the country where they have massive fraud so all this money gets drained to the tune of $60 billion a year in medicare spending to con men and people, fraudsters. that's what happens in so many parts of the country. and that's why this delivery system reform, the brave thing, the courageous thing to look at this, step back and say, how do we do this better, how do we do it so that we're rewarding, as the senator from new hampshire staitd stated, sstated, so we'rg quality not just quantity so that we're putting the patient first? that's what this bill is about. why does this matter? i think anyone who's got a checkbook understands why this matters. at $2.5 trillion a year, health care spending represents close to 17% of the american economy and it will exceed 20% by 2018 if the current trend continues. hospitals, clinics, every part of the country providing an estimated $56 billion in uncompensated care. that's taxpayer money going down the tubes. $2.4 trillion per year.

that's where we are right now. so everyone knows, it's costing them. it's costing our cufnlt it's making it very difficult for big businesses to compete against businesses from other countries that have more efficient health care systems. it is making it impossible for small businesses to keep all of their employees on health care. why? well, their cost costs are 20% e than big businesses. how -- the small businesses creating 64% of the jobs in the last decades in this country. we have to allow them to continue to thrive, not with this health care costs that are a drag on these small businesses. i always tell people, just remember three numbers. it's the easiest thing to do here. 6, 12, and 24. ten years, the average american family was paying about $6,000 in premiums. now they're paying $12,000. that's an average, because we've got a lot of small business owners all over our state who are paying, like, $20,000 a year, $23,000. well, if we don't do anything at all, ten years from now, it's going to cost between $24,000

and $36,000, average, in this country for individual families to buy health care. $24,000 to $36,000 average per family. that's why we must act. we know that inaction is not an option. if we do not act, costs will continue to skyrocket, and 14,000 americans will continue to lose their health insurance every single day. well, so what does this bill do, mr. president? well, first of all, it gives coverage to 31 million people that don't have coverage now. some people think, wow, where are they getting health care coverage now? it's the emergency room. like in the hospital i used to represent when i was the county attorney for the biggest county in minnesota. that was paid for by the taxpayers whvment someone doesn't have health insurance and a doctor and they've got diabetes and they're supposed to be doing their insulin and they watch their diet, you know where they understand up? in the emergency room and they

get their leg cut off. it is a disastrous quality of life for the person involved. that's rulely going on in this country. last year i was down in one of our smaller towns in southern minnesota, and i heard the story of how one hospital, a small science hospital, had three people come in with stomach problems, pen did i site is attacks. they are appendix burst. how come you didn't come in earlier? well, two of the people said, well, because we work at a small business and we didn't want the premiums to go up. it would have, like, hurt everyone at the small business. another person said, i had such high premiums, that i would have to pay that i didn't want to come in and have it checked out. you see, if you don't have that kind of safety net in place for people, you get more expenses on the far end, and that's what this bill does. it changes the delivery system, insuring 31 million more people. what else does it do? it helps to reduce the deficit. that was what i always said from the beginning, that i want to

support a -- this i don't want to support a bill if it's going to add to the add. this one reduces the deficit, reduces the deficit by billions and billions of dollars. third thing, what does this bill have? insurance refornls. what does that mean? that means is that if you've got a sick kid, you're no longer goingoing to lose your insuranc. you are not going to be put off in the deep and he all by yourself if your kid gets sick. if you have a kid that's going to college, you can keep them on your own insurance until they're 26 years old. that's what this bill does. it gives that kind of safety net, protections, consumer protections that the people in this country have demanded. finally, with medicare, adds nine years onto the life of medicare. right now medicare is scheduled to go in the red by 2017. no one eelly likes to talk about it. what this bill does, it keeps it solvent for nine more years. i can tell you, you know, my mom who is 82, she wants to stay on

medicare until she is way into her 90ess. people nor their 60's and want to get onto medicaid in their 90's, this bill, with the reforms in this, by closing part of the doughnut hole that's so difficult for our crns seniors, -- that's so difficult for our seniors, it closes that. this bill doesn't going to be perfect for everyone, mr. president. when i think about the people that i've heard from, the woman who wrote to me from northern minnesota, and she wrote this just heartfelt letter about how she had just gotten a call from her daughter whose husband worked at a small business and she said that that husband, her son-in-law, had just found out that they weren't going to have insurance anymore at his small business. and the woman who wrote the mom said she couldn't even understand her daughter. her daughter was sock and sobbing. she kept saying, what's wrong?

she said, i lost my snuns. you know why this mattered so much to this family? her daughter has cystic fibrosis. her daughter needs this insurance every moment of her life. and when that small business yanked that insurance coverage because they probably had to dirnl ale sure they didn't want to but just couldn't afford it anymore -- that daughter has to go out on the open market now, which when you have a preexisting condition, that's not an easy thing to do. she may not get insurance. that's what we're talking about when we talk about this bill. and the end of this lerks the mom said -- the mom said, i need you to be my daughter's voice. she's not going to be able to go to washington, d.c., and lobby for this like some of the -- all the companies that have come over here and lobbied for this thing and that thing much she needs us to be her voice. and that's what this is b now, the good thing here, mr. president, is we look at some of the things that are in the bill -- i didn't get everything i wanted to reduce costs in this bill. but there are some great things in this bill. look at this.

first of all, according to researchers at dartmouth medical school, nearly $70 million is wasted on ineffective health care. that's 30% of total health care spending. to rein in costs, we introduced a value index that -- i introduced the bill, senator cantwell, senator gregg were coyoauthors of the bill and senator can't bell got it on the finance committee bill and it's still in the merged bill today t says when you look at the medicare fees, evaluate them on a lot of things but make sure you evaluate them on value. this index willing help reduce unnecessary procedures because those who produce more volume will need to also improve care or the increased volume will negatively impact their fees. doctors will have a financial incentive to maximize the quality and value of their services. my doctors in the state of minnesota support this. they endorse this bill. and they understand that if we want to get that high-quality

care like you see in minnesota at places like the mayo clinic, like you see at iran mountain, all over this country, you have to have those kind of incentives in place. this bill also focuses on bundling and integrated care. i was thinking as i watched the viking game this weekend, mr. president -- yow if you noticed, but the vikings won again. brett favre is quarterback. we're talking about a primary care provider that works with a team. we have one person in charge, the quarterback in football, primary care doctor in medicine, working with a team, with the wide receiver, with a tight end, with all the team that they have working together, whether it is a cardiologist, a urologist, whether it is any kind of a doctor that they want to work with as a team, depending on what the illness s that's what integrated care is.

that you work as a teernlings you share medical records, patients don't get lost in the shuffle, don't get sent to another specialist and another specialist without anyone watching over their care. that's what integrated care is about. a quarterback with a team. the other thing about this bill is that we start to focus much more, as i mentioned, on reducing readmissions, on rewarding places like health partners or st. mary's in did he luge, places that work to have this integrated care, places that make sure we have less readmissions in the hospitals. and finally, and i am pleased that we got this in the freshmen package that's coming out, there is a much bigger focus on fraud in the system. $60 billion a year going down the tubes, going to fraudsters, going to conmen, getting sigh siphoned off the system, claiming that they should get some of the reimbursements that should be going to our seniors. that's $60 billion in medicare fraud alone every single year.

so increased penalties with some tools to make sure we're better enforcing the law. we can reclaim some of that money and give to to the american taxpayer, give it to our seniors. those are the things. that's just a few of themmism be talking about more this week when we talk about cost dploal this bill. so, mr. president, thank you so much for allowing me to share some of my thoughts on cost control. but, again to remember three numbers -- 6, 12, 24. ten years, average american family, $6,000 for their premiums. now what are they spending? $12,000. what are they going to spend ten years ago if we don't do anything about it? er somewhere between $24,000 to $36,000 a year. this isn't going to be sighs to bend this cost curve. we know there's going to be bumps in the road. it is not automatically going to turn around. but to just do nothing to put our heads in the sand at this moment in history is just plain wrong. the american people deserve to have better health care. they deserve to have that

high-quality, low-cost care. and this bill is the beginning. well, thank you very much, mr. president. i yield the floor. ms. klobuchar: mr. president? the presiding officer: the senator from minnesota. ms. klobuchar: mr. president,

i ask unanimous consent that the vote order with respect to the lautenberg and dorgan amendments to h.r. 3590 be reversed to dorgan and then lautenberg. the presiding officer: without objection. ms. klobuchar: i ask unanimous consent that the senate proceed to the immediate consideration of calendar number 224 s. 1755. the presiding officer: the clerk will report. the clerk: calendar number 224, s. 1755, a bill to direct the department of homeland security to undertake a study on emergency communications. the presiding officer: without objection, the senate will proceed to the measure. ms. klobuchar: mr. president, i ask unanimous consent that the bill be read a third time and passed, the motion to reconsider be laid on the table with no intervening action or debate, and any statements related to the bill be placed in the record at the appropriate place as if read. the presiding officer: without objection. ms. klobuchar: i ask unanimous consent that the senate proceed

to the immediate consideration of h.j. res. 62, which was received from the house. the presiding officer: the clerk will report. the clerk: h.j. res. 62, appointing the day for the convening of the second session of the 111th congress. congress. the presiding officer: without objection, the senate will proceed to the measure. ms. klobuchar: i ask unanimous consent that the joint resolution be read three times and passed, the motion to reconsider be laid on the table with no intervening action or debate, any statements related to the measure be placed in the record at the appropriate place as if read. the presiding officer: without objection. ms. klobuchar: mr. president, i ask unanimous consent that the senate now proceed to the consideration of s. res. 375, which was submitted earlier today. the presiding officer: the clerk will report. the clerk: s. res. 375, honoring the life and service of breast cancer advocate stephanie spelman.

the presiding officer: without objection, the senate will proceed to the measure. ms. klobuchar: i ask unanimous consent that the resolution be agreed to, the preamble be agreed to, and the motion to reconsider be laid on the table. the presiding officer: without objection. ms. klobuchar: mr. president, i ask unanimous consent that the appointments at the desk appear separately in the record as if made by the chair. the presiding officer: without objection. ms. klobuchar: mr. president, i ask unanimous consent that when the senate completes its business today, it adjourn until 10:00 a.m. tuesday, december 15, that following the prayer and pledge, the journal of proceedings be approved to date, the morning hour be deemed expired, the time for the two leaders be reserved for their use later in the day, and the senate resume consideration of h.r. 3590, the health care reform legislation, as provided for under the previous order. finally, i ask that the senate recess from 12:45 p.m. until 3:15 p.m. to allow fog for the weekly caucus luncheons p. the presiding officer: without objection.

ms. klobuchar: mr. president, senators should expect a series of four roll call votes to begin around 6:00 p.m. tomorrow. if there is no further business to come before the senate, i ask that it adjourn under the previous order. the presiding officer: the senate stands adjourned until 10:00 a.m. tomorrow.

the chairman of the republican national committee, michael steele talks about his decision to the senate health care legislation. >> this week on "the communicators," an insider's perspective on the wireless

industry with ralph de la vega of at&t mobility. >> host: this week on "the communicators" our guest is ralph de la vega, who is the president and ceo of at&t's mobile and consumer markets. mr. de la vega joins us from our studios in new york. thank you for being with us mr. de la vega. in a recent speech you called for a fact-based dialogue with the sec when it comes to potential regulation of the wireless industry. why did to emphasize fact-based, and what issues were you referring to specifically? >> guest: actually i think that chairman genachowski said when he was going to conduct his study was going to be that they said i think that is absolutely the way to approach it, so when the chairman and his staff visited with us that ctia in san diego, we kind of put forth what i think are very compelling

facts about the state of the wireless industry in this country and importantly how it compares to the rest of the world. for example, when you look at the wireless industry today in the u.s., the points that i made is it is the most vibrant and most competitive marketplace than the entire country, not only the country i should say but the world. we made our point using facts that the u.s., by any measure that you look at whether it is a concentration index like h hi that is used by the department of justice or just by the number of competitors that we have in this country it is the most competitive market in the world and the least concentrated market in the world, so i wanted to make those points, because some people have said and are still saying in fact that maybe the industry is not competitive enough but in the u.s., we have four national wireless competitors, but we also have 173 other local, regional or

specialty carriers for a total of 177. by contrast the next nearest country has a total of 37, so the u.s. whether you measured by concentration indexes or by just the sheer number of carriers it is a very competitive marketplace and the best evidence that supports those facts are the prices that we charge our customers. when you look at to the customers and the 26 developed countries over the world, the u.s. has the least cost per minute. that as we charge customers in the u.s. the least amount per minute of any other developed countries. not just the least amount. is 60% less than the average. that results in u.s. customers talking three times as much as the average of the developed world so it highlights that competition is working, that customers are getting a good deal and customers are getting great choices in the united states and those of the kinds of facts that we share with the chairman and his staff and i

commend them for coming out in meeting with us, and listening to what the industry has to say and taking that into account as they approach some very important roles for the country and for this industry. >> host: rules, such as what? >> guest: rules like net neutrality. that is the hot topic in the industry. is the hot topic in the wireline industry for a number of years and the fcc had four primary principles that it was using to address the concerns and the wireline industry. now, there are groups that are proposing that idea applied to the wireless industry as well and we think the wireless industry is a very competitive industry and that in the end, the customers ought to make that choice rather than regulation. so we are a pro-open network, a pro-net neutrality that we want to make sure we don't have burdensome regulations on how people use and run the internet. >> host: mr. de la vega if you

are pro-network neutrality as you say, would you be opposed to new rulemaking at the fcc? >> guest: we would be opposed to placing burdensome rules on the wireless industry. that is an industry that is competitive, that is vibrant, that is growing at five times the rate the economy of the country, so i think it would depend on how the rules are applied but in general we think the industry is working very well. is delivering very innovative products. it is doing things that we don't see in other parts of the world. for example i also mentioned using facts that today, when you compare what is happening in the u.s., all of the attention for wireless has turned to smartphones and we are beating the world and the deployment of smartphones and networks that allow those smartphones to work. so, that's like the fact that when you compare the u.s. and the use of their generation wireless technology, the u.s.

has 40% of the world's customers in those advanced technologies such as hsb the which are the most advanced forms of 3g technology. but we only have 7% of the world's customers so it highlights that the wireless industry today is working well. it is competitive. is delivering great value, great choices. is that the latest technology that customers are enjoying so before we put burdensome regulations, we should be talking very carefully and should have a lot to discuss and i think the chairman to his credit is seeking output from all sources and i'm sure will come up with rulings that will address those concerns not just ours, but the industry as well. >> host: paul kirby is joining in the questioning. >> guest: thank you. regarding the neutrality the chairman has made a point of saying, really stress the point that the fcc will realize wireless and wireline network

said different, technologic the difference so in adopting its rules it will realize that so as long as it realizes that, why is it a bad thing when it applies those rules to the wireless sector? >> guest: i think that is a great and important recognition point, a point that i personally made with the chairman and his staff. i am glad he recognizes it. what it says to me is that we should be thoughtful about how we apply them to wireless. it is different, spectrum is limited in wireless and so we should be thoughtful about putting rules in place that encourage people to preserve this very valuable resource, which is what spectrum is. so those kinds of details, that the-- devil is in the detail but just the fact that there is that recognition is encouraging on the part of the commission but i think until we seen the final rulings we will appeal to tell whether we have concerns are not. >> guest: on another topic that has gotten a lot of attention in the chairman talked about in his speech and that is

spectrum allocations. ctia his said the government should allocate an additional 800 megahertz of spectrum. some of the question whether you really need that much. can you give us a sense for why do you think you will need that much spectrum? >> guest: yeah, what we are seeing paul is a state of revolution like we have never seen him by the way that evolution is starting right here in this country. i would say today that the u.s. is the epicenter of the next revolution in wireless and what we are seeing is quite frankly just customers using data on these wireless devices like we never anticipated. they are using it in record numbers. just at&t we have seen a 5000% increase in data usage over the last several years so it is on a very dramatic up ramp. when you think threat though, here is the reason why. when you use your phone only for boys in really talk for so much during the day but when you use it for data you can consume a significant amount of data

depending on the applications you are using, which require more spectrum and what we see is customers using the devices to view streaming video, to look at videos, to play music around-the-clock, so those are applications consuming and significantly more data than we have with prior devices and i think it is one to require more spectrum so those applications can continue to thrive in our competitive environment. >> host: mr. de la vega do you agree with the fcc chairman genachowski that there's an upcoming spectrum crisis? >> guest: i think absolutely there is the need for more spectrum. and i think we need to do it quickly and i think the chairman said the crisis because it takes a long time to clear spectrum. our history has shown that even in the 700 megahertz spectrum which was just options, it took many years to clear the spectrum, so i think there's a sense of urgency, simply not just because of the spectrum of

how long it takes to clear the spectrum and put it into action. so i totally agree with the chairman that there needs to be a sense of urgency about doing this and doing it quickly. >> guest: to drill down a bit, which spectrum? >> fcc is talking about perhaps reallocating broadcast spectrum. dod and other military spectrum will be looked at some point either by the fcc or other agencies. can you give us a sense for politically to broadcasters have enough friends in congress to prevent that and how difficult politically willoughby to get dod spectrum? >> guest: i think anytime you try to reallocates beckstrom it is very controversial. i think given where we artist once hickson leadership on the part of the sec and the current adminstration to make the wisest decision. we are going to give them the input but i think they have to balance their various constituencies to be able to give us what we think will be in the best and also the quickest path to some additional

spectrum. >> guest: on another topic that has got a lot of attention lately and that is distracted driving. cdi says there neutral on rules banning talking while driving and a favor bans on manual texting. that is a change in position on the talking while driving. i wanted to get your input. has that changed the thing because the pr was getting with the industry and realize they needed to come out on the right side of it? >> guest: i have encouraged ctia as the incoming chair to take the issue of texting and driving and make it a top priority to go out and be aggressive about communicating the fact that we don't want people texting handwriting and to get a campaign that is proactive rather than reactive and i think you maxene ctia and its member companies take up that flag. i think that we don't want our young people texting and driving and we are very supportive of

any effort including all education efforts to make sure people understand that we don't want our young people doing that. >> host: we should note that ralph de la vega is the incoming chairman of the ctia which is the wireless association. go ahead. >> guest: i wanted to make one more point so you understand kind of what they are thinking is. at at&t we ourselves have taken a policy that we don't want our employees driving in texting, and so it is the best practices like that that we are encouraging all of the ctia companies to take up certain standards where we only don't talk to our customers but enforce those policies with our own employees so we want to be able to walk the talk in that is to say we have got to stop doing that ourselves and our employees and set the example for the rest of the industry to stop a tactic that i think is not safe for young people especially.

>> guest: some safety groups and people who have relatives talk about coggins event pac's and researchers of talking while driving. this ctia is neutral on that. is that something you think the industry should come out against his will and say people shouldn't talk while driving even if it is on a hand-held device because of the cognitive distraction? >> guest: that one is of little more controversial. people think that provides a great value in some cases so i think we have taken the position of letting the customer decide, looking at all the relative information, being transparent about that in letting the customer make that decision. when it comes to texting i think that is a very clear case that that is way too much distraction we want people to do that. >> host: mr. de la vega of look at return to net neutrality for just a minute. does want to ask with regard to the spectrum that at&t recently purchased but what happened that spectrum fell under net neutrality proposed rules? >> guest: that is a very interesting question