procedure, you'll pay for it because of this new tax. furthermore, under this bill, the floor for deducting medical expenses from income tax is raised from 7.5% to 10% of adjusted gross income. those who will take this deduction are most often seniors and those with serious or catastrophic medical issues. now, four a nam family of four earning $57,000, limiting the deduction means that they would lose a tax deduction deduction of $1,425. a family of four earning $92,000 would lose a tax deduction of $2,300. now, it goes without saying, i think, losing a portion of your tax deduction means you pay more in taxes. these are real dollars to hard-working americans. this provision alone raises $15

billion in new taxes on americans who deduct medical expenses. finally, this bill raises taxes for the more than 35 million americans who participate in flexible spending accounts. or f.s.a.'sment for the first time, this benefit to middle-income workers is taxed to pay for new government spending and an expansion of entitlement programs. f.s.a.'s are a key benefit for many families for whom health insurance does not cover or does not cover sufficiently some of the highest-cost health care expenses such as dental, vision, and also prescription drug costs. they are also important for individuals who manage chronic diseases such as diabetes, heart disease, or cancer. flexible savings accounts allow the participants to set aside money out of their own pocket to pay for these necessary expenses, but under this bill

the government caps how much can be set aside in an f.s.a. account at $2,500, effectively raising the tax burden on certain f.s.a. participants and increasing their health care costs. the typical worker who contributes more than $2,500 to their f.s.e. has a serious medical condition. this means that under this bill, working with serious illnesses and earning an average of $55,000 will be paying more in taxes. now, i've just hilted a few of the -- highlight add few of the many tax hikes in this bill and the fact fact that the middle-cs taxpayers will bear the brunt. but if there are any doubts remaining about what in bill means for americans' pocketbooks, let's consider this: iring's an analysis by the joint commission on taxation looked at four tax provisions in the bill and how, when taken

together, they will affect americans. they looked at the tax credit for health insurance, the additional medicare payroll tax and several that i've already mentioned, the high-cost plan tax and the medical expense deduction limit. their analysis shows that when this bill is in full effect, on average -- on average, individuals making over $50,000 and families making over $75,000 would see their taxes go up under this bill. even after taking into account the premium tax credit -- the subsidy that the government will provide to help people offset the cost of health insurance when this bill is fully in effect -- more than 42 million individuals and families, or 25%, one-quarter of all tax returns under $200,000, will see on average their taxes go up as a result of this bill. in addition, based on the same

information the joint committee on taxation identified two groups of taxpayers. now, the first are those individuals and families who are not eligible to receive the premium tax credit to purchase health care. and, second, are those individuals and families whose taxes will increase first before they then see some type of tax reduction as a result of the premium tax credit. taking these two groups together, the number is even more disturbing. 73 million individuals and families or 43% of all tax returns under $200,000 will, on average, see their taxes increase under this bill. the joint committee on taxation. to put it another way, under this bill, for every one individual or family that benefits from the tax credit to purchase insurance, this bill raises taxes on three middle-income individuals and families.

now, these tax increases are on top of those i discussed earlier, such as the new taxes on f.s.a.'s so the estimates that i've already mentioned understate the tax impact again on middle-income taxpayers. the j.c.t., the joint committee on tax acres has confirmed tha - all americans and middle-class taxpayers especially need to take notice of what these higher taxes will mean for them. and their families. they need to know that these taxes will be used in part to pay for a vast expansion of the role of government in health care and more government intrusion into families' health care choices. paying for health care on the backs of the middle class and working americans is the wrong solution for health care, violates the president's program to these taxpayers, terribly counterproductive in regards to the number-one issue facing this

country, and that's jobs and the economy. i urge my colleagues dish plead with my colleagues to -- i urge my colleagues -- i plead with my colleagues to support the crapo amendment. mr. president, i appreciate your indulgence and i know you are ready to go to your conference, and i yield the floor. the presiding officer: the majority leader. mr. reid: i ask unanimous consent that the senate stand in recess until 6:15 p.m. today. upon reconvening at 6 :15, the senate continue in debate only for an additional hour under the same conditions and limitations specified under previous orders. the presiding officer: without objection. mr. reid: mr. president, i would also tell all -- everyone here, there will be no more votes tonight. i don't think we can arrange any. the presiding officer: the senate stands in recess until

6:15 p.m. rst-degree amendment. we're working on lining those up. over the course of this debate, there's been too much misinformation about what health care reform is and what it will do. i'd like to set the record straight. the goal of health care reform is to lower costs and provide quality affordable coverage to american families, businesses and workers. and according to the nonpartisan congressional budget office, our bill, the patient protection and affordable care act, is a success. according to the c.b.o., this bill provides health insurance

coverage to 31 million more americans. that's a big success. it lowers health insurance premiums despite what some have said, some claimed about premiums rising, that's not true. the c.b.o. says this legislation lowers health insurance premiums but for 7%. that 7% gets much higher-quality health care insurance than it otherwise would get. the c.b.o. also says this legislation reduces the federal deficit by $130 billion over the first ten years. reduces the federal deficit by $130 billion over the first ten years. in addition, as the president promised this, bill does not raise taxes on the middle class. in fact, this bill has a net tax cut. over the next ten years this bill will provide a total $338 billion in tax credits to help american families, small businesses and workers buy

quality affordable health care coverage that they can count on. that's a tax cut, mr. president. a total of $338 billion in tax cuts. the chart behind me will begin to indicate that. over the next ten years this bill will provide a total, as i said, $338 billion in tax cuts. the bill provides a net tax cut of $40 billion in the year 2017. you can see that basically in the chart. $40 billion of tax cuts in 2017. that's $450 for every taxpayer afbgtd. these are -- affected. these are individual tax cuts. let me make that khraoefrplt american individuals will get tax cuts in this legislation in these amounts. in 2017 low- and middle-income taxpayers will see an average federal decrease of nearly 37%

that's c.b.o. don't take my word for it. that o'c.b.o. and the joint committee on taxation. the average taxpayer making less will receive a tax credit of more than $1,300. that tax credit grows in 2019. those are tax cuts, mr. president. it is very important we remember this bill is a net tax cut of this amount for american taxpayers. that's individual taxes, tax cuts. i have heard arguments that the responsibility to have health insurance amounts to a tax on the middle class. this is simply not true. in fact, this policy works to repeal the hidden tax of more than $1,000 in extra insurance premiums to american families for health insurance pay each other in order to cover the cost of those without health insurance. that is $1,000 per american family on average has to pay

into the current system. this bill would virtually eliminate that. additionally this bill provides americans with the tools they need to meet that responsibility by ensuring all americans have access to quality affordable health insurance. the bill eliminates barriers that prevent americans from getting insurance coverage, such as discrimination based on preexisting condition. this bill eliminates that. we all, either directly or through a family member or a friend, have heard horror stories on insurance companies denying coverage because of a preexisting condition. this legislation stops that. and it makes this legislation makes quality insurance affordable to every american through tax cuts and helps with co-pays and other out-of-pocket costs. if for some reason an individual still cannot afford to buy health insurance coverage that's unavailable to them, they're exempt from paying the penalty. clearly this penalty is not a tax. if you can't afford it, you

don't have to pay. no penalty. also heard arguments that the excise tax on private insurance companies offering costly and excessive insurance plans will raise taxes on individuals. this claim is equally untrue. the congressional budget office reaches the conclusion that that's not true. in fact, the spwoefpl c.b.o. reaches the -- the congressional budget office reaches the conclusion it will lower premiums. i think the amount is 12%, the amount stated in the letter to the congress. this policy, therefore, is not a tax on individuals. rather, it's a tax on private insurance companies and not pass on in the nature of higher premiums. this legislation is designed to encourage private insurance companies to offer and employers to choose health insurance plans with lower premiums below the taxable threshold and the congressional budget office noted just how effective this policy is in its report when it said most people would avoid the cost of the excise tax by

enrolling in plans with lower premiums, as a result c.b.o. says wages will increase as employers offer more money in workers' pockets. in fact, the bulk of the revenue raised by this provision, more than 83% of it comes not from the tax itself but from increased wages -- increased wages -- as account of this provision. and m.i.t. economist jonathan gruber says this provision will cause worker wages to rise, $700 in additional income for every household with health insurance. the truth is this bill is fully paid for. c.b.o. says so. and it is paid for in a fiscally responsible way. it reduces the federal deficit. it lowers the cost of health care costs, provides quality affordable health insurance to millions more americans. and it is a net tax cut.

net tax cut for american families, businesses, and workers which in these tough economic times means more than ever. a senator: mr. president? the presiding officer: the senator from oklahoma. mr. coburn: thank you. you know, i stand confused from the chairman of the finance committee because we have all the reports of the bill you're talking about and the bill you're going to be voting on because you're totally changing what you're doing. what is out there now is we're going to expand medicare to those down to 55 years of age, and we're going to expand medicaid up to those up to 150%. we're going to add billions of dollars of mandates even at 90% co-pay by the federal government to the states over the next ten years. we have a medicare program that you've taken $465 billion out of and you're going to add 34

million new people to under the new plan that -- the new plan we're talking about. you're talking about the plan that we used to have. it's interesting, though, as you make those points, when you say it's a net tax cut, three-quarters of the net tax cut goes to people in this country who pay no taxes in the first place. the chairman can't deny that. the fact is according to joint tax committee, the chairman conveniently doesn't look at the other body that gives us information on taxes, according to joint tax@@@@@@

talking about doesn't have any application because we don't have the bill again, because we a new the bill on the floor which is going to take a bankrupt program that our children today are responsible -- if you're born today based on the unfunded liabilities of medicare, you are responsible for $350,000 if you're a new child born today for what we have not paid for in medicare. and now we have the new plan that's going to come out. we've cut $465 billion out of medicare or moved it out of medicare to create a new program, and we're going to add

34 million new americans to it in a plan tha*s that has already mortgaged the few -- faln -- a mortgaged the few -- faln -- a >> the other thing that the chairman said is that costs and health care will go down. and that premiums will go down. well, there is 11 out of 12 people who have studied the plan that says premiums will rise. and what cbo says is that if you're in the individual market, your premiums are going to go up anywhere from 10 to 13%. and in fact, they're not sure whether premiums will decline. they say it's on the other groups from a 1% increase to a 2% decrease over what they already would have increased. so our problem with health care is cost.

that's the thing that stops access to health care in this country. and the plan, whether it's the new plan which nobody has gotten to see the details of, or the plan that we have seen the details of, the 2074 pages, and that we have seen the details of, raises costs of health care in this country. but none of that is important. because the most important thing is it puts government in control of your health care. through the preventative health services, through the medicare advisory commission, and to the cost comparative effectiveness panel. so with the wink of an odd is where going to put government in control of your health care. we're going to put 70 new bureaucracies between you and your doctor, we're going to put 20000 new federal employees between you and your doctor. and we're not going to lower the costs. and the average american is not

going to get a tax cut. they're going to see a tax increase out of this bill. the average middle income americans is going to see a tax increase out of this bill. and so consequently, what we have heard sounds good on the surface. but the most important thing to remember, it is you are no longer, you are no longer going to be in control of your health care. because once the government puts its nose under the tent, just like it did on breast cancer screening, and we have the gall to say we're going to recognize every time the agency does something that's harmful to a patient and her doctor relationship, that we're going to come to the senate floor and correct it. and the fact is that isn't going to happen. so ultimately, your health care, is going to cost more. your premiums are going to rise.

11 out of the 12 studies say that premiums are going to rise under the bill that's before us, and the people that get the tax cuts are the people who are not paying any taxes now. and to pay for those tax cuts, taxes are going to rise on 40 million american families. who earn under $200,000 a year here mr. president, i yield. >> i want to speak on the dorgan amendment. the senator from north dakota is a strong, good, talented legislator has a good amendment up. one i had looked at. it's been around his body for a long period of time, but i have to rise in opposition to the ranking member on the senate appropriations subcommittee on agriculture, and food and drug administration, the fda is in a subcommittee so i work on the issues of the fda. then also from my bride for just a second. university of kansas both one of the best pharmaceutical schools in the world. often rated number one as a

pharmacy school so anybody interested in that field of study or work, that's a good place to go. but also they're very concerned about what's in the dorgan amendment. the u.s. current has one of the safest drug supply systems in the world that allows the federal food and drug administration to monitor and regulate, manufacture and distribution of approved medicine throughout the country. the legal authority to import drugs already exists in this country. however, however, no hhs secretary democrat or republican has been able to certify that the importation of prescription drugs from foreign nations is safe, or will lead to cost savings. not have been able to. the dorgan amendment will allow for the importation of drugs from outside our current regulatory system, establish and enforce by the fda without certification. mistress -- the secretary of hhs or fda. allowing drug importation from foreign nations could threaten public health and result in

unsafe, i'm a prude and counterfeit drugs being place on pharmacy shelves in the united states. and i want to develop that part for you. the fda has been tasked with the responsibility of safeguarding this country's prescription drugs supply, and has executed that responsibility quite well. but as this country in the food and drug administration struggles to discover and prevent the growing threats posed by imported, foreign produced goods, as evidenced by recent failures to detect the polluted products such as infant formula, pet food and toothpaste, permitting the importation of drugs and four nations without the complete assurance from the fda, that it will not jeopardize public safety is a responsible and threatens this nation safety and proven drug supply. and towards that end, mr. president, i ask that a letter that senator carper received from the health and human services agency, the fda

director, the place into record after my comments. >> without objection. >> mr. president, this letter states in particular this and i just want to read from the fda chief what the commission of food and drug is saying about the dorgan amendment. for the efforts to include protective measures in the bill but address the inherent risk of importing foreign products, and other safety concerns relating to the distribution system of drugs within the u.s. however, as currently written resulting structure would be logistically challenging to implement and resource intensive. in addition, there are significant safety concerns related to allow the importation of non-bioequivalent product safety issue related to confusion, and distribution and labeling of foreign products in the domestic parts that remain before the address in the amendment. in other words, they don't think we can do this of drugs without

significant safety problems. there's been an explosion of illegal drug counterfeiting occurring around the world. and the emergence of a multibillion dollar international black market has proven to the senate current and past hhs secretary's and the fda that weakening our prescription drug framework would only increase the risk of life-threatening counterfeit, contaminated or diluted prescription drugs entering our prescription drug supply that millions of americans rely on, and they trust. prescription drug testing has become a highly profitable criminal enterprise. it has been taken of the international organization crime syndicates, rogue nations such as north korea, syria and iran. and developing nations such as china and pakistan. as they seek to exploit ineffective or weak counterfeit enforcement frameworks around the globe. criminals have realized that the production of counterfeit drugs is twice as profitable as the

trafficking of illegal marcotte x. it comes with significantly less criminal penalties compared with those handed out for illegal drugs. due to these limited and minimal criminal penalties, global counterfeiting has gone into an epidemic that reaches every country around the world. the w.h.o., world health organization, estimates that tens of thousands of people are dying to counterfeit a jd, diabetes and tropical disease medicine. unfortunately, most counterfeit cases it is not what is included in these fake drugs, it is what has been excluded that proves to be most harmful and deadly to patients. by taking counterfeit diluted or completely ineffective drugs, many patients fail to receive the important life-saving medicine they need. it is just as dangerous for a person with high cholesterol to use a counterfeit drug that lacks the prescribed medicine as it is for a person to ingest a contaminated or even a poisonous fuel. due to the global counterfeit

epidemic, two secretaries of hhs under oath the clinton and bush administration have been unable to certify that the importation of prescription drugs will not pose a substantial risk to the health and safety of citizens around within the united states. and current secretary kathleen sebelius from kansas has committed to preventing a drug importation system of the united states until he can be proven that the safety standards of the imported drugs are, quote, at or above american standards, and of course. the fda doesn't believe they can get that done at this time. now many have argued that the parallel trade in europe has proven drug importation across the nation boers have resulted in prescription cost savings and is not increased risk to consumers or general public health. however, these costs and safety assertions do not correctly reflect the european experts with the drug importation through what's called parallel trade. the study by the london school of economics on drug importation

are concluded that safety savings from imports from vendors that buy and resell the imported drugs and do not get passed under the patients in the form of lower prices. they say this, quote, although the overall number of parallel imports is continued to increase, health care stakeholders are realizing few of these effective savings. profits from parallel imports have proven mostly to the benefit of the third party companies that buy and resell these medicines. furthermore, the report by the university of london school of pharmacy, on the same safety of the peril of prescription drugs dated this. the united kingdom is the most vulnerable country in europe to counterfeiting a link to the high level of quote paralleled, in the quote. due to parallel trade and medicines and health care regulatory agency in the u.k. has issued 10 different recalls of counterfeit drugs in the past five years.

drugs recalled include prescriptions to treat schizophrenia, blood pressure, prostate cancer, most disturbing fact of his counterfeit infiltration were that these drugs entered the united kingdom through legitimate supply chains through parallel distribution trade. according to the regulatory agency in the u.k. another study, the european commission has found a prescription drug supply chain in europe which includes the former eastern block countries like latvia, slovakia and bulgaria, is increasingly targeted by international criminal counterfeiters. the european commission vice president stated european parallel trade quote brings a considerable risk for the safety of the patients. and at the increase in counterfeiting medicine is a very serious threat to public health and can cost lives. we don't want that happening to the united states. particularly with what we've seen in recent products coming in from china, not regulated under our system, in things like toothpaste, pet food and then

the problems we have here. do you want that to happen in the drug system? no, we don't and we can't certify that we can keep these products they've. so as you can see, safety concerns and a lack of savings that may result from exposing this country to the potential risk created by the importation of drugs from outside our current safety systems, these are real threats. now it's kind of an interesting study in october 2004, then governor rod blagojevich of illinois launched the ice age rx program to allow residents in illinois and later missouri and in my state of kansas to purchase low-cost drugs in canada. so he started this program. however by 2006, the illinois state auditor found that the program cost nearly $1 million was used i only 3700 people in illinois, and 267 residents of my state of kansas. mr. president, the health and

human services has concerns regarding the safety implications. the food and drug administration has concerns regarding the safety of importation. and given the opportunity to purchase canadian prescription drugs, only 206 to seven kansans took that chance. we should not corrupt the safety of our drug supply chain without safety assurances from this country's regulatory bodies. >> madam president, the minute that we are no not considering s the amendment i have offered that deals with drug reimportation. that is, the report nation of prescription drugs from other countries. and one might ask the question, why would we want to reimport drugs from other countries? well, fda approved drugs are made all over the world. and they are shipped all over the world. again, fda approved drugs approved by our food and drug administration, producing plants that are inspected by our food and drug administration, the difference is only difference is when they are shipped around the world the american consumer is

charged the highest prices in the world by far. here is an example of the drug lipitor. there are plenty of examples and i will go to a number of them today, but this is an example of lipitor. for an equivalent amount of lipitor, 20-milligram tablets, the u.s. consumer pays $125. the british pay $40. spanish page $32. canadians pay $33. germans pay $48. we are charged the highest prices in the world on lipitor. lipitor by the way is the most popular cholesterol-lowering drug. i have a couple of bottles in my -- anti-bottles i should say in the desk of torture that demonstrate this drug was produced in ireland. it was an all around the world. saintfield put in the same bottle made by the same company, approved by our food and drug administration. this was sent to canada. this was into the united states.

the difference, well, the american consumer was allowed to pay three times as much as the canadian consumer. shouldn't say it aloud. i should say forced. but it's not just u.s. versus canada. as you can see, it is u.s. versus every other country. and so the question is, should that be the case? should the american consumer be charged the highest prices in the world? my answer to that is no. why is it the case we are charged the highest prices in the world? because we are the only in which there's a special little law that prevents our citizens from accessing that fda approved drugs from whatever it is sold at the most advantageous price. we have a provision in law that says the american people don't have the freedom to import a prescription drug on fda approved drugs were that define for half the price, or 20 percent of the price in some

other country. i say give the american people the freedom. i hear so much discussion on the floor of the senate about freedom. this is the ultimate freedom. the freedom of the american people to access those prescription drugs that are sold virtually everywhere else, branding prescript and drugs at a fraction of the price. now i have examples of other prescription drugs as well. to show you it is not just lipitor. all the lipitor is the most popular cholesterol-lowering drug. this is plavix. now plavix is an anticoagulant. you will see that we pay higher than all of these countries, by far. more than double what the british pay. more than double what the spanish pay. this is the axiom. if you are someone who has alters and you are taking nexium, for an equivalent amount

of the same drug, nexium, you are charged $424 if you're an american citizen. $40 for the british, $36 for the spanish, $37 for the germans, $67 for the french. the american consumer trying to control their condition of ulcers pays $424. 10 times the amount of money that others are paying for the identical drug. 10 times. well, this kind of what i believe is gouging, that is a pricing strategy that god is the american consumer, can largely be resolved by the amendment that i have offered. it removes that little sweetheart and pediment in law and says to the american people, you may import prescription drugs that are fda approved from registered enterprises in other

countries. we specifically delineate which countries those are. there are a handful of them, that have identical chain of custody that we have in our country. identical. we also put in this amendment unbelievable safety provisions dealing with pedigree and tracers that don't exist now in our domestic drug supply, let alone reimportation. so if we were allowing the american people to do this, the congressional budget office says my amendment will save $19 billion. $19 billion. for the federal government. over the next 10 years. but about somewhere around $80 billion for american consumers above all. that's a pretty big savings. now, madam president, here is another chart that shows what has happened in addition to the fact that we are charged the highest prices in the world,

what has happened in recent months in 2009, brand name prescription drugs have increased in price over 9%. at a time when there is virtually no inflation. basie increased prices from prescription drugs in this country, just over 9%. cingular for asthma you get to pay 12% more. for osteoporosis, by the way, your prices that 18% higher. just this year. and that's what's happened. and there is nothing, i repeat nothing, in any of the health care plans considered by the senate or the u.s. house that addresses this piece. the price, the escalating price of prescription drug. there are a whole lot of folks out there in this country that are not senior citizens, better taking drugs to manage their disease. they take cholesterol-lowering medicine. they take medicine to lower

blood pressure. they manage their disease, or manage their health issues and don't have to go to an accurate care bed in a hospital because they are doing the right thing. and they're doing it with pharmaceuticals. the problem is the pharmaceutical prices are going up, up, up, way up, way above what other people in the world are paying. for the identical drug. and i'm saying it's just not fair. madam president, the issue is not that the pharmaceutical industry is a bad industry or that they are investing with bad companies that i just think that they have bad pricing policies. bad pricing policies. they are able to and therefore they do charge the american people by far the highest prices in the world. now, i want to talk about a couple of important issues with respect to this issue of giving the american people the freedom to access or purchase that fda approved the drug anywhere. as long as it comports with the

countries in which the chain of custody is identical to ours, which is in our bill, and our bill include as i said the establishment of pedigrees and tracers that don't even exist in safety for existing drug supplies. there are some who say, and to allege, that you can't do this safely. it causes all kinds of problems of counterfeiting and so on. well the fact is the europeans have been doing it safely for 20 years. are over two decades in europe under a program called parallel training, if you are a german and want to buy a prescription drug in spain, it is not a problem. you do it to the parallel trading system. if you're in italy and want to buy a prescription drug from france, no problem. they been doing that saved for a long, long time. to the just somehow we don't have the skill and the capability to do what the europeans have been doing routinely for 20 years is really in my judgment shortchanging our country, and certainly shortchanging our consumers.

now, we will, however, i think as people alleged again that this is risky. it's just a risky. i want to make the point about risk, because i want to demonstrate something that i think most people don't know. 40 percent of the active ingredients of our existing prescription drugs come from china and india. 40 percent of the active ingredients come from china and india. and in most places, from areas that have never been inspected. now, my amendment does not allow drugs to be imported into this country from china or india. i am talking about the ingredients in the pharmaceutical industry of choirs with which to make their drugs. we don't allow drugs to be imported from china or india, as a matter of this amendment.

only fda approved drugs from fda inspected plants in canada, the european countries, japan, new zealand or australian. that's all. why? because they have an identical chain of custody to us. and that's the basis on which we determine how reimportation could work and could work safely. but i want to describe a recent scandal that illustrates the double standard that some want to apply to this question. and the scandal was about a drug called heparin. a blood thinner commonly used by dialysis patients. it was a link to last year to more than 62 deaths. heparin was ultimately pulled from the market, and according to baxter health care, which markets have been in the u.s., the allergic reaction to heparin that caused those deaths appear to be cause by a contaminant that was added in the place of the active and greet and heparin

somewhere during the manufacturing process, most likely in china. "the wall street journal" did a really important story on the heparin contamination. they reported that more than half of the world's heparin gets it start in china's poorly regulated supply chain. this is what "the wall street journal" after its investigation concluded. half the world happened, the main ingredient in this widely used anticlotting medicine, gets its start in china's poorly regulated supply chain. wall street journal also published a series of pictures that i want to show, photographs of what is called the factory which processes take intestines used to make heparin. i want to show some photographs that came from "the wall street journal." this is a photograph of a facility, and that's the

outside. here is a photograph of someone in the facility who is doing a rusty vat full of heparin ingredients with a tree branch. the processing of heparin from pig intestines and a facility in china in which in this rusty vat, the worker is stirring with a tree branch. and so, are the ingredients that are used to make medicine with respect to the blood clotting issue. so when the industry and others say that we can't have the drug importation safely, from canada or ireland, the point is they're getting a lot of their ingredients from china and

india. and i would say simply look at this. and ask yourself whether the domestic drug supply with respect to the ingredient in those have sufficient safety. while the record-keeping at these chinese facilities make it almost impossible to trace the contaminant from this particular factory, these pictures taken by "the wall street journal," clearly show unsanitary conditions in which take intestines are process for that particular medicine. again, by contrast, the amendment we offer would allow the importation of fda approved medicines only with a chain of custody to ensure that drugs are handled properly. and it gives the fda the authority to inspect all facilities and all of the chain of custody. now, the amendment mandates the use of anti-counterfeiting technology to track and trace

for imported and domestic drugs to enter product integrity. that doesn't exist today. but that is required in this amendment. the amendment also requires pharmacies and drug wholesalers to register with the fda and to be subject to strict requirements to assure the safety of important medications, including frequent, random inspections. so the amendment i am offering here would ensure safety, and in fact provide a much greater margin of safety that now exist with all of our drug supply. and we need to have these improvements, in my judgment, because our own prescription drug distribution system is not as good as we think it is. here's an excellent example of something that took place in the united states, a 2000 -- well, this is a picture of mr. tim

fagan, a young 16 year old boy from long island new york. he received liver transplant. prescribed a drug after his liver transplant called apogee and to boost his red blood cells and to fight the immediate. after the operation. he received daily injections, but his red blood cell count was in improving and the doctors couldn't figure out why, what was happening. after two months, tim's mom went to her local pharmacy where she was told by the way, the epogen your son has been taking may have been counterfeit. and here is an example of, again, an example of counterfeiting in the existing domestic drug supply. counterfeiting in which this container held a counterfeit medicine and this container held the real medicine. there were subtle differences, but not much. turned out that the vials that tim was injecting contained one

20th of the strength of what he was supposed to be taking and what was this close on the label. how did that happen? well, the weaker drug so for $20 a bottle and the high-strength version goes for $445 a bottle. investigators found that 110,000 of the bogus bottles reach the market in this country. and it is estimated that criminals involved with that counterfeiting of that casemate $46 million. the manufacture of the drug, become legal and there's source distributed some of the product through a complicated network of the second orchestrators. although no one knew at the time, some of the epogen that americans eventually resold had most likely -- had most likely run through a cooler in the back

of his strip club. in the background of a seedy miami strip club called playpen south. and here is the chart that shows the distribution system at this particular counterfeit drug went through. again, this is not an import. this is a domestic drug. and you can see this unbelievable complicated distribution system. and at the end of that, they traveled through strip clubs. they traveled through homes. they traveled through trunks of cars without proper cooling, and this story was told in great detail by some outstanding investigation by catherine event, something called dangerous doses. i ask consent that i be allowed to continue using the time of

the democratic -- i ask unanimous equally divided with senators permitted to speak up to 10 minutes each with no amendment during this time. >> without objection and i ask i be allowed is because much time as i consume. >> without objection. ♪ (singing) again, talking about the issue i just described, they traveled through strip clubs, and trunks of cars without proper cooling. i'm talking about the issue of domestic drug supply that was counterfeit. the amendment that we are offering would fix this supply change problem. it will require a pedigree for all drugs, not just those that are imported. all drugs. should have been done long ago. and some of us have been trying for a long while. to allow us to track every single drugs from where it is made to the pharmacy where it is sold.

my m.a. malone require a set of anti-counterfeiting measures that are not in place now. if you think of it, i have a 20-dollar bill. and most people have looked at the most windowbuilder will understand there is very sophisticated and very substantial anti-counterfeiting technology in a new 20-dollar bill. that does not exist by the way. that sophistication, that relentless search for the ability to detect counterfeiting does not exist, regrettably in our drug supply. the pedigree that we require, the tracing capability will make that a requirement on our entire drug supply. this amendment will make our entire drug supply safer. it will allow americans to benefit from lower prices. the prices at which the same identical drugs are sold in other countries. many cases half the price and in some cases much, much lower, 10 percent of the price that

they are sold in this country. now, i want to talk just a moment about the issue of drug price inflation. because the drug price, what is happening to us in this country, is the drug price inflation that relentless increases year after year, that is the red line, 9.3% this year. this is the rate of inflation. so if we don't do anything to do with the issue, the price of prescription drugs, we will have missed the opportunity to do something to help the american people. now, let me just described a few stories about the need for this amendment. my home state, and north dakota, wrote to me. my husband has parkinson's disease so he takes a drug called mira pecks. we have medicare part d but in september he is up in the so-called donor. in 2008 when this happened we paid $106 for his medication. it increased to $187 in october

and november. $198 in the summer. now in september to those nine, the price was $286, 180-dollar increase in one year speedup will the senator yield for questions because i would be happy to. >> senator, i know is aware and is talked about this. how does the senator account for the fact that there is nearly 9% increase in the cost of pharmaceutical drugs, while the consumer price index this year has gone down 1.3%? and this is probably the highest increase i understand in history, or in most recent years, and the cost of prescription drugs. what is the explanation between the diversions of those two lines? >> well, the explanation i suppose, i mean, it is probably addressed to the pharmaceutical agency, how and why do you

increase the prices this way. my guess is they do it because they can. the fact is the cost of living, the inflation rate is the yellow line. the price of prescription drugs is the red line. >> would that have anything to do with anticipation, and coming reductions? or reductions in increase in cost of pharmaceuticals? >> i would say to the senator from arizona, my expectation is the pharmaceutical industry has said well, this is the time to increase these prices. and the most important element here is there's no restraint, no one has any capability of restraining them."p%there's onld restraint on this is if you've sent to the american consumer, you know what? you don't have to buy from these people at this price because it is sold in virtually every other country at half the price. and you say to the american people, we're going to give you the freedom to access that drug elsewhere, i think very quickly the pharmaceutical industry would be able to impose these

price increases. because then you would have competition. freedom equals competition in my judgment here in this issue. >> can i ask the senator another question? we understand that you can buy lettuce from overseas. you can buy many other products from overseas. you can buy dairy product that you can buy almost any item, except perhaps prescription drugs. and yet, the canadians in particular, as well as the countries that are included in the senator's amendment, all adhere to the same standards or higher standard than the united states of america does. and now, i understand that one of the senators, not you, has received a letter saying that this is still a problem. i don't get it. maybe the senator from north dakota can explain a little better. >> mr. president, i would say to the senator from the arizona there's not a safety issue here. to the extent there is any

safety issue, it is that we intend to increase safety of both the domestic supply of prescription drugs and the reimported prescript and drugs. because the fact is there is nothing in this point even with pedigrees and tracing capability. that doesn't exist at this point. we will insist on it in this amendment. so for anybody to suggest that somehow we're going to end up with a prescription drug industry that is less safe, or i should prescription drug products are laissez, that's just not the fact that as i indicated before the senator came to the floor, europe has been doing this for 20 years and something called parallel trading. for 20 years they have done it. if you're in germany and wanted by a prescription drug from spain that is an approved drug you can. if you're in italy and want to buy from france, you can. they do it successfully. i do believe anybody should tell if we are not capable of doing what the europeans have done for 20 years and that is giving people the freedom to access those prescription drugs where they are sold at a better price.

>> could i ask the senator another question? is it true that a letter was written to one of our colleagues from the administrator of the fda, the organization that would basically make sure that any product that goes to american consumers, along these lines, that would go through the bureaucracy, the senate would require significant amount of assets and resources, have since been told there is 11000 employees of that iraq is a. and i wonder if he thinks about that argument. and again, was the senator from north dakota informed about this position, which by the way, is the same position as the previous administrations? >> well, mr. president, the senator from arizona is correct. there is a letter from the food and drug administration? the fact is we have seen this over the years that they say

well, we don't have the resources, or it will impose more risk. the fact is this amendment provides the resources for them, because those are going to register to be able to ship fda approved drugs into this country at a better price are going to have to pay a fee. and the people that are selling will pay a fee. and those pharmacies and others in our country who will be receiving will also pay a fee. this actually funds -- require no additional funding from the taxpayer. >> no additional funny from a taxpayer at all. . . issue at all, and it will provide the additional resources and pay for those resources without asking the taxpayers to come up with the money. mr. mccain: do these countries that are included in the senator's amendment, could we have absolute assurance, could we look at the american people and say those countries and the agreements we would have with

them, that you could have products that are safe, that you could safely buy, and it would not pose any hazard to anyone's health? mr. dorgan: well, mr. president, the -- the countries that are involved in this amendment -- and they are limited -- are countries that have an identical chain of custody to our country. and so these are countries that are accessing the same drugs. i just mentioned -- let me do it again because i showed two bottles of medicine. they are empty, obviously. but both of these bottles contained lipitor. most of my colleagues know what lipitor is. this was made by an american company in ireland and then shipped all over the world. this little bottle was shipped to the united states. this little bottle was shipped to canada. same bottle. one was blue, one was red in the label, but the same bottle, same pill, same company, inspected by the f.d.a. now, what's the difference? the price. the american consumer is told the american consumer is told

>> what's the difference? the price. they were told, that's what you get to do. you get to pay almost triple. why? and it's not just the american consumer. if i can just hold up a chart that shows two drugs. i think if i can find it. one is nexium. it is advertised substantially. i al have one on lipitor. do you think they are losing money? europe? i don't think so. they charge $424. it is the pricing policy. >> wouldn't pharmaceutical companies say because we have to absorb the cost of all of the research that went into

developing nexium. >> that is also always raised. if you don't allow us to charge the american consumer the highest prices in the world, we don't get to do the research and development. but you know what? most of the recent studies have shown that those studies, the pharmaceutical spends more money on promotion, marketing, and advertising than they do on research. i want them to do research. there's one on piece, the congress gave without my support the proposal with the american money bring it back and let them pay lower. guess which industry was one of the largest? the pharmaceutical industry. now if we are making big profits abroad gouging your prices, why can't the american people have access to those prices? it's not because they are going to lose money.

because they know they have made money abroad. >> do the seniors like his state and travel to canada and buy the prescription drugs because they know and are confident that they are getting the same product? that's unfortunate when we have to do that. we have a much larger problem there. i'm sorry to say. mr. president, the citizens of north carolina, i'm told the story about the old man that was sitting on the hay bail on the cow yard. he was short of nibbling on the piece of straw. my wife has been fighting breast cancer for three years. 8 only way we can pay for the

prescription drugs was the drive to canada. when you buy it in canada, you may 1/10 or 1/5 of the price that you pay in the united states. we get that every three months so my wife can keep fighting breast cancer. of course they can do that. what is happening, is consumers are allowed to bring back about 90 theys worth of supply of prescription drugs for personal use only. but most american consumers don't do they. they don't live close to the border. can the american people have access to the same that the sold there? >> i ask the senators, isn't it true that the congressional budget office is determined that this measure of yours, this modest measure, of only countries that are concern of the highest level of quality of inspection, of all of the standards that we have, would it save the american consumers $100 billion -- $100 billion?

is that true? >> well, mr. president, it would save -- the congressional budget office says it will say the federal government about $19 billion. and another $80 billion to be saved by the consumers. that's nearly $100 billion and total $19 billion of which can be saved by the federal government and the rest by the american consumers. >> finally, i'd like to ask senator what is the basis of the argument against the senators amendment. what possible reason, frankly, expect for perhaps the influence of a special interest in this nation's capitol? i'm not a good advocate of the other side. i would say there aren't any arguments that the are the best. there's a range of poor arguments or arguments that don't hold much water. my own view that -- let me just

describe them. i want them to do well. i want them to keep finding and searching for miracle drugs. by the way, much of the work they will do with that comes from the national institute of health. i want them all to be successful. my beef with them i think the exit strategy that says to the american people, here's what you pay. that's because we decided it. we're going to offer everybody else lower prices. that's my beef. this is a pricing issues. they are wrong about it. and i think the way to correct it is to give the american people the freedom. give the american people freedom, you'll save money for the government, save money for the american people. i want to make one additional point. yesterday a read a whole series. you know, if the senator from arizona is like me, when i'm brushing my teeth in the morning, i have television blaring. i hear all of the crowds.

lots of doctors will give the pills to you. i don't know what the purple pills will do. i got to get out of here. i got to stop brushing my teeth and call the doctor to see if my life might be improved by taking the purpose pill. i've read all of these. does it keep you from sleeping. maybe it's time to ask if lunesta is right for you. ask how to get seven nights of sleep lunesta free. bladder problems andambien. i just say knock off a little. give us some better prices. god bless you for doing all that do. but give us fair prices. and knock off a little bit of the advertising. the advertising is for a product that only a doctor can prescribe. you can't get this product until the doctor thinks you need it.

so stop asking me if the purple pill is right or ask me to ask the doctor. knock it off. >> could i say -- ask enormous consent to make an addition no, ma'am comment >> it is without objection. >> i want to thank the senator from north dakota in pursuing this issue for a number of years. i really believe that we are on the verge of success. i appreciate his el wants, i appreciate his passion. but most of it on behalf of the citizens of my state who can't get up to canada, who know are experiencing unprecedented economic difficulties, who need these life-saving prescription drugs, many of them senior citizens, that i just want to say thank you for your advocacy. i think you made an eloquent case. and i hope that my colleagues have paid attention and will

vote for the affirmative for your amendment to the act. >> mr. president, let me say that senator mccain has been a part of this effort for a long, long time. this is one -- it's really interesting. with all of the action on the floor of the senate in the recent weeks, this is one of the few examples of a significant poll p si that is bipartisan. we have republicans and democrats over 34 sponsors who have worked with us to make certain that we can do this, do it safely, and get the american people the opportunity they deserve. this is really bipartisan. i appreciate that a lot. i want to say that the national federation of independent business support this is. the aarp supports this. we have a long list of organization that are strong supporters of this legislation or this amendment i should say. i really hope that today, perhaps, long lost after eight

or ten years. >> the pharmaceutical industry is formidable opponent. we've had difficulty getting this in a piece of the legislation to get them freedom and enterprise. and when we do this, senator mccain and myself and others. it is suggested that somehow we have no regard for the industry. it's not the case at all. we have no regard for the pricing policy that we believe is unfair to the american people. it's been that way for too long. a long, long time too long. perhaps today if you vote on this amendment, i expect later this afternoon, perhaps today will be the first step in getting that change. >> mr. president, i yield the floor. >> the senate is in recess while democrat senators meet to discuss the health care compromise. while we wait for the senate to return, here's the questions

with gordon brown. this is in london. >> questions for the prime minister. number one >> the floor listing my engagements, it is deep sorrow that we remember the first battalions, corporal that died on monday. my thoughts and i know the thoughts of the whole palace will be with his family and friends. every life lost is a personal tragedy. and the the -- we mourn every single loss. on the scale of the tactical, it is not diminishing but stripped of the power. this morning the industry. >> thank you, mr. speaker.

i saw the whole house. i endorse the prime minister tribute. last week, the prime minister told the house that was in the g20 and it had been in recession for longer than this country. neither of which turns out to be is correct. can we move from that? spain is mainly in its brain. [laughter] >> mr. speaker, i'm very glad glad -- i'm very glad -- i'm very glad that we are starting this week exactly as we ended last week. by talking about the economy. by talking about the economy. mr. speaker, i -- >> order. if you want to hear the prime minister rely, certainly people need to listen. elsewhere. we will have no further

interpretations. >> there are some people who get into the white house. they get their photograph taken and did not have the formal invitation. but the prime minister of spain was invited by the president of america to be part of the g20. and i have to -- i have to also -- i have to tell him -- i'm invited the prime minister of spain to the g20 meeting that took place in london. he was invited. in other words, spain was part of the g20. mr. speaker, i know they are going to talk down britain, but it's better than them talking down spain. >> last week on the side, it raises concerned about the effectiveness of legislation

related to today's results. will it be with me the small benefits of those concerned about this to be what can be done in the situation? >> mr. speaker, that's right. it was a terrible death. i'm sorry what happened to the little boy in liverpool, john paul masey. it would obviously be inappropriate to comment further on that instance. but the issue of dangerous jobbed was raised at the behavior working party a few days ago. we are working with the home office to assure they make full use of the power of the communities. the government has provided additional advice. and also funding to the association of police officers to help train the officers in

dangerous dog legislation. this is an event that should not recur. we're going to do everything in our power to make sure it doesn't happen. >> thank you. can i join in playing tribute to the lance corporal. at the prime minister and i have both seen, when you speak to the troops in afghanistan, it is not just pity, but support they are doing and the mission they are engaged in. in my bit we they are every bit of the men that stormed the beaches of normandy. we should be proud of what we are doing. the new strategy and the extra troops do show that we 15 the last best chance to get this right. does the prime minister agree with me that we cannot waste any time of getting every element of

the strategy in place including troops, helicopter, aide, civilian aide, and the pressure on president karzai to cut corruption. >> i'm pleased that he was able to go to afghanistan. i know there are many members who have visited. i play tribute to them for visiting our troops. i pay greater tribute to the troops for the great work that they do. he is absolutely right we must move quickly. additional troops will be going to afghanistan in the next few days. we have called the conference for january 28 in london to bring together all of the powers involved in the afghanistan, the 43 nation coalition that will discuss and president karzai will come as he started his second period of duty. at the same time, we are making available all of the equipment that is necessary, hep corporates -- helicopters and

vehicles. 80% of the death has been the result of explosive devices. we have brought in extra engineers and arms to survey the area. we are backing up our troops with the best equipment possible. we will do everything that we can to spare the loss of life. >> u.s. forces into helmond. isn't there a danger there will be a contrast before the uk forces and u.s. forces who aren't spread too thinny. does it need to change, and change urgently. >> if you heard what i said last week, i said we were going to

thicken our courses in key areas. it's a matter on the ground. i think it is recognized. two things have to happen. the second thing, however, i do emphasis is long-term strategy. we have trained the afghanistan forces so they can take over. and so 5,000 troops will be trained in helmand itself. we want to pass direct by direct to the afghan people. we have not only a reason to be there, but have a plan to get the afghan's control over the control so that at some point, our troops can come home. >> it's right. of course it's the minutes and commanders to make the dispositions. but everyone agrees that one of the keys to the successful counterinsurgency is a dense population of troops to protect the civilian population. and the figures do tell a vital story. soon there's be 20,000 u.s.

forces responsible for some 30% of the population. under 10,000 british troops responsible for some 70%. how quickly does he think the vital issue can be sorted out throughout southern afghanistan? >> mr. speaker, i'm thankful he raises these questions. i can point out we are part of a coalition. these decisions are made as part of coalition. >> we're going to leave the british house of commerce and return to the live coverage as senators continue debate on health care legislation. you know, it is easy to criticize in this business. it's hard to bring folks together. and maybe one day we can solve a hard problem where we get 70 or 80 votes, but i don't think this is that day. but one thing that i would point out about the process, somehow between the time this started

until now, something went wrong. this is what happened in -- this was what was said by candidate obama in january 2008: "that's what i'll do in bringing all parties together, not negotiating behind closed doors, but bringing all parties together and broadcasting these negotiations on c-span so that the american people can see what the choices are." in november 2007, he talked about in his presidency, "we're going to have a big table and everybody is going to be invited, labor, employers, doctors, hospitals, hospital administrators, patient advocate groups, the drug and insurance groups, they'll also get a seat at the table and we'll work on this process publicly. it'll be on c-span. it will be streaming over the net." march 2008, "but here's the difference: i'm going to do it all on c-span so the american people will know what's going on." august 2008: "when i come together around

this health care system, i'm going to do it all in the open. i'm going to do it on c-span." august 2508: , "i'm going to have all the negotiations around the big table. we'll have the negotiations tell vyingsed on c-span." well, the truth is i'm not so sure negotiating on c-span is the way to find a solution to hard problems. but being at the table with all parties represented representatived is probably a very --ed is probably a very good idea. our democratic colleagues are trying to negotiator mongt themselves to get to 60 votes. there was an announcement made last night by the majority that we've had a break through, i can't tell you what it is, but it's good. i would argue that's not the way we want to change one-sixth of the economy. i would argue that that's not the best process to make major decisions that affect the quality of americans' lives and the idea of medicare being

changed so dramatically by one party is probably not a good idea. now, what have we done on the medicare front? the actual bill that has been proposed increases spending by $800-something billion. to pay nor that there's a reduction or cuts in medicare of close to $400 billion to $500 billion and the money that would be taken out of the medicare system is not plowed back into medicare but is used to fund other aspects of this bill. and this is at a time when medicare, the trust fund is $36 trillion underfunded and will begin to be exhausted in 2017. so i would argue that both parties should be trying to find a way to save medicare from impending bankruptcy. do something about entitlements in general, social security and medicare, to make some solvent so that, one, they don't run out of money and we don't have to raise taxes in the future and

cut benefits for young people because that's th that's what wn order to save medicare. we're actually reducing the amount of money already going into an already-strapped system using it for something else. and there's another idea floating around. i don't know how serious it is. but -- that one of the solutions that may be coming out of this deal that we don't know the details of yet is that we're going to allow more people to buy into medicare under the age of 65, and we will be expanding the number of people going into a system that's already about to go bankrupt. and if you add new people to the system that's approaching insolvency, something has to give. and who will be coming into the system from 5 to 64? i would argue people who are going to be -- from 5 to 65? i would argue people who are going to be as a process of

adverse selection. it is going to put more pressure on a system that can't stand one more drop of pressure. that doesn't make a whole lot of sense to me. we know this medicare system is very much under siege. that the baby boomers about to come into the system by millions -- and there are three workers for every retiree today and in 20 years there are going to be 20. so what do we do? we take money out of the medicare system, use it for other things, and we're adding more people into the system that are going to drive up the cost overall to those already on medicare. so if you're over 65, your ability to receive treatment is going to be compromised because now we got to accommodate more people. and if you don't believe me, ask the hospitals and the doctors who are very worried about this. medicare reimbursement now, reimbursement system now makes it very difficult for doctors and hospitals to pay the bills. so the hospital association, the mayo clinic and others, have

warned the congress, please don't expand medicare because we can't survive on the reimbursement rates that we have today. if you add more people, you create more stress on the system -- the system that's han hanginy a thread. i would argue that's not change we can believe in or accommodate. if you had ran for president on the thighed i'm going to put -- on the idea that i'm going to put more people on medicare, take more money out of it to use for another purpose, you would never have had a chance to get elected. no one during the campaign for president ever suggested these ideas. so i just hope that we will as a congress stop, think about what we're doing, and realize that if we do this, if we cut medicare and expand the number of people that will be in the system, that we've made it impossible to save it down the road and made it very difficult for people coming behind us to have the same

quality of life we've enjoyed. between medicare and social security and other entitlement programs, we're about $50 trillion short of the money we're going to need in the next 75 years to pay the bills. so, in trying to reform health care, what we've done is taken a weakened -- a weak system and almost made it impossible to reform. we've expanded taxes at a time when the economy can't bear anymore tax burdens because part of the bill raises taxes by about $500 billion, and you'll never convince me or anyone else, i think, that if you raise $500 billion of taxes to pay for this new health care bill that it won't affect the economy in general. so there's just got to be a better way. i'm on the wyden-bennet bill. i am the republican to agrees to mandate coverage for everybody. senator wyden and bennet have a proposal that's revenue-neutral. we would take the tax reductions

given to business over a period of time, give them to individuals so that all of us would tax deductions to go out and purchase health care in the private sector. we would have exchanges where we could go shop for health care that's best for us. if you're single and 22, you'd want a plan different than if you were 45 and had three kids. and the trade-off is that republicans on the wyden-bennet bill would agree to mandate coverage. the democrats would allow people to purchase health care in the private sector and they would -- and we would all use the tax code to fund those purchases. if you didn't make enough money to have the tax deductions, you would get a subsidy. that makes perfect sense to me. and so i do want to solve the problem. i want to make sure everybody is covered because a lot of us are paying health care bills for those who are not covered that could afford to pay, about 7 million or 8 million people make over $75,000 a year and they don't pay anything for health care of our own so the rest of

us have to pay when they get sick, and that's not right. there's a better way in my view. i just hope that we will understand that what we're doing to one-sixth of the economy is going to have a lasting effect on the quality of american life, and now is not the time to cut medicare, add more people to it. now is the time to come together in a bipartisan fashion, to save medicare from impending bankruptcy. now is not the time to raise taxes. i hope our colleagues will understand that there's a better way, and i yield and appreciate the opportunity to speak. senator. the presiding officer: the senator from ohio. mr. brown: thank you, madam president. i appreciate the comments -- mr. reid: mr. president, could i ask my friend, the distinguished senator from ohio, to allow me to make a brief statement so the senate knows what's going on? i would ask, madam president, that the senator from ohio -- the presiding officer: the majority leader. mr. reid: -- be returned to the floor as soon as i finish my brief statement. the presiding officer: without objection.

mr. reid: madam president, i had a conversation earlier today with the distinguished republican leader. it appears now that we're going to get the appropriations bill from the house of representatives. the bill is something that is bipartisan. everyone has worked hard. we have some conference reports that we have completed and yet didn't find time to work here on the floor, for reasons everyone understands. that bill will come over from the house tomorrow. we can move to that with a simple majority vote. and then if i file cloture on it tomorrow, we would have a saturday cloture vote. 30 hours after that, sometime sunday morning, we would have a vote on the conference report. i've indicated to the republican leader that it would probably be to everyone's advantage if we

allowed people to go home for the weekend. and arrive at the same end rather than going through all of these procedural gyrations. we've worked really hard here. i had one senator come to me and said she hadn't been home now in two or three weeks and it was not a good situation. that senator said if we have to be here this weekend, she will be here. we need to not be doing things just to delay. i understand the republican leader doesn't want us to do health care. i appreciate that. he and i have different positi positions on that. i see no reason to prsh everybody this weekend, and -- i see no reason to punish everybody this weekend and i hope the minority will give strong consideration to the proposal that i've made.

we're waiting for a score to come back from c.b.o. anyway. everyone that's had any experience with c.b.o. knows that's going to take a matter of days -- in the plural -- and so i would hope that the minority would allow a little bit of time to go by so that we can have a respite here from the tedious work that we've been doing here on the floor. mr. brown: madam president? the presiding officer: the senator ohio. mr. brown: thank you, madam president. i've come to the floor most days reading letters from people in ohio who -- from springfield to mansfield who thought they had good insurance a year or two ago, if you had asked them, but found out their insurance was not so good when they got 0 preexisting condition or when they got very, very sick and costs were high, the insurance companies cut them off, or in some cases, as the presiding officer knows, that in my state and across the country, women so

often are paying higher premiums than men. and our bill will fix a lot of those things. but one of the things the bill still needs to fix, and we all have gotten letters on this, is what's happened with the price of prescription drugs. and i think this bill -- there's many things i like about the bill, a few i don't. this is one we can really improve. i rise to support senator dorgan's amendment 2793. i'll start with a story. about a decade ago, maybe a little more than that, i live in northern ohio and i used to take a busload of senior citizens to this -- every couple of months, a dozen times maybe, took a busload of senior citizens through sandusky to toledo into detroit and then into ontario, clear across the river into windsor, on tear yoavment i did that so that seniors could buy less expensive prescription drugs. i'd go into a drugstore in windsor, same drug, same

packaging, same dosage but the price would be one-half, sometimes one-thirds of what seniors paid in the united states. and i -- in many ways it broke my heart. as a federal official that i was going to another country to buy something that was more often than not made in the united states. when the drug companies charged twice or three times in the united states what they were charging in canada, i thought it made sense for seniors in my state and in my congressional district in those days to go to canada and to be able to get those prescriptions. they then would be able to get a refill every three or six months at least a couple of times with that doctor's signature that they got in canada to be able to buy those drugs. i think -- i appreciate senator dorgan and senator snowe offering this amendment. i hope it's signed into law as part of the health reform. if the drug companies are struggling not making any money, it could be a very different situation. but drug companies earn higher profits than almost any other industry in america. they have been one of the three

most profitable industries in our nation for decades. last year the pharmaceutical industry was the third-most profitable industry in america ranking up there with the oil conglomerates. but let's face it, to call these corporations american is a stretch. most of them are multinational. most of them reap huge profits from around the globe. it's true they earn higher profits in our country than any other but that hardly qualifies them as patriotic. as drugmakers earn billions, u.s. drug spending is fueling double-digit increases in health insurance premiums. there is a reason health insurance premiums go up. certainly the industry is one of the reasons. we know about insurance industry profits. we know about insurance industry executive salaries. the ten largest insurance companies, health insurance companies in this country, c.e.o.'s average around $11 million income. that's part of the reason. but part of the reason is drug prices continue to fuel the high cost of health insurance.

drug prices continue to drain tax dollars out of the federal treasury. and drug spending's undermining the financial security of millions of seniors who can -- and other americans, of course, but especially seniors who can why i am afford to be the piggy bank for big pharma's global operations because we don't allow importation, a decision our government has reached in all too close consideration -- all-too close consultation with the drug lobby, americans are forced to pay more for the same drugs than anywhere else in the world. it's not about safety. we know that. the equivalent of the food and drug administration in canada or in france or in germany or in israel or in japan, they know how to make sure drugs are safe in their country. it really isn't is a question of safety. it is a question of industry profits. prohibiting importation has cost americans and taxpayers dearly. it has driven up the cost of insurance premiums, medicare

paid by taxpayers, medicaid paid by taxpayers, tricare paid by taxpayers. in federal health care programs, again paid by taxpayers. it is reduced -- and this is equally important, not just the cost. but it reduces access to lifesaving medicines. some people simply can't afford the cost of these drugs. it's reduced seniors' budgets to the point where money can either buy groceries or heat their homes or purchase prescription drugs but not both. too often seniors cut their pills in half, take their prescription in smaller doses so it will last longer. and that obviously is jeopardizing their health also. this amendment is a step in the right direction for increasing access to those drugs. in 2008 the pharmaceutical industry had more than a 19% profit margin, had sales of $300 billion. i'm way more interested in protecting u.s. consumers, u.s. taxpayers, u.s. small businesses who are burdened by these high drug costs than i am u.s. drugmakers and their inflated drug prices.

the c.b.o. estimates, the congressional budget office says this amendment will save the government $20 billion over the next ten years. $20 billion. i want to encourage more competition. i don't want this body again to come down on the side of preserving monopolies. as it stand now, the u.s. government permits the drug industry to hold american consumers hostage. meanwhile, the largest drug companies -- pfizer, merck, others -- continue to outsource operations abroad to cut costs and increase profit margins. here's what happens, it's okay for big pharma to look abroad to cut costs and boost profits while american businesses are stuck paying the bill. the drug industry is trying to convince us -- the senate, the house, more importantly the american people -- that importation is unsafe. wait a second. they go to china -- i've had hearings about this, madam president, that i've conducted in the bank -gs -- in the health, education, labor, and pensions committee. we've had hearings, senator

kennedy a couple years ago asked me to chair, where american drug companies outsourced their production to china. they really couldn't tell us about the entire supply chain that supplied the ingredients to these drug operations in china that later made their way back to the united states. we know about heparin, a drug that killed several people in toledo, ohio, because it was contaminated with who knows what ingredients that came from china. so these companies, these drug companies are arguing these products are unsafe, these drugs you can buy in windsor, ontario, or pharmaceuticals you can buy in bristol, england, or farm suits you can buy -- pharmaceuticals you can buy in france or dues tkor of -- or dusseldorf. they're saying they're willing to import drugs themselves, lipitor, one of the best-selling drugs in the united states for

years was made in dublin. they can import their drugs from abroad. they can import ingredients from china which has nothing like we do like a food and drug administration, and then they are going to go around, hire their lobbyists and go around desk to desk, member to phefbg, office to office -- member to member, office to office, and they're going to tell us these drugs are unsafe? we know better than that, madam president. this amendment would simply make imported medicines available to consumers. it's a free-market mechanism. open it up so that people can compete for giving customers more purchasing power so they can pay lower prices. the drug industry should not be protected from the same competition every other industry faces in a global marketplace. i urge my colleagues to support the bipartisan amendment. senator dorgan from north dakota, senator snowe, grassley and mccain, all three are republicans from maine, iowa and arizona. this amendment makes sense for taxpayers. it makes sense for consumers.

it makes sense for businesses. it makes sense for our country. madam president, i yield the floor. a senator: madam president? the presiding officer: the senator from south dakota. mr. thune: madam president, i wanted to speak to a couple issues this evening. the first one has to deal with what we understand to be the evolving so-called deal that is being worked out by the other side on the public option/government plan and the attempt to try to reach 60 votes on the other side and what appears to be a process that continues to just sort of unravel and break down because every single day there is a new story about some new gimmick to attract the requisite number of senators to get to that threshold of 60. the most recent one -- like i said, i can't verify any of this because we haven't been privy to

or included in any of the discussions that have occurred behind closed doors. in fact, one of those meetings just occurred earlier this evening. but we read from press reports that one of the proposals now being contemplated by the majority to try to get that requisite number of votes is an expansion of the medicare program. and what's interesting about that, of course, is that that has engaged organizations that prior to this time had essentially been at the table and negotiated their own kind of agreement. but that's gotten the interest level up of the american hospital association, the federation of american hospitals, the a.m.a., the physician group, and they even have something here from mayo clinic. but i thought it's interesting that that would be considered now as an alternative to what previously had been discussed in terms of a public option. and here's why. medicare, as we all know, is destined to be bankrupt in the year 2017. it is a very large program that benefits a lot of seniors across

the country. we all support reforming it, making it more sustainable, putting it on a pathway to where it will be solvent well beyond that date and extending its life span. and what this would appear to do is allow people younger than 65 or 62 -- down to 55 -- to buy into medicare. essentially what you do is you would allow more people to participate in the program, in a program that as i said before is destined to be bankrupt in the year 2017. so what you're doing with this proposal, because we all know that the underlying bill cuts medicare reimbursements to hospitals, nursing homes, hospices, home health agencies and medicare advantage beneficiaries by about $1 trillion over ten years when fully implemented. you're going to take $1 trillion out of medicare. and th-pb remember, madam president, this is a program already destined to be bankrupt in the year 2017. so you're going to take $1

trillion of revenue out of it over the ten year period when it is fully implemented and expand and add the number of people who are going to be on it. the equivalent is like putting more people on a sinking ship. and in fact that's what gotten, i think, the attention of all these various organizations and provider groups around the country because hospitals, as we already know, can't recover their cost with the reimbursements that they're currently receiving under medicare. and most states it varies a little bit, 80 cents to 90 cents on the dollar. hospitals, what they do is shift that cost over to private payers, and that increases the cost for everybody who is receiving their insurance in the private market. essentially what you would be doing is expanding the government-run medicare program which under reimburses hospitals and physicians and other health care providers and forcing even more of a cost-shift. you're exacerbating the cost-shift that's already occurring, making it worse.

and in fact getting all these provider groups -- the american hospital association, the american medical association -- engaged in this debate because they see what a train wreck it would be for them. and, frankly, what that means is you'd have a lot of providers who wouldn't be able to make ends meet. they would have to shut their doors and go out of business because many of them are very dependent upon medicare patients. and i say that in my state of south dakota, most of your hospitals, especially in rural areas, are heavily dependent, 70% or thereabouts between medicare and medicaid. if they are not a critical access hospital and they're still getting reimbursed under the traditional medicare program, they're going to have a very, very hard time making ends meet because right now what they do is what all hospitals do. and that is they shift costs over to the private payers. here's what the a.m.a. said about that proposal. they have a long-standing policy opposing the expansion of medicare given the financial projections for the future. that's what the doctors group

has said. the american hospital association has urged all senators to reject expansion of medicare and medicaid as part of a public option, saying that medicare pays hospitals just 91 cents for each dollar of care provided. and this would expand the number of people that they would have to cover and shrink the private-payer market and lump more and more of the cost on those, and so everybody else's premiums would go up. the federation of american hospitals, which is the private hospitals across the country, said any medicare buy-in would invariably lead to crowdout of the private health insurance marketplacing more people into medicare. such a policy will further negatively impact hospitals after we have already agreed to contribute the maximum level to sustainable reductions in the deal that they, as i said, struck earlier. but it seems to me that these deals now have all sort of fallen off the table, and this latest proposal, if in fact this is what we're reading is true, i think they recognize would be a disaster.

here's what mayo clinic in their letter said. "any plan to expand medicare beyond its current scope does not solve the nation's health care crisis, but compounds it." they go on to say "expanding the system to persons 55 to 64 years old would ultimately hurt patients by accelerating the financial ruin of hospitals and doctors across the country. the majority of medicare providers suffer great financial loss under the program. mayo clinic lost $840 million last year under medicare. as a result of these types of losses a growing number of providers have begun to limit the number of medicare patients in their practices." that, madam president, is what we are talking about. as you start -- if you expand this program and you have a reimbursement system that does not cover the cost of hospitals they are going to cease covering medicare patients in the way they are not covering medicaid patients. they say 51% of physicians today have chosen not to accept

medicaid patients. you compound the access problem that many people in rural areas already experience. so these are -- the big problems with this. i have to come back to what congressman weiner said about this. he said extending this successful program to those between 55 and 64, a plan i proposed in july, would be the largest expansion of medicare in years would perhaps get us on the path to a single-payer model. therein i think lies the ultimate goal in this, that is to skphapbd medicare to -- expand medicare to where we have the government-run system in this country on the way to single-payer status. that is precisely what many on the other side want to hafplt ironically there are some who have expressed concern about this. our colleague from north dakota, senator conrad, said when asked about this proposal, it's got many of the same problems i have with previous versions of the public option. he went on to say that it ties

you to medicare levels of reimbursements for a whole new population. and he contended the hospitals in his state would go bankrupt. his state -- north dakota -- is not unlike my state of south dakota. hospitals are not going to be able to make it if these reimbursement levels that are currently afforded them under medicare are extended to a whole new population. and so, madam president, i hope this is a bad idea that is just being thrown out there as sort of a, one of these things being thrown at the wall and hoping it sticks in a desperate effort to get to 60 on the other side, because it this really is a bad idea and the provider groups are weighing in heavily against it. i think it is pretty clear it would be a disaster for health care delivery in rural areas of the country and for that matter, mayo clinic and many of the other providers who have weighed in on this, it would literally, i think, make it more difficult for people to have access to health care and certainly exacerbate the cost shifting issue that exists with regard to

the private payer market, make their costs and everybody else's costs go up more. madam president, i want to shift gears, because tomorrow senator hutchison and i will offer a motion to recommit. it deals with the whole tax component of this health care reform bill. in very simple terms -- and i want to show you why this is a relevant issue. because if you look at what the cost of this program -- this health care proposal, the reid proposal before us, and you can see what the costs are in the early years and how the costs explode in the out years. there's a reason for that. the revenues kick in right away. the tax increases come in right way. the spending proposals don't occur until much later. and so what you have is a 10-year picture, budgetary picture, and cost for this program that way completely understates what the true cost of the program is.

and so if you look at this particular chart, you look at the years 2010 to 2019, you can see how -- particularly in the early years, it doesn't look like there's that much spending. the number in the first 10 years is $1.2 trillion in spending. however, madam president, if you look at the cost of this when it is fully implemented, you take the year 2014 and extend it through the year 2023, you can see how the cost explode. and the totally, fully implemented cost over a 20-year period is$2 .5 trillion. there is a reason for that. a lot of budgetary gimmicks were use particularly in the first 10 years so people can say it's only $1 trillion. in fact, when it is fully implemented, it $ 2.5 trillion. one of the reasons for that and one of the major reasons is because the tax increases in the bill take effect 23 days from now. january 1 of the year 2010, many

of the tax increases in this legislation go into effect. now the spending and the benefits that are going to be distributed under this, the exchanges and the premiums -- the premium subsidies and that sort of thing, tax credits, don't begin to kick in until the year 2014. 1,484 days later. so for all those 1,484 days, or back out, i'm sorry, the 23 day from that, so 1,461, taxes will be assessed and levied on people across the country, small businesses, families and individuals, but you're not going to see any benefits for over 1,000 days. almost 1,500 days. what my motion is commit and senator hutchison, it is the hutchison-thune recommit, it aligns the taxes, the fees in the proposal with the benefits in terms of timeline so the tax

increases and the benefits occur at the same time. in other words, we would delay the tax increases in this bill until such time as the benefits package and structure would kick in. so that they are in sync. essentially you have four years -- yeah four years, of tax increases that will be borne by people all across the country including businesses, there is a lot of discussion about job creation and the need to grow the economy and the worst thing that you could do to small businesses when you're trying to create jobs is levy new tacks on them, which is what this -- tax on them, which is what that bill does. in the first four years years, $72 billion of taxes will be collected. i think that's through the year 2013. you have all of these taxes that kick in on january 1, 2010, less than 23 days from here and then actually you've got this amount of time, as i said, almost 1,500

before the benefits begin to pay out. in our motion to commit, we're saying let's align the tax increases in this and the benefit structure so you don't have this period of four years where people are paying taxes an receiving literally no benefits under this health care reform bill. and the advantage that has is it does accurately reflect the cost of this program in the first 10 years rather than understating because of the revenues that kick in immediately and the benefits that don't kick until much later. it is very straightforward. it is very simple. very understandable. tax increases that are designed to kick in on january 1, of this year, would not kick in until such time as the benefits kick in and so the fees and taxes and the tax increases in this bill are all alignedded and synced up, so to speak, when the spending under the bill begins much and, of course, what that does is give us a more accurate, i think, reflection of the

overall cost of the bill. many of these tax increases, madam president, which will kick in three weeks from three weeks from now, or a little over three weeks from now, january 1 of this year, will be distributed across many businesses, but also to consumer across the country. in a senator to -- in a letter to senate bayh this year said essentially, all of these fees on medical devices, fees on prescription drugs, fees on health care plans, all kinds of fees and taxes in the bill. and the c.b.o. wrote in a letter to senator bayh that these fees would raise insurance premiums. and the c.b.o. when this question was posed during the deliberation that the finance committee level was asked, what would all of these fees do to insurance premiums and they roughly it would increase premiums dollar per dollar. you have the tax increases an

fees that would kick in immediately that would have an upward impact on premiums. so people across the country will see the premium increases take effect. the tax increases are taking effect on medical device manufacturers and on prescription drugs. there's a whole other range of taxes in here. there's the tax on high cost plans, insurance plans. there's a health insurer fee. there's a botox tax, which starts january 1, 2010. and you can kind of go down the list. there are limits on f.s.a.'s, flexible spending accounts, which is something people use to put aside money so they can buy a high deductible plan and have, you know, dollars available to deal with the incidental health care costs that they have. and so the taxes are going to go up on those and you can kind of go through this whole list of taxes all of which, as i said, are going to kick in in the near term and none of the benefits kick in until years later.

unfortunately for the american public, they're going to see the premium increases that will come as these taxes are imposed on all of these various sectors of the health care economy, all of which will be passed on to consumers in the form of higher premiums. so the american consumer, the american public, the taxpayers of this country are going to see the cost immediately and won't see the benefits for five years. that is not fair. it's not right way to -- to set policy here in washington, d.c., and it's much more transparent if we have these dates, the tax increases and the fees and the taxes in this bill synced up, synchronized with the benefits when they begin so that everything starts at the same time. the motion to commit, madam president, very simply is a motion to commit this thing back to the finance committee to create a level playing field where the revenues that are raised under the bill don't begin to kick in until the benefits start to kick in and the spending starts to kick in.

that will give us the true picture, actual picture of the cost, which as i said before, is $2.5 trillion over 10 years when it's fully implemented. not the $1 trillion or under $1 trillion that's being used by the other side because you have to look at this full picture over a 10-year period when it's fully implemented. and, obviously, that gives you a very different perspective about the overall true kofs this particular proposal -- cost of this particular proposal. madam president, we have in front of us, just generally, the basic contours of this bill have not changed nor do we expect them to change. they will tweak around with this government plan, there was already a vote on the issue of abortion, which i believe the taxpayer fund should not be used to finance abortions. we had that vote and there will be other votes on individual aspects of this. but some of those things are not going to affect the fundamental core elements of this plan which have stayed the same throughout

the entire process. and those core elements are a massive expansion of federal spending, $2.5 trillion over 10 years when it's fully implmentd. massive cuts to -- implemented. massive cuts to medicare, about $1 trillion over 10 years when fully implmentd. again, that affects hospitals, nursing home, home health agencies, hospices an beneficiaries of medicare advantage of which there are about 11 million across the country and it's also financed with increases in taxes, which i have just mentioned. those are the basic components of this bill. 70 new government programs called for. all of the new spending, all of the new bureaucracy, all of the new taxes, all of the medicare cuts. those things have not changed since this thing first started being debated several months ago and that's where we are today. and that's why i believe this is such a bad proposal for the future of this country because even after all of that, if you look at what -- the impact that

it has on premiums, according to the congressional budget office, 90% of americans end up the same or worse office. when i say the same, i mean year over year increases in their insurance premiums that are double the rate of inflation. if you're buying in the small group market today or large group market according to the congressional budget office, you are going to see your insurance premiums continue to go up over time. if you buy in the individual market, you're going to see them continue to go up, but way more by 10% to 13% increase in premiums for people who buy in the individual marketplace above and beyond the rate of inflation that will impact people in the large and small group markets. so bottom line is if you're looking for reform, if you're the average american citizen out there and the person that i represent in south dakota when they hear the debate about health care reform, it means a couple of things, it means affordable access to people across the country and something that most of us i think here on

our side think ought to be part of this, and that is measures, proposals that actually bend the cost curve down rather than up. and what we have seen consistently throughout the course of this debate is with all of the spending and tax the increases and all of the medicare cuts, no positive impact on preaches the best that -- premiums. the best that you can hope for for 90 million americans is to maintain the status quo, stay where you are, your increase year over year, double the rate of inflation, or worse yet increases of 13% above or beyond that. that is what 90% of americans are looking at as a result of -- of the health care reform proposal that is currently before the united states senate. there is a better way, madam president, and we believe that the way to get this right is to start over and to actually focus on solutions that will drive down the cost of health insurance, that will bend that cost curve down.

interstate competition, allowing pooling for small businesses, medical malpractice reform. we have a series of things that we think represents the consensus view of this country, we have not been included in any of the discussions nor have our ideas been a part of those discussions. rather they have chosen to pursue this course of a big spending program with the higher taxes, medicare cuts and the higher premiums. so, mr. president, i hope -- i really, truly hope that there will be support for is this -- as this process moves on and we get to the critical votes ahead of us, a more rational step-by-step approach, getting away from the huge massive federal government in washington, d.c., and seriously focusing on solution that's do bend the cost curve down, that don't rely on these huge cuts to medicare, that don't rely on

these huge tax increases, but actually find savings, and they can be achieved in the market by putting policies in place that will -- that will constrain costs and put downward pressure on the prices that most people pay for health insurance in this country. it can be done, mr. president, but it will require some boldness on part of some of our colleagues on the other side. i think our side is really united. but this is a bad policy, bad prescription, will you will, for -- if you will, for america's future. but we will need help from a courageous democrat or two to make sure that that massive expansion of the federal government is defeated and that we can go back, start over, do this in a step-by-step way, and in a right way and in a way that actually does lower costs for people in this country. i certainly thinks that what my constituents in south dakota expect and most americans in the country expect and they deserve to have health care reform that gives them that outcome, lower

costs and access to affordable health care. mr. president, i yield the floor. mr. thune: mr. president, i note the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call:

the presiding officer: the senator from kansas.

mr. brownback: i ask further proceedings on the quorum call be dispensed with. the presiding officer: without objection. mr. brownback: i ask 10 minutes be allotted to me of the minority time. the presiding officer: without objection. mr. brownback: in the past few months, this body has been forced to stand aside as really senator reid and a few other crafted a 2,000-page bill behind closed doors, going on even right now. unfortunately, the product that was a result of the closed door meetings -- at least the one we have right now. i don't know about the future one -- still raises taxes by half a trillion dollars. probably under any new bill that comes out, you're going to have taxes going up roughly half a trillion dollars, cut medicare by half a trillion dollars, raise premiums on american families, fail to bend the health cost curve down and expands government's encroachment further and further into people's health care decisions. what i want to go through is a series of charts about how inflation is going to end up being the tax collector's best

friend in this overall plan and how the tax of inflation is going to be one of the key features of how the overall bill is paid for. and inflation, i hope most people remember when we had inflation -- a lot of people maybe don't remember when we had really significant inflation is a cruel tax. it is a very cruel tax on people on fixed income. it is a very cruel tax on people on low-income status because constantly the dollars you have are staying pretty stable and everything you're buying goes up. and so that inflation just kills you. it kills you in the pocketbook and it's one of the things that that -- that we have really got to be concerned about, particularly with the amount of money that's out in the money supply today and the likelihood of this moving forward and how it's built in to pay for this huge expansion that's -- that we can't afford in this bill. now, i'm joining my colleagues today in speaking against the the $500 billion in new taxes

that is in the democrat majority's proposal to levy on the american people and the job-creating small businesses that this is going to be put on in an attempt to pay for this big 2,000-page bill. this monstrous bill is flawed economic policy. i'll develop that point for you as well. it fails to lower health care premiums, fails to bend the cost curve down and will further cripple the struggling economy with massive and burdensome tax increases. mr. president, this carols legislation reminds me of a cautionary tale that's still being played out in another part of the world, and that's what happened in the early 1990's in japan. a surging economic giant at the time, suffered a severe economic recession at the time, in the early 1990's, of which the effects are still lingering even today in japan. during japan's lost decade from 1991-2003, their gross national product through a paltry 1.4% annually, creating a decade of

stagflation -- that's where you have a stagnant overall growth but inflation in the economy -- and limited economic growth. most economists believe that japan's economic recession would not have lasted nearly as long as it did had it not been for one fatal big error that the japanese government did. in the late 1990's, as their economy was recovering and appearing to pull out of its economic slump -- so the economy is just getting going, starting to pull out of the economic slump, the japanese government made a catastrophic decision to raise taxes. the result was that this one decision aborted the strong recovery the japanese economy was starting to experience and plunged it back further into an economic downturn that lasted for many more years, the hangover of which is still on them today. mr. president, what we are doing here today, discussing a a $2.5 trillion government entitle expansion that raises taxes half a trillion dollars,

plays budget gimmicks with our our $12 trillion deficit and raises health premiums and costs for all americans in the middle of a country's economic recession, what are we even talking about doing this? that's what i get most from people back home. they say why are you even talking about this? where we are now in this recession, raising taxes, why are you talking about this with our health care situation the way it is to raise the costs, raise insurance premiums, cutting medicare at a time when medicare needs more, not money taken out of it. now is not the time, this is not the bill and this is not the way the american people want to see their health care reform. what the american people want is for this body to lower health care costs and induce an economic recovery that creates jobs, not kills them, and grows the american economy, not thwarts it. and the way to do that, mr. president, is not to raise taxes as is evidenced by what happened in japan. increased mandates, increased regulations, and increased taxes are a recipe for disaster.

it's a recipe that kills jobs. in fact, president obama's chief economic advisor, dr. christina roemer, stated earlier this year that as many as 5.5 million jobs could be lost due to the democrats' new tax proposal in this 2,000-page government takeover of health care. nothing could be worse at a time when the nation is already experiencing 10% unemployment, a 26-year high. this bill will impose impose $28 billion in new taxes on employers that will ultimately be paid by american workers in the form of reduced wages and lost jobs. under this burdensome legislation, employees will face stunted wages and the loss of their benefits as their employers attempt to find ways to fund these newly imposed mandates. as small businesses struggle to keep their doors open, tough decisions will have to be made on whether to raise prices, cut wages, or let go workers in order to find the funds necessary to comply with the

federal mandates imposed in this bill. furthermore, this bill will kill jobs by penalizing small businesses who are looking to grow, and small businesses are the growth engine for the country. in this bill, firms with more than 50 workers that did not offer coverage would have to pay a penalty, a tax -- or a tax to the federal government for each full time worker if any of their workers obtain subsidized coverage through the government-run exchange. what businessman would would desire to higher that employee knowing if he did that the government would penalize his business and slap him with a new costly tax. so now companies try to stay under this limit rather than trying to grow the business. furthermore, certain circumstances firms with relatively few employees and relatively low wages would be eligible for tax credits to cover portions of their health insurance premiums. that's relatively few would be

eligible. mr. president, i ask you what employer would decide to increase the number of employees or increase the amount of their wages if they stand to lose government handout, support subsidies or face an increased tax burden. they simply won't be willing to do it. now, one of the most disturbing aspects of this legislation is the use of inflation to fund it. use of inflation, a hidden tax increase on working families to fund it. the ranking -- i'm the ranking member on the joint economic committee and we look at these aspects a great deal, and the use of inflation is built into the base of this to fund it. we know that the consumer, the individual taxpayer, pays all taxes no matter how the government claims to assess those taxes, they are paid by individuals. i have got a couple of examples i want to show you here. first, i want to talk about high cost plans tax hits the middle class. first let me talk about that. this is the tax on the so-called

cadillac health insurance plans. we know that insurance policies and benefit plans will be altered to avoid that tax. so in other words, if you get an insurance plan that's up above a certain level, you get taxed on that higher end, that so-called cadillac plan. so in all probability, most groups will not provide this high quality health care because they say you're going to get taxed on it. benefits that taxpayers with insurance currently receive on a pretax basis -- right now they get these in a pretax basis so that the company is paying for this, it's pretax to the individual, will gradually shift to after-tax benefits resulting in higher payroll and income taxes. so now that you have cut this, this cadillac plan to get underneath it being taxed, and then the company says okay, we'll just pay you in wages or we'll do this somewhere different, then you have to go around and supplement or have a lower quality of health

insurance, you're going to have to pay for it with after-tax dollars, resulting in more taxes but you don't get more benefits from this. this is a big tax hit on the middle class of people that are going to have to pay this as their -- their higher income or their higher based insurance plans are taxed. here's what the joint committee on taxation said about the distribution impact of the high cost tax plans." despite the president's promises, the majority claims 91% of taxpayers will be affected by this tax earn under hundred thousand, and the tax will hit married filers more severely than singles. 62% of the high cost plans tax impact will fall on married filers compared to 25% on single filers." why are we building the marriage penalty back into the insurance plan? we did -- we worked a long time

in this body to get rid of key portions of the marriage penalty, saying we shouldn't tax marriage, we should support this institution. it's being built back into this plan. this bill also imposes an additional medicare tax on wage and salary or certain types of business incomes of single taxpayers with incomes above $200,000 and married taxpayers with more than than $250,000. so right off the bat, there is another marriage penalty. two people living together but unmarried, making $150,000 each won't pay the tax. two married people making the same amount will. now, what's right about that? making matters worse, the thresholds aren't indexed for inflation. no indexing for inflation. and inflation is a cruel tax and unfortunately in this situation, it's not only going to be inflation, but you're going to be taxed then as you get inflated into these categories. from 2013-2019, the number of returns of people earning under under $200,000 in today's

dollars will rise from 75,000 to 345,000 under current trajectory on inflation. we're making the tax man's best friend inflation. that is wrong. so you're going to move 75,000 to 345,000, percent of new tax revenue. married couples will be hit hard, as i mentioned earlier in this. then you're looking at inflation. 2013, 2015, 2017, 2019, the number of people growing into this taxable category, affected by this medicare tax will increase in $2,009 from $75,000 from $75,000 -- from 75,000 to 345,000. some people -- if you want to think about this, think about the alternative minimum tax. first put in place, the alternative minimum tax was just supposed to be on very, very wealthy individuals. that's all it's going to be on, but it wasn't indexed for inflation. and now you get whole swatches

of people hit by it, and this body regularly tries to change that or deal with it on a one-year basis because it wasn't indexed for inflation. so what you build into the base of this bill is if you want to pay for the bill, you want inflation. so you get inflation and it hurts people on fixed income and you get more people taxed than what you started off with. and you didn't tell them about it at the outset. this plan clearly should be indexed for inflation. we know that should take place, and yet this is where a major part of the money for the bill comes from. inflation. is that something that the federal government should be banking on? is that we'll get inflation to pay for this health care bill? i don't think the american public wants to see that taking place. to put this in context, let's not just look at returns under

$200,000, let's look at all returns and how this tax will spread. according to the census bureau estimates between 2013 and 2019, the working age population of the country will grow by 1.6%. joint tax estimates that the number of returns that will be affected by this tax will grow by 52.6%. the revenue collected as a result of the tax will grow by more than 54%. over time, the reid bill medicare tax isn't just for the wealthy. this is a change from 2013-2019, comparing the increase in tax of growth for the working age population. this is how many more people get impacted. inflation become the tax man's key friend. japan's lost decade from 1991-2003, their gross national product grew a paltry 4.1% annually creating a degree

nation of stagflation and limited -- decade of stagflation and limited economic growth. it was because of policies like this, where you have inflation paying for it, where you have tax increases putting in place. these are the things that cause that to take place. it shouldn't be done. and i just add as a final note, when i'm here talking about people back home, all the time they're raising this health care bill. they're talking about it constantly. they are -- and if they're small business people, they are talking about not doing anything until the political environment is more stable in their estimation about how much taxes we're going to be talking about, about how much regulation we're going to be talking about. you've got this going on on the climate change debate and regulation in copenhagen and that just tells a lot of people in my area that are energy users and energy producers, don't do anything until this stabilizes. you talk about tax increases or inflation being a part of this proposal, you've got a bunch of

people saying just don't do anything, just stay on the sideline. that is a prescription for no job growth that. is a prescription for killing jobs. you want people out there and investing and creating jobs and opportunities. you want them to see a stable political environment where they're not worried about increasing taxes, not worried about increasing regulation but, rather, saying this is a stable environment we can invest and grow in it. that's not what they're doing today. that is repeating the lesson that the japanese learned when they raised taxes just when you're coming out of a recession. it's the wrong policy. it's wrong economic strategy. it's harmful. it's harmful for job creating. it shouldn't be a part of this bill. mr. president, i yield the floor. mr. baucus: mr. president? the presiding officer: the senator from montana. mr. baucus: mr. president, i ask unanimous consent the senate proceed to a period of morning business with senators permitted to speak for up to ten minutes

each. the presiding officer: without objection. mr. baucus: mr. president, i ask unanimous consent that when the senate completes its business today it adjourn until 10:00 a.m. thursday, december 10. that following the prayer and pledge, the journal of proceedings be 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 h.r. 3590, the health care reform legislation, that following leader remarks, the time until 1:00 p.m. be for debate only and equally divided with the time until 11:00 a.m. controlled between the two leaders or their designees with the remaining time until 1:00 p.m. controlled in alternating 30-minute blocks of time with the majority controlling the first block and republicans controlling the next block. the presiding officer: without objection. mr. baucus: mr. president, if there is no further business to come before the senate, i ask that it adjourn under the previous order. the presiding officer: the senate stands adjourned until

10:00 a.m. thursday, december 10. republican first-degree amendment. we're working on lining those up. up. here is some debate from earlier today. >> over the course of this debate and there has been too much to misinformation about what health care reform is and what it will do. i like to set the record

straight. the goal of health care reform is two lower costs. and provide quality affordable coverage to american families, business and workers. and according to the nonpartisan congressional budget office our bill, the patient protection and affordable care act, is a success. according to the cbo this bill provides health insurance coverage to 31 million more americans, that's a big success. it lowers health insurance premiums despite what some have said some claimed about premiums rising, that's not true. the cbo says this legislation alow worse health insurance premiums but 47% and that 7 percent gets much higher quality health care insurance than otherwise would get. cbo also says this reduces the federal deficit by $130 billion over the first 10 years, reduces the deficit by one into a 30 billion over the first 10

years. in addition as a the president promised to this bill does not raise taxes on that middle-class, in fact, this bill is a net tax cut. over the next 10 years this bill provides a total $338 billion in tax credits to help american families small businesses and workers by quality affordable health care coverage they can count on, that's a tax cut mr. president, a total of $330 billion in tax cuts. the chart behind me will indicate that. over the next 10 years this bill provides a total i said $330 billion in tax cuts. the bill provides a net tax cut of $40 billion in the 2017. you can see that's basically in the chart to. $40 billion of tax cuts in 2017.

that's $430 for every taxpayer affected. these are individual tax cuts, i will make that clear, american individuals with a tax cuts under this legislation in these amounts. the lower middle income taxpayers who earn between 20,000 and 30,000 will see an average tax decrease of nearly 37%, asked cbo, don't take my word for it to appear in independent organization. and the average taxpayer making less than 75,000 it will receive a tax credit of more than $1,300 in that tax credit rose to more than $1,500 in 2019, those are tax cuts mr. president. very important that we all remember this bill has a net tax cut of this amount for american taxpayers, that individual americans tax cuts. i have heard arguments that the responsibility to have health insurance amounts to a tax on

the middle class. this is simply not true. in fact, this policy worked to repeal the hidden tax of more than $1,000 in extra insurance premiums that american families pay each year in order to cover the cost of caring for those without health insurance. uncompensated care, that's a thousand dollars on average has to pay and deterrence system. and this bill would virtually eliminate that. additionally this provides americans with the tools they need to meet that responsibility by insuring all americans access to quality affordable health insurance. the bill eliminates barriers that prevent americans from getting coverage of such as discrimination based on pre-existing conditions and it eliminates that. we all of us either directly or through a family member or a friend with have heard the worst aureus how insurance companies to deny coverage because of the pre-existing conditions. this legislation stops that.

and it makes this quality insurance affordable to every american through tax cuts and help with copays and other out-of-pocket costs. and then for some reason an individual is still cannot afford to buy health insurance coverage that is unavailable to them if they are exempt from paying the penalty, clearly this is not a tax so if you can afford it you don't have to pay, no penalty. we have heard arguments in the excise tax and private insurance companies offer excess of the -- will raise taxes on individuals and this claim is equally untrue. the congressional budget office reached the conclusion that's not true and it reached the conclusion that it will lower premiums. i think the amount is 7212% if i remember correctly, stated in a letter to congress. this policy therefore is not a tax on individuals rather tax on private insurance companies and not passed on in the nature of

higher premiums according to cbo and, in fact, lowered premiums. this legislation is designed to encourage private insurance companies to offer employers to choose health insurance plans with lower premiums that are below the taxable threshold. and congressional budget office noted how effective this is reported most avoid the costs of excise tax by enrolling in plants with lower premiums. as a result cbo says premiums will decrease and wages will increase as employers offer more money in workers' pockets instead of an inflated health benefits. in fact, the bulk of the revenue raised by this provision more than 83 percent of it comes not with the tax itself but from increased wages, increased wages as a candid this provision. and the economist jonathan gruber is estimates it will cost more courageous to rise by $55 in 2019, that is $700 in

additional income for every household with health insurance. the truth is in this bill is fully paid for. fully paid for. cbo says so. and is paid for in a fiscally responsible way it reduces the federal deficit, provides quality affordable health insurance to millions of americans and is a net tax cuts. for american families, businesses and workers which in these tough economic times means more than ever. mr. president the senator from oklahoma. >> thank you. i stained a confused from the chairman of the finance committee because we have all the reports that the bill you were talking about isn't the bill we're going to be voting on because we're totally changing what we're doing. what is out there now is we are going to expand medicare to

those down 255 years of age and we are going to expand medicaid up to those at 150 percent, going to add billions of dollars of man days even at 90% copiague by the federal government to the states over the next 10 years. we have a medicare program that you've taken $465 billion out of it going to add 34 million new people to enter the new plan in the new plan we are talking about, you are talking about the planned use to have. is interesting bill as you made those points when you say it's a net tax cut as three-quarters of the net tax cut goes to people in this country who pay no taxes in the first place. in the chairman can deny that, the fact is that according to the joint tax committee the chairman conveniently doesn't look at the other body that gives us information on taxes. according to the joint tax

committee $280 billion of the 400 -- $394 billion will be refundable. that's refundable tax credit to people who are paying no taxes and out. >> can i ask the senator, the tax cuts whether or not refundable is extra dollars in people's pockets and. >> the fact is taxes to the average american family 40 million of them according to the joint tax committee taxes will rise on those who are making under $200,000 a year. the joint tax committee said that. now the point is is what you're talking about doesn't have the application because we don't have the bill again because we have a new bell on the floor which is going to take a bankrupt program that our children today are responsible. if you were born today based on of the unfunded liabilities of

medicare you are responsible for 300 and $50,000 if you are a new child born today for what we have not paid for in medicare. hpú4) that says premiums will rise. what c.b.o. says is that if you're in the individual market, your premiums are going to go up your premiums are going to go up and what cbo says is that if you

are in individual market your premiums are going to go out anywhere from 10% to 13%. and in fact, they are not sure whether the premiums will decline. they say it's on the other groups from a 1% increase to a 2% decrease over what they already would've increased. so are probably health care is cost. that's the thing that stops access to health care in this country. in the plan, whether it's the new plan which nobody's gotten to see the details of where the plan that we have been the details up, the 2074 pages that we have seen the details of, raises the cost of health care in this country. but none of that's important because the most important thing is that it puts government in control of your health care. through the task force on preventive health services, through the medicare advisory commission, and through the cost comparative effectiveness panel.

so with a wink and a nod is where going to the government in control of your health care. we are going to present a new bureaucracies between you and your doctor. we're tog0,0,0,0,0,ew federal employees between you and your.your and we're not going to lower the cost and the average american is not going to get a tax cut. they're going to see a tax increase under this bill. the average middle come unturned income america under american will see a tax increase. so what we have heard sounds good on the surface, but the most important thing to remember is you are no longer, you are no longer going to be control of your health care because once the government puts its nose under the tent, just like it did on rest cancer screening and we

have the gall to say we're going to recognize every time the agency does something that the harmful to their patient and doctor relationship that were going to come to the senate floor and corrected. and the fact is that ain't going to happen. so ultimately your health care is going to cost more, your premiums are going to rise. eleven out of the 12 studies they premiums will rise under the buildup before us and the people that get the tax cuts are the people who aren't paying any taxes now. and to pay for those tax cut, taxes are going to rise on 40 million american families who earn under $200,000 a year. mr. president, i yield the floor. >> mr. president, what is become the dorgan amendment, the senator from north dakota is a strong, good, talented legislator that has a good amendment up. the one i've looked at has been around his body for a long period of time. they have to rise in opposition

to this. a ranking member of the senator on agricultural and food and drug administration and the fda of our subcommittee. so i work on the issues of the fda. the university of kansas boasts one of the best pharmaceutical schools in the world, often rated number one as a pharmacy school. so anybody interested in that field of study or work, it's a good place to go, but also they're very concerned about what's in the dorgan amendment. the u.s. currently has one of the safest drug supply systems in the world that allows the federal food and drug administration to monitor and regulate the manufacturing and distribution of approved medicine route the country. the legal authority to import drugs already exist in this country. however, however no hhs secretary democrat or republican has been able to certify that the importation of prescription drugs in foreign nations is safe or will lead to cost savings.

none have been able to. the dorgan amendment will allow for the importation of drugs outside our current regulatory system established and enforced by the fda without certification and the secretary of hhs or a food and drug administration, the fda. allowing drug importation from foreign nations could threaten public health and result in unsafe, unimproved, counterfeit drugs being placed on pharmacy shelves in the united states. and i want to develop that part for you. the fda have been tasked with the responsibility of safeguarding the country's prescription drug supply and is executed that responsibility quite well. but as this country and the food and the food and drug administration struggles to discover and prevent the growing threat posed by imported, foreign produced goods as evidenced on a recent failures to detect polluted our backs such as infant formula, pet food, and toothpaste permitting the importation of drugs from

foreign nations about the complete assurance from the fda that it will not jeopardize public safety is irresponsible and threaten this nation's safety and proven drug supply. and toward that end, mr. president, i have got a letter that senator carper received from the health and human services agency, the fda of direct or be placed in the record after my comments. >> without objection. >> mr. president, this letter states in particular days and i just want to read from the fda chief put the commissioner of food and drugs is saying about the dorgan amendment. i commend the sponsors to include numerous protective measures in the bill that address the inherent risk and importing foreign products and other safety concerns related to the distribution system of drugs in the u.s. however, as currently written resulting the structure be logistically challenging to implement and resource.

in addition our significant safety concerns related to allow the importation of non-bioequivalent products and safety issues related to confusion and distribution of labeling of foreign products and the domestic products that remain to be fully addressed in the amendment. in other words, they don't think we can do this. importation, reimportation of drugs without significant safety problems. there's been an explosion of illegal drug counterfeiting occurring around the world and the emergence of a multibillion-dollar international black market is proven to the senate, current and past hhs secretary than the fda that weakening our prescription drug regulatory framework would only increase the risk of life-threatening counterfeit, contaminated, or dilute ascription drugs entering our prescription drug supply that millions of americans rely on antitrust. the ascription drug counterfeiting has become a highly profitable terminal

enterprise and has been taken up a international organization crime syndicates, rogue nations such as north korea,yria, and around in developing nations such as china and pakistan who seek to exploit ineffective four-week counterfeit enforcement frameworks around the globe. criminals have realized the production of counterfeit drugs is twice as profitable as the trafficking of illegal narcotics and comes with significantly less criminal penalties compared to those handed out for illegal drugs. due to these limited and minimal criminal penalties global counterfeiting has grown into an epidemic that reaches every country around the world. the who, world health organization, estimates that tens of thousands of people are dying due to counterfeit hiv, diabetes, and tropical disease medicines. unfortunately most counterfeit cases it is not what is included in these fake drugs, it is what has been excluded that proves to be most harmful and deadly to patients. by taking counterfeit deluded or

completely ineffective drugs are many patients fail to receive the important life-saving medicines they need. it is just as dangerous for a person with high cholesterol to use a counterfeit drug that lacks the prescribed medicine as it is for a person to ingest a contaminated or even a poisonous pill. due to this global counterfeit epidemic, two secretaries of hhs under both the clinton and bush administrations have been unable to certify that the importation of prescription drugs will not pose a substantial risk to the health and safety of citizens around -- but in the united states. and current secretary kathleen sibelius from campus has committed to preventing the drug importation system in the united states until it can be proven that the safety standards of the imported drugs are quotes, at or above the american standards, and of quotes. the fda doesn't believe they can get that done at this time. many of argued that the parallel

trade in europe has proven drug importation across nation borders have resulted in prescription cost savings and has not increased risk to consumers or general public health. however, these cost and safety assertions do not correctly reflect the european experience with drug importation through what's called parallel trade or at the study b the london school of economics on drug importation cost concluded that safety savings from parallel imports benefits middlemen and third-party vendors that buy and resell the impted drugs and do not get passed on to the patients in the form of lower prices. they say this, overall the parallel imports has continued to increase, health care steholders are realizing few of the expected savings. profs from parallel imports including mostly to the benefit of the third-party part of the needs buy and resell these medicines. furthermore, a report by the university of london school of pharmacy on the safe tea of the parallel prescription drug

stated thus wrote, the united kingdom is the most vulnerable country in europe to counterfeiting only to the high level of quotes parallel importing, and the quote. due to parallel trade, medicines and health care regulatory agency in the uk has issued ten different recalls of counterfeit drugs in the past five years. drugs recalled of prescriptions to treat schizophrenia, blood pressure, cancer, most disturbing fact that this counterfeit fition was that these are a country the kingdom are legitimate supply chains through parallel distribution trade according to the regulatory agency in the uk. the european commission found that the prescription drug supply in europe which includes the former eastern bloc countries like latvia, slovakia, and bulgaria is increasingly targeted by international criminal counterfeiters. european commission vice president gunter fair caught

stated that european trade brings a considerable risk on the safety of the patients. and that the increase in counterfeiting medicine is a very serious threat to public health and can cost lives. we don't want that happening to the united states, particularly with what we've seen in recent products coming in from china, not regulated under our system. and things like toothpaste, pet food, and then the problems we have here. do you want that to happen in the drug system? no, we don't and we can't certify that we can keep these products safe. so as you can see safety concerns and a lack of savings that may result from exposing the country to the potential risk created by the importation of drugs from outside or current safety system, these are real threats. it's kind of an interesting study in october 2004, then governor rob voinovich of illinois launched the i save our program to purchase low-cost

from canada. so we started this program. however by 2006, the illinois state auditor found that the program cost nearly $1 million was used by only about 3700 people in illinois and 267 residents of my state of kansas. mr. president, the health and human services have concerns regarding the safety implications. the food and drug administration has concerns regarding the safety of importation and we given the opportunity to purchase drugs, only a few kansans took that chance. we should not corrupt the safety of our drug supply chains without safety assurances on this country's regulatory bodies. >> madam president, the amendments that we are now considering as an amendment that i have offered that deals with the drug reimportation, that is the reimportation of prescription drugs from other

countries. you may have to question why we would want to import drugs from other countries. while fda approved drugs are made all over the world. and they are shipped all over the world. again, fda approved drugs approved by her food and drug administration produced in plants that are inspected by our fruit and drug administration. the difference is when they are shipped around the world the american consumer is charge the highest prices in the world by far. here is an example of the drug lipitor. there are plenty of examples in ochiltree number of them today but this is an example of lipitor. for an equivalent amount of lipitor, 20-milligram tablets in the u.s. consumer pays $125. the british pay $40. spanish paid $32. canadians pay $33, germans pay $40. we are charge the highest prices in the world for lipitor. lipitor buy the ways the most popular cholesterol-lowering

drug. i have a couple of bottles in my -- empty bottles and the desk story here that demonstrates this drug was produced in iowa. it was sent all around the world. same pill, but in the same bottle, made by the sum company approved by her food and drug administration was sent to canada. this was sent to the united states. the difference? well, the american consumer was allowed to pay three times as much as the canadian consumer. i should say forest. it's not just u.s. versus canada. as you can see as u.s. versus every other country answer the question as should that be the case? to the american consumer be charged the highest prices in the world? my answer to that is no. why is it the case that we are charge the highest prices in the world because we are the only counter he in which there is a special little law that prevents

our citizens from accessing that's fda approved drugs from wherever it is sold at the most advantageous price. we have a provision in law that says the american people don't have the freedom to import a prescription drug on fda approved drugs that they find for half the price or 20% of the price in some other country. i say give the american people the freedom. i hear so much discussion on the floor of the senate about freedom. as the ultimate freedom. the freedom of the american people to access those prescription drugs that are sold virtually everywhere else, brand-name prescription drugs at a fraction of the price. now i have examples of some other prescription drugs as well. just to show you that it's not just lipitor although lipitor is the most popular cholesterol-lowering drug. this is plavix. now plavix isn't anticoagulant.

you see that we pay higher than all of these countries by far. more than double what the british pay, more than double what the spanish day. this is an axiom. now if you or someone who has all servers and you are taking axiom, for an equivalent amount of the same drug axiom you are charge $424 if you are an american citizen, $40 for the british, $36 for the spanish, $37 for the germans. sixty-seven dollars for the french. the american consumer trying to control their condition of ulcers pays $424. ten times the amount of money that others are paying for the identical drugs. ten times. well, this kind of what i

believe is gouging that is a pricing strategy that gouges the american consumer can largely be resolved by the amendments that i have offered. it removes that little little sweethearts impediment in law and says to the american people, you may import prescription drugs that are fda approved from registered enterprises and other countries with which those countries are a handful of them that have the identical chain of custody that we do in our country. we also put in this amendment unbelievable safety provisions that don't exist now in our domestic drug supply, let alone reimportation. so if we were allowing the american people to do this, the congressional budget office says my amendment will save $19 billion, $19 billion for the federal government over the next

ten years, but about somewhere around $80 billion for american consumers above that. that's a pretty big savings. now, madam president, here is another chart that shows what is happening in addition to the fact that we are charge the highest prices in the world. what is happened in recent months in 2009, brand-name prescription drugs have increased in price over 9% at a time when there's virtually no inflation. they see increased prices for prescription drugs in this country, just over 9%. you get to pay 12% more. cingular for asthma you to pay 12% more. boning up for osteoporosis, by the way your prices now 18% higher this year. and that's what's happening. there's nothing, i repeat

nothing in any of the health care plans considered by the senate or the u.s. house that addresses this ease the price the escalating price of prescription drugs. now there's a whole lot of folks out here in this country that are not senior citizens that are taking drugs to manage their disease. they take cholesterol-lowering medicine. they take medicine to lower bread pressure. they manage their disease or manage their health issues and don't have to go to an acute care and a hospital because they are doing the right things and they are doing it with pharmaceuticals. the problem is the pharmaceutical prices are going up, up, up, way above what other people in the world are paying for their identical drugs. and i'm saying is just not fair. not a president, the issue is not that the pharmaceutical industries is a bad industry or that they are infested with bad companies. i just think that they are bad pricing policies.

just bad pricing policies. they are able to and therefore they do charge the american people by far the highest prices in the world. now i want to talk about a couple of important issues with respect to this issue of giving the american people the freedom to access or purchase that's fda approved drug anywhere. as long as it comports with the countries in which the chain of custody is identical to ours, which is in our bill and our bill includes as i said the establishment of pedigrees from tracers that don't even exist in safety for existing drug supply. there are some who say into alleged that you can't do this safely. it causes all kinds of problems with counterfeiting and so on. well in the fact that the europeans have been doing it safely for 20 years. for over two decades in europe under parallel trading.

if you want to buy a prescription drug in spain it is not a problem. you do it to the parallel trading system. if you are in italy and want to buy from france, no problem. they've been doing that safely for long, long time. suggest somehow we don't have the skill or the capability to do what the europeans have been doing routinely for 20 years is really in my judgment shortchanging our country and certainly shortchanging our consumers. now, we will however i think of people allege again that this is risky. it's just risky. i want to make the point about risk because i want to demonstrate something that i think most people don't know. 40% of the active ingredients of our existing prescription drugs come from china and india. 40% of the active ingredients come from china and india and in most places from areas that have

never been inspected. now, my amendment does not allow drugs to be imported into this country from china or india. i'm talking about the ingredients in the pharmaceutical company acquires with? to make their drugs. we don't allow drugs to be imported from china or india as a matter of this amendment. only fda approved drugs from fda inspected plants in canada, the european countries, japan, new zealand, australia. that's all. why? because they have a chain of custody to us. and that the basis on which we determine how reimportation could work and good work safely. but i want to describe a recent scandal that illustrates the double standard that some want to apply to this question. and the scandal was about a drug called heparin, a blood thinner commonly used by dialysis

patients was linked last year to more than 62 deaths. heparin was ultimately pulled from the market and according to baxter health care which markets it in the u.s., the allergic reactions to heparin that cost those death appeared to be caused by a contaminant that was added in the place of the active in gradient in heparin somewhere during the manufacturing process, most likely in china. "the wall street journal" did a really important story on the heparin contamination. they reported that nearly half of the world's heparin gets its start in china's poorly regulated supply chain. this is what "the wall street journal" after its investigation concluded. more than half the world's heparin, the main ingredient and is widely used anticlotting medicine gets its start in china's poorly regulated supply chain. wall street journal also published a series of pictures that i want to show, photographs

of what is called the intestine casing factory which processes pig intestines used to make heparin. and i want to show some photographs that came from "the wall street journal." this is a photograph of a facility and that's the outside. here is a photograph for someone in the facility who is stirring a rusty back full of heparin ingredients with a tree branch. the processing of heparin from pig intestines in a facility in china and which in this rescue that, the worker is stirring with a tree branch. and so, are the ingredients that

are used to make medicine with respect to the blood clotting issue. so when the industry and others say that we can't have drug importation safely, from canada or ireland, the point is they are getting a lot of their ingredients from china and india and i would say simply look at this and ask yourself whether the domestic drug supply with respect to that ingredients and those imports have sufficient safety. while the record-keeping of these chinese facilities make it almost impossible to trace brother the contaminant from this particular factory and these pictures taken by "the wall street journal" clearly show unsanitary conditions in which pig intestines are processed for that particular

medicine. again by contrast, the amendment we offer would allow the importation of fda approved medicine only with a chain of custody to ensure that drugs are handled properly. it gives the fda the authority to inspect all facilities and all of the chain of custody. now the amendments mandates the use of anti-counterfeiting technology to track and trace for imported and domestic to ensure product integrity. that doesn't exist today. but that is required in this amendment. the amendment also requires pharmacies and drug wholesalers to register with the fda and to be subject to strict requirements to assure the safety of imports and medications including frequent random inspections. so the amendment i am offering here would ensure safety and in fact are biting much greater margin of safety that now exist with all of our drug supply. and we need to have these improvements and my judgment

because our own prescription drug distribution system is not as good as we think it is. here's an excellent example of something that took place in the united states, a 2000 -- well, this is a picture of mr. tim fagan, a young 16-year-old boy from long island, new york to receive a liver transplant. he was prescribed a drug after his transplant to boost his red blood cells and to fight the anemia after the operation. he received daily injections, but his red blood cell count was and improving and the doctors couldn't figure out why, what was happening. after two months, tim's mom went to her local cvs pharmacy where she was told by the way the epogen your son has been taking may have been counterfeits. and here is an example of again an example of counterfeiting in

the existing domestic drug supply. counterfeiting in which this container called the counterfeit medicine and its container held a real real medicine. there were subtle differences, but not much. turned out that the vials that tim was inject dean could take one 20th of the strength of what he was supposed to be taking and what was disclosed on label. how did that happen? while the weaker drug sells for $22 a bottle and the high-strength version goes for $445 a bottle. investigators found that 110,000 of the bogus bottles reach the market in this country and is estimated that criminals involved without counterfeiting and that particular case made $46 million. ..