and it's about saving medicare. every year we're losing 45,000 americans who are dying prematurely because they cannot find health insurance and can't get the health care they need. we have a variety of ways in which in this bill we are saving dollars. we have analysis from the budget office and joint tax showing that. and, finally, mr. president, we are saving medicare for the future. the presiding officer: the senator has spoken for 10 minutes. ms. stabenow: and i would yield the floor. thank you. mr. enzi: mr. president? the presiding officer: the senator from wyoming. mr. enzi: thank you, mr. president. i found the afternoon to be very interesting. we have actually two debates

going on at the same time and sometimes they don't seem very related, but they are. one of the amendments that we're debate something the one from the senator from arkansas and it limits the deductible compensation for insurance executives to $400,000. and then we have the ensign amendment which suggests that we should do the same for lawyers with junk lawsuits, but doesn't go quite that unreasonable in that it only limits it as a portion of the -- of the -- of the lawsuit. of course, one of the reasons that the -- being given on the floor for supporting the arkansas amendment is that republicans are funded by insurance companies. i really have to object to that kind of wording. we could make a lot of

insinuations about who junk lawsuits are being supported by and where the money from those folks goes to. and they said, well, the evidence is that the insurance companies are putting so much money into defeating this piece of legislation. well, i found out that the pharmaceutical industry is now so firmly in the president's camp that it's developing plans to spend $150 million promoting the plan on tv. and that makes me kind of curious as to why the arkansas senator did not include executives of pharmacy companies in the same piece of -- same piece of legislation. i -- you know, i don't begrudge anybody anything that they make, but i -- i found it interesting that the abbott laboratories make $28 million. the aler again executive c.e.o. makes $14 million. bristol myer qib make

makes $12 million, c.e.o. of. mr. johnsonofjohnson and johnson makes $29 million. the c.e.o. of merck makes $25 million. the c.e.o. of fiezer makes -- pfizer make $15 million. and wyeth pharmaceuticals, the c.e.o. makes $25 million. why would we want to leave these c.e.o.'s out of the formula? are they taking the side of passing the bill as opposed to the side of informing the people. i'm sorry that the senator from minnesota finished his presiding in the chair, and i will still address the question to him. i did not expect him to give me an answer at the moment any way. he said that there was a 428% increase in profits for the

insurance company and i didn't quite get what the dates were. but he was talking percentages and as the accountant, i like to talk dollars. so i'd like to know what those dollars were from that first year to the final year. because -- for example, if a person makes $1 in the first year and in the last year side they make $5.28, that's 428% increase. it -- it -- if you start with a really low number of zero, you can have an unlimited infinity increase in the -- in whatever year you pick after that if they even make a penny. so percentages can give some bad numbers and also the senator from new jersey was talking about administrative costs and so was the senator from minnesota. and i would like to get the figures from minnesota to see how that's working to have a

limitation of 90% -- 91% of all insurance money going to evidently to pay claims. because i'm not aware of the administrative costs being quite that low in almost any -- any business. and i do know that with business, again, as the accountant i find that most people, and i can -- in most people i would include my colleagues here think that most businesses are pretty simple. but when i visit one of those businesses, and i learn a little bit about it, i find that if you scratch the surface, there's a lot going on out there that the average person couldn't handle. and some of it shows up in the legislation that we do. for instance, cash for clunkers. that was supposed to be a four-month program. we ran out of money in four days. that's how much we knew about the car business. so when we're talking about these -- these different things, i got involved with some of

these administrative costs when i wa was working on health plani did small business health plans. that was something rattling around here for 12 years, still is, and now it's about 15 years. how that works, it allows small businesses, through their association, to group together to form a big enough pool that they can effectively lobby against insurance companies or negotiate with providers. and they can -- they can make these associations across statelines. they can make them across nationwide if that will work better. presently you have to do it within your own state. that's the law we have setup. i found an example of one in ohio that is very successful. works really well. and that's kind of how i modeled my small business health plans. i've got to tell you, when i did small business health plans, i was taking on insurance companies. they were pretty upset that i

was doing anything in that area. they joined with some other people to keep me from getting choir to clotur cloture on the n to proceed with the debate. ohio has that association within its state boundaries. it can work because they have a huge population much we have less than 500,000 people that live in wyoming. and so if you break that down by associations, it would be really small pools and you don't get the actuarial value out of it that you would if you can go to a bigger population. but in ohio they can do it within the state. in ohio they did do it within the state. and it brought down the cost of health insurance. it brought down the cost. now not only that, the biggest savings was in administrative costs. it cost a lot more to keep track of all of the claims and everything from the small business than it does from a big business if the -- the bigger pool, again, the more capable

you are of handling unusual situations. but administrative costs came down from 37% to 12%. 25% savings. every business would like to have that. that's how much it costs to administer. that's why they wanted to group together through their association and form this bigger pool, which we haven't -- haven't been able to do. and i'd ask the chair how much time i have remaining. the presiding officer: two minutes and 15 seconds. mr. enzi: okay. thank you. because i do want to make some quick comments about the junk lawsuits. we do have to do something about that. when i talk about junk lawsuits. i'm talking about a bunch of them that are being filed these days that are $25,000, $45,000, $95,000.

whatever -- whatever is less than what it would cost to defend that lawsuit. because if it's less than what it would cost to do the lawsuit, the insurance companies' going to -- company's going to say, let's just pay him and we'll be saving money. it's a really bad precedent and it leads to more junk lawsuits being done. i'm interested to note that -- that both lawyers that are with the insurance companies and lawyers that are with the people that have been harmed don't want to have tort reform. kind of surprised me. then i thought i learned a lot of in -- they learned a lot of this in lawsuit. in law school they learned how this is important to somebody's retirement. i thought about the old west and how one lawyer comes to town, he's broke, but if they can get two, they can make a good living. it does take lawyers on both sides working these lawsuits.

but we do have to do something, particularly in the medical area, because we could save $45 billion a year if we -- if we were to have something in junk lawsuits. particularly with ob-gyn. we are losing all of them in wyoming. and it's because there's such a long tail on it. somebody can sue for 18 years after the -- after they get -- after they're born. and so the ob-gyn's have to pay a lot longer insurance tail on that. we had a dramatic case of a doctor attending a basketball game in douglas. and the reason that he chose that to announce his retirement because he couldn't afford the -- the insurance that he had to pay -- the reason he did that is because he had birthed almost every kid on both teams. and the mothers there don't have ob-gyn help as a result of his retirement because of what it

costs him for insurance. the presiding officer: the senator's time has expired. mr. enzi: i thank the chair and yield the floor. mr. brown: madam president? the presiding officer: who seeks recognition? the senator from ohio. mr. brown: thank you, madam president. i appreciate that. i come to the floor pretty often reading letters from people in my state who have had problems with their health insurance. and what's interesting, madam president, about this -- these letters are -- in almost every case, you had asked these people, you know marion from madison county, ann from montgomery county, sheila from richard county, if you asked them a year or two ago, are you happy with your insurance, most would say yes. but today they would say something different, because maybe a baby was born with a preexisting condition, they can't get insurance now. maybe they got very sick and the insurance company took them off their plan, kicked them off the plan because they cost too much. or maybe they changed jobs and lost their insurance or maybe they got laid off. so many of these problems -- the

other thing that i noticed, madam president is, that as you know, what happened in louisiana, from the letters you get from baton rouge and shreveport and all over, people 58, 62, 63, that don't have insurance, just pray they can make it until they're 65 because they know that they have a good, strong public plan at 65 that doesn't deny people from preexisting condition, medicare doesn't do that. a plan that is predictable and they can stay with and will help them. let me share handful of these letters. start with marry from madison -- mary from madison county. it is west of columbus. the county seat is london. for 26 years, i worked hard. carried my own insurance. when i started a home-base business, i started my husband's employer-based job. he had an injure andy went on employer disability in 2006. so i had to find my own insurance. i was turned down by almost every health insurance company

because of a preexisting condition which was a heart attack five years ago. the only insurance i could buy was a short-term policy. she got sick, had $40,000 in medical bills from her procedure. she wiped out her savings. today she said i'm unable to buy a major medical policy, too young for medicare and make too much to qualify for medicaid. mary's an example of somebody who would be helped by this bill. she can go on the insurance exchange. she can choose a private company or a public option. and she could make a decision based on what her needs are. whether she wants the private or public. and she knows with a public option that prices will be more stable, that the quality will be better because there will be more competition than there would otherwise. ann from montgomery county, the dayton area writes, our insurance premiums have tripled in the last six years going from $500 a month to $1,500 per month. at the same time we see no

benefit increase. since we bought our policy we have paid the insurance company $68,000 for the insurance. then she writes something almost like she's writing in a magazine. anthem's total spending for my family's total claim since we bought insurance $4,064. anthem's profit, $64,000. anthem's c.e.o. compensation last year alone $10 million. the reason these -- you know i'm sure that -- my friends on the other side of the aisle, who, clearly, one of their biggest, strongest support sers the insurance industry. -- supporters is the insurance industry. they support the insurance -- they're as supportive of the industry as is the industry of them. we do know that if we do insurance reform right, as i think we will, and the presiding officer from louisiana's been in a lot of these meetings where we discussed some of these changes that we want to make. we know that if we have insurance reform so that they

can't deny coverage, so someone gets sick and submits claims that they will get paid instead of fought over, and we know if there is a public option, there will be more competition, that these c.e.o. salaries will probably not be this high. the top ten, the average c.e.o. salary is $11 million. that is probably not going to happen if we have the kind of insurance reform. sheila from mansfield, ohio, writes i moved to ohio five years ago to be with my granddaughter. i worked hard all my life. i'm 60 years old still working and paying for my insurance. the other day i learned my insurance doubled. i'm alarmed because i'm wondering how long i'll be able to pay for my benefits. i talked to other people my age. they're feeling the same way. i never expected handouts but insurance companies are greedy. i have a problem with seniors being gouged because of age and because of health issues.

i think that says it all. most of these people, they all happen to be women. women are much more likely to write us about these problems often not just for themselves but often because they're taking care of their families and they are the major caregiver and they are the ones that navigate their way through these complicated policies to advocate for their families. these are people who work hard, play by the rules. they do everything we ask of them as american citizens. we owe them a little better treatment than that. this last one i'll read, madam president, is from kelly from delaware county north of columbus. i'm a 39 kwroefld mother of two young sons. my husband and i decided it would be better for me to leave my job and stay home to take care of our children. this meant we'd lose our health insurance through my employer. she had the insurance in the family. my husband works for a business that can't provide benefits. we ended up purchasing what we thought was a reasonable policy

but it tripled in price within a year. in 2008 i found out i was pregnant. i inquired about the maternity coverage we added despite the high cost. i was shocked to learn there was a nine-month waiting period before the coverage took effect. that meant obviously the pregnancy and birth wouldn't be covered because it's a preexisting condition. that's $15,000 to $20,000 that would not be covered. my husband and i talked about that that if i needed critical medical care could we end up bankrupt? $15,000 to $20,000 is obviously without major complications. by the grace of god my husband's company decided to offer health benefits and pregnancy was covered. then she writes, thinking of people other than hearse, please take up reform in a serious manner and consider public option. why can't insurance companies compete? what are they so afraid of? kelly gets it.

she understands that a public option will mean that insurance companies will have to compete. in southwest ohio, in the cincinnati area, two insurance companies have 85% of the insurance business. you create a public option, doesn't mean someone from lebanon or about a taeuf i can't or -- or batavia or cincinnati or middle town or hamilton has to take that public option. but it does mean because of the existence of the public option there will be more competition and the insurance company will behave better. you'll get better quality, lower prices. and you won't have these companies dropping coverage because of preexisting condition. let me just add one other thing, madam president. there was a story in the dow jones story a couple days ago entitled humana's third quarter profits up 65%, cease strong medicare advantage gains -- sees strong gains.

humana's third quarter earnings rose 65% amid improved margins its government. the company gave an initial 2010 forecast which the health insurer projects substantial membership growth resulting in well above the analyst forecast. the forecast takes into account reductions in medicare advantage overpayments. madam president, we sat on this floor the last few days listening over and over to my friends on the other side of the aisle defend the insurance industry saying if you do this the insurance industry will be in such trouble and will have to cut benefits. the insurance industry under our plan is going to get 25 million, 30 million new customers because all people without insurance will buy insurance. we don't want them to continue to deny care for preexisting condition. we don't want them to continue discriminating against women as

the presiding officer knows, that as a female but as a good senator, understands that women are paying oftentimes way more than men for more or less identical coverage and more or less identical situations. the insurance companies won't be able to do that anymore. so they'll have these new customers. we've got some rules so they won't be able to keep gaming the system. my friends on the other side of the aisle, i would hope, would sort of back off their defense of the insurance industry because that's not what we're here for. we're here to help make this insurance industry, this insurance system work better for all americans. that's the reason for the public option. that's the reason for the insurance reforms. it will mean people won't be denied preexisting condition. people won't have to fight so hard when they submit their claims and have the insurance companies turn them down. about a third of claims that people submit to the insurance industry are denied, and that

means on the initial round it means that people don't get reimbursed for their expenses. it also means people have to fight with their insurance companies far too often, people in a situation where they shouldn't have to do that. they're sick, caring for a loved one, whatever it is. that is really the reason this insurance reform is so very important, madam president. i ask that we move forward, pass this bill, and i yield the floor. the presiding officer: who seeks recognition? the senator from oklahoma. mr. coburn: i ask unanimous consent that myself and the senator from north carolina consume the next hour. the presiding officer: is there objection? without objection. mr. coburn: thank you. we have been discussing health care in washington for the past eight, nine months rather

vigorously. four years ago i started working on a bill with my colleagues in the senate, and we introduced a bill two years ago and modified it this year. it was introduced before the house bill. it was introduced before the senate bill. it was introduced before the bill that we have on the floor at this time. and it's called the patients' choice act. and we heard several times that the republicans just want to stop this. as a practicing physician, i fully recognize the need to significantly reform health care. there is no question. i recognize. and in that bill is guaranteed issue. no preexisting conditions are allowed in exchanges under our bill. but i also recognize that as we fix health care, some of the things that we cannot do is make our fiscal situation worse and

also our inefficiencies worse. and earlier today i submitted for the record research put out and published in october of 2009 which is a white paper on the waste in our health care. and this is robert kelly, vice president, health care annually particulars, thompson reuters. highly esteemed reputable firm that says every year between $600 billion and $850 billion of money is wasted in health care. is wasted. it doesn't help anybody get well and it doesn't prevent anybody -- anybody -- from getting sick. and when you look at the breakdown of where that comes

from, it's rather apparent that the largest component of it is unwanted use. and they break down. what is that? that's me doing -- as a physician, i'm a practicing physician, delivered thousands of babies, cared for thousands of grand moms, granddads, kids, set bones, done operations, old-time, broad-based practice. but this, what is this unwarranted use? 40% of $700 billion is $280 billion a year. $280 billion a year, they're saying a total of $700 billion. $700 billion times ten years, in my math, at least from oklahoma, is $7 trillion.

we haven't begun to touch in any of these other bills this unwarranted use, the fraud and abuse. 19%, all right? 19% comes to $175 billion a year in fraud. most of it's not in the private sector. it's in medicare and medicaid. that's where most of the fraud is. we haven't begun to attach that. we haven't attacked it. there's minimal $2 billion over ten years of direct fraud elimination in the bill that we have on the floor, administrative system inefficiencies. that's the bureaucratic paperwork that both the hospitals and the doctors spend money on to make sure they maintain compliance with the

regulation of medicine. 17%. 17% comes to somewhere between $100 billion and $150 billion a year tphafplt doesn't help one -- a year. that doesn't help one patient get well, doesn't prevent one patient from getting sick. in this unwarranted use happens to be the very thing that none of the bills attack except our bill, which is the defensive medicine costs in this country. defensive medicine costs. what -- why would it be important to fix that? because it's close to $200 billion a year. $200 billion of tests that are ordered on patients on procedures that are done on patients that they don't need because the doctor needs to do

it to prevent themselves being exposed to unnecessary litigation. $200 billion a year. that's $2 trillion over ten years. and yet, we don't address it not one iota in the bill that we have on the floor. available care -- avoidable care. those are complications. those are things that we cause. they are induced complications. we're not going to be able to do much of that. we could fix this -- lack of care coordination with accountable care organizations -- by incentivizing outcomes, by grouping in payment for how we pay. but we haven't done any of that. so here's thompson reuters that's showing if we really want to drive down costs in our health care system, what do we have to do? we have to attack where the

waste is. there's nary a reduction in these things in the bill that's before us. the other thing that i introduced earlier today was a report by the congressional research service which was issued december 1 this, year, last week. and what did they say? the question that was asked: what percentage of health care is run or funded by the federal government today, or the governments today? and the number came back -- i've been quoting 61% on my back of the envelope calculation. the number came back as affirmed by the congressional research that 60% of all health care in america is funded through or by

your tax dollars running through a government organization. and the question that has to be asked is: how well are we doing -- how well are we doing? could there be any coordination or connection to the fact that the government is now running 60% of the health care and health care inflation is twice what all the rest of the inflation is? could there be any connection between the inefficiencies that are in health care and the fact that we have bureaucracies that are, have themselves in between patients and their providers? i think the answer to that is an astounding yes. i visited with a cardiovascular surgeon because i made this statement on the floor and people have disputed it. find me a doctor who has trained in the last 30 years in this

country who spent part of his training at a v.a. medical center and ask him the following, or her the following question: if you or your family were sick and you had the choice of where you trained at a v.a. hospital or any other hospital you trained, would you go to the v.a. hospital or would you go to one of the private hospitals where you trained? 100% will say, no. our v.a. system has marketedly improved. i will readily admit, in certain areas, they're better than anybody else. especially prosthetics. especially post traumatic sin syndrome, stress disor. but in the vast -- disorder. but in the vast majority they're not. look at the indian health, we have a treaty obligation to provide health care to native

americans in this country. yet, indian health care is abysmal. that's a government-run program. then look at medicaid, which we're going to put millions of people in, and what happens? in medicaid 40% of the doctors in this country and 65% of the specialists won't see you. but we're going to say we're going to give you coverage in a system where you have access to only 6 important of the doctors -- 60% of the doctors. that's not choice. that's relegating to you a system that says you can't get care. and i've talked on this floor about pediatric sub specialties because of medicaid we have an absolute dearth of pediatric sub specialties because the payment mechanism is so low, that no one will spend extra time in medicine to be a pediatric sub

specialist, we can't find them. nobody will go there because the rates for reimbursement are set so low. so they make physicians graduating from medical school make an economic decision, based on the health and well being of their family, to not go into those areas. because we have forced it. what we know is there are poorer health outcomes in medicaid. that shouldn't be surprising. because some of the best doctors aren't available to medicaid patients. because we won't pay for their expertise. we also pay an extra $1,800 per family, everybody in this country, that has insurance because of the underpayment of medicare and medicaid. finally, with this large tranche of people under this bill that

are going into the medicaid program, we're going to break the states if they're not broken already. yeah, we're going to cover it for four years. for certain states we're going to do a whole lot better than that. louisiana and a few others that we have made special exceptions for. but we're basically going to transfer a load of fiscal responsibility -- call it equal and put that load on the taxpayers of the individual states. so as we look at health care, one of the things i wanted to do was to talk about the problems, but also talk about the bill that we have up before us. and make this point. are we better off with a government running health care? or are we better off changing the system in such a way so that

the patient is put first, the government's put last, and the doctor's 100% advocate for the patient? which would be the better way? knowing that we've got $700 billion to $800 billion a year wasted, why would we not design a system that goes after that waste and create the same opportunity for everybody in this country? so when you look at the patient's choice act, which my colleague, senato senator burr'g to talk about in main. there's a couple of things. first, let me tell you what the c.b.o. says about it. the c.b.o. said that it are will reduce future deficits, the first 10 years, $70 billion. but what it will do for the states is $1 trillion in savings the first 10 years. it will lead to lower budget deficits. that's what the c.b.o. said.

it said it also would reduce spending on health care because it will be more efficient spending. and then, finally, the federal contribution for medicaid would grow at a rate lower than health care inflation. which means it's going to save a ton of money for the states. the bill we have before us creates 70 new government programs. it has 1,697 times that we're going to write bureaucratic rules and regulations that are going to cause the government to step between the patient and their caregiver. 1,697 times. it's estimate right now is somewhere around 20,000 new federal employees. we're trying to get a handle on that. 20,000 new federal employees to tell you what you will and won't do in your health care. it's going to create at

least $5 billion to $10 billion in new requirements for the internal revenue service to check on you, that's per year, to check on you to make sure that you're filling out the forls right. it's going to create a massive disruption in the insurance market. nobody that practices medicine today likes insurance companies. and the very fact that we would have our colleagues claim that we're defending the process is absurd. what we're defending is allowing the free market with legitimate regulation to allocate a scrace resource without putting the patient second. there's a big difference. i can tell you horror stories about insurance companies. but i can tell you worse stories about the federal government and the fact that it denies twice as

many claims per 10,000 claims as all of the other insurance companies. so when we're talking about access to care, both of the bureaucracies are a nightmare. and, yet, this bill creates a -- the mother of all bureaucracies. the mother of all new programs. you know, it -- i'll make one last point and yield to my colleague. we've been down here fixing things that are wrong. you know, we fix the preventive services task force. we said it doesn't apply to breast cancer screening. that's what we said. we voted for it. it doesn't apply. are we going to pass that every time? we didn't get rid of it. we didn't get rid of the medicare advisory commission. we didn't get rid of the cost comparative effectiveness panel. every time they make a bad

decision, are we going to pass a law to say you were wrong? or are we going to trust the professionals -- the professional societies that guide my practice of medicine today or are we going to have a bureaucrat and a bureaucratic system that says what you will get and what you won't? under the bill we have, you don't have that. we've taken the hot potato off the floor in terms of breast cancer in terms of what they said. we said it doesn't apply. and we passed something for women's health, which i applaud. but what men b men's health? -- what about men's health? what about children's health? what about prostate screening for men? what about colon screening for men? what about cardiovascular screening for men? we didn't say a thing. why didn't we? because we know a larger percentage of the emotional

attraction has to do with those things associated with women. so we pounded our chest and passed the mikulski bill for preventive care for women and we ig arweignored the preventive requirements of everybody else in the country. how does that fit with what we should be doing? it doesn't connect. it's political. it makes good news. it satisfies local interest groups. but does it really fix the long-term problem? i'd yield to my -- my fellow senator from north carolina. mr. burr: i thank my friend from oklahoma. mr. president, this debate today has not been about health care reform. it's been about coverage expansion. we're learning how expensive it is to not do reform. in fact, incorporated in this

bill just short of $900 billion we're required to offset 100% of it because you don't receive savings unless you reform. now, when dr. coburn and i started work over 3 1/2 years ago now, to try to figure out how you change the united states health care system, to the most efficient, yet maintaining the same quality of care and innovation and bernank breakthre went on a search. we went to states to creative things that states have done. i dare say everybody trumpeted the reforms in massachusetts. what we learned early on is that massachusetts didn't have any reforms. they did coverage expansion. and where they used to pay for it out of right pocket, now they paid for it out of the left pocket. they promised that coverage would be extensive and include

everyone. and where are we today just a few years later? the companies they said they would never send bills to, they're sending an additional surcharge. -- to the massachusetts people that they said everybody would be covered. this year they're throwing people off of the massachusetts plan because they don't have enough money to cover it. real health care reform means that we're going to make sure that every american has the resources to be covered or to be able to pay out-of-pocket. because the real boogieman of health care today is the cost shift. it's costs that incurred when a service is delivered to you that the person or the institution delivering the service isn't reimbursed for. and if they received no payment for the service they provide, then they've got to shift the cost of delivery of that service over to somebody else. well, the somebody else is people that privately pay. they either pay out of their

pocket or they walk in with insurance and the cost of those services is shifted to everybody who falls into that category. up until this debate, most americans have thought that cost shift was only generated by people who had no insurance. what we've learned in this debate is that it doesn't stop there. the cost shift is also initiated from somebody that's underinsured. meaning they haven't got enough insurance to take care of the services that they need. but it doesn't stop there. you see, for every beneficiary that medicaid covers, we reimburse at an average rate of 72 cents of every dollar of service provided. meaning for the millions of americans that are covered under every state medicaid plan, we automatically cost shift 28 cents of every dollar of service they get to the private side. as a matter of fact for the

35 million to 40 million seniors under medicare, we reimburse at 91 cents for every dollar of service provided. therefore nine cents is shifted in some fashion to the private-paid side. no wonder that health insurance and the cost of health care has continued to rise at an unsustainable rate is because we keep growing the pool of people who don't provide 100% of the cost of the service provided. now, we're here debating a plan that they say is a reform. well, they do -- i will give them credit for this, they do cover 31 million americans that are not covered today. it still leaves 24 million americans uninsured, uncovered. but they do cover 31 million. 50% of that number, 15 million americans are going to be thrown into medicaid in the states they live in. if the attempt here is to reform

health care, the first place you start is with eliminating cost shift. the first place they've started is to take the least efficient medical delivery system in this country, medicaid, and jam 15 million americans into it. forget the fact that it's an unfunded mandate to the states at some point after the federal government pays 100% of the initial charge. we're exacerbating the problem that exists in health care today because we're putting 15 million new covered lives into medicaid and we know for every dollar of services that they get, we're going to cost shift 25 cents of that -- 28 cents of that over to people who pocket that or pay insurance. well, i will tell you that the direction that we started in is flawed because we haven't tried to address the cost shift that exists in our health care system. senator coburn and i attack that. after we got past massachusetts,

we looked at innovative plans like north carolina for medicaid where they were making progress, reaching new efficiencies, last year saved $200 million in their health care plan. but, you know, most people don't know it. medicaid is on opt-out. program. states can choose to opt out. that word's been used a lot as we talked about health care reform in the united states senate. as long as you do an opt-out, we'll be fine for a public option for the government-run system. we've got one of those. it's called medicaid. it is an opt-out government health care program. how many states opt out? none. why? because the subsidy is so big that they can't do it. but what happens when they want to change their plans? let's go back to north carolina. north carolina would like to change their plan further now

that they've learned things that they can do. they asked the centers for medicare and medicaid services for a waiver. religiously what happens, they're denied the waiver to change their health care plan to raise the quality and to reduce the cost. sound eerily similar to what we're talking about potentially in a health care plan that we're going to roll out for the rest of the country? maybe an opt-out plan where states could opt out where they say it's not a government takeover. if you've got to go to the government and ask their permission to change it to increase the quality of the care and decrease the cost because of the efficiencies you get through how you design it, i would tell you that's a government-run plan, plain and simple. we talked to self-insured companies. there was a gold mine of great ideas. companies like dell and sas and safeway and pitney bowes. companies that had frozen their

health care costs year after year after year. and we had one simple question: how did you do it? and they looked at us and they said, we invested in prevention, wellness and chronic disease management. even to the degree that one company, when they offered the employees that had chronic disease the ability to have a program specifically designed for them if they would enter into the program for free, employees in some cases chose not to go into it. and the company turned around and financially rewarded them by writing them a check to get into the programs. at one company, when they wrote them a check, they had 80% enrollment. and in the first 18 months they saved $1,782 per employee. that's real savings. that's bending the cost curve of health care down. that's not what we're doing in this debate.

even the c.b.o. says you're going to spend almost $900 billion and you've got to raise $900 billion to do it because there's no savings, because there's no reform. so, senator coburn and i went through that process and we began to construct a bill. he did the majority of the work. what did we find? we needed massive insurance reform in this country. as he said earlier, you can't be excluded from preexisting conditions, you can't be excluded because you get sick. what you've got to have is competition. well, i would tell you that in this plan, where they say there's choice and competition and innovation, they actually mention choice 40 times. they mention innovation 25 times. and believe it or not, they mention competition 13 times. yet, when they talk about taxes, fees, and revenues, they mention it 899 times.

that gives the american people some insight as to where the focus of this health care bill is. dr. coburn and i went exactly the opposite way. this is not a bill that needs to be a -- a reform effort that needs to be dominated by government. we chose the carrot versus the stick. in a bill we're talking about, if an individual doesn't buy insurance, they're fined. they're fined if they don't buy insurance. what we did is we thought the constitution said if you tax the american people, you have to do it equally. you have to apply the same tax to this group that you do to this group. and through equalizing the application of taxes in this country, we were able to come up with a plan that provided every american $5,700 per family per year in refundable tax credits. so every american family got that $5,700 every year. and if -- yes, we had that

individual who wasn't married and he or she got a $2,500, $2,800 refundable tax credit and they didn't use it, we gave the states the option that they could opt them in. they could actually enroll them with that $2,800 into a high-risk catastrophic plan. we didn't penalize the individual. we took what the government provided and made sure they had insurance so if next weekend they were riding their harley-davidson and had a wreck and ended up in the emergency room with no insurance, at least the $2,000 bill to get them well the hospital wasn't going to cost-shift to somebody else because they were going to have catastrophic insurance. maybe the hospital had to eat the first $5,000. but after that they had an insurance policy. this is the difference in approaches. we're not penalizing the american people. we want them to be part of a health care system that is reformed. we looked at medicaid.

we saw this problem with 28% cost-shift. we said we've got to reform medicaid. how do you do it? we gave states the option. if you want to roll your medicaid beneficiaries into this new plan that we created in this new competitive insurance market, then we'll double the investment in your medicaid beneficiaries so they can have $10,000 worth of coverage through the private sector. we didn't force them. we did what dell did, what companies did. we gave them cash because we think we can increase the quality and decrease the overall cost. tort reform, dr. coburn talked about tort reform. every doctor has talked about tort reform and defensive medicine, how it's run the cost up of diagnostic procedures because you've got to cover yourself for the one lawsuit that you get. we came up with a quite unique approach to it. we gave states three options.

we gave them the ability to have arbitration. we gave them the ability to create a health court. and we said to states if you adopt any one of these three options, we'll give you a 1% bonus on your medicaid. you don't have to adopt the tort reform. but if you want the 1% bonus on medicaid, then you have to adopt one of the three that we've put into it. so in essence, what are the three things that we've done in our bill, which dr. coburn, once again, said was the first bill introduced in the congress of the united states. i've sat on this floor, as tkw coburn has -- dr. coburn has, and we've had a sharp exchanges about what's in this bill and what hurts. i've listened to folks on the other side of the aisle say when are republicans going to offer something instructive? when are they going to offer a

pathway. we have. we were the first. we were ignored. we'll get an opportunity to debate it as we go through this. we'll get an opportunity to vote on it. i don't expect it to pass. but there are a lot of good things in here. mr. coburn: would the senator yield? mr. burr: i'll be happy to yield. downturn downturn does he recall -- mr. coburn: does he recall the vote in the "help" committee when this was offered, this bill that says if you like what you have now, you can keep it, this bill that no increase in taxes on american business, this bill that lowers everybody's health insurance premium, this bill that covers preexisting conditions, period. this bill that protects seniors' high quality of care and keeps their choices, this bill that increases personal control over health care, this bill that didn't do a medicaid expansion but instead put medicaid patients into real insurance so they had the same choice as every other american, this bill that protects physicians and patient relationships, and this bill that empowers patients,

families, physicians and providers, but doesn't empower the government. what was the vote? does he recall? mr. burr: all the republicans voted for it and all the democrats voted against it. mr. coburn: exactly right. the difference is you can either trust people or you can put all your trust in a nanny states. and the nanny states running 61%, 60% of our health care today. i thank the senator for answering my question. mr. burr: let me conclude, and i'll give it back to the senator. there are three objectives that dr. coburn and i set out to accomplish in this bill. the first was cover all americans, make sure that everybody had the capabilities to access affordable coverage. two, remember what the companies that were self-insured told us: invest in prevention, wellness and chronic disease management. the only direct cost savings in

health care today is prevention, wellness and chronic disease management. there are a lot of indirect savings: tort reform, insurance reform, insurance across state line purchases. but the only direct savings comes from prevention, wellness and chronic disease management. and third, and probably most important, make sure that it's financially sustainable. well, madam president, i don't know why right now we would create a health care plan in america that couldn't financially be sustainable for decades. why would we create a health care plan that for the current generation entering adulthood won't live with that health care plan in a financially sustainable fashion for their life? this one won't. it costs $2.5 trillion.

it doesn't make it through the first ten years. yet, we've got an option. it's an option that republicans have already introduced. we've let the american people see it. it's not 2,074 pages. i think it's barely 240 pages. and it incorporates much, much more. and oh, by the way, it fulfills, checks all the boxes the president said we needed to do when we started health care reform. it covers all the american people, financially sustainable, maintains the level of quality and bends the cost curve down. what's the most disappointing thing out of this debate so far? is that we don't have to get down here to tell the american people this is going to cost them more. they know it. they know their insurance premiums are going up if they've got coverage today. they know that the doctors are going to have to charge more because medicare is going to cut

its reimbursements. they know that more doctors are going to drop seeing medicaid beneficiaries because the reimbursements are going to continue to go down. the american people get it, and that's why in an overwhelming fashion they're opposed to what we're here debating. my hope is that at some point in this debate we will talk about some rationale things like what we've got in the patients choice act. i don't expect it to become law but i expect reasonable people to accept things that really do reform health care, and a lot of them are in this bill. i yield to my good friend. mr. coburn: i thank the senator. could i inquire of the chair how much time we have remaining. the presiding officer: 24 minutes. mr. coburn: thank you. i want to go back over some of the things of the patients choice act because, you know, people ask me why they haven't heard of it. it's because the president doesn't want to cover a

commonsense bill that doesn't spend money. the majority doesn't want to incorporate the ideas because it's not government centered. it's patient centered. and we have a bill that's totally government centered. but what does it do? and senator burr alluded to a lot of it. i want to go into a little bit of it. what it does is prevent the five diseaseness this country that consume 75% of our dollars. it costs two -- causes two-thirds of the deaths and consumes 75% of our dollars and it invests in preventing those diseases. the second thing it does is create affordable and accessible health insurance options. not government run, not government mandated. but uses the experience of 50 states through exchanges and sets a floor #.

what is the floor? the floor is the same level of care that members of congress can get. that's the floor. but you get to choose. nobody says you have to have this. you realize that 15 million americans that are going to be forced into medicaid in this bill won't have any choice. they'll just say you have medicaid. and they'll be denied 60% of the doctors in this country. it eliminates preexisting conditions. it eliminates the ability of an insurance company to drop you if you're sick. you get offered health insurance regardless of your age or regardless of your health. and yet, we're saving trillions and they're spending trillions. what is the difference? what's the disconnect? it gives you, as senator burr talked about, an auto enrollment

mechanism. if you choose to be irresponsible, that's fine, but the rest of us shouldn't have to pay for your irspofpblt if you don't sign up, you got an automatic enrollment with your tax credit so that if you have a catastrophic illness, the rest of us don't have to pay for you. it allows for states to pool in arrangements or regional areas where they increase their buying power through these exchanges. if you've -- whatever you've got today and you like it, you really can keep it. that's not true in this bill that's coming across the senate floor. there's absolutely zero tax increase on american families in this bill. it's not true on this bill. there's $500 billion worth of tax increases on either families or businesses. it lowers the cost of health insurance premiums. this one says at best for in the

large group of the meeting group market it's going to be the same trajectory of twice the inflation rate. if you're in the individual market, it will be 10% to 13% higher. this one lower's everyone's costs. it protects the seniors high-quality care and choices today. it doesn't pick winners and losers. it allows patients to pick what is best for them. it increases patients' own personal control over their health care. and it converts medicaid to a system where there are no longer patients in medicaid discriminated against. because what we do is we buy them an insurance system, allow them to buy an insurance that nobody will ever know that they're a medicaid patient. so no one will ever know to deny them because the payment rate will be equivalent to anybody

else in the insurance market. so we give them the same access -- you know, we treat medicaid like we treat indian health care. here area your health care, but it's not as good, so tough it. here's your health care, we know the outcomes aren't as good, so what. those ant tom coburn -- those aren't tom coburn's opinion, those are published data. we know that it isn't as good as the other insurance programs. we know it's not as good as the people in the cash harkt even though they -- market even they pay more. it protects patients and their caregiver's rivment and, finally, it -- relationship. and, finally, it empowers mothers for their children, it empowers the provide, but it doesn't empower the federal government. and the federal government's failing in health care right now. and it's not -- it really isn't

my ingenuity that came up with this. but since i'm around my three daughters and a lot of younger people who work for me on my staff is a comparison of the patients' choice act to the act that we have here is like comparing old ma bell to an iphone. in the patient -- and the patient's choice act is the iphone. a little over a decade ago iphones or even cell phones in general, who would think that they would be so widespread. apple iphones were 2 1/2 times faster growth in 2007. why did this object -- why did it take off? what did they do? they're hugely popular because they're user friendly. and they allow tons of options

and you get a personalized iphone experience that you control. so what does an iphone have to do with health care? both sides of the political aisle products which are personalized to fit their needs that are affordable and portable. sounds like -- a lot like an iphone. as a matter of fact my colleagues across the aisle are using the language choice in competition to try to sell this monstrosity to the american people on the massive expansion of federal control since johnson's great society. the problem is that the policies in this bill would discard the iphone's individual choices. and consumer control. but what it would embrace is ma bell. the old landline phone with the rotary dial. we're not going to embrace the

iphone. we're going to embrace locked to your house with limited choices, limited capability to expand our choices and limited freedom. a senator: mr. the senator yield? mr. coburn: i'd be happy to. a senator: my question is this -- it sounds like the patients' choice act allows an individual to design the coverage to meet their age, their income and their health condition. mr. coburn: absolutely right. mr. burr: and that's customizing your health care -- mr. coburn: it puts the consumer, i.e., the patient, in charge of their health care rather than the government in charge of their mc. -- of their health care. mr. burr: so one could then conclude that the current legislation that we're debating in the united states senate, not only limits, but it takes away choices that currently exist to seniors, to people who work, and to younger je generations?

mr. coburn: i don't think there is any question that that will happen. it will be worse than that. we've shrunk the differential for young people. if you're a young person, listen to me, the cost of your insurance is going to double under this bill. if you're a young couple or a young individual, and i'm talking 40 and under, 24 to 40, your insurance is going to double under this bill. and what you're going to do, you're going to do this: you're going to say, i'm going to pay the tax rather than cover insurance. because it is financially much more important for me to do that. and what we know is is that between six million and 11 million young people are going to cancel their insurance under this bill, according to a report put out by -- and i'll

reference it here, oliver wineman and associates. mr. burr: typically children are a lot less expensive to insure because they're younger and they're healthier. mr. coburn: so what do you think's going to happen? mr. burr: what happens? mr. coburn: the spread, the people -- if you're over 40 because these young people drop out, your premium's going to go up. so what is available today because of the mix of people that are in the broad group of pools that are insured, we're going to drop out young, healthy people so that small -- younger groups' insurance is going to go up, but because there's going to be six million to 11 million fewer of them and the insurance company keeps them in the pot to lower the cost for the lower, the non95 and above, their premiums are going to go up. so we're going to have exactly the opposite effect because when you mandate coverage and you

don't force people to buy it with a big government program, people are going to make an economic decision and the first year of this is $250 is all you have to pay. and it goes up to $750. they're going to say: why would i do that? i'll buy the insurance when i get sick. so what we're going to do is totally disrupt. and it may be planned to be that way. so that we can come back and say, look at the private insurance industry. it's not working. the government needs to take it all over. i don't know that that's the case, but the consequences of what this bill's going to do -- mr. burr: the way you've described it, the current bill that's being debated in the united states senate really doesn't benefit anybody. everybody loses. mr. coburn: no, no. we'll have at least 20,000 new federal government employees, it will benefit them. it will benefit the bureaucracies. it will give them power to

control. and it's not -- it's not a soft control, it's a heavy control. we will mandate on states bankruptcy through the medicaid, mandate to the states, the mother of all mandates to the states. so it will benefit the federal government and the bureaucracy, but will have minimal benefit for the patients in this country. mr. burr: so at best we can claim that the bill being debated in the united states senate is $2.5 trillion bill designed to stop waste, fraud, and abuse in the health care system? mr. coburn: supposedly. mr. burr: think about that. we're spending $2.5 trillion to try to get waste, fraud, and abuse out of just the government side of health care. yet, the bill itself is making

the government a bigger factor in health care, which means the likelihood is because of the design not changing, you have more waste, fraud, and abuse. so there's no real value to th the $2.5 trillion. except to the government workers that are hired to either collect the fines and the new taxes or sit on the panels to determine who gets coverage and who doesn't. mr. coburn: i wouldn't go quite that far. floss question that some people -- there's no question that some people who have no coverage will get medicaid. compared to the patients' choice act, they would get access to some of -- mr. burr: and sav save $2.5 trillion. mr. coburn: and have the flexibility of choice based on what they need or their children

and family need. so they do increase coverage, but how do they do it? they put you into a substandard plan. they put you into a plan that doesn't give you the same access that the members of congress have. they put 15 million people into that. and they decrease the flexibility of choice for those people, 11 million people, in medicare. because we know better. mr. burr: my good friend probably remembers the day that we marked this up in the health, education, labor and pension committee. as a matter of fact, it wasn't a day, it was 3 1/2 weeks an 56 1/2 hours, if i remember correctly. one of the amendments that they accepted is an amendment entitled "the 22-20 rule." my good friend being a doctor would recognize that this is a program that the federal government has to allow medical students to delay the repayment of their student loans until they actually got their practice up and running.

that was eliminated about two years ago. and i'm sure that the -- that the good doctor remembers that that was accepted under a u.c. in the committee. but if you read the 2,074 pages, what's noticeably absent is the 22-20 rule. yet, as you know, we have less than a million doctors in the united states of america trying to provide medical coverage to 300 million people and growing. and so suggest that if this bill passed, we would lose 25% of our doctors in the first year who decide that this is it. i'm going to retire. i'm out of here. the 22-20 provision is the only thing that we in our bill that actually created an incentive for more individuals to seek medicine as a career. mr. coburn: senator burr, if i

-- if i may inquire how much time do we have remaining? the presiding officer: nine minutes. mr. coburn: thank you. going back to incentives, carrots v. sticks. how do we have a shortage of primary care physicians? this country? why is it? we put a lot of money into medical schools. the state puts a lot of money into medical schools. we have student loans for physicians, average abou about $175,000 in debt when they get out of there. how is it that no one wants to be an internest or family practice doctor. why is that? mr. burr: reimbursement. mr. coburn: reimbursement where you can invest one additional year in residency and double the income that you can make being a physician. now, how did the payment rates get where they are? who set the payment rates? the federal government set the payment rates because 60% of the

payments to private physicians come from medicare, medicaid, tri-care -- mr. burr: indian health. mr. coburn: those are contracted. those are even lower. so they set it. the private insurance sets all the rates based on what the government does. so the government has created a shortage of primary care, which we are going to see just explode as we put other people -- the c.b.o. has rightly said, if you add lots of people, you'll get some increased utilization, a significant amount. they're not there. they're not there. so you take somebody in their late 50's, mid to late 50's or early 60's, who plan on practicing 10 or 15 years and all of a sudden, you -- we have a claim today that this extends the life of medicare. here's how it does it, it uses the medicare advisory commission

to force cuts in medicare, just cuts, it doesn't pay for the doctor fix, which is $250 billion, and then it cuts medicare. so -- and i don't have any problem extending the life of medicare. but it ought to be all about fraud. it ought to be all about the the vast majority of fraud in health care today is through government programs, not the private sector. the fraud rate in the private sector is less than 1%. and here we have $150 billion. we could save $1 trillion over the next ten years if we had an effective fraud program, which this bill minimally addresses, which our bill aggressively addresses. we even have undercover patients, undercover doctors, where we create sting operations to put people in jail. not fine them, not ban them from

medicare. we put them in jail if you're stealing from the american people. there's nothing anywhere close to that in this bill. in fact, we're aggressively going after the largest problem of the $800 billion that's wasted every year, which is fraud. and the second largest problem is we incentivize the states to fix, which is the tort extortion that's going on in this country that causes people to have tests done on them not necessarily without any consequence to their health and money wasted on tests so the doctors can be in a better defensive position. mr. burr: how could a group like aarp, whose primary role by design is to represent our nation's seniors, be in favor of a reform package that doesn't provide any additional benefit to our nation's seniors?

downturn -- mr. coburn: and doesn't reform. i wondered that. mr. burr: as the senator knows, we cut drastically medicare advantage, the only private-sector option that a senior has for coverage. we basically eliminate it. that's 11 million seniors in this country. mr. coburn: no, we don't. we've protected some through earmarks in this bill, certain states. we have protected some. some states, if you've got medicare advantage, you get protected. other states, if you don't happen to be on that side of the aisle or don't need the help in your reelection, you don't get that. tkwur tkwur if somebody didn't -- mr. burr: if somebody didn't have medicare advantage as a choice, what additional -- mr. coburn: they would have to go in the market, if they could afford it, that's where a -- in

the rural areas why medicare advantage is so important. and the fifth-largest seller of insurance policies in the country happens to be aarp. mr. burr: to eliminate medicare advantage is a tremendous financial windfall to aarp, the association that's supposed to be looking out over the seniors in this country. mr. coburn: we're fairly cynical, and we don't mean to be. we need to wrap up, if we can. there's two ways of fixing health care in this country. one is we got the government running it. and i'd make this point. everybody agrees 2017, 2019, medicare is belly up. medicaid in the states is already belly up. they're all in trouble. it's the number-one thing they

spend their money on. they're all running deficits. the census is broke. social security, we know it's going to be broke. the u.s. post office is absolutely broke. the cash for clunkers, broke before we started. highway trust fund, $18 billion to the red. and we're going to put another 16% of health care, 76% instead of 60%, in the hands of the government. or we can utilize what we know works, which if you incentivize the management of chronic disease, if you incentivize prevention, if you incentivize transparency and you create a way for people to have access, the patients choice act will insure 94% of americans with a real insurance policy, not medicaid, not indian health care -- we, by the way -- native americans, listen up, under our

bill, if you're due health care, you get a card. you can go wherever you want, and it's going to get paid for. we need to do that for veterans too. the point is there's a choice. we can run a large government option or we can run a small government with 50 states, incentivizing them to do the right and best things for their citizens where we will actually lower costs, we will increase access, we will have better care, we won't destroy the best health care system in the world. aeupbd challenge my colleagues -- and i challenge my colleagues to come down here on the floor and debate me on that because i guarantee in their family i can find somebody who was saved because they were living in this country. had they not, they would not be alive. the best health care system in the world. and why should we destroy that as we try to fix what's wrong? health care in america today?

mr. burr: i'm going to ask my colleague to put that next chart on the board. i'm going to ask the president unanimous consent for five additional minutes. the presiding officer: without objection. mr. burr: i thank the president. # i think this is self-sphrapb torry. today -- self-explanatory. today we're borrowing 43 cents for every dollar we spend. 43 cents of every dollar we spend in the government, we're borrowing from somebody. we talk about these unbelievable numbers in washington: billions and trillions. the most popular bumper sticker in washington today is "don't tell congress what comes after a trillion." personally, i don't want to know because i know if we get there, we're at a point of no return. tom and i, close to the same age. we've got kids that are just getting started raising

families. we know what they're going to be faced with. just to raise their families, to make sure that their children and their grandchildren get educations, to make sure that they go to college, have that opportunity, to make sure that they've got an opportunity after that for a place to work and an income. you know what's going to be the thing that dictates most what they're faced with? that right there. because for every penny we borrow, it means that we've got an obligation to pay interest on that penny. now today, interest is practically zero. we provide as the federal government money to banks that they can lend out and we charge them practically zero. that will not last forever. at some point interest rates are going to go up. depending upon how much money we've borrowed will dictate how much we are obligated to pay in

interest. mr. coburn: let me interrupt my colleague. we have a few minutes. here's what the calculation shows. walk with me slowly. if you're 25 years of age or younger today in america, and we go out 20 years, that will be 45 and younger. that's 103 million americans that will be in that group. here's what they're each going to obeyed on the unfunded -- to owe based on the unfunded liability of medicare, medicaid and social security. $1,119,000 that they will be responsible for. they will have to pay the interest. average interest will be about 6%. before they ever pay the first bit of income taxes they'll have to cover that interest. otherwise that will grow. how does that affect a young family 20 years from now? we're talking about tax rates that allow no increased standard of living.

as a matter of fact, we're talking about tax rates that decrease the standard of living by 35%. that's the heritage that we're creating and we're going to expand with this health care bill that the majority leader has brought to the floor. we're going to steal the future. we're going to steal the opportunity for those 25 years and younger today because we can't live and make the hard choices that are necessary, and we think the answer to every problem is more government rather than more personal responsibility, competition, transparency in a market and incentivizing people to do the right thing rather than punishing them when they do the wrong. mr. burr: you're absolutely correct. what we can only hope to pass on to our children and the next generation is an opportunity equal to what we've had. strap them with this debt, continue to go down this road, continue to pile on the obligations, and you have limited the next generation's

opportunity. and as you choke that opportunity for them, you will choke the fabric of this country in a way that the problems we're faced with today are minor in comparison to what they will deal with in the future. so as we sit here and we debate the pluses and the minuses of health care legislation, i just want to remind my colleagues when you talk about $2.5 trillion, and you probably never will save that money out of medicare, you probably never will cut that doctor's reimbursement quite as much as is in there. every time you don't do that, you're borrowing 43 cents of every dollar we spend. 43 cents of obligation that our children are going to inherit from us. i'm not willing to do that anymore. i want to make sure that we're focused on the opportunity

that's there for them. we can only do that by doing the responsible, the right thing as it relates to health care here. mr. coburn: madam president, i yield the floor. i note the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call:

the presiding officer: the senator from arkansas. a senator: i would ask that the quorum call be dispensed with. the presiding officer: without objection. mr. pryor: madam president, i ask unanimous consent that no amendments be in order to the pending amendments prior to the

votes on sunday, december 6. the presiding officer: without objection. mr. pryor: i ask unanimous consent the senate proceed to a period of morning business with senators permitted to speak for up to ten minutes each. the presiding officer: without objection. mr. pryor: i ask unanimous consent that when the senate completes its business today it adjourn until 12:30 p.m., sunday, december 6, that following the prayer and the pledge, the journal of proceedings be approved to date, the morning hour be deemed expired, the time for the two leaders be reserved for their use later in the day and the senate resume consideration of h.r. 3590, the health care reform legislation as provided for under the previous order with the majority controlling the first 60 minutes and the republicans controlling the next 60 minutes. the presiding officer: without objection. mr. pryor: madam president,

senators should expect at least two roll call votes tomorrow to begin at approximately 3:15 p.m. the first two votes will be in relation to the lincoln amendment number 2905 regarding executive compensation, to be followed by a vote in relation to the ensign amendment number 2927 regarding attorneys' fees. we are also working on the next amendments that will be offered, and we are hopeful that we will be able to vote on those tomorrow after the 3:15 votes. senators will be notified when any additional votes are scheduled. if there is no further business to come before the senate, i ask that it adjourn under the previous order. a senator: reserving the right to object. the presiding officer: the senator from oklahoma. mr. coburn: i have a unanimous consent request that my staff josh trent be allowed floor privileges during the duration of the debate on this bill. mr. pryor: no objection.

the presiding officer: without objection. under the previous order, the senate stands alex lang is a staff writer with "congressional quarterly." we are hearing president obama is coming to capitol hill to mark. why? >> he is going to rally the troops it looks like.

democrats have been fighting a little bit among themselves over the health bill yesterday and today and i think he wants to try to smooth things over. he had a number of his senior staff here today including the health and human services secretary. >> what time is that meeting set to happen? >> 2:00 p.m. to mark. >> we know the real work is going on behind the scenes. who has majority leader read in meeting with today and at the end of the day will he be able to report any progress? >> one of the lieutenants, charles schumer has been meeting with a group of moderate animal democrats vie for meat side, folks like john rockefeller from west virginia, mark pryor, tom carper from delaware, russ feingold from wisconsin. they are talking mainly about the public option and how their reach some sort of a compromise that will draw 60 votes. >> has there have been any progress at all on a public option or is it too early to say? >> one senator tom harkin told us their goal is to come up with

an agreement by monday but it is hard to tell how close they are. there disclosing much of what they are talking about or the direction they are headed. couple of moderates said they seem to be talking about the public option that is run by some kind of a nonprofit credit than being run by the government directly but it is really-- liberals are saying they are not comfortable with that sort of structure. >> one of the other challenging issues continues to be abortion language. of tillie more anything about abortion amendments? >> i just talked to senator nelson of nebraska. you still working on the language to that amendment. we are going to see it early next week. you said that it is still closely resembles the language and a house health bill which was written by representative bart stupak of michigan. a lot of pro-choice democrats can't stand that language and what it ought of the bill and i believe that senator nelson's amendment will fail if it closely resembles the tupac language. >> the senate is in tomar.

what can we expect? >> they are going to deal with a couple of amendments dealing with one by senator-- and all of this by the way is pretty open air. we didn't know until a few minutes before today's vote which amendments that were going to vote on but we think they are going to deal with an amendment by blanche lincoln. it will limit tax breaks for salaries. >> what will you be watching for tomorrow? >> we are definitely interested to see what happens after the president's visit whether he is successful and rallying the troops and there has been some grumbling by democratic aides and i think some democrats that the president has not been hands on enough in this debate in the last couple of weeks. i think for example sherrod brown of ohio told us that he would like to see the president come down and express how important to him the public option as an lean on some of these moderates who are saying they won't vote for the bill unless the public option.

>> senator majority leader reid has expressing once a have this bill done by christmas. do you think we are any closer to that goal? >> it is hard to tell but i would say that is definitely an ambitious goal of this point. they don't seem to be very close. i don't get the sense from talking to democrats on both sides of the spectrum that there are near an agreement on some of these major issues. if they lose over abortion and which seems likely at this point they are going to need it least one republican to vote for this bill and right now they don't have that republican vote. >> alice when is a staff writer with "congressional quarterly." thanks for joining us. >> thank you. >> and steinmark permission about the health care bill at cs bantz health care hub. it contains the bill, information about amendments as well as comments, interviews and briefings. is that sees spend.org/health care.

bomba. >> the first issue i want to take up is the issue of food miles and food miles really impresses, impresses me for a number of reasons and not mainly because i have been shocked at how quickly it has become an easy proxy for the carbon footprint of our food. i think a lot of consumers have a lot of-- do very quickly associate the distance our food as traveled with the environmental impact of that food, and the closer and closer and looked at the problem of food miles turned out to be in a lot of ways the least, the least of our concerns. and a number of reasons let me to think this. it led me to think there were problems with sort of getting too much priority to food miles and a distant star food travels to get from farm to play. one is i have noted, and i note in the book that it doesn't pay

attention or give enough credence to comparative advantage. there are places in the country, there are places in the world that are simply more conducive to producing lots of fruits and vegetables and other places, and in the united states this is particularly true. i would urge you to look at water stress, a map of water stressed regions in the united states. if you look at a map like that you realize there's certain places with a natural comparative advantage to produce lots of crops, with minimal water in putts because the water is already there, and they think a focus on food miles for gets this point and forgets the fact that we can produce food in places where perhaps it should be produced, where natural conditions are conducive to producing that food and then

ship it to other places and this shipping is really quite a small factor next to the cost or the small cost of the water. of course right now we are doing it all wrong. we are getting all of our friends from california and of course california is essentially a desert. gets all of its water elsewhere and to me that is the way not to do it, so comparative advantage is something that i think food miles does not pay attention to and i think it is something that we should pay attention to. the other, another factor that i think food miles does not really take into consideration is economy of scale. every now and then, every now and then i am guilty of thinking as a capitalist and economy of scale strikes me as an important concept when talking about global food production and

something that i make a point in the book, something that i like to remind people who are skeptical of me being critical of food miles is, 20,000 apples or 2,000 apples let's say traveling by truck, 2,000 miles is from an energy perspective is no different than 20 apples traveling by truck 20 miles, i mean the important calculation here is mile per apple and of course it is going to be the same for both of them. i have very little love in my heart for industrial agriculture and i believe i don't say good word about it in my book. fortunately, i think a lot of people who read my work think i am somehow out in bed with industrial agriculture because i am critical of some of these ideas. it just simply is not true but one area where i would give industrial agriculture a

complement is, when they need to move something efficiently and cheaply they can, so they can't take advantage of the scale of economy when there is an incentive for them to do so. this is again something that i think an emphasis on food miles knaves to take into consideration. distance is not always a problem that a lot of, i don't want to say propaganda but a lot of the food miles rhetoric would lead you to think. i think more important than the other two and the final point that want to mention about food miles and why i am critical of food miles in the book is if you are just going to focus on the distance food travels there's a chance, i'm not saying everyone thinks this way but as consumers we can only take on so much and there's a chance that you might not pay as much attention to what really matters when it comes to the energy cost of our food and that this production. life cycle assessments, which looked at the energy used in the production of food at every

stage, from a growing the food to packaging it to shipping yet, revealed that transportation as an overall energy sync, as an overall energy costs transportation and the overall life cycle of the food product is about 10%, and so my question is what is going on with the other 90%? and where are the inefficiencies that are happening? where the energy hidden is often in areas of production and one of the things that really frustrates me is, as ethically concerned consumers we are getting hung up on the smile measurement and we are not taking the time to wexler investigate our food is produced. let me just give you a couple of examples of how food miles and an emphasis on food miles can lead to counterintuitive results. there are two studies both which i summarize in my book. one has to do with the lamb. the study which was funded by

the new zealand government and has an interesting outcome here, but the study found that in great britain, it made actually more sense energywise and energy efficiency it made more sense to purchase your lamb from new zealand environmentally than it did to purchase your lamped locally in the u.k.. hugo welch, how is that possible? that can't be possible with all of the traveling across the world. transportation does not matter is it is produced under natural conditions, it is grass bedlamp and the land they were comparing it to us produced under bifurcate confined animal feedlot conditions, industrial conditions. the energy sync was in the form of production. it wasn't in the distance of the lamb traveling. study showed if you bought local hothouse tomatoes grown with and put some heat and under artificial conditions and you bought those locally it would be

ten times more energy inefficient then if you got to make those that were grown naturally on the other side of the world. and you know these examples are rallied more than anecdotal. i think the point to a hidden aspects of our food system that we are not paying enough attention to. so what may ultimately envision and propose an somewhat sketchy form is a kind of hub and spoke system for food production and food transportation greta hubs, ufc in the airline hub and spoke maps where, there is a natural comparative advantage to produce that good, with the inputs can be the lowest, produce the food there and then ship it as efficiently as possible to places. that should not be producing the food because they lack the comparative the band itself the grant system based on the economies of scale, comparative advantage and efficient means of

production. that is a story why i think that, if we just focus on where we came from, i think we miss that larger story. >> this was a portion of the booktv program. you can view the entire program and many other booktv programs on line. go to booktv.org. type the name of the author or book into the search area in the upper left-hand corner of the page. select the "watch link." now you can view the entire program. you might also explore the "recently on booktv" box or the featured video box to find regent and featured programs. >> senators are continuing their debate on the health care bill through the weekend. our regular booktv schedule

will be pre-empted during these rare senate sessions. with booktv programs resuming after the debate. watch the senate debate on health care, live gavel-to-gavel here on c-span2, the only network with the full debate and edited in commercial free. to read this and the bill and the house version plus watch video-on-demand go on line to c-span's health care hub. >> every once in awhile we get the chance to talk to a children's author on booktv, and judy blumberg is one of the more famous children's authors and she is joining us now while we are doing our show at the national book festival. why did you start writing? >> i started writing because i just had so much creative energy who locked up inside of me, and it was making me sick. i didn't know it at the time but i was sick throughout my 20s and once i started to write, all my

illnesses magically vanish. i do think that the creative child, i had a lot of outlets when i was in school and suddenly i didn't have the same creative outlets ore-ida didn't know that i did. i didn't know what to do, and once i started to write and i always have the stories in sight of my head, and i let it out, and it was cathartic and it was wonderful and it changed my life to this day. a continues to change my life. >> did you write when you were in school? >> never. i can't say never but creative writing when i was in school in the fifties was not stress. it wasn't something we did every day. i always like to write. when we were assigned reports, other kids would groan and i would think, of good. i worked on the high school newspaper, but it never occurred

to me that a person could grow up to be a writer. people who wrote books i thought were dead. i don't know what i thought, but it was just something so far away that i never dreamed of it and i never knew anybody who wrote. i never knew anybody who had written, and never knew anybody in publishing. so, i did this in my own little isolated world. and again, never dreamed of what could happen. >> who was the first person that encourage you to start writing again? >> i can't say that anyone anchorage me to write. i mean, it came from deep inside and what kept me going after my first manuscripts were rejected i think was that determination. i was going to-- and i got a rejection once and twice and after that it would be yeah that

book but wait until they see what i do next. iz believe that that kind of determination is what makes 160. you can be talented and be afraid to do it, and while i was a very fearful child, i have always been fearless in my riding and i cannot explain that. >> you mentioned that you are fearless in your riding yet some of your writing has been controversial. >> i never dreamed about that when i was writing. it never occurred to me. i tell people it is dangerous to think ahead when you are writing. you don't think ahead about who is going to read your book, you don't think about a censorship on your shoulder or a critic on the other shoulder. it comes from someplace else and it is so amazing when it actually works, when you sit in that room for a few hours and you look at the time and you

know, it is the other end of the day and you think well, and you look back and you say how did i do that, how did i know that? you are not aware of. isn't magic, but it is. >> is writing isolating? >> well, it is lonely writing can be relieved only have and there was a time in my life when i thought i didn't want to do that anymore. i wanted to be out in the world. i wanted to be an editor. i wanted to work with people. and, i never stopped though. i never stopped and then i began to be very grateful that i could do this and there have been other times when i have said this is it, i am never doing this again. it is too hard, it is too painful and i can't go through this again because it is

torture. as pleasurable as it is when you are working it is torture. i said i was quitting after summer sisters which is an adult novel and it took me three years and 20 something drafts and i said i'm never doing this again. i waited a few years and i couldn't wait to get back in that telegram alone with my characters. >> 20 drafts, self edited or did you have an editor you were working with? >> you know, somewhat more difficult than others. that was a particularly difficult drafting a plan through many, many drafts before i ever shown to an editor. thanks to that editor, she encouraged me to get right and by talking with her about it, i knew suddenly what i had to do. once i got there, you know, i could not stop writing.

it was over the summer. i was in my little cabin and i never wanted to come out. i which is working, working, working in they grill and the came together. >> do you use a computer? >> i started long before there were computers, so i been through manual typewriters, electric typewriters, so electric's and yes, i use a computer but i print out a lot, which i know is not green but i try to use, reuse the paper and the reason that i print out so much is depth i have to have a pencil in my hand and on those printouts, with the pencil, all of my best ideas and its revisions and i write all up and down, over and around and behind and sometimes i can't figure out what i meant but that is where it is really working.

it is that, whatever it is that happens between the brain and the pencil in your hand, that is really important to my process. you know, kids would ask me how you do this? i don't know how the creative process works but i have come to trust it. i have come to trust that will happen. >> is your computer connected to the internet? >> you worry about germany scripps getting out accidentally? >> i have never thought of that and yes i am on the internet and i have a husband who is extremely high tech, and so when i go home and ask him this question i am sure he is going to say laugh and say don't worry. i think anyway. >> how anonymous are you these days? can you be anonymous still? >> i can be anonymous enough, sure. and when i am recognized it is the sweetest kind, if you want

to call the same, that you could possibly have. it is the ups guy saying, hey your book super fudge was the first book i ever read. it is giving you your credit card to a sales clerk or a waitpersons somewhere in saying thank you for those books. it couldn't be nicer, but i don't really have any problem with that. except maybe at a book festival. >> do you get mached? >> today? c.s. >> and, do you enjoy it? >> i enjoy it when it is somewhat orderly. i mean i signed for two hours and we had to turn away a couple hundred people and that was very sad. i like doing that. >> judy bloom, you talk about people coming up in being very nice to you, glad to read your

books but not everyone has liked the topics that you have picked cqynar books. when somebody comes up to you and is not a fan what do you hear and how do you respond? >> i don't think i have never met any of those in person. i certainly have heard from a lot of them in writing, but i don't think anyone has ever come up and attacked me. ida want to give anybody any ideas here, because i wouldn't like that. and, you know, and the urge to keep books from children, the urge to ban books, to challenge books, it is maddening and yet it is interesting because i think it really grows out of the desire to-- is the year. it is fear that if my child reads this book you have written, my child is going to know about this and if my child

knows about this may be is going to happen to my child, maybe my child is going to do it or maybe my child is going to ask me questions that i don't want to answer or maybe my child is going to get new ideas and i don't want my child to have new ideas. but if u.s. a parent can talk to your kids all the time about whatever comes up, read the same books that they are reading, without becoming fearful, and just let it happen naturally, talk to your kids about characters and books is a great way to communicate. and don't be afraid, and don't be judgmental of what the kids are reading. the important thing is if they are reading. >> did your parents encourage your reading and writing when you were young? >> my parents totally in kurds might writing. my parents were both readers and there was never anything off limits. i said last night i came here

that's books were a good thing. reading was a good thing. there wasn't anything to be afraid of and there was no book in my house and there were many books in my house, that i wasn't free to explore. i was reading a lot of adult books at 12 and 13. i think also because there weren't any young adult books than. you went from nancy drew to sell an jerrett borut i don't no, john o'hara, and i never had the idea that i was reading anything wrong, because there wasn't anything wrong. they were books and they were to be cherished and they were there for me. the more i explore these books the more i wanted to read. and is through reading that you become a writer. i don't believe that anybody who can be a writer who has a first

been a leader. >> how many books are you currently working on? >> currently? i am a one project at a time girl. i have to focus and and it is very hard for me if i can't do that. i only take on one project at a time. >> how many ideas are in your head? >> i don't know. i am not sure. i never know. it is very interesting, and usually they sit on the back burner for a very long time before i know this is the day, okay is your turn, let's see what you have to say and i go into their room and start. for the first time in my life an idea came to me last year when i was listening to another writer talk about her book and it was just like-- and it came with a plot and with characters and required research which i have never had the pleasure of doing before because i write

contemporary fiction. this process of doing research, i loved it. i have fallen in love and i don't know if i ever want to do another book without it but i haven't started the book yet and my nonfiction writing friends say yeah, the research, that is the fun part. wait until you have to sit down and write the book. the book will be a novel based on something that happened in my town in the '50s when i was growing up. >> where did you go up? >> elizabeth, new jersey. >> can you give us an idea of what the event was? >> i would rather not. >> children's author, judy blume, thank you for being on tv. >> thank you so much. it was fun. >> anthony pitch author of seven books including-- his new book out called they have killed papa dead, the road to force the arab abraham lincoln's murder and the rage for vengeance.

>> i spent nine years researching and writing. i have tons of neira permission. the biggest thing i found was lincoln was going from the old senate chamber in the capital have been witness the inauguration of his vice president, went to the rotunda. and man burst through the crowd a few feet behind him and the commissioner of public buildings seized him. the man insisted on his right to be there and the man seized the men said maybe he is a new congressman i don't know and he released them. lincoln was inaugurated, and aware of this. this man you see is a relative, i found the letter and it said that was the face of the man i restraint. it was john wilkes-booth. >> if you could find that photo on line now, the and photo of this? >> oh yes. >> you takasu in this book about very early threats against lincoln during is presidency.

>> in great detail the opening chapter on his way by train from springfield illinois to washington for his first inauguration in 1861 there was a plot to assassinate him as he came to baltimore and it was smuggled into washington and head of his thunder and then i found new sources to corroborate that. >> you talk about the beginning, you talk about the middle, the execution and the assassination. can you talk about the conviction of these men? can you talk a little bit about their imprisonment and the result of the verdict? >> i found the great granddaughter and we became friends. she shared with me his original daily journal and private letters written to him and by him, and much of what i write about his brand new. the torture of the conspirators. they were headed, shackled, iron in cells 3 feet