John McCain

Mr. McCAIN

Mr. McCAIN. If the Senator will yield, on that map, I wonder should there not be a sticker for the State of Florida? According to a published report by one of my favorite columnists, Dana Milbank, of the Washington Post: Gator Aid: Senator Bill Nelson inserted a grandfather clause that would allow Floridians to preserve their pricey Medicare Advantage program. So maybe we should have one of those stickers for Florida there. By the way, that will cost my constituents more money because they will not have that same deal. Should there be a sticker for Montana? Again, according to Dana Milbank: Handout Montana: Senator Max Baucus secured Medicare coverage for anybody exposed to asbestos--as long as they worked in a mine in Libby, Montana. Should there be a sticker there? Continuing, Dana Milbank says: Iowa pork and Omaha Prime Cuts: Senator Tom Harkin won more Medicare money for low-volume hospitals of the sort commonly found in Iowa. . . . Maybe there should be a sticker for that. I don't know if you have North Dakota in there. Dana Milbank says: Meanwhile, Senators Byron Dorgan and Kent Conrad, both North Dakota Democrats, would enjoy a provision that would bring higher Medicaid payments to hospitals and doctors in ``frontier counties'' of states such as--let's see here-- North Dakota! Should there be one for Hawaii? Mr. Milbank goes on to say: Hawaii, with two Democratic senators, would get richer payments to hospitals that treat many uninsured people. Should there be a sticker there for Michigan? Mr. Milbank says: Michigan, home of two other Democrats, would earn higher Medicare payments for some reduced fees for Blue Cross/Blue Shield. Vermont's Senator Bernie Sanders held out for larger Medicaid payments for his state. (neighboring Massachusetts would get one, too). I guess there are a number of States that maybe should have stickers on them so that the American people can see where these special deals were cut out, and the majority of the population of this country can see where they were not. They are going to pay while those States pay less because of not just their location but because they happen to have been behind closed doors and cut special deals.

Mr. McCAIN. Sure. I ask that Senator Baucus be recognized.

Mr. McCAIN. Does that mean all these States are being treated the same?

Mr. McCAIN. This happens to be 2009. What happens between now and 2016?

Mr. McCAIN. If that is the case----

Mr. McCAIN. If that is the case, we will be glad to have the same provision inserted for the State of Arizona that was inserted for the State of Florida. You don't have a problem with that, do you?

Mr. McCAIN. Do you have a problem with that?

Mr. McCAIN. My question to the Senator from Montana is this: Would the Senator from Montana be willing to have the same provision that Senator Nelson, according to these reports, inserted, a grandfather clause that would allow Floridians to reserve their price in the Medicare Advantage Program? Would he accept a unanimous consent request right now that same provision apply to every State in America? I ask unanimous consent that the same provision that was put in for the State of Florida by Senator Nelson would apply to every State in America.

Mr. McCAIN. I think the fact that an objection was heard resolves the case. Those are comforting words on the part of the Senator from Montana, whom I appreciate, but the fact is, there are special deals for special people. It is well known. It is very well known. May I mention to my colleagues--sort of a personal privilege here-- the Senator from Louisiana came to the floor this morning and said: Recently, just yesterday, Senator John McCain, our colleague from Arizona, has claimed that the American people are opposed to reform and he speaks about the will of the majority. I would like to remind, respectfully, my colleague from Arizona that the will of the majority spoke last year when they elected President Obama to be President and they decided not to elect him, and the President is carrying out the will of the majority of the people to try to provide them hope and opportunity. I say in response to that, I really did not need to be reminded. I had not forgotten. Sometimes I would very much like to. But I appreciate the reminder. The fact is that the Senator from Louisiana and other Senators should know that poll after poll, public opinion, partially because of what the Senator from Mississippi is pointing out--the latest being ``U.S. Voters Oppose Health Care Plan by Wide Margin.'' A Quinnipiac poll finds 3 to 1 that the plan should not pay for abortion. And it says American voters mostly disapprove of the plan 53-36 and disapprove 56- 38 percent President Obama's handling of the health care issue. If I can remind my friend and colleague from Louisiana, I did carry her State.

Mr. McCAIN. And the State of the Senator from Montana.

Mr. McCAIN. If the Senator will----

Mr. McCAIN. But also, doesn't this bring up a larger issue--I ask all my colleagues to comment on this--whether our job here is to do whatever we can to just simply help our State, even if it is at the expense of other States, as the Senator from Mississippi pointed out, or is our title U.S. Senator, Arizona, Nebraska, Mississippi, et cetera? My title is not Arizona Senator, U.S.; it is U.S. Senator, Arizona. So of course I am here to represent the people of my State. But is a U.S. Senator's job to go out and do something which would then be at the expense of the citizens of another State simply by virtue of their clout and influence? Is that what we were sent here by our constituents to do? Is it true what the majority leader said yesterday: "I don't know if there is a Senator that doesn't have something in this bill that was important to them,'' Senate Majority Leader Harry Reid reasoned when asked at a news conference Monday about the cash-for-cloture accusation. ``And if they don't have something important in it to them, then it doesn't speak well of them.'' Does it speak well of us when we do something like the Senator from Mississippi pointed out, that favors Libby, MT, and not the rest of the country, that helps the seniors in Medicare Advantage in Florida and not in Arizona? Is that what we were sent here to do? That has never been my view of what our obligations to our citizens are, but also to the citizens of this country. I ask my colleagues to comment.

Mr. McCAIN. A Senator from Colorado came to the floor and proudly stated that he had not asked for anything or gotten anything, and I will ask the Senator from Nebraska a question because his State seems to be at the center of a lot of attention. But, first of all, there is a little booklet that is put out by the Government Printing Office that talks about how our laws are made. We give it to our constituents and send it to schools all over America. I have never seen anything in that little booklet--it is a very interesting booklet--that says you get behind closed doors and you cut deals. I know we are all a little cynical about politics and campaign promises, but the negotiating behind closed doors is especially so, particularly after your President says during the campaign, time after time: I am going to have all the negotiations around a big table. We will have doctors and nurses, hospital administrators, insurance companies, drug companies, they will get a seat at the table. They just would not be able to buy every chair. But what we will do, we will have negotiations 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. Of all people he recognized, the drug companies--who got the best deal of all? PhRMA. Who has spent the most money lobbying? Who has spent the most money on advertising? PhRMA. Who is going to cost the American consumer $100 billion, that could have been saved by the consumer if we had been able to reimport prescription drugs? But I would ask my friend from Nebraska because along with the ``Louisiana purchase'' and probably the Florida deal this Nebraska deal has probably gotten the most publicity and visibility. Maybe because it was the 60th vote. I don't know if it is the biggest or not, in terms of money, because we will be finding deals in this 2,700-page bill for months. For months, we will be finding provisions, even though our staffs have carefully read it. It is not 2,700 pages for nothing. So I would ask the Senator from Nebraska: How does this go over in the heartland of America? How do the people in Nebraska, who see that they have gotten some kind of special deal, a special provision-- certainly reported as so in the media--that would come at the expense of other taxpayers in America? I am curious about the reaction the Senator from Nebraska gets.

Mr. McCAIN. Let me make one additional comment. I have seen reform go through the Congress of the United States. The first one I saw was when we saved Social Security--a major reform of Social Security. There was no backroom dealing. It was a straightforward proposal as to how to fix Social Security. We fixed welfare, it was welfare reform--again, open, honest, bipartisan negotiations and bipartisan agreement. Welfare reform, Social Security reform, the efforts we made at tobacco reform, at campaign finance reform, at immigration reform and many others--the Patients' Bill of Rights. Every reform I have ever been involved in has had two major and sole components: No. 1, it is bipartisan; No. 2, there were no special favors or deals cut, provisions in thousands of pages of legislation. Again, we know where the train is headed. We know what is going to happen a short time from now, but they will make history. You will make history. You will have rammed through ``reform'' on a strictly partisan basis, without the participation of the other party, over the objections of a majority of the American people, done in closed negotiations, with results that are announced to the American people without debate or discussion and to this side without debate or discussion. The American people do not like it. They do not like for us to do business that way. I am sure this peaceful revolution that is going on out there already--because as the Senator from Idaho pointed out, because of the involvement of the car companies, the stimulus, the bonus, the generational theft we are committing, this, all on top of that, is going to give great fuel to the fire that is already burning out there, where they want real change, real change which they were promised in the last Presidential campaign and certainly did not get.

Mr. McCAIN. Of course, this legislation turns everything we know about budgeting on its head, although it has been done before and it has been done by Republicans, to our shame. Today, if you go out and buy an automobile, you can drive it for a year before you have to pay for it. Under this bill, it is the opposite. You pay the taxes, you have the reductions in benefits, and then 4 years later you start having whatever benefits would accrue from this legislation. So for 4 years small businesspeople, people all over America, will see their health care costs increased before there is a single, tangible result from it--remarkable.

Mr. McCAIN. Can I say, I appreciate the Senator from Mississippi bringing this important aspect to this issue and continuing to do so. I would like to pick up on what Dr. Barrasso mentioned about the Kennedy family. It is well known I had a very close relationship, developed over the years, with Senator Ted Kennedy and that we worked together on a variety of issues. So there is a great irony in the constant, over there on the other side of the aisle, references to Senator Kennedy, who always began legislation by getting bipartisan, by getting Members of the other side of the aisle committed and working together--whether it be on immigration reform, whether it be on health care reform, whether it be on one of the great achievements of President Bush 2, No Child Left Behind. In other words, every dealing I ever had with Senator Kennedy was to reach out, establish a fundamental base for agreement, and then move forward with legislation in a bipartisan fashion, which I think was one of the major reasons why he had such an impressive legislative record. How did the other side do it? Without a bit of serious negotiation, without bringing anyone on board before moving forward--no one--which ends up, now, with a 60-to-40 vote, which is a pure partisan vote and outcome when there has never been, in history, a single reform that was not bipartisan. That is why the American people are rejecting this. That is why the American people are seeing through it. To hear the constant refrain that the American people want this: Read any poll. It is just a matter of difference because the American people have figured this out. It is going to be one of the great historic mistakes--not historic--but historic mistakes made by the Congress of the United States.

Mr. McCAIN. There may be on the floor a unanimous consent request to remove the Nebraska Medicaid deal. I would hope, if there is any unanimous consent agreement at any time, that the whole bill will be fixed, which means every special provision would be removed, whether it be from Nebraska or any other State. We still have the Louisiana Purchase of $300 million. We still have the Florida Medicare grandfather clause, $25 to $30 billion. The list goes on and on. The Connecticut hospital--I guess it is the Connecticut hospital. It is always in legislation, so you have to do research to see who qualifies. I would hope we could have, again, agreement that all these special provisions that affect certain specific States would be removed as well. That would go over rather well with the American people. I want to say to my colleagues, thank you for your passion. I know a lot of people don't watch our proceedings on the floor. It has played a role in educating the American people as to what we are facing. The media played a role, advocacy groups, grassroots organizations all over America. But I have had the great privilege of engaging in these colloquies with my colleagues. To me, it has been both helpful to my constituents, and, frankly, it has also been helpful to me to work with people who have been involved in these issues, former Governors and others. We have made some kind of contribution, which I think is what we are all sent here for.

Mr. McCAIN. May I respond?

Mr. McCAIN. All the Senator had to do was have it authorized, bring it up on the floor as an appropriation, and I am sure the Senator's arguments would have been far more cogent than jamming it into a bill which has to do with health care reform, the policy of health care reform. This legislation and this cause of the Senator from Montana has been turned back several times on other grounds.

Mr. McCAIN. I am responding.

Mr. McCAIN

Mr. McCAIN. Mr. President, as we approach in less than an hour a very important vote--some have called it historic, some call it pivotal; it has been given various adjectives and adverbs--I think it might be appropriate to discuss for a minute or two how this all began. It all began in the Presidential campaign. I do not like to spend much time recalling it. But health care was a big issue in the Presidential campaign. On October 8, 2008, less than a month before the election, then-Candidate Obama said, concerning health care reform: I'm going to have all the negotiations around a big table. . . . What we'll do is we'll have the negotiations televised on C-SPAN, so that people can see who is making arguments on behalf of their constituents and who are making arguments on behalf of drug companies-- Keep that in mind: the drug companies-- or the insurance companies. That was the statement made by then-Senator/Candidate Obama. What we have is a dramatic departure. There has never been a C-SPAN camera. There has never been a negotiation, a serious negotiation between Republicans and the other side. There has never been. I say that with the knowledge of someone who has negotiated many times across the aisle on many agreements. So don't stand and say there were serious negotiations between Republicans and Democrats. There never were. But there were negotiations with the special interests, with PhRMA, the same ones the President said he was going to see who the American people were on the side of. Clearly, this administration and that side of the aisle was on the side of PhRMA because they got a sweetheart deal of about $100 billion that would have been saved if we had been able to reimport prescription drugs. The AARP has a sweetheart deal. There is a provision in this deal for them, plans that Medigap insurance sold by AARP are exempt from tax on insurance companies. The AMA signed up because of the promise of a doc fix. Throughout we should have set up a tent out in front and put Persian rugs out in front of it. That is the way this has been conducted. Of course, after the special interests were taken care of, then we had to take care of special Senators. One deal is called--we have new words in our lexicon now--the Louisiana purchase, the corn husker kickback. I have a new name: the Florida flimflam, the one that gives the Medicare Advantage members in Florida the benefit, but my constituents in Medicare Advantage don't get it. So in answer to this, in answer to a question today, the majority leader said: A number of States are treated differently than other States. Really? A number of States are treated differently than other States. That is what legislation is all about. That is compromise. Where is that taught? Where is that taught? A number of States are treated differently than other States. That is what legislation is all about. That is compromise. My friends, that is not what the American people call governing. That is called exactly an opposite contradiction of what the President of the United States said, where he says: We will have negotiations televised on C-SPAN so that people can see who is making arguments. I see the leader from Illinois over there. Just a few days ago, I said: What is in the bill? The Senator from Illinois said: I don't know. I am in the dark too. I can give him his own quote. So here we are, as the Senator from Tennessee said, in the middle of the night, and here we are, my friends, about to pass a bill with 60 votes. Sixty votes represent 60 percent of this body, but I can assure my friends on the other side of the aisle it doesn't represent 60 percent of the American people. In fact, 61 percent of the American people, according to a CNN poll, say they want this stopped. They disapprove of it. I guarantee you, when you go against the majority opinion of the American people, you pay a heavy price, and you should. I will tell my colleagues right now that when you--this will be, if it is passed--and we are not going to give up after this vote, believe me. For the first time in history, for the first time in history, there will be a major reform passed on a party-line basis. Every reform--and I have been part of them--has been passed on a bipartisan basis. This will be a strict party-line basis. I was thinking today about this vote, and I was thinking about other times and other examples I have had of courage or lack of or the fact that in the face of odds, you have to stand for what you believe in. I thought about back when I first entered the U.S. Naval Academy at the young age of 17. One of the first things they told us about in our learning of naval traditions was about a battle that took place early in the Revolutionary War. An American ship run by a captain engaged a British ship, the mighty British Navy. The American ship was outgunned and was outmanned. As they came together in mortal combat, with dead and dying all around, the British captain said: Do you surrender? The captain, John Paul Jones, said: I have not yet begun to fight. I tell the American people: We are going to go around this country. We are going to the townhalls, we are going to the senior centers, we are going to the rotary clubs. We are going to carry this message: We will not do this. We will not commit generational theft on future generations of Americans. We will not give them another $2\1/2\ trillion in debt. We will not give them an unfair policy where deals are done in back rooms, and we--all of us on this side of the aisle--will stand for the American people, and we have just begun to fight.

Mr. McCAIN

Mr. McCAIN. Mr. President, I am pleased today to join many of my colleagues in supporting a resolution designating January 2010 as ``National Mentoring Month.'' We all agree that young people need a supportive environment based on structured and trusting relationships with adults. The world is more complicated for children today than it ever was when I was growing up. Mentors can help young people through the difficult periods, help them see the difference between right and wrong, alleviate their doubts and concerns, and answer their questions frankly. Mentors can dramatically impact a young person's life by providing the support and encouragement that children need in order to grow into responsible, caring adults. This resolution recognizes the value of volunteering time to make a difference in the life of a child. A growing body of research has shown that high-quality programs can make all the difference and help students in need achieve the type of future they might never have thought possible. Children with mentors are shown to improve in school performance and attendance. Also, they are more self-confident, have good social skills, and above all else, they are motivated to reach their full potential. Unfortunately, a severe shortage of volunteers has left over 15 million young people without mentors. National Mentoring Month highlights the needs and goals of mentoring in this country and honors the contributions of the many volunteers across the country that are currently connecting with youth in such programs. Next month, nonprofit organizations, schools, businesses, faith communities, and government agencies--led by the National Mentoring Partnership and the Harvard School of Public Health--will join together to encourage adults to serve as mentors for our young people. Programs must be expanded to recruit more volunteers to help fill the mentoring gap. Mentoring has successfully helped many children in this country and we must work together to expand such valuable programs. I urge the Senate to approve this resolution.

Mr. McCAIN

Mr. McCAIN. Mr. President, much has been spoken about the need for Americans to access safe and affordable drugs and therapies. We know that the pharmaceutical industry has cut numerous deals to protect their interests and line their pockets at the expense of the taxpayers, including seniors and the uninsured. I don't think it is a secret that PhRMA cut a deal with the White House to block legislation allowing for the importation of safe and affordable prescription drugs from Canada and other approved countries. And it seems that PhRMA cut a deal to line their pockets by locking in more expensive brand drugs in the Medicare Part D doughnut hole. Finally, it appears that PhRMA made sure that their profitable biologic medicines are protected for 12 years from competition from FDA-licensed safe and affordable biosimilars. This legislation has so many sweetheart deals that we probably haven't even found them all yet. Today, I am filing an amendment that improves the biologic pathway in the bill. It creates a fair pathway for competitive biologics that balances incentives for innovation with patient access to safe and affordable biosimilar medicines. It is a fact that the cost to discover biologic therapies can be astronomical. That, unfortunately, leads to some patients being unable to afford the needed therapies. Patients benefit from continued innovation but they also benefit from safe and affordable competitive biologics that may not occur under the proposal in the Reid bill. My amendment ensures that incentives to innovate remain in the law. It is accepted that biologic therapies are different than chemical medicines. That is why there needs to be a unique structure for the approval and licensure of biosimilar medicines. In creating a pathway to competitive biologics we need to strike a balance that provides patients greater access to more affordable, safe biologic therapies and ensures innovation continues to thrive. Today, biologics have a monopoly for years and years. I am worried that the underlying legislation would allow biologics to game the system and block competition beyond the 12 years provided in the bill. Some have argued that brand biologic companies will be able to stack 12-year periods of exclusivity on top of each other. My amendment addresses this issue. My amendment also addresses patient safety issues. FDA has very specific recommendations that I wanted to recognize in this pathway. Access to safe, competitive biologics is only as good as the therapies are safe. My amendment seeks to ensure the pathway for generic biologic therapies is as safe and effective as the original product. Highlights of my amendment include 10 years of initial data exclusivity for the original product--a decade is enough. Reid--Hatch/ Enzi/Hagan, has 12 years of data exclusivity. It also includes two extra years of data exclusivity if the manufacturer conducts additional research and finds new indications for the original medicine. My amendment also incentivizes additional innovation and encourages second generation therapies to come to market as soon as possible rather than companies waiting until the end of the initial exclusivity period to introduce new versions. Additionally, prescribing physician must authorize therapeutic appropriateness for a biosimilar and finally, the competitive biologic manufacturer is required to ensure the biosimilar medicine is safe and effective through clinical studies. My goal in introducing this amendment is to ensure patient access to safe and competitive biosimilar medicines, to guarantee innovation thrives and to bring down cost while ensuring safety and innovation.

Mr. McCAIN

Mr. McCAIN. Madam President, I ask unanimous consent that the Senator from Tennessee lead a colloquy including the Senator from Oklahoma, the Senator from Wyoming, myself, and the Senator from Kentucky.

Mr. McCAIN. I thank the Senator from Tennessee who also understands this issue as well as or better than anyone, having been a Governor and recognizing the problems the Governors face. If I could step back a second, Governor Schwarzenegger is a very astute observer of the political scene in California. May I point out to my colleagues, in this morning's Wall Street Journal: ``Democrats' Blues Grow Deeper in New Poll,'' and then: ``Support for Health Overhaul Wanes.'' There is some remarkable information concerning the mood and views of the American people, following on a Washington Post ABC News poll out yesterday that says 51 percent of Americans say they oppose the proposed changes to the system; 44 percent approve. Thanks to the efforts of so many people, including our leadership, we have turned American public opinion because we have been informing them of the consequences of passage of this legislation. Let me quote from the Wall Street Journal article: More Americans now believe it is better to keep the current health system than to pass President Barack Obama's plan, according to a new Wall Street Journal-NBC News poll. Findings mark a shift from the fall when the overhaul enjoyed the edge over the status quo. According to the poll, 44 percent of Americans said it is better to pass no plan at all compared with 41 percent who said it is better to pass the plan. What they are saying is: Don't do this government takeover; don't increase taxes; don't increase spending; don't increase the costs. It is a remarkable shift, thanks to informing the American people. Could I mention a couple of other points made in this poll in the Wall Street Journal. In September, 45 percent of Americans said they wanted the plan passed; 39 percent wanted to ``keep the current system.'' In December, in polling out today, only 41 percent of the American people want it passed, and 44 percent say keep the current system. Then, of course, we have another interesting statistic: Trust that the government will do what is right: 21 percent say always or most of the time; 46 percent say only some of the time; and 32 percent of the American people say almost never. Of course, the anger and disapproval of this health care plan right now is the centerpiece of Americans' dissatisfaction of the way we do business. Let me say finally, because my colleagues wish to speak, we don't have a bill. We don't have a bill. Here we have been debating all this time and we do not have legislation. This was one of the bills we were presented with, but we know that significant changes are being made behind closed doors. We don't have a CBO estimate of the cost, do we? We understand they keep sending estimates over to CBO and it comes back and so they send them back, which probably is why last week the Senator from Illinois, the No. 2 ranking Democrat, said to me, I don't know what is in the bill either. I have the exact quote: I would say to the Senator from Arizona that I am in the dark almost as much as he is, and I am in the leadership. That is an interesting commentary. Of course, the issue of the protection of the rights of the unborn is still unclear. That is a big issue for a lot of Americans. It is a big issue with me, and I know it is a big issue with my colleagues. So here we are back, off of the bill itself, and apparently we are going to have some kind of vote on Christmas Eve or something such as that. What the American people are saying now is, when they say keep the status quo, they are saying: Stop. Go back to the beginning. Sit down on a bipartisan basis and let's get this done, but let's get it done right. Americans know that Medicare is going broke. Americans know that costs are rising too quickly, but Americans want us to do this right and not in a partisan fashion and not with a bill that costs too much, taxes too much, and deprives people of their benefits.