understand, while we have roughly $2 trillion in annual deficits running, we have $38 trillion in unfunded liabilities for medicare and the trust fund is anticipated to go insolvent. by the year 2017, less than eight years from now. so i appreciate the urgency of focusing on health care reform working under chairman baucus and ranking member grassley on the finance committee. i know other senators have been working hard at this as well. senator kennedy and senator enzi on th the "help" committee and i want to urge us to keep working very hard to work through all the complexities and moving parts of this very challenging problem. but i also want to say that i think how we discuss health care reform is very important but i'm also concerned that some voices are greeted with derision or

even implicit threats that suggest they better keep quiet if they know what's good for them. tremendous amount of work has gone into the series of three finance committee roundtables and walk throughs but i'm disturbed by some reports that perhaps senators and certainly staff have urged key stakeholders in the health care reform debate to keep their mouth shut. mr. president, every american citizen has a right to petition their government. this is a right every american citizen has. and no american should be told to keep quiet on the subject of health care reform, in particular. we know reforming health care is an urgent priority, as i said. and more than 300 million americans have a stake in our success. but congress needs to take the time given the fact this represents 17% of our gross domestic product.

and it is so complex. we need to take the time and get the input from everyone who has something to offer as we undertake this massive task. we have a highly complex $2.6 trillion system and we need to take time to get the reforms done right. i'm not talking about peddling in place, i'm not talking about wasting time, i'm talking about doing what the american people expect us to do, to get it right and not try to rush according to some arbitrary timetable. so i'm pleased to say some stakeholders are standing up against this notion that this deal ought to be cut at a closed back room somewhere. the american medical association, for example, announced its opposition to a government-run plan. u.s. chamber of commerce and the national federation of independent businesses expressed concerns about some aspects of the legislation that's been proposed by the president and by

leadership here in congress. but more voices, not less, indeed all voices deserve to be heard on something of such fundamental importance to our country. the american people deserve a transparent and open debate about the reforms, the various proposals on the table so they can judge for themselves whether washington elites have their best interests in mind. or to the contrary, whether they believe something else is going on. i also want to express my appreciation for the professionals at the congressional budget office for refusing to compromise their integrity and for continuing to provide objective analysis of all reform proposals. that's their job. there job is not to make policy but it is their job to give us unvarnished, objective information about costs so we can determine what policy makes sense and what policies we can afford.

i commend in particular the director of the congressional budget office who, i read, was quoted as saying the congressional budget office "will never adjust our views to make people happy." that demonstrates the kind of integrity we would want to inform our decisions. we're the ones elected to make those decisions on the part of the american people. we should be held accountable for those policies but we have to get good, objective, unbiased information from professionals with integrity like the c.b.o. some, it has been suggested, don't like the big price tag that congressional budget office has put on some of their proposals. but the solution is not for the congressional budget office to get creative. it's for senators to get real and deal with the reality. and to use that information in order to craft decisions that

may work. i want to speak in particular about the only bill that has been rolled out, more or less, or provisions. that is, the bill proffered by our colleague, senator ted kennedy. senator kennedy has been a leader in the health care reform debate for more than four decades. i appreciate the fact he is the first democrat on either end of pennsylvania avenue, who has actually put out a proposal with some detail for us to evaluate and to react to. while more dills ar details are, we already know there are some red lines, some hot spots, some areas, if embraced by the democratic leadership, will result in failure, not in success. i think we all should be invested in the goal of bipartisan success. in fact, there are some provisions in the kennedy bill that would make things worse, in my view and the view of others and i think if there's one thing

we should do, mr. president, that is tip the hippocratic oath, the same oath that medical practitioners take, to do no harm. we should take a legislative hippocratic oath to, first, do no harm as we undertake this massive reform. for example, in the kennedy bill it describes a plan called -- quote -- "a public health insurance plan operated by the federal government with a payment scale that is set in statute and based on medicare." mr. president, i believe medicare for all or a government-run health plan is a disaster in the making. and millions of americans, and the millions of americans who will depend open us to get this right. let me explain why. first, a government listen run plan will take away the health insurance that people have right now. last year, president obama campaigned on the promise if you like what you have, you'll be

able to keep it. i agree with him, that ought to be our goal. but with a so-called government plan, that will not happen. we all know that government is not just the regulator but it's also the one paying the bills. ultimately the government cannot be calling the balls and strikes as it takes to the field to be a so-called competitor. let me put a finer point on it. one group of analysts, the louen group, said the government plan would take away, ultimately, current health benefits from 119 million americans and force 130 million american into a washington-run health care plan. now how does that happen? well, ostensibly, you have the government competing with the private sector to provide health care but we know the government ultimately would provide a more generous package and could do so, of course, at tas taxpayer

expense and save the difficulty of having to compete in the marketplace and ultimately as the louen group concludes, it would undercut private competitors leaving everyone, or at least 130 million americans, on a washington-run health care plan. not a good idea, in my opinion. secondly, we know a government plan would drive up costs for those who remain with private insurance. now how does that happen? well, we know there's a phenomenon in health care called "cost-shifting," because medicare and medicaid pay submarket rates for health care and providers make it up somewhere else. where do they make it up? they make it up from people who have insurance. how do they do that? by people who have insurance paying more than what they ultimately receive because the costs are literally shifted from medicare and medicaid on to private insurance. according to a respected

actuary, commercial players -- i should say payers, subsidize the costs of medicare and medicaid by nearly $90 billion a year in cost-shifting. this represents a hid tax on american families and small businesses. it is estimated the average price health care premium is more than $1,500 higher per family than without the government cost-shifting phenomenon. a new government program would increase this cost-shifting dramatically and increase the health care premiums of every american family who continued on their private health insurance plan. third, mr. president, we know this medicare for all or government-run plan would basically be like medicare and medicaid on steroids. and so anyone is not confused, that is not a good thing. i believe medicare illustrates

what happens when the government takes over health care delivery. for example, first of all, it's not fiscally sustainable. medicare will go insolvent in 2017 and currently has $38 trillion in unfunded liabilities. low reimbursement rates and, frankly, that's how medicare and medicaid try to deal with costs -- they cut payments to providers, hospitals and doctors, below the otherwise market rate. these low reimbursement rates reduce patient choice and increase in wait times for physicians that they see. many providers, as you know, i'm sure the distinguished occupant of the chair in his state, we know many doctors are not taking new medicare patients and new medicaid patients because of low reimbursement rates are a problem. each year congress has to come back and reverse the cuts to physician payments under the medicare sustainable growth rate formula and those cuts, unless

we act to reverse them, will cut physician payments by 20% this january. according to the "the washington post," last fall, taxpayers also pay up to $60 billion a year in fraudulent claims on medicare. so in addition to being fiscally unsustainable, in addition to rationing we have $60 billion in fraud and waste in the medicare program -- hardly a model for medicare for all or a government-run option. well, medicaid has even more problems. medicaid provides coverage but it does a poor job of providing access. in one way, this is really a ruse being perpetrated on the american people under medicare and medicaid. we say, yes, you have coverage, but if you can't find a doctor or health care provider that will provide you access at that price then their coverage

doesn't do you any good. according to a recent "wall street journal" article, medicaid's low reimbursement rates which are lower than medicare have resulted in 40% of physicians restricting access to patients in the program. so it's no wonder as the journal of health affairs said last month that physicians typically have been less willing to take on new medicaid patients than patients covered by other types of health insurance. medicaid reimbursement rates, as i said, are lower than medicare. more than 25% lower than medicare. one group that has a significant presence in my state illustrates the problem with 1,300 physicians and 500 advance practice nurses specializing in the care of newborns and vulnerable children. they noted the lack of appropriate reimbursement is the most common reason for

physicians to refuse to accept new medicaid patients. they have noted that within our own national neonature toe patient population the current government rates pay an average of 28.7% less than rates from private insurers. no wonder it is hard for medicaid beneficiaries notwithstanding what congress does, it's hard for them to find a physician who will actually see them at that kind of rate. they say they believe a public plan will erode the availability of private health insurance and impact negatively patient access to needed health care. the fourth problem with the plan in the kennedy bill that i have is that the government plan would ultimately lead to rationing of health care so that means delaying or denying access to treatment. all we have to do is look at canada.

a recent op-ed by dr. david gratzer in the "wall street journal" talked about what a government-run plan in canada has done. thousands of our friends to the north, of course, come to america each year for life-saving surgery if they can afford it and after their government has told them they will just have to wait. various studies indicate the canadians, especially the poor, are less healthy under socialized medicine than those in our country. more and more canadians want to reduce the role of government and, expand private options for health care. even as elites in washington want to move america in the opposite direction. the 5th reason why a government plan is not a good idea, it leads to poorer health outcomes. many canadians realize socialized medicine is not working for them and so are many folks in europe. according to a piece in the washington examiner this week,

breast cancer rates in europe under nationalized health care systems are significantly higher than they are here in the united states. iewmpian women are much more -- european women are much more likely to have breast cancer than are american women. currently the united states leads the world in treating breast cancer. women in the united states with breast cancer have a 14% better chance of survival than those in europe. the mortality is 52% higher in germany and 88% higher in the united kingdom. this is not something that we should want to imewe late. there are -- emulate. numerous studies have documented the poor patient outcomes under the medicaid program relative to those in private plans. medicaid patients were 50% more likely to die after coronary

bypass surgery than patients with private coverage or medicare. the other problems with the bill that the distinguished senator from massachusetts has proposed -- again, i credit him with the first one to lay out a plan. we have not seen one from any other source. the fact of the matter is the kennedy bill is not paid for. we don't know how much additional borrowing or how much higher our taxes will have to go up in order to pay the price. it also includes some concept as pay or play for small businesses. in other words, if you don't have health care coverage for your employees and they're in a small business, you're going to have to pay a punitive tax. the bill also provides very generous federal subsidies to those making as much as $110,000 a year. we're all for a safety net for people who are low income an can't otherwise provide for themselves. but why should taxpayers be

forced to pay higher taxes to subsidize health care for people making over $100,000 a year? it just doesn't make sense. the bill also includes an innocuous sounding council called the medical advisory council. which in effect would give the government power over personal health care decisions and particularly to unelected and unaccountable bureaucrats. the bill creates new entitlements which we have no hope of paying for at the same time when unfunded liabilities for so much of our entitlement programs remains unpaid for. and, frankly, mr. president, while i applaud the distinguished senator from massachusetts and his leadership on this issue, i worry that this is a bill that has no bipartisan input. i applaud senator baucus, the chairman of the finance committee, and other committees on the -- other democrats on the finance committee who said we need to come up with a

bipartisan solution here. when i raised this in the finance committee, the kennedy bill was described more as a wish list than anything else. the bill reflects few ideas from republicans which we have offered to discuss and would hope to include in any comprehensive health care reform. it includes several provisions which have been off the table. i mentioned the government plan option, which kills bipartisanship because republicans cannot support a policy that will lead to a washington takeover of our health care system. there are better alternatives. alternatives which empower individuals, preserve the individual choice that each of us have to make health care decisions in consultation with our physician, our family doctor in the best interest of our families. empowering people rather than government is a much better solution than this proposal we see under the kennedy bill.

innovators in both government and the private sector have learned by embowing patients -- empowering patients and providing them incentives, they can actually see costs lowered. so, mr. president, i think there's a lot of good ideas out there. unfortunately, the partisan proposal that we have from the "help" committee is not one of them. we hope to continue to work together on a bipartisan basis toward a successful outcome. thank you, mr. president. i yield the floor. mr. reid: mr. president? the presiding officer: the majority leader. mr. reid: i move to proceed to calendar number 71, s. 1023, the travel promotion act of 2009. and i send with my request a cloture petition to the desk. the presiding officer: the clerk will report. the clerk: clotur cloture motio: we, the undersigned senators, in accordance with the provisions of rule 22 of the standing rules of the senate, do hereby move to bring to a close debate on motion to proceed to calendar

number 71, s. 1023, the travel promotion act of 2009. signed by 17 senators as follows: -- mr. reid: mr. president, i ask consent that the names not be read. the presiding officer: without objection, so ordered. mr. reid: i now ask unanimous consent that on tuesday june 16, following a period of morning, the senate resume to the motion to proceed to s. 1023 and there be one hour of debate. the motion to proceed with the time equally divided and controlled between the leaders or designees, upon the use yielding back of that time the senate proceed to conscious to -- to -- on the motion to invoke cloture. the presiding officer: without objection, so ordered. a senator: mr. president? the presiding officer: the senator from north dakota. mr. dorgan: mr. president, the piece of legislation that was just described by my colleague, the travel promotion act, is a piece of legislation i want to explain some. the travel promotion act is a bipartisan piece of legislation that i have introduced here in

the united states senate with senator ensign, senator inouye, senator klobuchar, senator reid, senator martinez, and many, many others. i believe in the last session of congress when we introduced this we had over 50 cosponsors here in the united states senate. let me describe what the purpose is, travel promotion. who can be against travel promotion? except here is what happened with our country with respect to jobs and economic growth that comes with foreign travel and destination in the united states. we have had a significant impact on our travel, that is, the travel to the united states by foreign travelers as a result of measure that's were put in place quickly after the 2001 attack on 9/11. we obviously wanted to be very careful about who we allowed into our country. we still do. but what happened following that is we sort changed what we did.

instead of reaching out to the world to say: visit the united states. this is a great place. we encourage you to come here, to vacation here, to see what the united states is all about. we backed away from that. but other countries have not. here's what we have experienced this is overseas travel between 2000 and 2008. the reason this is important is the expenditure by overseas visitors is about $4,500 per visit. it's a lot of jobs. a lot of economic activity for restaurants and hotels and all kinds of -- of opportunities, tourist attractions and so on. since 2000 and 2008, there's been a 3% decrease in foreign visitors to the united states. at the same time there's been a 40% increase in visitors to other countries. now, think of the consequences

of that to our economy. a foreign visitor -- overseas visitor coming to our country spending $4,500 per visit is a lot of economic activity. a lot of economic growth and a lot of jobs. but it's decreased in our country and substantially increased in others. now, why is that the case? well, mr. president, the -- the rest of the world is very anxious to attract destination visitors to their country, international travelers to say: we want you to come to our country as a destination for your trip. india, one special reason to visit india is this advertisement. incredible india, any time is a good time to visit the land of taj, but there is no time like now. not unusual to see this. it's not just india. arrived, looking for an experience to remember?

departed with an adventure you'll never forget? australia. come to australia. if you're an overseas traveler deciding where to visit, be sure to come to australia. go where ireland takes you. pretty straightforward. makes you want to go to ireland. great britain, italy, spain, france, australia, india, ireland, they say, come here, come to our country. travel to our country. see what our country's about. we're not doing that. and, as a result, let me show you the chart again. as a result in the last eight years we've seen a 3% decrease in foreign travel -- foreign visitors to the united states while the rest of the world is at a 40% increase in travelers destined to those other areas.

it makes a big difference. and it's very negative in terms of our country's economic opportunity that comes from travel and tourism. so i showed the examples of what other countries are saying in their very explicit campaigns around the world to say to the people that live around the world -- if you're traveling abroad, if you're planning a vacation, if you're planning a trip, come it our country. come and see italy, great britain, ireland, india. let me show what you is happening with respect to our country. headlines like these. "the sydney morning harold," "coming to america isn't easy". "the guardian," "america, more hassle than it's worth." the sunday -- "the sunday

times," "travel to america? no thanks." it's hard to get a visa. long waiting lines, they think. much of that has been c cleared away. in the construction of this legislation, we talked a lot about that. but we don't want this to be the message to the rest of the world. in fact, quite the opposite. what a large group of us in the united states congress want is we want our country to be eng gauged internationally to -- engaged internationally to say, come to america, to see the united states is to understand the wonder of this great country. come here, stay here, vacation here, and understand what america's about. i can't think of anything better in terms of our position in the world and our people think of this great country. -- country than to invite them and encourage them to come here. and that is what occasions this piece of legislation called the travel promotion act of 2009. interestingly enough, the

congressional budget office has scored, as they score all legislation, and the congressional budget office has indicated that this piece of legislation will reduce the federal budget deficit b by $425 million between 2010 and 2019. now, we don't bring many pieces of legislation to the floor of the united states senate in which the congressional budget office says this will make moafnl this is a net pros -- make money. this is a net positive. this will reduce the federal deficit. that's what this bill is about. let me explain what we're trying to do with the legislation. the travel promotion act will attempt to create international travel opportunities from all around the world to come to this country and it will setup a nationally coordinated travel promotion campaign running a public-private partnership to communicate to the world our

country's travel policies, but more important, communicate to the world you're welcomed to come here, we want you here, we want you to explore what this great country has to offer. this public-private partnership is, i think, an ideal method for us to improve all of those perceptions out there even as we work on visas and other things which we have solved in large part. this provides public sector accountability with private sector enterprise. this bill establishes something called the corporation for travel promotion, an independent, nonprofit corporation with an 11 member board of directors appointed by the secretary of commerce. and it creates an office of travel promotion in the department of commerce to work with that nonprofit corporation. it sets up a travel promotion fund as well. financed by a public-private mching program that -- the federal contributions will be financed by a $10 fee paid by foreign travelers from visa

waiver countries and collected in what is called the electronic system for travel authorization. let me point out that many, many other countries impose lots of fees for people coming and going. australia, $37 departure fee. an entry fee of $19 to $70. mexico an $11 departure fee, up to $38. new zealand $19 for departure fee. united kingdom, $19. there are a lot of fees for people traveling internationally. we intend to propose this with a modest fee of $10. and that $10 would be paid by foreign travelers from visa waiver countries. so this is very simple and should be relatively noncontroversial. there are many of us who have worked on this and worked very hard. my colleague from minnesota is here, senator klobuchar, who has