the second is an energy policy that makes us less dependent on foreign oil where we are far too vulnerable and far too dependent. and the third is the march -- the relentless march of increased federal budget deficits. all three of these, any judgment, threaten our country's future and i want to speak about them in the coming days. today i want to talk about health care specific. and let me again say that i do that in a setting and the understanding that first and foremost we have to pull this country out of the difficulties that we're in with the general economy and try to find ways to promote economic growth and put people back to work with jobs that pay well and give them the opportunity to care for their families, that's what gets america moving again. but when we did that, when we begin to restore this economy to economic health, the vulnerablities that will remain are health care, energy, and the federal budget deficits far into the future.

so let me talk about health care just a bit. i know there's a lot of discussion in the committees, the two relative committees, the discussion in the committees, so-called "help" committee, both of which are writing pieces of the health care reform bill. it is true that increased health care costs, increased cost of insurance for families, for business, for governments is on the march. now it consumes over 17% of the domestic product of this country. all the goods and services we produce, over 17% of that is consumed by health care. and the rate of increase is just unsustainable. families will not be able to pay the extra costs year after year after year. we are told nationally it now costs about $12,000 for a health insurance policy. so what do we do about this? well, we hear a lot of discussion on the floor of the senate about -- you start talking about health care, they say, well, now you're talking about a government-run health

care system in which a bureaucrat's going to make decisions about how much your doctor can provide treatment to you personally. that's just absurd. i mean, that's not what this discussion is about. but if we can get back to some thoughtful discussion rather than thoughtless discussion on health care, maybe we can all reach an agreement of how to improve this system. and i personally think the system needs improving. let me describe some things i think we should do. first of all, we don't have a health care system so much as we have a sick care system. we don't pay any attention in this country to the things that can keep you from being sick or getting sick. we just pay a lot of money to put you in an acute care bed once you've gotten sick that. makes no sense at all. we ought to change the entire model to say it is much, much less costly to do the preventive things than to the pay for acute care beds in the hospital once someone gets sick. now, this is all about behavior in many respects, and nobody wants to talk much about that. but behavior is a very important part of this.

we're told that two-thirds of the american people are overweight and one-third are obese. just that alone imposes unbelievable costs on this health care system of ours. and, by the way, attend attend tonight that issue of obesity -- attendant to that issue of obesity and overweight, is the march of diabetes. the incidence of diabetes in this country is unbelievable. it rach it's up, up and up -- it ratchets up, up and up every year. and you wonder about that, wonder about america's children and the number of children that are overweight and obese, and walk into a school and then find out that in a number of schools in our country, they've decided to -- to make money by allowing the -- the soda machines, the pop machines from the largest manufacturers in the country to sell coke and pepsi and the other soft drinks in the schoolroom hallways. and you can buy not only a soft drink full of sugar and then you can buy perhaps a bag of doritos to go with it in the middle of

the afternoon at school. so what kind of message is that in a country in which a substantial number of the people, especially children, are vastly overweight and in which we, by the way, minimize physical fitness in our schools because we've become very obsessed, and necessarily so -- we care now more about math and sciences and getting out of our school system more engineers, more people steeped in math and science -- but should that be at the expense of physical fitness? what kind of a brain is walking around without a physical being to propel it? how about some physical fitness in our schools and get the -- the soda machines or the soft drink machines and -- and the doritos and cheetos out of the school hallways? i mean, that -- those things are just common sense. it's about personal behavior, and it's about what we do in this country. and, by the way, the reason those machines are there is that they can put machines in the hallways at scoocialgz the companies will -- schools, the

companies will provide money to the schools. so that's the way we're going to fund our school system these days, through soft drinks and chips? doesn't make much sense to me. now, with respect to this issue of personal responsibility and behavior, let me describe a meeting we held about a week and a half ago with the c.e.o. of safeway corporation. i know that he's met with groups of republicans and democrats here in the congress. he said something very interesting. and i'm using numbers that i think approximate what he said. they may not be precise. but i believe he told us that there are between 45,000 and 50,000 employees at safeway corporation that are nonunion and he began a project with those 40,000 and 50,000 people in health care and now he's beginning to try to move that into the union contracts. here's the project. that company says to its employees, i want responsibility for four areas in exchange for health insurance. and we believe behavior is an

important part of controlling health care costs. number one, if you have high blood pressure, we want you taking nodes control your high blood pressure. number two, if you have high cholesterol, we want you taking medicine to control your high cholesterol. and i believe he said the company is paying for that. number three, if you're smoking, you have to have stopped or be on a program to stop. and, number four, if you are overweight, you have to be on a program to deal with that issue. cholesterol, high blood pressu pressure, weight, and smoking. in each case, from a baseline of costs of health insurance policies, those that are engaged in behavior that address -- that address these four issues have gradations of lesser costs for their health insurance premiums. in other words, it is about personal behavior and taking responsibility for addressing the things that can keep you healthy. and he indicated to us that they have had flat costs for five

years in that body of employees dealing with these -- this criteria in health care. that is a success, it seems to me. if that's the model that he's using, saying you have a responsibility -- and he also tossed me, by the way, even in their cafeteria where they have partially subsidized company food during the lunch hours, just as an example, he said we will still serve unhealthy things. we'll still serve the fried unhealthy food, but we charge much, much more for it. once again, trying to induce the behavior to take a healthy alternative. and so i think what steve bird, the c.e.o. of safeway, has suggested represents something that we need consider as we write our health care legislation. there is another element that was brought to my attention recently and i think has been brought to the president's attention and members of 9 congress and that is -- and

members of the congress and that is a new yorker article wrind by atua garndi of harvard. and he visited two knowns texas and wondered -- two towns in texas and wondered why in one city you have the highest costs per capita for health care and why is one city just average. what has caused this? and he has a lot of very interesting conclusions, especially about overutilization in health care. overutilization. and the movement of doctors' ownership with respect to the business side of health care, the doctors' ownership in a cancer clinic, ownership in a new heart clinic, those kinds of things that he says or suggests promote substantial overutilization. the fact is, in our part of the country, where it is reasonably sparsely populated, the northern great plains, almost every hospital of any size wants to have a cardiac surgical unit so they can do open-heart surgery. they don't all need to do that. in fact, it duplicates services

which ends up costing more because you're duplicating services. but every hospital wants it. and so many of our states have more than is necessary of cardiac surgical suites. this weekend i was reading about two hospital groups merging and one of them indicated that one of the advantages was -- would be they would be able to then perform perhaps procedures they don't now perform, citing especially heart transplants. why would we want duplication of a lot of facilities doing heart transplants? doesn't seem to make sense to me. there are not so much done in the -- there are not so many done in the united states that we shouldn't at least try to suggest that you don't need too many heart transplant centers. some say, well, then who should tell them they can't do that? well, if you just decide overutilization is all right, whatever it costs, it costs, whatever we pay, we must, i'm telling you, you can never solve this issue. again, i'm not suggesting

government-run health care, but i am saying we ought to be reasonably smart about what we're doing. and that has not always been the case. i want to just talk about one of the fastest-rising areas of -- of health care costs for a moment and that is the issue of prescription drugs. and, by the way, maybe they ought to tone down some of this advertising or knock it off. you get up in the morning and brush your teeth. if you've got a television set near and have it on just for listening purposes, you're no doubt going to hear a commercial that says, do you know what? you should go ask the doctor weather the purple pill is right for you. i don't know what a purple pill is, but they've just described a purple pill is going to do something for you and they've asked to you go ask your doctor whether you should be taking the purple pill. because you can't get it unless a doctor thinks you need it. now, mr. president, we have massive amounts of advertising on prescription drugs in this country. in fact, some have indicated that the -- the promotion of and

advertising and marketing of prescription drugs exceeds research and development by the companies that manufacture prescription drugs, and, frankly, anything that is prescribed only by a doctor and capable of being proscribed only by a doctor, why do you have direct to consumer advertising? most state -- most nations like ours do not allow that. i believe there's only one other that does of the industrialized nations. something to consider, about perhaps reduce health care costs. but i wanted to talk about the other side of prescription dru drugs. if i might by consent show two pill bottles. >> the presiding officerthe presid. mr. dorgan: one is lipitor, i believe "the" most popular drug in the united states for lowering cholesterol. they look identical here because they're produced by the same company. lipitor is made in ireland and then shipped around the world. the different i difference is ne medicine inside. it's the same pill, made in the

same place. the difference is where they're shipped. this one is shipped to canada and this one is shipped to the united states. the u.s. consumer has the pleasure of paying twice the cost of the canadian sciewrnl. but it's not just canadian, it's french, italian, it's great britain, it's almost every other industrialized country that praise peyse a fraction of the price -- pays a fraction of the price than we do. why should the american consumer be charged the highest prices in the world for this prescription drug? because those who apply the price have the ability to do it. and some of us, senator mccain, myself, senator kennedy, senator grassley, republicans and democrats, senator snowe, especially, my cosponsor, on the reimportation of prescription drug legislation, some of us believe that the american people ought to have the ability and the advantage of the world marketplace to purchase that identical prescription drug, f.d.a. approved, produced at an f.d.a.-inspected plant, to be able to purchase it from anywhere in the world at a fraction of the price.

we've put together legislation that dramatically improves the safety of our drug -- prescription drug supply in our country and the drugs coming in. because, by the way, a lot of the prescription drugs we take are imported. lipitor is imported into this country. and the pharmaceutical industry, which has always opposed our legislation because they want to charge the highest prices in the world to th the u.s. consumers, they say, well, if do you this, if you allow americans to import f.d.a.-approved drugs, there's a greater possibility of counterfitting. our legislation will dramatically improve safety because we put batch labeling, we do all kinds of safety mechanisms that do not now exist with respect to our prescription drug supply. so my point is, this is not rocket science. you want to reduce health care costs, i would say to the finance committee and the "help" committee, make sure you put this piece in your legislation, because one of the fastest rising costs in this country is

prescription drugs. and we know how to solve that. if we pass the legislation that senator snowe and i have introduced with broad bipartisan support that allow the reimportation of f.d.a.-approved prescription drugs by american consumers, it will require the pharmaceutical industry to reprice their drugs and to allow our consumers to have fair prices for the prescription drugs they take. and by the way, our legislation is actually a winner. it's a half -- nearly a half a -- a half a billion dollars, nearly $500 million in cost savings and deficit reduction. according to the c.b.o. evaluation. so the fact is, there's a lot of things we can do, and a lot of things that represent common sense. i know that some will want to put together a health care proposal that will look like a rubix cube, you know, with all kinds of moving pieces. it needn't be that complicated.

i've just described some of the things that we can do that in my judgment represent common sense. let me make one more point. when medicare was started, medicare has been a very successful program. but when medicare was started, the fact is they established a base funding for medicare that represented the costs for health care delivery at that time from that place. the result is those areas with the highest costs got the biggest reimbursements. and it's still true today that some of the states, including my state, that has the highest quality measured as the highest quality of health care in this country gets the lowest reimbursements because they were the most efficient. that's preposterous. whatever we do on health care has to address that issue. let us at least after nearly 40 years, begin to decide we won't reward inefficiency and we won't reward higher costs which has happened to some of our states as a result of the baseline for medicare reimbursements. well, i'm not suggesting this is

unbelieve by simple. it is not. in many ways i kind of wish it could harkin back to the old days but in the old days we didn't have the medical miracles we have. in my hometown of 300 people, small little town, we did have a doctor. he came as a young man and stayed until he died. and he provided health care. there was no medicare. he just provided health care to anybody that needed health care. if they couldn't pay him he would take chickens, a hog, or a side of beef. if he was on a ranch or farm and delivered a baby and they didn't have any money, and if somebody had money, he would charge them a little extra for the people that couldn't pay and he just administered his own health care system but they we couldn't look inside the human body, we didn't have the miracle medicines through the n.i.h. and pharma and others allowing us to stay out of acute care bed. we didn't have all of those things. so now health care has become much, much, much more complicated and for some, according to the new yorker magazine article which i commend

to everybody, when we have decided to make health care a "business proposition" so that you could get several doctors together and open up a cancer center and that becomes something in which you promote overutilization and it is happening in parts of our country, then we need to be concerned about that and try to evaluate what we can do together. one final point: some of my colleagues march to the floor every sing will day and allege that a bill that doesn't yet exist is going to be a government takeover of health care. well, apparently they are chairt but there is not a fact that allows someone to say there is a government takeover of health care because there is not a bill out of either committees. there have been some introductions of topics from legislative proposals but that is far different from a bill recorded out of a committee.

we will have unbelievably a robust debate. health care is a very important element if this country's economy and it's growing and growing too fast and we need to deal with it and make sure all americans have access to h healh care. a sick child should not wonder whether they get to see a doctor depending on how money their parents have in their wallet or bank account. that is not what health care ought to be in this country. we can and will do much, much better. i wanted to talk about the future lets of this country, one of which is the march of health care costs; the second in my judgment, is unbelievable vulnerability on foreign oil and energy; and the third is deficits. i'm going to talk about the following two in the coming days, as well. mr. president, i yield the floor and make a point of order that a quorum is not present. mr. cornyn: could you withhold the request? mr. dorgan: i withhold. mr. cornyn: the presiding officer would like to speak for

five manipulates and i ask unanimous consent following the senator from virginia being recognized to for up to five minutes, i be recognized to speak. the presiding officer: without objection, so ordered. mr. cornyn: thank you. mr. warner: mr. president? the presiding officer: the senator from virginia. mr. warner: thank you, mr. president. i'm sure sure we're in a quorum call. the presiding officer: we are not. mr. warner: mr. president, i rise today to discuss bipartisan legislation that i'm cosponsoring with my colleague, senator corker, considering the federal government's recently acquired ownership stake in a number of private companies. i think we all know that taxpayers have been on a roller coaster ride for the past nine months.

from their perspective each twist and turn has left us more deeply invested in troubled markets and oftentimes troubled companies. americans are concerned about getting their money back and want to keep politics out of how we manage these investments before he had to make over the last few months. so last week, senator corker and i introduced s. 1280, the tarp recipient occupiershirecipient g politics from the management of our taxpayer investments in private companies. second, it will ensure these investments are managed in order to maximize taxpayer runs. run -- taxpayer returns. and third, it will allow us to plan to removing the government from the p private sector by setting a date certain for selling the investments.

to achieve the goal, senator corker and i are propose that if the government own mors than 20% of a private company that we place that ownership stake in an independent trust. this trust would run, would be run with a fiduciary duty by taxpayers, by three independent directors, appointed by the president. these directors would agree to perform this work for tree. as a service to the country. and in doing so, would give the american taxpayers what they citizen. the upside on the massive investments they have provided over the past nine months. and the trust would not just be opened-ended ownership, the trust would have to sell all of the assets by the end of 2011 although they could ask for a brief extensions if it was again, in the interest of the taxpayers' return. in this way taxpayers can know we won't own stock in the

companies for the next 20 years. to practice to means the taxpayer ownership of a.i.g., citigroup, and general motors, would be managed in order to maximize the return open these taxpayer investments. mr. president, we've all seen how political and contentious the tarp program has budget. now, i know back when we voted on this matter earlier this year how controversial it was. i still think it was unfortunate we got into this circumstance but fortunately the right thing to do. while there is a lot of challenges about how we got into this program, if we do lock and and actually steven pearlstein in the "washington post" pointed out in an article, if nine months ago, if six months ago, or even three months ago back in the middle of march when the stock market was at its all-time low, in terms of reacting to this crisis, if any economist would have said by the end of june, by the end of june, would

you be willing to look at a circumstance where the market was up 25% or 30% although it was down today, if many of the banks that we had invested in tarp funds were actually trying to repay those tarp funds, and if we had soon the housing market at least in maybe communities start to substantiallyize, would we view that as a good outcome? well, that is basically where we are. while we have enormous problems we are seeing progress. but, however, one only needs to look at the number of tarp-related amendments filed in the senate this past month. the leader was speaking about the number of tarp amendments that could potentially be on the travel bill, to know, mr. president, this is becoming a lightning rod. some of the reasons for this concern are truly, truly relevant and they are because the american people don't know when and how the tarp program is supposed to end. and the american people, unfortunately, who invested in

individual companies -- some of the companies that now we've invested in -- don't know how much we as the public will get back or there we as the public investment will politically interfere with the management of these companies. that's again why we need to take and implement this legislation that senator corker and i have laid out that will put the ownership shares in this independent fiduciary trust. now, i don't support cutting off the tarp program right now or limiting the tools that currently provides the administration including the limited reuse of must be that is repaid to the government. tarp already has a sunset date after which more funds cannot be spent. since our marks are not back to normal even though there is imrofnment we shouldn't -- improvement we shouldn't prevent the use of tools we have. but we do need parameters for managing our investorments and winding them down in order to take the politics out of this program. american taxpayers deserve to have their investments managed

in order to maximize their returns. that's what the trust will do. and i hope we will consider using this model for other investments, as well. this trust will also help us take some of the politics out of the tarp practice and that is why i am proud this legislation is bipartisan and led by my friend from tennessee, senator corker. i hope my colleagues will join in supporting this bipartisan legislation, s. 1280, the tarp recipient ownership trust act. this will not resolve all our concerns surrounding tarp, i hope it can serve as a model to maximize the taxpayer returns on this investment: let me take an additional, moment, mr. president, and indicate another investment-related matter. under the leadership of senator jack reed from rhode island when the official tarp plan was put together -- when the initial tarp map was put together, senator reed said if we invest in banks in addition to a

traditional return we ought to see upside potential for taking the risks in terms of warrants. luckily we received warrants from a number of the banks we invested in. i am happy to see a number of the banks are repay the investments -- are repaying thee investments the public made. we hope senator geithner will consider placing the wants in an independent trust, as well, so, again, we, the taxpayers, can receive the upside of these investments. we took the risks with these batches during the troubled times. i'll happy to see the banks return the funds but for the banks to sell become the wants at what i believe is still a discounted price would not allow we, the taxpayers, to maximize our investments. i hope secretary geithner responds to the request senator reed and i have made making sure

the warrants are promptly put in the same -- are appropriately put in the same type of independent fiduciary accounts as under the tarp program. mr. president, i yield the floor. the presiding officer: the senator from texas. mr. cornyn: i ask unanimous consent to speak for up to 10 minutes. the presiding officer: without objection, so ordered. mr. cornyn: i thank the chair. mr. president, health care reform is very much in the news and very much on the agenda of the united states senate. as the american people know, so far they have learned very little about how congress plans to address what is broken in our health care system. as you know, two committees in the senate are primarily given the responsibility for writing a health care reform bill. of course, the help committee, the health, education, labor, and pensions committee, chaired by senator kennedy, the senator from massachusetts, and

the finance committee, chaired by senator baucus, the ranking member, of course, is senator chuck ghastly from iowa. these two committees, as well as the president of the united states, are considering numerous proposals that deserve the careful attention of the american people and of congress. because this legislation, however it turns out, could fundamentally affect the relationship between patients and their doctors as well as the relationship between the individual and our government. in the kennedy bill, which has been proposed and which is pending now before the health, education, labor and pensions committee, there are several troublesome provisions. one, a government-run plan which would compete, allegedly, with the private sector but, as we all know, the government is the 800-pound gorilla and there is no true competition when

government is involved. and, in fact, one projection is that as many as almost 120 million people would ultimately find themselves in a single-payer government-run system because essentially the federal government would undercut those private health mans to the point where individuals would find them them selfs with no choice other than to have government direct the health care. another troublesome provision is the "play or pay mandate." it goes without saying, almost, but i will say it anyway, that small businesses create the vast majority of jobs in america yet this proposal, i think, mistakenly would impose a punitive tax on small businesses that are unable to keep their doors open and provide health insurance for their employees. we want to allow small businesses to provide health care to their employees by bringing done