constitution and being the chair of that subcommittee for 13 years so being voinvolved in an impeachment and other springing intellectual resources and violatio violations. i thank them for accepting this responsibility. i wish them well. it is going to be a very big commitment of time and i don't think we could be better served than by patriotism and dedication of the managers that i am naming here this morning. thank you all very much. today the subcommittee looks

at the anti-semitism attack in tust. live covera u.s. online c-span.org. or listen live on our c-span a. congressman kurt schrader at our table today here to talk about prescription drug pricing. the house passed hr 3 last year. what is it and what will it do? >> it's the first attempt since the passage of medicare part d 20 years ago to reduce drug prices for americans. we hear again and again drug prices and health care costs are the biggest issue for americans right now and this would allow the united states government health and human services to negotiate drug prices. we negotiate drug prices in our private lives. we negotiate them with unions and businesses. why can't seniors, why can't

americans negotiate drug prices? it's a market based principle. republicans and democrats should be able to agree to that. if your drug costs go beyond a certain point, seniors are on the hook for 35, 40, $50,000. both democrat and republican bills would limit that to 2 or $3,000. we've learned in energy and commerce, in investigating drug pricing increases, there's a whole chain of events, a lot of different actors playing into these cost increases. we need more transparency to make the right move politically to make sure these increases don't affect people like they have so far? >> who on the business side, which companies would be impacted by that type of negotiation? >> probably first and foremost the pharmaceutical companies. i think pharmacy benefit managers who negotiate prices for different companies and different groups would also be affected. consumers would hopefully be affected in a positive way at

the end of the day. the federal government taxpayers would hopefully not have to pay as much out of pocket. so there's lots of people i think that would be affected along the supply chain. pharmacies themselves are caught between, they have to make a little bit of a profit on the medications they sell, but there's clawback provisions. they have to pay back, after the fact, dollars to various companies that these pharmacy benefit managers negotiate with. there's a lot of folks that would be impacted by this bill. >> how do you respond to republicans and others that argue that this could kill innovation, that pharmaceutical companies then are not incentivized then to spend the billions that they have to spend on research to find new drugs to prevent and possibly cure diseases? >> i think that's a little bit of a bogus argument, to be honest with you. will they bring quite as many new medications to market as they are right now? probably not. but you've got to weigh that

against the decrease in cost to the american consumers. if you can reduce these increases from 15 to 20% a year down to 2, 3, 4% a year, that's a huge savings to the bulk of the americans out there. most of the medications and drugs out there being formulated are what's called orphan drugs, they're neat, they work for targeted disease entities, but it only affects a hundred thousand people but the costs could be heavy to the taxpayer and the system. they're going to spend a lot of money on research anyway, it's their bread and butter, and there will still be a lot of medications coming to the market. >> there's story in "the new york times" about a new way of trying to pay for the cost of these very expensive drugs that treat these sort of niche diseases. and one of those ways is allowing these drug companies to pay it back.

what do you think about allowing the market to take care of it? >> i think that we have a twofold approach. one is the market should be able to take care of it like in hr 3 where you can negotiate drug prices or at least limit increases going forward. i've proposed a values-based approach that the pharmaceutical companies acknowledge is probably a very fair way to go, as well as protecting the consumer. >> explain that. >> well, if you come up with a medication or drug that's going to cure a disease like hep c, maybe you get the full reimbursement, the $50,000 that drug costs. but you could amortize that over a period of time. in other words, instead of paying $50,000 up front which would bankrupt care organizations in oregon, you would pay it back over the lifespan of the individual. or if your medication is only a

palliative, decreases your pain or reduces the mortality rate from five to two years, or from two to five years, then you get paid a lesser amount than the full cost of the medication. and i think there's very -- a lot of interest by the companies on trying to get to solving our problems with rising costs, rapidly escalating costs of pharmaceuticals. >> what did you make of president trump's attempts so far to reduce prescription drug prices? one of his ideas was to compare it to the international index of what we pay versus what other countries pay. but it seems that that did not go into effect. is that a good idea? >> actually that's what hr 3 tries to get at a little bit. the president tried it on his own, got rebuffed, why do we have to set it to european standards, all the drug prices are going to go up, the innovation argument you made. we're trying to get at that in a slightly different way in hr 3.

but i think beyond hr 3, there is an opportunity to incorporate elements that are in hr 3 as well as in the senate finance bill, as well as in the senate health committee's bill, and as well in the senate judiciary's bill. we could really have, and we've already seen it both on the house and senate side, bipartisan support to reduce these costs dramatically. maybe we can't get to the negotiation piece this session. i think it's important to bring it up, so american consumers realize, wow, why can't we negotiate? they'll demand action over the next several years. but we can limit out of pocket costs, we can do the transparency piece, and we can make sure that the drug prices for existing drugs don't increase beyond inflation. right now inflation is, what, 2, 2 plus percent. drug prices are going up 5, 5 plus percent. that's wrong. >> do you think any deal could also include an address to surprise medical billing? >> i certainly hope so. that's a big deal back home.

every american, certainly in oregon, is trying to get insurance, you stay in your network, your doctor, your hospital is all in network, you go in for your surgery for your knee or whatever, only to find out the anesthesiologist isn't in network and you've got a 20 or $30,000 bill, you go, my gosh, what happened? that's not right, that's not fair. the consumer has done the right thing, played by the rules, yet the way the arcane structure of health care is, they have this huge bill at the end of the day. so yeah, surprise billing. in the energy and commerce committee we came up with i think a really, really good approach. there was a bit of a fight. everybody agreed that no one should get stuck with those bills. but the question is, okay, who does pay what at the end of the day? the insurers had one idea, the doctors and hospitals had another. and we sort of split the baby. so no one really likes this right now. but it was a good approach where there is a bit of an index, a benchmark that we should be thinking about t thinking about for the costs of these out of network costs you

face. if there's disagreement, you go to arbitration and come up with a fair approach. new york does that, and they've had great success. >> all right. we're interested in our viewers joining this conversation as well. tell us about what experience you've had with prescription drug prices or surprise medical billing and what you want congress to do about it. let's go to yancin, i believe is her name, democratic caller. >> caller: yes, hello. [ inaudible ]. >> good morning. go ahead with your question or comment, we're listening. >> caller: all right. i recently went to my physician for an annual physical. it was october 29th of '19, 2019. i had been going to the same family practice for over ten years. never had to pay for a physical. this time, i came out with a $254 charge. i have been in contact with the

hospital corporation since 11/16 when they first sent me a bill, with no satisfaction. they're telling me that they're charging me $254 for advance directive counseling that was supposed to take at least 30 minutes on the bill, it said. if you've been to a doctor you know you don't spend 30 minutes in the doctor's office for anything anymore. i was there ten minutes. i didn't get the service they're saying. the young lady asked me, the physician, who is now my doctor, asked me, ms. richardson, what would you want to happen if you had an emergency reaction here in the office? would you want resuscitation? i said yes. cpr is what she said. i said yes. and she handed me a form for -- to fill out as far as that

procedure as far as -- not counseling, but directives for the hospital, if you can't speak for yourself. so that was handed to me. there was no discussion about what i should do with the form, who should help me fill it out, whatever. so i've been talking to them. they told me that i am responsible for this $254. my insurance, which is federal employees bluecross blueshield, is not going to pay for it. i do not have medicare. i cannot afford $254. what am i supposed to do? >> wow, you got ripped off, ms. richardson. you got ripped off. that's exactly why we're trying to get people universal access to basic health care. if you're on an exchange rate of plan, that physical, if it's a once a year annual physical, it's free. if they're trying to charge you for that in any way, shape, or

form, that's wrong, you can take them to court. on the advance directive, i hadn't heard that game played before, but unfortunately we're going to see probably more of that. i would certainly get a different doctor at the end of the day, if they're trying to do that. end of life planning is a basic thing that everyone should do to protect their family, not just yourself, but to protect your family from huge costs at the end of the day. and it should be incorporated in just any exam. i think that's egregious. i'm not a lawyer, i won't tell you how to go about this, but i would certainly seek some legal redress. i would call blue cross to the carpet a little bit and say, hey, basic health care information like you got should be totally covered with your once a year annual exam. >> lynnel, new orleans, democratic caller. lynnel, go ahead, please, for the congressman. >> caller: good morning. >> good morning. >> caller: thank you for taking my call.

my issue is about us spending money for drugs that -- the drugs that we're taking now instead of solving the problem, they're creating problems. >> what do you mean by that, lynnel, creating problems by doing what? >> caller: making you sick. you're getting cancer. and then we don't have the medical to take care of the problems that the medication is causing. >> okay, lynnel, you've got to turn down that television, it's causing confusion. listen and talk through the phone. congressman? >> hi, lynnel. yes, i'm a veterinarian, in real life i spent 30 plus years as a veterinarian, aware of side

effects from a lot of medications. a lot of the newer medication are more powerful, have a more targeted effect, perhaps, on your particular condition, but also big side effects that end up making you take other medications, which is probably wrong. what you need to do in my humble opinion have a conversation with your physician about side effects that your medications are having on you. is there perhaps a less potent but also very help fful medicatn you can take for your condition that wouldn't cause the side effects. one of the things you need to do very carefully is make sure you read these labels and question your doctor on any medication on the side effects they may cause for you. they extend the quality of life, hopefully for the most part, keep you out of the hospital, but the side effects can be debilitating and hopefully you can get a better idea what those are and get a different

medication. >> milwaukee, a democratic caller. >> caller: hi, thank you for taking my call. i called on the democratic line, however medication has no party. you know, and in this country, we might spend a lot of money on research and development, but other countries like canada and other places, they do negotiate with the pharmaceutical countries as to how much they will pay in order to do business with them. now, my question is, why is it so difficult for us to do the same thing? because when we have things like the epipen, when that young man, i can't remember -- >> right.

>> caller: -- who purchased the right to that, it went from one price, it skyrocketed. i want to understand, why don't our government prevent those kind of things happening to our citizens for our drugs, because, again, this is not democrat, it is not republican, and it is not independent. it is a matter of people being able to afford and access medication. so you're democratic, i would like for you to respond to that. thank you very much. >> sure, very good question, very thoughtful. i totally agree. the united states of america and americans, american taxpayers, shouldn't subsidized low cost drugs around the rest of the world. everyone should pay their fair share. i think our prices should be

able to come down, we should be able to negotiate prices. the little secret that a lot of the pharmaceutical companies won't tell you is that they're going to raise their prices on the folks in europe and other areas to make sure they can make a profit and do their innovation that they want to do. but i think there's got to be a balance. we should not be subsidizing these people. why can't we do it for seniors, why can't we do it for anyone? there's no defensible taken for that. we need to come up with an approach where it lowers the costs and frankly get the europeans and other countries to pay a little more. on some of these hedge fund managers that buy orphan pharmaceutical companies and jack the price up like they did on epipen and some of the other

medications, we went after martin srekeli, we went after mylan. we passed a bill in the last congress that would make that not something that they would be wanting to do because we put competition in the marketplace. if there's an orphan drug out there we allow a different company that wants to make a competitor to go to the head of the line, get quick approval and put it out there to drive that price right back down. so the incentive to rip off the american consumer is not there. >> west palm beach, florida, wanda, a republican, you're next. >> caller: good morning, thank you for taking my call. i agree with the former caller who called online and said there's no party regarding prescriptions and health care. and i agree. i tried to call the democrat ry line and couldn't get through. but long story short, the reason i'm calling is that for years,

since 2010, a small amount has been deducted from my check each month for what they called late enrollment penalty. from sometime in 2010. now, i've tried to resolve it, i called my representative and her expertise on the issue said, we don't know every law, there's nothing we can do about this. i've tried to explain the illogic of this. if you have a late penalty, for example, under irs, you take care of it, it's done, you don't pay for it the rest of your life. and so i think this is a very unfair aspect, even though it's a negligible amount, about $2.90. now, on the notice i received last year about how much i would be getting this year, it calls it information about your medicare prescription drug plan cost. it's no longer calling it a late

penalty. so, you know, this is astounding. another aspect is that i take a drug that's been around for decades. it's for hypothyroidism. it costs me $15 a month. and it's been around for 70 some-odd years. i was taking another medication because i do better, i know there's a controversy about that, about the brand name drug costs me $40. i had to cut back on my expenses and i feel i'm not doing as well. this is ridiculous, these drugs have been around for decades but drug companies are still getting a monumental amount. these drugs should be like an as principal, practically, although as principal is pretty expensive these days. what about those two issues, the cost of drugs that have been around for decades and the late penalty for enrollment that i'm not even sure that it happened,

it's ridiculous. but thank you for taking my call. >> good issues. and a lot of folks face those. i assume you're a senior on medicare. there is a late enrollment penalty, if you don't sign up exactly when you're supposed to. and it does go on for the rest of your life, which is, i agree with you, totally unfair. most other penalties are for a short duration of time, you pay your fine for the mistake you made, not when it comes to signing up for medicare. and we're trying to fix that. i've got a bill out there, we had a big hearing in the energy and commerce committee just last week on medicare enrollment penalties and what we can do about it. a lot of folks think they still have coverage through their job, that ends, and then they can't enroll for in oanother year or and what do they do for health coverage in the meantime? not right, not fair. a lot of folks don't read the

fine print, you're supposed to sign up for medicare at a certain age, there's conflicting advice out there, sometimes people get wrong advice. congress is listening. we're heard this. it's unfair. we're in the process of fixing it. we'll probably have a markup on a number of bills to address this medicare penalty. sometimes you can get that reduced if you make your case to the federal government, you had a good reason, you were misinformed, whatever. i would urge you to follow up on that. and, you know, with regard to the rest of the drug problem, i think the main thing is being able to have an opportunity to have that negotiation at the end of the day, and limit price increases. as a veterinarian i actually prescribed that drug and a bunch of others, they were very inexpensive, not costly at all, but what happens is they become unprofitable because they're fairly inexpensive, drug companies want to go on to the big new blockbuster, there's

more money in that, i get that, this is a capitalist market economy. drug shortages are a huge issue, both in theerinary field, the human field. we're trying to address that. there are innovative solutions coming forward by nonprofit groups, by some of the manufacturers themselves. hopefully over this next six, eight months, and to the earlier caller's point and yours, this is a bipartisan issue, a democrat and republican issue. we'll be able to get bipartisan support for reducing these costs so you can get the medication you need. and again, i'm very sympathetic to the fact that you actually require a brand name drug. i had many patients in my clinic, they were four-footed, and they required a brand name drug to get best results. we should make sure those costs are driven down. the most recent trade agreement helps us a little bit, believe it or not, in that area, as well

as hopefully the whole issue of getting to lower drug costs. there is bipartisan support for that. the senate health committee has what we had in hr 3 except for the negotiating piece, but it would limit increases going forward. the senate committee did good work to prevent these one-off raises in the generic marketplace you're talking about. there's a lot of bipartisan support out there to fixing these problems. >> dave in michigan, independent. question or comment here for congressman schrader. >> caller: yes, good morning to both of you. >> good morning. >> caller: and to the whole world out there. yes, i don't use drugs right now, prescription drugs, but that doesn't mean you don't want to be able to if you have to. i'm old, i'm on medicare now.

i got thrown off medicaid because i owned too many items in equity which i worked all my life for and now my dignity is all gone, i can't enjoy that. i'm not going to give you the hardship case, but kurt, if a system that could be worked out as a bid system annually on all these drugs, for all these companies, get their ducks in a row, put up a big system, it would be fair for everybody and supply and demand, you would be under control. and thanks, kurt, and have a good day. >> all right, dave. >> i agree, dave. i think you've got a good point. we all negotiate in our daily lives for best price, different stores, different insurance companies, auto, health, you

name it. we should be able to do that. on a regular basis, we shop for different insurers that offer the best deal, cover most of our medications or health care needs. we need to be able to do that more directly with pharmaceuticals. the problem is we've got this weird chain of command, if you will, that's grown up where the drug companies may only increase the price of the drug a couple of percentage points, and actually pharmaceutical costs have not gone up that much in recent years, but what you pay at the end goes up dramatically. there's pharmacies, there's pharmacy benefit managers, there's hospitals, all these intermediaries that get a cut of pie. the farmer is selling his produce for the same thing he got 20 years ago but the costs for you have gone up dramatically because of all these middle men in between.

we have to look at where people are taking extra profit. consumers should have more information so they can negotiate a better deal for them. i think that's the goal here. we're raising this issue for the first time in 20 years in the united states congress, getting a lot of play, folks like you are paying attention. and i truly think that bidding on various drug costs is the way to go. pharmacy benefit measures shouldn't do spread pricing, they should focus on unit pricing. a bigger discount on a higher cost drug means you may be paying a whole bunch more than a lower discount on something that may cost 10 or $20. if the veterans administration can negotiate prices and medicaid and dod can, why can't medicare folks? seniors who made our country a very great place to live, why can't they benefit from just notification? simple american market-based

principle. >> congressman kurt schrader, thank you for the conversation this morning. today the house homeland security subcommittee looks at the rise of anti-semitic attacks in the u.s., beginning at 2:00 peern p.m. eastern on c-span3. campaign 2020. watch our continuing coverage of the presidential candidates on the campaign trail and make up your own mind. as the voting begins next month, watch our live coverage of the iowa caucuses. on monday, february 3rd, c-span's campaign 2020. your unfiltered view of politics. next, national security experts talk about the u.s./iran tensions at a conference hosted by the center for american progress in washington, d.c. thank you all for coming