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this in the first part of your remarks. my great great grandfather did say 96 years ago, and i quote, "i appreciate the press for its great usefulness to scientists. it can help us by extending our results. it is the intermediary for reaching the ears and minds of the public." i am going to ask you if you agree to assume the role of intermediaries starting right now. as i have just announced, and before answering your questions you are going to proceed with the signing of the memorandum of understanding between the trust

and my foundation. thank you very much. [applauding] [inaudible conversations] >> can i borrow your pen? >> sorry. >> can i borrow your pen? [inaudible conversations]

[inaudible conversations] [applauding] >> okay. who is going to tell me what got sign here? [laughter] >> did somebody buy a house?

>> well, maybe we can up here and explain exactly the document that was signed. as all memorandums of understanding. it is the beginning of a relationship. it will take too much time to explain to you today, but if you want to say a few words, the ceo of my foundation. >> we can only add that we have already some potential track of cooperation in the field of conservation of the forests in canada with the working governorship with some canadian institutions. i hope it is a first concrete field of partnership. >> okay. we are going to start off with

some of our questions. we have lots of them. you want to pass your questions up to the front, please do so. we will start off with the controversy over climate change that. what do you think of the recent report on scientists who change their data to fit the climate change scenario of global warming? >> someone said that these were going to be easy questions. [laughter] is this the right luncheon? well, listen, i think quite simply for me we knew this was going to happen. of those who have followed these issues pretty closely over the last few years and months and on every subject of scientific nature there is some controversy or there can be some opposing

arguments or opposing theories. this will be reviewed. i can tell you from what i in my personal experience, not a scientist, but i think i have been in touch and engaged and talked to a lot of different scientists. i was out in the field myself. i can assure you that there are signs already out there of the effects of climate change. i don't think you can argue committee on the intensity of it, on it, on the fluctuations of temperature of averages around the world, precipitation averages, but one thing is for

sure, it is happening. it is happening on a global scale. you have to remember that it is not evenly this jury did, and the effects are seen more in some areas than others. it is definitely happening. we have to address this issue before it's too late. >> what is the most compelling evidence that you have seen about global climate change and global warming global warming t? back t? back global warming t? back >> well, if you look at the polar regions i think the subjects today because it is, as you said, i was over at the smithsonian for the summit, 50 years of the antarctic treaty. so i was able.

i was very privileged. feeling very privileged to have been to both polar regions. you see it very simply -- let's start with the arctic. wide areas of open water in the early spring which never used to be. and pretty close to the north pole. separately so pretty high up around the 89th parallel. so that was not the case just a few years ago. the loss of ice mass is also very very noticeable. you have had, obviously there has always been fluctuations in the thickness of the ice, but there tends to be more fluctuation now and more than ice. of course i noticed first-hand

and was able to compare wonderful photographs that were taken by my great great grandfather. he did four arctic expeditions. in the 1906 expedition they did take a picture of a very famous glacier on the island of spitzbergen in the archipelago. this is half way between norway and the north pole. the glacier there, we are able to compare just photographically and visually. and since 1906 it has receded some four-and a-half miles. ..

>> desert-like conditions although it is a very cold desert. but they have very little precipitation and high winds, but that's always been, that's more or less always been the the

case. but there are these big fluctuations. and what is also happening is that the hole in the ozone layer above antarctica is, has not receded at all. it's still very much there, and it still influences and sometimes in a very negative way the climate not only in antarctica, but as far as australia or south america. and it does have a major -- and part of the studies that are going on and that we're part of the programs, the research programs of the international polar year were to study even more the effects of antarctica and the climate around antarctica and how it influences different climate systems around the world. >> okay. so you're a prince. you could be doing prince things

like fitting glass slippers and rescuing damsels in distress. [laughter] what makes you so passionate about the environment? [laughter] >> where are those glass slippers? [laughter] well, i think it's, as i tried to say before, it's a, i think a heritage i got from not only my great, great grandfather, but my father was very instrumental in setting up different and being at the forefront of different initiatives for the mediterranean specifically and for the area around monaco. he set up more notably an agreement between france, italy and monaco and preservation of coastal areas and setting up a sanctuary for marine mammals in the mediterranean that has been

kind of a model for other sanctuaries around the world. and we wish there could be more. so it's all that heritage, i think, that came into play. he, and i understood pretty early on and maybe it was -- and i say this under the -- i was going to say under the authority, but under the guidance of -- there's some people here from the "national geographic" society. i think you might remember this, there was a poster that was, that you people very aptly produced in 1970 i think it was that was entitled, "how man pollutes his world." and it really showed how, in very simple and very educational terms, how air, land and sea pollution was happening around

the world and issues that concerned the environment that are still very pertinent today. and so that poster had a great effect on me all through my childhood. so that's another big reason. and then i've in recent years i've accompanied my father to different international meetings and more notably the rio summit in 1992. i was, i represented him and was the head of the delegation at the summit in johannesburg in 2002. and so the commitment then came and took on a different, different aspect. but it certainly is very much still there. >> okay. do you expect any true concrete action to come out of the copenhagen climate summit? what would you consider to be a

success? >> well, i think the, what we have learned now from meetings leading up to@@@@@@rr

so -- to settle for these numbers right now, and then we have a basis from which to then move forward. but it, it is a unique opportunity, and to get everybody around the same table on this issue and to try to commit to certain goals, it's better also to start maybe more, a little more modestly and then be able to review that in months and years ahead. >> while the arctic ice is melting, we have an increase in ice at antarctica.

nevertheless, a peninsula at wilkins island broke apart. how do you explain that incident? >> well, i referred to that a little while ago. i cannot substitute myself to scientists, and maybe there's someone in this audience who might be able to explain that better than i can. please. [laughter] >> [inaudible] scientists talked about this year ago. as it warms up slightly, enough extra water vapor arrives to make more snow. >> but that's what -- that's what i was talking about. [laughter] no, no, but that's what i alluded to before. no, but i was thinking more of the ice shelf breaking off. i don't know if you have an explanation of that. >> former ocean water is heating way up underneath. >> okay. >> well, thanks to the audience for pitching in there.

[laughter] >> audience participation. >> jack williams, our weather expert. okay. how did you get to antarctica, and do you recommend more people visit to get a better understanding of the challenges and the environment in general? and did you have a good time? [laughter] >> i had an incredible time. and it's, as i said, a thing very few people get to have such an extended tour and be able to visit as many stations as i have. and i'm really thankful to all those that made it possible. i came to antarctica through south america, through chile which is one of the -- by air. landed from, left and landed on king george island. maybe some of you have been there, maybe you have been there, mr. williams, and then

proceeded from there -- actually, we had to because of problems of aircraft and other technical issues that i won't go into, we had to go back to go further and deeper into the the continent. but it was mainly by air, and the only part that was terrestrial was on skis when i joined mike horn, the south african explorer, where we skied together for two days and camped out under, shared his tent with him, and we reached the south pole on skis. so that was the advent rouse part -- adventurous part of the trip. but -- oh, i can't remember the last part of the question. >> do you think more people should do it to get a sense of

the environment? >> that's a double-edged sword. of course, if you know a place and you tend to want to protect it more and do more for it, but the other side of that is if too many people go there and this is coming under review by the different councils that take care of antarctica that there could be a quo that on the number of -- quota on the number of visitor there, especially those that come from the cruise ships. because there is an impact when you have too many people going along these shores at the same time. that is already impacting not only the, the usual routes where these ships go, but it obviously

has an impact on the wildlife there. so you have to be very, very careful. >> so what about the wildlife management? what nation is in charge of protecting the wildlife and the environment from tourism, and is there some joint effort to handle it? >> wildlife worldwide or -- >> in antarctica. >> oh, in antarctica. well, it -- what happens is that the 12 original countries that signed the antarctic treaty have areas of responsibility. it's not an extension of their national territory, but they have areas of responsibility where it's mostly for safety issues and protection issues.

but the species that are studied in antarctica, obviously, it's mostly on the coastal areas because that's where the wildlife is. there's very little life on the antarctic, the antarctic plateau and the ice sheet of antarctica which i said is almost like a desert. so there are microorganisms, of course, but there is no -- you never see, never see a bird, you never see any other animal life. so the areas where it can't, where they can be monitored, obviously, it's not 100% protection for those different species, but we are seeing some

diminishing of populations of penguins and other marine -- but that's mainly from their food source because there's less and less krill because the waters are warming up as we've heard. and so they're very sensitive to variances in temperature. so that's one of the aspects that is going on. >> okay. so let's move on to oceans and fishing. do you support a world ban of blue fin tuna, and do you support the fish farming developments of japan's tuna developed at the university in japan? >> well, i'd be, i'd be remiss if i didn't support that because monaco was at the initiative of the, of the proposal to put

mediterranean bluefin tuna on annex one of the washington treaty and to, therefore, put its commercial -- as it will be listed under an endangered species annex list, and it is an automatic ban from commercial fishing. so that's -- based on the data that we have from scientists in the mediterranean that the stocks and the stock of bluefin tuna in the mediterranean is on the verge of collapse. so if we didn't do something, and quotas clearly are -- even though they were just, just reevaluated -- quotas will simply not allow the stock to replenish itself. and it simply will not work.

so we have to move now to the next step, and that's at the next, at the next meeting to be able to put mediterranean bluefin tuna on the annex one. and so we've been able to get support from many different countries, but mainly, also, from the united states, and we really appreciate that. we thank them, take this opportunity to thank the u.s. government and it different constituencies for their support. and their leadership in this. and we hope that we will be able b to be successful. >> the obama administration has an initiative to address housing and transportation by creating, quote, livable communities where people can drive less. it has become controversial

drawing criticism for trying to dictate how people live. how do you address such critics, and what do you think of such plans? you're tall. i'm moving that up for you. [laughter] >> well, i think that's, that's an effort. it's not ideal, but coming from a small country and a city-state we have our own issues of traffic and of mobility, and we are and we have been for the last few years putting a lot of emphasis on public transportation. as i said in my remarks, on clean mobility and the use of electric and alternative energy vehicles is a primary concern to us. but, obviously, you try to minimize the use of private vehicles in the small areas as

much as possible, and to emphasize other means of public transportation because that will help ease, obviously, your traffic flows. and so these kind of initiatives, i think, even though they seem a little odd or farfetched at first will -- you have to try them out. and there's no definite answer to all these problems and issues. sometimes you have to do a test for a certain period of time, and then if it works, you can continue implementing it. if it doesn't work, well, then you move to another solution. but these are huge issues for urban areas large or small. with population growth in

different countries around the world, it will become an increasing issue. if we don't start addressing these issues now, we'll be too late in months and years to come. >> so monaco, kind of small. what kind of effect could monaco exert on global understanding, culturally, economically and socially, and are there advantages in being small? [laughter] >> um, yes, there are. [laughter] you try to fit in twine the big -- between the big guys and try to help bridge those gaps. but i think and i've tried to on environmental issues i've also tried to get the small countries of europe together, and we were able to have a meeting a couple years ago in monaco to, you know, get a little consensus on what smaller countries can do.

and we can also albeit on a smaller scale, we can sort of be, i think, interesting test grounds to try out different, different policies or different tests that could be done for what we were just talking about, for mobility but for other issues too. and we've tried to play our part. we've tried to show that we can apply different, different innovative policies in transportation and recycling and alternative energies, and we will continue to do so in the future. >> what actions will monaco, will monaco take to minimize the environmental impact of cruise

ships? >> well, we can smile about this, but it is, the cruise ship industry, as you know, has@ã

hook up to the power lines. and they still use their generators. and that, as you know, that generates some, some pollution, and that's not very agreeable for anybody who's in the area. but they are, they are conscious of this, and they do, some do compensate for their carbon footprint and do on our part of offset programs, but there's still a long way to go. i think not only the cruise ship industry but as the automobile industry and as wills start

moving more and more toward clean mobility and cleaner alternatives to what they are using today. and we are, also, i've been in discussions with -- because i'm sure that this question will come -- for the monaco grand prix automobile races. we have taken this issue up with the fia, with the governing body of the automobile racing in formula one, and they have started to make steps toward energy recuperation, but they will have to move sooner or later toward the racing cars that will, that will use either

biofuels or even, or even hybrid cars. but it's still, it's still some ways away now. >> years ago you opposed expanding monaco by creating an artificial peninsula. however, earlier this year you approved bids from architects for such a project. how do you explain this reversal, and how do you be sure there won't be negative environmental impact? >> the reason why we, why i stopped the expansion project was twofold. first of all, that none of the five bids in competition fully answered our environmental impact guideline. and it was at the time where, if you remember a year ago, we didn't quite have the visibility

of where the potential economic downturn was going to take us. and i thought it was simply not responsible to engage monaco in this big project where the large, large financial backing of these projects was not necessarily private funds. and so it was potentially a difficult situation, and so i didn't want us to be caught in that situation. but it's a project that can be revived in the years ahead. we don't -- our development did not hang on this one project alone. >> okay. we have a few family questions. we'll try and work them in. what do you consider to be your father's greatest contribution to monaco? >> i think it was a number of

things. i think quite simply he was responsible for the development of monaco. the post-war, postworld war ii development of monaco. he simply brought it and helped develop it into a very different place 60 years ago to what it is today. and all, not only the physical aspect of monaco, but in its economic development, but in all other areas as well. and he can b be credited for credible achievements. >> okay. we are almost out of time, but before asking the last question, and i'm going to be fair, i'll ask one about mom, we have a few important matters. first, let me remind you of our

future speakers. on december 4th, joy zinnman, the artistic directer and co-founder of studio theater will talk to us about how a theater saved a neighborhood. on december 8th a gary knell will be here, apparently with some sesame street characters although i don't know which ones. [laughter] on monday, december 14th, karen mills, the administrator of the u.s. small business administration will be here. second, i'd like to present our guest with the traditional and much-coveted npc mug. [laughter] [applause] >> thank you. >> okay. and for our last question, let's see, which of your mother's films is your favorite and why? [laughter] >> well, i don't, i didn't say this when i did the voiceover

for turner classic movies, but i would have to go with rear window. i mean, i like all of them, but -- [applause] but rear window, i think, has a credible, well, it's a great story and an incredible quality to it. and the relationship in the movie between jimmy stewart and my mom was simply magical. so -- [applause] thank you. >> i'd like to thank you all for coming today. i'd also like to thank national press club staff members melinda cook, pat nelson and joann booze for organizing today's lunch, also the library for its research. the video archive of today's luncheon is provided by the national press club's broadcast operations center, and our events are available for free

download on itunes as well as on our web site. nonmembers may purchase transcripts by calling 202-of 662-7598 or emailing us at archives@press.org. please go to our web site at www.press.org. as we conclude, i'd ask you all to stay in your seats for a few minutes while the prince exits, and i thank you all for coming. we are adjourned. [applause] [inaudible conversations]

[inaudible conversations] let us debate our differences ss medicare for the future, and that's what's going to be is co. they want us toight states that domestic abuse ise e problems in bitterly, bitterly know, one ofis united states the things that i'd say to my

the presiding officer: the senator from illinois. mr. durbin: mr. president, there's a saying in iowa and in illinois that any old mule can kick down a barn door, but it takes a carpenter to build one. i would modify that slightly and say any old elephant can kick down a barn door, but it takes a carpenter to build one. we are debating health care reform. the american people are following this closely because it affects every single one of us in this room. everyone in the gallery and everyone watching. this is one of the few things we'll debate which you can bet will affect you and your family personally. it's rare that an issue comes before us at this gravity and an issue that reaches every single person in america. it may be the biggest single issue we have ever tackled on the floor of the united states senate. in terms of its scope and its impact on the future of every

single one of us. so for more than a year a lot of people have been working hard to come up with a piece of legislation that will have a positive impact on health care in america. it is involved committee hearings. the presiding officer is a member of the senate finance committee. they sat in meetings hour after weary hour, day after weary day considering amendments. before they produced a bill that is part of what we have before us today. the senator from iowa is part of that same committee. i understand that he met personally over 60 times with democratic senators and a few from his own side trying to see if we could come up with some kind of bipartisan approach. comind him for his good -- i commend him for his good faith effort in doing that. the health, education, labor and pension committee spent more days in deliberation on the bill, considered amendments and adopted over 100 republican

amendments to the bill and not one single republican senator would then vote for the bill. not one. one senator, senator snowe of maine, voted for the senate finance committee, one republican senator voted for that version of the bill. what we have today and i want to just slightly modify my friend from iowa's remarks is a 2,074 bill with -- page bill with a one-page add. this is senator reid's amendment as a substitute. 2,075 pages created by these two committees in the senate and a similar endeavor taking place in the house. for at least 10 days now this bill, in its entirety, has been available for public review. i ask anyone interested who wants to read this bill, as every member should, to go to the senate democrat website and

if you google senate democrats, you'll find it, and you'll find this bill in its entirety sitting there to be read and reviewed, as it should be. then i invite you, for reviewed, as it should be. then i invite you, for thvparison sake, to go to the

we've labored to produce this moneymental, historic legislation, our republican colleagues on the other side of the aisle have not broken a sweat to produce their own answer to this challenge facing america. all they can do is come before us and criticize this bill. any old mule can kick down a barn door, but it takes a carpenter to build one. we have been working for over a year -- almost a year to build this health care reform package. and here's what we know. we just received a report from the congressional budget office, which is like the referee up here. this is an agency that takes a look at what we do and tells us

whether it is going to reduce the deficit, add to the deficit, reach its stated goal or fail to reach it. it's maddening sometimes to have a separate agency kind of looking over your shoulder, but they do, and they just reported, just yesterday, that this bill will make health insurance more affordable for many americans and will not add to the costs for many others. i wish it would do more. i wish it would bring down costs dramatically, even more. but for weeks and months we have heard from the republican side that our health care reform proposals would run premiums sky high. turns out they were wrong. this bill that we have produced moves us toward more affordable health insurance. every american who pays any attention to what health insurance costs knows that is absolutely essential. in the last ten years, health insurance premiums have gone up 131% in america. ten years ago, a family of four

bought health insurance for about $6,000 a year. now they buy it on average for about $12,000 a year. and in seven or eight years, it will go up to $24,000 a year in premiums, projecting that it will eat up 40% of your income for health insurance in just eight or ten years. well, that's an impossible situation. we know it is. it's unsustainable. businesses can't offer health insurance that expensive. individuals can't buy health insurance that expensive. and so if we do nothing, we will reach a situation where the current health care system in america will start to collapse. i don't want to stand idly by and let that happen. neither does president obama. he has challenged us to address it and address it honestly. on the other side of the aisle, the senate republicans have not produced a bill, a proposal, an alternative which will make health insurance more

affordable, nothing. they come before us in criticism of what we have done and yet they cannot produce a bill. and i would also tell you the same congressional budget office tells us that the bill we put together will actually reduce the federal deficit over the next ten years by at least least $130 billion. this bill, this 2,075-page bill will cut more deficit than any piece of legislation we have ever enacted in congress. the senator from iowa is concerned about our national debt. so am i. where's the senate republican proposal for health care reform that is going to reduce america's deficit? and incidentally, the same congressional budget office says in the second ten years -- think that far in advance -- this approach will reduce the federal deficit by another $650 billion. i ask the senator from iowa with all his concern about the federal deficit, where is the senate republican bill that will reduce the federal deficit by

by $750 billion over 20 years? the answer i'm sorry to tell you is it doesn't exist. they either haven't or cannot write a bill. they are legislators, but frankly they have come here to be critical of what we've done and not offer a substitute or an alternative. there's something else this bill does. it is a travesty in america today that almost 50 million people don't have health insurance. a lot of these folks are children. a lot of them are people in low-wage jobs with no benefits, and a lot of them are the newly unemployed. 50 million of our neighbors in america who go to sleep at night without the peace of mind of having health insurance protection. in my life, it happened once. newly married, college student, baby on the way, no health insurance. and our baby had a problem, and i ended up carrying for eight

years medical bills that i slowly paid off year after year. that goes back many years ago, as you might imagine, but it was troubling and heart breaking to be the father of a child and not have health insurance. to sit at children's memorial hospital here in washington, in the room that was set aside for people without health insurance and wait until my number was called to bring my wife and my baby in for a checkup. i didn't have health insurance. i never felt more helpless in my life. 50 million americans go to bed each night with that feeling. they don't have health insurance. what does this bill, this 2,075-page bill do about it? it extends the coverage of health insurance, the peace of mind, protection of health insurance to 94% of americans. it is the largest extension of health insurance in our history. where is the republican alternative? it offers coverage for 94% of

americans? doesn't exist. they haven't written that bill. they don't know how to write that bill. they do know how to come and criticize this bill, but they cannot produce a bill which covers 94% of americans and provides tax credits and tax assistance to help those americans pay their premiums. if you're making under poverty wages -- let's say you're making less than $14,000 a year -- and i've got friends of mine in my state who are -- you're covered by medicaid. you don't pay premiums. the federal government compensates the states, pays the premiums. all the way up to about $80,000 for a family of four, we provide credits and help to pay your premiums, as we should because premiums can break the bank, not only for businesses but for families. there's also something we do in this bill that i never hear from the other side of the aisle, and i'll tell you why in just a

second. we give consumers across america a fighting chance when the health insurance company goes to war with you. you know what i'm talking about? somebody in your family gets sick. you know it's going to require a hospitalization or surgery and you know the cost is going to go sky high, and you say thank goodness i have health insurance. you make the claim and the health insurance company comes back and says we dispute the claim, we're not paying. people say wait a minute, i have been paying health insurance premiums for years just for this day, and you're telling me i don't have coverage? it happens thousands and thousands of times each day, and you know why? health insurance companies are profitable when they say no. what are the reasons for saying no? well, you failed to disclose a pre-existing condition when you applied for the insurance, and it turns out that they go to ridiculous extremes to find an excuse not to provide coverage.

we also know what happens when you lose a job, you can't take your insurance with you by and large. we know that when your child reaches the age of 24, they are no longer carried on your family health insurance. those are the realities of health insurance companies saying no. i have yet to hear the first republican senator come to the floor and say that is outrageous and it has to change, we've got to tackle the health insurance industry because the health insurance industry opposes this bill. the health insurance industry believes their profitability and their future depends on saying no. this bill starts saying to these companies you can't say no. based on a pre-existing condition, based on lifetime limit, based on losing your job. and we cover kids through the age of 26. we extend the family coverage to children to that age. and you know that's only sensible because a lot of kids are going to college and getting out without jobs, you want them covered by your family health

insurance plan. this bill does it. the republicans have yet to produce one bill, just one on health care reform that takes on the health insurance industry. instead, what they have come to do -- and the pending amendment by the senator from arizona leads with this -- is protect the health insurance companies. the first thing that the motion to commit does from the the senator from arizona is to instruct the committee, senate finance committee, to protect a program called medicare advantage. this is a great idea for health insurance companies and not a great idea for most seniors or taxpayers in america. allow me to explain. the health insurance companies came to us several years ago and said medicare is a bureaucratic mess, the government can't run these programs, we are in the private sector, we understand competition, let us compete with medicare. well, they were given the right to do that.

private health insurance companies were given the right to write health insurance that provides medicare benefits. they said they could do it more cheaply, and in fact some of them did. but at the end of the day, after years after watching them, it turned out these medicare advantage policies cost 14% more , not less, 14% more than government-administered medicare programs. in other words, we were subsidizing health insurance companies, paying them more for the same medicare coverage people already had received. they loved it. thousands and thousands of americans now covered by medicare advantage, these great subsidies coming from the federal government. talk about an earmark, senator. 14%, what an earmark that is. mr. mccain: yield for a question? since the gentleman mentioned my name, will he yield for a question? mr. durbin: what the basic problem with the senator from arizona's amendment -- i'll

yield to you in just a second -- what the basic problem with his amendment is he is protecting these health insurance companies with medicare advantage. first thing he does. he's protecting this subsidy, this big, fat earmark that we put in legislation, 14% bump in premiums is protected by this motion to commit. now, it's understandable that the health insurance companies want to keep this. it's a sweet deal. they're getting paid for something that they promised us would never happen. they also -- there's a provision in the senator's motion to commit that says that we should take out of here the conflict of interest sections in medicare. you know what that's about? that's when your doctor also owns the laboratory which does your blood test and the imaging center which does the x-rays and says i'm not sure what's wrong with you, but i know there are two things you need. you need a blood test and you need an x-ray. well, maybe you do, maybe you

don't. and we say in this bill you have to disclose to your patient that you have a personal financial interest in this laboratory and this processing operation and you have to give them an alternative to shop for another place if they want to. is that unreasonable? it's one of the provisions the senator from arizona wants to take out of here. it's a savings in medicare. now, that's unfortunate. we've got to do our best to eliminate the waste and fraud and abuse, as terrible as that old cliche is, in medicare. why is it that the same medical procedure offered in rochester, minnesota, to a medicare recipient costs twice as much or more in miami, florida? i think maybe we -- do you think maybe we ought to take a look at that? i think we should. i think maybe there is some price gouging here. i want to know, does that mean we're going to reduce the benefits for someone living in miami? not necessarily, but it means

the taxpayers won't be ripped off, medicare won't go broke. we're doing what we need to do to be responsible. so taking money out of medicare means shutting off the subsidy to the private health insurance companies for medicare advantage. it means stopping the selfdealing of some doctors who are sending medicare patients to their own labs and their own processing companies. it means finding out where the waste is taking place. the senator from arizona says we instruct the finance committee take out those provisions in the bill. keep medicare advantage there with the 14% subsidy for private health insurance companies. don't engage these doctors when it comes to these conflicts of interest. i don't think that's right. it wasn't long ago that my friend from arizona was a candidate for another office, and during the course of his campaign for president, he suggested that we have a pretty substantial cut in medicare and medicaid. in fact, during the campaign,

the senator from arizona called for $1.3 trillion in reforms in medicare and medicaid. more than twice as much as we're calling for in medicare. t

over $250,000 a year, that's the increase in the medicare tax is going to be buying five years of solvency for medicare. so when they talk about our raising taxes, true, at the highest income levels. what they don't tell you is the other side of the coin. the money brought in goes straight into the medicare trust fund to keep it solid. what else does this bill do? this bill starts filling the doughnut hole. you may not know what that means unless you happen to be a senior or have one in your family, but medicare prescription drugs stop paying at a certain point. this bill starts coverage in the doughnut hole, in the gap in coverage that currently exists in medicare prescription part-d. where is the republican bill to fill the doughnut hole?

it doesn't exist. at least i haven't seen it. it's not on their web site. here's ours. that's why aarp has endorsed this bill. the american association of retired persons knows this bill is a good bill for seniors. i urge my colleagues to oppose the mccain motion to commit. first, if we take this bill off the floor, which many republicans want us to do, it will take us days, maybe a week to bring it back to the floor. they want to delay this as long as possible. they want us to fail. they want us to stop. they want us to adopt the senate approach to health care reform, which is do nothing. leave the system the way it is. we cannot continue the system the way it is. this is a responsible bill. it makes health insurance affordable. it reduces the deficit, according to the congressional budget office, covers 94% of americans, finally tackles the

health insurance companies for the first time in a long time, and it buys at least five years more for the medicare program. i wish i could compare it to the senate republican approach, but that doesn't exist. any mule can kick down a barn door. it takes a carpenter to build one. i yield the floor. the presiding officer: the senator from arizona. mr. mccain: mr. president, i regret that the senator from illinois did not observe the courtesies of the senate, particularly when a person's name is mentioned as he continued to mention my name throughout and totally falsifying my position both in the presidential campaign and the position that we have on this side and this amendment. i've always extended the courtesy to the senator from illinois, and i deeply regret that even this comity of the senate is no longer observed. so, i say to the senator from illinois, i regret that you would not respond to a question

that i had posed and that you had said "i will respond in a minute." again, even that comity is not observed here. mr. durbin: if the senator would yield for a second? mr. mccain: i will go ahead -- mr. durbin: would the senator yield for a second? mr. mccain: the senator did not provide me the courtesy of allowing me to respond to a question. now you want me to respond to a question from you? i will display more courtesy than you displayed to me. go ahead. mr. durbin: i apologize. i planned on yielding to you. i'll be happy to yield to you. i always do, and i failed to. i apologize. mr. mccain: well, i guess my questions were, one, the senator who claimed that we had not -- no republican has done anything to curb the health care insurance industry, was the senator in the senate when senator kennedy fought for weeks and months for the patients' bill of rights? was the senator here then? was he engaged in that debate?

senator kennedy and i fought for the patients' bill of rights, and the majority on that side of the aisle opposed it. so the fact is that there have been efforts on my part to curb the abuses of the health insurance industry by sponsorship of the patients' bill of rights. second of all, during the campaign, yes, i said that we could reduce and eliminate waste, fraud, and spending in the -- fraud, abuse and waste in spending, and i said it because of senator coburn's patient choice act, which could save $1 trillion from the states in medicaid savings, $400 billion over the next ten years in medicare savings. i wish that the senator from illinois would examine the patients choice act as proposed by the senator from oklahoma. maybe we would learn something. the senator from oklahoma's bill wants to preserve the best

quality health care in america and not eliminate $120 billion to the medicare advantage program which 330,000 of my citizens are enrollees in and like and want to keep. $150 billion to providers, including hospitals, hospice and nursing homes, $23 billion in unspecified decreases to be determined by a -- quote -- "independent medicare advisory board" as well as billions of additional cuts to the medicare program. there is no relation between what i tried to do in my campaign and what is being done in this legislation, i tell my friend from illinois. i'll be glad to hear the senator from illinois' response. i'll be glad to extend him that courtesy. mr. durbin: i thank the senator from arizona, and i commend him for his work on the patients' bill of rights, which i joined him in with senator kennedy and would do it again. the point i was making --

mr. mccain: you just said no republican had done anything to curb the health insurance industry. the patients' bill of rights certainly would have done that. mr. durbin: my point was that there are provisions in this bill dealing with the rights of consumers against health insurance companies which i have not heard the senator or others -- mr. mccain: that's not what you said. mr. durbin: i would just ask you: do you support the health insurance reforms in this bill that give patients the right to -- against health insurance companies on preexisting conditions, for example? mr. mccain: my record is very clear advocating for patients and against the abuses of insurance companies across the board. mr. durbin: we thank you for that. mr. mccain: mr. president, i ask unanimous consent to yield to the senator from oklahoma to describe the patients choice act and the way we could truly save money in -- and reduce fraud, abuse, and waste in the system and at the same time preserve

quality health care. mr. coburn: mr. president? the presiding officer: the senator from oklahoma. mr. coburn: thank you. medicare doesn't cover everything. 84% of all medicare patients have to buy a supplemental policy now. do you know what kphaeupbg is about -- medicare crank? who set the price on medicare advantage? the government set the price. the very same people you want to run it now created a 14% premium. the insurance industry didn't set the prices. the center for medicare services set the prices. the government is responsible for that different repbgs. why is medicare -- for that differential. why is medicare advantage important? because the majority of people can't afford to buy a supplemental policy to make them whole. so medicare advantage for 89,000 oklahomans is the only way they get equality with the rest of their peer group that can afford to buy a supplemental policy.

an now we're going to take that ability away from the poor seniors in oklahoma, arizona, iowa, illinois, and we're going to say you don't get what everybody else because you are economically disadvantaged, so we're going to give you substandard care and we're going to take more of your income. medicare advantages offer the things you get with a supplemental policy when you can't afford to buy a supplemental policy. the very idea to say we're going to take that away, when you take that away, you're taking that away from the cheapest program that we really have in terms of peformance, because what medicare advantage does, which their bill and this bill purports to do is recommends and encourages and incentivizes prevention, like the senator from iowa wants to do for everybody. it incentivizes. it doesn't cause to have a prevention exam in medicare advantage. there is no out-of-pocket cost

for our seniors who are poor who happen to have the benefit of medicare advantage. you're going to take that away. you're going to destroy it for 11 million seniors. the ability to get a preclearance, a screening exam without them having to spend money on it. now, is there a way to get money out of medicare? yeah, there's $100 billion worth of fraud a year in it. and according to harvard, there's $150 billion worth a year of fraud in medicare. there's $2 billion worth of fraud. i want to address something else that -- mr. mccain: before the senator continues -- mr. coburn: i'd be happy to yield. mr. mccain: i ask unanimous consent to regain the floor and then be able -- the presiding officer: without objection. mr. mccain: and engage in colloquy with -- i ask unanimous consent to engage in colloquy with the senator from oklahoma. the presiding officer: is there objection? mr. mccain: mr. president -- the presiding officer: without objection. mr. mccain: mr. president, i have to address the situation

since i have been accused by the majority leader of changing my position. in 2005, the senate considered the deficit-reduction act of 2005, which called for approximately $10 billion in reduction in medicare costs. approximately $10 billion. senator harry reid, democrat, nevada, said -- quote -- "unfortunately, the republican budget is an immoral document. let's look at what is in the bill before us. the budget increases burdens on america's seniors by increasing medicare premiums, and we have not seen what the house is going to give us. it cuts health care, both medicare and medicaid, by a total of $27 billion." the majority leader was outraged in 2005 that there should be reductions in medicare and medicaid spending of $27

billion. now -- now the distinguished majority leader, with the white smoke coming out of his office, now says that he's for $483 billion in cuts in medicare. that, my friends, is a remarkable flip-flop. by the way, i might add that senator dodd, who is here on the floor, said concerning this reduction, this deficit reduction act of 2005, senator dodd said, "for example, this bill cuts funding from medicare and medicaid, which provide health care to poor children, working men and women, the disabled, and the elderly." what a plea. what a plea. senator barbara boxer said "mr. president, i strongly oppose the reconciliation bill before the senate. the bill would cut vital programs for the middle class, elderly and poor. that's why i cannot believe only two months after katrina we have a bill that would cut medicare and medicaid by $27 billion."

and the list goes on and on. and now before us we have cuts of $483 billion, including hospice, including hospitals, including other vital programs for our seniors. so, if we're going to go around and talk about flip-flops, let's look at the rhetoric that accompanied my colleagues on the other side in their opposition to $27 billion in savings, which, by the way, actually only saved $2 billion to $3 billion over five years. so i would ask my friend from oklahoma, does he believe that it is possible to make these cuts, including from the medicare advantage program, and establish a medicare commission

that would not over time cut benefits that exist today for medicare and medicaid patients? mr. coburn: mr. president, i would answer my colleague by saying this bill is a government-centered approach, not a patient-centered approach. it's the very reason that we're in the trouble that we're in today, is that we've had the government making the decisions rather than the patients and the physicians. and will in fact lessen the care for seniors. i gave a speech earlier this morning on the floor that if you're a senior, you should be worried because the medicare advisory commission and the cost comparative effectiveness commission will now decide ultimately what you got. and we have an amendment on the floor which in many ways i support, i would like to modify, about reinstituting what should

be the standard for mammography for women. how did we get there? we have a commission that looks at costs and not patients. k

them and what is not. and everything we know about medicine is that's exactly the wrong way to practice it. because every patient is different. every patient's family history is different. and so when we talk about taking $120 billion out of the medicare advantage program, what you're talking about is decreasing access to some of the most important screening capabilities that many of these people have. and making them unaffordable because they can afford a supplemental medical policy. they can accomplish it. i want to address one other question. the majority whip said the republicans haven't had a bill. during the markup in the "help"

committee, i went through point by point on the patients' choice act. the patients' choice act puts patients and doctors in charge, not government in charge. the patients' choice act neutralizes the tax effect to make everybody treated the same in this country as far as the i.r.s. right now if you get insurance through your insurance company, you get $2,700 worth of tax benefits. if you don't, you get $100. that's really fair. that's one of the reasons why people who don't get insurance through their employer can't afford health insurance is because we don't give them the same tax benefit. we give a tax cut to 95% of americans plus help them pay their share. the patients' choice act incentivizes states to have reform in terms of the tort problem that we have that we know costs at least 6% to 7% more than we've spent on health care than we would if we had a

realistic health system. we go after health insurance companies because we do risk readjustment. if you're dumping patients or cherry-picking, you have to pay extra. you have to pay to the very insurance companies that are covering those sick people. so we change the incentive to where aen insurance company is incentivized -- to where an insurance company is incentivized to care for somebody rather than to dump them. i was defeated at every turn trying to make this and to say that we didn't come with a bill when on a party-line vote in the "help" committee 13 voted against a commonsense bill that didn't increase taxes, didn't increase premiums, covered more people than this bill will cover by 4 million, put everybody in medicaid in a private insurance policy so that no longer are they discriminated against against the doctors who won't take medicaid, take the medicaid stamp off their forehead, and

giving them the same access to health care we have. mr. mccain: so does my colleague find it entertaining that the -- that my friends and colleagues on the other side of the aisle who in 2005 as part of the deficit-reduction act, we had to bring in the vice president from -- who i think was overseas in order to break the tie because they were worried about what senator reid called "immoral" -- the republican budget, "an immoral government document." is the senator aware that the citizens against government waste have come out against this? i ask that a letter from the group be included in the record? the presiding officer: without objection. mr. mccain: many of the seniors in my state, i would ask my colleague, have been very puzzled at the aarp's endorsement of a proposal that would cut their medicare, that it's already been made clear

that medicare advantage -- and there's 330,000 of them -- senior citizens in my state -- that are under medicare advantage; that it's been announced that it'll be slashed that somehow aarp is now supporting it. all i can say is, is my friend aware that there's an organization called 60-plus that is working very hard on behalf of seniors to make sure that they don't lose these benefits? mr. coburn: i am. i would tell the senator again, how are we where we are? how are we where we are when we're going to take programs that are working -- granted, i think medicare advantage could be decreased by -- through true competitive bidding bu c.m.s. -- but c.m.s. doesn't do that. this bill cuts the benefits in half. the extra benefits that medicare patients have by being signed up on medicare advantage that everybody has who can afford a supplemental policy. i want to address one other

thing, if the senator would allow me. the majority whip said, don't we want to get rid of conflicts of interest? yes. but his arkt was specious -- but his argument was specious. because the prices set for an x-ray who are a mammogram or a c.t. or a blood test, they are set a by medicare -- they are set by medicare now. there's no arbitrariness. the government sets the price for every medicare test out there by region. so there's no way to game it, as the senator from illinois said it was gamed. the best reason to have a lab and a doctor's office is so you don't have to wait and come back for another visit to the doctor that charges medicare another $60, because you get the answer right then. we want to eliminate that. so what will we do?

there's no cost savings in that. there is a cost increase. because now instead of giving an answer to a patient, you're going to wait after you send it back to the lab and have it come back in. mr. mccain: may i ask the senator a fundamental question here. how does the senator envision that we can eliminate the fraud, abuse, and waste and institute significant savings -- one of the ways is retain the provisions in this amendment, this motion to commit, that uses the savings from fraud, abuse, and waste elimination to make the trust fund stronger but at the same time preserve the benefits that our senior citizens have earned? how many times have you heard from senior citizens in your state saying, i paid into this trust fund. i paid for my medicare all my life. now it's going to be cut. how is that fair? how is that fair to my

generation, the greatest generation? mr. coburn: if yo you take $100 billion a year -- and that's not an exage rakes. even h.h.s. said the improper payments were $92 billion, the inspector general and the g.a.o. both say it is higher than that -- that's on medicare alone f we just captured $70 billion of that. now, how do you do that? you know how medicare pays now? they pay and then chase. so you submit an invoice. they don't know if it is accurate or not. they pay it. they pay it. then they go and try to get the money back afterwards. how about precertification of a payment like everybody else does that has anything to do with the volume that medicare has? the other way they do it is undercover patients where you put people actively defrauding medicare in jail. less than $2 billion in this whole bill goes after fraud.

that's 2% of the fraud per year. we could cover everybody in the country or extend the life of medicare 20 years by eliminating the fraud that's in medicare today. what are we going to do? we're not. we're going to create more government programs and more agencies that are going to be designed to be defrauded. and so, therefore, the fraud is going to go up, not down. the fraud is going to go up, not down. and we're also going to limit the availability of prevention to seniors. i've read the prevention text in this bill. there's parts of it i absolutely agree with. we know that if we manage prevention and we manage chronic disease, we're going to save a lot of money. but we're not going to save any of it by building jungle gyms and sidewalks. what we have to do is incentivize people, both physicians and patients to get in the preventive mode. we need accountable care

organizations. there's lots of things we could do. there's lots of things we agree on. i know that the senator from iowa and i agree on a lot about prevention. but we ought to be saving that money and we ought to eliminate the fraud. you know, if we did nothing in this body except eliminate the fraud in medicare, think what we would have done. think what we would have done. think what we would have done to the kids that follow. $447 billion spent on medicare. $100 billion in fraud. wheelchairs that have been billed out so many times that they collect over $5 million on them. doctors who submit false invoices, suppliers who split invoices for people who are deceased, and we try to go get that after the fact? there's lots of things we can do. this bill is short on that.

you all recognize it's short on it. it's the biggest savings out there. the reason there's not more in it is because c.b.o. won't score it. because we've never demonstrated the capability. one final point: this bill only scores the way c.b.o. scores because it says you intend to do what no congress has ever done. it says you intend to cut medicare. $460 billion to $480 billion. if you intend to cut medicare, the american people ought to know where you're going to do it and how it's going to affect them. but if you're just doing it for a scor scoring point, the young people in this country ought to know that, too, because where you say you're claimin saving $0 billion, you just adding to the deficit. we don't cut medicare that much. and is it fair to the medicare

advantage patients who are poor, don't qualify for dual coverage with medicaid, can't afford a supplemental policy, is it fair to take away the benefits that they have today that we have given them and it wasn't priced by the insurance industry -- it was priced by the c.m.s. -- and say, because c.m.s., the government agency didn't price it, we're going to take away half your benefits? it is not fair. it is not right. if there's anything immoral, that's immoral. with that, i'd yield the floor. mr. baucus: mr. president? the presiding officer: the senator from montana. mr. baucus: mr. president, i'd like to once and for all hra*eu once and for all lay to rest this false claim that the pending bill is going to -- quote -- "hurt seniors and it is going to hurt providers and it's going to be this long parade of horribles that the other side

likes to mention. it is totally, patently untrue, the claims that they are making. number one, all the crying, allegations on the other side that the underlying legislation cuts medicare, it cuts medicare, cuts medicare. that's what they say. what they don't say is that it does not cut medicare-guaranteed benefits. it doesn't cut benefits. it does reduce the rate of growth that hospitals would otherwise receive. it does reduce the rate of growth that medical device manufacturers might receive. all that is true. so it is true that it is cutting the rate of growth of medicare providers. it is not true that this legislation cuts medicare benefits. that is not true.

the other side would like you to believe that's true by using the words they choose, by saying cutting medicare. they want you to believe that's cutting medicare benefits, but it's not cutting medicare benefits. rather, it's -- the underlying bill reduces the rate of growth of government spending on providers, on hospitals, home health, hospice, lots of other providers. that's really what's going on here. don't let anybody fool you, this bill does not cut medicare benefits. it does not. it does reduce the rate of growth of providers. now, why are we doing that? first of all, most of these providers, virtually all the providers say, gee, we don't like our rate of growth of federal dollars coming to us being cut, but we'll go along with it.

they're okay. they're okay with it. why are they okay with it? why is the american hospital association okay with reducing the rate of growth of hospital paeupts by $-- payments by@@@@@ no cuts to medicare benefits. there are reductions in the rate of growth to medicare providers,

which the providers agree with by and large. i won't say totally. i won't stand here and say they're jumping up and down and they're enthusiastic about it. but i am saying that they realize they're really not getting hurt. they're going to do okay. they're going to do okay because they're going to make up on volume that they might otherwise lose. that is a very important point for people to understand. second, if you listen to the other side, what they would have us do is virtually do nothing. and what does doing nothing mean? doing nothing means that the solvency of the medicare trust fund is just over the horizon. this legislation extends the solvency of the medicare trust fund another four to five years. man, oh man, if i'm a senior or about to be a senior, i would sure like the medicare trust

fund to be solvent. i would like that very much. this legislation extends the solvency of the medicare trust fund by another four to five years to about the year 2017. so without this legislation, the actuaries say the medicare trust funds can become insolvent in 2012, around there somewhere. that's not very many years from now, mr. president. not many years at all. it's very important we extend the solvency of the medicare trust fund. now you might ask, why is the medicare trust fund in a little bit of jeopardy? why is that? why is that? the very basic reason is because health care costs are going up at such a rapid rate in america, at a very rapid rate in america. our health care costs are going up 50%, 60% more quickly than the next most expensive. we already pay per capita 50%,

60% than the next most expensive country. there is a whole host of things in this legislation to make sure we have some limit over health care costs. mr. president, i realize i misspoke earlier. currently the medicare trust fund is due to be insolvent in about the year 2017. this legislation extends the sol veteran sift medicare trust fund to the year 2022. so the principle is the same, but the five years is tacked on a little bit different later period of time rather than up front, so early. but we're doing a whole host of things in this legislation to reduce the rate of health care costs in this -- to people in this country, and it's health care costs which are driving up the cost of the medicare trust fund. and so we're doing all we can here to extend the sol veteran sift medicare trust trust fund.

some might say baby boomers are retiring more, that is going to add to the pressure on medicare. that is somewhat true, but the congressional budget office did a study six to eight months ago which i think it is about 70% of additional costs of the medicare trust fund is due to cost increases. it's not due to more baby boomers retiring when they reach the age of 65. what do some of the groups say about this legislation? let me just say what aarp says. i have a chart here which indicates what the american association of retired people says about the underlying bill. if they were cutting medicare like the other side says, you'd think they wouldn't like this bill. aarp hasn't totally endorsed this bill but they don't have problems with it because they know we're doing the right thing. what do they say? aarp says opponents of health care reform won't rest. they're using myths, misinformation to distort the

truth and wrongly suggesting that medicare will be harmed. after a lifetime of hard work, don't seniors deserve better? that's what the aarp says, referring to the distortions and misrepresentations and untruths, trying to scare seniors mentioned by opponents of this legislation. here's another aarp quote. "the new senate bill makes improvements to the medicare program by creating a new annual wellness benefit, providing free preventive benefits and most notably for aarp members, reducing drug costs for seniors that fall between the dreaded medicare doughnut hole that causes a gap in the prescription drug benefit." it's a very important point, mr. president. this bill not only does not cut benefits, it increases benefits for seniors. what is referred to right there, and that's the so-called doughnut hole, the gap in coverage under the prescription drug program, this legislation

in effect says that seniors now will have $500 of their drug benefit, prescription drug benefits paid for when they're in that doughnut hole period. and add to that, this bill also says it's all paid for, at least for one year in this doughnut hole. we may have to worry about that in subsequent years but this bill improves the benefits seniors will get, not take away benefits as the other side would imply. now it is true that private programs like medicare advantage are reduced from what they otherwise would be, just as hospitals are reduced in payments from what they otherwise would get. let me just -- i have a chart here. let me point out the next chart here if i could, which shows that the provider groups, hospitals, et cetera, are actually going to do okay under this legislation. what does this chart show? this chart shows that medicare spending will continue to grow

under this legislation. it will grow, and grow by a lot. here it is in 2010, it is $446 billion. you can see a steady growth in ten years of this bill. and i might say that parenthetically one of the previous speakers said rural health care is going to be hurt, rural hospitals are going to be hurt by this legislation. mr. president, i don't think that's entirely true. i've got a lot of hospitals in my home state of montana, pretty rural hospitals, they say it's okay. they approve it. in addition to that, there is no disruption to critical access. in rural areas most of those hospitals are critical access. so they're going to be okay. basically if we do not pass this legislation, these provider groups, hospitals, nursing homes, home health, hospice, medicare advantage, even part-b

and medicare improvement would all increase by about 6.5% over the decade. they would all increase by 6.5% over the decade. under this legislation, they all increase by about 5%, by 5% over this decade with a 1.5% cut, which they basically agree to. so i want to make that point very clearly, mr. president. we're not cutting medicare here. not cutting medicare benefits. not cutting medicare benefits, but we are reducing the rate of growth of medicare spending. now, another point i want to make here if i could, mr. president, is that there's nothing new here. many of the centers advocating killing this bill -- many of the senators advocating killing this bill made the obvious statement not too many years ago. what did they say? you have to reduce the rate of growth in medicare spending in order to save medicare benefits. that's what they said a few

years ago, exactly what they said. let me read from some. "we propose slower growth of medicare. medicare would otherwise be bankrupt." they're making the opposite statement today. the exact opposite statement today to try to scare people to kill the amendment. here's another senator. i am not going to embarrass them by giving their names. but they are senators who currently serve in this body. here's another one: "we do heed the warning of the medicare board of trustees and limit growth to more sustainable levels to prevent medicare from going bankrupt in 2012." that's what they said. experts know that if we're going to save medicare benefits, we've got to stop overpaying some of

the providers, hospitals and so forth. and we are overpaying them. let me tell you one small example of how we're overpaying them. did you know that the updates -- there's just a fancy term for paying more for hospitals and so forth -- did you know they don't take productivity into account when they make these recommendations? the recommendations are based by an organization called medpac. as the presiding officer knows, medpac is a bipartisan organization, it is a nonpart isn't organization composed of doctors and experts that advise congress on what the payment updates -- what the payment increases should be for different groups over the years. and we in congress basically look at them. we try to decide what makes sense, what doesn't make sense and so forth. but medpac has said, mr. president, that this is what we have to do. we've got to slow the rate of growth of some of these providers because they're getting paid too much. they're getting paid more than they need to be paid.

and i just said -- i'll repeat myself. we're going to allow still a 5% growth over the next ten years and none of them are really crying wolf, i might say. the -- that's the main point i just want to make, mr. preside mr. president. i mention what aarp is saying. let me mention the american medical association. "we are working to put the scare tactics to bed once and for all and inform the patients will the benefits of health reform." that's the american medical association. they are referring to the scare tactics of the other side. so the aarp and the american medical cal association and others know that no senior will see a single reduction in guaranteed medical benefits under this bill, not a single one. i might also say that this bill would reduce premiums that

seniors would have otherwise paid. much of those savings come from limiting massive overpayments to private insurers -- that is, private companies like medicare advantage. seniors hear the word "medicare advantage," they tend to think that's medicare. it's not. it's a private company. those are private companies. and they're basically enhanced under the 2003 medicare part-d legislation. they're give an lot more money to encourage them to have competition in rural areas t turned out that we gave them way too much additional money and they know it. and this legislation is trying to cut back on the excess that they're provided back in the year 2003. i might say the cut is about $118 billion over ten years. i don't have with me how much is remaining, but that 5% figure i gave you of growth, that includes medicare advantage plans. i mention already that this

legislation would reduce prescription drug costs. that doesn't sound like a benefit cut to me. it sounds like an additional benefit for seniors. and we also provide for new prevention of wellness benefits in medicare. that's in addition. that's not a cut. that's an addition. we're also helping seniors stay in their homes and not -- their own homes, not nursing homes. that's a benefit. i think it is important to point out here, the opponents of health care reform do not have a plan to protect seniors and strengthen the medicare program. they say, don't do what they said a few years ago. they say, recommit the bill, do nothing. they say, go back and start from scratch again. that's basically what they say. if you listen closely. if you listen to the music as well as the words, if you read between the lines, they say, kill it. that's what they're saying. i hate to say it because i tend to be a pretty nonpartisan kind

of guy, they're not true. sometimes you just got to call a spade a spade. that's exactly what's happening here. i might say that, you know, the medpac, the outfit that advises us, nonpart son, decides what to do here, they say that medicare advantage plans are overpaid by 14%. a typical couple that pays -- a typical couple will pay $90 more per year for part-b premiums to pay for medicare advantage even if they're not enrolled in the plans. that's not right. i might say this: medicare home health providers -- i gave you that list here, that earlier chart. one small part of that is medicare home health providers. they have an average margin of 17%. 17% for health. that's a little high. if we're trying to protect medicare benefits, we've got to make sure we're not overpaying the medicare providers. it's just common sense.

it is not the right thing toured. so many seniors need -- it's not the right thing to do. soament seniordo. so many seniors need@d ßh& frankly off taxpayers and seniors. we have added additional provisions in here to outlaw that fraud, additional

screening, additional certification, just different ways to make sure that medicare does a better job -- h.h.s. -- or c.m.s. does a better job deciding which providers are right and which are not right. what's the real impact of the medicare policies here? let's be clear. the real impact of these policies, even with the medicare changes in the bill, overall provider at the same times will still -- provider payments will still go up. i want to make it clear that we're not cutting benefits, folks. we are reducing the rate of growth of spending for health care providers, as hospitals and nursing homes. but reducing it in a moderate way that we're not reducing it by too much. as this chart shows, those providers still get at least a 5% net increase in payments over the years, and the groups themselves have not really complained about them.

let's take the pharmaceutical companies, hospitals, nursing homes, home health, hospice -- they're not crying big crocodile tears. remember that famous meeting down at the white house not too long ago? the industry all came in and talked to the president. remember what they pledged, all these providers, and how much they could cut the reimbursement to them. it is included to insurance companies. insurance companies, hospitals, everybody. $2 trillion over ten years they said they'd cut. $2 trillion. $2 trillion. this doesn't come close to -- or this legislation doesn't come close to cutting $2 trillion. doesn't come close to cutting $2 trillion. i think the figure is about $400 billion. that's not $2 trillion. that's $400 billion. so we're not hurting them that much. we're not hurting them frankly. they're doing okay. i've got quotes from the hospital associations.

here's sister carol keyan, president of the catholic health association. "clearly catholic health thinks the possibility that hospitals might find hospitals to be very, very unfounded." i've heard the legislation that this legislation is going to -- i've heard the climb that this legislation is going to -- he have a had so many quotes here. people believe this is okay. they're not going to pull out. "hospitals will always stand by senior citizens." the president of the federation of the american hospitals. we also know, as i said, some providers will do really well under this reform legislation. wall streetagessists have suggested that many providers including hospitals will be -- quote -- "net winners." hospitals will be net winners, according to generally the basic feeling among wall street analysts. because under our bill they estimate that hospital profitability will increase with reform because more and more hospital patients have private

health insurance. so nobody is going to pull out. there are not cuts in medicare benefits. it is true there is a reduction in some of the private plan nonguaranteed benefits that plans -- that companies would give to seniors at the expense of private-paid seniors. that is triewvment but medpac said it should be -- that is true. but medpac has said it has been cut more. we're giving them a break by not cutting them by what medpac says they should be cut back. the reductions in this bill are the providers, not beneficiaries. they're far less than the health care industry said it could save over the next decade, a reminder they pledged to save $2 trillion. right now -- over ten years. in this legislation, they're just going to be hit for $400 billion. i mentioned before the other

side has often said that this is exactly what we have to do, although today they say no, no, no. they're not exactly quite sure what the difference is. years ago they said, this is what we should do. perhaps they can explain that. i might mention here, too. this is very, very important in this legislation. we happen to lose sight of the delivery system reform. one of the reasons why there's so much waste in our health care system -- and there is a lot of waste. the estimates ritz estimates a. seniors, are not given the gifts they should receive. private patients aren't getting the benefits they receive because of all the waste. the waste is basically because of the way we pay for health care in our country. we pay on the basis of quantity. we pay on the basis of volume. we do not pay on the basis of

quality, or to state it differently, a hospital -- and they probably do the right thing, hospitals -- or doctors, they try to do the right thing. they're paid on how many procedures they provide basically, not outcomes, not quality. and that's the basic route in my judgment that's causing a lot of waste in the american system. health care is provided for differently in different parts of the country. the fancy term is called geographic disparity. health care is practiced in one way in one comunts. health care is practiced another way in another community. they're very different. many of us have read that new yorker article -- the june 1 "new yorker" article written by a doctor comparing el paso, texas, with mcallen, texas. i see the two senators on the floor here. perhaps they can help us understand what's going on in el

paso and in mcallen. health care in el paso is about half what it is in mcallen, another border town. about half. people are spending -- spending for a person in el paso, texas, is about half of what it is in mcallen, texas. yet the outcome -- that is, how well patients do -- is a little bit better in el paso than it is in mcallen. why? according to the article -- the author of the article -- it is because of how medicine is practiced, what's the ethic, what's the sense in el paso regarding health care and what st's in m mca-- and what is it in mcallen regarding health care. according to the author, his conclusion is that, well, in el pass so, it's because -- in el paso, the care is more patient-centered, it is coordinated care. it is less on making a buck. whereas in mcallen, it is less coordinated care, more

specialties hospitals, a little bit more providers than trying to make a buck. the medicine is practiced so differently all over the country, geographic disparities. some states in the northern high plains states, less spending per person. outcome is terrific. some of the sunbelt states, don't want to step on the toes of my colleagues, more spending the outcome is worse. just because it is based on volume and quantity, not based on. this legislation starts to put in place twice move toward reimbursing based on quality. not volume. and that paradoxically is going to result in lower costs and higher quality. lower costs but higher quality. virtually all folks in the health care community -- doctors, hospitals, administrators i've talked to, doctors i've talked to, health

care doctors i've talked to -- virtually all say, i'll be very conservative, 80% agree, 85% agree this is the direction we have to go. this legislation goes in that direction. failure to pass this legislati legislation, which the other side wants -- that is, not to pass it -- means we don't do any of that. means we don't start putting in plays ways to more properly reimburse doctors and hospitals and other health care providers. this bill includes those patient-centered reforms i just mentioned. what are they? they include accountable care organizations, bundling is another concept, reducing unnecessary hospital readmissions, create innovation centers. this bill starts to do that. there's something else this bill does which i know some on the

other side get all exercised over and i think it's -- they get exercised over it improper improperly -- and that's ways to start to compare the -- one drug versus another, compare one procedure versus another, you know, the one medical device versus another. and we just have to start doing more of that with a nongovernment agency, with a private-public agency that works together so it gets -- gives good, solid information, so we have more evidence-based medicine in america. rye now, a lot of docs, they want to do the right thing but what they do depends upon the drug republicadrug rep that comr office and start peddling certain drugs. docs feel unease he about that, they don't like it but -- uneasy about that, they don't like it but they see so many patients, they're busy and they're trying to keep up to date.

so we're trying to keep up to date with evidence-based medicine, and with i.t., medical text nolg so they catechnology t access to the best evidence here. there's so many reasons why this legislation is so important. and i personally believe we have to move a bit toward what's called integrated systems. you know, we hear a lot about geisinger, mayo, cleveland clinic, intermountain health care, there's home health out in seattle where doctors and hospitals and nursing homes and pharmacistpharmacists are more d together and that, therefore, cuts down on costs, increases quality, is more patient-centered, it's care-crrtd, and thi -- care-coo, and this legislation helps us move in that direction. you know, we're just trying to get started here with this legislation, get started on doing some of the right things that we know we should do. we're not -- we don't have all the answers here. nobody has all the answers. but if we get this legislation

passed in the next couple three or four or five years, we work with the basic underpings of this legislation -- underpinnings of this legislation, we're going to create some mistakes, we're going to see some new opportunities, we're going to be working on getting health care costs down, which we have to begin doing to help our people, help our companies. we're going to work to get more coverage so more people have health insurance. i mean, it's an embarrassment today, it's an absolutely embarrassment in the united states of america, an industrialized country doesn't provide health health insurance for its people. i mean, it's more than an embarrassment, it's a travesty, it's a tragedy. it's just wrong. it's morally wrong. so this legislation just gets us on the right track at moving. it helps medicare beneficiaries, not hurt them, as the other side would like you to believe. it does not unnecessarily harm doctors an and hospitals. they plan to go along with it. they know it's the right thing to do. they're still getting big increases in payments. and i just -- and there are other forums here which i

haven't got time to mention tonight, but i just strongly urge us to, you know, say, hey, this is the right thing to do. let's get started. let's pass this legislation and -- and certainly trounce this -- this recommittal motion to stop what we're doing. it's not right to stop this. we're getting started here. let's keep going. i yield the floor.

let us debate our differences ss medicare for the future, and that's what's going to be is co. they want us toight states that domestic abuse ise e

problems in bitterly, bitterly know, one ofis united states the things that i'd say to my