capitalist system says that they have to maximize it by trying to sell as many policies as possible. so there's some check on it. but it's clear that america is not happy with insurance companies. my good friend, the minority leader from kentucky, keeps saying we don't want the government involved. well, let me ask you, who is going to protect the individual and even some of the individual providers -- the doctor in a small town or inner city ghetto from the insurance company when the insurance company either charges too much, tries to get rid of, like in the case of the small businessman from springfield, that my friend, dick durbin talked about, or when they are denied coverage,

or when they can't get coverage, or we're not renewing your proposal, or whatever. we understand that there needs to be a check on the insurance companies, and left alone they will not provide the kind of low-cost full health care that many, many americans need. when we propose a public option, we are proposing someone to keep a check on them. that's the only point here. if we had complete faith in the insurance companies, we wouldn't be debating public option. if we had complete faith that left on their own, when you had the situation, an illness, and your costs went way up, they said, sure, we're going to take care of you, you signed the contract when you were healthy and now you're sick -- sometimes

that happens, i'm not saying it never happens but what about the times it doesn't. and praise god we're healthy, and it might happen? there has to be a check on the insurance companies. that is what the so-called public option does. the insurance companies are part of the free enter ris enterpris. it's a great system. insurance companies go -- probably in their charters -- their goal is to maximize profits to the shareholders by producing a good product. but we all know, particularly when it comes to health, that system has major flaws. it sometimes works. and it sometimes doesn't work. if we thought only the private sector should provide health care, mr. president, we wouldn't have medicare.

and i know there are some way over on the right side, who would like to get rid of medicare. if we thought that private insurance on its own worked just fine, we wouldn't have fought for years for a patient bill of rights. so this idea, coming from the minority, that we should have no check on the insurance companies which is what we would have if we had no form of public option, isn't where the american people are at. it's certainly not where i'm at. now, some bring up, and i think it's a valid art, the argument,f the government is involved -- by the way, we are not proposing that the government take over health care; we're proposing that in this exchange where all kinds of insurance companies compete that there be at least

one who doesn't put the profit motive above all but has to put patients above all, a public option. it doesn't make a profit. what we're saying is, if you believe in competition, why not let the public option compete. we do this in state governments. in state governments if you are a state worker you can sometimes -- in some states -- a public plan or a private plan. and the consumer chooses. that pass how it should be. we are simply saying, you know, just as there are some who might say i don't think there should be any private sector involved in health care, it should all be public -- and many people think that's not the right view; it's just as wrong if you think that's wrong, which i know my

friend from kentucky does, to say it should only be private sector. let's see who does a better job. let them compete in the marketplace. my view is this: there has to be a level playing field. you cannot give the public option such advantages that they overwhelm the private sector. the proposal i've made and others are looking at things like this, senator bingaman is one; my friends in the house, i think congressman welch and murphy, were saying we can try to make the playing teeld level. the government won't -- playing field level. the government won't keep pouring money in, it sets it up and it has to compete. if the private sector needs preserves, because of catastrophic option, so will the

public option. i am certain those who are interested in public obligation are interested in suggestions on making the playing field level but make no mistake the public option is a different model. the public option will not have to make a profit. that's about 10% or 12%, that guess to health care for the maybes. the public option will not have to merchandise and advertise. that's often 20%. so right off the bat public option has the same level playing field but has 30% of its revenues that can go to patient health care. now my friends on the other side say, well, the public option isn't very efficient. that it doesn't give new direction and direct you to the right opinion to cure this disease but lets people go all over. well, if it's not, it's in the going to work. mr. president, if i were designing a health care system, i'd even look carefully at

single-payer. i believe we do need control mechanisms. i think the insurance companies themselves no matter how we try to regulate them, will figure out ways around it. that is almost their mandate. their goal is to maximize profit. there is nothing wrong with that. but we're not going to get system pair here. we know -- not going to get single-payer here. we know that. and we're probable not giveen going to get something called medicare for all, a more pure system that frankly is not a level playing field. but just as we have to compromise and move to the center a little bit to get something done, so do my colleagues on the other side of the aisle. again, when they say no public option, it's the inverse of saying no private insurance companies. let's see who does better. my view is this: the public option will have certain advantages. it won't have to make a profit. it won't have to advertise in

merchandise. but on the other hand, it's going to have certain responsibilities. when dick durbin's friend from springfield can't get ensure from a private -- get insurance from a private company, the public option will be there and that may be more expensive. we will try to pass laws saying the private insurance companies has to keep dick durbin's friend, the small businessman who is paying for his own insurance who got a huge increase in costs. but if you do believe as i do and i think most americans that the private insurance company is not going to imris this anisnotg not going to embrace this, and there will be an intention of not covering people like that, the public option will step in. so it is a different model, there is no question. it is not just another insurance company that happens to be public but it will be a level

playing field. there will be a playing feed where if the private insurance under certain rules the public open plan is under certain rules. if the private company has to leave reserves, the public company will have to leave reserves. no one is seeking to unlevel the playing field but we are seeking keeping the insurance companies honest. a public option will bring in transparency when we know what the public option has to pay, we will say why isn't the private insurer paying the same. a public option will keep the exchanges' feet to the fire. that is why president obama feels strongly about it. he said so in his letter the my friend from iowa, senator grassley, said he was just being political. i don't think so. i think he studied this and he knows a public option will make the system work well. it may be after three years the

public option fails and isn't needed. fine. fine. but i don't believe that will happen. but we're not going to in the public option just keep putting more and more and more government money in till it wipes out the insurance companies. that's not the intent. the intent is to have a robust market like we have in other state and some of the federal systems where many different plans compete. one is a public option. there might also be co-ops like my friend from north dakota has been advocating. there will be plenty of private insurance companies. i'd say one other thing here: my friends on the other side of the aisle say -- well, why can't we just have the private insurer compote and is a whole lot of plans. we don't have that in the vast majority of states now. we have a system where any private company can sell insurance but i believe the

statistic is right and i'll correct the record if it is not but the thrust is, i think, in more than half our states the top two companies have more than 50% of the market. there is usually not unvarnished competition when you just leave it to the private insurance but rather, oligarchy and we know that leads to price setting, price leadership is what the economists call it. nobody tries to undercut on price. we've seen this with oil industry, for instance, where there are five big oil companies. and you don't get the kind of competition that you would from a public option even if there were only one or two insurance companies competing. so i ask my colleagues, in conclusion, on the other side of the aisle, (a), to be open minded; we haven't said "no" this or "no" that." weapon you say nwhen you say

no public option you say you want the private insurance companies, under the guise of competition, run the show. and if you believe that will work, fine. but then you also will believe the public option won't be a threat to them. some of us who were worried that left to their own devices the priefs insurance companies will not -- the private insurance companies will not serve either all or most of the public as they should be served say, let there be the competitive advantage or the competitive competition, being redundant, of a public option, on a level playing field that has no particular built in advantages but has a different model. no profit, no merchandising, serve the patient first. and this debate will continue. but i would just say to my

fellow members out there who might be listening to this, when you hear the other side say no public option, ask them, who will provide a check on the insurance companies? and do you believe the insurance companies, even with some government regulation, won't find their way out of the regulations or to avoid the regulations or to walk around. the debate will continue. i appreciate the opportunity to address my colleagues. mr. kyl: mr. president? the presiding officer: the republican whip. mr. kyl: mr. president, do i understand that the time for morning business has now reverted to the republican time, is that correct? the presiding officer: the senator is correct. mr. kyl: thank you very much. mr. president, i'd like to address two subjects.

the first is the subject that my colleague from new york was just discussing. it's what to do about health care issues that we have in the united states. specifically, i'd like to refer to some comments that beth he made and that the assistant majority leader made this morning. the first point i want to make when the assistant majority leader came to the floor this morning and in effect said unless you agree with our solution you don't believe that there's a problem. that's a fallacy, of course. i think everyone agrees there are lots of question. we all agree this are problems but let's don't suggest unless you agree with my solution or your solution that somehow or other we don't appreciate there are problems. we're frustrated. a lot of americans are frustrated because they may work for a small business or they're unemployed and therefore don't have insurance and it is not easy to take your insurance with you. it's hard to fine quality

low-cost health care, this has got to be a big priority for a lot of americans. we understand that. health care needs to be affordable. it needs to be accessible. it needs to be affordable and i think americans want it to be quality care as well. the question is how you accomplish the goals. now, one of the problems is what if you have insurance and you like it? the president says in that case you get to keep it. the problem is under the bill that's being discussed in the finance committee, you don't get to keep it. if you're an employee of a small business, for example, or you're an individual with your own insurance, when your insurance contract runs out -- and those contracts are usually one year, two years, sometimes as long as three years. let's say it's two years and you're through the first year of it, the bottom line is even though you may like it, at the end of next year when the contract runs out, you don't get to keep it. under the bill being discussed, there is a new regime of regulation for the insurance

companies about who they have to cover, how they cover them, what they can charge, and a whole variety of other regulations that mean that the policy that you used to have, that you liked doesn't exist anymore. now, it may be you'll be able to find coverage that you like, but it's simply untrue to say that one of the mainstays of the legislation being proposed is that if you like your current plan, you get to keep it. when your current plan expires, it expires, and you don't get to keep it because it can't be renewed in the form that it's in, point one. point two, we just had a discussion about government-run insurance. i find it interesting that some on the other side like to call this a public option, as if the public somehow or other is operating its own insurance company. let's be clear about who would operate this insurance company. it's the united states government. it's not the public. it's the government. and that's why senator

mcconnell has referred to it properly as government-run insurance. now the senator from new york just got through saying, well, who else is going to provide a check on the private insurance companies to make sure that they do things right? and the president himself has spoken about the need for a government-run plan to keep the other insurance companies -- quote -- "honest." well, insurance is one of the most highly regulated interprices in the united states. every state, in fact, regulation health insurance. this is an area that not only has some federal regulation, but every state regulates health insurance. in fact, one of the reasons that you can't buy a health insurance policy from the state that you don't live in, you can't go across state lines and buy a policy in another state is because we're so jealous of the state regulation of insurance.

so to the question of my friend from new york, who's going to provide a check? the answer is your state. if you don't trust your state to properly regulate health insurance, then i don't know where we are. but you're not going to provide better regulation by commissioning a government insurance company to exist and compete right alongside the private insurance companies. how does that provide a check on the private insurance companies? it's not as if there aren't enough private insurance companies or that they're not providing enough different kind of plans. so that can't be the problem. it's not a matter of a lack of competition in most places. if the question is who's going to regulate? the answer is the state is going to regulate. and to the extent it doesn't, the federal government is going to regulate. so that's why, a, it should not be called a public option if what they're really talking about is creating a government-run health insurance company, which is exactly what's being proposed. and the only legislation that's actually been put out there so far, the so-called kennedy legislation in the "help"

committee. that's precisely what he proposes. republicans say no thank you, we're not for that. now, the final point there is that the assistant majority leader said, well, there are lots of other government-run plans, and we're not afraid of them. he mentioned medicare and the veterans administration. first of all, these are not government insurance companies. these are government-run programs. but secondly, the president himself and everybody that i know of that has studied the issue agrees that medicare is in deep, deep trouble. the president has said its commitments are unsustainable meaning that we can't keep the promises that we've made in medicare to future generations because it is far too expensive. we have to find a way to get those expenses under control. how does adding another 15 million, 20 million, 30 million americans to an existing program

that's not sustainable going to make it any better? my colleague talked about waiting lines. and it may well be true that you can find that example or two of people who have to wait in line in the united states. that's something we shouldn't permit here in the united states. we know that's what exists in other countries, and i'll get to that in just a moment. why does that justify having an expansion of a government program? if we have a government program which causes waiting lines today, does it solve the problem by adding a who will lot more people to the rolls? what's likely to happen there? waiting lines are going to get longer because more people are going to have to be waiting for care. is that what we want in the united states of america? i submit not. so far from being a justification for a government-run program, i believe that that argues for not having a government-run program or at least not expanding the government programs that we already have. the government takeover is not the answer.

no country, even the united states -- the most prosperous country on earth -- has unlimited resources to spend on health care. and that brings up a third problem, which is the rashing. the inevitable delay in getting treatment or test and frequently the denial of care which results from that. when a government takes over health care as it has, for example in, britain, canada and many places in europe and other places, care inevitably is rationed. we all have heard the stories. one of the most direct ways that you can ration care is one of that the white house has already embraced and it's part of the kennedy bill that i spoke of earlier. the white house has said that comparative effectiveness research, which would study clinical evidence to decide what works best, will help them eliminate wasteful treatments. wasteful to whom? the recent national institutes of health project has a description of part of their plan that states -- and i'm

quoting here -- cost effectiveness research will provide accurate and objective information to guide future policies that support the allocation of health resources for the treatment of acute and chronic conditions. allocation of health resources is a euphemism for rationing. allocation means to allocate. and inevitably there will be denial based upon those things which are deemed to be too costly. as discussions about health care reform have dominated the news recently, stories have trickled out from individuals living in countries that ration care whose medical treatment has been delayed or denied due to rationing. and we're with going to -- we're beginning to hear of some of those stories. one i came across was reported in the "wall street journal." it was the story of one shana holmes of ontario, canada. when ms. holmes began losing her vision and experiencing headaches, panic attacks,

extreme fatigue and other symptoms, she went to the doctor. an m.r.i. scan revealed a brain tumor. but she was told she'd have to wait months to see a specialist. now think about this. she goes home and tells her family the m.r.i. said i had a brain tumor. i've got all of these symptoms, including losing vision and the rest of it, but i have to wait months to see a specialist, i gather, to confirm the diagnosis. i don't know. as her symptoms worsened, she decideed to visit the mayo clinic in arizona. so she left her home country, paid her way down to arizona and paid for the diagnosis and treatment that was called for in her case to prevent the permanent vision loss and potentially death that could have enshoed had she not been treated -- ensued had she not been treated in a timely fashion.

lindsey mccreef suffered from headaches and seizures. when he went to a doctor he was told the wait time for an m.r.i. was four and a half months. think about this, you're having seizures and the test that will reveal what if anything is wrong is going to be delayed four and a half months. one of the reasons i'm told, by the way, is there are very few places in canada where m.r.i.'s are located where you can get the test. in any event, he decided to visit a clinic in buffalo, new york, fairly nearby in order to get the m.r.i. well, he did, and it too revealed a brain tumor. now mr. mccreef is suing the government's -- canadian government's health care monopoly for jeopardizing his life. i just wonder if we want lawsuits to be the answer to this. when you can't get the care you want, you have to file a lawsuit to get it. is that what we want here in america? kwropbgdz. there are also people whose car -- i don't think so. there are also people whose care

has been denied. britain's national health care service denied smokers treatment for heart disease. and it's denied hip and knee replacements for people who are deemed to be obese. the british health care secretary has said it's fine to deny treatment on the basis of lifestyle. she said -- quote -- "doctors will say to patients you shouldn't have this operation until you've lost a bit of weight." end of quote, she said in 2007. that's easier said than done for some people. and in any event if they need a health treatment and they need it now, there is a question of whether they can accomplish the losing a little bit of weight as ms. hewitt said. all americans deserve access to quality care. but government-run insurance does not equate with access. rationing will hinder access. as i said, my colleague from illinois, the distinguished majority assistant leader says

that you can actually find some examples in the united states where there are long wait times. if that is true -- and i don't doubt what he said -- that's not good. it's bad. we should try to fix that. so we don't have wait times. we shouldn't justify having more weight times on the fact that we already have some -- having more wait times on the fact that we already have some. the fact there are some people in america who have to wait, therefore we should make it possible for everybody in america who has to wait. we should be like canada or great britain. that's not the answer. if we have wait times here, we should stop it, not say we might as well be like canada or great britain. americans do not deserve or want health care that forces them into government bureaucracy with its labyrinth of complex rules and regulations. think about the hassles of dealing with the i.r.s. or the department of motor vehicles or social security administration when you have a problem there. then imagine dealing with the same issues when it goes to getting health care.

we can't put a panel of washington bureaucrats through rules and regulations, put the politicians in charge of deciding who is eligible for a particular treatment or to decide when and where they can get it. that is wrong for america. it's wrong for the patients in america. and it is the wrong approach to health care reform. republicans believe that there is a better way for health care reform. rather than empowering the government, empower patients. rather than putting bureaucrats in between your doctor and yourself, try to remove the constraints that physicians have and hospitals have for treating people. try to remove constraints on insurance companies. one of the things i've asked for, for example, if all of these wonderful ideas about more government regulation of insurances, how about repealing some laws that currently prevent insurance companies from competing? i mentioned before, you can't compete across state lines. we all know that if you want to incorporate a corporation, why are all the corporations

incorporated in delaware. a delaware corporation. it doesn't matter whether you're in illinois or arizona, corporations are incorporated in delaware. that's the way it used to be. one of the reasons is because delaware had very benign laws regulating incorporation of business. it was cheaper to do it and less regulatory hassle. if the distinguished presiding officer, for example, looked across the river to the west and saw a, an insurance company in iowa that could provide him better coverage at less cost, then the company that insures him in illinois, why should he be restrained from buying the policy from the company in iowa? you can buy your automobile insurance that wait a minute you can buy your home insurance that way. why shouldn't you be able to buy your health insurance that way? well, you can't. so just one idea. i'm going to conclude this discussion now. but just one idea is to remove some of the barriers to competition that would make it more likely that insurance

companies could expand their coverage by competing, be required to compete with lower premiums or provide -- and/or provide better access to care. it seems logical. and in this country where people move around all the time -- my family just drove all the way across the country from washington, d.c. out to arizona to visit friends and family and to go on to california -- we travel all around in this country all the time. we move families, unlike back in the old days. why can't we have an insurance regime that enables you to buy insurance from another state? it just doesn't make sense and it inhibits competition. it makes prices hire. and it can have the effect of restricting care. those are the kinds of things that we need to do to reform our system. not put more government in charge and not put a government between you and what your physician says you need, or even put some time delay between the opportunity to visit your physician when you know that you've got something wrong with