we had senator wyden come out here and say he loves the enterprise spirit, but we're going to put an artificial tp*eupls in terms of -- fix in terms of of the insurance company. what if we had an insurance company that had a 20% greater efficiency in terms of outcomes and benefits? they have to still spend that money. in the name of the system, we're going to kill free enterprise? i bristle at the way i run into insurance companies. there is no question about it. we need to fix that. but the option and the point that senator burr was making is this is this way or the highway. we offered the patients' choice act. cuts taxes, doesn't raise taxes. expands exactly to the level or beyond of this bill and does it

at a faster rate. extends the life of medicare. gives medicaid patients the same kind of care we get. it was defeated in committee on a party-line vote. filed this as an amendment here. not acceptable. we had ten amendments voted on from our side on 2,400 pages of legislation. ten amendments. so it's not about being bipartisan. it's about being -- you get -- you get -- take this or leave it. what the american people ought to pray is that somebody can't make the vote tonight. that's what they ought to pray. so that we can actually get the middle -- not me, not mine, i understand i'm way over here -- but we ought to get the middle of america and the middle of the senate a bill that can run through this country and actually do what we say we all want to do.

there is a large difference of opinion and it's not rhetoric that's unfounded, as senator burr just outlined, as dr. barrasso outlined with the 1.6 million estimate of jobs lost by the nfib. and that may be old data because who knows what the data is now? we haven't had a chance to look at it, because in 30 hours after the bill's introduced and the cloture petition is filed, we're going to vote on it. not sure it's a great way to run the country. what's in the bill. there's zero guarantees that taxpayers won't finance abortion. there's zero prohibitions on the rationing of health care. zero. there's not one shred of

evidence that we're not going to ultimately ration health care under this bill. we are. and the only reason you would vote against a rationing amendment is because you intend to see rationing carried out. there's zero senators required to enroll in either medicaid or a government-run option, either through o.p.m. or medicaid. there's now ten new taxes created. there's 71 new government programs created. there's 1,697 times that the secretary of h.h.s. is going to write the regulations. and based on c.r.s. sal claitionzs.calculations, there'n 15,000 and 20,000 new federal employees that are going to be required to carry out this legislation. there's 3,607 times -- before we got the reid amendment -- that the legislation says the word "shall." now, "shall" is a very important word because the word "shall"

takes away your options. there is no option when the word "shall" is used. the word "shall" also says whoever's directing the "shall" obviously has more wisdom, more only bknowledge, more experiencn the person that the "shall" is applied to. so what we have said is in all our wisdom and all our many years of practicing medicine and being involved in the care of patients that 3,607 times we're going to tell the american people want to do. one of the big "shall's" that's not -- i don't think will ever hold scrutiny before the supreme court is you shall buy an insurance policy. that doesn't fit anywhere in the constitution that i read. and if you do the legal research on it, as my staff lawyers from the judiciary committee have done, it's highly unlikely that

that will ever hold up. so the whole premise of a large portion of the taxes collected in this bill will be out the window. it also will totally change through adverse selection all of the insurance premiums in this country, because if you don't have an individual mandate making people buy insurance, the costs relative to the illness and the age, even though we've compressed the ratios, will rise exorbitantly. there's still going to be 24 million people left without health insurance in this count country. there's a $10 billion cost just for the i.r.s. implementation of this bill. there's at least $25 billion in mandates based on the states,

unfund mandateed mandates. there's $28 billion-plus new taxes on employers. there's $100 billion by conservative estimates in fraud and medicaid a year and this bill goes after $2 billion over ten years. so we're going to go after $2 billion out of a trillion. not $200 billion, not $20 billion, we're going after $2 billion. there's $118 billion cuts to medicare advantage but only for those people who don't live in the state of florida and a couple other places. if you happen to live in oklahoma, the citizens in medicare advantage are going to lose. there's now over $500 billion in new taxes on americans.

there's a quarter of a trillion dollars that's not in this in expense that everybody knows is an expense. we are going to restore the s.g.r. we're going to fix that. and that quarter of a trillion dollars is based on no increase in physicians over the next ten years. how many in this body think we're not going to increase the pay of physicians under medicare in the next ten years? the assumptions in the c.b.o. report that accompanied the reid amendment, if you read what they said, they said it's highly unlikely that will happen. so that's a quarter of a trillion dollars, even though it wasn't in their numbers. it also said if the cuts came through, which they thought highly unlikely that they would, and if they didn't, then the fiscal numbers associated with the bill are out o out the wind. and the final number that everybody ought to really be paying attention to is

$12.1 trillion. and $12.1 trillion is what our kids owe. outside of owing ourselves. $12.1tril yon. trillion. that's going to double in the next ten years. anybody that had a lick of common sense that looked at the numbers on this bill would say, washington, your accounting programs aren't any different than enron. the same fate to those that created the enron scan ought to apply to the congress of the united states. the very fact that we're not considering an s.g.r. fix is evidence of that. so for at least yo you have to d a quarter trillion dollars every ten years to this bill just to keep doctors even. and don't forget the fact that 34 million new americans over the next ten years are going to

enter medicare. are going to enter medicare. so what are the alternatives? i won't offer other amendments and make the chairman object to them because i know his answer. he calls it a stunt. it's not a stunt when you don't have vigorous amendments offered on the senate floor. it's not a stunt. the stunt is, is not allowing amendments to be offered. to allow only 10 of our amendments to be offered on this bill is beneath the dignity of the senate, on "the" biggest bill in the last hundred years in this congress. the only bill in the last hen years that's going to affect every american in a personal way but also in a fiscal way, a financial way.

there was an amendment to be offered, a conscience protection for physicians, but we didn't get a vote on it. should we force physicians in this country to perform abortions? or should we have a vote on whether or not if they have a conscience protection, they ought to be excepted from that? and should that not be part of the health care bill? we're not going to get a vote on that. or how about an amendment to reduce the waste, fraud and abuse in medicare and medicaid programs and protect medicare benefits and increasing the fraud and waste from $2 billion to $10 billion over the next ten years? that's just 10% of what's there. we're not going to debate on that? it's incredible. the american people aren't going to hear the debate on that. they're not going to be able to make up their minds. do you know what? you don't want them to make up

their mind. if we wanted to have a debate on fraud, we would have a debate on fraud and we'd have an amendment and say put your stamp down. are we for people who are defrauding or are you for the status quo? we're for the status quo. we're for the well-connected. the amendment on rationing that i talked about, or an amendment to limit the bureaucratic increase associated with this bill. which is an amendment i offered. we're not going to get to debate on it. and that's a very straightforward amendment. it just says, we're not going to increase the bureaucrats in this bill. we're going to drive the efficiency in h.h.s. we're going to see you can't have a net increase in bureaucrats, so get more efficient. since we're running $1.4 trillion or $1.5 trillion in deficits, that's something everyone else in the country would do but we're not going to

do that. we're not going to lou a debate or vote -- going to allow a debate or vote on that. we're not going to allow that opportunity. you know, i've heard the majority mention several times that we didn't have anything to offer. you know, we offered the patients' choice act. ic.b.o. said it cut long materil costs in medicare, said it saved medicare. said it saved a trillion dollars over the first ten years for states, and the early estimate -- because we couldn't get the commitment that was made to us by the chairman of the "help" committee that he would score the bill -- the bill didn't ever get scored by c.b.o. but outside score says it saves at least $10 billion the first year and covered more people than this bill, saves personal choice. doesn't put somebody between you and your doctor. i heard the senator from rhode island say we were lying about

that happening. ist hang today both from insurance companies and medicare and medicaid. so if we really wanted to reform health care, weefd be attacking that. -- we'd be attacking that. and instead we're going to make it worse and let me tell you how we're going to make it worse. we're going to use cost comparative analysis, which is exactly what the u.s. task force on prevention services did. they used cost comparative effectiveness, and when they looked at breast cancer, they said it's not cost-effective to screen women before the age of 50. do you know what? they're right. it's not cost-effective. but it certainly is clinically effective, especially if your wife's the one that is 40 and has breast cancer and it got found by a mammogram. so you see, judgment goes out the window, so what did we do?

we reversed that finding. one of the first things we go d as we started the debate. are we going to do that every time the u.s. preventive services task force issues a ruling that is cost-effective but yet isn't clinically effective? are we going to every time the cost comparative effectiveness panel says you will do this and the american people say, that isn't right. the doctors say that isn't right. the american cancer society says that isn't right. are we going to start every time we get one of those that we're going to have to pass a piece of legislation to change it? you see, the purpose of the three panels is well intended. the medicare advisory commission? it's well intended, help us cut the costs. but the only way you go for costs is through prevention and management of chronic disease. you're not going to cut costs any other way.

because 75% of everything we spend is on five chronic diseases. so unless you attack what the real problem, the real disease with our health care system is, you're not going to solve it. what is going to happen and what will happen is the lack of art in medicine will become readily apparent in 2015, 2016, 2017. what will happen is we will see bureaucrat decisions in between a patient and their provider. that's not a scare tactic. that's the absolute fact. we have it now. -- now with medicare. it's there. if i have a woman who's 55 years

of age today and i order a bone density ometry test and find she has severe osteoporosis, i am not able to do -- under medicare rules she can't even use her own money to buy that test. she can't use her own money. so two years later we do the test and we haven't -- we haven't corrected her osteoporosis. we change medicines to try to find out. but, yet, we can't find out again. so she ultimately falls and breaks her hip. you know, it's just a 20% mortality of falling and breaking your hip. but that's the rules we're operating under now, right now, that you want to expand.

you see, government isn't ever compassionate. it is never compassionate. people are compassionate. thought has to be in the middle of the practice of medicine. not distant thought, near thought. the very fact that an insurance company tells doctors what they can and can't do is no worse than what we're getting ready to do with the rest of government-run health care. and we didn't fix that problem. we didn't address that problem in this. we didn't guarantee that you could walk with your feet. what we did is we said, here's how much money you can earn. but we didn't address that. i'll give you two examples. two people. -- two people taken care of over 15 years. both had absolute no clinical

indications that they had anything wrong. i contacted the insurance company. i thought they needed an m.r.i. of their brain. both of them were denied. i got friends who are raidologists to do their m.i.r. they both had brain tumors. one's still alive. what we're setting up is not any different about your gripe with the insurance industry. country fix that in this bill. there's no health care reform in this bill. there's health coverage expansion, but there's no reform. one of those people are still alive. but had we followed either medicare guidelines, cost comparative effectiveness guidelines, which would have absolutely forbidden doing an mim.r.i. on those individuals,

that one person out of the two would be dead today. so as we sit up here and we look at our health care system, my biggest worry -- i'm going to be in medicare. i'm going to get rationed. i know that. we can't -- the way we're going about it, that's what's going to happen. we're going to ration care. and we won't vote to not ration it. you all know that it will get rationed too or you would have voted for the amendment when it was in the committees, a prohibition on it. but my real concern isn't me and my generation. my real concern is those that are going to find us with th the $1.4 trillion worth of debt and those 20 years and younger of age will be responsible for debt. for which we will have to collect $70,000 a year just to pay the interest on what we're

sending them. before they pay their -- the rest of their income taxes, before they pay their payroll taxes, before they pay their unemployment taxes, before they send their kids to school, before they buy health insurance, before they buy a home, before they buy transportation, the real worry that should be in front of this country, which is the number one thing on the public's mind, is how do we get out of this will financial mess? that's the number one thing on people's mind in this country. it's not health care. and i have no hopes of convincing my colleagues that through 25 years of practicing medicine, dealing with medicare, dealing with medicaid, that that is of any value to you. because we are hell bent on

passing the health care bill and dealing to make sure we can and creating inequities throughout this country and dividing our country. we heard the senator from rhode island characterize us as liars, birthers, supporters of the ai r airian nation. that's what i heard. i sat and listened to it. i think he protests too much. for he knows those not to be true. there is nobody on our side of the aisle that cares anything less than anybody on the other side of the aisle about fixing health care in this country. where the rub is you believe the government's the most powerful thing and the best way to do it.

we don't agree with that. we actually believe in the american people. we actually believe in the entrepreneurial spirit of the average american making good decisions for themselves every day, doing things that we never do, which is prioritizing where their money's going to go and how they're going to spend it and working like heck to advance the cause of their own family, their own freedom, and their own liberty. you don't believe that. because if you did, you'd never put this kind of bill on the floor. this bill limits liberty. this bill says you shall -- i inquire of the chair, am i out of time? the presiding officer: i don't think so. you have eight minutes left. mr. coburn: thank you. just think of this first one big step in this bill. you no longer in the united states of america have the

ability to not buy health insurance. if you've got a half million dollars in the bank, and you want to buy -- and you want to put that at risk and say, i don't want to. you either have to pay a fine, a tax, or you have to buy health insurance. so where is the liberty and where's the commerce clause in that and where does that tie in with individual liberty and individual responsibility? you see, we say if you don't want to be responsible, then we'll make you responsible. we don't say, you have to suffer the consequences of your lack of responsibility. what built this country was people figuring out if you don't act responsibly it's going to cost you. and we're going to put a block on that. they say, you don't have to act responsibly. you don't have to act in your own economic interest. don't worry. we'll take care of it. there's a floor.

consequently jefferson warned us of that. one of the founders of this country. he warned us against doing the very thing that we're doing today. if you go read the federalist papers, you will see in those papers what madison wrote about the welfare clause and the commerce clause. and he said whenever the senate starts to think about claiming that it means something different than it does, here's when we want you to know. it doesn't. it's very limited in scope. i said yesterday in a press conference that this country is at the point of a crisis confidence like we've not seen in hundreds of years. and it's true. and whether you are a very liberal individual in this country or a very conservative individual in this country, you don't have any confidence in us. and the reason you don't, is

because we don't act in the country's best interest. we act in our political best interest. and we act -- and republicans are equally guilty. equally guilty. we look partisan issues rather than principled issues. and what we miss in all of that is the best right thing for our country. and we're missing it with this bill. we're missing the best right thing for our country. i'd be happy to yield to the senator from tennessee. a senator: the senator from tennessee. mr. corker: thank you, mr. president. i've been listening to the senator from oklahoma, who's a physician. and i know cares deeply about his patients, continues to treat patients as he serves near the senate. and it seems to me what you've done is pointed out the fact there will be much interruption, if you will, changes in the way that physicians and patients and their relationship is. but the big picture is -- is

what you're concerned about too, and that is the tremendous indebtedness this country has. the -- the fact that the good chairman of the finance committee, who's here today listening patiently, and i know this has to be painful to him, the fact is that half of the reform we're talking about is putting people in medicaid. a program that 40% of physicians won't see and 50% of specialists won't see. mr. coburn: and the outcomes are poor. mr. corker: the outcomes are poor. i read last week, so man prescriptions for anti-sigh could the ex-- antipsychotic drugs of people to don't want to deal with them on medicaid. half of the money is coming from medicare, which is insolvent. so we spent all of this time, an entire year, all kinds of bipartisan meetings, and i know you spoke about the issue of

partisanship. and i know the good chairman is here. we early on said that we wanted to join in in health care reform. we just didn't want to take money from medicare, which was an insolvent program, to fund it. and what was the major building block of this program? taking money from medicare medicare, $464 billion, to fund reform. so we were, in essence, blocked out by -- on the front end of seeing something that we felt was like the wrong type of principle to build upon. mr. coburn: would the gentleman yield? mr. corker: absolutely. mr. coburn: if, in fact, we got rid of 50% of the fraud in medicare and medicaid, we would generate $600 billion every 10 years. more than offsetting the cuts that have been outlined in this bill on medicare. mr. corker: so if i understand correctly, 50% of the new patients go into medicaid.

50% of the money comes from an insolvent program. we're not dealing with the doc fix. i want to go back again. many of the savings that they talked about are just like the doc fix. back in 1997, the a.m.a., both sides of the aisle agreed to do something to save medicare. as you know, now, the reid amendment takes out the doc fix, now there is a $587 billion gap, and it's another example of how we don't have the courage -- we put in place cuts. we're not going to do that. we know what damage that's going to do to patients. in this particular case we shouldn't do that. but in this particular case, many of these cuts that have been discussed will never take place. they'll never take place. so at the end of the day i come back to the very thing that you've talked about and that is that we have $12 trillion in

debt. $38.6 trillion in unfunded liabilities for medicare alone. for medicare alone. and here we are passing a bill that's using up the resources that we might otherwise use to make it solvent and instead of making it solvent, we're leveraging a whole new entitlement. i heard some of the pundits this morning, which we hear every sunday morning, par rotting what i heard on the other side of the aisle, which is, let's pass this bill. we know it's not very good. but we'll fix it as we move along. and what i fear is as we fix it, we're going to fix it by adding tremendous debt on generations. and my guess is, doctor, that over the next very short period of time, next two or three months, my guess is the other side of the aisle's going to come right back up here with a huge several hundred billion

dollar unpaid bill to deal with one of these issues we've been talking about, the doc fix. mr. coburn: you raise a good question. we're going to fix it. how long have we known and how long has medicare been in trouble but we haven't fixed it? we won't fix it. we'll do exactly what you just said, what we always do, what we've done since i have been in this body. we put the credit card into the machine and say transfer this to your grandkids. we take no pain ourselves. what is lacking in our country today is moral character to lead on the basis of sacrifice, and it should start with us as senators in this body. i understand our time is -- the presiding officer: the minority's time is expired. mr. coburn: and i appreciate the chair and i look forward to hearing the remarks in the cloakroom of the chairman of th.

mr. baucus: mr. president? the presiding officer: the senator from montana. mr. baucus: just a couple three points here, and then i see the senator from ohio wishes to speak. several times during this afternoon, senators on the other side of the aisle, in my judgment a little demonstration of trying to offer amendments. they repeatedly ask consent to suspend the normal working of the cloture rule to offer amendments. earlier, i just note for the record, they slow walked the process when an amendment was in order and wanted the whole amendment read. and now they are offering amendments again to slow down the process. this is clearly a tactic to slow the process. it's not part of the regular order. that's clearly what's going on here. those were not -- despite their protestation to the contrary, serious amendments. now, normally senators offer -- when a senator offers unanimous consent, he is allowed to speak

briefly on the subject, at least under the reservation, the right to object. my colleagues have not allowed me that courtesy earlier today to come up with the reservation with the right to object. i want to take a moment now to just explain what they are really up to. i could not because they would not give me the courtesy of saying words during the reservation. that's why i made that statement. i heard one senator complain that -- senator from the other side of the aisle complain that the majority is holding tonight's vote at 1:00 a.m., the middle of the night. let me set the record straight. the majority would be happy to have this vote earlier. we would be happy to have this vote maybe 10, 15 minutes from now, happy to have the vote at a decent time. it doesn't have to be 1:00 a.m. tomorrow. it's the other side which is insisting that that vote be at 1:00 a.m. in the morning. so it is they who are insisting on enforcing the letter of the senate rules.

that is, they are right. it is also they who are insisting on delay. i also want to put to bed some of the assertion that is this bill does that they claim this bill does not do real health care reform. let me just say a few health care reform provisions of this bill. i don't know if any of you have read -- mr. president, i don't know if you or my colleagues have read this second article in the new yorker magazine. the first article talks about two towns in texas, basically. the second article basically is looking at -- to see whether this bill really does reform health care and whether it really does cut down health care costs. it's an article i highly recommend to all of my colleagues in the recent issue of "the new yorker" magazine. but basically he, dr. gawandi concludes that all of the productive provisions that health care economists, stakeholders and people who have studied this issue suggest should be part of health care

reform. that's his conclusion, anyway. i'm happy to -- that he said that because we worked mightily to make sure we have all the provisions we can here to help constrain health care costs. what are they? one, although some may disagree with the policy is an excise policy on cadillac plans. that's a bit debatable. tonight, mr. president, i saw a tv ad where a group was advocating passage of this bill but just not my high-cost plans. pass the bill but just not my high-cost plans. i understand the tenor of that tv ad, but the main point is we do have to begin to limit to some degree the excessive costs of some plans, and i think we're very fair and modest here in proposing an excise tax on those high-cost plans. the trick is to set the level at a proper level, not too high, not too low. i think this bill does that. in addition, there are all the

delivery system reforms that this bill enacts with respect to medicare. so important to improving quality, reducing excess costs. we all know through history that when we reform medicare, make changes in medicare, the private sector follows. the private commercial market will follow whatever congress does with respect to medicare and makes good, positive changes. why? because medicare is such a large provider of care and they tend to have a real effect on what other providers do. what are some of those? well, basically, we start to change the way we pay doctors and hospitals. that is, start to pay on the basis of value rather than volume. that is, volume rather than quantity. the paradox of that, mr. president, when people stop to think about it. we are both going to cut down costs and increase value, at the same time, because we focus on quality. when you focus on quality, not

just quantity, not the whole volume of services, rather than focus on quality, you're going to get better quality because the costs will go down because we're not reimbursing things like excessive m.r.i.'s, excessive cat scans, excessive high-cost procedures that really do not in many cases get to the quality of health care but rather just are very expensive and medicare pays for them. so we're moving more toward reimbursing based on quality than quantity. what else reforms health care industry? one is bundled payments and shared savings program which is referred to as care organizations. this allows hospitals and groups to get together to cut down costs. we have bundling in here which is another idea of -- that moves along the same lines. these are all -- i might add, too, the c.m.s. innovation

center and independent payment advisory board suggests some of these. the bill makes it easier for employers to offer workplace wellness programs, to give employers greater flexibility to offer premium discounts for workers who are committed to leading healthier lifestyles. there is a lot of emphasis on wellness and lifestyle. we're giving incentive to employers to have wellness programs and preventative programs which will help, obviously, the worker, but in addition to that, addition to cut down costs. there are other provisions here. this bill keeps getting stronger. the so-called freshman package led by senator warner would give the senate the authority to expand the scope of the medicare board to the private sector. there are many other here, mr. president. i have a long list. i ask that they be included in the record as if read. the presiding officer: without objection. mr. baucus: i also ask consent that an excerpt from dr. gawandi's article in "the

new yorker" be printed at this point. the presiding officer: without objection. mr. baucus: mr. president, the senator from oklahoma at one point questioned the constitutionality of the mandate to buy health insurance. i might say we have thoroughly studied this issue. i believe there is ample authority for congress to enact such a provision under the commerce clause and also under the congressional authority to tax and spend for the general welfare provided for in the constitution. i might also add professor mark hall of wake forest university has done an excellent survey article on this subject, and i ask consent that professor hall's article be printed in the record at this time. the presiding officer: without objection. mr. baucus: i might also say, mr. president, that the senator from oklahoma said that the independent medicare advisory board would ration care. in fact, he even accused us in the congress of -- myself included -- of voting against a prohibition on rationing. but i might say i'm not for rationing care in the sense that

the senator from oklahoma talked about. they invited us -- congress is. we have to control costs in a fair way that increases quality. it also cut costs. that's the underlying premise of the delivery system reforms in this bill. but don't just take my word for it. right here in the bill on page page 1,004, the bill says with regard to the advisory board, quote -- "the proposal shall not include any recommendation to ration health care." i chuckle a little bit when i say that, mr. president, because the senator from is very concerned about using the word shall. if he doesn't like shall, then i suppose he means the board would have discretion. but we say shall not include any recommendation for rationing health care. that's on page 1,004 of the bill, right there in black and white letters, just read the bill, prohibition against rationing health care is right there.

mr. president, i see the senator from oklahoma -- the senator from iowa wishes to speak. mr. brown: i thank the chairman for his leadership. mr. president? the presiding officer: the senator from ohio. mr. brown: thank you. i -- i sit here listening. i was watching much of the debate in the last hour from my office, and then i came over in the last 20 minutes or half an hour watched it from here. i'm just incredulous when i hear my colleagues on the other side of the aisle talk about saving medicare. now, this is the same group of people with only one exception in the whole republican side of the aisle in 2003 that -- that rammed through the medicare privatization bill that was written by the drug companies and the insurance companies for the drug companies and the insurance companies. two things. one, they never paid for it. there was no discussion, no interest, no move to pay for their bill at all, and then they

criticized our bill as costing too much and running up the debt when the congressional budget office, which everyone knows is fair, they complain -- it's like in a sporting event, mr. president, the losing team complains about the ref because they are losing, the other side complains about the congressional budget office, but we know it's fair. we cite it, we must, we do, it helps us move forward, it helps us figure things out. but they don't even try to pay for their medicare privatization bill because the drug companies and the insurance companies wouldn't have gotten in their way so much if they tried to pay for it. but their bill shortens the life of medicare. our bill increases the life expectancy of medicare for ten years. then they have the gall to come to the floor and say that our bill doesn't treat medicare right, that our bill is going to ruin medicare, whatever. this legislation -- if you're a senior citizen in our country, understand what this bill does for medicare.

this bill guarantees benefits, number one. number two, this bill lengthens the life of medicare for several years, as i said. number three, this bill helps with the cost of prescription drugs by closing the doughnut hole that my friends on the other side of the aisle created back in 2003 with president bush because the drug companies wanted it that way and the insurance companies wanted it that way. and last, this bill provides all kinds of services to seniors that they weren't getting before. mammograms, colonoscopies, all for free physicals. not that we want to do a giveaway, but we want seniors to be healthy and live longer and healthier lives. we know that's good for our country, good for them, it's good for our families. i am just incredulous when i hear them talk about medicare. the second thing that i'm incredulous about when i hear them, this is pretty unbelievable, is how they talk about partisanship. in the health, labor, and

education committee which senator burr sits on, we accepted -- and that the presiding officer now sits on -- we accepted 160 republican amendments. i voted for almost all of them. they made sense, some were minor, some were more major, and that gave this bill a bipartisan flavor to it. but now they say the bill is too partisan, that we weren't listening, that we were bushing it through, whatever they say. but, mr. president, the reason that even with those 160 republican amendments, they don't want to pass it. or two reasons. one is people like senator demint's said this is the president's waterloo. if we can defeat this, we can end his presidency. part of their opposition is strict, win at any cost partisanship. the other reason for their opposition is even though there are 160 republican amendments, on the big questions of the day, it's just a philosophical difference. go back to 1965. very few republicans supported

medicare. in the house of representatives, on the key vote in the house of representatives, only ten out of 160 or 170 republicans supported medicare. over here in those days there were a few sort of rockefeller republicans that supported it. but by and large, the mainstream republican party, at least in congress, opposed medicare. so just like they opposed medicare, it was a big question. they are opposing this bill because it's a big philosophical question. that's fine, they disagree with us. don't accuse us of partisan when, one, many want president obama to fail, it's a strategy, political strategy, but second don't accuse us of partisanship when 160 republican amendments were in this bill in my committee and in senator baucus' committee, many, many amendments were accepted that were republican amendments. and then to say -- then to say that we have to slow this down because it has gone too pass, these negotiations have been going on for months. the finance committee, the gang of six started in mid june officially, and it began before

that. and i -- i want to put a human face on this. when they say let's not move too fast. you know why i want to get this done by christmas? we don't deserve to have christmas with our families until we finish this. you know why? every day in my state, every day in my state, 390 ohioans, 390 people lose their insurance. you know what, mr. president? 1,000 people every single week in this country die because they don't have insurance. 390 people just in my state alone, probably 350 in michigan, probably 250 in minnesota, every single day are losing their insurance. and in this country 1,000 people a week are dying because they don't have insurance. a woman with breast cancer is 40% more likely to die if she's uninsured than if she's insured. 40% more likely to die if she's uninsured than if she's insured. when i see my friends stall and

stall and stall -- and they have all kinds of reasons to stall. they have the clerk read the bill, they try to talk too long, whatever it is. however they're stalling in so many different ways, think about those 390 ohioans every day, think of the woman with breast cancer without insurance that just has more trouble fighting back. mr. president, to sort of further put a human face on this, i want to share letters from people in ohio who have written me. they are people who understand how important it is because it's important to their personal lives, their families, their loved ones themselves that this, that we take care of this bill by christmas. sandra from franklin county writes -- columbus area. a year ago my partner lost her job. in july she started working part time in the evening which offered no insurance. in october she found full-time work. we're grateful she's now employed. the job has no coverage. while she was unemployed it hurt

us tpupbgsly, but we can't afford health insurance now. a friend of mine lost his job last year. after looking for a job, he decided to go back to school. his family found a job. he's happy for that. again, he also doesn't have insurance. maria from montgomery county writes i work in a school and come in contact with families that can't afford basic care for their families please help. we want an america that sees health care as a right for air force. today, mr. president -- as a right for all of us. today i was on "face the nation" a woman i was -- a woman who was there has a contract, an independent contractor. she has her small business. she doesn't have any insurance. she has insurance that she pays a whole lot of money for, but she said five years from now i'm going to be on medicare. i look forward to having the

stability, predictability of real health insurance. that's why this is so very, very important. roberta from green county near dayton, between dayton and columbus, i'm a senior citizen who feels uncomfortable using my fabulous medicare benefits when others, parents, the unemployed, don't have health care at all. please pass health care for all who need it and are without medical care. roberta knows, roberta who is on medicare understands, one, how important medicare is to her. she also knows that she's going to get more from this bill -- free screenings for mammograms, a physical every year free, the cost of prescription drugs will be less because we're closing the doughnut hole, and she knows that this bill, unlike when the republicans privatized, tried to privatize medicare in 2003, this bill lengthens the life of medicare. mr. durbin: would the senator yield for a question? i'm going to be speaking at the

end of this hour that's been allocated to our side, and tkwropbt interrupt the senator from -- and i don't want to interrupt the senator from ohio but for one reason. i don't know if ohio is aware of a -- i don't know in the senator from ohio is aware of a statement today by our colleague, senator coburn, who came to the floor and said what the american people ought to pray, that somebody can't make the vote tonight. that's what they ought to pray. i've been trying to reach senator coburn because he's on a committee that i serve on and i work with him. i'm troubled by this statement. i'm trying to reach him to come back to the floor and explain exactly what he said. about a senator being unable to make the vote tonight. i'm reaching out to senator coburn. i'll be on the floor in the next 45 minutes. i hope he will join me there. i thank the senator from ohio for yielding. mr. brown: thank you. i did not see that quote. i watched what happened two nights ago when we were trying to pass the defense appropriations bill to make sure

our troops were funded in afghanistan, iraq and state side and europe and everywhere else, in korea, everywhere, and some republicans wanted to kill that even though it would mean no funding, it would mean military layoffs, it would mean we wouldn't be able to get things we need in supplies for the troops because they said we want to kill health care reform. i don't understand the desperation except maybe i do because everything about this debate is protecting the insurance companies. i guess that's more important to them than anything else. i'd be interested too. i appreciate the assistant majority leader's comments on why senator coburn said that. let me close with one last letter. valerie from coyote county, northeast ohio. i thank the lord my husband has a job with health pweufrs. if he didn't have -- benefits. i know how important insurance is. i can never imagine not being able to go to the doctor. i've had many surgeries and my

fair share of doctors visits. can you imagine yourself without medical insurance or not being able to go to the doctor. valerie says i bet most senators in congress never had to worry about that, but many americans have that worry and it is a scary, scary feeling. the time is now to pass health reform. i know that my colleagues have good health insurance. of course they do. that's a good thing. but i also know that many of my colleagues don't spend much time talking to people who don't. most people in our -- if you're a congressman or senator, make $170,000 a year, most people that you see that you socialize with probably are pretty upscale, probably have insurance. but most of us don't spend nearly enough time -- i know that the presiding officer does this in duluth and rochester and all over minnesota. i know the speaker next to the senator from colorado who worked on a lot of these issues with me in the house, when he goes to

boulder and he goes home and he goes to denver, he talks to people who don't have insurance. i just wish more of my colleagues who oppose this bill, i wish they'd meet some of the 390 people in my state or in their states who lose their insurance every day. i wish they would talk to a woman who has breast cancer without insurance, knowing she's more likely to die. i wish they would talk to some of those people whose family members died because they didn't have insurance. because most of us dress like this and most of us hang around with people who dress like this and generally have good insurance. i think we're a little out of touch. i would hope we could pass this bill, go back home, meet some of these people that this is going to matter for because i think it will make a difference in how we all look at this. i thank the president, and i yield the floor. a senator: mr. president? the presiding officer: the senator from montana. mr. baucus: mr. president, i yield ten minutes to the senator from colorado, senator udall. mr. udall: mr. president?

the presiding officer: the senator from colorado. mr. udall: i thank the senator from montana for yielding. -- [inaudible] i want to begin by commending my colleagues for strapping on their snow gear. the presiding officer comes from a state where this kind of a storm we've had here the last few days is not that unusual a development. i like a good 16-inch dusting from time to time. we all know what an important issue reforming our health care system is, so braving elements outside is a small price to pay. mr. president, i've come to the floor an awful lot over these last few months to discuss many of the challenges facing us as we work towards a fix for our broken health care system. one overarching theme that i consider to family size is how critical this effort is to putting our economy back on track. we've got a bloated $12 trillion federal debt which is being fed daily by growing health care costs.

every day employers small and large are laying off workers and slashing benefits for their employees. great american businesses, especially in our manufacturing sector, have nearly collapsed because of the rising costs of providing health care for their workers. and those americans who have coverage lack the peace of mind knowing that their insurance will be there just when they need it. mr. president, this lack of stability and this peace of mind is a fundamental problem with the status quo today because it takes away one of the things valued most by americans: their freedom. americans today are, they're reluctant to move to a new job, to advance their education or start a small business for fear that they won't be able to provide health care for their families. as we struggle to mend our economy, we can't afford to tell people to stay put. we know from history that encouraging the entrepreneurial spirit of americans is the key to promoting small business, creating jobs and driving our economic recovery. small businesses have accounted for 65% of all new jobs created

in the past 15 years. but today anyone who owns or has ever tried to start their own business can attest to our rising health care costs are such a major problem in this country. take, for example, the story of a gentleman who recently contacted me from denver. i pick up on the theme that the senator from ohio was touching upon. if we listen to the people in our states, there would be no question that this reform is necessary. dave is a small business owner, mr. president. last year he saw his insurance premiums skyrocket 27% for his employees. and when he questioned this unbelievable increase, his insurance company said all he needed to do to save money was just to stop offering tkofrpblg his employees -- offering coverage to his employees. when he looked into this, when dave checked out what that might involve, he found out nearly half of his workforce would be ineligible for coverage because of preexisting conditions and

that those who could obtain coverage were priced out, couldn't even afford it. i hear this story time and time again. small business owners who want to do the right thing but whoepbd up facing annual -- who end up facing annual double-digit increases in their costs. small businesses pay on average more than 18% than large employers for the same level of coverage. the status quo -- and presiding officer has been articulate and eloquent and involved in this fight, he knows it's unacceptable. and we can't kick the can down the road any longer. the good news is the legislation we're considering contains essential provisions aimed at small businesses, sreupdz and american -- individuals and american families across our country. let me touch on a few important provisions that are in this final package, mr. president. health insurers would be organized into well-regulated

marketplaces and forced to compete. this would involve the creation of a more transparent process for individuals and small businesses. for the first time you could compare insurance plans side by side. the legislation helps individuals pay for these newfound health insurance options. more than half the cost of reform goes to financing tax credits that put money back in the pockets of middle-class families to help them purchase a health plan. as chairman baucus has pointed out, these tax credits represent the biggest tax cut since 2001. in addition, starting in 2010, many small businesses will also qualify for new tax credits worth up to 50% of the cost for providing health insurance to their employees. also in this bill, i can't family size this enough, mr. president. americans will no longer go bankrupt because of health care costs. we are the only developed country in the world where citizens go bankrupt because they have health care costs that they can't afford.

insurers will be prohibited from denying access to health care because of preexisting conditions, limiting coverage because of age or gender or dropping the insurance someone has already paid for simply because they get sick. mr. president, regardless of what you hear from our friends on the other side of the aisle, this legislation saves money, it strengthens medicare, it reduces the deficit, and it puts us on a path to finally addressing our growing national debt. in fact, noted m.i.t. economist john gruber estimates this bill will save small businesses 25% or about $65 billion per year on health insurance. that translates into $30 billion in take-home pay and an estimated 80,000 saved jobs. mr. president, while the bill before us makes important improvements, i'd also like to say a few words about the package of amendments offered by the distinguished majority

leader. i took some time, as i think we all did, over the last snowy 24 hours to familiarize myself with the changes, and i want to touch on some of the most promising revisions that have been made. the i want to first note my appreciation for including the freshmen package. these amendments were offered by myself and the freshmen class, of which the presiding officer is a member. they've attracted bipartisan support. they boast the endorsements of business, labor and consumer groups. the provisions inject more cost containment in the bill, cut down on regulatory and bureaucratic red tape and push us more aggressively towards a rereformed health care system. i was particularly pleased to see a provision i worked on that expands the new board to monitor medicare. the board would look for ways to improve the entire health care system as a whole. i believe