the presiding officer: are any senators wishing to vote or change their vote? on this vote, the yeas are 61, the nays are 39. under the previous order requiring 60 votes for the adoption of this amendment, the amendment is agreed to. under the previous order, the motion to reconsider is considered laid upon the table. under the previous order, there will be now two minutes of debate equally divided prior to a vote in relation to amendment 2836 offered by the senator from alaska, ms. mikulski. the senate will be in order, please.

-- ms. murkowski. the senate will be in order, please. will the senators please take their conversations out of the well. who yields time? the senator from maryland. ms. mikulski: mr. president, the senate is not in order. the presiding officer: will the senators please take your conversations out of the well? senators, thank you. ms. mikulski: mr. president? the presiding officer: the senator from maryland. ms. mikulski: mr. president, i rise in opposition of the lisa murkowski amendment. although well intentioned, it does not guarantee universal access to preventative and screening services for women. it does not remove the cost barriers of high payments and codeductibles. it is -- co-deductibles.

it is opposed by the american cancer society and the american heart association. it primarily provides information on those matters. we salute her intention, but we think that her amendment is too limited, and really to quote the american heart association, that it would be an actual step backward in the area of making preventative services available, particularly not only in the area of cancer but in heart and vascular disease, the emerging number one killer for women. i urge the defeat of the murkowski amendment. the presiding officer: the senator's time has expired. the senator from alaska. ms. murkowski: mr. president, i don't believe that the body is in order. the presiding officer: will the senate be in order. thank you. the senator from alaska. ms. murkowski: mr. president, the purpose of this amendment is to ensure that we do not have government entities that are making those decisions that we

as individuals working with our doctors feel is best. the -- the intent behind this amendment is to ensure that those medical professionals, those medical professional organizations -- the presiding officer: the senate will be in order. thank you, senator byrd. ms. murkowski: we want to ensure that those medical professionals, whether it is the american society of clinical oncology or the college of surgeons or the radiation oncology, the american college of obstetricians and gynecolgists, those who are in the practice, those who are making the recommendations, these are the individuals that we want to know are being consulted, not some entity that has been created by those of us in government by some administration by some secretary. so what we propose with this amendment is an insurance

offering, if you will. you will know fully what is part of your plan. it's not -- the presiding officer: the time has expired. ms. murkowski: it is you and your doctor making these decisions. i would urge a yes vote on this amendment. the presiding officer: is there a sufficient second? there appears to be. the yeas and nays are ordered. the clerk will call the roll. vote:

vote:

6

vote:

the presiding officer: are there any senators in the chamber wishing to vote or to change their vote? if not, on this vote the yeas are 41, the nays are 59.

under the previous order requiring 60 votes for the adoption of this amendment, the amendment is withdrawn. a senator: mr. president? the presiding officer: the senator from colorado. mr. bennet: mr. president, under the previous order, i have an amendment 226 at the desk and i would -- 2826 at the desk and i would like to call it up. the presiding officer: the clerk will report. the clerk: the senator from colorado, mr. bennet, for himself and others proposes amendment number 2826 to amendment 2786. mr. bennet: mr. president, i ask unanimous consent that the reading be dispensed with. the presiding officer: without objection, so ordered. mr. bennet: i have been paying very close attention to the floor debate over the last few days and at times i'm beginning to wonder what bill it is we're debating much only in washington could the effort to extend the life of the medicare trust fund be viewed or distorted somehow as unfair or bad for.

we know that this does not take away any seniors guaranteed benefits. it extends the solvency for five additional years. how does it do it? it does it in a way from a way that government usually does business by is adding to program or cutting from a program. it changes the way we deliver medicine in this country and it does in a way that protects seniors' benefits and extends the life of medicare. the -- 8 tax on this bill and -- attacks on this bill and my amendment has nothing to do with those facts. the sad part is there are ideas on every side of this debate worth considering. i think we should be debating those ideas rather than claiming something that's not true about this bill. these washington tactics of trying to ship health care reform back to some committee to language is exactly why nothing ever gets done around here. the almost unbelievable part of this is the opponents of my amendment say that the health

care bill hurts seniors. yet the bill and the amendment is supported by the aarp, alliance for retired americans, center for medicare rights, and the national committee to preserve social security and medicare. what are the opponents of my amendment actually saying that the aarp and other senior advocates don't know what they're doing, mr. president? they know what they're doing and they also know what's in the bill. the aarp has seniors' best interest in mind and they want what's best for medicare in the long run. this senate bill makes tremendous strides to a more solvent, more stable medicare program for years to come. unfortunately in the hopes of eventually trying to kill the bill, there are people that are making claims that are frightening our seniors, meant to frighten them here and also back in my home state of colorado where people have been called on their telephones at home to convince them that

somehow i want to cut their benefits. in fact, nothing could be further from the truth. i believe strongly in the sacred trust that we've created with our seniors and that's why i introduced this amendment. seniors are looking for simple clarity on the health care reform -- on how health care reform can help their lives. this sayest in the -- says in the clearest terms that all guaranteed medicare benefits stay intact for every senior in colorado and all across the country. seniors will still have access to hospital stays, access to doctors, home health care and nursing homes and prescription drugs. the second part says clearly and directly to our seniors that we will use this bill to further protect and strengthen medicare. we will extend the life of the medicare trust fund. we will lower premiums or cost sharing, increase medicare benefits and improve access to

providers. you don't need to believe me on this. you can look at the congressional budget office. and these improvements will be paid for with money saved in medicare under this bill. what's so regrettable about this debate and that's so tragic if we don't actually get this done is that everybody understands that medicare would be bankrupt in seven years, 2017. in the senate bill we're now considering, we extend the trust fund solvency by five years, we lower premiums for seniors by $30 billion over 10 years. that's real money back in the pockets of our seniors p we eliminate co-pays that seniors have to pay for preventive care. when seniors go for a doctor for a colonoscopy, they don't have to make the co-pay. when seniors go to the doctor for a mammogram, the same will be true. we know that preventive care like that saves lives, mr. president, and it also saves money. most seniors live on a fixed

income. free preventive care is the best way to encourage seniors to seek important medical precautions. more preventive care is used to save lives and lower health care costs. mr. president, health care reform will also cut the cost of brand named prescription drugs in half for seniors who are stuck in the gap in coverage between their initial and catastrophic coverage. we eliminate the 20% cut physicians would otherwise see next year, making sure that seniors can continue to see their own doctors. the opponents of health care reform do not have a plan to protect seniors an strengthen the medicare program. i've heard more criticism about the number of pages in the bill than i've heard about a responsible alternative that would extend the life of medicare and make the other benefits that are in this bill. so i wanted to come to the floor today with a simple and straightforward message to our seniors. we will protect medicare. this bill does. we will make sure that no one touches your guaranteed

benefits. this bill does. we will make sure medicare is around for future generations. this bill gets us started in that direction. and that's why i've introduced this amendment and why i support health care reform. everything i have said today, mr. president, is entirely consistent with the findings of the congressional budget office. a nonpartisan organization that advises this chamber. this legislation makes explicit the commitment all of us share to seniors all across the united states of america. it's my hope once this amendment passes, we can get beyond the debate we've had over the last 72 hours and get on to the substantive aspects of this bill. p mr. president, -- mr. presidet for my amendment and yield the floor. a senator: mr. president the presiding officer: the senator from ohio is recognized. mr. voinovich: over the past several months, i've got to the

floor on a couple of occasions, i think one when you were presiding, to remind my colleagues and the american people about the unsustainable and fiscal crisis confronting our country. our national debt exceeded $12 trillion for the first time in history. from 2008 to 2009 alone the federal debt will increase 22%, posting the national debt as a percent of g.d.p. from 70% last year to 80% this year. we have not seen this kind of debt to g.d.p. ratio since the second world war which is some 65 years ago when i was about 7 years old. the american people know that this is unsustainable. but my senate colleagues from the other side of the aisle continue to ignore this reality. i pledge that i would continue to cry the emperor has no clothes until we did something to address this crisis. mr. president, i should explain. most people, i think, knows the

story, the hahns christian anderson story, the emperor goes about the land wearing a nonexistent clothes by a tailor who convinced the monarch that the silk was made of the finest silk, and said that the threads of his suit will be so fine, it will be unseen by those dim witted. the word spread of the emperor's new clothes to show the suit, a parade was shown, people lined the streets to see the emperor in his new clothes. in this case, mr. president, the health care reform before the senate -- the health care reform before the senate. frayed to appear dim witted and unfit, it is only when the child cries out the emperor wears no clothes that's the crowd acknowledges that the emperor is naked. like the little boy crying out, those of us on this side of the

aisle are pointing out that this bill is fiscally not responsible. while not addressing our current health care challenges, the so-called health care reform bill we're debating creates new programs at a time when we're not paying for the one we already have and adds $2.5 trillion to what we're already spending. i learned as a long time ago as a mayor and governor, if you can't afford what you're doing, how can you take on new responsibilities? we could be using this opportunity to fix our health care system by finally working to lower health care costs and pass those savings on to citizens who are already overburdened by an expensive health care system. yet, instead of common sense, incremental reforms that increase access to quality, affordable health care, reduce the cost of health care for all americans and lower our national health care spending, we would have this bill before us. unfortunately, the bill violates the medical principle. first, do no harm. instead, it is more of the same. more spending, more taxes on an

already struggling economy. this at a time when we are currently witnessing the worst recession that this country has experienced since the great depression. the legislation we're considering when fully implemented as i pointed out spends $2.5 trillion to restructure our health care system. it fails to rein in the cost of health spending in the next decade. according to the congressional budget office, the federal government's commitment to health care -- that is, the cost of health care paid for by the federal government, would actually increase. in other words, we're adding more onto this extraordinary debt that we have, unfunded mandate that we have in terms of medicare. the bill's proponents will tell you it is paid for, but as david broder points out in his november 22 "washington post" editorial -- "while c.b.o. said that both the house-passed bill and the reid -- and the one reid has drafted meet obama's test by

being budget neutral, every expert i've talked to says the public has it right. these bills as they stand are budget busters." and that's what many people are hearing right now from their constituents, particularly many of those individuals that are taking advantage of the medicare advantage program. furthermore, as former c.b.o. director douglas holtz eaken pointed out in "the wall street journal," this uses every budget gimmick in the books. what are these gimmicks? most troubling to me and what my colleagues have been on the floor discussing the last few days is what the bill does to the medicare program. i think we need to be honest to the american people. the medicare program is already on shaky footing. despite $37 trillion in unfunded, unfunded future medicare costs and the prediction that the medicare trust fund is expected to be insolvent by 2017, this bill calls for a $465 billion in cuts

to medicare, not to fix the program but as i said to create new programs. for example, this health care bill fails to acknowledge the the $250 billion that's necessary to reform the medicare physician payment formula to ensure that our nation's seniors will be able to see the doctor of their choice in the future. i've heard it firsthand from family and friends that in some places in ohio, medicare beneficiaries already face delays for physician services and right in my hometown i've had doctors tell me george, if i've got somebody before they are medicare eligible and they go on medicare, i'll take care of them. i'm not taking any more new medicare patients because of the reimbursement system. the same thing i've heard even on terms of medicaid. so we've got a problem out there. sadly, my friends on the other

side of the aisle don't want to be honest with the american people and include the cost of the physician payment fix in the bill. it should be there. let's be honest about it. let's be transparent. it's just another example, i think, of the smoke and mirrors of the budget gimmicks and tricks that former c.b.o. douglas holtz eagen mentions. we must fix our health care system system to help the millions of americans without insurance and those struggling to pay their health insurance premiums. we must make it easier for small business and individuals to purchase insurance and reform our medical liability system. now, we know -- reforming. i call this malpractice lawsuit abuse reform. we should have done that a long time ago, but the fact of the matter is that the trial lawyers do not want that to happen, and so we're really doing nothing about a problem that's causing physicians to -- to have -- to get unnecessary tests that are

driving up the costs of health care in this country. and most importantly, we need to focus our efforts on jobs. jobs, jobs, jobs, jobs, because one of the best things we can do to increase health care coverage is to help businesses start to hire again. i need a job. one of the reasons why i need a job is when i have a job, in most instances, i have some form of health care. we have a lot of people who are being dropped off. we need more jobs. we should be concentrating on that if we really want to up the number of people that can get health care. to repeat: we don't need to create another set of government programs that be spends an additional $2.5 trillion to build a new entitlement system when we can't afford the one that we have now. that's the biggest thing with me. if you can't afford what you have, how can you take on more? and when we do that, we're being fiscally irresponsible. we should deal with what we have. it's really amazing to me.

if you look around the country, states are cutting their expenses and they're raising taxes. and what are we doing here in washington? we're taking on more expensive programs that we can't afford, and that's what i think is troublesome to me as a debt hawk, that we really need to understand what we're doing here. the american people are paying attention and they know that the emperor has no clothes when it comes to doing something about our unsustainable fiscal crisis. we're losing our credibility and our credit worldwide. they know it's immoral to be putting this debt on the backs of our children and grandchildren. i believe that this health care bill does that. what it does is it exacerbates our current fiscal situation. no matter -- there are lots of good things out there. a lot of good things that we all like to do. but just like a family, if you can't afford what you're doing

now, how can you afford to take on more responsibility in terms of debt? mr. president, i yield the floor. mr. reed: mr. president? the presiding officer: the senator from rhode island is recognized. mr. reed: i think it is important to focus on the fiscal difficulties we have today but i also think it's important to recognize the probable causes of these two deficits -- two wars, unfunded. no attempt to fund them. spent simply by running up the deficit. tax cuts, many of which were unfunded and which did not ultimately generate the kind of sustained economic growth and job growth that their supporters advertised. and then the medicare part-d program, an entitlement which was completely unpaid for and used by deficit spending. today we have people talking about entitlement reform, how that's really key, but so many of my colleagues on the

republican side supported president bush when he proposed the mayor part-d program. a worthy program but in the context of not paying for it, something that we're living with today. and additionally, i think it's particularly ironic at this moment because we're considering a mccain amendment that would report this bill, the health care bill back to the committee with the instructions to restore restore $400 billion of spending roughly over ten years. if that is contrary to this notion of entitlement reform, i can't think of anything more contrary. what we have tried to do in this bill is to create a health care program that will maintain quality health care but also recognize these costs that we're facing going forward and the general economic climate that we face today. and again, let me remind you back in 2001, in january, the

unemployment rate was about 4.6%. when president obama took office, it was double that and growing and continuing to grow. we have seen some effects to limit this growth, but it's still a critical issue. this reform package is designed not only to deal with the quality of health care, accessibility to health care and affordability of health care, but it's designed to over the long term begin to rein in costs that are absolutely out of control. and the biggest sufferers from this course are the american people and in some respects small business men and women. their costs are going up faster than any other costs, and it's unsustainable. if you talk about a system that's unsustainable at the national level, the costs of health care are simply unsustainable. if in my home state of rhode

island we do not take effective act, you will see within several years premiums reaching $24,000 to $30,000 a year for a family of four, and we can't sustain that. so i would think if someone is really interested in taking the very difficult steps of entitled reform, they would reject out of hand the mccain amendment. but there are other reasons to do that. first, that the proposals go directly to programs that are funded rebusly but don't provide any significant quality improvements in medicare than traditional medicare. i'm speaking specifically of the medicare advantage plan. this was a program that was developed and sold essentially to the american people as cost containment. this was one of the proposals that would rein in out-of-control health care costs by giving insurance companies

the ability to manage more effectively. of course, what we have seen is a significant increase in medicare advantage payments over traditional medicare. now, these insurance companies can manage health care very well as long as they're receiving a very significant premium, and that premium goes not to essentially better health care. it certainly goes to essentially better profits for the insurance companies. we found out indeed that with medicare advantage, there's a rebate given to each insurance company. this is not the case with traditional medicare. and that was designed essentially to provide again lower cost access to health care benefits for the consumers of medicare advantage. but the g.a.o. found that 19% of medicare advantage beneficiaries actually pay more than traditional medicare for home health care and 16% pay more for in-patient services. so here's the irony.

we are paying the insurance companies more, but the beneficiaries of medicare advantage are indeed paying more. so there's no cost savings in these regards, these two programs at least. the other point which is, i think, critical and i've alluded to is that for the same services you receive in medicare advantage, it's a 14% increase overall for those similar services in traditional medicare. now, we have to, i think, take tough steps, but steps that will enhance the quality of care for seniors, and that is what is being done in this bill. these resources are being used to help redesign a system for all americans but also for seniors that are more effective and cost-effective. let me -- more effective and cost efficient. let me suggest right now we are all paying for right now the cost of uninsured americans.

it's been estimated that every private insurance company in america is paying every individual payer, businesses and individuals, are paying about about $1,000 a year for uncompensated care. that's the cost the hospitals shift from their uncompensated care on to their insurance providers, the carriers, and that's translated into higher premiums for all americans. under this legislation, the hospitals will now see patients present presenting themselves with an insurance card. 96% of americans, it's been estimated, will be covered under our proposal. so instead of showing up for free care, they will be under an insurance plan. the hospitals will benefit. medicare, medicaid, the whole system will benefit. so again, this is one of the proposed changes that would be reversed by the mccain amendment. also, we have taken steps so that hospitals will be much more effective in managing their patient flow, with readmissions

hopefully reduced by some of the provisions in this legislation. there are many things that we should do and will do, but i believe we can successfully balance expanding our coverage system, protecting the quality of care, but also recognizing as has been suggested the fiscal implications not just for the moment but going forward. and so i would suggest if someone is really serious about entitlement control, serious about the fiscal implications of this legislation or any other legislation, that we not simply order the committee to restore these cuts. they would do something much more, i think, proactive and indeed support what i believe is sensible, sound proposals to provide quality to ensure that over the long run, medicare is more solvent.

in fact, final point. the legislation before us would extend the life of medicare, the solvency of medicare over at least five years. so for those people to say we are trying to end medicare, their solution is simply to let it go bankrupt, apparently, in 2017 or to simply ignore it and let it find its own thing. i think we can do better. i urge rejection of this amendment, and i yieldthe floor. a senator: mr. president? the presiding officer: the senator from wyoming is recognized. mr. barrasso: thank you very much, mr. president. and i come to the floor also to talk about medicare and what i see to be significant cuts in the medicare program. i practiced medicine in wyoming for 25 years, taking care of families from across the state. many of these wonderful folks who are on medicare. they depend on medicare for their health care. they depend on medicare.

the patients depend upon it, the hospitals depend upon it, the physicians, the nursing homes, the home health care agencies -- all of them depend upon medicare for their health care. and i've listened to my close friends from across the aisle come to the floor as well, and they seem to be trying to convince the american public that the 2,074-page bill, weighs over 20 pounds, trying to convince the american public that the bill actually does not cut medicare. i heard the chairman of the finance committee talk about it on the floor, heard it from th the -- the majority leader. the health care reform plan that we're looking at on this floor cuts $464 billion from medicare. and i have a list of all of the medicare cuts in this bill. page after page, column after column. when you add them all up, it

cuts $135 billion from our hospitals. from our hospitals. who are the people that are there providing the care. we've heard about some of the cost-shifting from the senator from rhode island, cost-shifting occurs. medicare -- medicare is one of the biggest deadbeats when it comes to paying for hospital services, and it's why hospitals end up shifting more costs to people who have health insurance and why for those people their premiums will go up if this bill becomes law. so $135 billion cut from hospitals. it cuts $120 billion from a program called medicare advantage. mr. president, there are 11 million americans in this country today who are on medicare advantage. they know who they are. they know that it is a program that has worked well for them. people ask me what the difference is, why would somebody want to be on a program that's called medicare advantage? well, there's an advantage to those seniors who depend upon

medicare for their health care if they're on medicare advantage. and number one is it actually helps coordinate care. we know that one of the ways to help people keep down the cost of their medical care is to find problems early, get early treatment, and, therefore, find the problem and treat it before it gets too bad. well, medicare advantage both does preventive care as well as coordinates care. you know, one of the big problems with medicare is it will pay a lot for doing things to someone but it won't pay very much for helping someone stay healthy. and now all of a sudden we're going to be cutting $120 billion from medicare advantage, which actually works on prevention and on coordinating care. and then there's $42 billion from home health care agencies that will be cut. now, those are the folks that come into someone's home and help them stay out of the hospital. the advantage of home health care is to allow people get care at home and not need to be in

the hospital. but all of a sudden we're looking at $42 billion in cuts on medicare for home health care agencies. and then let's take a look at nursing homes. $15 billion in cuts for nursing homes who are taking care of people on medicare. which to me means they're actually cutting it from the people who depend on medicare for their nursing home needs. now, as an orthopedic surgeon, i've taken care of many people, where you know, grandma breaks her hip. she doesn't need to go into a nursing home permanently but what she needs to do is go there for a short period of time, a rehabilitation period of time, where -- where she can get better, get stronger. because she's not ready to go home and she's not needing to stay in a hospital but she needs to be in a nursing home for a fort get rehabilitated and to be ready to then get home to re -- to go back to an independent life. and there is a gap in time. nursing homes help with that.

they're wonderful as a way to give somebody an opportunity to gain their strength and with -- you know, our country as it is with so many grandparents now living in communities where, perhaps, their children or grandchildren are no longer living, they can't just go live with the son or daughter. they need additional help and they go to a nursing home. so far that patient whose broken her hip, who i've taken care of in the hospital, you're going to end up cutting from the hospital $135 billion for that medicare patient, you're going to end up cutting nursing homes $15 billion for patients who rely on nursing homes as they recover from their hip, and then to get them home for independent life, a lot of times they can benefit from home health care, someone coming into the home, checking on them, giving them medications, making sure they're doing all right, checking their wound, a number of different things, but yet this bill is going to cut $42 billion from home health care agencies. again, cutting the services to people who depend upon those services for their health care

needs. and then there's an $8 billion cut from hospice providers, people who take care of our patients, my patients in the final stages of their life. at a time in their life when their body may be riddled with cancer and they just need a place to go and be treated with respect and to be cared for, and yet we're cutting from this bill $8 billion from the hospice providers, people who are there who are helping people in the final stages of their life. so when i look at this and say, how in the world can my colleagues on the other side say that they're not cutting medicare for our -- for our seniors? and i read through the bill, there's $135 billion from hospitals, $120 billion from medicare advantage, $40 billion from home health care agencies, almost $15 billion from nursing homes, and $8 billion from

hospice providers for a total of $464 billion for this country's seniors. i don't think we should pass this bill. of course, there's another $500 billion in taxes, it's a huge, hugely expensive bill. but to me, this is absolutely being to be -- being done, robbing our folks who are on medicare to start a whole new government program. i'm worried that seniors all around the country are going to have less access to doctors and especially in rural and in frontier states like wyoming. i'm concerned that they're going to see that community hospitals and home health care agencies and nursing homes and skilled nursing facilities are going to be struggling to keep their doors open. it is time for this congress, for this senate to listen to america's seniors. let's listen to the administration's own chief actuary, richard foster, the chief actuary, mr. president, at the centers for medicare and

medicaid services, said that if these medicare cuts take effect, then many providers could find it difficult to remain profitable and may end up -- may end their participation in the program. may say, i don't want anything else to do with medicare. i am closing my doors to medicare patients. we cannot have that in this country, mr. president, but i believe that's what this bill does. even the nonpartisan congressional budget office that said these medicare cuts could reduce access to care or diminish the quality of care. is that what this senate wants, reduced access to care or diminish the quality of care? mr. president, how many experts does it take to convince the majority party that cutting medicare to pay for a brand-new government program is irresponsible? we all agree that medicare is going broke. the trust fund will run out of money in the year 2017.

it has more than $37 trillion in unfunded liabilities. you know in your state as well as mine, medicare's physician patient formula, which calls for doctors to face a more than 40% cut over the next ten years, is a system that is broken. the reid bill does nothing to fix this problem. instead, it takes a half a trillion dollars from medicare to create a brand-new entitlement program. it punishes a group of people in order to benefit another. and to me, that is not reform. it will only make the system worse. and that's why i support the amendment that we'll be voting on today, the mccain amendment. it says we are not going to finance a new government program on the backs of our medicare patients, on the people who depend upon medicare for their health care. it instructs the finance committee to write a bill that

doesn't cut hospitals, that doesn't cut home health care, that doesn't cut medicare advantage, and that doesn't cut hospice for our seniors who depend upon those services. a vote for the mccain amendment gives us a chance to get this right. mr. president, i do want health care reform. i just don't want this bill. this is the wrong prescription for our country. i don't believe that we have to take the money out of medicare and then spend it on a brand-new entitlement program. i go home to wyoming every weekend and members go home, listen to their constituents, and what i hear is, from the people of wyoming, don't cut my medicare, don't raise my taxes, don't make things worse for me i.in this economy, i certainly can't afford it. the people of wyoming want practical, commonsense health care reform, reform that drives down the cost of medical care, improves access to providers, and creates more choices. it's clear that this bill has a

very different plan in mind. it is not too late to work together for meaningful reform. we do not have to dismantle the current health care system and build it up in the image of big government. and then try to say, this is reform. the american people are telling us what kind of change they want and that's why i'm going to be voting for the mccain amendment. thank you, mr. president. i yield the floor. a senator: mr. president? the presiding officer: the senator from montana is recognized of the mr. baucus: mr. president, i wonder if the senator from wyoming would be available to answer a question? mr. barrasso: mr. president? mr. baucus: mr. president, i -- i'm very thankful to my good friend, neighbor in my state. is it true that the c.b.o. letters say that the senate bill will extend the life, extend the solvency of the medicare trust fund? is that true?

mr. barrasso: i don't have that letter with me, but by everything i look at, this is going to gut medicare, it's going to make it go broke sooner, and it's going to be bad for the seniors of america. mr. baucus: i don't have the exact letter in front of me but in all deference and respect for my good friend from wyoming, the c.b.o. says the exact opposite. the conclusion of the congressional budget office is that this legislation will help seniors by extending the solvency of the medicare trust fund by i guess four to five years. that's black and white. and if i had the letter in front of me, i'd read it to him. but that's a fact. this legislation will extend the solvency of the medicare trust fund by another five years. so instead of being insoft not in the year 2017, under this legislation, that's extended until the year 2022. that's a fact. at least the fact is, that's what the c.b.o. concludes in the letter. they say that is a fact. second, as a caring physician, i

mean, does the senator think that -- that we as a country should try to find a way to provide health insurance for, you know, so many americans, some of the them lower income, who just don't have health insurance in our country? after all, we're the only industrialized country in the world that doesn't find a way to make sure its citizens have health insurance. i mean, you -- as a physician who sees patients, and when of whom can't pay their bills, and defer medical treatment because they don't have health insuran insurance, i'm just wondering if the senator believes that this country should try to find a way where its citizens have health insurance? mr. barrasso: the senator absolutely believes that we need to find a way to make sure that all of the steps o citizens of s country have insurance. and there are ways to do it, allowing people buy insurance across state lines that don't take a 2,000-page bills. there are ways to do it to help get down the cost of care that will give individual incentives

for people to buy their own insurance, give tax breaks to people. this senator believes we could do things with tort reform like loser pays. this senator believes we could allow small groups to join together to have a better ability to barring toin get the costs of insurance down. so this senator absolutely believes we need to find a way to get everyone insured. and there are people that need help in this country that don't have help, and we need to find a way to do that. but it is not this 2,000-page bill, mr. president. mr. baucus: might i ask this question and then i'll finish because i know my colleagues wanted to speak here. one of the basic underpings of this legislation -- underpinnings of this legislation is that we should change the way we reimburse providers, moving away from quantity and volume and a little bit more toward quawvment and i'm just curious -- bit more toward quality. and i'm just curious. this is not an antagonistic question. i'm just trying to get a physician ace point of view. so man-- a physician ace point f

view. 's point of view. so many doctors think that's what we should do, move towards reimbursement on quality, coordinated care and focus on the patient rather than our current system which is -- which is -- which rereimburses more on quantity and the number of services provided, et cetera. but is that something you should we remembered pursue in this country? mr. barrasso: the current system is broken, mr. president. the reimbursement system focuses more on doing things than on helping patients stay healthy and get better. and medicare has done a terrible job of that over the years in terms of paying for preventive services has not done that over the years. this is -- it is now december and the way the system is broken is, my busiest time as a surgeon in wyoming is at the end of the year, people who met their deductibles, who have insurance, come into the office and say it's time for my operation, i

have to get it done before the first of the year because of my -- my -- my deductible. it has been used up. and i want to have my operation that i'm not going to have to pay for. we have the incentives all wrong, mr. president, in this country in terms of health care. so we do not health care reform. but i don't think this bill is the way to do it, which is a government takeover of the government system in america. mr. baucus: mr. president, i've got to address that one. my colleagues want to speak. i think it's worth repeating over and over and over again. this legislation is designed to retain uniquely american solution to health care, roughly half public, half private. it's designed to make sure that patients can still as they should, choose that your own doctor and doctor they want, primary doc specialist, no

gatekeeper and that sort of stuff. the doctor able to make their own decisions in consultation with their patients, d doc-patient, and in addition to that, frankly, more competition with the exchanges. this legislation, frankly, is -- is rooted almost entirely on -- maintain the current free market system in health care. there is an insurance market reform, which i think everybody agrees with and is denying preexisting conditions for denying coverage. and there is a modest expansion of medicaid, lower-income people that otherwise can't get health care. but otherwise this is legislation rooted in the current american system. we've got a good system that works and this is designed to make it work a little better, but make it like the senator in wyoming wants, based on quality. he didn't mention this, but i

know he agrees, insurance market reform, so those patients that come to him don't have to wait until the year as they have in the past. but i want to make it very clear this is no -- quote -- "government takeover." that's a scare tactic. that's not accurate. let's just maintain the current system. i'd like to yield to the senator from vermont. the presiding officer: the senator from vermont is recognized. mr. sanders: i'm going to speak on something other than health care. all right. that's fine. i thank my friend from montana for yielding. and, mr. president, what i want to touch upon is my strong belief that ben bernanke should not be reappointed for a second term as chairman of the federal reserve. and in that regard i place a hold on his nomination. mr. president, everybody in this country understands that we're in the midst of the worst economic crisis since the great depression. we are looking at 17% of our

people being either unemployed or underemployed. we are looking at average length of unemployment being longer than it has been since world war ii. we are looking at a situation where over the last eight or nine years, median household income has declined by over $2,000. we are looking at a situation where, according to "u.s.a. today", accept 18, 2009 -- quote --"the incomes of the young and middle-aged, especially men, have fallen off a cliff since 2000 leesk more age -- leaving more age groups poorer than they were in the 1980's." we're seeing a collapse in the middle class, an increased gap between the rich and everybody else. and then, to make a very bad situation worse, as a result of

the greed or irresponsibility, and illegal behavior of wall street, we're now in a terrible, terrible economic decline. mr. president, the american people voted overwhelmingly last year for a change in our national policies and for a new direction in the economy. after eight long years of trickle-down economics that benefited the very wealthy at the expense of the middle class and working families, the people of our country demanded a change that would put the interest of ordinary people ahead of the greed of wall street and the wealthy few. what the american people did not bargain for was another four years for one of the key teark architects of the bush economy, federal chairman, ben bernanke. mr. president, the chairman of the federal reserve, and the

federal reserve itself, has four main responsibilities. and i want the american people to determine whether they believe the fed has, in fact, succeeded in fulfilling these obligations. here they are, four main responsibilities. number one, to conduct monetary policy in a way that leads to maximum employment and stable prices. maximum employment. well, when you've got 17% of your people unemployed or underemployed, i do not think the fed or all of us or any of us have succeeded in that area. number two, to maintain the safety and soundness of financial institutions. well, obviously that has not been the case either. to contain systematic risk in financial markets. and, four, to protect consumers against the deceptive and unfair financial products. mr. president, not since the great depression has the financial system been as unsafe,

unsound, and unstable as it has been during mr. bernanke's tenure. more than 120 banks have failed since he has been chairman, and the list of troubled banks has grown from 50 to over 416. mr. president, mr. bernanke has failed to prevent banks from issuing deceptive and unfair financial products to consumers. under his leadership mortgage lenders were allowed to issue predatory loans that they knew consumers would be unable to repay. this risky practice was allowed to continue long after the f.b.i. warned in 2004 of an epidemic in mortgage fraud. here's what the bottom line is: the bottom line is that there are -- the key responsibility of the fed is to maintain the safety and soundness of our financial institutions and they failed.

they failed. and as a result of the greed and speculation on wall street, which the fed should have been observing, which the fed should have acted against, which the fed should have warned the american people and the congress about, they did nothing, and our financial system went over the edge. and then, mr. president, after not doing their jobs as a watchdog, not fulfilling their obligation to protect safety and soundness of our financial system, then the financial collapse occurred. and what happened? what the fed did is provide not only -- not only the -- that congress put $700-plus billions of dollars into the bailout, the fed provided several trillion dollars -- trillion dollars of zero interest loans to large financial institutions. and, mr. president, when i asked chairman bernanke which

financial institutions received these zero interest loans, the answer was, i am not going to tell you. not going to tell you. mr. president, the reason that congress, against my vote, bailed out wall street is they were too big to fail. large financial institutions were too big to fail. well, since the collapse, three out of the four largest financial institutions have become even larger. so the systematic danger for our economy is today even greater than it was before the bailout. mr. president, the american people want a new wall street. they want a wall street which begins to respond to the needs of small business so that we can begin to create jobs, not just to wall street and outrageous executive compensation. let me just suggest to you some

of the things that i think a fed chairman should be doing, things that mr. bernanke are not. number one, today bailed-out financial institutions are charging consumers 25% or 30% interest rates on their credit card. the fed has the power to stop that, to put a cap on interest rates. that's what they should be doing. the fed has the power to demand that bailed-out institutions provide loans at low-interest rates to small and medium-sized businesses so that we can begin to create the kinds of jobs that are desperately needed in this country. that is not what mr. bernanke has done. mr. president, the fed has the power now to do what is taking place in the united kingdom, something that many economists are demanding, and that is to start breaking up these large financial institutions which are too big to fail.

in my view, if an institution is too big to fail, it's too big to exist. we have to start breaking them up. not to allow them to get even larger. the fed has chosen not to do that. mr. president, we need transparency at the fed. i am the author of a g.a.o. audit of the fed which now has 30 co-sponsors, which i hope that we will pass. at the very least if the taxpayers of the country are putting at risk trillions of dollars being lent out to large financial institutions, we have a right to know which institutions are receiving that money and under what terms. let me conclude, mr. president, by just saying this, this country is in the midst of a horrendous economic crisis. millions of families all over this country are at their wits end. they are suffering. they're trying to figure out how they're going to keep warm this winter, how they're going to pay

their bills. the time now is for a new fed -- for a new direction on wall street, for a wall street which is helping our productive economy create decent-paying jobs. not a wall street based on greed only for themselves whose goal in life is to make as much money as possible for their c.e.o.'s. so, mr. president, we need a new fed. we need a new wall street. and we surely need a new chairman of the fed. my hope is that president obama will give us a new nominee and not mr. bernanke. with that, i yield the floor. the presiding officer: who yields time? a senator: mr. president? the presiding officer: the senator from montana. mr. baucus: mr. president, might i ask how much time's remaining on each side. the presiding officer: on the majority side, nine minutes and 20 seconds. on the minority side 23 minutes and 10 seconds. mr. baucus: mr. president, i yield nine minutes and how many seconds? the presiding officer: nine minutes an 11 seconds.

mr. baucus: i yield nine minutes and 11 seconds to the senator from iowa. mr. harkin: i'm sad to see that our republican colleagues have resorted to fear tactics in a desperate attempt to preserve a dysfunctional, costly status quo medical system that we have in this country today. republicans in their attempt to strike fear in seniors across the country are trying to convince people that they've changed from the party that's always opposed to medicare to being medicare's staunchest defenders. we all know if it was up to our friends on the other side of the aisle, there would be no medicare. they fought it's very creation. don't take my word for it, take one of their standard bearers who ran for president when he ran for president. senator bob dole, who is a good friend of mine, i have a lot of admiration for senator dole, i

just don't agree with him. he said, "i was there, fighting the fight, voting against medicare, one of 12, because we knew it wouldn't work in 1965." he said that in 1995 when he was running for president. he was proud of the fact that republicans and he had opposed the establishment of the medicare system. i said, well, that was then. but what -- what about recentrily? -- recently? former speaker newt gingrich, quote, we believe it's going to wither on the vine." speaking of medicare. you would think my friends on the other side of the aisle were the biggest supporters of medicare when they opposed it from the very beginning. now we hear all of the stuff about medicare advantage. medicare advantage. well, they like to tell you that if, in fact, we're going to be cutting a little bit out of medicare advantage, that somehow this is going to ruin -- this is going to ruin medicare.

well, if that were true, why would the national committee to preserve social security and medicare, aarp, the alliance for retired americans, groups that represent tens of billions of seniors, why would they stand with us in support of our bill and not with the republicans who want to gut the very provisions that we have in there that will strengthen and preserve medicare? do people really believe that our republican colleagues care more about seniors and these groups that actually represent seniors? well, the truth is when we talk about medicare advantage, we're talking about private insurance companies who promise that through competition, they were going to be able to deliver better quality health care to seniors at a lower cost. it all sounded really good. but what has happened since medicare advantage has come in? the reality is medicare is now paying on average 14% more to

these private plans than the same costs for beneficiaries under traditional medicare. in some cases, as high as 50% more. that's $12 billion a year more than these beneficiaries stated medicare. basically, we are giving a a $12 billion subsidy, a a $12 billion subsidy to these companies. and this -- again, don't take my word for it. this is from june, 2009, medpac report." we estimate that in 2009, medicare pays about $12 billion more for enrollees of medicare advantage plans than it would if they were in the fee-for-service medicare." $12 billion slush fund. now, we're saying that we're going to reduce some of those subsidies and i hear my friends on the other side say oh, my gosh, this is going to cost -- medicare is going to take away all these benefits and all that

other kind of stuff. well, not necessarily. right now, we know that according to the c.b.o., our bill will lower seniors' medicare premiums by $30 billion over ten years. lower their premiums by by $30 billion over ten years. then the other side said well, but if you cut these medicare advantage payments, you'll see their benefits cut. that is absolutely not true. all medicare plans, whether traditional medicare or private, must, must offer all required medicare benefits. now, here's the kicker. if, in fact, there are some cuts made in medicare advantage, then these private plans, these private companies that are making $12 billion is their slush fund. maybe rather than cutting the benefits, maybe they will decide to cut their c.e.o. salaries from $12 million a year to

to $10 million a year. maybe they will decide instead of three or four corporate jets, they only need one corporate jet. maybe they'll start reducing some of the profits that they're making, huge profits that they're making off of the taxpayers and off of medicare payees right now. so, again, if you cut the medicare advantage programs, i guess my friend on the other side say well, number one, they can continue to pay their c.e.o.'s $12 million a year salaries, they can continue the corporate jets, they can continue to have all their fancy buildings, they can continue to have all these outrageous profits, but they're going to have to cut medicare. that's what the other side is saying. what we're saying is no, cut the c.e.o.'s' salaries, cut these enormous profits, cut those corporate jets, cut all that stuff that you're using the slush fund for, but keep the benefits for medicare, and as i

said under present law, they cannot cut the basic medicare benefits. no senior anywhere in america will lose their core medicare benefits under our bill. let's be clear about that. if they were, aarp, the national committee to preserve social security, the national alliance of retired persons would never be supporting our bill. now, lastly, according to an economic survey done at boston university, the extensively analyzed medicare advantage payments, and they found that just 14% of the additional funds that these private plans have received have gone to benefit medicare enrollees. the vast majority of the payments, 86% go to profits, c.e.o. salaries, corporate jets, all these other things, or they might even, some of them, may go to things like gym memberships or spa memberships.

i raised a point the other day, why should my medicare beneficiaries in iowa have to pay more in medicare so that a medicare beneficiary, say, in arizona, in arizona can go to a spa and have it paid for by medicare advantage? paid for by the subsidies of of $12 billion that we give them. that come both from taxpayers and from medicare recipients right now. so i don't think it's fair for my seniors and i to have to pay for that. now, a lot has been said about all the people that are in the medicare advantage plans. i looked up the figures. right now, nationally, only 18.6% of all enrollees are in medicare advantage. a little less than one out of five. in iowa, in my state, it's 10%. one out of every ten.

why is that? well, we don't have a lot of spas in iowa. we don't have those fancy things like they got in florida and texas and arizona and california, wherever else all this stuff is going. but what my seniors need is they need the peace of mind of knowing that medicare -- medicare is going to be there for them in the future. they need to know that they're going to get the benefits that we put in this plan that's in our bill that will help our medicare beneficiaries -- and here's what it is. as aarp says -- "the new senate bill makes improvement in the medicare program by creating a new annual wellness benefit, providing free preventative benefits, and most importantly for aarp members, reducing drug costs for seniors who fall into the dreaded medicare doughnut hole." "the bill also makes improvements on age rating, a discriminatory practice that

allows insurers to charge exorbitant, age-based premiums to older americans. finally, aarp strongly supports provisions in the senate bill to strengthen long-term services and supports. we also applaud the inclusion of provisions to improve access to medicaid income and community-based services." all in our bill. all of which would fall if we adopt the mccain amendment. so i urge my colleagues to not listen to the rhetoric of the other side. listen to those that really do represent our seniors. make sure that we preserve and protect the basic medicare functions for our seniors and for those who are about to retire. you won't get that through medicare advantage. now, if medicare advantage wants to exist and compete on a level playing field, god bless them, go ahead and get it done. that's what we were promised. but medicare advantage came through here.

i remember it. oh, yeah. competition. but what we found out is we had to cough up an additional additional $12 billion a year to subsidize it. to subsidize it. well, mr. president, it is time for us again to say no to the fearmongers, to those who are trying to strike fear in our seniors. it's time to stand up, support the bennet amendment. support the bennet amendment which makes very clear -- and here's what the bennet amendment does. it makes very crystal clear that any savings that comes from medicare has to go back into medicare, and that's the way it ought to be. that's what's in this bill. the bennet amendment makes that crystal clear. the mccain amendment does away basically with all of the protections, all of the things we've worked so hard over since 1965 to provide for. and i'd say the mccain amendment basically when you strip away all the verbiage and

everything, really what it does is p basically would want to take us back to pre-1965 when we didn't even have medicare. that's really the kind of intent behind it. mr. brown: would the senator yield? mr. harkin: i yield to my friend from ohio. mr. brown: thank you, senator harkin, thank you for the public option, on affordability and wellness, especially. the way i have read and listened to the debate with senator mccain and others on medicare, it seems to me that what they are protecting is not medicare but the huge insurance company subsidies when president bush moved to privatize medicare. that it used to be the insurance companies told us they could do their part of medicare, their 1/5, 1/6 of medicare, they could do it more efficiently even though insurance companies have a 15%, 20% administrative cost overhead. medicare is 3% or 4% or 2% overhead. the presiding officer: the chair reminds the senator the majority

time has expired. mr. brown: i ask unanimous consent for an additional two minutes. the presiding officer: is there objection? mr. brown: thank you. the presiding officer: without objection, so ordered. mr. brown: thank you, mr. president. is that your read, much of what they are trying to protect is the insurance company subsidies, not really the medicare benefits which their party has opposed for much of the last 40 years, frankly, including its creation? mr. harkin: i thank my friend for pointing that out. as i said earlier, really, what they are talking about in preserving these benefits and the subsidy for medicare advantage is, as i said, the big c.e.o. compensation packages, the corporate jets, the fancy buildings, the high, huge profits somewhere between 30% and 200% profits. 30% to 200% profits made by these companies that are providing medicare advantage. that's what the republicans are trying to protect, not the medicare recipients.

the presiding officer: the senator from utah is recognized. mr. bennett: mr. president, i have listened with some interest to the comments that have been made when i came on the floor. i simply want to make this one observation about medicare advantage. president obama promised that americans who have coverage that they like would not lose the coverage that they have. there are a number of americans who have medicare advantage and they like it and they want to keep it, and this congress is about to say no, you can't. this congress through this bill if it passes is going to eliminate medicare advantage, and frankly, the people who go after medicare advantage because they like it are going to be the ones that are disadvantaged here. they're going to be the ones who will see president obama's pledge violated, and frankly i don't think they much care about how much an executive is paid or what happens in the company.

they care that they have coverage that they like, coverage that they're paying for, coverage that they have chosen, and they're being told by the federal government you cannot have what you want. now, there's another aspect of this that i'd like to explore in the time that i have. we keep hearing so much about the c.b.o. and all of the scores that the c.b.o. is pointing out. along with rhetoric that says we can't afford to wait. we need a solution now. the status quo is unacceptable. i'd like to point out once again that the status will remain quo for four years if this bill passes. in the budget smoke and mirrors that have been put into this bill, and in order to make it look as if it costs less money, they make the effective date in 2014, so there will be four years after the implementation -- after the passage of this bill where americans will not see any kind of change in their plans, but

what they will see is an increase in their premiums. they will see an increase in taxes. why do i say that? between january, 2010, and january, 2014, there will be four open seasons in which plans can be changed. and as the taxes start to hit, as the costs start to hit, those companies that are involved in offering these plans will say okay, we've got to get ready for the expenditures. what do we do? we have got four open seasons in which to change our plans before this thing hits. now, obviously, that cannot be scored by c.b.o. because c.b.o. doesn't know what changes will be made. but do we really think that we can go through four open seasons with no change whatsoever in the face of this enormous change

that will hit in january, 2014? do we really think everything is going to remain static? that's what the c.b.o. computers are. and do we really think that the the $500 billion that they want to take out of medicare to help pay for this will not be hashed over again and again? one of two things will happen. number one, democrats will blink in the face of the anger of senior citizens and say we really didn't mean it. yes, the bill cuts medicare by by $500 billion, but we really didn't mean it and we have four years in which to fix it. that is, four years in which to replace that $500 billion. and, of course, when that that $500 billion is replaced, if that's the way they decide to go, then we will know that the numbers we are getting out of c.b.o. are completely phony. then we will know that the

statement that this bill is revenue neutral is -- is a nonstarter. then we will know that there was never any intention to try to deal with this cost. but suppose future congresses stand firm and say yes, we are going to stand firm in this four-year period. we're going stand firm against the senior citizens who are going to get their medicare benefits cut. and we're going to take th the $500 billion out of medicare. then we will see the promises that are being made around here that there will be no cut in medicare services all disappear. i hear people say, we're not cutting benefits, we're just cutting payments to providers. that statement is being made over and over again on the other side of the aisle. we're not cutting benefits. we're going to take tha that $500 billion away from the

providers. but the benefits will remain the same. well, mr. president, in my state i have plenty of providers that are on the edge right now financially. there on the edge of going out of business right now financially because of the cuts that have been made in medicare in the name of cutting down payments to providers. what happens to the people that are in a nursing home that is currently dependent upon medicare payments in order to survive if they come in and say, all right, we're not going to do anything to the benefits these people are entitled to in this nursing home, we're just going to cut enough payments to the nursing home that the nursing home goes out of business? and what happened to the people who are in the nursing home under that circumstance? well, they're going to have to go someplace else and there's going to have to be money to pay for them to go someplace ems. and the -- else. and the money's going to have to

flow through medicare someplace else and we're back to the first option that i talked about, we weren't serious when i said we were going to take $500 billion out of medicare. we weren't really serious in order that you don't lose your benefits. we're going to have to start reinvesting in some of these providers. we've seen providers go out of business because of the cuts in medicare. we need to start putting that money back in medicare and we're back into the circumstance that we've been talking about all along that this thing is not paid for. one final point i want to make. we had a hearing today with the chairman of the federal reserve. ben bernanke is up for reappointment. and, of course, the entire conversation was about the economy and what is the future of the economy? there were a number of people who had a conversation about the past. but i wanted to focus on the future. and i pointed this out to the

chairman and asked for his comments with respect to future of our economy. most of my constituents don't understand what i'm about to say. frankly, most of the people in the press don't understand it and maybe some of you, even members of this body, don't even understand it. when we talk about the federal budget, two-thirds of the federal budget is beyond the control of this congress. two-thirds of the federal budget is on autopilot unless this congress changes entitlements. somebody says, well, what does this word entitlement mean? why do you talk about entitlement? entitlement means by law these individuals are entitled to this money whether we have it or not. the federal government has made a contract with them. all right, it's a social contract rather than a legal contract, but it's just as binding politically, where the federal government has to spend the money whether it has it or

not. and, indeed, that is what we have seen in 200 -- fiscal 2009. pardon me, fiscal 20 106789 the budget that -- 20106789 the budget said that revenue sincere going to be $2.02 and the entitlement is going to b be $2.2 trillion. which means that every function of government, our embassies overseas, our troops, wherever they may be, our troops, national parks, education, whatever it is, every dime will have to be borrowed in fiscal 2010. every single dime because every penny coming into the federal government is already programmed to go out without coming through the congress. it doesn't go through the appropriations process. we don't get to vote on it. people are entitled to receive this money and it's going to go out there. what are we talking about here? we are talking about creating a

new entitlement. a very expensive, new entitlement. and how are we going to pay for it? according to this bill, we're going to pay for it by transferring money from an existing entitlement. and anyone who thinks that's what's really going to happen in the face of the anger that is being generated by people who read about this believes a fairy tale. the whole notion of trying to balance the cost of this tremendous new entitlement by somehow a book keeping entry that says we'll take it out of the medicare account and we'll put it in this account and the computers, who don't think -- the computers simply compute -- will say, then, if you put it in this account, then this account

is revenue neutral. but the government's account is not revenue neutral. this thing's going to cos cost $500 billion wher wherevere get the money. it is a cynical employee, smoke an mirrors of the worst kind in a budgetary bait and switch to say that we're going to take this out of medicare. so, mr. president, i hear from my constituents, i hear from people who are not my constituents, who recognize me as a senator in airports and other places, as they say increasingly, do not pass this bill. we see it in the polls. but we see in the passion of the people that come up to us and let us know how firmly they are opposed to this bill. the american people don't want it. and the american people are right. i yield the floor. the presiding officer: the senator from iowa's recognized.

mr. grassley: mr. president, i'd like to also come -- make a statement related to the amendment that's present -- being presented by the senator from colorado. speaking for several members on my side, hopefully for all of the members on my side, we are very, very concerned, as i think we've all made clear by now, that the medicare savings in this bill are being used not for preserving medicare, but, instead, are being used to finance the creation of a new federal entitlement program. my understanding of the purpose of the senator from colorado's amendment is -- is to indicate that medicare savings will be used for extending the solvency of medicare and the trust fund, reducing medicare premiums, and

other cost sharing for beneficiaries, and to improve or expand medicare benefits and access to providers. now, nobody can really argue with that purpose that the senator has expressed or his amendment expresses. but the concern on our side that we have with this amendment is that it not -- does not require that the savings from medicare would only -- with emphasis upon the word only -- be used for that purpose. as a congressional budget office has made clear, the cuts in medicare in this bill are not being used solely for medicare as the senator's amendment suggests. but, instead, are being used mostly to fund the creation of an entirely new and separate

subsidy program in order for the senate to accomplish what he intends to accomplish would require entirely different language to assure that savings from medicare in this bill would only be used to protect medicare benefits for seniors as the law now expresses. the right approach would include language making sure seniors have the same access, as they have today, to moment health services, hospice care, hospital services, preventive benefits, and the benefits provided in the medicare advantage program. so the senate, seems to me, should also ensure that medicare savings in in bill are not being

siphoned off to finance a new and separate entitlement program. now, it's very clear to me and i hope we are able to make it clear to people -- all 100 senators that the bennet amendment, as written, does not protect medicare. i yield the floor. the presiding officer: who yields time? mr. baucus: mr. president, i don't think i have any time. but i ask consent that the time i do have after 2:00, i can take to ask a question from my good friend from iowa. the presiding officer: without objection, so ordered. mr. baucus: i ask my friend from iowa, senator grassley, a question, if he's available for a question. i'm taking time -- no, no -- mr. grassley: i will take a short minute to respond to a

question. but -- mr. baucus: i understand. i don't want to cut into that time at all. mr. grassley: could we discuss this a little bit later that you brought up. mr. baucus: i'm taking it off my time. not your time. mr. grassley: okay. mr. baucus: is it true that the congressional budget office said that this amendment -- that the bill over 10 years is not only deficit-neutral, but actually decreases the budget deficit by $130 billion. is that true? is that the congressional budget office? mr. grassley: that's true, but i don't think the senator wants to go down that road. don't forget there's six years of programs and expenditures and there's 10 years of revenue coming in. and if you want to play that game, you can pay down the entire national debt. mr. baucus: to be totally fair and respectful to my very best friends here in the senate, to cover that point, isn't it also true that the congressional budget office said in the second 10 years this will reduce the

budget by a quarter of g.d.p. -- a quarter percent of g.d.p., isn't that also true according to the congressional budget office? mr. grassley: i can't respond to that because i don't know that for sure. if you -- if you tell me -- i tend to believe everything you tell me. mr. baucus: we trust each other. we both trust each other. but that is what the letter said. thank you. the presiding officer: the senator from arizona's recognized. mr. mccain: mr. president, i ask unanimous consent that my colleagues and i be allowed -- the senator from tennessee, mr. alexander, and the senator from oklahoma, mr. coburn, and senator enzi, and senator crapo, unanimous consent that we engage in a colloquy. the presiding officer: is there objection? without objection, so ordered. the minority has three minutes and 42 seconds and then on top

of that at -- at 2:00, the senator from arizona controls 17 1/2 minutes. mr. mccain: thank you. i'll just let those minutes run together if there's no objection. mr. mccain: mr. president -- the presiding officer: without objection, so ordered. mr. mccain: i want to begin our conversation with a brief comment about the american association of retired persons known as the aarp, who has now come out against this amendment incredibly. and it's a fascinating history of that liberal democratic group because in 1993 they stated when we had some savings in medicare we had -- we had some savings in medicare in 1993, the aarp said -- quote -- "if we're talking about medicare cuts alone as a way of financing health reform, we would fight that with all of our strength. we've gone as far as we can down that road. the aarp on a $6.4 million medicare cuts in 2005 strongly

opposes, they said their conference agreement under minds the critical protections built into the medicare and medicaid programs instead of shared sacrifice to achieve budgetary savings. every time there's ever been a savings in medicare for social security in any way, shape, or form, the aarp has come out against this, except now, when the most massive cut in medicare in history and a transfer of those funds to a vast ne new $2.4 trillion o or $2.5 trillion entitlement program, described a as $2.5 trillion just yesterday by the chairman of the finance committee. i say shame on the aarp. i say to my friends, especially those under medicare advantage program, the 330,000 in my state who admittedly they're going to cut their medicare advantage benefits, take your aarp card, cut it in half and send it back.

they've betrayed you. a senator: mr. president? right here, mr. president. the presiding officer: the senator from oklahoma's recognized. mr. coburn: the chart behind me shows the cuts in medicare that are in this bill. and we've heard all sorts of arguments. and i have just a few rhetorical questions for my colleagues and my friend, the president of the united states. there's no question medicare advantage costs too much. i've agreed to that with the chairman of the finance committee. but you cannot say that coordinated care doesn't improve the care of seniors. and that's going to be cut. you cannot say that eyeglasses and hearing aids are not going to be cut, and they do improve the care. you cannot say to seniors who cannot afford a supplemental policy, who have medicare advantage, that they're not going to lose some of their

care. they are. in fact, 2.6 million, according to the congressional budget office, are going to lose that very care. not some of it. all of it. they're going to lose that advantage under this. the answer to the questions are, will this impact seniors' care? yes. we've heard that, oh, these cuts aren't going to impact anybody. the only people they're going to impact on the insurance companies. well, i'm all for impacting the insurance companies, but i don't want to impact patients negatively. so when we have cuts in medica medicare, hospitals $134.7 billion, hospices, $7.7 billion, nursing homes, $14.6 billion, medicare advantage, $120 billion, home health agencies, $42.1 billion, and then you say you're not going to do anything to impact the care of seniors? my colleague, whom i love, from iowa, disputed my statement the fact that the life expectancy is

going to go down under this bill. it is. he's never practiced medicine a day in his life. i know what goes on inside a hospital. when you cut $130 billion out of the hospitals, the time you're going to wait between the time you push your call button is going to get extended. and the complications from that are going to result in decreased quality of care and shortened life expectancies. there's no question about it. so we can -- we can play the game but the real thing that americans ought to know is almost $500 billion of spending on medicare patients today is going to go by the wayside to be spent on a new entitlement, on a brand-new entitlement. i would be happy to yield. a senatora senator: if the senam oklahoma would respond to a question. you're a physician and you have very well pointed out how the cuts to medicare advantage will reduce benefits to senior citizens. how the impacts on the hospitals and the home health care and the skilled nursing facilities and so forth will be reducing services.

mr. crapo: i'm aware of a june report from the medicare -- june 2008 report of the medicare payment advisory commission, medpac, which said that 29% of medicare beneficiaries who they surveyed who were looking for a primary care physician had trouble finding one who would treat them. and a similar survey in texas showed that in that state, only 58% of the state's doctors would be willing to take a new medicare patients, and only 38% of the primary care doctors accepted new payments. so my question is, in addition to the reduction of benefits, in addition to the reduction of access to hospitals and skilled nursing facilities and so forth, won't these cuts and the impact on medicare also represent a lack of ability by medicare recipients to literally find physician care? mr. coburn: there's no question, i'd answer my colleague from idaho, that it will -- if it doesn't eliminate the ability, it will deny by delaying the

ability. and care delayed is care denied. and all you have to do is read all the tragedies that have gone on in this country from people who have denied -- delayed care which has resulted in a large complication for that individual. mr. enzi: i'd kind of like to raise a appoint as kind of the accountant around here. there are only two ways you can pay for a government program. you've either got to do it through cuts or through taxes. and i don't think there's anybody in america that believes that you can do a trillion dollars worth of new programs and have them all paid for unless you steal somewhere. and that's what we're -- that's what we're doing from medicare. we say that that's not going to affect medicare? if you get -- eliminate just the dish payments which are part of this, it's going to put some wyoming hospitals out of business. and i can assure thaw if those

seniors can't -- assure you that if those seniors can't go to a hospital in their town, they are going to consider that a benefit cut. they're going to be upset, and they ought to be. same with nursing homes. if you -- if you -- if you cut back on nursing homes, the people in have to move to another town for a nursing home, because all of our towns don't have more than one nursing home, puts quite a burden not only on the patient, who isn't going to get to see their family as much, but also on the family who has to travel a long ways to see the patient. so i don't think we ought to be paying for the new programs by doing this when medicare needs an extended life. and i'm always fascinated when they explain that this will extend the life, because, yes, if you -- if you cut payments to everybody, that maybe saves money and extends the life of it. if we really did that. is there anybody that really thinks we're going to cut the doctors over the next ten years $250 billion? no, we're not going to do that. we never have. mr. coburn: would the senator

yield for a moment? mr. enzi: yes. mr. coburn: the one -- my one criticism of my colleagues in writing this bill is i think there's money we can save in medicare. it's called waste, fraud and abuse. a harvard professor says at least $125 billion a year in fraud who studies it. we've had several studies that say anywhere from $100 billion to $175 billion a year. there's nothing in this bill to eliminate fraud. what we're doing is we're taking care from seniors instead of taking the money from the fraudulent actors in the health care system. a senator: mr. president, if i may say to the senator from -- from arizona. mr. alexander: i greatly appreciate his making this amendment, because there's so much said here on the senate floor, it must be hard for many people to follow. but the one thing that -- i i be arrive agrees is that there are going to be $464 billion of cuts

in medicare over the next ten years, period. everybody agrees with that. i mean, the president of the united states has said that we're going to pay for half this new health care bill with one-half from medicare cuts and one-half from taxes. everyone agrees with that. what senator mccain's amendment is saying is two things. and senator mccain, see if i characterize properly your amendment because it's a very simple amendment as i read it. it's saying, send it back to the finance committee, to the committee, and say bring it -- bring the health care bill back without the medicare cuts. without these cuts to hospitals, cuts to hospices, cuts to nursing homes, cuts to medicare advantage, and cuts to home health agencies. and, second, if we're going to take money from grandma's medicare, let's spend it on grandma. let's take the savings that we find in medicare and absolutely make sure that we spend it on medicare, which the trustees have said is likely to go broke between 2015-2017.

now, did i correctly characterize your amendment? [inaudible] mr. alexander: and do you recall a few years ago when the republicans suggested saving $10 billion over five years in medicare that the majority leader said that was immoral and that other democratic senators thought it was awful? $10 billion in savings to try to make medicare stronger, what is spending nearly a half trillion on a new program called? a senator: i wonder if i could ask a question to my colleague from tennessee. you know, i'm new here and we're -- this is all new to me. i thought the goal here was we were trying to reduce health care costs, we were trying to provide health care for more americans. but we're taking money out of health care for seniors to create a new entitlement progr program. we're taking money out of nursing homes, home health care,

hospitals, and a program called medicare advantage that people in my state i know enjoy very much. how does it make sense that we are taking money out of medicare to start a new health care program? mr. alexander: well, i would say and then i think maybe others could respond, if you're going to spend $2.5 trillion a year, you have to get the money somewhere, and what the democratic health care bill does is get it three places. one is from seniors. one is from taxes. and one is from the grandchildren of the seniors; that is, debt. it comes from those three places. and what we heard earlier this week was the congressional budget office saying that the total effect of that $2.5 trillion is that for most americans, premiums would continue to go up just like they already are. and that for people who go into the individual market is they'll go up even more, they'll go up even more, except there are going to be some subsidies for those people. and where's the subsidy money coming from? it's coming from medicare. so that's the answer to the question. mr. lemieux: it would seem to

me, and, again, i'm new to this process, that a hundred senators would vote for senator mccain's proposal, because everyone in this chamber believes that we should strengthen medicare. who could be for taking money out of medicare if we don't need to do that? i mean, these are really two separate issues. shouldn't every senator in this chamber say let's send this back to the sphok that those cuts can be -- finance committee so that those cuts can be restored and we can start over and take a step-by-step approach. that only seems fair to me. perhaps my colleague from oklahoma could comment on that. mr. coburn: well, it's a -- the -- the presiding officer: the senator from oklahoma. mr. coburn: i thank the president. we're in trouble on medicare in this nation. everybody knows it. we've made promises. the -- the unfunded liability on medicare is $79 trillion. for us to take a half a trillion dollars, no matter what the enron accounting says afterwards, the fact is, is

we're going to reduce that, we're going to make that worse. now, we may not make it worse next year or the year after but we're going to make it worse, and it's going to be worse for seniors but it's also, like the senator from tennessee said, it's going to be extremely worse for the seniors' kids and grandkids. not only have we done that, we've raised the taxes in medicare on a certain group of people and we'ring if to take that money and not -- and we're going to take that money and not put it in medicare. we're going to take that money, a medicare tax, and create a new entitlement. so you're absolutely right, if you vote against the mccain amendment, you're saying you want to cut a half a trillion dollars out of medicare and that it will have no affect whatsoever on the care. i would remind the senator from florida, you have a million people on medicare advantage in the state of florida. a million people that are going to lose benefits under this bi bill. one million people in the state of florida will lose benefits under this bill.

mr. alexander: if i would ask the senator from oklahoma, who is a physician amendmen himselff the effects of the cuts in medicare is to make it more difficult for people who are on medicare to see a doctor. it's like giving somebody a bus ticket and not having a bus. and i've been reading in the newspapers, for example, "the washington post" last month that the mayo clinic, which is often held up as an outstanding example of a clinic that keeps costs under control, has announced that it no longer will accept medicaid patients from nebraska and montana and some mayo clinic facilities in arizona and in florida are beginning to say no more medicare patients. now, is this what the senator from oklahoma thinks could be happening at other hospitals and centers, even very good ones such as the mayo clinic, where they allegedly keep costs at a reasonable level? mr. coburn: i think that's entirely possible. i don't know that to be factual as of yet. what i do know is we're going to

have 44 million baby boomers in the next 12 years jump into medicare. and we're cutting medicare. we're going to have 44 million baby boomers jump into medicare. i'm one of them. and we're going to cut the amount of available funds for medicare under this bill. mr. enzi: mr. president? the presiding officer: the senior senator from wyoming is recognized. mr. enzi: i'd like to ask the senator from idaho what he thinks will happen with these medicare cuts as it affects the jobs and the economy. that's one of the biggest things on people's minds right now, are jobs and the economy. and we're concentrating on something here where we're going to maybe make a difference, but even though c.b.o. says there won't be be much of a difference. mr. crapo: well, i thank the senator from wyoming for that question, because as we've already reviewed here, there are going to be major cuts in benefits in medicare, in the medicare advantage program. there are going to be major reductions in access to medicare in terms of access at hospitals and skilled nursing homes and

facilities and home hospice and other care. but one of the other things that we haven't focused on is the fact that it's kind of interesting that today's the big white house jobs summit. what's going to happen as a result of these medicare cuts in addition to the reduction of access and care and benefits to seniors is we're going to lose jobs. i've had in my office here representatives of nursing and home health care facilities from idaho who have told me that if this bill is adopted, a number of those facilities are simply going to have to just go out of business or they're going to have to dramatically reduce the services that they provide, meaning that the nurses and the other caregivers who work there will no longer have jobs there. and that's part of the way that our medicare -- our senior citizens will lose access, because there will simply be fewer places, fewer physicians, fewer facilities that will take medicare patients with this kind of an attitude of the federal government toward funding of medicare. and in the end, what do we have?

we have a massive expansion of government, $2.5 trillion, with a massive new entitlement program, along with which comes these incredible government controls over the economy as well as the creation of a new government insurance company funded by half a trillion dollars almost of medicare cuts, a half a trillion dollars of taxes, and a massive debt, unfunded mandate pushes o pusheo the states. and that's one of the reasons that i think the senator from arizona was so wise in bringing this amendment as the first step in focusing on one of the first fixes that needs to be made to this bill. let's step back, let's not pay for a brand-new, $2.5 trillion entitlement program on the backs of our senior citizens. a. a senator:: mr. president, how much time is left? the presiding officer: the senator from arizona is controlling the time. he has three minutes and 20

seconds. the senior senator from arizona is recognized. mr. mccain: i mentioned the aarp and their support or their opposition to this amendment. i would also like to point out there is an organization called 60-plus that has plls of supporters and members, and they also feel very differently than the aarp. their message is soon you will vote on the mccain motion to commit with instructions. the motion would commit it to the senate committee of finance, et cetera. i and the 5.5 million supporters of 60-plus urge you to support this motion. the patient protection affordable care act is nothing of the sort to senior citizens. it would cut medicare by by $500 billion. these cuts would harm seniors who have paid into the program and expect it to be there to help them with their health care needs. at 60-plus, we pride ourselves on advocating for the best interests of seniors, and that is a yes vote on this motion. my friends, let's pay attention to 60-plus.

and again -- a senator: a question. does 60-plus sell a supplemental insurance policy to seniors? mr. mccain: i don't believe 60-plus does. mr. coburn: but au pair does. mr. mccain: most experts on the health care issue believe this could be a windfall of millions and millions and tens of millions of dollars for aarp if the legislation is passed as it is presently crafted. mr. alexander: the senator from arizona, how many medicare advantage members, for example, there are in the state of arizona? is it a small program or a large program? mr. mccain: our figures are 330,000 people in my state of arizona. and i did notice yesterday when the distinguished chairman of the finance committee and the senator from connecticut were talking, the way that they were disparaging the entire program, how it wasn't any good and about the cost overruns and it really was a bad program. they have opposed it from the start. and so the message is to 330,000

americans that -- citizen of my state who have medicare advantage, they're out to get you. mr. crapo: in tennessee, it is my understanding that nationwide it's about one quarter of all medicare beneficiaries. just about one quarter of all medicare beneficiaries in america will see their benefits cut. all beneficiaries in america will see their access cut. and these problems that we are talking about are not just limited in their impact. mr. mccain: let me respond again. there are cost problems with the medicare advantage. those cost problems can be fixed, and those cost problems can be brought under control. but the fact is to do away with the program that allows them a choice in how they receive their care is, of course, again an effort to have the government make the decisions for people which flies in the face of everything we stand for and believe in. mr. alexander: i say to the senator from arizona, we have heard some of our friends on the

other side say the republicans are scaring seniors about medicare cuts. mr. president, not the republican seniors are scaring seniors about medicare cuts. it's the democratic health care bill that's scaring seniors about medicare cuts because there are a half trillion dollars of medicare cuts that will pay for half of this new program and their out line here on this chart as the -- and they are outlined here on this chart as the senators have discussed. the presiding officer: the time of the senator from arizona has expired. the senior senator from montana has 15 minutes and 55 seconds remaining. mr. baucus: how much minutes? the presiding officer: 15 minutes and 55 seconds. mr. baucus: i will yield myself about ten minutes. the senator from tennessee says that these are going to hurt seniors. well, let's ask the seniors' organizations what they think about this and let's look at

this organization called 60-plus. what does the aarp say in the letter to senator reid, dated december? it talks about this legislation." the legislation before the senate properly focuses on provider reimbursement reforms." i'm sorry that all my colleagues have fled the senate because i would low-income them to stay and listen to this because i would like to see what their response is to all of this, but they have gone. they have fled after making sound bites. anyway, i'll take my time. the legislation before the senate -- this is the aarp letter dated december 2. the legislation before the senate properly focuses on provider reimbursement reforms. most importantly, the legislation does not reduce any guaranteed medicare benefits. this is the aarp. all this scare talk about grandma, and i do -- with due respect to my friend from tennessee say that. he has been using that phrase a lot. but aarp says grandma's fine.

grandma's fine. it says -- "most importantly, the legislation does not reduce any guaranteed benefits." it does not reduce any benefits for aarp. going on, ""aarp believes savings can be found in medicare." we're talking savings in medicare to extend the solvency of medicare. the actuary says this legislation extends the solvency of medicare, helps medicare. benefits longer than the status quo if this legislation were not to pass. and also that it does so, according to aarp, by eliminating waste and inefficiency, and aggressively weeding out fraud, waste, and abuse. the last sentence in the letter says -- "we therefore urge you" -- senators -- "to oppose the mccain amendment." the aarp says this hurts seniors, the motion to recommit. i think the job for aarp is to

try to figure out what's best for seniors. that's what their conclusion is. it's not just their view, aarp. there is another letter. this letter is the national committee to preserve social security and medicare. what do they say about all this? basically they say this legislation does not cut medicare benefits. this is the national committee to preserve social security and medicare. they say that rather this legislation includes provisions to ensure that seniors receive high-quality care and the best value for medicare dollars. very reputable seniors organization. the aarp is a very reputable seniors organization. the national committee to preserve social security is a very reputable organization. that's what they say. now, who is this 60-plus association i just heard referred to recently? let me just tell my colleagues what 60-plus really is. i'll just read. this is from wikipedia.

it may not be accurate. "60-plus is an american conservative advocacy group based in arlington, virginia. it bills itself as the conservatives' alternative to aarp." that makes good sense because over the years it has sought to privatize social security. 60-plus over the years has sought to privatize social security. they want to end the federal estate tax. it's true they also want to strengthen gun rights. well, that's not terribly relevant to here. according to the aarp -- now, this is a bit biased because this is what the aarp says about 60-plus -- "enjoy the talents of conservative direct mail mogul richard vigary." we all know who richard vigary is. 60-plus is an active organization of vigary. i think they have different fish to fry. the aarp also says it criticized

60-plus as being partisan because its issues and causes mirror those of only one of two major parties, as the republican party. and the final criticism by aarp about 60-plus is it lists no dues-paying members and, get this, receives the majority of its contributions from the pharmaceutical industry. the group is simply a front organization for the pharmaceutical industry. well, i ask unanimous consent to put that letter in the record. the presiding officer: without objection. mr. baucus: mr. president, i think it's pretty clear, the main organizations that care about seniors support this bill. another organization, 60-plus, i don't know what they think about this legislation. my guess is they're opposed to it because they want to privatize social security, they get most of their money from the pharmaceutical industry. i don't think they're caring much about senior citizens, frankly, and certainly not as much as the other organizations.

i think it's also important to point out here that this legislation is deficit neutral over not just ten years but over the next ten years, and it's more than deficit neutral. this legislation generates generates $130 billion surplus the first ten years, and as we all know reduces the budget by a quarter of the g.d.p. over the next ten years. so this is not irresponsible. it's very fiscally responsible. it's strongly supported by the seniors' organizations that really care for seniors. and i might say, too, that it's not really medicare at all. it's strengthening medicare. it's strengthening the trust fund, it extends the solvency of the trust fund. i think that therefore it clearly as the aarp says we should oppose the mccain amendment which hurts social

security beneficiaries, does not help them. and i'll yield such time as the senator from illinois desires. mr. durbin: could i ask the chair how much time is remaining on each side? the presiding officer: the senator from montana has nine minutes and 20 seconds. mr. durbin: and the other side? the presiding officer: the other side's time has expired. the assistant majority leader is recognized. mr. durbin: i would ask to be recognized for five minutes, and if the chair would please advise me? i found it interesting -- i'm sure the senator from montana has -- to listen to all of the republican senators who come to the floor to defend medicare, medicare. i'm sure the senator from montana has the same memory i do that when medicare was created, it was created by the democratic side of the aisle with the general opposition of the republican side of the aisle. they said it was socialized medicine. too much government. and it would fail. now they're coming, riding to the rescue of medicare. we have a right, i think, to be skeptical about the arguments they're making. imagining these republican senators defending medicare is

trying to imagine a fish riding a bicycle. i just can't put it in my mind but they're doing it. and the senator who has sponsored this motion to commit, senator mccain, just a year ago in the course of this press dengs campaign called for eliminating $1.3 trillion in spending from medicare and medicaid. now he comes to the floor and says that this bill which would reduce costs in medicare by less than half that amount over a ten-year period of time is irresponsible and the death knell of medicare. what's the real story here? the real story is the republican side of the aisle is defending the private health insurance companies, companies that are making generous profits for medicare advantage. this is a program offered by private health insurance companies to replace government-run medicare, and it turned out in many instances to have failed miserably. it costs more money because these private health insurance companies are taking profits out

of the medicare advantage program so they have pleaded with the other side of the aisle come to our rescue, and they have sent in their very best troops on the other side of the aisle headed by the senior senator from arizona can who has said the first thing i will do is to protect these private health insurance companies and their rights to over which charge -- overcharge seniors for medicare and medicare advantage. and he talks about the people now receiving medicare advantage who may be disadvantaged and see a different policy in the future. what the senator from arizona and others don't dwell on is the fact that everyone under medicare today pays $90 a year more into medicare to subsidize the private health insurance companies that offer medicare advantage. this is a tax, a tax which the senator from arizona is trying to preserve, a tax on medicare recipients. the senator from arizona was right a year ago. we can really take an honest look at medicare and medicaid, and we can take money out of the

system without disadvantaging the people involved. i do want to say to the senator from arizona and all, once we have dispatched your motion to commit, you will have a chance to vote for senator michael bennet's amendment from colorado. it couldn't be clearer. it has two parts. it says -- repeating what this bill says but it says unequivocally, "no provision in this senate bill can reduce any medicare benefit guaranteed by statute." next paragraph -- "savings in medicare from the bill will go to extend the life of the medicare trust fund, lower part-b premium or cost sharing, expand benefits, improve access to providers. -- to providers." we know and the seniors across america know that left unattended and uncared for, medicare may go broke in just a matter of seven or eight years. this bill before us today will extend the life of medicare for at least five years.

it will put medicare on sound footing which every senior and their families want to have. that's why aarp, the largest organization of senior citizens across america, has urged mesms of the -- members of the senate in both parties to oppose the mccain motion to commit, and that's why i stand today with the senator who is chairman of the senate finance committee and say to my republican friends and their newfound love affair with medicare that they should reject their -- what is it? 60 -- what's the name of the group? 60-plus organization, 60-plus organization, this wise council that they turn to that came up with the idea of privatizing social security. how would you like to have had all your social security money in the stock market over the last two years? boy, there is a great idea. so stick with this 60-plus group if you like the notion of privatizing social security. stick with aarp if you want medicare to be strong, on sound financial footing. i yield the floor.

the presiding officer: the senior senator from montana is recognized. mr. baucus: mr. president, i think it's just appropriate just to remind people of some of the visions that are in this bill. to repeat, some people have listened to this debate, some have not. some might be tuning in right now. but the fact is without reform, without this legislation, medicare is expected to go broke in the next eight years, and that's according to to the medicare trustees report. with this legislation, that's extended for at least five more years. that protects seniors. this legislation protects seniors. without reform, that is without this bill, the costs would continue to rise and seniors would be forced to bear more and more of the burden out of their own pockets. this legislation adds benefits to seniors, doesn't take it away as the other side implies. without reform, seniors will continue struggling to full

prescriptions in the doughnut hole. i remind my colleagues that this legislation will cut the cost of brand name prescription drugs in half for seniors during that gap, the so-called doughnut hole, and it would also help provide more benefits in terms of annual wellness visits when seniors go to the doctor for either colonoscopy or phoplg or other preventive -- mammogram or other preventive screening, they won't have to have co-pays. that's an added benefit that this legislation provides for seniors. i also say this legislation helps seniors who are eligible for medicare and medicaid access to home community-based alternatives to nursing home care. a lot of our seniors would like that additional benefit. that's all in this legislation. this legislation provides more benefits for seniors, not fewer. this legislation protects seniors. it doesn't harm them. this legislation extends the

solvency of the trust fund rather than not. i might also say, and i think the senator from illinois made a very good point, currently seniors who pay in part-b premium really are paying a $90 tax per year for those persons who are in medicare advantage. we know that medicare advantage is overpaid. the senator from oklahoma, senator coburn, agreed with me when i asked him yesterday if medicare advantage is overpaid, and he said yes. it is overpaid by a very large margin. this legislation adjusts that overpayment. i might also say too that the groups i mentioned support in legislation. but the main point i want to make is this, mr. president, there are so many fundamental provisions in this legislation that have really not come up very much in debate, a little esoteric but basically they're under the heading delivery system reform.

we must begin to change the way that reimburse doctors and hospitals, focusing much more on the quality of care rather than the quantity of care. some of that is already happening in america, integrative systems. i know a senator has talked about this new trend where doctors, hospitals, nursing homes and other groups get together and they coordinate their care. the care is much more patient-focused. we have to move much more in that direction because this will go a long way, once it starts kicking in it will take three or four years to begin to have an effect. it will go a long ways to eliminating the waste in our current system. estimates are we have between $200 billion to $800 billion annually of waste in the health care system. that's one of the reasons why health care costs are so high

for families, for businesses, for governments and what snowe. we just have to begin to get that under control. this legislation does that. and if we don't pass this legislation, we'll be postponing the date when we have to begin to get some of these excessive costs under control. and then it will probably be much more difficult. an ounce of prevention is a pound of cure is not only true in medicine. it's also true in legislation. i think clearly now is the time to exercise a little bit of ounce of prevention by starting to curb excessive costs, and this bill does that. the presiding officer: the senator's time has expired. the next ten minutes -- the next ten minutes are evenly divided between the senator from colorado and the senator from arizona. mr. mccain: mr. president, i'd like to yield two minutes to the senator from iowa.

the presiding officer: the senior senator from iowa is recognized for two minutes. mr. grassley: as i stated earlier, the bennet amendment as written does not protect medicare, so i have a modification that i'd like to protect that would ensure that medicare savings in this bill are not being siphoned off to finance a new and separate entitlement program. so to that end, i ask unanimous consent to modify the amendment by adding the following before the period at the end of subsection (b) "and furthermore not withstanding any other provision of this act or amendment made by this act, net medicare savings specified in the most recent estimate available from the director of the congressional budget office before enactment are appropriated to the secretary and shall be used for such purposes to maintain medicare policies for home health services, skilled nursing facilities, hospice care, hospital services, and benefits provided under medicare advantage program.

as under the provisions of such title as specified on the day before the date of the enactment of this act." end of my amendment. i ask unanimous consent. mr. baucus: mr. president, reserving the right to object, under current law if less is spent for medicare providers, the benefits inure to the medicare trust fund beneficiaries. although i have the greatest respect for the senator from iowa, this is a stunt, and i object. the presiding officer: the objection is heard. mr. grassley: then if i could -- the presiding officer: the senator from iowa. mr. grassley: i'd like to make very clear that this objection confirms that the bennet amendment does not protect medicare as the other side claims that it protects medicare. i yield the floor. the presiding officer: who yields time? the senator from arizona is recognized. mr. mccain: this motion sends the legislation back to the finance committee for a short period of time with instructions to report back with cost offsets

other than medicare cuts. the motion says we should retain the provisions in the legislation addressing fraud and abuse and retain those savings to strengthen the medicare trust fund. instead of cutting over $450 billion from medicare providers and beneficiaries, the committee should do what it should have done in the first place, protect seniors' benefits and access to providers. it is much-needed. my friends, let's have -- let's save seniors who have paid into the medicare program their whole lives from these damaging cuts. i hope you'll vote in favor of this amendment. let's use medicare savings to save medicare, not to fund a whole new $2.5 trillion entitlement program. i urge a vote in favor of the amendment, and i yield the balance of my time.

a senator: mr. president? the presiding officer: the senator from colorado is recognized for ten minutes -- for five minutes. mr. bennet: i'd settle for ten, mr. president. the presiding officer: five minutes. mr. bennet: i'd like to sum up this debate over medicare in the senate "help" bill and on the two amendments we have before us. only in washington, d.c. could an effort to extend the life of medicare somehow be distorted as being bad for seniors. we know from the congressional budget office, a nonpartisan organization that supports both sides of the aisle here, that this senate bill does not take away any senior's guaranteed medicare benefits. it extends medicare solvency for five additional years. my amendment simply confirms these two facts. i'm the first person that would insist that we have an open process for this debate, and i think there are ideas on each side of this debate on this bill that are worth considering and should be considered. but it's why i find it so con

founding that opponents of my amendment want to send the entire bill back to committee so debate stops. how can we return home to the people of our states and admit to them that we just gave up as a body and sent health care back to the committee for another round? the people who don't want change, the people who are content to leave it the same and don't have a theory about how to extend medicare would have seniors believe the bill is bad for seniors. yet, aarp, the alliance for retired americans, and the national committee to preserve social security and medicare beg to differ. they agree. they agree -- they disagree. they agree with this amendment. senior organizations, grass roots organizations with their ear to the ground hearing the concerns of seniors support health care reform. and they agree with my amendment this bill strengthens health care and preserves seniors benefits. with the bill finally reaching the floor, seniors are looking for simple clarity on how health

care reform can help their lives. nothing in this bill will cut guaranteed medicare benefits. and this bill will extend medicare solvency for five additional years. it actually makes the system work better instead of cutting or adding to a program, it actually changes the way medicare works so it will be stronger and more stable. mr. president, people may disagree with the prescription, but as a general matter everybody knows that the status quo is unsustainable. and this bill helps seniors. it eliminates the co-pay seniors have to pay for preventive care. we know that preventive care saves lives and it saves money. so as we close debate on my amendment and the alternative motion to commit the bill back to committee, i would urge all the members of this body to consider the consequences of inaction. my amendment affirms what the current senate bill does to help seniors and strengthen medicare. we all know even more can be done. so let's continue this debate, reject the motion to commit the bill back to the senate committee. and i urge every member of this

body to support my amendment. please vote "yes" on the bennet amendment and protect our seniors. i yield the floor. the presiding officer: who yields time? the senator from montana has one minute and 50 seconds. mr. baucus: all right. well, frankly, i think the senator from arizona has yielded back his time. we might as well yield back our time, and we could vote early. the presiding officer: the senator from arizona has yielded back his time. the senator from montana has yielded back his time. all time has expired. the question is on the amendment. mr. mccain: mr. president, i ask for the yeas and nays. the presiding officer: is there a second? appears to be a second. there is a second. the clerk will call the roll.

vote:

vote:

vote: vote:

the presiding officer: the senate will be in order. on this vote, the yeas are 100, the nays are 0. under the previous order requiring 60 votes for the adoption of this amendment, the amendment is agreed to. the presiding officer: there will be order in the senate. the senators please take conversations outside the chamber. there will now be two minutes of debate equally divided on the motion to commit, offered by the senator from arizona.

mr. baucus: mr. president? the presiding officer: the senator from montana. mr. baucus: mr. president, i would ask my colleague if he wishes to go first or whatever he wants to do. it's his amendment. mr. mccain: please, go ahead. mr. baucus: thank you. mr. president, the mccain amendment's next. unless we act today to pass health care reform, the medicare trust fund runs out of money in 2017. there are two ways to keep medicare solvent. one's to find efficiencies to medicare spends less or increase revenues going into the trust fund. there are two ways. our bill would make medicare advantage more efficient, we would introduce competitive bidding, and we would extend the trust fund -- mr. byrd: mr. president, may we have orderment may we have order. we have a senator speaking here. may we have orderment -- may we have order. i thank the chair.

mr. baucus: i thank the senator from west virginia. and we would extend the trust fund for five more years. that's in this bill. yes, medicare advantage plans would not be overpaid as much but those plans could pay for greater efficiency by cutting the profits or cutting their executives' pay. they could do that. nothing says they have to go after beneficiaries. our bill does nothing to reduce guaranteed medicare benefits. to the contrary, our bill would improve medicare benefits, it would help seniors in the prescription drug doughnut hole, add new preventive benefits, like annual wellness visits. the bill would help ensure that doctors would be available to treat medicare patients. we would prevent the 21% cut in doctor payments under current law. for all those reasons, the association for retired people supports reform, opposes the mccain motion. and i would urge my colleagues to support reform and oppose the mccain amendment. -- bill, motion to recommit.

mr. mccain: mr. president, this amendment proposes to take the legislation and go back to the finance committee and remove the nearly half trillion dollars in cuts that will severely impact all seniors who are eligible for medicare. as the senator from montana mentioned, the system is going to go broke in seven years, so what does this legislation contemplate? that we take a half a trillion dollars out of their savings and put it to fund a $2.5 trillion new entitlement program. what does that do for the medicare trust fund? nothing. i urge my colleagues to vote in favor of this amendment. send it back to the finance committee, do the right thing for the seniors of this country. the presiding officer: the question is on the motion. a senator: i can for the yeas and nays. the presiding officer: is there a sufficient second? there appears to be. the clerk will call the roll.

vote:

vote:

the presiding officer: is there any senator wishing to change -- wishing to vote or change their vote in in if not the yeas are 32, the nays are 6, under the previous order, the motion it withdrawn. without objection. mr. reid: would the senator withhold? mr. president. the presiding officer: the majority leader. mr. reid: i would ask unanimous consent that the senate be in a period of debate only between now and 4:30. it's my understanding that there's been an agreement that at 4:30 we're all going to go to the classified room in the visitors center to listen to what the administration has to

say about iraq and afganistan. so i haven't had a chance to clear this with the republican leader. but we -- for the next hour we'll be in a period of debate only. come back and offer the amendment after we finish with the classified brief. mr. president, the other thing, we have not yet had an agreement to recess at 4:30. i would ask, mr. president, we be in recess from 4:30 to 5:30 for our classified briefing. the presiding officer: without objection. a senator: mr. president? mr. president? the presiding officer: the senator from idaho. a senator: thank you, mr. president. mr. president, i want to

continue discussing the health care legislation that we just voted on. mr. crapo: we just had a series of votes dealing with the medicare issue. but i think i'd like to start out my remarks by turning to the senator from mississippi, senator wicker, and ask him if he has a few comments he'd like to make. mr. wicker: i appreciate the senator yielding to me. i think it's important to understand where we all are now. indeed, we have had a debate about the medicare issue. the senator had an opportunity with the mccain amendment to protect medicare from the almost half a trillion dollars in cuts that the reid bill proposed to do to medicare. instead we said, no, to that opportunity and instead passed the amendment by senator bennet of colorado, which in the sum total does absolutely nothing. what we've done now with -- with the bennet amendment is say that

along with apple pie and motherhood, we also love medicare and we want everybody to know that. but the substantive effect of what we've now just done is nothing. and i have this challenge to the managers of the bill on the other side and to the democratic leadership in the united states senate. now that bennet has passed and mccain has been defeated, i challenge them to take this bill, send it to c.b.o., send it back to c.b.s. and have the independent analysts there look at it again. they will be duty bound to come back with the facts. and the facts will be that the almost one half trillion dollar in medicare cuts are still there. now that mccain has been defeated and the sham of the bennet amendment has been passed, there are still the same

cuts to hospitals, there are the same cuts to medicare advantage and to all the senior citizens who depend on that and who were told during the campaign that their coverage would not be taken away from them if they liked it. the cuts to nursing homes are there. the cuts to home health are there, and the cuts to hospice are still there. send the bill back to c.b.o. we can continue debating it. we won't have to miss out on one bit of rhetoric that we've already had, but ask the independent analysts are the medicare cuts still there, they will be duty bound to come back to us and say yes, the same cuts that were there before are current in the bill now. we've accomplished absolutely nothing today to protect medicare, and i thank the gentleman for yielding. mr. crapo: i thank the senator for yielding. i ask unanimous consent that several of my colleagues and i may engage in a colloquy during the time we have. the presiding officer: without

objection. mr. crapo: thank you. mr. president, i'd like to follow up on the comments of the senator from mississippi, mr. wicker, because it's very critical that the american public understand what has just happened in the senate. when you talk about health care reform, the vast majority of americans have a couple of ideas in mind. first and foremost, they want to lower health care premiums and costs. that's what americans think about primarily when they think about the need for health care reform. they also want to see better access to quality health care and make sure that those who are uninsured have access to health care and those who are underuninsured have -- underinsured have access to health care and that we all have access to quality health care. that's what this debate should be about, but instead the legislation that we see before us does not achieve that. does it reduce the cost of health care? no. it drives up the cost of health care. it raises taxes hundreds of billions of dollars. it cuts medicare by hundreds of billions of dollars. it grows government by

by $2.5 trillion of new spending. it forces a needy -- the most needy in our society into a failing medicaid system. it imposes a damaging unfunded mandate on our struggling states. it still leaves millions of americans uninsured and establishes massive government controls over our health care economy, including even the creation now of a government insurance company. we have been focusing in the debate on one part of this for the last little while, and that is the medicare cuts. $464 billion of the revenue to pay for this massive new entitlement that is being created are to come from medicare. and it's nothing other than a direct transfer of assets in the united states from america's seniors in the medicare system

to a new government entitlement program. there are other cuts -- there are details to these cuts that i'll put up right now. and the debate that we have been having over the last -- oh, almost three or four days now is whether we should recommit this bill back to the finance committee so that these medicare cuts can be removed. we just had two votes. one is what i will call a cover vote. it said we don't want to cut medicare benefits and we should make sure that everything we do protects medicare. didn't have any detail in it but it passed 100-0 because it does nothing. it doesn't change what is in the bill. the second vote that we -- and by the way, like i say, that vote just passed by 100-0. the second vote we just took failed. was the vote 60-40? i don't recall the exact vote.

failed 60-40. what would that amendment have done? that would have put the bill back into the finance committee and required that we take out the medicare cuts, so let no one be confused. after the first round now in the senate, we still see this in the bill. a transfer of $464 billion from the medicare program to the establishment of a new entitlement program. i don't believe that that's what americans had in mind when they were talking about reform of health care. now, there has been a study come out -- okay, i've got the exact vote here. it wasn't 60-40. it was 58-42, but it was defeated in any event. and now we still have the cuts to medicare in the bill. we're going to continue debating

this issue. i myself have an amendment that will send for the skilled nursing homes the bill back to finance to correct the cuts for their skilled nursing homes. there are others who will try to address some of the pieces of this to see if we can't find a way to fix and restore the strength and stability of the medicare system. now, everyone admits that we need to reform medicare, but until this bill, none of us thought we were talking about taking from medicare in order to create a massive new entitlement program with the government control that comes along with it. what do these cuts do? i'm going to start out with the hospitals, the hospices, the nursing homes, and the home health agencies. the reduction in medicare spending on these medical providers will basically result in lower access to our seniors to care.

i've had representatives in my office of both skilled nursing facilities and home health agencies who have talked to me about what this means to them. they pointed out that the last time congress did something like this, we lost in idaho 30%, for example, i believe it is, of our home health agencies. they are just not there anymore. and if we have these kinds of deep cuts in the future, we're going to lose more of our home health care agencies. what one of the owners said to me, he put it to me this way, he said if you reduce the allocation of income to home health agencies, i have to either reduce employment, which means not hire as many nurses and medical providers, or i have to close parts of my building and stop operating as many rooms in the building or do something to reduce costs. what that means is seniors will have less access. but that's not all this bill

does. in addition to reducing the access to hospitals, hospice service, nursing homes, and home health agencies, it also cuts medicare advantage deeply. now, quickly, what is medicare advantage? medicare advantage is a program that about one out of four american seniors participate in in medicare. it is an opportunity which congress started a few years back to try to let the private sector become a part of the delivery system in medicare. in other words, to put it simply, private sector insurance companies can contract with the federal government to provide medicare services to medicare beneficiaries so that it's the private sector getting involved in the health care delivery rather than the government simply delivering the health care through a single-payer system. and that in a quick summary is what medicare advantage was all about. what we found is that it was phenomenally successful because the private sector was able

through its management to not only provide the statutorily required medicare coverage but additional benefits, very critical additional benefits like preventative health care, dental coverage, vision coverage and things like that, things that make a big difference in the lives of our seniors and enable some of those who can't buy additional medicare coverage for those things that medicare doesn't cover to get access to it through medicare advantage. that's why in my state, 27% of all of the medicare recipients have moved to medicare advantage. it's the most popular part of medicare in america today, and it's growing faster than any other part of medicare because it's delivering more to the medicare beneficiaries. well, this bill slashes slashes $120 billion from it, some of us believe because there is a bias against the private sector delivery of health care, but for whatever the reason, the medicare advantage portion is

where the cuts are focused. now, let's put up the next chart. when we have this issue before the finance committee, we had the head of c.b.o. before us, and i asked them a question about the cuts to medicare advantage. my question was -- we had had a colloquy between us at that point, and i said so approximately half of this additional benefit -- in other words, these additional things that medicare advantage has been able to provide to our seniors under medicare, so approximately half of the additional benefit would be lost to these current medical advantage policyholders, and his response was -- "for those who would be enrolled otherwise under the current law, yes." the point being not only will we lose skilled nursing facilities, home care, hospice care and hospital care and access to that care, we are also going to see senior citizens lose benefits.

and again, what is the purpose? the purpose is not to shore up medicare. in fact, it will take take $464 billion, taxpayer dollars that are allocated to medicare in our current system and transfer them straight over. let's go back to that chart with the picture. transfer them straight over to the establishment of a new entitlement program. and i want to let my colleague from nevada comment on this for a minute, but before i turn it over to my colleague from nevada , i would like to just point out that as we approach this issue, the question of why would we transfer $464 billion out of the medicare system to a new government entitlement program, one of the reasons is because the president pledged that he wouldn't sign a bill that didn't reduce the deficit. as i said earlier, this bill grows the spending in the federal government by over

over $2.5 trillion -- well, approximately $2.5 trillion over the first ten years of its implementation of spending. the only way to cover that increase in the size of the government is to either raise more taxes or to cut spending somewhere, and what this bill does is both. it raises taxes which we're going to be talking about in future days, and it cuts spending, and the place where it cuts spending is medicare. that's why what we see is increased taxes, cuts in medicare, growth of government, and the establishment of a new federal entitlement program with all the accompanying acarruth rements of -- acutements of federal control including a new government-owned and operated insurance company. i see my colleague from nevada standing and would turn to him for his comments on this issue. mr. ensign: first of all, i think my colleague from idaho has made some talent points about truly the cuts that are going to happen in medicare,

and, you know, don't take the politicians' word for these cuts. listen to the c.b.o. director. he is a nonpartisan, official scorekeeper, and when asked direct questions by not only the senator from idaho but others, he absolutely says the benefits, especially under medicare advantage, will be cut. in my home state, tens of thousands -- i think about 200,000 all together seniors in the state of nevada have voluntarily chosen medicare advantage over traditional medicare. the reason, very simple -- there's extra benefits. you hear the democrats talk about this doughnut hole. on the part-d medicare which is prescription drugs. well, there is no doughnut hole under most of the medicare advantage plans because the private sector through its efficiency has been able to fill that doughnut hole. in other words, they get complete coverage with

prescription drugs, but they also under medicare advantage, they get additional preventative health care services. they also get vision, dental, and depending on the plan, depending on its makeup, they put different types of benefits in to attract seniors to their plan. it's no wonder that about one out of four seniors in america have voluntarily signed up for medicare advantage. nobody forced them into this system. they voluntarily chose this system. and if you think about it, you know, seniors don't like change. most seniors, they like what they have, they don't like to change, and for one out of four seniors to have voluntarily changed, there has to be something pretty attractive about medicare advantage. well, there are some real attractive things, and that's why when you actually poll seniors on medicare advantage, the vast majority of them are thrilled with their coverage.

they don't want to lose benefits. who would want to voluntarily lose benefits? but under the $120 billion cut in medicare advantage that the democrat majority has put in this bill, about half of medicare advantage plans -- about half of the benefits will be cut. isn't that is correct, i ask my friend, the senator from the state of idaho? mr. crapo: the senator from nevada is correct. i'm thumbing through here trying to get the exact statistics. the c.b.o. indicated i think it was something like from an average number of $140 or so of extra benefits, it would go down, about half of that. they would get about half of those extra benefits. mr. ensign: that's per month. $140 per month, about half of those benefits would be cut under the new plan; is that correct? a senator: we have three

republicans now saying this. you quoted official sources. mr. wicker: let me quote a democrat. representative michael mcmahon -- and i quote -- "medicare advantage which serves approximately 40% of my seniors on medicare would be cut dramatically." that's why that democrat from the state of new york voted "no" on the plan when it was before the house of representatives. so you don't have to take our word for it from a partisan standpoint. democrats are saying no because of the medicare cuts and the cuts to medicare advantage. drastically cut. mr. ensign: the senator from idaho and i, we both serve on the finance committee where most of this bill, or a lot of this bill was written. and we both heard democrats on the other side of the aisle complaining about the cuts to medicare advantage. and yet, when i look in the bill, the total dollar figure in cuts in medicare advantage is the same as when it came out of the finance committee. isn't that correct? mr. crapo: the senator from nevada is correct.

i have the exact numbers from c.b.o. provided in the finance committee markup. during the markup c.b.o. estimated the value of the extra benefits offered by medicare advantage plans will drop from $135 a month to $42 a month based on the cuts contained in that bill which are essentially the same level of cuts that we now see in the bill before us on the floor. mr. ensign: i would -- let me just make a couple other points in general about this bill. i think we've covered pretty well that medicare advantage is going to take a pretty severe hit. medicare overall, hospice care, hospital care, nursing home care, home health, all of them are taking pretty severe cuts. you know, those cuts are going to come from someplace. and most like hreurbgs those cuts are going to come, if the government doesn't rescue those cuts in the future, those cuts are going to come from benefits to seniors. if the government decides to not have those cuts in the future,

then the deficit's going to go up. you can't have it both ways. you can't have a -- quote -- "deficit-neutral bill" and not have the cuts in medicare. in other words, you're going to either have the cuts in medicare or you're going to have the deficits ballooning into the future. there are several other problems with the bill. i just want to make a couple other general points about this bill. first of all, we know it's over 2,000 pages. incredibly complexion language -- complex language in that over 2,000 pages. it places bureaucrats all along the line? charge of health decisions instead of a patient-centered health care system that says the doctor-patient relationship is where most of the health care choices should be made. as a matter of fact, in this bill, according to the national center for policy analysis, almost 1,700 places it authorizes the secretary of

health and human services to make -- and i quote -- "to create, determine and to find things in this bill with regard to health care policy." 1,619 times to be exact. the secretary of health and human services basically provides health care policy. bureaucrats in washington, d.c. you mentioned before there was about $500 billion in new taxes, $500 billion in medicare cuts. we know this will lead to americans having their premiums increased. we talked about what's wrong with the bill, and many on this side of the aisle have offered positive solutions. we've tpaubgd about let's allow small businesses to join together to take advantage of purchasing power that big businesses have. we talked about let's allow people to buy insurance across state lines. some states, it's cheaper than others. you can buy your auto insurance

across state lines. why shouldn't we be able to buy our health insurance across state lines? mr. crapo: if i can interrupt there, my understanding is when the republican bill in the house which had those ideas in it was evaluated by experts taos what it would do -- as to what it would do to the cost of health care and health insurance premiums. those ideas would reduce health care presumes by 5% or 6% or 8%. i don't remember the exact number. the point is those ideas would hit the reasons americans would want health care reform, that is reduce the cost of health care coverage. mr. ensign: the number-one problem with health care in the united states is not quality. we have the finest quality by almost any measure, the finest quality health care system in the entire world. it's just too expensive. so we should be going after cost. this bill doesn't do it. it actually raises premiums for tens of millions of americans. that isn't the direction that we should be going. another place that we all, the vast majority of people on this side have supported is medical

liability reform. the c.b.o. has said between -- once again in the finance committee, we asked the question, i personally asked the question of the c.b.o. director, how much money would the medical liability reform, the common one that i've offered, that senator hatch has offered, how much would that save between the public, between the government and the private sector? he said over $100 billion. you know, that's not chump change. that's a significant amount of money, $100 billion. adding that to buying across state lines, adding that to small business health plans, incentivizing healthy behaviors, i think we can all agree we should eliminate preexisting conditions. i think that's republicans, democrats, everybody agrees. if you've had insurance, you play by the rules, you get a stkaoerbgs we should eliminate preexisting conditions. we shouldn't allow insurance companies to jack up rates. but we should take a step-by-step incremental

approach to health care reform instead of gutting medicare, as you have talked about up here, to create a new government entitlement program. that's what we're saying on this side, and it seems to be falling on deaf ears on the other side of the aisle. mr. crapo: i know my colleague from mississippi wants to make a comment. may i ask how much time is remaining for our side? the presiding officer: 7 1/2 minutes. mr. wicker: if i can take one minute of that time and then the gentleman can wrap it up. i want to emphasize what a devastating effect these medicare cuts are going to have on rural america. once again i want to quote some of my colleagues from the other end of the building because it shows the bipartisan opposition that we have against these cuts from rural america. mike ross, a democrat from arkansas, said "with more than $400 billion in cuts to medicare, it could force many of our rural hospitals to close." this is a democrat. "providing less access and care for our senior citizens."

representative larry castle of north carolina, "from the day i announced my candidacy for this office, i promised to protect medicare." he voted no on the bill in the house of representatives. ike skeleton said proposed reductions to medicare to further squeeze the budgets of our our rural health care providers. tpoupblly -- finally representative boucher, a senior representative from virginia said the plan could place at risk the survival of our region's hospitals. unless these medicare changes are taken out of the bill, this bill devastates health care for senior citizens in rural america, and i thank my colleague for yielding me the time. mr. crapo: thank you very much. i'd like to just use the remainder of our time to speak for a minute about what do the costs -- what does this bill do to different costs in our country. i think the point that we've made in this colloquy at this

point is that after the votes that we just took, let no one be confused, the $464 billion of cuts to medicare remain in the bill. but let's talk about the question of the cost curve. there's been a lot of talk about what we have heard to become known as the cost curve, and it's been said by everybody that we need to bend the cost curve down. some are saying that this bill bends the cost curve down. well, which cost curve are they talking about? are they talking about the size of government, the growth of government? no. if you take the first full ten years of the growth of spending in this bill, which, by the way, is delayed for four years, if you start, when the spending really starts and take the first full year, ten years of spending, the new spending, the growth of government is about $2.5 trillion. i don't see how anybody can say that that kofpt curve is bent --

that cost curve is bent down. it is skyrocketed up. would it be the cost of health care which i think the cost that americans are thinking about. health care insurance and the quality of health care that's provided. c.b.o. just came out with its report that apbldzed that issued -- analyzed that issue and there are a number of independent groups that analyzed it. they all pretty much say it's not going to reduce the cost of health insurance. it's not going to reduce the cost of health care. for the neediest in america, those in the individual market, it will drive the cost of their insurance up and not by just a little bit. by around 10% to 13%. and for those in the small group area, it will drive theirs up not as much, by about 1% to 3%. and for those in the large-group area, there's a possibility that theirs might taper off a little bit. the estimate is somewhere between zero impact and 2% reduction. is that what we're talking about in reduction, 30% of the people in this country seeing their

health care insurance costs go up and the rest seeing them remain basically stable? that's not the cost curve reduction that i thought americans were talking about in health care reform. so then what other cost curve could they be talking about? well, there's a lot of talk about the deficit. and sometimes they try to shift away from the cost of health care to the cost of the bill to the federal -- to the people in america. and they say that the deficit is reduced. well, how can you say that? there's only one way you can say that, and that is if you accept the budget gimmicks in the bill, if you raise taxes by over, around $500 billion, and if you cut medicare by $464, then you can say this massive expansion of government is somehow covered and that the deficit won't grow. well, i think we've talked about the medicare cuts part of this. we're going to talk about the tax increases, which are

hundreds of billions of dollars of new taxes in the future. but what i did i mean when i said you can only say the deficit goes down if you accept the budget gimmicks? this bill starts the collection of revenues and the cuts out at the front end, but doesn't start the spending for four years. so you have ten years in the ten-year window that you're looking at. you have ten years of revenue and six years basically of spending. and, sure, if you only count six years of the spending side of the bill against ten years of its collection side, you're going to be able to make that deficit look a little better. in addition, there are major expenditures that we all know are going to have to be done in health care, like the s.g.r. fix for physician compensation in medicare that are not even in the bill. an expense that we know over ten years is around $200 billion to $250 billion of extra dollars, simply not there, not counted.

if you want to show a deficit reduction, you certainly want to leave out of your bill a lot of the spending that you're going to do in the future. it's gimmicks like these, it's tax increases, and it's medicare cuts that allows one to say that the deficit goes down. the reality, again, in conclusion haoerbgs is that this bill -- in conclusion here, is that this bill will increase the growth of government by $2.5 tpr-l for -- for a full ten-year medicare, cut medicare by hundreds of billions of dollars, create a federal insurance company, create massive federal controls over the health care economy, push the neediest of the uninsured not into an insurance policy but into a failing medicare system and push an unfunded mandate of tens of billions of dollars on to our states. mr. president, that's not the kind of health care reform we need. and as my colleague from nevada indicated, there are reforms that do make a difference, that

will reduce the cost of health care, that will cut down the cost of -- the spiraling costs of health care insurance and will not require us to have such an intrusion of the federal government into the management of our economy. it's time for us to slow down and start step by step to address the kinds of reforms that will reduce the cost of insurance and the cost of health care and that will help us to increase access to quality care in america. we can do it, and we have a number of very good ideas on the table that we will be exploring in greater detail in future days as well that will help us to do it. and with that, madam president, i reserve the balance of our time. may i ask how much time does remain? the presiding officer: the minority has no time left. mr. crapo: thank you, madam.

mr. baucus: madam president? the presiding officer: the senator from montana. mr. baucus: madam president, i think it would be instructive to stop all this rhetorical talking past each other on medicare advantage, but explain a little bit how we got to where we are in this legislation. i don't know the exact year, but i think it was back in the 1980's sometime up to a certain point, medicare was basically paid fees for services. that's the basic medicare model. whatever the service that's provided, there's certain set rates for that service. then in the 1980's, private companies thought that maybe they could be more efficient as private insurance companies. so they came to congress and

said, we can do a better job in compensating medicare based on fee-for-service. so let's set up something called medicare advantage, private entities. and so congress thought, okay, competition. that's a good thing. so we -- congress did that. and basically set the rates to be paid to medicare advantage plans at 95% fee-for-service. after all, the planners said they could do it more cheaply. they could cheat and so we said -- they could compete, and so we said, okay, that's a good idea. we'll pay you 95% of what would otherwise be paid under fee-for-service. well, that continued for a while. then in 1997, the plan said, gee, we knead a little bit more money. and so congress -- we need a little bit more money. and so congress said, well, all right. that's 19 -9d 7. congress gave them a little

biforbitmore money. objection, we'll pay the 95 -- okay, we'll pay the 95%. if you're mott making money on 95%. we'll set kind of a higher floor according to certain areas of the country. and you can choose whatever enables to you have the greatest compensation. the big change occurred in 2003 in the medicare modernization act otherwise known as the drug bill, the legislation that created the drug benefits for seniors. as we all know, you know, frankly, when medicare was created, we didn't have a drug benefit because drugs weren't comparatively as important as they are today. today there are miracle drugs and they help in lots of ways. so we create add drug benefit back in 2003. well, we did something else in 2003. by "we" i mean congress.

many members of congress were concerned that medicare advantage might not offer their plans in rural port rural parts. wouldn't be enough incentive for medicare plans to go to rural parts of america. so congress frankly gave a lot of money to medicare advantage plans, so there could be at least two plans operating in all parts of the country, give enough money and they'll go. that was the theory. well, guess what happened? we give them a lot of money, and they went. and so the point now -- we've reached the point now where medicare advantage is, by everyone's estimate, quite dramatically overpaid. i asked the senator from oklahoma, senator coburn, yesterday are medicare advantage plans overpaid? he said, yes, they are.

they're definitely overpaid. and in fact medpac, which advises us on medicare reimbursement, has said to us and the congress the last several years, we're way -- we're way overpaying them, the medicare advantage plans. i hear figures between 14% and 18% overpayment. depends on which part of the country -- let's be conservative and say 14%. we're paying them 14% more per average than fee-for-service and they're overpaid. medpac is an independent advisory group that helps us in the congress try to figure out what in the world we are going to pay hospitals, what in the world we're going to pay nursing homes, home health, so forth. we're not the experts. we need some help here. congress, you're overpaying them big time. so we decided, well, let's figure out a way that reforms the system. how about a little competition? right now medicare advantage plans are paid -- certain -- the

fancy term is "obam "benchmark." we all know that fee-for-service is much less in rural america. i'm sure in the senator's home state and other high plains northern states and fee-for-service is much higher, much higher, i think twice as high, maybe more than that in some other states, in more urban southern states and so forth. so as it turned out, when the benchmarks were tied to fee-for-service, they're way overpaid in states where fee-for-service was so high. they're not quite as much overpaid in areas of the country where fee-for-service is so low. they just have a nutty system, frankly. that nutty system is current law today. so what are we doing in this legislation? basically we're saying, look, let's introduce a little competition. and we're saying, lealt -- let't

rid of this benchmark type of service. we won't have fee-for-service anymore. what are we going to do? we'll -- in the country there are geographic areas. in your geographic area, where ever it might be, uncle sam -- medicare will pay the average competitive bid for that area, your average cost, the average cost that you bid for that area, that's what we're going to pay, which eliminates this big disparity between some states and others, makes it much more fair so that reimbursement is based much more on what it actually costs in a certain area, on average, but will be competitively bid. that's what we're trying to do here. is that a good thing to do? i think most of us think so. is it perfect? don't know for sure. but we're just trying our best to make this a better system, a

better program than we currently have. and as a consequence, we're going to save some money. we're -- let a going to a little competition here -- there's going to be a little competition here. i think most of us think competition -- you know, often a pretty good thing. and that's -- i just want to remind my colleagues that that's what this is, and as consequence, we're not going to be overpaying medicare advantage plans anymore. the amount we've reduced the payment to is in line with what medpac says we should pay, the medicare advisory commission. we're trying to be reasonable, trying to be reasonable with taxpayers' money, with seniors' money, you pay into medicare. the point is often made here, oh, gee, this is going to hurt medicare advantage, this is going to hurt hospitals and so on and so forth. i think it is worth reminding all of us here of that meeting that occurred in the white house not too long ago. i think it was maybe four, five,

six months ago, whenever it was, when all the so-called providers, the hospitals and big insurance companies, including medicare advantage plan, they all came together with the president and said, mr. president, we agree in this country needs health care reform. reagree, we all said. -- we agree, we all said. let's move back in history a little bit. back when president clinton attempted health care reform, all the groups opposed. this time they're priche prettyn favor. they know if we don't fix it, this thing is just going to collapse. well, back at that meet ago few months ago, what did they say? they said, we've all gotten together here and we think that we can contribute -- we can cut collectively $2 trillion in payments that go to us over the next ten years, $2 trillion. that's what they said. that's pretty interesting, thank you very much. so we -- working together on health care reform reform --

why do you think they'd agree to $2 trillion? because they -- they got their calculators out, they got their financial officers together, and they said, well, gee, if everybody has health care -- remember, 46 million americans don't have health care -- i mean, insurance, don't have health insurance, if everybody has health insurance -- hospitals, medicare advantage plans -- hey, we could make some money here because everybody has health insurance. so that was the deal. a we'll lower margins -- we'll lower margins, make it up on involvement that's why the president said, we could cut $2 trillion out of it. so what did we do in this legislation? did we reduce the rate of increase over 10 years by $2 trillion? no. did we decrease the rate of increase in expenditures to them by half of that, $1 trillion? no. do we reduce it by the rate of

increase of health care expenditures down to, say, $450 billion, close to $500 billion? yeah, that's what we did. about one quarter of what the industry has said they could voluntarily contribute. are they squawking today? no. they're not squawking today. why? because they got a pretty good deal. and they know that they can continue to provide services. the hospitals are going to do pretty well, home health care is going to do well. i might add, madam president, that the profit margin for home health agencies is about 17%. that's pretty good. so we're cutting them a little bit. profit margin for nursing homes -- medicare payments for nursing homes -- is about 15%. so we're cutting that a little bit. but they're still making money. they're still going to do well. in fact, the average rate of growth over the next ten years for all the providers is going to be excess of 5% a year. wall street aifnlgts say, hey,

they're -- wall street aifnlgts say, hey, they're doing pretty well. you don't see their stocks going down. what we're trying to do is just reform medicare advantage -- the form i just outlined is a pretty fair amendment at reform and also reduce the payments to hospitals and other providers in an amount that they can -- not live with, an amount they're not happy with but an amount that they're okay with, because they know they can make money. what does that do? that extends the solvency of the medicare trust fund for another five years. so i hear all these senators crying crocodile tears, how seniors are going to get cut and this and that and so forth. but frankly, the changes we made i think are very fair. they're going to extend the solvency of the trust fund. not one dime of guaranteed medicare benefits are going to

be cut, not one thin dime in this legislation. it is true that because medicare advantage is being -- the rate of growth of increase in medicare advantage plans is trimmed back a little bit, that perhaps there will not be as many extra benefits -- not the guaranteed benefits, but extra benefits, the fringe benefits, the extras, like gym memberships and things like that might be trimmed a little bit. but that's not because that's a decision made by medicare or a decision made by congress. that's a decision made by the executive officers of these private companies. i'm not saying they should do this. but they could trim salaries. they could trim overhead. they could have a little bit less returned to their stockholders. they could cut down their administrative costs. there are various things they could do. doesn't have to be passed on to a reduction in fringes, a reduction in gym memberships and so forth.

so let's keep nings in perspective here -- so let's keep things in perspective of what's actually going on. i'd love to yield to my -- mr. dodd: i really appreciate what the senator from montana has just done, because this is an area where i think there's a lot of confusion, a lot of misunderstanding. a lot of it begins, madam president, with just the branding, just the title of something. and i -- this was -- in fact, it was a revelation to me a couple of weeks ago. i heard the words "medicare advantage," i assumed this was part of the regular medicare program because it's got the title "medicare. ." mr. baucus: i think most people did. mr. dodd: so would my colleague correct me. this is really not -- this is not traditional medicare we're talking about? mr. baucus: to be totally fair all the way around here, the other side likes to trot out this medicare pamphlet that basically includes medicare advantage. i think that's misleading. it is not accurate. the what the senator says is

totally -- what the senator says is totally accurate. these are private plans. mr. dodd: and the incentive in going back -- in looking back a few years ago ago, that the original reason -- and i don't recall the debate as well as my colleague does -- from montana shall the chairman odoes, the ce finance committee. i think it deserves being repeated. this was a way of reducing expenditures in a sense. that we were sold this idea on the fact that we could do this better, more efficiently and far less costly. mr. baucus: absolutely. that was the rationale. mr. dodd: that's why we all supported this concept and idea to try this idea. and of course a couple of things have happened since then. and that is, one, the overpayments on average i think are around 14%. i guess that would fruct wait. mr. baucus: it depends on the part of the country. mr. dodd: but 14% more overpayments. is it also true -- am i wrong on this -- that roughly 80% of

medicare beneficiaries don't get any of these benefits? mr. baucus: right. mr. dodd: and that the average medicare couple, if you will, over the age of 65 are paying, i'm told, about $90 a year more in medicare payments for benefits they don't get -- mr. baucus: comeact. mr. dodd: s -- mr. baucus: exactly. mr. dodd: so here we have the medicare beneficiaries paying more for benefits they're not getting for a program that confidents 14% more and it is a private plan. mr. baucus: with quite considerable administrative costs and profits that otherwise could go to seniors. mr. dodd: now, your bill, our bill here does something that i think our friend from oklahoma, senator coburn has pointed out, that is absolutely critical -- competitive bidding. that did not include in the original. how did these rates get set, did congress set them? mr. baucus: congress did. congress set the benchmarks.

mr. dodd: yeah. and under -- that if you actually now, as i'm told, that -- isn't it true that if these medicare advantage plans come in under the bench mark bid, they actually get a piece of the savings? mr. baucus: that's correct. mr. dodd: is that correct as well? mr. baucus: that's correct. mr. dodd: ask and so there's an incentive to trim costs in all of this from an administrative -- the cost of the administration of the program. isn't it also true the plans get bonus payments for care coordination and quality and plans can use these bonuses to improve benefits? mr. baucus: that's correct, under this legislation, let's say -- okay. now, in earlier medicare advantage plans, h.m.o.'s had some coordinated care but the other half, you know, private fee-for-service, preferred provider organizations, et cetera, did not have coordinated care and we're saying in the legislation here that if you're a medicare advantage plan -- which includes all those -- and you provide coordinated care, that we're going to give you i bump, we're going to give you a

bonus. a senator: would the senator yield for a question? the presiding officer: the senator from mississippiment a senator: i realize we don't have much time. i just have a quick question because i was listening to the debate on television and i understood the gentleman to say that medicare advantage is not a part of medicare. mr. wicker: and my question is, i have here the medicare handbook for 2010, medicare and you, and it says right on page 50, "medicare advantage plans part-c, and medicare advantage plan is another health care coverage choice you may have as a part of medicare." so my question to the gentlemen, to my friends on the other side of the aisle is: is the medicare handbook inaccurate? and, if so, will you be calling c.m.s. and medicare and asking them to be -- to change what they say explicitly on page 50 of the medicare handbook? mr. baucus: that's a very interesting question because when i was told about the medicare handbook, that's exactly what i was going to do, call up medicare and say hey,

that's misleague because it's inaccurate. and because it is misleading, it is inaccurate. these are private companies and it is not part of medicare. mr. dodd: it's a private -- mr. wicker: even though they put it in their handbook, had it for several years, that's wrong, it's not part of medicare? mr. dodd dodd: that's wrong. it's a private health care plan. it's a private health care plan. medicare is a public plan. medicare advantage is not medicare and it's certainly not an advantage given the overpayments that have occurred. mr. wicker: isn't it in part-c of the medicare legislation? mr. dodd: benefit plan. it's a -- my colleague understands that, i hope. medicare advantage is a private plan. you know that, of course, don't you? i assume you know that. mr. wicker: i know this. it's in the handbook. i want my two friends from the majority party to get it out of there, because we've thought all along it's part of medicare. and the -- the millions of senior citizens who rely on this and who were told in the

campaign, if they're satisfied with their coverage, they don't have a thing to worry about, they're going to be able to keep their coverage. under the democratic legislati legislation, they would not be be allowed to keep their coverage under this bill. mr. dodd dodd: if i could reclay time. 80% of our older americans are paying $90 more a month for th this. do they have any say at this at all? they don't get any of the about benefits. why are they writing a check for $90 a year to pay for a private plan where they get no benefits? why not them? don't they deserve something in all of this? mr. wicker: the question i had was, was it part of medicare? and i realize my friends have a difference of opinion. but the authorities for medicare who put this publication out year after year after year say that medicare advantage is part of medicare. it's part-c. and i just think it's disingenuous for my friends to say it's not part of medicare. mr. dodd: the only way is it's subsidized. this plan gets subsidized by the american taxpayer. that's the only qualification that puts it under a medicare

umbrella, if you want. that's the only thing it does. because our taxpayers are writing a check to it, to a private k. that's why it gets included as part of medicare. other than that, it is a private plan. mr. baucus: it really is a symantec question. it's -- but -- when you look to see the operational effects and the operational effects is, as my good friend -- mr. wicker: well, one other question. is it a symantec question to ask, are the -- semen particular questiothe sym, are the american seniors who are currently enjoying a medicare advantage program going to be taken out of this? and the answer is yes, in this billment mr. baucus: it expressly states there will be no reduction in what's called guaranteed benefits under medicare. mr. baucus: no reduction. whether that's under medicare advantage, whether it's under fee-for-service, whatever it is. no reduction whatsoever. now, to be fair to my good friend, i used the words "guaranteed benefits," and guaranteed benefits are the usual benefits that seniors

think of when they're under medicare, when they go to the doctor, hospital, and so on and so forth. now, we've given, unfortunately, so many additional dollars to these so-called medicare advantage plans, way above what they should have received. medpac agrees, senator coburn totally agrees, they just pay way too much. they've taken advantage of that advantage by giving additional benefits in addition to the guaranteed benefits and those additionals are things like gym memberships. i haven't got the long list but there's a lot of extra stuff that, frankly, is -- is not really part of medicare. it is not directly related to health, and i might say, too, i've said a couple three times -- i'll say it again -- that the reduction in the increase in payments to medicare advantage, the effect of those reductions is really a decision made by the officers of that company. they can take those reductions and apply them anywhere.

they can reduce their salaries. they can reduce their admin costs. they can take other actions which reduce the rate of -- rate of -- growth of -- rate of return to their stockholders. they don't have to take it out of beneficiaries. that's their choice. they don't have to. mr. dodd: medicare advantage, they decide how to use their extra payments to provide benefits. they decide. congress doesn't. there's nothing in the legislation that forces plans to reduce benefits at all. rather than reducing profits. in fact, medicare advantage -- many of you may not know this -- is one of the most profitable business lines of the private insurers. in fact, "the new york times" on november 2, just about a month ago, reported -- and i quote them -- "hugh man ago, in the health insurer, posted on monday a 65% jump in third-quarter profits." we're talking about a private health care. these are profits. 65% profits. off this plan. has a bulging membership and premiums overcame a lackluster

commercial segment." and look, again, i appreciate the fact that people are getting eyeglasses and things, that's wonderful. but we need to be clear about this. this is not -- these are not the gash teed benefits. -- guaranteed benefits. and 80% of medicare beneficiaries gets get none of these advantages and yet pay more. so there's other people under this private health care plan here because it's subsidized by the american taxpayer get them. so again, now we're going to put competitive bidding in place. our bill allows under these plans here for these -- if they follow and do some of the incentives here to actually share in some of the profits in all of this. so we're not talking about even eliminating all of. this we're trying to make it work better for people under the bill. but we've got to stop -- we've got to be honest about what we're talking about here. this is a private insurance program that's subsidized by the american taxpayer. it's not what traditionally people think of as medicare. mr. wicker: will the senator yield further? mr. dodd: i would be happy to yield. mr. wicker: the chairman, what n he's calling h.h.s. to get the

handbook changed, also needs to tell them to get their web site changed where it also says medicare advantage is part of medicare. but can the senator from connecticut guarantee that under this legislation the benefits to medicare advantage recipients will not be cut? can he make this guarantee? mr. dodd: what i want to say and i want to ask my colleagues -- mr. wickerer: he can't make this guarantee as it's got to come out of benefits. mr. dodd: i reclaim my time. guaranteed benefits -- there is not a single guaranteed benefit under medicare that is cut in this bill. not one. and i defy any member of this body to identify a guaranteed benefit under medicare that gets cut. they can't find one. now, do we cut out gym memberships, things like that? yeah, that may happen. but under guaranteed benefits, the operative word is "guaranteed," and under guaranteed benefits, there is not a sipping he will cut to benefits that. -- not a single cut to benefits. that is why an organization representing 40 million americans who endorsed the bush prescription drug plan, by the way, in 2003 -- hardly a

partisan organization, as some have suggested today -- has basically opposed the mccain amendment and has endorsed the legislation that's before us here today. that organization, i say to my good friend, that organization would never be endorsing a bill here that was going to cut guaranteed benefits under medicare. mr. baucus: i want to say something else to put this in a little bit of perspective, and that is according to an analysis of medicare advantage plans from oppenheimer capital fund -- this is dated november 12 of this year -- between 2006-2009, their estimate is that medicare advantage accounted for nearly 75% of the increase in gross profits among the larger medicare plans in the industry. and let me say this. that medicare advantage has been a huge -- this is quoting from the oppenheimer fund -- "a huge driver of earnings growth for the industry in recent years. between 2006 and 2009 we

estimate that medicare advantage accounted for nearly 75% of the increase in gross profits among the larger plans. the industry highlighted by an estimated gross profit increase of $1. billion in 2009 relative to commercial risk -- $1.9 billion in 2009 relative to commercial risk gains" -- that is basic insurance, health insurance, not medicare advantage plans, but basic health insurance - -- "of nearly $600 million. medicare advantage won't be as much of a contributor in 2009 but it's going to be a very large contributor in 2009." because of the advantages that they get. mr. wicker: it's clear that the gentleman doesn't like medicare advantage. it's also clear that no guarantee can be made that medicare advantage benefits will not be cut under this legislation. and it's also clear that there are tens and tens of millions of american senior citizens who like their medicare advantage notwithstanding the opinion of the senator from montana and

they stand to lose those benefits under this legislation. mr. dodd: now, again, one of the things we haven't talked about, i say to our friend from mississippi, under our legislation, this bill protects seniors in medicare advantage from plans that care more about profits than seniors in in trying to pass the buck. under our bill here, it allows the secretary of health and human services to kick out any plan under medicare advantage that significantly increases their premiums or decreases their benefits. that would not -- under existing law would not happen. under our bill, it does. so it's not about being hostile to medicare advantage. just being realistic about all of this and trying to make the tough decisions we have to make about trying to stabilize medicare, seeing to it that we're going to have the kind of protections in premium reductions and cost savings as well as increasing access and quality. and so all we're trying to point out is that when you have a medicare advantage plan that has run as poorly as this one has, at great cost, that we've now learned -- 14% above on average,

in some places it's 50% above, by the way, i would say to my friend from mississippi -- and a program that is run by -- it's a private health care plan that receives subsidies from the american taxpayer, where 80% of seniors today pay more and get nothing for it. now, you know, where's the equities in this? you know? there's no equity in this. why should 80% of that population pay $90 a year more on average for a benefit they don't get? where's the equity? mr. baucus: i might add, too, frankly, to my -- and remind us all here that this legislation provides additional benefits for everybody, all seniors, including medicare advantage plans -- recipients, additional benefits. it's no -- what are they? there's no co-payment for certain preventive care, mammograms, for example, and colonoscopies, and also screening benefits that otherwise would -- are not in existence today, and there's a whole host of others that are additional. this legislation provides additional benefits to medicare advantage members that are not

there today. and when i say "guaranteed benefits," i'm talking about t the -- the usual benefits that seniors think of under medicare. it's, you know, it's all -- it's hospital care, it's nurses, it's all medically necessary physician cares, diagnostic testing and supplies, it's home health care, it's preventive care, skilled nursing, it's hospice, you know, all the things that are just -- is basically related to health ca care. the only thing that might be trimmed back a little bit -- oh, i call them the fringe stuff, the excesses of, like, gym memberships. i wish i had the whole list but some of them are really -- they're not related. and as i said earlier, they may not be cut, don't have to be, it's up to the executive of th the -- of the -- of the private company as to whether they're cut or not. i have nothing against companies making profits. they should make profits. but it's our responsibility as senators to make sure that the reimbursement rates that

medicare pays to providers are fair and reasonable and not excessive. and we've been told they're excessive so we're just trying to find a way to make it fair. mr. wicker: this segment of debate will end at the bottom of the hour so it's almost over. i appreciate my friends yielding. this debate will continue for weeks and days. i would say to my friends, there are members on their side of the aisle who have come before this body and said these medicare advantage cuts are unacceptable and i think they're going to have a lot of convincing to and democratic members of the house have also come forward. so i'm not convinced. the presiding officer: all time has expired. the senate -- the senate -- without objection. mr. dodd: let me say to my colleague again, and i note, but here you have two organizations

representing 43 million seniors in our country. these are organizations that don't just write letters on the fly. they have staffs that examine proposals here, that's all they do. and when aarp, which is an organization highly regarded and well recognized representing 40 million seniors in the country and they commission to social security an medicare, and that's all they do. totally nonpartisan. representing almost 15 million of our seniors have examined in detail this bill, every dotted i, every semi-colon, every proposal and exhaustive research and said this is a good bill. it is deserving of support. we received a letter from them. they're not democrats. they're not republicans much they're not trying to get advantage over anybody. they're examining if this bill stablizes medicare, going to see

to it that we're going to extend the life of the program and provide guaranteed benefits, their answer is a resounding yes. yes, this bill is deserving our of support. now, again, i appreciate the debate -- the political debate here, but at some point we have to step back and listen to those whose job it is to analyze our suggestions and our ideas. just as aarp support president bush six years ago with his prescription drug bill. they didn't join democrats or republicans. they liked the idea. still do and supported it. today they're not supporting us as democrats. they would reject this bill out of hand if they thought we did something adverse to the interest of their membership. but they've said, no, this is a good bill. deserving of support. the two largest organizations in this country representing seniors who said, get behind this bill. let's support our seniors. let's make medicare stronger and strengthen it and this bill does it and that's why we ought to be joining together here. not fighting each other over this. medicare advantage is a private

health care plan, subsidized by the american taxpayer. 80% of seniors don't get the advantage. that's why we're creating the changes in this bill. i applaud my colleague from montana who did an incredible work in producing this product. the presiding officer: the senate stands in recess

>> american icons, three original documentaries from c-span now available on dvd. a unique journey through the iconic columns of the three branches of american government. see the exquisite detail of the supreme court through the eyes of the justices. go beyond the velvet ropes of public tours into those rarely seen spaces at the white house. america's most famous home and explore the history, arts, and architecture of the capital. one of america's most symbolic structures. american icons, a three disc dvd set. it's $24.95 plus shipping and handling. order online at c-span.org/store. >> new hampshire senator judge craig in a letter this week to republicans recommending how to slow health care. they discuss the communication today on the senate floor for about ten minutes. >> madam president, this is the

fourth on this bill and we are only late this morning coming to our first vote. even for the united states senate, this is a slow pace. i note that some have made plans for delaying this bill even in a more extreme fashion. and that's duly noted earlier today, on tuesday when senator circulated a list of delaying tactics available under the senate rules. i presume that all senators know the senate rules already. so i extend that letter to me i think leaves the impression that senator would like to urge senators to use some of those delaying tactics stated in that memo. but i urge a more cooperative force. out of courtesy to other senators who desire to offer amendments, i urge my colleagues to allow us to reach unanimous

consent agreement, to order the voting of future amendments in a more timely fashion. that simply the only way that we can ensure that more colleagues will have the time and opportunity to offer debate on their amendments. and i think all senators. madam president, i have a couple of unanimous request. first, i would like to ask senator harkin or stacey sacks sacks -- consent that stacey sacks of the health care committee and majority help authors be granted the duration of the private 90 tatian act. >> without objection. >> and one more to ask consent that the order of december 2 be modified to delete all afterward cable. >> without objection. >> i now ask consent that the

time at 2:45 p.m. this afternoon be devised as follows in the order listed. the first 17.5 minutes under the control of senator mccain for his designee. the next 70 minutes under the control of senator baucus for his designee. and the final ten minutes, five minutes each to senator mccain and senator dennis from colorado. >> without objection. >> thank you. >> senator from iowa. >> are the majority leader and his comments this morning say that one of the reasons they're kind of slow in this bill down and having all this debate is because i quote his words, a strictly partisan venture that far. well i beg to differ, mr. minority leader. and i share distinguished ranking member of our health committee here on the floor and the health committee and the health committee, let me just again in the light of presenters we have 13 days of markup, 54

hours, 788 amendments were filed, 287 amendments were considered, debated, and voted on or accept it. 161 republican amendments were adopted. 161 republican amendments were adopted. no one was denied the opportunity to offer any amendments to discuss and debate it and get it to vote or get accepted, whatever the case might be. to me this is truly a bipartisan way of proceeding. now, it seems to me that the minority leader, his arguments basically goes to the fact that the people of this country overwhelmingly elected democrats to guide and make changes for the future. and one of the biggest changes is in our health care system. and so one of the responsibilities of being a geordie party is to poke holes, that's what we've done. we are proposing changes in the

health care system in america. it seems to me the function of the minority is to offer amendments, constructive amendments, offer different ideas, and if their ideas are better or just the majority than the bill is best changed. and that's happened in our health committee as i said 161 republican amendments were adopted. to me that is bipartisan. and that's what we've been doing. what is kind of not acceptable is this idea that things are just going to slow down for the purposes of delaying and eventually making sure that we don't have a bill. well, let me just say that after all that lengthy debates we had in the health committee, we passed a bill. the same will happen here on the senate floor. i don't care how many times the minority wants to drag it out and slow it down and tried to kill this bill. this bill will pass the united states senate, will go to a

conference and not on the presidents desk early next year. >> madam president. >> senator from wyoming. >> some from yesterday and some that have just been made. on a partisan bill, i would draw those days of health committee. that bill was put together. senator kennedy was not able to be involved in that part of it. his staff did it. they did it in a hurry. we turned in 161 amendments that were accepted. most of those were with typos. and minor corrections. now there were a few of them actually had some substance to them. that bill was passed on june 17th without a single republican vote. it wasn't published. we didn't get to see the final version of that until september 17. and you know what, the ones that were really something that could've made a difference were taken out, without the

permission of any republican senators. that's not bipartisan. we talked about how many hours we spent together. if you don't accept things from the minority party, it's not bipartisan. it is still partisan. just spending hours doesn't make any difference. to move onto a different topic, yesterday we were talking about cost. and i hope that people take a look at a wall street journal article from yesterday that says the bill that raises price or is that lowers costs. we heard all day yesterday that this bill is going to save people a lot of money. well, this article says we've now reached the stage of health care debate when all that matters is getting the bill passed. so while news is good news, more subsidies means lower deficits and lower expensive insurance is really cheaper insurance. the nonpolitical mind reels. consider how washington received the washington budget offices monday on how harry reid's senate bill would affect cost

and not to be seen as a disaster for the bill. cbo found that premiums in the individual market will rise by ten to 13% more than if congress did nothing. family policy is under the status quo are projected to cost $13,100 on average, but under the bill that we're looking at it is jump to $15,200. fabulous news. no big costs rising u.s. premiums seen in the study said "the new york times" while the "washington post" declared senate health care bill gets a boost. the white house said that the cbo report was more good news about what reform will mean for families struggling to keep up with skyrocketing premiums under the broken status quo. iran's chairman baucus chimed in that the health care reform is fundamentally about lowering health care costs, lowering cost is what health care reform is designed to do. lowering costs will achieve the subject is.

except it won't. cbo says it expects employer-sponsored and cost to remain roughly in line with the status quo. yet even this is a failure. by mr. bacchus is in the white house's own standards. meanwhile fixing the old because it does not enjoy the favorable tax treatment given to the job-based coverage was supposed to be whole purpose of reform. instead cbo is confirming that the new coverage mandates will drive premiums higher. the democrats are declaring victory, claiming that these higher insurance prices don't count because they'll be offset by new government subsidies. while about 57% of the people who buy insurance that will supplant these individual markets will qualify for subsidies to cover about two thirds of the total premiums. for the bill will increase cost, but it will and disguise the cost by transferring them to taxpayers and individuals. kobe conjured away because they

are suddenly on the balance sheet. the rebuild 371.9 billion in new health tax is are also apparently not a new cost. because they can be passed on to the consumers are or have been hidden in lost wages. this is a pill you liberal of the root ball distribution and a very long way from the repeated white house claims that the reform is about mending the cost curve. the only thing being bent here is the proof here at mow over, cbo is certainly underestimating the cost increases based on county by county actuarial dancer well pointed out later that mr. bacchus will cause some things to triple in the individual market. i've seen what's going to happen in wyoming. the blue cross blue shield association came to similar conclusions. one is community rating which forces insurers to make rates regardless of health status or habit. cbo doesn't think this has much effect, but costs inevitably

rise in insurers aren't allowed to price based on risk and we have 35 states that give an example on that. at the white house decided to shoot the messengers like well point to avoid rebutting their messages. but amanda at mit, william congdon of the brookings institution and market bring them young have found similar results in a $2 a paper peer-reviewed forum for health economics and policy. these economists on the a community rating lives raise premiums to the individual markets by 20.9%. i asked that the remainder of this editorial be published in the journal. >> without objection. >> i yield the floor. >> you can read the letter from senator gregg to republicans c-span health care hub. also there, the senate and house versions of the health care bill video on demand from the senate floor and debate from the house.

that's at c-span.org/health care. the senate is back for more work on health care at 5:30 eastern teared as always, we'll be live here on c-span 2. the health homeland security could issue subpoenas to the northern virginia couples that made security at the house dinner. after the salami said they would not testify at today's hearing. the committee did hear from mark sullivan. here's a portion of the hearing while the senate is in recess.

[inaudible conversations] >> the committee of homeland security will come to order. the committee is meeting today to receive testimony on the united states secret service and presidential protection and examination of assistance failure. good morning. i want to thank the witnesses for a green to testify here today. some people have asked me why we are having this hearing. let me be clear. this hearing is not about crashing a party at the white house. neither is it about one of the celebrities for reality television. on the contrary, this hearing is about real world threats to the nation. we cannot forget that amid all the uproar the most important

and indisputable fact is that a couple gained unauthorized access to the white house grounds because no one from the secret service prevented them from entering. they remained at the white house because no one from the secret service required them to leave. we are not concerned about agency embarrassment, discomfort, or shame cannot serve as a substitute for performance. the security gaps at issue cannot be explained away as missteps by a few front-line employees. there were undeniable planning and execution failures of the entire secret service apparatus. with security feelings that seem to hang over that evening, we are all fortunate that this

diplomatic celebration did not become a night of horror. there is no doubt that this incident can be an enlightening case study, but it is not enough for us to merely analyze. we must die fact every fact, we must learn the lesson and fix the problem and after we do these things we need to give thanks that no lives were lost. today we've heard -- we will take a hard look at secret service actions and omissions that have been revealed and confirmed by this incident. this nation's response to the terrorism threats at home and abroad demands that we maintain vigilance. the fact that unauthorized persons gained access to the white house complex during an official state dinner mixed and mingled and were photographed with the president, vice

president, and the prime minister of india is about as far from vigilant as one can get. it is simply unacceptable. the american people deserve a full accounting and full accountability and we must be assured that this will never happen again. i look forward to the testimony presented today and i look forward to the actions that should follow. the chair now recognizes the ranking member of the full committee the gentleman from new york, mr. king on opening statements. >> thank you mr. chairman. and the me and the me think you and your staff on the level of cooperation you jump throughout this manner as far as scheduling the hearing, giving us what is going to happen and agreed with my request that desiree rogers because as a witness before this committee. and i agree with you completely, mr. chairman, that we cannot have discomfort or shame to be

reason not to testify and own up to responsibility. it's important as we dissect every fact. i miss a secret service does an outstanding job. obviously mistakes were made here. i commend mr. sullivan for that and conduct an internal investigation and for the level of cooperation is given to me. and i realize you as well of the last several days doing everything on the table and holding nothing back. whatever decisions he makes within the secret service, i'm assured he will do the right thing. mr. chairman, the reality is that a social event of the white house security is a shared responsibility between the secret service and the social secretary. we've gone back to two administrations and we cannot find any instance of any significant event in the white house with a social secretary's office without their stand with the secret service. there is reason for this. one is an event of someone is supposed to be on the list and is not. the social secretary's office can resolve that while the

secret service continues to process other people online. in this instance, for whatever reason the decision was made not to have one person in social secretary's office standing with the secret service that night, not one. this reverses policies of at least two administrations. now, the reason i ask desiree rogers to come here was not in any way to make this event data, not to elect her at all. the same reason we asked mr. sullivan to testify here. because we want to get a complete picture we have to learn from secret service what they did do and didn't do. what the social secretary's office did and didn't do and why they were not there that night. now during the week we had initially the white house and secret service was highly to blame. the roundabouts of last night the assistant chief of the staff at the white house is now going to begin a policy of having someone from the social secretary's office there with the secret service. when he's not saying is that this is the policy that was in effect for lease to previous

administrations. to me the issue is why -- who made the decision, why was the decision made not to have anyone from social secretary's office there that night. i will say and i've no doubt of this at all that someone from the social secretary's office had been there, doing what's been done for lease the previous 16 or 17 years, that couple would not have been allowed into the white house. they would've been stopped. you are not on the initial list. the secret service would've been handed them off to the social secretary's office and they would've resulted. and i know in previous administrations that homes in the social secretary of people there. the people there from the diplomatic office, people from legislative affairs, the one the president's own staff to avoid embarrassing incidents and to make sure that no one got in there that was not supposed to be there. so desiree rogers is not supposed to be here -- at a white house briefing yesterday mr. chairman you received a notice. we certainly didn't.

he said that white house staffers don't testify before congress. that is untrue. i was on the banking committee in 1994 during the whitewater air as when president clinton said george stepanov list, maggie williams, hillary clinton's chief of staff, president's council and also sent at the previous council, senator mark aaron press secretary. all testified before congress and even on this issue when we're talking about the security of the president of the united states a person who made that decision is not going to be here. i think it's wrong and stonewalling and i think it confronts our committee. this is a bipartisan request for the white house which prides itself for being open, which prides itself on cooperation. in this incident they are stonewalling. and for a committee to work with the white house of an element of trust they have breached that trust and i am going to do all he can to work with you to issue subpoenas to have them here. but i also believe we should subpoena desiree rogers. this is not a separation of

powers issue. this is an issue where they -- we're talking about an administrative decision to have equal or not the people sitting with the secret service and to change the policy at least 20 are standing and to me is your chairman this is an incomplete hearing. it is half of the hearing. but getting half the picture from the secret service who is being stonewalled stonewalled by the white house. i yield back. >> thank you very much. the salahi were not on the list. the secretary had a responsibility in this situation. their party planners. they are not security personnel. and i think one of the reasons we brought director sullivan here is to explain the role of the secret service or may security standpoint anticancer a number of these questions as we go forward. other members of the committee are reminded that under the

committee rules opening statements may be submitted for the record. our sole witness is mr. mark sullivan. mr. sullivan was sworn in as the 22nd director of the united states secret service on may 31, 2006. mr. sullivan has been the recipient of numerous awards for superior performance throughout his 26 year tenure with the secret service. including a distinguished presidential rank award in 2005. welcome mr. sullivan. i thank you for being here to debate. without objection the witnesses full statement will be inserted in the record. i am now asking director sullivan to summarize his statement for five minutes. >> thank you, mr. chairman. good morning chairman tom thompson, and other distinguished members of the committee. the secret service is an organization that maintains the

pride in the work it does on behalf of our nation. based on the high standards to which the men and women of this agency hold themselves and in the standards of the nation expects, i regret on tuesday november 24 the established protocols and procedures were t followed here at allowing two individuals entering into the white house. the moment this is brought to my attention on wednesday november november 25, i immediately directed our officer professional responsibility to begin an investigation and review into the events surrounding the previous evening. further, i directed the office of professional or science ability to contact the department of homeland security office of inspector general in order to advise them of our investigations. while the investigation remains ongoing, preliminary findings have determined that established procedures related to entering the white house were not

followed at initial check points. an error in judgment was made. in our line of work, we cannot afford even one mistake. in this particular circumstance, two individuals who should have been prohibited from passing through checkpoints and entering the grounds were allowed to proceed to the magnetometers and other levels of screening you for they were then allowed to enter the white house. although these individuals went through magnetometers and other levels of screening, they're entering into the white house is unacceptable and indefensible. the u.s. secret service relies heavily on the professionalism and training of our men and women to make informed decisions based upon sound judgment. in this case, i fully acknowledge that proper procedures were not followed and

human error occurred in the execution of our duties. this plot has not changed our agency standards, which is to be right 100% of the time. this event does not represent the quality of protection that the dedicated men and women of this agency provides every day. this past year, we processed more than 1.2 million visitors into the white house without incident. in our profession, however, there is no margin for error. i realize many people share our disappointment in this incident. as an agency, we will continue to remain our harshest critic and take the necessary actions to remedy this issue and continually successfully carry out our critical mission. i am