[inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] lets continue our second panel, and we thank our panelists for being here and for sitting through the first panel. Before i introduce our panelists, let me to say a few words. I think sometimes it is important to take a 30,000foot look at the systems under which we live. And we dont do that often enough. We deal with crisis by crisis. In my view, we are living with the Healthcare System which is broken and which is dysfunctional. We spend twice as much per capita on health care than any other country on earth. 13,000 every year, which is unsustainable. And yet despite that, 85 million americans are uninsured or underinsured. We are seeing in many parts of this country, unbelievably, above and beyond covid a decline in our life expectancy. We have half a million americanv whoever your experience bankruptcy which is related to the medical debt that they have. And we saw during the pandemic how unprepared we were for the major healthcare crisis that hit us. There are a lotot of reasons for the dysfunctionality of our Healthcare System, but one of them to me is the outrageously high cost of Prescription Drugs in this country, and what that means is that one out of four patients who received a prescription from their doctor are unablee to afford to fill te prescription. How absurd and counterproductive is that . Aukus to me cases these folks arerd only going to sector. Maybe they end up in the emergency room at a higher cost to the a system. We see medicare costs are extraordinarily high because they pay very high prices for the Prescription Drugs that they dispense,an meaning our deficit and National Debt go hyper at that altogether we are losing about 60,000 people youre unnecessarily because they cant afford the medicine they need or get to a doctor on time. So the questions that weve got to ask ourselves is, is our current Prescription Drug model working . Well, i guess it is working for the pharmaceutical industry and the pbms. Because they make tens and tens of billions of dollars a year. Their ceos make compensation packages of millions of dollars a year. Andd yet, millions of peoplenn cannot afford the outrageously high prices that we pay. Ask is how does it happen thatto we paid by far the highest prices of any major country for Prescription Drugs . Ive been with americans going to canada where they got their medicine they needed at onetenth the price of paint and the United States. All right . So what hope we will discuss is the dysfunctionality in my view of the current model and how we advance to another model which starts what we all want to do. L do we all believe that it is terribly important that with cutting edge Prescription Drugs to save lives . Yes, we do. Do we all understand the best drug in the world is meaningless if somebody cant afford it . Do we all understand we have a huge deficit which is in some ways attributable to the high cost of healthcare and Prescription Drugs in this country . What are the tools we need . What should we be doing that other countries do . St where they provide Prescription Drug to. The people at a fractin of the cost that we pay. Those are some the issues that hope we will be discussing. Senator cassidy. Thank you, chair. I have been so efficient i put away my opening remarks. [laughing] lets wing it. Thank you all. You all bring a unique perspective to this issue. We emerged from the pandemic with an understanding that however robust poppel was in the past those not adequately robust for the pandemic through which we just went. The always save the generals fight the last war. I think our generals plan for the next. It is true the generals are helping to plan for the next war. Somethings will we be considering here that are traditionally alone far afield from pahpa but thats where the committee has been picked nonetheless i look forward to your input and you all but awake very impressive resumes. Let me thank you all for giving a time to be here. Erthank you. Okay. Thank you, senator cassidy. Our first witness s will be docr Reshma Ramachandran who is an assistant professor ofdr medicie at the yale school of medicine, an expert ensuring equitable Patient Access to safe and Effective Health technologies. Dr. Ramachandran, thanks very much for being with us. Chairman sanders, Ranking Member cassidy, and distinguished terms of the committee. Thank you for the invitation to testify today. My name is Reshma Ramachandran, a assistant professor of medicine ideal school of medicine why codirect and Interdisciplinary Research and policy program called the yale collaboration for regulatory rigor integrity andd transparency. Ian am also a primary care physician at a federally qualified Health Center in new haven, connecticut. Im honored to testify before you today. I remarks with a puddle is not that of my employers who the organizations i work with. Anyone with the declaration of covid19 as a bulk of emergency will come to an end. With vicious reauthorization of pahpa comes an opt in to reflect on this and utilize the Lessons Learned from dispersing significant Public Investment led to the rapid and successful developing vaccines and therapeutics. To inform this Legislation Congress should answer the following fundamental question. R how can we ensure the American Public has equitable access to medical countermeasures developed in response to Public Health emergencies in the future . Looking back at the covid pandemic the federal government effectively remove manufactures risk and developing vaccines and treatments by granting direct Public Investment as well as access to scientific expertise and resources across agencies. In return the American Public underwrote these investments have received a little careri ta they will have equitable sustainable access when the Public Health emergency inns. Instead manufactures have announced plans to raise prices exorbitantly ignoring at even lower pandemic prices they been able to reap billions. Without intervention from the federal government my most bobo patients including those without Health Insurance as well as those at high risk of severe illness what disproportionally bear the burden of such untethered price hikes. While current policies are some measure of protection for insured americans, in removing cautioning for vaccine they will likely confront these prices indirectly in the form of higher premiums. The federal government and torturing vaccines and therapeutics will bear these expected increase costs. Further increase in taxpayer spending on the publicly funded medical countermeasures will mean there will be less money and Resources Available for other critical Public Health interventions to prevent future researchers or address of the threats. Moreover, twisted in public and private procurement of another publicly funded vaccine that of influenza these initial covid19 vaccine prices following the public of emergency period will likely be the floor forio continued price hikes in the future. So what Must Congress concluded as a part of pahpa to protect the American Public in their investment . First congress should empower federal, to accept necessaryry leverage with allocating funds for the filament of countermeasures and negotiatedas procurement contracts. Through bulk purchasing agreements the government could mitigate the impact of substantial price increases during negotiated lower price as it did during the covid19 pandemic. To prevent further these prices and continually rising do after you as a habit of the vaccines the government should call for ceiling price to be upheld. Additionally similarlyly to what theyve been able to negotiate in a few contracts the government could insure manufacturers given the best price compared to that of other high Income Countries. Besides securing reasonable provision the government must not sacrifice access and complaint safeguards within these contracts and the kinds of flex ability and speed. The use of contracting mechanisms such as other transactional authorities handed the building of the government to remove unnecessary access barriers to taxpayerfunded medical countermeasures such as unaffordable pricing. Instead, allocation of any such funds should be tied to provisions p that confirm the supported medical countermeasure is indeed safe and meaningfully effective. During an ongoing Public Health emergency it may be acceptable for these parts remain at the time of market authorization however, the government mustfe condition taxpayer funding on thee completion of additional studies that verify they do indeed work as intended and the answer of the important Public Health questions be on authorization and approval. Understand had different treatments and vaccines compared to one another or across different populations better informed the government in determining how t many doses of each individual product and at whatat price. Covid19 demonstrated how effective the government can be in inspiring measures. How will the success of these efforts should not be measured by whether these medical products reach they market. Rather Congress Must ensure the success under pop pop is red as give acting as a student of taxpayer funds and interequitable access are truly effective and safe Health Technology in return. Thank you. Thank you very much. Our next witness is mr. Roberts weissman, who is president of Public Citizen mr. Weissman is an expertxp specific ensuring a critical access to drugs. Mr. Weissman thanks a lot for being with us. I given much, chair sanders and Ranking Member cassidy for the opportunity to be here today. I think its fair to say operation warp speed wasei a grt success in speaking to the development of w Covid Vaccinesa validation of the bard investment model, to an extent. But it was also a great failure and we need to learn that lesson as well. It was a failure in that although the u. S. Government was responsible for funding the Covid Vaccine from before covid even emerged, to the isolation of the key spike protein come to the Clinical Trials and up through the development and production of the vaccine. Barda imposed effectively no restraint on how moderna and of the parties but especially moderna would operate. The result was while moderna executives became billionaires, taxpayers were price gouged. Hundreds of thousands or maybe millions of people lost their lives because we had a global shortage of a vaccine that couldve been avoided if we shared the technology. And now moderna has announced it plans to quadruple, further limiting access, further gouging consumers, further gouging the taxpayer. As of what you has agreed we need to learn the lesson from what happened during thegr pandemic and you better Going Forward. We absolutely need pahpa. We need barda but we need to do better. What are some key lessons Going Forward . First we need more transparency in the contracting process. Taxpayers should know who theyre providing grants to come within making acquisitions from and on what terms. Ro when Drug Companies and vaccine makers are making coinvestment and a product they should know, taxpayers should know how much is being done on the private sector side along with the public side. Second, we need to have reasonable pricing for the products that we the taxpayers pay for. That should be common sense. If we pay for it, we ought not to pay for it again with unreasonable prices. The starting point for reasonable pricing should be that the United States does not pay more than other high Income Countries do for a product but thats just the starting point. We can do much better than that. In general the way we should think about reasonable pricing is tailoring a reasonable price to the amount of private Sector Investment and risk taken. Where the government pays for the government of the drug all the way through, the reasonable price should beof a lot lower tn where private sector partner took on a lot of the risk and made a lot of earlystage investments. Third, we have to guarantee International Access but we know pandemics definitionally mean that everyone around the world needs the productsno we are talking about. Drug manufacturers, vaccine may not have to pass, often out of interest in serving the global markets. As such we should have a proactive requirement for licensing to the World Health Organization of Crucial Technology and licensing and sharing of technology and noah as well to make sure of the manufacturers can produce products that everyone needs. Last, we should consider as well as the traditional model for supporting research and Development Prize models such as those that you support in the past with legislation, chair sanders. We know in the case p of barda that the patent monopoly model support innovation by definition doesnt work. Thats why barda is making the investments because the private sector model in these cases as commissioner said earlier, doesnt work. Its at least insufficient. Given that we ought to think creatively about what might work better. Prizes can be calibrated to provide appropriate incentives sufficient to enable manufacturers and researches into the space while also ensuring affordability andit access on the backing. They can also do other things to promote innovation like giving people rewards when they dont actually get the final product but they make contributions along the way. These are some of the lessons i think that come out of the pandemic and that we must incorporate into pahpa Going Forward. Thank you very much. Thank you very much. Senator cassidy, did you want to introduce your panelist. We are joined today by dr. Martin mccoury, a researcher, profess at the Johns Hopkins of medicine professor Johns Hopkins carey business school. Dr. Markary focuses research and Public Health and healthcare derivative issues range from contra costa covid19. Covid19. He proves it worked the World Health Organization or help develop surgeons checklist which is help reduce surgery related deaths around the world. He completed his medical training at georgetown Johns Hopkins and is the author and coauthor of over 250 250 peerreviewed papers. Dedicate that right . Pretty impressive. Look for hearing from you today. Thank you for joining us. Thank you. Thank you, senator sanders, thank you Ranking Member cassidy and thank you, senator markey that its a privilege to present. I speak him have a soft and not Johns Hopkins university for the National Academy of medicine of which i am a member. Congress should avoid the false narrative that insufficient federal findings were to blame for our pathetic covid response. Take for example, one Johns Hopkins student created a cobra tracker that the world used, and it was not created by the 21,000 employees at the cdc. As a bad effect when hhs met with the cdc, they said it would take months to create such a tracker. Did cdc meet one of 5000 employees or 50,000 employees . We just had the head of aspirin the assistant secretary of preparedness and response essay, she needs more hiring power. How about firing power for incompetence, or both . I mean, 21,000 employees cannot come up with a cobra tracker . More tragically, the nih has 42 billion. Barda which is a part of the pahpa act has another billion dollars and they couldnt do the most basic Clinical Research we need it done quickly to answer the basic questions, to end the controversies and the conspiracy theories, to finally get out the questions americans were asking us, how does it spread . Is it from Touching Services . Do i need to port 20 cows of our call on my groceries . Fauci was telling teachers in july to wear gloves and goggles. Or once a spirit airborne . That couldve been answered and 24 hours in one of our labs. Or in one week of Clinical Research to answer the question, when are you most contagious . What is the peak day of virus shedding . How long to have to quarantine for . Two masks work . We couldve answered this with definitive basic Clinical Research early. They didnt. And so i think its fair to ask how did they do in preparing us for the pandemic . We spent over 20 billion on pop over the last 20 years. What has that been for as . How many lives were saved in the covid pandemic because ofve investments by pahpa . Or barda. They have done some good work. Ive seen it. But regardless of ones political affiliation, theyve got to acknowledge that we doctors in the public were flying blind. We had opinion ruling the day andth what we should do or not o when we couldve been governed by evidence. Policycy driven by good basic Clinical Research. We didnt have that and so we had a void of Clinical Research and guess what filled that void . Over half a year, i year, two years. What filled that void political opinions. L those controversies couldve been ended early. We had the money, and as a result the covid pandemic became the most politicized pandemic in u. S. History. St it was avoidable. Much of it was avoidable to my Research Team at Johns Hopkins did a study aboard inexpensive money in 2020. 2020. They spent 2. 2 times more money on aging research than they did on Covid Research the year of the pandemic. Now im all for aging research, especially as i get older, but not during a Global Pandemic went 3000 americans are dying a day. Much of this research was misguided and our study published that i included in the thpackage showed that it took te nih after they decided to find a Research Study at the in five months to give that money to the researchers. That does not work during a health emergency. While the nih is outside of the scope of the reauthorization, barda is and i think the public has a right to ask what has barda and what has pahpa done for them in preparing for covid . How many lives were saved because the investment . Whats the single best investment barda made with that roughly 20 billion before the pandemic . That saved lives during the pandemic. I think its fair to ask those questions. How many beds are available today . Do we track the number of beds available . We are going to have more catastrophes not just viral pandemics. Well have Mass Shootings and floods and other natural disasters. We have spent a lot of money at barda making hospitals a lot of money, giving them a lot of money, private Startup Companies making money, contracted making a lotct of money. But the question is where was the basic Clinical Research . We have been funding virus hunting internationally, sending teams to get exotic viruses bring them back in public areas. Thank you, senator sanders and Ranking Member. I look forward too your questio. Thanks thanks very much. Let me start off with an issue that has bothered me for a long time, kind of a philosophical issue, maybe ame moral issue. If i have a product, a Prescription Drug for vaccine that can save his life, and i say bill, you can have it but its going to cost you 100,000. And you say hey bernie, i do have 100,000. And i. And i said sorry, bill. My Business Model is, thats the price. Sorry youre going to die. Nice guy. Thats the way it is. Mr. Weissman come you areal talking about may be millions of people around the world, poor people dying because they dont have the vaccine. We havent come and think the vaccine ass understand can somebody correct me if im wrong, now cost a couple of dollars to produce. Not a whole lot of money. What is the morality, and i want all three of you to respond to it, of us have a product that cost a few dollars to produce but not making it available to people around the world who are dying . And in her own country as well,n but poor people around the world. Doctor. What you are describing, the hypothetical is the lived reality i see pretty much every signal time i have a clinic where patients come to me and say they cant afford whatever prescribing thin. The fact this could happen with a publicly funded vaccine is frightening frankly to me. After the Public Health emergency period ends. Absolutely, i think it should be unconscionable. It should not be allowed for that to happen. No one should be poor because theyre sick and no one should be sick because they are poor. And if i have a product that could save save the lives a few bucks, should i deny to you . No. Definitely not. Mr. Weissman. Thank you for the question. It really is a quarter its obvious it and unconscionable to know youre describing. When we look at the globally, whats worth underscoring is that thereco effectively is no market in low and low to middle Income Countries for big pharma. They are not holding out to see if someone can pay more. They are just not going to sell there at all. So leaving aside what we think about should happen in our own market or highincome country markets, in those markets we had to figure out ways to get the technology. When ite comes to lifesaving technologies like a vexing especially a u. S. Government supported vaccine, if they dont want to make a to sell there, find, but require them to share the technology with other manufacturers, give them the knowhow so they can make it on their own. Thats the least weno should do. Should people diedwn because they cant afford a product that costs a couple of bucks to manufacture progress cost should never be a barrier. However i must note their sacred cows no one will talk about in the United States like pharmacy benefit managers and Group Purchasing organization. We will talk about it. So thank you for your work. We will have the next week. They will be steady exactly where you are sitting along with the three major insulin manufacturers in the worldth are cows that . Great. Sole supplier contract is also tied into shortages. The fda commissioned which is asked about shortages and waiting and he said we need better data. How about these mass monopoly powers, weve got three suppliers a supply 85 of u. S. Hospitals, they enter into these cozy sole supplier contracts the manufacture gets a flinty supply chain for Something Like insulin. Insulin. We have maybe one manufacture these are good point of what to get back to you. Tell me about the moral issue. I have a product, cost me two bucks to manufacture. It will save his life. He cant afford it. Is that a moral Business Model that we should sustain . Its an unacceptable barrier, i think the best way to lower drug prices in a car to stop taking drugs we dont need and to cut the waste of the system. Okay. Senator cassidy. Thank you all for being here. Dr. Markary, what do you really think, man . [laughing] of course the theoretical was just given was an absurd theoretical. I said because moderna has already played to make this drug available. I come from treating a group of patients whoho were uninsured in louisiana. I speak with some authority in between Medicaid Expansion state and 340b end of the mechanisms. Drugs should be available for those with a wife would not. As regard vaccine i i could ao get a theoretical. What if we so dis incentivize the production of cutting edge therapies that somebody would not develop at . Weve seen that before, havent we . What happens is we end up not having cures. So i think we have to have a note of reality as we get the radicals. Dr. Markary, in full disclosure i had a productive conversation before the last year with dr. Walensky. One concern i had there seemed to be, and by the way, i think it first went to say federal agencies to which we refer generally concede they didnt dt well, some lease come before the pandemic but theyre making major efforts to reform. So lets acknowledgejo that. One of the production conversation ive ever had is how you have information sharing that it wouldnt be silent or if you will quarantine from others seen by federal agency but with sufficient, sufficient protection for privacy that there would be accessed by other researchers who might have a different idea than cdc. You are a person i think all three of you are people who are different ideas about how these things should be handled. And so again with sufficient protection of privacy having access to the database, cdc and maintain it or someone else, but some good researchdc at Johns Hopkins who wants to test the pieces could simply do so. One more time with appropriate safeguards what are your thoughts about that . Publichealth officially downplayed and silence dissent on many different levels. Why has the Oxford Astrazeneca vaccine never been approved in the United States . And given to over a billion people, covax and, why is it not been approved with what is it with the cozy relationship between regulators go back to the information sharing because thats the point of my question. You know is a way we can have more iconic Group Outsourcing a group of sourcing the analysis ofci the data that would allow s to make better publichealth decisions . We have not had good access to data. We have asked for hospitalization rates and people under 50 by booster versus nonbooster. We didnt get it. Why . Probably doesnt support the narrative. Science should not be censored or corrupt speech i accept the but but i got limited time. I dont mean to cut you off the mr. Weissman you heard dr. Califf that if you want to express no view that sufficient to protect intellectual property that would be a disincentive for companies to make largescale investments, et cetera, et cetera et cetera. Your thoughts onst that. I think dr. Califf is mistaken. In the snare you laid out for him there was no private sector market at all. You are talking about countermeasures where it was the give it was the sole purchaser. So the intellectual property the monopoly thats not whats going on. Le thought about how we can charge the most for private individuals. Individuals. All that doesut is give the company that the u. S. Government funded more Bargaining Power with the United States when we purchase from them. That doesnt seem like a sensible thing. Im not question following your logic. The original premise was it a try to get the company to commit significant resources to developing something, is a better student intellectual property whether not the u. S. Will be the sole but in this setting we are taught about the initial, to jumpstart it. The premise of the discussion was is it better to give them an express in which you bet the farm on winning the prize if that you lose, or the better to give intellectual Property Protection and better to give them sort of kind of tradition intellectual, et cetera . I understood the snare you laid off out was the u. S. Can purchase of it its an interesting question where the government is not. I would reverse what you said. To me the patent monopoly model is a winner take all. Its an uncertain winner take all. E the one he gets the patent come thats who the winner. Dont we know the value because you dont know what the market is going to be. You have more certainty with a price because you know the value of it but you can calibrate the prize and share, incentivize people to get in the speech even if theyre not the winner. You may give an award to someone who drove the Research Forward but didnt get the funding that would become speeders its nice group theory kind of approach to attack it a buddy with outsource that are not sure, i dont envision a lawsuit over its my share not your share. As you know that field is quite full. But thats a minefield thats only been welltrained and people understood. Dr. Ramachandran again thank you for good work. Let me finish by saying this. Maybe you need you could take this. I havegr a graph showing therea reasonable pricing clause in the cooperative research and the agreement which stopped in 1995. Prior to that theres this kind of level commercialization of research. And then after that, removal, there really took off. It suggests that, in fact, the conclusion of this is the primary stimulus or the increase in the cooperative research and Development Agreements after 95 was the removal of pricing clauses et cetera set up. Thats punch line. Would you disagree with that or lack of familiarity . No, i think mentioned before this is not causation. Also drink covid19 we did see the use of reasonable pricing clauses which Companies Including major manufacturers not too small Biotech Company settling one part in a portfolio accepted. Pfizer was one of them that negotiate with u. S. Government and actually within that contractor was a mostfavorednation clause pricing provision advisor accepted. Similarly others had reasonable price and closet traversing this even outside of medical countermeasuresnt base. Recently university of california berkeley announced reasonable pricing provision for u. S. Population for the products and that includes gene gens their developing. You can see even for products with her is a large commercial market these protections could be included and a special for an agency like nihses as leverage and access to technology that companies do want to have. Excellent answer. I yield. Thank you. . Let me just ask a followup on this. If im not mistaken i think you called my question and absurd hypothetical. [inaudible] it doesnt happen, i suggested people die or get sick because they cant afford medicine. You think thats an absurd hypothesis . I dont. Charge me 100 100 milr lifesaving speed is not 109. 100,000. 100,000. Cancer drugs are 100,000 right now. Ill write . So i would like the doctors i think we are to doctors and an expert on it. Isnt it a absurd hypothesis is just a people are dying or suffering or going bankrupt or having their lives disrupted because they cannot afford the outrageous price of Prescription Drugs . Doctor. No, its not hypothetical at all. Its the lived reality for so Many Americans especially people around the world. Y do you see in your practice . all the time. Mr. Weissman. A few points if i may, senator. First of all in the global context we were talking about its commonplace. Its the norm for how may my people do we think died because they did not access to the vaccine in the world . Do we have a guess . There are very good estimates come between hundreds of thousands and millions, its hard to pin it down and most of those who did get vaccinated didnt get the higherquality mrna vaccine. In the u. S. , second point, as you said, 25 or 30 of americans actually rationed their Prescription Drugs is a price. Now, not all were dying as result but some or. The launch price of new drugs right now is 182,000. When hundred thousand dollars is not a far out somebody correct me if im wrong, the ephemeral inhibited in many of the cancer drugs that are out there are over 100,000 you can miss a correct. Was thats correct and some that were going up to 2 million. One of the thing on the question you asked senator cassidy about the agreement and reasonable pricing. Actually what happened there is that in 1995 at the point that nih stop using the reasonable pricing provisions, they added a new category so the original category were standard, cooperative Research Development agreements. Those stayed roughly consistent after the removal of the reasonable pricing clause. They added a new category of material and force of number youre at that show this seeming juxtaposition pre95 and post 95 reflect the change in categorization, not the removal of the reasonable pricing clause. Dr. Markary, did i pose an absurd hypothesis to senator cassidy people are dying for something because they cant afford medicine . [inaudible] the American Cancer Society did a study that 48 of Cancer Patients say they have avoided or delayed future care fory fer of the bill so thats a real problem, and with the promise of the Affordable Care act lowering costs not panning out we now have higher deductibles treating a new problem called the function uninsured. They have insurance but they cant afford exactly right. I dont think senator cassidy that my hypothesis was answered. Candidates a course at nothing to do with pahpa. Dr. Ramachandran refer to toe goldman fyre festival. We can talk about vaccines lack of ability worldwide thats a different issue than pahpa. And by the way most of the patients do have coverage. Yes, this indication where the development Medicare Part d provides come schmoes of this cancer drugs. Occasionally, few who have no coverage is that which is a . If the Affordable Care act speedy i met your to defend the Affordable Care act or im just saying speedy obviously where weight the field of pahpa. We are but thats over. We have three witnesses here. He late afternoon, where having an intellectual exercise here. All right, i think we both had to catch plenty of what you think youll for the work you are doing and for thank you very much for being with us. And heres my bureaucratic thing here. For any senators who wish to ask additional questions, questions for the record will be due in ten Business Days on may 18 at. Vitally i ask unanimous consent to enter into the record six statements from stakeholder groups outlining their priorities from the pandemic and all hazards preparedness act. The committee stands adjourne. Thank you very, very much. [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] this afternoon at 4 p. M. Eastern house and Senate Leaders will be gathered with President Biden at the white house for talks on the debt limit aint to avoid a potential default next month. Republicans want spending cuts as a part of the talks as democrats and the president insists on a clean debt limit increase. Todays meeting comes more than three months after President Biden and House SpeakerKevin Mccarthy offered the initial position on the debt ceiling. Cspan cameras will be at the white house and on capitol hill