excise tax is -- is that it categorizes plans based on their actuarial costs, not solely on the generosity of their benefits. plan characteristics explain only a small percentage of the differential in costs. some reports suggest only 6% of the difference in costs as explained by generosity of benefits. i'll give you an example. small business that employs many older workers is going to face face -- is actuarially going to be considered higher than a business with a young work forc. even if both of these employers provide the exact same benefits their costs will be different. the employer with the older workforce faces a higher risk of falling under this tax not due to the richness of the benefits, but due to the age of its employees. the same goes for small workforces. if small business offers one set of health benefits and a large

company offers the exact same set of benefits, the cost for the smaller employer are higher because his risk pool is smaller. do we really want to penalize small businesses? or a workplace that retains older workers. senator sanders? mr. sanders: let me pick up on the point that the senator from minnesota made. when you use the term "cadillac," what the implications are, maybe we will get some guys from goldman sachs who have this off-the-wall outlandish benefits package. when the c.w.a. did a bit of work on this, what their estimate is that as health care costs continue to rise and we're seeing 6%, 7%, 8% increases every year, obviously the way the language of this legislation is written, it will impact more and more health care plans. by the year 2019, it will burden

one out of three health care plans in this country. does that sound like a cadillac plan? one out of three plans. and eventually as health care costs continue to rise, it will impact virtually every plan in this country. so the bottom line that we're talking about is, yes, we need to raise money. how do you do it? you do it by socking it to the middle class and working families. and as the senator from ohio has indicated, many of these workers have given up wage increases in order to maintain a strong health care benefit. and those are the people we're going to tax. or you tax the top .02%, many of whom received generous tax breaks in recent years. mr. brown: i want to talk for a moment about the people who will be paying more taxes. you said their income is, i believe, a couple million a year that will be paying these taxes. during the last ten years,

during the bush years, during the eight years president bush was in the white house, the tax system changed pretty dramatically during that taoeufplt my understanding -- during that time -- my understanding is that, my understanding for sure is that the tax system hasn't changed. it had much more of a tilt toward the wealthy. that is president bush's tax cut always included a few middle-class people. a family making $50,000 might be making a few tax cuts over the year. if you made millions of dollars, you got huge tax cuts. i remember warren buffet, who generally likes what we're trying to do here and wants a fairer tax system, warren buffet says he pays a lower tax rate than his secretary and he pays a lower tax rate than a soldier coming back from iraq.

talk if you would about what happened in the last decade for taxes for the group of people -- the wealthiest that we think should pay a little bit more under this plan. mr. sanders: i think the evidence is overwhelming that one of the reasons we have seen record-breaking deficits and we have a $12 trillion national debt, not just the war in iraq, it is also the huge tax breaks given to the very wealthiest people in this country. i think as the senator from ohio indicated, the facts are very clear. the middle class may have gotten some benefits, but the lion's share of tax breaks went to the people on top. what we are seeing in this country is a growing gap between the very, very wealthy and virtually everybody else. in many ways the middle class is shrinking, poverty is increasing. it makes zero sense to me that in the midst of all of that that we ask the middle class to pay more in taxes to provide health care to more americans, and we leave the top .02% alone. let me also just say this:

there is a lost support out there for the amendment -- there is a lot of support out there for the amendment that senator brown, senator begich and senator buries and -- senator burris and i are offering. let me read one. this is from the president of the fraternal order of police. these are cops out on the street. most people don't think cops and police officers are getting extravagant health care benefits. this is what he said: "i am writing to you on behalf of the membership of the fraternal order of police to express our support for your amendment which would eliminate the excise tax on high-cost insurance plans. this provision, et cetera, et cetera, is intended to tax the wealth plans for the -- health plans for the wealthiest americans but will also tax the plans of officers who need high-cost insurance due to the dangerous nature of their

profession. the fraternal order of police supports your amendment because it should not increase the tax burden who risk their lives to keep our community safe." mr. franken: let's think about these union folks who, again, they negotiated these health care policies and sacrificed in salary. what are they getting? they're getting affordable deductibles. they're getting affordable co-pays. sometimes they're getting vision and dental care. this is comprehensive health care that we want americans to get. and these -- that's who's going to get hit. in the whole, we have seen over the last 20, 30 years a squeeze on these people.

we have seen a squeeze on the middle class, a shift in the risk to people. that's what this whole bill is about. we're trying to eliminate the risk of losing your health care if you have a preexisting condition. we're trying to lose the risk of going bankrupt. that's the whole point of this bill. that's part of the whole point of this bill. and let's not shift more risk on to these folks who are doing these kinds of jobs and providing -- supporting their families with their salaries and their benefits. mr. brown: exactly right, senator franken. think about that. we want to give incentives for people to do the right thing. we're glad when people have good health insurance because then they don't rely on medicaid or they don't show up at the hospital in the emergency room and get the care for free while other people have to pay for

that care, others who use the emergency room and have insurance, others who use the hospital so the hospitals don't get stuck with the cost. if they have dental care, they're getting the right kind of preventive care so they don't have more expensive care later. we want people to have insurance that includes eye care, preventive care. if more people had this, there would be a lot less burden on taxpayers to take care of everybody else. it's clear the arguments here are not just, it's the right thing for the police officer, that senator sanders said. it's the right thing for the person that senator franken talked about that's getting dental and vision care. but it's good for society as a whole that people are willing to give up some of their wages in order to get a good medical plan. mr. sanders: senator brown a moment ago asked me a question about the extent of tax breaks given to the wealthiest people,

and i have that information. that is since 2001, senator brown, the richest 1% of americans received $565 billion in tax breaks. in 2010 alone, the wealthiest 1% of americans is scheduled to receive an additional $108 in tax breaks. that's point number one. point number two, let me be a little bit political here, in the presidential election of 2008, one of the candidates said that it was a good idea to tax health care benefits. that candidate -- senator mccain -- lost the election. the other candidate said it was a bad idea to tax health care benefits. that was barack obama. he won the election. let me quote what then senator barack obama said when running for president. here's what he said in 2008. "i can make a firm pledge. under my plan no family making less than $260,000 will see

their taxes increase, not your income tax, not your capital gains taxes. not any of your taxes. my opponent, senator mccain, can't make that pledge, and here's why. for the first time in american history -- this is senator obama speaking about senator mccain's plan. for the first time in american history, he -- senator mccain -- wants to tax your health benefits. apparently senator mccain doesn't think it's enough your health premiums have doubled. he thinks you should have to pay taxes on them too. that's his idea of change. end of quote. i agree with what senator obama said in 2008. i disagree with what senator mccain said then. right now we are in a position to follow through on what senator obama said at that point and make sure that the middle class of this country does not pay taxes on their health benefits. mr. brown: would the senator yield? thank you, i think that made that very clear, senator

sanders. earlier you talked about what the tax cuts during the bush years, what it did during to the national debt. you mentioned the $1 trillion war in iraq and afghanistan, not to mention the cost it is going to continue to be for the men and women who served us courageously with their physical and their meantal injuries from iraq. and senator franken is so familiar with this because of the tours as a private citizen he made to battle zones year after year to talk to troops and entertain our troops and didn't get a lot of credit for that but didn't care about the credit for that, and was there always doing that. one of the things that's pretty interesting, listening to my republican friends on the other side of the aisle, talk about this bill now which the congressional budget office says is paid for itself and more, while they continue on their side to talk about the budget deficit, it was that group who

passed, senator sanders and i, passed the medicare privatization act. and the people who were on the floor just talking to us voted for cloture for the medical modernization act. that bill was a giveaway to the drug industry. it has added tens and tens of billions of dollars to our national debt. on the one hand, they say, they support these tax cuts that are not paid for. they support the iraq war which is not paid for. they now want us to go into afghanistan and not pay for it, and increase the number of troops. they continue down this road when we are on this bill doing the right thing. even with our amendment here to eliminate the cadillac -- the tax credit, the tax in cadillac plans, we're saying we're going to find another way to pay for it. we're not just going to eliminate that cut in taxes. we want to, but we're going to pay for it some other time. every time -- senator franken, i

yield. mr. franken: we're actually addressing that doughnut hole that was in the medicare part-d bill, we're closing it by half. you know wh it starts? next year. senator thune did say that none of the benefits start next year, but he just -- i guess hasn't read the bill. i have so many constituents come to me and say "read the bill, read the bill, read the bill." mr. brown: would the gentleman yield? perhaps if you're going to vote against it, you don't need to read it? is that the way they think about it? mr. franken: i do find that many of my colleagues who i'm very friendly with have not read the bill and are not very familiar with it. and i think that if you're going to get on your feet and debate and make assertions, you should really be familiar with the content of the bill. that's what i thought. i've only been here awhile, so

maybe i'm naive. but i think when you say that none of the benefits are going to start next year, you should be right. mr. sanders: if i could add to the point that senator brown and senator franken made regarding concern about the national debt, every day there's a republican coming up here and said, you know, we've got a $12 trillion national debt and we've got to cut this and we've got to cut that, and all that. and yet, i think virtually every one of them is in support of the repeal of the estate tax, which benefits -- would benefit solely the top .3%, would cost the treasury $1 trillion over a 20-year period. $1 trillion, ten-year period, i'm sorry. $1 trillion over a ten-year period. i'm really concerned about the deficit. i'm concerned about the national

debt, but i'm prepared to vote for repealing the entire estate tax, which only impacts, gives $1 trillion in tax breaks over a ten-year period to the top .3%. some may question the sincerity about their concern about the national debt. mr. franken: in fairness, i'm not sure that they're all for that. i think i've heard some soundings from the other side to extend what we have this year, because this runs out on january 1, and we don't want to see a lot of plugs pulled. mr. sanders: i'm talking about what happens now, overall the vast majority of republican friends want to ablogical about hreurb -- abolish the estate tax. mr. franken: i want to bend over backwards to be fair to my colleagues on the other side. maybe i do that to a fault, and i apologize to our side.

mr. sanders: madam president, i would also point out that what senator brown and senator franken and i are talking about today, i think the polls show has overwhelming support among the american people and organizationally, it has the support of the afl-cio, the national education association, the fraternal order of police, the international brotherhood of teamsters, the communications workers of america, the united steelworkers of america, asme, the american postal workers union, and a number of other organizations representing millions of working people. this is not a complicated issue. somebody is going to have to pay more in this bill. and should it be the middle class and working families, or should it be the people at the top .on 002% over the period fd last eight or nine -- period of the last eight or nine years have enjoyed huge tax breaks? i think this is a no-brainer. and the good news is that our friends in the house have moved correctly in this area, and the bill before us in the senate has

not. so what we are trying to do is to get an amendment to take out the tax on health care benefits and replace it with similar language -- not exactly the same as exists in the house. mr. franken: let's get back to the excise tax. what it's purportedly supposed to do, it's supposed to bring down costs and generate revenues. while those are both necessary objectives, and i've been submitting stuff over and over again to bring down costs, including a 90% medical loss ratio, including uniform, standardized insurance forms which will save billions of dollars, i don't think this excise tax is the best way to bring down costs and generate revenue. first, we should be focusing on

actually bringing down the cost of services instead of trying to limit the availability of care,ancare, and one way to actg down the cost of services is the value index in the bill, which senator cantwell introduced in the finance bill, which is still in this bill, in which senator klobuchar fought for and from of us from the high-value states. and that will change the medicare reimbursement rates to incentivize value. another unintended consequence of the he can eyes tax is its effective penalty on comprehensive benefits -- the he can eyes tax is its effective penalty on comprehensive benefits that is given by the unions. and once again i come back to the unions, who gave up salary and benefits, who gave up earning benefits and who -- and

as soon as this keeps going -- this is going to be like the -- this is going to be returning year after year as we see medical inflation go up and up. i think this is at -- at the cost-of-living index plus one, right? mr. sanders: right. mr. franken: plus 1%. well, that's not what we've seen from medical costs. mr. sanders: and that's the point. point is that medical costs are going up substantially more than inflation, which is, in fact, general inflation as i understand is actually going down. and there is no question but that as medical inflation continues to remain high, that millions and millions and millions of more workers are going to be forced to pay this tax. and one of the other side effects of this tax is that many employers, in order to avoid it, are going to start cutting the benefits that -- the health care benefits that workers receive. today it may be dental. tomorrow it will be vision. the next day it will be more

copayments, higher deductibles. i think this is grossly unfair to the families. mr. brown: again, it's making choices. unlike the medicare modernization act, when the republicans pushed that through in 2003 -- and i -- you know, i know that my friend, senator ensign who's here, voted against that although he voted for cloture but he actually opposed that, to his credit -- but, you know, that was -- that was legislation that wasn't paid for. it was a giveaway to the drug and insurance industry. it wasn't paid for. our legislation is and our amendment is. we made a choice: do you charge the middle class, do you pay t tax, do you say to the middle clarks you're going to pay a tax on your -- middle class, you're going to pay a tax on your benefits or do we make somebody else pay who's gotten a lot of benefits over the last few years? since 2001, the richest 1% of americans, during the bush -- because of the bush tax cuts, got $565 billion in tax breaks,

$565 in tax breaks during -- since 2001. this year that same wealthiest 1% of americans are scheduled to receive an additional $108 billion in tax credits. so it's clear we want to go to the right place in this, we want to keep it fiscally sound, we want to keep it balanced, we want to pay for it, something that my friends on the other side of the aisle rarely do when it comes to war, when it comes to -- to tax breaks for the rich, when it comes to giveaways to the drug and insurance conditions, but we're doing it that way. that's why the sanders amendme amendment, the sanders-franken-begich-brown amendment makes so much sense. mr. franken: and just one last word on the deficit and the de debt. may i remind everyone that when the republicans were in the majority and president bush came to washington, we had a surplus, a record surplus. and at the time, the chairman of

the fed, alan greenspan, testified to congress that we had a new problem and the new problem was that because of the projected surpluses, we were in a number of years going to have too much money, that we were going to pay off the debt and the federal government would be forced to buy private equities and that this would not have a maximizing effect on -- on our economy. that's what he said after bush became president. that was what he said. he said we had -- we were going to have too much money. that's what the chairman of the fed said. so we handed the ball off to president bush and we handed the ball off to these republicans and the problem was we were

going to have too much money. well, that's not a problem anymore, is it? and now you hear them screaming about the deficit. well, think about the deficit they left us. think about the economic circumstances that left us in. we're talking about getting rid of this excise tax but we're talking about paying for it. the c.b.o. has scored this bill as cutting the debt in the next ten years by $179 billion and then $500 billion in the next ten. that's responsible. what we saw in the years that we had a republican president and a republican house, a republican senate was an explosion in this

deficit. i don't want to hear lectures about the deficit, and when i hear presentations from my colleagues, i want them to remember what senator mccain said when he said facts are stubborn things. when we debate in this hall, on this floor, let's stick to the facts. so many of the benefits in this bill start immediately and it simply is not fact to say they don't. mr. sanders: i think we probably -- how much time do we have left? the presiding officer: there was no time limit on the colloquy. mr. sanders: oh, okay. i think we are coming to the end of it. and i would just hope, focusing on this issue of the excise tax,

that the senate is prepared to support our amendment, and if that is not the case, certainly support what the house has done in the conference committee. taxing middle-class workers is not the way we should fund health care reform. mr. franken: thank you. and i want to thank both my colleagues from vermont and from ohio and urge my colleagues to support amendment 3135. thank you, madam president. the presiding officer: the majority leader. mr. reid: i ask consent -- unanimous consent that i be allowed to engage in a colloquy with the sthr senators from connecticut -- with the senior senators from connecticut and montana. the presiding officer: without objection. mr. reid reid: madam president,n the american people demanded last november and throughout this year that we make it possible for every northern afford a -- for every american to afford a healthy life, they did so because they know from personal experience just how broken our

country's health care system really is. and as the senate has worked to answer that call this year, we've drafted a bill that will save lives, save money and save medicare. many aspects of the current bill achieve that goal. but there's one more thing we can do, closing the notorious gap that arbitrarily charges seniors in nevada and throughout the entire nation thousands and thousands of dollars for prescription drugs. as seniors know all too well, the prescription plan is called medicare part-d and the coverage gap is commonly known as the doughnut hole. right now, medicare will help seniors afford their prescription drugs only up to a certain annual dollar limit, $2,700 a year, then stop and then help them again only once their bills reach another much higher level, $6,100. so from $2,700 to $6,100, that is the notorious, bad doughnut

hole. between these two points, seniors are stuck with the full bill. imagine if you had car insurance covered you until you drove 2,700 miles in a given year, then stopped, then started covering you again on once you t 6,100. the 2,700 miles to 6,100 would be pretty scary. that wouldn't work for drivers and it doesn't work for seniors. the effects of this broken system are painfully simple: more and more seniors have to skip or split the pills they need to stay healthy t. means that in -- healthy. it means that in january, somebody will pay $35 to fill a prescription. but by orkts he or she could be asked to -- but by october, he or she could be asked to pay thousands of dollars for the very same pills. madam president, i was at c.v.s. a day or two ago to pick up some stuff for my wife, at the prescription counter, and they had on counter there while you're waiting a list of the costs of all drugs.

i didn't fully understand it but i looked at it. there were some that had a value of thousands of dollars -- thousands of dollars to fill a prescription. the only one that i saw -- i didn't want to flip thou the pages, but the one page -- thrip through the pages, buflip through the pages. but the one, it was $9,800 for one prince. i don't know if it was 30 pills or what it was but it was striking. so if someone will pay $35 to fill a prescription, that's fairly inexpensive. but by october he or she could be asked to pay thousands of dollars? that's what it is. it's not an uncommon problem. millions of seniors, a quarter of all in the part-d program, reach that no-man's land during the year, the doughnut hole. but only a small fraction of them get to the other side. both numbers will get only worse if we don't act. not surprisingly, those caught in the middle simply don't take the medicine they need at far greater rates tha than those who

have coverage. like we see the uninsured americans of all ages, those who can't afford the treatments they need to get healthy will get even sicker. down the road, that means more expensive doctor visits, more expensive hospital stays, and more expensive medicine. it means more sickness and more death. we've already taken the first steps to fix this in the current bill, closing the gap by halfdd. because i'm committed to saving lives, saving money and saving medicare, i personally am committed to fully closing the doughnut hole once and for all. so once we pass this bill out of the senate, we'll do so in our conference committee with the house, whose bill already closes the gap. the doughnut hole in the house legislation closes the doughnut hole. the legislation we'll send to president obama for his signature will make good on his promise and ours to forever they understand indefensible injustice for america's seniors. mr. baucus: madam president?

mr. dodd: madam president? the presiding officer: the senator from connecticut. mr. dodd: madam president, i just want to agree with my friend, the majority leader, that we must close this doughnut hole. i think it's something all of us appreciate, and i second his commitment to doing so with this bill that we send to the president. as most seniors live on modest incomes, as we all know, it is imperative that we can afford -- rather, they can afford the prescriptions that they need. and as the majority leader has noted, seniors who have trouble paying for their prescription drugs are more likely to skip doses or stop taking their medication says altogether -- medications altogether which can lead to more serious health problems and higher long-term costs, beth for them and our -- both for them and our health care system as a whole n. my home state of connecticut, 25%, a quarter of all part-d enrollees fall into the doughnut hole. and so i understand the significance of delivering on the commitment to fixing this problem. we have a responsibility, i think as all of us can appreciate, to protect and strengthen medicare and to improve the lives of our seniors. if we fail to act, the doughnut hole, we're told, will continue to grow in size, doubling in

less than 10 years. the size of the doughnut hole is directly tied to drug prices, prices that are rising at an alarming. sen -- seniors will spend thousands and thousands of dollars, not including the cot of their premiums, before they get out of the doughnut hold an get the treatments they need. they can thought afford to wait any longer to close this costly gap. our historic reform effort must improve the quality and affordability of medicare. closing the doughnut hole is a clear and concrete way to do just that. i understand that we may not have the opportunity to fill thi--to fix this opportunity ine senate bill before it leaves this chamber. i want to to be known that i support the idea of closing the doughnut hole in the conference committee that will meet with the other body. the presiding officer: the senator montana. mr. baucus: madam president, in closing the doughnut hole -- closing the doughnut hole is clearly the right thing to do. medicare beneficiaries face extremely high out-of-pocket

costs for outpatient prescription drugs. in fact, they face costs that are six times higher than out-of-pocket costs for those of us fortunate to have employer-sponsored coverage. the doughnut hole contributes to these high out-of-pocket costs. as a result, the doughnut hole often results in seniors skipping vital medications. eliminating the coverage gap in this medicare prescription drug program will save people with medicare thousands of dollars every year. and lowering the cost for seniors will also keep them healthier by ensuring that they can afford the medications. in my home state of montana, 33% of seniors enrolled in the medicare prescription drug drug program fall through the doughnut hole everyee. one third. we all know what the consequences are when people cannot afford the medications they need to stay healthy, both for the affected individuals and

for society at large. recognizing the scope of this problem, in his address to a joint session of congress in september, president obama promised to close the doughnut hole once and for all. it is our responsibility to make good on this promise. and provide this needed relief to seniors. i will join my colleagues in committee that we will send a bill to the president that closes the doughnut hole and fulfills his promise. mr. reid: madam president? the presiding officer: the majority leader. mr. reid: if i could ask my clue two colleagues through the chair, if it is their understanding that the president fully supports this action. mr. baucus: mr. president, if i might respond to the leader, that is my full understanding. mr. dodd: madam president, that is my understanding as well. madam president, i'd -- oh, i see ... the presiding officer: the senator from nevada.

mr. ensign: madam president, i want to address a few of the things that were on the floor just now. but i want to start with talking about how this health care bill will affect small businesses. small businesses are the engine that drives our economy. we know that they're struggling right now. the president met with some bankers today over at the white house because many of the large banks aren't loaning money to the small businesses. we all know that. many small businesses are just struggling to keep their doors open. one of the reasons that small businesses are a little nervous right now is they don't know if this bill goes into effect what the -- what that massive effect is going to have on them, and so they're uncertain about the future. well, let me tell you a few things. first of all, we all know that there's a $500 billion tax

increase contained in this 2,074-page bill that is before us today. in that, there's an employer mandate -- $28 billion. this is what the nonpartisan congressional budget office has said about that $28 billion: not only does it fall mostly to small businesses, but it goes further to say that the workers in those small businesses would ultimately bear the burden of those fees. that's a direct quote. this bill also discourages small businesses from hiring folks. c.b.o. went on to talk and say, employment loss would be concentrated amongst those in the low-income categories. well, do we really want to do that to folks out there that are really struggling right now? we've heard across this country record numbers of people signing up for food stamps, for welfare, for all the various unemployment

insurance, all the various government subsidies that are out there to try to help people through a tough time. do we really want to keep them from getting the job? the payroll -- medicare payroll tax is $54 billion in this bill, will hit one-third of all small business owners. those small business owners that it'll hit employ about 30 million people in the united states. and pu you put a tax on somebod, especially during a recession, you're going to inhibit them from investing in their business and creating jobs. i've heard many people from the other side of the aisle talk about t it is not a good time to raise taxes. and yet in this bill we're raising taxes. sometimes they call them fees, they call them other different things, but they are taxes. this bill also will require

small businesses to buy a government-approved insurance plan. so even for those small businesses who currently have a plan that they like, works for them and their employees, they can afford it, they tried to do the right thing, that plan just doesn't quite meet the government criteria, maybe because it was a little more after bare-bones plan, they're going to -- this bill will require them to spend more money on a higher level of coverage maybe than they could afford. what will that do? well, if they're barely getting by now, barely keeping the doors open, and you require them to spend more money on health insurance, some people may be laid off or the businesses may close and they all may lose their jobs. most people in this body have never operated a small business. i've built, owned, and operated two different small businesses, veterinary clinics. i understand how difficult it is

for a small business owner, especially when you're just starting out, and you're investing, you're putting everything you had, all that hard work and the few profits you make, you plow them back into the bissments you're trying to expand, you're trying to hire the next person, and you are he trying to grow your -- and you're trying to grow your business. when the government comes along and puts extra taxes and extra burdens on you, it makes it tough. that's not what we should be doing, especially during this time of recession. well, this plan also -- this bill before us also caps what are are called flexible spending accounts at $2,500. now, flexible spending accounts are used by a lot of small businesses, but they're also used by just a lot of federal employees. they're used by a lot of people, and they're especially used by a lot of people who have serious chronic diseases. so you can put, if you're a

federal employee, for instance, you can put $5,000 into a splebl -- into a flexible spending account and then you can pay for out-of-pocket expenses for approved, for instance, health care expenses. this bill caps that at $2,5 a year, and so for those maybe -- maybe somebody who has multiple sclerosis, somebody who has diabetes, somebody who has a chronic disease that requires a lost medical attention, you're hurting those people who need that money the most. that's not something we should be doing. but that's exactly what this bill does. now, let me talk about some of the general provisions in this bill and not just how it affects small business. we talked about it a lot on the floor. we know thi there is a $500 biln cut in medicare. folks on the floor were just talking about the doughnut hole for senior citizens and the prescription drugs on medicare part-d.

well, medicare advantage is a place where they're cutting $120 billion out of medicare advantage. most medicare advantage plans have no doughnut hole. and yet they're taking $120 billion out, cutting those services. according to c.b.o., there will be a 64% reduction in extra benefits by the year 2016 for those seniors who have medicare advantage. 10 million seniors in the united states today have medicare advantage. they've chosen -- they weren't forced into it. as a matter of fact, it was a new program, and seniors don't like change that much. and yet they saw an advantage. they didn't have to pay their medigap insurance. they didn't have to pay -- they didn't have a doughnut hole. many of them got vision and dental servicessings and yet their benefits are going to be cut by 64% because of this bill.

overall, because of the way the smoke and mirrors are used, it says that this bill only costs $849 billion. well, the reason that the costs are hidden -- first of all, $849 billion is a huge number. but it's actually a $2.5 trillion spending bill. and the reason is because when you look at fully implemented -- right now a lot of the benefits don't start right away. but the taxes start right away. so when you look at the full ten years with taxes, benefits, and everything, it is a $2.5 trillion bill. it is a massive increase in the federal government. just as an example, within the 2,074 pages of this bill, there are almost 1,700 new places where it gives authority to the secretary of health and human

services to make health care decisions for the american people. 1,700 times it gives the secretary of health and human services the authority to make health care decisions for the american people. if that's not a massive government expansion into our health care field, i don't know what is. there's also about a $500 billion in new taxes. you can put up the quote -- this first chart. this is a quote by president obama on his health care promises. he said, "let me be perfectly clear, if your family earns less than $250,000 a year, you will not see your taxes increased a single dime. i repeat -- he said -- not one single dime. he said "nothing in this plan will require you or your employer to change the coverage or the doctor that you have.

let me repeat this: nothing in our plan requires you to change what you have." and thirdly, he said, "under the plan, if you like your current health care insurance, nothing changes, except your costs will go down by as much as $2,500." let me take especially this first vote. these are the new taxes that are going to be -- that are in this bill. there's a 40% insurance plan t tax, there's a separate insurance tax on top of the 40% insurance plan tax. this is the one, by the way, that several of my colleagues were just talking about that the unions are all up in arms about. this is the cadillac plan that they talk about that's going to be taxed and most union members have this cadillac plan, and their plans are going to be taxed at 40% above a certain dollar figure. and because it's not indexed to inflation, by the end of a decade, most americans' plans

will be subject to this 40% tax. there's also an employer tax. but as the congressional budget office said, employers -- this actually gets shifted down to the workers. there's a drug tax, so every time you purchase drugs, the taxes are passed on. so all of us are going to be paying more for drugs. there's a laboratory tax. every time you go in, there's a tax on the lab, lab fees. all of these things end up raising health care premiums. there's a medical device tax, there's a failure to buy insurance tax, there's a cosmetic surgery tax, and there's an increased employee medicare tax. now, the thing about this is, remember that first quote where president obama said he would not raise taxes on anybody making $250,000 or less? that was for families and individuals making $200,000 a

year or less. 84% of the tastles taxes in this bill will be paved by people making less than $200,000 a year. 84% of the taxes. now, madam president, another problem with this bill, it contains a sense of the senate on medical liability reform. the presidñ president -- the president talks about in his address on health care reform that we need to do something on medical liability reform. the problem is this bill before us is a sense of the senate. let me show you. this is how much money this health care bill saves with their sense of the senate. zero. with real medical liability reform, the congressional budget office said real medical liability reform would save $100 billion in this country between the government, what the government spends and what the private sector spends.

$100 billion. so, madam president, the problems with this bill are so numerous, we could go on and on and on. but we really do need to start over. we need to start over and take more of this step-by-step approach, this incremental approach where both sides can agree on some of the reforms we need to do without destroying our current health care system. we do need to do medical liability reform. we need to agree -- it's in this bill -- about eliminating preexisting conditions. we need to agree on an incremental approach on rewarding people for healthier behaviors. if you're a nonsmoker or if you have the proper body weight -- in other words, you watch what you eat -- it's cheaper to insure people who are nonsmokers and people who are not obese. it's about $1,400 a year for a nonsmoker versus a smoker, for

somebody who is in the proper body weight versus somebody who is obese. we also need to allow small businesses to join together, join together in a way that they can take advantage of purchasing power the same way that big businesses do. now, madam president, those are incremental reforms that won't destroy the quality of our health care system, that won't take the cost for small businesses and put that cost on small businesses. this is something that we should do. this is something we can do. but the only way to do it is to stop the bill we have before us. the only way to do it is to sit down together not as republicans or democrats, but sit down together, come up with the ideas that we can both agree on that will actually help the health care system in america. that's what this body should do if we want to do what's right

for the american people. i yield the floor, madam president. mr. mcconnell: madam president, i ask consent that senator mccain and i be permitted to engage in a discussion regarding the health care matter. the presiding officer: without objection. mr. mcconnell: madam president, last friday we heard from two entities. we heard from the center for medicare and medicaid services, indicating that health care costs in this country would actually go up under the reid bill. and we also heard from cnn, from sph-pls and from cnn. we heard from cnn how the american people feel about this health care measure. and at the time when all of the polls indicate the american people do not favor this bill, do not want us to pass it, when the government's actuary indicates that the bill will actually not cut health care costs, which we thought was what

this debate was all about in the first place, we are being confronted here with a procedure that is quite unusual, an effort to restructure one-sixth of the economy through a massive bill that it appears almost no one has seen. and at what point, i would ask my friend and colleague from arizona, at what point could we expect that the american people would have an opportunity to see this measure that's been off in the conference room here being turned into sausage in an effort to get the 60 votes? mr. mccain: i'd say to my friend, the republican leader, i've seen a lot of processes around here and a lot of negotiations and a lot of discussions. but i must admit that i have not seen one quite like this one, nor do i believe my leader has. you know, i was on the floor in

a colloquy with the assistant democratic leader a couple of days ago, and i said what's in the bill? and he said none of us know. talk about being kept in the dark. and you know you have to, i'd say to my friend from kentucky, you have to put this into the context of what the president of the united states said in his campaign. because the whole campaign, know better than anyone, was all based on change. and on the issue specifically, specifically surrounding health care reform -- and i quote -- then-candidate obama on october 18, 2009, said -- quote -- "i'm going to have all the negotiations around a big table televised on c-span so that people can see who is making arguments on behalf of their constituents and who are making arguments on behalf of the drug companies or the insurance companies.

and he went on to say that a couple more times. so i would ask my friend, hasn't it been several days that we've basically been gridlocked over one amendment, which is the amendment by the senator from north dakota, that will allow drug re-importation from canada and other countries? so then guess what the reports are today? pharmarenegotiating its deal. inside health policies, the pharmaceutical industry is negotiating with the white house and lawmakers on a revised health care deal under which the industry would ante up cuts beyond the $80 billion it agreed to this summer, possibly by agreeing to policies that would further shrink the doughnut hoefplt and i won't go into all the details of that. so just a few minutes ago on the floor, guess what? they announced that there would be some change.

there would be some change made, an amendment that would be included in the manager's package. and maybe, i would ask my friend, it may be the case that the majority leader, who is having a meeting as we speak of all the democrat senators behind closed doors, without c-span, has cut another deal along with the white house with guess who? the pharmaceutical companies who have raised prices some 9% of the prescription drugs this year. this is a process that the american people don't deserve, i would ask the senator from kentucky. mr. mcconnell: this is a process that gives making sausage a bad name. mr. mccain: we were hung up for -- shall i say gridlocked for two or three days, all entirely over the weekend. the republican leader even agreed to a unanimous consent agreement that would allow democrats, side-been-side --

side-by-side democrat amendment and that was not agreed to, until over at the white house, according to this report, pharma renegotiating its deal, and apparently they now have sufficient votes to defeat the dorgan amendment kh-rbgs as of last surges according to "the new york times," said the last deal, shortly after striking that agreement, the trade group, the pharmaceutical research manufacturers of america, or pharma, also set aside $150 million for advertising to support the health care legislation. is this the kind of process -- is this change in washington? is this changing the climate in washington, i ask my friend? or is it not only business as usual, but in my opinion, i haven't seen anything quite like this one. mr. mcconnell: i would say to my friend, it's certainly not

changing business as usual in washington. even more importantly than that, it's not changing american health care for the better, which is what we all thought this whole thing was about when we started down this path of seeing what we could do to improve america's health care, which almost everyone correctly understands is already the best in the world. mr. mccain: hasn't there been charge after charge that republicans are -- quote -- "filibustering" and that republicans have been blocking passage of this legislation? i would ask my friend, hasn't the republican leader offered a series of amendments that we could get locked into and having votes on? mr. mcconnell: i would say to my friend from arizona, we've been trying to get votes on the crapo amendment, for example, since last tuesday. it will be a week to. maybe at some point we'll be able to have amendments here. we started off on this bill with each side having amendments, and

we went along pretty well until i think the majority decided it was not only better to write the bill in secret, it was better not to have amendments on the bill. so they began to filibuster our efforts to have senators have an opportunity to vote on aspects of this bill, such as the half a trillion dollar cuts in medicare, the $400 billion in new taxes which we would like to be able to get votes on. this is the core of the bill. the american people have every right, i would say to my friend from arizona, to expect us to debate the core of the bill. the core of the bill. the essence of the bill, which is not, of course, going to be changed behind closed doors or during this meeting that's going on, democrats-only. mr. mccain: as i understand it, there's a meeting going on behind closed doors again. there's no c-span cameras. according to "the washington post" this morning, it says "the senate will resume debate monday afternoon on a popular proposal

to allow u.s. citizens to buy cheaper drugs from foreign countries, which led to a last-minute lobbying push by drugmakers last week and bogged down negotiations over a health care reform bill." it goes on to say "the fight over the imported drugs proposal poses a particularly difficult political challenge for president obama, who cosponsored a similar bill when he was in congress and who included funding for the idea in his first budget. but the pharmaceutical industry, which has been a key supporter of health care reform after reaching agreement with the white house earlier this year, has responded with a fierce lobbying campaign aimed at killing the proposal, focusing on democratic senators from states with large drug and research sector." so it will be interesting to watch the vote. and i would also point out to my friend, it's clear that the c.b.o., if we allow drug re-importation, will save $100

billion, according to c.b.o. and the first deal that was cut with the white house was that they would reduce by $80 billion. so they had a $20 billion cushion. now it will be very interesting to see what the latest deal is and how the vote goes. but again, i'd like to ask my republican friend, you know, you get a little cynical around here from time to time when you see sometimes deals cut and things done behind closed doors. i really am -- i'm past the point of frustration. i'm just -- i just get a little bit sad about this because i think we know that we're now bumping up against the christmas -- sometime we're going to break for christmas. and so the pressures now are going to be even more intense because i think it's well known and reported that if they don't

get a deal before we go out for christmas, then it will be very much like a fish sitting out in the sun. after awhile it doesn't smell very good when people see a 2,000-page bill which has all kinds of provisions in it. i understand without c-span cameras that all the 60 democratic members of this body are going to go down to the white house for another meeting tomorrow. but -- and we'll see what happens out of that. mr. mcconnell: talk about an example of manufactured urgency, is it not the case, i ask my friend from arizona, that the benefits under this bill don't kick in until 2014? mr. mccain: you know, my understanding is that if you go out and buy a car today from any car dealer that you don't have to make payments for a year. you can get that kind of a deal if you want to. this deal is exactly upside down. you get to make the payments

early and then you get to drive the car after four years. so, -- mr. mcconnell: the you are general circumstance -- the urgency, it strikes phaoerbgs the urgency is to get this thing out of congress before the american people storm the capitol. we know from the survey data, do we not, that the american people are overwhelmingly opposed to this bill. what is the argument i keep hearing on the other side -- i was going to ask my friend from arizona, i hear that the president says, and others say let's make history. there's been much history made. but much of it has actually been bad; right? mr. mccain: i'd also like to say that there's a history that we really should not ignore, and that is that every major reform ever enacted in modern history of this country has been bipartisan, whether it be medicare, whether it be social security, whether it be welfare

reform. as we remember under president clinton, every major reform has been accomplished by democrat and republicans sitting down together and saying, okay, what is it that we have to -- what kind of an agreement do we have to make? and some of us have been around here long enough to remember in 1983, ronald reagan an tip o'neill -- an tip o'neill, sat down with their aides across the table and key members of congress, and when social security was about to go broke. why can't we, since there must be areas that we agree on, now say to our democratic friends and the president, rather than trying to ram 60 votes through the senate, why can't we now sit down and proceed in a fashion, we'll give things up. we're willing to make concessions to save a system of

medicare that's about to go broke in six years. we'll make some concessions, but get us in on the takeoff and don't secretary us to be in on the landing when already the bill is wraind the fix is in. just as the fix apparently is in on the dorgan amendment. mr. mcconnell: i say to my friend from arizona, no one has done more in the senate in the time that i've been here to express opposition to and warn us about the perils of excessive spending. and, as i recall, one of the things that you came back after your campaign and told us is what -- what the american people are concerned about is the cost of health care. the cost of health care. and, of course, we're also concerned about government spending. the cost to consumers of health care and the cost of government spending. doctor christina roma, a part of the white house economic team said yesterday we're going to expand coverage to some

30 million americans, and, of course, that's going to up the level of health care spending. you can't do that and not spend more. now, maybe she didn't get the talking points for yesterday's appearances, but here you've got conflicting messages out of the white house on this very measure. in short, i think it is safe to say this is a confused mess. a 2,100-page monstrosity of confusion and unintended consequences and, ye yet, they'e in a rush to enact a health care bill. i'm astonished at the irresponsibility of this. mr. mccain: it's a remarkable process we're going through. i note my friend from tennessee here, and i know that he being the head of our policy committee and a major contributor to keeping us all informed and up

to date is here, and i know he'd like to say something. but i'd like to saying is that i had not planned on saying. and this has been a vigorous debate. we've been able to, i think, act in a way which has been -- in an effective way which has been reflected in the polls of the american people by, as you mentioned, largely opposed to this measure and greatly supportive of a process where we could all sit down together with the american people in the room, to be honest with you, when we're talking with one-sixth of the gross national product. and the republican leader's job is once has been compared to one of his predecessors as herding cats or keeping frogs in a wheel barrow. i'm not sure which is right. i'm not sure i have seen the

republican members on this side of the aisle as much together and cohesive and working in the most cooperative and most supportive fashion with each other since i've been in the united states senate. for that, i congratulate the republican leader. mr. mcconnell: i thank my friend from arizona. the presiding officer: the senator from tennessee. mr. alexander: i'd like to congratulate the senator from arizona for his comments and his own lea leadership on this issu. and i'd like to add my commendation to the republican leader. my thought is the reason we're working so well together is because we're afraid our country's about to make a historic mistake. i mean, there's a lot of talk about make history. there are a lot of ways to make history. put aside all the laws about

race. let's don't talk about them, because when we talk about race, that's often misunderstood. we didn't fail to make a historic mistake on talks about race until the 1960's when we began to correct those laws. let's put aside the historic mistakes that we might have made in failing to stop aggression before world war ii. we know about those mistakes. we can remember historic mistakes. i would ask the republican leader, the smooth hally ter if sounded like a -- tariff when president hoover pushed, raising tariffs on american goods an create more american jobs and it created the great american depression. shortly after our country was founded, we were going to -- made it a crime to publish false and scandalous comments, our

supreme court said it's a historic mistake. there was something called the medicare catastrophic coverage act of 1988. i wonder if the senator from kentucky or the senator from arizona might have been here there. so we're very capable of making historic mistakes. and, as the senator from arizona has said very well, most americans if presented with a problem wouldn't try to turn the whole world upside down to solve the problem. they would say: what's the issue here? and the issue here is reducing costs. we all can talk to family members and others. we -- we know what they're paying monthly for premiums. we would like those premiums to be less. and we would like for government's cost to be less. why don't we after we propose day after day, as the senator from arizona just said, why don't we go step by step in the direction of reducing costs, and i won't go into the long litany

of proposals that we made, take five or six steps in that direction, small business health plans, reducing junk lawsuits, buying insurance across statelines, we should be able to agree on that instead of a 2,000-page bill that raises premiums, raises taxes. seems to have a problem a day. so i think the -- the cohesion on the republican side is not so partisan. i mean, most of us, i know, i like to work across party lines to get results. that's why i'm here. i'm just afraid that our country is about to make a historic mistake and we're trying to help let the american people know what this bill costs, what it does to them and their health care. mr. mcconnell: the fear is palpable. in addition to the public opinion polls we've all seen, we're each having experiences with individuals. i just cite three win the lass

couple -- last couple of days. i ran into a police officer, a long-term police officer, african-american police officer, came up to me and he said, senator, you've got to stop this health care bill. and then health care providers, i see dr. barrasso from wyoming here, within the last week spoke to one of the nation's fine cardiovascular surgeons, he said, please, stop the health care bill. this is going to destroy the quality of our profession. he told me of a friend of his, a neurosurgeon, who had called him with the same concern. i -- i get the sense that there are an enormous number of health care providers, physicians, hospitals, everybody involved in the health care provider business apparently with the exception, as senator mccain points out, in the pharmaceutical industry, which has seemed to cut some special deal here, who are ra -- that te

finest health care in the world is going to be destroyed, as the senator from tennessee points out, historic mistake. mr. mccain: i might mention also on the issue of pharma again. here we are in the direst of economic times. a consumer price index, which has declined by 1.3% this year. and they have orchestrated a 9% increase in the cost of prescription drugs. i mean, that is a remarkable role. laying an additional burden, which, naturally, falls more on seniors than anybody else, since they are the greatest users of pharmaceutical drugs. and i don't -- i don't blame them for fighting for their industry. but the point is that what

they're doing is harming millions and millions of americans. so, again, about contributing the cynicism of the american people, whether you are for or against the issue of drug reimportation, to cut a deal behind closed doors and then apparently, because of opposition -- or support of an amendment by senator dorgan, go down and negotiate another deal, i mean, is not -- is not -- how do you describe a process like that? the presiding officer: the senator from tennessee. mr. alexander: unsavory would be a minimum word that comes to my mind. the problem i have -- americans have a perfect right to -- and the pharmaceutical industry has a perfect right to advocate its point of view. am i hearing this correctly, the

pharmaceutical industry is saying, we don't like drug importation. and the white house says, okay, we'll cut a deal with you -- behind closed doors as far as we can do it -- we'll change the law this way. mr. mccain: the original deal, as i might say, published in every newspaper, if they would close the so-called doughnut hole by some $80 billion. the c.b.o. said that we -- their profits would be reduced by some $100 billion if we allowed reimportation, so they had a $20 billion cushion. mr. alexander: it's a negotiation between the white house, the president of the united states, a big industry, about profits. who say, i'll do this and you do that and i'll go out, and is my understanding right, than the industry spends $150 million on television advertisements in support of the deal? is that the deal? mr. mccain: but then -- but

then, incredibly, they counted the votes. the votes were there to pass the dorgan amendment, and, according to published reports, the pharmaceutical industry is negotiating with the white house and lawmakers on a revised health care deal under which the industry would ante up cuts beyond the $80 billion it agreed to this summer. because that wasn't sufficient to get votes to kill the dorgan amendment that would allow reimportation of drugs, they went down and renegotiated. what is that called? mr. alexander: well, i -- you know, if i'm remembering right earlier this year, the republican leader made a talk on the floor -- i mean the editor of the white house, for a large company in the state of kentucky, if i remember was, if you don't agree with us on

health care, we'll tax you. that's the attitude. if you don't agree with us, we'll tax you. or if you do agree with us, we'll -- mr. mcconnell: my friend from tennessee, beyond that, the administration basically told the company to shutup. issued a gag order so offensive that the editorial page of "the new york times" said that it shouldn't have been done. that they could not communicate with their customers the impact of various parts of this bill on the product that they buy, the medicare advantage product. the tactics have been highly questionable, it strikes me from the beginning of the year up to present, and what senator mccain is talking about, is just the most recent example. mr. mccain: can i also give you, to illustrate, graphically, in this news report several lobbyists told inside health policy, that's the organization that's reporting this, they've heard that the pharmaceutical research and manufacturers of

america may have already reached a deal with the white house and aarp to close the senate bill's coverage gap by 75% v. the 50% under the current bill. pharma declined to confirm the reforms that would further close the doughnut hole, and aarp said that no agreement has been reached. we haven't seen a deal. so here's our old friends, the aarp, at it again. at it again. mr. mcconnell: will the senator from arizona yield on this point? is this not the same aarp that would, i'm told, actually benefit frl the decline of -- from the decline of medicare advantage because they sell a policy themselves that would likely then -- more likely be purchased by seniors?

is this the same aarp -- mr. mccain: when you lose medicare advantage, as dr. barrasso will fully attest, then you -- they are really almost forced into the so-called medigap policy that would not cover what is covered under medicare advantage, dental, vision, not covered under aspects of medicare advantage. so if -- so if you destroy medicare advantage, people will be forced into the medigap policies. who makes their money off medigap policies? aarp. mr. sessions: just a question about this deal with big phrma. i made reference to and quote

interested a few days ago a scathing editorial by robert reich who served as secretary of labor in the clinton administration who is a leading intellectual democrat who called this in the most scathing terms -- criticized these deals in the most scathing terms. used words that i was reluctant to use on the floor because as my colleagues said unseemly or whatever. i'd say it goes beyond that. he used the word extortion. i don't think he used that word lightly. and i think it's the kind of process -- and the senator has been here and many of you that are on the floor now have been here for a long time, but it seems to me this is pushing the envelope on deal making to the point that it really is a dangerous step, and it goes

beyond anything that we should countenance in my view. mr. mccain: i agree with the senator. again, i'd like to ask dr. barrasso, because he has treated patients that are under medicare advantage, but before i do, i just want to say again the whole process has been wrong. the process of going behind closed doors, the process where after nearly a year of addressing this issue, the distinguished -- and he's a fine person, a fine senator from illinois. the number two leader in the majority in a colloquy i had with him just two days ago said no one knows what's in the bill. said no one knows what's in the bill. this is after -- this is after a year. i mean, it's -- it's wrong, and what it does is this issue is vital, but it destroys the confidence of the american people to be truly represented here and have their interests

overridden by the special interests of which phrma and this deal that's going on right now is the classic example. i'd ask senator barrasso -- a senator: before dr. barrasso speaks, just listening to the senator from arizona, it seems to me it puts the democratic leadership in the extremely awkward position of even its leadership -- of proposing a bill that affects 15% of our economy and the leadership of the democratic senate doesn't yet know what's in the bill. mr. alexander: we certainly don't know what's in the bill, and they are in the awkward position -- or have been the last two or three days of actually filibustering their own bill at a time when they are insisting that we pass the bill before christmas, which we can hear the sleigh bells ringing. it's just a few days before that happens. mr. barrasso: and it just seems that as we are here on the senate floor talking --

mr. mccain: right. i ask the senator from tennessee take this colloquy? the presiding officer: without objection. mr. mccain: go ahead. i'm sorry, dr. barrasso. mr. barrasso: well, it just seems to me as we are here on the senate floor discussing this issue, wide open, any american can come in here, listen to us, hidden behind closed doors is the other party maybe sharing what's in the secret negotiations, maybe not because it sounds like a number of their members don't know, but what i do know from practicing medicine for 25 years and taking care of families around the state of wyoming is that people depend upon medicare for their coverage. there are seniors who depend upon medicare and medicare advantage, and the reason they call it medicare advantage is because there are advantages to being in it. it coordinates care, it helps with preventative care, which isn't part of the routine, the regular medicare program. i just heard my colleague from arizona say that there are those who want to shut down medicare

advantage, aarp, he said, because they are the ones to benefit and profit if, in fact, medicare advantage is lost to the seniors of this country. 11 million americans depend on medicare advantage, and yet they are losing that as a vote that this body took. this body voted to strip strip $120 billion away from our folks who depend upon medicare advantage. and i know the senator from arizona has another important point he wants to make. mr. mccain: the point i want to make, i -- this -- this has turned -- this process has turned into something, again, like i have never seen before. i was just handed this fox news just reported breaking news that harkin said -- i guess referring to the senator from iowa, senator harkin said that medicare buy-in and public option are now dead. i don't know what to say except it seems to me that they are

just throwing everything against the wall and see what sticks and what doesn't stick. this is really a -- again, one of the most astounding kind of situations that i have observed in the years that i have been here in the united states senate. medicare buy-in is dead, public option is now dead. what i'd like to see is that harkin would report that now republicans and democrats will sit down together and try to work out something that the american people would heartily approve of. mr. barrasso: i have great concerns about the health care availability for the people of our great country. this is a front page story in the "wyoming tribune eagle" on the 13th -- "doctor shortage will worsen." that's what i'm worried about. i'm worried about the patients at home. i'm worried about the folks in arizona and tennessee, alabama." doctor shortage will worsen. it's estimated that as many as one-third of today's practicing

physicians will retire by 2020, and provider shortages will continue to increase." and it said that based on health care so-called reforms that they are proposing, the strain on certainly wyoming's physician shortage even further, possibly leading to longer wait times for appointments as patients travel even further for care. so when i look at this bill that raises taxes $500 billion, cuts medicare $500 billion, and causes people who already have insurance, insurance that they like but they are concerned about the cost, the cost of those premiums going up, there is very little in this bill that i think the american people would be interested in having for themselves. the president has made a number of promises. he has said i won't add a dime to the deficit. 80% of americans don't believe him. recent polls, cnn. 80% of americans don't believe the president on that. how about taxes? and with taxes, he said they

won't add a dime to your taxes. 85% of americans don't believe them there. they believe their taxes are going to go up. but yet they don't believe that the quality of their care will be better, so when we talk about a bipartisan solution, we want to improve access to care. we want to get costs under control. this bill raises the cost of care. mr. alexander: the senator from idaho is here. we both had the experience of being governors, as did the presiding officer in her state of new hampshire. but we were talking the other day -- and i hope you don't mind me repeating that. i worked with the democratic legislature the whole time i was governor, but what -- what we always did on anything important was we sat down together, we had our different positions, we fought during elections, but we we -- we worked things out, and we didn't go forward unless we found a way to agree. and that -- that meant i usually didn't get my way. i got some of my way, but i had

to take into account that someone else -- in this case, the democratic legislature in tennessee -- might have a different idea. sometimes it was a better idea. and i would ask the senator from idaho, we talk a lot about bipartisanship around here, but the reason for bipartisanship is that these big bills are tough bills. we're expected to make difficult decisions. are we going to reduce the growth of medicare, are we going to expand medicaid, are people going to be required to buy insurance? what are we going to do about health care premiums? many of these decisions are controversial. when the american people look at washington and they see just one side of the political spectrum is pushing a bill through and the other side says absolutely not, what kind of confidence is that going to give the american people? on the other hand, if they look at washington as they did in the civil rights legislation that we talked about in the 1960's where lyndon johnson was president, a

democrat, and everett dirksen was the republican leader and they saw the republican leader and the democratic president saying okay, this is a tough problem but we have a solution that we both agree with, then the american people have some confidence in that. so bipartisanship is not just a nice thing, it's a signal to the american people that -- that people of different points of view think a controversial decision is in the country's interests, and isn't that totally lacking here? isn't that bipartisanship signal lacking across the country? a senator: senator, thank you. i am astonished at the process involved here. mr. risch: if one steps back and has a look at this at 30,000 feet and what we're doing here, what we're doing here is we -- and i say we. it's actually the other side of the aisle, but what the other side of the aisle is doing here

is they are attempting to entirely revamp the health care system of this country, and they're doing it all in one bill, which we think is a mistake. it should be broken into its component parts. but the bill contains and attempts to address quality, the cost, the accessibility and the insurance industry all put into one bucket and stirred and they expected to resolve all of this at one time. if youlike at what's happened here, the house produced three bills, multithousand-page bills, and those bills were stirred around over there and eventually in the dead of night, they finally got one of them passed with one or two votes to spare, and so then it came over here. there were already two bills over here, and the two bills were produced through the

committee process. now, the committee process is a very good process by which you produce bills. admittedly, both of those bills were heavily skewed to the democratic side, and the -- and all of the republican amendments or virtually all the republican amendments, certainly all the significant amendments were voted down on a party-line basis. well, those two bills came out of those committees, and one would expect that then it came to the floor and we would go through the process, but no. the two bills were taken over to the majority leader's office, the doors shut, the curtains closed, and various people were brought in. we don't know who, we don't know how, we don't know what the negotiations were. but at the end of the day, a third bill over here was produced, and it's 2,074-page long. it's usually kicking around here on the desks. i see they have removed most of them. i expect they have probably removed most of them because i was afraid and most people were afraid they would fall over and hurt somebody.

but these were 2,074 pages that were put together. nobody really knows exactly what's in them. there are some generalities that we know, but we don't know all the specifics. so then what happens is a week ago, they decided well, they will put ten people in a room, leave the rest of the 90 of us out, and they will try to come up with some type of a compromise, and they did, and the next day i got calls from home saying i guess it's over, they have put out an announcement, there has been a compromise, it's done, it's over. i said well, you know, that's news to me, but i don't even know what's in it. let me see if i can find out for you. so i start making calls. nobody will release the details of what this supposed compromise is. now, remember in the last election, we were promised things were going to be different. there was going to be change that we could believe in, that these things were going to be done out in the open, without lobbyists coming and going and getting their input into the bill behind closed doors, but that's exactly what has been

produced, is you have a secret document that has been produced that we haven't even seen yet. now, in spite of all this, the other side is saying by golly, we're going to produce a bill before christmas time. well, christmas is coming and christmas is very close, but i can tell you after looking at this 2,074 pages, not looking at the compromise because we're told we can't see it, it would be reckless, absolutely reckless to shove down the throat of the american people something that has been put together in secret, something that's been put together in the dead of night, something that they won't let us look at and examine, and to say you're going to take this now and shove it down the american people's throat before christmas time, this is not a christmas present that the american people want, and if you don't believe me, all you've got to do is look at the polling.

the polling shows every single day support for this deteriorates. it deteriorates amongst republicans, amongst democrats, and amongst independents. the last poll was, i think, up to 61% of the american people said don't do this to us. we need health care reform in this country. we want health care reform in this country. but this monstrosity that has been produced and whatever it is that they're going to drag out of the alley tomorrow and say is what we're going to vote on now is not what the american people want. i have a message for you on the other side from the american people -- don't do this to us. stop. bring some sanity into this. do it right. and i yield the floor back to my good friend. mr. alexander: may i ask the senator from south dakota unless the senator from arizona wants to lead the colloquy.

mr. mccain: if the senator would give me about ten seconds here. mr. alexander: let me ask that the senator from south dakota lead the colloquy on the republican side. mr. mccain: i would say to my friend, apparently if the news reports are right, that the public option and medicare is out, that's an interesting twist. and, again, i think affirmation, they're just throwing things against the wall to see if it sticks. but it doesn't change the core of the bill, which the senator from south dakota has been so eloquent about and that is a half a trillion dollars in cuts to medicare and increases in taxes. so you take the public option in or out, it still doesn't change the fundamental fact that it's going to restructure health care in america and do nothing to reduce the costs and nothing to improve the quality. i just wanted to comment to ask a comment of the senator from south dakota. and by the way, could i just mention, i haven't quite seen anything on the floor of the senate as i saw the senator from south dakota challenged earlier

today. i was watching proceedings on the floor. i wonder if the senator from south dakota would like to maybe respond to really accusations of misleading information, i guess is the kindest way i could describe it. mr. thune: well, i appreciate the senator from arizona yielding and appreciate the discussion of all our colleagues on the floor here this evening who are pointing out not only how flawed this process is and that it's being conducted behind closed doors in contradiction of all the promises and the commitments that were made that this was going to be a transparent, open process. the senator from arizona has been great at i think holding the other side accountable when it comes to these -- all these pronouncements about how this is going to be an soap and transparent process. clearly that's not the case. there's something going on right now that we're not privy to and i think at some point they're going to throw something, as the senator from arizona said, at the wall hoping that this latest thing will stick. but i do want to make one observation with regard to the

discussion that's been held earlier today, because someone -- a member of the other side, the senator from minnesota, had indicated that he thought that this chart was somehow inaccurate or misleading. and i want to point out again, madam president, that the chart is -- is very accurate. in fact, the taxes in the bill begin 18 days from now, on january 1 of next year. january 1 of 2010 is when the taxes under this bill begin. and, in fact, almost $72 billion of taxes will have been collected before the benefits that start to kick in will be paid out, the premium subsidies that are going to support, the exchanges that are going to supposedly help those who don't have insurance get access to it. that's 1,479 days from now:now, what the senator from minnesota got up and said -- he said -- request i quote -- "we're entitled to our own opinions. we're not entitled to our own facts. the fact is benefits kick in on

day one and the large majority of the benefits kick in on day one -- i'm sorry, on day one, and we shouldn't be standing up here with charts that say the exact opposite." well, madam president, it's not me saying this, it's the congressional budget office. the congressional budget office has said that 99% of the coverage spending in this bill doesn't kick in until january 1 of 2014 or 1,479 days from here. now, i say to my colleagues and to most americans around this country, do you think it's fair to construct a bill that, in order to understate its total cost, starts raising taxes in 18 days but doesn't start delivering 99% of the coverage benefits until 1,479 days from here? now, if the other side wants to have an argument about whether 99% of the coverage benefits kick in in the year 2014 or 100%, i'm happy to have that argument. the point is simply this: taxes

start 18 days from now, tax increases. $72 billion in taxes will have been imposed upon the american people and the benefits, $1,479 days from now. so, madam president, i want to make that point and refute the argument that was made by the senator from minnesota that a large majority of benefits kick in on day one. 99% of the benefits don't kick in until later. now, incidentally, i have an amendment that i hope we get a chance to vote on that will delay the tax increases until such time as the benefits begin. we only think it's fair to the american people that we synchronize the tax increases with the benefits. now, many of us don't support the tax increases in the first places, which is why we'll be supporting the crapo amendment tomorrow to recommit the tax increases back to the committee and hopefully get rid of them. but if you're going to have tax increases and you're going to start raising revenue immediately, then you ought to start paying out the benefits at the same time or at least delay the tax increases so that the

benefits and the tax increases are synchronized. that, to me, seems like a fair way to conduct and to do public policy for the american people. that -- this clearly isn't the case, and the reason it was done this way, madam president, let's be honest about it -- and the newspapers have made it pretty clear, in some of the statements they've made -- "the measure's effective date was also pushed back to one year, 2014. that projection represents the biggest cost savings of any legislation to come before the house or senate this year. but the measure's effective date was also pushed back." they keep pushing the date back to understate the cost. the reason they want to start collecting revenue right away and not start spending until later is because they know that if they start the spending earlier on, they're going to start inflating significantly the cost of this thing and the goal was to try and keep it under a trillion dollars. we all know now, and they've acknowledged, that the ten-year fully implemented cost of this isn't $1 trillion, it's $2.5 trillion. the american people deserve to know the facts. that's the fully implemented

cost. and the only reason that they can say that in the first ten years it comes in at a trillion dollars or thereabouts is because the tax increases start january 1 of 2010 and the benefits, 99% of the benefits don't start kicking in until january 1 of 2014. so i thank the senator from arizona for giving me the opportunity to clarify that. it is important that we make this debate about the facts. i've tried to do that when i come down here and speak and i'm happy to have the opportunity to restate the facts as they exist, as they have been presented to us by the experts, by the congressional budget office and by the c.m.s. actuary, both of whom have concluded the same thing when it comes to the benefits and what this is -- the impact this is going to have on premiums in this country, which i think is probably the most devastating blow to the argument the other side has made in support of this bill when the c.m.s. actuary came out last week and said this is actually going to increase -- you know, this is going to increase the cost of health care in this country by $234 billion over the next 10 years. so, madam president, i'm happy

to yield, i see a number of our colleagues are on the floor, the leader is here as well, and i would certainly yield some time to the leader. mr. mcconnell: if i could, i -- madam president? senator mccain and i had an opportunity to talk off the floor about things that may be in or out of the current reid bill that's over there behind closed doors, things are popping up and being left out and whether or not any of that is significant. and i would say to my friend from arizona, it doesn't make a whole lot of difference, does it? because the core of the bill, that which will not change -- has not changed in any of these various iterations of reid we've seen -- a half a trillion dollars in cuts in medicare, $400 billion in new taxes, and higher insurance premiums for everyone else. now, i would ask my friend from arizona, i don't think any of that's going to change, does he? mr. mccain: i'd just respond by saying whether the public

option is in or out or whether expansion of medicare is in or out, the core of this legislation will do nothing to reduce or eliminate the problem of health care in america which is the cost of health care, not the quality of health care. in fact, it will in many ways impact directly the quality of health care, increase the cost, as we all know, by some $2.5 trillion, according to the chairman of the finance committee, and this back -- but i also want to point out again, this back-and-forth, this is in, this is out, well, let's try this -- who up until a week ago ever heard we were going to expand medicare? now it's out. now it's in. you know, we used to ar are kino around here having hearings, proposals, witnesses, and then we shape legislation, which is amended in the committee, and

then brought to the floor and amended on the floor. here we have -- you know, we have to get news flashes to know whether the public option is in or out, whether medicare expansion is in or out. again, this is a kind of a bizarre process, i would ask my friend, but he is right, it doesn't affect the core problem with this legislation which is that it does not reduce costs and it increases the size and scope of government and the tax burden that americans will bear for a long period of time, including, by the way -- again, i don't mean to sound parochial. there's 337,000 of my citizens in medicare advantage program. the other side has admitted that medicare advantage program will go by the wayside. that -- that's -- that's affecting a whole lot of people's lives, i would say, and that's in the core of the bill. that will not be changed by expansion of medicare or public

option or no public option. mr. thune: well, the senator from arizona, i see a number of our -- leader, i would simply add that the -- this idea of expanding medicare, which just emerged last week, really was a bad one and one that even i think a lot of the democrats senators have come out in opposition to, which is why now they're back at the drawing board. but this relentless effort to try and, you know, tweak this thing around the edges to somehow get that 60th vote doesn't do anything to change the fundamental features of the bill which the leader and the senator from arizona have been talking about and that is the tax increases -- mr. mccain: will my colleague yield? mr. thune: yes, sir, i would be happy to. mr. mccain mccain: you know, ove weekend, people watch football games, i obviously was pleased to see my alma mater prevail over those great cadets of west point. and we have a tendency to divert our attention, even seeing the redskins for a change even winning a football game. but, you know, what we talked

about late last week is vitally important. the center for medicare and medicaid had some devastating comments to make. this is the -- the organization that is tasked to provide us with the best estimates of the consequences of legislation. specifically, medicare and medicaid. and -- and they said, the c.m.s., as i will call them now on, this bill will increase health expenditures by an estimated total of $234 billion. c.m.s., "we estimate that total national health expenditures under this bill would increase by an estimated total of $234 billion during calendar years 2010-2019." it goes on and on and talks about the devastating effects of this legislation. whether the public option is in or out, whether we expand medicare or not. and, i mean, it's remarkable information that's in this study. and so what we are seeing this

study being ignored, and clearly what's going on on the other side, only one senator is throwing proposals back and forth to the c.b.o. until they get something that perhaps looks like it might be saleable. if c.m.s. has already made their judgment on this legislation. a senator: and if i could respond to that. i've only been around here about three years but i passed an incredible scene. mr. corker: i think many of you coming to the floor may have seen it. but there's a huge gaggle of journalists and reporters and folks waiting outside of a room where our colleagues are meeti meeting. and the reason that this bill does not lower costs -- you know, i came from a world where if you had a problem, you identified what the problem was and then you had sort of a central strategy that you built out to try to lower costs, which is i think what all of us thought that health care reform would do. let's lower costs and create greater access for the american

people. well, instead of that, we've had a process where it's been literally like 50 yellow stick-ems were put up on the wall and let's figure out how we can get 60 votes. there hasn't been an attempt to actually lower costs. there hasn't been an attempt to try to create a mechanism where americans can actually choose with transparency the type of plans that work for them. instead, it's been a game from the very beginning about trying to get 60 votes, and that's why none of the goals except for one has been achieved that they set out to achieve. this is going to drive premiums up, it's going to add to the deficit, it's going to make medicare more insolvent, which is pretty incredible, because just when i got here, there was a bipartisan effort to make medicare more solvent. instead, we're using money from that to leverage a whole new program, unfunded mandates to states, new taxes, as the

senator from south dakota was talking about. so, again, what's happening in this room, the reason i bring up the 50 yes yellow stick-ems on e wall, some of which were circled to try to get votes, that's what this has been about from day o one. what's happening in the room right now is they're significant around not dealing with the core of this bill, which is very detrimental to our country, but they're in this room trying to figure out which yellow stick-em will get them the 60 votes. and in the process, doing something that's going to be very detrimental to this country. mrñ mr. mcconnell: could be the reason they're so anxious to do this before christmas is they think the americans will be preoccupied with the holiday season and somehow they can sneak in unpopular bill through and everybody will be busy opening presents or taking care of their families, and somehow the american people won't notice. but i would suggest to my colleagues, i think this is going to be a vote that'll be

remembered forever. this is going to be one of those rare votes in the history of the congress that will be remembered foreever. mr. mccain: if i could, before my friend from alabama, i wonder also when we're talking about dropping the expansion of medicare, as is reported by news reports -- i don't know -- we aren't -- haven't been informed. could it possibly have anything to do with the fact that the a.m.a. came out in opposition to it? , the american hospital association came out in opposition to it? and of course with the pharma situation that's a parliamentary procedure that's awaiting action on the floor speaks for itself, as we talked about before. mr. sessions: i just would agree with the senator completely, that this is -- as senator mccain earlier said,

it's just baffling. here we are all these weeks, and now we're being told that the public option is being dropped today and maybe this expansion of medicare -- oh, we just changed our mind on this, on a bill that's designed to reorganize one-seventh of the entire american economy, this is how we're being led here? i think -- i would say, senator mcconnell, it is historic. i think the american people have rejected this plan, and the numbers don't add up. the money is not there to pay for these schemes, and i think the american people know it, and so i guess i would suggest -- my colleague from tennessee, senator ale alexander isn't her- but rather than jamming it through before christmas, isn't it time to slow down and think this thing through in a positive

process that might bring some change in health care in america? mr. mcconnell: absolutely. that is what senate republicans have said for quite a while. let's start oaferredz and go step by step to deal with the cost issue. instead, there's in consuming desire on the other side of the aisle to transform one-sixth of our economy, have the government take it over, and to make history, and it's been pointed out in this colloquy by many senators. there are many things that have happened in our history that we wish had not occurred and this is certainly going to be one of them. but i'm optimistic. we just need one democrat, just one, to stand up and say, mr. president, i am sorry. this is not the kind of history that i want to make. i would loof to listen towrks but i also want to listen to my constituents. and it is very clear who my constituents are. if i have to choose twoon you, mr. president, and my constituents, with all due

respect, i am going to pick my constituents. just one democrat needs to stand up and say, i'm willing to listen to the american people rather than arrogantly assume that all the wisdom resides in washington and if we figure this out, and we're going to do it for you whents you want us to or -- whether you want us to or not. reicnot. a senator: people are watching. if you look at the polling, the polling is moving. it's moving in the wrong direction for them. but it is clearly moving. more importantly, i've got news for the people on the other side. if they think that this is going to go away after christmas, they got another thing coming. this is the -- this is one of the largest issues to be debated in this room for a long, long time. every senior citizen in america

is going to wake up after christmas and say, now wait a minute. let me get this straight. those people in washington, d.c., cut $500 billion out of medicare? don't they care about me? the system is already going broke. and they took $500 billion out of medicare, benefits that i've paid into all my working life, and transferred it over to start a new program, a new social program that also is not sustainable? what is wrong with those people? this discussion is going to go on. and because of the complexity of this, because of the size of this bill, there are going to be news stories every single day from now until november 2 of 2010. and, my friends, november 2 of 2010 is coming a lot quicker than what you think. and by the time you get there, you're not going to be able too run from this -- to run from

this voavment and the american people are wisely going to respond and they are going to tell washington, d.c., through their voting what they think of what happened in this debacle that is called health care reform, and it is misnamed "health care reform." it is higher taxes, higher insurance premiums, it is stealing from the medicare program, and it is creating a new, giant washington, d.c., bureaucracy. the american people don't want this. and i'll yield to my good friend from wyoming. beer biters a interesting. what you're really -- mr. barrasso: it's interesting. what you're really doing is talk about the core of the bill, the core that can'ting changed as they drop this or add that. it is the core that led the dean of harvard medical school to say this bill -- the core -- is going to make spending worse. it is going to drive up spend

and not improve quality. so this if i saights harvard has said people who are supporting this are living in collective denial. so it's no surprise that the american people are very skeptical, very suspicious, and is it's why the dean at johns hopkins medical center just this past week wrote an editorial that said we -- this bill will have catastrophic effects, and it will do more harm than good. and we're talking about the health care of the people of our country. mr. sessions: will the senator yield in now that -- those two deans are saying that the entire promises of this bill -- that it would reduce costs and improve quality -- both are not true? mr. barrasso: that's what we're hearing from these deans of medical schools. it's what i hear at home all the time. the people of wyoming read this and say this is wrong. it is going it make it harder for hospitals to stay open, harder to recruit doctors. now you're seeing it -- we're saying it in wyoming.

"the washington post" said it on saturday, "medicare cuts could hurt hospitals, expert warns." we're seeing that affecting the quality of care. we're seeing it in terms of will we have a doctor shortage, will that worsen? we're going to deal with that at home. but people are seeing it all across the country because fundamentally this bill is flawed. it will not address the sort of concerns that we have, and we are trying to get costs under control. this will drive up costs. we're trying to help improve the quality of care. this will not improve the quality of care. we're hoping to improve access for patients. this will make it harder. this will make longer waiting lines, it will limit care in rural communities, as i know about those in wyoming. you are know about them in alabama. when we see and we read the report by the actuaries, the committee that overseas medicare, and they didn't rush to do this. they're talking about the tbhail now has been out -- they're talking about the bill that now has been out.

it took them three weeks to do the report because they wanted to do a very thorough evaluation. and they looked at it and said, we think one out of five hospitals in the united states will end up closing in the next 20 years and one out of five doctors will have to close their offices if this goes through. and this is what they're proposing. this is what the democrats are proposing. something that is going to lead to one in five hospitals closing, one in five doctors' offices shutting doors, saying we can't continue to keep the doors open urpdz these circumstances. -- under these circumstances. this report has said this the whole effort to drive down the cost of care is wrong, at its coirts a wrong, that the cost of care is going to go up if we pass this bill that is ahead of us now. regardless of the little changes they may make at the periphery. at the core, this is going to drive up the cost of care. at the core it is going to cut our disrns who depend on medicare for their health care. medicare is going broke. this isn't going to in any way help that. it is going to make it worse and if they try to put more people

into that medicare shift that is already -- medicare ship that is already sinking, that will make it worse. if we try to solve that by adding these people, many of them will be put on medicaid, a program that governors across the political spectrum have all said is a failed program, a program that is driving the states into bankruptcy, a program that one -- a that governors call the mother of all unfunded mangeds. that's a wa -- call the mother l unfunded mangeds. still the same people of america have to pay those bills whether your paying your taxes here or there. plus they're going to raise taxes. this report from the medicare services group looked at that and said, all of those taxes that are going to go up, $500 billion in taxes. well, of course those are going to get passed on. so people of all different income brackets in the united states, all people are going to get hit with those taxes. some people may see a little benefit, but by 4-1, four times

as many people are going to get taxed as are going to get any benefits. so we're look the at a core fundamental of a bill that to me is fatally flawed, fatally flawed, that will raise prices, raise insurance premiums for people who have insurance, cut medicare and raise taxes. you say, how can people support that? we need a solution to improve quality, get costs under control and improve access. this doesn't do any of those things. plus it starts collecting taxes, as my friend from south dakota said, it starts collecting taxes in three weeks. but yet doesn't really give services for four years. mr. corker: if the senator would yield, i was listening to you talk about this bill being fundamentally flawed, which it is, and i think back about the comefntses that senator mcconnell has made on the floor, and i think orrin hatch the other day from utah expanded on it. but anything that is this major,

this major of a reform that we're going to live with for generations, it should be done on in a bipartisan way. and i know that senator hatch talked about the fact that something of this size should have 70 votesment, to pass a bill that will stand the test of time. earlier today i heard some of my frndles on the other side of the aisle talking about the fact that republicans walked away. and i don't look at it that way. but i remember that very early on when we saw the basic fundamental building blocks of this bill, almost every republican senator wrote a letter to senator reid, our majority leader, and told him that if there were going to be medicare cut cuts that were useo leverage a whole, new entitlement, we could not support bill. and so what did the majority leader and the finance chairman,

max baucus do, they used that as one of the fundamental building blocks of this bill. and so that is the -- that's paying for 50% of this bill. taking medicare cuts, a program that is insolvent, and using it to leverage a new program. and so what i would say -- and i see the majority leader here on the floor -- number one, i agree that bill of this size should have bipartisan support. i don't know how you get bipartisan support, though, when almost everyone in our caucus wrote a letter in the very preliminary stages of negotiation to let them know that we considered that to be a fundamental flaw. we card that not to pass the commonsense test. and yet it has been the major building block and causing this bill -- in causing this bill to come to fruition or to come to where it is today. mr. mcconnell: the senator from tennessee is entitle correct.

we made a major effort, senator grassley as well as senator snowe, were in endless discussions with the majority. then it came clear that they were not interested in doing anything short of this massive restructuring of one-sifnlg our economy, which includes, as you indicated, we expressed our concerns about earlier this half a trillion cuts in medicare to start a program for someone else. i would go so far as to suggest, the reason the public's reaction to this has been so severe is because they have chosen such a partisan route. had they chosen a different route, had we produced a bill in the middle, a bill much more modest in its intention rather than this audacious restructuring, the american people would see us behind it and they'd be behind it. so by choosing this sort of

narrow "my way or the highway approach" we're going to get the 60 votes and jam you, they have made it impossible to make this a proposal that they could sell to the american people because the american people are not foolish, and the difference between this issue and most issues is everybody cares about health care. regardless of age, the onlier you get, the more you care about it but everybody cares about health care. so they are a paying attention of the and they see that this is not in any way a bipartisan proposal. so they have created for them not only a terrible bill, in my judgment that should not pass and probably will not pass, but an enormous political problem along the way that would have been entirely avoidable if they had chosen a different riewlt from the beginning. mr. corker: i think the fact is, you know, that the two parties have a certainly differences, and we're seeing

that by the huge amounts of spending that are taking place right now. but the fact is that when we come together around bills, we do things that really can stand the test of time. and when we do that, it's not about a political victory, it's about us pushing -- airing our differences and seeing those places where we have common ground. i remember almost every one of us, i've watched each of you in your deliberations here on the floor. i know that very early on we talked about the fact if we could just focus on the 80% that we agree upon, we could pass a piece of legislation that would stand the test of time. and maybe, maybe it didn't solve every problem in the world. maybe it didn't go from end zone to end zone, but maybe we went 50 yards down the field but it was 50 yards of solid gain for

the american people, something that would stand the test of time. then we could come back and get other pieces of it. i know everyone in this room has been a part of the discussions to increase access, increase competitiveness, to drive down cost, to increase choices. i want to say that this may be historic if it passes. i actually still believe that there's a great chance that some of our friends on the other side of the aisle will realize that this is historic. and what's historic about it is this: if we pass this bill, or if the senate passes this bill, we will have missed, we will have missed an historic opportunity to work together and do something that will stand the test of time. all the energy would have been skpepbded on a bill -- expended on a bill that does not pass the

commonsense test, where the basic fundamentals are flawed. what will happen is this issue won't come up again for a long time. i know how the calendar here on the floor is and i know about the patience of the american people. but the history part of this is we will have missed an historic opportunity to do something that will be good for the american people. and that's the part that i -- that's the part that i guess bothers me the most. mr. thune: will the senator yield? the senator's been a mayor after good-size city. the senator's been a small business person -- actually bigger than small business person. but if you were running a business and you're being, you're in an environment like we're in today. we've got a tough economy, trying to figure out ways to cut back on your cost and figure out a way to sell a little more of whatever it is you're making or

doing and somebody comes to you and says we want to reform health care, and we want to do something that will get your health care costs down. yet, what they're selling is going to raise your taxes. and according to the referees, as i said earlier, the actuary for the center for medicare services is sort of the referee in all this. they don't have a political agenda, a political objective. they simply want to get the facts out. of course that's the role that's played traditionally here in congress by the congressional budget office, both of whom now say that c.b.o. says it's going to increase health care spending by $160 billion the first tkwraoerpbs and the -- years, and the c.m.s. is saying it's going to increase health care costs by $240 billion by the first ten years. you have the c.m.s. actuary saying if you close 20% of the hospitals that 17 million people who get insurance through their employer are going to lose it,

that the medicare cuts are not sustainable on a permanent basis in this legislation and that most of the, a lot of these tax increases will be passed on in the form of higher premiums which are mainly going to be borne by people who are trying to provide insurance to their employees. if you're sitting there as a businessperson and you're looking at that balance sheet and looking at that income statement and somebody is trying to sell you on an idea about health care reform that has the features i just mentioned, how do you react to something like that? i see what small business organizations are saying, but you've been there. tell me how you view -- mr. corker: i just met with a business man in tennessee on one of my more recent trips. they have an annual payroll of $4.2 million -- no, their health care costs are $4.2 million a year for their employees. and they file their tax return as a sub"s" company.

and so the income from the company actually ends up being attributed to the partners. and so when they file an income tax return, they don't take the money out of the company. they leave the money in to invest and make sure it's productive, and they have jobs for other people. but that income is attributed to them. so he was showing me what this bill did to them. first of all, their percentage of health care costs is 12% of their payroll. and -- so he's way above the minimums that this bill has said you have to be, i think it's 7% or something like that. by the time he looked at the taxes that were going to be assessed to them because they filed -- in other words, against their individual income, even though the money stayed within the company itself, what he was saying is this means not only will we not hire any additional employees, we're not going to do

that. but in addition to that, we're going to seriously look at just dropping our health care plan and paying the penalties that come with this bill. and i will say this: i do fear one of the things that people do when they see that the government -- you know, a lot of companies in this country do things because they think it's the right thing to do. but a lot of companies, when they see government sort of mandating what they have to do, or if they don't do that, there's an option for them, just to opt out and pay a penalty, when they feel like the government is being intrusive, sometimes they just decide, look, i'm not going to do this anymore. and so what i would say, to answer your question, is, number one, you end up depressing people's wages when you have these huge increases because at the end of the day you've got to have a profit at the end to operate.

you discourage people who are trying to do the right thing. you tax people at a level that because of the way our taxation system works, takes money out of the company which, again, is used for productive good to hire employees. and so what i would say at the very time when we're trying to create jobs -- and i know you've been out here a great deal talking about the fact that we need to create jobs in this country, we have legislation -- this legislation that is before us is a job killer. and the uncertainty of the american companies about health care and then the fiscal issues and then this whole notion of cap-and-trade is in fact what resoundingly people across this country are saying is keeping them -- a senator: would the senator yield? mr. mcconnell: i hear they are about to send us another stimulus bill. i think i hear the senator from tennessee saying the single-most

important thing we can do to jump-start this economy would be the -- mr. corker: no question. and to return to sanity. the fact is business people in this country -- and i know that sometimes it's hard for the other side to see this, but it's all about the cost delivering goods. and, secondly, understanding what the environment is going to be into the future. and this body has been so active and this president so active, producing legislation that are job killers, number one. but also produce such uncertainty that they're afraid to hire. and that is -- again, i know i've said this once. resoundingly the number-one reason that paoerpl not hiring people -- people are not hiring people on main street in our country. i do hope that we stop this because i do believe that this

directly will kill jobs. but i also hope we will stop it, and the american people will see that we're working on things that save money and not things that cost money and take money out of businesses' pockets, out of americans' pockets, which by the way that works hand in hand from the consumption standpoint. but this body doesn't seem to have gotten that message yet. i'm feeling that some of my friends on the other side of the aisle are greatly concerned. and i hope as the leader has said, we can stop this but then work together on something that lowers cost so that businesses will actually have a desire to hire even more people. i thank you for the time -- mr. barrasso: i'd like to ask my colleague the question because we're talking about a job-killing bill. what are we talking about? the national federation of independent business, they estimate that mandating that

employers provide health care will cost 1.6 million jobs -- 1.6 million jobs in our country over the next four years, between now and 2013. we're not talking about a couple of jobs. 1.6 million jobs when our unemployment rate is already 10%. so when i look at this as a job-killing bill, bad for our economy at a time when the number-one issue that i hear about at home are jobs and the economy. that's just another fundamental reason to take a look at a bill that at its core is fatally flawed and say don't do that right now. our economy can't afford it. the jobless rate in the country, we cannot afford to see that number get worse. mr. corker: it's amazing you bring that up. it reminds me of, if you remember during the general motors and chrysler debate, which i know americans equally paid attention to, there was this discussion about the fact, advocates for government funding

talked about the fact that they have to compete against company in other countries that may not provide health benefits. and if you remember, this whole discussion began around the fact that we wanted to lower costs, lower health care costs so that our economy would be more productive. and i think all of us said that's exactly what we need to do. here we end up with a 2,074-page bill that does exactly the opposite. now how we got here, it's kind of like you couldn't make this up. that a year ago -- here we are, as a matter of fact, almost this exact time having another historic vote around this whole issue of what might happen with these automotive companies and the big driving issue being, well, you know, we can't be competitive because we have costs that they don't. and health care costs do make our country less competitive.

so here we have a bill that's going to take us in exactly the opposite direction. this is why so many people in our country have lost, rightfully so, faith in our ability to solve problems. mr. thune: the senator from tennessee has met a payroll. he knows what this is like. he knows how hard it is, these decisions are when it comes to making decisions about whether you're going to hire somebody else and to try and squeeze those costs down so that you can buy a new piece of equipment. i think all small businesses are dealing with that. the senator from wyoming mentioned the national federation of independent business which, of course, is a very -- a business organization that represents a lot of small businesses across this country, indicating that the employer mandate would cost about 1.6 million jobs. the job issue is so absolutely pertinent to this debate. that's why nfib and the chamber

of commerce and every business organization i know of in this country, including farm organizations like the american farm bureau federation which represents a lot of farmers and ranchers in my state, those are the organizations that speak for these various small businesses around the country. and they've all weighed in, and they've weighed in heavily in no uncertain terms that this moves us back. you talked about getting that cost curve down. and every analysis that's been done, including by, as i said earlier, the referees, the congressional budget office, the actuary at the center for medicare services, all come back to the same conclusion. and i would say to the senator from alabama who also, i think, has a lot of small businesses in his state. members of the national federation of independent businesses, national association of manufacturers, lots of these organizations that have weighed in, it seems to me at least they've looked at this and they've looked at it carefully

and they've come to the same conclusion. i would be interested in what the senator from alabama might be hearing from the small businesses he represents with regard to the impact this would have on jobs. mr. sessions: i think you, senator thune, made the point here about the cost curve. senator corker, you hit it right on the head. there is a need for us to work together to help reduce the cost of health care and not hurt its quality at the same time. this bill does not do that. and, senator corker, what businesses tell me is that when you make it more expensive to hire a worker, that makes you less able to hire more workers. and if this bill, in effect, is driving up the cost of health care, not to mention the new taxes that are out there, as an economic principle, it does mean

we're jeopardizing jobs. is that -- do you agree? mr. corker: i mean, i don't know how -- i don't think that could be debated in a real way. i mean there's no question that when you add these mandates, you add the taxes, you actually drive off, drive up one of the major costs around hiring an employee in a firm and then you add all the government intrusion, there's just the whole hassle factor to have to meet all the obligations laid out in this type of legislation, all those things just calls people to -- to not want to hire folks. and -- and, you know, the thing is that it actually affects the most responsible companies most. you know, the way this bill is written, if you're one of those companies that hasn't been

providing health benefits, you could just pay a penalty -- just pay a penalty and not cover it. but this bill actually doesn't just stymie job creation, it punishes the companies that are the most responsible smaller companies in our country. so, again, you offset it -- you all have said it over and over again, the core of this bill, regardless of all of the acutements, -- accru maybe if we one vote in here, i'm sure there is something confused with all the vote counting taking place over the last few weeks, but the fact is the core of this bill is detrimental to our country. i certainly appreciate serving with all of you. and i know that all of us would love to see appropriate health care reform. i hope we're going to have the

opportunity after -- after this bill is, hopefully, defeated to be able to do that. and i thank you all for the time and the patience. mr. thune: i think that we have to wrap-up here. the senator from tennessee, the senator from wyoming, the leader is here from kentucky, my state of south dakota, i think most citizens would suspect, if we're going to do something to reform health care, we have to do something about cost, which has been pointed out repeatedly here, all the studies say that doesn't happen. the other thing i would mention, i can't imagine any of our constituents who wouldn't say, if you implement public policy, that you raise taxes in three weeks and not start the benefits until four or five years later. i mean, that seems to me that the average american out the there has got to be saying, okay, that's like me going to the bank and taking out a mortgage, but i can't move into the house for another four or five years, but in the mean time i'm going to be making payments. mr. corker: senator, if i could,

if i could. your point is so good. so many businesses are saying, i wish i could go to my local banker an use six years -- and use six years worth of costs an 10 years of revenue to get a loan. they're saying we can't do that at home. it is that thing that you pointed out so eloquently here, it is that very thing that builds that huge amount of distrust. they know it doesn't work. they know it doesn't pass the commonsense test in south dakota and tennessee, and i think they just continue again to wonder, you can't make this kind of stuff up. certainly you can't do it back home. thank you, senator. mr. thune: i thank my colleagues from tennessee, alabama, kentucky, and arizona, all of whom who have been here. i would say in crease close -- closing, in part to reduce costs the administration would delay creation of so-called insurance exchanges in which individuals

an small businesses could shop for affordable coverage all done to disguise the real cost of this, which is being acknowledged now widely by the democrats as well that this isn't a trillion dollar bill, it is it a $2.5 trillion bill, it cuts medicare, raises taxes and raises premiums for most american people. mr. president, i yield back our time. a senator: mr. president? the presiding officer: the senator from mississippi. a senator: mr. president, we've heard this described as a historic moment. my friend from iowa, mr. president harkin, we've served together on the agriculture committee and worked closely on appropriations and other issues, he described this as a historic moment. i think that we can all agree on but that's about all we do agree on on this issue. mr. cochran: i think that we have to say it, this patient protection and affordable care act is controversial. it sounds like just what the

doctor ordered, but you look at it closely, doctors are not favorably impressed with it. neither are the taxpayers, especially those who earn less than $200,000 a year. another issue that's troubled the pharmaceutical companies is the reimportation of drugs. the f.d.a., the food and drug administration has concerns about that. if the senate tries to ignore these and other serious concerns about the bill before the senate, it will be an act of hope over reality. which this senator cannot support. a senator: mr. president? the presiding officer: the senator from illinois. mr. burris: thank you, mr. president. i rise, of course, to speak on our health care legislation. mr. president, the united states senate is the greatest deliberative body that this world has ever known. and since the inception of this

body, its members have practiced and perfected the art of compromise. it's been said that politics is the art of possible. and this chamber's teeming with experienced legislators who know how to work with members of both parties to forge a more perfect bill. this means individual senators must inevitably give ground in the interest of achieving legislation that is built on consensus. and as a body of lawmakers and, in particular, as a democratic party, we have compromised throughout our history to bring about the greatest legislative achievements this nation has known. and in the process this senate has made the country better. today we find ourselves debating a measure that could overhaul

the entire american health care system. we stand at this point after nearly 100 years of discussion and deliberation stretching from teddy roosevelt to barack obama. what has defined us across the century is our commitment as a party to the fundamental pillars of health care all of which have been echoed in this recent debate. these values served us well in 1935 when the senate took up a proposal called social security. history recalls that debate was furious. it was not without struggle and it was not without compromise. in the end we achieved one of the most enduring public successes in american history. 30 years later, these very same values led this party and this

senate to take up the bill known as the medicare act. again, that fight was not easy. and compromise was necessary -- mr. reid: mr. president? the presiding officer: the majority leader. mr. reid: through the chair to my distinguished friend from illinois, i ask my friend, in his usual courteous fashion if he would allow me to enter a unanimous consent request, i would ask that the record after the republican leader and i finish, that he would retain the floor. the presiding officer: without objection. mr. reid: i ask unanimous consent that immediately after the opening of the senate tomorrow, tuesday, december 15, and following the leader time, the senate resume consideration of h.r. 3590, that there then be a period of five hours of debate with the time divided as follows, two hours divided between senators baucus an crapo or designees, two hours equally divided between dorgan and lautenberg or designees and one hour under the control of the republican leader or designees. during this debate time it be in

order for senator baucus to order a side by side amendment and senator laud lawsuitenburg be allowed to offer 3196 as -- and no further amendments or motions be in order during the pendency in this agreement that upon the use back of all of the time the that the senate proceed to the amendments baucus, crapo, lautenberg and toying. if they achieve the threshold that they be agreed, the motion to reconsider be laid on the table, if they are not achieved, that threshold, they be withdrawn that the crapo motion be withdrawn, provided further, mr. president, upon disposition of the above reference thed motions, the next two senators be recognized to offer an ocean is senator hutchison to offer a motion to commit and senator sanders to offer an amendment

number 2837, that no amendments be in order to the hutchison motion or the sanders amendment that upon disposition the majority leader be recognized. the presiding officer: is there an objection? mr. mcconnell: mr. president, reserving trite object and -- the right to object. i'm not going to object. i want to confirm with the majority leader, our understanding, although it is not locked in in this consent agreement, we a anticipate votig on the hutchison and sanders amendment? mr. reid: yes, and i say to my friend, either -- either vote for them for some kind of procedural motion, of which i have no idea what it would be at this stage. the answer is yes. i would also say that i have spoken to your floor staff and i -- i -- as i indicated the republican leader, we have to be in the white house for a while tomorrow afternoon. we'll give the republican leader that time, which will probably have to be in recess because the whole caucus is called.

but it's my desire to make sure that we finish this tomorrow. i think that's to everyone's interest. that's what we're doing here. mr. mcconnell: would that include both sanders an hutchison? mr. reid: no, as i schaind to your floor -- explained to your staff, i would like that to be offered. if we have five hours of debate and the four votes we have planned on. mr. mcconnell: during the time that the democratic senators are at the white house, would we be in recess? mr. reid: i think we should be in recess. mr. mcconnell: do you know how long the meeting will be? mr. reid: it is scheduled for an hour an 10 minutes. mr. mcconnell: what time? mr. reid: i think at 1:30. i'm glad that we got the balancing back and forth of the unanimous consent request finally settled on these matters. the presiding officer: without objection, so ordered. mr. burris: mr. president? the presiding officer: the senator from illinois. mr. burr: thank you, mr.

president. and i will continue from where i was. i'll pick up a couple of paragraphs above, and, for the record, i might repeat. as i said, history recalls the debate of this issue furious and it was not without struggle and it was not without compromise, but in the end, we achieved one of greatest, most enduring public policy successes in american history. 30 years later, mr. president, the same values led this party and this senate to take up a bill known as the medicare act. again, the fight was not easy. and compromise was necessary to realize our vision. but, once again, this body under -- and this party brought historic change to america. these hard-fought programs have been the valued cornerstone of our domestic policy for

generations. they defined the way we legislate and underlie the principle that this government's chief responsibility is to its citizens. today a new generation of americans and a new congress find ourselves in the midst of another historic debate. earlier this year, a new president was swept into office, full of energy and ideas and a clear -- armed with a clear mandate to bring reform to a health care system that was badly broken. so, once again, we took up the task of fighting for a more perfect health care system. americans all over the country struggling and suffering, many in personal -- personal health crisis havok their -- and there is a body -- and this

body needs to act. those that need help the most need the help now. so let us pass this health care reform legislation, but let us, mr. president, also do it right. let's not pass something just to pass something. mr. president, everyone in this room is a legislator. we approach our responsibilities with the knowledge that our most optimistic ideas must often be tempered with a pragmatic reality. in the process of this debate, we have all made concessions and we have all compromised. my own preference was for a single-payer system. some of my friends on the other side would like to see no reform bill at all, but as a body, and

at least as the democratic party, i hope that we will stay true to our fundamental pillars, fundamental pillars that have determined our course over the last 100 years. as mr. gandhi once famously said, and i quote -- "all compromise is based on give and take, but there can be no give and take on fundamentals. any compromise on mere fundamentals is a surrender." end of quote. it was in the spirit of constructive compromise that ten of our colleagues met and worked to forge a new compromise deal we have all heard about. i thank them for their hard

work. they are all deeply invested in this issue, and i applaud their willingness to come together at the table. at this point, specifics of this proposal are few. like new mexico this chamber, i -- like many in this chamber, i actually await the chance to examine the full detail of the proposal. mr. president, i do have deep reservations, deep concerns about what i have heard up to this point. until i see more, i can only say again what i have said from the very first day of this debate so many months ago -- that i am committed to voting for a bill that achieves the goals of a public option, competition, cost savings and accountability. i will not be able to vote for

lesser legislation that ignores these fundamentals. i will continue to fight every day to strengthen this legislation until its final moments on this floor, mr. president. i fully realize how hard my colleagues have worked. i know how difficult it has been to get this far. my colleagues may forge a compromise bill that can achieve the 60 votes that will be needed for its passage, but until this bill addresses costs, competition, and accountability in a meaningful way, it will not win my vote. the american people must -- most in need of help, although we can do better and we must do better. thank you, mr. president. i yield the floor.

the presiding officer: the senator from alabama. mr. sessions: mr. president, i want to share a few thoughts in the five minutes i believe that i have to -- on a different matter than we have been talking about earlier, but it's a very, very important matter. it's the procurement contract, the request for proposals that the defense department has put out in order to request proposals to -- for the defense department to purchase a new tanker for the united states air force. it will be the largest perhaps contract purchase in the history of the defense department, certainly since world war ii, and it's important that we do it right. later -- earlier, one of our colleagues, senator murray, who i have great admiration for, told npr "all things considered"

quote -- "i have stood on the line in everett, washington, where we have thousands of workers who go to work every day to bill these planes. i would challenge anybody to tell me that they have stood on a line in alabama and seen anybody build anything." close quote. well, we are prepared, as i will note, to construct the finest aircraft for a tanker that the world has ever known in alabama. my area of mobile, alabama, at the old brookley airfield which was a fabulous, huge airfield. it was closed 40 years ago, but the runway and the capacity and the location and the access by water and rail and interstate is all there, and it's going to be a fabulous place and already a significant engineering center is -- is constructed there, and the plans are to go forward if and when this contract is bid.

and i would just note that the people of alabama get a little bit offended when people suggest that they are not able to produce anything of a world-class quality. i would just remind my colleagues that it was in alabama that the saturn 5 rocket was developed that took a man to the moon and that virtually everything that goes into space goes through alabama, that we have some of the finest automobile manufacturing plants in the history of the world -- mercedes, honda, hyundai, toyota, all producing large amounts of some of the best automobiles in the world. and in mobile, they are building a new tri-marin ship that can cruise at 40 knots and has the fabulous capability of cargo. it's one of the finest new ships of its kind the world has ever known. we have a fabulous work force, second to none, of which i am

utterly proud of, and i would just say one of the complaints that i have about the department of defense's request for proposal -- i have four i had planned to talk about, but one i'm just going to mention in light of the comment of my colleague is that i believe there is an inadequate government assessment of acquisition and performance risk. in other words, the government should assess how well we can believe that the bidders are able to produce the product that the -- at the price and the time frame that they would like to see it produced on. and i believe -- i am so confident that the plan in alabama would be competitive with any that i believe the government should give higher weight to that, and, in fact,

they did last time in the previous bid process, and the aircraft plant in alabama was the -- came out with a better score on risk than the one in my colleague's state. so there are other matters there that are important, but i just wanted to emphasize that point. we are ready, able, and willing and anxious to produce the finest tanker the air force has ever seen. mr. president, this tanker aircraft today is now 50 years old, and i regret that we're having the kind of difficulties we are in this bid process. i respect so much the men and women of the department of defense, but i do have to say that this newly configured bid process is dramatically different before, and i believe it is in the wrong direction.

i believe it has failed our war fighters, and i have to express my concerns about it, in particular as it's reflected in the request for proposal that's been sent out to the two bidders. my intent here is simple. we'll make -- i will point out a few things that i think are significant. in essence, the department of defense abandoned out of the blue and without serious discussion, so far as i can tell, its decision to provide a transformational and game-changing aerial refueling tanker to the war fighter, and those were their words. and how has that resulted on -- was a result of the major changes in the request for proposals that have been set out. and the bidders are considering

those proposals. and in doing so, the result, i have to say, evidences a clear bias for one aircraft over another. and i hate to say that, but let me provide a snapshot of what this new r.f.p. does. i asked the secretary of defense about it at a hearing a few weeks ago. he indicated that this process for altering the r.f.p. is still ongoing, but i'm not sure the air force has been listening, so i'm concerned about it. let me make a -- provide a snapshot of what our concerns are. of the six discriminating features that favored the northrop k.c. 45 eads aircraft over the boeing aircraft in the previous competition, five of the six features were either eliminated or changed to a nonmandatory status in the

current draft r.f.p. a bias, i suggest. in contrast, eight features of the boeing aircraft were upgraded in the new draft r.f.p. which resulted in seven of those eight areas favoring their aircraft. so what is the bottom line? the very, very sad conclusion that i have had to reach is that this closely watched competition was altered with a purpose, and that purpose was to favor one bidder over another. so we're in a period now where i hope the department of defense will listen to the concerns that i believe are legitimate and to ensure fairness in this process, replacing the tanker is the air force's number one procurement priority and has been for quite a number of years. in fact, the department of defense has indicated they

understand this, and i think they understand that their integrity in the whole acquisition process is at stake in this so closely watched and so important bid. so, mr. president, i would just show -- and i will offer my remarks later because i see we got off schedule a bit tonight and other senators want to speak and i have just five minutes, but i am going to point out here something that we call a spider chart. it looks a bit like a spider web, and the -- the green lines here, the inside circle lines represent the least capability in 11 different categories of areas, such as passengers, fuel offload of 1,000 nautical miles, fuel offload capacity, boom

envelope, operational availability. all these 11 factors. i would just say that the green represents the current capabilities of the 50-year-old aircraft. the red represents the latest r.f.p. requirements for this knew what -- new what used to be considered transformational aircraft. it follows almost the same as the current capability. this is really unthinkable to me. it follows those capabilities on point after point after point. and in some areas, it's less capable than the current aircraft that's 50 years old. and the black line represents the capabilities of the boeing aircraft. for example, on passengers, it is 190, whereas the other

aircraft, the one that would be built in alabama if it would be the winner -- the presiding officer: the senator's time has expired. mr. sessions: mr. president, i would offer into the record the full statement that i would make tonight and would yield the floor and would indicate that this is a matter of such importance that i will find need to speak about it again in the future. the presiding officer: without objection. mr. udall: mr. president, i seek recognition. the presiding officer: the senator from new mexico. mr. udall: thank you, mr. president. this effort to reform our nation's health care system is finding ways to make quality health coverage affordable and accessible to all americans, and i believe the bill we're considering in this chamber as it currently stands goes a long way towards making that vision a reality. but even with this solid legislation, there is still a large group of americans who

continue to be left behind. i'm talking about our country's first americans, the 1.9 million american indian and alaska natives who are suffering because the federal government isn't living up to its promises. the law that provides the framework under which the health care programs for native americans are delivered hasn't been re-authorized for more than ten years. this means that the indian health services delivery system is chronically underfunded, and given the rapid advance of health care technology, outdated. as a result, too many native americans are struggling to receive quality, timely health care. this agency is supposed to be the principal health care provider and health advocate for indian people, yet every day because we fail to act, the health care situation in indian

country grows more urgent. native americans are diagnosed with diabetes at almost three times the rate of any other ethnic group. they often don't have access to preventive care, and native american youth are attempting and committing suicide at devastating and alarming rates. just two months ago in my home state of new mexico, a 14-year-old girl from the meskalara apache reservation became the fourth young person from that tribe to take her own life in a little more than one month. four young people in one month on one reservation. tell me this doesn't cry out for action. the senate indian affairs committee has reported the reauthorization bill. the house has put in its health care package the same kind of reauthorization bill.

both of these bills would bring us much-needed reforms to the indian health care system. this legislation, the senate must act upon it. we can no longer delay fo. for the past several years, grs congress has failed to get this legislation across the finish line. it has passed both bodies in the last several years. the house at one point, the senate at one point, but it is still not law. now is the time to put this in the health care bill and get the job done. i know my colleagues on both sides of the aisle are in agreement that our nation's health care system needs reform. we know health care reform is needed now. we know the status quo is unacceptable. but what is missing is the same

sense of urgency for our native american communities. this despite the alarming statistics from the civil rights commission several years ago that the u.s. spends more than twice the amoun on a federal prisoner's health care than that of a native american man, woman or child. that's $3,800 per year per federal inmate versus $1,900 per year per native american. that's right, our inmates have better health care than the population with whom we sign treaties and made a promise to provide health services. american indian and alaskan natives are three times as likely as whites to be uninsur uninsured. and almost half of our low-income american indians and alaska natives lack health coverage. the longer we wait, the more native americans suffer needlessly. the longer we wait, the more native americans go without

shipping with chronic conditions like diabetes and heart disease. the longer we wait, the more native american teens who may take their own lives because they're not getting the help they need. america has an obligation to provide quality, accessible health care for our country's first americans. so i say again, it's time to act on this important piece of legislation. it's time to reform the indian health care system and permanently reauthorize the indian health care improvement act. thank you, mr. president. i yield the floor. mrs. shaheen: mr. president? the presiding officer: the senator from new hampshire. mrmrs. shaheen: thank you, mr. president.

i rise today to support the health care reform legislation that's before us. and i want to talk a little bit specifically about what the bill does to reform our health care delivery system, and that's really health care jargon for the way we provide health care to people who need it. i've heard a lot of debate earlier this afternoon about the fact that the health care bill doesn't do anything to address costs. well, i think that's just wrong, mr. president. the fact is, this health care bill does begin to address costs in our system. that's one of the reasons we've got to pass it. in fact, we know that over the next ten years, it's going to reduce our deficit by $130 billion. but more importantly than that i think are the changes that i believe this is going to begin to make on how we provide health care for the people of this country. you know, the fact is, we all

know it. even our colleagues on the other side of the aisle know that our current health care system just is not working. it costs too much and for too many families, quality health care is simply out of reach. one of the problems is that 30% of the $2.5 trillion that we spend right now each year on health care goes to unnecessary, inappropriate care and administrative functions that do little to improve our -- on administrative functions that do the to improve our health. but, mr. president, our health care system didn't get this way overnight. years of perverse incentives have encouraged health care professionals to practice more medicine rather than better medicine. they struggle to see more patients and do more procedures to keep up. hospitals race to build new wings and state-of-the-art uni

units. as patients, we too often live unhealthy lifestyles and we expect the newest high-tech services to fix it. in the meantime, we undervalue things like primary care, preventive care, and mental health services. and despite all of our spending, we're not any healthier. over the past few months, i've joined, as the president has, with all of our freshmen colleagues on the floor to discuss why we can't continue this current system. it's too costly. it's too inefficient. and last week, the freshmen senators introduced a package of amendments that emphasizes cost containment. the provisions contained in our package may not be those that are currently grabbing headlin headlines, but i believe they really go to the crux of our

reform efforts. they are the delivery system reforms that will improve quality and control costs over the long run. so how are these going to work? well, our delivery system reforms build upon the current underlying bill. they reward improvement in providing care for better health outcomes. one way we can be more efficient in delivering care is through what are called accountable care organizations, or a.c.o.'s. these a.c.o.'s allow medical providers to work in teams to take responsibility for decision making, and they offer financial rewards for better health outcomes. our amendment allow medical providers to align medicare, medicaid and private-sector

strategies for improving care. doing this will help ensure that all americans receive high-quality care no matter how they're insured. a.c.o.'s provide the right kind of incentives and they promote value over volume. for years, the dartmouth institute of health policy and clinical practice has shown us that there are regional differences in the way care is delivered and how health care dollars are spent. now, over the summer, dr. atulee gegawande highlighted these findings for "new yorker" magazine. dr. gawande clearly made the case that higher quantity does not necessarily transslielt into higher quality. -- translate into higher quality. so that more procedures doesn't necessarily indicate better care.

dr. gawande's article has had tremendous impact on the health care debate. it's been quoted frequently by president obama. it's been referenced right here on the floor of the senate. in his latest article, which just came out recently, dr. gawande has once again made an important contribution to the health care reform dialogue. in this article, he emphasizes the importance of delivery system reforms in fixing our health care system and he points out that there is not one single answer, there is no silver bullet to what we need to do to change our health care system. and while we can all agree that something must be done, what we can't agree -- can agree on is what specific model will be the best and have the most desirable outcomes. but dr. gawande points out that our country has faced a similar challenge before. in the article, dr. gawande draws a parallel between our current health care system, one

that is very costly, a money drain, one that's practicing nented --one that's practicing , disorganized -- fragmented, disorganized and inconsistent. he compares our current health care to the agricultural system at the start of the 20th century. at that time, more than 40% of a family's income went to paying for food. the inefficiency of farms meant lower crop yields, higher prices, limited choice, and uneven quality. agriculture was on an unsustainable path. gawande points out that the federal government did not, however, offer a grand solution. rather, it provided incentives to change the way farmers produce crops. and, mr. president, through innovation, the promotion of best practices, and smart dissemination, today food only accounts for about 8% of a

family's income compared to that 40% at the start of the last century. now, as you know -- and we've heard discussed on the floor -- we have examples of great innovation and excellence in health care. places like dartmouth in my home state, the mayo clinic in minnesota, which senator klobuchar can speak to i know, intermountain in utah, and numerous other places of excellence around the country. these institutions have developed integrated health care systems that are patient focus focused. their practice -- practices have promoted high value and excellent outcomes, best practices which should be shared throughout the country. the patient protection and affordable choices act identifies some of these best practices and provides the types of incentives for doctors, nurses, and patients to change the status quo and to experiment

with innovation and excellence. the many programs supported in the bill before us move us in the direction of delivery system reform which is so important to our effort. by promoting innovative practices like accountable care organizations, payment reform, and medical homes, we can move away from the current fee-for-service system that rewards volume over value. that, mr. president, is true reform and i urge my colleagues to support the bill. thank you. ms. klobuchar: mr. president? the presiding officer: the senator from minnesota. ms. klobuchar: thank you very much, mr. president. and thank you to the senator from new hampshire for mentioning the mayo clinic along with several other great facilities across this country that have done things a little differently, mr. president. they've done things by focusing on the patient, by saying what's best for the patient is best for all of us. and when you do what's best for

the patient, you get higher-quality care. and when you get higher-quality care, you actually get lower cost. i think when people think of, say, going to buy a hotel room or pay for a hotel room, they always think, well, if i pay more, i'll get of get a better room, a better view. that's actually true. but not true in health care. the states and the metropolitan areas have that have the least efficient health care, least efficient, toned cost the most. and that's what we need to change if we want true cost reform. it's good for states like minnesota and new hampshire and wisconsin. why? because we tend to have higher-quality care at lower cost. so it will reward us for that. but it is also good for the states that need to get their quality of care up so we don't see those massive readmissions to hospitals. who when they go into a hospital and they're sick want to go back in again because they get sick in the hospital? that's not good. or who wants to have something go wrong in the hospital so they have to go back