when a state can decide in the political whim that will allow a public plan and leave its residents without affordable choices? mr. president, it simply makes no sense. rather, we ought to take the safety net approach at the forefront as we did on medicare part b which spurred competition and as the result, it never was triggered. and to ensure affordability not just in some states but all 50 states. i happen to believe a person's is a code should never dictate their ability to access to there are proketies to what we are doing -- there are practicalties to what we are doing and this legislation misses the mark in addressing the needs of mainstream america. just yesterday the ffib release add statement opposing the bill, the national federation of independent businesses saying that enactment of it would make health care for small businesses more expensive than what they can afford today. a disaster for small business is

how nfib describes it. now, that's coming from a group that supported the senate finance legislation and has been a constructive voice throughout the debate, so that ought to grab our attention. furthermore, in the finance committee, i insisted that c.b.o. provide an affordability analysis of what a silver plan would like like, for example. and i used that analysis to do my own modeling on all of the plans. it helped me to assess premium affordability and render an informed evaluation about the approach overall. for the measurable force now, the c.b.o. has yet to address the question of a affordability. so how do we go inured this legislation considering when we don't even understand some of the most fundamental aspects of this legislation? none of us can tell with adequate specificity at this point what an average plan will look like, which is what americans are going to be asking

us. what are the premiums? what are the deductibles? what are the co-pays? what are the coinsurance requirements? these are questions that americans rightfully will ask and are asking. what will reform mean to them? what will it look like? what will they pay for? those are answers to the questions we do not have, mr. president, because we haven't had a chance to evaluate this legislation, and we're going to have a vote tomorrow night to move along party lines, to ram it, to jam it, and that's what i'm hearing from my constituents. they're saying, do you really know what's in knows 2,000 pages? asking the right questions with great validity. they feel that their lives are out of control because they see washington. they think washington is out of control, because we don't have a profound understanding of what we're doing. that's why it took so long in the finance committee for four months t wasn't enough to be immersed in intensive discussions and deliberations. and there were artificial deadlines that were set time and time again, from march to angers

to may, to june, to july, august, september, october. it's gone on -- christmas now is the deadline. state of the union is a deadline. why not just try to get it right? and i've heard time and again people say, we just got to do something. well, what i'm hearing from my constituents and many earns is it's not -- and many americans, it's not just doing ssmght it's doth right thingment every line in this 2,000-page document matters because it is going to have profound ramifications and implications. there are unintended consequences. it is not just about cobbling something together in the dark of night. it's about making sure those mechanics work. and what it's going to do and what it's going to cost to the average consumer. what it's going to do to small businesses. what it's going to do in its time of, you know, the perilous economic climate. we must ensure that affordable coverage options are available to every individual and small business. i get back to the affordability

question, mr. president, because that is the heart and soul of this matter. we have to be assured that we are going to provide affordable health insurance plans. and that's why i recommend it. and i am going to push that through the amount process, that we open up the young, invincible, the catastrophic plans as described in the majority leader's bill. we should open up to everybody. it should be available to those under the age of 30. but open it up so that no one has to buy up in a more expensive plan if they don't choose to. i have also advocated national plans which i include in the finance bill, as small businesses should be able to purchase plans with uniform benefit packages sold across state lines, which is vital to enhancing competition and increasing choices for consumers, portability, driving down premiums, and in fact would drive down premiums by more than 12%. i'll be introducing an amendment

because regrettably it's not in the bill that we'll be considering, that states cannot opt out of these national plans because these plans should be able to be available to every state in the country. finally, mr. president, with our mound ever mounting deficits and struggling economy, if anything, we should be scaling back the copscope of health care reform wherever possible. we should take our u cues from e american people. i'm disturbed the legislation that we will be considering will increase medicare payroll taxes by $54 billion over the next ten years. that is diametrically opposed to the tact we should be taking. practicality should be the word of the day. then we have the insertion of a new costly program the so-called class act. i understand its laudatory goals. but it's going to be providing

long-term care. it's obviously very important. and proponents are pointing to the fact that it will raise $72 billion over the first ten years. but this is in fact a shell game as it collects premiums in 2011 but doesn't begin paying benefits until 2016, near the end of our current budget window. c.b.o. has concluded in the decade following 2029 the class program will begin to increase the deficit. and how much sense does that make to create this new bureaucracy, this new program that will begin providing similar benefits just four years before the social security disability insurance trust fund is expected to be exhausted, as opposed to first fixing that program? mr. president, i intend to offer amendments as legislation is considered on the floor and the pending amendment process will be a true test of whether there is a will to improve this legislation in a nonideological,

bipartisan manner. on that note, i hope the past is not a predirkt of the direction we are headed because in the final analysis, no one has a monopoly on good ideas. it is not a liberal idea, conservative idea. is it a good idea to exriewf this legislation because that's going to be our singular goal to improve the legislation that will be before us, irrespective of who is offering the amendment. or who has the vote, whether it is the 60 votes. that is my concern, mr. president, that if it's going to take 60 votes to undo or change those provisions that are essential to be modified. the american people have expressed the shock and legitimate note of caution as we pursue health care reform, especially during these challenging economic times. it is a message we would do well to reflect. so let the tone we set for this unprecedented debate rise to the level of a problem we have a

responsibility to resolve. this is already an undertaking of historic proportion. lit us ensure that this isn't -- let us ensure that this isn't the only historic legislation, mr. president, passed in the last half-century on purely partisan lines. thank you, mr. president. and headline.

.eadline.

so what my bill would do and it is a simple one-page bill, is end the program on december 31, of this year and allocate unused -- well, keep us from spending any funds and as funds come back to the program, make sure they are not recycled and reused and respent, but used to pay down the federal debt. >> this is a program that began under a republican

administration with a republican appointed treasury secretary. was it a good program? >> well, i think many of us supported it last year on the belief that we were on the virge of eminent financial collapse and needed to do something to reduce the risk our economy faced and i believe it did provide stability at the time. it has moved into something different. it began to be used as fund to support auto bail outs and there is a loan modification fund that used $50 billion of proceeds out of tarp to do that. the inspector general doesn't expect to recover any of the funds and i already know there are -- some of my colleague necessary congress have designs on using the unobligated balance for other purposes. i guess my purpose in the legislation is simply to say there is no higher priority we have right now than paying down the federal debt and wee ought

to be focused on that and make sure this program does not become a political sludge fund and morph into something other than the purpose it was created in the first place. >> do you have democratic support? >> we're working on that. there are democrats for this, it is a difficult position to be in because the administration doesn't want to see it sunset. i had a letter from treasury secretary geitner asking them to end in some sense the program on december 31st of this year and are hoping to build support among democrats. i have 18 co-sponsors right now on the bill, all republicans. we hope we'll be able to get enlightened democrats to come onbare. >> this program is carried live on c-span radio. let me explain the grounds crew doing work just outside where you are at and as luck would have it, the senator, it began as you came on the program. we appreciate you bearing with

us. we want to explain to the audience why you are hearing the noise in the background. i guess you could say it is taxpayer dollars. bruce in wilmington, ohio. good morning, bruce. >> caller: good morning. thanks to the senator for his great work. senator, we just hope that some of our republican brothers join in and help the administration, you know, i mean, i don't like the divide that i see. i'm one of the displaced workers, 10,000 from the dhl mess under the last administration and we really hope mitch mcconnell responsible for the mess. we have a new administration and you are a great senator and i appreciate the work you are doing. i'd like to see you and others who are doing a great job, try to show more unity in our country. thank you for your great work,

senator. >> host: thank you, bruce. >> i appreciate that. there are people hurting. people have lost jobs. the economy@ @ @ /1uå%/7n2zzzzz think there is common ground we can find. i don't believe the administration and the republicans in congress are not willing to work together.

i think they are, i think we have to find common ground. there are many of us who believe that growing the government by several trillion dollars right now is probably not a good thing to do with regard to the economy, particularly given the fact there are a lot of people across the country who are having to tighten their belt. the federal government ought to do the same thing and focus on creating jobs. >> host: there was a piece on wednesday in the "washington post" and you wrote it is irresponsible for one generation to steal from the next by passing along debt to future generations. do you place part of the blame on the bush administration and the republican congresses of 2002 and 2004? >> i think that the republicans when they were in control of the congress, steve, i'm not going to -- i think it could be argued republicans sort of lost their way. my argument in that piece was when we return to our first principles and republicans act like republicans and be the party of limited government and

less spending and lower taxes, that you get a growing and expanding economy and that that is what we need to be doing. i think we can reestablish the credibility of our party by returning to and restoring some of the core principles and beliefs. what has happened in washington has been i happen to both party when is they get here and that is spending continues to get out of control. i think with people across the country, there is belief washington doesn't get the message. the republican when is they were in control of the congress and that takes you back to before 2006, but since that time the democrats have had the purse strings in the congress and with the new administration coming to power it has just accelerated in multiples. you look at the amount of spending that has occurred in the last nine months and since the new administration came to power and it has been a bad situation. there is blame that can be shared by both parties. i think we have to as a country get our arms around this or we

will be placing enormous burden on future generations. it's not fair to them and it is something that as an american ethic inner generationally, one generation sacrifices so the other generation can have a better life. we have gotten away from that and are asking the next generation to sacrifice by piling debt on them because we haven't been able to live within our means. >> host: on the democrats line, good morning. >> caller: good morning, gentleman. i have a couple of comments to make this morning. i think that first of all when the republicans say american people, i don't think you are talking about me. i don't know who you are talking about because the concerns do not fit where i live.

peept want to have healthcare so we don't worry about that issue. >> host: senator, how would you respond to that sentiment? >> virginia, what i would say is when i say most americans, i mean obviously i represent a lot of people in south dakota, but i think a lot of people across the country are worried about spending or debt. that does capture a lot of the concerns that americans have. i think in healthcare there are things we can agree upon. i think a lot of americans are worried about what happens if i get denied healthcare or if i lose my job and the healthcare. those are things most of us agree upon and most people agree we ought to drive the cost of healthcare down.

healthcare costs keep going up at double-digit rates of inflation every single year. what i'm proposing is that we focus on solutions to getting the cost of healthcare down, that we address the issues, that concern a lot of americans and i think there are ways to do that. allowing people to buy insurance across state lines insterstate competition, allowing people to join small business health plans and doing something about medical malpractice reform and doing something about chronic disease management, there are a number of things that can be done to drive healthcare costs down and we can address the issue of pre-existing conditions and affordability and those are the concerns i hear from a lot of americans. i don't know if that describes your situation, but it describes the concerns that i hear from a lot of the people that i represent. >> host: do you think senator reid has 60 votes he needs to continue debate on the senator floor? >> he may. we vote tomorrow night at 8:00

in the evening and it is a motion -- a vote on the motion to proceed. he has to get 60 votes. i guess the question is whether or not he can deliver the 60 democrats in the senate. i don't believe there are -- they view that vote as a vote on healthcare. that is a vote on the substance in this bill and most republicans at least disagree with a lot -- a large amount of what is included in the bill. >> host: jamie is joining us from new jersey on capitol hill. good morning, jamie. >> hi, thank you for your service, senator. i have two quick questions and i believe a comment. my first question is based on the economy. has anybody in the white house defined a fundamental transformation of america and have they defined what a redistribution of wealth is? i've heard talk on the different news channels saying what it is, but nobody from the white house really defining what those two

things mean. i think that would clooer up a lot of this conspiracy theory or whatever you want to call it about socialism and communism in america. the way it looks it looks like it is leaning toward that. >> i will stop you and get a response. >> i think transformation of america can mean different things to different people. in the view of the administration, it means a bigger role for the government and more expanded obviously with regard to healthcare, you are talking about one-60 of the american economy and what has been propose side greater role for the government and a government plan which i think for a lot of people around here means single payer. a lot of people would like to see america move toward more of european model of healthcare delivery and frankly toward more of european model with regard to the economy and that calls for a bigger role from the government, more government say. i happen to believe that one of the foundational principles of this country is freedom. we believe in free market, free

enterprize, those things built the country and made it great. if i talk about transformation of america it would be along those lines as opposed to moving in a direction the administration may be talking about. in regard to redistribution of wealth, it is fairly clear objective a lot of people have. i think that there are those who believe that many of the policies that are being put forward by the administration, the democrat leadership in the congress, are designed to if you look at healthcare as a good example, okay, tax the people high-income people and distribute that money around. i think you see that in some of the policies coming forward and certainly at least to me that is a more straight-forward, i think understanding of what some of their agenda is about. but with regard to the transformation of america, that seems to me to be a subjective term which to me means something different than obviously it means to people perhaps in the white house. >> host: senator, have you been

able to put a price tag to the debt you think americans are inheriting? >> steve, if you look right now, we're going to double the federal debt in the next five years and trip telein 10. in i talk about publicly held debt, up to $17.5 trillion at the end of this next decade of publicly held debt, which makes the number larger. that is a massive amount, over $200,000 per household in this family. i think that is a real concern when you are handing a $200,000 bill to every family in this country, simply because of the amount of debt that we are acquire nothing this country. that is a very serious situation, not only for those families in future generations who are going to have to deal with the debt, but i think it is tremendous drag on the economy. we will deal with the consequences down the road. we are already seeing the devaluation of the dollar. there is potential for higher

interest rates and inflation. there is no good outcome to what we are doing as a nation. >> host: time for one more call. sherry is joining us from north carolina. good morning, on the republican line. >> caller: good morning, how are you? i am calling, i am a republican, i'm just so -- i've been a republican all my life and i'm just so upset. the republicans do not get it. i'm listening to you talk about what will take over insurance. listen, it's either the government take it over or we go down as a country because of insurance companies dominate us. 60% of my income is for health premiums. you're talking about our well being, our deficit, but we can't afford the health insurance. it is a god-given right to be

able to afford insurance and you are not doing that. >> host: and a response. thank you, sherry. >> sure. i think the thing is we want everybody in this country to have access to affordable health insurance. the way you accomplish that isn't to hand the keys over to the federal government. the federal government has already demonstrated with other things that it's done it doesn't do those type of big things for well. freddie mac is a good example. medicare is expected to be bankrupt by 2017, if we don't do something to make medicare sustainable. it will be bankrupt seven years from now. i'm not sure that -- i don't subscribe to the notion the way that you make a problem go away or come up with a better solution is to turn it over to the federal government. i think history has pruch the federal government doesn't do things very well and generally does it less efficiently and at bigger cost. what you are seeing with healthcare proposal in front of the congress is a massive

expansion of the federal government in most cases the full 10-year fully implemented cost of the proposals is $3 trillion. i just mentioned the amount of debt we are passing to future generations. i think we have a moral obgaigz and a responsibility in this country not to run the country into financial ruin, not to bankrupt it. the path we are on today is not sustainable and we will make it worse if we continue to borrow and grow the federal government at the rate we are doing it today. you can solve the issue of healthcare by making it more accessible and affordable to people in this country with some of the things i talked about earlier, but you don't do it by allowing the government to run it. >> host: saesht, have you had conversations with your former colleague, president obama, on healthcare or other issues? >> i have not visited with him about the most current healthcare debate. i occasionally run into him. it's been a while since i visited with him. i've not been invited to the

white house on this particular issue. it seems to me at least in this case the democrats are trying to do this just on their own. there hasn't been a lot of inclusion of republican or republican ideas as was evident by the fact the deal was written behind closed doors with senator reid and members of the white house staff. i would hope at some point if we are success envelope defeating this, we will turn to a discussion and hopefully a bipartisan one with the administration about things to agree on and find the common ground to drive healthcare costs down. the ironic thing about the proposals before congress is none of them reduce the cost of healthcare. every proposal so far actually increases healthcare cost in this country. when you talk to somebody like the last caller who is worried about healthcare costs, there isn't anything in these bills according to the congressional budget office that address this

concern. >> host: you both play basketball, were you invited to play basketball with the president to talk about these issues? >> i would welcome that opportunity. i have not had that invitation yet. i know the president is a big fan of basketball, that's something we certainly share in common and hopefully maybe some day that will happen. >> host: i know you have to get going, we apologize for the noise behind you. how did the ground's crew do? >> nice jo go back again. >> will do. >> host: continuing the conversation with sherrod brown. >> good to be back. i read the health education pension bill that came out of our committee. i've read lots of analyses and details and i have not read the new bill. >> host: the debate begins today and the vote tomorrow, what are you looking for? >> i like to see more cooperation. when this passed out the labor

pension committee and i heard my friend john thune talking about there was this bill written behind closed doors. he knows better than that. both bills went through long

double. everybody knows that, they doubled the last seven years. we are slowing that down. obviously insurance with our plan is not going to cost less five years from now than it does now, but cost less than way less than if we had done nothing. the bill more than pays for itself. the bill, that doesn't count when you talk about the baseball congressional budget stuff analysis. this bill doesn't count the prevention and wellness savings and doesn't count the savings when people are discharged from the hospital and a social worker or nurse or dietician works with them their first 30 days out of the hospital and works with them and saves a lot of their health because they are less likely to go back in the hospital. doesn't save -- has made major

cost savings at michigan hospitals and baltimore hospitals and rhode island and other places around the country. those savings are not reflected in the analysis of the bill, but surely will come. had >> host: where do you come down on the abortion issue? the president says he does not think the bill will have any federal dollars. >> the bill, the way we pass today in the senate, does not -- the senate bill, different from the house bill, the senate bill has continues present law, the height amendment, there will not be federal dollars for abortion coverage, but at the same time, people should be allowed to use their own dollars, unlike the supac agreement in the house, people should use their own dollars for a health policy that provides reproductive services. that is the way most private insurance policies in this country are and we should continue that. >> host: two other points and theb we'll get to the callers. this tax on medicare payroll

benefits, what is that and who would be taxed? >> to pay for this bill in part, several ways of doing it and several differences between house and senate. version one of the senate version, there will be an increase in the medicare tax for upper income people, so if you're making $150,000 a year or $200,000 a year, you won't pay medicare tax. i believe the threshold is 250 per person, less per couple, you will pay additional i think percent or two, i'm not clear on exactly what the percent is, on your income to pay for medicare, to pay into the healthcare system. -- >> host: how many would be -- 6 or 8% of americans would be without insurance? >> less than that. if the projections are right, it could go as low as 4% still

uninsured. most of the -- some people will choose to be uninsured and will pay a some kind of fee so and not get insurance but overwhelming majority of americans will have an opportunity, there will be expansion of medicaid so working poor can get on that insurance. there will be opportunity if you are making 30 or 40,000 a year to buy private insurance. it is too expensive, she said she's a republican and it is clear the insurance companies have had way more influence in the system than the government has had and that is driving prices up. you look at the comparison. medicare has about two or three percent administrative cost, private insurance has up to 20 or 25% in many cases administrative costs and how some of my colleagues can argue private insurance is more efficient than medicare is just doesn't have a basis and fact. >> host: is it politics or the policy preventing republicans from supporting this? >> i think it is both. i think it is less -- when i

went through this in the health committee, health education committee, we wrote this bill, it occurred to me it is less partisan politics than ideology. republicans and democrats, look at the callers that call on the republican or democratic line. we think different philosophically. go back to medicare, creation of medicare was a big government program that the country wanted and the country is generally satisfied with. republicans don't agree with that, democrats do. i think now it's become partisan and we've heard manner of senator thune's colleagues say they want barack obama to fail. i don't question anybody's patriotism, but i do question what they want for their country when they say things like that. there is a lot at stake here. i think republicans know if this is successful because i think this bill will work and it will be evident early that it works, as early as 2010, because things

will start happening already. i think they know politically that is not good for them, but if they had joined us and worked better with us, it would be a different story. >> host: the details of the bill show 2013 before we see full benefits paying for 2010, 2011 and 2012. >> that is mostly correct. major parts of the bill, the public option, insurance exchange will be 2013 or 2014. i still advocate to move that up, but other major parts of the bill earlier. wellness and prevention starts quickly. we will close the donut hole in half on the senate floor and try to amend it to close dotnut hole entirely within a few months. we're going to do a lot of insurance reform quickly in 2010. much of this bill will take effect quickly, quickly meaning within six months to a year. other parts of the bill take more time. obviously to set up insurance exchange to get the public option up and runing and get the insurance companies enrolld and all that, it is going to take

more time. i want to do it as quickly as possible, but not so hurriedly it is not done right. the benefit will come quickly, the whole plan won't be established for two, three, 3-1/2 years. >> we kep hearing bending the cost curve, how do you define that? >> clearly insurance rates are going up, healthcare are going up. when you have reid on this show, he talked about how and talked about this repeatedly, every country in the world is dealing with higher healthcare costs, even though they spend less than we do. partly because of technology, for a lot of reasons. instead of cost going like this, they would if we do nothing, we want to see them go like this, they will go up because things cost more, but they won't go up as sharply as they have. that is because of things like the discharge plan and the check list and the wellness and prevention and don't forget the competition. the public option, one of the attractive parts of the public option is how it is going to drive prices down.

southwest ohio, hamilton, butler, warren county, two insurers have 85% of the market, that means because of lack of competition, lower quality higher cost insurance. put the public option there and it begins to lower the cost curve, bring the cost curve down in a way, bend the cost curve down so that is what the competition can do. >> host: let's take phone calls. loretta joining us. good morning. >> good morning. my question is this. i have problem with the insurance we're going to here in georgia. i'm a state employee who retired, 68 years old. they have gone to the medicare advantage program. and a couple of years ago i had a fall and a major exchange store and i broke my knee cap. okay. on the general information, they

said that my claims can be denied because i have received a settlement. i have not received a settlement because of the fact that it was not their fault. i talked to several lawyers and they said i didn't have grounds to sue. all right. now the state insurance company, they sent a letter saying that i could be -- if you are denied by medicare advantage, that is which one they have, i valid to pay out of my pocket $600 for premium because state is no longer matching. well, that would take more than about one-third of my income. i'm disabled and my medicine

uses sometimes about $200 a month. recently i had eye problem and had to go to an eye doctor, he prescribed some drops so when i called and asked how much it was, they said $82. out of my pocket. i asked how much did the insurance pay and they said $22. so with that i don't know what i'd do if i had to pay $600 a month for premium. >> host: loretta, we will get a response and we got a response from lesly miller. what is a reasonable percentage of a person's income that ought to be spent on health insurance premiums? to her point and lesli's how would you respond? >> let me respond generally and more specifically to the retired lady in georgia. the legislation has a percent

that was different in both versions of the bill and i'm not sure what the percent is, i apologize for not knowing that. percent of income that premiums would not exceed so if you are making 30,000 a year you would get a government subsidy to keep your percentage of income going to healthcare premium at a reasonably low level. that is the point of the subsidy so everybody, because we are asking everybody to get insurance so everybody gets insurance. for your problem specifically, i would first of all, call your congressman or senator and ask them to go to bat for you with medicare advantage. medicare advantage is the privatized part of medicare. it's run by private insurance companies. it's about one out of five medicare beneficiaries has that private insurance and that's not easy to deal with sometimes. they hire people to deny care. that is the first thing. second, i think this bill will help you in the way we're going to get drug prices down in this

bill because of more competition and the medicare advantage is going to be more competitive because the insurance companies partly because of what we're doing with the public option, partly because of what we're doing with medicare with insurance reform. >> host: helen from louisville, kentucky. good morning >> caller: good morning. what i'm having trouble understanding is each insurance company as an independent business regulated by the state. each of the 50 states set up the rules for an insurance company so already you're seeing everything screwed up by the insurance companies. well, the state government tells them how they do the rule. i don't see anything in the federal laws coming out that are going to be any less -- if one

state has two companies that's all they have -- there's nothing saying more competition in that state. it's a federal law going to override all the state insurance rules? >> guest: first of all, we'll let insurance companies compete or in our version of the bill to compete more across state lines. there could be more insurance companies coming in. second, the rules, yes, there will be a new set of consumer protection rules that apply initially. no more pre-existing conditions, no more caps on life-time caps on coverage so if you have a particularly chronic expensive illness that the insurance companies can cut you off, no more discrimination. you are probably charged more for your insurance than a man your age would be charged, all other things being equal, because you are female. no more of that.

no more discrimination based on geography, all those things will be prohibited. it is natural law all insurance companies have to live under. the public option will inject competition in addition to any insurance company that come into cincinatti, for instance, not far from where you are, to compete. there will be the public option there to compete and the public option just like medicare is never denied somebody coverage because of pre-existing condition, but aetna and cigna does. the public option will never deny coverage because of pre-existing condition. we set the rule the insurance companies are not allowed to do that anymore. they are good at gaming the system. the public option will make them more honest. >> host: the "wall street journal" takes aim at this bill saying its entitlement benefits with one eye on twept10 and subsequent election to the democrats. i want to read a quote from judd craig. he says this is the wrong solution for america's

healthcare crisis and he would have dire fiscal consequences for future generations who will be saddled with the cost of this massive new

down. the republicans have had for years to figure out what to do during the bush years and only added to the deficit and the acuteness of the healthcare problem. this is the right thing to do. i think it will be a situation where republicans in the mid-'60s voted against medicare and had buyer's remorse because they were in the wrong side of history. some of thune's colleagues will look back if they vote no, look back and say, i might have cost the wrong vote, like they did on medicare. >> host: you have been on the show many times and your wife has been on many times. do you -- >> she has been writing about the horrible case in cleveland where the man is accused of murdering 11 women and they were buried in his yard, that's been a national story.

she's been -- she's not written much, a little about the healthcare bill. >> we will have the two of you together. >> i would like that. >> host: ed is joining us. >> good morning, how are you all? >> host: fine, thank you. >> caller: i want to pass on something. i am a strong independent. i am sure senator brown will understand where i'm coming from. i don't agree with either party, so first of all neither bill covers 100% and that is what they promised from the get-go. the other thing, 64% of the people in this country are against this, 34% are for the bill. it is not going to solve the emergency room problem because of illegals who are not insured will use it. then i come up with buzz words because i screen the internet a lot. first of all, is this constitutional and how long until there is repeal?

and what are they going to do about the go to jail if you don't have health insurance. is this what we've come to, forcing people to do something. i'm not a lib tarrian, but i believe in the constitution. >> host: thank you, ed. >> i believe in the constitution, too, ed. i am not a lawyer, but i have no question this is constitutional f. this is unconstitutional, so is medicare. i've had town hall meetings around the state and usually the support of this bill is two, 2-1/2 to one in support of the bill, i don't know the poll number you mentioned, two to one against the bill in the public and i don't believe that is the case. i believe there might have been a poll that said that, i ask people when they say it is unconstitutional, i ask if they want to repeal medicare and that would be unconstitutional, too. some people say repeal it. i'm not a lawyer and certainly not constitutional lawyer, but

there is tradition in this country government is involved when the private sector doesn't do things right and the private sector has not figured out a way to deliver healthcare in this country at relative affordable cost and high quality and include enough people. the government obviously, that is why medicare came along because half of americans over 65 in the 1960s had no health insurance and they relied on emergency rooms or simply died earlier. we live a lot longer in this country. i wear this pin on my lapel to depict canary in a bird cage and the mine workers took a canary in the mine and if the canary died, the worker got out of the mine. he had no government that cared enough to protect him. the life expectancy was about 45 then and people live a lot longer partly because of medicare and social security and minimum wage and safe drinking water laws and clean air laws and f.d.a. that keeps our foods

supply relatively safe. those were government and partnership with people, business and labor and it made us a better country. i defend to the death the constitution does allow and encourage us to do things like this healthcare bill. >> host: a twitter comment about if we are worried about healthcare cost, revoke president bush's tax cuts. >> that is one thing i support. i voted against the tax cut. the tax cut is over whelmingly for the wealthy. one thing in president obama's stimulus package, a third of the money immediately, within a couple months, went to tax cuts for the millel class. 80% got tax cuts under the plan we voted on in february, and that money went directly to middle class, not the wealthy. those are the kind of tax cuts we should do, not load up people who have done so well, including insurance executives. the ceo of aetna made his salary

for denying coverage for pre-existing condition and all the things they do. >> constituent from dayton, ohio. frank says without medicare i valid been bankrupt from huge medical bills. a proposal to ensure low cost in coverage for every citizen who chooses it is medicare for all plan. why was the plan blocked from being considered? >> medicare for all, i support it, but the president didn't. it was -- would have been difficult to pass it and basically say everybody in the country is eligible for a medicare-like plan. that was a dramatic change from the way we do it now. it could have been done. it was simpler than anything else. it wasn't in the cards. i tell frank i agree with him, but we weren't able to do it. the public option has a lot of those kinds of market disciplines, if you will. the public option competing with private insurance will keep rates stable and that is the

same philosophy there. >> host: how is the president doing? >> i think he's doing a good job. i remember riding on the bus with him after the lehman brothers and all the stuff that happened in september and october. i said this job looks harder than when you signed up. he had a look on his face likei'm ready and i think he has been and i think no matter what he does, the attacks started in february. they started within a month of his swearing in and they are often too personal. they are driven by who knows what, but i think he's doing well. >> host: next call is james from evansville, indiana. good morning. >> caller: good morning, senator, how are you? >> how are you? >> caller: i have a comment and then a question. i'm really, really glad that you are behind this healthcare bill along with our senator in indiana here, mr. baye.

and my comment is we really need this healthcare bill. a lot of us retired people who aren't able to be eligible for medicare yet can't get insurance because of pre-existing conditions and we really need it. and -- >> host: james, you brought up an issue i want to follow-up with the senator. what was your situation in terms of pre-existing condition? >> caller: well, i have rheumatoid arthritis and copd. and after my arthritis got so bad i had to retire then i couldn't afford the cobra, because it was more than my retirement. >> caller: how old are you, by the way? >> caller: 62. >> host: do you qualify for medicare now? >> caller: no, not until i'm 65. >> i go down to the senate floor almost everyday and read letters

from people from dayton and galleon and mans field and toledo, all over my state and almost all the letters have one of the following things, either people that were really happy with their insurance a year ago and found out because they had a baby born that had a pre-existing condition or they got an expensive illness and got cut off, found out it wasn't what they thought, oftentimes exactly your intagz. somebody 61, 62, 63 years old, they've lost their job or they've lost their insurance for whatever reason. they just say, i can't wait until i'm 65 until i get on medicare. what kind of healthcare system says to people, if you can live two or three more years we're going to take care of you. that says so much about the experience of the public option because you know when you turn 65, you know yooufr going to have reliable healthcare coverage that will not deny you care because of pre-existing

conditions. you are in a system now which does. the public option makes sense so that right now when we pass this bill and the president signs this bill in december or january and i'm certain that is going to happen, when the president signs this bill, you will be able to go to the insurance exchange and choose a private company if you want or choose a public option and you will not be denied coverage because of pre-existing condition. if that alone isn't a good enough reason to pass the bill, i don't know what is. it is going to matter for so many people in their 50s and 60s. i'm 57 and i get letters from people about my age, between my age and 65 that just talk about if i were only old enough for medicare. once i reach that, i know my pre-existing condition won't matter. >> host: next caller from canton. johnny, you are on with your senator. >> caller: hello, good morning. how are you? i had a couple points here. i agree about the pre-existing conditions that things have to

be done. you shouldn't be denied coverage. i think there should be more with the way of portability so you can keep your insurance kind of like how you buy insurance with your vehicles or your house, you could go anywhere, shop around, get the best that you can afford. and i agree, we have issues with the cost of healthcare. now my point is i'm a veteran at 100% disability and i use the v.a. for probably about 90% of my healthcare needs, which i have a chronic condition, kidney failure, and i was on dialysis and had a transplant recently, but had to go outside the v.a. system and it was bureaucratic issue. the issue of having to submit for my doctor to submit to

washington, d.c. for them to okay it and i was running out of time. i went to ohio state university and had them do the transplant. >> uh-huh. >> caller: and medicare picked it up so i still owe the 20%, but my point is i think that maybe what we need to look at is working the way v.a. works, streamline things a little bit and do away with some of the wastes that we're having with this medicare, some waste, i forgot the numbers that are out there. even president obama admitted to, you know, there's i believe billions of dollars of waste annually. >> host: johnny, did you have out of-pocket expenses? >> caller: lots of out of pocket expenses. $21,000 so far.

you know, i was asking the v.a. if they could pick it up and it was refused. >> host: thank you. we'll get a response. >> johnny, thank you for your service to our nation. we are grateful to that, when you were in the service. the v.a. takes care of 90% of your care until this. first of all, i would suggest you call my office in ohio and we'd be glad to go to bat for you on your some of the out of pocket costs with medicare and the v.a. the v.a. does some things, generally their course is waste because of the size of it. the fee for service medicare structure we have, we end up doing too many and too many treatments and doctors recognize that, that this isn't doesn't work that well for a lot of

people that way and there is -- less fraud than waste, i think. the bill will help deal with that, it will not solve all that and the president, as you said, johnny, acknowledged in the v.a. and medicare system and in private insurance, too many duplications of service, too much waste that way. i think we are on the road to beginning to clean some of that up. call our office and we'd be glad to help you on the costs that you don't think you should have worn and we'll look at it and try to help. i appreciate it. >> host: part of the conversation underway on twitter page is this. the only way to reform healthcare is by reforming campaign contributions. i call it legalized bribery. >> well, i wouldn't call it that, but i would call it that there is way too much money sloshing around here. some number shows, one of the studies said million dollars a day on by the health insurance

and healthcare lobby, not just insurance companies. drug companies, insurance companies spend millions of dollars lobbying and in campaign contributions and it clearly has an impact here. i agree. if we had a very different system of elections and different system of campaign finance, this legislation would have been shaped differently, i don't think there is a question about that. >> host: as we cover this debate on c-span 2, walk us through today and tomorrow. >> today debate all day and tomorrow at 8:00 we vote on mota closure. pledged not-to allow us to debate it on the floor or bring the bill forward for debate. i mean, they should at least let us go that far so they can then try their amendments. there will be lots of amendments offered, they are going to oppose that. we need 60 votes to actually have closure, stop the filibuster on bringing the bill to the floor.

after that passes there will be a quick vote on we only need 51 to actually bring the bill to the floor and then the debate begins over the next after thanksgiving, the debate begins on the bill itself. we'll process lots of amendments, people opposed to the public option will be able to offer a bill to eliminate it. it will fail in all likelihood, but they will have all kinds of chances. i have some floor amendment. it is not where we tpt to be, but it is a good bill if it comes in this form. it takes us exactly in the right direction. and then we'll have another closure vote at the end and then send it to conference committee, which will work out differences between the house and senate and come back to each house andnd sd it to the

mr. mcconnell: mr. president? the presiding officer: the republican leader. mr. mcconnell: mr. president, our good friends on the other side of the aisle have spent six weeks behind closed doors putting together this trillion dollar experiment in government-run health care that raises premiums, raises taxes, and makes drastic cuts to medicare. we have now had less than 48 hours to look through this

2,074-page bill, but there are ten things that we know for sure that every american should begin to understand. there are ten things about this bill that we can begin to convey to the american people with certainty starting this morning. the democratic bill includes nearly half a trillion dollars in new taxes that hit virtually every single american, including, mr. president, most importantly, including middle-class families who make less than $250,000 a year. almost a half a trillion dollars in new taxes, a substantial part of it hitting middle-class families who make under $250,000 a year. the second thing we know about

this massive 2,074-page bill is that it will raise insurance premiums for the 85% of americans who already have health insurance in our country, so we know buried in this 2,074-page bill are higher insurance premiums for all americans. mr. president, the third thing we know about this massive 2,074-page bill is there will be huge cuts in medicare. a half a trillion dollars in cuts in medicare over ten years. and it will limit many of the choices that seniors now have. additionally, mr. president, this monstrous 2,074-page bill, according to the congressional budget office, will not lower

health care costs. and my recollection was that the principal reason we went down this path in the first place was to do something about the cost increases that are hitting american businesses and individuals, so we go through passing presumably -- i hope we don't, but if we pass this 2,074-page bill, we will actually christmas eve costs. the true costs of this bill which was not stated by the majority at the announcement of the bill, if you look at the ten-year period when everything is implemented, the true cost of the bill is $2.5 trillion. certain gimmicks were employed to try to make it look like it actually was deficit neutral or even raised money for the government over ten years, and the way that was done, mr. president, was to delay the

implementation of parts of the bill. but once everything kicks in, if you look at a ten-year window after everything kicks in, this monstrous 2,074-page bill would actually cost $2.5 trillion. a massive, massive expansion of the federal government. the sixth thing, mr. president, we know about this bill for sure is if you like the health insurance you have, you may not be able to keep it. buried in this 2,074-page bill are provisions that clearly indicate that if you like the health insurance that you currently have, you may not be able to keep it. according to the congressional budget office, the democratic bill would force millions of americans off of the health

insurance they currently have. now, mr. president, the seventh thing we know about this bill is that it will let government bureaucrats dictate what kind of health plans americans can buy. no longer would they have the option to buy whatever health care plan might make sense for their family. the government will prescribe what kind of insurance plans americans can buy and thereby, of course, what benefits they can receive. so some bureaucrat here in washington is going to dictate the plans that are available for the american people. i suspect that people who are young and healthy and have high deductibles may not have that option anymore. those are the kind of americans, mr. president, for whom the cost of insurance is going to go

dramatically up. what else do we know about this 2,074-page bill? it creates a government plan that the congressional budget office has said would bring about higher premiums. now, we have said that the whole point of the government plan -- the majority has said the whole point of the government plan, having the government in effect get into the insurance business is to offer a lower cost alternative. but the only way to do that is to subsidize costs, ration care, and undercut private insurers which would lead to a government take overof -- takeover of health care. so the democratic plan, the

congressional budget office actually says that the government insurance plan, the government insurance company would have higher premiums. so clearly, the only way it could have a positive impact on the cost of insurance would be to subsidize costs, ration care, and undercut private insurers. and, of course, that, mr. president, would be the first step toward what some of the more candid liberals in the house have said is a single-payer system. they are actually disappointed this bill doesn't go far enough to create a government insurance company which then leads to a single-payer european type system. what else do we know about this bill, mr. president? well, the democratic bill for the first time in history, the first time in history, would allow federal programs to pay for elective abortions.

how do people out in america who feel strongly about that issue, what do they say about it? well, according to an a.p. story just this morning, a direct quote from the person with the catholic bishops who works with this legislative issue here on the hill, here's what he had to say. and this is a quote from this individual who works for the catholic bishops on legislative issues. here's what he had to say -- "this is the worst bill we've seen so far on the life issue." a spokesman for the catholic bishops on what is buried in this 2,074-page bill on the issue of whether the government will for the first time allow federal programs to pay for elective abortions.

another observation he made about it -- and this is a direct quote, two words, a spokesman for the catholic bishops -- "completely unacceptable." completely unacceptable, the abortion language in this 2,074-page bill, mr. president. that's how the catholic bishops apparently feel about this. finally, americans should know that this bill doesn't have the commonsense reforms that they have been asking for all along. nothing in this massive bill about getting rid of junk lawsuits against doctors and hospitals that c.b.o. said costs us $54 billion over a period of time. nothing in the bill about leveling the playing field when it comes to health care taxes. mr. president, what the american people would like for us to do is to step by step address the

cost issue to them. this bill doesn't do that in any way. americans would like to have health care reform, but higher premiums, higher taxes and cuts to medicare to produce more government isn't reform, yet that's precisely what we would get were we to pass this 2,074-page bill sitting here beside my desk. mr. brown: mr. president? the presiding officer: the senator from ohio. mr. brown: thank you, and i appreciate following senator bingaman. senator bingaman perhaps knows more about this issue than anybody in the senate. he was the only democratic senator to be on both committees that wrote this bill and did such great work both in the finance committee and on the health, education, labor, and pension committee. i would follow up his words,

mr. president, by pointing out that this process -- i was on a c-span show this morning and i heard one of my -- the previous senator that was on the show, a republican, saying that this bill was written behind closed doors and is a partisan bill, and i just -- i went through this process, as did presiding officer -- the presiding officer from oregon. we sat through seven days of markup all televised, all public. hundreds of amendments. we accepted 160 republican-sponsored amendments. the senator from oregon and i and senator bingaman and senator murray also on that committee voted for those -- most of those 160 amendments. this bill had a lot of bipartisanship to it. but on the big issues, the issues like the public option, the issues on how are we going to pay for it, some of the big issues, there is just clear philosophical disagreement. and you can go back to 1965 when medicare passed, republicans opposed it in those days because

they just had a different view of the world. their philosophy is government can never do anything right. our philosophy is medicare has been a pretty darn good program and lifted a whole lot of seniors out of poverty as has social security, and that medicare, in fact, has given people longer, healthier lives as a result. and so this issue is not so much partisan, although my friends on the other side of the aisle made it that, it really is a difference in philosophy. they wanted to continue -- my friends on the other side of the aisle pretty typically do the bidding of the insurance industry, and we can't have health care reform and do it the insurance company's way or there will be no health care reform. we have stood on this floor, senator merkley and i and senator kaufman and whitehouse and tom udall and others talking about some of the things insurance companies have done. pre-existing condition exclusions so someone that has an illness can't get insurance. when i was on the c-span show today, a gentleman from indiana

called and he's 63 years old, has a pre-existing condition, can't get insurance. he has got two years to wait to get on medicare. he knows when he is on medicare that medicare won't exclude his -- take away his coverage, exclude him from coverage because of a pre-existing condition. neither will the public option exclude him from coverage because of a pre-existing condition. but you know cigna does, you know aetna does, you know wellpoint does, you know blue cross, the insurance industry so often excludes them for pre-existing condition. that's why they can afford to pay their c.e.o. at aetna aetna $25 million a year. that's why insurance company profits have gone up 400% over the last seven years, because the insurance companies deny care for so many people so they can't get covered, they can't get insurance, and then they turn down so many claims. 30% of insurance company claims are turned down initially by the insurer. so even if you eventually appeal and get your claim covered, get your claim paid for from the company who you have paid

premiums to, even if you get your -- you ultimately get your claim paid for, why should you have to get on the phone day after day and call your insurance company and complain and complain and cajole and persuade and finally get it paid? i mean, that's -- that's not how our reform will work. that's not how the public option will work. mr. president, i know that senator murray is here to speak in a moment, and i just want to, as i have done many times on the floor in the last three months, i just want to share three or four letters from ohioans who have written me about this health insurance bill. what's really come through in these letters are a couple of things or maybe three things that come through in many of these letters that i've gotten. number one, most people i've found -- most of the people who wrote these letters, if i met them a year ago and said have you satisfied their health insurance, most of them would have said yes, but then something happened. they ls their job or they got sick and it was a very expensive -- it was very expensive and they lost their

insurance because they got canceled. or they had a child born with a pre-existing condition and they can't get insurance. so they once were happy with their insurance until they needed it, and that's happened too many times. the second thing i see over and over among people in these letters are similar to the man from indiana i mentioned earlier, that people in -- that are 61, 62, 63 years old, maybe 59 years old who are sick and can't get or they're not sure about their health and they can't get insurance, they just say i wish i was 65. i can't wait until i'm 65 so i can get covered because i know medicare is stable and won't cut me off their plan. what kind of insurance company, what kind of health care system do we have when a 61-year-old writes a letter to their senator saying i can't wait until i'm 65 so i have -- i have health care protection, i have health care security? there's something wrong with that. we fix that, too, mr. president. and the third thing that i hear in these letters, and then i will read them briefly, so often is that people know -- that people call for the public option because they know that a

public option will help them -- will help discipline insurance companies and make them behave, make them more honest. the public option will save money because they'll compete. southwest ohio, cincinnati, in the three adjoining counties to hamilton, claremont, warren, and butler, those four counties, two insurance companies, two insurance companies control 85% of the insurance policies in those four counties. with that lack of competition, the quality is low and cost is high with that insurance. injecting that public option will -- putting the existence of that public option will inject competition and make those insurance companies work better. the first hrert is -- letter is patricia from hamilton county. i am a senior. i have a supplemental insurance plan with reasonable co-pays but that have continued to rise. i don't have any patriotic accessing the care -- i don't have any problem accessing the care i need now.

however i have multiple sclerosis. when i was younger i was subjected to the preexisting condition inclusion. fortunately i was employed by the state which allowed me to secure a reasonable health plan. it is our responsibility as citizens to make sure all of our people have good health care coverage. a public option will ensure this happens. whether you choose aetna, whether you choose the public option or not-for-profit in ohio called medical mutual. the public option is in fact an option that will give people that opportunity. joyce from lawrence county, down sort of straight southern ohio along the ohio river, "i've been notified that any medicare part-d monthly premiums will increase 25% in 2010. i don't afford this increase. i need my medications. i'm a senior living on fixed

income. i don't know how to handle this situation except give up drug therapy. i support your efforts for health reform that includes a public option." one of the things that will happen under our health care bill is that the doughnut hole that keeps people like joyce around ohio and around the state and around the country, that keeps people from -- the doughnut hole that means people pay so much out of pocket for their prescription drug coverage, we will close -- initially we'll close it by half. we are going to offer some four amendments to close the doughnut hole entirely so that people don't get hit so hard by drug costs. karen from mora county, where i grew up in the mount gillian area, north central ohio. karen writes "please vote for health reform for all. as a middle-aged female, i'm

tired of seeing my community ravaged. with a preexisting condition i have no option but to stay with my present provider and cross my fingers each year on my birthday that i won't be dropped." this is a small business owner. one of the things we knew right away -- senator murray and senator merkley and i worked on in the "help" committee -- was to make sure that there were good, strong incentives for small businesses to be able to afford health insurance for their employees. we've all, whether it's in olympia or spokane or portland or eugene or cleveland or toledo, we've all seen situations where we have small business owners approach us all the time. i have 20 employees. one of them got cancer. it costs so much for this one employee that they're either dropping my coverage, my small business coverage or the cost has spiked so much that we can no longer afford it. what are we going to do? our bill will bend the cost curve for them. it will give them tax credits so they can buy insurance. it will allow them to go into

the exchange so they're in a larger pool so one or two illnesses in a company of 20 or 30 people won't cause the price spikes that a larger pool of insurance will be able to blunt. the last letter, and then i'll turn it to senator murray, gail from belmont county, saint clarenceville, flushing, that aerokwraft state. gail writes, "i'm a teacher. my husband is retired. march 2009 i was diagnosed with cancer and began treatments soon after. i had radiation therapy and chemotherapy. i have an employer-based plan but doesn't cover the entire costs. how does someone without insurance afford such treatment? the fact is they can't. i didn't realize how high health care had gotten until i got sick. one of my son is a veterans and has coverage that wait a minute one son is in college and is covered by my insurance. my third son is not covered at all.

he had an appendectomy a couple of years ago and the resulting medical bills destroyed his credit. i don't know what will happen if he becomes sick again. it is not right to leave the poor to flounder without proper medical coverage. it is time to end the greed of drug companies and have them face fair competition. mr. president we want to create a system with consumer protection so insurance companies can't drop people for preexisting condition, can't put a limit on their coverage so that they get sick, they lose their insurance. can't discriminate against women, whom they usually charge more for premium costs for their insurance policies than man. can't discriminate based on geography or disability and we want to give incentives to small businesses, and we want to bring competition into the system so insurance companies have to compete better than they have driving prices down. that's what this legislation does, not to mention a lot of the prevention and wellness provisions of the bill which

really will help keep people out of hospitals, help people live longer and healthier lives. that's our mission here. this congress has tried to do this for seven decades. tomorrow we vote on an historic moment. we'll vote tomorrow evening to move this bill to the floor of the senate so we can begin this process. it's the most important thing professionally i've ever done in my life. i feel privileged to get an opportunity to be part of this and to fight for 11 million ohioans because i know this isn't a bill just for uninsured ohioans. it's a bill to make business more competitive, to help small business, to give consumer protections to thoseer who who*r happy with their insurance and want to keep it and help medicare insurance by closing the doughnut hole and bringing some of their out-of-pocket costs down colleagues. the presiding officer: without objection. mr. enzi: thank you. mr. president, i rise to talk about the health care reform bill. this country needs health care reform. the status quo in health care is unacceptable.

health care costs are skyrocketing. insurance premiums are increasing. and too many small businesses can no longer afford to offer health insurance to their workers. no one on either side of the aisle denies that we need health care reform. we need to enact reforms to bring down costs so everyone will have access to quality, affordable health care. we need to take a step-by-step approach to reduce health care costs and lower premiums for individuals and employers. we need to eliminate discrimination based on preexisting conditions and ensure that people can take their insurance with them from job to job. i support commonsense reforms that would achieve all these goals. unfortunately, this 2,074 page reid bill fails to address these issues. instead this bill would raise taxes by $493 billion. it would cut another $464 billion from the medicare

program. the bill would reduce wages and eliminate the jobs of millions of americans. it would actually drive up healthu)ag!@ m%m n,mn)t htsána# american workers depend on a strong economy to create jobs, to help them feed their families

and build their dreams. unfortunately, the policies being pushed by the majority will only make it more difficult for america's businesses to hire workers or pay current employees more. the congressional budget office, health researchers and nationally recognized economists all agree that senator reid's new job-killing employer tax will mean one thing. more americans will be out of work if this bill becomes law. as i mentioned, this bill will raise taxes by $500 billion. $500 billion. the authors of the bill clearly believe that the greatest problem in our current health care system is that we don't pay enough taxes for our health care. under this bill, if you take a prescription drug, you will pay a new tax. if you use any medical devices or equipment ranging from walkers to wheelchairs, you will pay a new tax.

if you do not have health insurance, you will pay a new tax. if you do have health insurance, you will also pay a new tax. and if the government decides your health insurance is too expensive, there will be a new tax for that just as well. the problem with our current health system is not that we don't pay enough taxes. americans actually want to lower their health care costs. that's the message. not just pay more taxes to the federal government. all of these taxes will only increase costs, making health care even more unaffordable. the third major problem with this bill is that it will actually increase the cost of health insurance for millions of americans. the bill mandates that insurance premiums for younger, healthier workers be tightly tied to the costs for older, sick individuals. this will immediately drive up costs for the young, healthy individuals who coincidently

make up a significant portion of our current uninsured population. the bill also eliminates consumer choices, requiring americans to buy richer types of plans that cover more of the deductibles and cover more out-of-pocket expenses. these plans typically have much higher premiums. taken together, these insurance changes will increase costs for millions of americans. in looking at more modest provisions included in the senate finance bill, nationally recognized accounting and business consulting firms found that these changes would increase insurance premiums by 20% to 50%. the practical effect of this bill is that washington could dictate to every single american, even those who have insurance they like now, the coverage they would need to purchase. washington will tell you what is good enough coverage. the bill does not give people affordable options and it

penalizes those who do not purchase high-end, expensive plans regardless of what they want, need or can afford. before i was a senator, i was a small businessman. my wife and i owned three shoe stores. when i was showing someone a shoe and he said he didn't like it or couldn't afford it, i didn't try another sales pitch. i knew it was time to find another shoe, one he liked and could afford. if the customer is complaining, get something else to show. mr. president, the customers are complaining. the voices of august are still out there, and they know that this bill is just more of the same. there is a lesson in that story when it comes to reforming health care. it's time to listen to our customers and find an alternative they want and can afford. the intensity of the country's disapproval is apparent in town hall meetings, letters to newspaper editors, citizen

protests and constituent calls and letters from all across the nation. got some of those that say my senator's not listening, but you are. i want to find solutions. ask most of my colleagues, and they will tell you time and time again. i've been known to work across the aisle in search of common opinion h-sense reforms -- commonsense reforms on all kinds of issues. i worked closely with senator ben nelson from nebraska on a bill that would allow small businesses to combine their purchasing power across state lines even nationwide and collaboratively buy health insurance at discounted rates. i worked closely with the late senator ted kennedy on a bill to reform the drug approval process at the food and drug administration. i also worked closely with then-senator clinton on a bill to save lives and decrease costs by promoting greater use of electronic medical records. time after time i've advocated

that we set partisan differences aside and work on the 80% of the issue that will really make a difference for most people. unfortunately, rather than working with republicans to develop a commonsense solution, the majority drafted a flawed bill that spends too much, does too little to cut health care costs and puts seniors' benefits on the chopping block. the white house and democratic leader should have responded to these concerns with alternative ideas that actually address the health care issues that most americans care about: their cost. unfortunately, they decide to simply try a more aggressive sales pitch. as a result, opposition to it will only continue to grow. if this bill continues to move forward in spite of what most americans are telling us, i'm going to keep offering amendments geared at bringing down health care costs for american families, scaling back total health care spending and

protecting seniors. mr. president, i would yield the floor to my colleague from wyoming, who has a few copies of the bill. mr. barrasso: mr. president? thank you very much, mr. president. in joining my colleague from wyoming, he and i had a town hall meeting in gillette, wyoming. his hometown, a wonderful community. i was just there last week for a veterans day parade. and what senator enzi knows and what i know is when we talk to the people of wyoming, they want commonsense solutions. as i am here with the house-passed bill and the senate bill that we're now look at, people of wyoming are astonished at the amount of pages in this sort of thing. how to deal with this, how to comprehend it. what does it mean? what if i like something on page 208 and don't like something on

page 1,200? we ought to be using a step-by-step process. my colleague from wyoming has a ten-point plan to improve health care. any one of those would be a positive step in helping american families, helping get the health care that they would like and that they need. but not this bill, one through the house, one through the senate. i don't know if my colleague would want to join me in discussing that town hall meeting where people said we want health care reform. we want things that are going to make life better, but to help keep down our premiums, help keep down the cost of our care. because 85% of americans have health care coverage. they're just not happy with the cost. and what i've heard for the last hour here from my colleagues on the other side of the aisle is we need to cover more people, we need to cover more people. well, that's only part of it. we need to keep down the costs of care for the 85% of the people who like the care that

they have. and i mean, that's what happens when we get together with groups of people from around the state of wyoming who come out for our town hall meetings to discuss the issues, to listen. w*er there mostly to -- we're there mostly to listen. they're there mostly to talk. i would ask my colleague from wyoming, isn't that what we heard that they need changes but not this? mr. enzi: absolute hreufplt not just at the -- absolutely. not just at the town hall meetings. that's the way the letters and e-mails and phone calls are going to come in in response to what they anticipated they were going to get, which would be lower costs. they don't mind helping other people get insurance or subsidizing that insurance or in some cases providing it for free. but they really expected to be able to get something out of it themselves. we really missed the mark on this. you can tell that they missed the mark. the bill actually, that has been raised to vote on, is just a

little two-page bill. why didn't they put up the house bill? because they couldn't get 60 votes for the house bill. they know that's wrong. this isn't a whole lot different from the house bill. it is different; i give them some credit for that. they couldn't put this bill up because they can't get 60 votes. and they have to have 60 votes to move on to debate. so instead they put up a service members homeownership tax act of 2009, which is actually just two pages and then a summary. so there's not much to that bill. and there hope is they can get the 60 votes and people won't really concentrate on the fact of what's in this bill. and i really appreciate all of your efforts. you've been involved in the health care industry as a provider for a long time and a real student of what's in these bills. you have looked at these things in detail, and so you know a lot of the flaws. i really appreciate you taking the time to point those out. mr. barrasso: well, mr. president, there are a lot of flaws in these bills, because

what senator enzi and i both hear when we go to town hall meetings, but also i had a telephone town hall meeting just the other day, is they say don't cut my medicare. when you look at the details of this bill, this is going to cut almost $500 billion. $500 billion from our seniors who depend on medicare for their health care. they also say don't raise my taxes. but taxes are going to go up across the board. every family is going to notice an increase in their cost whether it's through taxes, through their premiums. an increase in the cost in their lives in terms of how it's going to impact the care that they're going to receive. they say don't make my family pay more for health care. but yet, across the board people that look at this say they're going to end up having to pay more. so when senator reid brought this bill out, he said, hey, this is -- of all the bills i've seen, it's the best. well, to me, it is the best of the worst bills that i could ever see. this is just more of the same. it raises taxes.

and it's not just me speaking. if you read from the people who have had a chance to read this bill -- "the washington post," "new york times," others throughout the country, through our e-mails as well as from home -- higher taxes, companies would pay a fee, rely primarily on a new tax. new taxes, new fees and then cuts in medicare. it is beyond me that this senate -- that this senate, the united states senate -- is ready to tell the seniors of this country that they're going to cut $500 billion from the care that these seniors get in medicare. and that's a growing number of people. year after year more people are on medicare, but yet it's going to -- the cuts are going to be there. and the gimmicks, the budget gimmicks are astonishing. the price tag, the advertised price tag is an astonishingly large number. over $800 billion. you know, to get down to that

astonishingly high number, they've used quite a few gimmicks. you get taxes, you get medicare cuts, and then you get the gimmicks. i visited with senator gregg from the budget committee earlier today. i know he's going to be on the floor to discuss the gimmicks. one of the things they've done is basically hide the true cost of the bill, and the true cost of the bill is going to be close to $2.5 trillion over a ten-year span. and they've done it by putting in a whole new program here called the community living assistant services and support act. it's a new federal long-term care program. what happens in these long-term care programs? mr. president, they take in the money early on, and then they don't spend it until many years

later. but with the way they count money around here, they do kind of a ten-year score they call it. well, for the first ten years, they're going to be taking in all of this money, and then when it's time to pay the money out, that money is not going to be there anymore because they will have spent it on the increased costs of medical care because these bills do nothing to get the cost of care down. kent conrad, democrat senator from north dakota, you know what he called this part of the bill, the democrat bill we're going to be asked to vote on? he called it a ponzi scheme of the first order. he said it's the kind of thing that bernie madoff would be proud of. so that's a democrat talking about what's in this bill? what has "the washington post" said? it said it's a gimmick. it said -- "these are not savings that can honestly be counted on the balance sheet of reform." do we need reform? yes. do we need health care reform? do we need to change the system?

absolutely. but this is not the way to go. and senator enzi is here who has done a remarkable job as both a member of the finance committee and the "help" committee and he has been part of the markups for both of the bills and he@@@@@ @ something that was intended to help the american people, but that got taken out and thrown away in the dead of night. i don't know if senator enzi would like to comment on that,

but this is a senator who is working to improve the lives and the health and the pocketbooks of the american people and his great ideas are thrown away. mr. enzi: i would like to comment on that. in some unprecedented action by a committee, we agreed in committee on some amendments, and then when the bill was actually printed -- which it wasn't done for two months which i think was so that people couldn't actually look at it before the august recess -- at the end of that two months when it was finally printed, some of the things that had been agreed to were left out. a big one was a wellness program, an actual wellness program, one that works for safeways that has helped to cut their costs in the year by 8%. heard of anybody cutting their costs in health care? their program did. since that time, it has been held level because of what they were able to do with wellness programs. we got that wellness program approved. it -- we didn't get much

approved when we were doing that bill, but we got that approved, but when the bill was printed, that was left out. staff, without talking to any of the members, had taken it out. i think that's unprecedented around here, but that wasn't the only instance either. i'd like to -- to direct people's attention to the costs on this bill which the senator from wyoming has mentioned. as the accountant, i look at those and they say that they're going to reduce the deficit in the first ten years and even more in the second ten years. well, there are kind of two ways you can do that and one of them is to raise taxes. the other is to steal money from other people, which is what they're doing for medicare. that maybe means they are overtaxing, so that might mean they want to stick some other things in that will be spending. but is there anybody out there that thinks that you can do a trillion dollar new program and it won't cost a dime? i hope people are taking a look

at things like the wednesday editorial by the president of harvard who made some comments about how things are working. i hope everybody reads that. this is a good way for our nation to go broke. they're not in very good shape right now, but that's a good way to go broke. and there are a lot of gimmicks in this bill, too. i appreciate the senator from wyoming pointing that out and i assume the senator from new hampshire, who is the chairman of the budget committee -- the ranking member on the budget committee now and really has a handle on a lot of these gimmicks will share some of those, too. mr. gregg: if i could join this colloquy with my colleagues from wyoming. what a great state to have such two exceptional senators. first off i want to make a point -- and a lot of people are pointing at this bill. i have one here. the senator from wyoming has one and the other senator from wyoming has one. because it is real.

up until now, most of the debate that has been occurring around here has been media. a lot of it has been theater. some of it has been good theater, i hope, but it's been theater to a large degree. now we're dealing with something that's extremely real. every page, 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 intrusive and expensive bill. the senators from wyoming have been alluding to this, but it really is historic. they say it is historical. it is historic. never in my experience -- and i don't think really in any

experience has the congress taken up a 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 that has to do with health care. and the cost that this is going to create in the area of increasing the size of the government is astronomical. you know, we heard this number that this is an $890 billion bill. that's pretty big. $890 billion. i suspect that would run wyoming, the state of wyoming for a few years, maybe a century. the state of new hampshire i think would probably run for pretty close to a century. in fact, more than a century to be very honest with you. i don't think our budget is

is $8 billion yet. and so that's a lot of money, money, $897 billion or or $800 billion-plus. but that's not a real number. that's a phony number. that's a bait-and-switch number. that number is arrived at by claiming over a ten-year period that the programs that are initiated in this bill, which is a massive new entitlement, massive new entitlement won't start until the fourth and fifth year. in fact, the house bill is 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 senator from wyoming, the senior senator from wyoming was just talking about and the fees and the reductions in medicare, they start pretty much in the first year. so they've taken ten years of taxes, fees, and cuts in medicare and they have matched them against four or five years of actual spending.

they claim that they are in budget balance and that the bill only costs $890 billion, only. in fact, c.b.o. has scored this over the real period when all the programs are in place, and over that period, over that ten-year window, when all the programs are functioning that are created under this bill, all of them being federal programs, brand-new entitlements, extraordinarily expensive initiatives, well, when that occurs, this bill costs by c.b.o.'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, you 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 are a few gimmicks here on top of just that huge gimmick, this massive bait and switch, that this is a a $800 billion bill when in fact it's a $2.5 trillion bill. there are a lot of other games in here that deal with budgeting. i found one of the more entertaining ones: the fact that they take credit in this bill for creating a new program called the class act. a massive, massive new program, long-term care program. they take credit in this bill as that being a budget surplus item. how do they figure that out? well, because on a long-term care program, basically people in their 20's, 30's, 40's, even into their 50's, they pay into it. they are like -- it's like buying insurance under this plan. and so that money comes into the

federal treasury. what they don't account for is when those folks go into their long-term care facility and the money goes out. the money goes out at an incredibly fast rate, and the program balloons radically in its costs. they don't account for that. they just account for the years when people are paying in, and they claim that as surplus money that they apply to try to reduce the cost of the bill. so they spend the money. i mean, this is -- this is classic. first they take in the money and claim it as an adjustment against the debt that they're running up, and then they spend it so it won't even be available to pay for the program they claim they're going to fund with it. how -- it's just inconceivable. you know, bernie madoff is in jail, and whoever thought up this program and scored it in this bill, bernie madoff would

be proud of that person. i mean, he would say my type of guy! that's the way you do accounting. fake it. it's unbelievable. there are a whole series of these types of games in here. the states, the states are just going to be taken to the cleaners by this bill. the allegation that you're going to expand medicaid by 20 million to 30 million people and the states aren't going to end up paying a huge bill as a result of that? absurd on its face, absolutely absurd on its face. more importantly, when you expand medicaid by 20 million 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're reimbursed at 60% of the costs. who pays the other 40%, by the way? of the present medicaid recipients, who pays that other

40%? i'll tell you who pays it. mary and joe jones who are working down at the local restaurant and have health insurance, they pay it with their premium. bob and marie black who are working over at the local software company, they pay it with their health care premium. the 40% of medicaid that's not paid for by the government is paid for by people with private insurance, their insurance premiums go up because they're subsidizing medicaid reimbursements, because the hospitals have to get paid for the cost and they're only getting 60% of it from the government, so the other 40% is being picked up by the private sector. so when you expand medicaid by another 20 million 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 to do. it will force employers to drop

private insurance and push people over onto the public plan, and that when you get down to it is what this is all about. this is an exercise at having the federal government basically get control over all health care, and it's being done in a -- in an incremental way. they're 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 here is that the costs of private health care will go up so much, that private employers will start to drop their health care. they'll take the penalty rather than -- which isn't that high in this bill compared to what they have to pay for 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. but then down the road, congress will change this government plan a little bit, and they'll start to put price controls in just like they want to do in

medicaid. basically that will mean that people will get less products because as you put price controls in, you'll 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-controlled events. and you'll find delays because that's what happens when you move to a government controlled program that controls costs. government can only control costs by controlling price. done. the senator from minnesota is recognized. ms. klobuchar: thank you very much. mr. president, i'm going to focus for the next ten minutes on the issue of cost. i know many people have focused on really important issues like the fact that this bill will finally eliminate the limitations on preexisting conditions so that if your kid

gets circumstance you don't have to lose your -- gets sick, you don't have to lose your health care. the fact that people are going to be able to keep their kids onary health care until they're 26. niece are very important parts of this bill. the other thing that's very important for the people of my state and the things i heard about all over the last few months was the issue of costs and more affordable caivment and this is why. at $2.4 trillion per year, health care spending represents close to 17% of the american economy, and it will exceed 20% by the year 2018 if the current trend continues. hospitals and clinics are providing an estimated $56 billion nun compensated care -- in uncompensated care. in fact, peter o orszag wrote a piece for "the washington post" that highlights the fiscal importance of passing health care refume. one of the things he stlaid is "looking forward, if we do nothing to slow the skyrocketing

cost of health care, the federal government will eventually be spending more on medicare and medicaid than all other government programs combined." he notes that it's time to move toward the high-quality, lower-cost health care care system of the future. as you know, mr. president, coming from wisconsin, we know how to deliver high-quality, high-efficient care. dhow it in which is, which they do it in minnesota. they do@@@@@@@ @ @ @

premiums, health care premiums. now they're paying $12,000. that's an average. i know a lost small companies in minnesota that are paying a lot than that. but right now the average nationally $12,000. if we do nothing to bend this cost curveg the average family will be paying on an annual basis $24,000 for their health care 10 years from now. meanwhile, a new study found that small businesses pay up to 18% more to provide health insurance for their employees. we are taking about a backpack company up in two harbors, minnesota. the guy started a small company, now up to 15 employees. he told me for his family of four, he's paying $24,000 in two harbors, minnesota, for his family just to make sure they have health insurance. he said if he knew it would have cost that much way back when he started this company, he might not have started this company.

now they're providing high-quality backpacks for our troops. those backpacks would hav woulde existed if he knew it would have cost that. but he was an entrepreneur and we should reward that entrepreneurship. the american people know that inaction is not an option. if we do not act, costs will continue to skyrocket and 14,000 americans will continue to lose their health insurance every single day. we must keep what works and fix what's broken. now, let kneel you about some good news. it's encouraging news that the billy the senate -- the senate is going to start considering and our vote is 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's good news. we achieve these long-term savings bhaik our health care system more efficient, rewarding quality, improving patient

outcomes and reducing administrative spending and waste. most health care, as you know, mr. president, is purchased on a fee-for-service basis. so more defendan tests and more surgesries. according to researchers at dartmouth medical school, nearly $700 billion per year is wasted on unnecessary or ineffective health care. that's 30% of the total of health care spending. one study showed that if the hospitals of some of these inofficiate areas would follow the protocol that the high yow clinic-- --that the mayo clinic follows, we would save $50 billion in taxpayer money every five years for chronically ill patients. $50 billion every five years. that's just one example for one set of patients. that's what we do in minnesota, and we want that same kind of health care, that same kind of high-quality care. we want the incentives, incentives on the federal level that aren't there now, and

that's what we're seeing in this reform package. i'm very pleased that the value index that i proposed that was also cosponsored by senator cantwell of washington and senator gregg of new hampshire was included in the senate bill. this indexing will help reduce unnecessary procedures because those who produce more volume will need to also improve care or the increased volume will negatively impact their fees. doctors will have a financial incentive to maximize the quality and value of their services instead of the quantity. this is supported by the doctors in my state. linking rewards to the outcomes for the entire payment area creates the incentive for doctors and hospitals to work together to improve quality and efficiency. in too many places, patients struggle against a fragmented delivery system, running all over with their x-rays in the back of their car, seeing different specialists, not having someone in charge, not having the quarterback running the team. ink stettedinstead, having 20 we

receivers running this way and that. that's why we need this kind of ingratintegrated care. what you pay for is the result, the combination of service servt give you good results. that's what bundling is about. another good thing about this bill. hospital readmissions cost $17.4 billion. a study found that medicaid paid an average of $7,200 per readmission that was likely preventable. who wants to go back in the hospital if you don't need to? but one of the problems is, if you don't have those quality indexes in place, my state has one of the lowest hospital readmission rates in the country, but if you don't have that quality index in place, you're rewarding bad practices. we want to reward high-quality. put the patient in the driver seat. that's what we do with these provisions in this bill. i'm encouraged that the senate bill includes a provision that calls for reduced payments if you have preventable readmissions.

in this bill we work to -- at places like mayo clinic, a patient's overall care is managed by a one-stop shopping. to better reward and encourage this collaboration, we encourage the creation of accountable care organizations. that's what i hear from the people of my state and across this country. we want more accountability in this health care system. and you know what else accountability means, mr. president? accountability means better enforcement of medicare fraud. when the dollars are so tight, when people are having so much trouble ad fording their -- affording their health care, why do we want to waste billions of dollars on fraud? think about what that money could be spent for to make it easier for people to go to the

hospital. this bill and some eaflts that we're going to be -- and some amendments that we're gobbing proposing will bring us much closer to reducing that fraud to bring that fraud down to hold that's perpetrators accountable, increase criminal penalties. that's important. making sure we have direct deposit, a tbhail senator snowe and i have so that no one can start making out false checks and trying get the money that way. giving our law enforcement officers more tools to go after medicare fraud. we can save $60 billion. in today's "washington post," peter orszag writes "as we gear the home strerchtion the greater risk we run is not completing health reform and letting this chance to lay a new foundation for our economy and country pass us by." mr. president, i would tharg one of the most important things we can do and i know everyone is focusing on who pays and and what this provision say, we need change the delivery system. we need to reward that kind of

high-efficient care so that our big companies are able to compete with companies in other countries that have more highly efficient delivery systems so that our small companies are able to exist and multiply and that they're able to keep their employees on health care, so that individuals in this country aren't cut off just because their child gets sick. that's what this reform is b thank you very much, mr. president. i look forward to the vote tomorrow. i yield the floor. the presiding officer: the senator from arizona. mr. kyl: thank you, mr. president. mr. president, the whole point of health care reform is to bring down costs and to make health care more affordable for american families. so why have democrat leaders produce add health care bill loaded with provisions that will increase premiums? independent studies from the nonpartisan congressional budget office and the joint committee on taxation and even a study by the chief actuary at the department of health and hiewsm services confirm this, that the democrat plan will drive up

premiums and overall health care spending faster than in the absence of these so-called reforms. well, how is this sold? let me mention five specific ways. first of all, new insurance mandates and new taxes on the insurance industry. new insurance requirements and new taxes on the insurance industry will force premiums to rise for many americans, particularly the young and healthy. according to an independent analysis that studied the effect of the new insurance reforms and new taxes on the insurance industry, insurance premiums in my home state of arizona could skyrocket by as much as $2,619 per individuals and $7,426 for families. think of that, an increase of $7,000 -- $7,426 for families in my state. that's outrageous. what could $7,426 buy in arizona -- buy an arizona family? well, a lot of things. could pay for a year of tuition

at the university of arizona, could pay for a year and a half of groceries or nearly two years of utility bills, or it could pay for two years of gasoline. families have a lot of expenses and a lot of important ways to spend $7,426. they don't need the federal government intruding on them and dictating that that money has to go somewhere else. now, our friends on the other side of the aisle will say that they could provide subs disand, in fact, the -- subsidies and, in fact, the legislation will provide subsidies to help with this increased cost, but not every family will qualify. and the subsidies may not even cover the total increase in co cost. moreover, wheapts the point of raise -- moreover, what's the point of raising the cost of health insurance and then subsidizing a portion of the increase? you're still raising premiums. it's nonsensical to have a health care reform that makes families worse off and then gives them a government subsidy to help them make up for part of the cost. second, new mandated benefits will increase costs. under the reid bill, the government will require insurers

to cover a broad range of new medical benefits determined by washington, regardless of whether those benefits are actually needed by each individual patient. these additional benefits may help some patients, of course, but insurers can't provide them to everyone free. so the costs will be shared among everyone in the insurance pool, and that means increased premiums for many americans. in fact, the council for affordable health insurance estimates that the new mandated benefits would increase the cost of basic health coverage between 20% and 50%. that's the second way insurance premiums are increased. here's the third -- the third way. limits on plan types. under this bill, this reid bill, insuressers are limited to offering a total of only four specific kinds of insurance plans, so the low-cost, high-deductible plans that currently many families and individuals enjoy will be virtually eliminated. they'll have to buy more expensive plans, again, paying

more in premiums. whatever happened to getting to deep -- keep what you have? just as one size does not fit all, in this case, four sizes does not fit all either. here's fourth way premiums increase. the new taxes that are imposed on groups like medical device makers. according to the congressional budget office and the joint committee on taxation, a new tax on medical devices will increase premiums and increase the price of everything from wheelchairs to diabetes testing supplies to pacemakers, and it will be paid entirely by the patients. its cost, according to the joint committee on taxation, $19.3 billion over ten years. and this tax will hit cutting-edge technologies, such as c.t. scanners, replacement joints, and the arterial stints the doctors use during angioplasty. the tax will clearly stifle innovation. as the "wall street journal"

editorialized -- and i quote -- "this new tax will eventually be passed on to patients, increasing health care costs t. will also harm innovation, taking a big bite out of the research and development that leads to medical advancements." the fifth way, mr. president, which this legislation will increase the costs for the insureds is that it actually taxes the insurance plans themselves for the first time. so you buy insurance, you get taxed. the reid bill for the first time directly accomplishes this. as the independent joint committee on taxation told us, this new tax will increase the costs of health insurance for everyone since insurers will pass the costs along to their patients -- to the patient. this tax alone could raise some americans' premiums by $487 per year. because this tax is indexed to regular inflation rather than to health care inflation, just as with the alternative minimum t

tax, it could soon start hitting middle-income families. according to the former congressional budget office director douglas olsiegen, half of all families making less than $100,000 per year could end up paying this tax. so those are five specific ways in which this bill will increase your costs, the increase in the premiums that you pay for health insurance once this bill is in effect. we believe there are better ideas. republicans have proposed a variety of solutions to target specific problems and, in particular, the problem of cost. i specifically want to conclude by mentioning the republican health care alternative in the house of representatives. a majority voted it down but the truth is it would, in fact, lower premiums for individuals, families and small businesses. so contrast the house-passed bill, which increases premiums, the reid bill, which increases premiums, but the republican house bill, which would actually decrease premiums, and you'll

see republicans in the senate proposing similar ideas. according to the congressional budget office, under the republican plan, premiums would be $5,000 lower than the cheapest plan under the pelosi bill. small businesses too would see their premiums decrease by as much as 10%, again, according to the congressional budget office. those in the small group market would also see a 10% decrease under the house republican bill. again, according to the nonpartisan c.b.o. the house republican bill included such reforms as allowing states to sell policies across state lines. you've heard a lot of senators on the republican side talk about that. that would have enabled a thousand companies to compete nationally, and that helps to drive down the costs. medical liability reform -- this is a proven way to cut costs. in my state of arizona, texas, missouri, these states have all seen premiums go down because of medical malpractice reform.

health savings account, which puts patients in charge of their own health care by allowing them to save their health care dollars to spend as they choose, this, too, would have been strengthened by the house bill. and you've heard republican senators talk about that as a reform. there are many other ideas we have. we'll be talking more about those ideas as we go forward. but i just want to conclude my remarks about the reid bill, loaded with provisions that increase insurance premiums and to make the point that since, as i said in the beginning, the whole point of the exercise was to reduce health care premiums, the last thing we should be doing is adopting the provisions in the reid bill which will actually increase health care premiums. let's keep in mind that health care reform is all about making things better for americans, and this bill does not meet that a senator: mr. president? the presiding officer: the senator from maine. ms. snowe: thank you, mr.

president. as i rise this evening after months of effort and countless hours of meetings, discussions, markup 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 about one of the most complex and intricate undertakings that the congress has ever confronted. instead we're dprontd with procedural gyrations that are as baffling to those outside the beltway as they are to those in some of the most critical elements in health care reform. as one who worked constructively to forge solutions to this endemic problem plaguing our health care health care system, i think it is imperative to assure affordable health insurance to the people of this country. it must be done so in an effective and common sense, and bipartisan way. it matters what's in those two thousand pages. that's why i find it deeply

disconcerting that the senate in its artifically generated haste to begin debate has resorted to this procedure before us, to proceed to an empty shell bill, which is replaced with actual health reform legislation, there is -- the two bills passed by the senate finance committee and the health, education, labor and pension. mr. president, the reality is beginning our deliberations in the senate with tactics rather than transparency does nothing to enhance the credibility with the american public at a time when so many are already understandably wary of the speed and direction of congress on this transformational issue. as i had mentioned on numerous occasions, it took a year and a half to pass medicare to cover 20 million seniors. so we simply cannot address health care on a legislative fast track and i'm truly disappointed that we're commencing this historic debate

on one of the most significant and pressing issues of our time with a process that has drawn a political line in the stand and foresaled the ability to arrive at a consensus on some of the crucial elements of health care reform. again, mr. president, i arrive at this moment as one fully emersed in this issue with senate finance committee process, the so-called group of six with the committee we were engaged in deliberations for almost four months intensively on a weekly basis. recognizing the pearlless state of -- perilous coverage of -- state of being health care coverage and the health care system that must be solved. 10 million more americans have lost their insurance since the last attempt at health insurance reform in 1993. today 75 million americans are burdened by inadequate or nonexistent coverage. over the last decade insurance premiums risen by 131%.

if you look at this chart, 131%, contrasting that with growth an wages of 38% and inflation 28%. that's what happened over the last decade when it comes to health insurance costs. in my home state of maine from 2001 to 2009, we've been hammered with a stunning 271% increase in average health insurance premiums in a small group insurance market. it's been estimated by the business roundtable that we can expect premiums to grow 166% by 2019, absent any reform. so given this current -- its current trend health care costs will continue to grow and more than double the rate of inflation, further driving up premiums, sending the entirety of the entire health insurance into a death spiral. health care could double to $33 trillion. the average cost of a family-based plan will reac reach $30,000 a decade from now if we fail to act.

even as everyone has differing opinions on how to address this issue, virtually everyone that i've encountered agrees the system is broken. in recent poll that asks how much if at all should the health care system in the united states be changed? an astounding 38% said -- 4% a great deal or moderate amount. 2% of all small business owners want congress to enact some kind of reform and no wonder as small businesses 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 after problem is what really brought us together in the senate finance committee in the so-called group of six that i commend chairman baucus and senator grassley as well. chairman baucus wanted to convene on a bipartisan basis earlier this year. it was the only bipartisan effort any committee in the house or the senate and we met more than 31 times to debate

policy, not politics in attempting to reach a bipartisan consensus on reform legislation. there really reflected the kind of extensive, meticulous process that an issue of this magnitude requires because the american people understand intuitively when you debate future of one-sixth of our economy in a matter of such personal and financial significance to every american, we shouldn't be railroading solutions along partisan lines. and to that point and a cautionary point for all of us a recent gallup poll showed that a majority of americans are bind them. without question people are already apprehensive about congress's ably to reform the system with gallup also finding that 66% of americans believe their member of congress doesn't have a good understanding of the issues involved in the current debate. well, mr. president, if there's one thing i've learned from my more than 30 years of legislative experience, is that the only way to allay people's

fears is by systematically working through the concerns, the issues and the alternatives. in fact, it was an aheerns to that that led up -- led to the finance committee markup and reported out of the committee that i supported. far from perfect, it produced a watershed bipartisan market reform, navigated the ideologies on both end of the political spectrum, building on the system and fostering choices, competition, and coverage and change, the accelerating cost curve of our health care spending. at the same time that was but one, albeit, significant step in the process. as i ahead in my remarks at the conclusion of the markup, it would be imperative moving forward that a course of action give deference to the scope and complexity of the issue. and there should be an inclination by the majority to earn broader support. the bottom line is policies that will affect more than 300 million people essentially

should not be decided by partisan one-vote margin strategies. thinking back over this last century, just consider for a moment social security, civil rights, or medicare could have been as strongly woven into the fabric of our nation had they passed by only one vote and on purely partisan lines. instead, as you can observe from this chart, these votes all occurred during a time when democrats controlled both the congress and the white house. so security -- social security passed the senate with 64% of republican support, 79% in the house, civil rights, 82% in the senate, in the house 80%. medicare would have passed in 1965 the senate republicans 41%, the house 50%. so those were significant bipartisan support. because it engendered a process of a consensus based approach, mr. president. those are not only impressive

numbers illustrating the strong bipartisan support that landmark legislation garnered in the past, but it would be nothing short of myth logical in today's political environment. at a time when we're supposed to be in a world of post partisan politics, we're facing a vote along partisan lines. when it comes to the subject at hand, the most consequential health care legislation in the history of our country and reordering $33 trillion in health care spending over the coming decade, surely we can and must do better. in a recent column, david broader captured the path we should follow, he wrote that scholars will make the point when complex legislation is being shaped, the substance it likely to be improved when both sides of the aisle contribute ideas. end quote. i couldn't agree more. when it comes to procedural gymnastics designed to move us to a purely partisan bill as quickly as possible on an issue as monumental as health care,

that only serves to enhance public cynicism when congressional approval ratings house oversight committee in the 20th percentile range, after a grand total of two amendments and 12 hours and 32 minutes of debate on almost 2,000 pages of a document. consider that it has been more than a month when the finance committee completed its work on legislation, even as it concluded that work needed remained to be done. even though there was 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 reform bill on a procedural motion designed to prevail not on policy grounds but on partisanship. because the result is that this procedural vote tomorrow 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, including a public option plan that was not included in the final finance committee legislation. mr. president, i think we all appreciate the impetus of the public option and that is a fundamental ms. trust of the insurance industry and that's a sentiment i strongly their as -- share as many have been victimized of the regrejus practices of denying coverage because of preexisting conditions, rescinding coverage because someone is sick, or denying based on one's gender. in my home state of maine that mistrust couldn't be more profound with two companies controlling 88% of the market resulted in not only the inconceivable increases in premiums as i described earlier, but forced thousands in my state to purchase plans with a remarkable $15,000 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 maine that dominate the market, it's become one of the most popular plans by virtue of its affordability, by virtue of the fact that it's all people can afford in the state of maine and certainly among small business owners. well, that is unconscionable, that is unacceptable when we think of their basic coverage ofening $15,000 deductible for an individual and $30,000 for a family. that is not what you would describe as reasonable coverage. in response to that, i worked to implement principles on which many of us have been adamant. ending flag rantly unfair practices so no american could be denied coverage, no policy could be rescinded when illness strikes, no plan could be -- and to address the dith of competition -- derth of competition, we created health insurance exchanges to become a powerful marketplace for creating competition and lowering premiums by bringing in

potentially 30 million new customers, which c.b.o. believes could reduce costs up to 10%. that's not even talking about the taxpayers and the subsidies. so clearly the exchanges will have a significant effect on lowering prices through administrative changes and competition. i would argue that we have taken these groundbreaking steps to alter the competitive landscape and i strongly believe that insert ago 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 a highly competitive environment we must have to make industry deliver lower-cost coverage. just when we want to provide americans a wide variety of competitive plans, can inserting a public option into smaller states such as my own actually encourage new plans to enter those markets or will we see just a pair of plans, an

existing dominant insurer, and the government? and is that limited option really the choice americans want? and when we also consider the difficulties we have@@@@@@bb resubmit their bid. at that point, if affordable plans still aren't offered, a federal fallback is provided without delay.

this will provide the certainty that affordable options exist so that no one falls through the cracks while c.b.o. also reports that the threat of a fallback in a state would also pressure industry to lower premiums. in stark contrast, the bill we will consider on the floor not only incorporates a public option but also a state opt-out provision that will allow any state at any time to drop that public plan for any reason whatsoever. irrespective of whether the residents in that state actually have access to affordable plans. so if affordability is our goal -- and it certainly is -- then will someone explain to me exactly how an indiscriminate opt-out achieves that end when a state could decide ton a political whim it won't allow a public plan and leave its residents without affordable choices? mr. president, it simply makes no sense. rather, we ought to take the safety net approach at the forefront, as we did in medicare part-d, which spurred

competition and as a result it never was triggered and to ensure affordability, not just in some states but in all 50 states. i happen to believe that a person's zip code should never dictate their ability to access affordable health care coverage. the public option provision is of paramount concern. at the same time, in examining the proposed legislation, it is not my only concern. there are proketies to what we are doing -- there are practicalties to what we are doing and this legislation misses the mark in addressing the needs of mainstream america. just yesterday the ffib release add statement opposing the bill, the national federation of independent businesses saying that enactment of it would make health care for small businesses more expensive than what they can afford today. a disaster for small business is how nfib describes it. now, that's coming from a group that supported the senate finance legislation and has been a constructive voice throughout

the debate, so that ought to grab our attention. furthermore, in the finance committee, i insisted that c.b.o. provide an affordability analysis of what a silver plan would like like, for example. and i used that analysis to do my own modeling on all of the plans. it helped me to assess premium affordability and render an informed evaluation about the approach overall. for the measurable force now, the c.b.o. has yet to address the question of a affordability. so how do we go inured this legislation considering when we don't even understand some of the most fundamental aspects of this legislation? none of us can tell with adequate specificity at this point what an average plan will look like, which is what americans are going to be asking us. what are the premiums? what are the deductibles? what are the co-pays? what are the coinsurance requirements? these are questions that americans rightfully will ask and are asking.

what will reform mean to them? what will it look like? what will they pay for? those are answers to the questions we do not have, mr. president, because we haven't had a chance to evaluate this legislation, and we're going to have a vote tomorrow night to move along party lines, to ram it, to jam it, and that's what i'm hearing from my constituents. they're saying, do you really know what's in knows 2,000 pages? asking the right questions with great validity. they feel that their lives are out of control because they see washington. they think washington is out of control, because we don't have a profound understanding of what we're doing. that's why it took so long in the finance committee for four months t wasn't enough to be immersed in intensive discussions and deliberations. and there were artificial deadlines that were set time and time again, from march to angers to may, to june, to july, august, september, october. it's gone on -- christmas now is the deadline. state of the union is a deadline. why not just try to get it right? and i've heard time and again

people say, we just got to do something. well, what i'm hearing from my constituents and many earns is it's not -- and many americans, it's not just doing ssmght it's doth right thingment every line in this 2,000-page document matters because it is going to have profound ramifications and implications. there are unintended consequences. it is not just about cobbling something together in the dark of night. it's about making sure those mechanics work. and what it's going to do and what it's going to cost to the average consumer. what it's going to do to small businesses. what it's going to do in its time of, you know, the perilous economic climate. we must ensure that affordable coverage options are available to every individual and small business. i get back to the affordability question, mr. president, because that is the heart and soul of this matter. we have to be assured that we are going to provide affordable health insurance plans. and that's why i recommend it.

and i am going to push that through the amount process, that we open up the young, invincible, the catastrophic plans as described in the majority leader's bill. we should open up to everybody. it should be available to those under the age of 30. but open it up so that no one has to buy up in a more expensive plan if they don't choose to. i have also advocated national plans which i include in the finance bill, as small businesses should be able to purchase plans with uniform benefit packages sold across state lines, which is vital to enhancing competition and increasing choices for consumers, portability, driving down premiums, and in fact would drive down premiums by more than 12%. i'll be introducing an amendment because regrettably it's not in the bill that we'll be considering, that states cannot opt out of these national plans because these plans should be

able to be available to every state in the country. finally, mr. president, with our mound ever mounting deficits and struggling economy, if anything, we should be scaling back the copscope of health care reform wherever possible. we should take our u cues from e american people. i'm disturbed the legislation that we will be considering will increase medicare payroll taxes by $54 billion over the next ten years. that is diametrically opposed to the tact we should be taking. practicality should be the word of the day. then we have the insertion of a new costly program the so-called class act. i understand its laudatory goals. but it's going to be providing long-term care. it's obviously very important. and proponents are pointing to the fact that it will raise $72 billion over the first ten years. but this is in fact a shell game

as it collects premiums in 2011 but doesn't begin paying benefits until 2016, near the end of our current budget window. c.b.o. has concluded in the decade following 2029 the class program will begin to increase the deficit. and how much sense does that make to create this new bureaucracy, this new program that will begin providing similar benefits just four years before the social security disability insurance trust fund is expected to be exhausted, as opposed to first fixing that program? mr. president, i intend to offer amendments as legislation is considered on the floor and the pending amendment process will be a true test of whether there is a will to improve this legislation in a nonideological, bipartisan manner. on that note, i hope the past is not a predirkt of the direction we are headed because in the final analysis, no one has a

monopoly on good ideas. it is not a liberal idea, conservative idea. is it a good idea to exriewf this legislation because that's going to be our singular goal to improve the legislation that will be before us, irrespective of who is offering the amendment. or who has the vote, whether it is the 60 votes. that is my concern, mr. president, that if it's going to take 60 votes to undo or change those provisions that are essential to be modified. the american people have expressed the shock and legitimate note of caution as we pursue health care reform, especially during these challenging economic times. it is a message we would do well to reflect. so let the tone we set for this unprecedented debate rise to the level of a problem we have a responsibility to resolve. this is already an undertaking of historic proportion. lit us ensure that this isn't -- let us ensure that this isn't the only historic legislation,

mr. president, passed in the last half-century on purely partisan lines. thank you, mr. president. and i now