a recent national institutes of health project description states -- and i quote -- "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. denying care based on cost. to that end senator mcconnell and i have entered legislation that would bar the government from using comparative effectiveness research to delay or deny care to anyone that. is a bear minimum that we should do to prevent rationing of care. our bill, incidentally, is endorsed by the american medical association. mr. president, government-run and rationed approaches have caused much pain to people in other countries. for example, in an article for the "manhattan

institute city journal" it was written of the long waits that canadians endure for any procedure or diagnostic test. seniors who lay on stretchers for five days in a hospital waiting room. a three-year wait list for a hernia operation, a two-year delay for sleep apnea treatment, a year-long delay for hip replacement and so on. it's one thing for washington it take over car companies, getting it wrong there usually won't lead to life or death problems. but it's an entirely different matter to allow washington to go into business as the nation's health care provider. who's going to protect you when they get it wrong? who are you going to appeal to? in his health car speeches president obama has stressed if you like your current health care, you can keep it. if you don't want to get on the washington-run plan. and that sounds allell and good, but it won't play out that way. the lewin group showed a study

if enacted the president's option would displace 119 million happily insured americans. their companies could take the easy route and sign a fine and tell employees to sign up for the washington-run health care even they don't want it. how does that square with the assurance that's people can keep what they have. a may 14th rasmussen poll shows that 70% of americans rated their coverages as excellent. another 23% rated it as fair. so most folks are happy with their current insurance and would not appreciate being pushed into washington's health care bureaucracy with all of its complex rules and hours of waiting on hold and webs of bureaucracy. and then there's the matter of cost. how much will it cost to add 47 million to the health care

rolls? who will pay? to not know the answers to these questions is to be fiscally irresponsible. we don't have precise estimates from the congressional budget office whose responsibility it is to tell how much the legislation will cost the tax paimples the congressional budget office preliminary estimate shows that only a part of the health, education, and labor costs $1 trillion. but it only reduces the number of uninsured by 16 million people. $1 trillion for 16 million people. the remainder of the bill has not been scored. my math shows that $62,250 per person and that covers one-third of the 47 million who are said to lack insurance and it doesn't take into account the estimated 119 million insured who will be switched from private coverage that they currently have to the government program. so what will the total cost be?

mr. president, there's another concern that hasn't been much discussed, but needs to be raised. it is a major concern for america's seniors. over the weekend the administration proposed trimming medicare's budget to pay nor new public plan. this is exactly the wrong thing to do and it only mean one thing, rationing and waiting lists for america's seniors. seniors want congress to strengthenedicare and make it more efficient and make it solve enter. ey want it to serve as intended, pay for the health care of seniors. they do not want the resources drained to pay for the new plan of 47 million uninsured plus the 119 million currently insured but soon to be displaced into the government system. seniors rightly ask: won't the new -- lead to dangerous waits for tests an treatment? president obama has acknowledged

that medicare's promises of treatment are financially unsustainable. and we learned recently that medicare's liability, that is the amount of benefits promised that are not covered by taxes is $38 trillion over the next 75 years. one lesson we can draw from medicare's financial troubles and veterans health care is that health care plans run by washington bureaucrats are not very efficient or cost effective. they have no incentive to be. in fact, the economic principle of the tragedy of the commons applies here since the money doesn't belong to any one individual or group, no incentive exists to be cost effective or streamline the bureaucracy. another way toay it is who washes their rent-a-car. seniors and veterans and private companies and those who insurance their workers, the uninsured, in fact, all

americans should be given the chance to review and discuss and provide feedback on any legislation as important as -- as important as this health care reform. it will affect the way we all get our health care. i look forward to an ongoing dialogue about the health care reform that we all want. but we must not rush to churn out an hastily past a plan that will lead to rationing and the displacement of millions from the insurance they currently enjoy. it's of paramount importance that the principles of quality, quality care, choice, freedom, and putting patients first triumph in the reform that we all want. mr. president, i note the b absence of a quorum. the presiding officer: the clerk will call the roll. quorum call:

mr. sanders: mr.? the presiding officer: the senator from vermont. mr. sanders: mr. president, i ask that the quorum call be vitiated. the presiding officer: without objection, so ordered. mr. sanders: mr. president, i think virtually everybody in our country understands that the united states of america is the -- is in the midst of a major, major health care crisis. we have 46 million americans without any health insurance. we have even more who are under insured and we have, in addition

to all of that we have some 60 million americans, 20% of our population, who do not have access to a doctor on a regular basis. the result of that particular fact is that we lose over 18,000 americans every year who die needlessly, who should not die because they don't go to the doctor when they should get the treatment that they need. that is six times every single year what we lost on 9/11. of people who died who should not die because they don't have access to a doctor. mr. president, in the midst of this horrendous lack of coverage, unique, i should mention among major nations on earth, the united states spends far more per capita on health care than any other nation. and those costs continue to soar. so when people make

international comparisons of the united states with other nations on how well or not well we're doing, that's good to do, but we should always remember that we are spending almost twice as much per capita on health care as any other country. and there is certainly something wrong and dysfunctional about a system which spends so much and, yet, leaves so many people uninsured or underinsured or without access to a doctor or a dentist or other preventive health care. at $2.4 trillion and 18% of our gross domestic product, the skyrocketing cost of health care in this country is unsustainable both from a personal point of view -- the needs of individual americans and also from a macro economic perspective, what is happening to our entire economy. at the individual level, the average american today spends

about $7,900 per year on health care. can you believe that? close to $8,000 per person on health care. and we all know folks who are out there making $20,000, $25,000, $30,00, and we are spending on average almost $8,000 per person. despite that huge outlay, unprecedented in the world, a recent study found that medical problems contributed to 62% of all bankruptcies in 2007. medical problems, bankruptcies. and i should add most of the people who went bankrupt had health insurance. they had health insurance, but what they had was inadequate health insurance. from a business perspective as opposed from the needs of an individual, general motors spends more money on health care per automobile than they do on steel.

more money on health care than on steel, which might lead us to understand why they are where they are today. and business -- small business owners in the state of vermont and around this country are forced to divert hard-earned profits into health coverage for their employees rather than new business investments. you're seeing many small businesses are trying to do the right thing in terms of their employees spending more than they have, they don't have the money available to make the investments they need to make their businesses grow. and the result of that, of course, is that as a result of soaring health care costs going up 10%, 15%, 20% a year, many small businesses and medium-sized businesses are cutting back drastically on their level of health care coverage or in some cases are doing away with it entirely. more and more businesses in america are say: i can't afford to provide health insurance to my workers.

now, despite all of that, we spend almost twice as much per person on health care as any other country, despite that fact of our spending, you know what, people say, you know what? you spend all of that money, the results must be great. well, that's not really the case. the bottom line is we get poor value for what we spend. according to the world health organization, the united states ranks 37th in terms of health system performance and we are far behind many other countries in terms of such important indices as infant mortality, life expectancy and preventible death. so we are spending almost double what any other country on earth is spending. we've got 46 million without any health insurance. we have more who are underinsured. we have thousands who die because they can't get to a doctor. and then in many other health care outcomes, we are behind many other countries around the world, some of whom are spending

far, far less per person than we are spending. now, it seems to me that as the health care debate here in congress heats up, we as a nation have got to ask two fundamental questions. different people will have different answers to it but here are the two questions i think we've got to ask. first, as a nation, should all americans be entitled to health care as a right? that's the first question. and honest people will have differences of opinion. some people will say, well, do you know what? hey, some people have big cars, some people have small cars. some people have big houses, some people have small houses. some people have good health insurance, some people have no headlight insurances. that is the way life goes. some people hold that view. i don't. i think that in america we should understand that every single person should be entitled to quality, comprehensive, affordable health care. and, in fact, i think most americans feel the same way.

second of all, if we are to provide quality health care to every man, woman and child in this country, how do we do it in a way that doesn't bankrupt the nation? how do we do it in a cost-effective way? those are the two questions that we have to ask ourselves. and, mr. president, i think the answer to the first question is pretty clear. and, in fact, it's one of the reasons that barack obama was elected president of the united states. most americans do believe that all of us should have health care and that nobody should left out of the system. we have a hard time understanding that joe smith, who works for one company, has good health care and his neighbor, mary evans, who works at another company, doesn't have any health insurance at all. what sense is that? so i think as a nation we are coming to understand that all of our people are entitled to health care as a right of being americans and the challenge that

we face is how do we do it in a cost-effffective way? in that regard, i think -- and i speak, obviously, just for myself here -- that the evidence is overwhelming that we must end the private insurance domination of health care in our country and move toward a publicly funded single-payer medicare for all approach. and i think the evidence is overwhelming that if you want universal, comprehensive, quality health care for all people, that is the only way actually that you can do it. our current private health insurance system is the most costly, wasteful, complicated, and bureaucratic in the world. just today -- not yesterday, just today. spoke to an i had who has a law degree. very smart guy. his wife has a ph.d. and they went through the federal employment benefit package

between a ph.d. and a lawyer. they spent hours trying to figure out what particular program could work best for them. and all over america people are spending countless hours trying to figure out is it this program, is it that program, i'm young, i may not get sick, but do you know what? i have a history of cancer in my family. should i get this comprehensive, should i get in high deductible? if i'm a small business, committee only negotiate this. i'm general motors, committee self-insure. what should i do? and the answer is there are 1,30000 separate private health insurance companies -- 1,300 separate private health insurance companies peddling thousands and thousands of plans. let me be clear, in case everybody has not caught on yet, the function of a private health insurance company isn't to provide health care. it is to make as much money as possible. that's what its reason for existence is about. and, in fact, whic when a privae

health insurance denies health care, they make more money. and in fact, the record is pretty clear that private health insurance companies have given bonuses to people, their own employees, who are successful in throwing people off of the insurance policy because those people were running off high health care costs. thus, we have the phenomena, the insane phenomena of something called preexisting condition. what a term that is. preexisting condition. meaning that you can't get coverage for the illness that you need to be covered for most. the person that had cancer three years ago, worried about a recurrence of cancer -- sorry, we can't provide insurance to you. then you have other circumstances where somebody gets really circumstances runs up a high medical bill and the insurance company says, oh, we don't want to continue your policy because we have to pay out so much money, we want to go to some young guy who can run the marathon and who promises us

never to get sick. those are the guys we want to cover. this is an insane system. it is a wasteful system. it is a bureaucratic system. how many people are spending half their lives on the telephone arguing with insurance companies to cover the claims that they thought they were covered for? so people on one end of the phone are spending huge amounts of time and money doing that and at the other end of the phone, we're paying somebody to tell us that we don't have coverage for what we thought we did have coverage. with thousands of different health benefit programs designed to maximize profits, not provide health care, private health insurance companies spend an incredible 30% of each health care dollar on administration and billing, exorbitant c.e.o. compensation packages, advertising, lobbying, and campaign contributions. one of the lovely things that the insurance companies do and

the pharmaceutical companies do, after they rip you off and they make huge profits, they take some of that money to hire all these fancy guys here in washington, d.c., to protect the status quo. and the bottom line is -- and all of the evidence makes this clear -- that public programs like medicare, medicaid, the schip program, and veterans administration are administered for far less money than our private health insurance -- than are private health insurance companies. mr. president, in recent years, while we have experienced an acute shortage of primary health care doctors, nurses, and dentists, we are paying -- we are paying for a huge increase in health care bureaucrats and bill collectors. here's the insanity, the dysfunctionality of the current system. we don't have enough primary care dock turk we don't have enough dentists, we don't have enough nurses, we don't have enough medical personnel, don't have enough of those people.

but over the last three decades, we have seen an explosion in the number of health care bureaucrats and people who are bill collectors. now, to my mind, i'd rather see somebody hired who can help somebody get well or prevent disease, not somebody on a telephone billing us or arguing about what we owe or don't owe. the fact of the matter is, though, over the last three decades, the number of administrative personnel has grown by 25 times the numbers of physicians. 25 times more bureaucrats than physicians. well, we don't need health care bureaucrats pushing paper. we need primary health care doctors delivering babies, taking care of the elderly and taking care of those people who are sick. not surprisingly, while health care costs are soaring, so are the profits of private health insurance companies. from 2003-2007, the combined profit of the nation's major health insurance companies

increased by 170%. health care costs are soaring, profits of the health insurance companies are also soaring. and while more and more americans are losing their jobs and health insurance, the top executives in the industry are receiving lavish compensation packages. it is not just william magoya, the former head of united health, who several years ago, mr. president, several years ago accumulated stock options worth an estimated $1.6 billion. hmm, okay? $1.6 billion a few years ago for the c.e.o. of united health and we don't have enough money to provide health care to people who are uninsured. and it's not just henry signa, ed amway made $112 million the

last seven years. the fact, is the c.e.o. for the top seven health insurance companies now averages over $1 $114 million apiece. moving towards a health care program which provides universal, comprehensive and quality health care for all will not be easy. it is the major political struggle that we face right now. the powerful special interests -- and they are all over capitol hill; they are all over, the lobbyists are here -- i would say that in the midst of the recession, mr. president, i would suggest that while unemployment in general is soaring, my strong guess is that unemployment for health care lobbyists and pharmaceutical industry lobbyists is going down. those grise plenty of jobs and -- those guys have plenty of jobs and they're making pretty good money. and i'm quite confident that those lobbyists will wage an all-out fight to make sure that we maintain the current dysfunctional system which enabled them, the insurance

companies and the drug companies, to make millions and billions of dollars in profit. in recent years, they have spent hundreds of millions on lobbying, campaign contributions, and advertising and with unlimited resources, we have no reason to believe that they will not continue to spend as much as they need. but at the end of the day, as difficult as it may be, the fight for a national health care program will prevail. decade after decade after decade all over this country, people thought for a civil rights movement which said we will judge human beings not on their color but on their character, who they are as a human being. the struggle for women's rights went on decade after decade before women had the right to vote or had a seat at the table. and in my view, the struggle for health care is the civil rights struggle of today. and i believe that 30 years from now, 50 years ago, people will look back and say, i don't

believe that there was a time in america where people who got sick couldn't find a doctor, where people went bankrupt because they committed the crime of being sick or having cancer. i don't believe that. and our job, mr. president, is to bring that day, when every american has health care as a right in a comprehensive, cost cost-effective manner, our job is to make that day come sooner than later. and if we work together and if we have the courage to stand up to the big-money interests who want to maintain the status quo, we, in fact, can do that. thank you, mr. president, and i would yield the floor. a senator: mr. president? the presiding officer: the senator from alabama. mr. sessions: mr. president, about two weeks ago, i spoke on the floor about the unprecedented budget deficits that this country is now facing. the fact that we're spending money we do not have, and i

specifically discussed the impact that's having on treasury yields. what we know is that president obama's budget has been scored by the congressional budget office, which is our group -- and i think they do a pretty good job. they take pride in being independent and fair. the head of it was selected by the democratic majority in the senate. they're certainly not a republican organization, they're just a fair, trying to do the best they can to calculate the numbers. what they calculated was, that the rate of deficit spending that we're now undertaking, the total american debt will dmowbl ten years from 5.-- double in tenears from $5.7 trillion to over $11 trillion. and in ten years, it will trip toll $17 trillion. now, that's a lot of debt. so you might ask: what happens, how do you do that? how do you spend more money than yo