leader in the middle east has responded to the hopes of mankind." mr. president, i have been to israel and i have shaken the hands of its citizens. i know there is a strong desire for peace and we can never lose sight of why peace is so important. after the unspeakable horrors of the holocaust, the jewish people would forever be mindful what turns history will take. every day we're mindful that anti-semitism has not gone away, whether in the form of a firebombing of a synagogue or a senseless murder here in washington, d.c. israel is the one place in the world -- the one place -- where anti-semitism can be impossible. it is a field of hope. an island of refuge that can stand firm no matter how stormy the sea. that's why we must always keep it safe and free.

the united states is not simply allied with a govment it is aen -- it is an ally of israel's eye deisms it is eye deal of its can-do spirit and amazing resill yens and the face of threats from all sides. in that sense we're not just israel's allies, we are admirers, we're partners and we're friends. i plan to do everything i can to see that we support that friendship this year, next year, and every year thereafter. let me close by saying, martin luther king jr. said -- quote -- "the arc of the moral universe is long but it bends towards justice." we know that in israel's quest for security there will be trials along the way. there will be setbacks and there will be dangers too tremendous for words. but if we continue the work that we do and continue to stay true to the stlals drive our journey, then the long arc will eventually rest inlace in the

land of israel, and it is a just and lasting peace tha that willg be at hand. thank you, mr. president. i yield back whatever time i may have left, and i yield the floor. the presiding officer: the senator from illinois. mr. durbin: how much time is recalling in morning business on the democratic side? the presiding officer: 16 minutes. mr. durbin: mr. president, i am going to ask consent for an additional five minutes on both sides in morning business and i will try to not use it, if i can. so i ask consent for an additional five minutes on both sides. the presiding officer: without objection, so ordered. mr. durbin: thank you. mr. president -- and i ask unanimous consent that after my remarks the senator from oregon be recognized. the presiding officer: without objection, swithoutobjection, s. mr. mccain: mr. president, could i amend that unanimous consent request that i follow senator wyden. mr. durbin: absolutely. and i ask unanimous consent that on the republican side, for their morning business, senator mccain be recognized first. the presiding officer: without objection, so ordered. mr. durbin: this morning the republican senate leader came to the floor to talk about health

care. it is a timely conversation. among members of the senate about the future of this important issue and i know senator wyden of oregon is going to address it at all. yesterday in chicago, illinois, which i am honored to rerntion the president came to speak to the american medical association, a gathering of doctors dpr all ove from all ove dwriewunitedstates to address te issue. they understand, as we do, that we want to maintain the best quality of health care in the world. nard to do that we have to face the realities. shored comings of our current health care system. though we have many of the best hospitals and doctors, some of the best technology, lead the world in the development of pharmaceuticals, we also know that the cost of this system is spinning out of control. people feel it, whether it is individuals buying health insurance, businesses, governments, state and local and federal governments all understand that if the government of health care

continues to rise as it's currently going up, it will literally break the bank, not just for the federal government and all of the health care programs that we have but for individuals and families and businesses. that's the reality. so if we do nothing, if we ignore this reality, we are doomed to face a situation where more and more of the dollars that we earn as employees will go toward health care protection and health care insurance and the protection there was diminish each year because that's the other reality. as the cost of health insurance goes up each year, the coverage goes down. people know what i'm talking about. when the health insurance company say, oh, we've got a great plan for you, but incidentally, you remember that cancer test you had last year? we won't cover anything related to cancer in the future. well, that's not much when it comes to insurance or protection or peace of mind. they also know that many health insurance companies make this a deadly game, a battle between what your doctor says you need

and what some insurance company bureaucrat is going to negotiate. you end up on the phone with some clerk in a distant location debating your doctor as to whether or not there's coverage and whether or not they can go ahead with the procedure they think is important for you or someone that you love very much and your family. that's the reality of where we are today. we have to deal with cost and deal with it in a fashion that is appropriate. and how do we deal with it? first, this system has a lot of money in it. we spend twice as much as any other country on earth when this comes to health protection and health care. and yet when you look at the results, the actual survival rates for many of the serious illnesses that face us, it turns out that companies -- or countries that spend a fraction of what the united states spends get better results. there's a lesson to be learned here. there is waste in this system. one of the articles that is making the rounds on capitol hill was written in the "new yorker" magazine on union 1 bay

boston surgeon and he went to mcallen, texas, and tried to understand why the cost per medicare patient there at $15,000 a year was so high, dramatically higher than many of the comparable cities in the state of texas and around the nation. well, what he found to his surprise and disappointment was that the doctors and hospitals in those areas were really bundling up and charging people as much as possible, ordering procedures that were unnecessary, doing things that weren't called for. the reason was obvious: there was money to be made. as long as they kept piling on the medical bills onto patients through medicare, they received more reimbursement. they didn't have healthier people. they didn't have an outcome that justified it. but they made a lot more money in the process. what the president has said to us is, with all of this money in the system, we have to find ways to bring in more efficiency. it's one thing to say that 48 million americans currently

uninsured will receive protection. i think that's basic. that's moral. that should be one of our primary goals. but that costs money. when the republican leader comes up and argues that i this is gog to be an expensive undertake, what he is saying is that we can't afford t insure people in mesh. i think he's wrong. we must do it. if they don't have health insurance they're still going to get sifnlgt they're still going to a doctor or hospital and all of us will pay for it. right now we estimate that for an ordinary family in america, we are paying about $1,000 a year more in health insurance premiums to cover those who are uninsured. in other words, the health insurance policy that i have with the federal government with the federal employees is $1,000 more than it ordinarily would be so that there's more money in the system to cover those uninsured. so if we can bring those uninsured into insurance coverage it gives them peace of mind, it relieves this hidden tax on families across america,

and it means that providers, hospitals, doctors, and others, are going to be adequately compensated for the care that they offer to currently uninsured people. so when president obama comes to the a.m.a. and talks about covering the uninsured, there's usually a cheer. that's 48 million more paying customers. but he also talks about something that's not as popular with many health care proirks and that is reducing the cost of this system. what happened in mcallen, texas, is unacceptable, that you can have health care providers trying to run the bill in an effort to make more money for themselves at the expense of the government, at the expense of health insurance companies but frankly not to the benefit of those who are being treated. the senator from kentucky frequently comes here and talks about how much he dislikes -- i'll use that word -- government-related health care. let's make it clear. i don't know anyone, including the president or leaders in congress, calling for a

government health care plan to cover for everyone. that's not what we're asking for. we want to try to make sure that there is private health insurance that is held accountable and is competitive so that we can help bring down the cost. imu to argue that there is something fundamentally wrong with government-sponsored health care even if it's just an option, a voluntary option, for cuss mess across america is to ignore the obvious. there are 40 million americans today protected by medicare. 40 million seniors and disabled people who have quality care because of a government plan that's been in place now for over 40 years. there are also a large number of our men and women who serve in the military, protected by the veterans health care system, another government health care system, who believe -- and i think rightly so -- that they're receiving some of the best medical care in america. i don't believe the senator from kentucky is opposed to the veterans administration and the health care it provides, but it is a government plan. the same thing is true when it comes to the children's health

insurance program. that's health insurance for individual children through private companies but the government has stepped in to make sure that's kids are covered. i'm proud of the fact that when president obama took office we extended that coverage to 11 million uninsured children in america. that was a government effort to make the private health insurance effort in our country work better. so we have to really get down to the bottom line here. are we going to succeed or fail when it comes to health care reform? if we ignore the obvious and ignore the challenges, there's a genuine chance that we may come up short. but if we accept this challenge, this historic challenge to come together on both sides of the aisle, i think the american people will cheer us on. they want to maintain what is good about the current health care sanldz fix what's broken. they want to make sure that at the end of the day if they have health insurance they like, a flan they thinkvite for them or their families, that they can keep that. they want to make sure that the health care reform is centered on patients and families and the

doctor-patient relationship, not on a government bureaucracy. they want to end the health insurance company bureaucracies that are so expensive for families acrossmark. so when the senator from kentucky, the republican leader, comes to the floor and really comes up with a series of criticisms about any attempt at reform, i have a question to ask him: what is your option? what would you do? do you accept the status quo? do you think this is as good it is a can be? i don't. i agree with president obama. we can do better. the president said one last thing that i'm going to say. that he said, if this were easy, it would have been done a long time ago. it's hard. and it'll take bipartisan cooperation for it to succeed. i encourage my colleagues to join in that conversation at the finance committee as well as at the "help" committee and i hope we can produce a product this year that shows we're going to move forward together to make sure we have affordable, quality health care for every american.

mr. president, i yield the floor. mr. wyden: mr. president? the presiding officer: the senator from oregon. mr. wyden: how much time remains on the democratic side? the presiding officer: 11 minutes and 24 second. mr. wyden: thank you. many senators on both sides of the aisle are working constructively to fix american health care and for several years i have spent time listening to colleagues going to the offices of about 85 snorks at least that -- of about 85 senators, at least that many in the house, and also listening to thousands in the public and private sector about their ideas for fixing american health care. my aim has been to try to help find common ground and to chart a path so that this congress and this president can go somewhere that the country has never gone before, and that is to real health care reform. today i come to the floor to lay out the specifics of what real

health care reform is all about. the president said yesterday there has never been a better opportunity to get the job done. specifically, to exriewf the lives of all americans -- to improve the lives of all americans, and to guarantee affordable, quality coverage to all people. the question now is will democrats and republicans here in the senate rise to this challenge? will this congress and the president overcome the fear tactics that have derailed past efforts? and equally important, will this congress and our president dare to pass real reform? the pitfall, as i see it, is too often we've been too afraid of failure. if we descraft legislation with an -- if we draft legislation with an eye only on what we think you can get through or what the american people may buy, if you play it too safe, my fear is you'll miss the opportunity for real reform.

and i believe that passing a reform bill that doesn't really reform the health care system is just about as wrong as not passing any bill at all. the president said yesterday he's going to support legislation that earns the title of reform. i agree with the president, which is why i'm going to use this morning to lay down at similar marker for what i believe is necessary to earn the title of real reform. first, real reform means that all of us -- and especially the powerful moneyed interest groups in our society -- all accept changes they have resisted in the past. insurers are going to have to change the way they do business. pharmaceutical companies will have to be more responsive to purchasers who insist on more

value and transparency. doctors and hospitals will be held accountable for the quality of care they provide. and malpractice suits would be held to stricter standards. and individuals would have to take greater responsibility for their health. real health reform means changing the way business is done in the private insurance market. it means, mr. president, an end to insurance company cherry-picking where the companies take the healthy people and send sick people over to government programs more fragile than they are. that's wrong. and this congress, democrats and republicans, will make it illegal. real reform means everyone is guaranteed coverage by their choice of insurer. under a new system, insurance companies must be required to cover all commerce, and they'd be required to price with

fairness so you don't get discriminated against because of your gender or your health status or your age. it means you no longer will be denied coverage or charged more because you were sick years ago or you might be sick five years from now. real health reform guarantees that all americans can choose their doctor and their health plan. the president said yesterday real reform will give every american access to the insurance exchange where they can choose to keep the care they have or pick a better plan that meets their family's needs. that means if you like the care you have, you can keep it. but it also means if you don't like the care you have, you can reject it. you can reject it and choose a better plan. real reform would not only cover the uninsured but it would make the lives of all of those who

have insurance coverage better. right now the majority of americans, mr. president, who are lucky enough to have employer coverage get no choice. i believe -- and the president said it yesterday -- those americans deserve choice too. now, some might say that this undermines the employer-based system. no, it doesn't. rather, it makes the employer-based system more accountable at the same time that it makes health care more portable. real health reform means that if you leave your job or your job leaves you, you don't lose your health care coverage. real reform would end once and for all the entrepreneurial tax in which americans are afraid to go into business for themselves because they can't take their

health care with them. the president himself said it best when he wrote in 2006, "with americans changing jobs more frequently, more likely to go through spefls unemployment and more likely to work part time or to be self-employed, health insurance can't just run through employers anymore. it must be portable." mr. president, real reform has to guarantee that all americans can afford quality health care. no longer should families be forced to pay more for their health insurance premiums than they pay for their housing. our goal should not be to exempt those americans who can't afford to pay. our goal should be to guarantee that all americans can afford the health care that they need. real reform will be affordable for our nation and for our taxpayers. it will reduce current costs and bring the rate of health care, inflation in line with economic

growth. failure to meet this test would result in massive new government obligations without means to pay for them. mr. president, real reform must end the health care caste system in which low-income americans are treated as second-class citizens. no longer should low-income americans have less access to doctors than their member of congress or other americans. today 37 million adults and 10 million children effectively lack access to primary care physicians. those are americans who have health insurance but who cannot find a doctor to care for them. real reform means ending the caste system in america that, in my view, discriminates against the most vulnerable and most impoverished among us, and it means with reform they will be

able to get a doctor when they need to see one. real reform rewards americans for making smart choices. americans ought to be rewarded for choosing the right insurer for their family and they ought to be rewarded for choosing a healthy lifestyle. this means a new health system that no longer focuses primarily on sick care but puts the priority on prevention as well. real reform would change the incentives that drive behavior of the american health system. it would reduce the demand and desire for unnecessary health care services. health care institutions would no longer profit from the quantity of procedures they run up, but instead, mr. president, would be rewarded for quality care. real reform takes an ax to administrative costs. americans ought to sign up just once for health care. they ought to have their premiums taken from withholdings

so they don't have to worry about making payments. they ought to go into larger, efficient groups so they are no longer left on their own on what can often be a cruel individual market. in today's nonsystem people are an afterthought to the self-perpetuating bureaucracy of medical billing, reimbursement fights, coverage fights and outright fraud, waste, and abuse. the president said yesterday real reform will replicate best african-americans, incentivize excellence and close cost disparities. in effect, he wants to see health care dollars go and pay for health care and quality, efficient health care. and that is what i have described today. real reform that provides care, it gets all of us under the tent for good-quality, affordable coverage, coverage that's portable, coverage that ensures that we end the caste system so

that all americans can see doctors when they need one, and a system that is more intent on keeping people healthy rather than profiting from illness. so the central question, when it comes to real reform, is not who pays, but how we pay. every american knows that ultimately the taxpayer foots the bill. it is now congress's job to create an accountable system that puts the focus where it belongs. not on misguided incentives, not on shedding risk, not on quartererly profits, but on quality, efficient care for all our people. that's what americans want from this debate about health care reform. that's what i think can bring democrats and republicans together, working with the president under the banner of

real reform. the country deserves it. it is time for this congress to give it to our people. mr. president, i yield the floor. mr. mccain: mr. president? the presiding officer: the senator from arizona. mr. mccain: tomorrow the committee on health, education, labor and pensions will begin consideration of a 615-page bill that seeks to reform our nation's health care system. this bill introduced by senator kennedy and others just last week has very grand ambitions. we all agree that health care reform is necessary. we all agree that congress must act. but we must not act recklessly. we must not act with haste and political expediency. health care reform will affect each and every american, and we must do it right. i strongly believe that we have to start over and act in a truly bipartisan manner to address the issue.

unfortunately, the legislation before that committee seeks to enact a massive government-run health care program that intrudes into the lives of all americans by making decisions on each american's choice of doctors, employer health plans and insurance providers. and it leaves major questions unanswered. every american should know the answer: how much will this massive expansion of government cost? and every taxpayer should have a clear answer to how are taxpayers going to pay for this massive government expansion? yesterday -- yesterday -- the congressional budget office released a letter that stated that the kennedy bill, the bill now pending from markup tomorrow, beginning tomorrow in committee, would ensure only one-third -- ensure only one-third -- of the 47 million americans that are currently

uninsured for the cost of $1 trillion. $1 trillion over ten years. and again, that only insures one-third of the uninsured. let me quote, mr. president, from the congressional budget office report. it says "once the proposal" -- that's the bill that we are now considering in the health care committee -- health committee -- "once the proposal was fully implemented, about 39 million individuals would obtain coverage through the new insurance exchanges. at the same time the number of people who had coverage through an employer would decline by about 15 million, or roughly 10%, and coverage from other sources would fall by about 8 million, so the net decrease in the number of people uninsured would be about 16 million." 47 million are without health insurance in america.

so this matches, mr. president, with an executive summary entitled the impact of the 2009 affordable health choices act, which is completed by the h.s.i. network, done by steve perenni, ph.d. and lisa tomai, m.s. mr. president, i ask unanimous consent that this report be included in the record. what this study concludes is it awe thepbt case the congressional budget office because -- it authenticates the congressional budget office because it says if you want to insure every american it's going to be $4 trillion. not $1 trillion, but $4 trillion over a ten-year period. so to ensure coverage for all americans under this proposed legislation, it would cost $460 billion annually, or $4 trillion over the next tenure years according to a report issued last week, as i mentioned.

so the best we can tell, the cost of the legislation that we are now considering is $4 trillion. now, hour we going to -- how are we going to pay for that, mr. president? how are we going to pay for it? is there a proposal yet besides eliminating fraud, abuse, and waste? well, it's unacceptable and it isn't health care reform. and i believe that the c.b.o. letter should be a wakeup call tpo all of us in this chamber to scrap the current bill and start all over, and start all over in a bipartisan fashion, with true negotiations. yesterday the president of the united states said the opponents of his legislation, or his proposals were fearmongering. i don't agree with that. i don't agree with that assessment, nor do i accuse the proponents of this bill of that motivation th-fplt isn't health care reform. any bill that strips 23 million

americans of their current health care coverage and ensures a mere third of the 47 million uninsured americans is not what americans are looking for in legislation. and let me say americans aren't calling -- they aren't calling for a massive government expansion. they aren't calling for a new government insurance plan that will do away with existing private insurance plans or enact a broad government panel exerting command and control of individual, small-group and large employer health care plans. they aren't calling for new taxes, cuts to health care services or penalties to individuals or small businesses, health coverage doesn't imply with washington's standards. they're not calling for a $1 trillion to $4 trillion to be spent to fund the appetite of some, some who are hungry for more government intrusion into the daily lives of americans.

americans need health insurance, good and complete health care coverage, the security of knowing they have a job and, even better, a job where an employer can afford to provide health care coverage. if the employer doesn't provide coverage, we need to make it easier and affordable to get health care coverage for an american. two ideas: one, give every american family $5,000 refundable tax credit and let them go out and an insurance policy that meets their needs, and let them go across state lines if they feel like doing it. that's pretty simple. it's not real complicated. it could be done in a bipartisan way and in a matter of weeks. that's not what -- that's not what's happened here. despite all of their calls along with the president for bipartisanship. but it can be done if we really want to solve the problem for the american people. i believe it's time for comocrats and republicans to