Amy Klobuchar

Ms. KLOBUCHAR

Ms. KLOBUCHAR. Mr. President, I ask unanimous consent that when the Senate completes its business today, it adjourn until 10 a.m., Tuesday, December 15; that following the prayer and pledge, the Journal of proceedings be approved to date, the morning hour be deemed expired, the time for the two leaders be reserved for their use later in the day, and the Senate resume consideration of H.R. 3590, the health care reform legislation, as provided for under the previous order. Finally, I ask the Senate recess from 12:45 p.m. until 3:15 p.m. to allow for the weekly caucus luncheons.

Ms. KLOBUCHAR

Ms. KLOBUCHAR. Mr. President, I ask unanimous consent that the joint resolution be read three times and passed, the motion to reconsider be laid upon the table, with no intervening action or debate, and any statements related to the joint resolution be printed in the Record.

Ms. KLOBUCHAR. Mr. President, I ask unanimous consent that the Senate proceed to the immediate consideration of H.J. Res. 62, which was received from the House.

Ms. KLOBUCHAR

Ms. KLOBUCHAR. Mr. President, I ask unanimous consent that the bill be read a third time and passed, the motion to reconsider be laid upon the table with no intervening action or debate, and any statements related to the bill be printed in the Record.

Ms. KLOBUCHAR. Mr. President, I ask unanimous consent that the Senate proceed to the immediate consideration of Calendar No. 224, S. 1755.

Ms. KLOBUCHAR

Ms. KLOBUCHAR. Mr. President, I ask unanimous consent that the vote order with respect to the Lautenberg and Dorgan amendments to H.R. 3590 be reversed to Dorgan and then Lautenberg.

Ms. KLOBUCHAR

Ms. KLOBUCHAR. Mr. President, I wish to speak in support of the Dorgan-Snowe importation amendment No. 2793, which provides some much- needed relief to Americans who are being crushed by ever-higher prescription drug costs. I wish to first note I am eagerly awaiting the details of some of the proposals that were put out there last night. I appreciate the work of my colleagues, but I do want to hear the response from the Congressional Budget Office. As I have said on this floor many times, I am concerned about expanding Medicare unless we do something about the geographic disparities that are already present in our system. When we look at some of the numbers, the average patient got $6,600 in Minnesota in 2006, and Texas is something like $9,300. What we want to try to do with this bill, and what I like about this bill, is all of the cost reform measures that are going to push us toward rewarding States that are participating in systems that provide more efficient care. If we don't do something about these geographic disparities, we are going to further exacerbate this by expanding Medicare. So I have some concerns about this, and I look forward to hearing from my colleagues as well as, of course, the solvency of the Medicare Program, which is scheduled to go in the red by 2017 under existing circumstances. Back to the Dorgan-Snowe amendment. This amendment not only would allow American pharmacies and drug wholesalers to import FDA-approved medications from Canada and several other countries and pass the savings on to consumers, it would also import some much-needed competition into the American pharmaceutical market. It is estimated that the amendment, which enjoys both Democratic and Republican sponsors, would result in Federal savings of $19.4 billion over 10 years, just at a time when we are looking for these kinds of savings. Millions of Americans depend on prescription drugs to help them manage chronic disease or other illnesses, but drug prices continue to skyrocket with annual increases well above the general inflation rate. From 1997 to 2007, retail drug prices increased an average of 6.9 percent per year, more than 2\1/2\ times the general rate of inflation, which was 2.6 percent per year over the same period. Look at that difference: 6.9 percent per year compared to 2.6 percent per year. As a result of these rising prices, many patients are forced to split pills, skip doses, or not fill their prescriptions at all. Yet right across the northern border of Minnesota and Canada, many of these same brand-name prescription drugs are available at a much lower cost. For example, according to one recent comparison, a 90-day supply of Lipitor costs $256 in the United States. In Canada, it is available for $188. In other words, Canadians pay 26 percent less than Americans for the very same drug. Here is another example: A 90-day supply of Nitroderm patches cost $303 in the United States but $125 in Canada. The Canadian price is 59 percent cheaper. We can go right down the line of major brand-name drugs and see these dramatic price disparities. In fact, every year, Canada's pharmaceutical pricing board compares Canadian prices for patented drug products with prices in a number of other countries. Consistently, prices in the United States are higher by double-digit percentages. In 2008 U.S. prices were, on the average, 63 percent higher than Canadian prices. Now, current Federal law says no one except the manufacturer can import a drug into the United States. Wholesale and retail pharmacies aren't allowed to. State and local governments aren't allowed to. Individual Americans aren't allowed to, even for personal use. But, of course, they do, and they have been doing it for a number of years. My State, as I noted, happens to be on the border of Canada. Every day Canadians cross over to Minnesota to work and make purchases and fish and do all kinds of things. Likewise, Minnesotans cross over to Canada every day to work and make purchases and fish. It is no big deal. We are not afraid of Canadians. Minnesotans know that Canadians pay less--much less--for many of their prescription drugs. Beginning in the 1990s, the Minnesota Senior Federation started organizing bus trips for seniors to go up and cross the border into Canada so they could get affordable prices for the drugs they depend on. The Senior Federation also introduced a prescription drug importation program and used its buying power to negotiate directly with Canadian mail order pharmacies to provide lower cost prescription drugs to Minnesota seniors. But drug prices in the United States just continue to go higher and higher and higher so the pressure to find some relief kept growing. Finally, some State governments decided to take their own initiative to help their residents purchase lower cost drugs from Canada. Minnesota was one of the very first. There was broad bipartisan support for this with a Republican Governor and Democrats and Republicans in the legislature. In February 2004, the State of Minnesota established RX-Connect, the first State-run Web site to provide citizens with information on how to safely purchase drugs from Canada. The Web site lists prices for hundreds of brand-name and generic medications as well as voicemail and e-mail contact information. The American pharmaceutical industry likes to use scare tactics to keep people from buying their medications in Canada. Look at what is happening. You don't see a lot of problems there with their drugs. The Dorgan-Snowe amendment takes on renewed importance and urgency because the American pharmaceutical industry has been imposing suspicious drug price increases this year. Last month, the New York Times reported that drugmakers have been busy raising prices for the most common prescribed medicines in anticipation of possible health care reform. The newspaper quoted industry analysts as saying that in the 12 months ending September 30, drugmakers have raised the wholesale prices of brand-name prescription drugs by about 9 percent. Overall, that means an additional $10 billion in health care spending. That is the largest increase since 1992, and it happened even as the consumer price index declined during the same 12-month period. Some analysts suggest that these prices are being inflated artificially in expectation of new reform that could otherwise reduce prescription drug prices. A similar trend was observed just before Medicare Part D took effect. Just last week, an economist at the University of Minnesota said: Curiously, prescription drug prices appear to rise more rapidly in periods just prior to major policy changes. Brand- name and specialty drug prices accelerated before the Medicare Part D program was enacted and implemented. That is what we are talking about here. This amendment would allow U.S. licensed pharmacies and drug wholesalers to import FDA-approved medications from Canada, Europe, Australia, New Zealand, and Japan and then pass on the savings to consumers. Real health care reform requires real changes from business as usual. This amendment would start to bring some real changes--opening up new choices to American consumers and injecting new competition into the pharmaceutical marketplace. I yield the floor.

Ms. KLOBUCHAR

Ms. KLOBUCHAR. I was not aware the Senator from Iowa had to leave. If he can keep it to 10 minutes, that would be helpful.

Ms. KLOBUCHAR. If people knew this, they would be shocked. In health care fraud, you are taking money from people who need it most--when they are at the hospital--and yet they would have shorter sentences than other types of fraud.

Ms. KLOBUCHAR. Madam President, we had a unanimous consent agreement. I am trying to figure out the order.

Ms. KLOBUCHAR. Madam President, I believe our speeches are 10 minutes long. If the Senator from Iowa could wait for 10 minutes, then we will be able to complete our speeches, as recognized by the Chair.

Ms. KLOBUCHAR. What I like about the amendment is it will protect our increased national investment in the health of Americans. We have decided Americans should be covered by health care; that people shouldn't be thrown off of their health insurance by preexisting conditions. The way we protect that investment, and the way we make sure the funds are there to help people, is by doing things such as increasing the tools we need to prosecute these kinds of cases. These criminals scheme the system to rob the American taxpayers of money that should be used to provide health care to those who need it most. We must put a stop to this, and we are doing that with this amendment. It provides straightforward but critical improvements to the Federal sentencing guidelines, to health care fraud statutes, to forfeiture, money laundering, and obstruction statutes, all of which would strengthen prosecutors' ability to combat health care fraud. As a former prosecutor, I can tell you that when we had these types of cases, we used every tool you could use to push someone to plead guilty, every tool you could use to make sure you got the maximum sentence so a message would be sent not just to that particular criminal but to other white collar offenders who thought this might be a quick way to make a buck. They need to hear they can be caught and they will go to jail. I know Senator Kaufman has worked on this and is taking a lead, and perhaps he can provide the details on this amendment.

Ms. KLOBUCHAR. Madam President, I thank Senator Kaufman. Before I begin, I wish to, first, acknowledge the amendment that has been offered by Senator Dorgan on drug reimportation, something I support and I know Senator Kaufman supports as well. We look forward to talking about that amendment in the days to come. The bill Senator Kaufman referred to, the Fraud Enforcement and Recovery Act, was passed in response to an unprecedented financial crisis. I was proud to work on that bill in the Senate Judiciary Committee along with Senator Kaufman. But Americans should expect Congress to do more than simply react to crises after their most destructive impacts have already been felt. We are always coming in after the fact and putting out the fire. That is not what we want to do. We owe it to our constituents to be proactive, to seek out and to solve problems on the horizon so that financial disasters can be averted. In the midst of the debate concerning comprehensive health care reform, we must be proactive in combating health care fraud and abuse. Each year, criminals drain between $72 billion and $220 billion from private and public health care plans through fraud, increasing the costs of medical care and health insurance and undermining public trust in our health care system. Think of all the money wasted--$72 billion to $220 billion each year--drained by criminals, that could be going to our seniors, that could be going for care. Let me give a couple of examples, Senator Kaufman, of the kinds of fraud we need to address. On June 23 of this year, eight individuals were indicted in Miami for cashing $30,000 to $80,000 several times a week at two check-cashing facilities they owned themselves. These crooks defrauded the U.S. health care system by creating a phony clinic that churned out medical bills in five States. They were not providing health care. They were phony clinics. Federal prosecutors announced this on Tuesday. Some of the purported clinics were empty storefronts with handwritten signs while others existed only as post office boxes, but none provided any actual medical services, according to prosecutors. By the time they were caught, in this one incident, this one group of con men, had bilked the government of $100 million. That is $100 million at a time when our taxpayers are trying to save every dime, while they are holding on to their jobs and trying to pay their bills. This one group of con men--$100 million. Here is another example. In November of 2007, the Department of Justice indicted a woman for billing Medicare for motorized wheelchairs that beneficiaries didn't need and for children's psychotherapy services never provided. According to the indictment, the woman then laundered the money through a Houston check-cashing business, cashing several Medicaid checks each for more than $10,000. Those are just examples of what we are dealing with.

Ms. KLOBUCHAR. The other thing that is great about this amendment is it updates the definition of ``health care fraud offense'' in the Federal criminal code so it includes violations of the anti-kickback statute, the Food and Drug and Cosmetic Act, and certain provisions of ERISA. These changes will allow the full array of law enforcement tools to be used against all health care fraud. The amendment also provides the Department of Justice with subpoena authority for investigations conducted pursuant to the Civil Rights for Institutionalized Persons Act--also known as CRIPA. Under current law, the Department of Justice must rely upon the cooperation of the nursing homes, mental health institutions, facilities for persons with disabilities, and residential schools for children with disabilities that are the target of these CRIPA investigations. While such targets often cooperate, they sometimes do not, and the current lack of subpoena authority puts vulnerable victims at needless risk. Finally, in addition to the very important piece of this amendment that Senator Kaufman has pointed out--where we are actually increasing the ability to get better criminal penalties--the amendment corrects an apparent drafting error by providing that obstruction of criminal investigations involving administrative subpoenas under HIPAA--the Health Insurance Portability and Accountability Act of 1996--should be treated in the same manner as obstruction of criminal investigations involving grand jury subpoenas. Senator Kaufman and I also plan to file an additional health care fraud amendment that would require direct depositing of all payments made to providers under Medicare and Medicaid. This amendment is incredibly important because the Medicare regulations already require direct depositing or electronic transfer, but these regulations have not been uniformly enforced and criminals are taking advantage of this system. Again, I ask the question: Why would we want this money--$60 billion estimated for Medicare fraud alone--to be going to con men and crooks, people who are setting up fake storefronts with fake signs that say doctor's office, instead of to the hard-working people in this country who can hardly afford their health care insurance? It is an outrage. That is why I am so glad Senator Kaufman would take the leadership here, that we have a group of us who were prosecutors working on this in the Judiciary Committee to include this in the health care reform bill, because Americans have waited too long for these kinds of changes.

Ms. KLOBUCHAR

Ms. KLOBUCHAR. Mr. President, I rise today in support of the amendment offered by Senator Pryor that calls for an enrollee satisfaction survey for health care plans offered through the exchange. As you know, the exchange will be a series of different policies from which people can choose. What I love about this idea is that for my small businesses and self- employed who are paying 20 percent more than people who work for big businesses right now because they simply cannot leverage their numbers, it is hard for them to get good rates because they are out there on their own, this exchange, where they can choose a number of different policies like Members of Congress can choose from, whether it is Blue Cross or a number of the other choices, they can pick a policy on the exchange. I serve with Senator Pryor on the Consumer Protection Subcommittee and know that he offers this amendment with the full intent of improving resources for individuals who buy insurance. A satisfaction survey will be a tool to help consumers navigate through the complicated process of purchasing health insurance. The survey results will allow individuals and small businesses to make well-informed health care decisions by comparing current enrollee satisfaction levels among the plans offered through the exchange. This survey also provides, as Senator Harkin has pointed out, an oversight tool for Congress so we can monitor the progress of the exchange and present information to patients in an open, transparent manner. As I have said many times, I come from Minnesota, often known as a ``medical Mecca.'' We are home to the Mayo Clinic. We are home to the University of Minnesota. Countless innovative businesses have contributed groundbreaking medical research that is bettering the lives of patients. The key to this Minnesota model, where we have some of the highest quality care in the country and some of the lowest costs, is by putting the patient in the driver's seat. I have been at the Mayo Clinic. I have seen what happens there. It is integrated care with one primary doctor with a group of doctors that work with him, like a quarterback on a football team. They also focus on the patients with satisfaction surveys, keeping the team accountable for what they are doing. I always say to my colleagues, it is counterintuitive. If you go to a hotel and pay more money, you often get the best room with a view. That is not true with health care in America. You can pay more money and get some of the worst quality care in this country because there is no accountability. That is why these patient surveys, in allowing consumers in this country to look at these different plans and figure out which one is better for them, is the way to go. In my State, 92 percent are covered by some form of health insurance, and we have done that by learning the importance of transparency and providing quality information to consumers. In 2004, a Minneapolis-based nonprofit called Minnesota Community Measurement developed a consumer resource called Developed HealthScores. HealthScores is based on information submitted by more than 300 clinics statewide and is available to consumers on an easily accessible Web site. HealthScores is also used by medical groups and clinics to improve patient care and by employers and patients to provide access to critical information about the quality of health care services. Researchers at the University of Oregon have studied public reporting efforts and found that public reporting motivates health care providers and insurers to work harder on improving care, largely because of a concern about their reputation. This is how the private market should work. You cannot just have insurance policies that have a name and not understand what they mean for the consumer. By having these surveys, we are going to be able to understand so a consumer can navigate through and figure out which policy is good, what it offers, what is best for their family. As we continue our debate on health care, we must remain focused on solutions with outcomes. Public reporting works. Senator Pryor's amendment ensures that customers are able to voice their approval or disapproval of plans offered by insurance companies and that information will be available to small businesses and individuals to make well-informed decisions about their health care. How can they make a well-informed decision without knowing what plans are good, what plans are bad, what plans offer? That is why we need this, if we want to make this private market solution work for consumers. As the experience in Minnesota has shown, public reporting also has the ability to improve quality as well. HealthScores in Minnesota has forced health plans, medical groups, and employers to focus on a common set of goals. Through this process, patient outcomes have produced dramatic improvements for chronic conditions such as diabetes. We know already that small businesses are paying too much--up to 18 percent more than large businesses--often forcing small businesses to lay off employees or cut back on their coverage. We all know, from the letters we have gotten in our offices, what the average American families are facing right now with these skyrocketing premiums. We must provide these patients and these consumers with tools to make informed health care decisions. Not only will we put consumers in the driver's seat so they can make the decision, we will also have an effect on the entire market. Because if insurance companies think no one is watching them, that consumers can't figure it out--maybe something has a great name so they go buy it--they will never get the kind of accountability and cost reductions we want. The lessons from Minnesota have shown that providing consumers with information about their health care has the ability to improve patient satisfaction and drive our system to focus on quality results. I yield the floor.

Ms. KLOBUCHAR. Mr. President, I ask unanimous consent to speak as in morning business for up to 7 minutes.

Ms. KLOBUCHAR

Ms. KLOBUCHAR. I ask unanimous consent to speak for up to 12 minutes.

Ms. KLOBUCHAR. Mr. President, I rise to speak about a true health care reform. The way I look at this in my State, it is a matter of affordability and cost. We have one of the highest percentages of people covered in the country in Minnesota. The issue is, it is becoming more and more expensive for the people to afford health care. I always try to remember three simple numbers of all the ones we will hear in the next few weeks. Those are the numbers 6, 12, and 24. Ten years ago it cost $6,000 for an average family to pay for health care a year. Now it is $12,000, with a lot of people paying a lot more. Ten years from now, if we don't do anything, it will be somewhere between $24,000 and $36,000 a year, something regular people just can't afford. It is not going in the right direction. If we don't act, costs will continue to skyrocket. The country spent $2.4 trillion on health care last year alone. That is $1 out of every $6 spent in the economy. By 2018, national health care spending is expected to reach $4.4 trillion, over 20 percent of our entire economy. Despite spending 1\1/2\ times more per person on health care than any other country, many of our people don't even have health care coverage. Many of them are losing their coverage because of preexisting conditions or because it simply is costing too much. These costs are breaking the backs of our families and businesses. We can see here, single coverage, 1999, $2,196. Now at 2008, the last figures we have available, $4,704, a doubling. Family cost, 1999, $5,791--that is the average family's premium--now they are paying $12,680. Look what is happening to small businesses. A study by the Council of Economic Advisers found that small businesses pay up to 18 percent more than large businesses to provide health care coverage. In a recent national survey, nearly three-quarters of small businesses that did not offer benefits cited high premiums as the reason. Look at it this way: Inflation usually raises the cost of most goods and services between 2 to 3 percent per year. Health care premium costs have been going up close to 8 percent a year. That is an increase Americans can't afford. Wages have not kept pace with the increase in premiums. Look at this. Between 1999 and 2007, the average American worker saw his wages increase 29 percent. Obviously, the last few years it has not been that rosy. How much did his insurance premiums go up? One hundred twenty percent during the same time period. In other words, the health care premiums are taking out a bigger and bigger chunk of the average worker's paycheck. These costs are breaking the backs of the American taxpayer. My colleague was talking about Medicare. The truth is, Medicare is projected to go into deficit by 2017, if we don't do anything about it. Recent Congressional Budget Office estimates show that the majority of the projected $344 billion increase in Federal revenues are scheduled to automatically go to cover rising health care costs. Medicare--something that people who are 55 want to get when they are 65; people who are 65 want to keep until they live to the ripe old age of 95--if we don't do anything about it, is going in the red by 2017. How do we do this? How do we get to the place where we want to go? We must get our money's worth from our health care dollars. The problem now is, we are paying too much and we are not getting a good return on what we pay. The solution must be to get the best value for our health care dollars; otherwise costs are going to continue to wreak havoc on the backs of government, businesses, and individual families. Medicare is 57 percent of all Federal health spending. If we want to sustain Medicare, which we all do, to provide that kind of high-quality health care our seniors deserve, we must do something to address the fiscal challenges. The root of the problem is that most health care is purchased on a fee-for-service basis, so more tests, more surgery means more money. Quantity, not quality pays. According to researchers at Dartmouth Medical School, nearly $700 billion per year is wasted on unnecessary or ineffective care. My favorite example is what Geisinger Clinic did in Pennsylvania. They were not happy with their diabetes treatment, so they decided we are going to have the routine patients see nurses. The more difficult cases will see doctors. Then those endocrinologists will review the records of the nurses and make sure this patient is progressing as we want. Guess what. Patient quality goes way up because they see nurses and they see them more regularly. Results go way up because endocrinologists are spending time on the most difficult cases and reviewing records of the other. Costs go down $200 per month per patient. Guess what. They get paid less--way, way, way less for that kind of good quality care. This system is messed up, and we need to change it so we are rewarding based on results. We put the patient in the driver's seat so that when that patient gets better results, then we reward with payments. In Minnesota, we have several great examples of this coordinated outcome system. At a place such as the Mayo Clinic, Park Nicollet, St. Mary's in Duluth, the priority is value not volume. As this chart shows, if the spending per patient with chronic diseases everywhere in the country mirrored the efficient level of spending in the Mayo Clinic's home region of Rochester, MN--this is Mayo Clinic quality health care. For the last 4 years of chronically ill patients' lives, if we used that same system all over the country, how much would we save, if we used this system in Texas, if we used this system in Florida? We would save $50 billion every 5 years for the taxpayers of this country and get higher quality care. This is not like a hotel right now in this country where if you pay more money, you get a better room with a better view. No. The opposite is true. In this country, the States where you pay more money, you get less quality care. That is what we need to change to bring all of the States up to that high-quality care, efficient care, that costs less but is a better value. That is what we need to do. How do we do it? Well, linking rewards to the outcomes for an entire payment area creates the incentive for physicians and hospitals to work together to improve quality and efficiency; using bundling, to bill, so you look at the whole outcome of everyone working together, so you rely on nurses when you want to rely on nurses, so you rely on doctors when you want to rely on doctors; by reducing hospital readmissions. Who wants to go back in the hospital over and over again just because there are a bunch of infections hanging around? In fact, right now, if you go back to the hospital, the hospital gets rewarded for that. So we want to put in place protocols that make hospitals safer places to treat patients. In 1 year, hospital readmissions cost Medicare $17.4 billion, and a 2007 report by MedPAC found that Medicare paid an average of $7,200 per readmission that was likely preventable. We need to have integrated care, where you have a primary care provider, working with a team, instead of having 15 specialists running around the field, running over each other. You need a quarterback, well, let's just say like Brett Favre and the Minnesota Vikings. You have one quarterback who is your primary care doctor, who is in charge, with a team of doctors who look at all the medical records. That is integrated care. That is what we should be rewarding. That is what this bill does. Looking at some of the other inefficiencies, the Presiding Officer has been a leader on Medicare fraud. Think about the money we can save. Medicare fraud alone costs taxpayers more than $60 billion every year. Instead of that money going to our seniors, do you know where that money is going? It is going to con men, people who are leeching off the system, people who are making up that they are providing services when they are not. The Presiding Officer and I have a bill we are working together on to bring that down so that money can actually go to our seniors instead of going out to a bunch of people who are ripping off the system, ripping off our seniors. If you look at how you save money, if you look at how you reduce costs in Medicare, well, you reduce costs in Medicare by making changes to this system and making this work. We must look to the future. That is why health care reform this year is so crucial. This bill is not about today or even next year; it is about 5 years from now, it is about 10 years from now, and beyond. We cannot afford for the people of this country to hold off any longer. We can bring these costs down. We can bring the quality up. And we can reward the people of this country for the money they are putting into health care. Mr. President, I yield the floor.

Ms. KLOBUCHAR

Ms. KLOBUCHAR. Mr. President, I come to the floor to call attention to the situation of three citizens of the United States--Shane Bauer, Sarah Shourd, and Josh Fattal--who have been detained by the Government of Iran for nearly 4 months. One of these individuals, Shane Bauer, comes from my home State of Minnesota, and so the safe return of these three young Americans is of particular importance to me. On July 31 of this year, Shane, Sarah, and Josh--who shared a common passion for travel and discovery--were on a hiking trip in a peaceful region in northern Iraq, when they reportedly accidentally strayed across the poorly marked border between Iraq and Iran and were surrounded by Iranian border guards. Since then, Shane, Sarah, and Josh have been held in near isolation in a Tehran prison and have been allowed no contact with their families in the United States. Despite repeated requests by the Swiss Government, which represents U.S. interests in Iran, the three have been denied regular consular access required by the Vienna Convention. They have been denied repeated requests to be able to speak with their families via telephone, and they have been denied public information on any charges they may face. In the 4 months they have been detained, the three have been allowed only two meetings with Swiss consular officials and have been denied due process and access to legal representation. Even more alarming, Iranian officials have recently declared the three may be charged with espionage, a charge that is not only baseless but also completely at odds with who Shane, Sarah, and Josh are as individuals. Shane, Sarah, and Josh made a simple mistake in accidentally crossing the border, and their continued detention is unwarranted and unreasonable. Since the three were detained, I have gotten to know Shane's mother Cindy and other members of the hikers' families. During our conversations, I have learned what a remarkable person Shane is and how he is dedicated through his work to bringing the world closer together through photo journalism. Shane grew up in Onamia, MN, a small town in the central part of our State, and he graduated from the University of California at Berkeley. Prior to being detained in Iran, Shane was living with Sarah in Damascus. He has traveled around the Middle East as a free-lance journalist, reporting from Syria, Iraq, Darfur, Yemen, and Ethiopia. His writing and award-winning photographs have been published in the United States, the United Kingdom, Canada, and throughout the Middle East. His latest trip with Sarah and Josh brought him to the Kurdistan region of Iraq, which is known for its scenic hikes among mountainous waterfalls. This is hardly the background of someone who would deliberately enter Iran in hopes of committing espionage. A few weeks ago, I met with Shane's mom Cindy and members of Sarah and Josh's families in my office in Washington. As a mother, I can only imagine how difficult this ordeal must be for all of them. They have had no contact with their sons or their daughter. Yet I have been overwhelmed by their resolve. They are pursuing every avenue they can find to demonstrate to the Iranian Government that their children made a simple mistake and clearly deserve to be released. I came away from our meeting even more committed to seeing that Cindy and Shane, along with Sarah and Josh and their families, are united as soon as possible. As we all know, Iran is in the center of many pressing foreign policy challenges we currently face. I, along with my colleagues, will address those, but Shane, Sarah, and Josh have absolutely nothing to do with these international fights. They have nothing to do with what is going on in Iran or Iran's differences with other countries. This is strictly a humanitarian case. I urge Iranian officials not to politicize it or seek to use the three hikers as diplomatic pawns. There is no cause for their continued detention, and nothing will be gained by prolonging it any further. Iran's leaders should demonstrate the necessary compassion by immediately releasing Shane, Sarah, and Josh and allowing them to return home to their families. In the meantime, they should at the very least allow them to speak to their families in the United States over the telephone. I thank my friend, the Ambassador to Switzerland, and Swiss officials for their work in this area. It has been 122 days since Shane, Sarah, and Josh were first detained; 122 days in captivity, apparently just for straying over a line on a map when they were on a hike. We will continue to work with the families, with the State Department, and Swiss officials to do everything we can to bring Shane home to Minnesota. Thank you, Mr. President. I yield the floor.

Ms. KLOBUCHAR

Ms. KLOBUCHAR. Mr. President, as the Senator from New York has so eloquently stated, the time for health care reform is now. We cannot afford to wait any longer. We can't afford to wait, for the middle class. There are a lot of numbers that get thrown out in the debate, but I think we can say it pretty simply by just using three numbers. Those numbers are 6, 12, and 24. What do those numbers mean? Ten years ago, the average family in this country paid $6,000 for their health insurance. Now they are paying $12,000. That is an average. I know of one small business in northern Minnesota, a backpack company, paying $24,000 for a family of four. One guy started a company with five employees. He now has 15--a growing business. He is paying $24,000. The average right now is $12,000 for a family of four. Where is it headed if we don't bend the cost curve for middle-class families--$24,000 average, little towns all over America, $24,000, 10 years from now. That is not the kind of stability the middle class needs. The middle class needs to know, people I know all over my State need to know that if their kid gets sick, they still can have health care coverage; that if their kid goes to college and they want to keep them on their policy, they can still do that. That is what we are talking about when we talk about stability. The other piece of this reform effort that is so important, coming from Minnesota, a State with high-quality, highly efficient care, is the cost issue, that we begin the long journey of reforming our Medicare cost so that we actually promote the kind of high-quality care we see in my State at places such as the Mayo Clinic and we promote the kind of efficient care we need to see. My favorite example is in Pennsylvania, the Geisinger Clinic. They had diabetic patients. They decided it was not going that well. The patients didn't feel that good about their treatment, and the quality they wanted was costing too much. They tried something else. For routine cases, they said they will see nurses and see them more often. The more difficult cases went to endocrinologists, and they reviewed the routine patients' records. Higher quality care, happier patients, better care, lower costs--$200 per patient per month--that is what happened. They got less money for that higher quality care, less money. That is what we are talking about. We want to use those kinds of models so we get higher quality care for America at a more efficient rate. Some of my colleagues across the aisle have been using the name of the Mayo Clinic in vain. This matters to me because I come from Minnesota. It is the home of the Mayo Clinic. The minority has suggested that the Mayo Clinic doesn't want any part of this bill. They have said the Mayo Clinic wants nothing to do with this bill. They have said the Mayo Clinic--and this is an exact quote from the Senator from Wyoming--``is no longer taking Medicare or Medicaid patients.'' Let me set the record straight. Like anyone in this country, the Mayo Clinic is looking at this bill. They like some provisions, and they don't like others. They have specifically said they support the creation of accountable care organizations, bundling of payments, the creation of an independent commission to evaluate Medicare solvency, which is in the Senate bill, the MedPAC idea. They are supportive of these issues because right now it is becoming harder and harder for them to cope with the current Medicare payment system. This allegation that they are no longer taking these patients is completely incorrect. They made a decision not to take about 80 patients a year from the State of Nebraska because they weren't getting paid. They are still taking all Medicare-Medicaid patients from Minnesota and the contiguous States. This is not a small amount. Forty percent of Mayo patients are on Medicare. Six percent--I wrote this on the back of an envelope driving in with one of their chief doctors, so you know it is accurate, unlike the ``facts'' we are hearing over there. Forty percent of their patients are on Medicare, 6 percent on Medicaid, 46 percent are on Medicare or Medicaid. Sixty percent of their business is from Medicare or Medicaid. It is just false. But what is true is that they want to see reform. They want to see reform of the Medicare and Medicaid system. They want to have it based on quality, not on quantity. That is why they support the quality index I sponsored, along with Senator Cantwell of Washington. Just putting your head in the sand and hiding behind the stacking of that bill--by the way, we had a three-page bill with the Bush TARP plan, that didn't work out that well when there were no accountability measures in that. That is not going to bring us the kind of health care reform the Mayo Clinic wants to see for the rest of this country. I heard a lot in Minnesota from small businesses. Small businesses are paying 20 percent more than big businesses for their health care right now. Why should employees of little businesses, which are really the entrepreneurial engine of our States and the Nation, why should they have to pay 20 percent more than people who work for big businesses? This reform effort allows them to pool their numbers, allows them to join together so they can buy private insurance off an exchange with the same kind of numbers you have at a major corporation. I know the Senator from Maryland has been very devoted to the idea of helping small businesses. I ask Senator Cardin about this specific issue. How does the Senator see this as helping small businesses in Maryland and helping the middle class in his State?

Ms. KLOBUCHAR. I thank the Senator. I believe our hour has ended. We yield the floor.

Ms. KLOBUCHAR. Maybe we should end with the Senator from Massachusetts, the home State of Ted Kennedy, having the last word of this very interesting colloquy, in which we heard from the Senators from North Carolina, Rhode Island, and Maryland.

Ms. KLOBUCHAR. There is a lot of talk about Medicare and our seniors and what this bill does. Think of the woman I talked about who is a fighter, as her mom says, but she cannot keep fighting a system that is so against her. As you pointed out, the advantage of this bill is, it gives our seniors a better playing field with the drug companies paying for their drugs in the doughnut hole. Also, it is my understanding that AARP wants to advance the bill. Certainly, AARP has stood up for seniors for years and years and years. They know we need to preserve Medicare and keep it safe. Can the Senator comment on AARP?

Ms. KLOBUCHAR. I thank the Senator from Massachusetts. The Senator from North Carolina is here. I know the people of North Carolina and the people in the South have concerns about the current state of affairs in health care as well.

Ms. KLOBUCHAR. Along those lines, before I yield to the Senator from Massachusetts, I started out talking about the cost issue. I wanted to put in the Record the statement of November 5, 2009, from the Mayo Clinic. There have been things said about their position. My friends on the other side have said they ``don't want any part of this bill'' and they ``want nothing to do with it.'' Those are exact quotes. They said they ``are not taking Medicare and Medicaid patients anymore.'' Those are exact quotes. They are all incorrect. I will put this in the Record. It is dated November 5, 2009. ``Points of Agreement and Divergence.'' They say: We are encouraged by much--including provisions to pay for value in health care, an insurance exchange, individual mandate, subsidies for people to achieve coverage, and pilot projects on accountable care organizations and bundling of payments. To be fair, they also say they are ``concerned about other areas including a public option that is based on Medicare rates. . . .'' As you know, the options in the House and Senate bills are not based on Medicare rates but negotiated rates. They are concerned about the long timeline for implementation of value provisions, as I am. They are concerned about across-the-board cuts for providers. They neither endorse nor support the bill. To say they don't want any part of the bill is false. I ask unanimous consent that this material be printed in the Record.