Medicare Premium Fairness Act

Mr. President, I am very pleased to be joined today by my distinguished colleague from Alabama, Senator Richard Shelby. We wish to present the Commerce-Justice appropriations bill to the Senate. What I wish to say to my colleagues is that as we do this, everyone should know this bill is a product of bipartisan cooperation. At times, when one views the Senate through the lens of the media, one would think that everything we do here is very prickly and very partisan. But that is not true, certainly of the Commerce-Justice-Science appropriations.

Senator Shelby and I worked together on this bill. Yes, I do chair it, but it has been with maximum consultation with others on the other side of the aisle. It was the same way when Senator Shelby chaired this committee.

We are pleased to present to the Senate the fiscal year 2010 bill to fund the Departments of Commerce and Justice and air science agencies. I thank Majority Leader Reid and Minority Leader McConnell for allowing to us to bring the CJS bill to the floor.

The CJS bill is a product of cooperation between Senator Shelby and me and our excellent staff. We have worked hand in hand. I thank Senators Inouye and Ranking Member Cochran for their allocation.

We were able to write a very good bill, but the stringent budget environment required the subcommittee to make difficult decisions. The CJS bill totals $64.9 billion in discretionary spending, consistent with the subcommittee's 302(b) allocation. So any amendments to the bill will need to be offset.

The purpose of the CJS bill is to fund the Department of Commerce and its bureaus and administration. Many people do not know what the Department of Commerce truly does. It is an array of complex agencies that is important to our economy: The Bureau of Industry and Security gives licenses for exports; the Economic Development Administration creates economic growth in our communities, particularly midsized to small towns; the Census Bureau, preparing now, somewhat unevenly, for the 2010 census; the Patent and Trade Office which protects our intellectual property; along with the International Trade Administration which enforces our trade laws.

We are particularly proud of the Commerce Department, of the National Institutes for Standards and Technology. It sets the standards for technology which allows our country and our companies to be able to compete in the global marketplace.

This subcommittee also funds the Department of Justice which keeps us safe from violent crime and terrorism. It prosecutes criminals of all kind--white collar, blue collar or no collar. It also has a vigorous approach to the despicable practice of being a sexual predator.

This subcommittee through the Department of Justice funds our State and local police departments which are so important as well from not only the enforcement end but the prosecution end through the U.S. Attorney's Office.

NASA is also funded through this subcommittee. It explores our planets and our universe and inspires our Nation and next generation to be scientists and engineers.

We also fund the National Oceanic and Atmospheric Administration, protecting our marine resources and the jobs that depend on them.

It also protects our weather to save lives. Many people don't realize that the wonderful weather reports they get in their communities comes because of the NOAA weather administration. They think it comes from the Weather Channel. We all love the Weather Channel, but the Weather Channel depends on NOAA.

The National Science Foundation is also funded, providing basic research at our universities to advance science and support teacher training and development.

We also fund several independent commissions and agencies, including the Commission on Civil Rights, the EEOC, the Legal Services Commission, the International Trade Commission, and the U.S. Trade Representative.

Senator Shelby's and my No. 1 priority is making sure that 300 million Americans who work hard and play by the rules are safe from terrorism and violent crime. We also want to protect jobs in our country. So we are the basic investors in innovation through education and through promoting an innovation-friendly government, making strategic investments in research and education in science and technology, keeping America No. 1 in science and also No. 1 in the space exploration program.

We want to create jobs in America that will stay in America. However, we, too, are fiscal stewards of the public purse and, therefore, accountability has been a hallmark of our bipartisan relationship. We do stand sentry against waste, fraud, and abuse with strong fiscal accountability and stewardship of hard-earned taxpayers' dollars.

I wish to take a few minutes to talk about keeping America safe. The CJS bill provides $27.4 billion for the Justice Department. We actually went above the President's request by $300 million because we wanted to make an extra effort to protect our homeland and protect our hometowns.

This bill is one of the most important sources of Federal funds for State and local law enforcement, for our frontline men and women of our State and local police forces. It is the cops on the beat who protect our families and at the same time they are asked to do more.

We are providing $3.2 billion to support that thin blue line to make sure the police are safe with equipment they need, such as bulletproof vests and also new technologies.

``CSI'' is not only a great TV show, but we think CSI should be funded in the Federal budget to use the best of science to catch the worst of the criminals.

We also fund Byrne formula grants, and this bill will provide $510 million for State and local police operations to do their job.

We are funding important programs in juvenile justice, which are very key programs of intervention and mentoring, but also very strong programs for antigang efforts--$407 million.

We also want to prevent, protect, and prosecute when it comes to violence against women, whether it is domestic violence, sexual assault, rape, or stalking--over $435 million--the highest level of funding ever.

We also have very important Federal law enforcement. All of us know and love the FBI. This bill will provide $7.9 billion to keep us safe from violent crime and also white collar crime, investigating financial and mortgage fraud.

I want to acknowledge the role of Senator Shelby, who is an authorizer on the Banking Committee and a member of this Appropriations Committee. He has taken on the issue of mortgage fraud and wanted it to be thoroughly investigated. We have done that through the FBI.

Many people don't realize, though, that after 9/11, when everyone was clamoring for something like the MI-5, such as the British have, we said: Three cheers for the British way, but we want a USA way, so we created an agency within an agency where the FBI is part of our most significant fight against terrorism.

We also fund the Drug Enforcement Agency to fight international narcoterrorists and drug kingpins. This bill provides $2 billion to do it.

I am very proud of the FBI because in the last few weeks their work has led to the arrest of two terrorism suspects who planned to blow up buildings in Texas and in Illinois. While they were working hard, the efforts of the DEA led to the arrest of drug kingpins who were shipping 95 kilograms into New York City.

We also have the Bureau of Alcohol, Tobacco, and Firearms and the Marshals Service, each of which has been funded at $1 billion-plus.

Our U.S. attorneys, who are the prosecutors of Federal crimes, have been provided $1.9 billion, a significant increase.

Once we catch and prosecute these criminals, there has to be Federal prisons, and we want to make sure our communities are secure and our prison guards are safe. This is one of the tattered areas of neglect, and we are very concerned about the safety of our prison guards. This bill provides $6.1 billion to upgrade, where necessary, the protective devices to ensure criminals are held securely--acknowledging their rights, but also the rights of those who guard them need to be kept too. Their first right is the right to security, guaranteed by their own government.

We look to protecting our children and our communities, and when it comes to protecting our children, crimes have gotten more sophisticated in terms of the Internet and other things that are used to lure children into terrible criminal situations. We have provided over $265 billion to deal with the issue of sexual predators, and we will continue that fight.

While we are busy fighting crime and protecting our children, we also need to protect America's jobs, and this is where science and innovation come in with an amazing race to keep America competitive.

This bill provides $880 million for the National Institute of Standards and Technology and, particularly, $70 million for the new Technology Innovation Program and $125 million for the Manufacturing Extension Partnership, so that we can keep manufacturing in our country. We also want to do the basic research that is needed for the new ideas that will come up with the new products for the new jobs.

This bill provides $6.9 billion for the National Science Foundation, and for NOAA we provide $4.7 billion, including $980 million for our weather service and $870 million for our fisheries.

This bill also funds our space program: $18.7 billion for NASA. In the space program, we don't agree with the House strategy; we agree with the White House strategy. The House strategy includes $500 million for the NASA exploration program. We believe we need to meet our obligations to fully fund the space shuttle and the space station. For the space shuttle, we need to make sure we keep our astronauts safe and our space station is able to continue the work we have begun. We also need to invest in the next generation of space vehicles at $3.6 billion.

It is very important we meet our obligations, our international obligations, as well as our obligations to our astronauts and to our Earth-bound scientists. However, if you meet those scientists, they are not bound by Earth very much. They are continually breaking barriers.

We know the House withheld money while waiting for the Augustine report. Well, we have the Augustine report. We know where the President wants to go. We know what the key advisers in the astronaut community have recommended to us--the gallant leaders from the past, such as Buzz Aldrin and John Glenn, to the most contemporary right now. I might add we have a space Senator in Senator Bill Nelson, one of our authorizers. So we have worked hand-in-hand with our authorizers.

We are also working very hard in terms of protecting our intellectual property. We have been concerned through the Bush administration--well, the Clinton administration, the Bush administration, and now we want to deal with this during the Barack Obama administration--that we have too many backlogs at our Patent and Trademark Office. We want to reduce those. American ingenuity should not have to stand in long lines to get their patents to protect their intellectual property and to come up with the products that will go into the global marketplace and at the same time create jobs here.

We are also very proud of what we do to protect our planet, and what we have done through NASA Earth science--$1.4 billion--and also what we are doing in weather satellites--$1.2 billion--which are very important global warming tools. If we can better protect and warn, we can save lives and save money.

The CJS bill ensures our constitutional obligation to do the 2010 census. We provide $7 billion to the Census. We are working hand-in- glove with Secretary Locke to make sure the Census Bureau is well organized to be able to do this very important job.

There are many more things we can talk about, but I know my colleague, Senator Shelby, wants to discuss the bill, and our good friend from Arizona has an amendment. So, Mr. President, I will amplify these other parts of the bill as we move forward.

I know Senator Shelby will return in a moment or two, so with deference and the usual courtesy and comity, if the Senator from Arizona wishes to offer his amendment, and then when Senator Shelby returns he can make his statement, we will just keep the business of the Senate moving as promptly and as well as we can.

Mr. President, I yield the floor.

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

Mr. President, this is a new amendment for us. We had not anticipated that this amendment--that a debate on immigration and the value of one person over another was going to become a subject of discussion in an appropriations bill. We would hope this type of conversation would be taken up on comprehensive immigration. I know my colleague from Utah, who is on the Appropriations Committee--and both are important to me, that he is from Utah and that he is on the Appropriations Committee--has thought this through greatly. He raises some very important points. I have discussed this amendment with my leadership. I know they want to take a more careful look at this and also consult on its full ramifications.

We are now talking about questions being asked through the census and the objective to be accomplished for that, which the census was originally for counting people for tax purposes, ironically. This is an apportionment question. So what we would like to do is go into a quorum while we look at how we may proceed on this amendment.

Having said that, I want to reiterate the importance of the census being taken every 10 years. The census must be taken for the reasons that our colleague from Utah outlined. No. 1, it determines the use of Federal funds, and that is why we count persons, because regardless of your status, you are a user of services--in some instances, maybe even more than a user of services. The second thing is with apportionment. I think that is a delicate matter that the Senator from Utah is raising. This gets us into constitutional questions. I am apprehensive about it. Again, we are going to consult with the leadership.

Also, as we move forward on the issue of the census, we have to make sure we do have a head count. The Census Department itself, right now, is under very serious duress. They were late getting started on some of their issues. There has been an enormous technological boondoggle with the hand-held technology, the enumerator, with which I believe the Senator from Utah is familiar. We have been working with the previous administration, this administration, and the Secretary of Commerce to get the census straightened out. My colleague said: Why don't they just print one more piece of paper? One more piece of paper sounds

simple. But everything we do that affects the census at this point presents a logistical and financial challenge that borders on a challenge to a nightmare. Again, we have calls in to the census that say, what will it take to do it?

I have reservations about adding this question, because I believe it will add to the logistics and costs. And No. 2, it could be a deterrent to people answering those questions because of who else is in their household. The other thing is that we have many people in our country who are green card people, who are here absolutely legally and justifiably. Some are in our own community at some of our community hospitals and are working as nurses. And asking this question and that question--I don't want to raise the issue of a deterrence and the ability to cooperate.

I want to take a closer look at this amendment. While we do that, I suggest the absence of a quorum.

Mr. President, I know we are debating here the nature of the questions that should be asked on the census. Our colleague, Senator Carper of Delaware, in a matter of minutes is holding a hearing on the census. At that hearing, he is going to seek some clarification on this and report back to us.

As we continue the debate on that amendment, I also want to bring to the attention of the Senate some of the very important things that are in this bill. We want to move this bill forward. I want to move this bill forward. We will dispose of, in an orderly, civil, rational way, the pending amendment of Senators Vitter and Bennett on the census. But we also want to move this bill forward. We want to do everything we can so that this bill passes by the end of this week so we can go to conference and be ready to move very important funding forward, particularly in the area of law enforcement.

This is absolutely a very compelling need. When we think about law enforcement, yes, we can think about law enforcement with illegal aliens. Yes, we can also think about law enforcement with violent criminals. We do deal with that in our bill. But we are also very much focused on white-collar crime. One of the areas on which we have worked on a bipartisan basis on this bill is the issue of mortgage and financial fraud. So, as we are debating amendments that are controversial, I want the people of America to know we are on their side and we can do it on a bipartisan basis.

One of the great pleasures of being on the committee is my ranking member--or the vice chairman, some people might call him--Senator Shelby is the ranking member on the Banking Committee. We put our heads together on how we can fight mortgage and financial fraud. He brought great expertise from his work on the Banking Committee. We now are looking at what we can do, by putting the money in the Federal checkbook, to go after those engaged in predatory practices, deceptive marketing and lending schemes.

Mr. President, you know from your background as a legislator and community leader that where there is need, there is often greed and often scams and scum doing it. We see it in the mortgage business. There are so many unsuspecting people who want just a piece of the American dream who were lured into some of the most deceptive practices that we have not seen in our country for several decades. They do have names. They are antiseptic names, but they mean a lot: predatory practices, deceptive marketing, lending schemes, flipping. The consequences have been enormous. During the past year, financial institutions have written off $500 billion in losses because of fraud in the subprime mortgage industry--$500 billion in losses. That is a lot when you think about what we have had to do to try to stabilize housing, to try to stabilize our mortgage industry. Numerous publicly traded financial institutions have declared bankruptcy or have been taken over by the Federal Government. I don't mean to imply that being taken over by the Feds was all due to the fact that they had been involved in fraudulent schemes, but it is time to say: No more.

What we want to be able to do is to go after the scammers who caused Americans to lose their homes, their life savings, and their dignity. Yes, I worry about the financial institutions, but I worry about people who put their money in the bank or took these loans that caused them, through balloon payments, excessive interest rates, two, three, four, five mortgages, all of which were unable to be sustained, to lose their homes. We on this committee say and we want our Senate colleagues to say: No more scamming and scheming. No more preying on hard-working American families.

What did the Commerce, Justice, Science Subcommittee do? Senator Mikulski, you don't have to use a lot of rhetoric, but will it take a lot of money? We are going to do it. We are going to put $437 million in the Justice Department to combat financial fraud and be able to do what we need to do. This is a $63 million increase over fiscal year 2009. We are going to hire new agents, new attorneys, and new special support staff--people who will be skilled in an exciting new field called forensic accounting.

Our FBI is going to play a major role in this. I talked personally with Director Miller about it, as has Senator Shelby. We have gotten the FBI's commitment to really beef this up. In our own hometown of Baltimore, the U.S. attorney has put together a special task force to be able to deal with this.

What does it mean? First of all, in the Federal checkbook, we put in $75 million. This is going to increase the number of these mortgage fraud task forces around the country. We have a very excellent one under Rod Rosenstein, working in Baltimore, in our State, right this minute. But we also wanted to be able to go into States with large rural populations and others that right now do not have them.

Specifically, the funding will be used for the FBI to hire, as I said, new agents and forensic accountants. This is highly specialized, but there are people with backgrounds in accounting with special training in forensics. It is like the CSI not only says ``hi'' to a test tube but says ``hi'' to the kind of accounting that will go after these crooks. It is amazing how they can look at the books and know how people have been cheating.

We want the agents to be able to detect and investigate and capture these white-collar criminals, but we also want our U.S. attorneys to prosecute complex financial fraud. We want to be able to increase prosecutions by adding U.S. attorneys. We are adding several U.S. attorneys and support staff around the country to be able to establish the task force and work in the task force. We are very proud of our U.S. attorneys, and I believe our Attorney General, Eric Holder, is helping to restore the integrity of our U.S. attorneys around the country.

We believe in Maryland we have a very high-value functioning U.S. Attorney's Office, but they are swamped. They are going after everything from drug dealers to other violent criminals, and we also want them to have the resources to go after the white-collar crime. This is a crime. It is not as if just because it is white collar we often don't equate it as a crime, but for the Criminal Division at Justice, we are also encouraging them to step up their activity. Again, we are adding attorneys and support staff and putting the money behind it to be able to do it.

We are also doing increased work in the Civil Division to fund initiatives and to also litigate these cases and make sure we not only detect them, we not only prosecute them, but we have the lawyers and the support staff to do it. Support staff are paralegals, clerical people. But again, it is a unique kind of crime. You have to come with multiple skills. You have to come being a great lawyer or a great person who is part of the legal team. You have to have strong litigating skills, but you also have to be well versed in financial services and accounting practices. So we want to be able to bring them on and be able to keep them as we go through many of these other cases.

These are the kinds of skills we need to not only go after white- collar crime but also violent crime. Remember, we got Al Capone, not in the act of robbing a bank but cheating on his taxes.

It was that brilliant FBI generation where you had to be either a lawyer or accountant to work for the FBI. Now, again, lawyers and accountants are welcome at the FBI. But they caught Al Capone cheating on his income tax. It was one of the ways we could nail him.

I am not saying we are going to be nailing people for cheating on their income tax, but we are going to nail people who cheated and schemed and gouged against innocent people who wanted to buy a home-- through acting like loan sharks, having phony ads, having fine print so that you bought a home in the large print and you lost it in the fine print. We want to make sure those people know how to read the fine print and know what it means.

While we are debating this bill and we are looking at those things that are going to focus on topics outside the scope of this bill, we want people to know we are on their side. For everybody who is stretched very thin financially, trying to keep their head above water, and trying to buy their home, we want them, at least when they go to get a loan or to refinance it, to be dealing with honest, reputable dealers. Let's foreclose on the bad guys and stop the foreclosure on homes.

I yield the floor.

Sorry I cannot stand. As the Senator from Ohio knows, of course, from the chair I am sitting in I have become an expert on health care from the wheelchair up. I broke my ankle coming out of church a couple weeks ago.

But I would like to ask the Senator from Ohio to yield for a few questions. I was taken by the three vignettes he just told. They are fairly representative of what I get from Maryland. I would like to talk about the young girl who had graduated and was deluged now with the debt of medical bills and the public option.

Is the Senator familiar with the fact that there are 47 million uninsured in our country? Does the Senator from Ohio know how many of those are between the ages of 18 and 30?

Well, again, for background in continuing the discussion. That is 35 percent of the uninsured. So is the Senator aware that if we followed through with the HELP Committee bill and the public option and also private sector competing with the public option offer, a reasonably no frills, reasonable cost health insurance bill for young people, especially young people's benefit, that we would cover 35 percent of the uninsured?

Can I go to the man who sands floors for a living, the small businessperson whom we worry about who is a self-employed person. Under the Senator's concept of a public option, is it true then that whether it is he or a florist, maybe a real estate agent, that one of the reasons they could afford it is they could go into the health exchange or the public option--would the public option not only offer insurance but offer bargaining power for better prices on insurance? They could bargain for better prices from hospitals, doctors, and pharmaceuticals?

In other words, why would a little guy or gal not only want to be able to buy in, not only would the price be exorbitant, or is it that it would be an Uncle Sam's club that is buying things at bulk rate that enables them to afford the services?

I thank the Senator.

Mr. President, I wish to thank the Senator from Utah for his remarks. We have essentially three space Senators on the floor--the distinguished Senator from Florida, our Presiding Officer, who has actually been an astronaut, and you can ask him if he wants to go into space with the lowest bidder. I think there are certain things that one can't pick who the lowest bidder will be.

I think there is much to be debated. We have the Augustine report, on which there has been a hearing, and our bill, the CJS bill, we fully fund the reliable transportation system that would be developed by our government. If the President were to change that, that would be a new direction and a new appropriation on which there would be tremendous debate and discussion.

So I wish to assure the Senator from Utah and the Presiding Officer, who often speaks for the brave men and women who go into space, that what the CJS bill does is fully fund, No. 1, what we need now to make sure our space shuttle is safe and fit for duty as it comes to the end in this decade of its usable service. Our No. 1 priority will always be the safety of the astronauts, not the bottom line.

The second thing is that in our appropriations we disagreed with the House. We actually put money in the Federal checkbook to develop the new programs, the new technologies for the next generation of reliable space transportation vehicles, and it follows very much the framework that the Senator from Utah has outlined.

So we look forward, once again, to working on our space program in a bipartisan way. One of the joys of chairing this committee is that when it comes to our National Space and Aeronautics Agency, we work on a bipartisan basis.

The Senator from Utah might be interested to know, when I first came to the Senate and went on the then VA-HUD Committee that funded NASA, the ranking member was Jake Garn, your colleague. As we all recall with fondness, Senator Garn was himself also a Senator astronaut. I must say it was Senator Garn who--I was a Goddard gal; Goddard is in Maryland. But space is about space, not about an individual State. Through his excellent workmanship, his patience, his guidance, I came to know the space program. Within 2 years, I happened to, with the retirement of Senator Proxmire, take over the committee. I could not have been an effective Senator had it not been for the wise guidance I received from Jake Garn. We did it because we worked together.

So this Senator has a real fondness for the Senator from Utah speaking about the space program. But I only want to reiterate how, when we work together, it is bipartisan, it is in the interests of our country, it is about the stars and the galaxies and the planets, but it is also about developing that new technology that creates the new jobs.

I am here sitting in a wheelchair wearing a space boot. I look like I am Sally Ride's advance woman. But it is a special device. Many materials were developed through our space program. It is an innovative technology, where you go beyond the outdated casts that neither expanded nor contracted during the day that this one can do. So this technology externally protects me from, quite frankly, anybody treading on me, if you can believe it, but it protects me. Internally, it has the genius devices that can deal with either the contraction or the expansion of your leg in the course of a day. All of that came out of our space program. So it is not only about Senator Barbara Mikulski and her space boot but all over we have been able to develop new medical devices because of our space program: digital mammography, saving the lives of women; a space boot that makes sure that after you have had the services of a talented and gifted surgeon, your leg is also protected. So you better believe I am going to protect the space program as much as the space program helped protect my leg today. So I wanted to let the Senator know that.

We are going to be voting in about 5 minutes on a Vitter amendment. I know there is another one that the Senator from Utah has cosponsored, which is going to be tomorrow. Right now, we are going to vote in a few minutes on sanctuary cities. I am going to yield the floor to the Senator from New Jersey, who is very knowledgeable on this topic.

I yield to Senator Menendez.

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

I ask unanimous consent to speak as in morning business.

Mr. President, I rise today to support the comprehensive review of our Afghanistan policy being conducted by the Obama administration. This is the right time for such a review because conditions have changed since the President's strategy was announced on March 27. I have traveled to the region twice since then--first in April and again last month--and can confirm the recent observations of General McChrystal that the Taliban has made inroads in Afghanistan and the situation is deteriorating and serious. At the same time, political dynamics have changed in the region. There have been flawed elections in Afghanistan, and an emboldened Pakistani military has taken actions against elements in the Taliban in Pakistan. In light of these developments, we must give the President the time he needs to review the strategy and reevaluate the mission.

Today marks 8 years since the U.S. military entered Afghanistan, but if there is one message I hope to convey to the American people today, it is that we have not been there in earnest since 2003. After launching a successful NATO campaign against al-Qaida and the Taliban- led government that sheltered it, resources were diverted to Iraq in 2003 before the job was finished. We essentially left Afghanistan to invade Iraq, and the result in Afghanistan was a resurgent Taliban and failure to capture Osama bin Laden.

This was not the first time we left Afghanistan. After resourcing the Afghans throughout the 1980s in their efforts to beat the Soviets, we abruptly ended our support in 1989 after Soviet troops withdrew. We were then absent for 12 years until 9/11.

Historically, and especially since 2003, our commitment to Afghanistan has been wavering and halfhearted. This has created a deficit of trust in the minds of the Afghans, especially among those who have allied with us and faced the prospect of life or death in our absence. I wish to repeat that. This has created a deficit of trust in the minds of Afghans, especially among those who have allied with us and faced the prospect of life or death in our absence.

As we enter the ninth year of the war, it is critical to reassess our strategy so we can get it right. This is why the President's review must be complete and must be comprehensive. It is not just about combat troops or the McChrystal report. Troops are just one part of the puzzle and the report submitted by General McChrystal is just one input. The President must consider multiple perspectives on the political and regional situation from U.S. Ambassador to Afghanistan Karl Eikenberry, U.S. Ambassador to Pakistan Anne Patterson, and the Special Representative for Afghanistan and Pakistan, Richard Holbrooke. He must also weigh broader concerns from the Department of Defense, including overall force structure and other global military requirements. The review will take time. There are many complex issues to deal with in Afghanistan which closely relate to our policy in Pakistan.

The President will present his plan to the American people when he has made his decision. At that time, Congress will be an important part of the process and will hold hearings on the President's plan, as it did with the President's plans in Iraq. Then each Member of Congress will cast the most important vote for any Member of this body: whether to send additional troops abroad and how to protect them. That debate should not be about politics.

I believe we must look at this challenge as a sum of the parts, and I wish to raise two primary questions. The first is about our mission and our objectives, which have been complicated by changes on the ground since March. The second is about waging an effective counterinsurgency strategy and what it would take to meet those requirements in Afghanistan. After we review our mission strategy in Afghanistan, we must also review how it correlates to our strategy in Pakistan. I will take each one of these questions in turn, both to give an indication of the complexity of the decisionmaking process and to share my observations on each subsidiary question.

First, the President must ask: What are our missions and objectives? In March, he presented his mission statement:

To dismantle, disrupt, and defeat al-Qaida and its safe

havens in Pakistan, and to prevent the return to Pakistan or

Afghanistan.

He also laid out key objectives: promoting a more capable, accountable, and effective government in Afghanistan, developing increasingly self-reliant Afghan security forces that can take the lead in counterinsurgency and counterterrorism, and assisting efforts to enhance civilian control and stable government in Pakistan.

As I have said, since March there have been at least three specific changes to the situation.

First, there were flawed Presidential elections in August which have further eroded confidence between the Afghan people and the government.

When I was in Afghanistan in April, there was hope--real hope--that these elections would lead to real change and progress. Unfortunately, the outcome has been a worst-case scenario, validating the fears of those who view the Afghan Government as plagued by corruption. As each day passes, the steady stream of election fraud revealed in the media further undermines trust in the Karzai government. This is especially harmful to our overall counterinsurgency strategy because the goal is to build support among the Afghan people for their government. Remember, this is not--not--between us and the Taliban, it is between the Afghans and the Taliban, and the perception of government corruption only strengthens the Taliban.

Second, we must review the challenges of training the Afghan national security forces.

While the Afghan National Army has demonstrated an ability to fight, there are serious questions about its size and effectiveness, and problems are even

worse among the Afghan National Police. Recruitment has been slow, attrition has been high, there are no noncommissioned officers, and many among the ranks are illiterate.

To build the ANA and ANP, we need to overcome limiting factors in the dearth of leadership development, qualified recruits, infrastructure, trainers, and equipment. During my trip to Helmand Province last month, I was struck by the side-by-side image of the Afghan Army troops in Toyota pickup trucks and U.S. troops in Mine Resistant Ambush Protected Vehicles, or MRAPS.

There is widespread recognition that there is a long way to go before the Afghan security forces can be self-sufficient and that the training plan requires adjustments.

We are now embedding American trainers with Afghan battalions to enhance leadership development, but we continue to do this better, which is why I strongly support Senator Levin's plan to prioritize and focus on training the Afghan Army and police. Specifically, I agree that we must expedite the training, equipping, and support for the army and police so they can double in size to 240,000 for the army and 160,000 for the police, not by 2013 but by 2012, and hopefully by the end of 2011. Based on my September trip to Afghanistan with Senators Levin and Reed, I believe this training can be expedited with the necessary focus and resources. This must--I say, must--be a top priority because our overall goal is not nation building in Afghanistan; it is self-sufficiency for the Afghans so they can provide for their own security, much like what has happened in Iraq.

The third changed condition we must consider is recent developments in Pakistan. When I traveled there in April, the situation was grave. The tension between the Pakistani Government and the Taliban was mounting. The deal that was cut with the Taliban to relinquish control over Swat Valley was unraveling, the Frontier Corps did not have the capacity to ``clear and hold'' in the tribal areas and border region, and I walked away very concerned about the overall political situation.

Immediately after the trip, the Pakistani military took decisive action against the Taliban in Swat Valley and has since regained control of the area. With our help, the Frontier Corps is building its capacity, and we just passed the Kerry-Lugar legislation, which would triple economic aid to Pakistan.

On my most recent trip in September, it was clear the political security environment had improved, but I still remain concerned about al-Qaida and its allies continuing to use Pakistan as a safe haven.

As we review our mission--taking into account these three developments and changing conditions--we must also consider the strategy used to meet our objectives. In March, the President announced ``an integrated civilian-military counterinsurgency strategy'' for Afghanistan. Partnering with the population and training local security forces has proven to be the best way to defeat insurgencies over time. Let me repeat: Partnering with the population and training local security forces has proven to be the best way to defeat insurgencies over time. Therefore, the second principal question we must ask is, Do we have the requirements necessary for waging an effective counterinsurgency strategy in Afghanistan?

Before I address these questions, let me say that I am struck--truly struck--by how quickly the military has adapted to counterinsurgency and how, from the bottom up, it has been adopted. Since General Petraeus wrote the U.S. Army/Marine Corps Counterinsurgency Manual in 2006, counterinsurgency has become fundamental to our military doctrine.

As long as we maintain the strength of our conventional forces, it is increasingly unlikely anyone will take on the U.S. military through conventional means. Let me repeat that. As long as we maintain the strength of our conventional forces, it is increasingly unlikely anyone will take on the U.S. military through conventional means. We must, therefore, prepare to fight future wars against insurgencies, nonstate actors, and asymmetrical forces. As such, the military, under the leadership of Secretary Gates, is rebalancing its budget and making other fundamental changes.

This is remarkable to me because any large organization, especially one as large as the U.S. military, is like a supertanker: it just does not turn easily. Through an incredible organizational effort, however, this supertanker has changed course, and I am truly impressed by the extent to which DOD and the U.S. military have accomplished this and have embraced counterinsurgency, from the privates to the four-star generals.

Counterinsurgency is a four-step process: First, shape a strategy; second, clear the area of insurgents; third, hold the area; and fourth, build through governance, essential services, and economic ability. It is important to note that troops are just one part of a counterinsurgency strategy. Equally important is training the indigenous security forces, providing essential services, promoting economic development, and strengthening systems of governance.

General McChrystal has recommended a full counterinsurgency approach in Afghanistan. As he mentions in his report, we should not resource the mission without reconsidering the strategy, and focusing on troop levels or resources alone ``misses the point entirely.'' Therefore, I ask again, do we have the requirements for an effective counterinsurgency strategy in Afghanistan? In order to explore this question, we must look at three key areas--governance, training, and the civilian role--and ask the following questions: First, can the Afghan Government offer a winning alternative to the Taliban? Second, can we train enough Afghan troops and police to meet the required number of counterinsurgents? Third, do we have enough civilians? Finally, we must also consider how to develop an effective strategy for reintegrating low-level insurgents.

Counterinsurgency is about trust building between the local population, the security forces, and the government. Without trust, we cannot expect sustainable progress, and that is why I am particularly concerned about allegations of fraud in the Afghan elections.

If this were a political campaign, there would be no need to run negative ads against the Taliban. According to the polls, the Taliban has only 6 percent support among the Afghan population. This is the good news. The bad news is that in the absence of jobs, credible governance, and essential services, this does not translate into support for the Afghan Government by the Afghan people. This is why we cannot just target the Taliban or insurgents. We must help the government develop a capacity to provide for its people so it can be viewed as credible and effective.

This is why the outcome of the recent election must be resolved in a clear manner so that whatever trust remains between the Afghan people and the government is not further diminished. We must ask--can we succeed in a counterinsurgency with a Karzai government tainted by allegations of fraud and corruption? How do we recalibrate our strategy in light of the recent flawed elections?

The second question I would like to raise is about the amount of counterinsurgents we need to succeed. Counterinsurgency doctrine tells us that troop size is not determined by the size of the enemy, but rather, by the size of the population. As such, we need a ratio of one counterinsurgent for every 50 citizens. The latest CIA World Factbook estimates the population of Afghanistan at 28 million, which means that we need roughly 560,000 ``boots on the ground'' which includes Afghans, NATO troops, and Americans.

During our visit, we learned that there have been 94,000 Afghan National Army and 82,000 Afghan National Police trained as of August. This brings the total number of trained Afghans to slightly less than 200,000. Combine this with 68,000 U.S. troops by the end of the year, and 38,000 NATO forces, and we have reached nearly 300,000. This is slightly more than half of the requisite number of troops, and is overly-generous in assuming that all trained Afghan security forces are combat ready and effective. Just by comparison, in Iraq, a country of two-thirds the size, there are already more than 600,000 trained security forces.

No one is suggesting we fill this enormous vacuum with American troops,

which is why we must focus on expediting training for the Afghans. And this is what Senators Levin, Reed, and I heard was wanted and needed by the Afghans themselves during our recent visit.

In the Garmsir District of Helmand Province, we met with more than one hundred local Afghans and tribal elders who insisted they want to independently secure their own population. They realize the need for U.S. troops to help to train and equip the Afghan National Security Forces, and recognized that American assistance is needed to accomplish this mission. But once the Afghans are able to provide security for themselves, they will be ready for us to end our military presence. In the words of the elders--once the Afghan security forces are trained, we will be welcome simply as ``guests.'' In the meantime, we have to find a way to prioritize training, so Afghans can eventually fill the security vacuums with minimal American assistance.

The third question regarding an effective counterinsurgency strategy is: do we have enough civilians to implement counterinsurgency in Afghanistan, and how can we expedite the deployment and training of civilians?

According to counterinsurgency strategy, once the troops have cleared and held an area with the support of Afghan Security Forces, civilians must partner with Afghans to build. And we need hundreds of additional civilians on the ground to fulfill a wide range of non-military requirements including improvements in agriculture, economic development, essential services, and governance.

We have heard lots of talk in Washington about the need for a ``civilian surge'' to complement the additional troops President Obama has pledged for Afghanistan this year. Many of those civilians have been hired, and the State Department expects to have nearly 1,000 civilians on the ground in Afghanistan by the end of this year. I support these efforts, but still believe that more must be done to build a stronger civilian capacity in Afghanistan.

During a visit to Camp Atterbury in Indiana last week, I met with 38 civilians deploying to Afghanistan. At Atterbury, civilians train with the military to cultivate an integrated approach and greater unity of mission. Like our soldiers, these civilians volunteer to leave their families behind and put themselves in harm's way to better the future of Afghanistan. We owe them and their families a debt of gratitude for their service, and we must ensure they have the tools, support, and training they need to succeed.

Civilians serving in Afghanistan from across the interagency are sharing trir expertise in everything from agriculture to governance, counternarcotics, accounting, energy, development, and education. The role of the military and civilians are complementary--one cannot succeed without the other. This is why military officials including Secretary Gates and General McChrystal are some of the strongest advocates for a deepened civilian commitment to Afghanistan. To succeed in counterinsurgency, we must do everything we can to expedite and increase the recruitment and deployment of qualified civilians.

Finally, when formulating an effective counterinsurgency strategy, we must ask if we have developed a plan for reintegrating low- and mid- level Taliban. I am not suggesting we speak with Mullah Omar or other members of the Taliban leadership, but we must recognize there are many Afghans working with the Taliban for purely economic reasons. One of the striking observations on my two trips was the fact that a primary concern of Afghans is jobs, just like Americans. And if we can offer economic incentives and alternative sources of livelihood--especially with regard to the drug trade--I am hopeful that we can reintegrate some insurgents ready to disavow violence. This will not be quick or easy, but the good news is that reintegration is possible, based largely on the model we successfully used for the Sons of Iraq.

You can see the complexities of determining our mission and objectives are great, and multiple questions remain in developing an effective counterinsurgency strategy for Afghanistan. But these considerations are only half the story.

Once we have reviewed the strategy and mission, we must also consider how our policy in Afghanistan impacts Pakistan. As the President announced on March 27, ``the ability of extremists in Pakistan to undermine Afghanistan is proven, while insurgency in Afghanistan feeds instability in Pakistan.'' The relationship is clear and U.S. interests are inextricably linked, which is why the President adopted the regional approach coined ``Af-Pak.''

In my view, there are four primary challenges in Pakistan that we must consider when formulating our strategy in Afghanistan.

First, Pakistan is a vital security interest because it has become a safe haven for al-Qaida, which has continued to train there and plan for future attacks on Americans. We know this based on the arrest less than three weeks ago of Najibullah Zazi, an Afghan planning a large- scale attack in New York, who is believed to have trained with al-Qaida in Pakistan.

Second, Pakistan has nuclear weapons and the delivery vehicles to use them. Therefore, political instability in Pakistan is not only a regional threat, but a larger global security interest. If Pakistan was destabilized or if control over its nuclear arsenal was compromised, it would pose severe security repercussions. It would be a nightmare scenario to have Pakistan ruled by fundamentalist religious fanatics with ``loose nukes'' in the hands of al-Qaida or other extremists.

Third, Pakistan's ongoing tension with India has limited its ability to respond fully to internal threats, such as the Taliban. The Pakistani military continues to see India as its number one threat, and has therefore hesitated to shift its focus from its eastern border to the west. This has improved in recent months since the Pakistani military went into Swat, but any U.S. policy must take into account Pakistani concerns about India.

Fourth, elements of the Pakistani intelligence service, or ISI, have at times allied with the Afghan Taliban. On the one hand, they want to hedge against a total U.S. total withdrawal from Afghanistan, as we did in 1989, or a limited withdrawal as we did in 2003. On the other hand, many in Pakistan worry that an increase of U.S. forces in Afghanistan may push extremists further into Pakistan.

This view was expressed today by the Pakistani Foreign Minister in the Washington Post. Quoted in an editorial, Foreign Minister Qureshi stated, ``If the likes of Mullah Omar take over in Afghanistan, it will have serious repercussions for Pakistan . . .'' He went on to say that the Taliban's actions in Afghanistan ``. . . will have implications on Pakistan and it will have implications on the region.''

All of these considerations indicate the need for a sustained U.S. commitment to Pakistan, which is why Congress just passed the Kerry- Lugar bill and economic assistance package. This is a $7.5 billion vote of confidence in the Pakistani people, meant to demonstrate that our commitment to Pakistan is strong and enduring. It is also meant to demonstrate that our interests are not just limited to the border with Afghanistan.

In conclusion, as one can see in the detail and number of questions that I have raised, this reassessment of our Af-Pak strategy is about much more than sending additional U.S. combat troops into Afghanistan. As Senator Levin has pointed out, talking about troop levels in Afghanistan is similar to talking about the public option in health care reform. Just as the public option is only one element of the health care debate, U.S. troop levels are just one element of a much broader set of issues in Afghanistan.

The White House is now engaged in the necessary process of evaluating realities on the ground and questioning underlying assumptions. I fully support this process. The questions I raise today are intended to contribute to this ongoing review, so that we may find the right solution.

The stakes are too high for us to carry on business as usual or to ignore the changing dynamics in Afghanistan and Pakistan. This is why the President should weigh all perspectives about conditions on the ground and the region, our counterinsurgency strategy, and the way forward in our mission. I fully support the President's comprehensive approach, and I agree it

is needed because we have to get this right. We owe it to ourselves, we owe it to the American people, and we owe it to the brave men and women who continue to serve with great courage, honor and sacrifice in Afghanistan.

I yield the floor and suggest the absence of a quorum.

Mr. President, I thank Chairman Mikulski and Ranking Member Shelby for their work on this bill. I rise today to speak about the importance of strengthening the Federal Government's ability to investigate and prosecute the kinds of financial crimes that have contributed to our financial crisis. I am pleased this appropriations bill adds significant resources for fraud enforcement, thanks to Chairwoman Mikulski and her committee and their attention to this critical issue.

In May, Congress passed the Fraud Enforcement and Recovery Act or FERA. In the aftermath of September 11, Federal law enforcement resources were shifted dramatically, and understandably, to counterterrorism.

One of the central features of FERA was to authorize the appropriation of substantial resources to rebuild our capacity to attack mortgage fraud and other white-collar crime. FERA was passed with overwhelming bipartisan support. The vote was 92 to 4 in the Senate, demonstrating our shared commitment to this effort.

Today's economic crisis has many causes, from serious regulatory failures to recklessness and greed. While we still have much to learn about what happened, one thing is absolutely certain: We need law enforcement investigators and prosecutors with ample resources and training to drill down now. Only a targeted and thorough investigation can find out the extent to which financial fraud contributed to the crisis and identify the individuals involved who should be held responsible.

We need to look at the mortgage brokers who engaged in systemic fraud. But we must also examine the financial institutions that pooled subprime mortgages and sold them with knowledge that they were toxic, the credit rating agencies that failed due to conflicts of interest to grade the assets properly, and the investment banks that failed to disclose the fair value of the toxic assets on their books.

In order to restore the public's faith in our financial markets and in the rule of law, we must identify, prosecute, and send to prison those individuals who broke the law. If we do less than that, we will fail to serve the American public and we will risk history repeating itself. But these cases are extremely complex. In this area, the bad guys have substantial resources at their disposal to fend off investigations. We need to remain vigilant in ensuring that our investigators and prosecutors are not overmatched.

That is why I am pleased to see the substantial resources devoted to fraud enforcement in this bill. The bill appropriates over $500 million for fraud enforcement, a 10-percent increase over last year. At the FBI, it adds funding for 50 new agents, 61 new forensic accountants, and 32 professional support staff, all devoted to investigating financial fraud. As a result of this increase and other resource allocation decisions by the FBI, we now will have investigative resources approaching those devoted to the savings and loan crisis. The bill also adds funding for 155 new lawyers and 49 support staff in the Department of Justice and U.S. Attorneys offices, all dedicated to financial fraud enforcement.

I was proud to join with Chairman Leahy and Senator Grassley in sponsoring the Fraud Enforcement and Recovery Act. I look forward to working with them and our colleagues on the Judiciary Committee to make sure these significant new resources are used wisely and effectively.

In closing, I thank Chairman Inouye as well as, again, Chairwoman Mikulski and Ranking Member Shelby for making funding for financial fraud enforcement a high priority of this bill. I look forward to working together going forward to make sure that as the economy recovers, we do not lose sight of the importance of fully funding enforcement efforts, not only to uncover and prosecute financial crimes that have already been committed but also to defer future crimes. Prosecuting bad people won't put an end to bad behavior, but it will have an impact on those people in the mortgage industry, on the trading desks, and in the boardrooms who might be tempted to put greed ahead of the law.

Thank you, Mr. President. I yield the floor and note the absence of a quorum.

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

Madam President, the Congressional Budget Office has issued its report on the Finance Committee legislation. That bill was sent over to the Congressional Budget Office a couple days ago. The report is quite promising. The report is good news.

Our balanced approach in the Finance Committee to health reform has paid off once again. Today, the Congressional Budget Office confirmed that America's Healthy Future Act--that is the legislation in the Finance Committee--remains fully paid for and reduces the Federal deficit. In fact, it reduces the deficit by $81 billion in the first 10 years.

CBO also says in its report that the legislation continues to reduce the deficit in the second 10 years; that is, it bends the cost curve in the second 10 years as well.

More important, it improves and expands health care coverage for tens of millions of American families. That is done by raising the coverage rate of 83 percent to 94 percent. In fact, that might be a slight increase from what we earlier anticipated in the committee bill.

This legislation, I believe, is a smart investment on the Federal balance sheet. It is an even smarter investment for American families, businesses, and our economy. Health reform will modernize the health care system for America for the 21st century. It is about time we got to that point.

The bill also reduces inefficiencies and focuses on quality and ensures we are getting the best bang for our health care buck.

Health care reform should be fiscally responsible as it expands and improves coverage. CBO confirms the legislation does that.

I am very pleased with that report. It will help us move toward the next steps in merging the bill with the HELP Committee bill.

Madam President, I yield the floor.

Madam President, unless the Senate acts soon, millions of seniors and disabled individuals will face sharply higher Medicare premiums next year. In this great recession, we

must act quickly to ensure we do not allow a formulated quirk to punish our seniors on fixed incomes in our financially strapped States.

Many seniors have their Medicare Part B premiums deducted from their monthly Social Security checks. Normally, the Social Security cost-of- living adjustment is greater than the increase in the Part B premium for that year. As a result, the beneficiaries' monthly checks in the new year are greater than their monthly checks were in the last year. But next year there is not likely to be an upward cost-of-living adjustment in Social Security checks. When that happens, most Medicare beneficiaries are held harmless against reductions in their Social Security checks. The Part B premium is reduced so that their monthly Social Security checks in the new year are not less than they were in the prior year.

However, 27 percent of Medicare enrollees do not benefit from hold harmless. The absence of a cost-of-living adjustment will expose these seniors to big premium increases next year. Under current law, these enrollees not only have to pay their own premiums, but they must make up the premiums by the 73 percent of beneficiaries we hold harmless. These 27 percent of Medicare recipients will be forced to shoulder the full load of next year's premium increases. This will mean an increase in premiums up from $96 to $120 a month next year. Who are these recipients? They include low-income beneficiaries who participate in both Medicare and Medicaid. They include new enrollees in Medicare Part B. They also include Medicare Part B enrollees who don't receive Social Security, such as some Federal retirees. They include higher income enrollees who already pay higher premiums.

This burden will hit Medicare beneficiaries hard, but financially strapped States will also feel the effect because State Medicaid Programs pick up the cost of Part B premiums for Medicare beneficiaries who are also eligible for Medicaid. The premium hike would also hit State budgets because of that reason. States all across the Nation are facing huge deficits and difficult choices, and we should not allow this quirk in the law to add to their burden.

The Medicare Premium Fairness Act would correct this. It would ensure that these 27 percent of Medicare beneficiaries would not have to shoulder any additional burden. No Medicare Part B enrollee would face a higher premium next year over this year. The bill would provide security to seniors on fixed incomes. To prevent Federal cost shift to States, the bill would pay for and would tap into the Medicare Improvement Fund, which was created to solve problems such as this.

Inaction on this bill is not an option for seniors and States, and I hope the bill will have broad bipartisan support.

Madam President, I ask unanimous consent that the Finance Committee be discharged from further consideration of H.R. 3631, the Medicare Premium Fairness Act, and the Senate proceed to its immediate consideration; further, that the bill be read a third time and passed, and the motion to reconsider be laid upon the table, with no intervening action or debate.

None.

Madam President, I regret that the Senator from Oklahoma feels constrained to object. I will continue to work to see that Medicare beneficiaries are not unfairly harmed. I must also say that this is not for the Ross Perots of the world. There are due eligibles-- there are many people who are very poor who will be harmed unless this legislation is passed. I might also say that this bill is paid for, despite the implications to the contrary. It is paid for with funds already set aside at an earlier date in the Medicare Improvement Fund-- a fund that was set up for just such purposes. So despite the implications about the future children and grandchildren, the fact is, this is already paid for in funds previously set aside.

Madam President, I ask unanimous consent to speak as in morning business.

Madam President, Hippocrates once said: ``A wise man should consider that health is the greatest of human blessings.''

Every day we see the real-world consequences for Americans who have been deprived of that blessing. A Harvard study found that every year in America, lack of health coverage leads to 45,000 deaths. People without health insurance have a 40 percent higher risk of death than those with private health insurance. No one should die because they cannot afford health care.

Every 30 seconds another American files for bankruptcy after a serious health problem--every 30 seconds. Every year, about 1.5 million families lose their homes to foreclosure. Why? Because of unaffordable medical costs. No one should go bankrupt because they get sick. A Kaiser Family Foundation survey found that health care coverage for the average family now costs more than $13,000 a year. If current trends continue, by the year 2019, 10 years from now, the average family plan will cost more than $30,000 a year.

No one should have to live in fear of financial ruin from crushing insurance premiums. Americans are looking for commonsense solutions to these problems. Americans want a balanced plan that takes the best ideas from both sides. Americans want their leaders to work together to craft a health care package that will get 60 votes it needs to pass.

The Congressional Budget Office has just given us their analysis of legislation we put together in the Finance Committee and it shows that our bill reduces the deficit by $81 billion over 10 years. That is a reduction in the Federal deficit of $81 billion. CBO also says the legislation out of the Finance Committee continues to reduce the deficit in the outyears; that is, the years after 10 years, the second 10 years, and the legislation increases coverage from 83 percent to 94 percent, so 94 percent of Americans will have health insurance.

For 2 years now, that is exactly what we have been doing in the Finance Committee--working to get that result. Over the last 2 years, the Finance Committee has held 20 hearings on health care reform. Last June we held a health care summit at the Library of Congress. The committee held three roundtable discussions with experts on each side of the area, especially on the three major areas of reform. We held roundtables on how health care is delivered, on coverage--that is insurance coverage--and on how to pay for health care. In connection with each roundtable--we had experts around the table, asked lots of questions, the experts just balanced--experts were not chosen for a certain point of view but just to get the facts. The committee put out a detailed option paper after those roundtables and we then held three walk-throughs to hash out those options--walk-throughs to see what might make sense after those walk-throughs.

Six members of the Finance Committee--three Republicans and three Democrats--then had meetings. They held 31 meetings to try to come to a consensus. We held exhaustive meetings and met for more than 61 hours. We went the extra mile.

I might say if a fly on the wall were to watch those six meet, three Republicans and three Democrats, I think Americans would be very proud. This was hard work. It was not ideologically driven. It was based on the facts. We asked questions of experts, actuaries were objective--of the Congressional Budget Office, the Joint Committee on Tax--a very solid effort to try to find out how the various parts would be put together in a balanced and fair way.

I can say the Finance Committee has held the most open and exhaustive consideration of this health care proposal. I put out the starting point and posted it on the Web on September 16. That was nearly a week before we started our markups, a full week notice before we started our markup.

In a first for the committee, we posted every amendment, all 564 of them, on the Web. We had never done that before, all posted, all available to the world. The committee has held a thorough markup, and I know the present occupant of the chair can attest to that. When the committee reconvenes to report the bill, the committee will have met for 8 days. Many of those were long days, often running past 10 o'clock at night. In fact, last Thursday we worked until 2 o'clock in the morning. It has been more than 22 years since the Finance Committee met for 8 days on a single bill. In the committee's consideration, Senators offered and the committee considered about 135 amendments. The committee conducted 79 rollcall votes and the committee adopted 41 amendments.

The result is a balanced, commonsense plan that takes the best ideas from both sides. It is a plan that essentially implements President Obama's vision to improve America's health care and it is a plan designed to get the 60 votes it needs to pass. We have just received from the Congressional Budget Office the numbers that we need to have to proceed to the next step. The CBO says we reduce the deficit by $81 billion in the first 10 years and the legislation that will be reported out of the committee soon will reduce the deficit further in the next 10 years, and it increases coverage to 94 percent.

I am confident that after Senators have had a opportunity to review the CBO numbers the Finance Committee will report the bill. Then we on the Finance Committee expect to work together with the HELP Committee to meld our two bills together. Our colleagues on the HELP Committee have done some wonderful things, especially in the area of prevention, workforce, and quality. We look forward to bringing together the best of both bills.

Then the majority leader will offer the combined bill as an amendment on the floor and I expect we will have a full and vigorous debate here in the Senate. I am proud of our work.

All Americans should have access to affordable, quality health care coverage. Our bill would raise the share of Americans with insurance coverage from about 83 percent currently to 94 percent, and our bill would deliver coverage to millions through new insurance exchanges and to millions more through Medicaid--that is the Finance Committee bill I am discussing.

Our bill would dramatically increase prevention and wellness, will begin shifting health care delivery to the quality of care provided-- not the quantity of services rendered but the quality of care provided. It is so important. This is transformative. This is game changing. When we look back several years from now we are going to see this is probably one of the more important items in this legislation because it will begin American health care to focus on where it should be, on quality and teamwork and the patient, more than today, where it is focused on quantity under the fee-for-service system. This is clearly the major, most important part, I think, when we look back at this bill 5, 6, 8, 10 years from now.

The bill also will lower prescription drug costs dramatically for seniors--no small point.

Our bill would reform the insurance market. It would protect those with preexisting conditions. It would prevent insurance companies from discriminating and capping coverage. And it would require insurance companies to renew policies as long as policyholders pay their premiums. No longer would insurance companies be able to drop coverage when people get sick. These reforms would give Americans real savings.

Under the Finance Committee bill, everyone making less than 133 percent of poverty would receive health coverage through Medicaid. Our plan will provide tax credits to help low-and middle-income families buy private insurance coverage. These tax credits would mean that our bill would deliver tax cuts for those whom it affects. Overall taxes would go down for people affected by this bill. These tax credits would help make insurance more affordable.

Some have made some pretty outrageous claims about our bill. Some folks frankly have said some whoppers. Let me take a few minutes to bust some of those myths.

Myth No. 1. Some say our bill cuts benefits for seniors. That is false. Nobody cares more about maintaining Medicare than I do. Medicare benefits will not be reduced under our bill. Seniors will get the same level of benefits they receive today. In fact, seniors have a lot to gain from health care reform by lower prescription drug costs

and more free preventive care such as mammograms and colonoscopies. Plus our bill takes the long view to help preserve the life of the Medicare Program. Our bill puts the Medicare Program on sounder financial footing. Our bill will remove from a system that pays for volume to one that pays for value. It would improve Medicare solvency by reforming the way Medicare delivers health care.

Don't just take my word for it. Don't just take President Obama's word for it. Go to the AARP Web site and see what they say. AARP is probably one of the greatest advocates for seniors. This is what AARP says:

Myth: Health care reform will hurt Medicare.

Fact: None of the health care reform proposals being

considered by Congress would cut Medicare benefits or

increase your out-of-pocket costs for Medicare services.

That is the conclusion of AARP in their letter to seniors.

Myth No. 2. Some say our bill will lead to rationing because we encourage comparative research. That, too, is false. The Institute of Medicine--MedPAC, that is the bipartisan group, nonpartisan group that advises Congress on Medicare payments--and former CMS administrators have all recommended that Congress invest in research to compare what works and what doesn't work in medicine. Groups such as the American Medical Association and the American Health Association support this idea.

Our bill would set up a nonprofit institute to provide for this ``comparative effectiveness research.'' The goal is better evidence, unbiased information that doctors and patients can use to make better health care decisions. Comparative effectiveness research is about giving doctors and patients the best information available on what works so they can decide, the doctors can decide in consultation with their patients, as to what procedure, what drug, makes most sense and what doesn't.

If one treatment works far better than another, then doctors and patients have a right to know. That is what our bill tries to do, it tries to foster the kind of commonsense research that can get better information in the hands of doctors and patients.

Nothing in our bill would ration care--nothing. The new institute could not make coverage decisions or issue medical guidelines. And our bill would prevent the HHS Secretary from using the research to ration care in any way. The Secretary could never use the evidence to discriminate against individuals based on age, disability, terminal illness, or their preferences between length of life and quality of life.

Calling this rationing only supports a delivery system that is pro- waste and antipatient education. That is what opponents will end up doing. That is the effect of it. That is not the type of care people deserve. They deserve the information that comparative effectiveness research produces to help them make informed health care decisions.

Myth No. 3. Some say our bill will cause premiums to go up. That, too, is false. There are a lot of things in our bill that would cause premiums to go down. Our bill would cut out fraud, waste, and abuse in our health care system. That is going to help. Our bill would spread insurance risk through a much broader population, including younger, healthier people. That would clearly help. And our bill would help to eliminate the cost of uncompensated care, which results in more than $1,000 in additional premium costs each year for American families. The effects of open competition in our new insurance exchange should bring premiums down as well.

CBO has said there are a lot of factors in whether premiums go up or down and, frankly, they punted on a lot of those factors. But in the one part of premium costs about which they did make a projection, CBO said that premiums would go down. In a September 22 letter CBO said:

CBO currently estimates that about 23 percent of premiums

for policies that are purchased in nongroup market under

current law go toward administrative costs and overhead.

About 23 percent of premiums for policies goes toward administrative costs and overhead. CBO goes on to say:

Under the proposal, that share would be reduced to 4 or 5

percentage points.

So if 23 percent of costs are administrative overhead under the legislation the committee reported out, that should be reduced by 4 or 5 percentage points. That is lower costs, administrative costs, which should result in lower premiums.

Myth No. 4. Some say you will not be able to keep your insurance. That, too, is false. Nothing in our bill would take people's insurance away from them. No one would be forced into a particular plan. This is the central feature of the way we have gone about health care reform. We have not tried to change the employer-based system, a system Americans know and understand. We improve upon it, make it work a lot better. We have not tried to fix something that is not broken. We have an employer-based system and it is very important we improve upon it, not eliminate it.

Some who do not share our best interests assert that cuts to Medicare Advantage will cause some plans no longer to be offered. We do bring the government's subsidies to Medicare Advantage more in line with the government's own commitment to Medicare, but our bill would not cut benefits under Medicare Advantage. Rather, it would cut out waste in the system to ensure that Medicare is sustainable for years to come.

Even after the cost of marketing and delivering benefits and after making a profit, insurance companies are paid about 14 percent more, on average, under Medicare Advantage than under traditional Medicare. Insurance companies pad their pocket with those subsidies. Our bill would end those subsidies for insurance companies.

If insurance plans want to pass cuts along to seniors instead of reducing their huge profits, that is up to them. In a competitive market, it will be hard for plans that do that to keep their customers.

Yes, under our bill Medicare Advantage plans will have to compete in the free market. But that has been true of insurance companies generally for as long as there has been insurance. It is true that we in our bill do not guarantee that the government will keep each and every insurance company in business. We should not and we do not, in our bill, guarantee that each and every insurance plan will continue to be offered. Those are business decisions. Those are decisions for the private sector. And that is where we leave it.

It is absurd to say that people will not be able to keep their insurance because the government is going to trim back wasteful subsidies. That is a pretty absurd statement.

Myth No. 5. Some stated our bill will raise taxes. That is false. In fact, our bill is a tax cut. Our bill will cut taxes for millions of Americans. When fully phased in, our bill will cut taxes by tens of billions of dollars every year. Let me restate that. When fully phased in, our bill will cut taxes by tens of billions of dollars every year. And millions of Americans will be able to use those tax cuts to buy health insurance coverage.

Myth No. 6. Some say that a high-cost premium excise tax will raise taxes on working families. That too is false. The bill levies the high- cost premium excise tax on the insurance companies. It will put downward pressure on insurance company profits. And it will put pressure on insurance companies to offer more efficient insurance plans.

In fact, the Joint Committee on Taxation tells us that much of the revenue that the high-cost premium excise tax brings in is because employers will give workers raises. People will avoid insurance plans with high-cost premiums, and as a result employers will raise workers' salaries with the money they save. That is what the Joint Committee on Taxation predicts will happen. That is what they say over and over again in publicly given testimony.

Finally, the biggest myth of all, myth No. 7. Some say our bill is a government takeover of health care. That is so false. We have built our plan on the exchange marketplace that allows choice among private health insurance company products, choice among private health insurance products.

People will be able to choose their own plan. They can choose their own plans among private options. Our bill does not include a public option. We did not include an employer mandate.

And we pay for every cent. This is a uniquely American solution. We are not Canada. We are not Britain. We are America. This is a balance. We have a tradition of balance between public and private. This legislation accomplished that.

We do not buy into government-only solutions in America, but we do believe in rules of the road. Our bill provides a balanced solution. And CBO says we do so in a balanced way.

Soon it will come down to the Senate. My colleagues, this will be our opportunity to make history. Think of it. Our actions here will determine whether we will extend the blessings of better health care to more Americans.

Ours is a balanced plan that can pass the Senate. Our bill should win the support of Republicans and Democrats alike. Now the choice is up to Senators.

Hippocrates said that ``health is the greatest of human blessings.'' But too many Americans are being deprived of that blessing. Let us enact this balanced, commonsense plan to improve health care. Let us reform the health care system to control costs and premiums. And let us extend the blessings of health care coverage to all Americans.

I yield the floor and I suggest the absence of a quorum.

The PRESIDING OFFICER (Mr. Nelson of Florida.) The clerk will call the roll.

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

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

Mr. President, let me spend a few moments talking about this issue of reimportation of prescription drugs and the history of it and the work many of us have done together, a large group of Members of the Senate, including Senator McCain, working on this issue.

Senator McCain has offered an amendment, No. 2629, which he has just finished discussing. As I understand the amendment, it would prohibit the use of funds appropriated under the act for preventing individuals, wholesalers, or pharmacists from importing certain prescription drugs. That is in the title. It does have, as I think Senator McCain suggested, perhaps a point of order against it. I do not know whether it is because it would be legislating on an appropriations bill. In any event, whatever the circumstances with this amendment, I was a bit surprised to see this amendment on this bill, but everybody has a right to offer amendments.

Let me say that Senator McCain is a part of a group of us who have worked together. We have worked on a piece of legislation called the Dorgan-Snowe legislation. Senator Snowe, as the major cosponsor, and many others, including Senator McCain as a cosponsor, have worked on this issue for a long time. The fact is, the appropriate place to address this, in my judgment, is in the health care bill that is going to come to the floor in the next couple of weeks. I have said previously that I fully intend to offer this bipartisan bill as an amendment. We have over 30 cosponsors in the Senate, Republicans and Democrats. It ranges from the late Senator Ted Kennedy, to John McCain and a wide range of Senators on both sides of the political aisle. That has been the support for legislation that I think addresses a very important issue.

Let me describe the issue, if I might. I have in my desk in the Senate two bottles that contain medicine. Actually, these are empty bottles. This is Lipitor. The medicine that would be contained in these bottles is made in Ireland by a company that produces Lipitor. It is the most popular cholesterol-lowering drug in America by far. It is made in Ireland, in a plant that is inspected by the FDA, and the medicine is then sent all around the world. These two bottles, as you can see, are identical. These two bottles contained identical tablets, 20 milligrams of Lipitor made in the same place, so it is the same manufacturing, the same pill, put in the same bottle, made by the same company. The difference? One is shipped to Canada, one is shipped to the United States. Difference? Price. Here is the one that was shipped to Canada; this is $1.83 per tablet. This was sent to the United States, $4.48 per tablet. The only difference is price. Why is that the case? Because the American people are charged the highest prices for brand-name prescription drugs in the world, the highest prices in the world for brand-name drugs. In this case, we paid $4.48 per tablet; someone else paid $1.83. It doesn't matter whether it is Canada. It could be England, Italy, France, Germany, Spain--we pay the highest prices in the world, and it is unfair.

The question is not, Is there a problem? Of course there is a problem. We have a whole lot of folks in this country who cannot figure out how they are going to afford to pay for their groceries and their medicine, so they go get their medicine first at the pharmacy in the grocery store and figure out how much they can eat later. Of course this is a problem.

I have described the guy who sat on a straw bale once at a farm a while back, 80 years old, who told me in a little meeting we had in a farmyard: My wife has fought breast cancer for 3 years. She is in her seventies. And we have spent all of those 3 years driving to Canada to try to buy Tamoxifen where it is sold for 80 percent less--an 80 percent lower price in Canada for the identical prescription drug. So my wife and I are trying to drive up and get Tamoxifen in Canada.

The reason they can do that is, apparently at the border, a small amount of personal use, up to 30 days or 60 or 90 days personal use of prescription drugs will be allowed to be brought over without a hassle.

But the question is what about the rest of the American people who cannot drive to the border or go to another country and access the same prescription drugs, same pill put in the same bottle by the same company who decided to charge the American people the highest prices in the world? What about those people?

My point is this: We are going to have a big health care bill on the floor of the Senate sometime in the next few weeks. Oh, it has been through this committee and that committee. It has been on a long, tortured trail. Lord knows every single day in the press we read the next little news item about who said what about this.

One way or another we are going to have some kind of health care reform on the floor of the Senate. Will it pass? Will it be omnibus? Will it be comprehensive? I do not know any of those things. I do know this: that the Gang of 6 and the gang in the Finance Committee or the gang in the HELP Committee are going to become a Gang of 100 or 100 gangs of 1 when it gets to the floor of the Senate. Everybody is going to have their amendments because most Members of the Senate have not had an opportunity to weigh in on health care at this point with their own views and their own amendments. They are not on the committee, not part of a small gang. Let me say, on behalf of myself and I think Senator Snowe, it is the Snowe-Dorgan legislation with respect to prescription drug reimportation, which includes Senator McCain as a cosponsor, that when health care comes to the floor of this Senate, you can count on it, that there is going to be an amendment and there is going to be a vote on the issue of the prices of prescription drugs.

Perhaps there are some people who do not want it. I understand they do not want to have a vote on it. But in my judgment, there cannot be credible efforts to address health care if you do not address the issue of health care costs, the relentless rising cost of health care.

Part of that, not an insignificant part, relates to the question of the relentless runup of prescription drug costs every single year. Take a look at the increased prices for prescription drugs every year and then think about the people out there who are trying to figure out: How do I pay for this?

I understand senior citizens have the opportunity, under Part D of Medicare, to have some drug coverage. I understand there is a problem with that, there is what is called a doughnut hole in the Washington lexicon. I also understand that someone made a deal with the pharmaceutical industry for $80 billion over 10 years, which is a relatively small part of their gross revenues, in order to fill part of the doughnut hole with 50 percent off on brand-name drugs.

I understand all that. I was not a part of it, nor was anybody I know of in this Chamber. The question is, What about all the rest of the American people and the fact that they are now charged the highest prices in the world for brand-name prescription drugs? Is it fair? I say no.

We will offer an amendment. My colleague says he was promised and he was concerned about that. I understand all that. All I am saying is, we are going to have this debate, this amendment, and this vote. It is going to be on health care. That is where it ought to be. It ought to be on the health care bill.

I know that when we have this discussion, we are going to have people say: If you do not allow the prescription drug folks, the pharmaceutical industry, to charge these prices in our country, they will do less research into finding cures for these deadly diseases.

You know what, the fact is they spend more money on promotion, marketing, and advertising than they do on research. That is a fact. I mean you get up in the morning and turn the television set on, perhaps while you are brushing your teeth or something, and then listen to the ads. The ads push at you every single day: Go ask your doctor today. It is Wednesday. Ask your doctor, is the purple pill right for you?

I do not know what the purple pill is, but it makes you feel like you should go ask somebody if I should be taking the purple pill.

Go ask your doctor whether you might need Flomax. Go ask your doctor what you ought to be getting, what you ought to be taking that you now do not know about or are not taking.

All these things are pushed at consumers in circumstances where the only person who can prescribe that prescription drug is a doctor who has decided you need it for your health. Yet every single day, relentlessly across this country on television, in the journals and newspapers and publications it says: Go check with your doctor. Ask your doctor if you should be taking this medicine.

What about cutting back on some of that and reducing the price of prescription drugs? What about that? Let me make one other point, if I might. My colleague indicated he has offered this, which is a funding limitation on prescription drugs. The fact is, this has been a long and difficult trail to pass legislation.

I understand. Were I working for the pharmaceutical industry, I would understand why you want to retain this little piece in Federal law that says: The only entity that can reimport or import drugs into this country is the company that manufacturers them. I understand why they want that to be the case. Because it allows them to price, in this country, however they want to price.

But we are told constantly this is a new economy, a global economy. If it is a global economy, then what about allowing the American people the freedom to access that global economy to find the identical FDA- approved prescription drug where it is sold for half the price?

They say: Yes, but you know what, if we do that, we are going to open it up to counterfeit drugs and so on. Guess what. Europe has been doing this for 20 years. It is something called parallel trading. In Europe, if you are in Germany and want to buy a prescription drug from France, if you are in Spain and want to buy a prescription drug from England, that is not a problem. They have a plan that is called parallel trading. It has been going on for 20 years, and there are no counterfeit issues of any significance at all.

Europe can do it and we cannot? We cannot keep track of this? The legislation that I and Senator Snowe and many others, including Senator McCain, have put together carefully has all kinds of safety measures that will dramatically improve the safety of the prescription drugs that are now sold.

It requires pedigrees be established on batch lots so you can track everything back. Everything. The only proposal we are suggesting the American people be given the freedom to do is to access that FDA- approved drug--yes, only FDA-approved drugs--only from countries in which the chain of custody is identical to ours and as safe as ours is. That is all we are talking about.

But that does it the right way. That says: Here is a plan. It funds the FDA to make certain that the drug supplies are safe and so on. This is the right way to do this. That is why we have taken a long time to put this together. It is a piece of legislation that has all the elements you would want to have that gives the American people the freedom to get lower priced drugs, FDA-approved drugs where they are sold and, at the same time, because they would have that freedom, would put downward pressure on drug prices in this country because the pharmaceutical industry would be required to reprice their drugs in the United States.

Let me say, as I always have to say, I do not have a grief against the pharmaceutical industry. I think it is a great industry. I think it produces wonderful, miracle prescription drugs that if taken can keep you out of an acute care hospital bed, which would be far more expensive. Prescription drugs, if taken, in many cases, can manage a disease that otherwise would have you in a debilitated condition.

I appreciate the research they do. I appreciate the new drugs they develop. Let me say this, that a substantial amount of work, with respect to the development of new drugs, is done with public funding, taxpayer dollars, through the National Institutes of Health, the knowledge from which then goes to the pharmaceutical industry to be able to use to create these drugs. That is a part of it.

Another part of it is the research they do themselves. Good for you, I say. My grief is not against an industry. I do not want to tarnish this industry. All I want to say is: We deserve fair prices. This country and the consumers in this country deserve fair prices.

We have been trying for 10 years to get this done. If we bring health care reform to the floor of the Senate and say: We are going to do something about health care costs and prices and fail to do something about prescription drug costs, in which the American people are required to pay the highest prices for brand-name drugs, then, in my judgment, we will have failed miserably.

It is my full intention that when we have health care on the floor, which I expect to be within a week or 2 weeks or whenever it comes, but it is coming for sure, I will be here, and I will fully expect and demand the opportunity to offer this amendment because there are 30 Members of the Senate, Republicans and Democrats alike, who have done the work to put together the bill that has all the safeguards and, finally, at long last, will give the American people what they deserve; that is, fair pricing on prescription drugs.

Of course, I will yield.

Let me say to Senator McCain that I expect the job of majority leader is a pretty tough job. I have watched from Bob Dole on, Tom Daschle, and so many majority leaders and minority leaders try to run this place. It is pretty hard to run. Trying to figure out a schedule is pretty difficult. So I respect the difficulties of juggling all these things.

With respect to the specific letter Senator McCain referred to, Senator McCain, I, and Senator Snowe all talked to the majority leader about this issue when the tobacco bill was on the floor of the Senate because we were fully intending to offer our prescription drug reimportation bill.

The majority leader did say to us, and then put it in writing, did say to us: I will guarantee you that you will get that up on the floor of the Senate. So that was a commitment by the majority leader. And he understands that commitment.

When I saw the letter he wrote, I went to him immediately, and he and I talked about that. Because I indicated to the majority leader: You have indicated that as soon as practicable, or perhaps at the end of the year.

I said to the majority leader: You should understand that if it is not up before health care, it has to be offered on health care. Because that is exactly where it fits. Nobody can come to the floor and say: We have to do health care. We have to try and control costs and put some downward pressure on prices. But, by the way, you cannot offer a piece of legislation that would put downward pressure on prescription drug prices. I said: That cannot be the case.

He understood and said: I understand that. That is going to be at the front end of this debate on health care. Based on that representation, I feel confident, I would say to Senator McCain, I understand the confusion in the reading of the letter, the writing of the letter, but I feel confident, having talked to Senator Reid, that we are going to have ample opportunity, right at the front end of this debate about health care, to have a full debate, to have a vote up or down, which is what we need to do, obviously. I think everyone in this Chamber, every Republican, every Democrat, needs to be on record: How do they feel about their consumers paying the highest prices for prescription drugs in the world? How do they feel about a bill we put together that has pedigrees and batch lots, all the safety so our consumers can have the freedom to access these lower priced drugs?

I think we can do that.

Mr. President, I understand the anxious state of all of us to do what we have worked on for so long. I understand. I also understand that the letter probably could have been more artfully drawn. I understand from my conversations with Senator Reid, the majority leader, that he fully understands and expects us to be planted on the floor when health care comes here and to offer our amendment and have a full debate and vote. If there is an attempt when we debate health care to decide that 30 of us Republicans and Democrats somehow don't have the opportunity we have been promised on the issue of prescription drug prices, in my judgment they are going to have an awful time getting any health care bill through this place. Because you can't say to me or to anybody else: We will do the bill we want to do and, by the way, prescription drug prices that are going up by double digits, we are not going to give you a shot at that.

Let me make one final representation. I said when I started, it is hard to schedule this place. I understand that. The Senator from Arizona knows we have had noncontroversial bills where we couldn't even get past a motion to proceed without having a filibuster to something that is noncontroversial. If I am majority leader, I am thinking this is not easy to do. I am sympathetic to the job he has to try to do all these things. I am convinced Senator Reid will keep the commitment he made to us. I am convinced that commitment will be kept when we get health care on the floor. I don't want it to be in the middle or toward the end. I want to be here front and center at the front end because the bill we have put together is a strong bill dealing with a very important issue.

I am happy to yield.

Mr. President, I believe that commitment has already been made by the majority leader.

I understand that. That is why I said I think the letter perhaps is not artfully drafted with respect to that last paragraph. I believe that commitment has been made to me because I went to the majority leader following the release of that letter. I have found over a long period that when the majority leader gives me a commitment, I believe he will keep the commitment.

I understand, but I believe the Senator will have that experience when health care comes to the floor and he and I are on the floor with our colleague Senator Snowe and others pushing for a solid piece of legislation that has broad bipartisan support. The Senator then will understand the commitment was made and the commitment was kept. I believe that will be the case.

I believe that commitment has been made to me. In any event, we are here on the floor on a Wednesday talking about something I believe is very important, and we have worked on this for a long time. We have spent a lot of time working on it. I don't intend to decide: OK, somebody is going to put up some barriers and that is OK with me. That is all right. And I don't think Senator Reid is going to do that. He has made a commitment to me that will not be the case. I am convinced that Senator McCain and I and others who have put this legislation together will have our day, and everybody else will have to stand up and say yes or no. I hope when the roll is called, we have sufficient numbers, finally, at long last, to pass legislation that should have been passed 8 years ago. Again, I appreciate the comments Senator McCain has made this morning. I will have further visits with him.

I know Senator Mikulski has a bill on the floor she wishes to manage, and we don't want to be in the way of that.

My view is that we are going to have our bill on this floor with a full debate and an up-or-down vote, and that will come as a result of Senator Reid keeping his commitment. I am convinced of that.

I yield the floor.

Mr. President, I intend to offer several amendments to the health care bill. I have not had a chance. I am not part of a gang of anything. I wasn't part of the Gang of 6. I am not part of the Finance or HELP Committees. This is my first opportunity. I have some things I think can improve it. If a bill comes to the floor with procedures--and it will not happen--that lock this up and we can't offer amendments, I wouldn't stand for that. I am not going to be a part of that process. My expectation and the representation made to me with respect to this amendment is when that bill comes to the floor, we will have an opportunity to offer amendments. I don't know how you would get health care through the Senate if the proposition would be that somebody says: The Gang of 6, they had their 6 months or 3 months, whatever they did. And the two committees had their opportunity. But the rest of you, sorry, can't do that. In that circumstance, health care would not be passed through the Senate. Perhaps we have tortured this subject to death.

Mr. President, I have an amendment at the desk and ask for its immediate consideration--amendment No. 2629.

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

Mr. President, I say to the distinguished manager, the Senator from Maryland, that I will be glad to interrupt my amendment upon the return of the Senator from Alabama, if he wishes to speak, and then I will continue after that. I thank the Senator from Maryland for her hard work and excellent explanation of the legislation before the Senate.

This amendment would lower health care costs for Americans immediately. It would provide access to safe, less expensive imported prescription drugs. For far too long, powerful lobbyists from the pharmaceutical industry have stood in the way of Americans' access to affordable imported drugs. Their enormous political campaign contributions made in return for political support of their agenda and their secret unsavory deal with the White House in exchange for their support of the health care reform have further contributed to the American people being prevented from accessing cheaper prescription drugs.

Instead, Americans continue to pay 60 percent or higher for the same prescription drugs that are sold in Canada. This amendment is necessary because Americans need access to lower cost drugs now. They need it now due to these difficult economic times. We all know about unemployment. Americans' salaries are being cut, household budgets are slim, and millions of Americans are struggling to make their

monthly mortgage payments. For these reasons, and so many more, Americans should not be forced to wait another day to purchase safe and affordable prescription drugs from outside the United States. While Americans all over the country are having to choose between their next meal and their necessary prescriptions, the large pharmaceutical companies continue to pressure Congress to delay consideration of any legislation to allow the importation of safe and lower priced prescription drugs.

I would like to also point out this is legislation on an appropriations bill, something I have long opposed, and still oppose. But there has been an unusual process taking place, and that process is one which has forced me to come to this situation. On two separate occasions the majority leader of the Senate assured me that legislation would be taken up before the Senate, and both times he has changed his mind. The majority leader resisted consideration of an amendment to allow for the importation of prescription drugs during debate on the Family Smoking Prevention and Tobacco Control Act.

At the time, the majority leader said on the Senate floor:

This is something that should have been done, I am sorry to

say, years ago, not weeks ago.

This issue is important legislation. If it should have been done years ago, then why wasn't it brought up for consideration immediately after the tobacco bill in June? While the stand-alone bill to allow importation--S. 1232--was placed on the Senate's calendar on June 11, 2009, there has been no further effort by the majority leader to call it up for consideration. Instead, he sent me a letter stating:

I committed to take up legislation that would permit the

safe importation of lower-cost prescription drugs as soon as

practicable.

The practicable time was back in June. There is no practical reason to prevent the majority leader from calling up this bill for a vote at any time.

I was told verbally by the majority leader as short a time as 3 weeks ago that upon the completion of consideration of the Defense appropriations bill that this legislation would be brought to the floor of the Senate. Then a week later I was told, no; that is not going to be the case. So I have been waiting for ``as soon as practicable,'' and so have millions of Americans who are looking for cheaper alternatives to the high-priced prescription drugs.

The majority leader also stated in his letter:

If this issue is not addressed during the full Senate's

consideration of comprehensive health reform, I guarantee

that I will move to proceed to S. 1232 before the end of the

year.

The majority leader of the Senate assured me it would be taken up after completion of the Department of Defense appropriations bill, which we have completed. Given the fact that it is possible that the health care reform bill will be brought up under a truncated pressure timeline, I have little faith that real, in-depth consideration of prescription drug import legislation will come about; therefore, I have no choice but to bring this issue up today as an amendment to this appropriations bill.

In the 2008 election cycle, pharmaceutical companies gave almost $30 million in campaign contributions to Members of Congress. Just this year, according to an article published in The Hill, the prescription drug industry has given more than $1 million to Republicans and Democrats, and the companies whip up their protector in Congress each time we bring forward legislation to help Americans get the imported prescription drugs they need.

Earlier this year, I read an e-mail sent by the top lobbyist for Pharmaceutical Research and Manufacturers of America, known as PhRMA-- this was back in June--which stated:

The Senate is on the bill today. Unless we get some

significant movement, the full blown Dorgan or Vitter bill

will pass. We are trying to get Senator Dorgan to back down,

calling the White House, and Senator Reid. Our understanding

is that Senator McCain has said he will offer regardless.

Please make sure your staff is fully engaged in this process.

This is real.

That was an e-mail from a lobbyist of PhRMA, which has given millions and millions in campaign contributions.

Guess what. In the immortal words of Jack Nicholson: I'm back. I am back on the Senate floor, trying to help millions of Americans who have lost their jobs, struggling to put food on the table, by giving them the opportunity to save on their prescription drugs immediately.

Recently, the White House struck a deal with a pharmaceutical company to further protect its profits. The deal was bragged about by the head of the company's trade association, who cashed in for millions of dollars once he wrote the Medicare prescription drug benefit legislation as a Congressman. He was quoted in an article in the New York Times, published August 6, 2009, stating that the White House ``wanted a big player to come in and set the bar for everybody else.''

The same article stated:

Mr. Tauzin said the White House had tracked the

negotiations throughout, assenting to decisions to move away

from ideas like the government negotiation of prices or the

importation of cheaper drugs from Canada. The $80 billion in

savings would be over a 10-year period.

Analyze that comment by the head lobbyist of one of the most powerful lobbies in Washington. He is saying the White House agreed to move away from--in other words, not support--ideas such as government negotiation of prices. Government negotiation of prices is absolutely necessary. We did it in the prescription drug bill, and it has reduced costs. In other words, the pharmaceutical companies would have to compete for Medicare contracts. One would think that is an obvious solution to bringing down costs.

The second, of course, is the importation of cheaper drugs from Canada. Here everybody is talking about reducing health care costs. We know that importation of less expensive drugs would save health care costs for the American consumer. But the White House apparently, according to Mr. Tauzin, agreed they would not support importation of less expensive drugs from Canada--a remarkable comment. You know, people wonder why the tea parties are going on, why the approval rating of Congress is so low--amazing. The Fraser Institute found in 2008 that Canadians paid on average 53 percent less than Americans for identical brand-name drugs. Specifically, the institute found that the most commonly prescribed brand-name drug, Lipitor, is 40 percent less in Canada, Crestor is 57 percent less in Canada, and the popular arthritis drug Celebrex is 62 percent less expense in Canada. Americans would love a 60-percent-off coupon for prescription drugs and deserve such a discount now more than ever.

I have been working on this issue for many years, and I will continue to do so. Americans should not have to wait a day longer for relief from higher prices for drugs. Inexplicably, the majority leader keeps delaying consideration of this needed legislation, which has now forced me to offer an amendment on the current appropriations bill. However, I believe it is necessary to protect all Americans' interests in obtaining affordable prescription drugs. The amendment states that no funds can be used to prosecute those who seek to import prescription drugs that have been approved by the FDA. If the big drug companies are getting an $80 billion savings, shouldn't we give a savings to American consumers? Why not now?

Again, I want to say there is going to be a point of order raised on this bill, and with righteous indignation people will say it doesn't belong on an appropriations bill. We just finished a Defense appropriations bill loaded--and I will have a list of them--with unauthorized appropriations on that bill. Every appropriations bill we take up has unauthorized appropriations, ranging from $300,000 for a museum in Nebraska to the addition of C-17s for $2.5 billion. The argument that somehow we should not be taking up this legislation on this bill flies in the face of what has been common practice around here, even though I do not agree with it.

Let me say this, too. If I had full and complete confidence that this amendment would get a full and complete airing as an amendment on the health care bill, I would be glad to withdraw this amendment. I will be glad to withdraw this amendment if we have assurance this amendment will be taken up on the health care bill. There are all kinds of things that are going to be

done in passage of the health care reform legislation--so-called--on the floor of the Senate.

I see my friend from North Dakota here. I have appreciated his efforts for a long time. He and I have been working on this for a long time. It is a fact that I received the word of the majority leader that this bill would be taken up and that has not happened. That has happened twice. I must say it has never happened to me before in the years I have been a Member of the Senate.

I ask unanimous consent to have printed in the Record the New York Times article of August 6, 2009, ``White House Affirms Deal on Drug Costs.''

I also ask unanimous consent to have printed in the Record the letter from Senator Reid to Senator Snowe, Senator Dorgan, and to me.

Mr. President, I wish to say again that we have been told time after time that this legislation would come before the Senate. It has not. I do not know what process the majority leader will use-- reconciliation, fill up the tree, vote on cloture, make this amendment nongermane. I have no confidence. If I had the confidence that this amendment would be taken up in a regular order fashion and that the full Senate would vote on it on the health reform bill, I would have some confidence we could get it done. In the absence of that, I will seek a vote on this amendment.

If there is a budget point of order on this amendment, let no one be fooled: It is not because they do not want to violate the budget rules of the Senate, because they violated them in every possible way in previous appropriations bills, to the tune of billions of dollars.

I yield the floor.

Will the Senator yield for a question?

I am very grateful for the leadership Senator Dorgan has shown on this issue for many years and it has been a pleasure and an honor to work with him on that and many other issues.

I ask my colleague, does the letter that was sent by the majority leader to you and to me and to the Senator from Maine, Ms. Snowe--I know you have read it--does it concern you that the last paragraph of the letter says:

Not withstanding these obstacles, I stand by my earlier

commitment to make sure the Senate considers S. 1232 as soon

as practicable.

And then this is the question I have for the Senator from North Dakota.

If this issue is not addressed during the full Senate's

consideration of comprehensive health reform, I guarantee

that I will move to proceed to S. 1232 before the end of the

year.

My question to the Senator from North Dakota is: Why would there be any question in the majority leader's mind that you or I and Senator Snowe would let a health reform bill go to the floor and be voted on without it being passed? It seems to me, and may I say, because I have been told twice by the majority leader we would take it up--and those commitments have been reversed--would it not concern you a little bit when it says: `` . . . if this issue is not addressed during the full Senate's consideration of comprehensive health reform . . .''

That is my question. That is what I am concerned about, that parliamentary procedures would be used. You and I have seen it before. The tree filled up. Cloture invoked, et cetera, where there have not been amendments that were clearly important to that legislation, not allowed to be considered.

That is my question to my friend from North Dakota.

Would you not feel better if the letter said--I know I would feel better if the letter said: I expect this issue to be brought up in the health reform bill.

Instead, there is a loophole, with all due respect, that if it isn't addressed during the full Senate's consideration, ``I guarantee I will move to it before the end of the year.'' Each day going by, seniors and, in fact, all citizens are paying a higher price for prescription drugs. Frankly, we should never have made that agreement when the tobacco bill was taken up because we could have passed it. Today seniors could be paying as much as 60 percent less for their prescription drugs. But we know what happened. The pharmaceutical companies weighed in with all of their clout. I urge the Senator from North Dakota to go back and get this language changed. The majority leader looked me in the eye and said: We will take this up after we finish the Department of Defense appropriations bill. And then decided not to do it. Maybe the Senator from North Dakota understands why I am skeptical about the interpretation of a letter that could be interpreted so that we don't take it up in the health care reform bill.

If the Senator will yield further for one final question.

I have great sympathy for attempting to schedule legislation in this body. I think our friend Trent Lott maybe didn't invent it, but he used to say that it is like herding cats, conducting business in the Senate. I agree with that.

I know the Senator from North Dakota is aware that no matter what the problems are, if the majority leader says: I will take up this bill, then you have to take his word. My question to the Senator from North Dakota is, can we get a commitment from the majority leader that parliamentary procedures will not be used to block consideration of the issue of importation of pharmaceutical drugs?

The letter is ambivalent.

I have not had that experience.

All I can say to my friend is, if we can get a commitment that parliamentary procedures will not be used to block consideration of an amendment concerning importation of prescription drugs, I will withdraw this amendment from this bill.

Very briefly, I say to Senator Dorgan, I appreciate his efforts, his leadership. I appreciate everything he has done. We have had the privilege of working together on many issues over the years. I wish to be sure that when the health reform bill comes up, there will not be parliamentary obstacles from that happening. I have seen the will of the majority thwarted on the floor of the Senate by certain parliamentary maneuvers--filling up the tree, for example. The Senator from North Dakota is as familiar as I am with some parliamentary procedures which can be employed by the majority and have been employed when both parties have been in the majority to thwart the ability of Senators to have their issues considered. That is what I want to see, is to make sure that when the health reform bill is before us, we will take it up.

But the sentence reads:

If this issue is not addressed during the full Senate's

consideration of comprehensive reform . . .

My question is, why wouldn't it? Why is that sentence necessary? All I can say is that I hope we can get that assurance. If we do, I will withdraw the amendment and allow this appropriations bill to receive full consideration and be passed by the Senate.

We have probably tortured it to death. Considering the fact that reconciliation continues to be held out there as an option by the majority is also a factor about which I have been concerned. All we need is a clarification to make sure there will be no parliamentary obstacles to consideration of the amendment of the Senator from North Dakota, an effort joined by me and Senator Snowe and others, to allow prescription drugs to be imported into the United States.

I yield the floor.

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

Mr. President, I have received assurances that there will be no blocks or impediments to consideration of the prescription drug importation issue, which I and a number of us have been seeking a vote on for a number of years. I have been given assurances that there will be no impediments to bringing that issue up when health reform is before the Senate. Therefore, I withdraw the amendment.

I yield the floor and suggest the absence of a quorum.