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Democratic Presidential Candidates Talk Prescription Drug Prices

Seventeen presidential candidates talk about their plans to reduce high prescription drug prices

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In this five-part series, 17 presidential candidates take on prescription drug prices. Watch all of the forums at aarp.org/election2020.

Part 1: Sen. Cory Booker, Gov. John Hickenlooper, Sen. Amy Klobuchar and former Vice President Joe Biden

Bob Edwards: Hello, I'm Bob Edwards with an AARP Take on Today. Today we begin bringing you a five-part series in which we talk about the issues that matter most to voters 50 and over with 17 candidates for president, from Bennett and Biden to Warren to Yang, and nearly every candidate in between. AARP recently hosted the 17 at town hall forums across Iowa. The project was a partnership of AARP and the Des Moines Register and kicked off AARP's 2020 voter education efforts. Candidates spoke for about half an hour, so we can't bring you everything they said in this podcast, but we've chosen to air each candidate's view on prescription drugs, given how top of mind that issue is for voters these days. The moderators were Kathie Obradovich...

Announcer: Kathie Obradovich, Opinion Editor for the Des Moines Register.

Bob Edwards:  ... and O. Kay Henderson.

Announcer: The News Director of Radio Iowa.

Bob Edwards: Each clip starts with the moderator's question, followed by the candidate's unedited answer. You can learn about each of the candidates' responses on other key issues at AARP.org/election2020 and listen to the complete five-episode series now. In this first episode, we share responses from the slate of candidates from our first presidential forum. This audio was recorded on July 15th in Des Moines, Iowa. Taking the stage were Senator Cory Booker of New Jersey, Governor John Hickenlooper of Colorado, Senator Amy Klobuchar of Minnesota, and Vice President Joe Biden of Delaware. Let's listen in on how each will address high prescription prices if elected. First up, Senator Cory Booker.

Announcer: United States Senator from New Jersey, Cory Booker.

Moderator: Thank you, Senator. You're an advocate of Medicare for All, and former Vice President Joe Biden today called for expanding the Affordable Care Act by adding a public option, which he says is more achievable than Medicare for All. How do you respond to that?

Booker: Well, I respond by saying, look, the reason why I'm for Medicare for All, the reason why I'm for this idea that in America healthcare should be a right, is because right now we have a country that pays more for healthcare than any other country on the planet Earth, but we have the worst outcomes of all industrial nations. And so I, as a senator, I want to solve problems. I'm a former mayor of our state's largest city, and I just say there's lots of ways to get to my ultimate goal, which is everybody in this country having healthcare. And I'll tell you what, there's no way, even if we have 60 Democrats right away, I don't think it's likely that we're going to have some kind of massive transformation of our system.

So as a former executive, I know you've got to take steps towards your goal, and my steps involve creating a robust public option. That way if you change Medicare to make it, number one, better in its reimbursements, better in its funding, which is a lot of problems with Medicare as good as it is, if you lower Medicare eligibility down to 55, these are actually steps that could help small businesses. These are steps that are going to help more Americans move into Medicare.

And you know what it's going to do to the private insurance plans, especially if you have people 55 and older moving into Medicare? It's going to lower the cost of those pools. So I don't think the Vice President and I are going to quibble over what we're using as labels. If I am your president, on day one I'm going to start doing things to repair the damage done to the Affordable Care Act from this president who's been going after it, and I'm going to make sure that we start the march towards getting more people access and driving down costs, because that's what Americans want.

And I'm going to give you my biggest pain point, my biggest pain point in my neighborhood. One of the things driving the cost of Medicaid and Medicare, one of the things driving costs for families, is the cost of prescription drugs in our nation. And this to me, I have a feeling it's going to come up, and I won't give you all the tactics I'm going to use, but I am just going to say this. If we can start driving down the overall costs, it's going to give us more of an ability to expand care, and that's what Americans are demanding, and I will meet that demand as your president.

Bob Edwards: That was Cory Booker of New Jersey. Next up, Governor John Hickenlooper.

Announcer: Governor John Hickenlooper.

Moderator: That 2017 plan that you advanced did not deal with the cost of prescription drugs, if I'm not mistaken, but that is turning out to be one of the biggest failings of the Affordable Care Act. What's your plan today?

Hickenlooper: Well, I think we need to, and I think the plan should include everything even beyond drugs, but drugs is a good place to start. The inflation in what we spend for healthcare has been close to double the Consumer Price Index, the CPI, for decades. And we've kind of looked the other way, and yet it continues to suck resources away from all manner of other government important infrastructure. I step back and I look. I mean, we're almost, by next year we'll be at 19% of our GDP. I'm not aware of any other countries that are above 11%. There's a lot of opportunity for us to find savings, and drugs are a great place to start. For reasons that were very good 20 and 30 and 40 years ago, Congress allowed drug companies certain benefits, such as that the federal government would not use the scale of their purchases, right?

Look how many drugs we buy from Medicare, and yet we're not allowed to negotiate a group discount in this country. We are the only industrialized country that doesn't. So that's a good place to start. Why not have a little transparency? And we can see what the different medical plans are charging for their pharmaceuticals that they acquire. Let's see what other countries are paying, let's make sure that Americans get the same deal everybody else does.

So in terms of pharmaceutical, I think that's a great place to start. But I also think that all Americans, but I think older Americans especially, should be looking at the healthcare system as a whole, because as long as we are, I would argue, wasting significant amounts of resources, everybody's healthcare is somewhat unstable. I won't say at risk, but we all have a vested interest in making sure that our systems work effectively.

Bob Edwards: That was John Hickenlooper of Colorado. Now let's hear from Senator Amy Klobuchar.

Announcer: United States Senator from Minnesota, Amy Klobuchar.

Audience Member: My name is Cathy Wilkinson Barrett and I have MS, and I've had it for over 30 years but had to go on Social Security disability in 2012 and then transitioned to retirement Social Security and Medicare. As a garden and food writer and photographer, freelancing is now very limited, so I'm dependent on both these programs. I remember what it was like not to have health insurance at one point, and it was very scary, especially with the costs of the drugs for MS, and wanted to know what you plan to do to ensure that Social Security and Medicare benefits continue for seniors and that we don't just keep going lower and lower into poverty level. Thank you.

Klobuchar: Well, thank you so much and thanks for sharing your story and for your personal strength in being here today. It is wonderful. First of all, I wanna thank AARP, and it's great to be in Iowa. As you know. I am your senator next door, and I can see Iowa from my porch. I was just at the Northwest Community Center in Des Moines and got to meet with a number of seniors. And that same question keeps coming up. And I think part of this is because seniors know that Social Security and Medicare are your safety nets, right? They are your security. And I am devoted to keeping them strong, to not privatizing Social Security, and to making sure we do everything to keep them solvent.

And the first thing with Social Security, we know that that could be going to a point in the year 2035 where we would only be getting out 90% of benefits, and that's not good. So what I would do is take the cap, which is right now at $133,000 in income, where people pay into it. I would put kind of a donut hole and then at $250,000 I would start it paying in again. And up, so the wealthiest people will be paying in. That would keep it solvent and strong, and that would help you.

For Medicare, I think the answer there is to first of all, make sure we have high-quality care and that our focus is on not quantity but quality of care, but there's something else that has just been untouched and that is the cost of pharmaceuticals. And from the day I got to the Senate, I have been leading on those efforts. I lead the bill, and as president I could finally get it done, to unleash the bargaining power of over 40 million seniors to negotiate better prices against those pharmaceutical companies under Medicare. That's what we need to do.

There are literally two pharma lobbyists for every member of Congress, and they think that they own Washington. Well, they don't own me, all right? And it is other things that we can do, including when you look at bringing less expensive drugs in from other countries like Canada. I've led that bill as well. It's a bipartisan bill with one of your senators from Iowa, who stepped in the shoes of Senator McCain, who used to lead that bill with me. And we've picked up a number of votes on both sides of the aisle. So I actually think that's another thing I can get done. And you know what I just found out? As president, you can do that. A president can do that on her own, all right? So those are things we can do to get it done.

Moderator: Senator, let's talk about those two bills that you are co-sponsoring with Senator Grassley. First of all, a bill that would allow-

Klobuchar: That's going to help me in the Democratic Caucus here. Thanks for bringing that up.

Moderator: A bill that would allow the personal import of prescription medications from Canada. A Montana court has fined a Canadian online pharmacy $34 million, because it was sending Americans counterfeit drugs. How do you determine the appropriate pharmacy and whether what they're selling Americans is safe?

Klobuchar: Of course it has to be safe. And I think one of the problems is people are looking and just desperately looking for less expensive drugs. So you've got situations where individuals or maybe even some individuals states trying to do it. It's much harder to do than if you do it with the federal government. You can better regulate which pharmacies, you can better make sure that people are getting a good deal, not only fiscally, but also that they're safe.

So that's one of the reasons that we do want to do this federally. And that's why Senator Grassley agreed to co-sponsor this bill with me. I think the other bill, two others I'd mentioned that we've done together, one is the bill to stop this pay for delay, where big pharmaceutical companies are actually paying off generics to keep their products off the market. Can you imagine this? They're paying them off, because that's good for both of them, I guess. Pharma pays them off and then the generics are able to get paid for it. And then the only one that loses are the consumers. So I have a feeling we may be able to actually get this bill done this year.

Bob Edwards: That was Amy Klobuchar of Minnesota. And lastly, Vice President Joe Biden.

Announcer: Senator from Delaware and former Vice President of the United States, Joe Biden.

Audience Member: My name is Coleen Kelleher. I'm the mother of a 49-year-old son who has been diabetic since age nine, and I know the cost of his insulin has increased exponentially. I also take prescriptions, and the last time I picked up my scrip, my pharmacist told me that my cost will be much higher the next time I pick it up, because where I am in the Medicare Part D coverage. What do you plan to do to reduce the cost of medicines, pharmaceuticals, and life-saving drugs?

Biden: Well, first of all, I empathize with you. My family has gone through a lot of the same thing. My son came back from a year in Iraq after being in Bosnia, diagnosed with ankylosing spondylitis, and the shots he took were $4,000 a shot. And then for a year with stage four glioblastoma, his drug prices were extraordinary, as well as others. Any rate, two things. Number one, the drug companies, I think it's a moral outrage. There is no justification for raising the price of a drug once it has been in fact invented and/or patented. There is no justification for raising it beyond the price of inflation.

So what I've proposed in my plan is, any drug that is in fact increased beyond the rate of inflation would not qualify to be covered by Medicare, Medicaid at all. That will be a gigantic incentive for drug companies to change their pricing. And not just for people on Medicare, Medicaid, the entire price must be reduced.

Secondly, the drug companies spend $6 billion a year right now, $6 billion a year advertising, advertising to sell drugs, many of which are quite frankly not needed, like opioids that they sell in terms of fentanyl and others. And so I would strip them of that requirement, that deductibility of their being able to deduct the cost of advertising for their drugs. Thirdly, the initial price, what's happening now. The president asked me to run the Cancer Moonshot, and after it was over a group of 21 heads of cancer hospitals and five Nobel laureates came to me and asked me whether I'd continue to do this, because this administration didn't pick it up with the same enthusiasm.

And I asked why. They said, because I can convene and I can embarrass. And by that I mean an awful lot of these drug companies now, and researchers, in dealing with rare diseases and rare drugs do not want to share any of the data with anyone, even though a significant portion of the data they received and learn was in public institutions, which you helped pay their tuitions, as well as making sure that they, through the great research universities. And so what I would insist upon, like they do in other countries, at least in Germany, is that the set price of a drug, and the reason they're going to get much more expensive, they're not chemical-based now, they're going to be bio-based drugs, and so what's gonna happen is the prices are going to be priced at exponentially high numbers.

And there's no justification for it. If you're going to go out and invent a new Bugatti automobile that has an 800-horsepower vehicle, goes zero to 60 in four seconds, you can charge anybody whatever they want, because it's not necessary. But when you have a drug that is literally a life-saving drug, the idea in the United States of America, we're going to say you are entitled to it only if you can afford it. Only if you can afford it. There should be some relationship to the cost of developing the drug, the efficacy of the drug, and the price charged. And so I would set up a independent commission at the Department of Health and Human Services that would bring in experts from around the country, that would in fact take a look at the research and the cost of going in to develop that drug, and set the initial price of that drug. After that, if they get a patent on that drug, after that they cannot raise it beyond the cost of inflation at that time.

Drug companies make a lot of money, and I'm not against anybody making a lot of money, but I'm against anybody making a lot of money off of my two sons and my wife who died and my son, who has spent a lot of time, and my mother, who was in hospice in my home for a long time, and my dad, who was in hospice in my home for a little over six months. And so there's a lot of things, but that relates to the drug pricing. There's more detail I can give you, but I know I'm supposed to... I guess I've overstayed my... I'm sorry.

Moderator: Well, I want to ask a quick-

Biden: I'm sorry. I went too long.

Moderator: That's okay. No, you're good, good. You're fine. I want to ask a quick follow-up on something you said. So if a prescription drug manufacturer raises the price beyond inflation after they've gone through these steps, you're saying they wouldn't be eligible for Medicare and Medicaid?

Biden: Or Medicaid. They would not-

Moderator: But doesn't that punish the people who might need those drugs to save their lives? I mean, what if insulin, for example, is-

Biden: If they're that dumb that they're going to give up their whole business, then that's fine. When the second thing that happens is that any patented drug that is ready for generic coverage should in fact... Right now these drug companies buy off the generics who want to develop the generic drug. So they pay them, pay not to play. And so what we would do is make sure that we set up that it has to be, if you get the patent, you have access. A generic drug company at the end of the time the patent runs has access to all the data they need to study how to make that drug in sufficient quantities.

But it is possible. And the last piece of this proposal is that if in fact they go ahead and they decide they aren't going to sell and they're just going to try to sell them on the private market, then we'll significantly increase their tax rates.

Moderator: Okay. All right. Thank you for answering that follow-up.

Biden: Other countries do this, so it's not like this is all original ideas with me. It's just a lot of work trying to figure out how to deal with these issues.

Bob Edwards: That was Joe Biden of Delaware. Candidates discussed many other issues at the forums, including Social Security, aging in place, Medicare, healthcare access, and more. And you can watch the complete series and the AARP Asks the Candidates video series at AARP.org/election2020.

Since listeners sometimes ask, AARP does not endorse candidates nor donate to campaigns or political action committees called PACs. But AARP has a proud 33-year history of nonpartisan voter engagement, and it provides voters with information on where the candidates stand on issues so voters can make their own decisions on election day. At the moment, the 2020 race is focused on the Democratic primary, but of course, we will bring you the Republican side as election day 2020 nears.

Tune into the next episode to hear Senator Kirsten Gillibrand of New York, Secretary Julian Castro of Texas, and Senator Kamala Harris of California, and of course, the rest of our Iowa presidential candidate forum series. For more, visit AARP.org/podcast. Become a subscriber and be sure to rate our podcast on Apple Podcast, Google Play, Stitcher, and other podcast apps. Thanks for listening. I'm Bob Edwards.

Part 2: Sen. Kirsten Gillibrand, former HUD Secretary Julián Castro and Sen. Kamala Harris

Bob Edwards: Hello, I'm Bob Edwards with an AARP Take On Today.

Today, we continue a five-part series in which we talk about the issues that matter most to voters 50 and over with 17 candidates for president. From Bennett and Biden, to Warren, to Yang, and nearly every candidate in between, AARP recently hosted the 17 at Town Hall forums across Iowa. The project was a partnership of AARP and the Des Moines Register, and kicked off AARP's 2020 voter education efforts.

Candidates spoke for about half an hour, so we can't bring you everything they said in this podcast, but we've chosen to air each candidate's view on prescription drugs, given how top of mind that issue is for voters these days.

The moderators were Kathy Obradovich ...

Speaker 2: ... Opinion Editor for the Des Moines Register.

Bob Edwards: And O. Kay Henderson ...

Speaker 2: ... the News Director of Radio Iowa.

Bob Edwards: Each clip starts with the moderator's question, followed by the candidates unedited answer. You can learn about each of the candidates' responses on other key issues at AAPR.org/election2020, and listen to the complete five-episode series now.

In this episode, we share responses from the slate of candidates from our forum on July 16th in Bettendorf, Iowa. Taking the stage where Senator Kirsten Gillibrand of New York, Secretary Julian Castro of Texas, and Senator Kamala Harris of California. Let's listen in on how each will address high prescription prices, if elected.

Announcer: You're a member of the US House of Representatives-

Bob Edwards: First up, Senator Kirsten Gillibrand.

Announcer: ... Kirsten Gillibrand.

Gillibrand: Thank you.

Speaker 2: Senator, yesterday, Vice President Biden proposed to eliminate coverage by Medicare and Medicaid for prescription drugs if the pharmaceutical company raised the price more than the cost of inflation. It's a little bit more complicated than that, but basically using the stick of the federal government to try to force pharmaceutical companies to keep the prices low. I'm wondering if you think that's a good idea. Do you think it would work?

Gillibrand: Well, I actually would do a lot more than that. I would do three things to get the cost of prescription drugs down.

First of all, you know back where I started. Laws are written in the dead of night by the special interests, by the drug manufacturers and their lobbyists because they have so much money. When Medicare Part D got passed under George W. Bush, they guaranteed that Medicare could not buy in bulk to get the lowest price. Canada gets to, Mexico gets to. How come America doesn't get to? Well, under my Medicare for All plan, the first thing I'm going to do is go back to the drug manufacturers and guarantee that American citizens and anyone on Medicare gets the lowest price for every drug.

Second, if we still under that have price gouging, if rates keep going up over and over every year ... Because I've seen it. I've seen a family whose husband was diagnosed with cancer. His medicine cost him $5,000 a month. They only had $60,000 dollars in savings, and so this husband and wife had to decide whether or not he was going to take his medication, and absorb all their savings within one year. He chose not to take that medication and he didn't survive.

That's what people have to decide every single day. So I will use a drug czar to use the DOJ, the SEC, the FTC, Department of Commerce, all the agencies to go after the drug manufacturers that raise prices inexplicably. I would prosecute them using the full weight of criminal justice and our Department of Justice, and I would make sure that when they do raise their rates just to make money ... You saw what happened with the EpiPen. You saw what happens with biologics like Humira, you've seen it. They're bought, their rates are raised because they have virtual monopolies.

So I would go after this and make sure our antitrust laws can get these prices down, and then last, fail-safe, if a drug company will not produce a generic within a reasonable amount of time, I will ask the NIH to produce that drug and provide a generic to create not-for-profit competition with the private drug companies.

Speaker 3: Senator, you are a sponsor of something called the Stock Price Gouging Act. There are ideas about indexing a prescription drug costs. Isn't that the kind of price controls that economists tell us didn't work under President Nixon and others?

Gillibrand: No, it's not, because under President Nixon and others, you didn't have drug companies raising the rate of a drug every year no matter what. And since that time you've seen drug companies have exponentially higher profits. They are literally sucking money out of the healthcare system every day because they can. Our antitrust laws don't work for current day drug companies because a lot of these drug companies with their patents are virtual monopolies. I also would make it impossible.

And I would outlaw the use of advertising to sell drugs. To have that direct advertising is so harmful because you're a patient and you've just watched this beautiful ad that they've spent billions of dollars advertising over and over again, "You must have that drug," it misleads you. It is encouraging the manufacturers not to produce generics, and the fact that they manipulate our patent system to change the formula just by a little bit, maybe change how much gets released. Maybe combine another medicine with it. They do it so it never has to be on generics.

Can I give one example? Insulin. When the inventor of insulin created his drug, he said "This is so lifesaving, I'm not even going to patent it. It has to be available to everyone." The current owner of the patent of insulin, there's still no generic. Insulin has been available for how many decades? I don't know. 30, 40 years. There's still no generic. It's an outrage! It's a life-saving drug. So as president, I would use the NIH to start producing drugs that should be a generically available because they are lifesaving and they've been on the market for more than a decade.

Bob Edwards: That was Kirsten Gillibrand of New York. Next up, Secretary Julian Castro.

Announcer: Julian Castro.

Speaker 2: Secretary Castro, your first question is coming from the audience. It's right here in front of you.

Audience Member: Good afternoon. My name is Ryan [Miday 00:00:07:14]. My wife and I rely on our social security and Medicare to live. We both have preexisting conditions, so making sure our health conditions are covered and affordable to treat is essential. What would you do if elected president to ensure Medicare and social security are secure and sustainable for the people like myself receiving it and for the younger Americans who are going to need it just as much?

Castro: First of all, thank you all very much for having me here today. Thank you to AARP and all the people who are here. Thank you very much, sir, for the question. I appreciate it.

And this is of course something that is on the minds of very many Americans, both Americans who are on social security now and Medicare now, and also many who know that they're going to be hopefully on social security or Medicare in the future. Here's what I would do. Number one, what we see is that we have Baby Boomers that are turning 65 at record numbers for your generation and drawing down on social security. You earned social security and so social security should always be strong and there for you, and that means that we need to look at ways to make sure that the Social Security Trust Fund is strong well into the future.

As you all know, right now, it's estimated that by 2035 it may be essentially in danger. Here's what I would do. I would increase the payroll tax beyond $130,000 to fund the Social Security Trust Fund. I would absolutely look for new revenue that we can put into the Social Security Trust Fund to ensure that it is stable for long haul. I don't agree with those who have said that we should somehow cut social security or take those benefits away from Americans because I believe that you did earn it and that, in this 21st century, we need a strong 21st-century safety net for our seniors.

Let me address Medicare and then let me connect the dots of what I think that we need to do very briefly. I believe that what we need to do is transition to a healthcare system that uses Medicare as its base, strengthens Medicare for the people who are on it, and then makes Medicare available to all those who want it. We need to strengthen Medicare though.

I believe that we need to allow the negotiation of drug prices by Medicare. We need to support the importation of drugs from countries that have a safe vetting process like Canada so that people can get those for prescription drugs that they need more cheaply. There is no reason that insulin should cost several times more here in the United States than it does in Canada or other countries. You know, I grew up with a grandmother who had Type II diabetes, and right before she passed away in early 1996, she had to have one of her feet amputated, which, as y'all may know, is very common for severe diabetics. That whole time she had Medicare and I saw the difference that Medicare can make. I'm absolutely committed to strengthening it and making sure that those who want it can also get it without risking degrading the program. We need to improve the program for the people who are on it.

Finally, very briefly, let me connect this to some of the other issues that have come up in this campaign. Maybe the prime issue that this president wants to run on is this issue of immigration. He's trying to scare a lot of Americans with fear and paranoia and division into believing that we can't handle this immigration challenge. I've offered a strong and compelling alternative vision on immigration that says we can maintain border security, but we should do that with compassion and common sense.

I've also said that the truth is that we need a lot of these folks who want to come to the United States because we have social security that is being drawn down on at record numbers, because last year in the United States we had the lowest birth rate in 32 years. We have an unemployment rate right now that is at 3.7%. We see countries across the world, like Japan, that are grappling with this issue of having an aging population and not enough vibrant young workers. We don't want to go down that path.

Part of the answer to make sure that we have a young, healthy, vibrant workforce that can support the Social Security Trust Fund well into the future is to ensure that we have a sensible immigration policy that allows for that young, healthy, vibrant workforce.

So I believe that if we do it right, we can maintain border security, we can address the issue of immigration by partnering with Central American countries so that people can find safety and opportunity there without coming in droves over here, and we can harness the talent from around the world to have that young, healthy, vibrant workforce that will help fund social security and other programs well into the future. And all of us can win in the United States with it.

Speaker 2: A quick follow up on social security. You said raise the $133,000 income cap. Would you eliminate that cap or would you raise it to a specific level?

Castro: Well, during the course of the campaign, we're going to release our plan for this, but-

Speaker 2: You can do it today.

Castro: I know, I know. I know. Always want folks to make news. I know!

But in the least, I think we need to significantly increase it. Yeah.

Speaker 2: You mentioned immigration, but where you are in Texas, there's also a lot of people from America who go across the border for medical treatment.

Castro: Yeah. That is true.

Speaker 2: What as president would be your approach to that cross-border medical trade? And also cheaper prescription drugs. That's why they they go as well. What would be your approach to reducing the cost of prescription drugs?

Castro: I mean, you're right. I'm from San Antonio, Texas. Hopefully some of y'all have been there. The river walk, the Alamo. It's a beautiful city. We have a lot of folks down there in Texas and those border states, as many people here will know, probably all have relatives or you have friends that live down there, that go down to Mexico to get prescription drugs that are lot cheaper. Some of them go to have medical procedures done. Same thing of people going to Canada.

Well, the way that I think about that is that shouldn't be the case. It shouldn't be the case that people need to do that, right? We should have an America where people can get those prescription drugs at the same rate as in these other countries, and also can get procedures for the same or less cost than they do in Mexico or Canada. And we can do it better here in the United States.

But if we're trying to make incremental improvements in the system, I would say that we have to allow for the negotiation of drug prices by Medicare directly with these pharmaceutical companies. Secondly, we have to ensure that we can import drugs from places like Canada that have a strong vetting process for their drugs.

I also believe that we need things like patent reform to close some of these loopholes that essentially allow these drug companies to keep renewing the patents on lifesaving drugs, and then jack up the prices so that people cannot get them for a reasonable price. There's no reason that that should happen, especially when it's the case that you and your family as taxpayers are the ones fund a lot of the research and development for these drugs. That doesn't make any sense. We need to address that legislatively and that's another thing that I would do.

Bob Edwards: That was Julian Castro of Texas. And lastly, Senator Kamala Harris.

Announcer: ... California, Kamala Harris.

Speaker 2: Senator, our first question for you is from the audience and right here in the front row.

Audience Member: Okay. Hi. Hello. My name is Lynn Davis. I'm on a specialty drug for a significant medical issue. I had been paying $375 for a three month supply from an independent pharmacy because my Medicare Advantage plan was too expensive for me to use. That was in April. My pharmacy has been bought out by a larger chain and now I am receiving services through them. Now the cost for the same jug drug in a generic form is $600 for a three month supply. So my question is can you explain what you would do to reduce the cost of prescription drugs?

Harris: Yeah, right. And I'm sorry that you're having that experience.

I'd just like to start with a value, which is I just feel very strongly that you should judge a society based on how it treats its children and its seniors. That is how it a society should be judged, and the idea that you would have to pay almost twice as much for this medication is immoral.

So we just unveiled today at a proposal that I have in terms of what we need to do to bring down the cost of prescription medication, and it is based on a number of things including the value that I just stated. It is based on the work that I did as Attorney General for two terms in California when I ran the second largest Department of Justice in the United States, second only to the United States Department of Justice. And I took on the pharmaceutical companies, and we won because they were engaged in false advertising and just unfair business practices.

So what I'm prepared to do as this, to bring down the cost of medication, one, when elected president to, one, require that the drug companies actually engage in fair pricing. And to do that in a way that is about empowering the Federal Department of Health and Human Services to actually do what other countries around the world do, which is to set fair prices based on benchmarks, based on looking at how they are charging for the same drugs in other country, based on comparing the rate of the rising of the cost to inflation and bringing those prices down.

Second, I am prepared to basically end the tax break that the pharmaceutical companies have been receiving for advertising prescription medication. You all may remember it was about in the mid-80s that that the rules changed and they got these phenomenal tax breaks for direct to consumer marketing, right? So all of a sudden, remember we started seeing all these things on TV, and they are making hand over fist in more money. They're putting more money into the advertising. I think it's like six fold more. But, of course, they're doing that because their main business model is about profit, not about public health, and they're putting more money into the marketing on television because then consumers start demanding it more, right? Which allows them to raise the prices and jack up the prices. So I'm prepared to do that.

I am also, when elected, prepared to require that Congress actually pass measures in order for us to fix prices in a way that they are affordable and fair, and to ban the marketing on TV in terms of banning the tax credit for the marketing. But if they do not, I'm also prepared to take executive action, one, to allow consumers, you and all of us, anyone, to actually buy from Canada, to require that they actually have a method of being held accountable by having and appointing an attorney general of the United States who will be prepared to use the Department of Justice as I have done as an attorney general of California in a way that is about going after the predatory practices of pharmaceutical companies and making sure that there is consequence and accountability when they are engaged in unfair advertising and predatory marketing practices, and to basically make sure that we have basically a consequence if they are engaged in unfair pricing so that we can bring the prices down.

And, again, that's going to be based on holding them to a standard like in other countries where there will actually be a fine associated where they will have to pay 100% tax on anything that they are charging above what would be the fair market price for the drug.

Speaker 3: Senator, one last question on this topic. What about patent parking? How would you get generics to the market quicker?

Harris: Yeah, so that would be part of the ... Well, part of the issue in terms of the consequence would be that we could actually, for those that are exceeding the rules, we could actually take their patent. Yeah. And so that's part of how we are approaching it.

And I've actually worked on this when I was Attorney General, because on the patent piece, there is an associated piece, which is the pharmaceutical companies that are attempting to suppress generics and doing that by attempting ... And that's what's happening under this administration. So part of what's happening under the current administration is they're actually feeding the pharmaceutical companies on so many ways, including open to allowing them to extend patents beyond the original duration of the patent.

And we have to take into account that what that means is that they're suppressing competition. And when they suppress competition, that means they can keep the prices jacked up because they're the only game in town. And so the patent issue, to your point, is a very big one and it is directly associated with the cost.

Speaker 2: Thank you. Senator. You've said that you would do away with eventually private insurance under your version for Medicare for All. I'm wondering if that includes Medicare Advantage, which is private insurance essentially, used by one-third of Medicare recipients? And what about Medicare Part D, which is the prescription coverage using private providers? Does that part go away under Medicare for all?

Harris: So under my vision of Medicare for All, we will still have supplemental insurance, but essentially there will be a phasing out of the need for private insurance, to be frank, because we will extend the coverage. So, for example, vision and dental, hearing aids, which right now are extremely expensive, and those who need them have to come out of pocket for that. So there will eventually not be a need for private insurance because there will be full coverage in terms of most of the services that folks need in terms of access to health care.

Bob Edwards: That was Kamala Harris of California.

Candidates discussed many other issues at the forums including social security, aging in place, Medicare, healthcare access and more. And you can watch the complete series and the AARP Asks the Candidates video series at AARP.org/election2020.

Since listeners sometimes ask, AARP does not endorse candidates nor donate to campaigns or political action committees called PACS, but AARP has a proud 33-year history of nonpartisan voter engagement and it provides voters with information on where the candidates stand on issues so voters can make their own decisions on election day.

At the moment, the 2020 race is focused on the Democratic primary, but of course we will bring you the Republican side as election day 2020 nears.

Tune in to the next episode to hear Representative Tulsi Gabbard of Hawaii, Representative John Delaney of Maryland, and Senator Michael Bennett of Colorado, and of course the rest of our Iowa presidential candidate forum series.

For more visit AARP.org/podcast. Become a subscriber and be sure to radar podcast on Apple Podcast, Google Play, Stitcher, and other podcast apps. Thanks for listening. I'm Bob Edwards.

Part 3: Rep. Tulsi Gabbard, Rep. John Delaney and Sen. Michael Bennet

Bob Edwards: Hello, I'm Bob Edwards with an AARP Take on Today.

Today, we continue a five-part series in which we talk about the issues that matter most voters 50 and over with 17 candidates for president. From Bennett and Biden to Warren, to Yang, and nearly every candidate in between, AARP recently hosted the 17 at Town Hall forums across Iowa. The project was a partnership of AARP and the Des Moines register and kicked off AARP's 2020 voter education efforts.

Candidates spoke for about half an hour, so we can't bring you everything they said in this podcast, but we've chosen to air each candidate's view on prescription drugs, given how top of mind that issue is for voters these days.

The moderators were Cathy Obradovich ...

Moderator 1: ... Opinion Editor for the Des Moines Register ...

Bob Edwards: And O. Kay Henderson ...

Moderator 1: ... the News Director of Radio Iowa.

Bob Edwards: Each clip starts with the moderator's question followed by the candidates unedited answer. You can learn about each of the candidates responses on other key issues at aarp.org/election2020, and listen to the complete five-episode series now.

In this episode, we share responses from the slate of candidates from our forum on July 17th in Cedar Rapids, Iowa. Taking the stage were Representative Tulsi Gabbard of Hawaii, Representative John Delaney of Maryland, and Senator Michael Bennet of Colorado. Let's listen in on how each will address high prescription prices if elected. First up, Representative Tulsi Gabbard.

Moderator 1: Tulsi Gabbard.

Gabbard: Aloha.

Moderator 1: Congresswoman, we're going to start right off with a question from the audience and she's right here in front of you.

Audience Member: My name is Joan [Murran 00:02:11], and recent stories in the Cedar Rapids Gazette and from across the country have covered drug companies' efforts to keep lower-cost generic alternatives off the market for years through pay-for-delay deals with generic manufacturers. Both my husband and I have recently witnessed embarrassed older Iowans walk away from the pharmacy counters without their needed medications, indicating they didn't have enough money to pay for their prescriptions. If elected, what is your plan to end this horrible practice of gouging customers and taxpayers on drug costs?

Gabbard: Thank you so much, Joan, for your question. I had a chance to meet your husband earlier as I was coming in, and the experience that you have had is unfortunately one that's becoming too common across this country. And there's one reason for it: crony capitalism.

These big pharmaceutical companies have been making exorbitant profits on the backs of people who depend on that medicine oftentimes just to stay alive. The fact that they are gaming the patent system to block these generic drugs, again, purely to make more profits without thought for what the impact on the wellbeing of the people are is exactly why we need to crack down on big Pharma and let them know that their influence, the power that they have wielded over Washington is finished.

The fact that our Department of Health and Human Services still cannot negotiate lower drug prices points to that crony capitalism and that influence over Washington that has really drowned out the voices of the people. So that's the first thing that I think that we need to make sure gets done. It's something that has bipartisan support. The only thing blocking it as big Pharma lobbyists.

As you well know, this was in the Affordable Care Act and the early drafts, allowing this negotiation to bring our drug prices down, but by the end, it was stripped out. Not because it would have a positive impact on people who need those medicines. No, it was because those lobbyists came in, and they had a seat at the table and they said, no, this bill cannot pass as long as that provision is included in there.

Now, the United States government is the number one customer, the number one purchaser of prescription drugs in the entire world. So when you look at the market share and the power to negotiate that lies within our hands, lies in the hands of our government, we can see how much of an impact that would have on driving these prices down and making it so prescription drug companies can't just willy nilly start escalating the prices up and blocking generics from having access to the patents.

We have to reform the patent system as well, and make it so that they cannot exploit those loopholes as they are now.

Moderator 1: Vice President Biden in rolled out has healthcare plan this week, and one of his proposals is to say that if a drug company raises their price of a drug that's gone through the patent period more than the rate of inflation, that Medicare and Medicaid just wouldn't cover it anymore. In other words, you'd take away that market for them. Is that a good idea?

Gabbard: I think that makes a lot of sense. I think that goes along with making sure we're utilizing the leverage that we have as the biggest purchaser of prescription drugs in the world, to make sure that these medicines, these prescription drugs actually remain affordable for everyone.

Moderator 2: You have also called for co-sponsored legislation allowing for the importation of drugs from over the border.

Gabbard: Yes.

Moderator 2: Do you feel like that can be done safely, considering that there have been some high profile cases where legitimate pharmacies have been caught with fraudulent medication?

Gabbard: Yeah, I do. The legislation that we've supported to allow the re-importation of drugs from places like Canada have the safety regulations built in to make sure that the medicines that we're getting at a cheaper price are actually the medicines that will help people. Obviously, safety and the health concern that people have is paramount, but really the issue here is the prescription drug companies exploiting the people, exploiting sick people when when they need help the most.

Moderator 1: You've also supported an international price index for prescription medications sold in the US. How would that work?

Gabbard: I think that can be a component to the first act that we've got to take, which is allowing for that direct negotiation with prescription drug companies to bring our prices down. If we rely solely on that international price index, then we're at risk of what's happening with other countries, what prescription drug companies may do in trying to shift or manipulate the markets in these other countries. So again, I think the number one thing we've got to do is use the leverage that we have as as buyers, as people in this country, to bring those prescription drug companies down and to hold them to task, hold them accountable so they're not able to run rampant and rising prices as they are now.

Bob Edwards: That was Tulsi Gabbard of Hawaii. Next up, Representative John Delaney.

Moderator 1: John Delaney.

Moderator 1: You propose to deal with prescription drug costs in a slightly different way than we've been hearing from other candidates. You propose an excise tax on the price difference between drugs sold in the US and other developed countries. Why take this approach, and how do you avoid having the cost transfer to consumers?

Delaney: Well, I have also proposed, which I think most of the other candidates have also proposed, allowing Medicare to negotiate the rates with pharmaceutical companies. So that's part of my proposal, too, and it's ridiculous that we don't allow Medicare to do that because the federal government's largest buyer of pharmaceuticals, and they should negotiate the prices.

But the bigger issue in many ways is the fact that most of the world is free-riding on US citizens as it relates to this issue. And what I mean by that, if you go to other wealthy countries like Germany or Spain or the United Kingdom, their citizens on average pay a third to a quarter of what we do for drugs. And I'm all for selling drugs to poor countries at low prices because they can't afford it, but I think US citizens should pay the same as other wealthy nations.

And so what I've called for as president is for the United States to basically make this a trade issue with the other wealthy countries in the world, where we work together, say, as 20 wealthy nations to negotiate the prices so that US citizens are paying the same as other countries. That may result in prices going up in other countries while they come down here. Because in some of these countries, they actually sell drugs below cost, but it doesn't matter because they just keep raising the prices here.

So to make this point, I proposed a tax, and the tax is equal to 100% of the price differential between where a pharmaceutical company sells a drug here and where they sell it in the G20, the other wealthy countries. So they sell a drug for $30 in the G20, and they sell it for $100 here, they would technically oh attacks of 100% on $70 which is the difference because I want them to lower the prices here and maybe they may have to raise them there so that we all pay the same price.

Moderator 1: Why would other countries agree to participate in that if they might see their drug prices go up?

Delaney: These many of these countries are our allies, and I believe in allies. Unlike the current administration, I think these allies are kind of a singular asset. They're our friends, but even with our friends, we have a lot of back and forth discussions, and I think if you sat down with these countries and you laid out the facts ... And the facts are unmistakable. The US citizens, you, subsidize the entire global pharmaceutical industry. Our taxpayers, our citizens are funding this whole industry, and we can't allow that to continue.

We want this industry to continue to have innovation. We want this industry to continue to put forth remarkable new drugs and cures and immunotherapy, but the cost of that investment should be shared, in my judgment, by all the wealthy nations. And so I think every once in a while you've got to sit down with your friends, you've got to put a lot of issues on the table, and you got to say this is a priority for me.

Bob Edwards: That was John Delaney of Maryland. And lastly Senator Michael Bennet.

Moderator 2: Michael Bennet.

Moderator 2: Another piece of legislation you're co-sponsoring deals with prescription drug prices, and it essentially sets up a process for citizen petition, and trying to pressure the FDA to act in regards to brand name drugs. How would that work?

Bennet: I think that it's to get the public on record in front of the FDA. I think the most important thing that we can do is require the federal government to negotiate drug prices on behalf of seniors, on behalf of Medicare. My public option plan, which is called Medicare X, which I hope I'll have the chance to talk about in a minute-

Moderator 1: We will.

Moderator 2: You will.

Bennet: So I'm going to leave that to one side, but like other pieces of legislation, requires that the federal government negotiate drug prices. It's long overdue.

This issue on drug prices is something every one of us is hearing in every one of our town halls. It's time for us to respond to the American people.

Moderator 2: What about importing drugs from Canada? You opposed that.

Bennet: Yeah. I don't think that actually is a practical solution. I know that's not a popular position, but I want to be honest about it. Our economy is nine times the size of Canada's. If we began to allow importation from Canada at scale, Canada would change their pricing overnight. The reason they have the pricing they have is because they've been able to negotiate with Pharma in ways that we have not.

We should not have to go to another country to get drugs that are at a reasonable price, or to go buy a drug there that costs 11 times less than it does here, in the case of insulin. That is an outrage, but I think what we need is a real solution for that. Not force caravans of seniors to have to go to Canada to buy drugs they should be able to get at their pharmacy around the corner.

Moderator 1: Several of your competitors have proposed some sort of indexing in different ways, but essentially having the federal government determine what the fair price is, and then sort of crackdown on any pharmaceutical company that charges above that fair price. Is that something you see working?

Bennet: Yeah, I think there's merit to that idea. I think there's merit to benchmarking our prices against international norms. There are lots of different ways we can do it, but what we can't do is perpetuate the system that we have today because people all over the country are having to decide between food and medicine. This is the only country in the industrialized world where that's true, and it shouldn't be true here.

Bob Edwards: That was Michael Bennet of Colorado.

Bob Edwards: Candidates discussed many other issues at the forums including social security, aging in place, Medicare, healthcare access, and more. And you can watch the complete series and the AARP Asks the Candidates video series at AARP.org/election 2020.

Since listeners sometimes ask, AARP does not endorse candidates nor donate to campaigns or political action committees called PACS, but AARP has a proud 33-year history of nonpartisan voter engagement, and provides voters with information on where the candidates stand on issues so voters can make their own decisions on election day.

At the moment, the 2020 race is focused on the Democratic primary, but of course we will bring you the Republican side as election day 2020 nears.

Tune in to the next episode to hear Senator Elizabeth Warren of Massachusetts, Marianne Williamson of California, Representative Beto O'Rourke of Texas, and Andrew Yang of New York. And of course, the rest of our Iowa presidential candidate forum series.

For more visit AARP.org/podcast become a subscriber. Be sure to radar podcast on Apple Podcasts, Google Play, Stitcher, and other podcast apps. Thanks for listening. I'm Bob Edwards.

Part 4: Sen. Elizabeth Warren, Marianne Williamson, Rep. Beto O’Rourke and Andrew Yang

Bob Edwards: Hello, I'm Bob Edwards with an AARP Take on Today. Today we continue a five-part series in which we talk about the issues that matter most to voters 50 and over with 17 candidates for president. From Bennett and Biden to Warren to Yang and nearly every candidate in between, AARP recently hosted the 17 at town hall forums across Iowa. The project was a partnership of AARP and the Des Moines Register and kicked off AARP's 2020 voter education efforts. Candidates spoke for about half an hour, so we can't bring you everything they said in this podcast, but we've chosen to air each candidate's view on prescription drugs, given how top-of-mind that issue is for voters these days. The moderators were Cathy Obradovich-

Announcer:  ... Opinion Editor for the Des Moines Register.

Bob Edwards: And O. Kay Henderson-

Announcer: ... The News Director of Radio Iowa.

Bob Edwards: Each clip starts with the moderator's question followed by the candidate's unedited answer. You can learn about each of the candidates responses on other key issues at AARP.org/election2020 and listen to the complete five-episode series now.

In this episode, we share responses from the slate of candidates from our forum on July 19th in Sioux City, Iowa. Taking the stage were Senator Elizabeth Warren of Massachusetts, Marianne Williamson of California, Representative Beto O'Rourke of Texas, and Andrew Yang of New York. Let's listen in on how each will address high prescription prices if elected. First up, Senator Elizabeth Warren.

Announcer: [crosstalk] Elizabeth Warren.

Obradovich: Senator, one issue that matters a lot to these folks is the cost of prescription drugs.

Warren: Oh yeah.

Obradovich: There's a lot of proposals on the table like how to get generics to the market faster, or deal with high prices. But you've proposed that the government actually get into the business of manufacturing some of these jobs.

Warren: Right.

Obradovich: Why is that a better idea than some of the other ideas on the table?

Warren: So look at how it is on drugs right now. You know what the basic deal was supposed to be. The United States would promise a drug company that if you'll get out there and do the R&D, we'll give you a period of time, say six years, that you can be the exclusive manufacturer of it. You'll make your profits then, and then it will go to generic. And that means anybody can jump in and manufacture it, and the price is going to go down like a rock. And basically the price will just cover what are the ingredients and labor costs to get this done and the price will be way down.

That's what was supposed to happen. That is not what has happened in America. So right now, about 90% of all prescriptions would be eligible as generic drugs. Insulin, anybody? High blood pressure medicine, cholesterol medications, allergy medicines, all of those would be generic. Shoot, insulin's been around what, nearly a hundred years now? And yet the drug companies have found a hundred different ways, we could talk about it, to keep those markets from working.

40% of the generics market has either zero or one manufacturer. 60% is only up to two manufacturers. This is not a market that's working. So here's my proposal on that. If we've got a market that's not working, like the market for insulin, then the federal government ought to come in and just do a contract and say, we will contract with a company to produce generic insulin, and then we're going to turn around and make it available to the American people at cost plus.

We do that a few times, and boy, the cost of prescription drugs goes down and a whole bunch of drug companies who've been finagling around in the generics market suddenly see that their plan doesn't work anymore. So that's one way we can bring down costs.

Obradovich: Why do you think that's a better idea than, say, Vice President Biden proposed that if companies are raising their prices more than the rate of inflation after that patent period, that you just say, "Hey, you're not going to have the market for covering under Medicare and Medicaid, that you're not going to have that government market anymore. And by the way, we are going to raise your taxes."

Warren: So look, if you're asking the question, should we negotiate with the drug companies? I'm all in on that. Of course we should negotiate prescription prices with the drug companies.

I'm just trying to add a little more muscle behind that negotiation. I'm for it. Should we be able to import drugs from foreign countries so long as they meet the safety standards here in the United States? You bet we should be able to import those drugs. There are a lot of ways we can go at this. And for companies that have... The 10% that are still in the period of complete patent protection on their drugs, yeah. Then if somebody is charging a price right through the roof, we have the capacity as the federal government to say, no. We'll let the contract and let somebody else make it so that everybody gets access to these drugs.

But this was the point that I was starting with, the reason we have a problem with drug prices in America is not because of the science. It's not because we don't understand it. It's because the drug companies are paying the pipers in Washington and they call the tunes. We have Washington right now that works great for drug companies. And they are spending big money on campaign contributions, on lobbyists, on bought-and-paid for experts, on think tanks, on advertising to keep things just as they are. What we need most in this country is some courage to take on the giant drug companies and say, "No more of this."

Bob Edwards: That was Elizabeth Warren of Massachusetts. Next up, Marianne Williamson.

Announcer: [crosstalk] activist, Marianne Williamson.

Obradovich: You're on the record as being in favor of importing prescription drugs from other countries to help lower the prices, and allowing the federal government to negotiate prices. Correct?

Williamson: Regulated.

Obradovich: Regulated. Okay. So Senator Warren was just out here saying the federal government should actually manufacturer generic medications to help reduce the prices. Do you agree with that approach as well?

Williamson: Yes, I would agree with the senator. I think we have to look at the bigger picture here. We need to look, for me, when it comes to the elders in the United States, we have two categories we need to look at. We need to look at threats and we need to look at opportunities. When it comes to threats, the greatest threat to the wellbeing of the American senior is corporate greed, and mainly corporate greed on the part of big pharmaceutical companies when they behave in predatory ways.

The fact that the United States government... Now let's be clear at what has happened here. We have two Big Pharma lobbyists for every member of Congress. The big pharmaceutical companies spend twice as much as fossil fuel companies lobbying our congresspeople and the United States government actually negotiated with big pharmaceutical companies on behalf of big pharmaceutical companies saying, we give away our capacity to negotiate.

Now, we've already talked about the vulnerability of our children. The two populations in the United States, which are the most hurt by and the most threatened by this corporate greed have to do with our children and have to do with our seniors.

So absolutely we have to ask ourselves as a generation, who is the government working for? Seniors, by definition, are people who worked, they are people who raised children. they are people who contributed to this society. And it's not only that the government should be protecting them from the greed and the predatory nature of big pharmaceutical or any other corporate entities, as they age, the government should actually be going further than that to reward people who, I know being 67 years old myself, have entered the third chapter of our lives and have more to give. We have more to give.

You know, Ralph Waldo Emerson said, "As I age, my beauty steals inward," and so much power as... It's an amazing thing, but all of us are a certain age, know it, a certain kind of physical power decreases, but there's an internal power, a wisdom, for instance, that increases. I read an article once that fascinated me about the brain of a senior. And it was all these fascinating, brilliant, amazing scientists from some of the most prestigious academic institutions in North America, neurologists, all kinds of psychological and neurological experts who were studying what happens in the brain of a person as we get older. And they were studying memory loss. And what this article, it was in the New York Times, and what it was saying was that some memory loss is clearly devolutionary, we all know that, but that there are other kinds of memory loss which are actually evolutionary. That the brain gets to a point where it recognizes patterns so it does a data dump.

That's why at a certain age, let's say we're talking to a younger woman and she's telling us about something in her marriage or something. And we can say, "Trust me, he'll be back," or "Trust me, he's not going to call." Why? Why do we know that? We've been there. We've been through it enough? We don't need any more data. We don't need any more evidence. We know.

There is so much potential in our society. I think there are so many seniors in our society, they're retired but they have so much to give. There is so much mentoring that could be done. There is so much foster grandparenting could be done. The government could work far more assiduously with things like Big Brothers and Big Sisters, with YMCAs, et cetera, in order not only, like I said, to deal with the threats to the seniors, but also the profound opportunities not only to seniors but to our society in allowing ways that we can be used and we can be even more helpful than we could have been when we were 30 years old and didn't know anything in comparison.

Bob Edwards: That was Marianne Williamson of California. Next up Representative Beto O'Rourke.

Announcer: Beto O'Rourke.

Obradovich: You've heard a lot of proposals to speak about how to help people pay for their prescription medication. One of them that we heard today was to actually have the government manufacture generic medication if companies won't lower the price. Is that a good idea?

O'Rourke: It may be an option that we look at and leverage to use to try to get drug manufacturers to bring down the cost of medications. This is something that's incredibly insulting to most Americans that I listen to. They remind me that as taxpayers, we paid for the initial research and development to many of the cures and medications that are subsequently sold back to us at some of the most expensive prices on the face of the planet today.

We inexplicably do not use the leverage of Medicare and its purchasing power to bring down the price. That's something that we'll change in our administration to make prescription drugs affordable for every American. We'll also allow you to buy from Canada, the European Union, Japan, other countries that have high standards for their testing of medications, but sell at much lower prices that we're seeing here today.

And yes, we need an FTC that will vigorously enforce against this monopolistic practice of generic drug manufacturers who are selling lifesaving medications back to our fellow Americans at prices that far too many of them cannot afford, to the point that they're doing without and dying prematurely or crowdsourcing the funding for medications in the wealthiest, the most powerful country on the face of the planet, the same country that came up with these medications so often in the first place.

Obradovich: Do you think that pharmaceutical companies, easy for me to say, are just really spinning people when they say that these kinds of measures will really eliminate their ability to research and bring into development lifesaving medication like for Alzheimer's or for cancer?

O'Rourke: You ask if they're spinning us. They absolutely are, and-

Obradovich: How do you know that, though?

O'Rourke: Because what we're seeing in the United States is not found in any other country. The fact that 97 years after the development of insulin, you have people dying of diabetes in the United States of America is unconscionable and inexplicable unless you follow the money. And these pharmaceutical corporations' ability to buy, not just access to members of Congress, not just influence, but outcomes along the lines of what we're describing today. To also be able to purchase almost, well, functionally complete impunity. I think of Purdue Pharma who has helped to market these opioids that have consumed the lives of tens of thousands of our fellow Americans, and that we have the largest prison population on the face of the planet. A lot of people there are serving time for marijuana arrests. More likely than not people of color, though all Americans use marijuana at the same rate. No one from Purdue Pharma has spent a night in jail or paid a meaningful price for what they have done to this country.

So when we hold pharmaceutical companies, manufacturers and marketers accountable, it brings down the price of medications. We also get improved outcomes and corporations who live and work in line with our values in this country. They are completely out of line today.

Bob Edwards: That was Beto O'Rourke of Texas. And lastly, Andrew Yang.

Announcer: [crosstalk] Andrew Yang.

Obradovich: Thanks for being here. Your first question is coming from the audience and he's right here in front of you.

Audience Member: My name is Doug Lehman and 10 years ago I became insulin-dependent after a kidney transplant. Prior to this, I do not take any prescription drugs. Now I need seven shots a day and I'm on 32 pills. The price for these medications has steadily increased over the past five years. Recently, the cost increased $500 a month. At 66 years old, I've had to seek other employment to cover the cost. If I was not able to work, I could not get the anti-rejection drugs I need to continue this kidney operation. So as president, what would you do to reduce the cost of prescription and lifesaving prescriptions?

Yang: Thank you for the question and it's a pleasure to be here with you all. It's a privilege and honor to address you. Your situation is not yours. And by that what I mean is, there are so many other Americans who are in the same boat, where if you talk to seniors in particular, they're being gouged. Notice drug prices never seem to go down, they only seem to go up, only seem to have one direction? And this is a uniquely American problem, unfortunately, because our society has been overrun by corporate special interests including the drug companies. It makes it so that Medicare can't even negotiate drug prices on behalf of the American people. The drug lobby managed to push that to the side. So I have a four-point plan to get the drug prices down. But then bigger picture, we have to make it so that when you need the money to survive that you're not heading back to the workforce, trying to find a job in a workforce that might not welcome you or have a path forward.

We need to rewrite the rules of the economy so it actually works for us, the citizens and owners of this country. It doesn't feel like we're the owners anymore. It feels like we're somehow passengers on a ship that we have less control over, but we're still the owners of this democracy.

So the way you get the drug prices down, first you give the government authority to negotiate lower prices. That seems straightforward. It seems obvious. Whatever reason we don't do it. The second thing is you say to drug companies, look, you cannot stick it to Americans at a level different than you're charging other countries. Does it make any sense to you all that they can charge Americans two, three, four times what they're charging people in other markets?

It's because people in other parts of the world have governments that are saying there is no way you're going to charge that for this drug. What they do is they use international reference points and say this is the international standard, so you have to be plus or minus 10, 20% of that international standard. Does that make sense to you all?

Yeah. America doesn't do it. America, the drug price gets set by the company and then we're all stuck with it. So what you do is you say to the drug companies, you have to come within this margin of the international standard, what you are charging other other citizens of other countries.

Number three if they don't go along with that, because you know companies just want to maximize the bottom line. They don't care about our health, they don't care about our wellbeing. So then you have to hit them where it hurts. You have to say look, if you do not come within these international guidelines then we, the government of this country have the ability to license your drug. And then we have public manufacturing facilities where we can manufacture your drug. That is the giant club. And so if you're a company, you know, if you push it too far, if you gouge the American people too much, the government will say look, you failed the test. We tried to let you keep your costs under control but you can't do it. So then we're going to take this license and then we have a public facility to manufacture that drug. Do you think that this plan would get drug prices down? Yes.

This is how we get drug prices down. These companies only know one language and it's dollars and cents, so we got to hit them where it hurts. They've long ago lost their sense of public interest, public good, public health. No, we have a system now where it just rewards the bottom line

Obradovich: First, before we leave prescription drug costs, you didn't mention reimportation from other countries. Do you think that would work? Is that part of your plan or is that a bad idea?

Yang: That's a good idea. So reimportation is that if American drug manufacturers can't either get their prices in line or produce what the American people need, then we can reimport the drugs from other markets and other producers.

Obradovich: But you want to try those other approaches first?

Yang: I think they'd be hand-in-hand, because again, the American system right now just rewards profitability. And so if an American drug company thought that we were going to bring in competing goods from another market, then that would actually help get the prices down.

Bob Edwards: That was Andrew Yang of New York.

Candidates discussed many other issues at the forums, including social security, aging in place, Medicare, healthcare access, and more. And you can watch the complete series and the AARP Asks the Candidates video series at AARP.org/election2020.

Since listeners sometimes ask, AARP does not endorse candidates, nor donate to campaigns or political action committees called PACS. But AARP has a proud 33-year history of nonpartisan voter engagement, and it provides voters with information on where the candidates stand on issues so voters can make their own decisions on Election Day.

At the moment, the 2020 race is focused on the Democratic primary, but of course we will bring you the Republican side as the Election Day 2020 nears. Tune in for the final part of the series to hear Senator Bernie Sanders, Mayor Pete Buttigieg, and Governor Steve Bullock, and of course the rest of our Iowa Presidential Candidate Forum Series.

For more, visit arp.org/podcast. Become a subscriber and be sure to rate our podcast on Apple Podcasts, Google Play, Stitcher, and other Podcast Apps. Thanks for listening. I'm Bob Edwards.

Part 5: Sen. Bernie Sanders, Gov. Steve Bullock and Mayor Pete Buttigieg

Bob Edwards: Hello, I'm Bob Edwards with an AARP Take on Today. Today, we bring you the final episode of a five-part series in which we talk about the issues that matter most to voters 50 and over with 17 candidates for president.

From Bennett and Biden, to Warren, to Yang, and nearly every candidate in between, AARP recently hosted the 17 at Town Hall forums across Iowa. The project was a partnership of AARP and the Des Moines Register, and kicked off AARP's 2020 voter education efforts.

Candidates spoke for about half an hour, so we can't bring you everything they said in this podcast, but we've chosen to air each candidates view on prescription drugs, given how top of mind that issue is for voters these days. The moderators were Cathy Obradovich ...

Speaker 2: ... Opinion editor for The Des Moines Register.

Bob Edwards: ... and O. Kay Henderson ...

Speaker 2: ... News Director of Radio Iowa.

Bob Edwards: Each clip starts with the moderator's question, followed by the candidate's unedited answer. You can learn about each of the candidates' responses on other key issues at aarp.org/election2020, and listen to the complete five-episode series now.

In the final episode, we share responses from the slate of candidates from our forum on July 20th in Council Bluffs, Iowa. Taking the stage were Senator Bernie Sanders of Vermont, Governor Steve Bullock of Montana, and Mayor Pete Buttigieg of Indiana. Let's listen in on how each will address high prescription prices, if elected. First up, Senator Bernie Sanders.

Announcer: ... United States Congressman, and current United States Senator from Vermont Bernie Sanders.

Audience Member: My name is Bill Grove. Too many older adults are struggling to afford their lifesaving prescription drugs. My prescription drug costs have doubled in the last few years. Fortunately, that increase has been manageable for me, but that is not the case for many other older Iowans. Too many make tough choices, like filling a prescription or buying food for the week. If elected, what is your plan to make sure Americans have access to affordable prescription drugs?

Sanders: Bill, thank you very much for that question. In Washington, D.C., there are a lot of selfish, greedy, dishonest entities, but I have had a hard time figuring out whether it is the pharmaceutical industry or Wall Street which is the worst. Not quite clear, but I think it may well be the drug companies.

All right, and let me tell you why, Bill. Last year, the top 10 drug companies made $69 billion in profit. How's that? Not bad. $69 billion in profit, while one out of five Americans cannot afford to fill the prescriptions their doctors write. Think about that. When we talk about a dysfunctional, irrational healthcare system, how insane is it that you go to the doctor because you're sick, doctor writes out a prescription, you can't afford to fill it? Well, what happens? You get sicker. You end up in the emergency room at greater cost to the system.

So, what do we do? First of all, we make it very clear to the drug companies that the day is over. Now. Today. First day as president, they're going to stop ripping off the American people, and charging us the highest prices in the world for prescription drugs.

Twenty years ago this year, I took a busload of women who were dealing with breast cancer in northern Vermont across the Canadian border to go to Montreal and buy Tamoxifen, a widely prescribed breast cancer drug. Take a guess, Bill, the differential in price between Canada and the United States for this breast cancer drug.

Audience Member: Five times.

Sanders: Well, it was 10 times. I remember, will never forget, women were ... These are working-class women, were crying that they were now paying one 10th of the price. In a week, I'm going from Detroit to Windsor, Ontario, with a group of people to buy insulin because they have diabetes. Once again, the differential will be 10 to one. They're going to pay one-tenth the price in Ontario than they pay in Michigan and in the United States.

So, this is what we are going to do. First of all, under the Medicare for All proposal which I've introduced, we do what the United Kingdom does, and what other countries do. We cap the amount of money that people will spend for prescription drugs at $200. Why is that? Because, when you talk about healthcare, you have got to talk about prescription drugs. You can't say, "Oh, you can go to the doctor, that's great, but we don't cover the cost of prescription drugs." Cap of $200.

How do we save money? Well, on prescription drugs, we do it in a variety of ways. Number one, we have Medicare negotiate prescription drug prices with the drug companies. Number two, we do pretty much what Canada does right now. If you take a look at what drug prices are around the rest of the world, you take five or six countries, and you say to the drug companies, "Guess what? You're not going to charge us any more than you do on average with these other five or six countries."

Number three, what you do is right now, as a result of that trip that I took to Canada 20 years ago, other members of Congress began to do it, Senators began to do it, and right now, sad to say, there are millions of people who are buying prescription drugs abroad. What we should make legal is for your pharmacist and prescription drug distributors to be able to buy FDA approved drugs in Canada and in other countries, and sell them in the United States at a fraction of the price that they are now being sold.

Fourthly, guess what? Your tax dollars have gone to develop many important drugs, and the drug companies use that research and then end up making as much money as they want. When taxpayers dollars are used for research, we're going to have reasonable pricing on the part of the drug companies. Those are some of the things.

I've been dealing with the pharmaceutical industry for 20 years. I am their worst nightmare.

Bob Edwards: That was Bernie Sanders of Vermont. Next up, Governor Steve Bullock.

Announcer: ... State of Montana, Governor Steve Bullock.

Speaker 2: ... into more traditional medicine. You're on the record as not favoring re-importation of prescription drugs from places like Canada. Why not?

Bullock: Well, well, I think that there's a couple of different things that ... First of all, you often hear, well, the prescription drug companies say, well, you know, we do all this research and development so it's not fair to get them from other countries. They spend more on advertising right now than they do on research and development. Re-importation is not my first priority or what I'd like to do first to try to get drug costs under control. It is to me a sign of both the toxic influence of money in our elections and how broken Washington, D.C., is when the biggest purchaser of prescription drugs, the federal government, can't negotiate drug prices. This is just insanity.

So goal number one for me would be to lift that and be able to negotiate for a fair price. If that doesn't work, if we don't get to the point where prescription drugs are a heck of a lot more affordable, because just like I was saying at the start, when I was doing energy issues, literally had people talking to me, seniors, AARP members saying, "I have to choose between heating my home and picking up my prescription drugs." Nobody should have to make that choice. If you can't get to that point, then I think there are things to look at from importation from other countries and possibilities of indexing and things, but the first ought to be that we ought to be able to just negotiate for a fair price.

Not trying to say that prescription drug companies have to give away all their drugs, not make any money, not invest in research, but if you're spending more on advertising than you are on your research, you shouldn't be getting a tax credit for that. Shouldn't be able to write that off. And then you ought to be able to, just like in every other area ... We negotiate for the cost or at least we can get several different options if we want to get our car fixed. We ought to be able to get the ability to negotiate when it comes to prescription drugs.

Bob Edwards: That was Steve Bullock of Montana. And, lastly, Mayor Pete Buttigieg.

Announcer: ... Please welcome to the stage south Indiana Mayor Pete Buttigieg.

Speaker 2: On the record I believe is supporting allowing Americans to import prescription drugs from other countries. How do you ensure the safety of those products, given that there's been some high profile cases of legitimate pharmacies having to pay multimillion-dollar fines for importing basically fake drugs?

Buttigieg: Well, I believe the FDA is up to the task if we are committed to supporting the FDA in its enforcement capabilities. Right now, far too many of our agencies are run by folks who don't seem that serious about holding industry accountable. Right. I'm being diplomatic here, and, and yet I'm absolutely convinced that a country that's delivered the standard of consumer product safety that we expect can apply that to things like imported drugs.

Speaker 2: Are there other ways that you would look at to try to reduce the cost of prescription drugs?

Buttigieg: Absolutely. First of all, and I'm guessing there's not much daylight among us Democrats running for president on this, but just in case it's not clear that I believe this, the government should be able to negotiate drug prices with drug companies. So I think that's important.

I think we do need a cap on out-of-pocket expenses, and we need to require that.

By the way, when I talk about the government's negotiating power, I don't only mean Medicare. I also think that private payers should be able, if they want to, to have the Health and Human Services secretary empowered to conduct those negotiations.

And when you get to the really extreme cases of pharmaceutical companies misbehaving in ways that are really just putting the squeeze on people, seniors or otherwise, who are just trying to get through life and are forced to choose between basic necessities and lifesaving medication, or cutting back on dosage because it's unaffordable. When it reaches a certain point where it's clearly abusive, then we have to have a government empowered to act on that, including being able to use our power to look at the intellectual property that's behind that in cases of extreme abuse and use that as the way to get them to the table for the kind of arbitration that I think will actually lower prices.

Speaker 2: And what do you make of the argument that those kinds of things, especially the patent restrictions, would show innovation that insurance companies are not going to be able to put as much money into research and development?

Buttigieg: Well-

Speaker 2: Not insurance. Pharmaceutical companies.

Buttigieg: Yeah, look, I support, if you invent a wonder drug, I want you to be rewarded for it, and a lot of experiments don't work out and that's one of the reasons why you use the profits from the drug that worked well to cover the cost of all the things that didn't work out. That's fine, but look at the rate at which profits have grown, and look at the rate in which investment in research has grown. Guess which one's higher? It's the profit one.

This is not about saying you can't make a profit. This is about saying you cannot harm people unnecessarily by manipulating the patent system, like making a little cosmetic change that isn't even real, and then saying, oh, we've got to start the clock all over again on the patent. It's in cases of abuse that we need that kind of enforcement power

Speaker 2: I want to move on, but just one really quick question. Should the federal government be in the business of manufacturing generic medication?

Buttigieg: Potentially. There are certainly cases where it seems that the private sector cannot deliver quality, affordable drugs, and usually when we talk about a public option, we're thinking about the public option for insurance, but if you zoom out and think about it, we've got public options on lots of things in this country. A library is a public option. A community-run swimming pool is a public option among different ways that you could get access to a swimming pool. And we should think a little more broadly about where public options are appropriate in order to fill some kind of gap, some kind of hole in the market that is working well in some areas but not in others.

Bob Edwards: That was Pete Buttigieg of Indiana.

Candidates discussed many other issues at the forums including social security, aging in place, Medicare, healthcare access and more. And you can watch the complete series and the AARP Asks the Candidates video series AARP.org/election2020.

Since listeners sometimes ask, AARP does not endorse candidates nor donate to campaigns or political action committees called PACs. But AARP has a proud 33-year history of nonpartisan voter engagement, and it provides voters with information on where the candidates stand on issues so voters can make their own decisions on election day.

At the moment, the 2020 race is focused on the Democratic primary, but of course we will bring you the Republican side as election day 2020 nears. You can watch the complete series of forums and the AARP Asks the Candidates video series at AARP.org/election2020.

For more, visit AARP.org/podcast. Become a subscriber and be sure to rate our podcast on Apple Podcasts, Google Play, Stitcher, and other podcast apps. Thanks for listening. I'm Bob Edwards.

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