a legislative hearing on S. 1690, a bill to amend the Act of March 1, 1933, to transfer certain authority and resources to the Utah Dineh Corporation, and for other purposes. The Committee will then conduct a hearing entitled ``Where's the Trustee? U.S. Department of the Interior Backlogs Prevent Tribes from Using their Lands.'' Those wishing additional information may contact the Indian Affairs Committee at 202-224-2251.

Mr. DORGAN

Mr. DORGAN. Mr. President, this issue of health care and health care reform has been an issue that has caused a great deal of advertising and claims on television from both sides, back and forth. A substantial amount of the advertising we have seen has been totally and completely without foundation--completely inaccurate. But, nonetheless, political dialogue in this country allows one to say whatever one wishes, so the very aggressive discussion about this issue of health care has taken on interesting tones--claims by some that Congress is working to undermine the Medicare Program. The fact is, those of us on this side of the aisle are the ones who created the Medicare Program, at a time when most senior citizens had no health insurance at all. There were no insurance companies in this country tracking down senior citizens and saying: Do you mind if we sell you a policy for health care? At a time when people's lives were going to need an increasing claim on health care benefits, were insurance companies tracking them down and saying: Can I do business with you? Of course they weren't. Over half the American people had no access to health insurance. Folks reaching the end of their lives, retired, would lay their head down on their pillow at night and wonder if tomorrow would be the day they would get sick and have no health insurance coverage; and wonder if they would get sick, who would treat them or how they would find the money to provide for themselves. So the fact is, this Congress created something called Medicare at a time when it was decided that maybe we should put together a program to give senior citizens an opportunity to be covered with health care. It was decried as socialism--unbelievable--when we tried to put together this government program to provide Medicare for senior citizens. Some old guy in a little town in North Dakota one night, at a town meeting, got up, and he was so angry with the government. He shook his hand as he spoke. He was a thin, older guy, and his neck was coursing out and bulging so that I thought he was going to have a heart attack right there, shouting about the government. At the end of the meeting, an elderly woman took me aside and said: You know what, I hope you are not upset with Ernie because he's been pretty emotional about a lot of things. He just had open heart surgery and he gets kind of emotional about things. So I saw the gentleman as he was leaving, and I sidled up to him and I said: I understand you just had open heart surgery, and he said: Yeah. So I asked him if his surgery was covered by Medicare, and he said it was. I said: Well, there is at least one government program that works. He said: Medicare ``ain't'' government. It just ``ain't'' government. Well, of course, it is government. The reason he had health insurance coverage was because we--that is we the government, the Congress, the American people--decided we weren't going to let people come to the end of their years and not have health insurance coverage. Some might say: Well, yes, you put together Social Security and Medicare and now you have trouble financing it. That is true. That is true. We have trouble financing it because of success. We can handle success. Our country can handle success. People are living longer and better lives these days--longer and better lives--and they claim more health care during those extra 5, 10 or 20 years they are living. I have often told my colleagues that I have an 89-year-old uncle who runs in the Senior Olympics. He runs the 50 meter, the 100 meter, and the 200 meter. He runs the 100 meter in under 19 seconds at age 89. Would that have happened 30 years ago? Not likely. But people are living longer and healthier lives and it causes some strain on Social Security and Medicare, but we can deal with success. Surely, we can deal with success. Now we are talking about a system of health care that doesn't work for everybody or it doesn't work very well for many people and it works very well for some others. But should we do nothing or should we decide to try to tackle this question? I walked into a restaurant about 2 weeks ago, and I saw what several of my colleagues have seen: advertisements on the wall. This particular restaurant, as you walk through the door, has a plate glass window up to the ceiling, and it had a couple of advertisements on it. Both of them were advertisements for people who needed to raise money to try to pay for their health care costs--spaghetti dinners, bake sales, various things to ask people to come and chip in some money for their health care needs. Let me read a few of them. I will not read the name, but this one is a benefit for Chris's family: A spaghetti feed and silent auction is going to be held from 5 to 7:30 p.m. to benefit Chris. He is a sheriff's deputy who was shot in the head and the abdomen while on duty and is still recovering at a rehabilitation hospital outside of Denver, CO. They will have a spaghetti feed and silent auction to try to raise the funds to benefit that family for their needs. Here is a spaghetti supper, silent auction, bake sale, free-will offering for supper or donations to be made to the Duane fund at the Community National Bank. He has stomach cancer that has spread to other areas and is undergoing various treatments and needs help with medical and living expenses. This is what you see on the side of the wall in cafes, posted to a bulletin board downtown: A burger supper and free-will offering to be held for Amy. In July, Amy was diagnosed with uterine cancer, which has metastasized to the lymph nodes. She has had surgery and is now undergoing chemotherapy radiation and needs to raise funds for health care costs. Here is a pancake breakfast to be held for Sean in the school cafeteria. Scrambled eggs, pancakes, and sausage will be served, and there will be a free-will offering. Sean's infant daughter was born with a heart defect and needs corrective surgery and a lengthy stay in the hospital. The staff is hosting the event to defray the expenses so they can provide the funds to try to afford this very expensive medical treatment. Joyce is the mother of Brandy. Brand is a 16-year-old who was involved in a car accident weeks after her parents decided to give up their health care coverage so they could afford mortgage payments. The family had a meatball and mashed potato dinner benefit last month to help pay for Brandy's health care needs. I have a long list. The list goes on, and one wonders whether we should be oblivious to that, that we walk into the business places in the downtowns and the Main Streets of our communities and see that there are many people who have to have a spaghetti supper or burger feed to see if they can raise enough money just to get to the hospital, just for transportation, let alone the surgery, let alone the medical treatment. I think it is the worst, not the best of our political system that when we debate these things, there is so much misinformation, so much bad information that is alleged about legislation to try to deal with health care. It is interesting to me, I do not know of an attempt of a government takeover of the health care system. I have heard it 1,000 times on this floor. I am not familiar with any legislation that has been discussed that represents a government takeover of health care. I am just not familiar with it. Maybe it exists in some cubbyhole someplace, but I have not seen it. But I know why the allegation comes to the floor every day--because it works. Scare the devil out of people. Somebody is trying to have a complete government takeover of the health care system. I wouldn't support a government takeover of the health care system. I wouldn't support it. I do support Medicare. By the way, that is a government-created system to make sure all citizens have access to health care because the private industry is not going to get there. They didn't prior to Medicare, and they wouldn't now if we didn't have Medicare. The very people who come and talk about government health care, it is interesting they do not come to the floor of the Senate offering an amendment that would abolish Medicare. I don't understand--if, in fact, they really do not like this at all, they should be offering an amendment that abolishes the Medicare Program, saying it is just not worthy, to have a system in which the government tries to guarantee health care for America's seniors. The reason I think they do not is they agree with Medicare. They believe Medicare should exist, and as a result, they support a form of government health care, at least for senior citizens. What I want to do briefly--I will talk more about that later. I am going to offer an amendment. I expect it will be tomorrow night or Tuesday. I see Senator Grassley is on the floor. He has been a cosponsor of this legislation, Senator Snowe, Senator McCain and others--many on my side--Senator Stabenow. There are a lot of folks who have worked on this, the issue of prescription drug importation. I want to make a couple of comments about that. I have not been on the floor speaking about the health care much until now, and I will be offering this amendment; I guess it will either be tomorrow evening or I expect it to be on Tuesday. But I want to make a couple of comments about it because I think it is very important. I don't think you can leave the issue of health care, having tried to do things about the escalating costs--some people talk about bending the cost curve, whatever that means. All I know is, putting the brakes on increasing costs at the time they are skyrocketing is important for businesses, for families, for individuals. The question is, What about prescription drugs? How can we possibly leave that subject behind? There are a whole lot of people in this country who are taking prescription drugs to manage their diseases and keep them out of an acute-care bed in a hospital. Cholesterol-lowering medicine, blood pressure-lowering medicine--a whole lot of people take both every day of their lives and do so to manage health care problems. Yet what they see with brand-name prescription drugs is a dramatic increase in prices. I want to just give some examples. This year alone, the average price of brand-name prescription drugs has gone up 9.2 percent, well over quadruple the rate of inflation. Justification for that? I see none. Should we do something about it? Should we try to put the brakes on some of this? I think we should. Let's look at some examples. Enbrel, for arthritis, up 12 percent in 2009; Nexium, for ulcers, up 7 percent in 2009; Lipitor, up 5 percent; Singulair, for asthma, up 12 percent; Plavix, up 8 percent; Boniva, for osteoporosis, up 18 percent this year. All of us understand--you watch television in the morning and brush your teeth, you have a television set there someplace, and they are saying to you: Do you know what you should be doing? You should be going to talk to your doctor. You should talk to your doctor and see whether the purple pill is right for you. I don't know what the purple pill is, but the television commercial is pretty seductive. You almost feel like: I ought to find a doctor someplace; maybe I am missing something; maybe the purple pill is right for me. The list go goes on and on. Flomax, Lipitor--you name it, they are advertising it relentlessly. Go ask your doctor whether these pills are right for you. The problem is, the American people, with respect to the price of prescription drugs, are charged the highest prices in the world. Not even close--brand-name prescription drugs cost much more here than anywhere else in the world. I have in my desk something I would like, by consent, to show. These are two bottles of Lipitor. This is, by the way, the most popular cholesterol-lowering drug in America. These bottles, as you can see, are the same shape. These pills are made in the same place. They are made in Ireland and then shipped around the world. This bottle was shipped to the United States. This bottle, with 20-milligram tablets of Lipitor, was shipped to the United States. You get to buy them as a U.S. consumer for $4.48 per tablet. This bottle--one is red, one is blue, same size, same pills, same company--this bottle went to Canada, same 20-milligram tablets. No, it was not $4.48, which the American consumer paid, it was $1.83. It does not matter whether it is Canada, Italy, Spain, Germany, France--I would cite exactly the same numbers in terms of the American people being told they should be paying double, triple, in some cases quadruple what other people are paying for exactly the same prescription drug. On this chart, this represents inflation--the yellow line. This represents the increased prices for prescription drugs--the red line-- which I think demonstrates clearly why something ought to be done. A group of us have put together a piece of legislation that is simple, and, in my judgment, very effective in addressing this problem that the American people are charged the highest prices in the world for brand-name prescription drugs. An example of that, I sat on a straw bale out on a farm once about a year or so ago with some people at a town meeting. One of the old guys out there--he was about 80 years old--he said: My wife and I have driven to Canada every 3 months so she could buy Tamoxifen to treat her breast cancer. I said: Why did you do that? He said: Because we can't afford to buy Tamoxifen in the United States. I bought it for one-fifth of the price in Canada of what it would cost us. My wife has been fighting breast cancer--in her late seventies now--for 3 years, and the only way we could afford the drug was to drive into Canada. Most people cannot drive into Canada. There is an informal opportunity for people to bring back a 3-month supply on their person if they go to Canada. Most Americans cannot possibly do that. But the same drug is sold all over the world by the major drugmakers, and the difference is they charge the highest prices to the American people. The question is this: Why shouldn't the American people have some freedom--the freedom to shop for that same FDA-approved drug wherever it is sold if it is sold at a fraction of the price? The answer is, they should have that freedom. Our legislation gives them that freedom. I assume there will be people coming here and saying: If you pass this legislation, that allows the American people to access, through pharmacists or through registered wholesalers, these identical FDA- approved drugs for a fraction of the price. If you do that somehow, we are worried we will have an unsafe drug supply, we are worried about counterfeit drugs. In this legislation I put together with my colleagues, Senator Snowe, Senator Stabenow, and Senator Grassley--a wide range, bipartisan group of Senators--that is pretty unusual. This is a bipartisan amendment, by the way. But in our legislation, we have the significant changes that are necessary to ensure safe drug supply, not just those you would ship in but those you buy here. We talk in our legislation about batch lots and pedigree and a whole series of things. So you track every drug right back through the chain of custody, right to its manufacturer, and that is something we do not do today. When we offer this, the question is, Do we have the votes to get this passed? We have tried for a long time. We have been rebuffed here and there for various reasons. There is a supposed ``deal'' that has been struck with the pharmaceutical industry, for $80 billion. I think the pharmaceutical industry has something like $220 billion a year in revenues, so that is $2.2 trillion over 10 years. A very small fraction of that $220 billion was agreed to by the White House, I guess, and somebody here in Congress. One of my colleagues who served here years ago said, ``I am not for any deal I am not a part of.'' Most Members of the Senate were not part of any deal. So my expectation is, the time and place and reason to offer this is right now. We can't do health care and leave behind this question of the cost, the price of prescription drugs. I think the drug industry is a fine industry. I want them to succeed. I want them to be profitable. I want them to be successful. I want them to produce the new miracle lifesaving drugs, and by the way, much of that comes from public investments we make in the National Institutes of Health. But I just want them to change their pricing strategy. Why should the American people be paying the highest prices in the world? Europe has had a strategy--it is called parallel trading--that they have had in place over 20 years. If you are in England and want to buy a drug from France, no problem. If you are in Spain and want to buy a drug from Italy, no problem. They have done it for 20 years successfully. Somehow, people are suggesting that we can't do what the Europeans do? That is nonsense. We are going to offer this legislation: myself, Senator McCain, I mentioned Senator Stabenow, Senator Grassley--there are so many Members of the Democratic and Republican side on this. We will offer this legislation, and I hope we will have the 60 votes necessary to pass it. I hope finally, at last--at long, long last--we will have enough people standing on the floor of Senate who will say: You know what, I am on the side of the American people here. I am not interested in having the American people pay the highest prices in the world for prescription drugs. How about some fair pricing for a change, fair pricing for the American people? And how about some freedom, freedom for the American people to access those identical drugs where they are sold at a fraction of the price? Why restrict the freedom of the American people? Everybody talks about this being a global economy. Well, that is so when it benefits everybody else, but what about a global economy that benefits the consumer when they want to access an FDA-approved drug when it is sold elsewhere for a half, quarter, or eighth of the price? Let's give people a little freedom. I hear people talk about freedom on the floor of the Senate. This will be a bill in which we decide whether we want to give the American people the freedom to access those low-cost prescription drugs. I am going to have a lot to talk about when we offer this amendment. Just this year, again, just this year the price of prescription drugs has increased 9.2 percent. I showed the chart. There is no reason that brand-named prescription drugs should be on a stepladder like that. What about the people who struggle, trying to figure out how to buy those drugs? Does anybody care about them? They say the deal that was made with the pharmaceutical industry affects what is called the doughnut hole, and 50 percent of the doughnut hole is being filled if they buy brand-named--I don't care about that. That is a recipe for a stew I was not part of making. What I do care about is a whole lot of folks going to the grocery store where the pharmacy is in the back of the store and they are trying to figure out, what do these drugs cost me this time when I fill them so I know how much money I have left to buy food. Over and over in this country, people are making those choices. There is no excuse for a 9- percent increase in these brand-name prescription drugs this year, in anticipation of health care reform. The fact is, health care reform ought to contain the kinds of things that begin to put brakes on this. I am not saying you put the brakes on it by imposing government pricing. I am saying you put the brakes on it by giving the American people the freedom to access those drugs where they are sold at a fraction of the price they are sold here. And you give the American people that freedom, I guarantee you, they will shop where they get the best price on identical drugs, FDA approved. It will force the pharmaceutical industry to reprice drugs in the United States. A couple quick points in conclusion. President Barack Obama was a cosponsor of this legislation last year when he was a Senator. The Chief of Staff at the White House, Rahm Emanuel, was one of the leaders in the House on this legislation last year when he served in the House. It tells you a little something about the breadth of support that exists or existed for this. Somebody told me at the door as I came in: We are not sure the White House is supporting this. I fully expect the White House to support an amendment they supported last year in the Senate. There are big issues and small issues. This issue is an important issue. A lot of us have worked for a long time to get it right. We have been thwarted by a very powerful industry that has a lot of friends in this town. I am hoping the consumers have a lot of friends as well. A lot of people are out there struggling to try to figure out how to afford the prescription drugs they need to take. A whole lot of folks are deciding, I guess what I will do is get the prescription drugs the doctor says I should have, and I will cut them in half and see if I can make that work somehow. The next time they show up at the counter, it is 9 percent more. I say knock off a little of that advertising. There are different reports, but there are some reports that say they spend more money on marketing promotion and advertising than they do on research. How about knocking off a little of that advertising if that is causing some of the relentless price increases. I want to begin the discussion because we will have a full discussion on this when it comes to the floor. It will be either tomorrow afternoon or Tuesday morning. Senator McCain will be joining me on the floor and many of my colleagues on both sides of the aisle to see if we can't finally lift this piece of legislation and get it over the finish line. It is important for the American people. I yield the floor.

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

Mr. DORGAN. I wanted to say it is so rare for us to have a bipartisan amendment. Those of us who have worked on this, including Senator Grassley and Senator McCain and many on my side, will be faced once again with the charge that this would undermine safety and so on. I wanted to make the point that Senator Grassley was one of those who especially worked with us--and Senator McCain--to make sure we had safety in this legislation, pedigrees, batch lots, safety that does not exist now even in domestic supply, let alone imported drugs. I appreciate the Senator from Iowa working with us on this legislation. This is a good piece of legislation. I look forward to seeing the Senator from Iowa on the floor when we get it to the floor to have that debate.

Mr. DORGAN

Mr. DORGAN. Mr. President, I move to reconsider the vote and to lay that motion on the table. The motion to lay on the table was agreed to.

Mr. DORGAN

Mr. DORGAN. Mr. President, I would like to announce that the Committee on Indian Affairs will meet on Thursday, December 3, 2009, at 2:15 p.m. in room 628 of the Dirksen Senate Office Building to conduct a business meeting on pending committee issues, to be followed immediately by an oversight hearing on Expanding Dental Health Care in Indian Country, and a second hearing entitled ``Promises Made, Promises Broken: The Impact of Chronic Underfunding of Contract Health Services.'' Those wishing additional information may contact the Indian Affairs Committee at 202-224-2251.

Mr. DORGAN

Mr. DORGAN. Mr. President, I note that this has been a lengthy discussion already. My guess is that because this is merely a motion to proceed to a subject on the floor of the Senate--my guess is that were this motion to be approved, we will have weeks on the floor of the Senate talking specifically about amendments, about approaches that will strengthen and improve some portions of the legislation that will be before us. The subject is health care. Frankly, health care is personal to everybody--from senior citizens on Medicare to people who get their health care policy from their employment, to families who are struggling to pay for increasing costs of health care year after year. So the question before the Senate tomorrow evening is: Should we debate and vote on these matters? It is not should we approve a health care bill but should we proceed to the bill to have a discussion and have some amendments. Health care has changed dramatically in a very short period of time. My background is from a town of 300 people. In my little town, as was the case many decades ago, we had a town doctor in a town of 300 people. It doesn't happen much anymore. We had a doctor, Doc Hill. He came when he was a young man, and he stayed until he died. He delivered probably 1,500 babies. They had a Doc Hill Day once, and all the babies he birthed came to march in the parade in my little hometown. As times changed, medicine changed, things changed. Doc Hill used to go on house calls to the farms, yes, to deliver babies and to deal with illness, house calls all around the region. Times changed and those practices changed as well. The big debates in the last half century or perhaps century about health care have, in most cases, advanced health care. I was not here, of course, nor were most of my colleagues--I guess a couple of them were perhaps here--during the debate on Medicare. I remember vividly as a very young boy the old folks in my hometown, some of whom had nothing, lived in little shacks, certainly had no health care, no health care coverage, because when you got old, back in those days, no insurance company wanted to cover you, even if you could pay for insurance. Nobody was chasing old folks to say: Now that you are 70, 80 years old, can't we sell you a health insurance policy? They couldn't find health insurance. Half the senior citizens in this country couldn't get health insurance. So the Congress came together and said: What do we do about the people in their sunset years, those who helped build this country, went to war, built the roads, built communities? What do we do about that? So they passed Medicare. Medicare has been an unbelievable success. Yes, there are financial strains on Medicare, but that is born of success. People are living longer and over a period of a longer life, they often need more health care. But that is a success, not a failure. We have changed medicine in our country in many ways. Medicare is one example. Miracle medicines, medicines that did not exist some decades ago now can be used to keep people out of acute care hospital beds. Vaccines can now prevent people from getting sick. Polio was cured. Smallpox was cured. Think of the changes over all of these years. And, yes, it is the case that if you have a very serious illness, in most cases you want to be in this country. It is the case, however, that many in this country cannot afford to access the health care that exists. But people come here, not elsewhere, for good health care. We have terrific clinics and opportunities for people to get good health care in this country. The problem is, the cost is relentlessly increasing every single year and pricing health care out of the reach of too many Americans. Too many families cannot figure out how to pay for health care. They cannot pay for the increased insurance premium that is going up double digits every year. They have to go to the grocery store and stop in the pharmacy to figure out what a prescription drug is going to cost. They buy their medication first and see what they have left for groceries. The fact is, prices of health care are marching relentlessly upward, so too many people do not have coverage. Families often cannot afford it. Small businesses cannot afford the price increases for health care. So what do we do about that? If there is a sick child, should a sick child who is crying because of pain be told: Your visit to a doctor depends on how much money your parents have? I don't think so. So we passed legislation dealing with that, providing health care opportunities for children who come from families of meager means. The question for us now is, Is there a way for us to extend health care coverage and also to put the brakes on these relentlessly increasing costs? If at the end of the day legislation that is considered here does not put the brakes on price or cost increases, I don't want to be a part of that. I am not going to be supporting things that really do not put the brakes on these relentless increases in health care costs. That is the purpose of all of this, is to try to get a handle on costs somehow. There was an author named Barbara Ehrenreich who described visiting with a friend of hers from a European country. She told her friend that she had breast cancer and had difficulty getting insurance because she had breast cancer. She said: But isn't that when you would most need insurance? Not understanding, of course, in our country you are least likely able to get what you need when you need it the most. That is another question in this set of issues, preexisting conditions. Is there a way for us to make it easier for people to access health insurance when they really need health insurance because they have a debilitating illness? I would hope so. What should happen when you pay an insurance company premiums for 10 or 15 years? You pay every month and all of a sudden the insurance company says: We are going to terminate you. What should happen? Is that fair? I don't think so. Shouldn't there be some opportunities to address those kinds of things--the denial of coverage, the termination of coverage? I think so. Let me also say as we discuss these policies, there is another element that is not very often discussed that I want to amplify, and that is the issue of personal responsibility--personal responsibility that goes well outside legislative activities. Two-thirds of the people in this country are overweight. One-third are obese, according to statistics. I invited someone from Safeway Corporation to meet with our caucus. The CEO of Safeway, Steve Burd, has met with folks in both caucuses in the Senate. He told of a very interesting program at Safeway. I think there were about 45,000 employees in this group, and he did the following. He said: Here is your health insurance plan. Here is the amount the Safeway company will pay, and here is the amount that you pay. So that amount the employee pays is X. But the company said to the employees, you can reduce the amount you pay if you do four things. You can reduce it in four steps: Do you have high blood pressure? You have to be on medicine to control it, and we will pay for the medicine. Do you have high cholesterol? You have to be on medicine to control it, and we will pay for it. Are you overweight? Then you have to be on some sort of weight reduction program, and we will pay for that. Are you smoking? Then you have to stop or be in a smoking cessation program, and we will pay for that. If you don't do any of those things, you don't want to do those things, you have high cholesterol, high blood pressure, smoke, and are well overweight, that is all right, here is your copay. It will be higher. But if you do all four of those things, and the company will pay in each instance for the cost of it, you will pay four steps below, less money every single month. He says with that program, they have had flat health costs for 5 straight years. Think of that: 5 years flat cost. While the rest of the country is seeing these relentlessly increasing costs, that program provided flat costs, no cost increases. Why? Because they incentivized personal behavior in the right way: Do this, improve your health, we will pay the cost of it and save yourself some money. That is exactly the right thing to do. I hope as we have this discussion, a fair amount of that impulse can be a part of what we are trying to do--incentivize the right behavior, personal responsibility. That makes a great deal of sense to me. One of the things I have always supported is the issue of health care coverage at the workplace. That is where most Americans get their health care coverage. I don't want to do anything to disincentivize that. I want, whether it is small, medium, or large businesses, for us to say: You know what, good for you. You are providing health care to your employees. We support that. I don't want to disincentivize that; I want to incentivize that. I know it is hard for small businesses during tough economic times to pay 10 percent more this year than last year and 10 percent more next year than this year. That is what they are seeing in health care costs. That is why it is important for us to put the brakes on these cost increases, for small businesses, medium-size businesses and large businesses as well, to help them be competitive. We have to find a way to do that. I am not talking about diminishing the quality of health care. I am saying let's put the brakes on the price increases year after year. Let's find out what is causing it--and I have some ideas about that--and let's put the brakes on it. That is what this debate needs to be about. I want to talk about an amendment I intend to offer as soon as we are able to offer amendments. It is an amendment, by the way, that is bipartisan, unlike a lot of things in this Chamber. My amendment was cosponsored by the late Ted Kennedy. It is also cosponsored by Senator Olympia Snowe, Senator John McCain, Senator Chuck Grassley, Senator Debbie Stabenow, and the list goes on including Republicans and Democrats. The amendment is about prescription drug prices, and I want to describe it. It says let's give the American people the freedom to access the identical FDA-approved drugs when they are sold for a fraction of the price everywhere else in the world. The American consumer is charged the highest prices in the world for brand-name drugs. By the way, here is what is happening to price increases for prescription drugs. We see the rate of inflation in this country. That is the yellow line. Take a look at drug prices, the red line. By the way, this past year, there was a 9 percent increase in prescription drug pricing. This issue is not some irrelevant issue. There are a whole lot of folks who use prescription drugs to manage their disease and keep them out of a hospital. I understand many of these drugs are miracle drugs. I don't want to slow the ability of companies to create drugs, do research and so on. A substantial amount of the research goes on at the National Institutes of Health, which is publicly funded. The knowledge from that research is made available to the drug companies, and that knowledge leads to a product. Good for them. But what I don't like is the fact that those same pharmaceutical companies charge the American consumers the highest prices in the world. They will say: If you offer an amendment, you Senators, Republicans and Democrats, that tries to give the American people the freedom to access the same identical FDA-approved drug when it is sold in Spain or Italy or Canada--name the country--when it is sold in a number of countries for a fraction of the price, then somehow it will harm research and development on new drugs. That is not true at all. Those name-brand drugs are sold for a much lower price in Europe, and they do more research in Europe--at least that was a couple years ago. I haven't seen recent data. The fact is, they have lower prices and they have done more research. In any event, there is more money spent on advertising, promotion, and marketing than there is on research. Watch television tonight and see when you see the next commercial that says: Shouldn't you be taking some Flomax--whatever that is. Shouldn't you ask the doctor whether the purple pill is right for you? Go find a doctor and say: I don't have any aches and pains, there is nothing wrong with me, but isn't the purple pill right for me? That is what the commercial tells you to do. I haven't the foggiest idea what the purple pill is used for, but they relentlessly push this advertising. Knock it off. Maybe they should use some of that money for a little more research and development, I say. To put a finer point on it, if I might, this is the price of Lipitor. This is the new price, by the way--$4.78 in the United States for a 20- milligram tablet and $2.05 in Canada. By the way, here is what the two bottles look like. The same pill is put in these bottles, made by the same company--Lipitor. It is the same manufacturing plant in Ireland. They put the same pill in these two bottles. This one goes to the United States; this one goes to Canada. The American consumer has the privilege of paying $4.78 per tablet, and the Canadian buys it for $2.05. That was June 4, 2009, when I priced it. It is not just Lipitor, although Lipitor is the most popular cholesterol-lowering drug. But Zocor, a 20-milligram tablet, the same thing, $5.16, $2.45, U.S. price versus Canadian price. I used Canada because it is a close neighbor. I could have used Spain, Italy, France, Germany. By the way, some folks on the floor of the Senate will support the pharmaceutical industry's pricing policies of pricing their brand-name drugs the highest in the United States--I don't support that. Some will. They will say you can't really import drugs safely. The fact is, in Europe they have been importing drugs for 20 years. They have something called parallel trading. If you are in Germany and want to buy a prescription drug from Spain, no problem. If you are in Italy and want to buy it from France, no problem. You have parallel trading of prescription drugs. The consumers have the freedom to buy it where it is least expensive. In our country, consumers don't have that freedom, and our amendment gives the American consumer the freedom to shop for those prescription drugs where they are sold for the most reasonable prices. I am not interested in having consumers buy their drugs from other countries. I am interested in the opportunity to buy drugs at a fraction of the price, forcing the pharmaceutical to reprice their drugs in this country. I sat on a straw bale once at a farm where we had a town meeting. We all sat around on these bales and talked. An old codger there, about 80 years old, said to me: My missus--he meant his wife--my wife has been fighting breast cancer for 3 years. Every 3 months, we have driven to Canada to buy Tamoxifen. That is the medicine my wife has taken to fight breast cancer. Every 3 months, we drive to Canada to buy Tamoxifen. I said: Why do you drive to Canada? He said: Because it costs me 20 cents for what I would pay a dollar in the United States. I can't afford it in the United States, so we drive to Canada. The fact is, they will allow someone like that to drive across with 90 days of use. But most Americans do not have that opportunity and most Americans could not access that drug from Canada because it would be against the law at this point. I want to give the American people the freedom to be able to access FDA-approved drugs, and the legislation I will introduce with my colleagues has the most substantial safety provisions, including batch lots and pedigrees on these drugs that will make the entire drug supply much safer than it is now. Price increases in 2009. The paper this week described what is happening with the pharmaceutical industry in pricing drugs. Enbrel, an arthritis drug, increased 12 percent this year. Nexium, for ulcers, increased 7 percent this year. Lipitor is up 5 percent this year. Singulair is up 12 present this year. Plavix's price increased 8 percent this year; that is an anticoagulant. Osteoporosis--if you are taking Boniva, there was an 18-percent increase this year. What is the deal? Does anybody understand what the reason for this is, these kinds of unbelievable price increases? I am going to offer this amendment with my colleagues. My expectation is if you want to say at the end of the day that you have really done something to address the issue of skyrocketing prices in health care-- you can't say that if you decide you are not going to do something to put the brakes on prescription drug pricing, because the American people should no longer pay the highest prices for brand-name drugs in the world. That is not something that should be allowed. It is certainly not something that is fair to the American people and not something that we ought to turn a blind eye to when we are talking about legislation here. My legislation will be about giving the American people freedom--the freedom to access those drugs from a number of other countries named in our bill that have an identical chain of custody to our country, where it will be safe and secure for the American consumer to access those drugs at a fraction of the cost. I want to say that some are pointing out that the issue of health care is also a jobs issue because the fact is, this is a significant burden on employers; that is, those who hire workers and who are covering them with benefits, as part of their compensation including health care. So it is a jobs issue, and when the burden becomes too great, it destroys jobs. That is just a fact. So I want to talk about jobs for a moment because even as we describe these issues, which I think are very important, they relate to jobs. But I want to go further to talk about jobs just because I have a bit of time today. I have seen some things in the press recently that have bothered me, some stories. I want to describe them. First of all, Senator Durbin and I are leading a task force to talk about how we put together a new effort to try to create jobs. What kinds of incentives will allow small- and medium-size businesses to create new jobs? What are the things that will get the economic engine restarted, not just in GDP but putting people back on payrolls, putting people back to work? I noticed that small- and medium-size businesses are having great difficulty in this country, even those that want to expand, because they can't find the financing to do it. I saw a report this week about the large financial institutions that got TARP funds, the bailout funds. The 22 banks that got the most help from the Treasury's bailout programs cut their small business loan balances by a collective $10.5 billion over the past six months. And the fact is that Wells Fargo got $73.8 billion in TARP funds, and in the last 4 months they have cut the amount of financing of small business loans by 3.9 percent. Think of that--a company gets $73.8 billion in TARP funds and cuts lending needed by small businesses by 3.9 percent. Bank of America, $41.9 billion in TARP funds, and they cut small business lending by 5 percent. I am quoting from a Treasury Department report, by the way, comparing 4/30/90 to 9/30/09. JPMorgan Chase, $25.4 billion in TARP funds, and they cut lending to small business 2.9 percent. American Express--the list goes on. I don't understand this at all. So the question is, How do we try to give some help to small- and medium-size businesses and see if we can restart this economic engine so that they can put people back to work? They are the job generators in this country. And we are looking for a mix of ideas. What are the best ideas we can use to try to put people back on payrolls? But what I want to talk about just for a moment is something I saw in the Washington Post this week when the President was in Asia. It talks about: [Folks from the] 21 Pacific Rim Nations at an annual event that this year has put some of America's policies in the line of fire. A chorus of complaints about U.S. trade policies . . . in the hour before the President's arrival [in Singapore]. Leaders of Mexico, China and Russia broadly condemned protectionism . . . endorsing free trade as the best engine of growth-- And so on. The bluntest criticism . . . [said] America is moving in the opposite sense of free trade. China and others have said the same. Let me just say, it takes an unbelievable amount of gall to suggest that we are moving in the opposite direction of free trade. We have an unbelievable trade deficit, and this is a trade deficit with China. It is a sea of red ink that has gotten worse and worse--a $266 billion deficit last year, a $266 billion trade deficit with China, and China is telling us we have a problem with free trade? They are the ones that have closed markets. We are the sponge for all the goods China wants to send us, only to find out we can't get into their markets. This is about jobs. This is about jobs that leave our country and go there. When we start talking about how to create jobs, maybe we ought to straighten out this trade mess. Let me say, there is a discussion in the same story about Korea and the trade agreement with Korea. I think it is pretty interesting. This is what happened with Korea last year. They sent us about 600,000 cars. They put them on ships and sent them to America to be sold. We were able to sell them 100,000 cars. Why? They don't want American cars on the streets of Korea. Ninety-eight percent of the cars on their roads are made in Korea because that is what they insist and that is what they want. They are criticizing us about the lack of free trade? That is unbelievable. Let me describe the Cash for Clunkers Program in this country. We did a Cash for Clunkers Program. Yes, it put people in some showrooms and sold some cars. The Chinese and the Koreans had cash for clunkers programs. A lot of us would have liked to have said: You know what, if you are going to spend some money on cars, maybe at least spend it on cars that are made in manufacturing plants in this country. But that was not a requirement because it was so-called illegal under the WTO rules. For example, when Japan and Korea decided, for their own economy, on a cash for clunkers program, they figured out a way to favor their domestically produced cars. In Japan, only 5 percent of the cars were imports and 95 percent were made in Japan because that is the way they wanted it in 2007. After the cash for clunkers program, even fewer cars came from imports. Why? Because Japan had what was called a certification requirement that was open to only a small number of foreign vehicles. For example, they would allow the sale of a Toyota Land Cruiser, but you couldn't buy a Ford Explorer in Japan under the cash for clunkers program. Yet we have these folks saying to us that we are not for free trade? Excuse me? How much gall do you have to suggest that a country with a $600-plus billion annual trade deficit, $260 billion of which is from China--to have our President go overseas and have others suggest that somehow we are not owning up to our responsibilities in trade? The reason I make this point is this is about jobs. I think restarting the economic engine is an unbelievable priority in this country. A good job that pays well makes almost everything else possible. There is no social program in America as important as a good job that pays well. That is what makes everything possible for you and your family. When we see the millions of people who have been laid off as a result of the deepest recession since the Great Depression, we need to get about our business. Senator Reid and Senator Durbin and I are working on that need, to address it. One of the ways to address it is with this trade issue as well. Let me conclude as I started, talking about the bill that is before us. The legislation we are dealing with is health care, and the vote that will occur is on the motion to proceed. There is a lot of hyperbole about these issues. This is a motion to proceed to a piece of legislation that we will then debate for weeks and we will amend, I expect. I just described one of my amendments that I feel very strongly about. It will be bipartisan. I fully expect it to pass. I have a couple of other amendments as well that I will offer. I don't want health care to be concluded by the Congress in some way or another without the Indian Health Care Improvement Act, which has been languishing for many years here in the Congress, being a part of it. These are the first Americans, and too often these days the first Americans have second-class health care despite the fact that we signed the treaties on the dotted line and we owned up to the trust obligations that we have, that we have never quite delivered in health care, housing, and education. I have spent a lot of time, as have some of my colleagues, on the subject of the Indian Health Care Improvement Act. I hope very much that in this discussion--and I certainly will raise it as an amendment--we will have the opportunity to do what we need to do with respect to Indian health care. I know there will be a lot of opportunity in the coming weeks to describe virtually all the things people want to describe about every single issue. I want to come back to something I mentioned in the middle of my presentation; that is, personal responsibility. We can do all we want to do. We can have all kinds of legislation. But there also has to be some personal responsibility with respect to health care. I hope, whatever we do legislatively, if, in fact, at the end of the day the legislation moves forward, I hope we remember the lessons we have learned from some companies around the country that are deciding that personal responsibility and the incentives for that kind of personal behavior is the right way to address some of these rising costs of health care. Certainly the Safeway example I described is in that genre. Our time is about up. I want to say again that we will vote tomorrow night, come back after Thanksgiving, and my guess is that for 3 or 4 weeks we will have a substantial, generous amount of discussion about how best to put the brakes on health care costs. This has to be done in a way that is fiscally responsible. It has to be done in a way that is effective. If not, there ought not be legislation passed, in my judgment. If so, if we can do this in a way that is fiscally responsible, in a way that helps the American people and begins to put the brakes on the skyrocketing health care costs, then I would want to be part of that. I yield the floor.

Mr. DORGAN

Mr. DORGAN. Mr. President, I ask unanimous consent that the Senate proceed to a period of morning business, with Senators permitted to speak up to 10 minutes each.

Mr. DORGAN

Mr. DORGAN. Mr. President, on behalf of Chairman Baucus, I ask unanimous consent that the list of staff from the Senate Finance Committee which is at the desk be granted the privileges of the floor during debate on the motion to proceed to H.R. 3509 and the cloture vote on the motion to proceed.

Mr. DORGAN

Mr. DORGAN. Mr. President, I ask unanimous consent that the Senate proceed to the immediate consideration of H. Con. Res. 214, the adjournment resolution received from the House and at the desk.

Mr. DORGAN. I ask unanimous consent that the concurrent resolution be agreed to and the motion to reconsider be laid upon the table.

Mr. DORGAN

Mr. DORGAN. I ask unanimous consent that S. 1194, as reported by the Committee on Commerce, Science, and Transportation, be star printed with the changes at the desk.

Mr. DORGAN

Mr. DORGAN. Mr. President, I ask unanimous consent that the Senate proceed to executive session to consider en bloc Executive Calendars Nos. 535, 536, 537, 538, 539, 540, 541, 542, 543, 544, 545, 546, 547, 548, 549, 551, and all nominations on the Secretary's Desk in the Foreign Service; that the nominations be confirmed en bloc; the motions to reconsider be laid upon the table en bloc; that no further motions be in order; that any statements relating to the nomination be printed in the Record; that the President be immediately notified of the Senate's action, and the Senate resume legislative session.

Mr. DORGAN

Mr. DORGAN. Mr. President, I ask unanimous consent that when the Senate completes its business today, it adjourn until 9:45 a.m., tomorrow, Saturday, November 21; that following the prayer and pledge, the Journal of proceedings be approved to date, the morning hour be deemed expired, the time for the two leaders be reserved for their use later in the day, and the Senate resume consideration of the motion to proceed to H.R. 3590, with debate as provided for under the previous order. Finally, I ask that the Republicans control the time from 8 p.m. until 9:30 p.m. tonight.