increase access. we don't need a government-run plan to achieve that objective. i will be offering an amendment that will allow states to opt-out without penalties of this plan if it passes. not just the government part of the plan, but all of the harmful measures. we should be providing choices, not forcing people into government plans. states should not be forced to participate in the government plan. they should not be forced to subsidize it. they should not pay for a plan through increased taxes norman dates on -- nor mandates on business. we want businesses to grow. we want businesses to hire people. we want to have jobs created. this bill is a job killer. has anyone noticed that we have one of the worst resessions since the great depression in this country?

that three million people in this country -- over three million people have lost their jobs. 300,000 of them live in my home state of texas, and that's in the first part of this year. and, yet, we are talking about a bill that is going to increase mandates on business. and surely we'll reduce the number of people that can be hired. there's a disconnect here, mr. president. -- mr. president, that we need to put back together and talk about options that can work, that can give more people health insurance coverage at a reasonable price and most certainly not be job killers with mandates and taxes on small business that already are having a hard time. staying afloat, creating jobs, and providing health care for their employees.

the first amendment that we will vote on tonight is the mikulski amendment that has to do with breast cancer screening and other preventive services for women. senator mikulski and i have worked together on women's health issues for a long time in this body. two years ago we champ beyond the reawth -- champ beyond the reauthorization of the national breast and cervical cancer early protection program which provides screening and diagnostic services. so we know how important it is to address women's health care issues. and i was in complete disagreement with this new task force recommendation on mammograms and the need for mammograms for women under the age of 50. but i am very concerned that with the recent recommendations of the task force and how this -- this health care bill that's before us relies on the task

force, that the amendment is not going to do anything that solves that problem. the health care reform bill relies on the task force 14 times and it even allocates money to pay for advertising the task force recommendations. but this amendment does not address the problem. rather than severing the ties with that task force so that it will not become the norm, the amendment now allows yet another government agency, the health resources and services administration to interfere with the relationship between a woman and her doctor. so now the decisions will be dictated by both the task force and the health resources and services administration. so instead of letting doctors and their patients make the decision about when a woman

needs a mammogram, we have now not one government task force, but two that we will have to have intervened in that decision. oh, my gosh. mr. president, that does not make any kind of common sense. while i agree with senator mikulski about this great importance of preventive care for women, i disagree with this approach because it still injects a government agency or task force into the decision that is going to determine whether women have access -- easy access, full access to the health care of their choice. the second item that we will be considering after the mikulski amendment and the murkowski

amendment, besides senator mikulski's, is the mccain motion. the mccain motion is going to strike the medicare cuts from this bill. his motion, which i certainly endorse and support, would send the bill back for a rewrite. it would send it back to the finance committee with instructions to give us a new bill that does not include half a trillion dollars in medicare cuts. a bill that would not be paid for on the backs of our seniors who we should be protecting. as i mentioned previously, the bill that is before us would cut nearly half a trillion dollars dollars, $500 billion from medicare. it will not make it stronger. it will fund more government spending, more government takeover in our health care system. health care reform should not mean slashing medicare by

cutting half a trillion dollars from seniors' care. this is not reform, mr. president. mr. president, if we can support the mccain motion to go back to the drawing board and look for a way that we can have a bipartisan bill that would have republican input as well as democrat and agree to step-by-step reforms that would increase access, reduce costs and not take away choices of seniors and certainly not have a government takeover of health care, then i think we could do something -- produce something that the president could signed the american people would embrace. right now, mr. president, everyone that i talk to in texas is scared to death. they're scared to death of this big government takeover of our health care system because they know that when government gets involved, that we're not going to have the quality that we have

known in the past. that the jobs are not going to be in the private sector. that we're not going to have the choice. and when the task force came out all of a sudden when this bill was before us and when this bill relies on this task force 14 times to make the recommendations that would determine what the coverage is of the government plan, all of a sudden we're starting to say women don't need mammograms before the age of 50 when we've always said it was after the age of 40. and after the age of 50, that with the doctor's input, that it generally would be an annual basis. the former head of the red cross and many of our health care

agencies and task force, bernadine heely said that that will kill women if we don't have early detection. early detection is all we have for breast cancer right now. we don't have a cure. we only have early detection as a way to fight breast cancer. but all of a sudden the task forces that relied on by this bill says we don't need mammograms before the age of 50 and after the age of 50 every two years, not every year. and after the age of 72, not at all. now, mr. president, that's not health care reform. that's not what the president promised and it is certainly not what congress ought to ascent to do. we can produce health care reform. we can lower the cost. we can give people access.

we can give people choices. and we don't have to mandate taxes and hurt business in this economic climate to do it. we have the capability to do something right. and if we pass the mccain amendment, we can go back to the drawing boards and do this right. that is the most important thing that i hope we will do this week in the united states senate. -- senate for the american people and they deserve it. thank you, mr. president. and i yield the floor. the presiding officer: the senator from connecticut. mr. dodd: mr. president, i'm going to ask consent, if i may, that i be allowed to speak for 15 minutes and at that time include a colloquy with my colleague from state of minnesota. the presiding officer: without objection. mr. dodd: i asked my staff to notify me. i want to address a couple of issues. about this debate on medicare cuts an savings. let me -- and savings. let me make a point to my

colleagues. about a year ago the bush administration sent us a budget. and according to the congressional budget office, again, and senate budget committee, the proposals in the bush administration's budget of last year alone called fo for $481 billion in medicare savings or cuts. it was not in the context of a health care bill. that was part of a budget proposal. so there's $4 1 billion, according to the c.b.o., just last year. going back to 1995 to 2005. this is literally 12 months ago, that was the proposal. in the context of an overall reform of the health care system in which we're trying to achieve savings to make sure that dollars are going to go farther and go for the things that are needed, our proposal calls fo for $335 in savings over the next seven years. people need to understand what we're talking about here. that is the difference. so a year ago $481 billion and no health care proposal. just to get to the budget

proposal. here we are in the context over 10 years of trying to put this bill and this idea on a more solid footing. the national committee to preserve social security and medicare representing millions of our fellow citizens wrote a letter to the united states senate, every member here, dated december 1, 2009. senator harkin earlier put the entire letter in the record. i'm going to ask that just one sentence here signed by barbara kanelli, the president and c.e.o. of this organization. in this one sentence -- quote -- "not a single penny of the savings in the senate bill will come out of the pockets of beneficiaries in the traditional medicare program." end of quote. now this is an organization that does not bear a political label. it doesn't represent democrats, republicans, independents. it merely spends every hour of every working day assessing what

happens to social security and medicare. that's all they do. although do -- all they do. believe me when i tell you this organization would not make a statement like that if it were untrue. i know the organization. i know the people involved. they're highly critical of democrats and have been when they think we've gone too far in various areas. they state categorically what this bill does to medicare. and so i ask, mr. president, that -- that that -- i will ask, in fact, once again that that letter be included in the record once again. the presiding officer: without objection. mr. dodd: secretarily or thirdly, i want to, if i can commend the senator from maryland, senator mikulski. a lot has been said about her proposal dealing with women's health. think of these two statistics as we try to get this right here. less than half of the women in the united states have the option of obtaining insurance through a job. less than half. they're forced to either purchase expensive insurance in the individual market or being dependent upon a spouse to

provide health care. right now today and whether you're a democrat, republican, conservative, liberal, whether you live in connecticut, texas, or minnesota, consider this, a healthy 22-year-old woman, mr. president, can be charged insurance rates 150% higher than a 22-year-old man in a similar condition. our bill before you ends that. ends that. if you defeat the mikulski amendment or recommit this bill, remember tonight or tomorrow when the vote occurs, that that 22-year-old woman and that 22-year-old man have a differential of 150% in health care premiums. that's what's happening in this very hour. the mikulski bill changes that as well. the last thing, and i will turn to my colleague from minnesota, just to remind our colleagues, again, what senator baucus has done with his committee and the finance committee, when we did in the "help" committee to provide some really meaningful advantages and help to people

across this country immediately. one, our bill will provid provide $5 billion in immediate federal support to provide coverage to uninsured americans with preexisting conditions. coverage under this program will continue until the new exchanges are operated in the next few years. secondly the bill creates immediate access to reinsurance for employer health care plans providing coverage for early retirees. again, this will help protect coverage while reducing premiums for employers and their retirees. the bill also reduces the size of the doughnut hole immediately by raising the ceiling in initial coverage by $500 in 2010, immediately. this will guarantee a 50% price discount on brand named drugs and biologics purchase bid low-income and beneficiaries. that's immediately. fourth our bill will offer tax

credits immediately to small businesses to make employee coverage more affordable. that's not a year or two or three from now. that's immediate, mr. president. that's up to 50% of the premiums will be available to firms that choose to offer the coverage as a result of the tax break. fifth our bill will require insurers to permit children to stay on family policies until age 26. these are the immortals. right now it ends at 23. this bill extends it to 26 immediately for those who have families and those staying home longer. our bill would require coverage of prevention of wellness benefits immediately. exempt from these deductibles and other cost-sharing requirements. not a year, not two, not three, immediately if this bill becomes law. and sixth, the bill would prohibit insurers from imposing lifetime limits on benefits and would restrict the use of annual

limits as well. and this bill also would prohibit group health plans from establishing any eligibility rules of health care ronch that have the effect of discriminating higher wage employees. we also in this bill establish standards for insurance, overhead to ensure that premiums are spent on health benefits. we also require public disclosure of overhead and benefits spending and require premium rebates for insurers that exkeyed established standards for overhead expenses. lastly, we enable the creation of a new website to provide information on and facilitate and inform consumer choice of insurance options. there are other immediate benefits of this legislation, but i think it's important as we discuss this bill that you understand there are substantial and meaningful improvements. we have debated this bill. we have debated these issues for months and months on end, mr. president. the time has come to act, to act, and that's what we are proposing with this legislation. with that, i appreciate the

indulgence of my colleagues from minnesota but i want to yield to him for any additional comments he might want to make in this area. mr. franken: thank you, senator dodd and thank you for your leadership on this bill. i want to talk about senator mikulski's amendment. first, just a little bit about some of the claims that have been made on the floor today about medicare. and senator dodd just pointed out that in the bush budget, the last bush budget, there was a bigger cut in medicare, but not in the context of any kind of health care reform. now, senator baucus said it so well about what part of these cuts are. they are to hospitals because -- and the hospitals are fine with it. as he said, they are not jumping up and down exsitedly about it, but why are they fine with it? because it comes in the context

of health care reform and we're covering 30 million more people. what does that mean to the hospitals? that means when these people come into the emergency room, they have coverage. the hospitals get paid. that's the context in which we're doing this. whereas when president bush was proposing that -- those kind of cuts or savings or whatever you want to call them, they were not in the context of insuring 31 million more people who when they go into emergency rooms for the most inefficient care possible and won't be now, we're costing every american family family $1,100 in insurance. you're comparing apples and oranges, folks. we're doing so many things, and senator dodd just talked about what some of the things this bill does.

i want to talk about senator mikulski's amendment because women are among the most severely disadvantaged in our current health system. right now, health insurance companies can and do discriminate against women solely on the basis of their gender. right now, it is legal in many states -- in many states, not all states. this is why when you're talking about getting health insurance from another state, you've got to be careful. in minnesota, we have high regulations. in other states, you don't. in many states, it's legal to charge women higher premiums or deny them coverage at all if they have had a c-section. it's a pre-existing condition.

if they have been the victim of of -- of domestic violence in many states in this country, an insurance company can deny a woman coverage because she has been the victim of domestic violence because it's considered a pre-existing condition. well, that's just wrong. and i'm immensely pleased that under this bill for the first time women will have access to comprehensive health benefits, including maternity care without having to pay more than their male counterparts, but we can do even more for women's health in this country. senator mikulski's amendment to improve the bill and making sure that women can get preventative screenings they need to stay

healthy. most importantly, the amendment will make sure that women have access to these life-saving screenings at no cost, so it doesn't interfere with a woman and her doctor, as my distinguished colleague from texas just said a few minutes ago. it makes these screenings available at no cost. why is this important? because right now, women are delaying or skipping preventative health care because they can't afford it. that's not just bad for women's health. that's bad for our system because it drives up costs unnecessarily. even in minnesota where we generally do a good job with health care, there are women in my state right now who are not getting the care they need. they're skipping their annual exams because they are uninsured. and women who are uninsured are twice as likely not to get the

care that they need. other women in minnesota simply can't afford the care -- the coverage they have now. just since 2007, the number of women who have delayed or avoided preventative care because of cost has doubled, and the economic crisis has only made things worse, but the economic situation is no excuse. the reality is that women are foregoing preventative services that could save their lives because of the way insurance works now. and make no mistake what that is about. from 2000-2007, health insurance companies saw their profits increase 428%. and women are foregoing preventative measures that could save their lives. is this the kind of country we

want to live in? now, there was some good news yesterday. the congressional budget office confirmed what many of us already knew, that with the insurance market reforms and subsidies in our bills -- in our bill, women will be able to purchase better coverage at lower costs than they would be paying without the bill. that's huge. and with senator mikulski's amendment, we will go even further, guaranteeing that women receive preventative care when they need it without barriers. these screenings catch potential problems like cancer as early as possible. this saves lives and, by the way, it saves money. for example, cervical cancer screenings every 3-5 years could prevent four out of every five

cases of invasive cancer, and regular screenings could prevent more than half of the cases of infertility. senator mikulski's amendment will give women the care they need when they need it. this is a huge, huge step forward for justice and equality in our country. it's also a top priority for me that health reform includes other -- another crucial women's health service, access to affordable family planning services. these services enable women and families to make informed decisions about when and how they become parents. access to contraception is fundamental. it's a fundamental right of every adult american, and when we fulfill this right, we are able to accomplish a goal that we all share, all of us, all

sides of the aisle. the presiding officer: 15 minutes -- 15 minutes has expired. mr. franken: my apologies to senator dodd. i guess i -- as a freshman, i don't -- i'm not necessarily familiar with all the rules. i think that means i must yield the floor. is that right, mr. president? the presiding officer: that's correct. mr. franken: in that case i do to my gd friend from texas. mr. baucus: mr. president, i don't think there is a time limit here. mr. dodd: i made an agreement. i suspect we'll have a lot of time to talk about this. i appreciate the comments of my colleague from minnesota. very well said. mr. franken: thank you. the presiding officer: the senator from texas. mr. cornyn: mr. president, i want to talk principally about the medicare cuts in this bill and make sure people understand the context in which this takes place and what it means in terms of benefits for seniors.

there has been a lot of parsing of language here in a way that i think can perhaps obscure what the real impact of this -- of these proposals are. but first let me just say there is broad agreement that our health care system needs reform, but i thought the purpose of the reform was actually to lower costs and make it more affordable, not raise premiums, not raise taxes, and not cut medicare benefits. so i would say again to our friends across the aisle no one wants the status quo, but it's clear that our friends across the aisle are not interested in any proposals from this side of the aisle as demonstrated by the party-line votes in the "help" committee and the finance committee and the product coming from the house of representatives. this is simply too important to do on a purely partisan basis,

yet that seems to be the intention of the majority. the american people want us to get this right because they understand that this impacts 17% of our economy and affects all 300 million of us. this is -- this is important to them, and as they have watched these debates and proposals, as they have learned more about them, it's no mystery why public opinion for these proposals have dropped like a rock. they've dropped like a rock. first of all, on costs, they realize that -- that the proposals as made masked the true cost of this bill and claimed there was celebration when the bill came in under under $900 billion. well, forget the fact that it didn't actually go into effect until four years into the budget window, the ten-year budget

window, so that was only for six years of implementation, and never mind the fact that it didn't include reversing the 23% cut in physician payments that goes into effect at the first part of next year unless congress acts. that was left out intentionally to make this look cheaper than it really is. the senate budget committee has pointed out that this bill, fully implemented, would cost the american people people $2.5 trillion. now, i have constituents who ask me do you know what a trillion is, because they say i don't know what a trillion is. we used to talk about a million dollars being a lot of money, then a billion dollars, now we're into trillion. hence the bumper sticker, don't tell congress what comes after a trillion, for fear that we will spend it. this bill written by the majority leader behind closed

doors increases taxes by nearly half a trillion dollars on american families and small businesses during the worst recession we've had since the great depression. unemployment is 10.2% and perhaps headed higher, yet what this bill proposes to do is make it harder on businesses to retain employees or perhaps maybe someday to hire employees and to bring down that unemployment rate. this is a job-killing bill. that's why the american people, the more they learn about it, like it less and less and less, and i predict that the longer this debate goes on, the more they learn about it, the less they will find to like about the bill for that and many reasons. this bill also, according to the congressional budget office, increases health insurance

premiums by $2,100 for american families purchasing insurance on their own. now, if you're fortunate and you're in a large group coverage, it's a little better than that, but for those who are not -- and there are millions who are not -- it increases the cost of their insurance by by $2,100 a year. but i want to focus primarily on the cuts in medicare. now, when our colleagues celebrate the fact that this comes back budget neutral, let me just explain the mystery. that means you've raised taxes so much and you've cut medicare benefits so much, you can claim it's budget neutral, but i dare say that's no cause for celebration. in order to create a a $2.5 trillion new entitlement program -- and that's what this is, a new entitlement program at a time when the unfunded liabilities of our current entitlement programs go somewhere into the $40 trillion to $60 trillion range -- this bill actually cuts $465 billion

in payments to medicare. -- from medicare, i should say. these cuts include $135 billion to hospitals. $135 billion. $120 billion from 11 million seniors on medicare advantage, including half a million -- or let me be more precise, 523,000 texans who depend on medicare advantage are going to see a cut in benefits because of this proposal if it passes. $15 billion will be cut from nursing homes. $40 billion will be cut from home health agencies, and and $8 billion from hospice care. you can try to parse those words and to say we're really not cutting medicare, but we are cutting medicare advantage, and indeed the obama administration's own actuary at

the center for medicare and medicaid services said medicaid cuts of this size would hurt seniors' access to care for several reasons. first of all, let me start with medicare advantage. well, medicare advantage provides benefits over and above medicare fee-for-service. but i think we need to understand that medicare fee-for-service in my state, last time i checked, 42% of physicians will not see a new medicare patient because the payment rate is too low for the doctors to be able to break even or maybe perhaps earn a small profit. 42% of medicare patients are denied access to a doctor in my state because medicare payments are so low. and so, what we did a few years ago is pass the medicare advantage program, which was created to give seniors choice. in other words, there's been so much celebration of the public option or the government-run plan, well, we have a

government-run plan now. medicare fee-for-service, which has, depending on where you read, somewhere between an 8% to 12% faulty payment rate. in other words, it pays somewhere around 7.8% to 12.4% of bills it does not owe to people who do not deserve it, diverting that money away from payment for beneficiaries. so what we decided to do a few years ago was to give medicare beneficiaries a choice, something that i thought we all were for, a choice that provided better care coordination and better benefits. today 11 million seniors, including the 532,000 i mentioned in texas, have chosen medicare advantage. but this bill if passed in its current form will take away health care benefits from those 11 million seniors on medicare advantage by cutting $118

billion from the program. during the finance committee markup, the congressional budget office acknowledged that medicare advantage cuts would mean fewer services like dental or vision. senator mike crapo asked this question. he said -- quote -- "so approximately half of the additional benefit would be lost to those current medicare advantage policyholders?" the congressional budget office office director doug elmendorf said -- quote -- "for those who would be enrolled otherwise, under current law, yes." so approximately half of the additional benefit would be lost to those current medicare advantage policyholders. what happened to the president's promise that if you like what you have now, you can keep it? this is another example of a promise that that breaks under this bill, in addition to the $2,100 per-family premium

increase for those who buy their insurance on the individual market. despite the fact that this bill cuts $465 billion from the medicare program, it also fails to deal with draconian cuts that will go into effect in january unless congress acts which will further ensure that seniors will be less likely to be able to see a doctor in 2012. we all know this is sometimes called the doc fix, but this is basically a misguided decision congress made back in the late 1990's to cut provider benefits thinking that they could do so and it wouldn't have any impact on access to care. but what it's done is while, on the one hand, congress can stand here and say we've kept our promise to seniors by providing medicare coverage, seniors are finding it harder and harder and harder to find a physician who

will actually see them because of those low reimbursement rates. and this bill does nothing to cut 23% cut in those benefits in 2012 which will have a extremely negative impact on seniors' ability to see a doctor. we know that the majority leader tried on a stand-alone bill to address this earlier, but it wasn't paid for. and on a bipartisan basis, senators in this body rejected sending a bill for $200 billion more to our children. we said we need to be responsible and to pay for the bill. then the president said health care reform would be paid for by dealing with waste, fraud, and abuse of medicare, but that's not what this bill does. the congressional budget office says the rebill only saves $5.9

billion from reducing waste, fraud, and abuse. $5.9 billion in a bill which over full ten years of implementation will cost the american taxpayer $2.5 trillion. instead of cutting medicare, we should be addressing this problem, though, and we know it's a serious problem. the obama administration found that there was at least $47 billion in medicare fraud, and that's a conservative estimate. according to another -- to a harvard professor, malcolm sparrow, medicare fraud may consume as much as 15% to 20% of the $450 billion medicare budget. that means the amount lost to fraud each year in medicare alone is $70 billion to $90 billion a year. and as i mentioned, improper payment rates, depending on where you look, range from anywhere from 7.8% of all medicare payments are paid improperly to as much as 12.4%,

depending on where you look. defrauding medicare has become so lucrative that even the mafia and other organized kr-lgs are getting into the act. according to the associated press last month, members of the russian-armenian crime ring were indicted of bilking medicare of more than $20 million and a week later the f.b.i. issued search warrants for medicaid fraud in miami, the body of a potential witness was found in the back seat of a car riddled with bullets. last year, or i should say earlier this year i introduced a bill which i would hope that our colleagues on the other side of the aisle would look at in a way to change the paradigm in terms of the way we address this problem of medicare fraud. rather than the pay-and-pursue model, we would have a model which would actually detect

potential fraud on the front end by certifying payees and otherwise making sure that money is spent properly. we need to implement commonsense solutions like this to fix fraud in medicare before we simply cut in half, or cut $500 billion out of benefits in terms of provider payments to create a new entitlement. now, we all understand medicare is in miserable shape financially. miserable shape. if nothing's done, medicare will go broke in 2017, according to the medicare trustees. the medicare part of entitlement problems has unfunded liabilities promises washington may but cannot keep and doesn't know how to pay for nearly $38 trillion. $38 trillion is more than three times the current national debt of $12 trillion. $38 trillion translated into the

burden on every american family means that each american family owes $322,000 more than most american families' homes are worth. so the bottom line is it is simply irresponsible to without fixing medicare, without fixing the fraud and the waste, which i know the presiding officer is concerned about as i am, and without, without dealing with the fact that medicare promises coverage but denies access because of low payments, it is simply irresponsible to pillage nearly $500 billion from a bankrupt medicare program in order to create a new budget-busting entitlement program. mr. president, there have been some talk on the floor a little bit earlier about earlier attempts to reduce the rate of growth of medicare, and

interestingly, back in 2005 when there were some proposals to do just that, but, frankly, the numbers paled in comparison, about $10 billion in cuts compared to $500 billion in cuts, the majority, current majority leader called those cuts immoral. i have a long list of comments made by our friends across the aisle which stand in stark contrast to the comments that they're making today. now, frankly, i think we need to do something about the insolvency of medicare. even if we didn't do anything else, that would be a great benefit to the seniors to whom we promised health coverage but to whom we currently deny coverage because of the problems i've already talked about. and i, frankly, i note distinguished chairman of the finance committee talked about the sterling endorsements that come from a variety of

washington-based advocacy groups, and one of them is the aarp, the american association of retired persons. mr. president, i would ask an article dated october 27, 2009, about aarp be made part of the record at the end of my comments. the presiding officer: without objection. mr. cornyn: mr. president, what this article demonstrates is one reason why aarp might be opposed to maintaining medicare advantage and be for the cuts in benefits to current medicare advantage beneficiaries is because they make -- that group and its subsidiaries collected more than $650 million in royalties and other fees last year from the sale of insurance policies, some of which are designed to fill that gap between medicare fee-for-service and what it actually costs to get to see a doctor. so, it is a conflict of interest

for this association. and, frankly, i don't think its endorsement is worth the paper it's written on, just like other associations who, contrary to the best interests of their members, have made a deal that is bad for the american consumer. the american consumer knows it. they know a bad deal when they see it, a deal that includes increased premiums, higher taxes and cuts in medicare. and so, frankly, i think those people with such glaring conflicts of interest should not be in the position of trying to endorse something that's basically going to make them to enrich them at the detriment of the american people. mr. president, i plan to offer amendments about this bill's provisions to cut nearly -- that as currently proposed cut $500 billion from the medicare program. my first amendment would make medicare play by the same financial solvency rules as private insurers. now, we hear our friends on the

other side of the aisle talk about insurance companies, and i have no doubt that their desire is, frankly, to do away with private-sector involvement in the health coverage field, which leaves, of course, only the federal government, ultimately a single-payer system making decisions out of washington, d.c. that affect the health care delivery to 300 million people. a bad idea. but my first amendment would make medicare play by the same financial solvency rules as private insurers, because private insurers are owned by their shareholders and have fiduciary responsibilities, they could not do business like medicare does. they couldn't tolerate high fraud, waste, and abuse rates. they couldn't function based on the same risk-based capitalization requirements that private insurance companies do. so, my amendment would ensure that before we pillage $500

billion from the medicare program to pay for as yet another unsustainable entitlement program, the medicare program should be able to meet the same solvency and risk-based capitalization requirements that praoeufs insurance plans meet. my second amendment would be to strike the unelected, unaccountable board of bureaucrats known as the medicare advisory board. now, we've heard this medicare advisory board extolled, but this is the same kind of unelected, unaccountable board that we saw a few -- saw just a couple of weeks ago issued a new order or recommendation on mammograms based on cost benefit which would have condemned some women between the age of 40 and 49, denied them access to a mammogram and, frankly, condemn them to an early, premature death because of the breast cancer.

when you put all the power to determine the coverage and also payment in an unelected, unaccountable board like the medicare advisory board, then, frankly, you're going to get more of that rationing and that same sort of cost-benefit analysis which is going to consign too many americans to a premature death because, frankly, the federal government doesn't care and is not going to see them get access to care. but after the reid bill pillages $465 billion from the medicare program to create a new entitlement, it sets up this new medicare advisory board, an unaccountable board of bureaucrats to find more ways to cut billions of dollars from medicare. unsurprisingly, patients, providers, and even congress don't always agree with experts that, including the ones we have in place today. according to "the wall street journal," the medicare payment advisory commission created by

congress in 1997 has recommended more than $200 billion in cuts in the last year alone, which lawmakers -- that means congress -- has ignored. artificial and arbitrary budget targets leave little room for innovation as well. what if we were to find a cure for alzheimer's in 2020? but because it would be too kpeuf, the medicare program or the medicare advisory board would saeut federal government's not going to pay for it. some have said this independent b -- would be a way to insulate medical payments from politics. that it was the result after political deal between the white house that insulated hospitals from future cuts. mr. president, i want to close by saying i hope my completion will reconsider and vote for the mccain amendment, which will reverse the pillaging of a half

a trillion dollars from the medicare program to create a new entitlement program. we should fix medicare's unfunded liabilities of nearly $38 trillion, not by -- and not steal from medicare to create another unsustainable entitlement program that will of course have to be paid for by our children and grandchildren, on top of all the other debt that we are piling on them. at a time of insolvent entitlement programs, record budget deficits, and unsustainable national debt, this country simply cannot afford to spend $2.5 trillion on an ill-conceived washington health care takeover. mr. president, i yield the floor. the presiding officer: the senator from montana. mr. baucus: mr. president, i understand we have several speakers that wish to speaker. first, the senator from michigan, senator stabenow, then senator hatch, senator cardin

would be third. i don't want to get had the way here. there's a little bit after time constraint here. we're going back and forth, we are. we're alternating. believe me, i'm respecting the alternating back and forth here. okay, i'll make it very clear that -- never fear. okay, senator stabenow, you're next. ms. stabenow: thank you. mr. president? the presiding officer: th the senator from michigan. ms. stabenow: thank you very much, mr. president. i first want to thank our distinguished leader on the finance committee. it is my pleasure to serve on the senate finance committee. we have been working on this issue for well over a year, i think two years now, and i very much appreciate the senator from montana and his leadership in getting us to this point because i don't think we would have been here without his leadership. and so i very much appreciate that, as well as the leader, senator reid, who has worked

higherlesworktirelessly, and ofe senator dodd and senator harkin from iowa. we especially appreciate their leadership. mr. president, the bottom line of the legislation in front of us is very simple. on behalf of the american people, we have put forward a health care reform bill that will save lives, it will save money, and it will save medicare. it does that in multiple ways. i want to spend just a few moments this evening talking about medicare because there is a very significant amendment in front of us that would undercut what we are trying to do to save medicare, and as we go through this next debate, as i have done many times, i'm going to continue to talk about the ways in which we are saving lives and saving money. but the reality is that medicare is a sacred trust, mr. president, with america's seniors, with people with

disabilities. our health care reform efforts, both in the house and the senate, will help ensure that trust is never broken. that's what this is all about. in fact, i don't think i could look my 83-year-old mother in the eye knowing how much she has benefited from medicare and be doing anything that would weaken medicare -- now or on into the future. we're going to extend medicare solvency while providing better, more affordable care for america's seniors and people with disabilities. in fact, we're going to add five years to the medicare trust fund solvency, which is extremely important. and i expect as we go forward in the long run, as we bring down costs, as we save money, we will in fact be adding years to the trust fund by what we are doing. we're going to crack down on waste and fraud and abuse in the medicare program, end wasteful overpayments to insurance

companies through a medicare advantage effort that essentially was set up to privatize medicare, turn it over to primarily for-profit insurance companies. reform is going to make sure that we have more affordable services for seniors. we're going to begin to close that doughnut hole or gap in prescription drug coverage right now, what was passed a number of years ago, and i might indicate not paid for. and our effort is entirely paid for. it does not add a dime to the national debt. in fact, it brings down the deficit. but we are closing a gap in coverage on prescription drugs by 50%. we're going to phase that in. we're going to keep going until we get that completely closed, mr. president. we're going to make sure that preventive services don't have a cost connected with them. no deductible, no co-pay.

we want people to be getting the cancer screenings, the mammograms, the wonderful colon colonoscopies. the other preventive services that people need as well as being able to have a yearly physical with their physician, without deductibles and co-pays. we're going to aggressively attack fraud and abuse that raise medicare costs for seniors and for taxpayers. reform is about also improving quality of care. it will move medicare towards a system of rewarding high-quality care, investing in innovations, more efforts in primary care, family doctors, better coordination of care, cutting down on duplication of tests and bureaucracy and all of those things that we so frequently complain about here in the senate, as we should. it's going to make long-term care services more affordable.

and there's such a growing demand and need for long-term services. and it's going to eliminate the eminent physician payment cut that threatens to stop seniors from having full choice of seeing their own doctor. and i am a -- as my colleagues know -- deeply committed to permanently fixing a flawed physician payment system. but we, in this bill, make sure that the 21% cut that is scheduled to take place next year does not take effect, and we will continue to -- we're committed to working until we completely solve this problem. now, it's not a surprise that our republican colleagues are opposing a plan that actually protects medicare, actually protects medicare benefits for seniors, people with disabilities, and keeps medicare finances in the black for five additional years.

just seven months ago, mr. president -- just seven months ago, nearly 80% of the republican house members voted to end medicare as we know it. -- by turning it into a voucher program that provides a fixed sum of money to pay to private insurance companies, which by the way has led -- we're now trying to fix overpayments to private for-profit insurance companies at the expense of medicare and services for seniors. a top aarp policy official called this scheme that was supported by 80% of the house republicans just seven months ago, called this scheme a very dangerous idea -- quote, unquote -- saying it would raise costs for all beneficiaries and lower the quality of care for less affluent seniors, lower-income seniors. so now, faced with a plan that

actually strengthens medicare, actually saves medicare for the future and makes sure that money goes to medicare beneficiaries rather than to insurance companies in high payments, some colleagues are pulling out all the stops to defend the health care status quo that sends hundreds of billions of dollars in overpayments to private insurance companies, and that's, unfortunately, the result of the mccain amendment, which i strongly oppose. many republicans are resorting to traditional scare tactics and falsehoods, myths. we've heard this over and over again, and you can go to the aarp web site and see the fact that time after time they have put up falsehoods to try to scare seniors, which i think is really outrageous. for proof of just how politically motivated these

attacks are on the president's proposal and our proposals to eliminate waste and insurance company overpayments in medicare advantage, you have to look no further than the fact that a group of republican senators actually introduced a similar proposal as recently as last -- this past may. now, these kinds of distortions, the fear tactics that have been used, would be offensive under any circumstance, but they're especially disingenuous coming from a group of people who have a long history -- a party who has a long here of opposing medicare and who very recently tried to kill the program as we know it. their most recent assault was just the latest in a war that republicans have been waging on the program since the beginning when a majority of them voted "no" on even establishing medicare. the overwhelming majority of republican colleagues voted "n

"no." the last time we had a democratic president, leading republicans across the country launched a vicious attack on medicare. they bragged about opposing the creation of the program in the first place. they called for huge cuts to medicare and even -- quote -- "the elimination of entitlement programs like medicare, as we know them." one even blamed seniors' "greed" for medicare's budget problems. so, as we now debate this issue, i find it so interesting that colleagues on the other side of the aisle are indicating that, after years of history of trying to cut, eliminate, change medicare, republicans have been voted against even establishing medicare, that somehow they are now the protectors of medicare. well, as aarp has said, there is

nothing in this proposal that is going to cut benefits or increase out-of-pocket costs for seniors. they would not be supporting the efforts that we have been involved with if in fact it did, and i think we all know that. mr. president, president obama and the democratic majority in this congress are committed to protecting and strengthening medicare, a program that we created -- i should say, my predecessor. i was not here. i was not fortunate enough to be here, mr. president, but it was democrats that created a program. and i'm very proud of it, because it's one of the great american success stories -- medicare and social security. it's a sacred trust with our seniors, and our health insurance reform plan will ensure that that trust is never broken. health care reform is about

saving lives, saving money, and saving medicare. i would yield back time. mr. hatch: mr. president? the presiding officer: the senator from ultimate. mr. hatch: mr. president, i'm honored to be able to speak on the floor today on this very, very important set of issues. and i rise in support of senator mccain's health care bill in order to eliminate the medicare cuts contained in the legislation. i do have to say, having listened to my friend from michigan -- and she is a really good person and a good friend of mine -- i don't see how taking $500 million -- cutting medicare $500 billion is good for the medicare program. when you start talking about we're going to fight it in fraud, waste, and abuse, that's the biggest dodge in years and years. it is not good for the medicare program. it is not good for medicare beneficiaries. and it's simply not true.

how can cuts of that magnitude -- $500 billion, a half trillion dollars -- be good for for the program? i support senator mccain's amendment. throughout the health care debate, we've heard the president debate not to -- quote -- "mess" -- unquote -- with medicare. that's not the case with the bill before the senate, h.r. 3590, the patients' protection and affordability care act. an interesting naivment the reid bill cuts medicare by $465 billion to fund a new government program. unfortunately, our seniors and the disabled are the ones who suffer the consequence as a result of these d deductions. med compare is very important to the 43 -- med compare is very important to the 43 million seniors covered by the program. i fought to protect and preserve

medicare for both beneficiaries and providers. medicare is already in trouble today. the program faces tremendous challenges in the very near future. the medicare trust fund will be insolvent by 2017 and the program has more than $337 trillion -- almost $38 trillion in unfunded liabilities. so we're going to take $500 billion more out of medicare? it doesn't make sense. every senior in this country ought to be up in arms about it. the reid bill is going to make a bad situation much worse. and why is that the case? again, the reid bill cuts medicare to create a new government entitlement program. more specifically, the reid bill will cut nearly $135 billion from hospitals, $120 billion from medicare advantage, and almost $15 billion from nursing homes, more than $40 billion

from home health care agencies, and close to $8 billion from hospice providers. how can that be good for our seniors? these cuts will threaten beneficiary access to care as medicare providers find it more and more challenging to provide health services to medicare patients. how can cutting $465 billion, almost $500 billion, out of medicare strengthen the program? it defies logic. i don't know how people can stand on this floor and say that. boy, the people out there have caught on to it. senior citizens have caught on to it. all across this country, they're up in arms and they should be. in addition, the proposed legislation permanently cuts all annual medicare provider payment updates. hospitals, home health agencies, and hospice facilities would face even more annual reductions over the next ten years. advocates of these reductions, known as -- quote -- "productivity adjustments" will

argue that today, medicare is overpaying certain providers because current payment updates do not take into account increases in productivity which actually reduce the cost of providing beneficiaries health care services. come on. to me, these permanent productivity adjustments will make it harder for medicare providers to remain profitable as medicare payments fail to keep up with the costs of providing these health care services. as a result of these payment reductions, i believe that many doctors and other medicare providers will stop seeing medicare patients. in utah, my home state, low medicare reimbursements rates are already a serious problem for beneficiaries and their health care providers. these additional reductions will only make it more difficult. i want to stress to my colleagues that cutting medicare to pay for a new government program is irresponsible.

any reductions to medicare should be used to preserve the program, not create a new government bureaucracy. an entitlement, if you will. i believe it makes more sense to target the medicare savings for paying off medicare's unfunded liabilities for preventing the future insolvency. i would like to take a few minutes to talk about the med care advantage program and how it is affected by the reid bill. as i stated previously, the reid bill reduces medicare by close to $500 billion, almost $120 billion comes out of the medicare advantage program. during the finance committee's consideration of the baucus health bill, i offered an amendment to protect extra benefits currently enjoyed by medicare advantage beneficiari beneficiaries. unfortunately, my amendment was defeated. in other words, the president's pledge assuring americans that they would not lose benefits was not met by either of the finance

committee bill or the reid bill currently under consideration here in the senate. and here is how supporters of the finance bill justified the medicare advantage reductions. they argued the extra benefits that would be cut, such as vision care, dental care, reduced hospital deductibles, lower payments, were not standard deductions in the medicare fee-for-service program. therefore, these benefits did not count. boy, they counted for the seniors who got them, let me tell you that. a few weeks back, our president once again assured the american people that they could keep their current health plan. quote -- here's what he said -- "the first thing i want to make clear is if you are happy with the insurance plan that you have right now, if the costs you're paying and the benefits you're getting are what you want them to be, then you can keep offering that same plan. nobody will make you change it."

yeah? what do you think this bill does? i believe that promise should apply to all americans, including those participating in the medicare advantage program. congress is either going to protect existing benefits or n not. it's that simple. unfortunately, under the reid bill, if you are a beneficiary participating in medicare advantage, that promise does not apply to you. i have some history with the medicare advantage program. i served as a member of the house-senate conference, as did the distinguished chairman of the finance committee. we both served as a member of the house-senate conference committee which wrote the medicare modernization act of 2003. among other things, this law created the medicare advantage program, and we did it because we wanted to get health care into rural america and it did. medicare plus choice didn't do it and we knew it wouldn't do it, and this is the only kind of

a program that would. when conference committee members were negotiating the conference report, several of us insisted that the medicare advantage program was necessary in order to provide health care coverage choices to medicare beneficiaries. at that time, there were many parts of the country were medicare beneficiaries did not have -- where medicare beneficiaries did not have choice in coverage. in fact, the only choice offered to them was the traditional fee-for-service medicare, a one-size-fits-all government-run program. by creating the medicare advantage program, we provided beneficiaries with a choice in coverage and then empowered them to make their own health care decisions as opposed to the federal government making them for them. today, every medicare beneficiary may choose from several health plans for his or her coverage. medicare advantage works. it has worked. and it will work in the future if we don't lause it up with

this bill. medicare-plus-choice and its predecessors did not, because many plans across the country, especially in rural areas, were reimbursed at very low rates by the medicare program. and i fear history could repeat itself if we're not careful. let me take a minute to talk about medicare-plus-choice, that program. i represent a state where medicare managed care plans could not exist due to low reimbursement rates. to address that concern, congress included language which was signed into law establishing a payment floor for rural areas. but it was not enough. in fact, in utah, all of the medicare-plus-choice plans eventually left because they were all operating in the red. and this happened after promises were made that medicare-plus-choice plans would be reimbursed fairly and that all medicare beneficiaries would have access to these plans. so during the medicare modernization act conference, we fixed the problem.

first, we rename the program medicare advantage. secondly, we increased reimbursement rates so that all medicare beneficiaries, regardless of where they lived, be it in fillmore, utah, or new york city, had choice in coverage. again, we did not want beneficiaries stuck with a one-size-fits-all government plan. today, medicare advantage works. every medicare beneficiary has access to a medicare advantage plan. and close to 90% of medicare beneficiaries participating in the program are satisfied with their health coverage. but that could all change should the health care reform legislation currently being considered become law. choice in coverage has made a difference in the lives of more than 10 million individuals nationwide. the extra benefits that i mentioned earlier are being portrayed as gym memberships as opposed to lower premiums, copayments and deductibles.

and to be clear, the silver sneakers program is one that has made a difference in the lives of many seniors because it encourages them to get out of their home and remain active. it has been helpful to those with serious weight issues and has been invaluable to women suffering from osteoporosis and joint problems. in fact, i've received several hundred letters telling me how much medicare advantage beneficiaries appreciate this program. additionally, these beneficiaries receive other services, such as coordinated chronic care management, dental coverage, vision care, and hearing aids. mr. president, in conclusion, i cannot support any bill that would jeopardize health care coverage for medicare beneficiaries, and i truly believe that if the bill before the senate becomes law, medicare beneficiaries' health care coverage could be in serious trouble. we owe it to the 43 million americans, seniors and disabled, who depend on medicare to reject the nonsensical medicare cuts

included in the reid bill. we must have better solutions that will not hinder their ability to see the doctor of their choice. look, i've been in the senate now for 33 years. i pride myself for being bipartisan. i have coauthored many, many bipartisan health care bills since i fist joined the senate in 1977. let me be clear -- i want a health reform bill to pass this chamber but i want it to be a bipartisan bill that passes the senate by 70 to 80 votes. if a bill involving one-sixth of the american economy cannot get 70 to 80 votes, that bill has to be a lousy bill, and especially if it's just a partisan bill, which this one is. if we could do it in 2003, when we considered the medicare prescription drug legislation, we can do it today. there has never been a bill of this magnitude affecting so many american lives that has passed this chamber on a straight party-line vote. in the past, the senate has

approved many bipartisan health care bills that eventually -- that have eventually been signed into law. the balanced budget act of 1970 -- 1997, which included the child health insurance program, the ryan white act, the orphan drug act, the american with disabilities act, and the hatch-waxman act are just a few of the success stories, and i was a prime sponsor in every one of those. if the senate passes this bill in its current form with a razor-thin margin of 60 votes, this will be yet one -- or even 61. to be honest with you, it would be so partisan, it wouldn't even be funny. and this would be yet one more example of 9 arrogance of powe power -- of the arrogance of power since the democrats have secured a 60-vote majority in the united states senate. there is a better way to handle health care reform. first and foremost, it must be bipartisan. and we stand ready, willing and able to do a bipartisan bill.

without the restrictions that were placed on the distinguished senator who chairs the finance committee, so it should be bipartisan. second, we cannot erode the existing system that has provided quality and affordable health care to most americans for decades. while we all agree that the current system should be improved, this bill is certainly not the answer. if the senate bill passes, the e mccain motion to recommit, we can begin to work on a bipartisan health bill that will eliminate the overwhelming medicare payment reductions and at the same time address the serious issues facing the medicare program in the near future. look, we know that insurance should cover preexisting conditions. we know that if we use 50 state laboratories by giving the states the money to solve their own problems in accordance with their own demographics, then not

only will they do it, but we would be able to learn from the states that were successful in doing it. we all know that if we do something about medical liability reform and get rid of the approximately 90% of the frivolous cases that are filed, costing anywhere between $100 -- well $54 billion to $300 billion a year in unnecessary costs, we know that that would help us to be able to pay for this bill. we know that there are so many things we could do about wellness and prevention that will work. i think all of us would agree on most of these things democrats could never agrow on medical liability reform because the personal injury lawyers who -- and they're a limited group in -- in the -- in what used to be the american trial lawyers

association -- are high funders of democrat races. they're unwilling to do anything about it. in fact in the house bill they even make it if you don't cooperate with the personal injury lawyers, you lose your money. it's unbelievable. we know there are a number of other things that we could do that both sides could agree on that would cut costs and make things work. we also know that we could live within much less means. we are currently spending in this country, without this bil bill, $2.4 trillion on health care all told. this bill will add over a true 10-year period anothe another $2.5 trillion to the cost. so it will be almost $5 trillion in health care. and why don't they admit it's going to be at leas least $2.5 trillion?

well, they don't admit it because for the first three or four years they don't -- they come -- they count the taxes that come in that are charged, but they don't implement the program until 2014. in the reid bill and 2013 in the house bill and even 2014 in some aspects of the house bill that's the only reason they can say it is $2 trillion. it's actually $2.5 trillion according to figures from the senate budget -- budget committee. using -- using the -- the figures of the congressional budget office. look, i hate to see medicare advantage taken advantage of. i hate to see $500 trillion come out of medicare at a time when medicare is going to go insolvent by 2017 or 2018. i think it's absurd. i think it's ridiculous.

i don't blame the seniors for being upset. they're very upset throughout this country. they have reason to be. i just urge my colleagues to support the mccain motion to recommit this bill and let's get working on it in a bipartisan way. there are some who have the reputation of working in a bipartisan way. we'd like to do it. we'd like to get it done. we'd like to have the vast majority of the people in this country happy with whatever bill we come through. we'd like to have -- between 75 votes and 80 votes as a minimum to pass this bill. that would be at least some assurance that at least it was bipartisan and that it might have a real chance to work. but if we pass this bill 60-40, let's just be honest about it, you know it's allowsy bill. mr. president -- a lousy bill. mr. president, i yield the floor. a senator: mr. president? the presiding officer: the senator from maryland. mr. cardin: mr. president, first, let me thank the senator from montana, senator baucus,

for bringing forward a bill that has been long overdue on the senate floor. this is a historic moment as we debate health care reform. many of us have been looking forward to this moment for many, many years. this bill out of the congressional budget office is now confirmed that for -- the overwhelming majority of americans it will bring down their health care insurance premiums. this bill will bring down the growth rate of health care costs. it will provide affordable options for millions of americans who today have been denied the opportunity to buy health insurance. the congressional budget office tells us that it will insure 31 million americans who otherwise would not have insurance, bringing down the uninsured rate. and most importantly, the congressional budget office, that objective score keeper, that's not democrats, not republican, this is the objective score keeper tells us

that this bill will bring down the federal deficit. so it's a responsible bill. a bill that will provide affordable insurance options for millions of americans that are denied insurance today, will reduce our deficit, and will start to get a handle on the escalating cost of health care. it saves money, it saves lives through prevention and early detection of deeses and by expanded -- diseases and by expanded coverage. and, mr. president, it saves medicare. why does it save medicare? because many of us who have been here for a long time understand that the only way that you can bring down the cost of medicare is to bring down the cost of health care. and that's exactly what this bill does. providing for the long-term safety of medicare for our seniors. it also expands benefits for our seniors and prevention and helps to start fill the doughnut hole in prescription drug coverage.

this bill, the underlying bill, moves us toward what we need to do in health care reform. it brings down health care costs. how? by managing diseases and understanding that -- the way that -- that the way we pay for diseases today is where most of the cost in health care is. this helps us manage diseases, expands insurance coverage which will bring down costs. it provides for investment and health information technology so we can bring down the administrative costs and invest in wellness an prevention. mr. president, i really take the time today to encourage my colleagues to support the mikulski amendment, which will ensure that women have access to essential prevention services. the leading cause of death for women are heart disease, cancer, and stroke. early screening for risk factors could prevent many of these deaths and lead to improved health and quality of life for women. but despite the benefits of early screening, many insurers

do not cover them. and too often women skip them because of the cost are prohibitive. we know that early detection of disease saves lives and so we must ensure that needed preventive services are available to all americans regardless of gender. i have long worked to improve access to prevention services nothing that we do now about the importance of prevention. it seems hard to believe that before 1998, medicare did not cover cancer screenings or other preventive services. i am proud that a bill that i authored in 1997 as a member of the house of representatives, it established the first package of prevention benefits in traditional medicare. it was part of the 1997 balanced budget act and it would not have passed but for strong bipartisan support. medicare now covers screenings for breast, colon, and prostate cancer, bone mass measurements

for osteoporosis, diabetes testing supplies and glaucoma. last year's bill, the medicare improvement providers act gave h.h.s. the authority to expand the list so as newly highly effective procedures are discovered, they can be made available to beneficiaries without waiting for congress to act. this wisely builds on the benefits package for seniors and expands it to cover all americans as part of their insurance coverage. we are expanding prevention and making sure it's available so that all americans will have a better insurance product that will cover preventive services. basic screening can have an enormous impact on health and save money in the long run. chronic disease incurs a huge cost for the health care system. today more than half of americans live with at least one chronic condition accounting for 75% of all health care spending each year.

to bend the cost curve, we need to reduce the onset of chronic diseases before they become much more expensive to treat. the american cancer society reports that the incident of cervical cancer and more at ity rates have -- mortality has decreased. this is mainly due to the introduction of the pap tass. the average test for the normal cervical screening in 2004 wa was $31. in contrast the treatment for early stage cervical cancer averages $20,255. and the treatment for late-stage cervical cancer was almost $37,000. screening saves lives, saves money. the bill before us invests in prevention. it will save money. it will save lives. breast cancer screening has also been shown to reduce mortality. early staged diagnosis gives a

five-year survival rate of 98% and statistics exiled by the american cancer society indicates that 61% of breast cancers are detected at this stage largely due to mammograms. the bill guarantees coverage for a number of services to promote public health and wellness and to prevent chronic devastating diseases, some measures include providing coverage for everyone who has an a or b rating by the u.s. prevention services task force. these screenings are either recommended or strongly recommended and includes screening for osteoporosis, colon cancer and would be covered with no cost sharing. a strong incentive for people taking advantage of these screenings. covering impewization recommended -- immunization recommended by the c.d.c. is also covered. preventive care services and

screening for infants, children, and adolescents that are supported in comprehensive guidelines from the health resources and services administration. all of that's in the underlying bill that will save us money and will save us lives. in addition to these vital services the waim prevention health services -- women's prevention health services must also be covered in the mikulski amendment. it extends the preventive services covered in the bill for those evidenced based services representedded for women by hrsa, a has the goal to improve access to primary and prevention care services to uninsured and and under insured individuals. it focuses on maternal and child health, hiv-aids care, recruiting doctors in underserved areas, health care in rural areas an organ donation. hrsa strives to develop the best practices and create a uniform standard of care including

eliminating health disparities among minority populations. additional services for women that will be covered under the mikulski amendment include mammograms for women under 50. in 2000, breast cancer was cancer that had 800 women died from the disease. according to the kaiser family foundation, 76.6% of women age 40 and over had a mammogram within the past two years. this amendment would ensure that all of these women would have access to mammography at no out-of-pocket cost. cervical cancer screening for all women regardless of whether or not they're sexually active, ovarian cancer screening, all of this would be made available under the mikulski amendment. ovarian cancer is the fifth leading cause of cancer for women in maryland. generally yearly women visits would be covered, pelvic

examinations, pregnancy and post part up -- pregnancy, postpartum depression screening. c -- diagnosed in the united states. approximately four million new cases of this disease occurs each year and up to 40% of the women affected with this tees may not be a-- of this disease may not be aware of this. h.i.v. screening for all women regardless of exposure to risk. according to the kaiser foundation among those women who have h.i.v. positive, 33% of the women tested for h.i.v. late in their illness were diagnosed with h.i.v. within one year of testing positive. we need to do a better job here. this is international aids awareness day. i think it's very appropriate that we have the mikulski amendment on the floor today. studies reported by the kaiser foundation indicate that women

with h.i.v. experience, limited access to care and experience disparity in access relative to men. women are the fastest growing group of aids patients accounting for 34% of all new aids cases in 2001 compared to 10% in 1985. so this amendment will help in regards to that issue for our women. sexually transmitted infections, counseling for all women who bear the long-term consequences of s.t.d.'s. screening for domestic violence is covered with the maryland network against domestic violence report that one out of four american women reports that she has been physically abused by a husband or boyfriend at some time in her life. the mikulski amendment provides screening for domestic violence, overweight screening for teens, diabetes screening, thyroid screening. much of the debate on health care reform has focused on

quality. how do we make our health care system work better and produce better outcomes for the money we spend? ensuring that women have access to prevention services that are recommended by experts on women's health is absolutely essential to providing quality care. this amendment protects women to consult with a doctor and determine which services is best for her and guarantees access to these services at no additional cost. preventive health care initiatives are one area that i hope that we all can agree upon. the senate has a long history of bipartisan support for women's preventive services. i hope the string remains unbroken with this amendment. i strongly support the efforts spearheaded by senator mikulski to extend the services covered for women. trongl support this very important amendment that makes a good bill better. this bill is desperately needed. let us vote for those amendments that improve it such as the

mikulski amendment and let us move forward with this debate. with that, mr. president, i would yield the floor. a senator: mr. president? the presiding officer: the senator from kentucky. mr. bunning: the pending business is still the health care reform bill? the presiding officer: it is and the motion to commit. mr. bunning: congress needs to look at ways to reform our health care system. too many americans are uninsured , underinsured or cannot afford the health insurance they have. reforming health care which amounts to over 17% of our gross domestic product is no easy task, and it is a process that should not be rushed. i believe congress should move in an incremental approach to reforming health care. we are restructuring 1/6 of our

national economy with this bill, and need to be darn sure that we know what we're doing. i believe congress should work in a bipartisan pay to draft reform legislation instead of working in secret behind closed doors. i support measures like passing medical malpractice reform, allowing small businesses to band together to buy insurance, and allowing individuals to buy insurance across state lines. these strategies will help lower costs, make insurance more affordable, and increase coverage. that should be the goal of health care reform. and we can do this without

putting washington bureaucrats and members of congress in control of your health care. this seems like a win-win situation to me. i also support the bill introduced earlier this year by senators coburn and burr called the patients' choice act which reforms the health care system. this bill helps states establish state-based exchanges, helps low-income families with health care costs, and improves health care savings accounts. i've heard members of the majority party claim that republicans don't have a health care plan. they couldn't be more wrong. we just don't have a 2,000-plus page bill like they do that will

drive up premiums, cut medicare by half a trillion dollars, and raise taxes on all americans. we just don't have a bill like they do that costs $2.5 trillion and will treat the future of our children and grandchildren as they struggle to pay the debts we are leaving them. i'd like to take a few minutes to explain my concerns with the bill that senator reid has laid out before us. unfortunately, it's hard to even know where to start. as i said, this bill is over 2,000 pages long. its table of contents, the table of contents is 13 pages long. it was written behind closed doors by a small group of

hand-picked people by the majority leader, so most of us in the senate and the american people had no idea what was in it before it was released. for a majority party that bills itself as being transparent, they certainly failed in writing this bill. the bill we have before us changes the way health care is delivered in this country. it will affect every american, regardless of whether you have insurance, regardless of whether you are satisfied with your insurance, or even if you are on medicare. we need to make sure we know what we're doing and know what the long-term consequences are of any changes we make. at this point, i'm not confident that we do. this bill will cost

cost $2.5 trillion over ten years when fully implemented. it raises taxes by almost half a trillion dollars. it cuts almost a trillion dollars from the comear -- a half a trillion dollars from the medicare program, yet it still leaves 24 million people uninsured. the bill jeopardizes the ability of americans to keep their own doctor and will lead to the rationing of care. the recent recommendations of the u.s. preventative service task force on breast cancer screening should be a wake-up call to all americans about washington bureaucrats meddling in their health care. under this bill, health care premiums will rise, five million americans will lose their

employer coverage, and 15 million more will be added to medicaid and the chip program. this, i think, is a move in the wrong direction. medicaid often underpays medical providers for treating patients, which makes it hard for doctors who want to treat these patients and hard for patients to find doctors to treat them. we should be finding ways to help people better afford private insurance, not simply adding them to the public dole. this puts washington bureaucrats and members of congress in control over many aspects of your health care, which should scare everyone within the sound of my voice. for example, starting in 2014,

washington will require most americans to prove they have health insurance or pay a penalty tax. the penalty will be phased in over a couple of years, but in 2016, the penalty will be $750 per person, with a maximum of of $2,250 for a family. these amounts are indexed in future years, however, so the penalty will continue to increase. if you aren't one of the bill's special exemption categories, you will have to prove that you and your family have insurance when you sit down to fill out your taxes. if you don't, then you'll get to send uncle sam an additional

additional $750 or $2,250 on april 15. i know the authors of this bill will try to argue that since their bill leads to nearly universal coverage, most americans won't be affected by this tax. that couldn't be farther from the truth. according to the congressional budget office, the official scorekeeper, this bill leaves 24 million americans uninsured. 24 million americans without insurance is not universal coverage or anything close to it. also, members of congress are going to be telling you what type of insurance you have to buy, and we won't even be giving every american access to the cheapest plan on the market. the bill requires that four types of health care insurance

can be offered in the exchange -- bronze, silver, gold, and platinum. all the plans would have to offer certain benefits and meet certain criteria. however, the bill creates a special catastrophic plan for only special groups of people -- those under the age of 30 and those who don't have affordable coverage. it doesn't matter that many more people want this leverage of coverage. if you aren't under 30 or meet some type of income eligibility test, you're just out of luck. catastrophic coverage is the right type of coverage for many different types of americans, including singles, younger

people, and the healthy. it's very likely to be the cheapest plan affordable on the exchange. i want you to think about this. a young woman in her 30's. she eats right. she exercises, doesn't smoke, takes good care of herself. she wants a catastrophic plan, and it's all she needs. under this bill, she couldn't buy into the catastrophic plan because of her age. members of congress tell her that she isn't entitled to the cheapest plan on the market because she is too old. she is in her 30's. or think of the 29-year-old male who has been enrolled in this catastrophic plan in his early 20's. on his next birthday, the

federal government has a big birthday surprise for him. he will get kicked out of the insurance plan he has enjoyed for years and be forced to join a more expensive health care plan. that's a wonderful birthday gift. i don't think congress -- congress' role is to require all americans to buy insurance. i don't think washington bureaucrats and elected members of congress should be dictating what health care options are available for the entire country. i understand the importance of insurance. i think everyone should have insurance, but i don't think it is the federal government's responsibility to force you to buy it or micromanage what insurance looks like. this bill also makes huge cuts

in medicare which will affect every senior. the bill cuts -- and you've heard it many times today -- today -- $465 billion from the medicare program. these cuts won't be used to shore up the medicare program which will be insolvent in just about eight years. instead, these cuts will be used to fund new government spending. this move further jeopardizes the viability of the medicare program. i know that aarp and the american medical association are trying to tell seniors that these cuts will actually be good for the medicare program, and the program won't be harmed, but let's be honest. when you think about it, does it really make any sense? congress is going to cut

cut $465 billion from a program that is already facing bankruptcy, and it will somehow make it stronger? if you believe that, i have some oceanfront property to sell you in arizona. under this bill, hospitals will be cut, nursing homes will be cut, health home agencies will be cut, hospices will be cut, and medicare advantage programs will be cut. by cutting the reimbursement rate for providers, they are making it harder for seniors to find medical providers to treat them, plain and simple. seniors will have -- will have the same benefit, but if they cannot find anyone to treat them, then their benefits don't do them any good, does it?

i have to tell you that there isn't one medical provider who walks in my office each year who is happy with their reimbursement rate under medicare. i cannot think of one. hospitals are unhappy. the doctors aren't happy. hospice care providers who provide such valuable service to dying americans and their family aren't happy. no one is happy. what do you think is going to happen to these reimbursements when the cuts go into effect? how happy will the providers be then? another problem with this bill is the creation of a government plan. i can say i do not support a government-run plan in any form.

i've already described significant problems with medicare and medicaid. creating a new government-run health program will lead to the same sort of problems that plague these plans. i fear that it eventually undermine private insurance enough so that we are left with a single-payer government-run system. i've been in congress long enough to know that that will be a disaster for this country. finally, this bill imposes an unprecedented tax increase on americans. the tax hikes in this bill would start hitting americans next year while the spending and benefits won't start in many cases to 2014.

that is how the majority is hiding the true cost of this bill, using ten years of tax hikes to offset six years of spending. everybody knows that tax increases are deadly in a fragile economy, but that is not the -- but that is not preventing the majority from pushing through a half a trillion dollars in tax hikes in this bill. in a further defiance of logic, these tax increases will actually drive up the cost of health care. i was under the impression that the we'll go of health care reform was to reduce costs, not increase them. as i mentioned early, if you have the misfortune of being uninsured, you will be further punished under this bill by

paying a penalty tax. if you are an employer who hires a low-income worker and cannot afford health -- to provide health insurance, you probably will be punished with a penalty tax. if you are an employer that offers retirees prescription drug coverage, your taxes will go up. if you have an extremely high medical cost and use itemized deductions for medical expenses to defray your costs, your taxes will go up. if you use a flexible spending account, health reimbursement account, or health savings account for over-the-counter medicines, your taxes will go up. if you have a flexible spending

account, it will be capped and then probably disappear in a few years because of the high cos cost -- high-cost tax plan, so your taxes will go up. this bill also creates a new marriage penalty in the medicare payroll tax and uses the money to pay for a brand-new entitlement program. it also imposes a new tax on cosmetic surgery. and if a family is forced to liquidate a health savings account because of tough economic times, the government will confiscate even more money. the bill also imposes new tax on brand-name drugs, medical devices, and health insurance, all of which will increase health care costs and drive up premiums. and now that the government has succeeded in driving up premiu

premiums, the government had hit you again by taxing high-cost insurance. it all makes sense. drive up insurance premiums with new taxes and then tax them again for being too costly. we could have health care reform that reduces health care costs for family and businesses. we could have had health care reform that didn't raid a half a trillion dollars from medicare. we could have health care reform that allowed people who like the coverage they have to truly keep it. we could have health care reform that didn't drastically expand government spending on health care or put -- push people into government programs. we could have health care reform that did not increase taxes on

the american people at the worst possible time during a recession. we could have health care reform that was done in the light of day rather than behind closed doors. the american people deserve better and we ought to defeat this bill. thank you, mr. president. and i yield the floor. mr. baucus: mr. president? the presiding officer: the senator from montana. mr. baucus: mr. president, as i understand it, there are a couple three senators left besides myself, senator sessions and senator burr. there may be others, but that's what i see at the moment. mr. president, america's health care system is in a crisis and

it's a crisis not just for the 46 million americans who lack health insurance. it's also a crisis for those who have health insurance but are worried they can't afford to keep it. also a crisis for those who are underinsured, those who have poor health insurance. rising health care costs affect families and american business businesses. that we know. health insurance premiums continue to outpace wages and inflation by a large emergency in. between 1999 and the year 2008, premiums for employer-sponsored health benefits more than doubled. in that nine-year period, they increased 117% for families and individuals and they increased 119% for employers. that is, each case both for families and for employers, health insurance premiums

doubled. clearly outpacing margins. i think the margin is 5-1, 6-1, premiums going up compared to wages. health care coverage for the average family now costs more than $13,000 a year. if current trends continue, by the year 2019, the average family plan will cost more than $0,000. -- more than $30,000. that is, over a ten-year period, from $13,000 the average family pays today for health insurance to $30,000 what that family will pay in just ten years. and annual health spending growth has continued to -- is expected to continue to outpace average annual growth in the overall economy by more than 2 percentage points in each of the next ten years. that is, health insurance is going up faster than the economy is growing. add to that the insult, frankly,

mr. president, this year alone not only will health spending increase 5.5%, but gross domestic product is expected to decrease .2%. so the gap is widening. even -- so the gap is widening even further. americans spend $4.5 billion on health care every minute of every day. just think of that. we in america spend about $4.5 million on health care every minute. that's $2.5 trillion a year. now, that's pretty hard for anybody to get his or her hands around a trillion, but we're talking about $2.5 trillion which americans spend on health care every year. and without reform, health care expenditures will increase to 4.4 trillion in just the next nine years. and that would be more than a fifth of our economy. so health care is taking bigger and bigger bite of our economy. and these are not just numbers, mr. president, every 30 seconds another american files for bankruptcy after a serious

health problem. just think of that. every 30 section, another american files for bankruptcy because of health problems. every year, about 1.5 million families lose their homes to foreclosure. why? because of unaffordable medical costs. mr. president, in america, no one should go bankrupt because they are sick. that is just immoral. these numbers tell us that we -- what we have to do. we have to do two things at once. first, our health care reform bill must provide health coverage for millions of americans who today do not have health insurance. at the same time, we must reduce the rate of growth in health care spending. we must do both. to be successful, health care reform must rein in the growth of health care spending and we must succeed. millions of americans depend on us. our plan would reduce the federal budget deficit by $130 billion over the next ten years. just think of that. many have said that the growth

of the economic recovery is through health care reform. we've got to get control of our health care spending. get control of our deficits. and one way to do that is you get serious control of our health care spending. our bill, the one before us now, reduces the deficit by $130 billion over the next ten years. we need to go much farther clearly, but $130 billion reduction is sure a lot better than no reduction. at the same time, our plan would reduce the number of uninsured by 31 million. reduce the number of americans who don't have health insurance by $31 billion at the same time we start -- we cut the federal budget deficit. so we're doing both. in this bill, it reins in costs through changes in spending. reforms in how providers deliver health care and changes in the tax treatment of health care. savings from this bill are estimated to total $106 billion in the year 2019. and c.b.o., the congressional

budget office, that we all rely upon, expects that in combination, they would increase by 10% to 15% per year the next decade. that is, savings growth, the rate of savings increases would grow by that much. that's what c.b.o. says. that's a strong rate of savings. those are all provisions to control excessive growth in health care spending. our plan also reevaluates the tax treatment of health care. the current tax code includes numerous health care subsidies and incentives. the current tax-free treatment of certain health care expenses encourages people to spend more on health care than they need to. why is that? because there's no limit under the law. none. that is, all employer-provided health care benefits in america today are totally tax free. and the more the benefits are, if a company wanted to provide just not only a cadillac but

diamond and goal benefits -- gold benefits -- that is great benefits not needed -- is tax tree. so what does that do? it tends to discourage -- it dendtends to encourage excessive health care spending. these health care costs totaled nearly $2 billion in the year 2008. that makes health care the largest federal tax expenditure. health care today is the largest federal tax expenditure because our laws changed about 60 years ago moving in that direction. that's got to be changed. but limiting these subs disfor expensive insurance plans, our bill limits incentive to overspend on health care. and our bill thus helps to slow the growth of health care spending. i might say also, mr. president, that the congressional budget office in a letter they sent to the congress yesterday concluded -- i think it was about this provision, that is, the tax on called cadillac plans, would result in a

reduction in premiums that those persons would otherwise pay. a reduction, i think it's about 5% to 11%. there's been a lot of concern in this body, and, frankly, beyond this body, that that provision, that is, the cadillac plan provision, would raise costs for those folks who have those pla plans. the congressional budget office concluded that actually the premiums for those kinds of plans would be reduced -- i think the figure is 5% to 7% rather than compared with current law. several other plans have this effect. i mentioned the high tax of health care insurance premiums. our plan also caps health flexible savings accounts. it puts a cap on it so it's not just totally unlimited. now, tax -- there's no cap so that the tax code tends to encourage excessive use of that

provision. in our plan, we also use the definition of qualified health experiences, the definition used for itemized deductions for medical expenses. that too will help. reducing existing tax expenditures for health care costs is one of the best ways to slow the growth for health care spending. we can use our code, use all the tools available, and our goal here is to not only reduce costs but also improve quality, and there are many provisions in this bill which accomplish that result, which improve quality health care. i think a lot of people in the country, they hear a lot of us talking about how costly health care is in america today, and it is costly. it's too costly. there's a lot of waste. we're enacting provisions that cut out the waste. i'm sensing that some americans are thinking gee, maybe they're going to cut my medicare benefits, maybe they're going to reduce the quality if there's -- if back there in washington they're worried about excessive health care costs.

mr. president, all provisions in here enhance quality of health care. the list is very long. some immediately come to mind is additional spending for primary care doctors. we all know that primary care doctors in america are underpaid. they're not taking medicare patients. they're going out of practice. especially in rural areas. this legislation adds 10% additional payment to primary care doctors in each of the next five years. that's going to help primary care doctors continue to practice. i might mention that health information technology will help improve quality. there are lots of demonstration projects and pilot projects to improve quality through bundling, care organizations, reining in excessive readmission rate that some hospitals have. we also have an outfit that

compares how drugs work compared with other -- other procedures and so forth, all of that's going to help address quality and i just want folks to know that while we're reducing costs, that is true, because costs have to reduce, we're also increasing the quality of health care in america. there are many other incentives in this bill which i don't have time to mention which accomplish that result. the response to the excise tax of high-cost insurance. insurance companies will offer lower-cost plans in fall under the thresholds. that's one one of the reasons that premiums for those folks will cause. it will give consumers lower-cost alternatives. they will have limited level benefits required by law under the new health care system. other treatments, tax -- will help individuals make more cost-effective health care decisions. our plan to require employees to tell their employees the value

of the health insurance. the other provisions here increasing work transparency. the hospitals tell people what their -- what they charge for various procedures and -- and so forth. i think the same should also apply 0 physicians so people have a better idea of what they will pay or their insurance company will pay for these procedures. as i said, our plan require employers to tell employees the value of their health insurance. this will help people to know how much you're actually they're going to spend. how much they're spending. i mentioned changes in the flexible savings accounts, health savings accounts, definition of medical expenses, they all will help. our bill will help to reduce costs by increasing competition. that's not been mentioned enough on the floor. this bill increases competition much we all know that in too many of our states there are too few health insurance companies. my state of montana, bluecross

blueshield provides half of the market. in some states blew cross has almost the entire market. they're wrong. there's not enough competition with the exchange we're putting in place, that will encourage competition. you know what else encourages competition? that is all the insurance market reforms. all of them. telling companies they cannot deny coverage based on preexisting condition, telling companies they can't rate current health status, dealing with rules in states. which means when you go to buy insurance, especially as an individual, there will be competition based on price. the companies will basically offer many of the same products, but they can't deny coverage for all of these preexisting conditions, et cetera, and the result should be that the price should come down because there is more competition in insurance

companies based on priesms then there's the public option. that's another addition in this bill. we don't know if it will or will not be. there are a lot of ways to help provide more competition. i think that health i.t. will help more competition. transparency will help more competition. competition's going to bring down price. our bill would reduce cost also by reforming the health care delivery system. i mentioned a lot of that already including how we pay for doctors. our bill is balanced. it finds savings in health care outlays. savings that are realistic, that make sense, that looks to re -- looks to reduce health tax expenditures, that is, that's a fancy term for -- for deductions. the bill reduces a failed deficit in the first 10 years. again, that point needs to be driven home. this bill reduces the federal deficit in the first 10 years and in the subsequent 10 years it also has a positive effect in

also lowering the budget deficit. in fact c.b.o. says in the second 10 years our plan would cut the deficit by a quarter percent of gross domestic product. that's about $450 billion. that's nearly half a trillion dollars in deficit reduction. we need to remember the cost of doing nothing is unacceptable. basically, mr. president, we have two choices in life: try or do nothing. and to ask the question is to answer it. of course we try. our nation's in crisis. it is in a health care crisis. it is a formidable task and difficult. but we have an obligation to try. to at least try to fix this. and if we try, that poses a second question. if we try, we have the question of -- do we try our best or not? well, of course, the answer's obvious. we try our best. this legislation is a

combination of a year or two of work of folks in the medical profession, of health care economists, of any -- of americans who are trying to find ways to get control of the cost an improve quality. that's basically what this bill is. there are not a lot of new ideas. there are ideas percolating around for the last year or two, some in massachusetts, some in other states. some of it is going into integrated systems like intermountain and these ideas of bundling organizations already practiced by some other institutions. but there's not a lot terribly new. here we're pulling together. we're helping to establish a policy in our country that -- that comes up with a more plan or system in america that allows doctors and patients that have total free choice. they choose.

we're helping doctors with the best evidence, the best information so they can focus on the patient care even more than they are now on what they want to do. we're cutting down on the budget deficit. that's very, very important. and we're also helping medicare by extending the insolvency of medicare another five years. these are things that are being pulled together. we just have to do. i very much hope that we can -- we can move on, get this legislation passed, work with the house and the president signs the bill that we can start finally putting together something that we can be very proud of. our country doesn't have a health care system today. as it free-for-all. it's a free-for-all for all kinds of groups. this is the first effort to kind of get something together that works giving doctors an hospitals and -- and hospitals and patients the choice that's they want to and should have and keeping costs down and improving the quality of health care. a senator: mr. president? the presiding officer: the majority leader.

mr. reid: mr. president, i appreciate the statement of the chairman of the finance committee. it is one of the most well reasoned statements that we've had. and rightfully so. no one has worked harder on this matter than senator baucus. so i really appreciate his dedication, his hard work and the way he handles that committee. the finance committee. i ask unanimous consent the time until 2:15 tomorrow, wednesday, december 2, be for debate with respect to the pending mikulski amendment and the mccain motion to recommit. that during this period that senator reid or designee be allowed to offer an amendment to the mccain amendment and senator murkowski be offered an amendment as a side by side to the mikulski amendment. that the debate time be equally divided. no other motions to commit in order to the pendency of these motions, at 2:15 the senate proceed to vote, prior to each

vote there be two minutes of debate divide and controlled in the usual form. after the first vote, the remaining votes in sequence be 10 minutes in duration. further, all amendments and motion provided under this consent require an affirmative 60-vote threshold for adoption. and those in the agreement do not achieve that threshold, the amendments be withdrawn. mikulski amendment 2791, murkowski amendment, reid designee amendment regarding medicare, mccain motion to recommit medicare. mr. president, before i put this to a final consent agreement, let me just say we've been trying to get some votes today. i think it would be very good that we could move this bill along, have some votes tomorrow afternoon. we'd have four votes. we have two amendments pending. this, in fact, would dispose of those amendments. mr. mcconnell: mr. president --

the presiding officer: is there objection? the republican leader. mr. mcconnell: reserving the right to object. i have to object. i would like to say to my good friend the majority leader, i thought over the last couple of hours, we'd get consent to have votes on the mikulski and murkowski amendments but i had indicated to him and i want to say publicly, we have a number of speakers who are interested in speaking on the medicare issue and the mccain amendment. so i will not be able to lock in the mccain amendment or the side by side that i gather under this consent, my good friend the majority leader, may offer. i would still like to be able to get the two votes earlier referred to, the mikulski and murkowski amendments, but, regretfully, i can't even lock those in right now. but i would like to be able to do that as soon as possible so at least we can get those two votes at some point reasonably

early in the day and turn back to -- to debate on the mccain amendment. i might say that we -- we want to vote on the mccain amendment. we certainly have no desire to delay that vote. but do have a number of people who want to speak to it. so with that understanding and with the -- the point i want to make to my good friend that i'd like to get the two amendments by mikulski and murkowski locked in as soon as possible, i must object. the presiding officer: the objection is heard. a senator: mr. president? the presiding officer: the senator from alabama. mr. sessions: mr. president, i would like to share a few thoughts as we go forward on the health care debate. and would like to remind our colleagues what we've been hearing at the town meetings that -- that most of us have been having around the country and what people are concerned

about. and part of it is they think we don't have a very good perspective on what's going on in america. they're not happy with us. they think we're really losing our fiscal minds. that we are ignoring the fact that we are facing soaring debt. we passed on top of the debt we already had, an $800 billion stimulus package. $800 billion, the largest spending bill in the history of america, on top of the baseline bills in america. the baseline funding bills, in addition to the stimulus, are in double-digit increases in bill after bill after bill, far more than bush ever had. he was criticized for reckless spending. he never had the baseline spending increases that have been passed this year just a few months ago, a few weeks ago in some cases. this year, as of

september 30th, we acknowledged and accounted for a $1.4 trillion budget deficit in one year. one year, $1.4 trillion, september 30th. the republicans never had a deficit so large in one year. and in next year, there's projected to be over $1 trillion and average almost $1 trillion over the next 10 years. and in the years eight, nine, and 10 of the president's 10-year budget, the deficit goes up. it's not going down. it's going up. and so, therefore, we end up with a debt that according to our own congressional budget office hired by the congress, the majority are democrats, they approve a budget director, and he tries to do a good job of giving us honest numbers and

this is what the numbers showed. as of 2008, we had $5.8 trillion in debt in america since the founding of the republic. by 2013, five years down the road that will have doubled t to $11.8 trillion. and -- and in ten years, the ten-year budget that the president submitted to us. i didn't submit this budget. president obama submitted it. it was passed by the congress. increases that to $17.3 billion, tripling the debt of america in ten years. and that's what people are very concerned about, among other things, and what does all this spending mean also? it means government power, government reach, government domination, government takeover. people are concerned about it. they're asking are you not getting the message? what's the matter with you? that's what i'm hearing. and i think people have a right to be concerned about that.

one of the things that i've indicated and raised is the fact that the interest on the debt in 2009 was $170 billion for one year interest. by 2019, interest on the debt, according to c.b.o., in one year would be $799 billion. that's larger than defense, it's larger than any other. we spend about $100 billion a year on education, i think think $40 billion or so on highways. we will be spending in ten years because of this unbelievable spending $800 billion on interest alone. and how much of that on foreign governments, many of whom are not our friends and not our allies. so even the president has said it's unsustainable. this debt, the economists say

it's unsustainable. every politician i know of say it's unsustainable, but here we go right on doing it. so in the midst of this financial tempest, what do we now have before us? the promise of a $200 trillion or $2.5 trillion new health care program. $2.5 trillion, they score it. the question is -- i would ask the president, ask the democratic leadership in the congress, but congressman, senator, we don't have the money. what do you say about that? oh, they say, don't worry, we have this great new program that's going to help in so many ways and we're going to spend a lot of money, true, but it's going to be budget neutral. my goodness, not even going to be budget neutral. it's going to save $130 billion

a year. will you guys just relax? don't worry about it. we're going to save save $130 billion. thank us. we're going to give you this program, going to save save $130 billion, and going to give a lot more health care out here. still 24 million uninsured but we will have a lot of money to help you with your health insurance. and the president said it would not add one single dime to the national debt. well, people say hmm, how are you going to do that? that sounds pretty good if we can make that happen. how are we going to do it? well, the answer is we're going to raid medicare, we're going to raise taxes, and we're not going to pay the doctors to do our work. $494 billion in tax increases, increases, $465 billion in medicare cuts, cutting medicare that's already heading on a

glide path to insolvency by 2017, and $250 billion shortfall for our physicians and their payments that they have been promised and they thought they were going to get as part of this fix. so i would just make the point, well, you could give everyone in america a new car if you just raise taxes and raided medicare. that would be pretty easy, wouldn't it? so this is not a deficit-neutral program. just because we raise taxes, does it have to be that we would use that money to start a new program? what about the shortfall in highways we're hearing so much about? what about the cost of our effort in afghanistan? what about other expense that is we have? what about medicare, what our

seniors depend on? if you're going to raise taxes, why don't we use the money for that? who says we've got to raise taxes to start a new program? well, i suggest to you that based on the doctors fix, we call it alone, we don't have a a $130 billion surplus in this bill, the fact that it's unpaid for, we have a $120 billion net deficit because the bill fails to pay $250 billion in doctor fees that we -- i predict will some way or another pay. the way we've done it in the past, we have just socked it to the debt. we have just paid the doctors, raised no revenue, changed the law in no way. just paid them and just increased our debt that much each year. so i -- i say this is not sound numbers. i'm telling you, the american

people's instincts are right about this. we are not being responsible. about how we manage the people's business. and the promises are that this is going to be better for everybody, but will, let me ask, the average american who is doing the right thing, who is struggling and scraping together money to make insurance premiums each month, will that person pay less for their health care? c.b.o. basically says no except for individuals that -- who are not in group plans already who already are paying the highest costs for health care in the country. no, those people are going to pay as much as 10% more. and will health care as a percentage of our total economy, our total g.d.p., will it be reduced by this bill, therefore getting more health care at

better costs? not according to the scoring that we've seen. in fact, just the opposite is the case. if this bill passes, more -- a larger percentage of our g.d.p. will go to health care than before. so i just raised concern. this is a plan to create an entirely new government dominated health care plan. this is a new program. how are we going to do it? raiding medicare, raising taxes, and not paying doctors, among a bunch of other flimflammery that's in the bill. and we talk about this public option. well, senator baucus said we may not have a public option. it's in the house bill and it's in this bill that's on the floor.

so we don't have the money for a monumental new health care program. we could do a lot of things to improve health care in america that could help contain the rising costs of health care, that could not be done in a way that would not diminish the circumstances that we're in today. and what about medicare? do you remember when president bush proposed fixing social security and many senators, democrats as well as republicans, said well, president bush, if you want to do something, why don't you fix medicare? that's the one that's in the biggest trouble. and in truth it is sinking faster. it will decline by 2017, go into deficit. we have a shortfall in medicare now. what we should do is be focusing on medicare every way that we can to create efficiencies and more productivity, contain growth and costs and extend that

period of time before it goes in default. the last thing we should be doing is taking $465 billion from medicare. it's only going to accelerate its decline. this is common sense. let me see -- mr. president, i would just like to read a letter from one of my constituents i got, and from mr. bill everly in huntsville, alabama. he says i strongly urge you to vote against the health care bill passed by the house. the worst part about this bill is that it will -- that much of the cost will be paid by cuts to medicare. i am 68 years old and i have paid into medicare for 40 years, believing that it would cover much of my health care costs when i became 65. now i am being told that the government has found people who need coverage more than i do and

they will cut the care for which i have paid for 40 years in order to cover people who have paid nothing. it is not the government's money. the money belongs to those of us who have paid into it for so many years, and we are watching as it is being taken from us." i think that's a pretty fair statement of it. look, medicare is heading to default in in-- and insolvency in 2017. we have had a number of proposals to try to help on that. we haven't had much support from our colleagues on the other side of the aisle, even for modest fixes. i remember one bill that was going to reduce medicare spending by $10 billion over five years, and you thought we were going to savage the whole program. all trying to make it more sustainable in the long run, and

it really never became law. it was -- it was a big mess, but now we're talking about about $465 billion taken from medicare? huge numbers. so mr. president, medicare is a big problem. we need to work hard to bring it under control and honor our seniors who have been paying into this program, not drawing a dime from it, on the promise that when they get 65, they will start being able to draw medicare and it will take care of their health care needs in their senior years. that is a solemn commitment. before we start some monumental new program, we need to make sure that we are prepared to honor that commitment because they paid their money. they have paid their money. and so if we raise taxes, why shouldn't we pay the medicare

bill first? we raise taxes, why shouldn't we pay our doctors the money we owe them or some of the other priorities that we have in our country? now, mr. president, i -- i just feel strongly that the american people are sending us the right message. they are acting like good public-minded citizens would. they're seeing a reckless new spending program that they rightly anticipate will grow and grow and grow and expand far beyond all the projections we have today, that it will result in a government takeover of a whole large portion of our economy, and that they have not been impressed that the government can run these kind of things very effectively, and they are not in favor of it. and so they are -- are rightly concerned, and that's why the

polling numbers show the american people don't favor this legislation. i think their instincts are right. i think we should listen to them. i appreciate the effort to improve health care in america. i support a whole lot of things, some of which are in this bill and others that could be a part of this bill to make health care more affordable, more effective, and help people who are having a hard time financing their insurance premiums. but the truth is the bill doesn't really reduce the premium costs for most people, people that are paying their bills today are not going to get any reduction. in fact, some will get an increase. so for these reasons, i oppose the legislation. i thank the president and would yield the floor. mr. baucus: mr. president? the presiding officer: the senator from montana. mr. baucus: i believe another

senator may be coming to the floor. in the meantime, i suggest the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call:

quorum call:

mr. durbin: mr. president? the presiding officer: the majority whip. mr. durbin: i ask consent the quorum call be dispensed with. the presiding officer: without objection, so ordered. mr. durbin: mr. president, today all day we've been debating the health care reform bill which has been a matter worked on in the senate and the house for a solid year. i want to salute the senator from wyoming, senator enzi, who joined with civil other senators in i understand 1 separate meetings talking about this bill -- 61 separate meetings talking about this bill in an effort that didn't bear fruit as they'd hoped but was a bipartisan effort to come up

with some sort of solution to our health care situation in america. i hope that we can still reach some bipartisan accommodation before this bill passes. at this point in time, only one republican senator has voted for any form of senate health care reform and that was senator snowe in the senate finance committee. we hope others will join us before this bill comes to final passage in the senate. but that is the reality of the political situation. and so the bill before us is over 2,000 pages long, and some have criticized its length. i would defy anyone to write down in 2,000 pages or less a description of the current medical system in america. i think it would take many more pages to explain the complexity of the situation. but people across america understand a few basic things. health insurance is reaching the point where it's not affordable. families can't afford to pay for it anymore. businesses can't. and fewer people have coverage at their workplace, and many who go out into the open market

can't afford to pay the premiu premiums. today we've reached a point where our cobra plan, which is health insurance for those who've lost their job, we had provided a helping hand to many unemployed people across ameri america. it expired as of today. it picked up two-thirds of the premiums. i've run into people who said, even with the two-thirds being picked up by the federal government, i still can't afford it. and so it's understandable that health insurance is no longary fordable and -- longer affordable and it isn't getting any better. we estimate in the next eight years, the cost of health insurance will double. in eight years, it's anticipated that families will spend up to 45% of their income on health insurance. that is just not sustainable. so the starting point here is to find ways to bring down costs. the congressional budget office gave us a report yesterday and said we are on the right track. i can come up with other ideas

which i think might be more helpful but this is the art of the possible. and i think we are moving toward a model which will start to bring down costs. the second thing that we do here that is critically important is that we expand coverage so that it reaches 94% of americans. currently, there are about 50 million americans without health insurance, and these are people who are unemployed, folks that work at businesses that can't afford health insurance or folks out on their own that can't afford to pay for their own health insurance. and so we now reach a point with this bill where 94% of americans have coverage. that's a good thing. we also do it in a fiscally responsible way, because this bill, according to the congressional budget office, which is the neutral referee in this battle, according to that office, we will save in the first ten years of this bill $130 billion or more from our deficit. it will be the biggest deficit reduction of any bill considered by congress. and so in the second ten years,

they estimate $650 billion in savings. so to think that we have three-quarter of a trillion dollars in deficit reduction in this health care reform tosses me -- reform says to me, in the eyes of the congressional budget office and most observers, it is a fiscally responsible bill. there is a section of the bill which i think is critically important too. many people with health insurance find out that when they need it the most, it isn't there. the health insurance companies will deny coverage, saying that they're dealing with preexisting conditions that weren't covered, there's a cap on the amount that they're pay, your child is now age 24 and is not covered by your family plan. all these things are excuses for health insurance companies to say no. and when they say no, they make more money. we start eliminating one by one these perverse incentives for health insurance companies to say no. we give consumers and families across america a fighting chance

when they actually need health insurance that it will be there. two out of three people filing for bankruptcy today in america file because of medical bills. and that reflects the reality, that we are each one accident or one diagnosis away from a medical bill that could wipe out our life savings. the sad reality is that 75% of people filing for bankruptcy because of health care bills have health insurance. and it turns out it isn't worth anything. when they needed it, it failed. so we need to move to a point where the health insurance companies are held accountable. where when you pay premiums for a lifetime, the policy is there to cover you when you need it and that's what this is about. we eliminate some of the most egregious discrimination in insurance premiums. you know, the insurance industry is the -- one of two businesses in america exempt from antitrust laws, so they literally get together. they collude and conspire when it comes to setting their premium costs and allocating their markets and they can do it

legally under the mccarre mccarren-ferguson act. because of that they created discrimination against some women, srn age groups, -- certain age groups and people living in certain areas. we eliminate buy and large the discrimination. there is a pending amendment by senator mccain. i will tell you as a democrat, we take great pride in medicare, it was lyndon johnson who led a democratic congress in passing it. very few if any republicans supported it. and over the years it's a program that we stood behind as a party because we believe it provided so much well-being for 45 million americans now, today, seniors. and so this bill starts to move us toward a place where you can basically say that there's a sound economic footing for medicare in the future. if we don't do something today, in seven, eight, or nine years, the medicare program could go bankrupt. if we wait five years to do it,

imagine a what we'll have to do then. so this bill moves in that direction in making medicare sounder by eliminating some of the waste that's currently in the program. there was a time when our friends on the other side of the aisle joined us in saying this program could be more efficient. senator mccain's amendment say that's there should be no cuts in medicare even if it is in wasteful spending. i would say that senator mccain has a strong bill on patients bill of rights. i would say that it goes too far when it comes to medicare. i hope that we can defeat it or he will reconsider it. the last point i want to make is that this debate will continue. we hope to move to amendments. if we get to a point where we're dealing with filibusters an slowdowns in an effort to run out the clock and make us all leave on christmas eve with a job not finished, i think many of us will get tired of that approach. if they're amendments brought in good faith and debated and brought for a vote, that's what the senate is about.

if we continue to delay the consideration of these amendments, i think that our patience will grow thin and we'll have to move to this a point where the bill is con honestly considered. i ask that the senate proceed to period morning business with senators permitted to speak up to 10 minutes each. the presiding officer: without objection. mr. durbin: i ask unanimous consent that the foreign relation committee discharge senate resolution 71 and the senate proceed to its immediate consideration. the presiding officer: the clerk will report. the clerk: senate resolution 71, condemning the government of iran for its state sponsored persecution of the baha minority in iran and the covenance on human rights. the presiding officer: without objection, the committee's discharged and the senate will proceed to the measure. mr. durbin: i ask unanimous consent that the wyden amendment to the resolution at the desk is agreed to, the resolution as amended be agreed, the the preamble be agreed to as amended be agreed to, the motions to reconsider be laid on the table

with no intervening action or debate and any statement related to the resolution be placed in the record in the appropriate place as if read. the presiding officer: without objection, so ordered. mr. durbin: mr. president, i ask unanimous consent that the judiciary committee be discharged from further consideration and the senate proceed to senate resolution 358. the presiding officer: the clerk will report. the clerk: senate resolution 358, designating december 12, 2009, as wreaths across america day. the presiding officer: without objection, the committee's discharged and the senate will proceed to the measure. mr. durbin: i ask unanimous consent resolution be agreed to, the preamble be agreed to, the motion to reconsider be laid on the table. the presiding officer: without objection, so ordered. mr. durbin: i ask unanimous consent that the senate proceed to the immediate consideration of senate resolution 365 submitted earlier today. the presiding officer: the clerk will report. the clerk: senate resolution 365, recognizing the 50th anniversary of the signing of the antarctic treaty. the presiding officer: without objection, the senate will proceed to the measure. mr. durbin: i ask unanimous consent resolution be agreed to, the preamble be agreed to, the motion to reconsider be laid on

the table with no intervening action or debate and any statements related to the resolution be placed in the record at appropriate place as if read. the presiding officer: without objection. so ordered. mr. durbin: mr. president, that when the senate completes its business today it adjourn until 9:30 a.m. tomorrow, wednesday, december 2. following the prayer and pledge, journal of proceedings be approved to date, morning hour be deemed expired, the time for the two leaders be reserved for their use later in the day and the senate resume consideration of h.r. 3590, the health care reform legislation for debate only with no amendments or motions in order. and that the time until 11:30 a.m. be equally divided with alternating blocks of time with republicans controlling the first 30 minutes, the majority controlling the second 30 minutes. further that the senate recess from 11:30 a.m. until 12:30 p.m. the presiding officer: without objection, so ordered. the presiding officermr. durbine expected to occur throughout the day. if there is no further business

to come before the senate, i ask that it adjourn under the previous order following the remarks of senators enzi and inhofe. the presiding officer: without objection, so ordered. mr. enzi: mr. president? the presiding officer: the senator from wyoming. mr. enzi: thank you, mr. president. after the -- after the speech by the senator from illinois, i feel compelled to make a few comments. one, he challenged us a little bit to do a bill in 2,000 pages or less. i'm 1 of those people who don't think -- i'm one of those people who don't think it could be done enough. i don't think there's enough pages there to solve the biggest problem in the united states for every american p people -- people are not comprehending how big health care is. the bill that we are doing will affect 100% of the people in

america. i don't know if we had a bill before that affected 100% of the people. 100% of the people, 100% of professions, 100% of the businesses. this is big. everybody has a role in health care. and we're trying to condense it into 2,000 pages and make seem a lot simpler than it is. the reason that our side said that you need to take it a step at a time and get it right is because that gives up some of the right. there are over 200 references in the 2,000 pages that say that the secretary of health and human services will solve that particular problem. in other words, put the details in. we don't have nearly the details in there to actually run health care for america. without the details, we don't know what the devil is. and that's the difficulty. so we really ought to break it down a step at a time. one step that i think would calm

america down is if we did medicare as a separate step. that we could assure seniors that medicare is going to be for medicare. yes, there are savings in medicare. yes, medicare is going broke. use the savings for medicare. it seems pretty simple to me. one of the things that they're complaining about is the doc fix that we have. we're not paying doctors adequately to be willing to take medicare patients. of course we're not paying them adequately to take medicaid patients either. but we're not paying them right and it would cost $250 billion to fix that. well, if we're talking abou about $464 billion worth of savings in medicare, why not use that $250 billion to fix that problem so we have doctors? i don't care what kind of insurance you've got. i don't care how much you pay for the insurance. if you can't see a doctor, you really don't have insurance. and that's what seniors are being faced with.

that's what medicaid people are being faced with. medicaid, well, that's another piece that ought to be maybe a step. because 40% of the doctors won't take medicaid patients because they're not being paid adequately for it. and if you're not paid adequately, you go broke. they're small businesses much they're affected by this bill in more than one way. they have to provide what we're saying is a government requirement for the minimum insurance that they have. and they also have to live with whatever rules we put, whatever pay fiksz that we -- fixes that we put in there on the government option one of the things that c.b.o. said was that the only way that that would ever bring down costs is if the government fixes prices for the doctors, for the hospitals. well, we're kind of doing that in this bill for the medicare because we're telling nursing homes they're going to take a big cut. nursing homes don't have a lot of margin. and if nursing homes go broke,

people have to go a long way sometimes, in wyoming, anyway, in colorado, wherever we have rural populations, they may have to go a long way to see their loved ones and they may not be able to do it. so we have to keep the small nursing homes in business as well. so we ought to do this in steps and get it right. and that's 1 of the problems that the group of six ran into. we weren't given the time. we -- we allocated about 13 different areas to go through. i think we made it through five completely and probably three fairly completely and the rest we were just asking basic questions yet. you know, with any business it looks pretty easy until you scratch the surface a little bit. and when you scratch the surface, you find out every job out there is fairly complicated. if you've never done it before and you're trying to come up with 2,000 pages of law to govern that, you're probably going to get it wrong. that's what the doctors are telling us. that's what the other providers are telling us. this bill has it wrong in a lot

of places. enough places that it's going to cause a crisis in america if this bill passes the way it is. we have never passed a major bill in this body with just one side voting for it. if that were to happen, the other side would take pot shots at anything that turned out to be something that hadn't been comprehended when the bill was written, and there will be mete of that in here. but just as importantly, the american people won't have confidence in it. they don't have confidence in us now. either side. i think that's what the elections in virginia and new jersey said. that's what the tea parties are saying. they're saying, we don't trust any of you. throw the whole bunch out. start over. well, we -- we need to really stop and get their confidence. and just steamrolling from one side, even if they've got the 60 votes, isn't going to do that. i've been saying that since we started this. it's something so important that we've got to get it right. and we don't have it right in

this bill. because there are a whole bunch of things, over 200, that we said the secretary of health and human services, you figure that one out. well, that's going to be thousands of pages and it's going to be done by an unelected bureaucrat. it's not going to be approved by this body. we ought to take the responsibility for getting those things right. and we can. yes, it takes time. yes, we have a lot of things to do. but i'm in agreement that health care is the most important thing that we have to do. and that we ought to take the time to get it right and there are a lot of ideas out there that would -- in fact, one of the things that always upsets me when they say, so where is the republican version? well, i've been working on this thing for about four years. i've been working on health care since i got on the committee over 13 years ago. but for the last four years, pretty intensively. senator kennedy and i sat down and worked out principles that we wanted to have. the principles are still the principles that we're talking about around here. we want to make sure that people

are covered in catastrophic situations, we want to make sure that preexisting conditionings are taken care of, to make sure that they have portability when they go from one job to another. the list goes on and on. and we reached agreement. and he was busy working on the higher education act. because it was way past due for being reauthorized. i was released to talk to everybody on health care. i worked both sides of the aisle finding out ideas that they had and boiled it down to a 10-step plan. and i did a tour with my 10-step plan to see what kind of problems there were with it and was really pleased with the reception. yes, i learn some things that needed to be done differently than what i thought. but if you'll check my website, there's a 10-step plan on there that is a bill. that covers the things that we've been promising people that they'd have. i would not suggest doing it sun several steps, not necessarily 10 teps, which are -- steps which are what are in there.

it would bring down the cost of health insurance. that's what i hear from people, bring down my costs. now, everybody's been real pleased with this c.b.o. clarification that came out that said that the costs were not going to raise -- they didn't say don't let them raise. they said, bring them down. bring them down. they said, we don't mind covering a whole bunch of other people, but don't increase my cost as a result. this bill increases their costs as a result. there's a way to do it and there are four different bills on the republican side and then there's a really bipartisan bill that senator wyden and senator bennett worked out and i think there were 15 co-sponsors on both sides of the aisle. those are all ways that this could be solved. but they're not in the bill. so senator wyden was left out of the that part of the process, i'm not sure it could be considered partisan. you