martin -- hartnet. when the mother arrived at the hospital, the doctor broke the water and found it was abnormal. rather than consider a c-section, donna's doctor tried to administer a trug to induce contractions, donna had not delivered after six hours, but the fetal monitor indicated that he was in severe fetal distress. the doctor performed a c-section, but waited an hour before she was taken to operating room. during that time the doctor failed to take immediate steps to help martin breathe. after he was born, he was in intensive care for three weeks. they later learned that martin had substantial brain damage and cerebral palsy, a direct result of the doctor not responding to the oxygen deprivation.

donna's doctor told her not to have anymore children because he said there's a serious problem with her d.n.a., which could result in similar disabilities in the future. well, that turned out not toob true. done -- to be true. donna has given birth to three perfecty healthy sons shown in the photo as well. donna sued the doctor responsible for martin's driferry and -- delivery and received a settlement in the case. this is a young mother who was told the problem was her problem. it turned out it was a problem in the way she was treated when she went to the hospital. again, the senator from nevada would reduce the likelihood that donna, the mother of this child who is going to face a lifetime of challenges wouldn't have the attorney to come to court for reasonable compensation. these are real-life examples, and i know the other side, the senator from nevada, said specifically, oh, you're going to hear about the victims but this is really about lawyers. these victims wouldn't have

their day in court and wouldn't have a chance to recover for medical malpractice that was eventually admitted or proven if it weren't for an attorney to bring them to court. and it does take a long time. i'll concede. the senator from nevada says it takes a long time on these cases, well, i've been there and i know why. the attorney representing the other side try to drag it out as long as they possibly can, filing motions and requiring discovery that can go on and on. and so an attorney who takes one of these cases up better not take up a frivolous case because it will be a lifetime of futility if you take that approach. i took a look and asked my staff, well, if this ensign amendment, senator ensign's amendment is dealing with victims' attorneys, are they really getting paid a lot more compared to the defense attorneys? well, we went and looked at the information. we found that in recent year, there was $1.3 billion paid to victims' attorneys who filed

medical malpractice cases in america. $1.3 billion. at the same time, $2.1 billion was paid to defense attorneys. so to argue that we just want to reduce the plaintiff or victims' attorneys and fees is to ignore a mitch match already. the defense attorneys in america are being paid substantially more, 50% more, than those who represent the victims. in texas, medical malpractice insurers earn $369 million in premiums. they paid out $17 million in losses. if a third of that, say, $5.5 million, went to victims' attorneys, how much went to defense americans to medical malpractice cases in texas? $41 million. $5.5 million for plaintiffs' attorneys, and $41 million for defense attorneys. this amendment doesn't even address the cost of defense attorneys. in tennessee, $79 million in loss to victims so perhaps

$26 million in victims' attorneys fees. $3 mil million in defense attory fees. there's no similar outrage on the other side of the aisle when it comes to how much money the defense attorneys are being paid. state of mississippi paid out $874,00 4,000 in losses and paid $4.1 million in defense attorneys' fees. so the -- it just goes on and on. the evidence is clear. overwhelmingly in the courtroom, the race goes to the swift, and the swiftest are the ones with the most resources. the most attorneys, the most discovery, the most expert witnesses, and they all cost money. and time and again, plaintiffs' attorneys come into many courtrooms at a distinct disadvantage to the insurance companies that would be benefited by this. now, what are we going to do about this issue? and it is an issue. well, i think the president's on the right track. first, we know it's a state issue when it comes to medical malpractice, historically the

states set the standards. and the states initiate the reforms. and a majority of states have already done that. limiting recoveries, even limiting fees in some cases. they've done it. why would we come in at the federal level and preempt that? secondly, the president has said, let's encourage some positive thinking about ways to end this. how can you reduce the number of medical malpractice lawsuits? there's one simple way and many states have discovered it. it's when a doctor walks in and tosses a patient -- and says to a patient, i made a mistake and i'm sorry. sounds simple, doesn't it? happened in my family recently. one of the members of my family went for a back surgery, had complications afterwards that went on for weeks, and he went in and the doctor said, i'm sorry, when i did your back surgery, i should have catheterized you right then and there rather than waiting through two miserable weeks until we finally did it. it was my mistake. well, my relative didn't file a lawsuit. that doctor was honest. we know doctors are human. they make mistakes.

some states have protected a doctor's right to say "i'm sorry," and many times that's all that's needed. there are other cases of states where they've put together panels to review lawsuits before they're filed. they do it successfully. other cases where they have to file an affidavit from a doctor that says this is a real lawsuit with a real possibility of medical malpractice being proven. all of these things are working and we want to encourage them. please, don't close the door to the courtroom to victims and their attorneys. don't benefit the defense attorneys, the insurance attorneys at the defense of the victims mr. brown: it's my understanding that some states have stricter licensing requirements for doctors. mr. brown: that typically, you know, very few -- very few doctors relatively commit significant repeated mistakes as they're practicing medicine but some small number of doctors are

responsible for the large number of medical errors and negligence and malpractice. how important is that, that the states strengthen their licensing requirements so those doctors who -- the small minority of doctors who really do seem guilty of the most malpractice, so those doctors are disciplined, either lose their licenses or disciplined in other ways so that they're not inflicting this on their patients? mr. durbin: i think the senator from ohio has really put his finger on part of the problem here. it turns out that the vast majority of lawsuits involve a very small percentage of doctors, many of whom are making errors repeatedly. i would recommend to my friend from ohio a book to read -- and i know he reads -- called "complications." it's by dr. galandi, a boston surgeon we're familiar with. and i tread and it was an eye-opener about what a surgeon explernz goes through. but -- learns and goes through. but he spends a whole chapter in

there of doctors and nurses who know of practicing doctors who are not up to skill any more because of age, alcoholism and drug addiction. and they're afraid to speak out. that is not common, it is rare, but it shouldn't happen at all. and those doctors who consistently make mistakes, consistently get sued or have these problems should be identified and removed from the practice until they can be rehabilitated or go off to another job. mr. brown: if the gentleman would yield for a moment again. don't the state licensing boards have the ability to do disciplinary action? i know no my state, in columbus, they do. are they not doing that enough? is there a way to strengthen that? mr. durbin: the point dr. gawandi makes is that there is this conspiracy of silence, this fear of outing a doctor, you know, a senior -- mr. brown brown: they don't wano speak up. mr. durbin: doctors and nurses aren't willing to speak up, other colleagues are not willing to speak up and they should for the sake of their own profession but certainty the sake of the

patients. mr. brown: so you're arguing, senator durbin, that if there was a mechanism that -- an environment where nurses and doctors would be willing to speak up if there was a doctor that -- a surgeon that had a problem with alcohol, that the problem -- this issue would not go away certainly but this issue would be much less serious, the issue of malpractice, the medical errors, the deaths, the injuries that come from some kind of medical error, medical malpractice, would be much alleviated? mr. durbin: i am. and i would see that my time is over. and i would just say -- just thank the senator from ohio and i would say this is one part of the answer. but denying victims a day in court i don't think brings justice to this country or fairness, and i know that senator kennedy would be saying the same thing if he were here today. and i yield the floor. the presiding officer: the senator from wyoming. mr. enzi: the senator from nevada. the presiding officer: the

senator from nevada. mr. ensign: mr. president -- madam president, excuse me. it's a football day. i apologize. probably had that kind of male thinking going on. madam president, there's an urban myth that people like to talk about when they're discussing health care reform. it's like one of those rumors that runs rampant on the internet. nobody knows where it started but you're sure it must be true. the story about canadian health care. you know, everyone there is covered and they have a progressive health care system that we should somehow copy. well, it's time to bust this myth and tell the american people what a government-run health care system like canada would mean for us here in the united states. canada and great brit i object offer what is typically referred to as universal coverage. universal coverage, however, does not mean unlimited access to care or readily available care. let me tell you why. let's talk about spending first. the u.s. spends about 16% of its

gross domestic product on health care while canada only spends about 10%. and i know that some members of this body have been asking, well, if can did can spend less money on health care, why can't we? well, there's a right way to reduce spending with technology, healthier behaviors, common sense, medical liability reform, other things that i've talked about, and there's a wrong way. in canada, the government spends 10% on health care by setting a global budget. when the demand for health care exceeds that amount, the canadian government does not increase funding. instead, medical care is often delayed and/or denied. some estimate that about 750,000 canadians are currently on a waiting list for medical procedures or referrals to specialists. mr. president, can you imagine waiting up to six months for a hip replacement or up to six months for cardiac bypass

surgery? what if you had to way up to four months to get an m.r.i.? people who live in countries that have government-forced health care system on which wait and then wait -- often wait and then wait some more for medical care. these are the typical wait times for -- wait times in canada. in the blue are the median clinically reasonable wait times that you should see. in the red, you see the actual wait times. so this is what they think should be reasonable but the red is what you actually see. and interesting to note here that in every single one of these cases, whether it's cardiovascular surgery that's elective, general surgery, gynecology, internal medicine, neurosurgery, ophthalmology, you go down the list and the wait times -- the actual wait times are always much longer than what a clinically reasonable way time should be in canada.

now, madam president, median clinically reasonable wait time for neurosurgery, for instance, is 5.8 weeks, but as we see here from this chafor chart, the actt time is 31.7 weeks. that's the neurosurgeon. that's this part of the chart here. orthopedic summer, the clinically reasonable wait time is 11 weeks. we see the actual? it's almost 37 weeks. this is hard to fathom. in canada, the wait time depends on many factors. getting in to see doctors depends on the province in which you live, whether you're an urban or rural resident, the urgency of your medical condition, and your age. i want to encourage all americans not to take my word for it on these wait times. you can go to this web site.

ontariowaittimes.com. and it will actually tell you what the wait times are. as a matter of fact, my assistant that's on the floor with me today, she broke her arm several months ago. and it was interesting, she went to this web site to find out how long her wait time would be. well, she needed a procedure done and by the time she would have got in in canada to have the procedure done, her arm would have already healed -- it would have heled indirectly but it would have already healed. that's unacceptable but that's typical of what happens in places where you have government rationing, government setting these global budgets. think about how frustrated you would be if you had to have the wait times that we talked about today. some canadians get tired of this waiting. they leave the cube, catch planes, trains, automobiles to the united states to get the medical care when they need it and where they need it.

the mayo clinic, for example, sees about 2,000 canadian patients each year. the henry ford clinic in michigan saw 191 hospital patients from canada and had about 1,400 outpatient visits from canada last year alone. those numbers have increased steadily over the past three years. in fact, cef knew from canadian patients have increased by -- revenue from canadian patients has increased by $7.5 million for the henry ford clinic in the last seven years. and although these clinics do not track why some canadian patients come to the united states for medical care, i believe the significant wait times in canada are one of the primary reasons that they choose to cross the border. i also believe that canadian patients come to the united states to reap the benefit of america's research and development and to access new breakthroughs in medical technology. many of my colleagues have her the story of shawna holmes.

shawna, a canadian citizen, was experiencing numerous conditions, including headaches, fatigue, and severe vision problems. her primary care doctor in canada ordered an m.r.i. and i results suggested a brain tumor. shawna would have to weight four months to see an oncologist or -- shawna traveled 2,000 miles to go to the mayo clinic in scottsdale, arizona, and paid for the visit herself. she was diagnosed with raftiskclef ciyst. she returned to canada and attempted to have surgery. the canadian government was not able to do the surgery within the six-month time period. since shawna's vision was rapidly declining, waiting six

weeks for surgery was unacceptable. her husband took a second job and took out a second mortgage an borrowed money from family and friends for surgery at the mayo clinic. the mayo clinic recommended a second surgery. she went back to canada and got in line. it took three years to get her second surgery in canada. three years. in written testimony before the house energy and commerce committee, shawna said and i quote -- "if i relied on my own government-run health care system in canada, i would not be sitting before you today. at the very best i would be blind and at the very worst, i would be dead. madam president, shawna isn't the only canadian citizen who has come to the united states for access for timely medical care. a private company called timely medical alternatives was created in 2003 to help canadian citizens obtain medical care in

the united states. over the years the company has sent more than 500 canadians to the united states for timely medical care. richard baker, the founder of timely medical alternatives has said -- this is his quote, "the canada health act is responsible for more pain, more suffering, and more death than any other piece of domestic legislation in canadian history." madam president, i'm concerned that the inclusion of a government-run health plan in the democrats' health reform bill will destroy the american health care system as we know it today. section 1323 of this bill establishes the community health insurance option. don't let them -- the name fool you. it is a government-run plan. states can opt-out of the government-run plan if they enact a law prohibiting the offering of the government-run plan in the exchange. but i honestly expect few states will take this course of action.

and regardless of the language indicating that people won't be forced to par tis nature a public health insurance program, and won't be personalized for not participating, i still believe some individuals will be forced into this government-run plan and i also believe that this is just the first step toward a complete government-run plan. under the bill the secretary of health and human services will be required to negotiate provider reimbursement rates. madam president, the government typically doesn't negotiate with doctors an hospitals. government would likely resort to price setting based on medicare or medicaid or use existing government programs as leveraged for negotiations creating similar effects. remember, medicare and medicaid currently reimburse at much lower rates than the private

sector. madam president, the democrats claim they won't be putting other insurance companies out of business, but because of the cost shifting that can go on -- madam president, i would ask for an additional three minutes. the presiding officer: is there objection? without objection. mr. ensign: thank you, madam president. they claim that they won't be putting their insurance companies out of business much but it seems they're -- business. but it seems they're doing everything possible to make it harder to stay in business. i question whether members of congress will be required to participate in this government-run option. we should. if we're going to pass this on for other americans, we should participate. and i know there will be an amendment to make us do exactly that. but i want to -- since i only have limited time, madam president, i ask consent that my full statement be made part of the record as -- as i've read. the presiding officer: without objection. mr. ensign: i want to tell a final story about how members of

congress in this country and others country don't necessarily live under the same laws that they pass. belinda stroknack a former member of the canadian parliament. she opposed the canadian -- until she ended up get sick. she had led the charge against having a private system in canada. but when she was diagnosed with breast cancer, she didn't want to wait for the lines she would have to wait for in canada. what did she do? she came to the united states. as a matter of fact, she went to ucla and she paid for that treatment at ucla out of her own pocket. because she knows if she waited in canada, the chances of her having successful treatment would be a lot lower. let me close with a final chart. can you put the chart up that talks about survival rates? now, others have said, well,

okay, we're not going with canadian. we'll go with the european models. here's the european success rate in cancer and the rates in the united states. the united states is in gold, european union is in red. these are five-year survival rates. kidney cancer lower in the e.u. kolorectal cancer, we have better survivor rates because we don't ration care, we don't delay care and we have better technology here in the united states. so, madam president, i think that as a result -- and we could go on and on talking about the types of m.r.i.'s, the number that we have here in the united states, the number of -- of advanced medical equipment that you have in other countries compared to here, and because we don't ration care, we don't put a limit on the amount of money,

we let the private sector do, that we have a lot better and a lot more advanced medical equipment and we have plenty of examples in my statement that go through each and every one of those. so i think that this body should take a look at what it would mean for the quality of care and access to medical care in the united states if we adopt a government-run health care system. that's why many of us on this side of the aisle are so opposed. we don't want these kind of survival rates that the european union have. we don't want people from canada coming down here and not having a place to go. as a matter of fact, if we do it here, where will the people from america go? all americans should think about that when this bill is considered on the floor of the united states senate. the presiding officer: the senator's time has expired. mr. ensign: i thank the other side for their indulgence and i yield the floor. the presiding officer: the senator from minnesota, and as a

result of previous agreed upon conditions, three minutes will be added to the senator's time. mr. franken: thank you, madam president. i actually was kind of feeling bad because i thought i was going to be changing the subject here when senator durbin said i'd be the next democrat to speak because our good colleague from nevada brought up an amendment on medical malpractice liability and the senator from illinois responded to it and i thought the senator from nevada was going to respond to his response with some factual information or something, but completely changed the subject. so i -- you know, i -- to the

canadian system, to rationing. he will include his entire statement, which include this, "we don't ration care near the united states -- i mean the government -- we let the private sector do that." and they do a great job of rationing care, the private sector. that's where we ration care in this country. they ration it by cutting off your insurance when you get sick. they ration care by not giving you insurance if you have preexisting condition. but i want to talk about a -- an amendment -- that's when i was going to change the subject. let me talk a little bit about -- just a little bit about tort reform liability insurance. senator durbin mentioned atila gawande. senator and ensign talked about

the tort reform in texas. mccallen, texas, has the most expensive medicare in the country. what kind of progress is that. they have the most draconian medical liability reform. minnesota, we don't have anything like that. we do it for one-third of the cost they do in texas. and with better outcomes. well, that -- the reason i actually asked for time today is important -- is to express my support for senator lincoln's amendment to limit the tax that -- benefits that the insurance c.e.o.'s receive. it is not limit their compensation as was claimed by the senator from nevada. now, most americans would agree that the government, though, shouldn't be giving tax breaks to insurance companies for lining the pockets of their c.e.o.'s at the expense of

working families who are forced to pay more and more as their premiums spiral out of control. the savings from removing this tax deduction, senator lincoln's amendment, will go directly to our seniors as a direct deposit into the medicare trust fund. this amendment is immensely important because it reinforces one of our primary goals with this bill, which is to rein in the cost of health care. one of the key ways we can control cost is by holding insurance companies accountable. i am pleased to be working with senator lincoln on another effort to make our health care system focused on patients, not profits. senator lincoln joined me, senator rockefeller and others to introduce an amendment that required 90% of your premium dollars go toward actual health services. we do that in minnesota. we do that in minnesota. 91 cents actually. i urge my colleagues to support both of our amendments to ensure

that we get the highest possible value -- value for our premium dollars because nobody can contest the fact that for-profit health insurance companies have been making obscene amounts of money while americans watch their premiums skyrocket. from 2000 to 2007, insurance company profits rose 428%. 428%. -- 428% in eight years. during that time same we saw more than six million more americans become uninsured. and during that same time -- period american families saw their premiums almost double. so nobody can stand on this floor and argue that american families aren't suffering. no one can dispute what i hear from minnesotans every day, that in this economic downturn one of the greatest fears that families

have is: what happens if i get sick? what happens if my spouse or my child gets sick? we're hardly holding on now. we're just one illness away from losing everything. that's what i hear. that's what i hear from minnesota families. and this is a state that has less expensive, higher quality health care than the rest of the country. if minnesotans are struggling, we know we have a crisis on our hands. that's why i'm working to make sure this bill does everything it can to bring down costs, improve quality, and hold private insurance companies accountable. the current reality is that most of us don't know where our health insurance premiums go. it's difficult enough to understand a billing statement

from your health insurer, much less track where your money is spent. well, we're going to change it. we're going to change that with transparent reporting of how health insurance companies are spending your money. that's in this bill. clear reporting written in plain english will help us hold them accountable. but reporting isn't enough because now some of the health insurance plans being marketed and sold in this country are nothing short of a rip-off. a recent report in "business week" magazine described the policy that was being solid in florida to florida college students in which only 10% of the premiums went toward actual health services. only 10 cents out of every dollar goes to health care in this plan. the rest goes to marketing, to

wasteful administrative costs, and of course to profits. and this is legal. this has been legal. it's legal in this country. it was legal when republicans had the white house and controlled this congress. we're going to make it illegal. i don't think this is what we want for our children. insurance companies pocketing millions of dollars at the expense of our physical and economic health. is that the kind of country we want to be? i believe we can all agree that this health reform bill must guarantee that americans get value for the premiums that we pay. i implore my colleagues to support these efforts because health insurance should be about providing the best possible

health care, not about marketing, wasteful administrative costs, c.e.o. pay, and profits. thank you, madam president, and i yield the floor. a senator: madam president? the presiding officer: the senator from new jersey. mr. lautenberg: thank you, madam president. i ask unanimous consent -- how much time is left available? the presiding officer: 4 1/2 minutes. mr. lautenberg: i ask consent to be able to speak for up to ten minutes. it will be less, i promise, but i think we had a little misqueue in our timing. is there any objection to that?

mr. franken: is there any objection? mr. enzi: reserving the right to object, would it be possible for the senator from arizona to do a five-minute speak and then have you do five minutes plus the four? mr. lautenberg: all right. we have been patient, i think, if we can be assured that the senator's speech will not take more than five minutes, i would consent. that then includes a unanimous consent for me to have up to ten minutes. i see our colleague from michigan here, and i don't know whether that would disturb her. ms. stabenow: if i might just -- mr. enzi: mr. president, i'd be willing to let her then go as well, and then we'll make up the time on our side after that. ms. stabenow: if i could ask my friend a question. do i understand then it would be the senator from new jersey, then the senator from arizona

and then myself? mr. enzi: the senator from arizona, then the senator from new jersey, then yourself. the presiding officer: without objection? mr. kyl: thank you. i want to thank both of my colleagues very much for their courtesies. you will cut me off at five minutes, and i hope i won't even take that long. i just wanted to respond to some comments earlier that were made relative to the amendment of the senator from nevada relative to capping attorneys' fees. we have an amendment we'll be voting often tomorrow that caps executive compensation effectively. the response to that from the senator from ensign was, well, if we're going to do that, let's cap the attorneys' fees because we can really accomplish something by doing something that in these medical malpractice cases. we can make sure the people who were injured get more of the money that comes from these awards and less of it goes to the attorneys. i think this would be a very salutary situation. this con -- contingent fee

system can lead to abuses. i would like to cite statistics from a study done in 2005. 52% of all awards in medical malpractice lawsuits exceed $1 million. think of that. over half of the awards in these malpractice cases exceed $1 million. the average award weighs in at $4.7 million. $4.7 million is a lot of money. obviously juries felt that's what the victims in these cases needed in order to be properly compensated. what the ensign amendment would do is to limit the amount of contingency fees in these kinds of lawsuits to no more than a third of the first $150,000 recovered and a quarter of any recovery in excess of $150,000. for example, an attorney representing the client in this average case, $4.7 million verdict, would still receive

$1,187,500 for his or her services under the ensign amendment. not a bad deal with a $4.7 million verdict, the attorney gets $1.1-plus million and the injured plaintiff gets the remainder. i just ask my colleagues if that situation if $1.1 million isn't enough for compensation. we're limiting the compensation for an entire year for an executive insurance company to $400,000 as the amount that would be deductible to the company as a usual and ordinary business expense. here a lawyer has just one case, and you can have many, many cases in a year, and he would be limited in this particular situation to $1.1 million. a lot of folks have been asked to sacrifice under this legislation: hospitals, doctors are supposed to sacrifice, states are supposed to sacrifice by accepting more medicaid patients under their program.

seniors would obviously face sacrifices because of the $500 billion cuts in medicare. individuals would see their premiums rise. small businesses would get hit here. the one constituency that hasn't been asked to sacrifice anything is the trial lawyers. and i don't think it's much of a sacrifice to say when you get this kind of an award, $4 million award for your client, your fees shouldn't exceed a little bit over $1 million. even howard dean stated -- and i quote -- "tort foreman is not in the health care bill -- tort reform is not in the health care bill because the people who wrote the case didn't want to take on the trial lawyers." surely it wouldn't be too much to ask trial lawyers to limit a little bit in the contingency fees made in this cases. there is a study that found that medical liability lawsuits are being driven by the plaintiff's bar. it goes in to cite all the advertising costs and the

increase in the amount of advertising they're doing. that's where a lot of this money is going, to advertise for these lawsuits. additionally, it showed that spending for the ads increased dramatically just in the last few years. the threat of these jackpot justice suits against doctors is one of the reasons why health insurance premiums are rising faster than the rate of inflation. tph-fbg, a price -- in fact a price waterhouse cooper study found 10% of the cost of health care premiums are contingent on litigation. an even bigger cost is the practice of defensive medicine. a 2005 survey in the journal of the american medical association found that 93% of physicians reported practicing defensive medicine costing the health care system $200 billion annually. so we clearly need to reform the tort system and not in the form of some sense of the senate, but in the way of something real. it seems to me that the ensign amendment begins that process by saying let's at least allow the

injured plaintiffs in these cases to keep more of the award that is granted to them and have less of that go to the lawyers that bring the cases. surely it is an adequate incentive that they receive about $1 million out of a $4 million lawsuit. again i want to thank my colleagues from michigan and new jersey for their courtesy in allowing me to speak. the presiding officer: the senator from new jersey. mr. lautenberg: i rise to speak in support of the amendment that's proposed by senator lincoln from arkansas, and i thank her for an excellent idea. i want to say at the outset that before i came to the united states senate, i was a founder and the c.e.o. of a major new york stock exchange company, a company now employing over 40,000 people. i say that because i do

understand how business works and i know that we have to pay executives to encourage their full capacity. but the money being paid to top health insurance executives is simply outrageous. most of these companies where these executives work get subsidies from the federal government through payments to medicare advantage and medicare part-d. our tax dollars then wind up stuffing the pockets of insurance company executives. remember, these companies are obliged to provide health care funding when people are ill or need counseling to improve their health and their longevity. the average compensation package for the top five insurance chief

executives between 2006 and 2008 was almost $15 million a year. their services in these companies, i think, more resemble a fire deposit or emergency response organization than a traditional product producer or wall street firm. these companies are not selling lawn mowers. i emphasize they have a different obligation, and their obligation is to provide, to guarantee, to help people maintain better health. and while essential for individuals, should be great for our country. our country's going to save money by reducing overhead and improving programs that will fight to make products -- to make living better and longer. and as our executives make millions and millions of dollars every year, their customers are

being, are getting messages like this: sorry, this operation, that operation is not covered by your policy. or, we don't pay for that kind of medication. in an example that really lays it out perfectly was a company, is a company called united healthcare care. they're a major health insurance company. and after that company engaged in the practice of backdating hundreds of millions of dollars in stock options -- remember, when that's done, that's to get an even better price than a shielded gain that they get. so backdating hundreds of millions of dollars, their c.e.o., william mcguire, was forced to quit for questionable

peformance. despite this scandal, united gave mcguire, mr. mcguire a golden parachute of more than $1 billion. of more than $1 billion. where did that money come from? it came from the pockets of senior citizens. it came from the people who had programs that were covered by these companies. $1 billion for an out going c.e.o. who engaged in misconduct while ha*rd working efrt americans tkpwo*t get turned down for critical -- get turned tkoepb for critical medical procedures. there was a disease in that board room that permitted inexplicable decisions. while health insurance executives have been gouging working families, they're gorging themselves with their outrages pay, corporate jets and other perks. a cancer victim may not get

critical chemotherapy. a family may not be able to cover the ravages of a child with diabetes. but health insurance companies, health insurance company executives draw down millions of dollars, and it doesn't add up. this amendment will not tell insurance companies what they can pay their executives. they can pay them whatever they choose to do. but only $400,000 annually can be treated as an expense. $400,000, that's the president of the united states' salary. and the rest of it will be taxed, and with those funds going to make medicare more solvent. phr-pbt, the lynn -- mr. president, the lincoln amendment wisely uses that next, that new tax revenue, and i

repeat, generated by this measure to further shore up medicare. mr. president, an observation that i want to make, as i've listened to the debate over a long period of time, not just in these recent weeks but long before this about getting health care improved for the people across our country, over 40 million people who can't go to a doctor but who will go to an emergency room, draw a ticket like you're waiting for a table in a restaurant and hope that you get seen before some critical disease gets worse. what we hear is objection after objection. they like the status quo. they've got their friends in the industry. just look at the advertising budgets that we see. and the percentage of commercials paid for by those

who were opposed has contrasted with those who desperately need the insurance. we're seeing now, for instance, that one element of this -- of our reform program is the political -- the government plan. the -- the plan that covers -- that makes the industry more competitive. the public option. and we hear all kinds of reasons why that can't be. what does -- what is the ultimate conclusion? is that this lush bill that the insurance companies plow day after day, year after year, should be held intact. and it's the wrong way to go. and i ask them, stand up. say that you don't want 40 million people or -- or somewhere over -- near that number to get health care

coverage. say that they don't deserve it just because they may not be able to afford it. say, you don't deserve it. you don't have the money to pay for it. who do you think you are? citizens of this country, people who are here, who have worked in many instances, who have lost jobs in this recession are being told they don't use the language. but the message is clear, you don't deserve it. but they want the insurance company executives to be treated particularly well. so when we need clarification of the thinking of the republicans' side, and i have a lot of good friends over there, and i know there are a lot of good-thinking people. but when the senator from south carolina said publicly that if we can bring down this health care plan, we will present the

waterloo for president obama. so what they're seeking is a political victory. they're not seeking to help people who are desperate. more people are worried about the loss of their health insurance than they are about their jobs. because the job of some sort often can be available. but if you lose your health care, if you have a condition that -- that an insurance company -- isn't going to cover it, you're in deep trouble. so i plead with my colleagues. i plead with the people across our country who may hear our voices to protest -- protest this assault against logic, this assault against those who need help, those who understand that government can be better. mr. president, i was a young boy when i enlisted in the army, 18.

he was 43 years old when he was diagnosed with cancer. he was a healthy man. he used to work in th out in thd all those thing, take care of himself. but cancer overtook him. 13 months of ill, painful illness because they didn't have the materials in those dies reduce the pain that victims felt. and he died leaving a 37-year-old widow, my mother, who not only was grief stricken but flat broke, no money. she owed pharmacists, she owed doctors, she owed -- she owed hospitals. i learned then, mr. president, that if you can't turn to government in the united states, you're in bad shape. and we have the means to do it and we must do it. and i thank you. i yield the time.

the presiding officer: the senator from michigan. ms. stabenow: thank you, mr. president. i want to specifically respond to the senator from nevada who was talking about the canadian health care system a little earlier and i appreciate the information, the education. of course, it has nothing to do with this debate but it was nice to hear, we now understand a little bit more about the canadian health care system. the great news for us is that what we are designing is a uniquely american health care system. and i want to walk through the hments of tha -- the elements tt have and take just a moment. about 60% of the folks in the great state of michigan get their health insurance through their employer, and that will continue. we are told that either their premiums will stay the same or go down, according to the congressional budget office, and we believe many of the efforts in this bill will actually bring costs down. one of the reasons that costs will come down is that those of us with insurance will no longer

be paying through the back door for people that use the emergency room, that are sicker than they otherwise would be and they use the emergency room and then the costs are shifted on to people with insurance. and we know that there's about an $1,100 tax, a hidden tax, that we each pay on our premiums to pay for people right no that don't have insurance and use the emergency room inappropriately. so those with insurance now won't see their insurance change in terms of how they relate to their employer and their insurance company, but they will see costs go down because others will actually have insurance and not be using emergency rooms inappropriately. we also have put in place protections for consumers, basically those as the senator from minnesota was talking about, who have a preexisting condition, can't find insurance now. somebody who has insurance. i don't know how many times i've

heard from constituents of mine who have paid all their life, said i don't have a problem. i have insurance and then somebody gets sick. and then somebody gets dropped. they get drppe dropped from ther insurance because the insurance company doesn't want to pay for it. and so people with insurance now will keep the system that they have now, but will benefit from consumer protections and from gradually seeing costs come down because we're not paying for people who are using other health care services inappropriately. so we have about 80%, 85% of the public right now that is covered with insurance or through medicare -- the great american success story or through medicaid or the v.a. and so on. and so for the 15% or 20% of the public that we are trying to

provide options for for affordable insurance, those are mainly people working, mr. president. people that we're talking about work for small business. they work part-time. they work two part-time jobs. they work three part-time jobs. and i've been hearing from small businesses for years, we wish we had the same clout as the big business? we wish we could pool together all the small businesses and the individuals that that entrepreneur working out of their garage, that realtor who doesn't have a group pool, pool us all together and give us the same clout as the big business. well, that's what we're doing in this bill? versions of this bill have been, in fact, proposed by the distinguished senator from wyoming. i know that back during the clinton years in the debate that senator bob dole proposed something similar. this has been a democratic idea and a republican idea for years. we are calling this an insurance exchange, where basically if

somebody right now can't find affordable insurance by going out by themselves in the individual market, they're going to be able to go to a place where companies will bid on the large pool of everybody who doesn't have affordable insurance now. and just like what we do for the federal government, just like our insurance plan, our federal employee insurance plan, which is an insurance exchange, someone will be able to go to a web site or be able to get information and be able to find out about the private insurance companies that want to offer insurance to them through this insurance pool. now, one of the things we're debating is whether or not there should be a public insurance choice for people. i believe there should be. i believe in order to provide competition for the for-profit companies, we should have that. but the exchange is set up basically for small businesses

and individuals to be able to purchase and we're told that people will see cheaper rates, being able to do that, and to make sure they can afford it we are including tax cuts, refundable tax credits for individuals, for small businesses that can't afford insurance today to be able to help them afford insurance. that's what the exchange is about. that will affect 15% to 20% of the public that does not have insurance today. we also have in the bill another option where a state could choose to take the tax credits available to people in the exchange and could decide to pool those together and do a basic health insurance plan. and negotiate with an insurance company to get a better deal for people in their state. we also have something that i wish had been in place, mr. president, a couple of years

ago with my own children and that is we're going to say to young people that you can stay on your parents' insurance until your 27th birthday. we also have a policy that's more geared to young people within the exchange that will be less cost to them. but can you imagine all of the young people today, college or not, who come out and get the first job, like my children -- no health insurance -- who will benefit by saying you can stay on your parent's insurance until your 27th birth day. that's in this bill and it's very important reform. we also basically make medicaid for low-income individuals a safety net basic some that anyone below 130% of poverty can qualify. and what that says is -- and this is very important to my state, where we have the highest unemployment rate in the country -- is you lose your job, you're not going to lose your insurance. very important right for

americans. we're improving the medicare system and we have certainly been talking about that for a long time on the floor. a lot of time being spent about the medicare program. but we're cutting out overpayments to insurance companies the for-profit companies right now that are being paid more than they should be and putting it back into the medicare system to make it stronger for the future to help pay for exprugz to be able to create more preventive care for seniors. and then another very important piece, i was very proud to coauthor with senator kerry relates to early retirees. we have a lot of folks that are retiring early not by choice. they are being told they're going to have to retire early, at age 55 or age 58 or 59. and they may or may not have insurance. and if they do, they're a higher cost for their employer. and if they don't, it is

extremely difficult to find affordable insurance for somebody more likely to be using health care at that point. and so we have a provision where the federal government will partner with a business, with an insurance plan to make sure the costs are lower for the early retiree. it's called reinsurance. but for higher costs or episodes, the federal government will come in above a certain level and cover the cost. so it's a partnership between the private sector and the federal government to make sure early retirees, who are already being hit with a thousand different challenges as a result of early retirement, to make sure that they can afford insurance. so, mr. president, this is just kind of a snapshot of what we're doing here. again, the vast majority of people are in private, employer-based insurance today.

that will not change other than this will over time bring our costs down and it will give them new protections. because if something happens and is happening every single day, where an employer has to decide, well, do i pay the 30% increase in premiums or do i keep people employed? so if people find themselves in a situation where their employer drops insurance or drops employees as a result of costs, they have another option. they have some place to go where they can't today. they can go into the insurance exchange. they can get tax cuts that will help them be able to purchase more affordable insurance from a large group pool just like a big business does. so let me just say, mr. president, that bottom line for all of this for us, despite everything that is being said, is that