it's $24.95 plus shipping and handling. order online at c-span.org/store. senator john kerry outlined the elements of climate change legislation in the senate thursday. seeing majority leader harry reid has set a deadline for passage of early next year. the massachusetts democrat is joined by republican lindsey graham of south carolina and independent joe lieberman of connecticut. this is almost half an hour. [inaudible conversations] >> thank you, all, for being here today. senator gramm and lieberman and i have been engaged in a lot of meetings over the course of the last several weeks, sitting down regularly with our colleagues to develop a framework that will guide our efforts to develop comprehensive climate change and energy legislation that will pass the senate early next year. today, we are sending a letter

to president obama off porting this framework and we are releasing this framework to do and others. this week in the epa's endangerment finding, the obama administration sent a clear message about the serious threat climate change poses to public health. they also sent a crystal clear message to congress, "get moving." impose regulations by definition will not include the job protections and investment incentives that we are proposing in our framework today. in the potential for agency regulation those who aim to grind the legislative process to a halt would later come running to congress to secure the kind of incentives that we can pass today. industry needs and is asking us for the certainty that comes

with congressional action on this vital issue, and we intend to deliver it. we would like to underscore the fact that the framework we are releasing today is the starting point for negotiations going forward. we really do look forward to continuing to work with our colleagues and we will work with them very closely and the at patrician to develop comprehensive legislation that addresses the urgent challenge of both putting america back to work and addressing climate change and -- advancing energy independence. this framework should send a strong and clear message to americans. we can create millions of jobs and increase our economic and national security by setting the target to reduce pollution and make ourselves more energy independent. senators graham and lieberman will talk more about that in a minute. it will also send a strong

message to the world and to the world gathering at copenhagen. that message is the united states senate is committed to addressing this challenge and the majority leader has committed us to do so early next spring. we believe climate change is a global problem and requires a global solution. we support strong international agreement with action from all countries. with strong financial support to assist developing countries to accept the impact of global change, reduce emissions from the deforestation and transition to a low carbon future. our framework embraces the president's and house of representatives commitment to reduce emissions in the range of 17% in the near term and at least 80% by the mid century. this also reflects the agreement reached by the g8 and italy last

summer. pollution reduction target is necessary to drive innovation, and give business the certainty it needs to plan for low carbon future and restore america's global leadership in the clean energy economy. this is why leading business people around the country increasingly are coming to us in support of an effort to pass the legislation. our framework embraces and encourages the use of all energy sources, including renewables, clean coal, natural gas, and nuclear power. we also embrace significant energy initiatives, energy efficiency initiatives as a critical short-term opportunity to reduce our nation's energy dependence as well as household energy bills. we will include important provisions to advance domestic manufacturing and ensure that

the queen energy jobs of the future are located here in america. we also support strong protection for consumers and businesses large and small to avoid increases in energy prices during the transition to a low carbon economy. we believe in the strongest market oversight to ensure transparency, accountability and avoid any kind of potential manipulation. finally, we look forward excitingly to next year to working with all of our colleagues in the coming weeks and months in order to advance this critical comprehensive legislation and send it to the president's desk, and we firmly believe comprehensive domestic which a solution will create jobs, real and to give the american economy and take back control of our energy future. and to talk about that a little but let me turn this over to senator graham.

>> thank you. i believe our collaboration has presented the best opportunity for the nation to become energy independent since i've been in congress. on the campaign trail it doesn't take very long term from voters that they are upset with the fact our nation is using more foreign oil now to run the economy than we did 30 years ago. that we spend about a billion dollars a day overseas to buy oil from countries that are in very tough circumstances and some of that money works its way into the hands of terrorist organizations and they would like that to come to an end. what if you could cut in half? what if he could save a couple hundred billion dollars a year and invest here and not send overseas? the other thing that drives my willingness to join my colleagues is i believe the grain economy is coming. that's not a question. if it is going to happen it is just when it is going to happen. the sooner the better for me because the jobs of the future i do believe lie in energy independence and cleaning up the environment. my state of south carolina would benefit enormously from energy

independent effort. now what does that mean? that means all the above. that means neither power is going to be in increase in a way collaboration has never been under thank you so all those americans to believe the power is part of the solution we represent your best hope. they tell me you are going to need 117 plants to meet 17% target reduction. that is going to take a long time to build 117 plants but if we can start the process of building six or eight in the near term and show the world in our own countrymen that we can do this, then you're going to create millions of jobs over time because the nuclear power industry represents american jobs, the best of american jobs that would never go overseas. offshore drilling for oil and gas, that is when to be part of our energy independence initiative. i represent a cultural state. we all do and we want to make sure we do this in an environmentally sensitive manner but every barrel of oil we can find at home, every leader we can extract in an

environmentally sensitive wimax as energy independent so that we took part of the mix and yes, cleaning up the environment. people always ask me what's true and what's not? well i am by no means a scientist. but i've traveled throughout the world and seen disturbing things in the arctic regions. i've been to alaska and heard some disturbing stories about how to our environment is changing. i believe acid rain is real. nobody doubts that. i have come to the conclusion of this, that why can't america have the cleanest air and purest water and why would any republican or democrat not want that to be so? that is something i think every citizen should embrace. and increase in a way that makes us more energy independent and create jobs. it can be a win-win. all the cars and trucks and power plants that spew out millions of tons of carbon of day in my view are not helping

things. and on a limited perpetual carbon pollution is not going to create a better environment for the next generation of americans. the good news is you can solve that problem, become more energy independent and create jobs that pay well and will never leave this country. so let's do it. >> senator lieberman to beat >> thank you. it's been a great pleasure to work with senator kerry and senator graham over the past month. we have talked to a lot of people. we talked to the chair of all the relevant committees. we've talked to colleagues on both sides of the political iowa and senator kerry said the framework for action we present today is a starting point, not an end point but in my opinion it does reflect some broadly

held positions and hopes in the united states senator. the most of the british conversations we had is there are well over 60 votes in the u.s. senate that are in play. we don't have over 60 votes but there is well over 60 members of the united states senate who i think would like to get to a point where they can say yes to climate change energy independence legislation, and that's the work that we have ahead of us. we have made baseline decisions reflected in the framework document we have sent to president obama and that we released to you today. the first basic decision was made by senator reid in asking senator kerry to begin this process, and that is that we should combine both the climate change legislation coming out of the environmental public works committee and the energy

independence legislation coming out of the energy committee, and the good news obviously is that most of the steps we would want to take to put america back and the leadership of the world and doing something about global warming or exactly the steps we would want to take to make america energy independent. in fact the revenues generated from the pollute or pay system and the climate change part of our legislation really will produce revenue that can be used to fund the energy independence part of our legislation. so we hope as we release this framework today for action here in the united states senate that we not only reflect what we have heard from our colleagues in the senate but send a message to the delegates gathered in copenhagen that the movement for climate change legislation in the united states senate is alive and well and moving forward. we've made other baseline

decisions. my colleagues have talked about targets of reduction of greenhouse gas pollution and range of 17% in the near-term. generally speaking, i think most of us feel that is 2020 and 80% by 2053. we have also made a commitment to a market-based system of getting there to do that, in which the greenhouse gas polluters will pay and in that we have rejected both the argument for a significant increase in carbon taxes on one side and those who would like to see command and control old-fashioned approach to environmental protection on the other side. i've been asked to speak very briefly about to parts of this which my colleagues of our frame work, my colleagues touched on so i'm going to be a real quick. first is economic security. and the relationship of this combined legislation to economic security. in my opinion, a strong new

climate change and energy independence mall we is the single most significant act this congress can take to replace the millions of jobs that have been lost in the recession by setting a price on carvin we will create new jobs, restore our domestic manufacturing base with new technologies, and recast america as the global leader and i believe the global the leading exporter of clean energy technologies meet here at home. you don't have to take our word for it. some of america's most prominent leaders of very different businesses like agee, rio-tinto, honeywell, duke energy and shell we'll have met with us and asked us to limit greenhouse gas emissions because they know that putting a price on carvin will drive demand for new, low, or no

carbon emitting technologies and products which will in turn create millions of new jobs for american workers who will make, install, and monitor those technologies and products. as jim rogers, the ceo of duke energy put it, a global warming clean energy bill, but particularly the carbon price part of it could lower carbon green revolution and more rapidly with this recession and our rear view mirror. we are also confident climate legislation will keep american jobs in america. our program and plan will provide significant assistance to manufacturers to ensure continued competitiveness of american made goods. we are going to provide financial incentives to both large and small manufacturers to improve the energy efficiency of

process he's which mean no new jobs. where does the money come from to provide that assistance? from the money polluters will pay until they clean up their act. our plan will also bring about the employment of tens of thousands, hopefully hundreds of thousands in the building trades by developing additional nuclear wind and solar power installations that need to be built. second final, national security independence, these two go hand in hand as i said, and as lindsey said we are more dependent on foreign allele that we have ever been in the past, and that inhibits our national security independent and compromises of course our economic security. by spurring the development and deployment of new clean energy technologies and increasing our supply of domestically produced oil and natural gas on land and

offshore our legislation will ensure america's energy security. our plan will send money back to the states that choose to allow drilling and provide new federal revenue to mitigate the impact of climate change. we've got a lot of work to do to get to 60 votes. but i think we are off to a very good start. and we are going to get this job done in this session of congress because we have to. thank you. >> senator graham? yesterday senator mcconnell had a press conference, and he was talking of several measures the senate is working on now that would mean jobs. one of the once you referred to as climate change, and that seems pretty stark contrast to what you're seeing now. how do you think you can get republicans on board? >> by sharing their republican colleagues to the business community can create jobs from what we do.

at the end of the day of the environmental policies we are seeking are not good for business, we are not going to get 60 votes. but i think if you ask senator mcconnell is he for building more power plants? he would suggest. u.s. car you for offshore drilling of oil and gas he would say yes. i think if you asked him or you for using clean coal, he would say yes. what we have to prove to him and others, that the admission standards are going to be acceptable to business, to our utilities and our manufacturers, and i would argue to senator mcconnell and others, if you want this greenie economy that we all constantly talk about, you have to price carvin. that is sent me singing it. it is business people from all sectors of the economy. so my answer would be if we can't make this good business it will happen. i believe we can. changes have to be made to get us their fighting began in environmental policy the best business policy and the jobs of the future, where do they come from? from the transmission lines that you would need to have a better

dread if you're going to have wind plans or forms they got to be connected where people live. the supply change has been lost. to rebuild the supply chain alone creates literally millions of jobs and energy independence is where it is at. and from the republican point of view i want to associate myself with this concept. all i am for clean air. i am for cleaner water. and i believe that we can make it good business. >> can i make one quick comment on that? not that anyone asked me -- [laughter] -- but the cruelest tax of all americans is not doing anything. because if you don't do anything not only do we lose jobs to china, india, germany, europe, the rest of the world, jobs that won't come back, but we also have huge costs that build up the international economic agency recently reduced --

released an analysis showing that each year we do not act it costs us $500 billion annually. and the tax payers are going to wind up picking that up at the back and when the air gets even more polluted or the water is more polluted and it is even harder to clean it up. so the tax is the unstated tax of not acting. >> when i look at this framework respectfully i don't see anything really new that's been developed over the past several weeks. can you say why there's not specific language like that would name a number on a loan guarantee authorities that would give these six to eight nuclear or i don't see any specific language on where the drilling -- and secondly, senator graham, why are there none of your gop colleagues standing up there with you now? >> as to the loan guarantees for

nuclear power they are going to go up. but how far depends on how many votes we can get. you are a nice fellow but we are now seeking your vote. we are trying to get colleagues engaged and here's the good news they are very engaged and we are not going to negotiate against sales, but the fact that the loan guarantee program needs to go out to get 60 votes you can count on how far depends on the negotiating. where do you drill offshore and how much revenue is to be shared is a subject and negotiation but we know that is what we are pursuing. so the details that you're asking about will come with a new bill and that new bill if it is quick to pass has to have more republicans than lindsey graham and here is what i think about the republican colleagues. most of them have approached this in the senate, not all, and the idea of on limited carbon pollution in a perpetual form doesn't sit well with most

republicans. how you price carbon and whether or not you lose jobs is very important. so what i would say to my colleagues and that is what i'm saying to them, i need the nuclear power industry to say that this bill gets coal companies to say that the clean coal provisions will not only put us out of business we can actually increase value of coal in america and i'm going to need the will and gas industry to save the oil and gas provisions are you add into the inventory amicus more energy independent and that's good business, and i'm talking to republicans about all those things, and the hope is as we develop more details you will see more republicans and democrats coming. >> why do we not have -- you said this bill, why did we not have any language as of yet?

>> [inaudible] >> i appreciate that. [laughter] >> we purposefully today are only putting out a framework by differ with you there's nothing new in it. this is the first time we've expressed a framework for the senate by those of us requested by harry to sort of go after this that has set a specific target. we have embraced the house and president's target. that is different from the bill that came out of the committee here. secondly we have a grouping of steps that has never appeared before in a framework or otherwise as a for group with respect to all of the measures that will be given specific language as we go forward, and by talking about the various components of the clean coal, the nuclear, the renewables, the efficiencies etc.. there are parts of them that have been in different pieces of legislation but never put together as a whole in the way

that we are presenting them with the manufacturing components and the international components. that's a framework. the reason there is not specific language today is very specifically because of the process that we are honoring within the senate. we sat with the chair. blanche lincoln will be holding some hearings hopefully very much and early january, and max baucus is committed to reporting out language from the finance committee and is very committed to helping to pass this legislation. we don't want to jump ahead of their committee process. we want to honor the committee process. we want donner colleagues within the process, and as they bring it together we will work with them to bring the best of the language to this legislation. likewise on the commerce committee we've sat with senator rockefeller. we are working closely with him. there's a couple of parts where the commerce committee, which i

serve on, has jurisdiction. barbara boxer serves on it. we want to allow that committee also to be able to weigh in. but the target as has been set by harry reid and the president -- the president said very clearly he wants to move immediately this legislation when we finish financial regulatory reform. that's our goal because it gives time in january and february to pull this specifically which together. and that is exactly what we are doing today pete >> i can't resist, just very briefly, what's different about what we've presented today. i mentioned that we are emerging to bills, climate change from environment and energy dependence from energy. but in the work that we've done which expresses a lot of what we've heard from our colleagues on both sides of the aisle we've brought together here a series of commitments in this framework that have not been together before. some people who have been leery about nuclear power are committing here to a very robust

nuclear power title in a merged bill. i've been working with a group of senators in both parties for three or four months. we've got a very robust nuclear power support a bill which will have loan guarantee extensions and expedited processes so we've got strong support for nuclear power. so people before haven't been eager to support offshore drilling. we are saying we've got to do that in this combined bill and we've got to share some of their revenue with the state's. on the other side some of our colleagues have been reluctant to support an exact cap on carbon reductions in and near term and to support this market-based system to get to it. they are committing to do that. so this is a package that has a lot of new agreements and eight and shared vision about how we get over 60 votes. >> senator, could you talk about the role of epa? you talk about market-based

approach, and we presume that means cap-and-trade, but how much epa authority do you envision them retaining? administrator jackson said she doesn't see this as either or environment, but both. how would you address that? >> well, first of all, all of us agree and believe very deeply the terminology of cap and trade doesn't describe what we are doing. we are setting up a pollution reduction targets to reduce the pollutants the epa said endanger the health of americans. and as senator graham said i don't know people who want to go out and run saying i am for pollution and i am for, you know, increasing the amount of pollution we have in the air so we are setting a target to reduce pollution and create an economic incentive for private companies to determine by

themselves cannot by the government, how they want to behave within that target. they are underneath the target date can actable sell the portion they are under if the target to the company that can't meet that target at that point in time. as we have the ability to take an asset and trade in the marketplace the way everybody does. that is purely capitalist market based free enterprise way of getting to a goal that we want to get their and we believe people need to start to focus on it for what it is. and i think that as people do they are going to find that there is a reason that a republican named george herbert walker bush first increased that because it was the least intrusive, most effective way, least cost of achieving environmental pollution reduction goals. remember, part of that polluters, the zero matters that are beyond the target, the cap,

will have to pay to continue to pollute and that market. remember there was the hardest ones previously known as prince? this is the market-based system for punishing polluters previously known as cap-and-trade. [laughter] [inaudible conversations] >> now an update on the h1n1 flew from the head of the center of disease prevention. >> good afternoon, everybody. today we are releasing new estimates as we said we would. last month we said we would release estimates of the number of people made ill by, of sliced from and unfortunately killed by h1n1 influence. it's three to four weeks later

so we are releasing the estimates today. the bottom line is by november november 14th the date at which those estimates includes many times more children and younger adults unfortunately had been hospitalized or killed by h1n1 influenza that occurs during the usual full season. it will also cover vaccine supply which is expanding with increasing access in many parts of the country. and highlight that it is still a good window of opportunity to get vaccinated against h1n1 influenza. tomorrow we will provide the flu view update. it is likely the disease continues to decline as the current wave recedes. what will happen in the future only the future will tell. the flu season generally lasts until may and as i indicated

before when we have asked flu experts from around the country and around the world what they think will happen in the rest of this flu season, about half the we will have more cases between now and may, half think we won't. the truth is we don't know. only time will tell and that is why vaccination remains the most important thing you can do to protect yourself and your family from h1n1 influenza. what we provided last month were up dates from april through october 17th. it's based on the best available data from multiple data sources. what we have seen so far predates people under the age 65 are most heavily impacted by influenza, that by november 14th, many times more children and younger adults unfortunately had been hospitalized were killed by h1n1 influenza than happens in the usual for the season.

specifically, they're have been we estimate nearly 50 million cases, mostly in the younger adults and children, more than 200,000 hospitalizations which is about the same number that there is in a usual flu season for the entire year. and sadly nearly 10,000 deaths including 1100 among children, and 7,500 among younger adults. that is much higher than the usual flimsies and so as we have seen for months this is a fluid that is much harder on younger people and fortunately has largely spared the elderly and until now. ..

like diabetes and asthma that are more common, access to health care rather than a genetic or brace ethnicity difference. since the beginning of the h1n1 outbreak we have been aware of the potential for greater harm in populations with higher

susceptibility and we have prioritized the vaccine working with states to ensure that indian health service and other facilities that care for american indians and alaskan natives get enough maxene entreatment antivirals early on to reduce the burden of illness and death to the greatest extent possible within existing technology. vaccine supplies continue to grow. we added more than 12 million additional those is available in the past week. that brings us to 85 million doses h1n1 influenza vaccine available. many states have increased the eligibility, having met the demand in the five priority groups to the general population and that is consistent with the recommendations of the advisory committee on immunization practices, so this is entirely consistent with what has been recommended. we have seen an increasing number of states do this.

sometimes an individual communities are counties within states, sometimes entire state. it is important as they have been doing at the state local level to plan for that, to get that the now more widely to retell families that can vaccinate to a wider group of clinicians who want to vaccinate. doing that has a lot of benefit. not only does that enable people who want to get vaccinated to get vaccinated but because they are more providers giving vaccine it increases the number of people in the high priority groups to get vaccinated as well. since people with diabetes or lung disease goes to pharmacies and go to their doctors' offices and more pharmacies in doctors' offices that have vaccine income provided the more people at high risk as well as others will be activated. this past week cdc consistent with policy where we are located here in georgia began offering vaccine to all employees and i will get vaccinated using the nasal spray vaccine in a few

days. and i have course will make sure that we continue to prioritize the highest group encouraging those with conditions and care for infants to get vaccinated in particular. this is still a good window of opportunity to be vaccinated. i can certainly understand that many people might say well there has been so much disease and it is going done so much, why get back in it now but the fact is we don't know what the future will hold. justice in the usual flu season ticket vaccinated because you think might be a bad flu season and the vaccine is likely to protect the. that is the situation we are in now. we are the beginning of december. we don't know what the future will bring in terms of h1n1 influence the. we might have a lot more cases. we might have you. there still spread going on now and it is likely there are more cases that it will be different in different parts of the country. it is a big country with different patterns of disease over this past season.

i hope that all who were interested in being vaccinated will be vaccinated. it is the best way to protect yourselves and your family from bilmus, serious illness, hospitalization or death and it also even if you wouldn't become severely ill will protect you from being out sick from school or work for a week. the more people who are vaccinated the more people who will be protected from influence the, the fewer cases we will have in the future, the less likely be will be to have a third wave or more cases in the weeks and months to come. thanks very much and i will take questions. starting in the room. >> thanks for doing this. to questions. one come. tell us a little bit about what is going on with seasonal flu? is that starting to appear more and also you said you were going to get the mazel vaccine. why nasal? that the studies have shown that

shots are more effective. >> so, in terms of which formulation to get i think each year the data will show and the and whether comparable or one is a little better or one is not. i figured i would get it this year. your first question was? the flu will be provided small but basically, until recently we have seen very little seasonal flu. we are beginning to see influenza b as i have mentioned in the past. we did have a death in a child from influenza b. that is covered by the seasonal flu vaccine. we know the uptick of seasonal flu vaccine has been fairly widespread and the supply is nearing its end for seasonal flu vaccine but there's some still out there in some places. >> thanks dr. frieden.

one clarification, is this the same, are you using the same methodologies for these estimates as you did in october and i just wanted to see, so if we have 10,000 deaths now, that means there have been 6,000 in the past month. and secondly i was wondering if you could talk more broadly about how this compares so far with seasonal flu. i know the time period is different but are you thinking now that this is taking a worst holden seasonal flu generally or less of a toll? >> so the methodology details are all given on a web site. you can refer to that for the details. it is not quite that you could take the current estimate and subtract the previous estimate because there are some corrections for late reporting, but there has a lot more of a disease in the months that is reported then in the months before. in terms of comparison of this

year's flu with h1n1 influenza with seasonal flu, we know it is much milder for older people and much less likely to result in death because older people are much less likely to get infected, but it has been a much worse flu season for people under the age of 65, particularly younger adults and children. in the estimate we have, the estimate we are releasing here is not done in the same way that gives us the 36,000 estimate. that estimate is a different methodology and would give a slightly larger number than this number would give but if you were to compare even though it is not a directly applicable comparison, under 50 in that as the mad there are less than 1,000 deaths a year and 850. we didn't break out, we were not able to at this time the 60 to 64 but it large portion of the 7500 adults are under 50, so it

is really many times more severe in terms of severe illness and hospitalizations are several times higher for children and young adults as well. in h1n1 than usual flu season. on the phone. >> if you have a question over the phone you may press star one. "washington post," your line is open. >> thanks a lot. dr. frieden has the and the mwr report notes, the high are, much higher mortality and aboriginal people goes all the way back to 1918 pandemic. i am wondering if anything is known about the genetic component of that risk, and what the, where it resides, what mechanism is, whether it is the same for aboriginal peoples in the americas and in the

australian and places like that or is that to stay completely mysterious subject? >> there's a lot of debate about why the rate of disease in serious disease is high here for influence and for other infectious diseases. i think it is very difficult if not impossible to tease out the effects of the environment, where nutrition starting in early childhood is different, where access to health care is different, where the likelihood of having an underlying conditions such as diabetes which is highly prevalent in many populations particularly in the u.s. of american indians and alaskan native so i think it is very difficult to tease that out but the bottom line is this thing, vaccinations is very poor and prompt treatment of those who are severely ill is very important. the scientific work of sorting that out i think still has a fair amount to be done. on the phone.

>> "los angeles times," is open. >> do you have any estimate for what proportion of the native americans have now been vaccinated? >> no, we don't have detailed estimates and because of the sample size it is difficult for the alaskan natives. we do know although there are large differences between different tribes in different areas, in many places vaccine uptick is quite high among american indians and alaskan natives and in fact some of the most important vaccine studies that been done have been done showing the effectiveness of different types of vaccine in the indigenous population. >> next question on the phone. >> cnn medical news, your mind is open. >> dr. frieden thank you for taking my question. my question is about h1n1 and the homeless population. it is a particularly susceptible population and i'm curious of the numbers of how many homeless

people have been infected nordyke and to cut can you talk about the vaccination push in that population both in shelters and on the street? >> many people who are homeless fallen to the higher risk categories because of the underlying health conditions and of course in any congress give facility such as a homeless shelter there is the potential of an outbreak. we have not seen as many outbreaks as we might have expected. we have seen more of the school based college based outbreaks that clearly this is a population that has significant medical needs and wants to try to encourage rapid treatment and if they are in a high priority group vaccination and now that many states have expanded vaccination to the general population, a group that can be vaccinated. next question on the phone. >> bob rose, your line is open. >> thank you. dr. frieden wondered if you could measure this point what

the level of the population for h1n1 either by vaccination or infection and if anyone can estimate what the level of the population it would take to prevent a third wave this winter? >> there are a lot of theories about what would or wouldn't prevent a third wave and how many people are immune now through either the virus or vaccination. again, about 15% of the population have been infected and had symptoms of flu by mid-november. that still leaves, even if there were a lot of infection some people who didn't have symptoms and a lot of people vaccinated that leaves most people without immunity and it is going to be different in different communities. they are going to be very different rates and even within cities there will be different parts of cities with different rates so what that means in terms of future cases is very hard to predict, and the only i

think certain answer is that only time will tell what the future will hold, but we know that the more people who get vaccinated the lower the likelihood will be of additional cases for a third wave. next question on the phone. >> jessica, modern health care magazine is open. >> thank you for taking my call. i would like to confirm that the figures you gave for the hostile stations include since the virus emerged in the u.s. until november. >> that is correct. the first seven months of the pandemic in the u.s.. any questions in the room? >> thanks. doctor there have been a couple of developments regarding the antivirals. i believe the cdc's to give guidance. would you mind speaking about that and also, maybe i'm wrong but the bmj article this week that's a just tamiflu is not as

effective or reemphasizes it is mildly affected. >> all of the evidence we have seen about tamiflu is consistent with our recommendations. we don't recommend it for routine cases of influence in healthy people in this season. we do recommend that people who have underlying conditions are people who are severely ill get promptly treated with antivirals because that will reduce the likelihood of severe illness and death and we have in the encourage that in the infection program sites the proportion of kids coming in on antivirals is much higher than it was last year, much higher than usual flu season so the message of early treatment of those with severe illness i think stands and is quite important to reduce the likelihood of severe illness or death. other questions in the room? >> thank you dr. frieden. can you talk a little bit about the americans.

how receptive are they and have you done any polling on getting the vaccine now that it is beginning to be opened up to the general public. are you getting a feel for how many people are willing to get it? >> the polling has been consistent, about half of the people want to and ask for vaccination. as more states and more communities open up to the general population. on the phone, one or two more questions. >> richard knox, npr is open. >> thank you. as you may know yesterday the corporation did a survey from november showing they say about the same number of people who are getting vaccinated this year get the seasonal flu although it has shifted forward in time but at the same time, you said in the past that more seasonal vaccine is out there and you said a minute ago that we are reaching the end of the supply so i'm having trouble

reconciling those two things. >> i think as i have said before we don't usually have coverage figures until the end of the season, but we do know that early on a lot of seasonal flu vaccine was available. a lot of it was given much earlier as you know that has been given in the past and we began hearing reports of shortages of seasonal flu vaccine fairly early as more was being sent out. remember that seasonal flu vaccine is done in a very different way from the h1n1 vaccine program. the government is involved in the purchase or distribution of only about a tenth of the seasonal flu vaccine so most of that is just in the private sector. we get our information from health care providers from surveys and from the providers in the producers of the vaccine in contrast to h1n1 where the vaccine supplies to the health departments. one more question on the phone and one more in the room and then we will end.

>> "washington times" your line is open. >> dr. frieden i'm reading from the steady where it says 38% of people said there was no vaccine available when they tried. yet to indicate the supplies that are dwindling and therefore they would not have a chance. do you have a feel for what that is about, that survey? >> i think there was more interest in seasonal vaccination then there has been in the past probably because of the amount of attention to influence the generally and probably some people who wanted to get vaccinated did not have the opportunity to be vaccinated. it is a challenge because when the manufacturers make more vaccine then there is demand, they have excess vaccine at the end of the year, as this happened before. and if there is less, it is something of a guess in terms of how much the manufacturers make and how much the market will bear. that is of a seasonal flu

program runs and it is up to the manufacturers to decide how much to make. the government only buys about one-tenth of that industry but that the public clinics. we have been providing more support for that to the vaccine for children program and one of the real benefits of the h1n1 experience has been our ability to reach groups that need to get seasonal flu vaccine every year in the future including particularly school kids with lots of schools now having experience giving vaccine at school and women who are pregnant. with more and more obstetricians vaccinating in their office as we hope many more will do. any other questions? >> i was just curious, is there a mechanism or guidance for redistribution of h1n1 vaccine, if one out with has a lot and one out that needs it? that is still the case in some cases. oris that up to the state? >> many states are adjusting

within counties. if one county has more than another, to address level of demand. what we are seeing is as there is a big increase in the amount of vaccine available come a doubling the amount of vaccine available in the last month, there's more opportunity to identify a vaccine that would be available for places with the highest demand and we will be looking at in the coming days and weeks. thank you all very much for your interest.

>> more details now in the presence in this tragedy in afghanistan and pakistan. joint chiefs of staff chairman mike mullen talks about training afghan security forces, a counter-terrorism operations and a timeline for u.s. withdrawal. from the pentagon, this is 30

minutes. >> good afternoon everyone. i have just a few opening remarks and then i look forward to getting your questions. much of the focus these past few weeks has been rightly on the details of the president's strategy for afghanistan and pakistan and about the process that led him to his final decisions. general mcchrystal and ambassador eikenberry as peeno have been here all week testifying in congress to those decisions into their views on the state of the insurgency in afghanistan. indeed they were on capitol hill before the house foreign affairs committee. as i testified myself last week i not only support the president's decisions, i support the manner in which they were derive frugal more critically it is my belief and that of our commanders that this extended search of 30,000 u.s. troops coupled with additional contributions from our nato allies give general mcchrystal all the forces he needs in 2010 to reverse the momentum of a

growing and increasingly lethal insurgency. earlier this week i have the opportunity to visit with some of the troops who will surely be deployed to afghanistan to fight that insurgency. i thanked them and their families for their service but i also urge them to think carefully about how they will accomplish the mission they have been assigned. the debate is over. the decision has been made. it is time to execute. that must be our focus now, our only focus, and it is. less than 72 hours after the president's speech engineers, combat infantry and civil affairs experts were ordered to afghanistan. a batallions worth of marines will arrive next week spending their holidays in homand province reinforcing the troops already there. we are excel rating deployment plans for the rest of the extended forces and i'm confident we will be able to get the bulk of these troops to afghanistan by midsummer with the remainder writing in the fall. this is faster even than general

mcchrystal's original intent and there will be difficult time confident joint staff and dieter planners as well as those of the four services will rise to the task. we are all on the of our feet, leaning forward. several hundred new mraps are in afghanistan with dozens more on the way, rapidly being airlifted wherever and whenever possible. tens of thousands of tons of construction materials, winter gear and other supplies are also in the pipeline. indeed, hundreds of combat engineers and cds are right now working to expand air heads and forward operating base is to accept the incoming material in forces but no one is underestimating the scope of the challenge here. as they told the troops monday in fort campbell and kampusch in afghanistan is not iraq. we don't have, for that country a major logistics hub the can to the one we having to wait. we don't have been afghanistan anywhere near the number of real

clubs or rode networks that exist in iraq. nb don't have quite frankly the same ground to cover. as one soldier told me on the first visit to afghanistan back in 2007, the terrain itself is an enemy. that said one of the hallmarks of the american military throughout our history has been the willingness and the capacity to literally move mountains when required. is required today and expect we will do just that. and i really want to give credit to those in logistics' and operational planning business who have already given so much of their talent and their time to make it happen. with that i'm happy to take your questions. >> the 400,000 goal for training the afghan security forces, we heard a variety of things about that over the last ten days or so. do you still consider it to be a

commitment or a cool, something less and how did the change-- >> i would say that it is anything more than an aspirational goal. it is very clear that this is one of the two most critical parts of the overall strategy. there is considerable risk associated with the development of the afghan security forces, both their army and police. we are very focused now on achieving the goal for 2010, which is about 134,000 in the afghan army and i think it is about 109 or 110,000 for the afghan police from a baseline of mid 90,000 for both those two forces. we know that we have to in fact decrees attrition, increase retention and increase recruiting. in fact i saw the report this morning that, with the initiative to raise the salary

of the afghan security forces from about $180 u.s. per month to about $240 u.s. per month, that a significant number of additional recruits showed up, and that is a good sign, and part of what we have to do is incentivize these aspects of it, the attrition peace, the retention fees as well as the recruiting fees. so, we are looking at the school over the next year. we will learn a lot and that and we will set a goal at the end of this next year which focuses on what we think we can achieve over the following 12 months, let's say that 2011 goal. so that 400,000 is aspirational but it is not definite yet, and then it will be locked in in any way. it will also be a combination of the development of these forces, their abilities, how quickly we

can do it in those of the security environment so based on those two things, in the end, we'll determine exactly how many afghan national security forces we need. >> can i just followed, if you are going to be at something like 280 by the july 2011 date, 400 doesn't seem like that much of a leak. it is there some low balling going on here? >> not at all. actually i think it is exactly the opposite. this is a realistic approach given the challenges and given the risk and the desire to accelerate this and make this happen as quickly as possible. so we nowhere we are right now and we nowhere we are going to be at the end of 2010 and there are a lot of challenges associated with that in the areas i talked about. so we are focused on that. we will see how wooed do and we will move out over the next 12 months within just go for that

period of time. >> earlier this week said that since the u.s. is not winning the war in afghanistan, the u.s. is losing the war in afghanistan, so it seems to me you have got a little further in that regard with that statement and why do you think the u.s. is losing the war? >> actually i have said before and it is tied to my belief about insurgencies, and the insurgency is always moving and it is moving in one direction or another. we are in our third straight year of still a very significant deterioration but with respect to the security environment. the 2009 levels of violence, up 60% from 2008, to speak to one measure of that. it is tied as well to general mcchrystal's assessment of what he found, when he was there and certainly from that standpoint,

we are not winning. in an insurgency u r e the winning or losing and if we are not winning we are losing, which is why i said that, because of the trend in this insurgency. it also speaks to the requirement to reverse this thing as rapidly as possible which is to why we are getting as many forces there as fast as we can, why the president made this decision, because it is important to reverse that momentum. >> speaking of reversing momentum one of the issues that never came up in the last couple of days with general mcchrystal is the role of counter-terrorism tactics-- tactics. he talked a little bit about this with charlie rose yesterday and it was pretty, he didn't say much but what role does focus come truism in al qaeda and irreconcilable taliban have in this strategy? >> i think the role of counter-terrorism is significant and it is an embedded role in

this counterinsurgency strategy, as it is in any counterinsurgency strategy. and so it is ongoing as we speak. it has been. we did it in iraq and we think it is a very important to component of the counterinsurgency strategy so every effort will be made to focus on certainly key leaders of the insurgency, the key leaders in the terrorist world from the point of view of counter-terrorism and every effort will be made to capture or kill the men that is ongoing as we speak, and that is a very important part of the overall strategic approach here. >> do you have any feel for how many of the 30,000 would be special operations types? i mean just rough border as opposed to specific numbers? the i couldn't tell you what the specific numbers will be. i would actually be guessing.

it is not a vast proportion of the 30,000 but it is a significant number of special operators, if you will, as it has been in iraq but it is typically vastly outnumbered in ratio by the other conventional combat forces that are there. the same is true in afghanistan. >> mcchrystal yesterday said in iraq the u.s. focused on midlevel al qaeda versus trying to decapitate the organization and the things that this is one of the things we are going to do in afghanistan the set. do you agree that you focus on the mid-level professionals on than the rest could collapse? the there is nobody that understands where the focus areas need to be better than general mcchrystal, based on his previous experience so i don't second-guess that. as we look of these networks, one of the things we have learned is you have to attack the network over time at every level so just taking the head office and going to work, just going in at one level isn't

going to work but his assessment right now is that is the most important areas so and i am sure that is where he will go to work. >> and i know i am out of turn, but i want to follow up. >> you are coming on. >> just a follow-up on tony's question the general yesterday talked briefly about enablers. whited you give is a little sense of the joint staff perspective of what percent of force might be enablers versus combat forces understanding that a lot of those combat forces could be training simultaneously with their combat mission. >> one of the things that think was a very important decision that the president made was to give general mcchrystal the flexibility inside the 30,000 to ask for and us to soars the forces that he won it. we have ordered some, i think it is about 16,000 or so in since the decision was made the other day, and we are working our way through the details of what the

rest will be. it honestly takes beyond the concept here sometimes two to three weeks to really pound out the details of what the force composition is going to be and we are working that with centcom and with isaf as we speak. pardon this is, as i indicated, nato has the the pier and they are going to send additional forces as well, understanding what those are and where they'll work. so we have very good clarity on the front end of this that has been ordered. the backside of this, the other half if you will is something we are still working away through so i can't really give you an answer that would be very accurate at this point with respect to the specifics. >> udall no percentagewise? >> no, i just can't do that because i know one, it would be wrong and there's an awful lot of detail work that is still got

to be done to answer that question. >> president karzai said the other day that it could take five years before afghan forces were ready to leave on their own. how does that fit in with the july 2011 days of possible drawdown and handing over to them? could you hold up for five years for them to be ready? >> the way i understood president karzai's statements is that is his cool to essentially take complete charge of their own security destiny with forces in five years. the july 2011 date is they begin to transition of that process based on conditions, doing it responsively, where we can with the afghan security forces for them to start to take the lead, not unlike what we did in iraq. we did not pick a date and turn them all over, give them the lead in the rack on a single

day. it was done their province by province. it will be done here both province by province in district by district so that goal which we all understand and seek to meet, is out there and we will have to see i think in the-- in 18 months where we are with respect to achieving that, but that is what i understood president karzai's intentive bu by what he said. >> follow-up, idid also warned-- yourself and cummins the other day. you want the troops to brace for more casualty's this year. how many? >> i honestly don't know that. it is very clear when we surged in iraq the level of violence when the. when we added troops this year in afghanistan, the level of violence when up and my expectations are that the level of violence will go up as we add these 30,000 troops. i thought it was very important

to look those in the eye who are actually going to face this threat, and to be open and honest with them about this expectations. i think it is very important for the people of america to understand that. as we have been to this debate, as we continue to focus on this war, this war and all of our wars, we pay a price for that, and i'm anxious to be as open with respect to that, in every way as i possibly can. that said, i believe the strategy which will reverse this so quickly in the long run, will result in far fewer casualties than if we were not able to reverse them in the end. >> admiral mullen, going back to jim's question when you said we are not winning, what struck some as a motive is that you use

the word when it all. have you noticed any reluctance on the part of some administration officials to use the word when or victory in afghanistan? >> i'll let some administration officials speak for themselves. i intend to be very clear with respect to that because i believe we are not in this strategy can put this in a place where we can turn this thing around in 60. having an intellectual debate about winning and losing and other words like that sometimes can move into a direction that is, that i just don't think is very helpful. i certainly noted secretary gates said the other day we are in this thing to win and that is certainly where i am, understand that. but i also don't want to ever under state or in any way not speak to the significance of the challenge based on where we are right now.

as general mcchrystal found when he went over there, and as all of us including the entire review group assisted to be, which got as to the president's decision which i think was the right decision. >> and kennen gist asked since you at this point now, can you be more specific about where these troops are going in afghanistan? >> i certainly wouldn't go into specific details. general mcchrystal was asking for troops to focus mainly in the south and east but not exclusively their, and he is going to have to work his way through our troops get a portion also based on what nato troops are added and we don't have the specifics yet so there still is an awful lot of work to do to know exactly where they are going to be. jim? >> sir, we have been training the afghan national army since 2002 and i'm just curious, how is it as a fighting force and are there some units, afghan

national army units now that are ready to take the lead? >> there are some afghan national army units that are in the lead as we speak but that number, that percentage is pretty small. but that is clearly the idea of with respect to the training. and the reports i get back from commanders in the field and my visits out there, particularly from the army, on the army side, is there actually is they are trained and equipped and certainly the ones that in lead dare, really good for years, could fighters. they have also been at war for a long time. it should not be lost on us. there are many many afghan army losses, many many afghan police losses, individuals giving up their lives for their country, which we all see and know as well.

we oftentimes focus on ours and understand that, but we should never forget the sacrifices so many have made in that country as well, so we have been doing this since 2002 but like many of the efforts in afghanistan, we have not resourced it well enough to really generate the kind of output that we need to have them take charge of their own destiny. >> as peeno the army and marine corps testified today about reset costs for equipment. can you walk us through the budget process of this, how you going to pay for the surge in what should we expect in terms of supplemental coming up and what might be the size of them? >> that is really for the administration to decide as well as congress to approve, clearly. that is a part of this process and i haven't been to the specific plans on how this is going to be done. your comment about reset is one of significance to all of those,

because we are beginning to be able to reset the force if you will. the marine corps or the next year will actually get out to wait two-to-one dwell time to deployment time ratio. the army will not, still the army will take a couple of more years to do that and all that speaks to more time at home, training for additional missions other than just counterinsurgency as well as rehabbing and refurbishing equipment which is worn as well as purchasing new, and what we have no-- mostly 82 year to three year period of time to do all of this, what i've asked my staff to do is look in detail in terms of exactly what it is going to take, exactly how long is going to taken exactly how much money it is going to take so there is a level of detail that still has to be worked out, particularly now that we are

starting to reset, if you will, the force based on an extended period of time of war. >> during portions of the iraq war there was this notion of robbing peter to pay paul, taking equipment from holland stations so do you anticipate problems there is research into afghanistan? >> i clearly think there will be some of that. the specifics of it really are up to the service chiefs and probably more so in the army then in the marine corps because they are the services press the most tear but i just don't have any details on that. it will not be on the kind of scale we saw at the height of the iraq surge specifically, although we are familiar with how to do this. i think there will be some of it but it certainly won't be on the same scope and scale. >> if you days ago at lucien u.s. dave ramphal of marines who

had been to afghanistan before and literally only a few of them raised their hand. are you concerned that this initial wave of troops going in as part of the surge have so little experience and they may take longer to get up to speed? >> they have so little afghan experience. they certainly have an enormous amount of combat experience and they have combat leaders that no this is, no it is different in many ways and they recognize that and our training ahead of time but what i focus on and one of the areas that focused on for them that i want them to think a lot about this this whole issue of civilian casualties because they are the ones, the small unit leaders of the ones that are going to have to make these decisions and that is a huge change general mcchrystal put in place. it is an enormously positive because the number of casualties have gone down dramatically, get these are the young soldiers and marines that are going to have to make that decision and have

to do it and split second time but there's also a piece of that that is tied to planning ahead of time, training ahead of time as well as the replanning mission and go executes so i was anxious to have them spend some time on that as well. and, we went through this to some degree in iraq. there was early concern with the marine corps rotations because they were seven months in anbar and yet after two or three rotations the number of marines who had already been there, more than filled the gap of familiarity and understanding in relationships with the iraqi leaders. so, the same thing will happen again this time with the marine corps. we are putting an extraordinary amount of effort into the cultural peace, the language fees and taking advantage of the lessons we learned in iraq to get this right for afghanistan. >> just to follow up real quick but at the same time general

mcchrystal was talking about having that experience in that country. you all made the point about how different iraq and afghanistan are and the idea of this surge so to speak is speed to get them on the ground and into the fight quickly. wanted take more time that they have no familiarity with afghanistan? >> i think to some degree theoretically, yes but if i were going to use the marines and helmand and i was there a couple of weeks after their initial operations, it didn't take them very long. they settled out now very quickly and an example of what we would like and what we expect the results of this surge to be in terms of the overall area and providing security where we have troops focusing on population security. so we are obviously not an ideal situation with respect to that and understand that but i have a huge amount of confidence in our

marine corps based on their ability to adapt what they did in iraq and what they are doing in afghanistan, so it is not a big concern. >> if i could ask you two questions. are you comfortable with the characterization of the july 2011 date as a drawdown or is it withdraw? because there have been many characterization's both on the hill and the presence that they cannot is a focal point in the strategy. >> july 2011 is the beginning of the transfer of responsibility for security, scope and scale and place unknowns at this point to do it responsibly and it is based on conditions at the time. it was not an arbitrary date. it was the date that those of us, myself included, feel very strongly about that we will know

by july 2011 for this is working more not. it is a date which incentivizes the afghans, something that they have to focus on and you'll have already seen i think public statements from the afghan leadership that they know this is something they have to step up to. so it was a combination of things but it was not a deadline to withdraw. there is no and a to it and is we get to the assessment about a year from now decisions associated with that and where we will be in the middle of 2011, we will make adjustments to move forward accordingly. >> my second question was, with the state as the beginning of the process secretary gates said a couple of weeks ago the for the strategy was unveiled that this would be a district by district, province by province process giving more security transition to the afghans. some districts are already near that goal. does this mean than that you stop that process in wait until

july? >> not at all. >> some of these districts could already transition prior to that date. >> we will transition as soon as we can, as soon as they are in a position to take the lead and that is really going to be up to general mcchrystal. i think by and large, it will be district by district. and, so we are by no means with this approach waiting until july 2011, but that is a very clear date president has set and one with which we will very strictly comply. >> within the next couple of months. >> theoretically could but that is up to the boss out there. >> admiral the other the president karzai said that the u.s. may have to be responsible or will be responsible for paying for troops, paying for their troops past 2020 i

believe. is that-- you have a reaction to that or is that something that your secretary gates or the president took into account when you were developing the afghan strategy? >> we all recognize there is the significant cost on the manpower side if you will of the afghan national security forces at a certain level, even though that level lewis still to be determined and recognizes that is going to be, there will be a requirement to sustain it. and yet we are not there and that is something i think we will work our way through over the next couple of years, how we do that. part of this again, and refocus the significant part today on the military side and i understand that we should never forget that there is a critical need for president karzai and his government, from national leaders to local leaders, to

step up to meet this mission requirements as well. there is a significant civilian part of this which we are putting in place and the state department has worked incredibly hard to generate civilian capacity, not just numbers but individuals with the right skills or we can leverage that to the accomplishment and we expect that. so, we know that there is a bill out there, if you will. we receive fairly significant contributions from several countries. this is an international effort. just to remind, 43 countries have combat forces here. there is a lot of work to be done with this and i won't speak for president karzai. he was clearly articulating a requirement which we all understand needs to be sustained. the exact mechanisms that will

be put in place to sustain them, to sustain that are yet to be determined. last question. bean what kind of cooperation with this in-- secret nuclear treaty-- and what you think is the long-term implication of this kind of public investigation? >> deppan's newly elected leadership is to decide what it wants to do and how it wants to do that. it is clear that the leadership feels this is important and that is obviously up to them and they will carry that out accordingly. we have certainly engaged, when asked, engage the japanese leadership on this issue and they know what our queues are but that has been done privately and that is where i will keep it. okay, thank you.

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oklahoma and tennessee. the presiding officer: without objection. mr. mccain: mr. president, we are here obviously, as we are on a daily basis, to discuss the a daily basis, to discuss the >> mr. president, we are here obviously as we are on a daily basis to discuss the issue of health care reform, but we are and a rather unusual situation this morning, because we don't know what we are discussing or debating. i mean refiners cells in an interesting situation after almost a year of consideration of health care reform, with the measure of that is-- at least a couple of the outlines of that we no, but frankly we have had no details, except that medicare

is going to be extended to eligibility for medicare is going to be extended to age 55. i just would quote, there was a meeting yesterday amongst the senate democrats and many senate democrats emerged from yesterday's caucus meeting saying "they learned little about the public option agreement and there were many outstanding concerns. senator mary landrieu called the agreement a very good idea. senator burr lance lincoln said more information is needed and senator ben nelson said i just want to know what the costs are. so do the rest of us, so did the rest of us. so here we have a proposal after nearly a year that is being assessed by the congressional budget office and here we are with no knowledge of what that bill is about with the exception of some bare essentials that had been leaked. what is this got to do with change? what is this got to do it by

partisanship? what is his guts to do with anything? rankly we have the editorial in "the washington post" this morning that calls that "medicare's kasich." and isd man is consent that this editorial from "the washington post" be made part of the record. >> without objection. >> the emerging proposal could have costly and detention, costly unintended consequences but we don't know what it is. what we no, never before in this entire gear i would ask my colleagues have we seen a proposal that would increase eligibility, the changing eligibility for medicare down to age 55. never before. so, the majority leader came to the floor this morning and said, well if we except that i'm going to boost the multi-trillion dollar bills by unanimous consent and by the way that build the omnibus appropriations bill, six bills totaling

450 billion, 1,000 crandon 51 pages long, 4,750 to earmarks totaling $3.7 billion in by the way spending on domestic programs increased by 14%, except for veterans which has increased by only 5%, so the majority leader wants us to go out for the weekend after keeping us in all last weekend and here we have an unspecified proposal that none of us know the details of the cost so i'm supposed to go home to arizona this week in and say my friends we have been working on health care reform for a year and guess what? i can tell you nothing. we need to stay in and we need to know what the proposals are. we need to tell the american people what is going on behind closed doors. >> with the senator from arizona yield? i recall our good friend the majority leader telling us that we would be here the next two weekends in the recall our

friend the majority leader saying monday of this week we would be here this weekend. my assumption was we were here to deal with this important issue that the majority has been indicating to everyone is so important that we must the here in do it and we are prepared to be here and vote bracketone fact we have been trying to vote for a couple of days now and it is then difficult to get votes. >> i would ask the republican leader, if we are not going to have a vote maybe we ought to table the amendments at least have the senate on record and can i finally say i know new orleans is nice this time of year but perhaps maybe we ought to stay here and get this job done. >> a couple of nights ago, i think it is important to reflect on the season we have here. couple of nights ago the senator from arizona ghaith lenin's--- impressive speech for the lighting of the christmas tree. this is the christmas season coming up, two weeks tomorrow,

it's very important season and the majority leader said it is important for us all to stay through christmas it necessary to debate this bill and the of said alright, that is what we will do. we will stay until new year's day, we will stand still valentine's day because this is an historic bill and we don't want to make a historic mistake because it affects our children, our grandchildren and 17% of the economy, all 300 million americans. none of this had ever seen their constituents more involved in an issue then in this issue, so we are here ready to go to work. so i'm wondering, as they listen to the senator from arizona not only do we not know what this bill is that we are supposed to enact by two weeks from today, our friends on the other side don't know what it is. they can't tell each other what it is. they come out of there, they have sort of a rally yesterday, one of the senators described it as the go team go rally but they

didn't know what they were going to. all we have heard they are going to and i imagine the senator from oklahoma who is a physician, who has delivered many babies and see many patients and still continues to do so would have comments on it. record. the presiding officer: without objection. mr. alexander: and i'll just read one sentence from it. "that expend spanning the current medicare system to persons of 5 to 64 years old would ultimately hurt patients by accelerating the financial ruin of hospitals and doctors across this country." so, i'm very puzzled ideas like this are being cooked up behind closed doors two weeks before christmas and we don't know what they are. and the suggestion is that we don't vote today and go home this weekend.

mr. mccain: not only is there questions that need to be -- not only is the oppose significance from the mayo clinic but the american medical association and the american hospital association have come out steadfastly against. i quote from this editorial. here we are going out for the weekend, and the editorial for "the washington post" says, "presumably, the expanded medicare program would pay medicare rates to providers, medicare rates to providers, "washington post" says presumably the expanded medicare program would pay medicare rates to providers, raising the question of the spillover effect on health care system already stressed by a dramatic expansion of medicaid. will provider's cost or shift them to private insurers driving up premiums? will they stop taking medicare patient or go to congress standing higher rates? wants 55-year-olds are in they are not likely to be kicked out and the pressure will be on to

expand the program to make more people eligible. the irony of this late breaking medicare proposal is that it could be a bigger step toward a single payer system than the public option plans rejected by senate moderates as too disruptive of the private market. >> i would answer my colleague as somebody who's practice medicine for 25 years. medpac said last year 90% of medicare beneficiaries surveyed were looking for a primary-care doctor and had great difficulty in finding somebody to treat them. that's now. in the state of texas 58% of the state's doctors to cut new medicare patients. but only 38% of the state's primary care doctors took new medicare patients. and i would make the case to you that if you delay care that is

denied care and it is exacerbated in our older population because an older person with a medical need is much more susceptible to the complications that can come from that initial problem. so if you delay the care you are denying the care and you are actually increasing the cost. so if you add -- there's 15 million people in this population and i have no idea if their plans and put all of them that if you had 15 million new people to medicare, or you're going to have this 50% of them are not going to find a primary-care physician to care for. because the rate of reimbursement doesn't cover the cost of care. so i think the editorial you quote is exactly right. i would also note, if i may, president obama loves the mayo clinic and rightly so. i had a brain tumor removed the summer before last by mayo polemic. i'm standing here on the floor because of their expertise.

>> the -- the senator from oklahoma couldn't have a heart attack. [laughter] >> i will ignore that comment. [laughter] the fact is is what mayo says is we've got to figure out how we create incentives in terms of how we get people cared for at a lower cost. medicare is in the way to do it. as a matter of fact i heard our colleagues talk. we had eight votes since last saturday. we are ready to vote. this is a 2,074 page vote. i've got 15 amendments. i want to vote on them. they don't want to vote because they don't want the american people to hear all the bad things about what is going to happen to their health care if the bill passes and if we do medicare what's going to happen as medicare costs are going to skyrocket but access is going to go down.

>> i would ask my colleague from tennessee we don't know what we would be voting on because there has been a free right of this health care after a year and we, with the provisions of the bill or accept what has been leaked, and apparently my colleagues on the other side of the all with the exception of the majority leader don't know what it is either. >> but if the senator would yield there are some things we could vote on. president obama outlined very specific things that ought to be in this bill and we ought to vote to put them in the bill. what he said he wanted and what this bill presents are two different things. so we ought to vote on making sure everybody has access. we ought to vote on making sure we are under the same plan as everybody else that we are going to put into any new expanded health care coverage. we all to vote in making sure everybody is treated fairly in this country. we ought to vote on your prescription drug free

importation. we ought to vote but what we're doing is getting the slowdown. we are of stretching the bill. we are not obstructing the bill. any bill that comes before this body that had 2,000 pages on it we would allot eight weeks, ten weeks to debate, and as our colleague from meen noted there is not a more complicated subject that will affect more people that this body has ever taken up. and we are trying to squeeze that into three and a half weeks and the last two weeks we don't know what is in the bill? timeout. >> i would like to thank the senator from arizona for his leadership on this issue, and i agree with all of them here. i would love to continue this discussion, the colloquy if you will and vote. that is what we need to do all we can do is talk about this issue and vote. there are numbers of amendments.

but senator, the thing that is interesting for me is you have been for years one of the great champions in this country as it relates to trying to make sure we live within our means. you have pointed out waste in government, you pointed out over spending. and what happened during this christmas season is for our friends on the other side of the aisle medicare has become a gift that just keeps on giving. i know that when you talked about during your campaign and all of us have we need to get medicare to the point it's solvent, where seniors actually have the ability to use the benefits later on that now or in place. so we all talked about the need to make it solvent. but what does the base of this bill do? it takes for under $64 billion out of medicare to create a new entitlement it doesn't even deal with the fix we said many times, and so now, the reason by the

way we don't know what this says is the leadership on the other side this is another one of those yellow post-it, they are throwing it up on the wall just to see if it works. they are not telling us what the game play and as because they don't yet know whether it works. but what they are hoping to do is solve a major problem they have within their caucus again by taking from medicare. if you think about the fact mayo clinic, the model for all of us won't even take new medicare patients get our friends on the other side of the ogle are trying to for a whole decade of seniors into the plan, what that means is less and less seniors are going to have access to care. that is what this means and the other side of the ogle which i would like to say based on history i am surprised but continue through their policies to throw seniors under the bus. and i don't, i do not understand

what has happened. this must be about a political victory and not about health care reform. i want to see must think. i know the senator from texas and south dakota are here. what we would do is more firmly put in place, again back policy. the problem with medicare today is physicians and providers are paid fees to do more work so now what we are doing instead of health care reform which is what senator coburn and all of us talked about for some time, we are putting in place and see meant something that works poorly that the mayo clinic says is damaging to them and their patience, we would be putting it in place for even more people so i want to thank the senator for his leadership. i hope to be with you all weekend discussing amendments important, voting on those amendments. i can't imagine a better place for all of us to be. >> i thank the center. can i ask the republican leader again to be very clear that it

is his view and that of our entire republican members of the senate that was the and to get this issue resolved and we are prepared to vote through the entire weekend if the majority leader moves to the omnibus appropriations bills. we will have a conference report and have a discussion about a bill that has could put earmarks totaling $3.7 billion in it. but we shouldn't get off this. i would ask -- >> i would say to my friend from arizonan you are correct. i can only quote the majority leader who said we are going to be here this weekend and expect to be here this weekend, and if he tries to leave we will have a vote to adjourn and confident every republican will vote against adjourning because it either is or isn't as important as the majority says it is.

if it's that important me to be here and more important than being here come equally important to being here is to vote. we try to get a vote all day yesterday on an amendment by senator crapo and what we heard as we are working on a side by side. that's kind of parliamentary inside talk for delay. we are ready to vote. several colleagues suggested we keep hearing about these new iterations of this bill. it reminds me at the end of a football game trying to throw a hail mary pass. just somehow, someway find a way to pass this bill. i think it's important for everybody to remember what happens to most he'll mary's. the fall to the ground in complete. you get the impression they are far less interested in the substance of the bill than just passing something. when the president came up here last sunday he said make history.

make history? the american people are not asking us to make history by passing this bill. they don't believe it is about the president. they believe it is about the substance. and we aren't here preparing to talk about the substance of this measure, offering amendments and we fully intend to do it for as long as it takes and as the senator from arizona said just the majority live leader petites to a conference report which he's able to do under our process, we will spend all the time it takes to deal with the above report. >> may i point out again as the senator from maine, senator snowe pointed out it was highlighted in "the wall street journal" today no major reform in the history modern history of this united states senate has been enacted without bipartisan support. a reason to go back to the drawing board. i know that senator from texas has been heavily involved in the issue of hospitalization and the

american hospital association's reaction to what appears to be an expansion of medicare. >> on thank the senator from arizona and in so please our leader is standing strong to say that nothing should take precedence over our handling of this bill and making sure that it is done right, and that is what the republicans are trying to do is make sure this is done right. we talked about the medicare expansion that is in the purported bill that we haven't seen yet but that the democrats appear to be putting forward. and yet we've been spending a week talking about half a trillion dollars in cuts to medicare. so now we are talking about possibly expanding medicare at the same time we are cutting half a trillion dollars out of the care that medicare patients would get. one of the amendments. the senator from arizona mentioned, excuse me, oklahoma

mention he has 15 amendments pending. i have an amendment, and it would stop the cuts to hospitals. $135 billion in the underlying bill that would cut hospitals reimbursements from medicare patients. that's my amendment. now we are talking about possibly expanding medicare, and the american hospital association put out an alarm. it's an action alert and says medicare pays hospitals 91 cents for every dollar of care provided. medicaid pays 88 cents for every dollar provided. so the cuts in medicaid which also have been discussed as an expansion and the cuts in medicare which we are talking about possibly expanding would go forward which means what? the hospital association knows what? what is moral hospitals that

care for medicare patients are going to go under. so what kind of services can be provided if there is no hospital in a whole county that can provide care to the senior citizens? so why ask the senator from arizona who has been such a leader on this we are going to cut $135 billion out of medicare coverage for hospitals, we are going to now talk about expanding the coverage of more medicare patients which will mean we are going to cut more from the hospitals and is even envisioned in the underlying bill. help me understand this, senator. how would you suggest that passes the common sense test? >> may i say the things to fit the bottom of my class at the naval academy i am out entire loss to explain that.

>> [inaudible] [laughter] >> perhaps before i turn to the senator from south dakota maybe we could get a response from dr. colburn. >> they are going to cut care which means you're going to have more complications which means you're going to have worse outcomes. that is what is going to happen. and rather than -- rather than changing the payment which is what we should do by rewarding quality and rewarding outcome, rather than recording -- rewarding, you know, flipping the switch, that is what needs to happen. but we are going to stick to the to the same into credit system, cut $465 billion from it and then add, as my colleague from tennessee -- its 34 million people. if the input everybody from 55 to 64, into the same program. speed is the senator say whether you're the top of your class like the senator from oklahoma were the senator from tennessee or the senator from south dakota were the bottom of your class as the senator from arizona has admitted he held down the fort,

regardless of where you are on the quotient of where you stood in your class you know what the bottom line is. >> health care is to be impacted. if the senator would let me shortly come here is a survey of 90,000 physicians. 90,000. that is more than practicing physicians of ama. what do they say? more than eight physicians surveyed think reform are the best policies for physicians and patients to improve the system for all americans. only 5% of the physicians surveyed rated current government health care program as effective. 5%. >> the senator from south dakota. >> i would just ask my colleague from arizona, because if this is what happens when you end up with one-party rule, one party trying to do this on their own because this seems to be a model of dysfunction and how to come up with a solution to one of the

major problems facing the american people, and dysfunctional even by washington's twisted standards. but the just seem to be desperately throwing things at the wall hoping something will stick. but surely there has to be a better suggestion coming from the other side than to expand a program that is destined to be bankrupt in the year 2017. i mean, it's the equivalent of a ship is sinking. it's like the titanic. you're going to put more people on the deck of a sinking ship, and clearly the overall objective at least amongst some and i think some of them have been very transparent about it, someone quoted earlier today the congressman from new york and the other body who said that this is the mother of all public options. he went on to say never mind that campbell's knows, we have his head and neck in the tent on the way to a single payer system. and so, obviously there are some people here who really want to see a single payer system, they

want to see government-run health care. we don't happen to believe that is the best solution for america's health care system, but the amazing thing about this proposal is it takes a program destined to be bankrupt in a few short years, cuts a trillion dollars out of it over ten years when it is fully implemented and then adds millions of new people into that program. it's hard to come up with any rational explanation for what is going on here other than that they are left with just in desperation trying to throw something at the wall hoping you will stick. so i would say to my colleague from arizona is this typically what happens around here when one party tries to go on its own on something that is this consequential to america, one sixth of our economy is represented by health care in this country and essentially what they are saying is we want to expand the part of the economy that isn't working today that is headed for bankruptcy debt under reimburses doctors

and hospitals, puts more people into the field system, exacerbate the cost shift problem by forcing the people who in the private payer market to pay higher and higher premiums. it seems this creates all sorts of problems that make matters even worse. so i would say to my colleague from arizonan, i appreciate his leadership on this issue and pointing out what inevitably is going to happen. and when you have, as you noted the "washington post" editorial this morning even acknowledging the terrible problems that this creates for health care and the way that this is being conducted, the sausage being made here in washington, d.c. that i would say again, even by the washington's twisted standards this process has become so dysfunctional i don't know how they can recover. about one thing that they could do is decide to sit down with republicans and actually figure out some things we could do that would help drive health care costs down in this country but rather than make them go up. i will say to my colleague from arizona. >> i thank the senator from

south dakota. i have to say that i have never, in the years that i have been here, seen a process like this. i mean, it is incredibly bizarre that after a year, after hundreds of hours in the health committee, after hundreds of hours in the finance committee products are here on our desk in -- it's in front of the senator from tennessee's desk, and yet there is a meeting yesterday of the democrats and they come out and don't know what the proposal is either. apparently there's only one senator that knows what the proposal is and that is the majority leader. now, and also that it's okay to go home for the weekend. i honestly say that my colleague from south dakota i've never seen anything quite like this. especially when we are talking about one sixth of the gross national product of this country. and of course, already from with the no, the hospitals and doctors and others have come out

in strong opposition to the expansion of a program and the senator from south dakota points out it is going broke. >> i would say to my friend from arizonan he made reference to date to the senior senator from maine and her very insightful and thoughtful and correct speech a couple of weeks ago about how an issue of this magnitude was historically dealt with here and what was not being dealt with this way. she pointed out the major domestic legislation in modern u.s. history was without exception donner on a largely bipartisan basis, and that whole process as the senator from maine pointed out has been entirely missing. as we have moved along here toward developing of this 200074 page monstrosity of a bill designed to entirely restructure

one sixth of our economy on a totally partisan basis. i don't think that is what the american people had in mind. and so they want us here as we all indicated, debating, discussing, and amending this proposal, and that is what we would like to do for as long as it takes. >> [inaudible] >> if the republican leader will think back when he first came to the senate as a young aide in 1969, the year before i was a young aide in the senate, and i can remember president johnson, a democrat, everett dirksen, the republican leader dealing with the open housing legislation in 1968, a very controversial bill. how did they deal with it? the democratic president had the bill literally written in the office of the republican leader with staff members and senators trooping in and out. the country looked to washington and said the republican leader and democratic president both think it's important. they are trying to work it out. and in the end they voted for

cloture, and in the and they got the bill. >> by friend from tennessee is entirely correct, and right before we got here, right before we got here in '64 and '65, democrats had overwhelming majority as they do now. civil rights bill of 1964, and the voting rights bill of 1965 passed on an overwhelmingly bipartisan basis. the leader of the republicans, everett dirksen was every bit as much involved in that, if not more involved than even the democrats. republicans supported on a percentage basis and a greater number -- >> minority time has expired. >> i ask for one more minute. >> without objection so ordered. >> an even greater percentage and the ups principal its bills of 64 and 65 than democrats. but it was a truly bipartisan landscape for the country. a landmark, important. and it was widely accepted by

the american people because of the broad bipartisan support that it enjoyed. that is what has been lacking from the beginning. >> mr. president i ask unanimous consent that a list of the physician organizations that oppose this act over one-half million representing over one half million physicians be included in the record. >> without objection so ordered. >> thank the center from montana for his courtesy. >> mr. president? >> the senator from montana. >> mr. president, i must say some of the debate on the other side of the ogle is a little surreal. they say they want to move ahead. and then they refuse to enter into any reasonable time agreement to consider necessary appropriations measure. i find it very impressive -- very impressed how the minority can maintain both that they want to move more quickly and not

move at all. it's surreal. mr. president, i want to also explained, despite the claims on the other side, that we have attempted mightily to work together with both sides of the aisle to get health care reform passed. they claim it's all one-party rule. nothing could be further from the truth. that may explain why. when we began this effort over a year ago we had many hearings, in fact it was last year i think i had ten hearings on the finance committee health care reform. to educate ourselves because we knew health care reform was to be a big issue in the year 2009. so in 2008 we had finance committee hearings on different aspects of health care. how does the system work? how the parts fit together. how does this all work? we were there to educate

ourselves. we didn't have a political act to grind. we were not trying to make points. we just got the experts in and how does that work? how do the different parts of the system worked together? then we issued a white paper, november of last year. basically the call to action we called it, but 80, 90 page paper -- statement as an option, health care option, delivery system reforms, various ways to get health care coverage, various ways to help with insurance market reform. lots of different provisions. and i might say casting all to the wind that white paper call to action back in november of 2008 is probably the basis, the springboard of which most of the ideas that we've been debating both in the house and senate and both sides of the all come from. they basically come from there. and i might say it has all been

totally transparent. it is all on the internet. it is all but open for everybody. republicans and democrats participated fully. first was the congress all-day session. both sides. that was over year ago. and since then, that was in 2009 this year we have had countless number of the finance committee, countless number of we call them around tables, countless number of walk-throughs, countless number of hearings and all the various aspects of health care reform. fully open. and also i instituted something else here, mr. chairman, and that is we got to the point we finally get to the markup, put the mark up a bill on the internet again so everybody sees everything. we also made sure all amendments were on the internet and fully debated by both sides.

it would be open, totally transparent. and i prided myself on doing that. in fact one very well known health journalist works for a major paper walked up and said max come is this the only way of doing things? beebee you started something with being so transparent and working so much together. i think this is a model for the future. i don't know, i said, but it really pressed him how much we tried to work together and did work together with people on both sides of the aisle. so this is -- i cannot think of a more comprehensive, more transparent more bipartisan effort than this. so what happened? well, the help committee had their version passed and so we in the finance committee worked on hours, and to move the ball i shifted it to another group, we call it the group of six, three republicans, three democrats to try to get the core provision together that could be taken to

the full committee. we have a countless number of hearings were meetings. i forgot the number of days we met. i think it is in the nature of 30 or 40 meetings, close to 100 hours. republicans and democrats, guess what. it was very, very, very constructive. i wish the american public could be an ally on the wall at these meetings and watch these proceed. very good questions asked by senators on both sides, republicans and democrats. i highly compliment my friend from wyoming, senator enzi. i highly commend my friend from maine, senators know, and i highly complement everybody the was there. they asked very good questions and senator grassley of course, ranking member of the finance committee, the same on the democratic side. in an effort to try to find a good, solid health care reform bill. well, we kept working. a bipartisan, working together for days and days and hours and

hours. and unfortunately, mr. president, it got to the point where i'm just calling it as i see it. i can't -- one of my feelings as i am too honest about things. and it's -- the republicans started to walk away. they were pulled away from the table. they had to leave. i ask you why. why did that happen? and the answer is, to be totally fair it is because their leadership asked them to. their leadership asked them to become disengaged from the process. i know that to be a fact. why did their leadership asked republicans to leave, to become disengaged from the process and become totally candid? it is because they want to score political points by just attacking this bill. they were not here to help make -- help be constructive to find bipartisan solutions. they were for a while. they wanted the rubber to start to meet the road and wanted when it came time to make decisions

they left and began to attack. i think that one of the -- a big unfortunate circumstance out of all of this, we are going to pass health care reform. it's going to pass. it's going to do wonders for the american people. we are going to dramatically reform the health insurance market. people are going to have health insurance they do not now have. we are going to help put in place delivery system reforms. that is a fancy term of seeking changing the way we've reimbursed hospitals and doctors at a very positive way so we are focusing more on quality and less on quantity involved. this was great to be passed. it's been to be very good bill finally was passed and people understand, but the unfortunate part is this: on fortunate in my judgment that the other side pursued a strategy of just seeing no and attack, attack, attack. and that is basically what we've heard here the last several weeks.

instead of coming up with a comprehensive alternative, instead of coming up with a comprehensive alternative health care reform package, and then it would have been just wonderful if we had an honest to goodness solid debate on the pros and cons of each side, the merits of each side, a constructive dialogue pursuit inquiry focus on which portions of this should be put in the bill and which not but that did not happen. we did not have this constructive alternative provision presented to us. we had no provision presented to us and by that i mean the american public so we can debate whether they just said no. we have worked as hard as we could to be bipartisan and honest and candid about the other side walked away. they walked away. and i think that is very unfortunate that happened. i'm happy to respond to my

distinguished colleague. i think it's pretty evident to everyone here not only what has happened here on the senate floor with the statements that have been made. publicly and privately. and certainly i'm not going to discuss the private conversations i've had, but based on the rush limbaugh, glenn beckham, which is all the news today they are upset at senator mcconnell because he is not opposing the health care bill enough. the reasonable process on this, there are no efforts made to improve this bill, only to kill this bill, and i think that this debate has really come to a point i have rarely seen in the senate, in fact i've never seen this to. to have my friends on the other side of the aisle come to the

floor and in some way try to in paris or denigrate me by virtue of the fact that in fact trying to embarrass me. but they should understand any defense i had scheduled this week that have been canceled. even so i had last weekend have been canceled. four or five of them. so i am to say the least i would never, ever intentionally come to the floor and try to talk to somebody about having had a fund-raiser and that is when they are trying to get out of here. the reason that i laid out to the senate what i thought was a reasonable schedule procedurally we are where we are. the rules of the senate are such that once cloture is invoked that is where you stay with. and i thought it would be

appropriate because we worked pretty hard here to have a day or two off. anything reasonable i would be happy to deal with, but there was no reason of this to read everything that could be done to stall, advert attention to this bill has been done and that is too bad because it is important legislation. today 14,000 americans will lose their health insurance. between now and 3:30, and number of people will die as a result of having no health insurance. so, we are engaged in some important stuff, as the pundits have said some of the most important legislation that's ever been to this body. so i am going to proceed to follow the rules of the senate, and i'm sorry we have not been able to work with republicans in a constructive fashion on this bill but it's of the joyce lee

-- optus we have. >> i ask consent to people to respond briefly. >> is their objection? so ordered. >> i would reiterate to my good friend from nevada all i said was the creepo m and that has been pending since tuesday. we would like to vote on amendments. and there's been some difficulty apparently coming up with a side by side to the crapo amendment but i am perplexed that it would come to the cody two days to come up with a side by side. this has been stated by my good friend of the majority leader as the most important issue some have said in history been acquainted with a variety of different monumentally important pieces of legislation in american history. all we are asking is the opportunity to offer amendments and get votes, and i said it in the most respectful way and

meant it in the most respectful way i think it is pretty hard to argue with a straight face that we are not trying to proceed to amend and have votes on this bill. that's what we desire to do. the majority leader certainly has the right to move to the conference report, and he is now done that or about to vote on doing that. all i suggested was we would like to get back on the health care bill as soon as we can, resume the debate process on what has been described as an issue of historic importance and let senators vote which is what we do in this body. >> the majority leader. >> i would say to my friend from kentucky that i have an even i'm going to now to vote and i will come back and see if we can work something out. up next senator robert menendez talks about his opposition to provisions on u.s. cuban policy. the measure is in a spending bill the senate is working on.

the new jersey senator spoke on the senate floor for 20 minutes. >> i rise to speak about the omnibus conference bill before the senate and specifically about provisions on cuba that have not passed the senate and have not been subjected to debate by this body. these provisions would undo current law where the castro regime would have to pay in advance of shipment for goods being sold to them because of their terrible credit history. yes, cuba's credit history is horrible. the paris club of creditor nations recently announced cuba has failed to pay almost $30 billion in debt among poor nations that's the worst credit record in the world.

so why ask if the cuban government has put off paying those who would already owes $30 billion to, why does anyone think would meet new financial obligations to american farmers? considering the serious economic crisis we are facing right now we need to focus on solutions for hard-working americans, not subsidies for a brutal dictatorship. we should evaluate how to encourage the regime to allow a legitimate opening, not in terms of self phones and hotel rooms cubans can't afford, but in terms of the right to organize, the right to think and speak with the believe. however, what we are doing with this omnibus bill, mr. president, is far from that evaluation, and the process by which these changes have been forced upon this body is so deeply offensive to me and so deeply undemocratic that i have

no intention, no intention of continuing to vote for omnibus appropriation bills if they are going to jam foreign policy changes down the throats of members in what some consider must pass bills. and i'm putting my colleagues on notice. you may have the wherewithal to do that, you know, because you have a kennedy purge or opportunity to stick something in that hasn't been debated on the floor of the senate and what you think is a must pass bill but don't expect me to cast a critical votes to pass that bill. an example of the danger of what we are doing by changing the definition that is now being changed in this omnibus bill of what we call cash in advance is exhibited by a bureau press report. i want to quote from that report, quote, during the trade fair this month in havana, germany's ambassador to cuba,

quote robert l. mur, told german businessmen that cuba's debt to the german government had been forgiven. ferguson, in hopes that cuba will meet its debt obligation to them, meaning to the businessmen. in other words, a german tax payers will now be responsible for bailing out its private sector and by implication the castro regime. thanks to the u.s. policy we've had up until now requiring the castro regime to pay cash in advance for its purchases of agricultural products u.s. taxpayers could be rest assured that the same wouldn't happen to them, that we wouldn't have to forgive any debt obligations in order to make sure that private business people got paid by the regime because otherwise there would be left defaulted. the castro regime mastered the art of making some european

governments acquiescent to its every win even if it means free pass for its daunting repression. so, how do they do it? it is rather simple. they give european countries the choice, either you do what we say, or we will freeze your national bank accounts and default on any debt. to me that is also known as black male. let's take spain for example. recently european news services reported spain has begun a diplomatic offensive to convince the castro regime to one block nearly 266 million heroes were the equivalent of about 400 million united states dollars in funds that have been frozen by the castro regime of over 300 spanish companies in cuba. these are spanish companies doing business in cuba and now can't get access to their money. so what this spanish government

does not coincidently the spanish government announced upon assuming the presidency of the european union in 2010 it would enter into a new bilateral agreement with the castro regime that would replace the current european union policy which contains diplomatic sanctions for human rights violations. the castro regime made it clear to spain the current european policy was an insurmountable obstacle to normal relations. and i might add for spanish nationals and companies to get their money back, there for the spanish government immediately responded to what i consider to be black male. and on a recent visit to cuba seems minister met for three hours with roel. he didn't get one concession, not one on human rights. but he did get $300 million cuba

owed spanish companies that do business inside of cuba. is that what the united states of america intends to do? so the lesson for dictators is go ahead and freeze the bank accounts of other countries companies and create debt that you don't intend to pay for and to get a free pass for repression. look at another article that highlights cuba continues to block access to foreign business bank accounts. let me quote from that article. many foreign suppliers, this is a quote come and investors in cuba are still on able to repay hundreds of millions of dollars from local accounts almost a year after cuban authorities blocked them because of the financial crisis or diplomats and businessmen say. goes on to say in the article, quote, the businessmen who asked not to be identified because

they are fearful if they are said they were increasingly frustrated because the communist authorities refused to offer explanations or solutions to the situation which stems from a cash crunch in the cuban economy triggered by the global downturn in heavy hurricane damage last year. this is a quote from one of those, it says i have repeatedly e-mail and visited the offices and sent my representative to the offices of the company i did business with for years and which owes me money and they simply refused to talk to me, a canadian businessman told reuters. the article goes on, delegations from foreign banks and investor funds pulled in commercial paper from cuba's state banks have repeatedly traveled to cuba this year seeking answers from the central bank or other authorities without success. representatives of some companies with investments of joint ventures on the island say they were bracing for the

possibility of not being able to repatriate year-end dividends paid to their accounts in cuba. now let's remember that is a 90% of the country's economic activity is in the regime's hand, in the state's hands. foreign economic attache is in commercial representatives in cuba said most of their nationals doing business with the caribbean islands still face payment problems. that's all from that article. these are all those doing business with cuba now finding themselves and their money trapped. last week the russian federation's of that chamber revealed the cuban regime failed on three occasions to pay installments on the equivalent of $355 million in a credit deal it signed with russia in september of 2006. and that's just the latest episode in this saga of that and 2009 alone includes first

reports by mexico and spain newspapers that hundreds of foreign companies that transact business with the cuban regime's authorities have had their accounts frozen since january of 200. by the regime owned bank that is solely in power to conduct commercial banking operations in that country. secondly, june 9, 2,009 reuters article said, and i quote, cuba has rolled over 200 million year rose and bond issues that were due this may. as the country's bank asked for another year to repay holders of the debt, financial services in london and havana said this week. those are direct quotes from those articles. as a reminder in castro's kube you can only do business with the regime because private business activity is strictly restricted. so the real reason why so many whose work is often subsidized

by business interests advocate cuba policy changes is about money and commerce, not about freedom and democracy. and it makes me wonder why those who spend hours and hours in havana listening to castro's soliloquies cannot find minutes, minutes for human rights and the locker see. makes me wonder why those who go and enjoy the sun of cuba will not shine the light of freedom on its full of political prisoners. the advocate for labor rights in the united states but are willing to accept forced labor in side of cuba. they talk about democracy in burma but are willing to supply rahm with cuban dictator's which takes me to a place in cuba called [inaudible] to read this is a city in the villa in the center of cuba, in the heart of the island, the

center of cuba. in other words, it isn't a beachside resort by canadian and european tourists. it is also the home of this couple, the home of cuban political prisoner and pro-democracy leader jorge luis garcia generally known as antunez. 19901025-year-old antunez stood at the center square listening to the government official radio transmission calling for the fourth congress of the communist party. he spontaneously began to shout, quote, what we've launched and what we need our reforms like the ones performed in eastern europe. immediately he was beaten by state security agents, charged

with oral enemy propaganda and imprisoned. mr. president, that what began a 17 year prison term which is about half of his current life he spent in prison. his crime? saying we need the type of changes that took place in eastern europe. for that, 17 years in prison. he was not released until 2007. he's now 45-years-old hopefully with an entire life ahead of him. the castro regime would love for mr. antunez and his wife, also pro-democracy activist. this says in spanish we are all the resistors and long live human rights.

they would love for him to leave the island permanently but he refuses to do so. he's decided to stay in cuba and demand the human and civil rights of the cuban people be respected. for this, she has been rearrested over 30 times since 2007. last week, at the same center in the small town, where he had been originally arrested simply for saying what we need is the change as we saw in eastern europe, antunez and other local pro-democracy leaders gathered together to honor cuba's current political prisoners, people who simply through peaceful means tried to create changes for democracy and human rights inside of their country and get arrested and languish in jail. antunez and his colleagues were

not educated on the importance of human rights and civil disobedience by foreign tourists, says some of my colleagues suggest what happened. we need to send foreign tourists to educate the cubans about human-rights and civil disobedience. he and all of those languishing in castro's jails understand about human-rights and civil disobedient in a way to try to capture your rights. unwittingly the, the tourists finance their repression and give money to the regime that ultimately gives them the state security forces that throw people like antunez in jail. so let me read an open letter that just came out by mr. antunez that was sent to cuba's dictator, raul castro. and i'm going to quote from an english translation of a live dustin ennis consent to put his spanish version of the record. >> without objection. >> it says mr. raul castro, this

is mr. antunez speaking now. my name is jorge luis garcia yes antunez, former political prisoner, and i'm writing to you again not because i pretend to make you aware of something that far is commonplace in cuba due to the nature and politics of your government. so for several months now, my spouse and i find ourselves under forced house arrest by your political police. the week before the concert of the famous colombian singer, high-ranking state security officials upon of arresting me informed me that there had been an order for my arrest throughout the island of cuba where if i might be found. he emphasized they were going to be watching every step i take. and since that day i've lost count of how many times i have

been arrested. the majority of times with violence. mr. dictator, allow me a few questions that may help to clarify some doubts among those compatriots of mine who are hopeful that your government would diminish repression or that even in space openings could be made. he poses this question: with what right do the authorities without a prior crime being committed detain and impede the free movement of their citizens in violation of a universally recognized right? what feelings could move a man like the captain to beat my wife, a defenseless woman, so brutally causing lasting effects to her bones for the act of our riding at a radio station to denounce with evidence the torture that her brother received in a cuban prison.

or is it that for you there are only five families that exist in our country that have the right to protest and demand justice for their jailed relatives? should you not be ashamed that your corporal and police officers remained stationed for days at the corner of my home to impede us from leaving our house and monitoring our movements in our own city. where is the professionalism and ethics of your support with their ridiculous operations to mockery of the populist were these persons almost a daily basis. how do you feel when you encourage or all of these persons who call themselves man to beat and drag women through the streets, such as [inaudible]

and most recently the well-known blogger. i'm adding here for the record the well-known blogger although he doesn't say that she is well known internationally now. recently beaten simply as she was trying to go to a place of civil disobedience. how can you and others sleep after deliberately and maliciously knocking down on more than one location a woman that is several months' pregnant? how can you and your government speak about the battle of ideas when you are constantly repressing ideas through beatings, arrests and years of incarceration? mabey your followers cannot find or even attempt to find response. however, i find myself on long list of persons that are not afraid to respond. you act this way because you are

a cruel man, and insensible to the pan suffering of others. to act this way because you are faithful to your anti-democratic and dictatorial vocation. because you are convinced that dictatorships like the one you preside over can only be maintained through terror and torture and because the most minimal opening can lead to the loss of the one thing that you are interested in, which is maintaining yourself in power. last, and this is him speaking now, mr. antunez, referring to my case in particular i will respond without even asking you before and the concrete road if of your continued repression against my person. my government and your servants and the court cannot forgive my two biggest and only crimes. first, that despite almost two decades of torture and cruel and inhumane punishment during my on jos and severe sanction you

could not break my dignity and my position as a political prisoner. and second, because even though i am brutalized and above all risk returning to prison i have taken the decision not to leave my country and which i will continue struggling for change that i believe is both necessary and inevitable. and the letter is signed from jorge luis garcia antunez in december, 2009. .. dictatorship, not what the regime tells the world about that, you know, cubans who are all white are -- seek to oppose the dictatorship. most of the movement for democracy inside of cuba are

afro-cubans. inside of cuba, they are subjected to a citizenship status that is less than any human being should be subjected to. antunas' voice rings in my head, mr. president. it tugs at my conscience. his words -- "despite almost two decades of torture and cruel and inhuman punishment during my unjust, you can not break my dignity and my position as a political prisoner, because even political prisoner, because even >> i have taken the decision

not to leave my country and which i will continue struggling poor a change i feel is necessary and inevitable. yet she is ripe for change is inevitable but the united states needs to be a catalyst of that change. it does not need to be a sustainer of that dictatorship broker does not need to create an infusion of money that amigos to a regime that ultimately uses not to put more food on the plates of cuban families but arrested and utilize people. these of a human-rights activist that some would turn their back on for the sake of doing business. i guess the only thing they can see is the color of money. not me. not now. not ever. figure mr. president and with that i yield the floor.

>> good afternoon everyone. uc cent-a-share crapo here tonight left he had an amendment pending on the health care bill since tuesday. we ran last weekend presumably because the majority felt it was important to try to pass the health care bill. we agreed and is an important subject but now they pivoted to another measure which the majority leader can do under the rules of the said it. and even suggested we take off this weekend. i think i can speak for all 40 republican senators will not interested in taking off but to stay here and debate the measures before the

senate and get back to health care as rapidly as possible with a series of amendments that give the american people and opportunity to understand what is being proposed. and how bad it would be for the country. this is a debate that we will come in. we're anxious to get back. and it is my hope and expectation although we do not have an assurance yet, we will not only go back to the health care bill but have votes on amendments to the health care bill. >> guy has been in the senate for a number of years. i have appreciated the debate that we have had on the floor, the colloquy, the discussions with our friends on the other side of the ideal. it has been vigorous vigorous, spirited and

respectful with the exception when senator reid alluded to those that oppose the abolition of slavery and compared it to what we were doing. with that exception, this has been a debate which has been very educational for the people of this country and what the senate is supposed to be all about. we have had those unimportant amendments we think senator crapo has an important amendment and i am told there is great dissension among some democratic caucus over senator dorgan amendment concerning the importation of drugs and from canada and other countries. i do not know why we left this bill. the eyes of the american people are on the issue that affects 16 of the american and the economy. it is hard to understand right after spending all of last weekend in session and voting and debating that

somehow the majority leader would want to take this weekend off but yet still finished up by the end of next week. >> tell him what the amendment would do. >> guest. i appreciate the fact this amendment is a very tough vote to cast. but there is a lot of issues of the legislation that need to agree brought forth. my amendment is very simple and would commit the bill to the finance committee with instructions that the finance committee change the bill also it complies with the president's pledge on taxes. very simple. of the president pledged many times, these are his words come a people would not have to pay, people who earned under 250,000 as a couple or 200,000 as an individual would not have to pay any taxes under the health care bill brought forward under his

leadership. when pressed, he meant any taxes. in fact, paraphrasing closely he said not income tax, property tax, not any of your taxes, and not one dime. all this amendment would do would commit the bill to the finance committee to have the bill changed so it comply -- complied with the pledge to the american people. >> as capital reporters come you understand how things work in the u.s. senate. when the majority leader suggests that the reason we have not had votes this somehow because republicans are trying to object to that, i hope they will use the knowledge that you have here and point* out in your stories how that is not true. we wanted to be able to take votes on these amendments.

both senator crapo amendment and what senator mccain alluded to. he always has his leader time he can say whatever he wants to save it is up to you to hold all of us accountable and i don't think anybody can argue the republicans have been unwilling to debate and have amendments and to vote on amendments. that is so we have asked the majority leader to allow us to do. any questions? >> your amendment and strikes may more as a political card shut amendment. do you separately from this amendment have any related to health care? >> first of all, it is very related to health care and a core part of the bill and the way to explain away the amendment that it is a message amendment but how can it be other than a focus on this bill? this bill increases the size

of government in the first full 10 years of spending by 2.5 trillion dollars. even if you're only counterpart the use is gimmicks too not count the first four years and is almost $1 trillion of new spending. that is offset by about $500,000 of new taxes three huge portion of which are paid by people in the united states earning less than $250,000 per of course, this is a strong pork is on a huge weakness in the bill but to characterize it as political ases wrong as to focus on the medicare cuts or the increase growth for focus on the government option in the bill as political. of these are key parts of the bill when put together enable the democrats -- democratic leadership to claim the bill is budget neutral and the only way is with the

gimmicks, medicare cuts and the huge tax is included in the bill. that is why the president made in the of pledge. if it is a political than the president's pledges political. >> let me point* out that the real sticking point* is not the crapo amendment but the importation of drugs amendment. of which the democrats are badly split. if it passes, as it should come and allows drugs to be imported into this country come it breaks the year agreement and so the white house as well as pharma has been appear lobbying furiously and reno for a fact that democrats are not sure they have the votes to feed it yet the. >> that it is the fda has sent a letter he is blocking the amendment talking about

safety and soundness. >> and would require a lot of resources. there is only 11,000 people that were over there and i am sure every day they are filled with responsibilities. come on. we all know what this is about. it is the deal of pharma cuts. that is what was bragged about on the front page of newspapers all over america. let's not kid each other. they made a deal with format and they want good deal to hold. that means no drug we importation or competition among medicare patients outside of part sea. that is the deal. i am not revealing any secrets preferred has been on the front page of every paper in america. >> just to reflect it was not too long ago that you had a very different relationship with the man to your rates do not exactly on the same side.

[laughter] and of the list goes on. you reluctantly endorsed in 2008 and have you feel? >> first of all, i learned the best way to get along with john mccain is to go along with john mccain. [laughter] our differences were always overstated in related to a very few policy differences and we found ourselves differing on the myriad of things but i am happy to be standing by his side of cement is for that you plan to be here for the weekend, will you try to filibuster the omnibus package? >> real-life to get back to health care. >> what do mean by filibuster? >> will it require 60 votes to pass the budget busting

omnibus? of course, it will. thank you everybody. >> can i just say we're not doing it because of the lay we object to a bill that has domestic spending increased by 14% and reduction by only 5% with your marks totaling 3.7 million dollars. are they so insulated from the american people that they think we can afford earmarks and continued this practice? this is why we need 60 votes is because it is an outrage the. >> is that something you will oppose him if we have to wait to see how they package the remaining business of congress. you have patriot act provisions expiring, apparently the need to raise the debt ceiling, a tax extenders and a variety of different unfinished items that really must be done this year and we have spent a lot of time

on a bill that should not be done in this year or any other year in its current form and that is the health care bill. [inaudible conversations]

the. >> good morning. the hearing of the big game subcommittee on transportation development will come to order. i would like to a first of all, things german dodd and ranking member shelby and their staffs are working with us to put together today's hearing prepare chairman dodd is a busy man these days and in the midst of a chevy the most important reform in our health care system in a generation while at the same time working hard to completely overhaul our regulatory financial system and not to mention his central role in formulating

legislation to jump-start our economy and create millions of new jobs. if the interest of giving him a few minutes to sleep and eat i volunteered to the the this hearing. we appreciate everything he is doing. want to start off five praising secretary lahood there overseeing transit policy at the time of historic writer should also the time with states and localities have the resources to meet this demand. they have proven themselves able and visionary leaders in these trying times proceed by the proposal there will discuss their relationship on safety. transportation policy safety must be of paramount importance. this past summer of the tragic metro crash claimed the lives of nine people including the d.c. national guard a retired teacher and

to work with it nurses around the world. we must forget coming up short resultant tragedies that must be avoided at any cost. as we begin this discussion there are a few key points of like to make. first, the way we current may regulate mass transit safety does not make sense there is no federal role of transit safety oversight and that is shocking. we have 27 states with a mismatch of regulations underfunded, understaffed and lacking in oversight of often not doing a good job of maintaining transit assets. in the past two years there has been a disturbing trend in transit safety. fatalities and derailments seemed to be trending upward we must act promptly to make sure this is stopped and reversed for the third time it is important to keep in mind the lack of federal oversight and the disturbing

trends, mass transit is by most measures the safest mode of transportation there is. much safer than driving, flaying -- viagra commuter rail bed is governed by a robust safety system. no matter how we regulate safety rican not expect save systems if we do not invested infrastructure her according to the ft reports it would cost $50 billion just to get the nation's seventh largest transit systems to iran acceptable state of repair. a jobs bill is being put together as we speak and i'm hopeful modernization funds will be part of the bill. rail modernization funds spent out quickly and create jobs and are an investment in infrastructure critical to our economic house. these was the part of any effort to make transit safer. i think the administration

for a well thought out proposal and the ford to working with them and the chairmen to make transit safety an important federal priority. this issue is of the utmost importance and cannot be held hostage by the reauthorization process part of there four despite a committee schedule i certainly hope and expect no mark of safety legislation early next year. with fact, that may recognize the distinguish ranking member senator vitter for his comments. >> i am eager to hear the testimony so i will think you and the committee for his -- in a hearing and welcome secretary but i had the pleasure of serving with him in the house so thank you for your continuing service swim i think you mr. chairman prior appreciate the chance to be here and thank you and the ranking member for holding this important hearing for apologies on the front end

those on the other panel i do have to step out and about 20 minutes. but first of all, of late to echo the chairman's comments on the importance of transit safety and the fact it is an area at least up the federal level, overlooked percoset and as a former governor perhaps that the state level overlooked as well. want to start by applauding the secretary for his approach he has taken to see how the federal kph me can be in default with the state and local efforts in terms of safety and i am looking forward to working with you to make sure we move forward. act to win again, but what the chairman said if it is more than a network that serves my communities in

virginia and we remember the tragic accident in maryland in june but as we know, there have been a series of other incidents taking place and three of them in virginia one as recently as november 29th. this string of incidents really heightens the needs for our attention and focus. echoing what the chairman said we have to make sure of adequate funding and recently conference report on the appropriations bill includes 150 million of new funding for grants and we will go after some of those to address the safety and maintenance issues. all of us who live in a greater capital area realize mattress systems which i can still remember when three prided itself when it was brand new is giving up in age.

i have worked with them for many, many decades about 35 or 40 years old at this point*, just like any house that age things start to break down at once and we're seeing that on the meat inside with metro showing its age. i echo the chairman's comments data may do need to increase our focus on safety but also our focus on maintenance. just want to make two final points. i hope we look at this from the standpoint of how do we get transit safety rate? >> there probably should be an increased federal transit safety role as siam echoed earlier so many states perhaps the exception of california do not doing a

good job. i know we have gone back to my secretary of transportation who was also my secretary of transportation and trying to look at what authority we had in virginia. it has never been highly befog the priority list and there is some uncertainty. with mr. that is further compounded because of the three jurisdictions. up and no the biggest abide often talked about is the potomac river between the virginia and maryland and the district. we will have to find a way to look at the oversight board and look at how we strengthen both local and state abilities to look at safety purpose cents i will not be here for mr. cato's comments i do want to pose a couple of questions. we have read the measure has lost a number of experienced

employees. in the normal course of retirement did as we have seen come with some of the positions going to save to your oversight but replaced by a much younger employees i welcome to hear from his testimony what he is doing to publicize safety and training of all employees to make sure it is a high priority and richard and employees are measured on safety performance. and what else can redo to slow further attrition of the experience to work force? and what training programs are in place? has there been any thought on a short-term basis to bring back some of the recently retired employees on how they might consoled or further train them to work force? i will not be here to hear his response i'll afford to getting the answer to those

questions and look forward to working with you mr. secretary to get this right. thank you. >> i just want to recognize and his secretary lahood it was of pleasure serving in the congress and also peter who is very kind and able when he was here. thank you. >> and he is still kind and abell. [laughter] >> we will see. [laughter] that is why i posed to the question. let me introduce secretary lahood who we all know very well. the 16th secretary of transportation and while the offender relatively short tenure he has distinguished himself in the role. of some of us have had the opportunity to serve with the secretary back in the house of representatives were reprise they serve with him on the transportation infrastructure committee.

with that we welcome you and are ready for your comments by chairman and ranking member figure for the opportunity to testify on our proposed legislation to reform the department of transportation role to oversees the safety of our nation's rail transit systems. with me today is peter rowe got through it all of you know, the transitive and straighter and doing a great job. traveling by transit in the united states is safety at serious accidents to occur such as this summer's tragic washington metro crash and others from boston to san francisco we believe additional action is needed to make rail transit even safer. rail transit is currently the only mode within the department that operates without comprehensive safety regulations or enforcement authority and we must regulate the gap. they carry far more

passengers than our domestic airlines or passenger and commuter roads worst it is regulated restrictive labor of the deity is prohibited by a provision from issuing national safety regulations for rail transit systems. that the antiquated provision put into law 45 years ago for a change it now so we can address the safety needs of the more than 14 million americans who use the rail transit systems every day. it is an antiquated lot and needs to be change. the major metropolitan subway from seattle to san francisco chicago, boston, new york and atlanta are subject only to the federal transit administration state safety oversight program. this program lacks federal statutory authority to

establish meaningful states where it rail transit systems operate. each rail transit system is permitted to determine its own safety practices. it is up to state government not the fda to determine the extent of regulatory oversight and enforcement granted to each transit system. this results and a patchwork of 27 separate state oversight programs guided by regulatory framework of inconsistent practices come unlimited standards and marginal effectiveness property