in fact, a little more private. the figure i have in 2007 it's 46% public and about 54% private. but roughly that's where we are. it might change ever so slightly. but we're not any of those other countries. we're america. in america, it's half public and half private, and this legislation before us maintains that philosophy, is that correct? ms. staben ms. stabenow: absolutely. i think it invites the private sector to participate in a new marketplace. mr. whitehouse: if i could interject, senator baucus, i would add that it's a relatively familiar american principle to put public and private agencies side by side in competition, in fair competition and let the best for the consumer win. we see it in public universities. many of us have states with public universities we are very proud of. they compete with private

universities. i think almost every one of us has a public university in our home state, and it's a model that works very well for education. many of us -- unfortunately not in rhode island, but in many other states there are public power authorities that compete with the private power industry. in fact, some of the most ardent opponents of a public option go home and buy their electricity from a public electric cooperative or from the, a public power authority. you see it in workers compensation insurance. a lot of health care is delivered through workers compensation insurance. mr. baucus: isn't that a pretty good system. don't put too many eggs in one basket? mr. whitehouse: i think it's the old american principle of competition as the distinguished chairman of the finance committee pointed out. mr. baucus: doesn't this legislation provide for more competition than currently

exists? mr. whitehouse: i think it does. mr. baucus: with health insurance market reform and with the rating reforms, et cetera. mr. whitehouse: all those and a public option. all of that adds to a better environment. one of the interesting things about this is that you really only have a good and fair market. america is founded on market principles. we all believe in market principles. one of the things about a market is people will cheat on it if there aren't rules around the market. if you don't make sure that the bread is, you know, good, honest, healthy bread, then some rascal will come and they'll sell cheap, lousy, contaminated bread in the market. you have top discipline in walls to protect the integrity in the market. that is what the health insurance market has lacked. i think it will enliven the market in health insurance and animate the market principle. mr. baucus: i ask my colleagues: is there anything

in this legislation which will interfere with the doctor-patient relationship? that is today people choose their own doctors, whichever doctor they want. they can by and large, with the hospital they want. though the doctor may send them from one hospital to another. is there anything in this legislation which did diminishes that freedom of choice patients would have choosing a doctor? mr. whitehouse: nothing. ms. stabenow: if i could add, i think one of the most telling ways to approach that is the fact that the american medical association, the physicians of this country support what we are doing. they are the last ones that would support putting somebody, somebody else, i should say, because i believe we have insurance company bureaucrats tpraoebgt fully between our doctors and -- frequently between our doctors and patients but they would not be supporting us if it were doing what we're hearing. mr. baucus: what about procedures doctors might want to

choose for their stphaeurbts is there anything in this legislation which at all interferes with the position a physician might have as to which procedure to prescribe in consultation with his or her patient? ms. stabenow: as a member of the finance committee with the distinguished chairman, we have written nothing that would in any way interfere with procedures. in fact, what i believe through the fact that we are making insurance more affordable, we're going to make more procedures available because more people will be able to afford to get the care they need. mr. whitehouse: the american academy of family physicians, the american nurses association support this legislation because they know that instead of interfering between the doctor and the patient, we're actually lifting out the interference that presently exists at the hands of the private insurance for-profit industry between the patient and the doctor. they want to see this, and

that's one of the important reasons. another important reason is something that you, the distinguished chairman of the finance committee, are very responsible for beginning all the way back at the start of this year when the finance committee under your leadership had the prepare to launch, full-day effort on delivery system reform. and what you will see is doctors empowered in new ways to provide better care, to have better information through -- mr. baucus: i might ask my friend, that's very true. could he explain maybe how doctors might be more, in this legislation, empowered to have better information to help them provide even better care? mr. whitehouse: there are a great number of ways, and much of it is thanks to your leadership and thank to the khraoerp of chairman dodd on the "help" committee who put together a very strong package which has now been melded by leader reid. the main ingredients are taking

advantage of medical health records so you are not running around with a paper record, not having to fill out that clip board again, not having to do another expensive m.r.i. because they can't access the one you had last week. if you have drugs you're taking, the drug interactions that might harm you might be caught by the computer and looked at by the doctor. the electronic health record is a big part of it. investment in quality reform is a huge, huge issue. hospital-acquired infections are prevalent throughout this country. they cost about $60,000 each on average. they are completely preventible. nobody knows this better than senator stabenow from michigan, because it was in her home state that the keystone project began which has since migrated around the country. it's gone statewide in my home state through the rhode island equality institute. it's been written up in "the new

yorker" magazine in new york. what they have shown, the information from the senator from michigan's home state was that in 15 months they saved 1,500 lives in intensive care units and over $150 million by better procedures to prevent hospital-acquired infections. ms. stabenow: if i might just add to that and thank, thank you as chairman for putting in language on the keystone initiative into the bill. in this bill, we are in fact expanding what has been learned about saving lives and saving money, by focusing on cutting down on infections and the intensive care units, by focusing on surgical procedures, things that actually will save dollars, don't cost a lot, that saves lives, but they involve thinking a little bit differently, working a little bit dimple as a team. our physicians and nurses and

hospitals have found if they made it a priority, it became a priority. there are so many things in this legislation that will save money, save lives, increase quality. and that's really what this is all about, which is why so broadly we see the health care community, all the providers -- nurses, doctors, and so on -- supporting what we're doing. mr. baucus: i think it's important not to overpromise because some of these initiatives, some of these programs will take a little time to take effect. in fact, some of the provisions don't take effect for a couple, three years. but still wouldn't my colleagues agree that some of these are going to probably yield tremendous dividends in the future, especially generally the focus on quality, not outcomes and reimbursing physicians in hospitals based on quality of outcomes and pilot projects,

bundling and other similar efforts in this legislation. one or the two of you both may want to comment on that point. mr. whitehouse: it's a very important point. again, this is a point that isn't something that emerged suddenly or overnight. the distinguished chairman of the finance committee has been working hard on this for a long time, back even before prao*ep "prepare to launch" which was an early reflection of the work you've been doing. as we've been looking at this bill, this legislation will save lives, saves money and saves medicine. and we can vouch for that through the findings of the congressional budget office. but the congressional budget office has been very conservative in its scoring. and there is a letter that the c.b.o. wrote to senator conrad, and there's testimony and a

colloquy that he engaged in with me in the budget committee that makes clear that beyond the savings that are clear in this legislation, there is the promise of immense further savings. what he said is "changes in government policy, such as these, have the potential to yield large reductions in both national health expenditures and federal health care spending without harming health. moreover, many experts agree on some general directions in which the government's health policies could move." and you've developed those general directions through those hearings, and it's now in the legislation. but the conclusion he reaches is "the specific changes that might ultimately prove most important cannot be foreseen today and could be developed only over time through experimentation and learning." and the m.i.t. report that just came out the other day, professor gruber, dr. gruber said the toolbox to achieve

these savings through experimentation and learning is in this bill. i think his phrase was everything you could ask for is in this bill. and as the distinguished chairman of the finance committee knows better than i do, there are big numbers at stake here. if you look at what president obama's council on economic advisors has estimated, there is $700 billion a year. when we talk numbers, we're usually multiplying times 10 because it's a 10-year window. when people say there's this much in the bill, it's over one year. new england health care institute estimated $850 billion annually in excess cost and waste. the lewin group, which has a relatively good opinion around here, and george bush's own former treasury secretary, secretary o'neill, estimated it is over $1 trillion a year. whether it's $700 billion or $850 billion or $1 trillion,

even if these tools in the toolbox that we will refine through learning experimentation, even if they only achieve a third of it, it's $200 billion or $300 billion a year. mr. baucus: some people are worried perhaps that, gee, there they go back there in congress. they talk about waste, which is good. want to get rid of waste. then they talk about waste, they talk about cutting out the waste. and some think, well, gee, if they're cutting out the waste and they're cutting health care reimbursements, gee, won't that hurt health care in america? won't that reduce the quality if they're cutting so much, $600 billion, $700 billion, $800 billion, that's a lot of money, aren't they going to start to cut quality health care in america? i'll ask my colleagues, i see my good friend, the chairman of the

"help" committee, he might want to join, adding points why the legislation we're putting together here increases quality. doesn't cut quality but increases quality at the same time we're reducing waste. i wonder if i might invite either of my colleagues to comment on all that because it is an extremely important point to drive home our legislation, improves quality of care at the same time that it's cutting out waste. mr. dodd: if i could, if my colleague and chairman of the finance committee, there is a lot of good things about our health care system. we want to start out by acknowledging that our providers, doctors do a wonderful job in many instances. we also know the system is fundamentally broken because it's based on quantity rather than quality. there is a question mark at the end of this. it's my opinion that that is what it is. in other words, doctors and hospitals, the system is rewarded based on how many patients you see, how many hospital beds are filled, how

many tests get done, how many screenings are provided along the way. so it's all based on a quantity system. the more quantity you have, the system survives. we all inherit in that is, of course, if that's what drives the system, only quantity, obviously what you're going to end up doing, you've got a sick care system, not a health care system. we're trying, as i understand it, is to fundamentally shift away from a quantity-based system to a quality-based system where we try to keep people out of doctors' offices, out of hospitals, out of situations where they need to be there. that's what we're trying to achieve. and to do that in a sense, you need to have incentivized a system in reverse. incentives today are to fill all of these places. we're trying to incentivize the system by keeping people healthier, leading better lifestyles -- quitting smoking, losing weight, eating better food, all of these things which are not only good for you but overall save money.

am i wrong in that direction? that's the idea behind all of this. mr. baucus: i think my colleague is exactly right. as you're speaking, senator, i was thinking of that article which a lot of us referred to often, a june 1 "new yorker" article comparing el paso, t*bgs with -- texas with cullen texas. in el paso, the health care is about half than it is in cullen. yet the outcomes in el paso are better than the they are in mccullen. why is there twice as much spent in mccullen than el paso and the outcomes are different? i think the basic answer is we have a system which allows the mccullens. the system that allows it is payment in basic quantity and volume as opposed to volume. it depends in the community what the culture is.

some communities have cultured coordinated care and so forth. and the current system allows that. if the culture is more to make money, our reimbursement system today allows for that as well. so i think one of the things we're trying to do is get more quality in the system, reimbursement to pay docs as you said and that's going to even out a lot of the geographic disparities that occur in the country over time so that the quality will increase and the costs -- wand the waste will decrease. mr. dodd: one last question i wanted to raise, if i could. our colleague from montana said something yesterday that i think deserves being repeated. just on the point you just made and that is the gwandi piece which did that comparison between mcallen and the counselty which is the poorest county in the united states. a felllloy by the name of don

burwick, an expert on integrated care. one of the things he says -- i'd be curious because i think you said this yesterday. it isn't just that the cleveland clinic or the mayo clinic where this happens. that kind of a culture that exists in community hospitals, small hospitals all over the country where they have figured out integrated care. that is, where doctors and hospitals have figured out how to provide services and reduce costs. i have 31 hospitals in my state and like all of our colleagues i presume are visiting many, talking to people. manchester community hospital, a very small hospital in ma manchester, connecticut, they have reduced costs. they have figured out between the provider physician physiciae hospital how to do that. your point is, this is happening all across america in many places and we need to be rewarding that when it occurs. that's really -- mr. baucus: that's in fact -- it's interesting you mention his name because it wasn't too long ago i asked him that very question. i asked him -- mr. burwick, why

is it that in some communities they get it and some they don't? and his answer is its you a just sometimes maybe -- maybe it is a hospital, it's pretty dominant as a player, kind ever starts it out and gets it right. and it's true. he said -- he invited 10 integrated systems to washington, d.c., to kind of talk over what works and what does not work. these are not the big-name institutions. they're the lesser-name institutions. and in fact one of m of them isn montana. they participated last year in the same process. integrated the docs, the acute cairks the post-acute care and they significantly cut down costs and they've significantly improved their quality. they're very proud of what they've done. mr. whitehouse: may i offer a specific example from the bill as an i will strags of this. one of the very few areas in

which the congressional budget office has prepared a document of savings from these quality improvements is in the area of hospital readmissions. and the chairman of finance worked very hard to get hospital readmissions language into his bill. i think we had it in the "help" bill as well, chairman dodd, and it is in the bill that leader reid put together. and what it does is it strips over 10 years $7 billion, i think is the number, $7 billion of money that hospitals would otherwise be paid when somebody gets out of the hospital and is readmitted within 30 days for the same condition. and the reason they're willing to apply those savings is because now you can demonstrate that if you have better prerelease planning, then people will go out and they'll do better on their own. they'll do better at home, or they'll do better in the nursing home, and therefore they won't come back. and so you save lives because

the health care is better, you save money because they don't come back to the hospital, you improve on the front end and the hospital will do that; they will invest and improve on the front end because they don't want to pay the back end if they're not recovering their costs on readmission. and it is a win-win for everyone. the individual american who has to be readmitted to a hospital and reundergo all of the procedures and all of the risks of being in a hospital, because he or she didn't get a proper discharge plan, that person is not helped out by having to go back to the hospital. mr. baucus: i have a very direct experience in this. my mother, who was in a hospital three years ago, in another hospital -- not the billings clinic -- and there was no discharge plan. there was no sort of way to kind of help deliver health care for her when she left the hospital

and went into a rehab center, kind after nursing home. and sure enough, she didn't get the proper ms, she didn't get the -- ms, she didn't get the proper ateption. the doctor didn't see her every day. lo and behold, she had to be readmitted back to the doctor. she had a gastro intestinal issue. she went back to the hospital. when she was discharged, they did her right. they, you know, they knew about the mistakes they made. i saw it firsthand. it really irritated the dickens out of me frankly in just seeing how they didn't pay sufficient attention to my mother, now. if it is to my mother, my gosh, i bet it's even worse in lots of other swraitions. -- in lots of other situations. mr. dodd: i want to thank senator whitehouse who was on our committee, senator baucus, for the duration of our markup and did just a stellar job. a very valuable member of the committee and made some wonderful suggestions to our bill all the way through the process. one of the things we do in the

"help" committee bill -- maybe not enough because right to the point, the chairman was just talking about -- i was told the other night there was a friend of mine by the name of jack conners, sits on the board and chairs the board on the hospitals in boston. i think may colleague may recognize the name. staff can correct me if i'm wrong on these statistics. but i recall what he told me the other night, the average adult, elderly person gets on average four medications. within one month, that individual -- in most cases living alone, maybe with someone else, but on in the years and so less capable of understanding it all -- is basically not taking the four medications, only taking parts of them and then finding themselves back in readmission. we do a little in our bill a little bit of that. i think there's some effort in the finance committee bill as to sell vision -- there's ways through technology to provide some advice. but the idea of having -- and this might not be a bad idea in terms of employment issues t wouldn't take much to train people to be a home health care

provider to be able to stop in -- because you don't want to put them in a nursing home. most people end umin their own apartments or back in their homes. mr. baucus: she's back home now and is getting great attention. mr. dodd: but the whole idea of putting people to work, deploying people do it i think would be vastly less than -- mr. baucus: i was talking to the head of denver health in the system. i forgot her name. man was she enshoesias stick about the integration they performed at denver health. let me give you one small, small, small example. it's basically the one you just mentioned. we have patients here -- heart patients and they're discharged and we ask them, are you taking your meds? are you controlling your blood pressure? traiking your medication to control your blood pressure? oh, yeah, yeah, yeah. why is your blood pressure so

high? well ... because they're intergraded, they check with their pharmacy which is part of their system. they check the refill rate of the patients. and sure enough they've found their patients' refill history show they were not taking their meds. the patient comes back, oh, you're not taking your meds. oh, i guess i wasn't. we're check on you. and sure enough, when they're taking your meds, their blood pressure is under control and much better outcomes with the patients because of that integration. mr. dodd: it works. mr. whitehouse: and part of what the distinguished chairman worked on so hard was to put in place the program so that we'll be able to begin to reimburse doctors for those kind of discussions. mr. baucus: absolutely. mr. whitehouse: and right now our payment system is driving them away from having that kind of simple discussion. it doesn't adequately support the electronic describ prescribt

would let you know they are not picking up their meds anyway. but president obama did a great job on this with the electronic health funding that he put through. but this question of doing what you're paid to do, if all you're paid for is procedures, then the hospital doing the discharge summary, if they couldn't get paid for that, but they did get paid when the person came back and was readd militar readmittee $40,000, $50,000 a day, it doesn't take too long to figure out where their effort is going to be. and it is not glg to be in those areas that save -- and it is not going to be in those areas that save money. we've set up the payment system with all these perverse incentives. mr. baucus: sometime ago i noted that senator hatch wanted to speak at 5:00. i'm just trying to be a traffic cop here. mr. dodd: i wanted to, if i could, mr. chairman shall make d

to, if i could, mr. chairman, make the case. if that's all we were doing, the complaint would have great legitimacy. what we've done in this bill is to try to paint a justification for that and provide the resources that make those cuts reasonable. if you're having fewer readmissions in the hospital, the hospitals support, if you're doing the kind of things that we are taking about to keep people healthy so they don't go back in, these numbers become very realistic numbers. it is not just saying we're cutting out funding. we're setting up in this bill -- people pick up the bill all the time and say, look how many pages. it's because a lot of thought has gone into this to do a exactly what the senator from rhode island has talked about. this isn't just a bunch of language here. it goes to the heart of this and how we intend to accommodate the interests of the individual by improving their quality and

simultaneously reducing the cost. now, everyone has made those claims that that's what we need to do, increase quantity, reduce cost, increase cost. you cannot just say it and not complain explain how do you it. what we've done is explain how we do that, how we increase access, how we improve quality for the individual and institutions and simultaneously bring down costs. that's what we spent the last year working on to achieve exactly what's in these pages that people weigh and pick up now all the time. if they'd look into them, they'd see the kind of achievements we've reached. and those achievements have been recognized by the most important organizations affecting older americans -- aarp and the commission to preserve social security and medicare. all have examined this and these are not friends of ours. these are people who objectively analyze what we're doing. and it's their analysis, their conclusion, reached independently, along with many others, that we have been able to reduce these costs, these

savings in this bill, and simultaneously increase access and improve quality. it has been the goal that we've all talked about for years. this bill comes as close to achieving the realities of those three missions that has ever been done by this congress or any congress thor that matter. and so when people talk about these cuts in medicare, they need to be honest enough for people to realize that what we've done is to stablize medicare, extend its solvency and guarantee those benefits who rely on medicare. that has all been achieved in this bill. and so when you -- when people start these scare tactics and language to the contrary, listen to those organizations who don't bring any political interest to this. don't wear an "r" or an "d" at the end of their names. their organizations are designed, supported, financed and applauded by the very individuals who cants on having a solid -- who count on having a solid, sound medical

organization. these organizations have said the guaranteed benefits in this bill remain intact. we stablize medicare. we provide the kind of programs that will save lives and increase the quality of lives of people. it's not only to stay alive but the quality of your life. and to be able to live a quality life independently for as many years as possible. at the end of the day, we all die one at a time in this country. and no matter what else we do, that's the final analysis. to the stnts you can send extend that life and save the kind of money that we ought to be able to do so is the goal of this bill and we largely achieve t and i applaud again the finance committee and the leadership of max baucus to help us get through and navigate these very difficult waters. i thank our colleague from rhode island for his articulation of these issues as well as his contribution during the "help" committee proceedings on this bill and brought many sound and very positive ideas to the table. mr. president, i wanted to take a minute or two as well, if i could, and respond to our

colleague and friend from rhode island, who went at some length to talk about his problems with the so-called class act an in te "help" committee bill. i want to address that. the class act was an issue that senator kennedy championed for many, many years. the idea of providing an independent, privately funded source of assistance to people who become disabled but who want to continue working and earn a salary, do notes want to be limited by the -- do not want be limited by the constraints a medicaid system which is basically an income supplemental -- income support system, i think is very desirable. not a nickel of public moneys are used. individuals make the contribution. if it vests in five years, which it does, and you're faced with disability issues, you can then collect as much as $5 or $80 a day to provide for your needs. maybe a driver, providing meals.

but you then have the opportunity to continue working as an individual without any limitations on what you can make or earn. again, no public moneys involv involved. it builds up after the actuarial, frankly, thanks to judd gregg in the committee who offered the amendments, that depended on the actuarially soundness of it. here it is. i have it behind me. assisted transportation, in-home meals, help with household chores, adult day care. but it allows them to function and work. and there's $2 billion in medicaid savings. there are many provisions in here that almost instantaneously do that. the dollars have to remain just for this purpose. you cannot raid this purpose for any other -- raid this fund for any other purpose, which was a concern raised by some that this $75 billion may be used for other purposes. and so we have written into the legislation that protects these moneys from being offered for any other purpose. in fact, senator gregg, when he offered his amendment, said i

offered an amendment which was ultimately accepted that would require the class act premiums to be based on a 75-year actuarial analysis of the program's costs. my amendment ensures that instead of promising more than we can deliver, the program will be fiscally solvent and we won't be passing the buck, or really, passing the debt, to future generations. i'm pleased the "help" committee unanimously accepted this amendment. which we did. when i hear some of my colleagues say this bill doesn't anything but technical amendments of the 161 republican amendments i took on the bill, this was one of the amendments. senator gregg's amendment, which we accepted unanimously. my colleague from utah is, of course, a member of the committee, diligently paid attention to every amendment that was offered and i know remembers as we adopted one of his amendments dealing with biologics in the committee that senator kennedy strongly supported in conjunction with senator hatch. but this class act is a unique and creative idea and we thank our colleague from massachusetts, no longer with us, for coming up and

conceptualizing this idea that individuals with their own money, contributing to a fund could eventually draw down to provide these benefits should they become disabled but want to continue working and being self-sufficient, without getting into that medicaid operation which limits your income, restrains you entirely, and becomes, as i said, an income transfer program rather than really assisting individuals. so here's a totally privately funded program, no public money, just what you're willing to contribute over a period of years to protect against that -- that eventual that you might become -- eventuality that you might become disabled and you might continue to function function. i have one case here, sarah baker, 33-year-old, a woman my home state of connecticut living in norwalk. two years ago, sarah's mother, who was only 57 years old at the time, suddenly suffered a massive stroke, mr. president. the stroke left the right side of her body completely paralyz paralyzed. she lost 100% of her speech.

and sarah recalls that fateful day when she got the call. i will quote her. she said, "i was living out west in arizona working, living and loving my life. and then i got a phone call and in seconds literally my entire world fell apart. i swear i can still feel that feeling through my whole body when i think about it. so there i was in a state of complete and total lunacy, getting on a plane with one suitcase home to connecticut. guess what? i never went back. sarah's mother was transferred to a rehab hospital. sarah went to the hospital every single day for two months to be at her mother's side as she went through therapy. sarah's money worked as an r.n. for 17 years. her mom in the hospital, a social worker both agreed her health insurance was as good as they come, end of quote. however, when it came -- comes to long-term care, they didn' didn't -- they don't come as good. her mother was abruptly discharged from the -- from the rehab hospital after 60 days when her insurance company decided she made enough progre

progress. sarah went nine months without working, dipped into what savings she had and then went into debt to provide the long-term services and supports her mother needed. and as she recalled -- and i'll quote her again -- "i made the whole house wheelchair accessible. i became a team of doctors, nurses, aids and a homemaker. i -- aides, and a homemaker. i helped her shower, made food, gave medicine, took her blood pressure. what would have happened if i wasn't there? basically one of two things. i could have hired someone to come to the house, all out of pocket, of course, or the state could have depleted her assets, her home, her savings and everything, and she would have been put in a nursing home funded by medicaid. stories like sarah's, mr. president, are not the exception, unfortunately. they happen every minute of every day all across our count country. they are common in my state as well as any other state in the nation. at any rate, as any one of us or someone we live can become disabled and need long-term services. we also have an aging populati

population. in my home state of connecticut, the number of individuals 85 and over, the population most likely to need long-term care, will grow by more than 70% in the next 20 years. families like sarah's are doing the right thing. they take care of each other, as most people understand. we all would dry trie and do. they do -- we all would try and do. they do whatever they have to do. but the costs of long-term care can be devastating on middle-class working families. and 9 -- or 46 million americans lack health insurance. more than 200 million lack any protection against costs of long-term care. the class act will help fill that gap. it doesn't solve it all, mr. president, helps fill a gap. it's an essential part of health care reform. the class act will establish a voluntary, purely voluntary, there are no mandates on employers, no mandates on employees, no mandates on anyo anyone. if you decide -- only you decide voluntarily -- to contribute and participate in this, it happens.

it's a long-term care insurance program financed by premium payments collected through payroll at the request of the individual, not a mandate on the employer. and when individuals develop functional limitations, such as sara's mother, they could receive a cash benefit in the range of $75 a day which comes to over $27,000 a year. it's not intended to cover all the costs of long-term care but it could help many families like sara's t. could pay for respite care, allowing family caregivers to maintain employment t. could pay for home modifications. it could pay for assisted -- assistive devices and equipment. it could pay for personal assistant services, allowing individuals with disabilities to maintain their independence and community participation. it would allow individuals to stay in their homes versus having to go to a nursing home. and it would prevent individuals from having to impoverish themselves by selling off everything they have to then go through that title 19 window and to become the medicaid recipient and then be restrained on what

you can possibly earn if you weren't as bad off as sara's mom. but for people who are in that shape, this young woman, sara, had she had a family living where she was out west, her own children, instead of being single, how would she have done that? how would she have been able to pack up a whole family and move from the west to the east, back to take care of her mother in those days? so while this proposal here isn't going to solve every problem, it's a very creative, innovative idea that does not involve a nickel of public money. not a nickel, mr. president. it's all voluntary, depends upon the individual willing to make that contribution. to provide that level of assistance, lord forbid they should end up in this situation, where they find themselves disabled and they need some care to allow them to survive and to live a relatively normal life, including going back to work, without impoverishing themselves, selling off everything they have in order to make themselves qualify for medicaid assistance. so i applaud my colleague from massachusetts. a lot of great things he did over the years.

he was a champion of so much, to working families and their needs and health care. but this idea, the kennedy idea of the class act is one that has a wonderful legacy to it. it's a part of this bill. it's been endorsed and supported by major -- 275 organizations in the country. i've never seen a proposal like this receive the level of support across the spectrum that the class act is getting. and so, mr. president, i know there will be those who will try to take this out of the bill, and i had stand here hour after hour and defend this very creative, innovative idea that could make a difference in the lives of millions of our fellow citizens not only today but for years and years to come. and i -- and i again thank senator kennedy and his remarkable staff who did such a wonderful job on this as well. and i thank senator gregg, even though he's critical of the program, senator gregg's ideas were adopted unanimously in our markup of the bill, provided the actuarial soundness of this proposal for a long 75 years to come.

and to that -- for that, we're grateful to him for offering those amendments which were adopted by every republican and every democrat on the committee at the time of our markup last summer. mr. president, i see my colleague from utah. and i have great respect for my friend from utah. he and i have worked on so many issues together. either he would get me in trouble politically or i would get him in trouble politically when we were work on things. very the first major piece of legislation was to establish support for families who need it for child care. it was a long, drawn-out battle. but the person who stood with me almost a quarter of a century ago to make that happen, and today it's almost commonplace for people to get that kind of assistance. but as long as i live, i'll never forget hi a partner named orrin hatch who made that possible. and that's not the only thing we worked on together but it was the very first thing i worked o. and he joined with me in that effort, it became the law of the

land, and today millions of families manage to navigate that difficult time of making sure their families are going to get proper care and attention while they go out and work hard and try to provide for them as well. so i thank him for that and many other things as well. mr. hatch: mr. president? the presiding officer: the senator from utah is recognized. mr. hatch: mr. president, i want to thank my colleague. there's no question, he's a great senator and i've always enjoyed working with him. and we have done an awful lot together. i really want to compliment senator whitehouse too. he's a terrific human being be,, great addition to this senate and i have a lot of respect for him. he gives me heartburn from time to time, as does senator dodd, but on the other hand, they're great people and they're very sincere. our chairman of the committee, max baucus, is a wonderful man. and he's trying to do the best he can under the circumstances, and i applaud him for it. senator stabenow from michigan, she and i have not seen eye to

eye on a lot of things but we always enjoy being around each other. this is a great place, there's no question about it. we have great people here, but that doesn't make us any less happy about what we consider to be an awful bill. but right now, today, let me just talk about one specific thing. today the senior senator from illinois came to the floor and spoke about my efforts to reduce the costs associated with -- with medical liability problems, medical malpractice liability. i don't think his statements should go unanswered here. not only were a number of his statements simply incorrect as a factual matter -- or as factual matters, but some of them even bothered on offensive. now, i'm not offended. i can live with it. i can take criticism. but some of them were really i think a little bit over the top. first of all, he referred to the recent letter i received from the c.b.o. which indicated that the government would realize

significant savings by enacting some simple tort reform measures. i don't know anybody in america who has any brains who doesn't realize we've got to do something about tort reform in this bill. according to the c.b.o., these measures would reduce the deficit by $54 billion over ten years. that's a lot of money. private-sector savings would be even more significant because the $54 billion applied only to federal government savings. private-sector savings even more significant, a reduction of roughly $125 billion in private health care spending over the same ten-year period, and that's a low estimate. democrats apparently want the american people to think these numbers are so insignificant that this issue should just be ignored in this health care bill, and i have to respectfully disagree. i may be one of the few senators in this body who actually tried medical malpractice cases,

actually defended them, defended doctors -- defended doctors, hospitals, nurses, health care practitioners. i understand them. there are cases where there should be huge recoveries. i'd be the first to admit it. i saw the wrong eye taken out, the wrong leg taken off, the wrong kidney -- you only have two of each of those. you can bet your bottom dollar we settled those for significant amounts of money. but i also saw about 90% of the cases were frivolous, brought to get the defense costs, which generally ranged between $50,000 and $200,000, depending upon the jurisdiction. and if a lawyer can get a number of those cases, they can make a pretty doggone good living just by bringing those cases to get the defense costs, which, of course, add to all the costs of health care. and there's no use kidding about it. i might add that furthermore, senator durbin of illinois, the distinguished senator from illinois, cited this same c.b.o. letter in order to claim that the tort reform measures

supported by many on my side of the aisle would cause more people to die. give me a break. i can only assume that he's referring to the one paragraph in the c.b.o. letter that addresses the effect of tort reform on health outcomes. in that single paragraph, the c.b.o. referred to three studi studies. one of these studies indicated that a reduction in malpractice lawsuits would lead to an increase in mortality rates. one of the three. the other -- other filed that there would be no negative effects on health outcomes and no negative effects could be expected. apparently omitting studies that disagree with your conclusion is becoming common practice these days on the floor. now in a speech earlier today the distinguished senator from illinois also discounted the prominence of defensive medicine in our health care system saying only that -- quote -- "some doctors" unquote perform unnecessary and inappropriate procedures in order to avoid

lawsuits. once again, the facts would contradict this generalization. a number of studies demonstrate this. for example a 2005 study of 800 pennsylvania physicians -- this is just pennsylvania, where i used to practice law, by the way. in high risk specialties found that 93% of these -- of those physicians had practiced some form of defensive medicine. now, that was published in the journal of the american medical association june 1, 2005. in addition, a 2002 nationwide survey of 300 physicians, nationwide, this is the interactive fear of litigation study found that 79% of physicians ordered more tests than are necessary. think about that. if they're ordering -- 79% are ordering more than are necessary, you can imagine the

multibillion dollars in unnecessary defensive medicine that comes from that. but that's not the end of that fear of litigation study. 74% of physicians referred patients to specialists that in their judgment did not need any such referral. think about it referring people to specialists that they knew they didn't need. think of the cost, the billions of dollars in cost. 52% of physicians suggested unnecessary invasive procedures. that word invase i've an important word. 52%. why? because they're trying to protect themselves by making sure that everything could possibly be done. 41% of physicians prescribed unnecessary medications. now, this is a nationwide survey of 300 physicians. apparently they obviously answered the questions. i knew all of that. the cost associated with the

defensive medicine are real. and i would say unnecessary defensive medicine because i believe there are some defensive medicine approaches that we would -- we would want the doctors to do. but not to the extent of these. ordering more tests than are necessary. ordering more specialists than are necessary. suggesting unnecessary invasive procedures. unnecessary medications. this is the medical profession thaifts admits this. price waterhouse in their study found that defensive medicine accounts for approximatel approximately $210 billion every year. or 10% of the total u.s. health care costs. now here's something -- more facts from this price waterhouse coopers study. of the $2.2 trillion spent every year on health care in the u.s., as much as $1.2 trillion, can be attributed to wasteful spending. $1.2 trillion of $2.2 trillion.

and they deny that the -- unnecessary defensive medicine is being utilized in this country? defensive medicine is the largest single area of waste in the health care system. it's on a par with inefficient claim processing and -- and care spent on preventible conditions. yet despite these overwhelming numbers -- and i know some democrats will say that's price waterhouse, they must have been doing it at the expense of someone who had an interest. price waterhouse and other accounting firms generally try to get it right. and they got it right here. and those of us who were in that business understand it. yet, despite these overwhelming numbers, my friends on the other side have opted to overlook them. and, instead, relate horrific stories associated with doctors' malpractice apparently trying to imply that republicans simply don't care about these truly tragic occurrences. well, i settled some of those

cases because they should have been settled. we've had to settle other cases that shouldn't have been because they would settle it for what they brought them for to begin it, and that was the -- the defense costs. well, we do care about these truly tragic occurrences. the assertion of some of my colleagues that we don't, nothing could be further from the truth. in all of the proposals that have been offered in this debate there has not been a single suggestion to prevent plaintiffs from personal injury lawyers, i should call them, that's what they are, and they have a right to be. and they're not the vast majority of personal injury lawyers who do this type of thing. but let me just say there has not been a single suggestion to prevent personal injury lawyers from obtaining the compensation for actual losses they've incurred. not one suggestion that they shouldn't. instead we have sought to impose some limits on the noneconomic

damages. all economic damages are fine, fair game. but impose some limits on the noneconomic damages in order to -- to define the playing field, encourage settlement, and introduce some level of predictability to the system. now, mr. president, it's no secret that personal injury lawyers, some of them, are prolific political contributors to those politicians who fight tort reform. and with a democrat majority and a democrat in the house -- in the white house, they're lobbying efforts in this congress have reached unprecedented levels. in fact, it is said that they are the largest single source of hard money to democrats in the political system today. i personally don't believe that because i think the unions are even more. but the unions give up t to $1 billion in every two-year election process in soft money

that doesn't have to be reported because they're not -- they're not subjected to the same rules that everybody else is. it would take 60 votes in the senate to get that to occur. now, the expenditures by the personal injury lawyers have risen to unpress deptd levels. given this reality it is obvious why trial lawyers have not been asked to give up anything in the current health care legislation. supporters of this health care bill would be asking the american people to pay higher health care premiums for seniors to give up medicare advantage, which 25% of them have enlisted in, for businesses to pay higher taxes, for medical device manufacturers to pay more just to bring a device to the market that may save lives or make lives worth living. in fact, the only group that has not been asked to sacrifice or change the way they do business happens to be the medical liability personal injury lawyers.

i would hope that we would focus our efforts more on helping the american people than on a fundraising stream for politicians. sadly that doesn't appear to be happening in the current debate. now, there are some very honest and decent attorneys out there who bring cases that are legitimate cases where there should be. -- should be high rewards. but the vast majority of those cases, i can personally testify to you, are frivolous to get the defense costs. or some measure of the defense costs. and that's costing every american citizen an arm and a leg. and, let me tell you, it's something that we ought to resolve. we ought to resolve in a way that takes care of those who truly have injuries, but gets rid of these frivolous cases that are driving up the cost for every american. not too long ago i talked to one of the leading open-heart

specialists in washington. he just acknowledgeled we all order a lot of tests and so forth that we don't need. that we know we don't need. but we do it so that that history we have of the patient that we -- shows that we did everything possible to rule out everything that could possibly occur, even though we know we don't need to do it. and, to be honest with you, under the current -- under the current lottery system of lawsuits, i don't blame them. i don't blame them. they're trying to protect themselves. now, by the way, while we're talking about it, i think the distinguished senator from illinois mentioned that there might be a few thousand deaths because of medical malpractice. that may be true. but how about the thousands and thousands of deaths because we don't have enough obstetricians and gynecologists because young people are not going into that specialty or those specialties

as much today because they know they're the most likely to be sued. or let's make it a little bit more even difficult. how about the lack of -- of brain surgeons and neurological surgeons? look, when you go into the brain, you might have disastrous frults time to time -- results from time to time, no matter how good you are as a doctor. if you're going to get sued every time that happens, it doesn't take long for people say i'm not going into that specialty. i can name some others. we have areas in this country where you can't get obstetricians and gynecologists to the people. and law schools will tell you -- at least the ones i know will tell you that there aren't that many young people going into obstetrics and gynecology today because, first of all, they may not make as much money, and, secondly, the high cost of medical liability insurance are so high that they really can't

afford to do it and, thirdly, they don't want to get sued. especially in a frivolous case brought for defensive medicine. well, so much for that. i love my distinguished friend from illinois, and he knows it. i care for him. but, let me tell you, i think he knows better and knows that i know better. i'd be the first to come to bat for somebody who was truly injured because of the negligence of a physician. i don't have any problem with that at all. i wonder how many babies have difficulties and were not born or died because we can't get an obstetricians and gynecologists to work with the mothers to be. and i think it's significant. the fact of the matter is you could go down through every specialty where they have high insurance rates and where there's a high likelihood of

being sued, it sure takes away the thrill of practicing medicine. by some people who are absolutely super and need to be in those specialties, who can save lives and help people, especially women. i've been there. this isn't something i'm just popping off about. i've been there. and i've got to say that i'd be the first to fight for those who are truly injured as a result of medical negligence. but if you look at the vast majority of those cases, the vast majority are brought because they can be brought. what happened was in the early days, if a doctor met the standard of practice in the community -- and today many doctors do it beyond the standard of practice -- if they met the standard of practice in the community, it was an automatic summary judgment in the court. now they changed to the doctor

of conformed consent. there is no way to fully inform the patient of all of the problems that could come from some sort of medical surgery. just to mention one aspect. and, therefore, every case now guess to the jury. when there is a bad result, even though the highest abilities in the medical field were used, and there was no intent to hurt a person, and there was no negligence, the insurance companies are certainly going to try to settle those cases rather than take a chance on a runaway jury even though they're absolutely right in their defense. well, i just thought i'd make a few comments about this. but, again say i understand some of the excesses that go on on the floor. that was an excess this morning. even though i know my dear friend is sincere and dedicated and one of the better lawyers in

this body. so, having said that, i'll end on that particular subject. now, mr. president, let me once again to talk about the medicare provisions in this democratic party health care bill. throughout the health care debate we've heard the president pledge not to -- quote -- "mess," unquote, with medicare. unfortunately that's not the case with the bill before the senate. to be clear, the reid bill reduces medicare by $465 billion to fund a new government program. unfortunately seniors and the disabled in the u.s. are the ones who suffer the consequences as a result of these reductions. everyone knows medicare is extremely important to 43 million seniors and disabled americans covered by the medicare program. throughout my senate service, i have fought to preserve and protect 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. the program has mor more $37 trillion in unfunded liabilities. this will be saddled with our children and grandchildren. the reid bill will make the situation much worse. why is that the case? again, the reid bill cuts medicare to fund the creation of a new government entitlement program. more specifically, the reid bill will cut nearly $135 billion from hospitals. where are they going to get this money? $120 billion from medicare advantage. almost $15 billion from nursing homes. more than $40 billion from home health care agencies. and close to $8 billion from hospice providers. these cuts will threaten beneficiary access to care as medicare providers find it more and more challenging to provide health services to medicare patients. many doctors are not taking medicare patients now because of

the low reimbursement rates. let me stress to my colleagues that cutting medicare to pay for a new government entitlement program is irresponsible. any reductions to medicare should be used to preserve the program, not create a new government bureaucracies. and as i just said, the president has consistently pledged, we're not going to mess with medicare. once again, this is another example of a straightforward pledge that has been broken over the last 11 months. now, maybe you can't blame the president because he's not sitting in this body. this bill strips more than than $120 billion out of the medicare advantage program that currently covers 10.6 million seniors or almost one out of four seniors in the medicare program. according to the congressional budget office, under this bill, the value of the so-called -- quote -- additional benefits, unquote, like vision care and

dental care will decline from from $135 to $42 by 2019. now, that's a reduction of more than 70% in benefits. you heard me right -- 70%. during the finance committee's consideration of health care reform, i offered an amendment to protect these benefits for our seniors. many of whom are low-income americans and reside in rural states and rural areas. however, the majority party will not support this important amendment. the majority chose to skirt the president's pledge about no reduction in medicare benefits for our seniors by characterizing the benefits being lost -- vision care, dental care, and reduced hospital deductibles as -- quote -- extra benefits, unquote. now, let me make this point as clearly as i can. when we promised american seniors that we will not reduce their benefits, let's be honest about that promise. so we are either going to protect benefits or not. it is that simple, and under

this bill if you are a senior with -- who enjoys medicare advantage, the unfortunate answer is no, they're not going to protect your benefits. all day today, we had members on the other side of the aisle claim that medicare advantage was not part of medicare. this is absolutely -- i've got to tell you, it's absolutely unbelievable. i would invite every member making this claim to turn to page 50 of the 2010 medicare and you handbook. it says -- "a medicare advantage is another health coverage choice you may have" -- get these words -- "as part of medicare." let me repeat that again. "a medicare advantage is another health coverage choice you may have as part of medicare." that's the 2010 medicare and you handbook. who's kidding whom about it not

being part of medicare? so the bottom line is simple. if you're cutting medicare advantage benefits, you are cutting medicare. now, i've also heard the distinguished senator from connecticut this morning mention that the bureaucrat-controlled medicare commission will not cut benefits in part-a and part-b. but once again, my friends on the other side are only telling you half the story. so much for transparency. on page 1,005 of this bill, it states in plain english -- "include recommendations to reduce medicare payments under c and d." i'm just waiting for members on the other side of the aisle to come down and now claim that part-d is also not a part of medicare. we all know it is. it's also important to note that the director of the nonpartisan congressional budget office has told us in clear terms that this unfettered authority given to the medicare commission would

result in higher premiums. it's important details like these that the majority does not want us to discuss and debate in full view of the american people. they call it slow walking. they call it obstructionism. making sure that we take enough time to discuss the 2,074-page bill that will affect every american life and every american business is the sacred duty of every senator in this chamber. now, we'll take as long as it takes to fully discuss this bill, and you can talk for a month about various parts of this bill that are outrageous. and some that are really good, too, in all fairness. not many, however. i've heard several members from the other side of the aisle characterize the medicare advantage program as a giveaway to the insurance industry. you know, when you can't win an argument, you start blaming somebody else.

so they want a government insurance company to take the place of the insurance industry. well, maybe that's too much. they wanted to compete with the insurance industry, but how do you compete with a government-sponsored entity? and there are comments that that so-called plan will cost more than the current insurance businesses that they are so criticizing. i'm not happy with the insurance industry either, but by gosh, let's be fair. let's give everyone watching at home a little history lesson on the creation of medicare advantage. i served as a member of the house-senate conference committee which wrote the medicare modernization act of 2003. the distinguished senator from montana would agree with me that

it was months of hard, slogging work every day to try and come up with the medicare modernization act of 2003. among other things, this law created the medicare advantage program that gives people vision care, dental care, et cetera. when conference committee members were negotiating the conference report back then in 2003, 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 where medicare beneficiaries did not have adequate choices and coverage. in fact, the only choice offered to them was traditional fee-for-service medicare, a one-size-fits-all government-run health program. by creating the medicare

advantage program, we were providing beneficiaries with choice in coverage and then empowering 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. we learned our lesson from medicare plus choice which was in effect at the time and its predecessors. these plans collapsed, especially in rural areas because washington decided -- again, government got involved -- washington decided to set artificially low payment rates. in fact, in my home state of utah, all of the medicare plus choice plans eventually ceased operations because they were all operating in the red, and you can't continue to do that. it was really stupid what we were expecting them to do.

and i fear history could repeat itself if we are not careful. during the medicare modernization act conference, we fixed the problem, we increased reimbursement rates so that all medicare beneficiaries, regardless of where they lived, be it fism lmore, utah, or new york city, had choice in coverage. again, we did not want beneficiaries stuck with a one-size-fits-all washington-run government plan. and that was both democrats and republicans on that committee, by the way, and the leader was, of of course, the distinguished senator from montana. i admire him for the way he led and i admire him for trying to present what i think is the most untenable case here on the floor during this debate. he's a loyal democrat. he's doing the best he can, and he deserves a lot of credit for sitting through all those meetings and all of that markup and everything else and sitting day in, day out on the floor here.

today, medicare advantage works. every medicare beneficiary has access to a medicare advantage plan if they so choose. and close to 90% of medicare beneficiaries participating in the program are satisfied with their health coverage, but that could all change should this health care reform legislation currently being considered become law. in states like utah, states like idaho, states like colorado, new mexico, just to mention some western states, wyoming, montana. you can name every state. rural america was not well served until we did medicare advantage. now, choice in coverage has made a difference in the lives of more than ten million americans nationwide, almost 11 million americans. the so-called -- quote -- extra benefits, unquote that i mentioned earlier are being portrayed as gym memberships as opposed to lower premiums,

co-payments, 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 homes and remain active. it is prevention at its best. it has been helpful to those with serious weight issues. it has been invaluable to women suffering from osteoporosis and joint problems. in fact, i have received several hundred letters telling me how much medicare advantage beneficiaries appreciate this program. they benefit from it. their lives are better. they use health care less. they don't milk the system. they basically have a better chance of living and living in greater health. and throughout these debates, throughout these markups, throughout these hearings that have led us to this point, every health care bill that i know of has a prevention and wellness section in the bill that will

encourage things like the silver sneakers program that has benefited senior citizens so much and wasn't one of the major costs of medicare advantage. dishly, these beneficiaries receive other services such as coordinated chronic care management. that's important, coordinated chronic care management for seniors, dental coverage really important for low-income seniors. vision care. can you imagine how important that is to people over 60 years of age? how about those who are over 70 or 80 years of age? and hearing aids, can you imagine how important that is to our senior citizens? this program helps these seniors and it helps them the right way. let me read you some letters from my constituents. these are real lives being affected by the cuts contemplated in this bill. remember, there is almost almost $500 billion cut by this bill from medicare which goes

insolvent by 2017 and has a a $38 trillion -- almost almost $38 trillion unfunded liability. let me live you a letter from this constituent in leighton, utah." i recently received my health care updater for 2010. i'm in a med advantage plan with bluecross blueshield. thanks to the cuts in this program by medicare, my monthly premium -- my monthly premiums have risen by 49% and my office visit co-pay has increased 150%. senator hatch, i am on a fixed income and this has really presented a problem for me and many others i know in the same program, and at my age i certainly can't find a job that would help cover the gap. i worked all my life to enjoy my retirement, and thanks to the current economy i've lost a lot of those moneys that were intended to help supplement my

income. "this is a constituent from logan, utah, where the great utah state university is. "please stop the erosion of medicare advantage for seniors. a very many of us are already denied proper medical and dental care, not to mention those who cannot afford needed medications. hardest hit are the ones on social security who are just over the limit for extra help but cannot keep up with the rising medical costs that go way beyond the so-called, quote, cost of living increases, unquote, which we are not getting this year anyway. if those in government who make these decision has to live as we do, day to day, i think we would find better conditions for seniors. the difference in decisionmaking changes when you are hungry and cold your own self." here's a constituent from pleasant grove, utah. "please do not phase out the medicare advantage program. senior citizens need it. our supplement insurance rates go up every year and our income does not keep pace with the cost

of living." a constituent from salt lake city, utah -- "we met with our insurance agent this morning about the increased costs of our medicare advantage plans due to the health care reform bill now before congress. our our premium costs have been significantly increased. we are in our 80's and cannot afford these increases and are hurt by the decreased coverage. we are writing to you to have you stop the cuts and restore the coverage to medicare advantage plans. this is an issue that is very important and very real to us at this point in our lives. please stop the cuts and restore coverage. mr. president, i can't support any bill that would jeopardize health care coverage for medicare beneficiaries, and i truly believe that this bill would be -- before the senate becomes law, medicare beneficiaries health care coverage could be in serious

trouble. i've been in the senate for over 30 years -- 33 to be exact. i proud myself on being bipartisan. i coauthored many, many bipartisan health care bills since i first joined the senate in 1977. almost everyone in this chamber, you know, wants a health care reform bill to be enacted this year. i don't know of anybody on either side who would not like to get a health care bill enacted. and on our side, we'd like to do it in a bipartisan way, but this bill is certainly not bipartisan. it hasn't been from the beginning. but we want it to be done right. history has shown that to be done right, it needs to be a bipartisan bill that passes the senate with a minimum of 75-80 votes. we did it in 2003 when we considered the medicare prescription drug legislation, and i believe that we can do it again today if we have the will. and if we get rid of the partisanship. i doubt there has never been a bill of this magnitude affecting

so many american lives that has passed this chamber in an almost or maybe in a complete straight party-line vote. the u.s. senate is not the house of representatives. this body has a different constitutional mandate than the house. we are the deliberative body. we are the body that has in the past and should today be working through these difficult issues to find clear consensus. true bipartisanship is what is needed here. in the past the senate has approved many bipartisan health care bills that have eventually been signed into law. i know a lot of them have been mine along with great colleagues on the other side who deserve the credit as well. the balanced budget act in 1977 included the hatch-kennedy schip program. how about the ryan white act? i staot right here on the floor and counted the ryan white bill. his mother was sitting in the

audience at the time. how about the orphan drug act? when i got here, we found there are many only two or three orphan drugs developed. these were drugs for population groups of less than 250,000 people. it's clear that pharmaceutical companies cannot afford to do the pharmaceutical work to come up with treatments or cures for orphan conditions. so what we did is we put some incentives in there, we put some tax benefits in there. we did some things tharpb really unique. it was like a $14 million bill. today we have over 300 orphan drugs, some of which have become blockbuster drugs along the line because they would not have been developed had it not been for that little, tiny orphan drug act that was a major bill when i was chairman of the labor and human resources committee. how about the americans with

disabilities act? tom harkin stood there, i stood here, and we passed that bill through the united states senate. and it wasn't easy. there were people who thought there was too much federal government, wasn't this, wasn't that. but senator harkin and i believed, as did a lot of democrats and a lot of republicans, as the final vote showed, that we should take care of persons with disabilities if they would meet certain qualifications. how about the hatch-waxman act stphr we passed that. henry waxman, a dear friend of mine, one of the most liberal people in all of the house of representatives, is currently a very powerful chairman of the energy and commerce committee over there. we got together and put aside our differences, and we came up with hatch-waxman which basically almost everybody admits created the modern generic drug industry. and, by the way, most people will admit that that bill has saved at least $10 billion to

consumers every year since 1984. i could go on and on, but let me just say i've worked hard to try and bring our side together. our sides together so we could in a bipartisan way do what's right for the american people. now let me just tell you, if the senate bill passes or if the senate passes this bill in its current form with a razor-thin margin of 60 votes this will become one more example of the arrogance of power being exerted since the democrats secured a 60-vote majority in the united states senate and took over the house and the white house. there are essentially no checks or balances found in washington today. just an arrogance of power with one party ramming through unpopular and devastating proposals like this one after another. well, let me say there's a better way to handle health care reform. for months i've been pushing for

a fiscally responsible and step-by-step proposal that recognizes our current need for spending restraint while starting us on a path to sustainable health care reform. there are several areas of consensus that can form the basis for sustainable, fiscally responsible and bipartisan reform. these include reforming the health insurance market for every american by making sure that no american is denied coverage simply based on a preexisting condition. some of my colleagues on the other side have tried to blast the insurance industry, they are an evil powerful industry. no, we need to reform them; no question about it. and we can do it if we work together. protecting coverage for almost 85% of americans who already have coverage they like by making that coverage more affordable. this means reducing costs by rewarding quality and

coordinating care. gives families more information on the cost and choices of their treatment options. i said it earlier, discouraging frivolous lawsuits that have permeated our society and made the lives of the high percentage of our doctors, especially in those very difficult fields of medicine, painful. and not very popular to go into today. and, of course, we could promote prevention and wellness measures. we could give states flexibility to design their own unique approaches to health care reform. utah's not new york. colorado's not new jersey. new york is not utah, and new jersey's not colorado. they both have -- each state has its own demographics and its own needs and its own problems. why don't we get the people who know those states best to make health care work? i know that the people closer

to -- that the legislators closer to the people are going to be very responsive to the people in their respective states. i admit that some states might not do very well, but most of them would do much better than what we'll do here with some big albatross of a bill that really does not have bipartisan support. actually, talking about new york, what works in new york will most likely not work in new york let alone utah. as we move forward on health care reform, it is important to recognize that every state has its own unique mix of demographics and each state has developed its own institutions to address its challenges. and each has its own successes. we could have 50 state laboratories determining how to do health care in this country, in accordance with their own demographics, and we could learn from the states that are successful. we could learn from the states that make mistakes. we could learn from the states

that cross great ideas. we could make insurance so that it crosses state lines. can you imagine what that would do to costs? we could do it. there's no desire to do that here today with this partisan bill. there's an enormous reservoir of expertise, experience and field-tested reform. we should take advantage of that by placing states at the center of health care reform efforts so they can use approaches that best reflect their needs and their challenges. my home state of utah has taken important and aggressive steps toward the state of their health care reform. they already have an exchange. they're really trying some very innovative things. and by anybody's measure, the state of utah has a pretty good health care system. is it perfect? no, but we could help it to be with a tpwrabg shun of the federal -- with a fraction of the federal dollars this bill is going to cost. this bill over the next ten years is at least $2.5 trillion.

that is on top of $2.4 trillion we're already spending, half of which they claim may be not well spent. we know a large percentage of that is not well spent. like i say, my home state of utah has taken important and aggressive steps toward sustainable health care reform. the current efforts to introduce and define contribution health benefits system and introduce the utah health exchange are laudable accomplishments. the vast majority of americans -- i believe this to be really true -- agree that a one-size-fits-all washington government solution is not the right approach. that's why seniors and everybody else except a very few, are up in arms about these bills. and that's what this bill is bound to force on us, a

one-size-fits-all washington-run, controlled government program. i'm not just talking about the public option. that is a small part of the argument here today. if we pass this bill, you have washington governing all of our lives with regard to health care. i can't think of a worse thing to do when i look at the mess they've made of some very good programs. unfortunately, the path we're taking in washington right now is to simply spend another $2.5 trillion of taxpayer money to further expand the role of the federal government. i just wish the majority would take a step back and put their arrogance of power in check and truly work on a bill, a bipartisan bill that all of us can be proud of. and they've got the media with them and selling this bill that's less than $1 trillion. give me a break. between now and 2014, yeah, they'll charge everybody the taxes that they can get and the costs that they can get, but the bill isn't implemented until

2014 and even some aspects until 2015. that's the only way with that budgetary gimmick they could get the costs to allegedly be down below $900 billion. but even the c.b.o., certainly the senate budget committee acknowledges that if you -- i think my colleagues on the other side acknowledge that if you extrapolate it out over a full ten years you've got at least $2.5 trillion and in some circumstances as much as $3 trillion. how can we justify that with the problems we have today? a $12 trillion economy, national debt going to $17 trillion, if we do things like this? how can we justify that? how can we stick our kids and our grandkids and our great grandkids -- elaine and i have all three, by the way: kids, grandkids and great grandkids. how can we stick them with the

cost of this bill. it is not only one bill. i hate to tell you some of the other things being put forth in not only this body but the other. and how can we do it on bills that are total partisan bills? if you look at what's happened here, the "help" committee -- health, education, labor and pensions -- came up with a totally partisan bill. not one republican was asked to contribute to it. they just came up with what they wanted to do. it was led by one staff on capitol hill. and it is a very partisan bill. then the house came up with their bill. not one republican, to my knowledge, had even been asked to help. and it's a tremendously partisan bill. and both of which are tremendously costly too. then the distinguished senator from montana tried to come up with a bill that would be

bipartisan in the finance committee. but in the end, even with the gang of six -- and i was in the original gang of seven but i couldn't stay because i knew what the final bill was going to be, and i knew i couldn't -- i couldn't support it. so i voluntarily left not because i wanted to cause any problem, but because i didn't want to cause any problems. i found myself coming out of those meetings and decrying some of the ideas that were being pushed in those meetings. i just thought it was the honorable thing to do to absent myself from the gang of seven. it became the gang of six, and then the three republicans finally concluded that they couldn't support it either. but i will give the distinguished chairman from montana a great deal of credit because he sat through all that, he worked through it, he worked through it in the committee. but then it became a partisan exercise in committee. by and large, yeah, there were a couple of amendments that said, my gosh, look at that.

then what happens? they go to the majority leader's office in the senate, and they bring the "help" bill and the bill from the finance committee, and they mold this bill, this 2,074-page bill with the help of the white house. not one republican that i know of had anything to do with it, although i know my dear friend, the distinguished majority leader, did from time to time talk with at least one republican, but only on, as far as i could see, on one or two very important issues in the bill. and there are literally thousands of important issues in this bill, not just one or two. there are some that are more important than others, but they're all important. i'm not willing to saddle the american people with this costly, overly expensive,

bureaucratic nightmare that this bill will be. and i hope my colleagues on the other side dish hope they'll listen and i hope -- and i hope my colleagues one the on the othere take a step-by-step approach that is not a one-size-fits-all solution to these problems that both republicans and democrats can work on, that will literally follow the principles of federalism and get this done in a way that all of us can be proud. i don't have any illusions. but thus far it doesn't look like that's going to happen. but that's the way it should be done. and i can just warn my friends on the other side, if they succeed in passing this bill without bipartisan support, if they get one or two republicans, because they are a not bipartisan support. they should have to get at least 70 to 80 votes in order -- and i would say 75 to 80 in a bill

this large, one-sifnlg the american economy, 17% o of the american economy, you should have to get 75 to 80 votes minimally, and it would be even better if you could get more, like we did with chip and with some of these others bills. some of them we got unanimous votes on. it costs money, by the way. the republicans voted for it, too. the republicans would vote for a good bill, even if it costs some money, but we're not about to vote for something that's going to cost $2.5 trillion to $3 trillion. i don't think the american people will stand for it either. so beware, my friends on the other side, beware what you're doing. because i can tell you right now, this isn't going to work. i just want to make that point as clear as i can. with that, i yield the floor. mr. burris: mr. president? the presiding officer: the senator illinois.

mr. burris: thank you, mr. president. as a lifelong public servant, i've always believed in the fundamental greatness of this country. i'm sure this is a belief shared by every single one of my colleagues in this body. it's what drove us to serve in the first place. just as it has driven generations of americans to serve in many capacities throughout our history. democrat or republican, liberal or conservative, we're united by our underlying faith in the democratic process and our respect for the people who have come -- people who we've come here to represent. that is what makes this country great, the belief that together

we can make progress. together we can shape our own destiny, mr. president, and that is why we gather here in this august chamber to bring the voices of the american people to washington, to the very center of our democracy. earl warren, the late chief justice of the supreme court, articulated this very well. and i quote: "legislators represent people, not trees or acres. legislators are elected by voters, not farms or cities or economic interests." end of quote. he said this in reference to a court case about elective representatives at the state level. but his insight rings especially true here in the highest law-making body in the land.

mr. president, i'd ask my colleagues to reflect upon this simple truth for a moment. we address one another as "the senator from illinois" or "the senator from texas" or "the senator from colorado," the senator from utah," but we do not speak for towns or counties on the map. our solemn duty is to listen to the people we represent and to give voices to their concerns and their interests here in washington. we strive to do this every day, but far too often partisan politics gets in the way. when it comes to difficult issues like health care reform, the voices of the people sometimes get lost in all of the talk about republicans versus democrats, red states versus

blue states. the media gets caught up in the horse racing more often than we'd like. an atmosphere of partisanship follows us into this chamber. and so, mr. president, as our health care reform bill has cleared the first hurdle and moved to the senate floor, i would urge my colleagues to listen to the people, not just the party leadership, as they decide how to vote. if they shut out the health care insurance lobbyists and the special interests and the partisan tug of war, they might be surprised at what they will hear from the american people. in my home state of illinois, the weight of consensus is hard to ignore. folks stop me on the streets, stop me in hallways outside of my office, talk to me on airplanes, they tall, they write, they e-mail -- they call,

they write, they e-mail, they contact me in every way possible. and the message is always the same: we need real health care reform. they're telling me, don't give up. don't back down. that's because the american people overwhelmingly support reform, and they need health care reform now, not tomorrow, not next year. they need it now. i urge my colleagues to think of the uninsured people in their own states. think about that in their own home states. who are the ones that are uninsured? these are the folks who need the reform the most. we have all heard of the hard-breaking stories. sadly, we will never be able to hear them all because there are just too many, mr. president. so it's time for us to listen and to take a stand on their

behalf. it's time to bring comprehensive health care reform to every state in the union because in my home state of illinois, 15% of the population is uninsured, ann the most advanced country on earth, this is simply -- simply unacceptable. we need to dramatically expand access to quality, affordable health care. let us not -- but it's not just the blue states. it is an american issue. this is a problem that touches all of us. in fact, as we look across the map, we see that many of our states that need the most help are actually the red states.

18% of the people in tennessee, utah -- and utah don't have health insurance and can't get the quality care they need. the number of uninsured stands at 20% in alaska, another 21% in georgia and florida and wyoming. in oklahoma, nevada, and louisiana, more than 22% of the total population is uninsured. 24% are without health insurance in mississippi. more than a quarter of the population of new mexico can't get health insurance. and in the great state of texas, almost 27% of the population has no health coverage. mr. president, these numbers speak for themselves. we need to expand coverage to include more of these people. a recent study conducted by harvard university shows that the uninsured are almost twice as likely to die in a hospital

as similar patients who do have insurance. this human cost is unacceptable, and the financial cost is just too much to bear. while my friends on the other side seek to delay and to derail health care reform at this crucial juncture, this bill seeks to save the health of our citizens, to save thei the livef americans and to save money in the way coverage is offered and delivered. by extending to these -- coverage to these individuals and increasing access to preventive care, we can catch illnesses before they become serious. that's why i'm proud to support the provision like the amendment offered by my colleague from the great state of maryland, senator mikulski. this measure would guarantee women access to preventive care

and health screening at no cost. more women can get regular screenings and tests such as mammograms. we can catch serious illnesses like breast cancer, heart disease and diabetes. we can help more people -- we can keep more people out of the emergency room. we can save lives. we can save money, mr. president. so, mr. president, the best way to expand access is to create a strong public option that will lower cost, increase competition, and restore accountability to the insurance industry. so i'm fighting for every single illinoisan to make sure that they have access to quality, affordable health care. to make sure that they have real choices. i'm fighting for every illinoisan because every one of us will benefit from comprehensive reform. but i recognize that those who are uninsured need help the most, and they need it now.

so i ask my colleagues to consider this need and to think about how many of their constituents stand to benefit from our reform package. it is no secret that my republican friends think about blocking and delaying this legislation. many of them represent the so-called red states. their opposing health care reform is seen as a good political move. and in the simple course of politics as usual, most of those red states would be written off because they typically support the republican party. but not this time, mr. president. health reform isn't about politics. it's not about one party or the other. it's about the lives that are at stake here that we're trying to help. its a about the people who --

it's about the people who suffer every day under a health care system that fails to deliver up to the promises of this great nation. so when i come -- when it comes to our health care legislation, a vote against reform is a vote against the people who so desperately need our help. that is why i'm asking my republican friends to rise above politics as usual when they make this choice. recently some of my colleagues across the aisle have said that our bill would slash medicare. mr. president, this is simply not the case. this doesn't cut medicare, no $465 billion. our bill would do nothing of the kind. this is just another cynical attempt to scare seniors into opposing health care reform. and we've had enough of that, mr. president. and the truth is this: according to the nonpartisan

congressional budget office, health care reform will lower seniors' medical care premiums by $30 billion over the next ten years while focusing on prevention and wellness, increasing efficiency and making the program more cost-effective. my republican friends can choose to engage in partisan games, spread the fears and disinformation about health care reform. they can turn their backs on the people they swore to represent. or they can cast aside the tired constraints of partisanship and stand up for what is right. and when they go home to the people who sent them to washington, they can look those piem people ipeople in the eye i fought for a you. i stood up to the special interests and the campaign donors and the political forces that tried to block reform."

"i didn't vote like a senator who represents a red state or a blue state. i voted like a senator who represented your state and all the good, hard-working people who desperately need this help." friends, colleagues, that is the spirit that drove each of us into public service in the first place. that is what makes this country great. the belief that policy is decided by the interests of the people, not big corporations or political parties. mr. president, this country is more than just a set of lines on a map. and the more you cross those lines, the more you learn that ordinary americans don't care who scores political points or who gets reelected. they care about results. they care about real costs and real health outcomes.

so it's time for us to deliver, mr. president. it's time to stand up for the uninsured, the sick, the poor, and all those who can't stand up for themselves. colleagues, it's time to come together on the side of the american people to make health care reform a reality. and this health care legislation has been debated on this floor -- that's being debated on this floor now, it will save lives, it will save money, and, mr. president, it will save medicare. thank you, mr. president, and i yield the floor. mr. ensign: mr. president? the presiding officer: the senator from nevada. mr. ensign: mr. president, i'd ask unanimous consent that myself and my colleague -- two colleagues would be able to engage in a colloquy. the presiding officer: without objection. mr. ensign: mr. president, i want to start by talking about the bill in general, make a couple of general points.

i would be happy to yield. mr. durbin: could you give us an indication how long you expect your colloquy to last? mr. ensign: 30, 40 minutes, somewhere in there. mr. durbin: thank you. mr. ensign: mr. president, there's a lot of talk about this bill. i want to make some general comments about it. first of all, following up on my colleague from illinois, he said that this was not a half a trillion dollars in medicare cuts. well, according to the congressional budget office, it's $465 -- $464 billion to $465 billion in medicare cuts. so maybe not quite a half a trillion but certainly -- certainly we're getting close to that. there are, however, a half a trillion dollars in new taxes in this bill, 84% of which will go to those -- be paid by those making less than $200,000 a

year, a direct violation of a campaign pledge made by president barack obama when he was then candidate obama. this bill will result for millions of americans in increased premiums and health care costs. this is a massive government takeover of our health care system. as a matter of fact, according to the national center for policy analysis, in this bill, this 2,074-page bill, almost 1,700 times -- 1,697 to be exact -- there are references to the secretary of health and human services, giving her the authority to create, determine or define things relating to health care policy in this bill. basically we are placing a bureaucrat in charge of health care policy instead of the

patient and the doctor making the choices in health care. now, mr. president, i believe we just can't be against this bill. i do believe we need a step-by-step approach, an incremental approach with some good ideas that we should be able to come together on. i think both sides agree that we should eliminate preexisting conditions. somebody who has played by the rules, had insurance, happens to get a disease, they shouldn't be penalized for that, they shouldn't be charged outrageous prices, have their insurance dropped. i think we can all agree on that. i think we should be able to agree that if you can buy auto insurance across state lines, you should be able to buy health insurance. in the state where it's cheape cheapest. find a state that has a policy that fits you and your family, be able to buy it there. you can save money and you happen to be uninsured, especially today, it seems to make sense. let's have that as one of our incremental steps.

i also believe this bill covers some of it, but i believe we need to enscene activize people to -- incentivize people to engage in healthier behaviors. 75% of all health care costs are caused by people's behaviors. let me repeat that. three-quarters of all health care costs are driven by people's poor healthy -- by people's poor choices in their behavior. for instance, smoking. smoking costs on average around $1,400 a year to insure a smoker versus a nonsmoker. somebody who's obese versus somebody who's in the proper body weight. it's about the same, about $1,400 a year. somebody who doesn't control their cholesterol versus somebody who does with medication, it's several hundred dollars a year. somebody who doesn't control their blood pressure versus somebody who does. so let's give incentives through lower premiums to encourage people to engage in healthier

behaviors. that will save money for the entire health care system and it will end up with people having better quality of lives as well. currently today, big businesses, because of their numbers, are allowed to take advantage of purchasing power. we ought to allow individuals and small businesses to be able to join together in groups to be able to take advantage of that purchasing power. they're called small business health plans. and i believe that my colleagues are going to talk about an idea that they have, something i've talked about for years, the idea of medical liability reform. there's several models out there. they're going to talk about a loser pays model, which other countries have engaged in and they don't have nearly the frivolous lawsuits nor the defensive medicine that we practice in this country. how many doctors order unnecessary tests in the united states because of fear of frivolous lawsuits? talk to any doctor and they'll tell you, everybody orders unnecessary tests simply to

protect themselves against the possibility that a jury may say, geez, why didn't you order this test, even though it wasn't indicated at the time? so there's a lot of costs. as a matter of fact, the congressional budget office said $100 billion between the private sector and the public sector would be saved with a good medical liability reform bill. see, i believe that we need a patient-centered health care system, not an insurance company-centered health care system, not what this bill does, a government-centered health care system, where a bureaucrat's in control of your health care. we need a patient-centered. now, we have an amendment before us known as the mikulski amendment. this is more of government-centered health care. we had a report out based on prevention that said mammograms shouldn't be required -- or shouldn't be paid for basically

for women under 50 years of age, from 40 to 50 years of age, and women in the medicare population age, we don't need annual mammograms for them. well, this was based mainly on cost. and if you look at that time from a cost standpoint, that's probably correct. but just think about it. if you're a woman and you get cancer and you could have had a mammogram diagnose that a lot earlier, well, i'll tell you what, you would have sure rather had that mammogram than had that mammogram denied. so the senator from maryland has proposed an amendment to try to fix the problem. the problem is that instead of one government entity determining whether somebody's going to get coverage, she turns it over to the secretary of health and human services. another government bureaucrat will determine whether something like this would be paid for or not. according to the associated press, it doesn't even mention mammograms in her bill.

senator murkowski, senator coburn have come up with an alternative that actually puts the decision whether to cover something on a preventive service, whether it's for a mammogram for breast cancer or some other test to may be developed that's better than a mammogram, which most people think that an m.r.i. is going to be better than a mammogram for diagnosing breast cancer, or whether it's a test for prostate cancer for men. those kinds of things should be determined by experts in the field, not by government bureaucrats. the various colleges, the american college of obstetrics and gynecology, for instance, they come out with certain recommendations, along with the american college of surgeons. those are the experts with peer-reviewed science. that's who should determine what the recommendations are for whether we pay for preventive services or not. not a government bureaucrat. and, unfortunately, the mikulski amendment just gives it to a

government bureaucrat. that's why we should reject the mikulski amendment, adopt the murkowski amendment, the senator from alaska, because she puts it in the hands of the people, of the experts, where that decision should be made. and let me close with this. we have seen a lot of comparisons, people saying that other countries have a better health care system than we have. well, let me just give you an example on cancer survival rates, comparing the average european union with cancer survival rates in the united states. and this gets to whether a government bureaucrat is making the decision or somebody -- the doctor and the patient are making that decision for their treatment. and when they get their treatment. on kidneys -- okay? -- these are five-year cancer survival rates. european union, 56%. on kidney cancer, in the united

states, 63% survival rate after five years. on colorectal cancer, about the same kind of difference between the united states and the european union. look at breast cancer down here, 79% after five years in the european union, 90% in the united states. and a dramatic is on prostate cancer. 78% survival after five years in the european union, 99% survival rate in the united states after five years. these are dramatic differences. where would you rather get your health care if you had one of these cancers: the united states or europe? canada, by the way, has even worse results than this. as a matter of fact, belinda stronak from the canadian parliament, a member of the canadian parliament, several years ago led the charge against a private system side-by-side with the government-run system

up in canada. she didn't want the private system. tragically, a couple years later, she developed breast cancer. did she stay in canada to get treatment? where there's a government-run health care system? no. where did she come? to the united states. she actually got treated at ucla. because we have a superior system of quality here in the united states. we have a problem with cost. some of the choices -- some of the incremental steps that i've talked about will address costs, and i want to turn it over now to my colleagues, because one of the things they're going to talk about is this idea of medical liability reform. let's look out for the patient instead of the trial lawyers in the united states and their idea on a loser pays system i think has a lot of merit and i think something this body should consider very seriously. so i would yield the floor to the senator from georgia, my good friend and colleague. mr. chambliss: well, i thank the senator from nevada for yieldi yielding. and senator graham and i do have an amendment that we have filed today with respect to reforming

the health care system in a real, meaningful way. and it's an amendment that deals with tort reform, and it is a true loser pays system. and we're going to talk about that in a few minutes, but before i goat that, i want to go back to some of the things that the senator from nevada has talked about. and i particularly appreciate his work on the mammogram issue, especially since this has been highlighted over the last couple of weeks with regard to the recommendation that has come out of the independent board that advises h.h.s. so i thank him for his -- his work on that issue, and he's dead on. and all of us know that our wives are told every year when they reach a certain age that they need to have a mammogram to make sure, just like we do every year, go in and get a physical. they need to get their mammogram. and the senator talks about

those kinds of checkups providing you with the kind of preventive health care that's going to hold down health care costs. and i'm a beneficiary of that. during a routine medical examination in -- in 2004, it was determined that i had prostate cancer, and i was very fortunate that it was picked up when it was, at an early stage, and instead of having to go through a lot of expensive procedures that i might have had to go through, we were fortunate to be able to treat it. we're working on getting cured. and he's exactly right, that this is the kind of test that we need to make sure that we encourage females to get and not put barriers in front of them. you know, medicare is such a valuable insurance policy and program that 40 million americans today take advantage of.

1.2 million georgians are medicare beneficiaries. again, i'm one of those that's a medicare beneficiary, so this is particularly important to me. but more importantly, in addition to these 40 million medicare beneficiaries that are in the country today, there's another 80 million baby boomers that are headed towards medicare coverage. and we've got an independent medicare commission that was established by congress years ago that is required to come to congress every year and give congress an update on the financial solvency of the medicare program. the purpose of that bipartisan commission is just to allow this body, along with our colleagues over in the house, the benefit of the work that they do every year in looking at the amount of revenues that come in in the form of the medicare tax and the outlays that go out in the form of payments to medical suppliers

for our medicare beneficiaries. last year -- this year -- in the spring of this year, 2009, the independent medicare commission reported back to congress and said that unless real meaningful reforms are made in the medicare system, that medicare is going to start paying out more in benefits than it takes in and tax revenues in the year 2017. now, mr. president, what that means is that in 2017, medicare is going to be insolvent. and it's just a matter of time before medicare goes totally broke. and those individuals who are baby boomers that have been paying into this program for 40 years, 50 years, whatever it may be, are all of a sudden going to reach the medicare age where they expect to reap the benefits of the medicare taxes that they've been paying for all of these years. and guess what? not only are benefits going to

be reduced about, unless something happens -- unless there is meaningful reform and it's done in right way, there's not going to be a medicare program. now, i want to go back to something that the junior senator from illinois said a few minutes ago. when he said, in talking about this issue in cuts in medicare, that this bill that we have up for debate now that's filed by senator reid, does not have cuts in medicare, he could not be more incorrect. and that's not a republican statement. it's not a statement by anybody other than the congressional budget office. and i refer to a letter that's already been introduced during the course of this debate. and it's a letter dated november 18th. and it's to the honorable harry reid, the majority leader. and i would refer the senator to page 10 of that letter in which the director of the

congressional budget office says this in reference to provisions affecting medicare, medicaid and other programs, and i quote -- "other components of the legislation would alter spending under medicare, medicaid and other federal programs in total. c.b.o. estimates that enacting these provisions would reduce direct spending by $491 billion over the 2010-2019 period." then the letter goes on on this page alone to delineate three areas where medicare payments, medicare provisions are going to be reduced or cut. and i would specifically refer to them. the first is a fee-for-service sector. this is other than physician services. it's going to be reduced b by $192 billion over 10 years. in the medicare advantage program, a program that

literally thousands and thousands of georgiaians take -- georgians take advantage of and millions of americans take advantage of, is going to be reduced by $118 billion over the years of 2010 to 2019. medicaid and medicare payments to hospitals, what we call disproportionate share payments or additional payments will be reduced or cut by $42 billion over 10 years. well, what does a reduction in these benefits mean to each individual community or each individual state? i can tell you what it means to the local hospital in the rural area of georgia where i live. the reduction in dish payments are going to amount to a reduction in income at the regional center in georgia b

by $16.8 million over a 10-year period. these reductions or these cuts in medicare are going to result in a reduction in payments to emery hospital in atlanta in the amount of $367 million over a 10-year period. so anybody who says these aren't cuts in medicare spending simply has not read the bill and certainly has not read the letter from the director of the congressional budget office to senator reid dated november 18, 2009. now i want to turn this over to my colleague from south carolina after this final statement with reference to reductions in medicare spending. there's a specific reduction o of $8 billion in this bill over a 10-year period in hospice benefits. again, we've heard a number of personal stories around here. and i have a particular personal story myself. my -- my father-in-law died when he was 99 years old.

it was three years ago. the last two years of his life he lived in an assisted living home and he had hospice to come in two, three, four days a week. whatever he needed. had he not had the benefit of hospice, he would have had to go into the hospital, and no telling how much in the way of medicare, medical expenses he would have incurred. but thank goodness we had hospice available and he spent two days in the hospital. otherwise he was able to live in his assisted living home, have my wife go by and spend quality time with him, which she will tell you today are the best two to three years of her life, as far as her relationship with her father was concerned because she had hospice there to take care of him. and here we're talking about reducing a benefit by $8 billion that save, no telling how many thousands of dollars in the case of my family, and you multiply

that across america and it's pretty easy to see that we don't need to be reducing a benefit that's going to save us money in the long run. and i'd like to -- to turn it over to my friend from south carolina who also has some comments regarding medicare and then we'll talk about our bill. mr. graham: i'd like to thank my friend from georgia and i'll try to be brief. i goes say we don't -- we need to do health care reform, i think that's pretty obvious to a lot of people. the inflationary increase in private sector in the health care ar is unsustainable. a lot of individuals are having to pay for their health care costs are getting double-digit increases in premiums. in the public sector, the medicare and medicaid program are just unsustainable. medicare alone is $38 trillion

underfunded. over the next 75 years we've promised benefits to the baby boom generation and current retirees, and we're $38 trillion short of being able to honor those benefits. what has happened? you've created a government program everyone likes, respects, and is trying to save and actuarially it is not going to make unless we reform it. so what have we don't? in the name of health care reform we've taken a program that many senior citizens rely upon, all senior citizens practically. we reduced the amount of money that we're going to spend on that program and give the money from medicare to create another program that the government will eventually run and it makes no sense much we need to look --

sense. we need to look at medicare from impending bankruptcy. why would you reduce medicare by $764 billion, take the money out of medicare that is financially already in trouble to create a new program? well, it makes no sense to me. that's not what we're trying to do from my point of view to reform health care. now, medicare, cuts that senator chambliss was talking about, they're real. the way our democratic colleagues and friends try to get to revenue neutrality on the -- on the additional spending to get it down to where it doesn't score in a deficit format is they take $464 billion out of medicare to offset the spending that is required by their bill. now, here's the question for the country: how many people in america really believe that this congress or any other congress

is actually going to reduce medicare spending b by $464 billion over 10 years? i would argue that if you believe that, should not be driving. there is absolutely no history to justify that conclusion. in the 111th congress there were 200 bills proposed, and i was probably on some of them, to increase the payments to medicare. in 1997 we passed a balanced budget agreement when president clinton was president slowing down the growth rate of medicare. that worked fine for a while until doctors started complaining, along with hospitals, about the revenue reductions. every year, since about 1999 1999-2000, we have been forgiving the reductions that were due under the balanced budget agreement because none of

us want to go back to our doctors and say that we're going to honor those cuts that we created in 1997 because it's creating a burden on our doctors. will that happen in the future? you better believe it will happen in the future. in 2007, senator cornyn and gregg introduced an amendment to reduce medicare spending b by $33.8 billion under the reconciliation instructions. it got 23 votes. i remember not long ago the republican majority proposed reducing medicare b by $10 billion. not one member of the democratic senate voted for that reduction. they had to fly the vice president back from pakistan to break a tie. over $10 billion. so my argument is quite simple to the american people. we're not going to reduce

medicare by $464 billion. and if we don't do that, the bill is not paid for. and that creates a problem of monumental proportions. if we did reduce medicare b by $464 billion, and took the money out of medicare to create another government program, we have done a very dishonest thing to seniors. we're dammed if -- damned if we do and damned if we don't. during the whole campaign, i don't remember anybody suggesting that you needed to cut medicare to create medicare reform for not medicare services. but that's exactly what we're doing. now to my democratic colleagues, there will come a day when republicans and democrats will have to sit down and seriously deal with the underfunding of medicare, with the impending

bankruptcy of medicare. everything that we're doing in this bill may make sense to save medicare from bankruptcy. it doesn't make sense to pay for another government-run health care program outside of medicare. it makes no sense to take the savings that we're trying to find in medicare and not use them to save medicare from what i think is going to be a budget disaster. so let it be said that this attempt to pay for health care, to make it revenue neutral, will require the congress to do something with medicare that has never been done before and it's not going to do in the future. so the whole concept is going to fall like a house of cards. the way we tried to pay for this bill has got so many gimmicks in it, it would make an enron accountant blush. now, as to tort reform. quite frankly, i used to

practice law and did mostly plaintiff's work. i am not a big plan of washington taking over state legal systems. i prefer to let states do what they're best at doing and let the federal government do a few things well, and we're doing a lot of things poorly. but if we're going to take over the entire health care system, that's going to be the option available to us, then we also need to nationalize the way we deal with lawsuits. and to the a.m.a., there will come a day, if we keep going down the road here of where the national federal government will determine how you get to be a doctor. and there will be no state medical societies. and we'll have a national system to police doctors. that's what's coming if we continue to nationalize health care. so with senator chambliss, i tried to come up with a more reasoned approach when it comes to legal reform. i always believed that people

deserve their day in court, and there's no better way to resolve a dispute than have a jury do it. i'd rather have a jury of independent-minded citizens to decide a case than politicians or any special group. one thing i've always been per flexed about in america is that the risk of stewing somebody is -- suing somebody is very one sided. most developed nations have a loser payroll. i think you should have your day in court but there ought to be a down side to bringing another person into the legal system. so a loser payroll i think will do more to modify behavior than any attempt to cap damages. let both wallets be on the table. you can have your day in court, but if you lose, you're going to have to pay some of the other side's legal costs, which will make you think twice. now, as to -- as to the indigent person, most people who see each

other are not indigent -- who sue each other are not indigent. the judge would have the ability to modify the consequences of a loser payroll, but we need to know going in that both wallets are on the table, and under our proposal, we have mandatory arbitration where the doctor and the patient will submit their case, the case to an arbitration panel, and if either side turns down the recommendation of the panel, they can go to court, but then the loser payroll kicks in. i think that will do more to weed out frivolous lawsuits than arbitrarily capping what the case may be worth in the eyes of a jury. i think it really does create a financial incentive not to bring frivolous lawsuits that does not exist today. if you have a $500,000 damage cap, most of the people i know say i'll take the $500,000. that's not much of a deterrent. but if you told someone you can bring this suit, the arbitration didn't go your way, but if you

go into court after arbitration, you risk some of your financial assets, people will think twice. so i think that's why this is a good idea. the national chamber of commerce has endorsed it, and i'm proud of the fact that they have endorsed it. i would rather not go down this road, but if we're going to nationalize health care, we also need to do something about a legal system that's going to be affected by the nationalization of health care. the final comment i would like to make about what we're doing here is that it's probably worrisome to people at home that we're about to change 1/6 of the economy and you can't find one republican vote to help. now, i guess there's two ways to look at that. is the problem the republican party or maybe the bill is structured in a way that is so extreme there is no middle to it. and i would argue that what we

have done here is that we have abandoned the middle for the extreme. it's pretty extreme in my view to take a program that's that's $38 trillion underfunded, cut it and take the money to create a new program rather than saving the one that's in trouble. it's pretty extreme in my view to take a country that is so far in debt you can't see the future and add $2.5 trillion of more debt onto a nation that's already debt laden in the name of reforming health care. when you look at the second ten-year window of this bill, it adds $2.5 trillion to the national debt. is that necessary to reform health care? do we need any more money spent on health care or should we just take what we spend and spend it more wisely? the first ten years is a

complete gimmick. what we do in the first ten years of this bill is collect the half a trillion dollars in taxes for the ten-year period and we don't pay any benefits until the first four years are gone. now, that is just not fair. that's a gimmick. and that catches up with you in the second ten-year period. so the reason we don't have any bipartisan support is because we've come up with a concept that has no middle to it. this is a power grab by the federal government. this is a chance to set in motion a single-payer health care plan that the most liberal members of the house and the senate have been dreaming for. this is a liberal bill written by and for liberals, and it's not going to get any moderate support on the republican side side -- and there is some over here to be had -- and they're going to have a hard time

convincing those red state democrats that this is good public policy. so that's where we find ourselves, trying to change 1/6 of the economy in a way that you don't have any hope of bringing people together. so i would argue we should stop and start over. i want to thank my good friend from georgia for trying to find a way to change lawsuit abuse in a more reasoned fashion. mr. chambliss: i thank my colleague from south carolina, senator graham, for his really thoughtful process that we went through and thinking through the loser pays bill and the amendment that we have filed here, and just like you, i haven't practiced law for 26 years before i was elected to the house the same year you were and then we were elected over year. i tried plaintiffs' cases as

well as defendants' cases. i never represented a defendant in a malpractice case. i was always on the other side, and i have great sympathy for individuals who are wronged by a physician who is negligent. and you and i agree that anybody who is the victim of negligent action ought to have their day in court, and that's what we provide for under our bill. there is absolutely no question about the fact that anybody who is subject to negligent acts on the part of a physician, that they can have their day in court, and they should have their day in court if that's what they decide they want to do. but under a loser pays provision like we have designed here, we can eliminate hopefully the frivolous lawsuits that add significantly to the cost of health care delivery in this country. in 2003, direct tort litigation

costs in america accounted for 2.2% of our g.d.p. that's double the percentage of canada, great britain, germany, france, and australia, all of which have loser pay system. the state of alaska has had a loser pay system since 1884. tort claims in the state of alaska constitute a smaller percentage of total litigation than the national average. florida which applied a loser pays rule to medical malpractice suits from 1981-1985 saw 54% of their plaintiffs drop their suits voluntarily. it does make a difference on frivolous suits. in the state of florida during that same period of time, the jury awards for plaintiffs rose significantly, and just as in our situation anybody who had a legitimate case in florida during that period of time had the right to have their case

adjudicated by a jury, those that made a decision to do so received more significant awards, and that's the way the system ought to work. this is a win-win situation for the cost of health care delivery. it's a benefit to the physicians, sure, because they eliminate part of their significant costs of delivering health care services, but it also is a huge benefit to those individuals in america who are subject to negligent acts on the part of physicians. i would, mr. president, ask unanimous consent that a letter to senator graham and myself from bruce johnston at the u.s. chamber of commerce, dated november 3, 2009, be submitted for the record. the presiding officer: without objection. mr. chambliss: and with that, i would yield the floor. the presiding officer: the senator from illinois. mr. durbin: mr. president, could the chair inform me how much time was used on the republican

side during the last group of speakers? the presiding officer: 42 minutes and 14 seconds. mr. durbin: i thank the chair, and i am going to proceed to speak in the same manner and yield to the senator from vermont, and our time will be less than that in total, so i see the senator from louisiana is here so we're going to be speaking less than 42 minutes. we guarantee you that much. and we're going to follow the same process, if there's no objection, that was just followed where three republican speakers spoke in that 42-minute period of time. and i ask unanimous consent that senator sanders be recognized after me to speak and that our total time be no more than 42 minutes. the presiding officer: is there objection? objection was heard. mr. durbin: well, mr. president, i just offered that to the republican side and they asked

me for permission and i gave permission, unanimous consent, so we'll speak as long as we would like and we'll enter into a colloquy. i hope that the senator from louisiana will reconsider. let me try to address a few of the issues that have been raised here on the floor. first on the issue of medical malpractice, this is an issue often brought up on the other side of the aisle. the first thing i would like to say is this is the bill we are debating. it's 2,074 pages and one extra page makes it 2,075 pages. it's taken awes year to put this together. there have been a series of committee hearings that have led to the creation of this legislation, and it has been posted on the website for anyone interested if they go to google, for example, and put senate democrats in, they will be led to a website which will let you read every word of this bill. it's now been out there for 12

days at least and it will continue to be this for review by anyone interested. if you then google senate republicans and go to their website on health care and look for the senate republican health care reform bill, you will find this bill, the democratic bill, because there is no senate republican health care bill. for a year and with an enormous number of speeches, they have come to the floor and talked about health care but have never, never sat down and prepared a bill to deal with the health care system, which leads us to several conclusions. this is hard work, and they haven't engaged in that hard work. it is easier to be critical of this work product and they have chosen that route. that's their right to do. this is the senate. we are the majority party. we are trying to move through a bill. but all of the ideas they've talked about tonight and other evenings have not resulted in a

bill. secondly, it may be that they don't want to see a change in the current system. they are happy with the health care system as it exists today. that is possible. in fact, i think it drives some of them to the point where they criticize our bill but don't want to change the system because they like it. i guess there are some things to like about it. there are good hospitals and doctors in america. some people are doing very well under the current system, but we also know there are some big problems. we know the current system is not affordable. we know that the cost of health insurance has gone up 131% in the last ten years, that ten years ago a family of four paid about $6,000 a year for health insurance. now that's up to $12,000 a year. and that we anticipate in eight years or so that it will be up to $24,000 a year, roughly 40%

or more of a person's gross income will be paid in health insurance. that is absolutely unsustainable. so businesses are unable to offer health insurance as well as individuals are unable to buy health insurance. the republicans have not proposed anything, nothing that will make health insurance more affordable. this bill addresses that issue. they have nothing. secondly, we know that there are about 50 million americans without health insurance. these are people who work for businesses that can't afford to offer a benefits package. they are people who are recently unemployed, and they are people in such low-income categories they can't afford to buy their own health insurance and their children, 50 million. this bill that we have before us will give coverage to 94% of the people in america, the largest percentage of people insured in the history of our country. the republicans have failed to

produce a bill that expands coverage for anyone in america. under the republican approach, nothing would be done to help the 50 million uninsured. the third issue is one about health insurance companies. everybody has an experience there, and it's, unfortunately, not good for most because when you paid premiums all your life and then need the health insurance, many times it's not there. what we do is to give consumers bargaining power and a fighting chance with health insurance. that to me is a reasonable approach. it eliminates discrimination against people because of pre-existing conditions. putting caps on the amount of money that's being paid. we extend the coverage for children under family health plans from age 24 to age 26. we do things that give people peace of mind that when they really need health insurance for themselves and their family it will be there. the republicans have failed to offer anything that deals with health insurance reform.

that's fact. they have said a lot about medicare. i would like to tell you that tomorrow or soon, we will be -- i will be co-sponsoring and senator bennet of colorado will be offering an amendment which couldn't be clearer on this bill and the medicare program. the amendment is so short and brief and direct and understandable, i want to read a couple of highlights. senator bee bennett's amendments nothing made by provisions i in this act -- the health care reform act -- shall result in dwarguaranteed benefits under te 13 of the social security act. i want to make it clear, that's medicare. and what senator bennett is saying is that people will have their medicare benefits guaranteed, nothing in this bill will infringe on their medicare benefits, despite everything that's been said.

the bennett amendment, which will be offered, goes on to say, "savings generated from the medicare program under title 18 of the social security act, under the provisions of and amendments made by this act" -- health care reform -- "shall extend the solvency of medicare trust funds, reduce medicare premiums and other cost sharing for beneficiaries and improve or expand medicare benefits and protect access to medicare providers." all of the speeches made the last three days about how this bill threatens medicare -- it does not -- will be completely cleared up by this bennet amendment. i hope some of the republican who have a newfound love of the medicare program, which we started many years ago, will join us in voting for this amendment. it would be great to see if their speeches to save medicare will result in their votes for senator michael bennet of colorado's amendment. this is a critically important amendment. i commend him for being so straightforward and showing real

leadership on an issue of this magnitude. i would like to -- i know that the senator from vermont is interested in speaking and i'm prepared to yield to him for comments and questions. but before we do, i would like to say by way of introduction that we just heard one of our republican colleagues say that this is a single-payer bill. that at the end of the day, we will have created a single-payer system. i think the senator from vermont is familiar with the concept of single-payer, and i would invite his comments or questions through the chair to me about his feelings on this issue. mr. sanders: well, i thank my friend from illinois for asking that question, because coincidentally, we have just introduced and brought to the desk legislation for a single-payer national health care program. and i would suggest to my friend from illinois and my republican friends that it is a very different bill than the

legislation that we are now looking at. in no way, shape or form is the legislation being debated now a single-payer national health care program. and as my friend from illinois understands -- and i would ask his views on this -- you know, i have heard some of our republican friends talk about how strong this current health care system is that we have right now. and i would ask my friend from illinois, do you think we can do better than being the only major country in the industrialized world that does not guarantee health care to all of its peop people? can we do better than that? mr. durbin: in response to the senator from vermont, we must do better. this is the only civilized, developed, industrialized country in the world where a person can literally die because they don't have health insurance. 45,000 people a year die because

they don't have health insurance. what does it mean? well, one illustration. if you had a $5,000 co-pay on your health insurance policy -- and people face that -- and you go to the doctor and the doctor says, durbin, we think you need a colonoscopy, and i realize that i have to pay the first $5,000 and a colonoscopy is going to cost $3,000 and i say, i'm going to skip it -- which people do -- and bad things happen, i develop colon cancer and die, my insurance has just failed me. basic preventive care is not there. we are the only country, civilized, developed country, where that is a fact. mr. sanders: and i would ask my friend from illinois, has he talked to physicians who have just on that issue told him that they have lost patients who walked into their office and they say, why didn't you come in here six months ago or a year ago? and that patient said, well, you

know, i didn't have any money and i thought maybe the pain in my stomach or my chest would get better. now, i've had that conversation with physicians in vermont. i wonder if you've talked to physicians who have said the same thing. mr. durbin: i would say to the senator from vermont, a lady that i met two weeks ago in southern illinois, 60 years old, a hostess at a hotel who serves breakfast in the morning -- we know they're there as we travel around our states -- has never had health insurance in their life, is diabetic and told me that she -- her income was so low -- it's $12,000 a year -- she couldn't afford to go to a physician to check out some lumps which she had discovered. i mean, that is the reality of the current health care system in the wealthiest, greatest nation on earth. mr. sanders: and when -- if i may say to my friend from illinois, we have heard discussions of "death panels." well, i think you might agree with me that when we talk about death panels, we're talking in reality about 45,000 people who die every single year -- every

single year -- because they don't get to a doctor on time. that seems to me to be what a death panel is. and in the midst of all this, with 46 million uninsured, with 45,000 people dying every year because they don't get to a doctor when they should, when premiums have doubled in the last nine years, when we have almost 1 million americans going bankrupt because of medically related bills, i would ask my friend from illinois, isn't it time for a change and isn't it time that this country now moves forward and provides health care to all of our people in a comprehensive and cost-effective way? mr. durbin: i would say to the senator from vermont through the chair that i certainly agree with him. i'd add one more statistic to what he just said. of the nearly 1 million people filing for bankruptcy in america each year because of health care costs, medical bills they can't pay, three-fourths of them have health insurance.

mr. sanders: right. mr. durbin: three-fourths of them were paying premiums. these were the people who were turned down when they needed coverage. these are the people who ran into caps on coverage on their policies. these are folks who had to battle it out and lost the battle with the insurance companies to try to get lifesaving drugs. that is the reality of the current system. and the fact is, the republican side of the aisle has not produced an alternative. we have worked long and hard to do it. they have not. mr. sanders: and i would ask my friend from illinois, if we are not just dealing -- not just with the personal health care issue of 46 million uninsured and people dying, but are we not dealing with a major economic issue? how are businesses in this country going to compete with the rest of the world when every single year they're seeing huge increases in their health insurance? rather than investing in the business that they're supposed to be in, they're having to spend enormous sums of money as health care costs soar in this country. now, i know small businesses in vermont tell me that in some

cases not only can they not provide health insurance to their workers, they can't even provide it for themselves. i got to believe this is a similar situation in illinois, is it not? mr. durbin: in response to the senator from vermont through the chair, we're sent many books and some of them i have a chance to glance at. this is the recent one i received called "bend the health care trend," and they have here information which says, "american health care spending reached $2.4 trillion in 2008 and will exceed $4 trillion by 2018. we know that we expect a doubling of basic health insurance premiums in eight to ten years, and we know what you just described is reality. that even businesses owned by a couple, husband and wife, are finding themselves not only unable to provide health insurance for their employees because of its costs, they can't cover themselves. i had a friend of mine, one of my boyhood friends, grew up with him and his wife, and he -- his

small business had one of their employees who under the health insurance plan had -- his wife had a baby with a serious illness. as a result of it, their premiums went through the roof and he had to cancel his group health insurance. he gave his employees the $300 a month, whatever it was he was paying, and said we're all on our own now. we have to go in the private market. the couple with the sick baby couldn't find any health insurance. my friend, who is in his 60's, he and his wife are in a pitched battle every year about how much they have to pay for health insurance. and the company, the only one that will cover them, each year excludes whatever they turned a claim in for last year. so that is the reality of health insurance for small businesses. i also want to tell my friend from vermont that about one-third of all realtors in america are uninsured, have no health insurance. they are independent contractors and they have no health insurance. one out of three. mr. sanders: and while we're

talking about the economics of health care in this country, i wonder if my friend from illinois has had the same experience that i've had in vermont where people tell me they're staying on their job not because they want to stay on their job but because the job is providing decent health insurance and they can't go where they want go because the new job may not or they're afraid about the interval when they may not have any health insurance at all. and i wonder if my friend from illinois happened to see the piece in the paip - paper -- unbelievable -- where a guy drawing -- a middle-aged fellow joined the united states military. do you know why he joined the united states military? his wife was suffering from cancer and he couldn't find a way to get health care for her so he joined the military. do you think that this is what should be going on in the greatest country in the world? mr. durbin: we can do better. and i would say to those who call our plan a single-payer

plan, what we're trying to do is to get fair treatment from private health insurance companies for consumers and families across america and to give them choices. the senator from vermont i assume is part of the federal employees health benefit program. so am i. and most members of congress belong to this program. 8 million federal employees and members of congress are part of this program. it may be the best health insurance in america. because we can shop. i just got a notice in the mail that says open enrollment coming. if you don't like the way you were treated by your health insurance plan last year, you can change. pick a different plan. if it's a generous plan, more money will be taken out of your check. if it's not, less money will be taken out. we can shop. what we do on the insurance exchanges in this bill is say to these americans who wouldn't otherwise have options, go shopping, find the best health insurance plan for your family, exercise your choice. and i would say to senator harry

reid, who drafted this bill, i thank him for his hard work. he includes a public option, a not-for-profit health insurance plan with lower costs that people can choose if they care to. giving people that choice, giving them an option to go shopping for the most affordable, best health insurance plan is what we enjoy as members of congress and what every american family should. mr. sanders: i would ask my friend from illinois -- and this is kind of an awkward way to communicate with the chair here and the american people, but that's what we're obliged to do here -- but i would ask my friend from illinois, why do you think some of our republican friends feel so threatened and so upset by giving the american people the option -- option -- to choose a public medicare-type plan as opposed to a private insurance plan? do you think that maybe, just maybe, some of our friends are more interested in representing the interests of the big private insurance companies rather than the needs of the american

people? mr. durbin: i'd say to my colleague from the state of vermont in response through the chair, i'm waiting for the first republican senator to offer an amendment to this bill to abolish medicare. if they really believe that government health insurance is such a bad idea, they ought to step right up and show it. mr. sanders: well, i would say to my friend from illinois that that's an interesting proposal and, in fact, i was almost thinking of offering an amendment at one point, because, you know, we have a lot of people in this country who stand up and say, "get the government out of health care." well, i think that some of my republican friends have kind of echoed that message. and i do think that the senator from illinois is right, we may bring forth an amendment to allow our republican friends to say, let's abolish the veterans administration. because, as you know, that is a government-run program which most veterans in my state, and i think around this country, are very proud of. they think it's a good program.

and what the statistics tell us, it is a very cost-effective way to provide quality health care to all of our people, all of our veterans. so maybe we should bring forward an amendment to those who say, get the government out of health care. you want to abolish the veterans administration? go for it. and what about tricare? maybe you want to abolish tricare? go for it. maybe you want to abolish the s-chip program, which has provided high-quality health insurance for millions of kids in this country. so maybe, i would say to my friend from illinois, we might work together, bring forward an amendment, let our republican friends who say "get the government out of health care," let them abolish the veterans administration, medicare, s-chip, medicaid -- let them do that and we'll see how many votes they might get. mr. durbin: i would say to the senator from vermont, there's another way that senators who loathe the idea of government-run health insurance plans can show personally their commitment to that idea, by coming to the floor and publicly announcing they will not participate in the federal

employees health benefit progr program, which provides health insurance for members of congressment i have yet to hear the first member -- congress. i have yet to hear the first member critical of government health plans come forward to say, so, in a show of unit and personal commitment, i am going to opt out. mr. sanders: i would suggest to my friend from illinois, we would take it another step further. i go to the capitol physician's office right here. that's where i go. we pay extra money for it. i have bluecross blueshield, you know who runs the physician's office to get primary health care, it's that terrible government agency, the united states navy. so maybe some of our friends busy denouncing government health care, might say they don't want to take advantage of that fine high-quality health care. that speaks to the military as well. while we're at it, maybe you should bowlish health care for the united states military, which is all government run and,

by the way, generally regarded as pretty good quality health care. i would ask my friend his views on that. mr. durbin: i think you'll hear a lot of speeches about specialized medicine, socia soc, but with when it comes down to it, there's not a is single member on the other side to say i'll offer an amendment to abolish it. they'll have a chance to in this bill. i don't think the people who have this coverage today would like to see it gone. mr. sanders: there's another area where there is the semigovernment nonprofit, which the senator from illinois feels strongly about, that is the family qualified community health center, started by senator kennedy. we have 1,200 community health centers, and this is widely supported in a bipartisan or tri-partisan way, because the community health centers provide

quality health care an dental care and prescription drugs an mental health counseling. i might say to my friend from illinois, that one of the provisions in the 2,000-page bill is legislation that you and i have worked hard on is to substantially expand the community health center program into every underserved area in america. we talk about 46 million people being uninsured in this country. we have 60 million people who don't have access to a doctor on a regular basis. and if we expand the community health care program and expand to a significant degree the national health service call so that we can help young people become primary health care physicians by paying off their very substantial medical debt, would my friend agree with me this is a major step forward in improving primary health care in america? mr. durbin: the senator from vermont has been -- when senator obama came forward with the recovery bill, that the senator from vermont was one of the

leaders to put additional funds in this bill to build clinics all across america. in rural areas we represent in the towns and city that's we represent as well for the very reason you mentioned because for a lot of people that i represent in downstate southern illinois and some of the rural eachs, it's a long drive for a doctor's clinic or primary care. so these community health clinics are going to offer people primary care, i think, as a result of this bill when we enact it, and i feel very good about the enactment of this because i think we sense this is a moment in history we shouldn't miss. we are going to see this network grow across america and it is -- it has proven itself to be so good in the city of chicago i visit these community health clinics, and i'll bet you do in vermont. and what i'll find there many times we'll walk in the door, the administrator will be there, i'll meet the doctors, i'll meet the nurses and when i get a chance to drink a cup of coffee and say to them, and i mean it,

if i were sick, i would feel confident walking in the front door of this clinic that i was in the best of hands. better than the most expensive clinic in my state. mr. sanders: my friend from illinois makes the point. i have visited all of them in the state. we have two to eight, we have 100,000 people in the state of vermont who use these health centers. i that my friend from illinois is also aware when we talk about health care, you've got to talk about dental care. because what is true in vermont is true in illinois, you're going to have a whole lot of people who don't have access to a didn'tist which these federally qualified health centers have, and mental health counseling an low-cost prescription drugs. i think my friend from illinois, i'm sure that you and i will work together that we, in fact, are successful in keeping people out of the emergency room, keeping thoiment of the hospital by en-- keeping them out of the hospital by enabling them to get the medical care when they need it. i look forward to working with

my friend on that. mr. durbin: the senator from vermont raised an important issue. we need more primary physicians. there are provisions in this bill to encourage people to pursue primary care, internists, practitioners, those are the people needed more frequently for preventive care an basic checkups so people have a chance to see a good doctor before they get sick or become seriously ill and much more expensive. so we are pushing forward for more and more health care professionals. again, the republican critics of this legislation have offered nothing, nothing when it comes to encouraging the growth of our health care workers in america. we -- this ought to be something that's nonpartisan. i mean, i would think that at some point they would agree that many things in here are essential for the future of our country and i think that's one of them. mr. sanders: would my friend from illinois agree that it doesn't make a whole lot of sense for people who do not have health insurance today to go

into an emergency room, run up a huge cost or to get terribly ill because they don't go to the doctor when they should and end up in the hospital. wouldn't it make a lot more sense, both from the personal health of the individual and saving money for the system, to provide health care to people when they need? mr. durbin: i agree with the senator from vermont. and i would say we have some of the best health care in america, but also the most expensive health care in america. spend more per person than any other nation on earth and a lot of it has to do with money not being well spent and people who do not have access to a medical home, we -- which we established in this bill, do not have access to a community health care clinic, in desperation will take a baby with a high fever into an emergency room. they will wait for hours to finally see a doctor and once there, they'll have the most expensive care they could ever face when they could have gone for a doctor's appointment and have been taken care of at a traction of the cost. that isn't good for the

hospital, because many of them are getting charity care that they don't get compensated for and they pass that cost along to other patients and it certainly isn't good for the family's that's involved. mr. sanders: at this point let me thank my friend from illinois for allowing me to engage this colloquy with him. i will yield back the floor and thank him for his very good work. mr. durbin: i would say at this point in time we have three or four amendments before the senate on health care reform. we started the dethe bait on monday. we -- debate on monday. we are wrapping up on wednesday much we're about to go -- wednesday. we're go to go into the fourth day of the debate on one of the most important bills in the history of the united states senate. we have yet to reach an agreement with the republican side of the aisle to have the amendments voted on. if we're only doing four amendments or three eamsdz in four day -- amendments in four days, this is not going to be the kind of debate that the american people expected. they expected us to bring issues

before the floor here, debate them in a reasonable period of time, vote, move to another issue. there's certainly a lot of things to talk about. and so i hope that the republican side of the aisle will have a change of heart and start to join us in this dialogue, will offer area that amendments in a timely fashion, we will give them their opportunity to debate them and then bring them to a vote. but the fact is we've not had a single vote this week on health care reform amendments because of objection from the other side. that is not in the interest of moving forward this important legislation and giving members an opportunity to present their amendments and have them voted nona timely fashion. an, mr. president, i yield the floor.

mr. durbin: after any leader time on december 3, the senate resumes consideration of h.r. 3590, then it be in order for any of majority republican bill -- majority or republican bill managers to be recognized for a total period of time not to extend beyond 10 minutes. equally divided and controlled. that the time until 11:45 a.m. be for debate with respect to the mikulski amendment 2791 and mccain motion to commit and during this time it be in order for senator murkowski to call up her amend with respect to mammography and that it be in order for senate bennet the side-by-side amendment with respect to the mccain motion to commit that no other motions be in order during the pendency of these amendments in order that at 4:11:45 that the senate proceed to vote in relation to the mikulski amendment, that

upon disposition of the mikulski amendment, that the senate proceed to the murkowski amendment, that upon disposition of the two amendments, that the senate debate until 2:45 p.m. the bennet of colorado amendment 2826 and the mccain motion to commit with the time equally divided and controlled between senators baucus an mccain or their designees and then at 2:45 p.m. the senate proceed to vote in relation to the bennet of colorado amendment 2826, that upon disposition of that amendment the senate then proceed to vote in relation to the mccain motion to commit. that prior to the second vote in each sequence there be two minutes of debate equally divided and controlled in the usual form. that each of the above reference of amendments or motion be subject to an affirmative 60-vote threshold and that if the amendments or motion do not achieve that threshold, then they be withdrawn. further if any of the above listed achieve the 60 vote threshold, the amendment or motion be agreed to and be laid

on the table. if there is a request for thians to be ordered with respect to that amendment or motion, regardless of achieving the 0-vote threshold, if the yeas and nays are requested, that the vote occur immediately with no further debate in order with respect to this particular consent. the presiding officer: is there an objection? mr. mcconnell: mr. president, reserving the right to objects. and i will not object. i would like to point out we've had difficult oi actually on both sides getting to the two votes that are designated in this consent agreement. our side of the aisle, republican side of the aisle, was prepared to vote on both of those amendments tonight and then a problem developed on the other side, which i understand, because we had a problem on our side earlier, but i do just want to make it clear that republicans were prepared and fully ready and willing to vote on the two amendments in the consent agreement tonight.

mr. president, i do not object of. mr. vitter: reserving right to object. the presiding officer: the senator from louisiana. mr. vitter: thank you, mr. president. mr. president, i certainly concur with the distinguished majority whip's goal of more amendments and more votes. with regard to this very important screening and mammography issue, my goal has been a very, very focused one. i have a filed second-treed -- decked-degree amendment that has a focus, that is, i believe, extremely noncontroversial. i believe it will be supported by everyone in this body. that is simply to ensure that there is no legal force an effect to the recent recommendations issued in november of 2009 by the u.s. preventive service task force with regard to breast cancer screening, use of mammography

and self-examination. as everyone knows those new recommendations were shocking and how they took a giant step back from the previous recommendations and took a giant step back in terms of recommended screening, which virtually every expert i know of strongly disagrees with. so this filed simple second-degree amendment simply says that those new recommendations of november of this year have no force and effect. and i'll read the amendment. it's very short. to be clear, it does nothing more than that. quote, "for the purpose of this act and for the purpose of any other provision of law, the current recommendations of the united states preventive service task force regarding breast cancer screening, mammography and prevention, shall be considered the most current other than those issued in or around november 2009." close quote.

so we're simply ensuring that those new relations, which i strongly disagree with, experts strongly disagree with, i believe all of my colleagues do, have no legal force and effect. so i would simply ask that the unanimous consent proposed be modified so that the mikulski amendment incorporate this language. and i would propose that as an alternative unanimous consent request. the presiding officer: is there objection to the request as modified? mr. durbin: i object. the presiding officer: objection is heard. mr. vitter: mr. president, -- the presiding officer: objection to the original request from the senator from illinois. mr. vitter: i continue my right to object. this is a noncontroversial provision, i would suggest another solut