so that might mean they want to stick some other things in that will be spending. but is their anybody out there that thinks you can do a trillion dollar new program and it will cost a dime? i hope people are taking a look at things like the wednesday editorial by the president of harvard made some comments about how things are working. i hope everybody reads that. this is a good way for the nation to go broke, not in good shape right now but that's a good way to go broke and there's a lot of gimmicks in this bill, too and i would appreciate a senator from wyoming pointing that out and i assume the senator from new hampshire and was the chairman of the budget committee, the ranking member of the budget committee now and really has a handle on a lot of these gimmicks. we will share some of those, too. >> if i could join this colloquy with my colleagues from wyoming, what a great state that is, to exceptional senators. first off i want to make this

point, and obviously a lot of folks are pointing at this bill which i have right here and the senator from wyoming has one, senator from wyoming has won because it is a debate that's been occurring around here has been media. a lot of it has been failure. it's been a theater to a large group. but we are dealing with something extremely real. every page of this 2,074 page bill will have an impact on americans. every page of this bill will make a decision and direct a policy that will affect the health care of every american, every american. and it's an extraordinarily interested and expensive bill. the senators from wyoming have

been deluding to this, but it really is historic. this is a historic building. it is historic. never in my experience, and i don't think really in any experience as the congress taken up the bill which is essentially going to restructure and fundamentally change the way 16 to 20% of the national economy is affected. in such an immediate and intrusive way. essentially the federal government will affect every decision that has to do with health care as a result of this piece of legislation, every decision has to do with health care. and the cost this is going to create in the area of increasing the size of the government is astronomical. we have heard this number, that this is an 890 billion-dollar bill. that's pretty big, $890 billion.

i suspect that would run the state of wyoming for a few years, maybe a century. the state of new hampshire i think would probably run pretty close to a century. in fact more than a century to be very honest with you. i don't think our budget is 8 billion yen. and so, that's a lot of money, $897 billion. or $800 billion plus. but that's not the real number. that is a phony number. that is a bait and switch number. that number is are arrived at by cleaning over eight in your period that the programs that are initiated in this bill, which is a massive new entitlement, a massive new entitlement, won't start until the fourth and fifth year. in fact, the house bill was even more -- was at least a little more honest than the senate bill. it started in the fourth year. the senate bill starts in the fifth year with most of the spending. but the taxes, which the center because senator from wyoming was just talking about, and the fees

and reductions in medicare, the start pretty much in the first year. so they've taken ten years of taxes, fees, and cuts in medicare and match them against four or five years of actual spending and claim they are in the budget balance and that the bill will only cost $890 billion. only. in fact, cbo has scored this over the of real period when all the programs are in place. and over that period, over that in your window with all of the programs are functioning that are created under this bill all of them being federal programs, brand new entitlements, extraordinarily expensive initiatives, when that occurs this bill costs by cbo's estimate, $2.5 trillion. $2.5 trillion. in order to pay for that, you would have to cut medicare by

over $1 trillion in order to pay for that he would have to raise taxes, fees by over $1.5 trillion. massive increase in the size of government. massive increase in tax burden, massive effect on medicare. now the senator from wyoming mentioned there's a few gimmicks on top of that huge gimmick which is this mess of eight and switch this is somehow an 900 billion-dollar bill or 800 billion-dollar bill when in fact is a $2.5 trillion bill. there are a lot of other games in here that deal with budgeting. one of them i find more entertaining in fact they take credit in this bill for creating a new program called the class act, a massive new program, long-term care program. they take credit in this bill as that being a budget surplus idle. how do they figure that? well because on a long-term care

program basically people in their 20s, 30's, 40's, and even into their 50s, they pay into it. it's like buying insurance under this plan. and so that money comes into the federal treasury. but they don't account for is when those folks going to the long-term care facility. and of the money goes out the money goes out at an incredibly fast rate. and the program balloon's radically in its cost. they don't account for that. they just account for the years people are paying in and they claim that as surplus money that they apply, try to reduce the cost of the bill. so they spend the money. i mean this is classic. first they take the money and claim it as an adjustment against the debt that they are running out and then they spend it so it won't even be available to pay for the program they claim they are going to fund with it.

it is just inconceivable you know, bernie madoff is in jail and whoever thought up this program and scored it in this bill bernie madoff will be part of that person. he would say my type of guy. that is the way to do the counting. fecund. it's unbelievable. there are a whole series of these types of games in here. the state's, the states are going to be taken to the cleaner by this bill. the allegation that you are going to expand medicaid by 20 to 30 million people and the states are not going to end up paying a huge bill as a result of that? absurd on its face. absolutely absurd. more important when you expand medicare by 20 or 30 million people the doctor will tell you back here the reason medicaid is

in such dire straits is because doctors won't see medicaid patients. why? because they are reimbursed at 60% of the cost. who pays the other 40% by the way of the present medicaid recipients? who pays the other 40%? i will tell you who pays it. mary and jo jones working at the local restaurant, they paid with their premium. bald and marie black working over at the local software company, they pay with their private health care premium. the 40% of medicaid it isn't paid for by the government is pete for by people on private insurance. their insurance premiums go up because they are subsidizing medicaid. reimbursements because hospitals had to get paid for the cost and they are only getting 60% from the government said the other 40% is picked up by the private sector so when you expand medicaid by another 20 or 30 million people, you are

inevitably going to drive up the costs of private insurance. again, so the private insurance policies go up. and what does that do? well it does what this bill is basically intended push people to the private plan and when you get down to it that is what this is all about. this is an exercise in having the federal government basically get control over all health care. and it's being done in an incremental way. they are setting up a scenario here that won't be immediately apparent to people. but as we move through the years it will become apparent because what will happen is the cost of private health care will go up so much the private employers will start to drop their health care. they will take the penalty, which isn't that high in this bill compared with the have to pay to health care costs and move their people and say all right, sorry, i'm not going to

give you health care anymore, or never will. go over and get this government plan and then down the road congress will change the government and a little bit. and they will start to put price controls and just like they want to do in a decade. and basically that will mean people will get less product because as you put price controls and you will have less innovation, less drugs, less devices will be developed because people won't be getting a return on their investment because there will be price control even and you will find delays because that is what happens when you move to a government program that controls cost, the government can control costs by controlling price and that creates the lease or access which is what happens in england and canada so the quality of the health care system across the nation -- >> mr. president i ask the following fellows be granted

floor privileges for the duration of the consideration of h.r. 3590. the legislative vehicle for the patient protection and affordable care act 2009, sarah so great, stephanie temmins, caroline the achtenberg. >> without objection. >> the debate has now begun on well the bill we call our health care reform bills. it's taken a long time to get here. a lot of hearings, a lot of markups, a lot of public discussion and town meetings around the country, and now we are at the final pivotal moment. and historic moment in the long march to pass meaningful health care reform. when i say long marks because it started with theodore roosevelt and continued on through the new deal, continue on to harry

truman's administration and onto this time. every time we've been turned back by the status quo forces, those that just want to stick with what we've got. those who were afraid of making changes. well, this time they are not going to stop us. this time it is on stoppable. we have come this far and we are not going to come back. now, just listening to a little bit of the discussions on the republican side today and sort of listening to what the republicans have had to say about health care reform in the last few months and anticipating what we will hear from republicans in the next few weeks it will be a message of fear that somehow by changing the status quo the american people are going to be worse off

than they are now, that somehow we are going to take away something that they have. that somehow if we just stick with what we have everything will be fine. but you will hear a lot of words and messages from the republican side meant to frighten people, to put fear over what we are trying to do. well, mr. president, there really frightening thing for the american people, they're really frightening thing is if we do nothing. if we stick with the status quo. too many people in this country have no health insurance whatsoever. thousands every day in this country every single day thousands of people lose health care coverage. so many people who have pre-existing conditions cannot get coverage at all.

people who are beginning to retire but they are not quite 65, they can't get on medicare, they are left in a state of limbo they can't get health care coverage. so many people in this country are being discriminated against in health insurance because they are a woman or perhaps because they are older, perhaps a person with a disability. for a variety of reasons they are being discriminated against in health insurance coverage. and so we have to make these changes. we cannot continue to spend over $2 trillion a year and still be lacking in of the essential health care services for the people of this country. we spend twice as much in this country on health care as europe

get twice as many people sick with chronic illnesses. that doesn't seem to make sense. we have some of the highest medical devices and procedures and interventions anywhere in the world, and of course people who have a lot of money in other countries we always see kings and princes and wealthy people from other countries, they come here. they come here for the very high-tech, high-cost interventions. and we are very good at that. we are the best. but where we fall short is helping the very broad mass of american people. to have the peace of mind to know that if something happens to them, if they get ill they are not going to lose everything.

the single biggest cause of bankruptcy of the mill in my state of iowa and i think most of the country biggest single cause of bankruptcy is because of medical expenses because people bump up against lifetime caps or annual caps and can't make it and they declare bankruptcy. no other country in the world, and no other country of the world is this allowed to happen. so, it is incumbent upon us to get this bill through. at the beginning i want to salute the majority leader, harry reid. for what he has done. we had our bill that came out of the committee that i am not privileged to share after the untimely death of a our esteemed colleague and friend, senator ted kennedy. our help kennedy bill came through under the great leadership of senator chris dodd. we passed on july 15th. and then the finance committee under the able leadership of my

friend and classmate, senator max baucus of montana. they did their work and then the two bills had to be put together, and that was done by the majority leader. and he did a masterful job of putting the two bills together and getting it down to the congressional budget office and getting a score on what it would cost, what it would cover. and when we solve the bill combat that we now have in front of us, the so-called merged bill truly is a port of genius by the majority leader. i said the other day that he has the patience of job, the wisdom of solomon and the stamina of samson to get this job done. and i also salute of the senators, democrats and republicans, whose ideas or incorporated in this bill. it is a robust bill. it went to a long bipartisan process and in our committee we

had 13 days, 54 hours republicans were full-fledged participants. they offered 210 amendments, we accepted 161 many of them making substantive changes in the bill. a similar open and inclusive process was followed in the finance committee. and i dare say when we got our bill throop after all of that, the amendment offered and accepted or adopted that were offered by republicans, not one republican would vote for the bill. not one. it is unfortunate that now that we have put the bills together we have gone through this long process that has taken most of this year. it is unfortunate republicans have chosen a path of delay and filibuster and obstruction. why are we even hear today? we are here because the republicans are fighting to prevent us from even bringing the bill to the floor for

debate. how many people in america know that the reason we are here is because the republicans don't even want to bring the bill to the floor for debate and amendment. while, that's their right under the rules of the senate is their right. they can filibuster, deily, obstruct. they can say no. but just as surely as that is their right it is our responsibility as democrats to move this bill forward. i would remind my colleagues on the other side of the ogle that last year voters overwhelmingly voted for barack obama to lead changes, to make changes, and one of the changes he campaigned so hard for most changes in the health care system. and just as surely voters elected democrats to majorities, big majorities in the house and senate to do the same thing so it's our responsibility to lead. and that's what we are doing now

by bringing this bill to the floor. we are taking another giant step toward fulfilling the mandate, the mandate the people of this country gave to president obama and the democratic party last november to undertake a comprehensive reform of america's health care system. and as this not only the long debate has made clear to the american people but just in eight lead the american people know and understand that the current system is hugely dysfunctional. it's wasteful and abusive. people are aware of the abuse that have become standard practice in the health insurance industry. denied coverage because of pre-existing conditions. health insurance dropped because they get sick. other insurance premiums jacked up 100%, 200% simply because they had an illness. people know they can be charged

higher rates because they're women. we have the data. we men, men, age, same occupation, status, the woman is charged more than a man for the same policy. and they are charged more if they are older. we know about annual and lifetime caps. i just mentioned that cause people to go into bankruptcy. i think the bottom line is this, that every american family knows that in many cases they are one illness away from a financial catastrophe. it is if you want to talk about fear that is what people are afraid of common also much of getting sick. that's part of life. but the fact that illness will drive them into financial ruin they won't be able to have enough money to take care of their kids to send them to

college or take care of themselves in their old age to supplement their social security. because the money will be used for an illness. as i said earlier 62% of u.s. bankruptcy's are linked into medical bills and what is really the kicker is 80% of those were people who actually have health insurance. but they ran up against the lifetime cap, abuses and by the health insurance industry because they can do it and get by with it. think about it this way, health insurance companies employ armies of claims adjusters who routinely denied requests for medical tests and procedures. why do they do that? because they get bonuses by saying no to the policyholder. think about that the insurance

company says to the claims adjusters we will pay more the more people you denying. with a system. it's outrageous. it's intolerable and we can't afford to let it go on any longer and one of the things we do in this bill is crack down on these health insurance company abuses in a very strong and robust way. again, i deeply regret that our republican colleagues refuse to join in this reform effort. they have chosen to defend the status quo, protect the insurance companies and their profits over the health of the american people. indeed my friends on the republican side are joined at the hip, seen talking points, distortions, seem on truth about this bill, the same bogus cooked up studies, the same determination to obstruct and kill any health care reform

effort. as i said earlier this time they will not succeed. the more the american people learn about this bill and what's in this bill the more they like it and the more they are demanding that we get the job done. president obama pledged we would do health reform and not add to the deficit. we have done that with this bill to read the congressional budget office says this bill will actually reduce the deficit by $130 billion next year. and by 650 billion thereafter and sorry, in the next decade $650 billion reduce the deficit continually every decade thereafter. so all the budget concerns have been put to rest. now we can focus on what is in the bill. the congressional budget office says our bill will cover 94%, 94% would not be able to have

the peace of mind to know that they have health insurance coverage. our bills as if you have a health care plan that you like it that you want to keep nothing will disturb that, nothing. you can keep whatever plan you want if you like to read a lot of people say this bill doesn't -- the plan doesn't go into effect until 2014. well it does take time to get these exchanges and things set up there are some immediate things that will happen next year and the american people ought to know what that means. for example, our bill right now what dan lifetime and excessive annual limits on coverage. not 2014 or 2015, next year. think about that in your own policy. a door policy i guarantee has some kind of lifetime cap or annual cap. next year they will be able to do that any longer. how will bill bans rescissions.

what that means is right now so many people know that their health insurance policy can drop you. there is equals that says when you are up for renewal they can drop you for any reason and the reasons they use is if you get sick. think about that. i can't tell you how many people life's spoken to in my state of iowa that have said especially during the town meetings and stuff we had this summer people say i like my health insurance policy, i've got a good health insurance policy and i want to keep well it was fine, that's okay if you have it that's fine but i want to ask a couple questions. what is your lifetime or annual cap? most often people say well why don't know. i said well, do you have a lifetime or annual cap in your policy? well, they were not certain. i said do you have a precision

calls in your policy? and i can tell you 100% of the people i talked to said what does that mean? i said what it means as if you get sick and have to have a kidney transplant or get cancer or heart disease can your insurance company dropped you when your policy comes to with no explanation whatsoever? well, they didn't know. you've got to look at your policy and find out because most policies have the was rescission clauses. so i daresay madame president when a lot of people say they have a good health insurance policy the answer is yes they do have a good health insurance policy as long as they are healthy. as long as you are healthy once you get sick out the window it goes because you have a lifetime cap or annual and you have a recision calls. the of the thing i hear from a lot of families is you know my kids were covered when they were in school. they are now out of school. they haven't quite gotten the

job yet. and i can't keep them on my policy. it will cost a lot of money. to put them on a different policy. our bill says now you young people can stay on the family policy until age 26. this is a huge benefit to working families. now i have said many times the two biggest winners under the reform bill are small businesses and self-employed. small business, now we are in a deep recession. we want to get out of that recession we better start focusing on the businesses because the small businesses that greater for 65% of the jobs in this country get small businesses are thwarted in their effort to expand and grow and one of the biggest is trying to get cost of health care for their employers. so many businesses have dropped health care coverage because they simply can't afford it or

the premiums have gone up, the deductibles are huge and basically what it's gotten to be is basically catastrophic coverage for their employees. small businesses need help in order to grow and expand and get us out of this recession. this bill will provide immediately next year up to 35% tax credit for health insurance policies for their workers. that is a big deal. and it's not just small businesses, it's for farmers and self-employed, so many self-employed in this country. up to 35%. and we are going to have next year a new policy option for people do have pre-existing conditions. so if you have had an illness in the past, if you have been living with cancer and you've got it under control you have a

chronic illness we are going to provide next year in a policy option to put people like that into a high risk pool and provide they can get insurance coverage at prices they can afford. when the exchanges come on in three years all of that will go by the wayside. they will not discriminate because of pre-existing conditions the next year right away people who have pre-existing conditions can get policies that prices they can afford. how many times do i hear people tell me that, you know, here i am, i've been working hard, i've been a construction worker and stuff like that that's hard work. i'm 55, i have some accidents, i have a bum leg and my back is bad. i can't work until i am 65. what am i going to do about my health insurance? well, we have in here starting next year next year if you are an early retiree we have a

program to protect board coverage. at the same time reducing premiums both for you and you're in plenty to the time when you get to the age 65. this is a big deal for so many people in this country. last, madame president in what ever time i have left, how much time does the senator from iowa have left? >> 37 minutes and 15 seconds. >> i understand my friend from north dakota wishes to speak. i will wrap this up by saying there's one other part of this bill so important that doesn't get much play like considered to be one of the mo are important parts of this bill and that is a new emphasis on prevention and wellness. keeping people healthy in the

first place. there's a lot of talk about ending the cost curve and how we are going to get costs down. i submit not only the best way that perhaps the only way we are going to do this is by keeping people healthy in the first place putting emphasis on prevention. i've often said we don't have a health care system in america we have a sick care system if you get sick you get care. almost all of our expenditures beaufort interventions and patching and fixing and mending when somebody gets sick. very little goes for prevention. about 96, 97 cents of every dollar goes for taking care after you get sick only three to four goes to prevention. it's time to do more of that, time to do more for prevention and wellness, keeping people healthy in the first place. so in this bill we have a provision that says if you want

to go in for your annual checkup and physical and screening no copay or deductible. and for certain other screenings like colonoscopy is and breast cancer screenings and things like that no copay, no deductible. there is a lot more in the ensuing days and weeks when we debate this i will be talking more about the prevention and wellness of this bill. it's big. it's the first time we've ever done something like this to begin to move the paradigm in this country away from sick to health care. with this provision is to change america into a wellness society where it is easier to be healthy and harder to be on healthy. just the opposite of what it is today. it's hard to be healthy. we are going to change that around. and we are going to start with this bill. the most important parts of this

bill is the massive prevention and wellness. so, madam president, with that i note the presence on the floor and my colleague from north dakota -- [inaudible] i yield the floor at this time to my friend from north dakota. >> senator from north dakota is recognized. >> i thank the senator senator harkin and want to commend him for the outstanding work he did especially on the prevention provisions. and i don't think there's anyone in the senate that has been more dedicated to moving us from sickness system to a wellness' system than the senator from iowa and he really did outstanding work on the prevention and health committee bill many of which now are in the bill before us. and i want to applaud him for his leadership because in many

ways the laws are the most important provisions. if we can require people to lead healthy lifestyles and have an emphasis on wellness we can change the quality of millions of people's lives. so i personally think the provisions that senator harkin authors that are part of this legislation are in many ways the most important pieces of this bill. and what is interesting is they have received very little attention in the public debate pitting in fact many of the most important provisions of this bill have received very little attention in the public debate. hopefully over the next weeks that will change and people will learn what's really in this bill versus the rumors of what is in this bill. they are very different things and again i want to thank the senator from iowa for his leadership that made a difference to the quality of this bill. why are we here?

we are here because we face in health care in this country a completely on sustainable situation. medicare is going broke. premiums are rising three times as fast as wages. 46 million people have no health insurance. spending is twice as much per person in our country as almost any other country in the world, and the outcomes of our system for our people are not as good as they should be. so, is very clear the status quo is unacceptable, doing nothing is not an option. failure is not an option. it is critically important that we reform the health care system in this country. if we do not, our family budgets will be threatened.

our businesses will be threatened, and the government itself is threatened. that is the reality. so i want to praise leader reid for putting together a responsible package and a really very good first step. i also want to praise senator baucus for his leadership in the finance committee. he did an outstanding job. i have never seen in my 23 years in the committee chairman have as diligent and focused an effort senator baucus gave this in the senate finance committee over a two-year program. our group was six alone met 61 times and there were dozens and dozens of other hearings, meetings, forums, round tables. senator baucus organized a health care summit last year the

was a model of how congress ought to approach an issue, so i want to give high praise to senator baucus and senator dodd who was called in at the 11th-hour to replace senator kennedy because of senator kennedy's illness deserves enormous credit, enormous praise for picking up the ball at a critical juncture in the carrying it across the line in the health care committee as well. mr. president, senator reid had a very difficult task of bringing together of the finance committee bill and the health committee bill combining them into a vehicle for consideration here. when this bill is not perfect. no work of humans ever is. certainly more needs to be done to control costs. that's what i believe. and this is a very good beginning. this bill makes an important contribution to improving health care in this country and those

who labored for months and months and months to produce it deserve our thanks and praise. i am somewhat taken aback by speeches i have heard from colleagues over the last several days acting as though this vote tomorrow is the end of the story. anybody who understands senate procedure even a little bit knows this is the beginning of the story. this is the beginning of a debate, this is the beginning of a process to amend and improve the bill. this is the beginning of a discussion on the floor of the senate about legislation of reform the health care system. i don't know of a single credible reason to vote against going to consideration of legislation to reform the health care system in this country.

this isn't about the final result, this is about beginning of the discussion and debate. who would want to prevent a discussion and debate? who would want to prevent senators from being able to offer amendments to improve the legislation? if people are dissatisfied with the product at the end of the process that's when they can vote no. they can vote no against cloture, they can vote no against the package. there's lots of opportunities to oppose it if you are unhappy with the final result. but being on willing to even discuss the subjects strikes me as a preposterous position. now, let me say that this plan -- let's go to the first if we can, meets key health care reform benchmarks.

it is fully paid for and in fact according to the congressional budget office was not controlled by republicans or democrats. it is strictly nonpartisan. congressional budget office says this measure before us reduces the deficit by $130 billion over the first ten years. that's their judgment. in the second ten years they say this legislation will reduce the deficit by $650 billion. when people come out here and say this increases the deficit, this increases the debt i don't know what legislation they are talking about. it's not the legislation before us. they are of course free to make up whatever numbers they want to make up. but the officials evaluation of this legislation by the

nonpartisan cbo congressional budget office is that this bill reduces the deficit in both the short and the long term. it also expands coverage according to the congressional budget office to 94% of americans. it contains critical insurance market reforms and it contains perhaps even more important delivery reforms and we will get into those in just a minute. let's talk about the need for action. this show is what's happening to premiums for health insurance coverage in this country and premiums are projected to continue to rise on american families. in 1999 premiums averaged $6,050. 1999. in 2009 the increase by 117%.

and what the experts are telling us now from 20092019 they will go up another 71% to average premiums in this country in 2019 of $22,000 an american family. $22,000 for health care premiums in 2019. how many families will be able to afford premiums of $22,000? and at the same time, we see the employer based health care coverage in our country and the vast majority of people receive their coverage of their place of employment. but the employer based health care coverage in this country is in decline from 60% to 62% in 2008. in 2016% of companies were offering health care coverage. that's down to 62% and 2008.

at the same time, we know 46 million of our fellow citizens do not have health insurance. that is projected to increase by 2019 to 54 million that will not have health insurance in this country. it's interesting because every other industrialized country in the world has universal coverage. they have figured out a way to provide health insurance to every family in their countries. think about that, france, germany, great britain, japan, every other major industrialized country has figured out a way to provide health insurance for every one of their citizens. it is time for america to do the same. that is just moral issue. that is not just a financial issue. it is a moral issue.

what kind of country are we going to be? this is a letter that i received from a constituent in september and i wanted to share it with my colleagues. dear senator conrad, i'm 51-years-old, have never given much thought to writing a senator until now. three days ago we received some of the worst news a person can get. my husband has been diagnosed with bladder cancer. he does not have health insurance. we are self-employed. our income is low but we do owned some property which makes us ineligible for most assistance programs. a few years ago we both dropped out or blue cross blue shield coverage because the premiums were too high. i reapplied and got my insurance back but my husband was denied due to his weight. he quit smoking four years ago and put on weight gradually since then. we are stunned by the diagnosis

and are terrified the the uncertainties of his prognosis. we already $02,000 just for the emergency room costs and he has surgery scheduled for said kimber 22nd with at least an overnight stay in the hospital. the medical bills will be astronomical. if the cancer is not localized he will be referred to oncology and will begin for chemotherapy radiation treatments and possibly even more surgery. we will have to sell almost everything we owned to pay the bills. please, sir, consider our story when thinking about health care reform. any change will happen to slowly to help us but others will benefit. don't give up. we are counting on you to make a difference. welcome to that woman, i would make this pledge, i am not going to give up and i think a lot of my colleagues will not be giving

up. so that we can at least begin the the date as to whether there should be health care reform debate in this country. i want to repeat i can't think of a single credible reason why somebody would vote against the wing to begin the debate to have a chance to amend if you don't like the product as it's come to the floor that is what legislating is about the opportunity to amend, the opportunity to improve, the opportunity to convince colleagues we need to move in a different direction. i don't know what could be more clear than that we have to move in a different direction in this country on health care. we are now spending 17% of our gross domestic product on health care. that is one in every $6 in this economy. and the experts tell us by 2015 -- by 2015 we will be spending 30% of our gross domestic

product on health care if we stay on the current trend line. that would be more than one in every $3 on the health care in the economy. the would be disaster for the american economy. that would be disaster for the budgets of our family and businesses. that simply cannot be the result for the nation. and on medicare and medicaid spending we are in 1980 if you put the two together, medicare and medicaid they consumed 2% of our gross domestic product. one in every $50 in this economy was coming to medicare and medicaid. in 2010 we are up to almost 6% of gdp for medicare and medicaid, three times as much as a share of our economy. but look where we are headed. by 2015 and again on the current trend line we would be spending 12.7% of our gross domestic

product just on medicare and medicaid, six times as much as back in 1980. and if we look at the indebtedness of our country there is no bigger contributor than medicare. it is the 800-pound gorilla $47.8 trillion of unfunded liability in medicare. the comparable number for social security is $5.3 trillion. so you can see the unfunded liability in medicare is seven times the unfunded liability and social security. some say let's not even go to a debate, let's not even go to discussion on reforming health care. what is their proposal? are they afraid to offer one? do they not have one? is their answer to do nothing? is their answer really to do

nothing in the face of a crisis of this magnitude? their answer is let's not even debated or have a chance to amend it. that is not a credible position. it's not a responsible position, it's not a serious position. that is the position of obstruction pure and simple. and if we look at our system we have had a preview by dartmouth, the dartmouth medical school, and they concluded although many americans believe more medical care is better evidence indicates otherwise. evidence suggests states with higher medicare spending actually provide lower quality care. they went on to say we may be wasting perhaps 30% of u.s. health care spending on medical

care that does not appear to improve our health. as a country we are spending almost $2.5 trillion a year on health care. if 30% of that money is being wasted it is not contributing to better health, for 30% of $2.5 trillion is $750 billion a year. and the answer by some of our colleagues is let's not even debated, let's not even discussed, let's not even attempt to address it. that is really a remarkable position to take. if we look at our country versus others around the world we see we are spending far more as a share of our income than they are. if you look country by country, japan is spending 8% of gdp, the united kingdom, 8.4, belgium

10%, germany about ten, switzerland almost 11, france, 11, and we are at 16%. that is of 2007. we have gone up to 17% of gdp in 2009 on health care. we are spending as a share of the economy almost twice as much as any other major industrialized country in the world. and yet we still have 46 million people without any health insurance and under the british model they have universal coverage. under the so-called bismarck model, the countries of germany, france, japan, switzerland, belgium, have universal coverage and debt yet if we remember their costs we see even though they are providing universal coverage in these other countries, their costs are much lower than ours. and if we look further at the

quality of health care outcomes, quite an interesting story emerges because those countries have a universal care, lower-cost and if you look at quality outcomes, they do better than we do on an preventable death, which according to the commonwealth fund which is very distinguished, non-partisan, they looked at preventable deaths around the country. they found the united states came in 19th but other countries that have much lower costs and have universal coverage, for example france and japan are ranked one in two with much lower costs and universal coverage they are getting better results. and some don't even want to debate going to healthcare? i mean, they are going to have a

tall order to explain why they don't even want to discuss it. on infant mortality the united states ranked 22nd again according to the commonwealth fund. again, countries with universal coverage, much lower cost than we do ranked number one. france was number five, germany was number nine and from my earlier chart he will remember each of those countries has universal coverage, and much lower cost than we do and did they are getting on these metrics better outcomes than we are. and it doesn't stop there. here's life expectancy. the united states ranked 24th. this is according to the international keeper. and again, japan, switzerland, france, universal coverage much lower cost, still ranked much

higher than we did on that metric. japan, universal coverage, much lower cost than we do in fact have as much as ours. and again they were number one. switzerland, number two. universal coverage much lower cost than we do. and yet they ranked number two. france, universal coverage, much lower cost. they ranked sixth in the world. you know, it would seem to me we ought to look to evidence, and evidence shows there is a better way and that's what this legislation seeks to find. as seeks to find a better way to expand coverage to an improved quality and contain exploding costs and the key element of this health care reform plan are these, one of reduces both short and long-term deficits. i noticed in one of the newspapers circulated on the

hill today, full-page ad asking how can senator conrad, who is a deficit hawk before this bill? because i have read the cbo analysis, the congressional budget office analysis that says clearly and unequivocally this bill who lowers the deficit, it will were said by $130 billion over the first ten years. it lowers it by $650 billion over the second ten years according to the congressional budget office. so, when somebody asks how can a deficit hawk be like senator conrad for this bill it's because this bill where is the deficit. that is not my analysis. that is the officials analysis of the congressional budget office that is non-partisan. mr. president, this bill also expands coverage to 94% of the american people, and promotes choice and competition, reforms

the insurance market, and improves the quality-of-care. all of these are at the heart of what reform must be. mr. president, the senate health plan redos is short and long-term deficits, extends medicare solvency. medicare is going to go broke in eight years. this bill extends the life of medicare by four to five years, extends the solvency of medicare by four to five years. it includes reform to improve delivery of care, reduce cost. it curves overpayment to medicare advantage plans. some medicare advantage plans are costing 150% of traditional fee-for-service medicare. medicare advantage was started on the basis it would save money.

in fact it was initially capped at 97% of additional fee-for-service medicare. it was supposed to save money. now there are medicare and vantage plans that cost 150% of traditional fee-for-service medicare. not seeding money. it's costing much more money. and it will break medicare if we don't reformate. that is clear. .. reduce overutilization and to begin to control the exploding

costs. mr. president, when i say this bill reduces the deficit, that is not my assertion or the work of the senate budget committee. that is the judgment of the official scorekeeper here, the nonpartisan congressional budget office, and here is a wage from their report and it shows very clearly from 2010-2019, this legislation reduces the deficit by $130 billion. i've heard colleagues come to the floor and give all kinds of speeches about how this increases the deficit. they've got every right to come here and make up any numbers they want to make up. they want to make up. >> they can make any claim that they want. but let's be clear.

the official analysis of this bill, by the agency that we have all empowered to give us objective analysis, has concluded that this bill reduces the deficit by 130 billion over the first 10 years and six and a 50 billion over the second 10 years. this cbo on the senate health plan reducing long-term deficits "the cbo expects the bill, if enacted, will reduce federal budget deficits over the ensuing decade beyond 2019 relative to those projected under current talk with a total defect during that decade of a broad range with 10 1/4 of 1% gross domestic product. gdp over the second tenure

point* is forecast to be at $260 trillion. one-quarter of 1%, $260 trillion is $650 billion. cbo anticipates it will continue to reduce deficits relative to those under current law and a subsequent decades. in other words, , it would continue to reduce deficits beyond the first 20 years. mr. president, the excise tax that virtually every analyst has said needs to be part of a package of your to be serious about six straight days controlling the explosion of cost will target plans that have a value of more than $23,000 per year per of the average

premium is projected to be 15,000, $740. the cadillac plans have a value of more than $23,000 per year. very few people have plans of that value today and very few that will have values of 22 -- 2013. the health care plan also expands coverage according to the cbo, covers 94% of the american people by building on the existing employer based system recreates a state based exchange for small businesses and provide tax credits to help individuals and in individuals buy insurance. there are more than $400 billion of tax credits. somebody said this is a tax increase. they must have left out the

$400 billion of tax credits. they must not have gotten to that page broke it expands medicaid eligibility with assistance to the states so they can afford it. mr. president, the senate health plan promotes competition with a public option to compete with the private plan, but not based on medicare bubble of reimbursement. many of my colleagues know that i resisted a public option tied to the medicare levels of reimbursement because that would work a hardship in my state. in this plan, there is no try to medicare levels of reimbursement. states can opt out. it provides seed money for nonprofit cooperatives, a member run and member controlled cooperatives to

compete with private plans. mr. president, this chart shows the medicare reimbursement for 2006. you can see new york was getting near the $10,000, north dakota dakota, 6,000. that is the kind of disparity that exists in medicare reimbursement and more dramatic if you look at institutions and for many years i was showing a hospital in devil's lake, that would get one half as much to treat the exact same illness. that is based on formulas based on historic cost, that is why many of us believe that would be unfair to tie the public option to medicare levels of reimbursement. that disparity works in extreme hardship bob low

reimbursement states like mine. mr. president, the cooperative plan allows not-for-profit co-ops to provide affordable, accountable alternative to private insurance. to provide best value for consumer members and operate at the state, regional, national level. their self governed by members with an elected board cannot control by the federal government. subject to the same state federal rules and regulations as private plans and $6 billion of start up funding for the capitalization by the federal government and that would be the end of the federal government's role. mr. president, the senate plan also reforms the insurance market prepare prohibits insurers from denying coverage from pre-existing conditions and prohibits rescinding coverage when people become sick after they have paid

premiums for kuban's insurers from lifetime caps a and unreasonable annual limits on benefits and prevents the insurers from charging more based on the health status. mr. president, this plan also improves the quality of care and covers preventive services, provides incentives for healthy lifestyles, promotes adoption of best practices in comparative effectiveness research and includes delivery system reform to encourage quality over quantity of care. mr. president, when we look at the major reforms that are in this bill on the delivery system and compare them to the house, we see the senate has accountable care organizations and both have primary-care payment bonuses. both have a ignition reform, only the senate has hospital bellevue based

purchase is. both have comparative effectiveness research. have a innovation centers. only the senate has an independent and medicare advisory board and only the senate has a full platform for bundling pro the house just passed a pilot. mr. president, debunking the math, there's no government takeover of health care here. the cbo says 2% of the american people. that is hardly a takeover and their is no timing of the public option to medicare levels of reimbursement. there is no cut in the guaranteed benefits for seniors no coverage for illegal immigrants in node does panels and no expansion of federal funding for abortion services.

mr. president, to conclude, if we look at the senate democratic plan and the only republican plan and compare them, the senate plan has deliver reforms and there are none in the republican proposal. the senate democratic proposal reduces the number of uninsured by 31 million people. the republican plan makes no progress on that front. senate democratic plan reforms insurance industry banding pre-existing conditions and precision of coverage and health status reaching and lifetime benefit limits. the republican plan has no similar provision and the republican does not have a medicare reimbursement. >> your time has expired. >> i asked for 30 seconds

spec the democratic plan extends medicare solvency by four years the house republican plan has no extension of medicare solvency and finally, the senate democratic plan reduces the deficit according to the cbo by $130 billion, twice as much as the republican plan from the house provide thank the chair and my colleagues. >> thank you. mr. president, we will focus on the next hour on perhaps one of the most pernicious aspects of leader reid bill by cutting almost 500 billion out of medicare. there are a lot of seniors in the state of arizona and

my other republican colleagues. those seniors are scared of these cuts. not because of anything republicans have said to try to scare them, they simply have become aware of what is in the bills. by these bills, i am talking about the senate bill, offered by the majority leader and the house bill which are the two bills that would presumably try to be reconciled in conference. seniors have been told under both bills the benefits will be cut enough to scare them. >> a recent "usa today" says overwhelming americans, a 61% will pay for health care reform. yet despite the overwhelming opposition democratic

leaders in congress move ahead as i said half a trillion dollars from medicare to pay for a new health insurance program. they're simply not listening when americans have to say. if democratic leaders have their way hundreds of billions of dollars will be slashed from hospitals that treat seen years from medicare advantage programs. from nursing home care, home care, hospice care medicare already faces a severe challenge including $38 trillion of unfunded liabilities and insolvency by the year 2017. that is almost incomprehensible and in just a few short years $38 trillion of unfunded liabilities. obviously seniors want us to fix that problem rather than reading medicare to pay for a new program and they want

to do that. cutting medicare advantage is a very popular program. medicare advantages the opportunity we have given seniors to enroll in a private insurance company to help them receive medicare benefits. what the private insurance companies do, is to make a more attractive program by adding some additional benefits to the basic set of benefits that are promised under medicare. the seniors are telling us they are very important to them like a vision, hearing, i am getting a little older i can tell you both my vision and hearing is like starting to go like that benefit. dental, preventative and screenings, flu shots, home care for chronic illness illness, prescription drug

management tools, will this programs, durable medical equipment and by the way physical but this program is one of which has a great program called the silver sneakers program and they're very supportive because it keeps them physically fit to. i get phone calls from my constituents using prescription drug coverage with the overall decline and the quality bantustan will occur when the doctors payments are cut when they finally hit they know it will impact in their care and they don't like this interference from bureaucrats getting between them and their physician. but we just three portions of the constituents and i will yield to my colleagues break one constituent writes

dear senator kyl please fight the cuts to medicare advantage by on the social security disability and on a fixed income. medicare advantage insurance has literally been a lifesaver. i cannot afford to lose coverage that includes prescription drugs. i need your help on this. to beneficiaries a husband and wife right to me, we believe our health is our responsibility and we have a right to make the decisions regarding our health. we do not need permission from our government to take actions to preserve our health and we do not need a third party who has never met us are active in our decisions and we do not want to lose our medicare hmo, that is medicare advantage. then one constituent who incidentally is a world war ii veteran, wrote a very powerful letter how medicare advantage to improve his life and his wife "as a b-17

pilot i flew 50 combat missions out of england and earned five bair metals after flying on the coastal submarine patrol. when we move to arizona i visited a local v.a. hospital to find out i had a $50 coal pay for each visit and i never sought a position, just an assistant. in desperation i purchased a medicare supplement it is $600 per year i only received $8,303 per month the social security of fortune and arizona we were both able to sign up for an advantage plan with no monthly payment and simple 10 or $20. paper:that made it possible for us to purchase a home. with health care reform being considered, we understand the advantage plan will be reduced or eliminated. what happened to if i like my insurance i can keep it?

" end quote. it is a good question for my constituent broke and of course, he is right. when the promise was made if you like your insurance, you can keep it, unfortunately, that is not the way this legislation works. as a result a lot of benefits they are currently receiving for medicare advantage would be cut or eliminated. my constituents are right to be rid of their cuts and realize you cannot cut half a trillion dollars from medicare without adversely affecting health care. let me close. >> if the senate would yield. >> i would be happy. >> i think it is important to understand there are some differences between the bills to help build the finance committee and that has come out of the house of representatives but of each and every case the proposals

put forward to have half a trillion dollar cut in medicare and as the senator pointed out medicare advantage and to nursing homes and home health and hospice. and i appreciate the senator breeze some information and to the public about his constituents. in the previous hour, i heard a senator on the other side of the i will talk about scare tactics that republicans would be putting forward during the coming weeks of this debate you read letters from your constituents outlining why the people of arizona are legitimately fearful for the coverage they have enjoyed.

but i would tell my colleagues that the opposition to the medicare cuts have come and a bipartisan way and we heard a great deal about that from our friends of the other end of the building with the house of representatives was talking about this. the president of the blue dog democrats, a senior democrat who has worked to try to make this palatable to people in his constituency, one democrat from arkansas has this to say about these medicare cuts. "more than 400 borat billion-dollar of cuts to medicare it would force rural hospitals to close providing less access and care for our seniors. less than 12 days ago representitive ross said

this. his constituency is very much like mine in mississippi. i can assure the senators that a great number of our hospitals in mississippi and throughout the country are rural and no doubt in arizona as well. so there is a very real concern. the gentleman from arkansas flat says that it could force many of them to ] representitive from north carolina said from the day i announced my candidacy for this office, i promise to protect medicare. i gave my word i would not cut it and i intend to keep that promise. and the representitive from north carolina concluded in his judgment the only way he could keep that promise was to vote no on the legislation. representitive at from new

york said medicare advantage which serves approximately 40% of my seniors on medicare would be cut dramatically. this is not a republican scare tactic, this is a flat statement by an elected democrat from the state of new york and the northeastern part of the country, one of the larger states, but he said flatly that medicare advantage would be cut 40 percent of the seniors and he voted no on that basis. representitive skelton, the chairman of armed services committee said the proposed reductions to medicare reimbursement could further squeeze the budget's of rural health care providers. the chairman says i also oppose the creation of a new government run public option and continue to have serious concerns about its potential

unintended consequences. or people from misery you have the private insurance plans that they like. we know that this bill before us also has the government run option. finally, to quote representitive about your another senior democrat from virginia, says i did intend to oppose the bill because of my concerns that the insurance plan could place at risk the survival of our region hospitals. i am concerned and it determined to protect the rural health care that we have been the state of mississippi and in the districts represented by these comments. and the senator from arizona can conclude his part of the initial remarks and say that

the concerns are not only coming from republicans but from actuaries, people who have analyzed this bill and coming from democrats who have read the bill and understand its meaning and understand the cuts to medicare are real and hurtful. i yield back. >> senator from mississippi is exactly right for, not just members of the house or senate republicans, democrats come as senior citizens in arizona. here are either a third party sources. the senators from medicaid services, the outfit that runs medicare they confirmed the cuts will compromise the care seniors receive. "the washington post" newspaper. how about that? is summarizes a report in november 15 article entitled the bill would reduce senior

care. that is specific quote mackay plan to slash more than $500 million from future medicare spending. one of the proposed health care overhaul system would sharply reduce benefits for senior citizens and could jeopardize access to care for millions of others. " end quote. and "politico" which is a capitol hill newspaper reported by 2014 enrollment would drop 13.2 million down as seven days 4.7 million because of less generous packages. looking at my colleague start with medicare advantage what my constituents have written to me, the concern is that people now enrolled, 13.2 million will be reduced down at 4.7 million because the reductions of the benefits are simply no longer sufficient incentive for

them to enroll in the program. of course, that is what the perot government run health care folks want to happen. they're all for a public company competing with private insurance companies in the market, but when it comes to medicare, they don't want the private companies competing to provide medicare advantage, they allow them competing with the government program. under this bill they will get their way. we'll go down 4.7 million. that is a lot of senior citizens who will lose medicare advantage coverage. i will will confirm what the senator said. it is not just representatives from those who are sworn to help protect our constituents the third parties source as well. people in the government and in the media that this will

cut benefits and do it for senior citizens. we will talk later about the republican ideas instead of identify them but i will note republicans suggested a step-by-step approach for specific solutions to specific problems like medical what liability reform allowing americans to purchase across state lines, assn health plans, most ideas are cost free and do not add 1 penny. they would not cut medicare or diminish the quality of care but they have been rejected by the democratic colleagues. i hope my colleagues would agree that the place to start with this legislation is not to cut medicare. why would you cut medicare if the whole idea is to provide greater opportunity more for affordable health

care for american citizens? >> mr. president, i will focus on the next 10 minutes on the issue of cost brenneman the people have focused on important issues like the fact that this bill will finally eliminate the limitations on pre-existing conditions so if your kid gets sick, you don't have to lose health care and people can keep their kids on health care until 26 these are very important parts of the bill but the only thing that -- the other thing that is very important and from what i heard all over the last few months is that issue of cost and more affordable care. 2.$4 trillion per year health care spending represents is closed at 17% of the american economy and will exceed 20% by the year 2018 if the current trend continues.

hospitals and clinics provide the estimated $56 billion of uncompensated care. today peter orszag the budget director wrote an opinion piece in the "washington post" the highlights the fiscal accordance of tapping health care reform. one of the things is looking forward, if we do nothing to slow the skyrocketing cost of health care the federal government will eventually spend more on medicare and medicaid for all other programs combined and know it is time to move toward the high quality lower cost system of the future. as you know, , coming from wisconsin, we know how to delivery a sliver high-quality care. they do it in washington state and a number of states have figured out how do that and those are the models we will see all across the country. we need to make health care affordable for everyone and

reduce waste and fraud the -- fraud. and lawyer health-insurance premiums increase by 5% two times inflation in the annual premium averaged nearly $12,000. you only have to know three members, six, a 12, 24. 10 years ago the average family paid $6,000. now they pay 12,000. as an average. lot of small companies in minnesota pay a lot more than that but the average nationally is 12. if we do nothing to bend the cost curve the average family will pay on an annual basis, $24,000 for their health care 10 years from now while now a new study shows that small businesses pay 18 percent more to provide health insurance.

we're talking about a backpack company the guy who started a small company now 15 employees for his family of four he would make $24,000 for his family just to make sure they fl insurance if he knew it cost that much when he started he might not have started the company now they provide the great backpacks for our troops that are serving us. those would not even has existed if the new lows happening. those jobs would not have existed because he could not afford that. he could work at a big company really was an entrepreneur and we should reward that. the american people know inaction is not an option. if we do not act cost will continue to skyrocket and 14,000 americans will continue to lose health insurance every single day. we must keep what works and fix what is broken. let me tell you about some good news. it is encouraging the bill

by the senate will start considering a boat tomorrow night will reduce the federal deficit by $127 billion in 10 years and if you go out 20 years $650 billion reduction in the deficit. that is good news. we achieve the long term savings by making the health care system more efficient, rewarding quality, improving patient outcomes and reducing administrative voice but the most health care is purchased on a fee-for-service basis. more test means more money it is quantity over quality. according to researchers 700 billion per year is wasted on unnecessary or ineffective health care. 30% of the total health care spending. one study showed of the hospital's would follow the protocol, high a quality that the mayo clinic uses and people like to have that

health care we would save $50 billion of taxpayer money for chronically ill patients. 50 billion every five years? that is one example for one set of patience. that is what we do in minnesota we wanna the incentives and that is what we see on the reform package. also supported by senator cantwell was included in the senate bill. indexing will help reduce unnecessary procedures because those the reduced more about the volume will have the increased volume will negatively impact their feet. doctors will have a financial incentive to maximize quality and value instead of quantity. this is supported by the doctor.

it creates the incentive for doctors to work together. patience worked against a fragmented delivery system with x-rays and the back of their car seeing specialist, not having a wide and charger having a quarterback instead 22 wide receivers that is why we need integrated care reported in the bill. bundling of services. but you pay for results, the combination that give you a good results part of that is what bundling is about. and ed michelin cost 17 point* $4 billion and medicare paid an average of $7,200 per readmission pro who wants to go back into the hospital if you don't need to? but if you don't have the quality index and a

place, if you don't have that, you are rewording bad practices. we want to reward high quality with the patient in the driver's seat that is what we do with these provisions in this bill. it calls for reduced payment if you have preventable the addition. we work on the integrated health system r it with a patient overall care managed by a primary-care doctor with a specialist and nurses and health care providers for their role community critical access hospital utilizes the model to provide quality health care for residents and their communities. two better reward and encourage this collaboration recurs accretion of accountable care organizations. that is what i hear from people in my state. more accountability.

do you know, what else? mr. president it means better enforcement of medicare fraud. when dollars are so tight or people have so much trouble why do want to waste $60 billion per year on fraud? think of what that money could be spent for to make it easier for people to go to a hospital or pay their doctor bills 60 billion wasted? this bill and the amendments we are proposing in the next month will bring us much closer and to hold perpetrators accountable and increase penalties and making sure we have direct deposit a bill that we have so no one can make false checks and trying to get the money that way. am law-enforcement officers can go after medicare fraud we could save 60 billion per year. in today's "washington post" peter orszag writes and to

the home stretch we run the risk of not having health care reform and letting this opportunity pass us by. i would argue one of the most important things we can do, i know everybody focuses on who pays but we need to change the delivery system and reward a high quality, high efficient cares of the big companies can compete with companies and other countries that have more hire the efficient delivery system so small companies can exist and will supply and keep employees on health care so individual in this country are not cut off just because their child gets sick. that is what this reform is about. thank you very much i yield the floor. >> the senator from arizona? >> thank you. whole point* of health care reform is to bring down costs. and make health care more

affordable for american families. where democrat leaders producing a bill with provisions that will increase premiums? independent studies from the nonpartisan cbo and the joint committee on taxation and a study by the chief actuary at the department of health and human services confirm that the democrats' plan will drive up premiums and overall health care spending faster than in the absence of these so-called reforms. how is this so? five specific ways, that new insurance mandates have taxes on the insurance industry. that will force premiums to rise for many americans, particularly the young and healthy. according to an independent analysis insurance premiums in my home state of arizona could skyrocket by as much

as $2,619 for individuals and $7,426 for families. think of that, an increase of $7,426 for families. that is outrageous. what could $7,000 by a family? a lot. if a paper one year tuition at university of arizona or two years of utilities or two years of gasoline. families have a lot of expenses and important ways to spend $7,426.70 the government intruding saying the money has to go somewhere else. your friends will say they can provide subsidies and the legislation well if there is an increased cost but not every family will qualify and the subsidies might not cover the total increase of cost.

what is the point* of raising the cost of health insurance then subsidizing a portion of the increase? new still raise premiums it makes no sense to have families worse off than give a government subsidy to make up for part of the cost. a new mandated benefits will increase costs. under the reid bill there will have to cover a new range of medical benefits determined by washington regardless if they are needed by individual patience. they could help some patients but they cannot provide to everyone for free so it will be spread to everyone and that means increased premiums. in fact,, the council for affordable health insurance estimates the new mandated benefits would increase the cost of basic health coverage between 15 and 20%. that is the second way.

third way, under this bill, ensures are limited to offering a total of only four specific kinds of insurance plans. the low cost high deductible plans that many enjoy will be virtually eliminated because they'll have to buy more expensive plans. whatever happened to getting to keep you have just as one size does not fit all in this case for sizes does not fit well at either. >> the new taxes imposed nine groups like medical device makers according to the congressional budget office and joint committee it will increase premiums and increase everything from wheelchair's to diabetes testing supplies to pacemakers. and paid entirely by the

patient. of the cost according to the joint committee is 19 point* $3 billion over 10 years. that taxable oil cut off technologies such as ct scanners and the book they need and they will clearly stifle innovation as they realized it will be passed on to patients increasing health care cost. also will harm innovation taking a big bite out of the research and development that leads to advance men. the legislation increase the cost with the insurance to think eight that they can buy it themselves a but if you buy insurance, you get tax. as the independent joint committee on taxation told

us, this tax will increase the cost for everyone since ensures will pass the cost along to the patience. alone could raise some premiums by $487 per year and because it is indexed to regular inflation rather than health care inflation just as with the alternative minimum tax sick and soon start to hit middle income families. according to the former director half of all families making less than 100,000 could end up paying the tax. those are five specific ways in which this bill will increase your cost, the increase in premiums that you pay for health insurance wants the bill is in effect. we believe there are better ideas, republicans have proposed a variety of solutions to target problems and in particular cost per

car one to include the mentioning the republican health care alternative in the house of representatives. the majority voted it down but it would have lower premiums for individuals and premiums premiums. the democratic bill or in the reid bill which increases but the republicans decrease and you'll see others promote similar ideas. out according to the cbo under the republican plan it would be by thousand dollars lower than the cheapest will plan and small businesses would see premiums decrease by as much as 10% according to the cbo. that is the small group market that a 10% again according to the nonpartisan cbo.

it allows states to sell policies across state lines. that would have been able to have 1,000 companies to compete nationally that helps to drive down the cost. medical liability reform it is my state of arizona my states has seen premiums go down because of medical malpractice reform. health savings account which puts patients in charge of their own care to allow them to spend their dollars as they choose this would be strengthened by the house bill because you've heard republican senators talk about that. we will talk more about those ideas as to go forward. i want to conclude my remarks about the that reid bill and to make the point* the whole point* of the exercise to was to reduce health care premiums the last thing we should do is adopt a provision which will

increase health care premiums. let's keep in mind health care reform is all about making things better for americans. this bill does not meet that test by a long shot. >> mr. president frank. >> the senator from wyoming. >> 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 the engine that drives our economy is small business. we just heard this bill right here, the large bill that is the bill but the senate is considering right now over 2,000 pages, i hear the small businesses of a maine and wyoming will be penalized when they try to

hire another employee her 10.2 percent unemployment right now and the people and our states are well aware of the numbers. it seems to be neglected but maybe trying to hire people. i believe the health care bill makes a much tougher. certainly to provide insurance and make it tougher to give raises and it is unfortunate in my opinion we're looking at the senate floor that will raise the premiums for the american people who like their insurance and their biggest concern is the cost. would get a bill that will cut medicare for seniors who depend on medicare and looking at the bill, the numbers are huge, almost 500 billion and one that will raise taxes on american

people i heard the senator from maine talking about this and she can jump in if i am wrong but i heard her say it is not just a tax on the rich but none of people all across the board because the taxes will be passed on from medical devices and she is nodding her head in the affirmative when taxes are raised on medication or medical devices, those are costs that will get passed on to all consumers of health care and the country. and ready for this party took the floor we have the senior senator from minnesota talking about the mayo clinic and a wonderful care it has given them. it has. but they also said it elected a part of this bill. nothing to do with it to the point* they say doctors and my home state and those who surround the mayo clinic who refer patients, and i have

practiced medicine in 25 years we send patients to the mayo clinic basis stop sending them on medicare and medicaid because the government is the biggest deadbeat pay year and every time we get one of those patients, we have to charge the people that pay their own way and pay their own bills and have insurance, we have to change the show charge them more and we don't want any more of these patience. the hospitals and communities the senator from nevada, south dakota, hospitals have to take a patient so what happens to those that pay their own way? hospitals have to charge them more to make up for the biggest did the pair of all time, the federal government. what happens? i see the senator from

nevada taking his be i imagine the same thing and nevada so the premiums a boeing upon the 85% of the people that have insurance that they like but we in the senate tomorrow night will vote on a bill that the people of america said to like it. seniors do not like it the most because they're concerned. they note that those are going to be hundreds of billions in cuts in medicare and it could start a whole new program it will cost more or for those who don't have insurance make it harder or if they go to an emergency room, that bill will be higher because of what i believe it is irresponsible legislation. that will be a huge weight on our economy with 10.2%

unemployment but i see the senator from nevada has a similar copy next to him and he might want to chime in what he is seeing and what he is hearing from hospitals and providers. >> the pieces of legislation we put them on our desk to show the american people exactly what we're dealing with. we only have just totally doing through these films and already we found major problems with the legislation. what we will talk about over the next few minutes is the premium increases caused the american people. if you have insurance now coming your premiums will go up. >> probably because we don't know about yet because we will discover it in the future.

>> but we know what will talk about bill as some of the problems that i believer in the bill and then some alternative ideas the republicans have come up with in a step-by-step approach. we know this bill cuts medicare by $465 billion. we know that including 118 billion from medicare advantage passport of millions of seniors will lose the plan and at and i know they are across the country. >> reno taxes will go up by almost 500 billion and we know premiums will go up and as i stated we know the overall cost of health care in america, and this was to

be called the bend the cost curve that it helps the deficit and though the because of the smoke and mirrors. vase says -- say it does the cost curve but if we look at the people and their actual costs, there curve continues to grow up and up into the future purpose of this bill also lead to rationing. we saw this week the federal board that talks about mammograms and it caused an outrage women across america. that is the sort of thing that will happen because of this legislation. federal bureaucrats will be in charge of your health care, not your doctor or you. we need to have legislation that focuses on that dr. patient relationship and it should be so sacred in the health care system

today. republicans have come up with the idea to drive down the cost of the defensive medicine. reno doctors order kinds of unnecessary tests to prevent themselves from being said and frivolous lawsuits. we agree less eliminate pre-existing conditions. that is something we agree on. that is part of the step by step approach. this side would certainly be willing but we also need to encourage healthier behavior. 75% of all cost are because of people's behavioral choice. >> we know that contributes to every cancer or heart disease or diabetes and it is an epidemic in this country. if we don't

turnaround, getting them to exercise, rake, i don't care , we will not do anything in the driving down and the high cost of insurance or health care is the number one problem with the health care system in america. we believe we should have a small business health plans where they can join together to buy health insurance and take a vantage of the purchasing power of a large businesses and individuals should buy across state lines like car insurance prepared your state is too high, and then buy it in another state where it is cheaper parker does that make sense. >> but walk into the doctor's office you should be able to shop so we have more consumers making more intelligent choices on health care in the united

states. >> was last time you read your doctor and have a written estimate? if you walk into my practice you get a written estimate and have to sign a written estimate because 50 give that. that is part of the general practice we need to bring that to human medicine. we need to have transparencies for mac how does the bill drive up premiums? there are nine new taxes supported by the democratic majority. the insurance plan tax for the cadillac plans come another tax on insurance insurance, one employer tax, medical device tax tax, cosmetic surgery, and also increased it is the

structure of the medicare taxes. who pays for these kinds of taxes? on the failure to buy eight insurance? seventy-one% of that will be paid for people who make less than $120,000 per year. almost every one of the tax is that i put up of the nine new the vast majority are paid by people who president obama when he compete today's campaign to said they would not pay one dime more of new taxes. he repeated that time after time and said with a with the ball off but in this plan approximately 80 percent of all new taxes are paid by people making less than two 1/5 thousand per year. >> another way the massive

piece of legislation raises premiums is because it is known as cost shifting. he was talking about the clinic be cut as doctors to know what to take medicare patients anymore because the government pays 20 or 30% less than private health insurance when the reimbursement dr. asks that. >> that is absolutely the case. one of the so-called solutions is they will put more people, more people on medicare. >> how many more will go on medicare? >> it is millions of people with a cost to the state and you will nazi it in this bill because there will make the states pay over $20 billion because it is a

matching program. they get off the books of washington embedded is still the taxpayers of the state and that will drive up the cost for individuals as well. >> because we're in a practice of medicine and other gases and better from wyoming i have heard members as high as 15 million new people on medicaid plus we have a new public options so there will be more people on another government plan. as far as cost shifting those of us who have private insurance and the tents what will happen to their cost of insurance when more people are on government plans? 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@@@@@ bb insurance then they get paid for

people on medicare and medicaid and medicaid is worse than medicare in terms of the payment. so it is this cost shifting that occurs and coupes that? people with regular insurance. it's 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 because house south dakota is a state like my own where we have lots of small businesses who are going to be hit specifically barred as they try to continue to provide insurance this doesn't even allow small businesses to group together to get better deals. you talked about letting people -- the center of nevada talked about buying insurance across the lines to get the cost down this prevents that and also small-business groups to get together which will be great help and i know the senator himself to tell the -- some of the code is in the discussion and i invite him to this aspect and impact of all of these

increasing premiums on the folks of his state. >> wyoming is not a lot unlike south dakota as wyoming still knows they have a few larger businesses in nevada, the people that get hit hardest under this bill are all businesses. gunning of the impacts on small businesses. the ironic thing about that is that a lot of small businesses they would want to encourage to offer health insurance to their employees will be discouraged from doing so under this bill and in fact most of them are probably going to do is pay the $750 penalty and then push everybody off into the government plan and the assumption being made in here is the government plans it will grow over time obviously i think 5 million people will lose their private insurance according to the cbo. my guess is that number is going to be much higher because i think what is going to happen is the 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 and the other thing i want to point out and echoing what my colleague from wyoming and nevada have said is on would be some what 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 the mind of most americans is let's drive the cost curve down. i have heard my colleagues on either side get up and talk about their plan is going to decrease cost for people in this country. here's the cost curve. the blue represents the cost curve. that is what would happen if we do nothing. what is 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.

as we are going to spend $160 billion more on health care in this country than if enacting the bill this monstrosity of the bill right here which as my colleagues have pointed out this is 2,074 pages both senators from nevada and wyoming have the house version which was 2200 pages but look at this thing. you think somewhere in all of these volumes of paper there would be a way to do something to bend the cost curve down but all that represents more spending. and in fact if you look at the amount of spending in the bill when it is fully implemented is much more than what the cbo estimated would cost. there was all the publicity when we release, and field this plan a couple of days ago that it's going to be under a trillion dollars. in fact we know they've used a lot of accounting gimmicks, a lot of scoring tricks, a lot of ways to obscure the true cost of testing and in fact even the first ten years it understates the cost which is over a

trillion dollars but the ten year fully implemented cost of this bill is $2.5 trillion. two and a half trillion dollars 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 fees' we have all talked about half a trillion dollars in medicare cuts, ten years implemented and it's over a trillion dollars they have to cut medicare to pay for this and then to raise taxes by another trillion dollars so you're talking about not only cutting medicare to senior citizens as you have all talked about about raising taxes on small businesses, but at the end of the day after its all said and done what do you end up with? you and up with a increasing cost above and beyond what we would see if we did nothing. tell me how you can call that reform. one other point before i yield back to my colleagues if you are someone who already has

insurance, 182 million people in this country have insurance you are not going to be able to participate in exchange. you get no more options out of this. there are 19 million americans who would benefit from being part of an exchange but if you are one of the 182 million people in this country who currently have insurance you can't get into an exchange, you don't get subsidies. what you get our big fat tax increases and increases in 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 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 three to one great thing, you are going to raise premiums for a lot of people in this country and raise them the most for people who are 18 to 34. what the people who are 18 to 34 don't realize is what is coming at them today but about 69%

increase in their insurance premiums. they are the ones that get stuck the hardest but if you are any of these on hundred 82 million people your taxes are going to go up on insurance premiums are going to go left and you're not going to see any benefit from being able to participate in exurban change. so these are the cold hard facts. now, i have heard countless democratic colleagues come down and talk about bending 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 cbo cost estimate of what would do to the cost curve and as i said before the red represents the increase, under $60 billion increase in health care spending over ten years all of which is going to be borne by those 182 million americans in this cover you already have insurance. >> what soft coating field, i would like to get your comments may be 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 is actually going to bear the taxes because a lot of people think that, let's tax the insurance companies, let's just tax the medical device companies, let's tax somebody else this is what the congressional budget office -- let me read a couple of quotes. one quote is also the surcharges would be imposed on the firm's, workers in the firms will ultimately bear the burden of those fees. just as they would in a pay or play a requirement. many of those workers are more likely to have earnings at or near the minimum wage. it is the low-income people who are going to end up paying when you actually put those taxes we've talked about. another quote from the congressional budget office that as remindful of congressional budget office is non-partisan. it's not a republican, not democrats, the or the objective scorekeeper round here. another quote they say, these

taxes will increase costs for the affected firms which would be passed on to purchasers and will ultimately raise insurance premiums with corresponding amount. last quote is this, this is by the joint tax committee, generally we expect the entrance to pass along the cost of the excise tax to consumers by increasing the price of health coverage. this is when you're talking about on the other chart and i would like to hear the comments on that. >> you're absolutely right and i think what the cbo has pointed out is, and i've got the joint tax committee there, the data they produced on this and similar to what cbo said that 84% of the tax burden is going to fall on people making less than $200,000 a year. and half the families making under $100,000 a year are going to get hit with new taxes under this bill.

so it is going to fall, to call the week of all those people in the 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 afford that and 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 purpose of health care reform which should be to get health care costs down and not raise them and you have delude it to the senator from wyoming he alluded to a number of things we believe would do that that actually does put downward pressure on health care costs in this country. it's done in a step-by-step way. it's done in a way that doesn't throw out everything about the health care system in this country creating this massive

new expansion of the federal government here in washington, d.c., two and a half trillion dollars in cost over a tenure period when it is fully implemented. and probably who knows if a lot of these things don't happen the tax increases will occur, medicare cuts don't occur it means borrowing from future generations and the talk about reducing the deficit by what hundred $30 billion only because they didn't include physician fee six only because they had a $72 billion in revenue from something called the class at which we know is never going to become law and even if it does it is a huge money loser in the out years so you've got all of these things they did including delaying implementation by five years so it understates the true cost of this thing. all these things that 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, the 182

americans who already have health insurance who are going to get hit the hardest under this. >> maybe we could have the senator from wyoming comment. one of the big things republicans have been talking about about driving premiums of which this bill does, driving premiums down could be discuss for instance medical liability reform which the congressional budget office, which is a very conservative estimate has said that it would save about $100 billion in medical costs in this country as a practicing physician talk about the on a separate tests ordered, the huge increases in medical liability insurance costs the physicians face today. >> you do a poll of doctors and so have you ever ordered a test? ever ordered a test that was really not one to help that person get better, that patient get better but you were doing it because you didn't want to miss something for fear of a malpractice suit every hand will go out of every physician. the massachusetts medical society did 87% of doctors said that massachusetts has the

health care plan and as an aside, the dean of harvard medical school have an editorial in one of the major national publications this week and he gave this whole thing. he said i give this a failing grade. he said people that support this, though legislation that's being proposed are engaged in collective denial. we need to do some things that will help with cost, access, quality all of this is going to drive up the cost with no improvement at all in quality so there are step-by-step and things by insurance across state lines getting the same tax breaks as others exercising, getting down the cost of their care by getting their cholesterol down. but also you have to deal with lawsuit abuse. you could do that and just as easy as the loser pays. obviously great objections to try to do that. there are people that would oppose that all the way. but it would help eliminate a lot of the unnecessary tests,

and certainly a lot of the costs of the system because two-thirds of the cost of the whole liability system go to the system, doesn't even go to the injured person. if somebody is injured you want to take care of them. but this doesn't do without all. and one of the things the senator from south dakota mentioned fairly quickly in passing was age, the band, reading, which flies in the face of the things we've been talking about about individual responsible the opportunity for people to stay healthy, the big problem is when a 50% of all the money we spend on health care in this country is 5% of the people. the people that he's too much, exercise too little and smoke. but yet under this government forced insurance where people will be forced to buy insurance and if young people don't buy yet they are going to be listening either tax cheats or criminals because they will define and taxed for not buying the insurance. they will have to buy insurance. and as the senator from south dakota talked about 3-1 ratio

and the senator from me and mentioned the same thing what that means is for the youngest, healthiest personally buying insurance ticket out of college, stay healthy and work in construction, good shape, going to the gym, what they are doing on a three to one 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 the insurance premiums this person can pay no less than one-third what this person did. when realistically you might have 100 young people their total health care bill is for your equal to that one person that exercise is too little and 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 and say their premiums are going to go, did i hear 69%? >> 69%. if you're 18 to 34 that is when you are looking at in the form

of a premium increase. not to mention the fact future generations are going to deal with all of the debt that we continue to pile on them which i think bears heavily on this debate right now. when you were looking a trillion dollar deficit as far as the eye can see. this isn't a good deal if you are a person in america. >> it's the wrong prescription for america, mr. president. >> i'm going to continue to speak on the for mr. president about the things i think our problems with this bill. it is the wrong approach. i think it costs we to much. i think it raises taxes on all americans. it cuts medicare and what we have heard now and we know for sure is it is going to raise premiums for people who have insurance who like the insurance they have who want to keep the insurance 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 craft faster than if nothing was passed. >> time is expired. i have listened to several of my republican colleagues and i want to note that they have the bill in front of them and they are attacking this health care bill, but nowhere on their desk do we see their bill. they have no answers. no solutions and face -- >> would the senator from california yield? >> i can't deal. they have no solutions, at all, on an issue that affects every single american, and what we have before us in this bill negative and -- 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 the change isn't easy. it's easy to come down here and demagogue and count your fist and complain. it's human nature to resist change. but every once in awhile, mr. president, a situation cries out for change. and that is the case today with our health care system. the status quo is not benign. it is hurting our people. and i would like to share the story of mickey white house brought to us by the book, "the healing of america," by t.r. reid. he talks about her in the prologue where he poses as a moral question. what we do about health care. and this is what he writes. if mickey white had been a resident of any other rich country she would be alive

today. around the time she eckert read from college, she 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, etc. the health care systems would have given her the standard treatment for lupus and she could have lived a normal life span, but nicky white 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 to little

money to pay for the drugs and doctors she needed to stay alive. she spent the last months of her life frantically writing letters filling out forms, mr. president, pleading for help. when she died, nicky white was 32-years-old. that is the story that should move everyone of us, but everyone of us to action. we have spent years studying and analyzing what is 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 the broken promises of a health insurance system that abandoned them when they need the most. too many cannot afford health insurance. to many are getting sick after praying to god that they wouldn't because they knew that sickness could leave them an

economic room -- reubin. mr. president, braking is not a health care insurance plan. americans will spend over $2.5 trillion on health care next year. $2.5 trillion in 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 spent twice as much and the results are not anywhere near where they should be. it's clear why. to many people don't have affordable health insurance and they wait too long before they

get the help they need. or they are like speed and they never get the help they need. health care premiums have more than doubled the past nine years, more than doubled the last nine years and one respected 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 is by 2016. 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 downgrade what we are doing and never addressed that issue. it's time for change. when we know two-thirds of all bankruptcy's are due to a crisis it's time for change.

when we know that every day, every day another 14,000 americans lose their health care coverage, that tells me it's time for change. i know there are many people listening who think the uninsured, that that's not their problem that it doesn't get health -- effect health care they are wrong. every one of us with health insurance is being $1,100 a year, each of our families for those who are uninsured. why? because we have to pay for emergency room services they get when they are rushed into the hospital because they've neglected a health care problem and it's very expensive and we are paying for it. that tells me it's time for change. wind family after family tells us they paid for insurance for

years but when they have a crisis their insurance companies walked away from them. in t.r. reid's book we learn 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 insurance company new it was going to cost them a lot. you know what they did? the reason that his insurance. they told him that years earlier she didn't tell him 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 change. and today, 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 of these things i have said are truths and everybody here has to be moved by that and i believe we will finally bring change. i'm hopeful. i am hopeful because of the work of so many of our colleagues and the work of senator harry reid he is the the bill before us that lsi 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 gives you the security of knowing it will be there for you. when you needed. and if you don't have health insurance you will be able to get affordable coverage through a new exchange which includes the public option. i 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 revenues in this bill to offset the new important programs. when this bill signed into law, mr. president, america's families will see immediate improvements to their health care. they will not 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 me that reason because they no longer want to cover you. and they will no longer be able to tap your coverage. i can't tell you how many people think they are safe because they had a $500,000 cap on their insurance. they never dreamed they would use it up.

but one difficult and a terrible illness can use it up and then they are out of luck. no more precision's common no more caps. parents will be able to keep their children on their health care policy of 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 on to 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's a sample of of the major

provisions. this is a very important one, mr. president. in this bill no family of four making less than 88,000, $200 a year will have to pay more than 9.8% 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 say the poverty rate all the way up to $88,200 you never have to pay more than 9.8%. for health care premiums and if you are on the lower end, it is even less. it goes down to about 2.2%. so it ranges from 2% to 9.8% at

88,000. that means more than 62% of all of our families will be able to be ensured they will not have to go broke to buy health insurance and remember what i said a respected study has already stated if we do nothing by 2016 people will be paying 45% of their income on premiums. and this bill we ensure our middle class down to our working poor do not have to worry about those kind of premium increases. now for the rest of the nation's families that are more affluent there is the security of knowing that the insurance company reforms in this bill are going to help you in the insurance company can't walk away from you if you have a pre-existing condition they can't turn you down if you have a child he want to keep on until age 26 you can.

if you are a small business he will get tax credits to help pay for your employees. there are many other benefits including some for the prevention coverage that kicks in right away. so, no more discrimination against those with a pre-existing 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 is a gender discrimination. that will end when this bill becomes law. in this bill we increase competition which is perhaps one of the most important things we can do to bring down the cost to our families. we have the health care exchange which includes a public auction that will compete on a level playing field with insurance companies to keep them honest. in other words, there will be a

government auction, but there won't be anything different about the government plan in terms of the way it negotiates with the insurance companies. now there has been a lot of shouting with my colleagues of the public option. why shouldn't the american people have access to republika option? i ask that question. i don't hear my republican friends coming down to the floor saying they are 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 benefit program. i don't see one of my republican colleagues trashing the public option, coming down to the floor and saying i want to get rid of mine. no, they like it. but they don't want it for the rest of the people.

i do not understand it. to me i just don't understand. let's leave it at that. there are lots of public options we have to leave medicare is a public auction. run by the government i don't hear my republican friends coming down here singing which it and medicare. they used to say that. they don't sing anymore. now they say the defendant. it is a public auction. 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 auction called medicaid. how about the veterans' health care program? i don't hear one of them coming down pounding the table saying get rid of the public option for the veterans. i will tell you maybe they want to but they won't say it because the veterans would be at their door because that public auction covers 7.9 million veterans. not one of my republican colleagues says they want to end it. i don't hear my republican friends have coming down to the floor to say we should end our tricare program for the military. that is a public auction. for 9.5 million people. i don't hear them. say stop at public auction. and again, their own health care that they have brought to them

by fehcp. they don't seem to want to ended when it comes to everybody else, they come down here and basically say the government takeover of health care. false. the public office and is one option in the exchange and has to run by the rules of all the other insurance companies. and i say if it is good enough for a republican member of the senate a democratic member of the senate, 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 ever ready is aware of this that small businesses pay as much as 18% more for the same health insurance as large businesses.

and in california, we have seen increased premiums to small businesses that meant the choice between leading off employees or not providing health insurance at all. more and more of these businesses are dropping health care coverage. if you are in a position you work for a small business and you are loyal to them and want to stay there when this bill goes into effect you can go into the exchange. then you will have 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. because before medicare became law half of our senior citizens went without health insurance. now 90% of seniors are covered by medicare. if they believe in the program and they want to continue and those of us supporting this bill

want to make medicare stronger and we do. this bill, patient protection affordable care act will ensure a stronger more sustainable medicare program. at a worse 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. mauney republican colleagues are standing here saying democrats want to hurt medicare. by the way, a public auction medicare say the democrats want to hurt medicare, a public option. obviously, who can believe that? in 1964 george h. w. bush called medicare socialized medicine. new gingrich when he was the speaker of the house said he wanted to see medicare, quote,

whether on the fine, and of quote. in 1995 when seeking republican nomination for president senator bob dole brad he voted against creating medicare in 1965. he bragged about it. he said i was their fighting the fight, voting against medicare. because we knew it wouldn't work in 1965. so the republicans are saying that the democrats wanted 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. we didn't just wake up this morning. we know who brought us medicare. this bill expands medicaid. that's the ticket for the poor to ensure the poorest and sickest can get into the program

and we are going to get into the program those with incomes below 133% of the poverty level. that means more than 1.5 million of my californians who are now uninsured or struggling with the cost of health care that will allow them to be covered. i want to thank the majority leader for working with us to ensure california receives increased federal support as we expand medicaid. for the first three years of this expansion the federal government will cover the cost of expanding medicaid. now i talked a little bit about prevention. today only 4 cents of every dollar was spent on health care spent on prevention, yet more than half of our people live with one or more chronic condition. five chronic diseases. heart disease, cancer, stroke, chronic obstructive pulmonary disease and diabetes are responsible for more than two-thirds of the death in

america. this bill will eliminate co-payments and deductibles for preventive care so people don't get to that serious illness. and those preventive services going into effect immediately. so that is 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 is too long, it is too complex. they said one of them six wholley war. this bill for some reason caused them to fight a wholley war. again where is the bill? they don't have one. after all of the things we know are wrong with the system you don't have to agree with us on everything but where is 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 dan bringing down the cost of health care. they care more about all of that than to him and josie of los angeles california. tim is retired from raytheon and he gets his health care through his retirement plan. during those seven the first year of his retirement the monthly health care premium was $460. during the wait it rose to $640. 09 come $850. that is an 85% increase in two years for this retiree. mr. president, tim wrote to me and said i understand that compared to many we are fortunate to have good health care and insurance but we look forward to you, senator boxer, the senate and house addressing the seemingly unfounded increase in health care costs. and mr. president, we do with in this bill. people like tim will be

protected but my friends across the also know we are not going to help him. what about madeline foot of costa massa california? she turned 25, 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 pre-existing condition. they said you can have health care what 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 am forced to hope nothing extremely bad beatles me. so she is another one who is bringing him not to get sick. that is not a health care plan. but my friends on the other side of the all say no, sorry we are not going to help you,

madeleine. and i have so many other stories. douglas, 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 auction, and i do. and my republican colleagues are saying no, we are not going to help you. and it goes on, the stories go on and i will put them all in the record. one of these stories is from a doctor, a retired pediatrician in sacramento california, dr. robert who wrote to me and said parents begged him not to write on the forum after he saw a child with asthma, please don't write down asthma, police say it was bronchitis, please because if you write down that my child has asthma they will have a pre-existing 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? might republican friends don't seem to want to think about that. they just seem to be thinking about politics and the next election and we all know the bill before us is in perfect. they should vote to start the debate. they can try to make a better. there are many issues i'm working on for california that disproportionate share hospital program i'm working to get even better prevention for when in 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 elusive goal since teddy roosevelt's first proposed it nearly a century ago. our dear friends, ted kennedy, senator ted kennedy who we miss so much fought for health care right here on this senate floor from the moment he our live 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 invent history itself but each of us can work to change a small portion of defense and in the total of all of these acts will be rich in the history of this generation. mr. president, this is our time, this is our moment. this is the moment for us to come together as a nation and make sure our people never again have to face what nicky plight faced in her last days, filling out forms, praying to god she could get health care and not being able to get it and don young at age 32. that is immoral. it isn't necessary. and we can fix it and we should.

nicoe three you very much and yield the floor. mr. president? >> the senator from maine. >> mr. president, as i rise this evening after months of effort and countless hours of meetings, discussions, marked in the senate finance committee to craft a health care reform bill i had hoped to come to the floor today to talk strictly about the substance and policy, one of the most complex and intricate undertakings but congress has ever confronted. instead we are confronted with procedural gyrations. there is baffling to those looking outside the beltway as they are unfortunate for those who would prefer to of broad agreement on the critical elements of health care reform. mr. president, as one who has worked constructively to forge solutions to this endemic

problem plaguing the health care system, i think is absolutely imperative to ensure affordable health insurance coverage to people of this country. but it must be done so in an effective and common sense and bipartisan way. in a matter is what is in those 2,000 pages. that is why i find it deeply disconcerting that the senate in its debate has resorted to this convoluted process before us and which we first vote to proceed to an empty shell which is then replaced with actual health reform legislation. a result of the behind-the-scenes integration of the two bills. passed by both senate finance committee as well as a health education labor and pension committee. mr. president, the reality is beginning of deliberations in the senate, with tactics rather than transparency does nothing to enhance credibility with american public. at a time so many are already understandably leery at the

speed and direction of congress on this transformational issue. as i have mentioned on numerous occasions it took a year and have to pass medicare to cover 20 million seniors. so we simply cannot address health care on the legislative fast-track. and i am truly disappointed we are commencing this historic debate on one of the most significant pressing domestic issues of our time with a process that has drawn a political line in the sand and forestalled our ability to arrive at a broad consensus on some of the most crucial elements of health care reform. again, mr. president, i a right that this will it as one who has been fully immersed in this issue with the senate finance committee process to solve the so-called eckert of six with a committee where we were engaged in deliberations for almost four months intensively on a weekly basis recognizing the state in america and also recognizing the looming protectory of stable costs and health care systems that is a critical problem that

must be solved. 10 million more americans have lost insurance as a last attempt health care reform in 1993. today 75 million are burdened by inadequate and not existing coverage. over the last decade insurance premiums have alone risen by 131% if you look at this chart, 131% contrasting out with broken wages of 30% and inflation 28%. that's what has happened over this last decade alone when it comes to health insurance cost. in my home state of maine from 2001 to 2009 we have been hammered with this stunning 271% increase in average health insurance premiums our small insurance market. it's been estimated by the business roundtable we can expect premiums to grow 166% by 2019 absent in the reform. so given the current trend, health care costs will continue to grow and more than double the rate of inflation further

dredging up premiums, spending the entirety of the health insurance system into a death spiral. health care spending could total 33 trillion the next decade. average cost of inflation based family plan will reach 40,000 from $800 just a decade from now should be failed to act. so even as everyone has differing opinions on how to address this issue virtually every 1i have encountered agrees the system is broken. and in a recent poll that asks how much is also health care system be changed an astounding 84% answered a great deal or moderate amount to 84%. the national small business association reports 62% of all small business owners want congress to enact some kind of reforms and as a small business have experienced annual premium increases of at least 20% year after year after year. and the reality that this is not simply a solution in search of a problem is what really brought

us together in the senate finance committee and so-called grove 6i commend chairman bachus and senator grassley as well and chairman bachus wanted to convene on a bipartisan basis early this year. it was the only bipartisan effort in the committee of the house and senate we met debating policy, not politics and attempting to reach a bipartisan consensus and reform legislation they reflected the extensive process that an issue of this magnitude requires because the american people understand intuitively we need to debate the future of one-sixth of our economy in a matter of personal and financial significance to every american we should be real routing solutions along partisan lines. and to that point in the cautionary note for all of us, a recent gallup poll concluded neither party can boast that a majority of americans are currently behind them on this issue. without question people are already apprehensive about, chris's ability to reform the

system and the dow also finding 66% of americans believe their member of congress doesn't have a good understanding of the issues involved in the current debate. mr. president if there is one thing i've learned from my more than 30 years of legislative experience is that the only way to relieve people's fears and systematically working for the concerns issues and alternatives. in fact there was an adherence to those very temmins that led up to the finance committee markup that was reported on the committee and i support it because wild fire from perfect to produce watershed bipartisan market reforms navigated the ideologies on both ends of the political spectrum by bolstering what works in the current system building upon the basis system and fostering choice is competition and coverage and change accelerating the cost curve of the spending at the same time there was but one albeit significant step in the process as i said in my remarks at the conclusion of the market it would be imperative moving

forward in a course of action giving difference to the scope and complexity of the issue and there should be an inclination by the majority durham broad support. the bottom line is policies that will affect more than 300 million people simply should not be decided by partisan one vote margin strategies. thinking back over the last century just consider for a moment social security civil rights for medicare could have been strongly woven into the fabric of the nation by the one vote in on purely partisan lines. you can observe from this chart these votes occurred during a time when democrats controlled both converse and the white house, so security passed the senate with 64% of republican support. 79% in the house from civil rights 82% in the senate and house 80%. medicare when it passed a 1965

the senate republicans, 41% house 50%. so those were significant bipartisan support because it engendered a process that yielded by partisanship and the consensus based approach, mr. president. those are not only impressive numbers illustrating the strong bipartisan support bill landmark has in the past but they would be nothing short of mythological in today's political environment. because in a time when we are supposed to be in a world of post partisan politics here we are facing along partisan lines. and when it comes to the subject at hand the most consequential health care legislation in the history of the country and we ordering 33 trillion in health care spending in the coming decade surely we can and must do better. in a recent column, david captured perfectly the path we should be following. she wrote scholars will make the point when complex legislation

is being shaped the substance is likely to be improved when both sides of the all contribute ideas. and i couldn't agree more. so, when it comes to procedural gymnastics designed to foster a purely partisan bill as quickly as possible, on an issue as monumental as health care that only serves to enhance public cynicism at a time when congressional approval ratings already hover in the 20 percentile range and after a vote on the house reform bill that occurred after a grand total of two amendments in 12 hours and 32 minutes of debate on almost 32 pages of the document. consider that it's been more than months as the finance committee completed its work on legislation even as it concluded that we remain to be done. a month in which progress might have been made toward building greater consensus on some of the most critical and contentious matters in this debate. but that opportunity was regrettably forsaken and mr. president i cannot support

moving to a health care bill to prevail not on policy grounds but on privacy because the result is this procedural vote presents a serious obstacle. if you have substantial concerns about the legislation as a process going forward will likely require a threshold of 60 votes to add, change or remove any major provision and putting it public option plan not included in the final finance committee legislation. mr. president i think we all appreciate the impetus for the public auction and that is a fundamental mistrust of the insurance industry and that is a sentiment i strongly share as many have been victimized by their a egregious practices in denying coverage based on pre-existing conditions, rescinding coverage because someone actually has its in parody to get sick or discriminating based solely on one's gender. in my home state that mistrust can be more profound. where two companies are controlled 18% of the market has

resulted not only in the inconceivable increases in premiums i described earlier but was forced thousands to purchase plans where the remarkable 15,000 were deductible for an individual and $30,000 for a family. and as i was told by one of our insurance companies and one of the two in may and that dominates the market it has become one of the most popular plans by virtue of its affordability. by virtue of the fact all people can afford in this state of maine and certainly among small-business owners. that is unconscionable and unacceptable when we think of the basic coverage being $15,000 for an individual and $30,000 for a family. that is not what you would describe as reasonable coverage. in response to that i work to implement principles which many of us have been adamant, and think flagrantly unfair practices so that no american can be denied coverage.

no policy can be rescinded when illness strikes. no plan can be priced based on health status agenda. to address the competition in the market, we created health insurance exchanges to become a powerful marketplace for creating competition and lowering premiums by bringing in a potentially 40 million new customers which the cbo believes could reduce costs of to 10%. that is not even talking about tax credits and subsidies. so clearly the exchanges will have a significant effect on lowering prices through administrative changes and competition. i would argue we have taken these groundbreaking steps to alter the competitive landscape. and i strongly believe that inserting a government sponsored plan in today's dysfunctional marketplace, before reforms can work to improve the market, could actually inhibit the entry of new competitors, and could undermine achieving the highly competitive environment we must have to make industry deliver

lower cost coverage. and just when we want to provide americans a wide variety of competitive plans, inserting a public auction into smaller states such as my own actually encourage new plans to introduce market? or will we see just a pair of plants existing and the government, and is that limited option really dutch police americans want? and when we also consider the difficulties we have experienced in improving care and ensuring prompt, fair, and accurate payments in medicare and medicaid we certainly must ask whether a public plan would spur the innovation that is so vital in the health care coverage. but we also cannot leave the performance of insurance companies and the success of reform to chance. i have proposed there is a role for the federal safety net plan if affordable choices that are specifically defined are not offered in a given state. moreover, under my provision

companies would submit their pricing a year prior to the open enrollment period. and if it is determined that affordable plans are not available in states they would have 30 days to resubmit their bid. at that point if affordable plans still are not offered a federal fullback is provided without delay. this will provide the certainty that affordable options exist so that no one falls through the cracks while cbo also reports the threat of a fallback in the state would also force industry to lower premiums. in contrast, the bill we will consider on the floor not only incorporates the public option, but also a state of the provision that will allow any state at any time to drop that public plan for any reason whatsoever your respective whether the residents in the state actually have access to affordable plans. so if affordability is the goal and it certainly is and will someone explain to xc