mr. durbin: mr. president? the presiding officer: the majority whip. mr. durbin: i ask unanimous consent the call of the quorum be suspended. i ask unanimous consent the call of the quorum be suspended. the presiding officer: without objection, so ordered. mr. durbin: i ask unanimous consent to speak in morning business after i have presented to you four unanimous consent requests for committees to meet during today's session of the senate with the approve the majority and minority leaders, consent that they be agreed to and printed in the record. the presiding officer: without objection, so ordered. mr. durbin: mr. president, as we meet on the floor of the senate, we're deliberating a

bill about promoting tourism in america which turns out to be a way to increase economic activity, create some business activity, keep people in their jobs and maybe attract folks from overseas to see this beautiful land of ours, we're now in a procedural holding pattern. the minority party has asked us to wait 30 hours before we talk about it. it's unfortunate because we're prepared to go and ready. we have a lot of things to do but the rules of the senate are available for them as for us and they are utilizing them now to delay and stop action on this bill which is very routine, bipartisan and enjoyed the support of over 90 senators when it was called yesterday on a procedural vote. in the meantime as we are waiting on the floor for the republicans to give us permission to go forward, the committees are at work. i left the judiciary committee where the presiding officer is also a member, with the attorney general, and we spoke of the critical issues. right across the hall from us is

the finance committee and they are debating the future of health care in america. that's a debate we're all following very closely. it is clearly time for us to acknowledge the obvious: we have some of the best doctors and hospitals in the world the fact is the cost of health care in america is spinning out-of-control. if we don't have the political will and encourage to step up at this moment in time and address that it's going to get much worse. people will find there will be more uninsured people, people with health insurance that isn't worth much, and that the cost of what you can buy will be so expensive that average people can't afford it. you'll find if we don't do something health insurance companies will continue to exclude people because of preexisting conditions, continue to argue incessantly with doctors over what the right prior might be and we will find there will be a situation where we don't have a chance to utilize the very best health care in our country for needed

procedures. now, many people say, senator, i've listened to that but, count me out. i've got a great health insurance plan. i don't need to be part of your debate. what the president has said and what we've said and congress says, okay, we accept that. if you have health insurance that you like, that you want to keep, you can keep it. there won't be any change. but if you happen to be one of those americans who thinks they can do bet we for something more affordable or sadly one of the 48 million americans with no health insurance, we think we've got to change some of the ways we do business in this country. one of the key elements here as i've mentioned already is what to do with 48 million uninsured. if these uninsured people had their own health insurance it would be a benefit to all the rest of us who happen to have health insurance. some of these political commentators like to write that members of the senate have some special health insurance plan. well, we're fortunate to have one of the best in the world but

it's the same plan that federal employees have across america, eight million federal employees and their family, and members of congress who opt to buy into it have a wonderful plan. i'm lucky. my wife and i are very fortunate to have that kind of coverage. for a lot of people they don't have that luxury. once each year i can choose from nine different private health insurance plans that sell to federal employees who live in the state of illinois. that's quite a good deal. if i don't like the way i was treated last year by my health insurance company i can change. it's like shopping for a car. i have a lot of different places to stop and look but most americans don't have that luxury. most americans don't have the option of looking for health insurance. and if they do, they can't afford it. if you have to pay for it out-of-pocket you may find yourself unable. and small businesses, which want to provide health insurance, not only for the owners but the workers, say it's just too darned expensive. we can't afford to do it. that's why 48 million

americans -- not the poorest because we cover them with medicaid; and not those lucky enough to have health insurance, but those smack dab in the middle who get up and work every day and go to business, maybe businesses that they own, don't have health insurance. one in four don't have health insurance. so we have worked with them to try to come up with an approach debated by the finance committee to have small businesses and self-employed people have a chance to buy health insurance. just like federal employees can buy health insurance. but we really have to get to the bottom line of this issue. it isn't enough just to say we're going to cover 48 million americans currently not covered. that's prnts. because uninsured people who show up at the hospital in america today are not turned away. they're treated. who pays for them if they can't pay for themselves? the rest of us. taxpayers and people with health insurance. it's estimated the average family pays an additional $1,000 a year, almost $100 a month for coverage for uninsured people.

we're picking up their health expenses because they don't have health insurance. that's a hidden tax. so when we talk about the cost of health care reform there's a real cost of doing nothing -- about $1,000 a year out-of-pocket for most american families. now knee wed knew move into the tougher issue, an issue that is debated at element here on the floor. the bottom line is the cost of medical care. we spend twice as much as any other nation on earth for medical care for our citizens. sadly, we don't have the results to show for it. if you look at the basic health indicators, many countries that spend far less mr less mr. persn the united states have -- far less per person than the united states have a better out come. we have the technology and the drug companies, why aren't we the healthiest in the world? some of it is our fault. you look at the chronic conditions that cost so much in the health care system it is a

choice of a person who decides, i'm going to keep smoking cigarettes. well, that is a terrible choice. it can lead to sickness, disease, and even death. and that's a lifestyle choice that people shouldn't make -- and they do -- and we pay dearly for it. other people don't watch their diets closely, and i am no one to preach on that but when we suffer from obesity in this country people end up in the hospital and end up in doctors' offices, ten times more frequently than those not obesity. this can be managed in lifestyle choices and preventive medicine which we don't focus on in america today. so we need to do more of that. but back to the other element of costs we need to bring down the costs of health care. there's a widely read article here which has been referred to over and over and over again worth repeating, published by a

doctor who is a surgeon in boston. his name is atool gauandi, and i commend it to everyone following the debate because most members of congress are reading it closely. the doctor went to texas, and wanted to know why the average cost for medicare patient treatment in that town in texas was $15,000 a year while the average cost in el paso -- and chicago, i might add -- was right at $10,000 a year. why did it cost 50% more to treat a medicare patient in mcallen, texas. he sat down with doctors because he knew what to ask and the first answer was "defensive medicine," because the lawyers will sue us. and another say, wait, that is not true. texas has the toughest medical malpractice law in america

limiting pain and suffering recovery to $250,000 and this doctor went on to say and said nobody is suing us around here. it is not about defensive medicine. if it is, it is a tiny part of it. many of the doctors in the community -- and hospitals -- are ordering more procedures than are needed. if you are a patient, or the parent of a patient you are not going to question it when a doctor says, i think we need an m.r.i -- are you going to say, doctor, are you sure we need an m.r.i.? you trust his judgment and that judgment can be very expensive. because the trkts in that town are motivated by more procedures, more billing, more money, more profit. that's the wrong motivation. the motivation should be, a healthy patient, a good medical outcome. he contrasted mcallen, texas, with the mayo clinic, a fantastic medical research in rochester, minnesota.

mayo hires the best docks they can find and pays them by salary. they aren't paid by patient. or how much they bill. so these salaried doctors are looking for good outcomes. they don't want to order anything more than a patient needs. they want a good outcome. think in the difference in motivation between the doctors in mcallen, texas, and the doctors in rochester, minnesota. the congressional budget office sends a report yesterday and says if you want to reduce the cost of health care in america you have to get to the question of reimbursement. now, when you talk about that you get everybody at the american medical so on their feet, shaking their fist, saying if you cut back on compensation and reimbursement for doctors, fewer people will go into the profession, you won't be able to get the best procedures, and you understand what they are going to say. many of us have heard it. but we've get to find a good way to approach this.

we've got to bring down the rising costs of health care in this country. one of the suggestions is that in addition to private health insurance companies offering health insurance, that we have a public option, that we have a plan, that, really, is not motivated by profit -- whether it's a government-response red plan like medicare or if it's some other plan, a cooperative, which senator conrad has proposed, it really says let's take the profit out it and see if we can move toward the best health care outcomes and see if we can reduce the costs of health insurance so this we get a good medical outcome at a reasonable cost. some have come to the floor and criticized that idea. i think they're wrong. i take a look at the medicare system 45 years after we enacted it, it's been an unqualified success. just look at how long seniors are living because they have good medical care after they reach the age of 65. it isn't a question of whether you're rich or poor.

and i've run into people in my state of illinois, a woman, a realtor who said to me in harrisburg, illinois, she said, senator, i want you to meet me. i'm 64 years old and never had health insurance one day in my life. i couldn't believe that. she said, next year i'm 65 and i'm going to have medicare and finally i can breathe easier knowing that the savings that i have put together won't be wiped out by a trip to the doctor. we understand that medicare worked and createdded quality care. we know that veterans administration, another government approach for the men and women who served our country who we honor with a medical system that is there for them provides some of the best care in our country. so we need to find a way to work out these differences. believe me, at the end of the day, there is always a reason to do nothing. there will be political risks in doing something. but the american people have to stick with us in this debate and understand that if we don't

address this fundamental issue, it isn't just a question of having deficits as far as the eye can see with medical costs of programs going through the roof, it is a question of whether we will have a peace of mind of health protection for ourselves and our family to make sure that we have something that we can afford based on quality. it all comes around. every family face it's. when that day comes around we want to make sure we've done our part this year. president obama's challenged us, but we're sitting idly on the floor today doing nothing except give speeches. he said don't go home this year without health care reform. he's right. it's time to roll up our sleeves and get the work done. i also ask that an article by david lynnheart be inserted in the record after my remarks. the presiding officer: without objection. mr. durbin: i yield the floor and suggest the absence of a

quorum. the presiding officer: the clerk will call the roll. quorum call:

quorum call: