Transcripts For CSPAN2 20090626

i now turn to senator enzi. >> thank you mr. chairman. it's been an interesting discussion this morning and our side is going to expedite a little bit of the morning's process partly because senator coburn is also and the defense markup that senator mccain is in and has seen what happens with a number of his amendments. @ @ @ @ @ @ @@@@@@ comments on the bill and a couple of comments on some of the amendments that could have been offered and we can have senator mccain come in and present his amendment, i guess. i want to thank senator sanders for his comments. i do need to point out the criminal charges and settlements that he described involved medicare and medicaid, both which are government-run plans, and perhaps the problem is with government-run plans and their underinvestment administrative controls and distortions that are caused by their price controls, and i w or ones that are prosecuted and won during the bush administration had. so there has been some oversight and some activity there. the difficulty with fraud and abuse section that this bill has is that it drastically increases the cost of health care for large employers. the bill imposes new restrictions in the name of combating fraud but is a clear attempt to limit the ability of employers to offer uniform benefit packages across the country and that reduces administration costs. you eliminate that you increase the cost of health insurance. it is these changes employers may not provide a target of plans for their employees. the authors say they would like to focus on the private-sector not the public sector. this seems to be a theme throughout the bill the prevention section to evaluate employer wellness plans will federal dollars and now they want to combat fraud in with federal dollars. here's an idea out like to throw out. let's concentrate on combating fraud and the government run programs before we spend taxpayer dollars on saving money in the private sector. those cases that were one word government run, we could be saving the government -- >> with my friend yield? >> if we target -- i didn't interrupt while you're talking -- but instead will spend money on, adding outside the federal government. i also included in this bill provisions relating to false claims. it states employer in short will be false claims penalized and maybe and the jurisdiction of the department of justice. so what this section will lead to is one thing and one thing only and that would be a more frivolous lawsuits. we have seen there is no defense in the liability area that will shipped off to the judiciary committee referring and if you want to combat fraud and the sense of congress will fund fraud and abuse activities at the centers for medicare and medicaid services and that is where we find the real from and there for the savings have done that in the medicaid area animator real advances. in fact, i talked to a man that moved to handle that situation and talk about what could be done in the medicare area and finally the bill before us establishes a senior adviser to the secretary of health and human services and another to the attorney general. at the kennedy done the bill does not combat fraud, it creates more bureaucracy. hhs and the department of justice on the advice on how to combat fraud, they need resources and the government programs. increase the council to it developed issues and these do not need to further discuss fraud and abuse, they need the resources to combat it and there isn't anything that will reduce fraud. and should be a bipartisan issue and i think our side has raised some amendments but we know they are not going to be included in it. senator coburn has i think nine but there are six he is particularly interested in. to reduce medicare fraud and i could never do an adequate job of discussing these and won't even attempt to, but he points out that the way to prevent fraud and abuse and all of the amendments are aimed at medicaid and medicare fraud and and we know from state experiments which do with medicaid because that is the one i have to pay a portion of and there are extension in there are huge opportunities there. even suggest a doctor from the squad was should be a demonstration program or there would be health care professionals that would conduct random visits to health care practices and attempt to purchase pharmaceutical medical equipment participated in visits and inspector general two follow-up on notable findings in refer individuals to appropriate federal authorities. and, of course, help the courts come up again the state health courts, state medical liability situation senator gregg has much more technical amendments he would offer but would ask you to look at because the kennedy bill would open up the current preemption of state fraud laws under erisa and allows the plans to be subject to 50 different state laws on fraud. and his amendment was strike that provision and maintain the current law. that is one of those things where we would be make it extremely difficult for employers to comply if they have employees and most of the states. another one of his eminence is to the department the kennedy bill the authority to take summary, seizure plans and a hazardous condition and our the department of labor had the authority for a season or a seizure on health insurance plans and that shuts them down and eliminates the service that might come to the people instead of some kind of mechanism for making sure they continue to be covered. all of the amendments deal with a erisa particularly the seas or seizure parts of it, i hope that the other part will take a look at those and see if isn't at the least a glimmer of idea to have some basis for a needed and hopefully have something done. he expands and the erisa and amendment number 34 and then senator hatch has an amendment number 28 which is studied to determine the need for separate health-care fraud offices within the hhs and the brahmin of judges -- justice but not all being offered in this morning. i would ask you to take a look at them and see if there is some value in them, some way they can be used in some way that they can be switched from placing this emphasis on the the erisa companies that are over a number of states and more who administrative health care oriented. i think that leads us to the mccain amendment. >> as i understand it i will have staff take a look at these proposals and as i said earlier in the week with the issues raised wanted to proceed by doing title by title of this legislation so have a manageable way to proceed in and while we still have remaining obviously to deal with the long term care issues because of a scoring problems and have had no one to come back to as well the matters will be left open until the following week from independence day recess, but i also made it clear that i wasn't going to be insistent upon that title because of circumstances to handle matters that come up and i tend to live by that promise as well but i would ask colleagues again and i respect the fact we all have conflicting obligations around here as evidence by our colleagues during the other things as well as to be here and tancredo with a tennis we have had over the last few weeks and with another way to go will be critically important. i understand why they can't be here and the intent is two have my commitment to go over these and see if there is in something to accommodate. i would like to mention regarding the fraud and abuse section and that is the majority of the amendments filed to this title may policy or add new authority to medicare and medicaid and while we clearly are stepping on each other's jurisdictions an awful lot of this is more appropriate in the jurisdiction of the finance committee not to say we can't be heard but i think most are aware of that and the importance of fraud and abuse of public programs. i don't think it is our intention. >> i wanted to respond i get tired and i think the american people to do about hearing medicare fraud and the implication is we have people who work with a garment to are dishonest. we've done a little research is not definitive and on not aware of major examples where people were for the government have been abroad. i haven't seen it. when a talk about medicare from what we're really talking about is pharmaceutical industry from against medicare. insurance company fraud against medicare. a private hospital insurance fraud and i hope this with medicare and medicaid we put in our figure who is committing fraud. i hope we rephrase. >> i think it is medicare and medicaid to have the obligation to do the enforcement of its demand that is fair enough but we can make that better but when for example of some it doesn't pay your taxes in the go to jail or don't get a government job we don't say is the irs fraud. we say you did not pay your taxes appear less put our finger on the people, i agree with you i think that is what this bill is trying to do but the people who are committing that fraud is not medicare and medicaid, it is prime rib corporate insurance. >> i tried to quantify this does not easy but briefly share with my colleagues how much fraud is out there. in 1990 the fbi estimated 10 percent of all health spending is lost to fraud and abuse. in the national health care anti-fraud association estimates 3% this lost to fraud and abuse. 10 present presumably in their but significant amount and some suggest senator sanders has answered that clearly looking at how well the programs are managed is very important but i think your analogy is is a suggestion that is where it is occurring i think is to misplace. they employ key enforcement agent and as of may of 2009 it issued 7608 criminal investigations of any monetary penalties. they currently have 73 investigations ongoing in criminal activities organized-crime operations involved individuals losing millions. organized crime is not employed as medicare or medicaid, the people taking advantage of the systems giving it as a disadvantage of the people who count on these so to the extent i am aware there may be exceptions and is important to know are investigating employees of the department of health and human services or the medicare program itself. i suspect most of these are focusing on non-governmental employees and the people of using the process. i see my friend -- >> mr. chairman, and want to interrupt the flow here but i do want to respond to it senator enzi arguments of we can do that. >> can i say to my colleague, i apologize, i am in the middle of the mark above the defense authorization bill down below and i want to apologize to all members, but we are trying to wrap this up obviously today as the chairman is trying to wrap up so i appreciate your indulgence. i think the chairman of for your courtesy. this is a simple amendment, and tissue banks around for years and one that no matter what happens today we will win sooner or later because it's in the interest of the american people and fm and could get handed out i would appreciate its. >> mccain member for. >> is the one on importation. >> yes one of my favorite scheme and normally when this comes up either thad cochrane or senator roberts puts in amendment dealing with safety section which i assume you do not have in that amendment. they would not have an opportunity at this point. >> this requires the secretary of hhs to verify the safety of imported prescription drugs, so i don't know what more you want in it. but if we get the amendment out maybe could clarify it for you. >> appreciated, thank you. >> i don't know of any senator who opposed an amendment that would allow unsafe or dispersed and oftentimes that did not meet all the safety standards. so simply put it would provide access to safe import a prescription drugs and much lower price. the amendment would actually lower the price of this legislation due to the significance savings and provide americans and the government the eminence would waive the federal food and drug demonstrations limitation on the importation of prescription drugs from outside and require to verify safety of imported prescription drugs, prohibit manufacturers from engaging actions to restrict the importation of, prescription drugs and% for the provisions governing the purchase of prescription drugs from an internet web site. they have been found imported to be 35 to 55 percent less expensive than those sold in the u.s. at a local pharmacy and the budget office's asked $50 billion over the next decade in. if they were able to buy imported drugs according to an april 2008 poll by kaiser public opinion they take prescription medicine daily. there is no better soon as for the 50 percent of all americans to take prescription drugs daily end the millions prescribed msn when diagnosed with an enormous. we are going to hear the wish that my colleague and friend were here because he is far better at this than i am. and he has seven bottles of pills and describes the different cost if you bought in canada or the u.s. and doesn't really great job. i have seen the act about 30 or 40 times and i enjoy seeing it again because he does every job. i think it is lipitor he carries around to different bottles so i don't pretend to do as persuasive a job as my friends of north dakota but we're going to hear arguments from the pharmaceutical industry on why the amendment shouldn't pass and the most powerful lobby in washington is pharma and they exercise their muscle with great frequency income should be millions of dollars to campaign coffers. this i understand the opposition here. you are going to hear the industry. we had a little intercepted e-mail the other day when we were going to get in on the floor and the arguments were they needed to contact various people in order to stop this and they will argue they are not safe and argue that fda doesn't have resources to ensure the safety of imported drugs. but let's be clear, the almighty pharmaceutical industry concern is competition. any claim that important -- imported trucks is inaccurate, safety is of utmost concern in this amendment would require pharmacies and drug wholesalers to register eight yen is industry safe requirements including many fratricide inspections. additionally require strong anti counterfeiting measures and chain of custody rules to ensure that only authorized persons handle medications. it would provide the fda the resources and authority to ensure the safety of imported drugs and stop illicit sales. i don't know whether this will pass on this bill particularly when it may have some additional courtesy given the fact we're trying to find ways of paying for the universal health care making an affordable to all americans. i have watched the pharmaceutical industry and a powerful army and they may be able to do so and again, but i have been around this kind of issues where we taken on the special interest for a lot of times over the years. we will do what is right in the long run. maybe not in this committee or on this bill but as some point in time because it benefits the american consumer and 50 percent of the american people that have to take prescription drugs everyday and to their benefit and sooner or later they will prevail. with that i know we will go to the same discussion and i would request a recorded vote on the amendment but i also wouldn't take too much of a time because we have a ventilated this in the past. >> i presume this is the same amount offered as part of the mccain dorgan snowe of language. >> another issue has been raised by senator enzi and the question of whether it was going to language and as part of this bill i don't know the answer. >> according to the staff is not in here. they put safety provisions in there and always mention that, but i have gotten a copy of the cochrane roberts language which places requirements for safety and certification before the bill can go into a fight which is what we have always past when this bill has come up and some point they figure that with that amendment in there is a worthless bill. but i would ask unanimous consent to be able to offer her the second-degree amendment to the mccain amendment. >> mr. chairman, we will have to vote on that but let's have no doubt you wrote that parma and thus have no doubt about the fact, it would kill the bill so you can vote for this if you want to but the fact is that it kills the ability to import drugs and that, let's not have a charade. and so i would be happy to do what ever the committee wishes are two have a vote on that but have no doubt it would have the effect of killing legislation and amendments before us. >> mr. chairman i have supported this proposal and the past and i think the case has been made on the importation. i supported this in the past, we had a vote to something similar to this and i supported it and i would again today. i think this is an important provision and moving that direction but obviously members i have disagreed at this point i don't think the when bush necessarily kills the bill, it does raise the issues about effectiveness but nonetheless i want to be on record as being supportive of this effort and another has been an effort in the past you talk about this in different vehicles but this is certainly major cost factor in dealing with health care so i'll leave my colleagues to express their views but that is where this stands on the issue. >> thank-you and i rise to support the mccain amendment and oppose and a secondary amendment, i have been two this as john has for a decade and a half working on these and patent issues that pharma seems to when we went the battles they win the war. any weakening language has been buying the cost savings to consumers and public safety. as john points out it denies savings to consumers and doesn't save us the money it was saved if we were to do this right. for a year i represent a district in northern ohio about four hours from the canadian and i used to take a bus loads of ohio consumers mostly elderly by not all to canada to buy drugs and it was a peculiar thing for a federal official to take people to another country to buy prescription drugs that could have bought and a local drug store and the same brand name and same box even this exact same drug inner to an active ingredients but the price was have for a third or one for them in the cases and that is because canada and not because of a single payer health care system but because the government did with the v.a. does in this country negotiates drug prices directly on behalf of 30 million canadian consumers and with the drug industry got price savings of 50 or 60 or 80% as of the mccain approaches the right approach and cost savings that are so important will be contributed to this bill and we pass the mccain and language without the weakening language. out at those same cost savings we can see in the biologics when we do the section of the bill later because it would be how generic drugs have cut the cost of chemical pharmaceuticals and we also know the same process will save billions over 10 years plus and has a pretty good score as we're trying to consider this quarter. and keeping the cost down and so this is one element of doing that. not to be weak in the by the cochrane firm of language as suggested and coupled with what we can do in biologics i think it will bring prices down for consumers for hospitals and private payers and taxpayers. >> mr. chairman, i am going to apologize to my committee member and the ranking member did not to an adequate job. i'm not going to ask for the second-degree amendment because i think it is a terrible precedent for us to set, we will never get our committee work done if we start having second degree eminence and we do need to get committee work done. i am not going to make that request. i am going to make a request -- worded viggo? >> he laughed. >> it's a little hard for me to make a request of him if he is not here. >> mr. chairman, senator mccain said he had to go back to armed services. >> my request he will probably want to have some input on for him to defer this to the coverage section. it is coverage and could be voted on there and i suspect it won't change a single vote but that would allow us to put an amendment without changing the precedent for the committee for second degree eminence. i suspect that it will get the same result at that time that they would right now so i would just ask for that courtesy partly because i have no way to know what the proxy's would be on my committee for either: be a second-degree amendment or a mccain amendment. i am not prepared for that. >> senator mccain's staff is here? i presume. there you are. >> they would object and i would. i think we vote on this and can deal with that. >> mr. chairman, i would ask senator brown to hold on this to do under the coverage section of it senator enzi, this is clearly an issue that any tax everybody. i have tremendous empathy for making sure all of our constituents get to the best possible price on drugs but i have a concern and we've had a lot of news and the past couple years about things been imported and that have had tremendous health impacts. we have a system that i know senator mikulski and i and senator dodd and worked on to reform fda to make sure we're getting drugs through quickly but the end of the day has a process where safety is critical because when ours go into a drug store they need to know it is the gold standard. so i haven't had chance to look at the mccain eminence. i want to take everyone's word is the same language but i have some concerns and out ask senator brown, it has been dropped

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