John McCain

Mr. McCAIN

Mr. McCAIN. I thank the Senator from North Dakota who has been pursuing this issue for a number of years. I believe we are on the verge of success. I appreciate his eloquence, I appreciate his passion, but most of all, on behalf of the citizens of my State who can't get up to Canada, who now are experiencing unprecedented economic difficulties, and who need these lifesaving prescription drugs--many of them senior citizens--I just wish to say thank you for your advocacy. I think you have made an eloquent case, and I hope my colleagues have paid attention and will vote in the affirmative for the Senator's amendment today.

Mr. McCAIN

Mr. McCAIN. Madam President, I wish also to add my words of congratulations to the new Members for their eloquence, their passion, and their well-informed arguments, although they are badly misguided. But I do congratulate them for bringing forth their ideas and taking part in this spirited debate. We welcome it, and I hope that someday we will be able to agree on both sides for us to engage in real colloquy between us, back and forth. I think the American people and all Members would be well informed. Madam President, I ask unanimous consent for the next 30 minutes to engage in a colloquy with my colleagues.

Mr. McCAIN. Madam President, I talk a lot about C-SPAN. I am a great admirer of C-SPAN. And the President--at least when he was running for the presidency--believed in C-SPAN as well, because he said C-SPAN would be in on the negotiations. Here is what was posted by a reporter from Politico last night at 5:48 p.m., entitled ``No C-SPAN Here.'' Right now a group of moderate Senators is meeting behind closed doors to try to hash out a compromise on the public option. Reporters, waiting for the meeting to break, were just moved out of the corridor nearest the meeting and shunted around the corner, making it harder for the press to catch Senators as they leave. C-SPAN this is not. I would remind my colleagues that the amendment we are discussing here is drafted to prevent drastic Medicare Advantage cuts from impacting all seniors in Medicare Advantage. The amendment says simply: Let's give seniors who are members of Medicare, who have enrolled in Medicare Advantage, the same deal that Senator Nelson was able to get for the State of Florida--at least most of the seniors who enrolled in the Medicare Advantage Program. There are 11 million American seniors who are enrolled in the Medicare Advantage Program. This amendment would allow all 11 million to have the same benefits and there would be no carve-out for various groups of seniors because of the influence of a Member of this body. I want to quote again the New York Times, my favorite source of information, from an article entitled ``Senator Tries to Allay Fears on Health Overhaul.'' . . . Mr. Nelson, a Democrat, has a big problem. The bill taken up this week by the committee would cut Medicare payments to insurance companies that care for more than 10 million older Americans, including nearly one million in Florida. The program, known as Medicare Advantage, is popular-- And the article lists the benefits, and then continues as follows: ``It would be intolerable to ask senior citizens to give up substantial health benefits they are enjoying under Medicare,'' said Mr. Nelson, who has been deluged with calls and complaints from constituents. ``I am offering an amendment to shield seniors from those benefit cuts.'' He is offering an amendment to shield senior citizens. Well, I am offering a motion that deals with all of the 11 million seniors who are under Medicare Advantage, as the Senator from Florida said, to shield seniors from benefit cuts. That is what this motion is all about. We should not carve out for some seniors what other seniors are not entitled to. That is not America. That is not the way we should treat all of our citizens, and I hope my colleagues will understand this amendment is proposed simply in the name of fairness. I ask the Senator from Tennessee and the Senator from Texas, who have a large number of enrollees in the Medicare Advantage Program, whether they feel this would be unfair?

Mr. McCAIN. As the Senator points out, a few days ago, by a vote of 100 to 1, we voted to pass an amendment proposed by the Senator from Colorado, Senator Bennet, which included words such as ``protecting guaranteed Medicare benefits'' or ``protecting and improving guaranteed Medicare benefits.'' The wording was: ``Nothing in the provisions of or amendments made by this act shall result in the reduction of guaranteed benefits under title XVIII of the Social Security Act.'' Is there any Member on the other side who can guarantee that seniors in his or her State in Medicare Advantage will not lose a single benefit they have today--not the guaranteed benefit the other side goes to great pains to talk about. I think those who are enrolled in the Medicare Advantage system believe that since they receive those benefits, they are guaranteed benefits as well. I would ask our two physicians here on the floor, who both have had the opportunity to deal directly with the Medicare Advantage Program, if you have a patient come in and you say: By the way, you are having your Medicare Advantage Program cut, but don't worry, we are protecting your guaranteed Medicare benefits, do you think they understand that language?

Mr. McCAIN. So a preponderance of people who enroll in Medicare Advantage are low-income people, and a lot of them are rural residents?

Mr. McCAIN. May I also point out, for the record, on September 20, 2003, there was a letter to the conferees of Medicare, urging them to include a meaningful increase in Medicare Advantage funding for fiscal years 2004-2005--a group of 18 Senators, including Senators Schumer, Lautenberg, Clinton, Wyden, et cetera, including Senator Kerry, who now obviously wants to reduce the funding for Medicare Advantage. Again, perhaps he was for it before he was against it. I would also like to point out, as short a time ago as April 3, 2009, a group of Senators, bipartisan, including Senators Wyden, Murray, Specter, Bennet, Klobuchar, and others, wrote to Charlene Frizzera, acting administrator of the Centers for Medicare and Medicaid Services: We write to express our concerns regarding the Centers for Medicare and Medicaid Services' proposed changes to Medicare Advantage rates for calendar year 2010. The advance notice has raised two important issues that, if implemented, would result in highly problematic premium increases and benefit reductions for Medicare Advantage enrollees across the country. Again, as recently as last April, there was concern on the other side about cuts in the Medicare Advantage Program.

Mr. McCAIN. The point of all this is, the Senator from Florida, a member of the Finance Committee, felt so strongly that Medicare Advantage was at risk he decided to carve out, and was able to get the majority on a party-line vote of the Finance Committee to carve out a special status for a group of seniors under Medicare Advantage in his State. My motion simply says, everyone whom the Senator from Oklahoma made reference to deserves that same protection. That is all this motion is about.

Mr. McCAIN. So seniors, by losing Medicare Advantage, would then lose certain provisions Medicare Advantage provides and then they would be forced, if they can afford it, which they are now paying zero because it is covered under Medicare Advantage, then they would have to buy Medigap policies that would make up for those benefits they lost when they lose Medicare Advantage. Guess who offers those Medigap insurance policies. Our friends at AARP, which average $175 a month. We are telling people who are on Medicare Advantage today, when they lose it, they can be guaranteed, if they want to make up for those benefits they are losing, they would be paying $175 a month, minimum, for a Medigap policy. A lot of America's seniors cannot afford that.

Mr. McCAIN. They can't afford it.

Mr. McCAIN. How much time remains, Madam President?

Mr. McCAIN. I ask Dr. Barrasso, have you treated people under Medicare Advantage?

Mr. McCAIN. So you are making the case that even though it may cost more, the fact that you have a weller and fitter group of senior citizens, you, in the long-run, reduce health care costs because they take advantage of the kind of care that, over time, would keep them from going to the hospital earlier or having to see the doctor more often.

Mr. McCAIN. I ask the Senator from Tennessee, do you know of any expert economist on health care who believes we can make these kinds of cuts in Medicare Advantage and still preserve the same benefits the enrollees have today?

Mr. McCAIN. Madam President, I ask unanimous consent for an additional 30 seconds for the Senator.

Mr. McCAIN. I wish to finally point out what Dr. Coburn said. Medicare Part C, which is Medicare Advantage, is part of the law, and to treat it in any way different, because those on the other side do not particularly happen to like it, I think is an abrogation of the responsibilities we have to the seniors of this country. I thank my colleagues and yield the floor.

Mr. McCAIN

Mr. McCAIN. Mr. President, this amendment is about an earmark. It is about a special deal cut for a special group of people who happen to reside in the State of Florida. I am never so presumptuous. I have lost too many votes trying to eliminate earmarks. But what I am trying to do is allow every American citizen who is enrolled in Medicare Advantage to have the same protection of their Medicare Advantage Program as the Senator from Florida has carved out in this bill. That is all it is about. It is about equality. It is about not letting one special group of people who reside in a particular State get a better deal than those who live in the rest of the country. That is all this amendment is about. It will probably be voted down on a party-line vote. But what you have done is you have allowed a carve-out for a few hundred thousand people in the State of Florida and have disallowed the other 11 million who have Medicare Advantage from having their health care cut. That is what this is all about.

Mr. McCAIN

Mr. McCAIN. I object.

Mr. McCAIN. Madam President, as is the agreed-upon procedure by the two leaders, I send a motion to commit to the desk with instructions, as part of the side-by-side procedure that has been agreed to by the majority leader and the minority leader, and ask for its consideration.

Mr. McCAIN. I ask unanimous consent that reading of the motion be dispensed with.

Mr. McCAIN. Madam President, the motion I am offering would simply commit the bill back to the Finance Committee for a short period to apply the same grandfathering provision in this legislation to all Medicare Advantage beneficiaries, the provision in the bill as it is specifically drafted, to prevent the drastic Medicare Advantage cuts from impacting some seniors in Florida, which compare to the cuts facing Medicare Advantage enrollees in the rest of Florida and the rest of America, including the 330,000 Medicare Advantage enrollees in my State. Basically, this motion says that the same benefits that have been granted in the legislation to citizens in Florida would also apply to citizens who are enrollees in the Medicare Advantage Program all over America. It is pretty simple. Specifically, starting in 2012, this motion would accomplish a fix that allows all Medicare Advantage enrollees to maintain the current levels of benefits on the date of enactment. That would be in keeping with the sense-of-the-Senate resolution that was agreed to by the Senator from Colorado, Mr. Bennet, that called for all Americans to be able to keep the same level of benefits as they presently have today under Medicare and Medicaid. During the Finance Committee markup, the senior Senator from Florida advocated in favor of treating certain Medicare Advantage enrollees in Florida better than the rest of America's seniors under Medicare Advantage. Let me read from two articles written at the time of the Senate Finance Committee's deliberation. From the New York Times, ``Senator Tries to Allay Fears on Health Overhaul,'' September 24, 2009: But Mr. Nelson, a Democrat, has a big problem. The bill taken up this week by the committee would cut Medicare payments to insurance companies that care for more than 10 million older Americans, including nearly one million in Florida. The program, known as Medicare Advantage, is popular because it offers extra benefits, including vision and dental care and even, in some cases, membership in health clubs or fitness centers. ``It would be intolerable to ask senior citizens to give up substantial health benefits they are enjoying under Medicare,'' said Mr. Nelson, who has been deluged with calls and complaints from constituents. ``I am offering an amendment to shield seniors from those benefit cuts.'' Pretty simple. The Senator from Florida believes there would be cuts to the Medicare Advantage Program, and he was able to get into this bill an exemption for some 950,000 enrollees in Medicare Advantage in Florida. Admirably, the Senator from Florida was able to insert in this bill protection for 800-some or 900-some thousand constituents of his who are Medicare enrollees. There are 330,000 of them in my State who are seniors, who have paid into Medicare, who have the Medicare Advantage Program which, under the legislation, with the exception of the carve-out for the citizens in Florida by Mr. Nelson, would also then lose their benefits. Similar concerns exploded into public view on Wednesday as members of the Finance Committee slogged through a mammoth health care overhaul bill for a second day. Senator Nelson said Republicans were waging a ``scare campaign,'' but he shares some of their concerns. His predicament highlights the political risks for Democrats eager to reassure older Americans who vote in large numbers. There are risks for President Obama as well. He cannot afford to lose Mr. Nelson's vote. White House officials have offered to work with him to address his concerns. Mr. Obama has said repeatedly that ``if you like your health care plan, you will be able to keep it.'' That is one of the remarkable statements that is obviously contradicted by anybody who reads this bill. Any one of 11 million Americans, with the exception of Senator Nelson's constituents, who are under Medicare Advantage will see cuts in Medicare Advantage. That is a fact. If those 11 million Americans like their health care plan, they will not be able to keep it. The cost of Mr. Nelson's proposed fix--to preserve benefits for many people enrolled in the private Medicare plans--could total $40 billion over 10 years, and that could also be a problem for the White House. Mr. Obama has promised not to sign a health bill that increases the deficit, and so far Mr. Nelson has not said precisely how he would pay for his amendment. Approval of the amendment could invite other Democrats to ask for similar deals that might make the bill more palatable to their constituents, but more costly as well. Well, since that September article, obviously other Senators have asked for the same shielding of their constituents who are enrolled in Medicare Advantage. An October 20, 2009, Bloomberg story, ``Reid Leads Democrats into Carving Out Favors for States on Health.'' Democrats such as Senator Bill Nelson of Florida and Ron Wyden of Oregon secured provisions setting aside $5 billion to shore up benefits for constituents who participate in Medicare Advantage. That program allows private insurers to contract with the government to provide Medicare benefits. Nelson said the aid isn't directed solely at Florida. ``It affects several States, including New York,'' he said. ``We're trying to grandfather in seniors so they don't lose the benefits they have.'' Well, I am trying to carry out Senator Nelson's ambition. Senator Nelson said that, in effect, several States, including New York, are trying to grandfather in seniors so they don't lose the benefits they have. That is exactly what this motion is all about. I assume I can expect Senator Nelson's affirmative vote, along with all others listed in the motion of the 11 million people who are under Medicare Advantage in their States. And the deal-making continues. We have now learned about the special provisions in the 2,000-page legislation designed for certain Senators--I might add, at the expense of Medicare Advantage members in other States and the American taxpayer. We have had to read about such deals because they have been cut in secret closed meetings without the benefit of the C-SPAN cameras, as promised. Just the other day, it came to light that this legislation has special provisions for Oregon, New York, and a special one in Florida. I have had a conversation with Senator Wyden of Oregon, and he says that is not the case. I will certainly take Senator Wyden's word for it. I want the same protections extended to all seniors. That is all this motion is about--the same protection for all seniors, no special deals for any constituents related to the State in which they reside or the influence of their elected representatives. That is not the way we should treat seniors who have paid into Medicare Advantage. The special carve-out for some Florida seniors is quite interesting. Despite beneficiaries in Florida hearing the President's promises about being able to keep what you have, it appears the 950,000 Medicare Advantage enrollees in Florida aren't satisfied with the Democrats' promises to protect so-called guaranteed benefits. Medicare Advantage beneficiaries in Florida thought they would be able to keep the Medicare Advantage benefits that provide protection from high cost sharing in traditional Medicare, wellness programs, and vision, hearing, and dental benefits upon which they have come to rely. However, when Florida beneficiaries learned they were not going to be able to keep what they have--in fact, they were going to see a 64- percent cut in benefits--a deal benefiting some at the expense of other Medicare Advantage beneficiaries and taxpayers was added in exchange for support to move forward on the cuts. Let me point out, despite attempting to protect hundreds of thousands of Florida seniors from benefit cuts, Senator Nelson's deal still leaves approximately 150,000 Florida seniors and seniors across the country unprotected. So even in the proposed deal that was cut, Senator Nelson was willing to leave 150,000 beneficiaries subject to Medicare Advantage cuts. The Medicare Advantage Program is a program that had bipartisan support and the support of 11 million seniors who are enrolled in the program. Just a few short years ago, when Congress enacted the Medicare Modernization Act, new funding was intentionally provided to stabilize the Medicare health plan program. This was one of the few issues on which there was strong bipartisan agreement during the 2003 Medicare debate. It was done to ensure seniors all across America had access to an option in the Medicare Program, an option for additional, better benefits than are available under the traditional Medicare Program. In June 2003, several of our colleagues, including Senator Schumer and Senator Kerry, offered a bipartisan amendment on the Senate floor to provide additional funding for benefits under the Medicare Advantage Program. So I find it a little interesting that Members on the other side want to cut benefits to seniors now. Even though they supported the funding before, they now want to cut them. Later in 2003, as the Medicare conference committee was completing its deliberations, a bipartisan group of 18 Senators signed a letter urging the conferees to provide a meaningful increase in Medicare Advantage funding. This letter was signed by a diverse group of our colleagues, including Democratic Senators such as Dianne Feinstein, Christopher Dodd, Ron Wyden, Frank Lautenberg, Patty Murray, Arlen Specter, Mary Landrieu, and Maria Cantwell. Here is a letter dated September 30, 2003. It says ``United States Senate,'' and it is signed by a number of Senators, including my colleague, Senator Kerry. It says: Dear Medicare conferee: We are writing to ask you, as a member of the Medicare conference committee, to ensure that the final Medicare bill includes a meaningful increase in Medicare+Choice funding in fiscal years 2004 and 2005. So I guess my friend and colleague, Senator Kerry, was against cuts in funding before he was for them. He was against them before he was for them. So anyway it goes on to say: We strongly support additional Medicare+Choice funding for two very important reasons: (1) to protect the health care choices and benefits of the nearly 5 million Medicare beneficiaries who are currently enrolled in private sector health plans; and (2) to strengthen the foundation for future health plan choices. We believe that the Medicare+Choice funding provisions . . . are critically important to preserving choice and quality for America's seniors. We urge you to include these provisions in the final bill reported out of the Medicare conference committee. Since then the Medicare Advantage Program has been popular enough so that 11 million of our senior citizens have joined the program. I think that is a pretty impressive number of people who have decided to join the program. So I urge my colleagues to vote for this motion, just to give equal access to a very popular program to all citizens rather than just give it to several hundred thousand who happen to live in a certain part of the country.

Mr. McCAIN. I am not sure. So, Madam President, recently there was an article in the North County Times from San Diego, dated Saturday, December 5, 2009. I would say to the Senator from California, in response to her question, this is a very important issue, as the Senator from California just pointed out. I have a lot to say on it, and I have waited my turn to speak. In keeping with the procedures that are in keeping with the agreement between the two leaders, I do not expect to be too much longer, but I do not expect to curtail my remarks on this very important issue at 5:20 p.m. in the afternoon. So here is an article from the North County Times from San Diego, dated December 5, 2009: ``REGION: State ends subsidy for mammograms to low-income women under 50.'' I repeat: ``State ends subsidy for mammograms to low-income women under 50.'' It goes on to say: The eligibility age for state-subsidized breast cancer screening has been raised from 40 to 50 by the California Health and Human Services Agency, which will also temporarily stop enrollment in the breast cancer screening program. Advocates for low-income women, whose health care the department helps pay for, say the cuts put a two-tier system in place that is based on money rather than medical standards. The cuts will greatly harm the clinic's mammogram program, said Natasha Riley, manager of Vista Community Clinic's Breast Health Outreach and Education Program. The clinic and others like it in San Diego County provide reduced-cost care, mostly to low-income people, with money from the state and some private donations. ``More than 50 percent of the women we give breast exams and mammograms to are in their 40s,'' Riley said. ``The majority of our current breast cancer survivors are women in their 40s.'' The state's decision, announced Dec. 1 and effective Jan. 1, follows a controversial federal recommendation last month that mammograms before the age of 50 are generally not needed. So now we see the Federal recommendation that was made last month-- that mammograms before the age of 50 are generally not needed--is now being implemented in the State of California. Moreover, private health care systems such as Scripps Health have rejected the federal task force's recommendation, choosing instead to keep the existing standard, which calls for a mammogram at age 40, with annual mammograms thereafter. That means doctors will be using two medical practice guidelines, distinguished not by knowledge but by the pocketbook, said Dr. Jack Klausen, a gynecologist and obstetrician who practices at Vista Community Clinic. ``If we are in a situation where we don't screen, but the private-practice doctor can screen, then we are actually not practicing to the standard of care,'' Klausen said. Madam President, I ask unanimous consent that this entire article be printed in the Record. I certainly hope that a decision like this would not be implemented in discrimination against low-income women in the State of California.

Mr. McCAIN. Madam President, I have found that the debate on the floor has been invigorating. I have found it to be educational not only to the Members of this body, and this Senator in particular, but I think to all Americans. Believe it or not, a lot of the deliberations and the debate and discussion we have had on the Senate floor have been vigorous. They have been sometimes passionate because this is such an important issue--issues such as the one I just discussed--and they have been sometimes tough. But I must say, I have always tried to be respectful of the views of my colleagues, even though we have had some--especially the Senator from Illinois, the distinguished whip of the Democratic Party, whom I have engaged vigorously--but they have always been respectful debates. I intend to maintain that respect, as I have throughout my career. But I do not mean that means I will not be passionate. So I was astonished--I was astonished--and taken aback to see a foxnews.com article that just crossed my desk titled: ``Reid Compares Opponents of Health Care Reform to Supporters of Slavery.'' Senate Majority Leader Harry Reid took his GOP-blasting rhetoric-- I am quoting from the article-- to a new level Monday, comparing Republicans who oppose health care reform to lawmakers who clung to the institution of slavery more than a century ago. Senate Majority Leader Harry Reid took his GOP-blasting rhetoric to a new level Monday, comparing Republicans who oppose health care reform to lawmakers who clung to the institution of slavery more than a century ago. The Nevada Democrat, in a sweeping set of accusations on the Senate floor, also compared health care foes to those who opposed women's suffrage and the civil rights movement--even though it was Sen. Strom Thurmond, then a Democrat, who unsuccessfully tried to filibuster the Civil Rights Act of 1957 and it was Republicans who led the charge against slavery. So not only was Senator Reid wrong in his accusations, Senator Reid was also incorrect in who opposed slavery and who supported the Civil Rights Act. But that is not the important point. The important point, as the article goes on to say: But Reid argued that Republicans are using the same stalling tactics employed in the pre-Civil War era. And I quote from the article that is quoting Senator Reid: ``Instead of joining us on the right side of history, all the Republicans can come up with is, `slow down, stop everything, let's start over.' If you think you've heard these same excuses before, you're right,'' Reid said Monday. ``When this country belatedly recognized the wrongs of slavery, there were those who dug in their heels and said `slow down, it's too early, things aren't bad enough.' '' He continued: ``When women spoke up for the right to speak up, they wanted to vote, some insisted they simply, slow down, there will be a better day to do that, today isn't quite right.'' ``When this body was on the verge of guaranteeing equal civil rights to everyone regardless of the color of their skin, some senators resorted to the same filibuster threats that we hear today.'' That seemed to be a reference to Thurmond's famous 1957 filibuster--the late Senator switched parties several years later. Sen. Orrin Hatch, R-Utah, said Reid's remarks were over the top. ``That is extremely offensive,'' he told Fox News. ``It's language that should never be used, never be used. . . . Those days are not here now.'' Sen. Saxby Chambliss, R-Ga., suggested Reid was starting to ``crack'' under the pressure of the health care reform debate. ``I think it's beneath the dignity of the majority leader,'' Sen. Tom Coburn, R-Okl., said. ``I personally am insulted.'' So this is a debate which has been spirited. This has been a debate which has been passionate. This has been a debate that I think has been very helpful to the American people. Some of the back and forth that I have seen I think has been excellent. It has been excellent debate and discussion. I enjoyed it when the Senator from Montana and I had a discussion about various endorsements. I appreciated the fact that Senator Durbin brought my record to light and questioned it. But, most importantly, most of the conversation has been about the components of this bill and its impact on the future of America. So to somehow compare--as this article says--we who believe firmly in the principles that are being violated by this 2,000-page legislation to people who supported slavery, I would very much appreciate it if Senator Reid would come to the floor and, if not apologize certainly clarify his remarks that he was not referring to those of us who believe we are carrying out and performing our constitutional duties; that is, acting in the best interests of our constituents on an issue that will impact the future of the United States of America for years and years and years. Madam President, I ask unanimous consent that the foxnews.com article be printed in the Record.

Mr. McCAIN. So if I could return to my amendment. My amendment would make sure every beneficiary is protected and receives equal treatment. I would expect strong bipartisan support, since I think we would all like to see the same protections guaranteed for our own constituents. I know the Senator from Pennsylvania will appreciate this amendment, since he filed his own amendment to spend $2.5 billion in taxpayers' dollars to protect Medicare Advantage beneficiaries in Pennsylvania. I guess the 864,000 Medicare Advantage beneficiaries in Pennsylvania weren't satisfied with the promise to protect so-called guaranteed benefits either. This motion to commit is straightforward and will help the President keep his promise that if you like your health insurance you have today, the policy you have today, you can keep it, and will protect 10.6 million Medicare Advantage beneficiaries from at least a 64-percent cut in benefits. May I say, again, I think it has been an important debate we have engaged in. I do not and will not impugn the motives or the integrity of those who are sponsors of this legislation. Yes, I will argue we didn't keep the President's promise and commitment over a year ago during the Presidential campaign when he said he would have the C-SPAN cameras in, that there would be bipartisan negotiations with the C-SPAN cameras in, with Republicans and Democrats sitting down together so, in his words, the American people could see who is on the side of the health insurance companies and the special interests and who is on the side of the American people. I think that is a legitimate statement and a legitimate questioning as to the process that is taking place today, where there have been no negotiations with the Members on this side and there has been no C-SPAN camera included where these negotiations are taking place. So I hope there will be. I hope this legislation is defeated. I hope we can go back and sit down together, Republicans and Democrats, and agree on medical malpractice reform, on crossing State lines to be able to get the best insurance policy for every citizen and their family, to emphasize wellness and fitness and reward it, and to enact outcome-based treatment for our patients. I hope we can produce a lot of measures and take a lot of significant steps that would truly reduce the cost of health care in America, not enact a $2.5 trillion new entitlement program that is a scam. It is a scam because of the way the budgetary process has been set up. Right now, today, I can go out and buy an automobile, and I don't have to make a payment for a year. Under this proposal, you start making the payments and 4 years later you get the benefits. That is Enron accounting. I hope my colleagues will allow us to continue this spirited debate and discussion. I say, with the greatest respect, these are tough issues and there are strong differences of opinion. But I think, overall, this debate and discussion is good for the American people and, hopefully, the outcome will be one where we will be better informed and can better address the issue of the skyrocketing costs of health care in America and our ability to provide them with affordable and available health care. I yield the floor.

Mr. McCAIN

Mr. McCAIN. Mr. President, I suggest the absence of a quorum.

Mr. McCAIN. Mr. President, I am pleased to see my friends on the floor again today--very intelligent people, such as the Senator from New Hampshire and my friend, Senator Enzi, who is an expert on this issue, and the rest of us who know that a fight not joined is a fight not enjoyed. I look forward to another spirited discussion with my colleagues. Maybe if I could, to start with, I will take up a point about the debate and discussion we had yesterday on the floor with the Senator from Montana, the chairman of the committee, where he asked me why did I think that certain groups supported this legislation pending before the Senate. I said I didn't know what kinds of deals had been cut. I referred to the deal made with PhRMA and others. I didn't know exactly why because I am not taken into the discussions and negotiations off the floor in the office of the majority leader. There seems to have been some blowback on that, and somebody said maybe that wasn't appropriate to talk about deals that were cut. This morning, on the front page of the Washington Post, it says: Deals Cut with Health Groups May Be at Peril. Perhaps the Washington Post is impugning the reputation of someone or staffers or others. They have certainly impugned mine from time to time. But the fact is, this is a news story. Again, I go back, very briefly, because we have a lot to talk about, my colleagues and I. The fact is, there have been deals cut, just like is reported in the Washington Post this morning, as has been reported all over America about the deals cut with various interest groups that don't necessarily represent the people they claim to represent. I know the American Medical Association does not represent the majority of physicians and caregivers. In the State of Arizona, I know too many of them. I also know they have a very large lobbying presence in our Nation's Capitol, as do the other interested groups that have ``cut deals'' that may be at peril now, according to the Washington Post. With that, I will mention, again, that the doctor is in. Would the doctor care to give us some enlightened information, before we give our various opinions on this issue?