cuts in the medicare program, a program that already has long-term financing problems. according to the c.m.s. actuary, these proposed deep cuts will threaten medicare's fiscal stability and push one in five hospitals, nursing homes, and home health care providers into the red. many of these providers, i fear, would simply stop taking medicare patients which would jeopardize care for millions of seniors. now, mr. president, i want to make clear that i do believe there are savings that can be found in the medicare program. for example, far too much is lost each year to fraudulent

claims. that's an area where we need to crack down. as we put in place the health care reforms that have widespread support on both sides of the aisle, we could also achieve real breakthroughs that would improve the quality of care while lowering the cost. but, mr. president, that's not what we're talking about in the underlying bill. instead we're talking about essentially across the board cuts, deep cuts, cuts that are going to hurt some of the most vulnerable people in our country, our seniors and our disabled citizens. this became even more clear to me as a result of a conversation that i had this past week with peter chuck, the c.e.o. of

central maine health care. he runs the -- not only theter share i hospital in lewiston, maine, but also rural hospitals in western maine, in rumperd and bridgeton as well as a smaller hospital in brunswick, maine. so you can see from that description if you're familiar with the state of maine that the hospital network that he covers makes a huge difference in the lives of so many mainors. well, -- mainers. well, here's what he told me. he first pointed out that maine is one of the oldest states in the country so we have a substantial medicare population. despite being recognized nationally, for providing high-quality care, maine's hospitals currently receive the

second lowest medicare reimbursement in the country relative to their costs, so, mr. president, there is no fat to cut in the reimbursements of hospitals in the state of maine. they have very high quality. some of the highest quality in the nation, according to health care experts, according to medicare itself, and yet they get the second lowest reimbursements. the c.e.o. of this hospital network put it bluntly to me. he said that passage of this bill in its current form would be disastrous for the state of maine. he said that the bill would saddle maine's hospitals with some $800 million in medicare cuts over the next decade, with very little upside benefits from

expanded coverage since about 90% of maine residents are covered by some type of insurance policy today. we have a large population in our state medicaid program, for example, which led him to another concern. mr. chuck described to me what the impact would be of a further expansion of the medicaid program. he said it's simply not sustainable since maine has repeatedly demonstrated its inability to pay for the current medicaid program. in maine, that program is known as maine care. it paid central maine health care just 60% of its allowable costs. moreover, maine care will owe central maine health care more than $50 million by the end of

the year. the state is already unable to pay its medicaid bills. the failure on the part of medicare and medicaid to pay their full share, to pay the amount that is actually -- that it actually costs to provide the care simply results in cost shifting to private payers. in maine, this cost shifting means that individuals who have private insurance cover 130% or more of hospital costs. that shouldn't be a surprise to us. if both medicare and medicaid are not paying at a sufficient level to truly cover the cost of care, what happens? it gets shifted to private pay, to private insured patients. and because we have such a big

gap in the state of maine, it's one reason that maine's insurance rates are the fourth highest in the nation. so this is an untenable situation. the c.e.o. told me that if congress passes this bill, maine's hospitals and physicians will be forced to expand cost shifting, further increasing the pressures on private insurance markets, further making that cost an extraordinary burden on middle-class families. mr. president, medicare, which is so critically important to our nation's seniors, should not be used as a piggy bank for new spending programs when the revenues are needed to shore up the current program. i know my colleague from

tennessee has been talking about that issue for a long time. i joined him in a letter that said if there are savings to be found in medicare, let's use those savings to shore up medicare. it's financially not sustainable. we all know that, so what are we doing? we're putting nearly nearly $500 billion out of a program that does not have sufficient funds to deal with the influx of the baby boom generation, much less with the costs that it is now incurring. it is fiscally irresponsible to raid medicare to pay for a new entitlement program. i would be happy to yield. a senator: i have heard some of our colleagues say that these

draconian medicare cuts will actually lead to the closure of some rural hospitals. mr. mcconnell: i'm wondering if the senator from maine thinks that may even be possible given the magnitude of these medicare cuts that we're hearing complaints about all across america? ms. collins: mr. president, the minority leader brings up a very good point. the republican leader i know is familiar with the analysis that was done by medicare's own actuary that says that one out of five hospitals -- and these are likely to be the small rural hospitals that are so important in our states. one out of five would be so jeopardized by these cuts that they may not survive. and what else will happen is that physicians are going to have to start turning away

medicare patients. mr. mcconnell: i ask my friend from maine, isn't that beginning to happen in some states already before we even take this additional step? ms. collins: it is. my friend from kentucky is exactly right. in my state, there are already severe shortages of primary care physicians, particularly in the more rural areas of the state, the northern, eastern, and western parts of the state. their practices are full to start with, and what we're asking them to do is to keep accepting new medicare patients that won't -- whose reimbursements won't cover the cost of their care, and that's why in many states you see physicians limiting how many medicare patients that they will take. and i know how painful that is for our physicians.

after all, they became physicians to care for people. they want to ensure that people have the care that they need, but there is a limit to what they can do. so i share the concerns of the senator from kentucky that the result of this bill will be to jeopardize the very existence of rural hospitals, small nursing homes, home health care providers, which in my state are absolutely critical, and after all, i know my colleagues from tennessee and kentucky have had the same experience i have had of talking to seniors who are getting home health care. they are so happy to receive health care in the privacy and the comfort and security of their own home rather than being

forced into a hospital setting or a nursing home. and yet the bill before us singles out the medicare home health benefit for a disproportionate share of the cuts. it proposes that home health and hospice care, hospice care, mr. president, would be slashed by $42 billion over the next ten years. that just makes no sense whatsoever. it's $42 billion for home health and $8 billion on top of that for hospice care. and a home health care director in my state, a nurse that i know well, really summed it up well. first she described the impact on visiting nurses from arusta.

that's where i'm from in northern maine. it had total revenues of of $1.9 million last year. it estimates that it will lose lose $313,000 in the first year of the house bill if that were to pass and $237,000 under the senate bill. according to the director of this agency, cuts of this magnitude would cause this home health agency to consider shrinking the area we serve or discontinuing some services. they can't afford to cover such a geographically huge area as arusta county with that kind of cut. but here's what i want to share with my colleagues.

because this is what this debate is really all about. what she told me is the following. it's going to be hard for our staff, and our staff is scared, but it's our patients who will pay the price if congress makes these cuts in home care. and, mr. president, that is what concerns me. it is not just the impact on our rural hospitals, our dedicated physicians, our struggling nursing homes, our valiant home health agencies. it's their patients. it's the vulnerable senior citizen who lives on a rural maine road, who may lose access to home health care. it's families who want to live

in rural communities but can't if there isn't a hospital nearby. it's a nursing home that closes and thus a family has to move a loved one so far from the family members. those are the real-life consequence, the real-life consequences of slashing medicare. so mr. president, i hope that we will reconsider the cuts in this bill. it is so disappointing that the senate has repeatedly rejected attempts to try to mitigate those cuts. there are so many other problems with this bill, mr. president. i see that the republican time is about to expire, but i hope

as we proceed that we can also talk about what the impact is going to be because of the gap between when all of the new taxes under this bill go into effect and when the subsidies are proposed to go into effect. there is a four-year gap. $73 billion in new taxes and fees will go into effect. some of those new taxes start in two weeks, two weeks under this bill if, in fact, it is passed, and i hope it will not be. we would be taxing pharmaceuticals, medical devices. there is a health insurance fee. next year, there is a penalty for health savings accounts. it makes no sense to me.

we want people to be able to shelter some money to help cover their deductibles. next year, the bill proposes to restrict flexible spending accounts. again, makes no sense to me. so $73 billion in taxes and fees which are going to be passed on to consumers without a doubt. c.b.o. says that. the joint committee on taxation says that. but when do the subsidies go into effect to mitigate this upward pressure on premiums? not until 2014. mr. president, that makes no sense whatsoever. thank you, mr. president. the presiding officer: the senator from minnesota. ms. klobuchar: mr. president, i ask to speak as if in morning business for five minutes. the presiding officer: without objection.

ms. klobuchar: thank you very much, mr. president. mr. president, i come to the floor today to voice my support for the department of defense appropriations bill that we are currently considering, and my disappointment that some of my colleagues have chosen to hold up this important legislation for reasons completely unrelated to anything to do with this bill. mr. president, we have been debating health care in the senate for months, and in the coming days, we will continue to debate health care. there are many honest disagreements about the best ways to reform our nation's health care system. they deserve discussions. i will say hearing from my colleague from maine, i'm concerned about medicare as well. i'm concerned because medicare is going to go in the red by 2017 if we don't do anything about it. i look at my mom who is 82 years old and wants to make sure that she keeps on medicare. i look at the friends that are in their 50's and want to make sure they get medicare when they are 65. and we need to make sure that we put in place those cost reforms

that are going to give us the high quality kind of care that we have in minnesota. but what i want to talk about today is the defense appropriations bill. whatever disagreements we may have on health care, they have absolutely nothing to do with the defense spending bill. funding for our troops in iraq, afghanistan, and around the world as well as for defense, health, and other critical programs, should not be dragged into this debate. we should be able to separate the two issues and pass this defense bill swiftly and overwhelmingly. senator inouye and several other of my colleagues have already discussed the importance of this bill's funding provisions to our ongoing operations in iraq and afghanistan and to our overall nation's defense. i'd like to spend a few minutes on the importance of this bill to the home state of minnesota where the president, the presiding officer here, also resides. mr. president, there are currently over 1,300 members of the minnesota national guard employed in iraq.

these deploying members are with the 34th infantry division, the famous red bulls, longest serving unit in iraq. they assume command of all u.s. forces in iraq's southern quadrant in may of this year, taking over from the new york-based tenth mountain division. this means these minnesota national guard soldiers have command responsibility for nine of iraq's 18 provinces. for the last seven months, they have overseen the continuing transfer of security responsibility to iraqi forces which will ultimately enable the responsible withdrawal of u.s. forces from iraq. in order for these minnesota national guard soldiers to successfully complete their mission, mr. president, and return home to their families early next year as scheduled, we need to provide them the funding included in this bill. i know that all of my colleagues share my belief that we have a responsibility to the brave men and women we send overseas to provide them with the resources they need to carry out their mission, and there is simply no

reason for delay. in addition to providing our troops with what they need when they are overseas, we also have the responsibility to take care of them when they return home. in minnesota, as you know, mr. president, we are proud to have created the beyond the yellow ribbon reintegration program. this ground-breaking initiative pioneered by the minnesota national guard helps soldiers make the transition from their life as a soldier to civilian life through counseling and other services. due to its overwhelming success in minnesota, this program now serves as the model for the national yellow ribbon program that i have worked with my colleagues to authorize and fund in recent defense bills. the bill on the floor right now includes funding that will continue the minnesota yellow ribbon program as well as funding for similar reintegration programs in states across the nation. these are soldiers that don't have a base to come home to. they go home to small towns all over this country, and the idea here is to bring them in to meet with their commanders again, to see if they have got a job, to

see if they have the right health care, to see if they have got their education benefits set. that's what the idea is with beyond the yellow ribbon. when the 13 minnesota national guard soldiers return home early next year, they and their families need this funding in place that is in this bill in order to resume civilian life. any delay makes it harder for commanders to have necessary resources in place. when our brave soldiers signed off to fight for us, mr. president, there wasn't a waiting line. and when they come home to the united states of america, there shouldn't be a waiting line when they need health care, there shouldn't be a waiting line when they need their education, there shouldn't be a waiting line when they need a job. when they signed up to fight, there wasn't delay and there shouldn't be delay in washington, d.c. when it comes to funding for our troops. thank you, mr. president, and i urge my colleagues on the other side of the aisle to support this bill and get this voted on as soon as possible. in fact, immediately. thank you, mr. president. i yield the floor. mr. cork he: mr. president?

-- mr. corker: mr. president? the presiding officer: the senator from tennessee. mr. cork he: thank you, mr. president. i a-- mr. corker: thank you, mr. president. i agree with my friend and colleague from minnesota, there shouldn't be a delay in funding our troops. i do find it odd with such urgency that the bill has come to us a week before christmas, something that we passed out of here months ago. and i know that history has shown, and certainly the members who are part of the republican side of the aisle, have shown constantly that we care deeply about our troops and want to make sure that they're funded. but i think the fact that this bill has come up at this time just demonstrates a tremendous hypocrisy of what is happening as sausage is being made in the majority leader's office on this health care bill. and the reason i speak to that, this is must-pass legislation, and the senator from minnesota, like all of us, wants to see this pass. all of us know this will pass. but i'd like to point out that in this bill, there's

$1.2 billion in money to go to physicians so that their way will not be cut. and what this bill does is just point out again the tremendous fallacies of the process that's taking place right behind the ultimate passage of this bill and that is the health care bill that we've been discussing now for months is months and months. the fact is that we're taking $464 billion out of medicare if this bill passes, we're using that money to leverage a whole new entitlement, and the fact is, we're not dealing with the physician pay cuts that we all know are looming. we all know that there's $250 billion worth of cuts that will take place in physicians' pay over the next ten years. we know that this bill does not deal with that, and yet somehow or another on this defense appropriations bill, we're dealing with that for a few months, because everybody in the world that can wake up and put

one foot in front of the other knows that right after this health care bill passes, in the name of being budget neutral -- again, using all the gimmicks that the senator from maine just talked about a minute ago, using six years worth costs and ten years worth of revenues, taking money from an insolvent program to create another program that begins, being created in a way that will make it insolvent over time. but what it doesn't deal with is this whole issue of s.g.r. and the doc fix. and so what will happen is the majority leader or chairman of the finance committee will come forward with a bill, right after this passes, ironically, i'm sure and pass something, another $250 billion -- or try to pass another $250 billion piece of legislation, unpaid for, just so that we can say, so that you can say, so that they can say that, in fact, a piece of health care legislation passed that was budget neutral.

mr. president, i have to tell you, i came from a world where we focused more on results and the process really wasn't much a part of it. but in this body, with a hundred senators and 435 house members on the other side of the building, process matters some. it matters because it really keeps each of us feeling hopefully, if we have the right process, that there's integrity in what is happening. and i think between the way th the -- this body, my friends on the other side of the aisle have used the c.b.o. office and six years worth of costs and ten years worth of revenues and all of this to make it look like that this bill is budget neutral yet knowing we haven't dealt with this very important aspect, it points to one part of this process. but the fact that in the morning the majority leader is going to lay down a -- about a 300-page amendment, one that i haven't seen yet -- i think there are a few people that have been working in close quarters to

develop that. i don't know if the president -- the presiding president has seen this piece of legislation. but the fact is that we hear a plan that the majority leader's going to lay this down and then file cloture on an amendment with 300 pages worth of changes that i understand are going to be fairly important changes and then us not having the ability to amend this legislation to me is pretty incredible. this is an important piece of legislation. it's going to affect every american in this country. i overheard some of my colleagues talking earlier today -- actually i didn't overhear, i was talking with them myself, and what they were pointing out -- and i know the senator from south dakota has been very concerned about the provisions of this bill. he pointed out the other day about, as the senator from maine did, about the taxes that start in two weeks and the benefits starting in four years mostly -- i know there's some benefits that start on the front end -- but what these -- what my

friends on the other side of the aisle were saying, that once this bill passes, that's just the beginning. there will have to be multiple changes over the next six -- next four years to actually cause this bill to work. which points to the -- points to the fact that this is about a political victory. and i -- i guess i would ask my friend from south dakota, if we were going to pass a landmark piece of legislation that would stand the test of time. wouldn't you think we would vote on more than seven amendments. wouldn't you think that we would actually debate the bill in a real way, try to work out these difficulties in advance. again, just not -- not but a few hours ago, my friend were telling me, look, we're just going to try to pass this thing and then we're going to try to fix it over the next four years, before all of these problems hit americans throughout our count country, because what we're really doing on the front end is just collecting a lot of money.

that's what we're doing to make this budget neutral. and then the real changes to the health care system take over time. and we know that we've got -- we have problems but we'll fix those down the road. that's not exactly a process that i think passes muster with most people back home. mr. president, i'm disappointed. i would love to hear from my friend from south dakota as to what he thinks about this type of process. mr. thune: and i'd like to if i might, through the chair, mr. president, ask a question of my -- if the senator from tennessee would yield, because he's absolutely right. this is being rushed. this is a massive reordering, restructuring of one-sixth of our economy, which we're going to be expected to vote upon in just a few days on a managers' amendment which will be the so-called layest deal that's been struck behind -- latest deal that's been struck behind closed doorksz as the senator -- doors, as the senator

mentioned, we're going to be expected to vote on it without having seen it today. in fact, i don't think any of our colleagues on the other side -- or very few of them -- have seen it, nor the american people. but it strikes me, because i've listened as the other side has gotten up here today and with all these statements about outrage and all the -- that it's insulting, that it's unconscionable that the -- this side would be holding up funding for the troops. and what strikes me about that is that the deadline for passing the appropriation bills is september 30. now, i think that faind outrage is all about a grand sort of cynical plan that's at work here to try to push this health care bill through. but would the senator from tennessee perhaps maybe be able to answer a question regarding this, because the defense appropriations bill passed the house last summer, it passed the senate in october -- i think october 6, so we're talking eight, nine, ten weeks ago now. clearly, the -- the democrat majority's clock management is

either really, really bad or this was part of some big, grand plan to push this thing into the very end, to jam this thing through to try and set it soup that these -- the health care bill would -- could be, you know, passed right before the christmas holiday without the american people having had an opportunity to see it, and the defense appropriation bill, which carries a bunch of other unrelated items, would pass as well. does it seem a little odd and coincidental to the senator from tennessee that you would be debating the defense appropriations bill right now when it could have been done weeks ago, if not months ago, and in fact these bills are supposed to be done by september 30? mr. corker: the two of us, all three of us on the floor on our side of the aisle signed a letter to the appropriations committee and to the leader of the senate asking that these be taken up one at a time so that we'd be finished with this work

by the time the fiscal year ended. so it is ironic. let me tell you the purpose, in my opinion, and i certainly don't know all the inner workings of what's happening on this floor in the senate but this is sort of a filibuster. in other words, there's a segment here where we discuss this must-pass piece of legislation where some things can be added in that haven't been dealt with that are unrelated and unrelated to defense but also 1,720 earmarks, many of which are mighty suspect. what it is is this is a filibuster, in my opinion, where during this period of time we can be be drafting, or the majority leader can be drafting what i would call the bad actors amendment. what i mean by that is if you have have had opposition to the bill, to the health care bill, the real issue we're going to be dealing with over the next few days, if you've had some trouble with the bill, they can you can

go in and get some niceties. for instance, i'm sure if i decided i was going to support this bill, the health care bill -- which i'm not -- i'm sure there's all kinds of things that might spring newspaper tennessee as a part -- that might spring up in tennessee tennessee as part of the health care legislation. my guess is this manager's amendment is going to be quite interesting to read. i look forward to seeing the details. my guess is it not only fixes technical issue, but my guess is it also fixes wants and needs of people who might otherwise have had difficult passing this legislation. i think the defense appropriations bill is given a little time for that to germinate. we'll see that tomorrow, no debate, no amendments. i think it's a shame that the senate has gotten to the point

where this is a type of process in place. mr. president, i understand my time may be up. if not, i'd love to yield to the senator from south dakota. the presiding officer: the time for the republicans has expired. mr. corker: thank you, mr. president. a senator: mr. president? the presiding officer: the senator from pennsylvania. mr. specter: mr. president, i have sought recognition to comment briefly on the proceedings in the senate in the last few days. and i would call upon my fellow senators to reconsider the tactics which are being used to defeat the pending legislation. this body prides itself on being the world's greatest deliberative body, but that designation has been destroyed with what has occurred here in the last several days.

we have seen the filibuster on the defense appropriations bill. we are more than we have 68,000 young men and women in afghanistan today who are giving life and limb for this country, and we are debating whether or not they ought to be funded. i have heard the question raised by those in the military, doesn't the congress support the troops. and the impact on morale is potentially devastating. when the senate is not moving ahead to provide the funding -- money to support their efforts. i have no hesitancy in extolling

their virtues at the highest levels of patriotism, and i wouldn't want to make any comment about a corollary negative as to what is going on in this body, but it is hardly in the spirit of patriotism that we're asking these young men and women to be in harm's way and to give life and limb. and we have seen procedures involved here on the reading of the amendments. well, rule 15 does provide for reading. amendments shall be reduced to writing, read, copies deposited on the desks of the majority leader and minority leader before being debated. well, those are the purposes involved. but there is no intent here on

the rules of the senate to have hours spent reading an amendment for dilatory purposes. the intent of the rule and the spirit of the rule is to inform people but not to have this body paralyzed by this kind of conduct. so that we have -- we have passed the point of civility. we've really passed the point of decency in the way this body is being conducted. so i would call upon my colleagues to reconsider these tactics and to try to move ahead and do the people's business. the american people are perplexed, mystified; hard to find words strong enough on what

the public reaction is. the public opinion polls show that approval ratings are plummeting. plummeting. people have no confidence in what is happening in this body, no understanding as to what is going on, and see partisan political gridlock of the worst sort. and the -- in the time since my election here in 1980 and from my conversations with those who have been in this body a good bit longer, and from my own study of the history of the united states senate. so i would urge my fellow senators to reconsider these kinds of tactics and to try to get on with the people's business because that's why we are here. i yield the floor.

a senator: mr. president? the presiding officer: the senator from massachusetts. mr. kerry: mr. president, i thank the senator from pennsylvania for his comments, and i would associate myself with them and appreciate what he just said. we really find ourselves in a remarkable situation here where, frankly, there's an extraordinary amount of distortion and fakery taking place on the floor of the united states senate. there's a great strategy of deception which the republicans have engaged in and which they continue to engage in claiming that they're being left out of the process, claiming that we ought to go back and start over, claiming that they haven't been included, claiming they don't know what's going on. we are here where we are today after a year and a half of effort in this initiative

specifically. years and years beyond that. you want to go back to teddy roosevelt and harry truman and every president since then. but right now we've had a specific effort going. we began in the finance committee a year and a half ago, the summer a year ago where we assembled over at the library of congress and we had an entire day of a forum, during which time we had republicans and democrats. we listened as a committee to experts from across the country about how to do health care. subsequent to that, we began hearings, constant hearings. and then at the beginning of this year, 11 months ago, we began what we hoped would be a bipartisan process. no chairman in the 25 years i've been here and working here has ever reached out as much as i watched chairman max baucus

reach out in an effort to try to get a bipartisan effort. how many senators from the other side came to the table? for the entire summer, three months were taken up with the so-called gang of six, six senators -- three republicans and three democrats. unfortunately, several of the republicans had already walked away because they didn't like something that 60 members of the senate might want to do. so they walked away. the senator from utah is one. he was part of those early negotiations, then he said "i'm not going to do this." in the end the senator from colorado and the senator from iowa, senator grassley, walked away. senator snowe, to her credit, stayed at the table, worked hard with people, continues to try to have a dialogue about what it may need or not need. somehow they come here with the

notion that they have a right to dictate what's in the bill that 60 senators might think otherwise about. and because they just can't get their way on the big picture, they're even willing to try to block the funding for the troops in afghanistan and iraq. that's just stunning to me. i learned full well firsthand what it's like to be fighting in a war when people back home aren't supporting it, and i vowed that when i came back that would never be a mistake we'd make again. we might disagree with the war but we'd never confuse the war with the warriors, the people fighting it. and in fact, these folks, they don't care. folks on the other side, willing to just hold it hostage, do anything they cannot just to defeat -- do anything they can not just to defeat health care because it is different philosophically how they would

approach it. i hope america hears this. this is the party over here that opposed medicare when it was put in. opposed medicaid. they don't believe in that. they run around talking about the ills and danger of government program for health care. which of them has brought an amendment to the floor ever or a bill to the floor to say stop medicare? end it. they never do that. it's a government program. how many of them want to take away veterans' health care, a government program. they never do that. but they come to the floor and they jumbo mumbo around the words on the floor and they confuse america and make everybody believe this bill is somehow what it isn't. tried and true tactics. in a lot of places you call it demagoguery. and they've come here relying on crude but effective,

emotionally-laden buzzwords, tried and tested focus groups, funded with millions of dollars. and where do the millions of dollars come from? they come from the people who want the status quo. 14,000 people a day in america lose their health insurance. where's their plan to put those 14,000 people back on the rolls? they don't have one. we do. we do. that's what we're here to do. there's so much good in this bill. is it perfect? of course it's not perfect. i'll talk about that in a minute. you know, it's extraordinary to me that the folks who oppose philosophically -- i mean they're never going to change. they keep talking about let's go back and start over. going back and starting over to them means let's write the bill the way we want it even though there are only 40 of us. and literally to hell with the

rest of you 60 that represent the majority of the country. that's their idea of going back to the beginning. it's not going back to the beginning and coming up with a instructive way -- constructive way to approach it because they had that chance. all year long they had that chance. all they want to do is beat president barack obama. that's their theory. i was here in 1994. unfortunately, it has some potency out there. you make the institution look back. make the entire congress look bad. and then the voters will say, oh, my god, who's running it? it's those guys. we've got to go to the other guys now. just make it look bad because people won't discern who's really responsible. well, let me be very clear, we're trying to move this forward. and we've tried and tried again and again to reach out in a bipartisan way which requires compromise. some people have come to the

united states senate in modern times with a new definition of compromise. their definition is do it my way. not meet you halfway. not give in to what a majority might feel they have a right to say as a fundamental bedrock principle as the way they want to approach a particular piece of legislation. so here we are with some of our folks now on our side of the fence actually being emboldened by the comments they hear that distort the bill on the other side and say, oh, you know, you guys better throw it in. don't vote for it. we heard yesterday a person that i admire and like and have become a good friend of -- howard dean, who worked his heart out in 2004 to try to win then and worked his heart out in 2008 to help elect this president. and yesterday wrote something which incidentally had some errors of fact about what was included and not included in the

bill. but he wrote yesterday, let's kill the bill. and start over. or there's another person whose work i greatly admire because i think he holds things accountable. keith oberman said wednesday night, this is not health reform. not health, he said, and not reform. well, i respectfully -- i mean that -- respectfully disagree with both of them. i just disagree. i don't think they fully evaluated what is in this bill and what it accomplishes for america nor fully evaluated the realities of what it would mean if you said kill it and start over. starting over is just, you know, there's no president who is going to step up in the next few years if we don't make progress here. there's no senator who is going to invest in a process after this if we don't make this reform work now. you follow that kind of advice and give up now because this

bill isn't everything you want it to be individually, then the very reforms that people have spent their life working for, mr. president, reforms that the democratic party has been proposing for decades that are in this bill, many of us ran on them and said this is why we want to come to washington to accomplish this, they would be destroyed. that would be it. it would be gone. what a mistake that would be. i want to -- you know, the fact is there are things that i wanted that aren't in this bill. i am a passionate supporter of a public option. i believe a public option will, and particularly the way we defined it, you know what our public option was in this bill? our public option ultimately in this bill required the people who take part in it to carry the option with their premiums. not very different from a

regular plan, except that it wasn't for profit. and it had no public money to support it, and it wouldn't allow public money to come in and bail it out. it had to work on the actuarial terms of the marketplace just the way private insurance companies do, but it just won't have shareholders and a for-profit structure, so that it could drive competition in order to have those companies that we all know have not really stepped up when it comes to making sure that they're there for the patients. why? because if you're for profit and you're one of these insurance companies answerable to wall street and your shareholders, their principal concern has been driving that profit. and so what do they do? they hold on to the money to the last minute because they get to float in the market. as long as the money is in your coffers, then you're working the interest on it or you have it to use for your company. and if you pay out at the last

moment, you make more money. if you pay less than you have to pay, you make less money. if you cut people off, you make more money. if you cut people off, which they would do all the taoeufplt you make more money. if you tell people who bought their insurance who thought they had the insurance, sorry, we don't really have that insurance for you because of little clause down here that you didn't read, too bad for you, but you don't have insurance even though you have stage 4 cancer and you have two kids and you're a divorced parent, too bad for you. you don't have insurance. they do that because then they make more money. these are real stories. you can find thousands of them across america. how else do you lose 14,000 people a day who lose the insurance they thought they had or wanted. the fact is that this wasn't easy for franklin roosevelt when he tried to do it, mr. president. it wasn't easy for harry truman when he tried to do it.

it wasn't easy for bill clinton when he tried to do it, and some of us were here and tried with him, and we understand how difficult it is. but you don't sound retreat. you don't ignore history and say we're going to be better off by giving in to 40 people who are trying to destroy a presidency and simply can't stand the fact that there are 60 votes here and there's a president who's got an agenda to fix these things, so the best thing they can do is try to stand up and stop it. some of our progressive friends have said we, you know, because it doesn't have the public option, we ought to do that. you know what it does have, even though it doesn't have a public option? it has a not-for-profit structure that has the ability to be able to drive some competition. we don't have that today. is that not worth fighting for here on the senate floor and putting into this bill? again, i say, my friend howard dean wrote in "the washington

post" real health care reform need this had public option that -- quote -- "would give all americans a meaningful choice of coverage." well, i happen to know this because he and i spent some time combatting each other for the presidency, and in 1993 howard dean said of medicare -- this is what he said of medicare -- "one of the worst federal programs ever and a living advertisement for why the federal government should never administer a national health care program." so, you know, that sort of shift of opinion on something as important as this leaves me asking whether they've really analyzed, all of these folks, the level of reform that is in this bill. now, we need to step back and see the forest for the trees of what this legislation really does. i believe this legislation, even though it doesn't have the public option i want, there are a lot of other things that it doesn't do that i think it could do more effectively. but i believe when you take the

totality of this bill and measure it against the problems we have in america today in delivery of health care to people and you look at the ways in which this bill increases coverage for seniors, providers lower-cost drugs for seniors, expands the people who will be able to afford health care in america, helps to put any number of individual reforms, almost every single idea that is worth considering, that has been put forward by any think tank or any group in america is in this legislation in an effort to do what we call bending the cost curve, terrible phrase, washington phrase. it just means lower the cost increase in health care, bring it down so it's reasonable with respect to what people can afford and to the rate of increase of inflation and other costs in our lives. well, the senate bill, the senate bill that's attracting all of this trumped-up,

completely inapplicable but very effective sort of politics of destruction, this senate bill in fact provides a provision that will allow the states to establish health care coverage for people between 133% and 300% of poverty. it allows states -- not the federal government telling them what to do. no government from washington, as everybody's trying to pretend this does, doesn't tell the states what to do, but it allows the states to contract directly with plans that provide insurance. and it allows those states to have the authority -- this is states' rights. this is the party that always talks about states' rights. we're empowering governors. we're empowering states individually to have the right to negotiate the premiums, the cost sharing and the benefits

for their citizens. something else the senate bill does, it provides $6 billion in start-up funding under the consumer-operated and oriented plan co-op program, this money would foster the creation of a new nonprofit-run health insurance that offers coverage in the individual and small-group markets. those are the markets, mr. president, as i know you know, where the costs have gone up most rapidly and where americans have the hardest time sursraoeufrg. -- surviving. i came back from washington. an unemployed pilot came up to me at the airport and talked to me about the $1,100 a month he pays for his family premium and it was killing him. it goes up 20% a year. it's the market that's squeezing most americans out. we lowered those costs. we tampenned down that increase. and we make it more affordable

for the people at the lowest end of the income scale who deserve to buy and have insurance, and we make it more accessible to them and more affordable. now, the press has reported that one of the options considered in the managers' amendment is the creation of the office of personnel management administered plan. that's a -- that's a plan administered by the federal government that would offer them under this sort of co-op an option to get a plan. so i'd say to keith olbermann and howard dean and the lot of them, take a look at this. look at this o.p.m. and co-op managed plans that actually provide a not-for-profit option at the federal level. when i ran for president, i offered -- i proposed allowing everyone to have access to the same health care coverage offered to federal employees and to members of congress. ask any american: do you think

you should have access to the same health insurance that the members of congress give themselves? and they'll say yes. that's exactly what we do. we have the possibility of it. we don't do that precisely, because we don't say that it has to be that plan. but there is the possibility that in the plan that they put together, there could be that kind of option for people. i think leveraging the role of o.p.m. to encourage the creation of a national nonprofit plan is a key way to lower health care costs and to enroll more americans in plans that devote a higher premium option to medicare. now, some of our progressive friends have also said, we ought to kill this bill because it has an age-rated premium. they want us to kill this bill because it has an age-rated premium. now, i don't like age-rated premiums. it would be wonderful to get rid

of them all together. an age-rated premium for people who don't understand it, it's a premium, let's say for a lot of young people, because young people are healthier, when an insurance company looks at a young person, the odds of that young person having the high blood pressure or any other disease that seniors tend to have or more is older is less, therefore, we ought to charge those people less. and we're going to charge the seniors a whole bunch more because they're much more likely to be sicker and cost the system more. that does make sense to some degree. and so, but, you know, the whole theory of insurance is to spread the risk of being sick among everybody. those young people will be old people one day. not a bad idea that they're going to be able to pay an affordable premium for good health care when they're older too. and so maybe there's a sharing across the board. that's what you do, your home

insurance, your car insurance. it's spread across the entire population of users an risks that are -- and risks that are within those users an risks. although, there is some allocation that we all understand for age ratings and -- and the likelihood that if you're young and a new driver, you may have an accident, more prone, and we have some differential there. as we do in this bill. but, mr. president, what's important here is that -- well, let me say a number of things that are in here that i think weigh on this distribution of income. the senate bill requires insurance to abide by new rules to protect consumers. people are criticizing this bill ought to stop and take a look at what it does. insurance companies are going to be prohibited from denying coverage or charging more because of a preexisting condition. how many people in america have

complained, i can't get insurance. they turned me down because once upon a time i had this. or i had cancer four years ago, but now i'm cured, but they won't give me insurance because it may come back and i'm going to be sick later on. that's what insurance is for. but -- but companies have been allowed to say no. this bill will prohibit people from denying insurance to people because they had a preexisting condition. i introduced the women's health insurance fairness act, which prevents insurers in the individual market from charging women higher premiums than men. that's what's been happening in america all of thyme. -- all of this time. and i'm happy to say that in this legislation in our bill we prohibit the discrimination in those premium increases for women. and -- and insurance companies will also be prohibited from dropping coverage once someone

becomes seriously ill and they are going to be required to renew your coverage each year. why would americans across the board not say, wow, you guys are going to protect me so i can't be kicked off? you're going to guarantee that i can go buy it even though i had a preexisting condition? that sounds pretty reasonable to me. our colleagues don't come to the floor to talk about that. they use a lot of scare tactics, pretending they don't know what's in the bill. they know what's in the bill. because we did it in the health and human services committee and in the finance committee and we've been doing it for 11 months. so insurance companies are going to be prohibited from providing a lifetime cap or an unreasonable annual limit on coverage. that sounds pretty reasonable to me. now, i also wish the bill would include an age rating so that

insurance -- insurance couldn't charge older americans more. i hope older americans will listen to this carefully because the fact is that the senate bill imposes a 3-1 limit on age rating. i.e., the rating charged seniors is restricted to three times the level of premium that is charged to a young person. now, a lot of people are going to react, oh, my god, you mean i'm going to pay three times more than a young person? that doesn't sound fair to me. well, guess what? when it began in the bill, it was 5-1. before the bill, it was 25-1. there are states that charge 25-1. 20-1, 15-1. that's what it is today. that's what seniors face today without this bill. and guess what? in this bill in the finance

committee, we knocked it down from 5-1 to 4-1, and then on an amendment that i put in we knocked it down to 3-1, and in the house bill, it's 2-1. i ask a simple question, is 3-1 or 2-1 better than 25-1 or 20-1? that's what's in this bill. this bill limits the age rating disparity in america. i offered an amendment to try to limit it to 2-1, but we weren't able to carry that in the committee. every republican voted against it. charging older americans nearly three times as much for health insurance is by no means ideal. i know that. but boy when you look around the country, there's no rating structure in place across the country in the individual market at all. and there is a huge rate

disparity as i described in the small group bracket market. so you have no rating restraint. so we get down at least to 3-1, the house is at 2-1, and today in america, there is nothing, a zero for the individual market and there is high rating bands, as i said, of 20%, 25% for the small group market. kentucky, let me give you an example for kentucky. we have a couple of senators from kentucky here on the republican side. the rate bands in the small group market in kentucky are as high as 25-1. i guess that's okay with them, because they don't want this bill. in utah, the rate bans in the small group market can be as high as 34-1. i guess that's okay with them. as i said, the 3-1 is too high, but boy is it a vast improvement over current law. now, some of our friends have said we should kill this bill

because the exchanges aren't strong enough. well, mr. president, i have been working on the exchanges with about 70 different groups in america ranging from seniors representatives, union representatives, small business, other representatives, all of whom are concerned about the exchanges being strong, and i'm pleased to say that those who claim the exchanges in this senate bill aren't strong enough just haven't read the bill. you don't have to get past the first 200 pages of this bill to see how the exchanges have been strengthened. in the finance committee, i offered an amendment to allow state exchanges to engage in prudent, selective purchasing of insurance. under my proposal, exchanges would negotiate with plans for lower bids, encourage plans to form select networks and exclude

plans that don't offer good cost and good value. the senate bill that we're looking at now provides exchanges with strong authority to certify whether or not a plan can participate in the exchange based on a number of criteria, including whether or not the plans meet certain marketing requirements, whether or not it has broad provider networks, whether or not they deliver quality benefits for the price. they can literally negotiate for all of those things. you don't have that today. you just have plans and you have no control over what's in them. so we actually create an exchange that can negotiate down the prices, and they have the power to approve the participation of plans if they are determined to be in the best interests of qualified individuals and qualified employers in the state. now, i've advocated for these provisions because of a simple reason, mr. president. in massachusetts today, we have

this ability, we do this. and it has driven down the premiums. in massachusetts, we have something called the connector. in fact, the exchange that is in this bill is significantly based on the connector in massachusetts, and in that, the connector has the ability to negotiate contracts for what's called commonwealth care and it's placed pressure on carriers to reduce the rates overall. we have had this in place for three years now. the average premium increases have been only 4.7% compared to 8% average premium increases for private insurance. the language in the senate bill is modeled after the strength of the exchanges in massachusetts, and i believe it will insure that taxpayer dollars are spent in a smart way. that's what this does.

it guarantees that you can go and negotiate for the expense of the taxpayer dollars so you're driving down the costs to the taxpayers. now, this bill also will ensure that all americans have access to quality, affordable health care and will create the transformation within the health care system necessary to contain costs. the congressional budget office has determined that it's fully paid for, fully paid for and it's going to provide coverage to more than 94% of all americans. and even as it does that, it stays under the $900 billion limit that president obama established, it reduces the costs of health care in america, and it reduces the deficit over the next ten years and beyond. i can't think of how many -- how few the times are over the course of 25 years here where we had a piece of legislation that accomplished a social goal that managed to simultaneously lower

the deficit. that's an enormous accomplishment. this bill includes immediate changes to the way that health insurance companies do business to protect consumers from discriminatory practices, and it provides americans with better preventative coverage, something we don't do enough of in america. you know, we spend an amazing amount of time in our health care system just -- just responding to symptoms. addressing disease. hospitalizing people with expensive procedures. a classic example of that is diabetes. because we don't screen people, because a lot of americans don't have coverage, they don't get screened at an early stage. therefore, when they are discovered to have the diabetes, it becomes a far more acute treatment as a consequence of having gone all those years without the discovery, and so you wind up with expensive

alternatives like amputation of limbs, dialysis, instead of having treated them earlier with oral intake of a pill or other treatments, diet, and other kinds of things that ultimately would save billions. the saiments are that this costs america about $100 billion a year in unnecessary additional expensive treatment because we don't do preventative, we don't talk enough about wellness. so we have food that people eat, we breathe air, we drink water, we do all kinds of things that ultimately increase the amount of disease that we wind up having to treat, and we have lifestyles in addition which add onto that also. well, this bill tries to encourage the embrace of better preventative coverage and the information it -- information.

it empowers people in america. it doesn't say in washington you have to do this or that. it's not command and control. it puts information at the disposal of americans so that every american can decide what they want, where they want to go get it, who will treat them, and that -- that fundamental principle of american health care is absolutely totally preserved and sacrosanct in this bill. every american could choose their own doctor, choose their own plan. no one is told to go do this or go do that. uninsured americans with a pre-existing condition can have access to immediate insurance program and help them avoid medical bankruptcy, one of the huge bankruptcy causes in america is health care. how many -- how many seniors have had the situation where they have had to spend down by selling their homes, selling

their -- if they are lucky enough to have any, stocks, whatever assets they had, sell the family farm, sell the small business because they are very, very ill and they don't have the money and kids don't have the money, but they hope to leave that money to their kids. they hope to leave something to their children. instead, we just wipe it out because we don't provide a lot of those folks with the insurance that they deserve. the new health insurance exchanges will make coverage affordable and accessible for individuals and small businesses. premium tax credits and cost-sharing assistance is going to help people who need assistance. insurance companies are going to be barred from discriminating based on pre-existing conditions, health status, and gender. the bill also improves the quality and efficiency of health care itself. as the president knows, the president and presiding officer knows, we are strengthening the medicare program for america's seniors. and here i just want to -- i

cannot believe the distortion that has been taking place over the course of these last weeks and months. time and again, someone on the other side of the aisle will come to the floor and say that this is attacking medicare or that this is going to tax the benefits. well, we believe, we, the party that created medicare, we, the party that expanded medicare, we, the party that believed that what we said we would do we have done which is lift a huge percentage, 80%, 90% of americans out of poverty over the last 50, 60 years through medicare, that it's a sacred trust and we're going to keep it. and this bill helps, in fact, to extend the life of medicare. the costs of inaction is unacceptable for seniors, and the medicare program that serves them. in fact, the medicare hospital trust fund as we know is

expected to go broke in over seven years. this bill makes medicare stronger. it makes it more sustainable. it extends the solvency by nine years. medicare currently reimburses health care providers on the basis of the volume of care that they provide rather than the value of the care that they provide. for each test scan or procedure conducted, medicare provides a separate payment. and -- and so we do that regardless of whether or not that was necessary or whether or not it had anything to do with the outcome for that particular patient. that doesn't make a lot of sense. i mean, we don't -- we don't pay people to build our home the wrong way or to build something that we didn't ask for and charge us more or a whole bunch of other kinds of examples. but medicare is doing that. now, i think americans deserve to get something better out of their taxpayer dollar. this bill includes a number of

proposals to move away from what we call a la carte medicare, fee-for-service system, so that we begin to pay for the quality and the value, and that reduces costs to america's seniors. this bill promotes, as i said, preventative care and improves the public health to help americans live healthier lives and to help restrain the growth of health care costs over time. it importantly eliminates co-pays and deductibles for recommended preventative care, and it provides individuals with information that they need to be able to make good decisions about their health care and it improves education on disease prevention, public health. it invests in a national prevention and public health strategy. it does all of that, mr. president, and all of those things, just put to shame the idea of just scrapping this legislation.

currently, 65 million americans live in communities where they can't access a primary care provider. an additional 16,500 practitioners are required to meet their needs. if you scrap this, that number is going to go up and the numbers of millions, 65 million today of americans who don't have access to a primary care provider is going to go up. this bill addresses the shortages in primary care, and in other areas of the practice by making necessary investments in the nation's health care work force. specifically, this bill will invest in the national health service corps, scholarship, loan repayment programs. it will expand the health care work force. and the bill includes incentives for primary care practitioners and for providers to serve underserved areas. but, you know, mr. president, don't listen to me on the transformation of this.

listen to a fellow by the name of john griewber -- gruber who is a very respected and renowned economist from m.i.t., and here is what he writes -- "the united states stands on the verge of the most significant change to our health care system since the 1965 introduction of medicare. the bill that was passed by the house in a parallel bill before the senate would cover most insured americans, saving thousands of lives each year, and putting an end to our status as the only developed country that places so many of its citizens at risk for medical bankruptcy. moreover, the bill would accomplish this aim while reducing the federal deficit over the next decade and beyond. they would reform insurance markets, lower administrative costs, increase people's insurance choices, and provide insurance for the inassured by disallowing medical underwriting and the exclusion of

pre-existing conditions, and the senate bill in particular would move us closer to taming the uncontrolled increase in health care spending that threatens to bankrupt our society." that's what this bill does. that's what the republicans are proposing. these aren't minor things. these are things we have been striving to accomplish here for decades. i see colleagues who are here with me back when we struggled with the clinton's administration on health care. every one of us would have been more than happy to accept right then and there what we have accepted here today. we would have had republicans like senator john chasey and others in that lifetime who tried to get a compromised pass not different from what we're moving in here and it was

rejected by the clinton administration. so now is the time for all of us to reexamine what we promised our people and decide really where we stand. we know where the other side that says let's begin over, pretending to america there's someplace to begin over here, they've engaged in fear amongering, deliberateness information. those have been the core of the arguments that they've used. and -- and fundamentally to stop the success of president obama. they're also continuing now, obviously, to use procedural tactics, chiewp the senate's time a -- chew up the senate's time a week before christmas, let's see if we can back it up and make it look as bad as possible and try to make the congress look as bad as possible, make them fold. they're using this idea and they're willing to block the funding for our troops so that we can go on this delay. we could have voted today. but they said, no.

no reason to do this. i think there's a snowstorm coming to washington. i suspect they're hoping the snow will prevent some senator from getting here and then they won't be able to vote. normal decency would say, why don't we inconvenience everybody and have the vote before the snowstorm. but, no. so they link it to blocking the money for the troops. i the hate to think what some of those troops think is going on here. it's embarrassing. mr. president, we've heard repeatedly from republicans that our health care reform bill is going to drive insurance premiums sky high for families. that's what they say. but the congressional budget office says the opposite. it says that the 134 million americans who get their insurance through their employer would end up paying 3% less for their premiums if we pass the reform measure before us.

in addition, the c.b.o. says the subsidies that are included in the measure would result in a 59% reduction in costs for nearly 18 million americans who purchase their own insurance. 59% reduction. a lot of americans out there who buy their insurance individually. they'll get it through the employer. you don't think they want a 59% reduction? and despite the fact that the c.b.o. said that there is a 59% reduction, they continually come out here and just tell people otherwise. because one of the things that we learned in american politics is, if you just throw the mud out there, throw the lie out there, throw the distortion out there enough, enough people will hear it and they won't know the difference. health care reform has dramatically reduced the premiums in massachusetts, mr. president. premiums fell by 40%. we're not -- we're not here conjecturing to what's going to happen. this isn't some pie in the sky

theory that if we do this, here's what's going to happen. we've done it. in massachusetts, we are insuring 97.6% of all of our citizens. the highest level of insurance in the united states of america. and, mr. president, guess what? the numbers of companies participating in the program has gone up since it was passed. and they like it. the premiums fell by 40% from 85,037 -- $8,537 at the end of june while the rest of the nation saw a 14% increase. so, massachusetts, premiums go down, for the individual market, by 40%. the rest of the nation they go up 14%. what do you think most americans

would rather have, the 40% reduction or 14% increase? our bill gives americans the opportunity to get part of, not all of, because we're not able to do enough of it, but part of the experience of what's happening in massachusetts. we've also heard repeatedly from republicans that this bill will add billions of dollars to the federal budget deficit despite the fact that c.b.o. analysis conclude that the bill is not going to add one dime to the federal deficit. not one dime. mr. president, from the very beginning of this debate, our -- our colleagues on the other side of the aisle have tried to make the care that seniors medicare benefits -- benefits are jeopardized by our reform measure. well, that's just patently false. you keep hearing it. it gets repeated again and again no matter how many times it's been shown to be fasms the bill before us -- false. the bill before us, in fact, does exactly the opposite.

it actually adds benefits for seniors. for example, there are new screening benefits. the bill shrinks the so-called doughnut hole and the medicare prescription drug benefit. when we pass the prescription drug benefit, a whole bunch of seniors -- millions of seniors were covered up to -- i think it was 2,000. i can't remember. about 2,000. and in between that and $4,000 and something there was a hole where they have to pay a difference. that's a lot of money out-of-pocket for seniors. well, we've reached and agreement where that will be closed and no longer will seniors be out-of-pocket for drugs in the middle of that bracket. in addition the nonpartisan national committee to preserve social security an medicare sent a -- and medicare sent a letter to every senator.

republicans and democrats alike have got the letter. it hasn't stopped them from keeping the argument. here's what the letter says, not a single penny in the senate bill will come out of the pockets of beneficiaries in the traditional medicare program. in fact, the letter thadz our reforms, i quote -- "will positively impact millions of medicare beneficiaries by slowing the rate of increases and out-of-pocket costs and improving benefits and it will extend the solvency of the medicare trust fund by five years." to me, i think to all of my colleagues here, on our side of the aisle, that's a win-win for seniors. and it's a win-win for the medicare program. since sending that letter, the c.m.s. actuary released a report saying that the solvency of the medicare trust fund would be extended by nine years as a

result of the senate bill. so it's been interesting to watch republicans speak about protecting medicare as i said earlier, a program that their party has opposed since the very beginning. and while claiming to be trying to protect medicare, they've simultaneously warned us many times about the evils of a government-run program. well, again, i would ask if they're so opposed to a government-run program, why don't they come to the floor with an amendment or proposal to do away with medicare. they won't, of course. because medicare prevents millions of seniors from falling into poverty due to health care costs. they also always promote the idea that competition is good for the marketplace. and, yet, they adamantly oppose adding an option here that could help provide some of that competition. you know, president obama said it clearly, that a public -- a

private-public plan would help to keep the private plans honest. i couldn't agree more. like some of our friends, some of our progressive friends, the republicans have argued again and again about starting over. well, let me remind -- let me remind my colleagues about one of the greatest legislators of the united states attitude about that. ted kennedy fought for health care when the day he came here. the first major speech he made on the floor of the senate was -- one of the first speeches. i think the first speech may have been the civil rights speecspeech. he spoke about health care. and he often said that the biggest political mistake that was made that he made -- that he personally made in the 46 years he legislated was turning down a health care deal with richard nixon in 1971 that for the first

time would have required all companies to provide a health plan for their employees with federal subsidies for low-income workers. that's how far the republican party has drifted from one of their own presidents who most people would agree, despite what happened in terms of, you know, what cost him the presidency, that he was a strong and capable president with respect to social policy in america. the fact is that for the first time all companies would have been required to cover their employees. that's the plan richard nixon offered ted kennedy and ted kennedy made the mistake of turning it down. he backed away from that deal under heavy pressure from fellow democrats who wanted to hold out for a single-payer system once the party recaptured the white house in the wake of the

watergate scandal. well, 38 years have passed and single payer is still out of reach. not even on the table. some people want to give up what we have available to us here and repeat that greatest mistake? the lesson that teddy learned is this: that when it comes to historic breakthroughs in america, especially in social policies, you make the best deal that you can. and then, immediately, you start pushing for ways to improve the deal. let me share a quick story with you. we all remember how ted kennedy on the floor of the senate kept pushing and pushing to raise the minimum wage, which hadn't been raised in years. and, finally, he pushed so hard that robert dole, who was then the majority leader, who was then running for president, decided he couldn't run for president while ted kennedy was pushing that hard, tying up the

senate to get the legislation passed. it might raise people just a little bit. wouldn't even get them up to par. robert dole resigned from the united states senate to go run for president. he said ted kennedy doesn't run the world when he did. well, trent lott came in, senator lott from mississippi, became the majority leader. he vowed the same thing. hwithin months senator kennedy was doing the same thing, pushing for the rise in the -- in the -- in the minimum wage as senator lott aseeded to him, we got the minimum wage passed. and at a rally where he was celebrating the rise of the minimum wage, which wasn't up to par, he was in the victory moment and he turned to congressman george miller and he said -- to george miller he said i'm introducing a bill to raise

the minimum wage. and george miller said, what do you mean? we haven't even let the dust settle. he said, we've got to move on this. well, that's what's going to happen with this bill. we all know there are things that we're going to have to watch, there are things that we're going to have to improve, there are things in it that -- to pass the opportunity to talk about all of the things that i talked about and listed would be an enormous, enormous mistake. e and medicaid were created, they've evolved and improved over the years. when medicare first passed, it didn't cover individuals with disabilities or individuals with end-stage renal disease. now it does. similarly, medicaid evolved to allow states to cover additional services like home and community-based care. now both medicare and medicaid are an indispensable element of the total social contract in the

united states. mr. president, our march to this point has been too long and too slow. almost a century in fact. it began in 1912 when teddy roosevelt ran for president, promising government protection against, as he put it, the hazards of sickness. there have been fits and starts ever since. and through the shouting and the distortion and big interests clinging to the status quo, we can't allow that to continue any longer. we know that the legislative process is a long one. 97 years is way too long, way too long for america to finally join the other major industrialized nations in guaranteeing health care for all of our people, that we are here today with an opportunity to take a giant step shows not only what a challenge this undertaking has been, but it also shows what hard work, skill, and dedication a lot of

senators have shown in trying to get us here. and i particularly applaud the efforts of our leader, senator reid, who has personally sacrificed in the effort to help move this, the entire leadership and senator baucus, the chairman of the finance committee, and senator dodd, the chairman of the human and health services committee, who was carrying that load for senator kennedy. and now tom harkin is doing that job. he and barbara mikulski and jeff bingaman were central to help shape what's come to the floor. senator baucus accepted hundreds of amendments on the republican side. so the bill is not perfect, but tell me what bill is. all of us would like to change it here and there, but none of us can credibly claim that we did not get a chance to have input to this bill. make no mistake, this legislation, that with cooperation and bipartisanship

can make history and improve the lives of americans for decades to come is important to this country and to our economy. it can help change who we are as a country. 94% of americans would have health care. just think of that. if we do nothing, things are only going to get worse. more expense, more bankruptcies, more people without coverage. i can't help but think how often we have some private conversations around here at the prayer breakfast, at the national prayer breakfast, the senate prayer breakfast and private conversations about what the duties are and obligations of good adherence to most of the organized religions of the world, and certainly most of the philosophies of the world. they all, all of them embrace a component of the golden rule. and you can go to any scripture, and you can read about one

person's human responsibility to another human responsibility. these kinds of opportunities to live up to those guidelines, those values don't come very often. many of us here saw that pass in 1993. we learned a lot of tough lessons then. and i'd say to my friends, progressive friends in this country, after that we did a little better with the children's health insurance program and we did better with portability and little pieces here and there. but still the system is out of whack. still the system gets more expensive. still more and more americans lose their health insurance. still we wind up with institutionalized unfairness. i just remind my colleagues of what, when ted kennedy worked on the children's health insurance program. you know who the minority cosponsor was then? senator orrin hatch. you know what he said? he said that passing it was the mark of a compassionate, caring

congress. we still have millions of kids who aren't covered by that health insurance. so compassion could be the mark of this congress if we act with respect, with courage and with cooperation. i don't think we can stop now. i don't think there is any option but to get this job done after all these years. i yield the floor. a senator: mr. president? the presiding officer: the senator from new jersey. mr. menendez: mr. president, my distinguished colleague from massachusetts has been talking about the urgency of now and the importance of this legislation has done so mass tperly. we have been -- masterfully. we have been debating health care for weeks. we have been debating it for months if you think about the markups that took place in the

health committee as well as in the senate finance committee. we have been debating it even more if you consider the time of negotiations that took place between a group of six members of the senate, three democrats and three republicans, in search of a bipartisan effort. so, all of this talk that this is a rush to judgment is, doesn't just square itself with the facts. but there is another bill that is pending before the senate, a bill that should have passed without any difficulty. mr. president, the tactics of delay and obstruction that we have seen on this floor for the last few weeks on the part of the minority have now reached critical mass. we're fighting two wars. it's nice to be home. it's nice to be home for the holidays. it's nice to be here in the comfort of the senate.

it's nice to be able to see your family. we are fighting two wars abroad, and we have work to do for the american people, and these continued unnecessary delays on the republican side of the aisle are now impacting our military men and women on the ground in iraq and afghanistan. these delays come at a time when we are seeing greater success in iraq, a time when we are more focused in wiping out al qaeda along the afghan-pakistan border. our colleagues on the other side of the aisle are engaged not in governing, not in the bipartisanship they claim to embrace, but in pure politics. a political game that does not threaten the majority. it does not benefit the minority. what it does is threaten the health, safety, and in some cases the lives of military men and women in harm's way. mr. president, never have so few

been asked to sacrifice so much on behalf of their country. never have a relatively small group of americans in uniform in harm's way been asked to sacrifice so much, multiple tours of duties while the rest of america enjoys its security at home because of their sacrifice. you would think, you would think that our friends on the other side of the aisle would want to join skpe dishesly to make -- expeditiously to make sure that their pay and their health care and the equipment they need would be there as quickly as possible. but our friends on the other side of the aisle have determined that their only strategy is to bring the work of the senate to a halt. to diminish the effectiveness of the senate they serve in in an effort to diminish the majority. you know, it's a shame but our republican colleagues have come

to the view as a political tactic that the road to electoral victory next year in the midterm elections of 2010 and then preparing themselves already for the presidential election of 2012 is for this president to fail and for this congress to fail. now if you looked at it as a political tactic, you might say, well, as a political tactic maybe it might make sense for them. it is a horrid political tactic because it is not about this president failing. it is not about this congress failing. it is about the failure for the country in one of its most precarious moments. this is a country, and this president who inherited the worst economy since the great depression. and i don't think people understand how close to the

abyss we were from facing a real depression once again in our history. financial institutions that were collapsing, and we cared about them not for the sa*eupl sake of them as -- not for the sake of them as a big institution but what it meant to the economy as a whole. the reality of two wars raging abroad that he inherited in iraq and afghanistan, nuclear north korea, nuclear thirty iran, an energy policy that sends $1 trillion to countries of does pottic wishes ill -- despotic wishes ill. this is what our president inherited. instead of working with him, our colleagues on the other side of the aisle have determined that the politics of failure will lead them to electoral victory.

and that is more important than the future of the country. they've come to the floor of the senate to say no, no to everything. first to health care, now to providing for our troops in harm's way. they've come armed with an arsenal of parliamentary maneuvers not to govern, not to do what's best for the american people, not to do what what's bt for the senate, but to do what's politically expedient for them. mr. president, diminishing the senate's ability to pass defense appropriations as well as health care reform in order to score political points and then call it victory is an insult to the american people. it flies in the face -fs what our founders intended of a true representative democracy, not to tear down the institutions of government and bring them to a halt, but to make them work for the people. sam rayburn once said -- quote

-- "a jackass can kick a barn door down, but it takes a carpenter to build one." my friends on the other side of the aisle seem intent on kicking the barn door down. in my view, that's not victory. doing nothing, delaying, obfuscating, saying "no," "no" to everything, blocking the ability of this chamber to fulfill its duty to the people is no victory. saying no to funding our troops serving bravely overseas in iraq and afghanistan is hardly victory. delaying it is hardly victory. saying no to funding medical care for military men and women and their families is not a victory. it is shameful delay of needed care. saying no to 120 million for traumatic brain injury and

psychological health research at a time when so many of our troops are coming home from iraq and afghanistan with such injuries is by no means a victory. saying no to funding necessary funding to train and equip afghan security forces so that they can stand up for their own country and get our people out is contrary to the president's surge policy which our friends on the other side of the aisle have publicly supported. imagine, imagine if the tables were turned and it were democrats delaying funding for mine-resistant vehicles to protect our troops in iraq and afghanistan. what would our friends on the other side of the aisle say? imagine if it were this side of the aisle delaying passage of $636 billion for the military, including $128 billion in funding for contingency operations in iraq and afghanistan. imagine if it was this side of

the aisle delaying $154 billion to increase readiness and training of our troops. imagine if it was this side of the aisle delaying funding for bradley fighting vehicles, striker combat vehicles and b-d-2-e eye hawk aircraft. imagine if it was this side of the aisle delaying all of this critical equipment. imagine if democrats were standing in the way of funding military health care for service men and women and their children. this is all included in the defense appropriations bill. that's what our republican friends on the other side are doing. imagine if democrats were holding up needed assistance in health coverage for americans who lost their jobs and are unemployed in this economy at this time of the year. that's included in that bill as well. but that's what our friends on the other side are doing.

what would our colleagues on the other side say of our patriotism if we on this side were delaying funding for our troops? mr. president, patriotism doesn't shift with the political tides. it is not something used to advance a political agenda because if it is, it's not patriotism. mr. presy -- mr. president, we can disagreen on the -- disagree on the issues, we can have opposing views. there is no victory in diminishing the responsibilities of government, the duties of this chamber for calculated political gain. there is no victory in holding up extending desperately need unemployment benefits included in this bill. there is no victory in blocking the extension of cobra health insurance subsidies in this bill from people who lost their job, their health care, and may be in danger of losing everything -- everything they've worked for.

especially at this time the year. as i think about this time of the year, mr. president, it's not a stretch to look at the delaying tactics of our friends on the other side of the aisle on this legislation and think of that famous christmas movie, "a christmas carole" and think of ebebbenezer scrooge when asked r a contribution replied, what? are there no poor houses? our colleagues on the other side are holding on so tightly to their tactics, they forget the democratic values they professed so clearly to protect. i urge my colleagues on the other side to seek victory not in delay and obstruction, but in doing what's right for the american people. do what's right for our military men and women who will spend this holiday season in iraq and afganistan in harm's way.

and assay if -- and i say if the tables were turned, my colleagues on the other side would come to the floor, wave the flag and claim themselves as the only patriots and vilify the other side as unpatriotic and undemocratic. the fact is we are all patriots. and as patriots we have a job to do. and that job is to make sure that those men and women have everything they need. even when we we disa-- when we disagree as to whether or not it is an appropriate disengagement. once they engage, it is our responsibility to make sure that they're appropriately taken care of. the tactics of delay for political advantage can never, never be accepted. i urge my colleagues, don't play politics with the defense appropriation that includes funding necessary to protect our men and women in uniform. let's not play politics at the expense of unemployed americans in need of this economy at this time of the year. it's not time for those debates. those debates should be behind

us. it's not time for the political tactics that, in essence, put people at risk. there are many other ways to try to achieve political victory and do with the power of your ideas. you certainly don't have to do it by a political tactic that puts the country in jeopardy. it puts our men and women in jeopardy. that at the end of the day says, we'd rather see failure than success so that we can win an election. that, mr. president, is not acceptable. mr. president, with that, i yield the floor. mr. menendez: mr. president? the presiding officer: the senator from new jersey. mr. menendez: i ask unanimous consent that the senate proceed to a period of morning business with senators permitted to speak up to 10 minutes each.

the presiding officer: without objection. mr. menendez: i ask unanimous consent that the veterans' affairs committee be discharged from h.r. 1377 and the senate proceed to its consideration. the presiding officer: the clerk will report. the clerk: h.r. 1377, an act to amend united states code to expand veteran eligibility for real imbusment and so forth and for other pupses. the presiding officer: without objection, the committee is discharged. and the senate will proceed to the measure. mr. menendez: 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 in the appropriate place as if read. the presiding officer: without objection. so ruled. mr. menendez: mr. president, i ask unanimous consent that the senate proceed to the immediate consideration of calendar 230, s. res. 364. the presiding officer: the clerk will report. the clerk: calendar 230, senate

resolution 374, recognizing the cooperative efforts of hunters sportsmen associations and so forth and for other purposes. the presiding officer: without objection, the senate will proceed to the measure. mr. menendez: i ask unanimous consent, resolution be agreed to, the preamble be agreed to, the motion to reconsider be laid on the table with no intervening action or debate and any statements related to the resolution be placed in the appropriate place as if read. the presiding officer: without objection. mr. menendez: mr. president, i ask unanimous consent that the foreign relations committee be discharged from further consideration of h. con. res. 218 and the senate proceed to its immediate consideration. the presiding officer: the clerk will report. the clerk: house concurrent resolution 218, expressing sympathy for the 57 civilians killed in the southern philippines on november 23, 2009. the presiding officer: without objection, the committee is discharged and the senate will proceed to the measure. mr. menendez: mr. president, i ask unanimous consent the concurrent resolution be agreed

to, program, -- the preamble be agreed to, the motion to reconsider be laid on the table and any statements related to the measure be placed in the record in the appropriate place a as if read. the presiding officer: without objection. mr. menendez: mr. president, i ask unanimous consent that when the senate completes its business today it adjourn until 6:45 a.m. saturday, december 19, 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 until later in the day, and the senate resume consideration of the house message with respect to h.r. 3326, the department of defense appropriations act with the time until 7:20 a.m. equally divided and controlled between the two leaders or designees with the final 10 minutes reserved for the two leaders with the majority leader controlling the final five minutes and i ask that the time during the adjournment and any period of morning business count postcloture. the presiding officer: without objection. mr. menendez: mr. president, senators should expect multiple

votes to begin at approximately 7:20 a.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 6:45 a.m. tomorrow.

>> he was not an imposing figure, not a giant of this time and yet emerged as the nominee at a time when the party was populated by big fears. >> is markon history includes manifest destiny and the butterfield of james k. polk a country of vest designs.

stilling time for the holidays american icons on the beady, c-span's three original documentaries on the iconic homes of the three branches of american government, the special three disc collection is only $24.95. for this and other gift-giving ideas from c-span this its c-span.org/store. >> while defense spending was the official business on the senate floor today senators spend much of the day talking about the health care bill that was set aside for defense debate. health care is expected to come back to the senate floor tomorrow. here is what republican and democratic leaders had to say about the debate today. >> mr. president the majority leader has signaled that we will finally unveil, that he will find the andel the most significant piece of domestic legislation in modern history sometime on saturday and and force a vote in the middle of the night about 36 hours later.

this is truly outrageous. this will be a bill that none of my constituents have seen, that none of the majority leader's constituents have seen, that none of you have seen and that nobody outside the capitol have seen. you could fit into a phonebooth the number of people who have seen this bill that will affect the lives of every single american in the most profound way. every american should have an opportunity to know what their centers are being asked to vote on before anyone can see it. i doubt if anyone in this chamber could come down here and defend the secrecy surrounding this bill. earlier this week the president said quote, i think it is important for every single member of the senate to take a careful look at what is in this bill. in fortunately there is no bill to read. let me repeat, there is literally no bill to inspect. even senator durbin my good

friend from illinois he was here on the floor, the second-in-command on the democratic side admits he is not seen the details of the bill. the only thing we know for sure about this bill is that it will raise taxes, raise premiums and/medicare. that much we know for sure. the medicare cuts will be nearly half a trillion dollars to pay for fast expansion of government in the health care that an overwhelming number of americans we now know oppose. that is what is at the heart of this bill that no one has seen yet. so we may not know all the details, but we already know this bill can't be fixed. and we know americans are outraged by what has happened in this debate. a bill that was supposed to lower costs, and lower taxes and lower premiums will actually raise all three. making existing problems not better but worse. it is not too late to start over and deliver their reform americans really want, the

step-by-step reforms that we know what actually lower health care costs. the majority knows this bill is a kolasa legislative blunder. that is why they are rushing it through. that is why the only argument they are left with the zichal to history. history will be made either way. and this much is clear. passing this bill in this way would be a historic mistake that those who support it will come to regret. mr. president i yield the floor. >> mr. president? >> the senator from illinois. >> mr. president, this is the bill that is before the united states senate, 200074 pages and it has been on the internet now for three weeks in its entirety. you cannot only read it on the democratic senate web site, you can read it on the republican senate web site so you might ask, where is the republican comprehensive health care reform

bill? it is not to be found. not on the floor of the senate, not on the web site because it doesn't exist. after one year of debate about america's health care system, the republicans in the senate have failed to produce any legislation that has gone through the scrutiny this legislation has faced in terms of its impact on america, its impact on our budget, of their empty handed. what they bring to us on the floor of the senate are speeches, press releases, charts and graphs, and an occasional criticism. i say locational because for 19 days on the senate floor we have debated this measure, comprehensive health care reform and let's take a look at the record after 19 days of debate on the floor of the united states senate. the republicans in the united states senate, there are 40 of

them, have offered four amendments to the bill in 19 days. for the amendments? they have offered six motions to take the bill off the floor and sent it back to committee. they have looked at this, and you've heard the minority leader in his criticism of this measure, and found four things that they are willing to bring before the senate to change. it doesn't strike me that this is a good-faith effort to try to bring us to closure in a bipartisan way. instead, what we hear from the republican side of the aisle in addition to only four specific amendments over 19 days is, we haven't had enough time to offer amendments. 19 days, for amendments? you know, i guess some of us are reaching advanced stages in life and age and maybe don't have the energy we