chance to lay a new foundation for our economy and country pass us by." mr. president, i would tharg one of the most important things we can do and i know everyone is focusing on who pays and and what this provision say, we need change the delivery system. we need to reward that kind of high-efficient care so that our big companies are able to compete with companies in other countries that have more highly efficient delivery systems so that our small companies are able to exist and multiply and that they're able to keep their employees on health care, so that individuals in this country aren't cut off just because their child gets sick. that's what this reform is b thank you very much, mr. president. i look forward to the vote tomorrow. i yield the floor. the presiding officer: the senator from arizona. mr. kyl: thank you, mr. president. mr. president, the whole point of health care reform is to bring down costs and to make health care more affordable for american families. so why have democrat leaders

produce add health care bill loaded with provisions that will increase premiums? independent studies from the nonpartisan congressional budget office and the joint committee on taxation and even a study by the chief actuary at the department of health and hiewsm services confirm this, that the democrat plan will drive up premiums and overall health care spending faster than in the absence of these so-called reforms. well, how is this sold? let me mention five specific ways. first of all, new insurance mandates and new taxes on the insurance industry. new insurance requirements and new taxes on the insurance industry will force premiums to rise for many americans, particularly the young and healthy. according to an independent analysis that studied the effect of the new insurance reforms and new taxes on the insurance industry, insurance premiums in my home state of arizona could skyrocket by as much as $2,619 per individuals and $7,426 for

families. think of that, an increase of $7,000 -- $7,426 for families in my state. that's outrageous. what could $7,426 buy in arizona -- buy an arizona family? well, a lot of things. could pay for a year of tuition at the university of arizona, could pay for a year and a half of groceries or nearly two years of utility bills, or it could pay for two years of gasoline. families have a lot of expenses and a lot of important ways to spend $7,426. they don't need the federal government intruding on them and dictating that that money has to go somewhere else. now, our friends on the other side of the aisle will say that they could provide subs disand, in fact, the -- subsidies and, in fact, the legislation will provide subsidies to help with this increased cost, but not every family will qualify. and the subsidies may not even cover the total increase in co cost. moreover, wheapts the point of raise -- moreover, what's the point of

raising the cost of health insurance and then subsidizing a portion of the increase? you're still raising premiums. it's nonsensical to have a health care reform that makes families worse off and then gives them a government subsidy to help them make up for part of the cost. second, new mandated benefits will increase costs. under the reid bill, the government will require insurers to cover a broad range of new medical benefits determined by washington, regardless of whether those benefits are actually needed by each individual patient. these additional benefits may help some patients, of course, but insurers can't provide them to everyone free. so the costs will be shared among everyone in the insurance pool, and that means increased premiums for many americans. in fact, the council for affordable health insurance estimates that the new mandated benefits would increase the cost of basic health coverage between 20% and 50%. that's the second way insurance premiums are increased. here's the third -- the third way. limits on plan types. under this bill, this reid bill,

insuressers are limited to offering a total of only four specific kinds of insurance plans, so the low-cost, high-deductible plans that currently many families and individuals enjoy will be virtually eliminated. they'll have to buy more expensive plans, again, paying more in premiums. whatever happened to getting to deep -- keep what you have? just as one size does not fit all, in this case, four sizes does not fit all either. here's fourth way premiums increase. the new taxes that are imposed on groups like medical device makers. according to the congressional budget office and the joint committee on taxation, a new tax on medical devices will increase premiums and increase the price of everything from wheelchairs to diabetes testing supplies to pacemakers, and it will be paid entirely by the patients. its cost, according to the joint committee on taxation,

$19.3 billion over ten years. and this tax will hit cutting-edge technologies, such as c.t. scanners, replacement joints, and the arterial stints the doctors use during angioplasty. the tax will clearly stifle innovation. as the "wall street journal" editorialized -- and i quote -- "this new tax will eventually be passed on to patients, increasing health care costs t. will also harm innovation, taking a big bite out of the research and development that leads to medical advancements." the fifth way, mr. president, which this legislation will increase the costs for the insureds is that it actually taxes the insurance plans themselves for the first time. so you buy insurance, you get taxed. the reid bill for the first time directly accomplishes this. as the independent joint committee on taxation told us, this new tax will increase the costs of health insurance for everyone since insurers will

pass the costs along to their patients -- to the patient. this tax alone could raise some americans' premiums by $487 per year. because this tax is indexed to regular inflation rather than to health care inflation, just as with the alternative minimum t tax, it could soon start hitting middle-income families. according to the former congressional budget office director douglas olsiegen, half of all families making less than $100,000 per year could end up paying this tax. so those are five specific ways in which this bill will increase your costs, the increase in the premiums that you pay for health insurance once this bill is in effect. we believe there are better ideas. republicans have proposed a variety of solutions to target specific problems and, in particular, the problem of cost. i specifically want to conclude by mentioning the republican health care alternative in the house of representatives.

a majority voted it down but the truth is it would, in fact, lower premiums for individuals, families and small businesses. so contrast the house-passed bill, which increases premiums, the reid bill, which increases premiums, but the republican house bill, which would actually decrease premiums, and you'll see republicans in the senate proposing similar ideas. according to the congressional budget office, under the republican plan, premiums would be $5,000 lower than the cheapest plan under the pelosi bill. small businesses too would see their premiums decrease by as much as 10%, again, according to the congressional budget office. those in the small group market would also see a 10% decrease under the house republican bill. again, according to the nonpartisan c.b.o. the house republican bill included such reforms as allowing states to sell policies across state lines. you've heard a lot of senators on the republican side talk

about that. that would have enabled a thousand companies to compete nationally, and that helps to drive down the costs. medical liability reform -- this is a proven way to cut costs. in my state of arizona, texas, missouri, these states have all seen premiums go down because of medical malpractice reform. health savings account, which puts patients in charge of their own health care by allowing them to save their health care dollars to spend as they choose, this, too, would have been strengthened by the house bill. and you've heard republican senators talk about that as a reform. there are many other ideas we have. we'll be talking more about those ideas as we go forward. but i just want to conclude my remarks about the reid bill, loaded with provisions that increase insurance premiums and to make the point that since, as i said in the beginning, the whole point of the exercise was to reduce health care premiums, the last thing we should be doing is adopting the provisions in the reid bill which will actually increase health care premiums.

let's keep in mind that health care reform is all about making things better for americans, and this bill does not meet that test by a long shot. ms. collins: mr. president? the presiding officer: the senator from maine. ms. collins: thank you, mr. president. mr. president, i rise today to discuss the health care bill that the senate will begin voting on tomorrow evening. let me begin by making clear that i believe health care -- our health care system needs fundamental reform. one of my top priorities as a senator has been to work to expand access to affordable health care. the fact is, however, mr. president, that the greatest barrier to health care coverage today is the exploding cost.

monthly health insurance premiums in maine have risen at an alarming rate. they now often exceed a family's mortgage payment. and whether i'm talking to a self-employed fisherman, a displaced mill worker, the owner of a struggling small business, or the human resource manager of a large company, the soaring cost of health insurance is a vital concern. mr. president, much of the health care reform debate so far in this congress has centered around the need to expand coverage to the uninsured, a goal that i embrace. the fact is, however, that it will be difficult to achieve our goal of universal coverage until we find a way to control health

care costs that have driven up the cost of insurance coverage for families, employers, and governments alike. while i agree that our health care system is broken and in need of major reform, the bill that we are about to consider falls far short when it comes to reining in health care costs. this is a critical issue. it is "the" critical issue because the high cost is the biggest barrier for those who lack insurance. the high cost of health care is what is driving up the cost of insurance premiums, causing many middle-income families and small businesses to struggle to meet these needs. i'm concerned that this bill

takes us in the wrong direction and that it will actually increase the costs and reduce choices for many middle-income americans and small businesses. mr. president, health care reform should give americans more, not fewer, choices of affordable health insurance options. under this bill, many americans will be required to purchase health insurance that is more expensive, not less expensive, than the coverage they currently have. under the majority leader's bi bill, all individual and small group policies sold in our country must fit into one of four categories: bronze, silver, gold, or platinum. and they must have an actuarial

value of at least 60%. post-reform, if this bill becomes law, it will be illegal to issue new policies in the individual or small group markets that do not meet those standards. moreover, unless they are grandfathered, most americans who are not enrolled in at least a bronze plan will face a new $750 fine. now, let's look at what this really means. in my home state of maine, 87.5% of those purchasing coverage in the individual market today have policies with an actuarial value of less than 60%. in other words, they have policies that do not qualify

under the standards that would be established in this bill. the most popular individual market policy sold in maine costs a 40-year-old about $185 a month. under senator reid's bill, that 40-year-old would have to pay at least $420 a month -- more than twice as much -- for a policy that would meet the new minimum standard or pay the $750 penal penalty. mr. president, i believe that americans should have the choice to purchase more affordable coverage if that is what works best for them. health care reform should be about expanding affordable choices, not constricting them.

it should not be about forcing millions of americans to buy coverage that is richer than they want, need or can afford. yet under this bill, even an individual who does not qualify for any taxpayer assistance, for any subsidy, would have to buy a proscribed plan rather than, for example, a low-cost/high-deductible policy that, when combined with a health savings account, may best meet his needs. there's another problem that's going to drive up the cost, mr. president. the very tight rating bands in this bill will increase the cost for young people. now, why does that matter when

we're trying to expand coverage to those who are uninsured? for this reason, mr. president. more than 40% of uninsured americans are between the ages of 18 and 34. extreme price increases for the young and healthy will simply force them out of the market because most young people, i fear, will just do the math. they'll decide to pay the ne new $750-a-year fine, rather than paying $5,000 a year or more for health insurance. this is particularly true because under the bill if they do get sick later, they can still buy insurance with no penalty, no increased cost. and that's why the national association of insurance

commissioners -- and keep in mind this is the association of state officials who regulate insurance. these are public officials. according to the naic, these provisions will lead to severe adverse selection that will drive up the cost of premiums for everyone else who's in the insurance pool. now, proponents of this legislation contend that the subsidies included in the bill for low and moderate income americans will compensate for any premium increases. well, let's take a look at that, mr. president. first of all, it's important to know that the increase -- that the subsidies do not go into effect until the year 2014. and, yet, a lot of the taxes,

which i'm going to discuss later, which are also going to drive up the cost of premiums go into effect next year. so that's a problem as well. moreover, these subsidies are going to be available, it is estimated, to fewer than 8% of americans. moreover, if you receive your health care, your insurance from your employer as the vast majority of americans now do, you aren't eligible for a subsidy under this plan. but your premiums are still going to go up because of the increased taxes and fees imposed by the bill. mr. president, when americans understandably are so upset about the high cost of health

care, and when health insurance premiums are going up by double digits, making it so difficult for most americans to afford health insurance, the last thing we should be doing is to make the situation worse. i can't help but think of the hippocratic oath, do no harm. shouldn't that be our first rule? americans who are already shouldering the burden of two-high -- too-high health care costs would hardly consider a bill to be reformed if drives those costs up further. and, yet, i fear that is exactly what will happen if this bill becomes law as written. in light of this, mr. president, i think that it's a legitimate question to ask whether this bill may actually increase the

number of uninsured americans by driving up the cost of health insurance for years before the subsidies go into effect. now, let me take a further look at some of the increase -- the increased taxes that are in this bill. if you look at this bill, there are numerous taxes that are going to go into effect. in fact, americans will face at least a dozen new or increased taxes and fees amounting t to $73 billion before the subsidies go into effect.

what kind of new taxes are we talking about? this chart shows just some -- just some of the taxes that will hit americans when the bill goes into effect. and there are many more. here's just a few. there's a tax on pharmaceutical manufacturers, a tax on health insurance providers, a tax on medical devices. think of what we're talking about here. we're talking about insulin pumps, artificial hips and knees, extents put into -- stents put into hearts. all sorts of medical devices. if a new fee is put on them, that is going to be passed on to consumers and reflected in insurance premiums. there are all sorts of new tax taxes. and these taxes will be paid

right away by americans in the form of higher health insurance premiums. and that's not just my opinion. that's the view of the congressional budget office which evaluated the impact of several of these taxes. for example, here is what the c.b.o. said about th the $6.7 billion increased tax on insurers. we expect a very large portion of the proposed insurance industry fee to be born by purchasers of insurance in the form of higher premiums. the way these taxes are structured, they're going to be passed on. it isn't just the taxes on insurers that will be passed on. here's what the c.b.o. director said about the taxes, the new

fees on the pharmaceutical industry and also on medical devices. c.b.o. said, and i quote -- "those fees would increase costs for the affected firms which would be passed on to purchasers and ultimately raise the insurance premiums by corresponding amount." the joint committee on taxation looked at the tax on the cadillac plans, the 40% excise tax. again, here's what it says, the insurers pass along the cost to consumers by increasing the price, the cost of employer-provided insurance will increase. this leads me to another point, mrmr. president. i am so concerned about the impact of this bill on our small businesses, they are the job creators in our economy and the

rising cost of health care has been particularly burdensome for them. a small business owner in maine just recently e-mailed me to say the following: i've just received a renewal proposal for our small business. the plans are all up anywhere from 12% to 32% on the three plans that we offer. you are right when you say we need to address the cost of health insurance, not create another vehicle to deliver the services. the current legislation, as i understand it, totally misses the mark. mr. president, how does this bill help small business? on balance it doesn't. and that, again, is not just my opinion.

that's the opinion of our nation's largest small business group, the nfib. in a statement on the bill released yesterday, the nfib said, "this kind of reform is not what we need. new taxes. new mandates. new entitlement programs paid for on the backs of small business." in fact, and if i -- nfib described the bill as a disaster. i would ask unanimous consent that a copy of the nfib statement be entered into the record at this point. the presiding officer: it will be done. a senator: i support and have long proposed the idea of tax credits for small businesses to help them afford to provide

health insurance for their employees. but the credits for small businesses in this bill are poorly structured. only businesses with no more than 10 workers paid an average of $20,000, can get the full tax credit. so if a small business hires additional employees or pace more, its credit begins to decline, and it's eventually phased out. ms. collins: businesses with more than 25 workers are paying average wages of about $40,000, get no tax credit whatsoever. so just take a look at this. i realize this chart's a bit busy, but stay with me. under the finance committee bill, if you have 10 employees

and you pay them, on average, $20,000, you get a 50% tax credit applied to the cost of the insurance. but then what happens is if you give them a raise, the tax credit begins to decline. so if you have 10 employees, but if you pay them $25,000 on average, you only get a tax credit of 38%. let's say you're trying to improve their quality of living, they've done a great job for you, so you give all your employees a raise, bringing the average wage to $30,000. now you're only going to get half as much of a -- of the tax credit as when you paid them $20,000. if you pay them $40,000 on average, zero. you lose the tax credit all

together. mr. president, what we have here is a tax credit that is structured in such a way that it discourages small businesses from adding employees and paying them better. that doesn't make any sense at all. that makes no sense at all. mr. president, this legislation would have enormous consequences for our economy and for our society. there are several provisions in this bill that i support and that i believe have broad bipartisan support. it is so disappointing that that isn't our focus. then we could add provisions, come up with the best ideas on both sides of the aisle.

we have to remember that this bill would affect every single american -- every small, large employer, every health care provider. it affects 17% of our economy. there are many reforms, such as, allowing small businesses to pool together to have better bargaining clout, that have strong bipartisan support that could have been the basis for further debate and amendments. so it disappoints me greatly that we are about to proceed to a decisive, partisan bill. i continue to believe that the american people would be better served by a bipartisan bill that brings together the best ideas on both sides of the aisle.

and i pledge to continue to work with members on both sides of the aisle to develop alternatives that will bring about true health care reform. thank you, mr. president. a senator: mr. president? the presiding officer: the senator from wyoming. mr. barrasso: thank you very much, mr. president. i find it fascinating listening to the comments from the senator from maine, and maine and wyoming are similar in a number of ways, and one is that the engine that drives our economy are small businesses. what we just heard is that this bill right here, mr. president, this large bill which is the bill that the senate is considering right now, over 2,000 pages, underneath it is the bill passed by the house. i hear that these are actually

going to penalize the small businesses of maine and the small businesses of wyoming when those businesses try to hire another employee. mr. president, we're looking at 10.2% unemployment in the country right now, and the people in our states are well aware of those numbers. it seems to be -- i don't know if that number is just being neglected by others, but for small businesses trying to hire people, i believe this health care bill makes it much tougher. it's certainly going to make it tougher for them to provide insurance. it's going to make it tougher for those small businesses to give raises to people, and it's indeed unfortunate in my opinion that we are here on the senate floor looking at a bill that is going to raise the premiums for the american people who have insurance, who like the insurance that they have. their big concern is the cost. we're log at a bill that is going to cut medicare for our seniors who depend on medicare, and we're looking at a bill

that -- and the numbers are huge. almost $500 billion. and we're looking at a bill, we're looking at a bill that's going to raise taxes on american people. as i just heard the senator from maine who was talking about this -- and she can jump in and correct me if i'm wrong -- what i heard her say is it's not just a tax on the rich. it's a tax on people all across the board because the taxes are going to be passed on with medical devices -- and i see the senator nodding her head in the affirmative, when taxes are raised on medical devices, on medication, on one thing after another after another. those are costs that are just going to get passed on to all the consumers of health care in the country. and right before -- before the -- this party took the floor, we have the senator, the senior senator from minnesota talking about the mayo clinic and the wonderful care that is given there, and it is wonderful care. but the mayo clinic has also said they don't want any part of

this bill, nothing to do with it, to the point that they have sent doctors in my home state and states surrounding the mayo clinic who refer patients -- and i practiced medicine in wyoming for 25 years, taking care of families there as a physician, and we sent patients to the mayo clinic. they just said stop sending patients on medicare or medicaid. we want nothing to do with it because the government is the biggest deadbeat pair. the government doesn't pay. and the mayo clinic said, you know, every time we get one of those patients, we have to charge the people that pay their own way, the people that pay their own bill, the people that have insurance, we have to charge them more and we don't want to take any more of these patients on medicare and medicaid. the hospitals in the communities of maine, and i see the senator from south dakota here and the senator from nevada here. hospitals in those states have to take all of those patients. so what happens to people that pay their own way, that have their own insurance either because they buy it themselves or they get it through work?

the hospitals have to charge them more to make up for the biggest deadbeat payer of all time, the federal government. so what happens? and i see the senator from nevada taking to his feet. i imagine the exact same thing is happening in the hospitals in nevada. so premiums are going up on the 85% of the people that have insurance that they like, but yet we -- we in the senate tonight -- tomorrow night are going to vote on a bill which to me the people of america don't like. and you know who doesn't like it the most? seniors. you know why? they're concerned. they know medicare is being -- is going broke, and by the year 017, there will be $500 billion of cuts in medicare. and yet, the money that's being cut from medicare isn't being used to save medicare. it's to start a whole new program that's going to cause americans who have insurance to pay more. it's going to cause people that don't have any insurance to make it harder to get, or if they go to an emergency room, have to pay more, that bill is going to

be higher. all because of what i believe is an irresponsible piece of legislation that is going to be a huge weight on our american economy at a time when you have 10.2% unemployment. but i see the senator from nevada has -- he has a similar copy of the bills next to him and he may want to chime in on what he is seeing in his home state and what he is hearing from people who live in nevada and the small businesses as well as the hospitals and providers. mr. ensign: if the senator would yield? we -- these pieces of legislation that we have before us, we put them on our desks to show the american people exactly what we're dealing with. we have only just started going through these bills, and already we found major problems with the legislation. let me just -- what we're going to talk about over the next few minutes is the premium increases that are going to be caused to the american people. if you have insurance now, your premiums are going to go up because of all of this legislation that we have before

us. probably other ways we don't even know about yet we'll discover in the future, but we at least know some ways that are going to cause the premiums to go up. but let me talk just generally first about the bill and what some of the problems that i believe in the bill, and then -- and just briefly on some alternative ideas that republicans have come up with in more of a step by step type of an approach. we know that this bill cuts medicare by $465 billion. we know that. including $118 billion in medicare advantage cuts. that means that millions of seniors who are on medicare advantage today will lose the plan that they have, and medicare advantage plans in my state are incredibly popular among senior citizens, and i know they are across the country. we know taxes are going to go up by almost $500 billion, and i'll talk a little more about those in just a second. we know premiums are going to go up for millions of americans, as

i stated. we also know that the overall cost of health care in america america -- you know, this was supposed -- this bill was supposed to what's called bend the cost curve. they say because it is actually deficit neutral, maybe helps the deficit a little bit because of the smoke and mirrors that they play with it, they say that that bends the cost curve. but when we look at the american people and the actual costs that they're going to be paying for health care, their cost curve continues to go up and up and up into the future. this bill will also lead to rationing. we saw this week this federal board that talked about mammograms. and it caused an outrage with women across america. well, that's the sort of thing that's going to happen because of this legislation. federal bureaucrats are going to be in charge of your health care , not your doctor and you. we need to have legislation that

focuses on that doctor-patient relationship that should be so sacred in our health care system today. so republicans have come up with the idea, let's bring in medical liability reform and start driving down the costs of all of this defensive medicine that's practiced. we all know doctors order all kinds of unnecessary tests to prevent themselves from being sued in all these frivolous lawsuits. let's -- we free i think with both sides. let's eliminate the pre-existing conditions. that's kind of a given. that's something we all agree on. that's part of that step-by-step approach this side of the aisle would certainly be willing to do. i also believe we need to encourage healthier behavior in america. 75% of all health care costs are because of people's behavioral choices: smoking, people who are overweight. we know that obesity contributes to every kind of cancer. it contributes to heart disease,

all kinds of -- diabetes, and it's epidemic this country. and look at our young people. if we don't turn around people's behavior in this country, getting them to exercise more, eat right, quit smoking. i don't care what health care reform that you pass in this country, we are not going to do anything about driving down the costs, and cost, the high cost of insurance, the high cost of health care is the number one problem with our health care system in america. we believe that we should have small business health plans where small businesses can join together to buy health insurance, take advantage of purchasing power that large businesses have. we believe that individuals should be able to buy across state lines like you do car insurance. if your state is too high on insurance, buy it in another state where it's cheaper, where maybe they don't have as many mandates. doesn't that make sense? we also believe that we should have transparency on cost and quality. when you walk into your doctor's office, you should be able to

get a written estimate of what it's going to cost. you should be able to shop that estimate so that we have more consumers making more intelligent choices on health care in the united states. when was the last time you went into your doctor's office and actually got a written estimate or knew how much something was going to cost? i happen to have practiced veterinary medicine for many years. you walk into my practice, you get a written estimate. we actually have you sign that written estimate because we've got to give that. that's part of our general practice. we need to bring that into human medicine, whether it's hospitals or dors practices -- or doctors' practices. we need to have transparency for cost and quality. now, how does this bill drive up premiums for americans? first of all, there are nine new taxes, nine new taxes put in by the democrat majority. there is a 40% insurance plan tax -- insurance plan tax for what are called the cadillac plans. there is another tax on insurance -- on your insurance companies. there is an employer tax, a drug tax, a lab tax, a medical device

tax, failure to buy insurance tax, a cosmetic surgery tax -- brand-new in this bill -- and also an increased employee medicare tax, a brand-new tax structure on the medicare taxes. who pays for these kinds of taxes? it just isn't insurance. on the failure to buy insurance -- put the next chart up -- 71% of that tax is going to be paid for by people who make less than $120,000 a year, and almost every one of the taxes that i just put up of those nine new taxes, the vast majority of them are paid by people who president obama when he was campaigning said they would not pay one dime more in new taxes, and he repeated that promise time after time. he said no new fees, no new taxes, capital gains. he went through the whole litany of the types of taxes that would not be raised, and yet in this

plan, approximately 80% of all of the new taxes are paid by people making less than $250,000 a year. another way that this massive piece of legislation raises premiums in this country is this thing known as cost shifting. the senator, the doctor from wyoming, practiced medicine. he was talking about the mayo clinic and why the mayo clinic, cleveland clinic, other places and other doctors around america don't want to take medicaid patients, medicare patients anymore. why? because the government pays 20% to 30% less than private health insurance when it's reimbursement to doctors. isn't that is correct? mr. barrasso: that's absolutely the case, plus when you read this bill, one of their so-called solutions is they're going to put more people, more people on medicaid rolls. mr. ensign: i would ask the senator how many more people are going to go on the medicaid rolls?

mr. barrasso: it's millions and millions of people with the cost to the states -- they say we'll take it out of here, you won't see it in this bill because they're going to make the states pay over $20 billion in money because it's a matching program. so they get it off the washington books, but it's still the taxpayers of the states, and we all come from states and that's going to drive up the costs for individuals as well as increasing taxes around the country. mr. ensign: because you were in the practice of medicine, i would ask the senator from wyoming also -- i've heard numbers as high as 15 million new people on medicaid, plus we have a new public option so there will be even more people on another government plan. what will happen as far as cost shifting to those of us who have private insurance, for those tens and -- tens of millions of americans who have private health insurance, what will happen to their cost of insurance when more people are on government plans? mr. barrasso: well, those costs are going to have to go up. the premiums are going to go up

for all of the people that have insurance, private insurance, and the numbers -- and the senator from nevada is correct. some people think the number is 15 million more who are going to go onto the medicaid rolls because there is a -- medicaid roles because there is a difference between the senate bill and the house bill as to how many more folks they move onto the medicaid roles. but either way, you're talking tens and tens of billions of dollars that are going to come out of the taxpayers' pockets around the state, but that's still for a government-run program that doesn't reimburse, doesn't pay the hospitals, doesn't pay the doctors even what the cost of delivering the care is. across the board, across the board hospitals will tell you they cannot keep their doors open if everyone paid at medicaid rates or medicare rates. the only way they could even -- pay the nurses, keep the lights on, take the food around on the trays to the patients, do all the things that a hospital has to do or keeping a doctor's

office open, the only way they can do it is because they charge more to people who have private insurance than they get paid for people on medicare or medicaid, and medicaid is worse than medicare in terms of the payment. so it's this cost shifting that occurs, and who pays that? people that have regular insurance. it's the hard-working men and women of america through their jobs, as we just heard from the senator from maine, and any time you try to help that individual -- and i see the senator from south dakota is here as well, and he may want to jump in as well because south dakota is a state like my own where we have lots of small businesses who are going to be hit specifically hard as they try to continue to provide insurance. this doesn't allow small businesses group together to get better deals. the senator from nevada talked about buying insurance across state lines to help get the costs down. this prevent that. it also prevent small business groups to get together, which

would be great help. i know the senator from south dakota, who is interested in getting in the discussion, and i invite him to discuss this very aspect and the impact of all these increasing premiums on the folks of his state. mr. thune: wyoming is not a lot unlike south dakota, as the senator from wyoming knows, or nevada, although they have a few larger businesses in nevada. the people who get hit hardest under this bill are small businesses. you heard the senator from maine, senator collins, point out the impacts on small businesses. the ironic thing about that is a lot of small businesses that you would want to encourage to offer health insurance to their employees will be discouraged from doing so under this bill. and, in fact, what most of them are probably going to do is pay the $750 penalty and then just push everybody off into the government plan. and the assumption that's being made in here is the government plan that, you know, it will grow over time obviously. i think 5 million people will lose their private insurance, according to c.b.o. my guess is that number is going

to be much, much higher because i think what's going to happen is small businesses who are impacted the most by these tax increases are going to find themselves less and less able to provide health insurance coverage to their employees. the other thing i want to point out, in echoing what my colleagues from wyoming and nevada have said, is i would be somewhat, i guess, interested in what's being proposed by the other side if it did anything to impact cost. but it doesn't. the whole purpose of this exercise, at least in the minds of most americans, is let's drive the cost curve down. i've heard my colleagues on the other side get up and talk about, well, their plan is going to decrease costs for people in this country. here's the cost curve. the blue represents the cost curve. that's what would happen if we do nothing. that's the increase, the expected increase in health care costs in this country if we do nothing. now, what's ironic is the red represents what happens under

this bill. and so instead of bending the cost curve down, it actually increases the cost curve. so we're going to spend $160 billion more on health care in this country by enacting the bill, this monstrosity of a bill right here, which as my colleagues have pointed out, this is 2,074 pages. but look at this thing. and you think somewhere in here, in all this volume of paper that there would be a way to actually do something to bend the cost curve down, but all that represents more spending. in fact, if you look at the amount of the spending in the bill when fully complemented it is -- when fully implemented it is much more than c.b.o. estimated it would cost. when we unveiled this plan a couple a days ago they said it would be under $1 trillion.

they used a lot of scoring tricks, a lot of ways to obscure the true cost of this thing. in fact, even the first ten years it understates the cost, which is over $1 trillion. but the ten-year fully implemented cost of this bill is $2.5 trillion. $2.5 trillion expansion in the size of the federal government. and if you look at how that plays out and how it's paid for over the fully implemented phase, we've all talked about $500 billion in medicare cuts. ten years fully kpwhrepltd, it's over $1 trillion that they have to cut medicare to pay for this thing and then to raise taxes by another $1 trillion. so you're talking about not only cutting medicare senior citizens, as you've all talked about, about raising taxes substantially on small businesses. but at the end of the day, after it's all said and done, what do you end up with? you end up with an increase in costs above and beyond what we would see if we did nothing.

tell me how you can call that reform. the other point i'll make before i yield back to my colleagues is that if you're someone who already has insurance, and 182 million people in this country have insurance, you're not going to be able to participate in exchange. you get no more options out of th-fplt there are 19 million -- options out of this. there are 19 million people who might benefit from exchange. if you currently have insurance, you can't get into an exchange. you don't get any subsidy. what you get are big fat tax increases and increases in your insurance premiums for all the reasons that have been mentioned. because when you tax the health insurance companies like this bill does, when you tax the medical device manufacturers like this bill does, when you tax the pharmaceutical companies like this bill does, and when you create all new kinds of mandates on insurance companies, including changing these age band ratings going to a 3-1 age band rating, you're going to raise premiums for a lot of

people in this country and you're going to raise them the most for people who are 18 to 34. what the people who are 18 to 34 don't realize what's coming at them today but about a 69% increase in their insurance premiums. they are the ones who get stuck the hardest. if you're any of these 182 million people, your taxes are going to go up, your insurance premiums are going to go up, and you're not going to see any benefit from being able to participate in any sort of exchange. these are the cold, hard facts. i've heard countless democratic colleagues come down here and talk about benning the cost curve down and reducing premiums for people in this country. this is the congressional budget office number. this isn't anything that the republicans put together. this is the c.b.o. cost estimate of what it would do to the cost curve. as i said before, the red represents the increase, $160 billion increase in health care spending over ten years, all of which is going to be borne by those 182 million americans in this country who already have insurance. a senator: if senator from

south dakota would yield, i'd like to get your comments maybe from both of my colleagues on a couple of quotes from the congressional budget office as well as the joint committee on taxation dealing with this premium increases and who's actually going to bear the taxes. mr. ensign: a lot of people think that, well, let's just tax the insurance companies. let's just tax the medical device companies. let's just tax somebody else. this is what the congressional budget office -- let meet read a couple of quotes. one quote is "although the surcharges would be imposed on the firms, workers in those firms would ultimately bear the burden of those fees just as they would in a pay-or-play requirement. many of those workers are more likely to have earnings at or near the minimum wage." it's the low-income people who are going to end up paying when you actually put some of these taxes that we've talked about. here's another quote from the congressional budget office. let's remind folks, the

congressional budget office is nonpartisan. it's not republican, not democrat. they are kind of the objective scorekeeper around here. another quote that they say: "these taxes would increase costs for the affected firms which would be passed on to purchasers and would ultimately raise insurance premiums by a corresponding amount." the last quote is this. this is by the joint tax committee. "generally we expect the insured to pass along the cost of the excise tax to consumers by increasing the price of health coverage." this is what you're talking about on that other chart that you have up. we would like to hear your comments on that. mr. thune: you're absolutely right. i think what the c.b.o. has pointed out is -- and i've got the joint tax committee there, the data that they produced on this is very similar to what c.b.o. said. 84% of the tax burden is going to fall on people making less

than $200,000 a year. half of the families making under $100,000 a year are going to get hit with new taxes under this bill. and so, it is going to fall. it's going to fall on those people in this country -- and i think they like to think that they're taxing medical device manufacturers and everybody else. but at the end of the day a lot of this stuff gets passed on. and the taxes in the bill, premium increases in the bill are going to be borne by the people who are probably least able to absorb that and to take that. and it's going to be the people in the lower-income categories. and so, the gentleman from nevada is absolutely right, and, again, i come back to the basic premise of this whole purpose of health care reform, which should be to get health care costs down, not raise them. and you have alluded to, the senator from wyoming have alluded to a number of things that we believe would do that, that actually does put downward pressure on health care costs in this country. it's done in a step had i

been-step -- step-by-step way. it is done that is not throwing out everything good in health care in this country, creating a massive expansion peer tphao*er washington, d.c., $2.5 trillion in costs when fully implemented. who knows, if a lot of these things don't happen, if the tax increases don't occur, medicare cuts don't occur, it means borrowing from future generations. they talk about reducing the deficit by $130 billion only because they didn't include the physician fee fix, only because they had a revenue from something called the class act which is never going to become law. if it does, it's a huge money loser in the out years. and so you've got all these things if they did, including delaying the implementation date by five years so it understates the tree cost of this -- the true cost of this thing. all these things have been done to try to make this turkey look like something other than what it is, which is a massive increase in spending, massive

tax increases on the american people, and increased premiums for americans, particularly americans, those 182 americans who already have health insurance who are going to get hit the hardest under this legislation. mr. ensign: maybe we could have the senator from wyoming comment. one of the big things republicans have been talking about, instead of driving premiums which this bill does, driving premiums down, maybe discuss the medical liability option which the a very conservative estimate says it would save $100 billion in medical expenses in this country. as a practicing physician, talk about the unnecessary tests that are ordered, the huge increases in medical liability insurance costs physicians face today. mr. barrasso: you do a poll of doctors and say have you ever ordered a test, ever ordered a test that is really not going to help that person get better, but

you were doing it for fear you didn't want to miss something for fear of a malpractice suit, all hands would go up. massachusetts has their new health care plan. the dean of the harvard medical school had a publication this last week and said i give this whole thing a failing grade. he said people that support this, the legislation that's being proposed, are engaged in collective denial. we need to do some things that will help with cost, with access, with quality. all this is going to do is drive up the cost with no improvement at all in quality. so there are step-by-step things we can do. letting people buy insurance across state lines, getting the same tax break as others. you talked about helping people stay healthy, exercising, getting down the cost of health care by getting their cholesterol down. also you have to deal with

abuse. just the same thing as loser pays. there are people that would oppose that all the way, about it would help eliminate -- eliminate -- a lot of the unnecessary tests and certainly a lot of the costs of the system. two-thirds of that cost of that whole liability system go to the system. it doesn't even go to the injured person. if somebody's injured, you want to take care of them, but this doesn't do it at aufplt one of the things that -- doesn't do it at all. one of the things that the senator from south dakota mentioned was age banned rating, which flies in the face of the things we've been talking about, about individual responsibility, opportunities for people to stay healthy. the big problem is 50% of all the money we spend on health care in this country is on 5% of the people. the people that eat too much, exercise too little and smoke. yet, under this government-forced insurance where people are going to be forced to buy insurance and if young people don't buy it they're going to be listed as tax cheats or criminals because

they're going to get fined and they're going to get taxed an amount for not buying the insurance, they're going to have to buy insurance. as the senator from south dakota talked about a 3-1 ratio and the senator from maine mentioned the same thing, what that means is for the youngest, healthiest person buying insurance, got out of the college and staying healthy, working construction, in good shape, going to the gym, what they're doing on a 3-1 ratio is that person has to pay a lot of insurance compared to the person who does eat too much, exercises too little and smokes. the ratio of their insurance premiums, this person can pay no less than one-third of what this person, when realistically you might have 100 young people that their total health care bills for a year would be equal to that one person that exercises too little, eats too much and smokes. so these young people are going to end up paying the cost. and it's their premiums -- and i think we heard that from the senator from south dakota, and

if you want to jump in -- their premiums are going to go up. did i hear 69%? mr. thune: 69%. if you're 18 to 34, that's what you're looking at in the form of a premium increase, not to mention future generations are going to continue to deal with the pile of debt we're going to put on them. this is not a good deal if you're a young person in america. mr. barrasso: it's the wrong prescription for america, mr. president. well, i am going to continue to speak on the floor, mr. president, about the things that i think are problems with this bill. i think it is the wrong approach. i think that it costs way too much. i think it raises taxes on all americans. it cuts medicare, and what we've heard now -- and what we know for sure -- is that it is going to raise premiums for people who have insurance, who like the insurance that they have, who

want to keep the insurance that they have, and their costs are going to continue to go up if this becomes law at a rate faster than, as we saw from the graph, faster than it nothing was passed at all. the presiding officer: time has expired. mrs. boxer: mr. president? the presiding officer: the senator from california, mrs. boxer. mrs. boxer: mr. president, what's the order? the presiding officer: the democrats control the next hour. mrs. boxer: thank you very much, mr. president. i listened to several of my republican colleagues, and i want to note that they have the bill in front of them, and they're attacking this health care bill, but nowhere on their desks do we see their bill. they have no answers, no solutions -- a senator: will the senator from california yield? mrs. boxer: i can't yield. they have no solutions at all on

an issue that affects every single american, and what we have before us in the reid bill, i think, is an excellent piece of legislation that will make life better for every single american, and i will spell that out in the course of my remarks. we all know change isn't easy. it is easy to come down here and demagogue and pound your fist and complain. it's human nature to resist change. but every once in a while, mr. president, a situation crisis out for change -- a situation cries out for change, and the that's the case today with our health care system of the status quo is not benign. it is hurting our people, and i'd like to share the story of nick chi white, as brought to us in the book "the healing of

america" by t.r. reed. he talks about nicky in the prologue where he poses it as a moral question, what we do about health care. and it is what he writes: "if nicky white had been a resident of any other rich country, she would be alive today. around the time she graduated from college, nicky white contracted lupus. that's a serious disease but one that modern medicine knows how to manage. if this bright, feisty, dazzling young woman had lived in, say, japan, the world's second-richest nation, or germany, the third-richest, or britain, france, italy, spain, canada, et cetera, the health care systems there would have give enher the standard treatment for lupus and she could have lived a normal life

span. but nicky white wrasse a citizen of the -- was a citizen of the world's richest country, the united states of america. once she was sick, she couldn't get health insurance. like tens of millions of her fellow americans, she had too much money to qualify for health care under welfare but too little money to pay for the drugs and the doctors she needed to stay alive. she spent the last months of her life frantically writing letters and filling out forms," mr. president, "pleading for help. when she died, nicky white was 32 years old." that is a story that should move every one of us, move every one of us, to action. look, we've spent years studying and analyzing what's working in our health care system and what's not working. what it comes down to is this:

too many of our fellow citizens are suffering because of the broken promises of a health insurance system that abandoned them when they needed it the most, too many cannot afford health insurance, too many are getting sick after praying to god that they wouldn't because they knew that sickness could leave them in economic ruin. mr. president, praying is not a health care insurance plan. americans will spend over $2.5 trillion on health care next year, $2.5 trillion n all, we spend twice as much per person on health care as other advanced nations. yet the united states of america, our great nation, ranks near the bottom of the 30 leading industrialized nations in basic measures of health such as infant mortality rate and

life expectancy. the bottom of the list. that's where we are. so we spend twice as much and the results are not anywhere near where they should be. it's clear why. too many people don't have affordable health insurance, and they wait too long before they get the help they need. or they're like nicky and they never get the help they need. health care premiums have more than doubled in the last nine years, more than doubled in the last nine years, and onerred nonpartisan study says if we fail to act, the average american family will have to spend 45% of their income on health insurance premiums alone, and that's by 2016. by 2016. 45% of their income, the average

family, by 2016, if we do nothing. and my friends on the other side stand there with the bill and downglobal aids we're doing and never address that issue. -- and downgrade what we're doing and never address that issue. it's time for change. when we know that twoirds of all bankruptcies are due to health care -- when we know that two-thirds of all bankrupts are due to health care issues, we know it's time for change. every day another 14,000 americans lose their health care coverage. that tells me it is time for change. i know there are many people listening who think the uninsured, that that's not their problem, that it doesn't affect their health care. they're flat wrong. right now every one of us with insurance is paying $1,100 a year -- each of our families -- for those who are uninsured.

why? because we have to pay for the emergency room services that they get when they're rushed into the hospital because they've neglected a health care problem, and it's very expensive, and we're paying for it. that tells me it's time for change. when family after family tells us they paid for insurance for years but when they had a crisis their insurance company walked away from them. in t.r. reid's book, we hear about a man who paid all his life for insurance and he got struck by an automobile and he was in the hospital with a terrible situation, and the insurance company knew it was going to cost them a lot. you know what they did? they rescinded his insurance. they told him that years earlier he didn't tell them that he weighed more than he should have, and they walked away from him.

story after story. good, hard-working people unable to get health insurance, knowing that their future is dark. it's time for a chaifnlgt and today -- it's fipple for a change. and today i want to say to america's families, change is definitely on the way. it won't be easy, and it's going to be tough. but all these things that i have said are truth, and everybody here has to be moved by that, and i believe we will finally bring change. i'm hopeful. i'm hopeful because of the work of so many of our colleagues and the work of senator harry reid. he has put a bill before us that, as i said, will make life better for every single american. it's called the patient protection and affordable care

act. first and foremost, if you have health insurance that you like, this bill gives you the security of knowing it will be there for you when you need it. and if you don't have health insurance, you'll be able to get affordable coverage through a new exchange which includes the public option. ultimately, under this bill, we are expanding health care to cover more than 94% of american people, and all the while we are cutting the federal deficit by an estimated $130 billion over ten years because there are real savings and real revenues in this bill to offset the new, important programs. when this bill is signed into law, mr. president, america's families will see immediate improvements to their health care. they won't have to wait. for example, right away when president obama signs this bill,

your insurance company won't be able to kick you off your plan for some made-up reason because they no longer want to cover you and they will no longer be able to cap your coverage. i can't tell you how many people think they're safe because they had a $500,000 cap on their insurance. they never dreamed they would use it up. but one difficult and terrible illness can use it up, and then they're out of luck. no more rescissions, no more caps. parents will be able to keep their children on their health care policy up to the age of 26. small businesses will have immediate access to tax credits to make covering their employees more affordable. and seniors -- seniors will have a more generous benefit through their prescription drug coverage. we all hear about that doughnut

hole that comes onto seniors as soon as they need to buy more pharmaceuticals. this will give them another $500 before they reach that point. those are just a few of the immediate benefits of the patient protection and affordable care act. here is a sample of other major provisions. this is a very important one, mr. president. in this bill, no family of four making less than $88,200 a year will have to pay more than 8.7% of their income for health insurance premiums. let me say that again. no family of four making less than $88,200 a year will have to pay more than 9.8% of their income for health care premiums. so if you make anything between

the, say the poverty rate all the way up to $88,200, you never have to pay more than 9.8% of your income for health care premiums and if you're on the lower end, it's even less. it goes down to about 2%. so it ranges from 2% to 9.8% at $88,000. that means that more than 62% of all of our families will be able to be insured, that they will not have to go broke to buy health insurance. and remember what i said ... a respected study has already stated that if we do nothing, by 2016 people will be paying 45% of their income on premiums, and in this bill we ensure that our middle class down to our working poor do not have to worry about those kinds of premium

increases. now, for the rest of our nation's families that are more affluent, there's the security of knowing that the insurance company reforms in this bill are going to help you. the insurance company can't walk away from you, if you have a preexisting condition, they can't turn you down, if you have a child you want to keep on until age 26, you can. if you're a small business, you'll get tax credits to help you pay for your employees. there are many other benefits, including some free prevention coverage that kicks in right away. so no more discrimination against those with a preexisting condition, and, by the way, no longer will insurance companies be able to discriminate based on gender. right now women in my home state of california are paying almost 40% more for the same insurance as men. there's gender discrimination.

that will end when this bill becomes law. this bill, we increase competition, which is perhaps one of the most important things we can do to bring down costs to our families. we have the health care exchan exchange, which includes a public option, that will compete on a level playing field with insurance companies to keep them honest. nerdz, therin other words, thera goption, but there won't be -- a goption, but there won't be -- a government option but there won't be anything in terms of the way it negotiates with insurance companies. now, there's been a lot of shouting from my colleagues about the public option. why shouldn't the american people have access to a public option? i ask that question. i don't hear my republican friends coming down to the floor

saying they're going to give up their public option, mr. president. more than 90% of us have a public option right now, the federal employee health care benefits program. i don't see one of my republican colleagues who've been trashing the public option coming down to the floor and saying, oh, i want to get rid of mine. oh, no, they like it, but they don't want it for the rest of the people. i do not understand it. to me -- to me, i just don't understand it. let's leave it at that. there are lots of public options that we have here. medicare's a public option, run by the government. i don't hear my republican friends coming down here saying we should end me medicare. they used to say that. they don't say it anymore. now they say they defend it. it's a public option. 45 million americans are covered by it. not one of them said get rid of

medicare. i don't hear any of my republican friends coming down to the floor saying we should get rid of another public option called medicaid. that public option is for the poor. it works well. it's tough. there are problems with it, but it works well and it covers 60 million americans. so you've got 45 million americans in a public option called medicare, 60 million americans in a public option called medicaid. how about the veterans health care program? i don't hear one of them coming down and pounding the table and saying, get rid of the public option for our veterans? i'll tell you, maybe they want to but they won't say it, because the veterans would be at their door because that public option covers 7.9 million veterans. not one of my republican colleagues says they want to end it. i don't hear my republican

friends coming down to the floor to say we should end our tricare program for our military. that's a public option for 9.5 million people. i don't hear them saying, stop that public option. and again, their own health care that they have, brought to them by fehbp, the federal employees health care benefit program. that's a public option. that covers 8 million people, including them, and they don't seem to want to end it. but when it comes to everybody else, they come down here and they basically say, a government takeover of health care. false. the public option is just one option in the exchange. and it has to run by the rules of all the other insurance companies. and i say, if it's good enough fofor a republican member of the

senate, a democratic member of the senate, a public option ought to be an option for the people that we represent. small business, mr. president, really needs help here. i don't know if everybody's aware of this, that small businesses pay as much as 18% more for the same health insurance as large businesses. and in california, we've seen increased premiums to small businesses that meant the choice between laying off employees or not providing health insurance at all. more and more of these businesses are dropping health care coverage. if you're in a position where you work for a small business and you're loyal to them and you want to stay there, when this bill goes into effect, you can go into the exchange and then you'll have some buying power or your small business can go into the exchange. this bill, mr. president, will

protect our seniors and it will strengthen medicare. medicare is a success story. before medicare became law, half of our senior citizens went without health insurance. now 98% of our seniors are covered by medicare. they believe in the program and they want it to continue, and those of us supporting this bill want to make medicare stronger, and we do. this bill, "th pient protection and affordable care act," will ensure a stronger, more sustainable medicare program. it lowers prescription drug costs, as i mentioned before. it increases access to preventive services for our seniors, and it extends the solvency of the medicare program by four to five years. now, my republican colleagues are standing here saying democrats want to hurt medicare. by the way, a public option, medicare. they're saying the democrats

want to hurt medicare, a public option. honestly, who could believe that? in 1964, george h.w. bush called medicare socialized medicine. newt gingrich, when he was speaker of the house, said he wanted to see medicare -- quote -- "wither on the vine." in 1995, while seeking the republican nomination for president, senator bob dole bragged that he voted against creating medicare in 1965. he bragged about it. he said, "i was there fighting the fight, voting against medicare because we knew it wouldn't work in 1965." so the republicans are saying that the democrats want to destroy medicare in this bill that. is beyond ridiculous. the american people know who's on their side when it comes to

protecting medicare. you know, we didn't just wake up this morning. we know who brought us medicare. this bill expands medicaid. that's medicaid, for the poor, to ensure that the poorest and sickest among us can get into the program. and we're going to get into the program those with incomes below 133% of the poverty level. now, that means that more than 1.5 million of my californians who are now uninsured or struggling with the cost of health carehealth care, that wiw them to be covered. i want to thank the majority leader for working with us to ensure that california receives increased federal support as we expand medicaid. for the first three years of this expansion, the federal government will fully cover the cost of expanding medicaid. now, i talked a little bit about

prevention. today, only four cents of every dollar we spend on health care is spent on prevention, yet more than half of our people live with one or more chronic conditions. five chronic diseases -- heart disease, cancer, stroke, chronic obstructive pulmonary disease, and diabetes -- are responsible for more than two-thirds of the deaths in america. this bill will eliminate co-pays and deductibles for preventive care so people don't get to that serious illness. and those preventive services go into effect immediately. so that's an overview of the patient protection and affordable care act. my friends on the other side have already come out against this bill. they say it's too long, it's too complex. they said -- one of them said it's holy war, this bill is going to, for some reason, caught them to fight a holy war.

again, where is their bill? they don't have one. after all the things we know are wrong with this system, you don't have to agree with us on everything, but where's your bill? it seems like my republican friends care more about playing politics than protecting our families. that's what it seems like. that's what it feels like. they seem to care more about bringing down our president than bringing down the cost of health care. they care more about all that than tim and josi e hintas of los angeles, california. tim is retired from raytheon and he gets his health care through his retirement plan. during 2007, the first year of his retirement, their monthly health care premium was $460. during 2008, it rose to $630. 2009, $850. that's an 85% increase in two years for this retiree.

mr. president, tim wrote to me, he said, "i understand that compared to many, we're fortunate to have good health care and insurance, but we look forward to you, senator boxer, the senate and the house addressing the seemingly unbounded increase in health care costs." and, mr. president, we do it in this bill. people like tim will be protected. but my friends across the aisle say no, we're not going to help tim. what about madeleine foote of costa mesa, california? she turned 25. she lost her health care coverage that she had under her parents. she tried to get coverage but because she had taken medicine, she was denied. they said it was a preexisting condition. they said, oh, you can have health care but you have to have a $3,000 deductible and premiums of $300 a month. she wrote, "as a young person working in a restaurant, repaying student loans and trying to make it, this is a huge financial burden. i can't afford insurance that

charges me so much. for now, i'm forced to hope that nothing extremely bad befalls me." so she's another one who's praying not to get sick. that is not a health care plan. but my friends on the other side of the aisle, they say, no, sorry, we're not going to help you, madeleine. and i have so many other stories. douglas engolspie, a small business owner in santa barbara. he had 11 employees. he couldn't afford to get them insurance anymore. he asked that i support a public option, and i do. and my republican are saying, douglas, no, we're not going to help you. and it goes on. the stories go on, and i'll put them all in the record. one of these stories is from a doctor, a retired pediatrician in sacramento, california,

dr. robert meager, who wrote to me and said, parents begged him not to write on the form after he saw a child with asthma, please don't write down asthma; please say it was bronchitis. please. because if you write down that my child has asthma, they'll have a preexisting condition and when they go out on their own, they can't get insurance. can you imagine a doctor has to face a parent like that? my republican friends don't seem to to want think about that. they just seem to be thinking about politics and the next election, and we all know the bill before us isn't perfect. they should vote to start deba debate. they can try to make it better. there are many issues i'm working on for california. the disproportionate share hospital program. i'm working to get even better prevention for women. but at the end of the day, mr. president, this is where we stand. health care coverage for all of america's families has been an

illusive goal since teddy roosevelt first proposed it nearly a century ago. our dear friends, ted kennedy, senator ted kennedy, whom we miss so much, fought for health care right here on this senate floor from the moment he arrived in the senate in 1962 to the moment he died. today i am proud to say we are moving closer to fulfilling this promise of health care for all. robert kennedy once said, few will have the greatness to bend history itself, but each of us can work to change a small portion of events, and in the total of all these acts will be written the history of this generation. mr. president, this is our time, this is our moment, this is our moment for us to come together as a nation nation and make surr

people never again have to face what nikki white faced in her last days, filling out forms, praying to god she could get health care and not being able to get it and dying at age 32. that is immoral. it isn't necessary. and we can fix it. and we should. and i thank you very much, and i yield the floor. mr. dorgan: mr. president? the presiding officer: the senator from north dakota. mr. dorgan: mr. president, i neat this has been a lengthy discussion already -- i note that this has been a lengthy discussion already, and my guess is that because this is merely a motion to proceed to a subject on the floor of the senate, my guess is that were this motion to be approved, we will have weeks on the floor of the senate talking specifically about amendments, about

approaches that will strengthen and improve some portions of the legislation that will be before us. the subject is health care, and, frankly, health care is very personal to everybody. senior citizens on medicare, to people at work who get their health care policy from their employment, to families who are struggling to pay for increasing costs of health care year after year. and so the question before the senate tomorrow evening: should we debate and vote on these matters? should we proceed? not should we approve a health care bill? should we proceed to the bill to have a discussion and have some amendments? now, mr. president, health care has changed dramatically in a very short period of time. my background is from a town of 300 people. and in my little town, as was the case many, many decades ago, we had a town doctor in a town of 300 people. it doesn't happen anymore much.

but we had a doctor, doc hill. he came when he was a young man and stayed until he died. and he delivered i think probably 1,500 babies. they had a doc hill day once and all the babies that he birthed came to march in the parade in my little hometown. and as time changed, medicine changed, things changed, doc hill used to go on house calls to the farms to deliver babies and deal with illness. house calls all around the region. times change and those practices changed as well. but the big debates in the last half century or perhaps century about health care have, in most cases, advanced health care. i wasn't here, of course, nor were most of my colleagues. a couple of them were perhaps here during the debate on medicare. but i remember vivid lace a very young boy the old folks in my

hometown, some of whom had nothing, lived in little shacks. certainly had no health care. no health care coverage because when you got old back in those days, no insurance company wanted to cover you. even if you could pay for insurance, nobody was chasing old folks saying, now that you're 70 or 80 years old, can't we sell you a health insurance policy? they couldn't find health insurance. half the senior citizens in this country couldn't get health insurance. and so the congress came together and said, what do we do about the people who are now in their sunset years, those who helped build this country, went to war, build the roads, build communities? what do we do about that? they passed medicare. it has been an unbelievable success. there are some financial strains with medicare, but that is born with success. people are living longer, with a longer life, they often need health care. that's a success, not a failure.

and so we have changed medicine in our country in many, many ways. medicare is one example. miracle medicines. medicines that didn't exist some decades ago now can be used to keep people out of acute care hospital beds because the medicine to manage diseases now exists. polio was cured. smallpox was cured. you think of all of the changes over the years. and, yes, it is the case that if you have a very serious illness, in most cases, you want to be in this country. it is the case, however, that many in this country can't afford to access the health care that exists, but people come here, not elsewhere, for good health care. we've got some terrific clinics and opportunities for people to get good health care in this country. the problem is the cost is relentlessly increasing every single year and pricing health care out of the reach of too many americans, too many families can't figure out now

how to pay for health care. they can't pay for the increased insurance premium going up double digit every year. they have to go to the grocery store and look in the back where it says pharmacy and try to figure out what is the prescription drug going to cost so i can buy that first and find out how much i have left for groceries. the price for health care is marching relentlessly up. too many people don't have coverage. families often can't afford it. small businesses can't afford the price increases for health care. so what do we do about that? if there's a sick child, should a sick child who is crying because it hurts be told that your visit to a doctor depends on how much money your parents have? i don't think so. and so we passed legislation dealing with that, providing health care opportunities for children who come from families of meager means.

the question for us now: is there a way for us to extend health care coverage and also to put the brakes on these increasing and relentlessly increasing costs. if at the end of the day legislation that is considered here doesn't really put the brakes on price or cost increases, i don't want to be a part of that. i'm not going to be supporting things that really don't put the brakes on these relentless increases in health care costs. i mean, that's what the purpose of all of this is to try to get a handle on it somehow. now, there was an author named barbara errin wright who described visiting with a friend of her's from a european country and she told her friend she had breast cancer and was told she had difficulty getting insurance because she had breast cancer. and her friend said: but isn't that when you would moss need

insurance? not understanding in our country, you're least likely to get what you need when you need it most. that's another question in this set of issues, preexisting conditions. is there a way for us to make it easier for people to access health insurance when they really need health insurance because they've got a debilitating illness? i would hope so. and many of the proposals would allow us to do that in legislation that has been discussed and also written that will be considered, i know. what should happen when you pay an insurance company for 10 or 15 years premiums, you do it every month, and all of a sudden the insurance company says, you know what is this we're going to perforterminate you. is that fair? i don't think so. shouldn't there be an opportunity to address those type of things? the denial of coverage. the termination of coverage. let me also say that as we

discuss these policies, there's another element here that's not very often discussed which i want to emmy pie, and that is the -- amplify, and that is the issue of personal responsibility. personal responsibility, that goes well outside of legislative activities. two-thirds of people in this country are overweight. one-third are obese according to statistics. i invited someone from safeway corporation to come and meet with our caucus. i know the c.e.o. of safeway, steve byrd met with both caucuses in the senate. he told of a very interesting experiment -- i program i should say at safeway. i believe it was 35,000 of their employees and they did the following. they said here's your health insurance plan. here's the amount that the safeway company will pay. and here's the amount that you pay. so that amount the employee pays is x. but you can reduce the amount you pay, the company said to the

employees, if you do four things, you can reduce it in four steps. four things. you have high blood pressure, you have to be on medicine to control it and we'll pay for the medicine, the company said. you have high cholesterol, you have to be on medicine to control the cholesterol and we'll pay for it. are you overweight? then you have to be on some sort of weight reduction program and we'll pay for that. are you smoking? then you have to stop or be on a smoking cessation program and we'll pay for that. if you don't want to do those things, if you have high blood pressure, high cholesterol, smoking, you don't have to do that. that's all right. here's your co-pay. if you to all four of those things and the company pays for each of those, you won't pay up here, you'll pay four steps blow, less money every single month. he says that with that program, they've had flat health costs

for five straight years. think of that. five years flat costs. while the rest of the country is seeing these relentlessly increasing costs, that program provided flat costs. no cost increases. why? because i think they incentivized personal behavior in the right way. do this, improve your health, we'll pay the cost of it. and save yourself some money. that is exactly right thing to do. and i hope as we have this discussion, a fair amount of that impulse can be a part of what we're trying to do. incentivize the right behavior. personal responsibility. and that just makes a great deal of sense to me. now, one of the things that i have always supported is the issue of health care coverage at your workplace. it's where most americans get their health care coverage. and i don't want to do anything to disincentivize that. i want whether it is small,

medium or large businesses to say, you know what? good for you. you're providing health care to your employees. we support that. i don't want to disincentivize that. i want to incentivize that. i know it's hard for small businesses during economic times and reach and pay 10% more this year than last year and 10% more this year than next year. that's what we're seeing in the health care costs. that's why it's important to me for the interest of small and need-up -- medium-sized businesses and large businesses to put the brakes on this. i'm not talking about diminishing the quality of health care. i'm just saying let's put the brakes on these price increases year after year. let's find out what's causing it. i have some ideas about that. let's put the brakes on it. that's what this debate needs to be about. i want to talk about an amendment that i intend to offer, as soon as we're able to offer amendments. it is an amendment that is bipartisan, unlike a lot of

things in this chamber. my amendment was co-sponsored by the late ted kennedy. also co-sponsored by john mccain. co-sponsored by chuck grassley, debbie stabenow. the list goes on, republicans and democrats. both philosophies, and it's about prescription drug prices. and i want to describe what this amendment is. it says, let's give the american people the freedom to access the identical f.d.a. approved drug, identical drug that is f.d.a. approved when it is sold for a fraction of the price everywhere else in the world. the american consumer is charged the highest prices in the world for brand named drugs. here's what's happening to price increases for prescription drugs. you see the rate of inflation, that's the yellow line. take a look at drug price, the red line. and, by the way, this past year 9.3% increase in prescription

drug pricing. now, mr. president, this issue is not some irrelevant issue. there are a whole lot of folks who use prescription drugs to manage disease an keep them out of a hospital. and i understand many of these drugs are miracle drugs. and i don't want to retard the ability to create drugs or explore and do research and so on. a substantial amount of the research goes on at the national institute of health, publicly funded. the knowledge of which is made available to the drug companies that turn that knowledge into a prescription drug. good for them. i say good for them. but what i don't like is the fact that those same pharmaceutical companies charge the american consumers the highest prices in the world. now, they will say, well, if you offer an amendment, you senators, republicans and democrats, offer an amendment that tries to give the american people the freedom to access the

same identical f.d.a. approved drug when it is sold in spain or italy or canada or name the country, when it is sold in a number of countries for the identical price -- excuse me for a fraction of the price, i should say, in the u.s., if the u.s. consumer tries to access that lower price, then somehow it will retard research and development on new drugs. that's just not true at all. those brand named drugs are sold for a much lower price in europe and they do more research in europe, at least that was a couple of years ago. i haven't seen recent data. but the fact is lower prices and they've done more research. and in any event, there's more money spent on advertising promotion an marketing than there is -- and marketing than there is on research. watch television and see the next commercial that asks, shouldn't you take flomax,

whatever that is. shouldn't you find a doctor to ask if the purple pill is right for you. go to a doctor and say, i don't have any aches or pains, but is the purple pill right for me? i don't have the foggiest idea what the purple pill is for. they relentlessly push this advertising. maybe they should use that money for research. but, mr. president, to put a finer point on it, if i might, this is the price of lipitor. this is the new price, by the way. $4.78. -- in the united states for a 20 mil20-milligram tablet. this is the same pill put in the same bottle made by the same company, lipitor. same manufacturing plant in ireland, they put the same pill in these two bottles.

this one goes to the united states. this one goes to canada. the american consumer have the privilege of paying $4.78 per tablet and the canadian buys it for $2.05 per tablet on june 4, 2009, when i priced it. mr. president, it's not just lipitor, although lipitor is the most popular cholesterol-lowering drug, but zocor, 20-milligram tablet, same thing. $5.16, $2.45, u.s. price versus canadian price. and, mr. president, i just used canada because it's a close neighbor. i could have used spain, italy, france, germany, and by the way, some of our folks on the floor of the senate who will support the pharmaceutical industry's pricing policies are pricing their brand name drugs, the highest prices in the united states -- i don't support that, but some will. they will say well, you can't really do this and do it safely,

allow people to access these f.d.a.-approved drugs from elsewhere. well, the fact is in europe, they have been doing it for 20 years. they have something called parallel trading. if you are in germany, want to buy a prescription drug from spain, no problem. if you're in italy, want to buy it from france, no problem. they have parallel trading of prescription drugs. the consumers have the freedom to buy it where it is least expensive. in our country, consumers don't have that freedom, and our amendment gives the american consumer the freedom to shop for those prescription drugs where they are sold for the most reasonable prices. i'm not interested in having consumers buy their drugs from other countries. i'm interested that if they have the opportunity to do that at a fraction of the price, that the pharmaceutical industry will be forced to reprise their drugs in this country. i sat on a straw wale once at a farm where we had a meeting. we all sat around on these bales

and talked. an old codger there about 80 years old said to me, my missus, he said, my wife he said has been fighting breast cancer for three years, and he said we have every three months driven to canada to buy tamoxifen. that's the medicine my wife has taken to fight breast cancer. every three months we drive to canada to buy tamoxifen. it costs me 20 cents for what i pay a dollar for in the united states. now the fact is they will allow someone like that to drive across with 90 days of use. but most americans don't have that opportunity and most americans could not access that drug from canada because it would be against the law at this point. i want to give the american people the freedom to be able to access f.d.a.-approved drugs and the legislation i will introduce with my colleagues has the most substantial safety provisions, including batch lots and pedigrees on these drugs, that

will make the entire drug supply much, much, much safer than it is now. now, mr. president, price increases in 2009. a story this week described what's happening by the pharmaceutical industry in pricings drugs. interesting ... an arthritis drug, enbrel, increased 12% this year. nexium frr ulcers increased 7% this year. lipitor, up 5% this year. asthma, singulair is up 12% in year. plavix, price increase 8% in year. that's an antico[^agulant. osteopour row circumstance if you're taking boniva, an 18% increase this year. what's the deal? does anybody understand what the reason nor this is? these kinds of unbelievable price increases?

and so i'm going to offer this amendment with my colleagues, and my hope -- my expectation -- is you want to say at the end of the day that you've really done something to address the issue of skyrocketing prices in health care, you can't say that walking out this door, if you decide that you're not going to do something to put the brakes on prescription drug pricing. because the american people should no longer pay the highest prices for brand-name drugs in the world. that is not something that should be allowed by -- it's certainly not something that is fair to the american people and not something that we ought to turn a blind eye to when we're talking about legislation here. my legislation will be about giving the american people freedom, the freedom to access those drugs from a number of other countries named in our bill that have an identical chain of custody to our country where it will be safe and secure

for the american consumer to access those drugs at a fraction of the cost. now, mr. president, i want to say that some are pointing out that the issue of health care is also a jobs issue. the fact is, this is a significant burden on employers; that is, those that hire workers and are covering them with fringe benefits, including as a part of their compensation health care. so it is a jobs issue. and when the burden becomes too great, it destroys jobs, and that's just a fact. and so i want to talk about jobs just for a moment because even as we describe these issues, which i think are very important, they relate to jobs, but i want to go further to talk about jobs just because i have a bit of time today. and i've seen some things in the press recently that have bothered me, some storks and i want to just describe them. first of all, senator durbin and i are lead ago task force to talk about how we put together a

new effort to try to develop jobs, create jobs. what kind of incentives will allow small business- and medium-sized businesses to create new jobs in what are the things that will get the economic engine restarted, not just in g.d.p. but in putting people back on payrolls, putting people to work? what will that be? i notice this small- and medium-sized businesses are having difficulty in this country, even those that want to expand, because they can't find the financing to do it. and i saw a report just this week about the large financial institutions have gotten tarp funds, the big bailout funds, and the fact is that the -- wells fargo, $73.8 billion in tarp funds. in the last four months, they have cut the amount of financing of small business loans by 3.9%. now, think of that. a company that gets $73.8% in

tarp funds and cuts lending needed by small business by $p-.9%. america of america, $43.9 billion in tarp funds and they cut small business lending by 5%. ema quoting from a government rorkts by the way. treasury department comparing 4/30/09. american express and the list goes on -- i mean, i don't understand this at all. so the question is, how do we try to give some help to small- to medium-sized businesses and see if we can restart this economic engine so that they can put people back to work? they are at ones that are the job-generators in this country. what are the best ideas that we can use to put people back on payrolls? but what i wanted to talk about just for a minute is something that i saw in the "washington

post" this week when the president was in asia and it talks about folks from the 21 pacific rim knacks at an event that is -- -- quote -- "has put some of america's policies in the line of fire, a chorus of complaints about ution trade policies. in the hour before the president's arrival in singapore, leaders of mexico, china, and russia broadly condemned protectionism endorsing free trade as the best engine of growth" and so on, "but the blunt criticism said that america is moving in the opposite sense of free trade. china and others have said the same." now, mr. president, let me just -- let me just say, it takes an unbelievable amount of gall to suggest that we're moving in the opposite direction of free trade. we have an unbelievable trade deficit. and this is the trade deficit with china. it is a sea of red ink. it has gotten worse and worse

and worse. $266 billion of deficit last year, $266 billion trade deficit with china, and china is telling us that we have a problem with free trade? no, they're the ones that have closed markets. we're the sponge for all the goods that china wants to send us, only to find out that we can't get into their markets unless they describe the circumstances and restrict our ability to get into their markets. mr. president, could i have order? the presiding officer: order. thank you. the senator from north dakota. mr. dorgan: mr. president, this is about jobs. this is about jobs that leave our country and go there. and when we start talking about how to create jobs, maybe we ought to straighten out this trade mess. and let me just say -- there is a discussion in the same story about korea and the trade agreement with korea. i think it is pretty interesting that -- this is what happened with korea last year.

they sent us about 800,000 cars. they put them on ships and sent them to america to be sold. we were able to sell them 4,000 cars. why? they don't want american cars on the streets of korea. 98% of the cars 0 on their roads are made in korea because that's what they insist and that's what they wafnlts and they're criticizing us about the lack of free trade? that's unbelievable. now let me just describe that the cash-for-clunkers program in this country, we did a cash-for-clunkers program and, yes, it put some people in showrooms and sold some cars. the chinese and the koreans did cash-for-clunkers programs. a lot of us would have liked to have said, you know what? you're going to spend some money on cars, maybe spend them at least on cars that are made in manufacturing plants in this country. but that was not a requirement because it was so-called illegal

under the w.t.o. rules. but when japan and korea, for example, decided to -- in their own economy for a cash-for-clunkers program, they figured out a way to favor their domestically produced cars. in japan, only 5% of the cars in japan were imports, 95% made in japan because that's the way they twants -- in 2007. after the cash-for-clunkers program, even fewer cars came from imports. why? because japan did what was called a certification requirement that was opened to only a small number of foreign vehicles. for example, they would allow the sale of a toyota land cruiser, but you couldn't buy a ford explorer in japan under the cash-for-clunkers program. yet we've got these folks significant to us that we're not -- saying to us that we're not for free trade? excuse me? how much gall do you have to

suggest that a country with $260 billion of a tried deficit with china to have our -- trade deficit with china to have our president go overseas and be suggested that we're not holding up to our responsibilities in trade. the reason that i make this point is because this is about jobs. and i think restarting the economic engine is an unbelievable priority in this country. you know, a good job that pays well makes almost everything else possible. there's no social program in america as important as a good job that pays well. that's what makes everything possible for you and your family. when we see millions and millions of people who have been laid off as a result of the deepest recession since the great depression, we need to get about the business and senator durbin and i, senator reid and many others are working on that to address it. but one of the ways to address is is to deal with this trade issue as well. mr. president, let me conclude, as i started, talking about the bill that is before us.

the legislation that we're dealing with is health care, and the vote that will occur is on the motion to proceed. there is a lot of hyperbole about these issues. that is motion to proceed to a piece of legislation that we will then debate for weeks. and we will amend, i expect -- i just described one of my amendments that i feel very strongly about. it'll be bipartisan. i fully expect it to pass. i have a couple of other amendments as well that i will offer. i don't want health care to be concluded by the congress in some way or another without the indian health care improvement act that has been languishing for many, many, many years here in the congress to be a part of it. these are the first americans and the first americans too often these days have second-class electric, despite the fact that we signed on the dotted line the treaties and we owned up to the trust obleses that we have that never --

obligations that we have never quite owned up to. i spent a lot of time on the subject of the indian health care improvement act. i hope very much in this discussion -- and i will trays as an amendment -- that we will have the opportunity to do what we need to do with respect to indian health care. mr. president, i know that there will be a lot of opportunity in the coming weeks to describe virtually all of the things that people want to describe about every single issue. i want to come back to something i mentioned in the middle of my presentation and that is personal responsibility. we can do all that we want to do. we can have all kinds of legislation. but there also has to be some personal responsibility with respect to health care and i hope that whatever we do legislatively, if in fact at the end of the day the legislation moves forward, i think it will, to a conference committee -- if that is the case, i hope that the kinds ofes