it presents those proteins in a very concentrated, focused way the same as they are on the virus. when we get recombinant proteins the first generation ones are not tethered in the same way or at the same absolute concentration. that is the reason they are being looked at. my prediction is as the production technology gets better and as we learn how to manipulate these proteins scientists will start to do the same things and i presume the efficacy will improve over time. >> i would like to add for a few examples of what gary was saying, people are thinking right now about trying to figure out how to best present it. people are putting proteins into national particles. doesn't necessarily have to have that but the way it has

conformed. if you think about almost a polymer delivery system, the ways people are looking to present the antigens in that way. there are other ways of thinking about it. >> yes? go ahead. >> if you talk to the companies that are manufacturing -- the biggest problem going forward is the economic model that reimbursement is really low and markets are uncertain and there is a high utilization, cargoes what you are thinking you might address? >> you point out a problem, sustainability of these efforts going forward, being able to

have these new companies and products. part of that is how can we have more people take influenza vaccines on a year-to-year basis and that is an effort not only with companies but the government and how we can encourage that. we have an opportunity with the 2009 pandemic to educate and bring out the outstanding qualities of more people being vaccinated. part of what we have done is to help manufacturers get the return on their investments by helping them with advanced development. they received a very large amount of contracts that they don't have to spend and they can go forward after being on something else. it takes eight hundred million to 1 billion dollars to move

from the beginning at to have it on the market. the other processes on these facilities, that is how we are helping them. >> to expand on that, in the mind of all of my colleagues the best way to get this to the system where the companies have a degree of confidence that things will not rollercoaster on them is to get more and more people vaccinated each year. if you look history of vaccinations over the last several years with the increased expansion of the recommendation we have gone from $50 million up to over $100 million. as a public health person i would think the goal i would see to release stabilize the system and make it less of a crisis issue when you get to have a pandemic flu which will again

occur as predicted even though there are rare events to get as many people vaccinated as possible and what we foresee in the future is influenza vaccine will be something that is essentially a routine vaccination for everyone. as we transition into the universal vaccine you may only do that every couple years and get people protected not only from seasonal flu but pandemic flew. ..

>> the more they're a seasonal use not in the united states but around the world, the more this base will be on. >> just to follow up on what dr. fauci just said. once we get to the holy grail of universal vaccine, isn't that going to put the other companies who spent billions on these others side note out of business, some of these other things you're been speaking about? >> i'm not so sure it would put them out of business but i think if you do develop a universal

vaccine, there are many, many vaccine preventable diseases that we still can make vaccines out of. i think if you show the company that you have a stable market, we're not going to stop with influenza. the subject of the discussion today is influenza, but there are few other diseases out there that we would love to get vaccine companies involved with. how about tuberculosis and malaria, just to name a few? few? and hiv-aids. >> yeah, i would add one thing to that, and i think it's important just in the broader context of universal, just to project how it would happen. and i think it's important to realize it will not happen overnight. fda is going to want to get a good look. we're going to want to get a good look at how effective they are, how safe they are. and i would say even in the best case scenario, if we had a candidate to go forward in the next five years, i think there's going to be some interim period

where we still use the seasonal vaccine at the same time that we move in some of the universal vaccines. so i think there will be plenty of opportunity for the companies to adjust to the new knowledge-based, to the new products. and then do the kind of things that tony just described. >> another question from online. >> we have a question from the university of minnesota. the question is for dr. robinson, dr. gellin that has been local opposition to the rollout. named because it is untested and new. given that, how are you planning to be able to persuade the public to truly accept a new vaccine with new technology? >> well, i think there's nothing special about the flu and new technology. i think what we've indicated is there's research, a number of

new technology that's coming that is threatening trajectory and each of the timeline, they are quite long. there are a lot of ideas that have to go through many stages with increasing experience. there's a whole series of those tests to determine how effective and how safe they would be. i think that's going to be true of any new technology, to be able to demonstrate science-based or why it's being introduced, why it's been licensed and why it's been recommended. sunday hesitate until there's more of a track record. i think that's true with every product. but i think it's our job to be able to demonstrate why the vaccine has achieved the status it has to be licensed and recommended, and some may want to wait longer than others. i think particularly when the diseases that these vaccines are preventing our very clear, then i think people have a better understanding of what the bite of the vaccine would be in preventing that illness. >> or any other before we move on?

i think we will move on with the last, final two speakers. critical partner in all this is food and drug administration that applies irregular processes to this whole endeavor. so our first speaker will be doctor jesse goodman who is a chief scientist and deputy commissioner for fda. >> i am delighted to be here. thank you, nih, bill, for sponsoring this event. and i am happy to talk about how we are working to apply regulatory science, both to increase the available in other current vaccines and future vaccines. and i think safely is a really important bottom line here is part of the answer to that last question. now as you can see here, we're trying to speed things up. this is for people who live in a district of columbia, this is kind of speeding ticket we

frequently get. but we want to speed things up also without causing problems or safety issues. we've heard a lot lately about curves and bending curves, and i had wanted to have all the time but i didn't in the last day to prepare a slight. but what i think what we're really trying to do with influenza vaccine, there is a curve as the pandemic occurs, there's a lag that we start to produce a new vaccine. this is true with seasonal vaccine. so there's a spirit of, you know, right now almost about five months before going very, very quickly we can begin to that in the vaccines. so that's where the curve is kind of flat, and then it goes up. and then that goes up. i think what we want to do is to think. we want to shift the curve to the left, so that we get vaccine sooner and faster. and those are really transformative technologies, some of which we have heard about. we also can increase the slope

of the curve so we get more vaccine, more quickly. both of those things can happen here. i want to say a word about regulatory science, because i think something you heard in some of the remarks here is that we really play an important role for the public, and more commonly conceived about being sure these products are safe. but we are also particularly with vaccines and gazed at every step of the way here and trying to get something that is a concept or works in an animal to become a reality and a product that can help people. as noted here, there's a large gap between some of the amazing advances in basic science where we can understand something like the human gluten protein, a single -- atomic kind of level, and the availability of final manufacture product.

in fact, in its most extreme, this gap has been called a valley of death. there are a lot of reasons that this exists. one, is because it's quite hard to go from that concept to a product that can be reliably manufactured. another is that a person is not a mouse. there's lots of expenses with things where a drug or vaccine works in an animal system, and if it doesn't work in an animal system, it's very unlikely it's going to work in a human. but just because it does, doesn't mean it will. so one of the things we try to address is this lack of information and tools to get from that idea to a treatment that might work in a mouse but to something that can really work for patients. and this is not a problem unique. cancer therapies is an area of very intensive investigation. this is very commonly a problem. so we believe that quite regular

science which is frequently in collaboration with our colleagues at nih or academia can help bridge this gap and help get the products they're. we also in this evaluation process that we do, can take innovation steps to make that go faster. products are developed. and one of the things we really put our resources into is when there's a very important public health problem, like pandemic influenza, to interact intensively with the product developers from their earliest stages and try to say, how do we have a process where production, devaluation, etc., we discover problems where we speed it up early rather than coming to a point at the end of the day where, let's say, a product can be manufactured or there is a safety question late in again. we tried were possible to provide guidance. and for example, i will mention

we have provided guidance on how to safely produced so cultured based vaccines that all manufacturers can use to accelerate their development. and then we have some regulatory mechanisms, including accelerated approval. asks overread approval allows us to approve a medical product based on what we call a likely surrogate marker, or something that short of preventing the disease is correlated with a high likelihood of preventing a disease. and for example, with influenza vaccines, we know the amount the antibody response against, is a reasonable measure that correlates with protection. it's not perfect, but this is actually allowed us in the last five years to approve for additional seasonal influenza vaccines. one to two years or more earlier than would have been approved. and even though we all faced the supply challenges, with seasonal

vaccine and this year with the pandemic, we are much better off because of the broader spectrum of products we have to choose from. now i think most important where fda can help is working on science to get tools and standards that improve our evaluation, or improve the speed and quality of testing and manufacturing of vaccines, as well as evaluation of their safety after they are approved. and i want to say that this is a major priority of our leadership at fda right now, is to strengthen the agency as a scientific agency. and to make us more able to collaborate and have working capacity to really facilitate product development. and are focused areas here are all very critical for our response to influenza and other public health emergencies. this includes development of novel technologies, products for unmet public health needs. we just heard a question about

how do we incentivize the development of these products where markets are not as strong as for some therapies, and part of the way weekend incentivizes is helping in the regulatory science process. and then harnessing the power and information of the genome, etc. now, one thing people don't realize that we live every year and this gets to what can we do even with what we have now to improve how quickly we mobilize vaccine, is that influenza vaccine -- is almost as if we are preparing for a pandemic every year. every year we're making new vaccine. there's new viruses that emerge. and based on that surveillance, we pick new strains of virus. and uniquely here, fda in particular our cynical biologics and you'll be hearing from the doctor in a minute, but fda is

very engaged with global public health community, with the cdc, and with manufacturers in being sure we get a vaccine each and every year. and it was no different -- except that it was much accelerated in time and urgency. but at many of these places there are really opportunities for improvement. so you've heard about have a based vaccines are 50 plus years old, and we need additional technologies. the same is true for many aspects of how we evaluate the vaccine each year and release it. there is room for improvement in those areas. and the improvements we make will benefit us when we have so cultured based vaccines and other vaccines as well. so weak, with support from hhs and congress, we put significant effort into trying to improve how we can do things to get vaccine out each year. these are some examples of where

we are engaged. so for example, every single year we worked with colleagues around the world to select the strained. quite honestly, we could use information to improve how we do that, and we and colleagues are engaged with that. we work with a global network of w.h.o. laboratories, cdc and others, to help reduce and eventually dries what we call real swords. you have to take this wild type virus and transform it into something that is safe and suitable for most manufacturing processes here but as occurred this year, and a curse not with seasonal vaccine, some strains grow quite poorly in eggs, and i don't think cell culture will completely solve the problem. some strangle probably not grow that well in certain cell cultures either.

so we are working on methods to improve growth in manufacturing. we had create reagents, we didn't produce, humans get the right does when they go to the doctor. the current methods are probably more archaic that actually egg-based production it's a. they rely on methods that when i was a medical student were a curiosity, then, and shortly arnelle. and again, we are working on methods to measure potency that don't depend on having commercial vaccine themselves available. so today's methods, before we can really use them, the vaccine itself has to be available. so this is a matter of taking months that really should be able to be able to reduce two weeks. doctor weir will talk about some

of those efforts. as part of our quality and safety oversight, every lot of vaccine is carefully tested and examined. the methodology for doing that are in many cases poised for speeding and improved including using more rapid methods to detect issues like microbial contamination, which is always a risk of any biologic products. on samples from clinical studies like we used this year and dr. fauci and also industry performed in record time, studies do show that this vaccine produced an excellent immune response, but we measure that response exacta as it was measured also something like 40 years ago. and we need to improve how we do that. we need to approve how those measurements correlate with what then happens in the patient peculiar a little bit about that. and i don't want to leave out

safety assessment and monitoring. because even once a vaccine is approved, tested, distributed, even though we have very high safety expectations and our regulatory requirements are rigorous, we know that very rare adverse events can always occur. and we know that products being given to millions of people have to be a very, very high safety standard, so building good surveillance systems that use health care data to detect unexpected events are extremely important and i will get to that. not in a pandemic, as i mentioned, this becomes a president. there are also some unique lead, global ordination and we with our colleagues at w.h.o. have led an effort to bring regulatory agencies around the world together to share information, to try to get vaccine to develop. not just for the united states, but for the world more quickly. but you know, the real issue

there is if we think in this country we have a challenge in terms of manufacturing capacity, in terms of seasonal immunizations to prevent flu, the world has a much greater challenge. we are very well off compared to the world. and in fact, our response to this age when in one -- h1n1 pandemic has been very rapid compared to what the world has been able to mount as is our capacity. and again, obviously in these situations as we have seen, we can turn around and redo things as is merited by the public health emergency rapidly. we can potentially if the secretary of hhs determines a public health emergency, and we don't have licensed products to meet the need, we have a mechanism called emergency use authorization that can allow us to even consider unlicensed products, but to do so based on

a necessity of science in terms of risk and benefit. and for example, the dr. fauci mentioned the issue of adjuvanted vaccines which we have the ones that could have been used in the united states this year are not licensed products. however, we have been collecting data on those, and if they were to be needed, this is the kind of pathway we have available. but even try to licensure, we can evaluate them. and then we got a lot in the last several months working closely with barda and manufacturers. people don't realize that once you produce the vaccine, and certainly the biggest factor in the gap between supply and demand this year has been the slow growth of the virus, you know, the virus just didn't want to behave. and every time a manufacturer though they have improved that growth, it didn't behave again. that's the biggest factor. but there's also a factor of getting that vaccine material once you have grown into vials.

and we have tried to compress that by bringing on board additional capacity. now, i want to end up talking about the new technologies, and what are some of the issues that people may not be thinking about that make these not so simple? there are incredibly promising things are, and i think along with the other speakers, that we are poised for a transformation in how we produce and use influenza vaccine. we're going to have more capacity. were going to have methods that will allow us to increase the reliability and speed of production. again, getting to that, going from a a mouse or even a human clinical trial to large-scale manufacturing, and assuring we do that safely, is not always a simple issue. now you've heard about a bit about potent novel adjutants.

these include oil and water adjutants that are available right now. one of them has been in a european licensed flu vaccine that's been used only in the elderly, but for several years in europe. we recently approved a human virus for cervical cancer vaccine, including an adjective, not exactly the same adjuvant. so we are quite interested in this, as the dr. fauci mentioned, they offer the potential to increase the intensity of the immune response with age five or the avian influenza. we saw that we could not induce an effective immune response without adding one of these adjuvant. the good news here is that our study shows that we could induce an extremely effective and robust immune response without adding adjuvant. however, these adjuvanted vaccines do offer potential in terms of potentially increasing

yield and amount of vaccine available, potentially improving for example seasonal vaccine -- vaccination as well, if for example, children and the elderly might have a stronger immune response. so we are really looking at these. there are some potential issues. these to cause an inflammatory response. individuals who get these have sore arms, when they have a sore arm that is sore, they have more fever, etc. you know, when considering the serious disease like influenza, those may be kind of effects that are expected and not of a degree that merit particular concern. however, they do indicate there is a biological response going on. there is no evidence, but there's been concern, that could we stimulate unhealthful immune responses, for example, against antigens of the body or what we

called autoimmunity. there is no evidence to date in humans, but we need a better understanding of how these adjutants, could we for example, separate the boosting immune response against what we want to boost it for, from causing these more general inflammatory effects. and this is a great area for basic science. we don't have time to mention it today, but we have people looking at what are -- can we get better tests for safety using, for example, the response of human cells to an adjuvant or vaccine to potentially predict what's the response of a person going to be. but as you heard from dr. robinson, hhs has been sponsoring nih has been involved, and we've been very involved also, in getting more data about these vaccines.

and as you have heard, we do anticipate the potential that some of these may be submitted to the u.s. for licensure in the near future. now, cell culture vaccines, i think it's important again on background to say these will not transform influenza vaccines production, but they could be a great help. they could increase the liability, and in some cases of viruses may grow better. and as tony mentioned, they could increase our ability to scale up quickly, potentially. and it's important for the public to realize that there's nothing new or scarier, novel, about vaccines. we've been using them for years that almost every vaccine currently available, moms, measles, rubella and, etc., polio, one of the greatest vaccine success stories of all, are made in cells.

but there are some special challenges themselves, and the reason we don't have cell culture influenza vaccine is not because of some major safety concerns. it's because it's taken a long time to get a good yield and a good antigen out of cell cultures influenza vaccines. another case where the flu virus has not behaved in the way we would like it to, this is required looking at new cell lines, new approaches to creating so-called to vaccine, and very recently there was a first cell culture influenza vaccine approved in europe. but again, like the adjuvant vaccine, it is important to realize in the bonding to the 2009 h1n1 pandemic, the first vaccines that were available, despite all these challenges, were egg-based vaccines and non-adjuvant. so even though we are beginning,

and i think as i said, vaccine programs will be transformed by things like so cultured vaccines, we're in a transitional period between how we have done it historically and how we can do it in the future. again, many licensed vaccines, but when you use a cell, there are some important safety concerns that you need to address. and an important point is you can very successfully address them if you do this properly. and this is another area where regulatory signs can help. so a cell can carry along not just the virus we want, but potentially other viruses. they could've been there to begin with and that so cell culture limas may. or they can get in there somehow. some cell lines, most enough but there is some cell lines that maintain -- because cell lines

often putting potential to proliferate, that in theory could have genes or others abilities to costumers. so it's a very important that you make sure that the vaccine you produce in a cell line like that is very pure and doesn't have any of those properties. this can be done and it can be done relatively easy. and in fact, so cultured vaccines now are among the purest vaccines that are produced. and again, this is standards, testing extensively. we heard this recently in the discussion of the influenza vaccine which as you heard, has really made tremendous progress. but it is too grown in cells in that case insect cells. and it is very important, you could potentially have proteins or residual of those cells that could cause allergic or immune reactions.

again, this is why cell culture vaccines are highly purified to prevent that problem. now, fda has had an extensive program to try to design and share with people guidance about how to make these vaccines. and save say, how to test for what we call advantageous or infectious agents to be sure they are not there. fda developed an essay that detects certain kind of virus called retrovirus indexing. and in fact, we've had tremendous support and partnership with dr. fauci and the national institute of allergy and infectious disease to develop these tests and provide this guidance. and we see these vaccines coming along safely, very much in the near future. you heard about recombinant proteins, viruslike particles. and again, we are not allergic to those. they just need to be produced

properly. there are uproot vaccines such as the hepatitis vaccine that is saving millions of lives. around the world. cervical cancer vaccines are, in fact, viruslike particles. so this is technology where we are gaining experience, and there is no reason it cannot succeed for influenza as well. but the problems here are very much, how do you make lots of it, how does the protein come out the same way every time? because these become very complex systems, and the consistency of knowing that an influenza vaccine in january and march is the same, and it's just as safe and effective, it is critically important. and then we did hear about novel targets and universal vaccines. i think it's very important to emphasize as everyone has, that these are several years off.

if we can succeed. because this is a very genetically, virus influenza that had trick humans time and time again. there is a reason it causes global pandemic. very similar to a very different kind of infectious disease, hiv, but it prevents similar vaccine challenges in that it is a virus that changes its self, not just annually, but daily. daily this virus is changing. the biggest challenge here from fda evaluation and scientific point of view is that the real way we're going to know that these vaccines protect people is by saying that they were attacked people, and that's going to require real clinical data. we don't have something like antibody levels against human gluten that will tell us whether the vaccine will be protected. so a whole science is going to need to develop around these

vaccines that tells us what's protecting. >> and then just too close, again, very important. that these products to be safe. as i mentioned earlier, they are given to millions of people. these are healthy people. they include children. that track record has been extraordinary. we are monitoring safety of the h1n1 vaccine issue carefully. that trackwork has been as would have expected, but we are continuing to monitor it very positively. but we are building systems now that enhance our safety surveillance and our ability to detect any unpredictable problems were quick to. i think we can also harness modern biology. there are people who very rare serious adverse events to any medical products, including vaccines. and we can start understanding what it is about those people and their genomes, thanks to the

human genome product. and perhaps identify people who might be at risk for those rare events, and even ultimately prevent them. i think we face a future where every individual, we're going to know what genes they have that are medically significant. and we should be sure that we build the vaccine enterprise we can take advantage of that information because that will only increase public confidence. we have a huge opportunity here to protect people and save a lot of lives. even with this years campaign, i think if people continue to get immunized, our public health folks tell us that we can help prevent and impact of a third wave which might really occur. and imagine if we can get vaccines to face not just influenza, but the next czars or other emerging threats, not in -- it's remarkable to have something in five months, but imagine if we could do it faster and we could get enough for not

just the united states, but for the entire world. and that's why we're here. so with that, i will just thank you. and dr. weir, who is director of our division of viral products at the center for biologics will talk about some of the efforts to provide regulatory signs that can support that transformation. thank you. >> thank you. and thanks everyone for hanging around to the end. i know we are ahead of schedule, but my goal is to still be pretty brief and basically provide a short update on some of the research at the center

for biologics at the fda. as a dr. goodman just pointed out, we have a somewhat unique role in regards to influenza vaccine production and development. data do not only to the uniqueness of influenza virus and the fact that we make the vaccine every year, but of course also the fact of public health importance of the virus and the disease. what i want to go over today is sort of give you a snapshot, some of the research that we do in support of the production of influenza a vaccines and to facilitate the development of new ones. that's listed on the first two bulletins of the slide. basically we conduct research to do two things. one is to support and improve current influenza vaccine production. regardless of what you have heard about antiquated technology, the fact is we cannot over 100 million doses of vaccine every year that is safe and effective.

there is room for improving and we're dedicated to trying to do what we can to improve and speed up that process. and the second thing that we tried to do it to facilitate the development of new vaccines from both seasonal and pandemic vaccines that as dr. fauci pointed out in the very first talk, these are interrelated. to prepare for one by being prepared for the other. and it's our job to look down the road and to try to see what's coming in to be prepared for these. you've heard the second part of the slide show some of the challenges that we face. these have been other two and mentioned several times this morning so i'm not going to spend much time on the. i think there are obviously a good end to. what i want to do is give you a quick little snapshot, as i said, an example of how we are trying to approach some of these. but clearly, vaccine yields depends on virus growth. that's a challenge that we face. preparation of standards, we have 100 billion doses that a been vaccinated every year. we have to standardize those

because they are made by different manufacturers. there is improvement needed for different inputs. for new vaccines, we do need to define protection because a lot of these new vaccines will not work in the same way that traditional vaccines have worked. new generation of vaccines will require new methods for both product characterization in clinically valuation. so the next slide, i'm going to my snapshots now, here are the challenges. why did i focus on influenza b.? well, if you think about it any trivalent axing of the total amount of vaccine that one can produce is limited by the poorest growing virus strain in that mixture. year in and year out that tends to be influenza b. the fact is for invalidity there do not exist high-growth reassortment that are available to make that very high producing strength.

so some of the work we've done recently to address this problem is shown on this flight. we have shown that adaptation of influence to be high-growth and eggs in associate with change in the molecule only. this is important because this means it is not easy to design a high-growth reassortment in the way that they are made for influenza a. on the other hand, we've also had some recent results and show that certain amino acid changes can increase virus yields but actually having minimal black on properties. for too little data pieces i show on the right of the slide show how only a single amino acid change in influenza a -- i mean the influenza b. molecule can result in approximately a 10 fold increase in virus you in both eggs and tissue culture. and a fourfold increase in total content. and a single communal acid chain has no affect on the properties.

interestingly, the adaptation of high-growth does correlate with properties. just look at the color coding on the right. the top shows the original low growth virus. the green line shows that are typical for infecting the cells and after the amino acid change, you see receptive usage that are typical for avian substrates or so the point here is that this shows that there is a possibility that improvements can be made in the growth of influenza b. viruses for vaccine production. similarly, over the last few years, it's commonly known in the field that h5n1 candidate has grown relatively poorly. the basis of this is not fully understood. but we have recent work in which using reverse genetics or molecular biology basically, we can show that actually by swapping the molecule in

increased yields in the h5n1, and using the color-coded schematic at the bottom of this slide, you see that one exactly designed molecules were you make such that the epitopes of the original h5n1 are retained, but actually you get pretty high-growth and increased comparative to the original h5n1 that was the original vaccine. once again, showing that these abilities by using molecular genetics one can devise methods to increase improved vaccine for production. okay. the challenge was on this flight is to improve a current reagent calibration process. as i said because we make so much and activated vaccine, by so may different manufacturers, it's important that we produce reagents to standardize the amount of vaccine -- the amount of hhs in the vaccine so they're all the same. this process takes that it takes approximate one month during the

normal production cycle to make these reagents, calibrate them and get them out to people. that recently our colleagues at cdc described an isotope solution approach, for quantifying the amount of ha that is in complex virus pictures. so we have set up a multicenter collaboration using not only the cdc and sieber, but also our colleagues at the center for food safety. and what we've done is we set a collaboration to evaluate this technique to determine the absolute quantity of ha and primary influence of standards. and what we hope is if this can be correlate with our current methods, this could shave some time off of this relatively inflexible process of calibrating and distributing reagent. it will not shorten it from many months to one month, but it could shorten this part of the process from a month to several weeks to a few days. so anyway, we're hopeful about this. the bottom part of the slide is to illustrate the current

techniques used to determine the amount of ha and its primary standard using a mixture of total protein determination, gels, takes several days, weeks to do this and compare results from centers were as on the right you have a mass analysis and hours. this is another promising technique to improve the process. another potential bottleneck in the current process regarding the reagent production is the fact that we have to make a strain specific antibody and antigen for every string that we put in the vaccine. typically this works pretty well, but antibody production takes time. it also requires that one be able to grow the virus to sufficient yield, purify the ha off of it, put it into animals and make an antibody. sometimes that doesn't work as well as one hopes. what we have shown here is that as an alternative we can take recombinant techniques in the

absence of the virus, use these recombinant techniques to use vectors and proteins, put them in animals, make an antibody and that antibody will function just as well as the traditional antibody. shown here are three examples of two h5n1 vaccines and the most recent pandemic h1n1, which indicated by these laws, you see an alternative antisera. you see that both are equally good at determining potency of the vaccine. once again, showing that we have alternative to at least one other potential bottlenecks of the process. so now i'm going to turn my attention to the last couple of slides, two ways in which we try to facilitate that the government of new vaccines. as i said earlier and dr. goodman said and many others

have said, new vaccines may be fundamentally different from the current vaccines. that will require that we develop new tools for understanding the response of those vaccines. shown in this light, is a method that we have developed over the last couple of years to use what's called a phase displayed library for delphi the epitopes, protective epitopes to vaccination and to characterize the immune responses to different vaccination strategies. what's shown on the right, if you just look again at the color coding, each little bar is essentially an epitope that is identified to which an immune response, an antibody response. and you can see as you go down the slide, non-vaccines do reduce a number of antibodies that identified a certain number of epitopes, complex with adjutants, you get a much broader response. auto response includes antibodies as well as to other parts of the ha molecule.

what this is showing is that this is a new tool that allows us to both understand the response to vaccination but it also helps us in the design of new vaccine. it helps you to determine vaccination strategy to understand how the response very someone vaccine to another. and finally, repeat myself, new generation vaccines may contain other influence of components that contribute to it protection in addition to ha. it is vital for us in advance of the vaccines coming available that would actually have the tools to both characterize the product and characterized the immune response. show here is something we have done over the last, again, the last year or so where we've have improved the responses to the viral. it is a possible component of new generation vaccines. shown on the far left you see the typical or the existing

current format which really does involve test tube, and each test tube is a one sample. you can see as you go to the right of the slide, it's been put in a 96 little format and the final slide on -- babies on the right shows both sensitive, sensitive in terms of what it can detect, specific for the type of neuraminidase that is being detected. so my last one, and just reemphasized that influenza vaccine development and influenza vaccine production is challenging and we and all of our colleagues are trying in many ways to both speed up the current process and the ball boys to be prepared as these vaccines come online in the future. i will stop there. >> thank you, dr. weir. at this point, i would like to open up to any further questions

for our final two speakers or to any of our panel members from earlier this winter. >> yes, this is where dr. goodman. in europe to use a market strategy for developing vaccines for pandemic. i wonder if you think that would be useful in the united states? >> it's a very complex issue, and there are different laws and regulations in both areas. what you are referring to is the europeans made a template, and it was specifically initially made around h5 which that if you submit to us some initial data about a vaccine that could function with any pandemic strain, we will then provide a regulatory pathway where you can plug in the pandemic strain that emerges and the data will be limited. i would just date that we actually do a similar thing and

it's not involve the same. so for example, when we do what's called a strain change, essentially all that the -- so if we appreciate i would a vaccine with vaccine technology and the manufacture can just come along and show us, here's what we are swapping into that for a new virus that emerged, that's an accelerated process that, you know, and they can just take days or weeks, the penny on the issue. so i think we have a parallel to that. i think our preference is to get as much information as possible before a pandemic to understand the safety and effectiveness of the vaccine, to have assigned to be strong. if we don't have enough data to be an approval standard as i said, we can look at a vaccine for emergency use. but i think we don't -- we're also conscious of not confusing people by having some vaccines out there that we might know

less about and have less certainty about and others without being really clear about that. but i think it's partly a result of different systems and laws and that we do do something similar. so for example, without that, we did -- i believe we were the first country to license a vaccine in the world this year. >> any other questions here in the room? yes. >> it sounds like in the next couple of years vaccine for the flu are going to become all the more complex and will have more vaccines, we will have adjuvants. from a practical point of you getting this out into clinical practice, i mean, who's going to be setting the guidelines for what issues, when and for whom? >> again, the answer to that is going to be competent because you're dealing with multiple products. i think the actual efficacy

safety scalability of it alone is going to do a lot to what is determining what the relevant rank order of what's going to be used out there. certainly, products will be submitted to the fda, and i will leave it to jesse to make that amplified a bit on the. you know that influenza that we give out seasonally, and i don't think many people really fully appreciate that, what happened this year with age when anyone is a very, very different from what happened yearly on a seasonal basis where the pharmaceutical companies that get licensed product produced it and it gets ordered to the tune of about 90 percent of what goes out there is a direct relationship between the pharmaceutical companies and private distributor's, and only about 10 percent of it is bought up by the cdc almost on an

emergency basis. so it really is the competition of the market, if in fact you have a licensed product. i really don't see, and less jesse wants to contradictory on this and i would be happy, that the federal government is going to recommend a particular product among a group of products that are actually licensed by the fda. once you get licensed by the fda, and you're in the arena of the private enterprise, i think you're going to see the same sort of competition in the market that you actually see with any other product. jesse, am i off base on that? >> no, i think that is correct or i think the signs will drive the public health recommendations. and also the approvals. so it's very important to recognize that all of these different candidates may have optimal use in different settings, different populations and for different viruses. so we've heard how adjuvants may be very important for some populations were some viruses, but not for all.

we know that, for them, the live vaccine which manufactures spectacular well this year and is a great vaccine for young people, however, that vaccine, you know, there is less evidence to support it in the elderly, so that is currently only recommended in children and young adults. so i think we're going to have to see where the science comes out and have it driven by the science. it's true that once it is approved, the marketplace is the primary driver. however, also our advisory committee and particularly cdc's advisory committee on immunization practices makes widely recognized public health recommendations about what the best strategy to use the available vaccine. and i think there will be an opportunity again to have the signs dried it best preventive behavior out there.

>> and a translates to how they perform. i think jesse was alluding to how they perform, the different populations. but even, the past several years, the advisory committee has been in discussion about broadening the standard trivalent vaccine. now there is increased capacity come is the potential that there was an additional strain that could be put in it. so there is the idea is that i think what we see now is a whole range of technologies that are going to be providing a new generation of vaccines that are going to perform differently. i think what we hope to see is those with the best performance will have the best market. >> a question online. >> we have another question. this is for dr. goodman or dr. weir. will you please give additional details regarding which is a new technologies that will require developing new entity, how long you've got that to take and how much additional time that is likely to add to bring the new

technology to market? >> let me start. first, if the way the vaccine is working is by inducing a response against the standard origins of hemoagglutinin, i think we don't need new and that and that can follow the accelerated program at the. i think we will see again some of the pulmonary science developed so this is changeable to know what we see in clinical trials, so there may be other approaches, but i think when you start looking at molecules we don't understand the protective response potentially, cellular immune response, responses to these proteins and nuclear proteins, i think for their ultimately we're going to depend on like we did previously on evidence from clinical studies that showed effective in

producing -- in protecting people against flu. that will not hold up development in a sense, but it will mean, and i think rightly, because until we have those we will not know that they protect people. so it will mean that we will have to see that they protect people, you know, infrequent that does take a large clinical study during an influenza season. so it sort of deprives us of being able to speed the process by a year or two with the vaccine we really understand the enemy in response to one where we will have to follow more standard process. now, what we are all doing, and i age, manufactures, and to the extent that we can facilitate it, is we could develop a clear cartlidge protection for some of these other responses, and we may be able to do some of that sooner rather than later, then there's the potential for more accelerated pathway. but i think science is what it is. we can't go saying something is effective until we know that.

>> any other questions? okay. well, that brings us to the end of our program today. i would like to remind everyone that the video of today's session, along with a transcription of the presentations from today will be posted online within the next few days. and will be available on the web at www.flu.gov. so with that i would like to thank all of you for attending today. in particular are presenters are spending a couple of hours with us this pointer and for being here. and with that i will bring today's section to close. thank you very much. [inaudible conversations] [inaudible conversations] to turn to defense spending. the measure is an agreement by

house and senate leaders to spend about 2% more on defense department programs this year. it includes funds for the wars in iraq and afghanistan, as well as a number of nondefense items. the bill contains temporary extensions for a number of brogue rants about to expire, including patriot act and highchairs and provisions. off the floor negotiations continue on health care, and democratic leaders say they hope to bring the measure back, maybe this weekend. currently several senators have gone to copenhagen for the united nations climate change talks. live senate coverage now here on c-span2. the presiding officer: the senate will come to order. the chaplain, dr. barry black, will lead the senate in prayer.

the chaplain: let us pray. o god, from whom all noble desires and all good counsels do proceed, crown the deliberation's of our lawmakers with spacious thinking and with sympathy for all humanity. as they face perplexing questions, quicken in them every noble impulse, transforming their work into a throne of service. lord, shower them with your blessings, enabling them to see and experience evidences of your love. may their consistent

communication with you radiate in their faces, be expressed in their character and be exuded in positive joy. sanctify this day of labor with the benediction of your approval. we pray in your great name. amen. the presiding officer: please join me in reciting the pledge of allegiance to the flag. i pledge allegiance to the flag of the united states of america and to the republic for which it stands, one nation under god, indivisible, with liberty and justice for all. the presiding officer: the

clerk will read a communication to the senate. the clerk: washington d.c., december 17, 2009. to the senate: under the provisions of rule 1, paragraph 3, of the standing rules of the senate, i hereby appoint the honorable kirsten gillibran, a senator from the state of new york, to perform the duties of the chair. signed: robert c. byrd, presidet pro tempore. mr. reid: madam president? the presiding officer: the majority leader. mr. reid: following leader remarks the senate will resume consideration of the motion to concur with respect to h.r. 3326, the defense appropriations act. the first hour will be equally divided and controlled between the two leaders or their designees. the republicans will control the first 30 minutes. the majority will control the next 30 minutes. we filed cloture on the motion to concur. that vote will occur sometime in the next 10 or 12 hours. madam president, we're going to finish this health care bill before we leave here for the holidays.

we're nearly -- for nearly an entire year we've reached out to the other side, offered republicans a seat at the table, tried to negotiate in good faith. nearly a whole year. now we're closer than ever to fixing a badly broken system and doing more to make sure every american can afford to live a healthy life. republicans have made their point through obstruction manuals, missions they believe is good for stalling for electoral politics. tkpwapl mutts like we saw -- gamuts we saw yesterday. they made their point to the american people. they made it perfectly clear that they have no interest in cooperation or legislating. but families and businesses who are suffering have no time for these games. that's why we'reing going to fih health care whether the other

side cooperates or not. health care isn't the only critical issue this body faces. it is not the only issue for this country or this body. right now we have to complete a bill that supports fighting men and women this have country, whether they're in iraq, afghanistan, korea, japan; all those many bases where tens of thousands of people are stationed. it's as simple as that. here's some of the good things in the bill that is now before the senate. message of the conference report from the house. funds more than $100 billion for operations, maintenance and military personnel requirements for the waors in iraq and afghanistan -- for the wars in iraq and afghanistan. more than $23 billion for equipment used by our service members in iraq and afghanistan to do their jobs and stay saefplt more than $150 billion

to train our troops and prepare them for battle. more than $30 billion for the health care of our service members, their families and their children. it also gives our brave and valiant troops a pay raise, 3.4% this year. this is not a partisan issue. yesterday this bill passed the house 395-34. more than 90% of democrats voted for this bill. more than 90% of republicans in the house of representatives voted for this bill. that's because they know that our fighting men and women, those brave americans half a world a way, a lot of them, wage two wars on our behalf. it is up to the leaders to give them all the resources they need, progressives or conservatives.

surely our troops on deployment after deployment spend more time counting the days until they can see their loved ones again than they do counting political points scored by either side. they don't care most of the time, madam president. they just do their job. the house proved as much yesterday. the senate should do the same today. we received this bill yesterday at 2:00 p.m. are we really going to wait until tomorrow to pass it? this simply is not right. let's give our troops what they need to succeed and do it now, and then let's get back to giving all americans what they need to stay healthy. these two bills, these two pieces of legislation are about life and death. our responsibility is too great to waste time playing political games.

mr. mcconnell: madam president? the presiding officer: republican leader. mr. mcconnell: madam president, senators on both sides acknowledge thatd health care bill we're -- that the health care bill we're considering is among the most significant pieces of legislation any of us will ever consider. i think, i would argue the most significant piece of legislation certainly in my time here. so it stands to reason that we'd devote significant time and attention to it. indeed, some would argue that we should spend more time and attention on this bill than most, if not every previous bill we've considered. the majority obviously disagrees. why? because this bill has become a political nightmare, a literal political nightmare for them, as

evidenced by more and more public opinion polls, including the "wall street journal"/nbc poll this morning. they know americans are overwhelmingly opposed to it so they want to get it over as quickly as possible. americans are outraged that the majority took their eyes off the ball. americans were told that the purpose of reform was to reduce the cost of health care. instead democratic leaders produced a $2.5 trillion, 2,074-page monstrosity that vastly expands government, raises taxes, raises premiums and wrecks medicare. they want to rush this bill through by christmas? they want to rush this bill through by christmas that does all of these destructive things. one of the most significant, far-reaching pieces of

legislation in u.s. history, and they want to rush it. and here's the most outrageous part: at the end of this rush they want us to vote on this bill that no one outside the majority leader's conference room has seen yet. no one has seen it. that's right, the final bill we vote on isn't even the one we've had on the floor. it's the deal democratic leaders have been trying to work out in private. that's what they intend to bring to the floor and force a vote on before christmas. so this entire process, madam president, is essentially a charade. but let's just compare the process so far with previous legislation for a little perspective. here's a snapshot of what we've done and where we stand on this bill. the majority leader intends to bring this debate to a close as early as this weekend -- four days from now -- on this $2.5 trillion mistake.

no american who hasn't been invited into the majority leader's conference room knows what will be in the bill. the bill has been pending business of the senate since last november, less than four weeks ago, but we've actually only started the amendment process two weeks ago. just two weeks ago on the amendment process. we've had 21 amendments and motions, less than two a day. so let's look at how the senate has dealt with previous legislation arguably of lesser consequence than this one. no child left behind in 2001, 21 session days or seven weeks, 44 roll call votes, 157 amendments offered. the 9/11 commission homeland security act in 2002: 19 session days over seven weeks,

20 roll call votes, 30 amendments offered. the energy bill in 2002: 21 session days over eight weeks, 36 roll call votes, 158 amendments offered. now, madam president, this isn't an energy bill. this is an attempt by the majority to take over one-sixth of the u.s. economy, to vastly expand the reach and role of government into the health care decisions of every single american. and they want it to be done after one substantive amendment. one large, substantive amendment. this is absolutely inexcusable. i think senator snowe put it best on tuesday. this is what she had to say tuesday of this week: "given the enormity and the complexity," senator snowe said, "i don't see anything magical

about the christmas deadline if this bill isn't going to become law until 2014." and i think senator snowe's comments on a lack of bipartisanship at the outset of the debate are also right on point. here's what senator snowe said in november of this year, late november -- quote -- "i am truly disappointed we are commencing our historic debate on one of the most significant and pressing domestic issues of our time with a process that has forced all our ability to arrive at a broader agreement on some of the most crucial elements of health care reform. the bottom line is the most consequential health care legislation in the history of our country and the reordering of $33 trillion in health care spending overt coming decade shouldn't be determined by a one-vote margin strategies. surely -- surely -- we can and must do better."

well, senator snowe is entirely correct. the only conceivable justification for rushing this bill is the overwhelming, overwhelming opposition of the american people. democrats know the longer americans see this bill, the less they like it. here's the latest from pew. it came out just yesterday. a majority -- 58% -- of those who have heard a lot about the bill oppose it while only 32% favor it. there is no justification for this blind rush except a political one. and that's not good enough for the american people. and that's not justification for forcing the senate to vote on a bill that none of us have seen. americans already oppose the bill, the process is just as bad. it's completely reckless and completely irresponsible.

madam president, i yield the floor. the presiding officer: under the previous order, the leadership time is reserved. under the previous order, the senate will resume consideration of the house message with respect to h.r. 3326, which the clerk will report. the clerk: house message to accompany 3326 an act to make appropriations for department of defense for the fiscal year end 2010 and for other purposes. the presiding officer: under the previous order, senators are permitted to speak for up to 10 minutes each with the first hour equally divide and controlled between the two leaders or their designees, with the republicans controlling the first half and majority controlling the second half. a senator: madam president? the presiding officer: the senator from arizona. mr. mccain: madam president, i ask to -- unanimous consent that the senator from tennessee lead

in a colloquy, including the senator from oklahoma, the senator from wyoming, and myself and the senator from kentucky. the presiding officer: without objection. mr. alexander: well, i thank the senator from arizona. i was thinking when i listened to the -- i wonder if the senator noticed the california governor's comments on sunday. governor schwarzenegger said that he supports the idea of overhauling health care, but -- quote --"the last thing we need said governor schwarzenegger is another $3 billion in spending. he was referring to one of the unintended consequences of this bill which is the big state costs of medicaid being shifted to the states. here's governor schwarzenegger's advice following up the comments of the leader. so i would say be very careful to the federal government. this is from the govern or of california. before you go to bed with all of

this, let's rethink it, said governor schwarzenegger. there is no rush from one second to the next. let's take another week or two. let's come up with the right package. i wonder if the senator saw this. mr. mccain: i thank the governor of tennessee. i recognize that you understand this better than anyone having been a governor and realizing the challenges that the governors face. governor swartz anything thatter ianything-- schwarzenegger -- democrats blues grow deeper in new poll and then support for health care overhaul weigh in. some remarkable information concerning the mood and views of the american people following on a "washington post"-abc news poll out yesterday that 51% of americans say they oppose the

proposed changes to the system. 44% approve. thanks to the efforts of so many people, including our leadership, we have turned american public opinion because we've been informing them of the consequences of passage of this legislation. let me just quote from "the wall street journal," article. according to -- more american now believe it is better to keep the current health care system than to pass president obama's plan according to a new "wall street journal"-nbc news poll. the findings mark a shift from the fall when the overhaul enjoyed an edge over the status quo. according to the poll, 44% of americans said it's better to pass no plan at all compared with 41% who said it's better to pass a plan. what they're saying is: don't do this government takeover. don't increase taxes, don't

increase spending, don't increase the cost. and it's remark -- it's a remarkable shift thanks to informing the american people. could i mention one other statistic to my -- a couple of other points made in this poll in the -- in -- in "the wall street journal,". in december -- in th "the wall street journal,". in december 44% said that they wanted to have it pass. in december this poll out today only 41% of the american people want it passed and 44% say keep the current system. and then, of course, we have another interesting statistic. trust that government will do what is right. 21% say always, most of the time. 46% say only some of the time. and 32% of the american people

say almost never. and, of course, the -- the anger and disapproval of this health care plan right now is the centerpiece of americans' dissatisfaction of the way we do business. we don't have bail. we don't have a bill. -- have a bill. we don't have a bill. we have been debating and we do not have legislation. this was one of the bills that we were presented with. we know significant changes are being made behind closed doors. we don't have a c.b.o. estimate of the costs? do we? we understand that they keep sending estimates over to c.b.o. and it comes back and so they send them back which is probably why last week the senator from illinois, the number two ranking democrat said to me, i don't know what's in the bill either. i have an exact quote. he would say i would say to the senator from arizona that i'm in the dark almost as much as he is and i'm in the leadership.

that's an interesting commentary. and, of course, the issue of the protection of the rights of the unborn is still unclear. that is a big issue with a lot of americans. it's a big issue with me. and i know it's a big issue with my colleagues. so here we are back off of the bill, itself. and apparently we are going to have some kind of vote on christmas eve or something like that. what the american people are saying now when they're saying keep the status quo, they're saying, stop the. go back to the beginning. -- stop. go back to the beginning. sit down on a bipartisan basis and let's get this done. but let's get it done right. americans know that medicare's going broke. americans know that costs are rising too quickly. but americans want us to do this right and not in a partisan fashion and not with a bill that costs too much, taxes too much and deprives people of their benefits. mr. alexander: the senator of arizona, i thank him for his

comments. and i see that we have the two physicians in the senate, dr. coburn from oklahoma, and doctor barrasso from wyoming. i wonder if they would bear with me for just a minute or two to reflect on something that the majority leader said and the -- what the minority leader said. the minority leader talked about a historic mistake. there's been a lot of talk around here about making history on health care. the problem is there's many different kinds of history as the republican leader -- leader has pointed out. it seems our friends on the other side are absolutely determined to pursue a political come cozkamakazee mission for td states. i did a little research on historic mistakes. we made them before in the united states congress and maybe we'd be wise to take governor schwarzenegger's advice and slow down and learn from our history

rather than try to top our previous historic mistake, like the smoot-halley tariff when it sounded like a good idea to buy american. there was the alien incidition act, we were going to keep the foreigners in our midst, mostly french, from saying bad things about our government. 1969, congress enacted a millionaire's tax they called it to try to catch 155 americans who weren't paying any tax that turned out to be a historic mistake because last year it caught 28 million american taxpayers until we had to rush to change it. and just a couple more. there was the catastrophic coverage act of 1988. that was well named because it turned out to be a catastrophe. a congressional catastrophe.

the idea was to help seniors deal with financial reverses, but seniors didn't like paying for it. they surrounded the chairman of the ways an means committee in -- and means committee in chicago. and then there was the luxury tax on boats over $100,000. another historic mistake. because it only -- it raised about half the taxes it was supposed to and nearly sank the boating industry and it put 7,600 people out of jobs. i would ask my friends from oklahoma and wyoming. it's going to be a lot harder for congress if they try to fix all of this health care system at once to come back and repeal it than it was t to repeal a bot tax. don't you think we should take the time to avoid another historic mistake? mr. coburn: i would answer my colleague from tennessee that as a practicing physician, what i see is the historic mistake is we're going to allow the federal

government to decide what care you're going to get. we're going to divide the loyalty of your physician. no longer will they be a 100% advocate for you. they're going to be an advocate for the government and what the government says. this bill, even the one that's going to come, has three different programs that puts bureaucracy in charge of what you can and cannot have. it doesn't consider your personal health, what your past history is, what your family history is. they're going to say what you can and cannot do. that's called rationing. that's in the bill. that's coming. and that's a historic mistake. because it ruins the best health care system in the world in the name of trying to fix the smaller problem in terms of access. it ignores the real problem. the real problem is that health care in this countryst costs too much. this bill doesn't drive down costs. it increases cost. your premiums go up. your costs go up. your care is going to go down because the government is going to tell you what to have.

that is a historic mistake and we haven't addressed. i wonder what my colleague from wyoming thinks. mr. barrasso: as a physician practicing medicine and taking care of people in wyoming for 25 years, i have great concerns about this bill or at least what we know for sure is in it, which is $500 billion of cuts in medicare to our patients who depend on medicare, and that's a system we know have gone broke. that's why there's a front page story in one of the wyoming papers, "doctor shortage will worsen." it will be harder for rural communities around the country if this goes through. we know that because folks who looked at the parts of the that we have seen, they said that one-fifth of the hospitals if they're able to keep their doors open will operate at a significant loss 10 years from now. that is not the best health care for our country. i had a telephone town hall meeting, people from around the

state of wyoming could ask me questions. said that: what's in the bill? what's coming to the senate? we don't know. we haven't seen it. they said when you know, come home, let's have town meetings so we can have some input into what you think. that's what we ought to dos a a senate. let us go home and see it and share it. so right -- right now the american people are from what they have seen, the 2,000-page bill, the american people believe this will increase the cost of their own personal care. mr. corn: if my colleague would yield. i ask the chairman of the finance committee to agroo to a unanimous consent that in fact at least 72 hours that the american people get to see this bill. that the members of the senate get to see the bill. that there will be a complete c.b.o. score so we can have a complete understanding. he denied that request. that goes to transparency. the american people expect us to

know what we're voting on and have read what we're voting on. and his explanation was that i can't guarantee that. that presumes a certain level of perception on my part and delving into the mind of the senators that they would understand. what does understand mean? that's the kind of gibberish that the american people don't want. they want us to know what we're voting on when we vote on this bill. mr. mccain: isn't that a violation of the commitment made that for 72 hours that the legislation would be online not just for us to see, but for all americans to see. could i ask the senator from kentucky, again, the leader: is it not the perception now that this bill is probably going to be pushed through through various parliamentary procedures that we will -- that the majority will try to force a final vote on this legislation no matter what before we leave?

and isn't that in contradiction to what the american people are saying? mr. mccain: that they want us, the majority want us to do nothing. is this the responsible way to govern? have the senate in around the clock 24 hours? people on the floor. quorum calls and all of this kind of stuff? and, really, there would be no amendments allowed at that time for us to at least address some of the issues of this -- of this bill that begins cutting medicare by $500 billion, increases taxes by $500 billion on january 1 and in four years begins spending $2.5 trillion. is this a process that the american people are not reacting to in a negative fashion, obviously, by polling data. by the way, madam president, i ask unanimous consent that "the wall street journal," article entitled "democrats blues grows deeper in new poll and support for health overhaulway ins be

included in the record. the presiding officer: without objection. mr. mcconnell: i would say to my friend from arizona, with issue to the process, it has been a bit of a charade. in fact, a total charade. we've been out here for two weeks on the amendment process. we've had 21 votes. many have been side by side in order to cover the majority against potential down side on voting to cut medicare and voting to raise taxes, but no serious effort to engage in any kind of genuine amendment process such as the senator from arizona and i have been involved here for quite awhile. then the bill that we're actually only allowed to have about two votes a day on is not the real bill. the real bill is -- well, the we know what the core of it is but there's a lot of things around the edges that are being slipped

in and slipped out. and they want to jam the public before christmas, as the senator from arizona indicated. how arrogant is that? we know better than you. we know better than the republicans. we know better than the public. why don't all of you all, the republicans and the american public, sit down and shut up and leave it to us, and we'll take care of it before christmas. a senator: to the republican leader, the senator from kentucky, there is another bit of history being made. mr. alexander: this isn't very hard to understand. i mean, the proposal is to take 16%, 17% of our economy, affecting 300 million americans. nothing could be more personal, as the kentucky senator has said, than our health care. and we don't have the bill. we do not have the bill.

it's being written in secret in another room. and if there's any part of this debate that went through to every single household in america, i believe it was when the finance committee voted down the motion, the democrats voted down a motion that the bill should be on the web for 72 hours so the american people could see the text, know what it costs and know how it affects them. eight democratic senators then wrote the democratic leader and said we want to insist that we know what the text is, that we have the official score from the congressional budget office, and that we have it for 72 hours before we move to vote. now, we don't have the bill. we don't have the official score from the congressional budget office. 72 hours is three more days. even though eight democratic senators and all the republican senators said we want to know what it costs, know what it is

and know how it affects us, they want to run it through before christmas. mr. mccain: maybe -- could i just mention to my colleague, maybe the reason why they don't want it to be online for 72 hours is because when they examine what we have, on page 324 on this bill, an $8 billion tax on individuals that have nongovernment -- quote -- "approved plans." page 348, a $28 billion tax on businesses that cannot afford to offer to their employees. on page 1979 raises an almost $150 billion tax on many middle-class workers using so-called cadillac health insurance plans. page 1997 will cost families and individuals an additional $5 billion by prohibiting use of savings set aside for health care expenses. paeubg 2010 make the cost more

expensive by charging more. that's one reason why maybe it's going to be difficult for them to win passage of this after 72 hours of examining this 2,000-page bill. mr. mcconnell: it makes this bill, in addition to all its other problems, a job killer. with unemployment at 10%, a big tax increase on a variety of different americans, as senator mccain just pointed out, in addition to all its other problems -- its substantive problems, process problems, it's a job killer in the middle of a difficult recession. mr. coburn: i say to my colleagues, the lack of transparency, one of the things my friend, president obama, said he wanted to have is transparency. there's been no transparency in this process. if there's not going to be

transparency in the process, we ought to at least have it transparent to the american people for 72 hours. even the quote from the chairman of the finance committee is i think it's impossible to certify that any senator will fully understand. here we're going to have a 2,000-plus-page bill and the chairman of the finance committee says tepbgz's going to be -- tepbgz's going to be -- it's going to be impossible for any senator to certify they fully understand this bill. if we don't understand it, you can bet the american people aren't going to understand it. mr. mccain: enough americans are beginning to understand it that they don't want it. that's thanks to the efforts that have been made all over this country to educate the american people about what the impact of this bill would be. mr. barrasso: following along what you're saying, that's why the support right now of the american people for this bill is at an all-time low, the lowest

level of support ever. this is the new nbc poll out yesterday, fewer than one out of three americans support this bill. they don't know what's in it but they sure don't like what they see so far because they all believe, overwhelming numbers believe their own cost of their own care will go up, that this will add to the deficit, will hurt the economy, and that their health care would actually be better if we pass nothing. so why would the american people support a bill that's actually going to cost them more personally and their health care is going to get worse? that's not the value the american people have ever wanted. so, you know, that's what i hear from my patients at home. that's what i hear at telephone town hall meetings. that's what we're hearing in all of our states. that's what the american people continue to say: do not pass this bill. as our leader said, we do need health care reform. dr. coburn certainly knows that, but it's not this reform that we

need. mr. alexander: we come to the floor every day and pointing out the problems with the bill. we've done that today. one, we don't have the bill, can't read it, don't know how much it costs, don't know how it affects the american people. we point out that it raises taxes, raises premiums. it will increase the debt because it doesn't include a lot of things like the physicians reskpwurplt. and -- respwurplt. and it -- reimbursement. but we also point out what we think should be done. what we think should be done -- colleagues pointed it out many times -- instead of wheeling in another 2,000-page bill, we should focus on the goal of reducing costs and take several steps towards reducing costs. the senator from arizona talked about one of those, reducing the number of junk lawsuits against doctors. i don't think that's in the bill unless it's secretly being added in the back room today. mr. mccain: that's one i doubt is being added.

again, i also want to point out americans are now against passage of this legislation but in that polling data, it's very interesting also. the the majority of seniors by much larger numbers, the actual beneficiaries of medicare are turning against it. and the intenseity of americans against it, which is hard tore gauge in a poll -- harder to gauge in a poll, is incredible. if the responses that our efforts are getting are anything indicative of the mood of the american people and the intensity of it, it is probably as great as i have ever seen in the years that i have had the privilege of serving in the congress of the united states. and this polling data says more americans now believe it's better to keep the current health system than to pass president obama's plan is the

message that's being sent. and the intensity of it is higher than any i have etch observed in my -- ever observed in my years of service. i thank them for it because there's a chance -- there's a chance -- that we could stop this, beginning in january we'd be willing to sit down together, negotiate with the c-span cameras, with the c-span cameras as the president committed that he would do as a candidate, and we'd sit down together here, at the white house, anywhere, and fix this system which we all know needs fixing because as the senator from oklahoma saeed, it's the -- oklahoma said, it's the cost that has to be addressed, not the quality. mr. coburn: i'd like to bring up an example. we have the u.s. preventive health task force put out a recommendation on breast cancer screening through mammography on

the basis of cost. and what they said was, is it's not cost effective to screen women under 50 with mammograms because you have to screen 1,900 before you find one breast cancer. but comparing -- and on cost, they're right. but over 50 you have to screen 1,470. so what we had was a decision that was made on cost, not on quality, not on patients. but based on cost. we fixed that as part of an amendment to this bill. we actually fixed that. there's three different agencies within this bill that are going to do the same thing. and every time they make a ruling based on cost, not based on clinical outcomes and what's best for patients, are we going to fix it? we're transferring the care of the american patient to three bureaucracies within the federal government, and they're going to

decide what you have to do. and if you think about it, just this week a member of this body's wife was diagnosed with breast cancer, and she was diagnosed through a mammogram. and under that task force recommendation, she wouldn't have gotten it. mr. mccain: could i ask the senator from oklahoma, would that aspect of this bill come to light if it hadn't been for the recommendation that was made by another but similarly acting policy-making body? in other words, that's what's triggered the investigation of what was in this bill which would have had exactly the same effect. so if we hadn't had that information of a recommendation by another government policy-making bureaucracies we would not have known about this until the bill would have actually taken effect. mr. coburn: so there is no transparency. and what we do know that is

transparent is that we're going to have three organizations -- the medicare advisory commission, the cost comparative effectiveness panel and the u.s. preventive task force -- that's going to tell everybody in america what they're going to receive. mr. mccain: this would never have been known if it hadn't been for the actions of the bureaucracy. doesn't that bring into question what else is in this legislation? coburn what are the unintended consequences of this, they don't know. what we know is there are 70 new government programs that with 1,690 times when the secretary of h.h.s. is going to write rules and regulations about your health care in america. mr. coburn: the secretary. not your doctor. not your doctor is going to write the rules and regulations about what your best care is. the secretary of h.h. is s. is going to -- the secretary of

h.h.s. is going to write the rules. mr. mccain: the majority leader keeps bouncing proposals to c.b.o. back and forth. that's why we don't have c.b.o. information now for many days. but there is the committee -- commission for medicare and medicaid that clearly points out that this legislation would increase taxes dramatically, increase costs dramatically, and decrease care and would have the effect of forcing people not only out of the system but even if they're in the medicare system, they would not have physicians to provide the care because more and more physicians would fail to treat medicare patients. mr. coburn: we go back to the 72 hours. we're going to get a new bill. we're not going to have the opportunity to amend it. we're not going to get the time to read it and study it. the american people aren't going to get the time to read it and study it. what do you think the outcome of that is going to be?

mr. mccain: i think we know what the outcome -- we'll either be able to reflect the feelings and the intense feelings of the american people about the -- the majority of the american people about this legislation and say let's go back to square one. let's all commit to a bipartisan approach to this issue. or we will see jammed through on christmas eve legislation that will have the most far-reaching effects and devastating effects i think not only on our ability to provide much-needed medical care to all of our citizens, but also impact that would be devastating on the debt and the deficit which we have already laid an unconscionable burden. we really have two choices here, it seems to me: go back to the beginning, enact many of the reforms we could agree on. and there's many of them that we could agree on immediately on a bipartisan fashion.

and as the senator from tennessee pointed out, there has never been a fundamental reform made in the history, modern history that was not bipartisan, or we're going to see jammed through over the objections of the majority of americans, thraegs they've never seen nor read. or understand. so that's really the choice between us. that's really what this choice is boiling down to. and i think that, frankly, the american people should be heard, not the majority over on the other side. mr. barrasso: the american people are saying, don't cut my medicare, don't raise my taxes, don't make things worse than they are right now. and this bill cuts medicare, raises taxes, and for people depending upon a health care system in this country, this makes things worse. mr. mccain: by the way, could i mention, you know, if you live long enough, all things can happen. i now find myself in complete

agreement with dr. howard dean. who says that we should stop this bill in its tracks. we should go back to the beginning and have an overall bipartisan agreement. dr. dean, i am with you. the presiding officer: time has expired. the senator from pennsylvania. mr. specter: mr. president, i ask consent that i may speak up to 20 minutes. the presiding officer: without objection. mr. specter: i have sought recognition to speak about the patient protection and affordable care act. and it has been an extraordinary legislative process with a good bit of the calendar year, 2009, taken up with very intensive work to try to pass health care reform. and at the moment there is still some doubt as to what will happen with the bill. the congressional budget office

has not yet submitted a report on the so-called managers' package. and there's still some concerns being expressed by some senators. and i can understand the frustration that some have had as we have moved away from a public option. i have been an advocate of a robust public option and think that it ought to be part of the legislation. the public option is just what it says. it's an option. there have been efforts made to demagogue the issue by saying it is a takeover by the federal government. well, it is not. the private insurance industry remains in the field. and this is one option. as president obama has put it, it is an option to try to keep

the private insurance companies honest. we have seen in the past several months very large increases in premiums for small business. and the reports have been that those increases in premiums have come from wall street pressure on the insurance companies to try to increase their profits before their is a legislation. well, the public option would be a forceful actor dealing there. when the objections were raised to the public option in an effort to find 60 votes, and i is difficult when you have no help at all from the republican side of the aisle illustrated by the performance just put on on their prepared colloquy.

it is -- it is not easy to find everyone in agreement. and then there was an effort to move to expanding medicare. and i think that is a fallback position that would have been very, very helpful. and there are some who are contending that people who are disappointed from the lack of a public option -- disappointed from the retreat of expanding medicare to say that we ought to start over and begin again. and i can understand that frustration. my own view, after thinking it through very carefully, is that we ought to proceed and do as much as we can this year. realizing that some of this health legislative achievements take a period of time to

accomplish. the civil rights act of 1957 was necessary, although it didn't go as far as people would have liked then to get the civil rights act of 1964. again, didn't go as far as people would have liked. but we did find the civil rights act of 1965. and we have to find times when we have to build incrementally on these matters. and i have been in the senate following the elections of 1980, and i've seen matters take a very, very substantial period of time. while it's not on the subject, trying to -- trying to provide more than 100,000 jobs in pennsylvania by deepening the chanel. and the authorization came in 1983. it took until 1992 to get the corps of engineers to agree. then funding, now has $77 million, and we are still in court.

but it is going to move forward. i don't expect health care legislation to take that kind of a long term, but -- but it is a matter which does take some time. it is my hope that we will, yet, improve this -- this bill. it is my hope that when the bill goes to conference, that we will find a way, perhaps, even to bring back the public option in a refined sense. the public option is in the house bill. one republican senator who has stated opposition on the ground that there hasn't been time enough to review the bill. well, it is complicated. i think there has been time enough to review the bill. but i respect the view of the senator on the other side of the aisle and when the bill goes to conference, that senator will have an opportunity to review the bill further.

and that senator has shown some inclination to support the bill having voted it out of the finance committee. another republican senator has commented that the bill has been very greatly improved. not sufficiently for the taste of that senator, but perhaps we will find a way -- a way to improve the bill. and we still do have a bicameral legislature. we do have the house of representatives which has the public option. comments were made about the fall of the expansion of medicare on the ground that it was considered in too brief a period of time. not enough time to digest it. not enough time to think through it. well, we'll have -- the month of january. some time to consider that further. and in conference we may well find that we're able to improve the bill. now, we can't get to conference

unless we pass the bill out of the united states senate. i was asked yesterday: how will i respond to my constituents if we have the bill which has had so much taken from it? and i said, a morrell vent question or equally relevant question is how will i respond to my 12 million constituents in pennsylvania if we go home with -- with nothing? and that if we have 80% accomplished, then -- then that's a great achievement or it is a starting achievement. and it may well be that it will take the campaign in 2010, if this united states congress will not pass a bill with a robust

public option, could well be a campaign issue. i believe that my colleagues on the other side of the aisle may well be misreading the american people. i believe the american people do want health reform. and it does take time for the american people to understand the ramifications of it. but this may well be a campaign issue in 2010. and the 111th congress may have a different view as to how we ought to proceed. during the month of august, when i was making the rounds of town meetings in pennsylvania, in accordance with my habit to cover almost every county, almost every year. when i got to the first town meeting, the second tuesday in august, first week we were in recess, i found instead of the customary 85 or 100 people, more

than 1,000 people and three national television sound trucks, cnn, msnbc and fox. and there were two -- one man approached me, said that the lord was going to stand before me. i think he got mixed up. i think he meant to say that i was going to stand before the lord. senators are reputed to have power, but not quite that much power. well, i think the public tenor is considerably more favorable to health care insurance today than it was then. and after the 2010 election, it may be substantially more favorable. but i think we have to move ahead with building blocks. and we do have the chance to approve the bill in conference -- improve the bill in conference. i would point to the provisions of the bill as to what we have. we have very significant insurance reforms.

eliminating discrimination based on preexisting conditions. we have new health insurance exchanges. we have an elimination of a cap. we cover many of the uninsured, expanding to some 33 million additional people. substantial more small business assistance. preventive care. increased health workforce. we have improvements in the health delivery system. we have fiscal responsibility. that this bill will not add to the deficit, it will, in fact, reduce the deficit in the first decade by $120 billion and in the second decade b by $650 billion. we have a provision that i have pressed in earlier legislation, senate bill 914, that to provide

for transformational medicine. during my tenure as chairman of the appropriations subcommittee on health and human services, i took the lead with the concurrence of senator harkin, who was then in the minority, to increase n.i.h. funding fro from $12 billion to $30 billion. and then in the stimulus package to add $10 billion more. and there has been a gap on what we call transformational medicine, going from the so-called bench in the laboratory to the bedside. and while i haven't seen the final version of the managers' package, i'm informed that that provision will be a part of the bill. we have very important measures for preventive care, for annual exams, which will cut off many chronic illnesses which are so debilitating and so expensive.

i have pressed a -- an amendment, which is pending, to have mandatory jail sentences for at least six months for someone convicted of $100,000 or more of medicare or medicaid fraud. and jail sentences are a real deterrent. the experience i had as philadelphia's d.a. has showed me that when you have a fine that's added on to the cost of doing business, passed on to the consumers -- i would ask consent that the statement of the provisions which i briefly summarized, which are very favorable in this bill, and a statement of testimony in a criminal justice subcommittee hearing be included showing the value of -- of deterrence. the presiding officer: without objection. mr. specter: mr. president, how much time do i have remaining?

the presiding officer: the senator has seven minutes remaining. mr. specter: i thank the chair. mr. president, there is another very, very important aspect, in my opinion, of the senate enacting legislation on this bill. and that is we were sent to washington to govern. and what we have seen in the recent past has been a staggering partisan politics. partisan politics became a blood sport in washington, d.c.. some blood sport on the floor of the united states senate, pervades the entire town. and the point from the republican side of the aisle has been very clear.

that is, to make this president obama's waterloo. to make this -- to -- quote -- "break president obama." and i saw the ramifications when we took up the stimulus package earlier this year. and there were only three republicans -- senator snowe, senator collins, and myself -- who would even talk to the democrats. and there was a determination to look ahead to the 2012 elections on the presidency even before the ink was dry on the oath of office taken by president obama on january 20. this was the second week of february, the wao*efbg february 6, as i re -- the week of february 6, as i recall, just a

couple of weeks, and already the plans were for the next election. as i reviewed the matter, it seemed to me we were on the brink of going into a 1929 depression. the 1929 depression was very hard on the specter family, living in wichita, kansas, at the time. both of my parents were immigrants. in the mid-1930's the family moved from wichita to philadelphia to live with my father's sister. that's what happened in a depression, you moved in with relatives because there were no jobs. i sided with supporting the stimulus package and played a key role in having that enacted. and the political consequences on a personal level are not something to be discussed in this forum at this time. but the conduct of partisanship on the stimulus package is

directly relevant to what we're doing here today, and that is we're being stonewalled. and i think it is harder for a republican to stand up on health care reform and join the democrats today than it was in january and in february, when three of us did so. and if i were on the other side of the aisle today, i would be supporting health care reform. i would be supporting it. and perhaps if i were on the other side of the aisle today, i could bring somebody with me. i don't know. that's entirely speculative. and without revealing any more of the confidence which went inside the republican caucus when i talk about a republican senator's statement of this should be the waterloo of president obama, and this should break him, those are matters in the public record.

but the pressure over there on the republican caucus is absolutely intense. and we were sent here to govern. and a democratic caucus and the presiding officer, the distinguished senator from colorado, was there on monday evening when my turn came to speak, i said i have two sentences. and may the record show a smile on the face of the presiding officer. i said i have two sentences. one sentence is that the bill is a great deal better than the current system. and the second sentence was we should not let obstructionism prevent us from governing. and that's why i crossed the aisle to make the 60th vote. and very surprised it's been in the public record, been in the newspapers, everybody stood up and applauded and i read in one of the hill newspapers today that you could hear the applause

down the corridor. they knew what was going on. well, that's the rule, it seems -- the role, it seems to me, of a united states senator. and we are facing a situation where if defeated, we'll have a significant impact on the tenure of president obama. we had a meeting on tuesday, two days ago, in the executive office building, and it was rather a remarkable setting. it was a large rectangular table, and in the center on each side, one side was president obama, the other side was vice president biden. and almost all of the 60 senators were present. i think senator byrd couldn't be there because of his ailment, but i believe everybody else was present. and during the course of that

session, the president expressed himself. this has also been publicized -- that if action was not taken now that twos discourage -- that it would discourage anyone in the forseeable future, any president from undertaking health care reform. if now you can't get it through the senate and get it conferenced and get it enacted. and some of those who were most vocal urged -- most vocal in favor of the public option urged those in the caucus who disagreed to reconsider their position. and i would renew that request, that they reconsider their position. and the people who classify themselves as most progressive in the democratic caucus have swallowed hard and have announced publicly that they would support this bill, even though it doesn't have the

robust public option, doesn't have the medicare expansion. and that may, that may, that may shift yet. but we have an enormous number of problems facing this country. i think it is fair to say, accurate to say -- 30 seconds more, mr. president? the presiding officer: without objection. mr. specter: -- fair and accurate to say there are more pressing problems confronting united states today than at any time in our history. we have to finish health care next year to move ahead to jobs. we have the issues of global warming and climate control. we have the problems of the mideast peace process, the difficulties in iran and north korea and afghanistan. we need a strong president, and we need a congress which has the courage to act and the tenacity, willingness to confront tough

problems. and we need to show the american people that it's not all gridlock here, that it's not all desperate, tkes lute partisan politics. so my vote will be in favor of the bill although i am, frankly disappointed and share the frustration of people who say go back and start again. this is a significant step forward. we have a great chance to improve it in conference. beyond that, there will be another congress. with the analogy of civil rights legislation, we can get the public option and get greater governmental involvement for the benefit of the american people. i thank the chair and yield the floor.

mr. president? the presiding officer: the senator from pennsylvania. mr. specter: in the absence of any other senator seek recognition, i ask consent to speak for up to three minutes on another subject. the presiding officer: without objection. mr. specter: mr. president, there has been a wide publicity given to three young americans who were taken into custody by iran and with the recent reports that they are going to be tried in an iranian court. senator casey and i in the senate introduced a resolution urging the iranians to release those three young americans. congressman allison schwartz did so on the house side and it passed. it is my hope that iran will change its view. i was talking to the syrian ambassador yesterday who advised me that when the five british citizens were taken into custody

by iran, the government of great britain made a request to the syrian government to use their good auspices to secure the release of the five british citizens. that request was made via syria and they were released. i have written to the state department that afternoon to find out the status of u.s. activity. because if we have not asked the syrians for help, my view is we should. it would be my hope that with the very difficult problems facing the united states in iran that iran would relinquish the custody of those three young americans and release them to their family and friends especially at this time of the year. and i have been an advocate of dialogue with iran for years.

i have tried to go to iran since 1989 when the iran-iraq war ended. senator shelby and i got to iraq and met saddam hussein. as yet we have not had an interparliamentary exchange which i have sought for a long time with the iranians. it would be my hope that iran, for humanitarian reasons, would release these people and that we would exercise our best efforts -- the united states government -- working through syria or whatever other channel we could find to secure their release. i yield the floor.

i suggest the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call:

quorum call:

quorum call:

a senator: mr. president? the presiding officer: the senator from oklahoma. a senator: i ask consent the quorum call be suspended. the presiding officer: without objection. mr. durbin: before the senate now is the issue of funding our military, the department of defense appropriations bill. this is a bill that's critically important because it provides the funding that our men and women in uniform now risking

their lives while we meet in the safety of our business and offices and homes here in america, it's funds that they need to make sure that they will be safe, perform their missions effectively and come home. and without fail, every year this bill comes before the senate and is a consensus bipartisan bill, because regardless of our debates over foreign policy, we all want our men and women in uniform to know we stand behind them. and as a consequence, this bill usually passes with an overwhelming number. i asked, if i have it here handy -- yes, i do. i asked how this bill fared in the house of representatives when it was considered yesterday. the vote was 395-34. there were 164 republicans who voted "yes" on this bill. it was clearly an overwhelmingly positive bipartisan vote, and

there's no reason why it won't be the same here in the senate. but there's a problem, and the problem is this: tomorrow the funding for our troops runs out. it's the end of our continuing resolution and funding. now we're not going to leave them high and dry, but we are going to leave them uncertain if we don't act decisively and quickly. why would we do this to them? military families across america, as we go into the holiday season, i'm sure are saddened by the absence of their loved one who may be in iraq or afghanistan, saddened by separation from children and other loved ones that they would like to avoid in their lifetime but they've offered it up for this great country. with this kind of uncertainty and sadness and emotion, why would we be uncertain when it comes to funding our troops? here's where we are. we offered this yesterday. we said let's vote for t. let's

vote for our troops and get this behind us so the department of defense was clear. and the other side of the aisle said "no." we want you to go through all of the hurdles that you have to go through under the procedure of the senate for the most controversial bills. we want you to file a cloture motion which means there cannot -- it would put an end to a filibuster. it can't continue. we want you to fill the tree with amendments so that it isn't -- this bill pw*eul isn't a -- this bill isn't assaulted. the terminology would lose most people, including many senators. the bottom line sth-rbgs instead of doing -- is this, instead of doing what we know needs to be done and should be done, the republicans have insisted we delay this process for at least two days. why? why would we want to delay funding our troops in the middle of a war? why would we want to say to our troops that military pay raise that you were counting on so your families can get by back at home and for those stationed in

the united states, make sure that they have what they need, why would we say to them that we are going to raise a question as to whether or not we are going to put $29.2 billion into defense health program, the health program for our military members and their families? why would the republicans insist on delaying a vote for $472 million for family advocacy programs for military families who are separated, many of which are going through extraordinary stress because of the separation? why would they want to delay a pay raise for the military? why would they want to delay $154 for equipment and training for our military? i don't understand it. it would seem to me that we ought to come together by noon today and say let's do this. let's is not waste another minute in terms of helping our

troops and showing them we stand behind them. but, no, the decision has been made on the other side of the aisle that we're going to delay this matter until tomorrow. they say in politics for every decision there's a real reason and a good reason. well, there may be some good reason that they're giving on the other side of the aisle for delaying funding our troops. the real reason is their hope that they can stop health care reform in the senate. that's what's behind this. and the lengths which those on the other side of the aisle will go to were demonstrated yesterday. we had this defining moment when the leadership on the senate republican side insisted through senator coburn through oklahoma that an 800-page amendment be read by the clerk of the senate. it is the right of a senator to ask for that. it's an archaic right because people don't sit here hanging on every word to understand an amendment. that never happens, and it didn't happen yesterday. but the clerk started reading,

and almost two hours into it it was pretty clear that it would take ten hours to finish this 800-page amendment despite the best efforts of the clerks' office. why did the senate republican leadership want to take ten hours out of a day for something that was meaningless, the reading word by word, line by line, page by page of an 800-page amendment? to stop debate on health care reform. during that time no one could debate it, no one could amend it. the republicans have conceded they are finished with the debate and amendment phase of health care reform. they have decided now that the only thing they could possibly do is to delay everything the senate could consider in the hopes -- in the hopes -- that maybe we get tangled up with our desire personally to be home with our families during the holidays and don't do our duty here. well, they're wrong. we're determined to do this. we're determined because health

care reform for this country is so absolutely essential. the presiding officer, senator kirk, of massachusetts, has an awesome assignment succeeding the late senator ted kennedy whom he counted as a close friend and served as a member of his staff. in our cloakroom is a cover of "time" magazine where senator kennedy is looking out with that smile on his face saying "we're almost there." there's an article he wrote before he died about health care reform, and he, more than any person in this senate, had the authority to speak to it. senator kirk told us in a meeting of our caucus the other day that it was 40 years ago, if i'm not mistaken, that senator kennedy took to the floor as a young man and said about the priority of health care reform -- 40 years, when you think about it, 40 years waiting for this moment to vote on health care reform. and if he were here today -- and

i wish to god he were -- he would be back there at that desk. that was kennedy's spot. thundering in this senate chamber about this historic opportunity and how if it cost us christmas eve or cost us christmas day or even more, we cannot let the people of this country down. i see the polls. this complicated issue of health care reform has a lot of people confused and even worried. they've heard some of the wild charges on the other side. at one point a few months ago they were arguing on the other side about death pants, that ult -- death panels, that ultimately the government would decide if you were going to live or die. that was one of the cruelest distortions in this debate. the issue was raised by republican johnny isakson, a republican from georgia, who i thought raised a serious

consideration and one that all of us should reflect on. senator isakson said every person under medicare ought to have a compensated paid-for visit to a doctor if they want it, voluntarily, to talk about end-of-life treatment. there is hardly a family in america that doesn't contemplate that possibility, doesn't have a husband say to a wife, "honey, i don't want any of that extraordinary stuff. don't keep me on life support." and what senator isakson wanted to do was to give medicare patients an opportunity to sit down with a doctor and say what instructions should i leave. if this is what i believe, whom should i tell? that was a humane, thoughtful amendment. but the critics of health care reform twisted it and distorted it into a death panel that was going to tell granny we're going to pull the plug. it's sad. it's sad when senator isakson

offered such a good-faith amendment to have it distorted. it's no wonder to me if the critics of health care reform would go to those extremes to try to defeat this bill why other extreme things have been said about it. if you listened on the floor of the senate while we debated health care reform and listened to the speeches on the other side of the aisle, you would believe that this bill is going to destroy medicare. many republican senators who historically did not support medicare and wanted to privatize medicare are now its most fervent champions. you might question their sincerity. we don't do that in the senate because we don't question the motives of people. but i will question their accuracy. this bill that we have here -- and it's over 2,000 pages -- knows the future of medicare is important to all of us. if we do nothing today, medicare will go broke in eight years. we won't be bringing in enough

money from payroll taxes to pay the medicare services that we promised. eight years, that's a fact. but this bill is going to change it. this bill will add ten years of solvency to medicare. i wish it were more. but it's a step in the right direction to say to those receiving medicare and those about to go into medicare, this important program will be there when you need it. ten years of solvency in medicare added -- medicare on sound financial footing for ten more years because of this bill. and there's something else it does. at the end of our conference between the house and senate on health care reform, we're going to take care of a problem in medicare. it's a serious problem. when we pass the medicare prescription drug program, there wasn't enough money to fund it. and so they created this strange situation where if you were seriously ill under medicare and receiving medication this,

medicare part-d plan would pay for your prescription drugs up to a certain limit and then stop in the midst of any calendar year, some were confined to several months in that year that medicare part-d was not paying for any more prescription drugs. you would be responsible personally to pay for them. and after you had paid a certain amount of money, the part-d coverage would kick in again. it was known euphemistically as the doughnut hole, that gap in coverage in medicare prescription part-d. when this is over, this health care reform is going to fill that gap, close that doughnut hole, give to 45 million americans under medicare the peace of mind of knowing that their prescription drugs will be paid for, and they won't find themselves exhausting their savings or going without when it comes to basic medication. that's why this bill is important, and that's why some of the things that have been said and debated about are so

misleading. there's something else this bill does which we ought to take pride in as americans. most civilized and developed countries in the world have a health care system that protects their people. we are the only developed country on earth where a person can die because they don't have health insurance. we're the only one. and you say, senator durbin, aren't you getting a little carried away here? die because you don't have health insurance? well, 45,000 people a year do. let me give you one illustration. what if you had a $5,000 co-pay on your health insurance and you didn't have $5,000? and the doctor says to you, i'm a little bit worried about some of the things you tell me and, senator, i think you need a colonoscopy. well, that's something that i can understand because my mother had colon cancer, so i'm very careful about this. i have a history in my family. but if you had a policy that said the first $5,000 you pay for and went out and asked how

much does a colonoscopy cost, you'd find in many places it's $3,000. and there have been cases, a man from illinois wrote said i didn't have the $3,000 so i skipped the colonoscopy. without health insurance, without coverage, without enough money to pay for that basic test , this individual is running the risk of developing a serious cancer. that could claim his life at least cost a fortune to take care of. that's what inadequate health insurance does to you. that's what no health insurance does to you. at the end of the day this bill will say for the first time in the history of this great nation, 94% of the people have health insurance. 30 million people today who have no health insurance will when it's over. 15 million will go into medicaid because they're in low income categories. i met one of those people when i was in my home state of

illinois. her name is judy and works in a hotel in marion, illinois. she is a hostess in their morning for the free continental breakfast, sweet ladiy, big smile on her face, early 60's. she came up to me and said, senator, i'm sure sure this health care reform is good for me. i said, judy did you have health insurance? and she said, no, i haven't had health insurance. i'm a few years from medicare. i said, how much money do you make? she said, well, they cut our hours at the hotel because of the economy. i work about 30 hours a week now and i make about $8 an hour. and she'd said there isn't a person working here on the hotel staff that has health insurance. i said, does that mean your income each year is abou about $12,000. i guess, she said. it's the only job she has. i get by on it. i can't imagine how. she said, i get back on that. i checked into it and i saw her the next morning before i checked out, i said, judy, under

this bill that we have, because you make less than $24,000 a year as an individual, you will qualify for medicaid. you will have health insurance under the illinois state medicaid program and you won't have to pay for it because you're in a low-income category. she said, that's great. because i have diabetes. think about that. age 60. no health insurance. low income. no doctor regularly available to her. and she said, i've had a few lumps i'd like to have checked out too. i said to myself, this poor lady. she is a classic illustration of what we're talking about in this bill. she's not lazy. she's a hard-working person. she gets up at the crack of down to make sure that people feel right at home at that motel and no health insurance. 94% of the people in this country will have health insurance. people like judy, for the first time in her life will have health insurance. is that worth something? is it worth something in america for us to take pride in the fact that we are expanding the peace

of mind which some of us take for granted of having health insurance coverage? i think it's worth a lot. i think it's important for us and the critics to step up and acknowledge that they've never come forward with the single proposal to deal with that issue. not one. we've never heard from the republican side of the aisle how they would cover 94% of the people in america. they have never put together a comprehensive health insurance plan. they've never talked about submitting it to the congressional budget office to make sure that it does as promised, as we have. and they come to the floor with criticisms of what we're trying to do. it's their right as senators to do that. but it's also our right to ask them the basic question. is it the fact that you don't have a republican health care reform bill mean that you like the current system? that you don't want to change it? that's one conclusion. the other conclusion is this is

hard work. writing a bill that does this takes a lot of time and effort and they haven't -- they haven't put in that hard work. and so they come empty handed to the floor with good speeches and good graphs and good press releases, but without good amendments to take care of the basic problems. there is one other element in this health care reform bill too. how many times have you met somebody in your family or at work or through a friend who told you about a battle they had with a health insurance company when somebody got sick in their family? i run into it a lot. a few years back when i was a congressman in springfield, they had a unique program it was the sagaman county state medical society would invite members of congress to invite -- on rounds at the medical hospital. i said, you don't want me walking into a patient's room talking about their private health situation. no, no, they said.

we ask permission, and it's interesting, people are bored in the hospital and amiewzed by poll -- amused by politicians. and so i accompanied a doctor, and he had a patient who was suffering vertigo and as a result of an x-ray they discovered that she had a tumor that need to be removed. she was living by herself and she was falling down at home and he wanted to operate on her on monday. this woons friday. he wanted to keep her in the hospital. he wanted her to stay in the hospital and ready for surgery on monday. but before he could say to her, be prepared to stay over the weekend, he had to call her health insurance company. i stood next to this doctor at the nurses station at st. john's hospital in springfield, illinois, as this doctor argued with a clerk at a health insurance company, somewhere at a distant location about why this woman needed to stay in the

hospital and the clerk said, no, we're not going to pay for it, send her home. bring her back on monday for the surgery. he said i'm not going to do that. and they said we're not paying for it. he hung up the phone and said that she's staying in the hospital. we'll fight it out later on. those battles take place every day in america. i told a story on the floor here, a great friend of mine, he's a baseball coach at southern illinois university. his name is danny callahan. he has been battling cancer for years. danny's a young guy. got a young family and a good wife. and he's just a terrific guy from a great family. and he's been battling cancer, chemo, radiation, even surgery, removing part of his jaw and trying to stop the advance of cancer. his oncologist came up with a drug that is working. it's kawltd avastat. and this drug is experimental.

it works on some cancers, it's certified to work on them. it is found that it works on other in on off label application. the oncologist wrote to the insurance company and said this is working, we want to keep using this drug and they said no. it costs $12,000 a month and we're not going to pay for it. what's he going to do? you don't make a fortune as a baseball coach at southern illinois university. his family pitched in, borrowed some money to cover a month of treatment. he's going to have a trial at a washington -- rather in st. louis at barnes hospital connected with washington university there. i mean, he's trying his best to keep this going, but he's battling this insurance company that said no. this bill gives people that i've just described a fighting chance. it gives them a chance to fight against the discriminatory wrong decisions of health insurance

companies. is that worth anything is it worth it? i've yet to see an amendment from the other side of the aisle that does this. we used to call it a patients bill of rights and it used to be a bipartisan issue. senator john mccain joined with senator kennedy and the two worked on this saying that patients in america have the right to fight insurance companies that turn them down because of preexisting conditions, that turn them down because the cost of care is -- is so high. that turn them down because they lost a job or turned them down because their child reaches the age of 24. this bill provides protections for those protections for people. when people said, you know, i heard governor dean, i like him. howard is a friend of mine. former governor of vermont, wrote a big article in "the washington post" and said vote against this bill. it isn't everything that i want it to be. well, governor dean, it's not everything that i want it to be either but how could we in good conscience explain to 30 million americans who would have health insurance for the first time in their life, like judy, down in

marion, illinois. judy, i'm sorry, we won't be able to get you health insurance this time around. we couldn't get everything we wanted. it's not a very compelling argument from my point of view. how do we say to people who want to have a fighting chance against insurance companies who say no and will have the legal right to do that? i'm sorry, you're just going to have to continue to do your best fighting these clerks at health insurance companies who say no because this bill doesn't have everything in it that we want? you know, you learn in this business of life and politics that concessions and compromise are critical parts of achieving a goal. within the democratic caucus there are conservative and liberal or progressive members, and we've got to find that sweet spot, that middle ground where they come together. i think we have. i'm sorry that we don't have any republican support for this. it is a fact, mr. president, that though we've spent an

entire year debating health care reform on capitol hill, the sum total of republican support for health care reform by vote comes down to two. one republican congressman from the state of louisiana voted for the house bill. and one republican senator, senator snowe of maine, voted for a version of health care reform in the senate finance committee. not a single vote beyond those two in support of health care reform. in fact, some take great pride in the fact that they are never going to vote for health care reform. -- until is comes down exactly as they want it. we've invited them into conversation. in fact, my friend, the senator from iowa, who's on the floor today, was part of a conversation with senator baucus an four other members of the senate that went on, i'm told, for weeks, if not months in an effort to find a bipartisan -- effort to find a bipartisan common ground and they couldn't. it would have been better to a real bipartisan effort before

us. i thank the senator from iowa for his hard-work efforts to try. we come here today with an -- we come with the reality that if we fail this time, we will address health care reform, i'm afraid, in my political lifetime or the lifetime of many people following this debate. it took us 16 years since president clinton last offered an effort to try. if we wait another 16 or 20 years, i can't imagine what's going to happen. we know what's going to happen to health insurance premiums. 10 years ago a family of four, average cost of health insurance premium, $6,000 a year. $500 a month. pretty steep, right? average cost today, family of four, health insurance premium, $12,000. doubled in a 10-year period of time. and it's going up so fast that it will double in the next seven or eight years to $24,000. imagine working, earning $2,000

a month just for your health insurance premium. that's it. and imagine how meager that coverage is going to be because each year you know what happens. the costs go up, the coverage goes down. what will it be 10 years from now? if you talk to people who are negotiating for contracts, like labor unions, all they talk about is health insurance. they don't talk wage increases. they talk about health insurance. and those are the issues that really break down the negotiations and end up in work stoppages and strikes. it's become that contentious and that difficult. so are we going to accept that? is that the best we can do in america? i don't think so. and are we going to accept a strategy which says, we're going to slow down the business of the senate to a crawl or stop it as they tried yesterday in an effort to defeat even a vote on health care reform? don't we owe the people of this country at the end of this debate a vote on health care

reform? shouldn't it be in a timely fashion? shouldn't we first pass this bill that funds our troops that's sitting on the floor here, that passed the house 395-34. why would we delay that funding of our troops in the midst of a war? why don't we do that today before we break for lunch and say to our troops, we took care of you? i might add in here, there's a provision that extends unemployment benefits. is there any doubt on the other side of the aisle that they will vote to extend unemployment benefits in the midst of a recession? the last vote we had was 97-0, on the floor of the senate to extend unemployment benefits. that was a few weeks later. i assume that the republican senators feel as democratic senators do that we owe it to these families to try it help home to out. how could we in good conscience go home and celebrate christmas or hanukkah or whatever our who

holiday might be and sit and have a glorious christmas morning before a tree to enjoy the great blessings of this tree and this life and turn down the unemployment benefits? we couldn't do that in good conscience. why don't we do that. why don't we say regardless of your strategies on health care reform, let's not shortchange the troops. let's not leave them with uncertainty. let's not leave those unemployed with uncertainty that they're going to get the benefits that they've come to expect and deserve. i hope we can. mr. president, i ask unanimous consent to put in the congressional record at this point a recent article that's published in "the new york times" relating to the trauma of joblessness in the united states. i ask consent that this article be included at this point in the record. the presiding officer: without objection, so ordered. mr. durbin: thank you. i'm going to close by saying, for those who wonder whether or not it makes