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Mr. McCAIN. I would say to my friend, the Republican leader, that I have seen a lot of processes around here and a lot of negotiations and a lot of discussions, but I must admit I have not seen one quite like this one, nor do I believe my leader has.
I was on the floor in a colloquy with the assistant Democratic leader a couple days ago, and I said: What is in the bill? He said: None of us know. Talk about being kept in the dark.
I would say to my friend from Kentucky, we have to put this into the context of what the President of the United States said in his campaign because the whole campaign, as I well know better than anyone, was all based on change. On the issue specifically surrounding health care reform, I quote then-Candidate Obama on October 18, 2009:
I am going to have all the negotiations around a big table televised on C-SPAN so that people can see who is making arguments on behalf of their constituents and who is making arguments on behalf of the drug companies or the insurance companies.
He went on to say that a couple more times.
I would ask my friend: Hasn't it been several days that we basically have been gridlocked over one amendment, which is the amendment by the Senator from North Dakota that would allow drug reimportation from Canada and other countries?
So then, guess what the reports are today:
PhRMA renegotiating its deal? Inside Health Policy's Baker, Pecquet, Lotven and Coughlin report: `The pharmaceutical industry is negotiating with the White House and lawmakers on a revised health care deal under which the industry would ante up cuts beyond the $80 billion it agreed to this summer, possibly by agreeing to policies that would further shrink the ..... doughnut hole. .....'
I will not go into all the details of that.
Just a few minutes ago on the floor, guess what. They announced there would be some change made, an amendment that would be included in the managers' package.
I would ask my friend, is it maybe the case that the majority leader, who is having a meeting, as we speak, of all the Democratic Senators behind closed doors, without C-SPAN, has cut another deal along with the White House with--guess who--the pharmaceutical companies that have raised prices some 9 percent on prescription drugs this year?
This is a process the American people don't deserve, so I would ask my friend from Kentucky.
Mr. McCONNELL. I would say to my friend from Arizona, that is a process that gives making sausage a bad name.
Mr. McCAIN. So we were hung up--or should I say gridlocked--for 2 or 3 days, over the entire weekend. The Republican leader even agreed to a unanimous consent agreement that would allow a Democratic side-by-side amendment, and that was not agreed to--until over at the White House, according to this report, PhRMA renegotiated its deal and apparently they now have sufficient votes to defeat the Dorgan amendment which, as of last summer, according to the New York Times, said the last deal shortly after striking that agreement, the trade group--the Pharmaceutical Research Manufacturers of America, or PhRMA--also set aside $150 million for advertising to support the health care legislation.
I ask my friend, is this changing the climate in Washington or is it not only business as usual but, in my opinion, I haven't seen anything quite like this one.
Mr. McCONNELL. I would say to my friend, it certainly is not changing business as usual in Washington. Even more important than that, it is not changing American health care for the better, which is what we all thought this whole thing was about when we started down this path of seeing what we could do to improve America's health care, which almost everyone correctly understands is already the best in the world.
Mr. McCAIN. Hadn't there been charge after charge that Republicans are ``filibustering'' and Republicans have been blocking passage of this legislation? I would ask my friend, hasn't the Republican leader offered a series of amendments we could get locked into and have votes on?
Mr. McCONNELL. We have been trying to get votes on the Crapo motion, for example, since last Tuesday. It will be a week tomorrow. Maybe at some point we will be able to have amendments again.
We started off on this bill with each side offering amendments, and we went along pretty well until, I think, the majority decided it was not only better to write the bill in secret, it was better to not have any amendments to the bill. So they began to filibuster our efforts for Senators to have an opportunity to vote on aspects of this bill, such as the $ 1/2 trillion worth of cuts in Medicare which we, fortunately, were able to get votes on; the $400 billion in new taxes, which we would like to be able to get votes on.
This is the core of the bill. The American people have every right, I would say to my friend from Arizona, to expect us to debate the core of the bill--the core of the bill, the essence of the bill--which is not, of course, going to be changed behind closed doors or during this meeting that is going on with Democrats only.
Mr. McCAIN. As I understand it, there is a meeting going on behind closed doors, again, where there are no C-SPAN cameras.
According to the Washington Post this morning, it says:
The Senate will resume debate Monday afternoon on a popular proposal to allow U.S. citizens to buy cheaper drugs from foreign countries which led to a last-minute lobbying push by drug makers last week and bogged down negotiations over a health care reform bill.
It goes on to say:
The fight over the imported drugs proposal poses a particularly difficult political challenge for President Obama who cosponsored a similar bill when he was in Congress and who included funding for the idea in his first budget. But the pharmaceutical industry, which has been a key supporter of health care reform after reaching agreement with the White House earlier this year, has responded with a fierce lobbying campaign aimed at killing the proposal, focusing on Democratic Senators from States with large drug and research sectors.
So it will be interesting to watch the vote.
I would also point out to my friend, it is clear that if we allow drug reimportation, we will save $100 billion, according to CBO, and the deal that was cut--the first deal that was cut with the White House was they would reduce it by $80 billion, so they had a $20 billion cushion. Now it will be very interesting to see what the latest deal is and how the vote goes.
But, again, I wish to ask my Republican leader, we get a little cynical around here from time to time and we see sometimes deals cut and things done behind closed doors. I am past the point of frustration; I am getting a little bit sad about this. Because I think we know we are now bumping up against Christmas. Sometime we are going to break for Christmas. So the pressures now are going to be even more intense because I think it is well known and reported that if they don't get a deal before we go out for Christmas, then it will be very much like a fish sitting out in the sun. After awhile, it doesn't smell very good, when people see a 2,000-page bill which has all kinds of provisions in it.
So I understand, without C-SPAN cameras, that all the 60 Democratic Members of this body are going to go down to the White House for another meeting tomorrow, and we will see what happens then.
Mr. McCONNELL. I would say to my friend from Arizona, talk about an example of manufactured urgency. Is it not the case, I ask my friend from Arizona, that the benefits under this bill don't kick in until 2014?
Mr. McCAIN. Well, my understanding is, if you go out and buy a car today from any car dealer, you don't have to make payments for a year. You can get that kind of a deal if you want it. This deal is exactly upside down. You get to make the payments early, and then you get to drive the car after 4 years.
Mr. McCONNELL. So the urgency, it strikes me, I would say to my friend from Arizona, is to get this thing out of the Congress before the American people storm the Capitol.
We know from the survey data, do we not, that the American people are overwhelmingly opposed to this bill? So what is the argument I keep hearing on the other side? I was going to ask my friend from Arizona: I hear the President and others say: Let's make history. Well, there has been much history made but much of it has actually been bad, right?
Mr. McCAIN. I would also like to say, there is a history we should not ignore; that is, that every major reform ever enacted in the modern history of this country has been bipartisan, whether it be Medicare, whether it be Social Security, whether it be welfare reform, as we remember under President Clinton. Every major reform has been accomplished by Democrats and Republicans sitting down together and saying: OK, what is it we have to do? What kind of an agreement do we have to make?
Some of us have been around here long enough to remember that in 1983, Ronald Reagan and Tip O'Neill, a liberal Democrat from Massachusetts and the conservative Republican from California, sat down with their aides across the table and key Members of Congress when Social Security was about to go broke.
Why can't we, since there must be areas we agree on, now say to our Democratic friends and the President, rather than trying to ram 60 votes through the Senate, why can't we now sit down and proceed in a fashion--we will give things up. We are willing to make concessions to save a system of Medicare that is about to go broke in 6 years. We will make some concessions but get us in on the takeoff and don't expect us to be in on the landing when already the bill is written and the fix is in, as the fix apparently is in on the Dorgan amendment.
Mr. McCONNELL. Could I say to my friend from Arizona, no one has done more in the Senate, in the time I have been here, to express opposition to and warn us about the perils of excessive spending.
As I recall, one of the things the Senator from Arizona told us after he came back following his campaign was, what the American people are concerned about is the cost of health care--the cost. Of course, we are also concerned about government spending--the cost to consumers of health care and the cost to government spending. Dr. Christina Romer, a part of the White House's economic team, said on one of the shows yesterday:
We are going to be expanding coverage to some 30 million Americans and, of course, that's going to up the level of health care spending. You can't do that and not spend more.
Maybe she didn't get the talking points for yesterday's appearances. But we have conflicting messages out of the White House on this very measure.
In short, it is safe to say this is a confused mess, a 2,100-page monstrosity of confusion and unintended consequences. Yet they are in this rush to enact a bill--the benefits of which don't kick in until 2014--before Christmas Day this year. I am astonished at the irresponsibility of it.
Mr. McCAIN. Madam President, it is a remarkable process we are going through. I see that my friend from Tennessee is here. I know he, being the head of our policy committee and a major contributor to keeping us all informed and up to date, would also like to say something.
First, I will say something I had not planned on saying; that is, this has been a vigorous debate. I think we have been able to act in an effective way, which has been reflected in the polls of the American people who are largely opposed to this measure and greatly supportive of a process where we can all sit down together--with the American people in the room, to be honest--when we are talking about one-sixth of the GDP. The Republican leader's job has been compared by one of his predecessors to herding cats--I agree with that--or keeping frogs in a wheelbarrow. I have not seen the Republican Members on this side of the aisle as much together and as cohesive and working in the most cooperative and supportive fashion of each other since I have been in the Senate. For that, I congratulate the Republican leader.
Mr. McCONNELL. I thank my friend.
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Mr. McCAIN. I will mention, also, on the issue of PhRMA, again, here we are in the direst of economic times, with a Consumer Price Index that has declined by 1.3 percent this year, and they have orchestrated a 9-percent increase in the cost of prescription drugs--that is remarkable--laying on an additional burden, which naturally falls more on seniors than anybody else since they are the greatest users of pharmaceutical drugs. I don't blame them for fighting for their industry. But the point is, what they are doing is harming millions and millions of Americans.
Again, about contributing to the cynicism of the American people, whether you are for or against the issue of drug reimportation, to cut a deal behind closed doors and then, apparently, because of support of an amendment by Senator Dorgan, go down and negotiate another deal--how do you describe a process like that?
Mr. ALEXANDER. Well, ``unsavory'' would be a minimum word that comes to my mind. The problem I have is that Americans have a perfect right to their view, and the pharmaceutical industry has a perfect right to advocate its point of view.
As I hear the Senator describe what has been going on, am I hearing correctly? I mean, the pharmaceutical industry is saying we don't like drug reimportation. The White House says: OK, we will cut a deal with you behind closed doors--as far as we can tell--and we will change the law this way, and then--
Mr. McCAIN. The original deal was published in every newspaper, and it was that they would close the so-called doughnut hole by some $80 billion. CBO said their profits would be reduced by some $100 billion if we allow reimportation. They had a $20 billion cushion.
Mr. ALEXANDER. So it is a negotiation between the White House, the President, and big industry about profits: I will do this, you do that, and then you go out--and my understanding is that you write in as part of the deal that the industry spends $150 million on television advertisements in support of the deal. Is that the deal?
Mr. McCAIN. But then, incredibly, they counted the votes. The votes were there to pass the Dorgan amendment. According to published reports, the pharmaceutical industry is negotiating with the White House and lawmakers on a revised health care deal under which the industry would ante up cuts beyond the $80 billion it agreed to this summer.
In other words, because that wasn't sufficient to get votes to kill the Dorgan amendment that would allow reimportation of drugs, they went down and renegotiated. What is that called?
Mr. ALEXANDER. Well, if I am remembering right, earlier this year the Republican leader made a talk on the Senate floor. The attitude of the White House toward a large company in Kentucky, as I remember, was: If you don't agree with us on health care, we will tax you. That was the attitude, it seems, to come out. If you don't agree with us, we will tax you, or we will make it difficult for you to do business. If you do agree with us, we will make a deal with you that affects your profits.
Mr. McCONNELL. I say to my friends, beyond that, the administration basically told this company to shut up. They issued a gag order that was so offensive, even an editorial in the New York Times said it should not have been done. They could not communicate with their customers the impact of various parts of this bill on a product they buy, Medicare Advantage. The tactics have been highly questionable, it strikes me, from the beginning of the year up to the present. What Senator McCain is talking about is just the most recent example.
Mr. McCAIN. Can I also give you this to illustrate it graphically? In this news report, several lobbyists told Inside Health Policy--that is the organization that is reporting this--they have heard that the Pharmaceutical Research and Manufacturers of America may have already reached a deal with the White House and AARP to close the Senate bill's coverage gap by 75 percent versus the 50 percent under the current bill. PhRMA declined to confirm the reports that it may be agreeable to reforms that would further close the doughnut hole but signaled discussions were underway, and AARP said no agreement has been reached. We haven't seen a deal.
Here are our old friends at AARP at it again. They are at it again.
Mr. McCONNELL. Will the Senator yield for this point?
Mr. McCAIN. Yes.
Mr. McCONNELL. Is that the same AARP that would, I am told, actually benefit from the decline of Medicare Advantage because they sell policies themselves that would be more likely to be purchased by seniors? Is that the same AARP?
Mr. McCAIN. When you lose Medicare Advantage, as Dr. Barrasso will fully attest, then you are almost forced into the so-called Medigap policies, which then cover the things that are no longer covered under Medicare Advantage, such as dental, vision, fitness, and other aspects of Medicare Advantage.
So if you destroy Medicare Advantage, then people will be forced into the Medigap policies. Who makes their money off Medigap policies? AARP.
Mr. SESSIONS. If the Senator will yield for a question about this deal with big PhRMA, a few days ago I made reference to and quoted from a scathing editorial by Robert Reich, who served as Secretary of Labor in the Clinton administration, who is a leading intellectual liberal Democrat who criticized these deals in the most scathing terms. He used words I was reluctant to use on the floor--as my colleague said, ``unseemly,'' whatever. I would say it goes beyond that. He used the word ``extortion.'' I don't think he used that word lightly.
I think it is the kind of process--the Senator has been here and many who are on the floor now have been here for a long time--but it seems to me this is pushing the envelope on dealmaking to the point that really is a dangerous step. It goes beyond anything we should countenance, in my view.
Mr. McCAIN. I agree with the Senator. Again, I would like to ask Dr. Barrasso because he has treated patients who are under Medicare Advantage. Before I do, I want to say again that the whole process has been wrong. The process of going behind closed doors; the process where, after nearly a year of addressing this issue, the distinguished--and he is a fine person, a fine Senator from Illinois--the No. 2 leader in the majority, in a colloquy I had with him just 2 days ago, said no one knows what is in the bill. He said no one knows what is in the bill. This is after a year. It is wrong. What it does is--this issue is vital, but it destroys the confidence of the American people to be truly represented here to have their interests overridden by the special interests, of which PhRMA and this deal that is going on right now is a classic example. I ask Senator Barrasso.
Mr. ALEXANDER. Before Dr. Barrasso speaks, just listening to the Senator from Arizona, it seems to me it puts the Democratic leadership in the extremely awkward position of even its leadership--proposing a bill that affects 17 percent of our economy and the leadership of the Democratic Senate doesn't yet know what is in the bill, we certainly don't know what is in the bill, and they are in the awkward position--at least they have been the last few days--of filibustering their own bill at a time when they are insisting that we pass the bill before Christmas, which we can hear the sleigh bells ringing. It is just a few days before that happens.
Mr. BARRASSO. It seems, as we are on the Senate floor talking--
Mr. McCAIN. May I interrupt? I ask unanimous consent that the Senator from Tennessee take over this colloquy.
The PRESIDING OFFICER (Mrs. Shaheen). Without objection, it is so ordered.
Mr. McCAIN. Go ahead. I am sorry.
Mr. BARRASSO. It seems to me, as we are on the Senate floor discussing the issue wide open--any American can come in here and listen to us--hidden behind closed doors is the other party, maybe sharing what is in the secret negotiations, maybe not, because it sounds as if a number of their members don't know.
What I do know from practicing medicine for 25 years and taking care of families around the State of Wyoming is that people depend on Medicare for their coverage. There are seniors who depend on Medicare and Medicare Advantage. The reason they call it Medicare Advantage is because there are advantages to being in it. It coordinates care. It helps with preventative care, which is not part of the regular Medicare Program.
Yesterday, I heard my colleague from Arizona say there are those who want to shut down Medicare Advantage--AARP, he said--because they are the ones to benefit and profit if, in fact, Medicare Advantage is lost to the seniors in this country. Madam President, 11 million Americans depend on Medicare Advantage. Yet they are losing because of a vote this body took. This body voted to strip $120 billion away from our folks who depend on Medicare Advantage.
I know the Senator from Arizona has another important point he wants to make.
Mr. McCAIN. The point I want to make is this process has turned into something, again, like I have never seen before. I was just handed this FOX News, just-reported breaking news that HARKIN said--I guess referring to the Senator from Iowa--HARKIN said that Medicare buy-in and public option are now dead. I don't know what to say except it seems to me they are just throwing everything against the wall and seeing what sticks and what doesn't stick. This is really, again, one of the most astounding kinds of situations I have observed in the years I have been in the Senate. Medicare buy-in is dead, public option is now dead.
What I would like to see is that HARKIN would report that now Republicans and Democrats will sit down together and try to work out something of which the American people would heartily approve.
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Mr. McCAIN. Very briefly, I say to my friends, apparently, if the news reports are right, the public option and Medicare is out. That is an interesting twist, and again, I think affirmation that they are just throwing things against the wall to see if anything sticks. But it doesn't change the core of the bill, which the Senator from South Dakota has been so eloquent about, and that is the $ 1/2 trillion in cuts from Medicare and increases in taxes.
So you can take the public option out or leave it in, and it still doesn't change the fundamental fact that it is going to restructure health care in America and do nothing to reduce the cost and nothing to improve the quality. I just wanted to make that comment and ask for comment from the Senator from South Dakota.
By the way, could I just mention, I haven't quite seen anything on the floor of the Senate as I saw when the Senator from South Dakota was challenged earlier today. I was watching the proceedings on the floor, and I wonder if the Senator from South Dakota would like to maybe respond to accusations of misleading information, I guess is the kindest way I could describe it.
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Mr. McCAIN. I would respond by saying whether the public option is in or out or whether expansion of Medicare is in or out, the core of this legislation will do nothing to reduce or eliminate the problem of health care in
America, which is the cost of health care not the quality of health care. In fact, it will, in many ways, impact directly the quality of health care, increase the cost, as we all know, by some $2.5 trillion, according to the chairman of the Finance Committee.
But I also want to point out the back and forth of this--is it in there, is it out? Well, let's try this. Who, up until a week ago, ever heard we were going to expand Medicare? Now it is out, now it is in. We used to have hearings around here, proposals, witnesses, and then we would shape legislation, which would be amended in the committee, and then brought to the floor and amended on the Senate floor. Here we have to get news flashes to know whether the public option is in or out, whether Medicare expansion is in or out. Again, this is kind of a bizarre process.
But my friend is right; it doesn't affect the core problem with this legislation, which is that it does not reduce cost, and it increases the size and scope of government and the tax burden that Americans will bear for a long period of time, including, by the way--and, again, I don't mean to sound parochial, but there are 337,000 of my citizens in the Medicare Advantage Program. The other side has admitted that the Medicare Advantage Program will go by the wayside. That is affecting a whole lot of people's lives, I would say, and that is in the core of the bill. That will not be changed by expansion of Medicare or with a public option or with no public option.
Mr. THUNE. Would the Senator from Arizona yield? I see a number of our colleagues and the leader.
I would simply add that this idea of expanding Medicare, which just emerged last week, was a bad one, and one even I think a lot of the Democratic Senators have come out in opposition to, which is why we are now back to the drawing board. But this relentless effort to try to tweak this bill around the edges, to somehow get that 60th vote, doesn't do anything to change the fundamental features of the bill, which the leader and the Senator from Arizona have been talking about, and that is the tax increases and spending.
Mr. McCAIN. If I could just mention this. Over the weekend, obviously people watched football games. I was obviously pleased to see my alma mater prevail over those great cadets at West Point. We have a tendency to divert our attention--even seeing, for a change, the Redskins winning a football game--but what we talked about late last week is vitally important. The Centers for Medicare and Medicaid Services had some devastating comments to make.
This is the organization that is tasked to provide us with the best estimates of the consequences of legislation--specifically Medicare and Medicaid.
The CMS, referring to this bill, said:
..... we estimate that total national health expenditures under this bill would increase by an estimated total of $234 billion during calendar years 2010 to 2019.
It goes on and on and talks about the devastating effects of this legislation, whether the public option is in or out, whether we expand Medicare or not. It is remarkable information that is in this study, a study being ignored by the other side. Clearly, what is happening on the other side is only one Senator is throwing proposals back and forth to the CBO until they get something that perhaps looks like it might be sellable. But the CMS has already made their judgment on this legislation.
Mr. CORKER. If I could respond to that, I have only been around here by about 3 years, but I passed an incredible scene--I think many of you coming to the floor may have seen it--a huge gaggle of journalists and reporters and folks waiting outside a room where our colleagues are meeting. There is reason this bill does not lower cost. I came from a world where if you had a problem, you identified what the problem was and then you had sort of a central strategy that you built out to try to lower cost, which I think is what all of us thought that health care reform should do--let's lower cost and create greater access for the American people.
Well, instead of that, we have had a process where it has been literally like 50 yellow stick-ums were put up on the wall to figure out how they could get 60 votes. There hasn't been an attempt to actually lower cost. There hasn't been an attempt to try to create a mechanism where Americans can actually choose, with transparency, the type of plans that work for them. Instead, it has been a game from the very beginning of trying to get 60 votes, and that is why none of the goals, except for one, has been achieved that they set out to achieve.
This is going to drive up premiums, it is going to add to the deficit, and it is going to make Medicare more insolvent, which is pretty incredible because when I got here there was a bipartisan effort to make Medicare more solvent. Instead we are using money from that to leverage a whole new program with unfunded mandates to States, new taxes, as the Senator from South Dakota was talking about.
So, again, what is happening in this room, and the reason I bring up the 50 yellow stick-ums on the wall, some of which were circled to try to get votes, that is what this has been about from day one. What is happening in the room right now is they are sitting around not dealing with the core of this bill, which is very detrimental to our country. But they are in this room trying to figure out which yellow stick-ums will get them the 60 votes.
In the process, doing something that is going to be very detrimental to this country.
Mr. McCONNELL. It could be the reason they are so anxious to do this before Christmas is they think Americans will be too occupied with the holiday season and somehow they can sneak this unpopular bill through and everybody will be busy opening presents or taking care of their families and somehow the American people will not notice.
I suggest to my colleague, I think this is going to be a vote that will be remembered forever. This is going to be one of those rare votes in the history of the Congress that will be remembered forever.
Mr. McCAIN. If I could, before my friend from Alabama, I wonder also, when we are talking about dropping expansion of Medicare as is reported by news reports--I don't know; we have not been informed--could it possibly have anything to do with the fact that the AMA came out in opposition to it? Could it have anything to do with the fact that the American Hospital Association came out in opposition to it? Of course, that the PhRMA situation is a parliamentary procedure that is awaiting action on the floor speaks for itself.
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