Bernie Sanders

Mr. SANDERS

Mr. SANDERS. Mr. President, reserving the right to object, and I won't, I would appreciate it if we could add to the end of that tranche the Klobuchar-Sanders amendment. Would that be all right?

Mr. SANDERS. Mr. President, I ask that the amendments be called up as under the previous order.

Mr. SANDERS. Mr. President, perhaps people then will ask a simple question: How does it happen? How does the same exact same medicine sold in the United States sell in countries around the world for a fraction of the price that we have to pay? The answer is severalfold. No. 1, we are the only major country on Earth, of course, that does not have a national health care system guaranteeing health care to all people. We are the only major country on Earth not to have that. As part of that problem, we are the only major country not to negotiate drug prices with the pharmaceutical industry. You can walk into a drug store today, and the price could be double or three times what you paid a year ago. There is no law to stop them. They can and they will raise prices as high as the market will allow. If people die as a result of that, not a problem for them. If people get sick, not a problem for them. Perhaps next to Wall Street, the pharmaceutical industry is the most powerful political force in this country. They have spent more than $3 billion on lobbying since 1998, and they have 1,400 lobbyists on Capitol Hill. We have 100 Senators. There are 435 Members of the House. Yet the drug companies have 1,400 lobbyists on Capitol Hill. They have lobbyists all over the country in every State capital. These are no small-time lobbyists. These are former leaders of the Democratic Party, leaders of the Republican Party, people who have enormous contacts. So the drug companies are able to raise prices to any level they want because we as a nation, uniquely among major nations, do not negotiate prices with them. The reason we do not negotiate prices with them is they got lobbyists and they make very hefty campaign contributions to make sure Congress, in fact, does not pass legislation which will lower drug prices in this country. The pharmaceutical industry is an industry that is not only incredibly greedy, but they have a business model which is largely based on fraud. Like Wall Street, their business model is largely based on fraud. Almost every major drug company, not widely known--but almost every major drug company in this country--multi, multibillion-dollar corporations--have been fined for illegal activities and for cheating consumers in our country and all over the world. Since 1991, with lax enforcement--it is not like we have a vigorous Attorney General's office that really goes after these guys. With relatively lax enforcement policies, drug companies over the years since 1991 have paid over $35 billion in fines or reached settlements for fraud and misconduct. Imagine that. This is just when they are caught, and I suspect that most of the times they cheat, they don't get caught--but $35 billion in fines or settlements since 1991 from the major drug companies in this country. Let me give you just a few examples of some of the settlements and fines the major drug companies have made in recent years. In 2013, the Justice Department ordered Johnson & Johnson to pay $2.2 billion in fines because they ``recklessly promote drugs for uses that have not been proven to be safe and effective.'' According to the U.S. attorney handling the case, Johnson & Johnson's ``promotion of Risperdal for unapproved uses threatened the most vulnerable populations of our society--children, the elderly, and those with developmental disabilities.'' In 2010, AstraZeneca Pharmaceuticals paid $520 million to resolve allegations that it illegally marketed the antipsychotic drug Seroquel for uses not approved as safe and effective by the Food and Drug Administration. In 2009, Eli Lilly was fined over $1.4 billion for its off-label promotion of another antipsychotic product known as Zyprexa. According to Federal investigators, Eli Lilly's ``illegal activity increases patients' costs, threatens their safety and negatively affects the delivery of healthcare services to the more than nine million military members, retirees and their families who rely on'' TRICARE. Very interestingly--and I am sure many of the Members saw it-- President-Elect Trump had a press conference this morning, and in his press conference, he said that pharma is ``getting away with murder.'' Mr. Trump: Pharma is ``getting away with murder.'' Do you know what? Mr. Trump is exactly right. Pharma is getting away with murder. Pharma has gotten away with murder for many decades. The interesting issue is, with a Republican President-elect telling the truth, that pharma is getting away with murder, will the Republicans, will all the Democrats have the guts finally to stand up to the pharmaceutical industry and their lobbyists and their campaign contributions and fight for the American consumer and end the disgrace of having our country pay, by far, the highest prices in the world for prescription drugs? The good news is--I say to my fellow Republicans and to Democrats-- the good news is that tonight you are going to have that opportunity because as part of the so-called vote-arama, I will be offering a very simple amendment which I hope wins strong bipartisan support. In fact, there have been a number of Republicans over the years--in the House and in the Senate--who have supported the concept of reimportation for many years. What this amendment will do is allow pharmaceutical distributors and pharmacists and those involved in the pharmaceutical industries--those people who sell drugs--to import low-cost medicine from Canada and other countries which will be FDA-approved. In other words, all over this country people ask a very simple question: We can eat fish and vegetables that are grown all over the world, but somehow we cannot get into this country brand-name prescription drugs manufactured by some of the largest drug companies in the world from an advanced country like Canada? The reason we can't do that is for one reason and one reason alone, and that is the power of the pharmaceutical industry. I would hope that tonight, both Democrats and Republicans will stand together and demand that this country be able to import safe, low-cost medicine from Canada and from other countries. I should also mention that I will be introducing legislation with Representative Elijah Cummings from Maryland in the coming days on this very issue, on the issue of reimportation and also another issue that Mr. Trump touched on, I believe, today; and that is, the need for Medicare and the government, in general, to negotiate prices with the pharmaceutical industry. The VA does it. Clearly, Medicare should be doing it as well. I believe we are going to have an amendment on the floor tonight. I would hope people support that amendment. I will be introducing legislation on that issue as well as reimportation. When we talk about the health care crisis in America, one of the issues of concern to most Americans is the outrageously high cost of prescription drugs. The question is whether the Congress has the guts to take on an enormously powerful industry, the pharmaceutical industry, with all of their lobbying and all of their campaign contributions. I certainly hope we will do the right thing, and tonight we can begin that process. With that, I yield the floor.

Mr. SANDERS. Mr. President, the repeal of the Affordable Care Act will throw perhaps up to 30 million people off of health insurance. I would yield to my friends if they will tell me now what the replacement is. How many of those 30 million people are going to die? What is your plan to cover them, plus the other 28 million people who have no health insurance? How are you going to end the international embarrassment of the United States being the only major country on Earth not to guarantee health care to all people? They don't have a plan. I understand Senator Corker wants more time. Maybe they will develop a plan. Right now what they are talking about is repealing legislation which has brought millions of people health care, and they have no substitute. I would urge the defeat of the Barrasso amendment. Madam President, I raise a point of order on Barrasso amendment No. 181, that the pending amendment is not germane to the underlying resolution and therefore violates section 305(b)(2) of the Congressional Budget Act of 1974.

Mr. SANDERS. OK. If we could add Klobuchar-Sanders as the fourth amendment of that tranche--it is all right. OK. Thank you. Amendment No. 61

Mr. SANDERS

Mr. SANDERS. How am I recorded? On behalf of elderly people who cannot afford higher prescription drugs, I vote no.

Mr. SANDERS. Mr. President, the adoption of this budget resolution will allow Republicans to come back to the floor of the Senate with a budget reconciliation package which will repeal the ACA with a simple majority. If they do that, up to 30 million Americans will lose their health care, with many thousands dying as a result. Because if you have no health insurance and you can't go to a doctor or a hospital, you die. Medicare will be converted into a voucher program. Medicaid will be decimated. Rural hospitals will be closed, and they have no alternative proposition. They want to kill ACA, but they have no idea about how they are going to bring forth a substitute proposal. This is not what the American people want. This is irresponsible. This is dangerous. This should be defeated.

Mr. SANDERS. Mr. President, last year the five major drug companies made $50 billion in profit, while one out of five Americans cannot afford the medicine they need. Please don't tell me that we can import fish from all over the world, but we can't bring medicine in from Canada.

Mr. SANDERS

Mr. SANDERS. Mr. President, this amendment does two basic things. No. 1, it says that the Senate should not go on record in throwing 30 million people off of health insurance, raising the cost of prescriptions drugs for seniors, and privatizing Medicare. But it also does something else maybe even more important. It says that we should support President-Elect Trump when he campaigned throughout this country saying that I, Donald Trump, will not cut Social Security, will not cut Medicare, will not cut Medicaid. Let's tell the American people that we think that when a candidate for President says something over and over and over, when he promises the working people and the elderly that he will not cut Social Security, Medicare, and Medicaid, we stand with him and we are going to support him and make sure that there are no cuts to Social Security, Medicare, and Medicaid. Thank you.

Mr. SANDERS. Mr. President, when my friend Senator Flake talks about reforming Social Security, what he is talking about is cutting Social Security. He is suggesting that is the only way we can save Social Security. Of course, that is nonsense. I would urge my good friend from Arizona to get on board legislation that I will be offering. Do you know what it does? It extends the life of Social Security for 55 years and expands benefits, and it does that by lifting the cap so that billionaires contribute more into the Social Security trust fund. To suggest that nobody on this side wants to do anything is inaccurate. We do want to do something. We want to raise benefits and extend the life of Social Security. And, yes, some campaign donors-- billionaires--may have to pay more in taxes. I urge my colleagues to reject the Flake amendment and support the Sanders amendment. Mr. President, I raise a point of order that the pending amendment, No. 52, is not germane to the underlying resolution and therefore violates section 305(b)2 of the Congressional Budget Act of 1974.

Mr. SANDERS. Mr. President, as the ranking member of the Budget Committee, I want to take this opportunity to make several points in opposition to the Republican side-by-side amendment and in support of the amendment that I have offered. Like many Republican proposals, if you read the Republican amendment, it sounds good on the surface, but if you probe half an inch into it, you recognize what an incredible disaster it will be for working families of this country--nice words, but devastating impacts. So I want to talk about that. No. 2, I want to talk about what it will mean if, in fact, the Republicans are successful in doing what they want to do, which is repealing the Affordable Care Act--something which I, and I think virtually every Democrat, will do our best to oppose--and what it will mean to the American people if the Affordable Care Act is repealed without any alternative to replace it. What that, in fact, will mean is throwing 30 million people off of their health insurance. Thirty million people will lose their health insurance. I have not seen any Republican studies as to how many of those people will die, but certainly many thousands of them will die because if you are sick and you don't have any money and you don't have any health insurance, you cannot get to a doctor or you cannot get to a hospital. In fact, there have been some studies suggesting that thousands of people will die, and certainly many others will become much sicker than they should be. That is what happens when you simply throw 30 million people off of health insurance and you have no alternative plan. Nobody in the Senate thinks the Affordable Care Act is perfect, least of all me. I think it needs significant changes. Let's work together to change it. But you cannot just repeal it without any alternative. Not only will a repeal throw 30 million people off of health insurance, it will devastate millions and millions of low- and moderate-income families by making major cuts to Medicaid, and that includes many middle-class families who use Medicaid to support payments for their parents who are in nursing homes. If you repeal the Affordable Care Act without a replacement, you are going to significantly increase the cost of prescription drugs for senior citizens, many of whom have a hard time right now paying for their medicine. And while you have thrown millions off of health insurance, while you make devastating cuts to Medicaid, while the repeal of the Affordable Care Act will raise the cost of prescription drugs for seniors, a repeal would do something else, which is not terribly surprising coming from Republicans. It would provide $346 billion in tax breaks to the top 2 percent. Millions lose their health care, the costs of prescription drugs go up, middle-class families will not be able to afford nursing home care for their parents, but, importantly, from the Republican perspective, $346 billion in tax breaks will go to the top 2 percent. Now, this is a set of priorities which I, frankly, believe the American people do not support. Also this afternoon I want to touch on another issue that is actually even more important than the previous two, and that is, to my mind, in a Democratic society, a candidate for President--in this case Mr. Trump--cannot simply say one thing over and over again, cannot go out to the American people and make campaign promises, but the day after the election, forget about what those promises were about. Now, here is the purpose of the Republican amendment. This is what is in front of all of us right now. Purpose: To strengthen Social Security and Medicare without raiding it to pay for new Government programs, like ObamaCare, that have failed Americans by increasing premiums and reducing affordable health care options, to reform Medicaid without prioritizing able-bodied adults over the disabled, and to return regulation of insurance to State governments. That is the exact quote of the purpose of the Republican amendment that we will be voting on in a few moments. It sounds pretty good. But let us translate it into English, and let us be very clear about what these words actually mean and why this amendment should be opposed by every Member of the U.S. Senate. The Republicans say in their purpose that they want to ``strengthen Social Security and Medicare.'' Well, count me in. That is exactly what I want to do. But how do they propose to go about doing that? They are going to strengthen Social Security and Medicare by making devastating cuts to Social Security and Medicare. That is a strange way to strengthen a program. As we speak right now, the Republican chairman of the House Ways and Means Subcommittee on Social Security--the committee that has jurisdiction over Social Security--has introduced legislation which will make devastating cuts to Social Security. That is a very unusual way to strengthen that program. My Republican friends will tell us that the only way we can ``strengthen Social Security'' is, in fact, to cut Social Security. Now, talk about fake news; talk about Orwellian language. We are strengthening Social Security by cutting Social Security. To all those seniors and disabled veterans who are out there and who are trying to get by on $13,000, $14,000, $15,000 a year in Social Security benefits, my Republican colleagues are going to ``strengthen'' Social Security and they are going to do it by cutting your benefits. That is a very strange way to strengthen Social Security. It seems to me that if we are serious about really strengthening Social Security, what that means in plain English--not Orwellian language--is, No. 1, if you want to strengthen it, we have to extend the life of Social Security. Social Security now can pay out every benefit owed to every eligible American for 17 years. That is OK. It means we are not in a crisis, but it is not good enough. I want to see Social Security be solvent for another 50 or 60 years. That is strengthening Social Security. When we talk about strengthening Social Security, that means increasing benefits, not cutting benefits. The truth is that seniors in this country cannot make it on $13,000 or $14,000 a year in Social Security benefits; we need to increase and expand their benefits. Thirdly, if we are serious about strengthening Social Security, we need to end the absurdity of seniors who this year got a COLA of three- tenths of 1 percent, and in recent years have gotten COLAs of zero percent because the formula that determines COLAs for people on Social Security is totally inadequate and an incorrect formula, not really measuring the cost-of-living expenditures of senior citizens. That is what we have to do to strengthen Social Security. How do we do that? I have legislation that will do just that. But do my colleagues know what? Despite all of the talk of my Republican colleagues wanting to strengthen Social Security, we have zero Republican cosponsors on that idea. The way we do it--a concept supported by many of the major senior organizations in this country--would eliminate the earnings cap on all taxable income above $250,000. Right now, if you make $1 million a year, $10 million a year, you contribute the same amount into the Social Security trust fund as somebody who makes about $118,000. That is wrong. That is unfair. Lifting that cap, starting at $250,000 and above, would impact only the top 1.5 percent. If we do that, we can extend the life of Social Security for well over 50 years and we could expand benefits for people living on less than $16,000 a year by more than $1,300 a year. That is how we strengthen Social Security. But I have not heard one Republican in this body speak in support of that proposal. Now, Republicans say they want to strengthen Medicare without raiding it to pay for new government programs like ObamaCare. That is what they state in their purpose. So let me be absolutely clear. That is a totally false statement. It is not true. The so-called raid was an effort to save some $700 billion over a 10-year period by making Medicare more efficient and more cost effective. My Republican friends talk every day about the need to bring increased efficiencies into government programs. They are right. We need to do that. And that is precisely what the Obama administration did. My Republican friends will not get up here and tell us that there was one nickel of Medicare benefits cut as a result of the creation of the Affordable Care Act. There was not one nickel of benefits cut. They know it. I know it. They will not say otherwise. So the $700 billion was in savings, doing the right thing--not cutting a nickel of benefits from Medicare. I hope my Republican colleagues will not continue to try to spread this mistruth. The Republican amendment that we are going to be voting on talks about reforming Medicaid without prioritizing able-bodied adults over the disabled. It sounds good. What are they talking about in real English? What they want to do is ``reform'' Medicaid without prioritizing able-bodied adults over the disabled. What does that mean? It means not only do they not want to see Medicaid expanded, as over 30 States have done, what they want to do, and what this language is really about, is to throw millions of people off of Medicaid. We are the only major country on Earth that does not guarantee health care to all people. Some 28 million Americans today have no health insurance. They want to throw millions more off health insurance. So if you are an ``able-bodied'' adult making the Federal minimum wage of $7.25 an hour--which, by the way, they don't want to raise. Vermont has raised its minimum wage to $10 an hour. I don't know what it is in Wyoming--$7.25. But if you are in a State where minimum wage is still $7.25 and you are able-bodied, do the arithmetic. If you have a couple of kids, health insurance will cost you $10,000, $15,000 a year. How do you afford that when you are making $8, $9, $10 an hour? You don't afford it. That is able-bodied. The last I heard, it is not criminal activity to be working and making $8, $9, $10 an hour. Unfortunately, that is what millions of people do. They cannot afford health insurance. What many of us have tried to do is expand Medicaid so that they will get health insurance, but what the Republican proposal and their language is about is the denying health insurance for the so-called able-bodied. Let's get rid of the word ``able-bodied.'' Let's talk about working people at starvation wages who cannot afford health insurance. That is what that language means in English. The Republican's proposal we will be voting on also talks about ``returning regulation of insurance to State governments.'' OK. It sounds good. What does that mean in the real world? That means you could be denied coverage for a preexisting condition. I just met a woman last night dying of breast cancer. That is her reality, but she was able to get health insurance, despite having a very severe situation, because we abolished the insurance companies' ability to say no to her and to millions of other people who have preexisting conditions. When you want to return regulation of insurance to State governments, that is precisely what they can do--the law is gone. The insurance companies can say: You have cancer; we are not going to cover you because you are going to cost us too much money, and we can't make any money from you. Insurance companies could refuse to cover needed things like maternity care, prescription drugs, or high-cost diseases like HIV and many others. That is what they mean when they talk about returning regulation of insurance to State governments, doing away with all of the patient protection we have passed here in Washington that is widely supported by the American people. Go out to Wyoming, go to Vermont, go to Oregon, go to any State and ask the people if we should repeal preexisting conditions so insurance companies can discriminate against people with illness, and they will tell you overwhelmingly no. So the Republican proposal, which sounds nice, is in fact a devastating amendment that would very negatively impact many millions of people. I hope every Member of the Senate will reject that Republican amendment and in fact vote for an amendment I will be offering which addresses two very important issues: No. 1, at a time of massive income and wealth inequality, at a time when a tiny sliver of our population--the people on top--are getting phenomenally wealthy, phenomenally richer, we have an explosion of billionaires in recent years while the middle class continues to shrink. At a time when we are the only major country on Earth not to guarantee health care as a right to all of our people, it would be absolutely unacceptable to take away health insurance from 30 million Americans, unacceptable to privatize Medicare, unacceptable to slash Medicaid, unacceptable to increase the costs of prescription drugs for seniors, unacceptable to defund Planned Parenthood--a high-quality health care organization providing health care to over 2 million Americans, many of whom are low income women. So a vote for the Sanders amendment rejects all of those very bad ideas. If we throw 30 million people off health insurance and if we do not have a plan to replace it, I would hope my Republican colleagues would have the decency to tell us how many of those 30 million people will die. If we are going to be considering this legislation and throwing 30 million people off who can no longer get to a doctor, can no longer get to the hospital because they don't have the money, how many of them will die? Tell us. Tell us so we can hold that in consideration as we look at this proposal. For years, it is no secret Republican leaders like Paul Ryan and Congressman Tom Price have wanted to end Medicare as we know it. That is what they have told us. It is not what I am saying. It is not a great secret. What does that mean? What does it mean if we end Medicare as we know it and if we turn it into a voucher program, handing a 65-year-old senior who has been diagnosed with cancer an $8,000 check and telling them to go out to a private insurance company and buy insurance on their own. That is what privatizing Medicare is about. It is a voucher program. Here is a check. You go out to the private insurance companies. You do your best. If you are an 80-year-old suffering with cancer and you have a check for whatever it may be--$8,000, $9,000 a year--and you go to an insurance company and you say: What do I get for my $8,000 check, they will laugh at you. They will laugh at you because they understand the cost of your care--your hospital care, your prescription drugs--will go well beyond 8,000 in the first week, let alone year. You will get nothing. That is what the Republican idea is in terms of privatizing Medicare. Let me get to the last point I want to make, and that gets well beyond the Affordable Care Act and well beyond Medicaid, Medicare, and Social Security. It gets to the essence of what our political system is supposed to be about, and that is, if we run for office--and every person in the Senate has run for office. If you run for President, you cannot say over and over again that you are going to do this, and the day after the election decide you are not going to do it. That is why so many people in this country are disgusted with the political process. They see people saying: Hey, vote for me. I am going to do A, B, and C, and the day after the election you do the very opposite, D, E, and F. When he ran for President, Donald Trump ran a very unconventional campaign. That is for sure. He said: I am not a typical Republican. That is what he said. He said: If I am elected President, I, Donald Trump, am not going to cut Social Security, I am not going to cut Medicare, and I am not going to cut Medicaid. He didn't say that once. He wasn't caught in an ambush interview. That was the heart and soul of his campaign. That is what he said to the elderly and to working-class Americans, and many voted for him precisely because he said he would not cut Social Security, Medicare, and Medicaid. On May 7, 2015, Mr. Trump tweeted: ``I was the first and only potential GOP candidate to state there will be no cuts to Social Security, Medicare, and Medicaid.'' April 18, 2015, Trump said: Every Republican wants to do a big number on Social Security. They want to do it on Medicare, they want to do it on Medicaid, and we can't do it. And it's not fair to the people that have been paying in for years. Now, all of a sudden they want to cut it. August 10, 2015, Trump said: I will save Medicare, Medicaid, and Social Security without cuts. Without cuts. We have to do it. People have been paying in for years and now many of these candidates want to cut it. March 29, 2016, Trump said: You know, Paul [Ryan]-- Paul Ryan is, as we all know, the Speaker of the House-- wants to knock out Social Security, knock it way down. . . . . He wants to knock Medicare way down. Two things. You will lose the election if you are going to do that. I am not going to cut it, and I am not going to raise ages, and I am not going to do all the things that they want to do. Welcome to ``they.'' That is what the Republicans are trying to do. Back to the quote: But they want to really cut it, and they want to cut it very substantially--the Republicans--and I am not going to do that. That is where we are today. Republicans have a proposal which will make devastating cuts to Social Security over in the House, and here by repealing the Affordable Care Act, they are going to cut Medicare and Medicaid. In December of 2011, Trump wrote: Now, I know there are some Republicans who would be just fine with allowing Social Security and Medicare to wither and die on the vine. The way they see it, Social Security and Medicaid are wasteful entitlement programs. But people who think this way need to rethink their position. It's not unreasonable for people who paid in to a system for decades to expect to get their money's worth. That's not an entitlement. That's honoring a deal. We as a society must also make an ironclad commitment to providing a safety net for those who can't make one for themselves. On May 21, 2015, Trump tweeted: I am going to save Social Security without any cuts. I know where to get the money from. Nobody else does. On and on and on. These are just some of the quotes. This is not like a statement in the middle of the night. This is what he campaigned on. What this amendment is about and says to my Democratic colleagues and says to my Republican colleagues is, do we hold and support the process in which a candidate runs for office and over and over and over again tells working families and the elderly he will not cut Social Security, Medicare, or Medicaid--do we hold him to his word or do we just say: Hey, that is just campaign rhetoric. He lied. That is OK. That is politics in America. It doesn't matter what he said. This is the reality. We are going to cut Social Security, Medicare, and Medicaid. So this amendment tells us that if we go forward with what the Republicans want to do, it will be devastating to the American people, but perhaps, more importantly, what this amendment says is that in a democratic society, we must have faith with the American people. You cannot run a campaign, make promises, and the day after forget about everything you said. I would hope very much that my Republican colleagues will join all of us on this side in supporting what democracy is supposed to be about. We have differences of opinions. Mr. Enzi and I disagree on a lot of things, but I have never suggested that Mr. Enzi--when he campaigns, I believe he says what he believes. People vote for him or they vote against him. It is called democracy. Now you have a situation where a candidate for President goes to the working class and says: I will not cut Social Security, Medicare, and Medicaid. Let us tell Mr. Trump: Let us keep faith with the American people. We heard what you said, and we are going to hold you to your word. Let us support the Sanders amendment. Mr. President, I yield the floor.

Mr. SANDERS. Mr. President, pursuant to section 904 of the Congressional Budget Act of 1974, I move to waive all applicable sections of that act for purposes of the pending amendment, and I ask for the yeas and nays.

Mr. SANDERS

Mr. SANDERS. Mr. President, I begin by thanking Senator Paul. He has shown a lot of courage for standing and exposing the hypocrisy of the Republican budget resolution. Year after year, we have heard from our Republican colleagues that the United States is going broke, that we have huge deficits, that we have a $19 trillion national debt, that we have to cut Social Security, we have to cut Medicare, we have to cut Medicaid, we have to cut funding for education, we have to deal with the deficit. As Senator Paul has indicated, if the Republican budget resolution passes, the Federal deficit would more than double over the next decade, going from $571 billion this year to over $1.3 trillion 10 years from now. I hope all of the deficit hawks on the Republican side hear what Senator Paul has to say and support him. I will not support him because I understand that the cuts that he is proposing are devastating to working families, to the elderly, to the children, to the sick, and to the poor. They would mean massive cuts in Medicare, Medicaid, Federal aid to education, and a variety of programs people desperately need, so I will oppose the amendment. All of my Republican friends who talk about the deficit year after year, here is a vote you should cast. Thank you.

Mr. SANDERS

Mr. SANDERS. Mr. President, I call up amendment No. 19, which is at the desk.

Mr. SANDERS. Mr. President, I ask unanimous consent that the reading of the amendment be dispensed with.

Mr. SANDERS. I ask unanimous consent that the reading of the amendment be dispensed with.

Mr. SANDERS. Mr. President, I ask unanimous consent to set aside the pending amendment and call up amendment No. 20.

Mr. SANDERS

Mr. SANDERS. Mr. President, I ask unanimous consent that Mike Jones and Josh Smith from my staff be given all-access floor passes for the Senate floor during consideration of the budget resolution, S. Con. Res. 3.

Mr. SANDERS. Mr. President, I ask unanimous consent that Jenna Sablan and Natalie Rico, detailees to the Budget Committee, be granted floor privileges during the consideration of S. Con. Res. 3.

Mr. SANDERS

Mr. SANDERS. Mike Enzi, the Senator from Wyoming, is a friend of mine. He comes from a beautiful rural State--Wyoming. I come from a beautiful rural State--Vermont. That is probably the end of our commonality. We look at the world very differently, and I hope that in the course of this debate, the American people will see the very profound differences we have not only on health care, not only on tax policy, not only on the deficit, but on many other important issues. What we are looking at right now is a budget process whose ultimate goal is to remove health insurance from tens of millions of Americans. Let's be clear. Today, the United States of America is the only major country on Earth that--I live 50 miles away from the Canadian border. Many of us have visited Europe. We are the only major country on Earth that does not guarantee health care to all people as a right. It is something I passionately believe in. I believe that health care for all is a human right. I had hoped we would work together to figure out what is a complicated issue as to how we can move forward to guarantee health care to all people in a cost-effective way, but that is not what we are debating today. Let's be very clear. The Republican plan--their budget plan--lays the groundwork for ending the Affordable Care Act, which will remove tens of millions of Americans from the health insurance they get. There is nothing wrong with change. We can always improve. I hope that during the course of this debate, my Republican friends who want to repeal the Affordable Care Act will come down and tell us what their plan is, how, in fact, they are going to provide quality, cost-effective health care to all Americans. Well, you know what. They all voted against the Affordable Care Act. Senator Enzi is right--we did not get one Republican to vote for it. They have had 8 years to think about how they are going to come up with a new plan, and I would hope but I do not expect one Republican to come to the floor and say: Oh yeah, we are going to throw 20, 30 million people out of their health insurance. This is our new plan. This is how we are going to provide health care to those people. They have no ideas. Their theme is to repeal and then delay. Someday they are going to come up with a new plan. You don't destroy a house without having another house in which people can live. You don't throw 30 million people off of health care without having a plan to provide health care to those people. Under the Republican proposal--something many Republicans have been talking about for years--they want to end Medicare as it presently exists, a program that is life-and-death for millions of seniors. They want to voucherize Medicare, give people a check, and then let them go to the private insurance market and get the best deal they can. Imagine that you are an 85-year-old senior citizen who has been diagnosed with cancer and you get your check for whatever it may be. We don't know what it will be--$7,000, $8,000, $9,000. You go to the insurance company and you say: I have $9,000. I am 85. I have been diagnosed with cancer. I want you to take care of me. Give me an insurance program that will take care of my medical needs, my hospital needs. The insurance agent will laugh in your face because $9,000 or $8,000 will last you, at most, for 1 week. That is their plan. I have been all over the country, and right now the American people are outraged at the high cost of prescription drugs in this country-- let's be clear--because of the power of the pharmaceutical industry and their lobbying and their campaign contributions--a power that exists, by the way, not only influencing Republicans but too many Democrats as well. We pay the highest prices in the world for prescription drugs. In fact, one out of six Americans who goes to a doctor to get a prescription for an illness cannot even afford to fill the prescription. Yet, under the Republican proposal, if you eliminate the Affordable Care Act, the doughnut hole fix, which now helps seniors pay for their prescription drugs, will be eliminated and prescription drugs for seniors could rise by as much as 50 percent. By the way, at a time when we have more income and wealth inequality than any other major country on Earth, when the very rich are getting richer while the middle class shrinks, the Republican proposal not only throws 20 to 30 million people off of health insurance, not only raises the price of prescription drugs for seniors, not only moves forward to privatize Medicare, but, shock of all shocks, our Republican colleagues want to give massive tax breaks to the top 2 percent. Among many other negative impacts that the repeal of the Affordable Care Act will have will be one that will impact heavily rural States, such as Wyoming, Vermont, and other rural States around this country; that is, as a result of the repeal of the Affordable Care Act, rural hospitals could be forced to close their doors--not getting the funding they need--leaving millions of Americans with nowhere to turn for critical medical care. I look forward to this debate. Nobody here thinks the Affordable Care Act is perfect. Nobody believes that at all. The goal is how we repair it, how we improve it, how we expand health care to more Americans, how we end what has been the case for decades in this country--that we pay, by far, the highest prices in the world per capita for health care. Maybe we should understand that we are the only major country in the world that allows private insurance companies to profit off of people's illness. The proposal being brought forth by the Republicans is not only poorly thought out, it really is not popular. It is not what the American people want. Go to your hometowns and ask people--at a time when the top one-tenth of 1 percent owns almost as much wealth as the bottom 90 percent, when the top 1 percent is earning 52 percent of all new income, go out and ask your constituents whether we should give huge tax breaks to the top 2 percent, and they don't think that is a good idea. According to a poll released this month by POLITICO and Morning Consult, 80 percent of the American people think the Federal Government should be spending more money on Medicare. Only 10 percent think we should be spending less. Seventy-one percent of the American people think we should be spending more on Medicaid. So 84 percent of the American people think the Federal Government should be spending more on Social Security. In other words, the proposal we are seeing from the Republicans today is way, way out of touch from where the American people are. There is another issue out there that I find extremely interesting. Senator Enzi mentioned--and, of course, he is right--that within a couple of weeks we are going to have a new President. Donald Trump will be inaugurated as President, and it is interesting that we listened to what Donald Trump said during the campaign. The Democrats heard what he had to say during the campaign, what he campaigned on, and more importantly, Republicans, listened and heard what their leader had to say about these issues. This is what Donald Trump said, and he didn't say it once in the middle of the night. He didn't say it in an interview. This was a central part of his campaign. This is what he asked millions of elderly people and working-class people to vote for him on. These are the principles that Donald Trump ran and won the Presidency on. On May 7, 2015, Donald Trump tweeted: ``I was the first and only potential GOP candidate to state there will be no cuts to social security, Medicare and Medicaid.'' On April 8, 2015, Mr. Trump said: ``Every Republican wants to do a big number on Social Security.'' That is not Bernie Sanders talking; that is Donald Trump talking. They want to do it on Medicare, they want to do it on Medicaid and we can't do it. It is not fair to the people that have been paying in for years. That is not Bernie Sanders--Donald Trump, our soon-to-be President. On March 29, 2016, Mr. Trump said: You know, Paul [Ryan]-- Paul Ryan is the Republican Speaker of the House-- wants to knock out Social Security, knock it down, way down. He wants to knock Medicare way down and frankly . . . you're going to lose the election if you're going to do that. I am not going to cut it, and I am not going to raise ages and I am not going to do all of the things they want to do, but they want to really cut it and they want to cut it very substantially, the Republicans, and I am going to do that.'' What Mr. Trump said was exactly right. Here are the ``they.'' This is the day. They want to cut Social Security. They want to cut Medicare. They want to cut Medicaid. Mr. Trump was right, and millions of people voted for him on the belief that he would keep his word. Well, it seems to me that Mr. Trump right now has to do one of two things. No. 1, if all that he was talking about was campaign rhetoric, then what he is obliged to do now is to tell the American people: I was lying. Yes, I said that I would not support cuts to Social Security, Medicare, and Medicaid, but I was lying. It was a campaign ruse. I just said what came to my mind to get votes. I have no intention of keeping my word. If that is what he believes, if that is what the case was, let him come forward and say that. But if that is not what the case is, if he was sincere, then I would hope that tomorrow or maybe today he could send out a tweet and tell his Republican colleagues to stop wasting their time and all of our time and for Mr. Trump to tell the American people that he will veto any proposal that cuts Medicare, that cuts Medicaid, and that cuts Social Security. What we are talking about right now--let us be clear: no debate. That is exactly what this goal is. That is what this budget proposal is. It is to move toward the voucherization and privatization of Medicare, to make massive cuts in Medicaid and throw millions of people off health insurance. So there is a lot of responsibility on Mr. Trump's shoulders, but I would hope that he could save us a whole lot of time by telling the American people that he was sincere in what he said during the campaign, that he was not lying. If that is the case, we can end this discussion, get into the serious business of how we create a quality health care system guaranteeing health care to all people in a cost- effective way. With that, I yield the floor.

Mr. SANDERS. Will my colleague from Michigan yield for a moment?

Mr. SANDERS. I want to thank my colleague for her very thoughtful presentation talking about the implications of simply repealing ObamaCare. The assumption that many of my colleagues seem to start from is that before ObamaCare, the health care system was great in America, that everybody had health care in a cost-effective way and then ObamaCare came along and all of these problems arose. What the Senator from Michigan just told us--and I want people to remember it--8 years ago, if you were diagnosed with cancer and you walked into an insurance company, they would say: Why would we give you insurance? We will lose money on you. Your cancer may recur. You are a woman and you want maternity coverage? What do you think is going on? Why should we do that? You are a family with a kid who is 21 years of age and you want his insurance on your policy? Well, you couldn't have it. I think what the Senator from Michigan pointed out is not that anyone thinks the Affordable Care Act is perfect--nobody thinks it doesn't need improvement. But to simply throw out all of the benefits, for 30 million people to be thrown off of health insurance--during the budget hearings a couple of years ago that Senator Enzi chaired, I asked a question of my colleagues when this idea came up, and I would ask it again to my good friend from Wyoming. What are the studies you have seen in terms of the number of people who will die when they lose their health insurance? How many thousands of people will die because they no longer have health insurance and they cannot go to the doctor and the hospital? The studies I have seen suggest that many thousands of people will die. That is common sense. If you throw 30 million people off of health insurance, they are going to die. How do you go forward providing a death penalty to thousands of people without having any solution to it? Further, I would add to the excellent points made by the Senator from Michigan. Senator Enzi and the Senator from Texas before him talked about the impact of health care problems in rural areas. I come from a rural area. Michigan has large parts of the State that are rural. The Senators from rural areas on the Republican side have said they want to make sure their constituents in rural areas can see a doctor. That is certainly a modest proposal. Of course they should be able to see a doctor. If that is the case, my Republican friends should understand what the Federation of American Hospitals and the American Hospital Association said about repealing the Affordable Care Act. These are major hospital organizations. According to a very recent report, what they said is that a repeal of the Affordable Care Act will mean a reduction in payments to rural hospitals of over $165 billion over a 10-year period. According to the hospital associations, rural hospitals will suffer an additional loss of $289 billion from their inflation updates. This is a report from the Federation of American Hospitals and the American Hospital Association, major health care institutions in America. They said in their report: ``This reversal of health coverage would represent an unprecedented public health crisis.'' Furthermore, they said: ``The magnitude of reductions would threaten hospitals' ability to serve patients.'' So when we talk about the needs of rural Americans, I would hope my colleagues listen to what the Federation of American Hospitals and the American Hospital Association have to say. With that, I yield the floor.

Mr. SANDERS

Mr. SANDERS. Madam President, I ask unanimous consent that the order for the quorum call be rescinded.

Mr. SANDERS. Madam President, I rise in strong opposition to this legislation, the so-called 21st Century Cures Act. While I appreciate the work Senator Murray, Senator Alexander, and others have done on this legislation, I cannot in good conscience vote on it in its current form. It goes without saying that everybody, whether Republican, Democrat, or Independent, wants to find cures to the terrible diseases that are impacting the lives of millions of people, such as cancer, Alzheimer's, diabetes, and the terrible illnesses that strike children. We all want to find cures for those illnesses, but that is not really what this debate is about. The debate we are having on this bill is simple: Do we continue to cave in to the demands of the pharmaceutical industry--an industry that is making recordbreaking profits by charging the American people, by far, the highest prices in the world for prescription drugs--or do we have the courage to stand up to the CEOs of big drug companies whose prices are so high that one out of five Americans who gets a prescription from a doctor is unable to afford to fill that prescription? Let's be clear. If you cannot afford to fill that prescription, you will likely get sicker, and in some cases, you are going to die. It is incomprehensible to me that we have a major bill dealing with prescription drugs, and yet we are running away from the most important issue that impacts millions of people and that the American people feel very strongly about, and that is the greed of the pharmaceutical industry and the outrageously high prices our people are being forced to pay. That is the issue on which we must focus. If we were really serious about finding cures for life-threatening illnesses and diseases, maybe--just maybe--we would adequately fund the National Institutes of Health and the Food and Drug Administration. Over the last 12 years, medical research has been cut by over 20 percent after adjusting for inflation. Even if this bill passes, funding for NIH will still be roughly $7 billion less this year than what it was in 2004. Meanwhile, over the same time period--just to put this in context--the top 1 percent has received over $1 trillion in tax breaks. In other words, we cannot fund the agencies that are trying to find cures for diseases, but we can give unbelievably significant tax breaks to the 1 percent. Let me very briefly give a few major reasons this bill should be defeated. No. 1, as I said a moment ago, the most important prescription drug- related crisis facing our country right now is the skyrocketing price of prescription drugs. This bill does not even deal with that issue. How can we talk about a bill dealing with the pharmaceutical industry without addressing the elephant in the room, which is the fact that we pay the highest prices in the world for medicine? And in many cases, those costs are soaring. In America today, one out of five people between the ages of 19 and 64 cannot afford to fill their prescriptions. Hundreds of thousands of seniors are forced to cut their pills in half because the medicine they need is just too expensive. Let me give just a few examples. Since 2007, Mylan has raised the price of a package of EpiPens by 461 percent while rewarding its CEO with a 671-percent increase in compensation. Maybe, just maybe, we might want to address that issue. Last year, Turing Pharmaceuticals increased the price of Daraprim by 5,000 percent overnight. It went from $13.50 to $750 for just one pill. While thousands of children in Flint have been poisoned by lead, Valeant increased the price of the drug to treat this disease 2,700 percent in a single year--from $7,100 to about $27,000. Meanwhile, at a time when 35 million Americans cannot afford the medicine they need, the drug companies are making enormous profits and providing extremely generous compensation packages to their executives. Last year, fellow Americans, while you were paying more and more for prescription drugs you desperately needed, the 5 major drug companies made over $50 billion in profit--$50 billion in profit, 5 drug companies--while the top 10 pharmaceutical executives received over $320 million in compensation. In fact, the prescription drug companies literally have money to burn. This year, the pharmaceutical industry spent $131 million to defeat Proposition 61, a ballot initiative in California that would have lowered average drug prices by at least 24 percent for millions of people. They spent $131 million in California to defeat a proposal that would have lowered drug prices. How does it happen that the pharmaceutical companies can charge any price they want for prescription drugs? The answer is clear: The prescription drug industry, along with Wall Street, is the most powerful political force in America. I have been fighting the greed of the prescription drug industry for decades, and as far as I can tell, the pharmaceutical industry always win. They never lose. They win, but the American people lose. Since 1998, the pharmaceutical industry has spent more than $3 billion in lobbying all over this place. There are hundreds and hundreds of lobbyists telling Members of Congress what the pharmaceutical industry wants, and they have made hundreds of millions of dollars in campaign contributions. They currently have over 1,200 lobbyists on their payrolls here in Washington, including former leaders of the Democratic and Republican Parties. That is why the pharmaceutical industry makes huge profits while the American people cannot afford the medicine they need. It would be one thing if these outrageous price increases were happening in other major countries. Are these price increases taking place all over the world? The answer is, they are not. In 2013, we spent nearly 40 percent more per person on prescription drugs than Canada and five times as much as in Denmark. How is it that the cost of prescription drugs in Denmark, Canada, the UK, and France is significantly lower than it is in the United States? That is an issue, and it is high time we begin discussing it. For example, it costs $730 for a 90-day supply of Crestor--which is used to treat high cholesterol--in the United States but just $160 in Canada. Americans with heartburn pay $736 for a 90-day supply of Nexium, but that same product costs $214 in Canada. Americans with arthritis are forced to pay $895 for Celebrex, but it costs just $280 in Canada. During this recent campaign, President-Elect Donald Trump promised, among many other things, to lower the prices of prescription drugs. That is what Mr. Trump said. He promised that he would ``allow consumers access to imported, safe and dependable drugs from overseas to bring more options to consumers.'' He also promised to require Medicare to negotiate with the drug companies for lower prices-- something that is banned by law today. Here is what President-Elect Trump said while on the campaign trail: We are not allowed to negotiate drug prices. Can you believe it? We pay about $300 billion more than we are supposed to, than if we negotiated the price. So there's $300 billion on day one we solve. Since President-Elect Trump supports requiring Medicare to negotiate with drug companies to lower prices, which is an idea that many people in this body also support, and since Mr. Trump believes we should be able to reimport low-cost medicines from Canada and other countries, I am quite confident that all of my Republican colleagues will support an amendment in my hands that will do exactly what Mr. Trump said he would accomplish as President. Think about what you can do to pave the way for Mr. Trump when he comes into office. You will have already satisfied one of his major campaign pledges. Therefore, Madam President, I ask unanimous consent that the pending motion to concur with an amendment be set aside, and I ask unanimous consent for the immediate consideration of a motion to concur in the House amendment to the Senate amendment to H.R. 34 with a further amendment that I send to the desk.

Mr. SANDERS. Mr. President, two points. First of all, let me reiterate that is for inflation-adjusted dollars, not nominal dollars. The funding for the National Institutes of Health this year will still be roughly $7 billion less than what it received in 2004. That is point No. 1. Point No. 2--and I will yield briefly to my friend from Missouri--did I hear him say that he is supportive of reimportation and having the Federal Government--Medicare--negotiate prescription drug prices with the pharmaceutical industry? That is what I thought I heard him say. I yield to my friend.