in the bill, and i want to acknowledge senator rockefeller for his work in developing the idea, and also leader reid for putting even more bite into the authority of this important panel of experts. second, i want to express how proud i am that majority leader reid put so much emphasis on the marine's amendment -- manager's amendment in improving health care for rural america. the difficulty accessing quality in rural areas is a unique quality i've been concerned about especially since traveling around colorado's rural areas. i'm glad to see inclusion of an amendment i offered to establish a rural physician pipeline training program designed to help boll -- bolster our rural health care workforce. many colleagues joined us in this amendment which has the potential in recruiting doctors to train and practice in rural areas. in in addition, i offered an

amendment to would establish a rural element to the community transformation grant program which is aimed at helping prevent and reduce chronic disease in communities acontracts on country. my amendment would ensure that rural areas are getting their share of this critical prevention and wellness funding and i was very proud to see this important change included as well. mr. president, as i begin to close, i want to just say that although this bill has been strengthened significantly by the majority leader's efforts, it isn't perfect but i don't think anyone expects congress to craft a prft piece of legislation. wperfect piece of legislation. we could never send the president a bill that fixes all of our problems or a bill that reflects all the priorities of a single member of congress, including myself. but what i'm confident of is that this legislation can establish a sturd eye foundation upon which -- sturdy foundation upon which we will build and improve and strengthen health care in america. will there be mistakes made along the way? i don't doubt t. but as a

lifelong mountain climber, i know from experience the stumbles you experience along the way are a necessary part reaching any mountaintop. mr. president, providing insurance and quality care for all our stirnz is a once i once-in-a-lifetime opportunity to improving the life of all americans. these are the goals of our health insurance reform and over the next few days i look forward to passing a bill which modernizes our health care delivery system, increases much-needed choice and competition in the health insurance industry and helps put our economy back on track while improving the financial security of middle-class working families. mr. president, i yield the floor. mr. baucus: mr. president? the presiding officer: the senator from montana. mr. baucus: mr. president, i yield ten minutes to the senior senator from michigan. the presiding officer: the senator from michigan. mr. levin: thank you, mr. president. first let me thank the senator from montana for the extraordinary work that he has put in on this bill for so long,

so many months, so many years. thanks also go, of course, to the democratic leader, our majority leader, senator dodd and others who have worked so hard to get us here. we are at a pivotal moment in the long fight to reform our health care system. everyone should by now be well aware of the history, of how presidents of both parties have tried and failed to achieve reform. and of how, after months of painstaking review, we've arrived at this instant, closer than ever to health care reform. it would be impossible to fashion legislation on an issue so massive and so complex on which all could agree on every detail. those seeking perfection will have to look outside this chamber or, for that matter, in any piece of complex legislation. but when they look outside the walls of this capitol, senators will also find problems that dwarf the imperfections of this bill. they will find a broken health care system, one in which we pay

vastly more than other wealthy nations for care that is in many cases demonstrably inferior. they will find americans struggling to afford the health care coverage that they have and employers struggling to provide insurance to their employeesme employeesment -- employees. they will find manufacturers struggling under a costly health care burden from which their international competitors were long ago freed. they will find employee and employer alike plagued by never-ending uncertainty about the cost and availability of health insurance, an instability that haunts families and hinders job creation. they will find costs rising so fast that they threaten to swallow the rest of the federal budget and sink family budgets. they will find astonishing amounts of money spent, not on better care or innovative treatments, but on overhead and bureaucracy. and they will find millions of americans with no coverage at all, a tragedy for the uninsured

and a source of inefficiency and expense that makes health care more expensive for all of us. so the choice before us now is whether any imperfections we might see in this bill outweigh the mountain of evidence that our current system is in dire need of repair. it is between moving forward on a significant repair of a broken system or quashing yet another attempt to reform health care and surrender to the status quo and to the rhetoric of distortion and fear. to me, this choice is clear. we cannot wait any longer for health care reform. the people of my state cannot wait. the people of this nation cannot wait. now is the time for all those years of frustrated effort, all the research and analysis, all the debate and discussion to reform a broken system. we must vote for cloture on the managers' amendment before us and continue to vote for cloture

on the endless filibusters that confront us because we cannot wait. we cannot wait any longer to reform had system -- reform this system because its costs are out of control. in 1990, this nation spent 12.3% of its gross domestic product on health care. that's $1.0. by 2018, the centers for medicare and medicaid services, c.m.s., estimates that figure will increase to 20%, $1 in every $5 will go to health care. c.m.s. estimates that after spending about $6,000 per capita on health care in 2003, we will spend more than $13,000 per capita in 2018, more than doubling our per-person expenditures in 15 years. this translates directly into unsustainable costs for the american people. according to the kaiser family foundation, thousands fewer of our businesses are offering insurance than a decade ago, a

clear sign they can no longer contain cost increases of 6% or more year after year. if we do nothing, these costs will continue to rise at a rate which will swallow the budgets of families, businesses, and government. we cannot wait any longer, because even for those fortunate enough to have insurance where they work, are increasingly unsure that it will be there when they need it most. every member of this body has heard from constituents who thought that they had solid health insurance only to find out that their insurer had wriggled out of paying for debt desperately needed care or found a convenient preexisting condition that voided their coverage or capped their coverage so that they faced a crushing choice between treatments that they had to have and costs that they could not afford. even in cases where families

have health insurance, medical emergencies can leave debilitating costs in their wake. according to a study in the "american journal of medicine," 62% of all bankruptcies filed in the united states in 2007 involved medical costs&, and even more compelling -- costs, and even more compelling, three-quarters of those bankruptcies involved people who had health insurance when they got sick. there can be no clearer sign of the need to act than the fact that having health insurance is no insurance against bankruptcy from medical costs. we cannot wait any longer, because so much of the enormous costs at the heart of health care -- of this health care crisis is money -- is money spent on things that have little or nothing to do with quality care. for example, those who purchase insurance in the individual market, roughly 30% of the costs that they pay will stem from the

insurance company's administrative expenses on bureaucracy, not medicine. in 2003 study published in the "new england journal of medicine," found that in 199, americans spent over a thousand dollars per capita on health care administration costs. more than a thousand dollars for every man, woman and child in this nation spent on paperwork and red tape. electronic medical records, which make administration more efficient and improve the quality of care, are still not in use for more patients. finally, mr. president, we cannot wait any longer because the inefficiencies of our system are crushing us and our budgets and even more pointedly because so many lives are at stake. 140,000 americans have lost their lives since 2000 because

they lacked health insurance. we cannot afford to walk down this road any longer. we must change direction. this bill will do it in a positive direction. i ask that the balance of my statement be inserted in the record. the presiding officer: without objection. mr. levin: and, again, i thank my good friend from montana and the other leaders who've made it possible for to us get to this point. mr. baucus: mr. president? the presiding officer: the senator from montana. mr. baucus: mr. president, i'll yield 16 minutes to the senator from illinois. mr. durbin: i thank the chairman of the finance committee. and i want to renew my invitation to senator coburn of oklahoma to please come to the floor but to do it soon before my time expires. i called his office to make sure that he knew i was trying to reach him. i've spoke own the floor to alert the republican side that i wanted to ask him to explain a statement which he made on the floor earlier today. the statement by senator coburn of oklahoma said, "what the american people ought to pray is that somebody can't make the vote tonight. that's what they ought to pray." i am troubled by this statement.

i want to give the senator from oklahoma an opportunity to explain it, because the simple reality is that i don't think we should be wishing misfortune on any of our senate colleagues on either side of the aisle. i don't know if this was an innocent statement or something that he now wants to clarify, but as stated, it troubles me. it troubles me because i'm afraid it reflects the situation we find ourselves in too often in the united states senate, where people are literally invoking god's name and prayer for political purposes in -- in this case to wish misfortune on one of our colleagues who wouldn't be able to make our 1:00 a.m. scheduled roll call. i don't wish misfortune on any of my colleagues. will baucus: mr. my colleague yield on the that point? mr. durbin: i would be happy to. mr. baucus: i want ask my colleague, who knows senate procedures so well, why are we having a 1:00 a.m. vote anyway?

isn't it possible it could be a different time? mr. durbin: i thank the senator from montana, because he's exactly right. under the usual business of the senate, we agree that we'll do something that is more thoughtful and humane and have a vote at an earlier time. senator reid has approached senator mcconnell and said, we have one of our senators, senator byrd of west virginia, with significant health proble problems, who's been brought to 9 floor now -- brought to the floor now early in the morning, late at night in a wheelchair. he looks better than ever, i might add. but the fact is that he is being asked to show up at 1:00 in the morning because we couldn't reach what is usual comity and gentlemanly accord on scheduling a vote. and it's unfortunate, because now we face this 1:00 a.m. vote. and with no cooperation on the other side to even change the vote for a very humane reason. mr. baucus: our -- the requests on this side for a vote at a reasonable hour, say, what, now it's 5:10, maybe 5:00, 6:00,

7:00, 8:00, that a at a reasonable time, instead of 1:00 a.m., have been rejected by the other side? mr. durbin: unfortunately, the senator from montana is correct. and now, as the senator from oklahoma says -- and i quote -- "what the american people ought to pray is that somebody can't make the vote tonight. that's what they ought to pray." i don't think it's appropriate to be invoking prayer to wish misfortune on a colleague. and i want him to clarify that. i've invited him. i've tried to reach out to him. he is my friend and i have worked with him. but this statement goes too far. the simple reality is this. we are becoming more coarse and more divided here. it is understandable that we would disagree on political issues. that happens all the time. but, unfortunately, we've allowed that political disagreement to spill over into our personal relationships and friendships here, and that really does hurt this institution. we rely on one another on both sides of the aisle so much.

i would say from the start that senator reid has offered to the republican side of the aisle accommodations and asked that we try to do things that might help the families and individuals who are in the senate, and we've not had any luck to date. but hope springs eternal. i hope senator coburn can make it to the floor to explain his statement. earlier this week, there was a prayer cast involving several senators. i didn't hear it. i only heard references to it, where they were actual until a group praying for the defeat of this -- actually in a group praying for the defeat of this legislation, on health care reform. it is their right to do that. i can recall as a high school football prayer saying a -- player saying a prayer that my team win a football game. i don't know if god had enough time to worry about my little football game, but when it reaches a point that we're praying, asking people to pray that senators wouldn't be able to ask the roll call, i think it has crossed the line. and i hope my colleague and friend from oklahoma will come and explain exactly what he

meant. now, snar as far as this bill ts before us, i must say i wish this bill were different. i wish it had a strong public option. i wish it offered medicare to people 55 years and older. i wish it eliminated the mccarran-ferguson antitrust exemption for health insurance companies. unfortunately, it doesn't do those things. but my disappointment over those elements shouldn't lead me to conclude that this bill is wanting or this bill is bad. just the opposite's true. just the opposite is true we have to look at the positive side of what this legislation will do. it will extend the reach of health insurance coverage to 30 million more americans. i see on the floor this evening my colleague from arizona, he and i were on a television show early this morning. i'm sure we got great ratings, because the public can't wait to hear us. during the course of the television show, the senator from arizona expressed concern that 20 million americans wouldn't be covered by our bill.

interesting, isn't it? today 50 million americans are not. 50 million americans are uninsured. this bill will provide insurance for 30 million more, meaning 94% of americans will have coverage. the highest percentage in the history of our country. and the senator from arizona says it doesn't go far enough and include more people. we have waited patiently now for 21 days during the course of this debate on health care reform for the republican plan for reforming health care. it's never been produced. promised, but never produced. and i think the reason's obvious. it's doesn't exist. several times they've said on the floor, oh, we have a plan and they'll wave a bill at us. when the republicans had a chance over a three-week period of time to offer their substitute, they never did. in fact, over 20 days of active debate on the floor, there were exactly four republican amendments on the floor, four in 20 days. one every five days.

at that rate, how long would be the republicans have us stay on the floor waiting for the next amendment? i mean, that is the reality. they offered six motions to stop the debate, remove the bill from the floor, send it back to committee. but, of course, when it came to actual substantive amendments, changing sections of the bill, they wouldn't do it. so the republicans have come up empty. they're running on empty when it comes to health care reform, which means that this task of writing a bill is either beyond their pay grade or beyond their will and they like the system as it exists. i don't. 50 million uninsured americans is unacceptable in this country. and i think we have to reach a point where we move forward with 30 million now and then find ways to bring the additional 20 million in. remember, when social security was enacted into law with the resistance of the republicans, they resisted it saying it's too much government. the safety net extended to widows. we extended in years that

followed social security protection to dependents and survivors and the disabled and we added a cost-of-living adjustment. it wasn't the end of social security in the 1930's, in the years that followed, we built on the original bill and we will build on this original model of health care reform. the same thing's true under medicare. medicare originally offered, didn't cover disabled people, it didn't provide home health care or therapy an didn't provide prescription drugs much and over the years we added those benefits. so i believe this is an important starting point. i also think it's important that we provide insurance protection for americans. when it comes right down to it, too many people are denied the therapies, the surgeries, the medications that their doctors recommend because some clerk in an office at a health insurance company is instructed to just say no. and they say no repeatedly. we also make sure that patients are first even with our additional amendment guaranteeing right of people to pick their doctor and keep their

doctor. it's a patient-first approach that we're using on this. we hold the health insurance companies accountable and say if they gouge the patients before they want to be part of the insurance exchange, they can be disqualified. we saw what happened with credit card reform. when the banks had their way after the passage of credit card reform, during the period before it went into law, they ran up the interest rates on credit cards. i get letters in the mail from american express and others who say, because of the federal law, we're going to raise the interest rate on your credit card over 20%. we know some of these per chance with greed -- some of these merchants with greed will try to exploit the system. the medical loss ratio is important. i'm sure that the health insurance companies are not going to be happy with it. it says, stop taking the premium dollars and turning them into administrative expenses, advertising, bonuses for c.e.o.'s, high-paid salaries, take the premium money and pay for medical services for the

people you insure. and if you don't, if you take too much of this money for your profiteering, we're going to have to rebate it to your customers. it's changing the balance here, giving customers a chance when it comes to health insurance, something that's long overdue. we expand the health care safety net, 1.8 million in my state of illinois will have access to affordable health insurance. hard-working people for small businesses, part-time employees, unemployed people. none of them have health insurance. well, 1.8 million in my state of almost 13 million are going to have that chance to be covered. we'll have 10,000 more community health centers. i can't tell you what an exciting idea this is. if you visited a community health center in illinois or arizona, this is a clinic in a small town, where people can literally walk through the front door and get sack s. to primary care physicians who will help them through their medical

difficulties, they don't have to wait until they're so bad they show up at the emergency room where the cost is dramatically higher, they have a doctor, a nurse, a medical professional or dentist in their community. we estimate this bill will add 10,000 more commune health clinics across the united states. it will add 20,000 more primary care physicians across america. if there is anything that we need more it's family practice an internists who can deal with the medical needs of people before they're referred to a specialist or before their situation's deteriorated. this bill will provide for all people with under 133% of poverty. that's just about $29,000 for family of four the security of knowing they're under medicaid protection without health insurance costs, without health insurance premiums. so we will say to those working poor people, you're going to have health insurance.

we also believe that progress is going to take some time. i recall that senator teddy kennedy, who i wish were here for this great battle he prepared for for four decades, said in his book that real reform is never over. it isn't. this is a beginning. it's an important beginning. it establishes important principles. i would say to the critics, we don't expect every aspect of this bill to work perfectly. it is a product -- an imperfect product made by mere humans trying to do their best. but some of the things in this bill are going to dramatically change health care in america for the better. we are going to find ways to deliver quality care to people in a cost-effective way. we are going to change parts of our system today, which, unfortunately, under this current system are out of control. the costs are out of control. so moving coverage to an additional 30 million people. 94% of americans under coverage, something that no other bill

from either side of the aisle has proposed. reducing our deficit, and, incidentally, we now have a c.b.o. statement which makes it clear that the budget savings in the second 10 years, first 10 years is $130 billion, second 10 years is up to $1.3 trillion. they qualified it. but it still is the most dramatic deficit reduction bill in the history of the united states. there's never been a bill that's come before us that reduces the deficit so dramatically. it reduces it because it works to bring town the cost of health care. as far as medicare sr concerned, this bill will -- as far as medicare is concerned, this bill will add at least 10 years of life to medicare. medicare will face serious financial problems in seven or eight years has a new lease on life in this bill of nine or 10 years. to say that this saves medicare and puts it on sound footing is a fact confirmed by the congressional budget office, all the speeches on the floor

notwithstanding. this bill is also going to move us forward in the whole area of looking at ways to deal with medical negligence and medical malpractice. we provide incentives and grants to states to find ways without penalizing the true victims of medical malpractice to reduce the incidents of lawsuits, to reduce defensive medicine. that is a conscious and thoughtful way to approach this. i would say, if i would ask anyone to offer a prayer, and i don't do that very often, i would say a prayer for the 50 million uninsured in america. folks who will go to bed tonight without the peace of mind of knowing they have health insurance for themselves and their families. say a prayer for those who have been turned down by health insurance companies when their doctor says they need a certain therapy or certain medication or certain surgery. those are the people i think of. i pray good fortune for them. i don't pray misfortune for anyone. not for any of my colleagues, not for any of my political

opponents. i don't think that is an appropriate use of prayer to do that. i'm sorry as i bring this to an end that the senator from oklahoma has not come to the floor. i have tried through the cloakroom and other ways to invite him to come and explain his remarks, i'm troubled that -- when he says that i pray that somebody can't make the vote tonight i don't pray for any misfortune for anyone in the senate. let's have all 100 senators here voting their conscience an voting their heart. mr. president, i yield the floor. a senator: mr. president? the presiding officer: the senator from montana. mr. baucus: mr. president, i'll be a bit presumptuous here. i think i can speak for most senators an most -- and probably most of the american people. in life it is so difficult to deal with is when you're working with somebody irrespective of the situation and so forth, and

you're trying to resolve an issue or problem. and the person that you're talking to or working with is not dealing in good faith. when each side is dealing in good faith, each side will begin to recognize that the merits of the other person's point of view and each person tends to recognize the deficiencies and the faults of his own point of view. it's a good-faith exchange. not very many things in life are black and white. and not many issues are black and white. most of them are some shea of gray. -- some shade of gray. you may think even though my issues -- i'm not white and the other guy's black. might think that my shade of gray is more gray than his shade of graism what' gray. it is important to try to talk about it and work out a combination. i think most americans think

that our health care system needs some repair. it's too costly and too many cases where the insurance industry looks like cherry picks, takes advantage of people. it's not the right thing to do really. and also we have to figure out a different way to pay for doctors and hospitals who are reimbursing more on basic quality and not quantity. almost all doctors agree that we should move in that direction. a few minutes earlier, one senator got up and said that, well, gee, the c.b.o. made this huge, big error. it's a half a trillion dollar error. and on and on and on about this hfl a trillion dollar error -- half a trillion dollar error. to be honest, if we're going to deal in good faith here, we should mention the pluses and the minuses and let the senators and the public just kind of figure out where it nets out. the c.b.o. made many statements which most of whom i think the

democratic side put the light on the c.b.o. made some other statements that the republican side relies on. it is not black and while as it shade of gray. in this case it is true that c.b.o. sent a letter, i think it was today, in fact, i have it with me. that they made a half trillion dollar error in the second 10 years. what was the error? i don't remember the exact figure, but essentially the c.b.o. said that this legislation would reduce the debt in the last 10 years by i think it was half a percent of g.d.p. which comes out to abou about $1.3 trillion to the good. it reduces the debt b by $1.3 trillion. the c.b.o. in a letter to us says, well, they made a mistake. that -- that it -- this legislation does reduce the federal budget deficits over the

subsequent 10 years, but not by as much as the half percent of g.d.p. it really should have been, well, between a quarter percent of g.d.p. and half a percent of g.d.p. half the story the c.b.o. said that they made an error of half a percent of g.d.p. the congressional budget office said that all told, the c.b.o. expects that it would reduce the federal budget deficit over the decade after 2019 relative to those protected under current law with a total effect during the decade that is in a broad range between one-quarter and a half percent of g.d.p. the c.b.o. is saying, yeah, we made a mistake, but, still it will reduce the deficit in the next 10 years betwee between $650 billion and say $1.3 trillion. that's the full story. i just hope that we debate here. that we get both sides of