plan. why? because i believe that's the best way to create the kind of competitive pressure that will restrain a group of insurance companies that have shown no to restraining themselves over these past years. if you're for the status quo, you'll vote no the way our colleagues have voted. but the american people are not satisfied with the status quo. people in america understand that health care costs are breaking the back of families. they're breaking the back of businesses. they're a huge albatross around the neck of american competitiveness. many of our companies have a harder time competing because there's the health care premium tax, if you will, for the uneven distribution of being sick in america. incidentally, obviously, if you're sick in america, you get

care at some point in time. it may well be that that point of time is when you're on your deathbed or when you're so sick that you finally go into a hospital in an emergency room and the emergency room becomes your first contact with the medical system or it becomes your primary care facility. we have almost 50 million americans for whom that's true. 50 million americans who don't have health care, so they don't get an early screening, they don't get an early determination of what may be wrong with them. they don't get what somebody who has a health care plan gets, which may be a mammogram or a pap smear or a -- a p.s.a. test for prostate cancer, any number of evaluations. early detection of diabetes. we spend almost $100 billion in the united states of america for unnecessary dialysis and/or

amputations that take place because people weren't able to go to a doctor earlier and learn that they had a type of diabetes that might have been able to be treated in a far less expensive and dramatic and personally costly way. so, you know, the word "history" gets thrown around in the united states senate probably more than it ought to and we often refer to something as being historic or otherwise and sometimes it's a reach. there is no question that we are on the threshold of an unbelievably historic moment in the senate. this is history we're living here now. when i think of what we tried to do in 1993 and 1994 when president clinton was there, we tried to pass health care and we got beaten back by false advertisements, "harry and louise" scare tactics, and, i

might add, a plan that didn't quite pull the pieces together as effectively as we have, and we've learned a lot of lessons since then. and we've had many fits and starts: children's health care, portability, trying to deal wi with, you know, certain gender discriminations or other discriminations within the systems. we've got little pieces done. but all the time, the basics of the system have been without the reform necessary to bring down costs and make health care more accessible to more americans. so i have no doubt that we are reaching a moment of historic importance here. this is a moment where we are going to finally provide access to almost all americans. 31 million americans are going to gain health care coverage through this legislation when we pass it, and that will bring us

up to 94%. just to give you an example, madam president, in massachusetts, where we passed health care reform a couple of years ago, where we mandated that everybody be covered, and where we created a penalty for companies that don't offer the insurance but we have a pool that helps provide coverage to people who can't afford it, we now have 97.6% of all of our citizens are covered in the state of massachusetts. and the fact is that the premiums in the individual market, which is where it's most expensive for americans to go out and buy health insurance, the premiums went down by 40%. while the premiums went down by 40% in massachusetts for a quality of care that people lo love, the premiums in the rest of the country went up 14%. that's a 54% spread in the cost

of premiums between those who got health care reform and those who did not. and that is precisely what we are going to be able to provide americans -- beginning to provide americans with this, and one of the reasons we can't provide it as effectively as in massachusetts is because there are certain things we do in massachusetts that the other side or some folks have prevented us from being able to do here. the fact is that -- let me sort of lay out -- there are a couple of things also that bother me about this. we keep hearing from our colleagues -- and i heard this from the senator from south dakota -- that we're not going to be able to save money in the legislation that we're going to pass. and, in fact, really nothing could be further from the truth. the fact is that we don't measure -- we don't get measured, i should say, from the c.b.o., the congressional budget

office, they don't measure many of the things that we're going to do in this legislation that, in fact, will reduce -- all of us know as a matter of monday cn sense, many of the measures in this legislation are going to reduce the costs of health care. and one of the reasons is that the c.b.o. analysis is generally limited to the federal budget. it doesn't attempt to account for savings in the health care system that come from policies that are implemented through reforms. so, for example, the c.b.o. found only $19 billion in government savings from transitioning toward post-acute bundled payments in medicare. but recent research in the "new england journal of medicine" suggests that bundled payments -- bundled payment, for somebody listening and doesn't understand, is when you take all the payments that come to a hospital or to the providers who

provide the care and the payments are all put together for the various services that you get, and they have to decide how to provide you those services in a cost-effective way based on the whole universe of the money that's been put on the table. it's different from what we do today, where we don't bundle it and say, take care of this patient and all of you various parts have to fit into a hole. today we just pay each of the separate parts without relationship to what their connection is to the total care of a patient. it's unbelievably wasteful, ineffective, sometimes redunda redundant, it's noncommunicative. and that's one of the reasons why in america we don't get the same outcomes for less money that people get in europe or in some other countries. so what we've learned is that -- that -- that the "new england journal of medicine," which is highly respecteahighly respectel

journal, suggests that the bundled payments for chronic disease and for electivs and foe summers could reduce health care surgeries for as much as 5% for 2011-2015. but we don't get credit for though savings. they don't talk about it. but common sense tells, because we've seen it, where they've done these bundled payments, you're going to reduce the costs. in addition, even if such savings only applied to half of the spending in the health care sector, the result would be more than $900 billion of savings over the next 10 years. if bundled payments get expanded beyond the post-acute care and even half of the potential savings from bundled payments were realized in the medicare program during the upcoming decade, these savings would translate to an additional .2%

of savings per year or reduction in program expenditures, and that would be more than $190 billion between 2010 and 2019. so i just talked about a trillion dollars, a trillion dollars of savings that don't even get formally presented to the american people as part of this process because of bureaucratic technical rules about what the budget applies to. everybody on the other side of this aisle knows as a matter of common sense that if you look at the experience, the way it's already proven in the marketplace, and if you just apply your thinking to this, we're going to reduce the cost of health care. similarly, large reductions in federal health care expenditures are plausible from the combination of other delivery system reforms. a lot of americans aren't aware of this, but here's what we ha have. accountable care organization organizations -- we don't have that today.

suddenly we're going to have an accountability in the care organizations delivering service. that's going to provide savings. we have incentives to reduce hospital-acquired infections. one of the biggest single fears people have today in america when you go to the hospital is you're actually going to get an infection in the hospital. and the chances of coming up with a staf a staph infection oe other kind of infection are very real and very high. there are actually different practices between different hospitals' operations. i happen to know this on a personal basis because my wife recently had an operation in one hospital system and they -- they had a certain pressure to try to deal with the mercer infection and a certain washing and disinfection process you went through. and i know some other hospitals where they don't do the same thing. in addition, we're going to have health information technology reform adoption. there's going to be

administrative simplification that would standardize and streamline insurance paperwork. i mean, you know, if you go to the a.t.m. machine and pull out some money, it's about a penny or a half a penny per transaction. if you go to the hospital where they don't have technology managing the records and people are doing it, it's about $20 to $25 per transaction to pull the records in the age of computerization and information technology. it doesn't make sense, and all of us know that, but we also know that because we're putting money on the table and incentives in place to help do that, we're going to be able to get additional savings. all of the savings are on top of the trillion dollars of savings that i've already talked about, none of which gets measured when our colleagues come to the floor and air is what a terrible bill this is. c.b.o. has also grossly underestimated savings in the past, and i'm not picking on

c.b.o. they've had an incredible hard job. they have done an incredible job. they've been completely overworked on any number of efforts where we've been asking them for the -- the models and naltses. analyses. but it's just automatic in a process that you're going to lose some things. according to the generic pharmaceutical association, in 1984, it was predicted that the hatch-waksma-waxman act would sr country $1 billion in the first decade. now generic medicines save more than that every three days. every three days we do what was predicted to happen in savings every 10 years. in the mid-1990's, the congressional budget office released an analysis showing that in 1994, the 10th anniversary of the hatch-waxman annual savings from generics had reached approximately $8 billion to $10 billion. the new data released showed that by 1999, 15 years after the

hatch-waxman became law, generics were generating $49 billion in annual savings. and in the last decade alone, generic haves saved consumers -- ger erics have saved consumers, businesses, state and federal governments $34 billion. so, madam president, i am convinced -- i haven't even talked about the wellness provisions or the prevention provisions that are in here. when we start getting all of america more tuned in to the things that we can do to prevent preventable diseases and take actions in our lives, our lifestyles and our diet and any number of things, we can bring the cost of health care down in america. now, let me -- let me just say that, you know, there's nothing -- we keep hearing about the secrecy, about how this legislation's been hidden from folks for a long period of time. again, that's just not true. there's nothing in this legislation that we haven't been working on or talking about or wrestling with in committee, out

of committee, in hearings, in the public debate for over a year now. and if the minority had taken a little less time to have press conferences and spend their time doing news conferences denouncing what they hadn't really analyzed, they'd have a better sense that they might have been able to read the managers' amendment on the internet for over a month -- excuse me, the internet -- the managers' amendment was on the internet on saturday and many of us looked at it because many of us have worked on the provisions, we wanted to make sure they were in there. it wasn't hard to read it and see what was included and what wasn't. and in addition, the underlying bill has been posted on the web for over one month. but the fact is, the minority has made a fundamental political calculation here. they don't want to work with us. in all the time that we were in the finance committee trying to mark it up, we never had people come to us, as i often have here in the 25 years i've been here

when you're legislating seriously and people come to you and they say, "hey, if you include this or if you work this a little or if you tweak this, i think i could support this bil bill." there's just a fundamental political divide, a fundamental philosophical divide. we're looking at a party for whom opposition to health care for americans is not new. my colleague from california talked about it a few minutes ago. 1935, they tried to kill social security. and succeeded in preventing health care from being included in the bill at that time. they argued in 1935 the same thing that they argue now. could i ask how much time we have? the presiding officer: the senator has consumed 20 minutes. mr. kerry: how much time do i have? the presiding officer: the majority has 15 minutes remaining. mr. kerry: and is that

predesignated? is the 15 minutes remaining predesignated, madam chair? the presiding officer: not by order. mr. kerry: madam president, in fairness, i was not aware -- i thought i had the full amount of time, but i don't want to -- i want the senator from connecticut to be able to share thoughts also with you, so let me just say that -- and i'll wrap it up here -- that the insurance industry -- the insurance industry which they sought to protect survived the passage of the social security act. in 1965, we passed medicare, medicaid came afterwards. they opposed it. they opposed medicare. one of the most important programs in the united states of america that lifted countless numbers of seniors out of poverty. they said no. the insurance industry survived,

medicare and medicaid. they're doing very well. according to c.b.o., the gross cost of the manager's amendment is over the next ten years years $871 billion, less than the trillion dollars we started with in our committee, but it buys a lot, and i will talk at some time perhaps tomorrow or afterwards about what this bill provides in addition, but i think it is critical for people to follow the truth here, to look for the facts, and to measure the reality of the positive ways of which this legislation will change -- will provide additional help to seniors, will reduce premiums for many americans, will help people afford coverage who don't have it today, will spread risks throughout the system more effectively, will improve care and delivery within the hospitals, will prevent people from being denied insurance if they have a pre-existing condition, will prevent them from being kicked off of insurance that they paid for and thought they had when they get

sick and they suddenly get that letter that says sorry, you're not covered anymore and families go bankrupt. that's over. and that alone is an enormous step forward for this country. so i will -- i would -- before i yield the floor, i would ask unanimous consent that some portion of the statement be placed in the record as if read, and i'll decide what that would be, and i thank the chair. the presiding officer: without objection. mr. lieberman: madam president? the presiding officer: the senator from connecticut. mr. lieberman: i thank the chair and i thank my friend from massachusetts. madam president, i rise today to declare and explain my support for the patient protection and affordable care act. first i want to commend senator reid and all of those he worked with so long and hard, including my friend and colleague from connecticut, senator dodd, for all that they have achieved in this legislation. madam president, the truth is that no piece of legislation as significant and complicated as this is could possibly be

totally satisfying to every one of us. in the end, each one of us has to ask ourselves do the positives in this legislation substantially outweigh the negatives? are the things we like in the bill greater than the things that worry us? for me, the answer to both of these questions is yes, because this bill makes real progress on the three important goals i have had, i think most people have had for health care reform. first, most of us have wanted to stop the continuous increases in the cost of health care that burden every individual, family business, our government and our economy. second, we have wanted to regulate insurance companies to provide better protections for consumers and patients. and third, we have wanted to find a way to make it easier for

millions of americans who cannot afford health insurance today to be able to buy it tomorrow. i believe this bill makes real progress in achieving each of these three goals, and most importantly, it does so in a fiscally responsible way. the patient protection and affordable care act not only doesn't add to our national debt through new health care delivery reforms, it will help reduce the deficit by -- debt, really, by by $130 billion over the first ten years, according to the independent congressional budget office. that figure could multiply many times over during the second ten years, thanks in part to the manager's amendment that incorporated stronger cost containment proposals that several of us across party lines made to senator reid. it is very significant in addition that according to the

actuary at the center for medicare and medicaid services, this bill will extend the solvency of the medicare trust fund for an additional nine years. madam president, this act will also take substantial steps toward creating a health care delivery system that pays for the quality of the care patients receive rather than the quantity of care. and i'm proud to have worked with members of both sides of the aisle to include amendments that would do just that. for instance, senator collins and i introduced an amendment, parts of which were included in the manager's package that will enhance transparency for consumers so they can make more informed decisions in choosing their health care providers and insurers. in fact, our amendment will create physician compare, a new website where physician quality

measures that exist now but are not known by the rest of us will be posted for everyone to see and to use in the choice of physicians. this will also create incentives, we believe, for doctors to provide high-quality, more efficient care. i also cosponsored an amendment introduced by senator warner and some other freshmen senators that will contain costs even more. this amendment creates prevention programs to help us understand how to effectively manage chronic diseases such as diabetes, and it requires prescription drug plans under medicare part 2 to offer medication therapy management services to beneficiaries so they can better adhere to their prescription treatments. all that is progress on the first goal that i and most others had, which is to reduce the costs of health care without

compromising, in fact, improving its quality. the second goal, if this bill passes, insurance companies, senator kerry said, will not only be able -- not only not be able to deny coverage if an individual has a pre-existing condition, and they will not be allowed to rescind coverage if you become sick, which is the outrageous reality today. thanks to changes made by the manager's amendment, insurance companies will also be required to spend more of the premiums they collect on medical expenses for patients rather than on administrative costs and profits. that's real progress on the second goal i mentioned. as for the third goal, the fact is -- attested to by the c.m.s. actuary and c.b.o., 31 million more americans will be able to have health insurance as a result of this legislation. we say that so often, i think we

forget the power of it. 31 million people who don't have health insurance today will have it after this bill passes. that is a giant step forward for our society. it is not only the right thing to do, but it will also eliminate the so-called hidden tax that each of us who has health insurance today pays in higher premiums when someone who has no health insurance gets sick and goes to the hospital to be treated. that's real progress on the third fundamental goal of health care reform that i mentioned. now, is there anything in the bill that worries me? well, of course there is, and i'd say most of all i worry that we and future congresses will not have the discipline to keep many of the promises we've made in this bill to control costs by transforming the way health care is delivered, because some of

these reforms are controversial, and they're going to be opposed by some health care providers and health care beneficiaries. so without the kind of discipline i have just mentioned, this bill will add to our national debt or increase taxes, and neither of those results is acceptable. if we stick to the contents of the bill, this bill will cut health care costs and it will reduce our national debt. in my opinion, our exploding national debt is the biggest domestic threat to our country's future. that is why i've said this bill must reduce that debt, not increase it. accumulated debt is currently over $12 trillion. with our budget office estimating that an additional additional $9 trillion will be added in the next ten years. that is unprecedented in our history. we are -- we are running up to

the time when we can see a moment possible that we never thought would be possible when our capacity as a nation to borrow will be imperiled, when we'll have to raise interest rates so high that it will constrict our economy and send us back into a recession worse than the one that we're coming out of now. madam president, we cannot bring the fiscal books of our government back into balance by only making the health care system more cost-effective, but we will never control our national debt without doing so. medicare is in a particularly perilous condition today. without reform, the medicare trust fund will be broke in eight years, broke, with tens of millions of baby boomers reaching the age of eligibility, we simply must protect medicare so it remains a viable program for both current and future

generations. and this leads me to my firm opposition to the creation of a new government-run insurance company, program, and to lowering the age of eligibility for medicare to 55 years. that opposition was rooted in my very serious concerns about our long-term national debt and the fragile fiscal condition of medicare. for any new government-run insurance program, including the medicare extension-expansion idea, the moment premiums don't cover costs, the federal government -- that is, federal taxpayers, the american people, would have to pay the difference. that could easily put our federal government and the taxpayers on the hook for billions and billions of dollars in future liabilities and further jeopardize the solvency of medicare. because of the insurance market reforms in this bill, the

creation -- and other measures, the creation of new -- a new system of tax credits and subsidies for people making up to 400% of poverty, the creation of a new government-run health care, so-called public option or the expansion of medicare to people under 65 is not necessary. neither proposal would extend coverage to one person who will not be benefited by the new provisions of this bill. neither the public option nor the expansion of medicare. yet both proposals would, in my opinion, lead to higher premiums for the 180 million people who have insurance today and are struggling to afford the health insurance they have now because of cost shifting. according to studies by the c.b.o., a new government-run insurance program of public option would actually likely charge higher premiums than

competing private plans on the exchange and expanding medicare to cover people 55 years or older would lead to additional cost shifting. madam president, i know that the removal of the public option from the bill here in the senate disappointed and angered many members of the senate and the house, and while i know it pleased and reassured others, i want to say to those who were not happy about the removal of the public option from this bill that i believe president obama never said a public option was essential to the reform goals he set out to achieve and that most of us have. when the president spoke earlier this year to the joint session of congress, he said that a public option is, and i quote -- "an additional step we can take." end quote. an additional step, he said, but not an essential one. and then he added, and i quote again -- "the public option is only a means to that end." end quote. and conclude thad we should

remain, and i quote again -- "open to other ideas that accomplish our ultimate goal." i'm confident, madam president, that this bill accomplishes the goals that the president and most of us set out to achieve without the creation of a brand-new government-run insurance company or the further weakening of medicare. this bill as it appears it will remerge from the senate is delicately balanced. i understand that the normal inclination in the conference committee with our colleagues in the house is to split the difference, but splitting the difference on this bill runs a real risk of breaking the fragile 60-vote senate consensus that we have now and preventing us from adopting health care reform in this congress. that would be a very sad ending. so rather than splitting our differences, i hope the conferees will adopt our agreements so that we can enact health care reform this year.

the rules of the senate require 60 votes to end debate on a conference report. each member of the senate will have to decide once again when this bill emerges from conference whether he or she wants to be one of the 60 votes necessary to take up and pass the conference report. the presiding officer: the senator's time has expired. mr. lieberman: madam president, i'm going to try this once again as i did once before on this floor. i ask for an additional moment, unanimous consent for an additional moment -- or maybe two moments to complete my remarks. the presiding officer: without objection. mr. lieberman: i thank my friends. each member of the senate, i repeat, will have to decide once again when this bill emerges from the conference whether he or she wants to be one of the 60 votes necessary to take up and pass the conference report. in this case, my own sense of the senate is the same as that expressed in the last few days by senators conrad and nelson and others. if significant changes are made to the senate bill and conference, it will be difficult

to hold the 60 votes we now have. i have two priorities that will matter a lot to me. the first is to continue and maintain the health care reforms that will improve the cost-effectiveness of our health care system and help reduce the national debt. second, i hope there will be no attempt to reinsert a so-called public option in any form in the conference report. that would mean that i would not be able to support the report, and i want to support it. i believe i'm not alone in that opinion among the 60 who supported the bill last night. as i have said, our exploding national debt is the biggest threat to our nation's future. that means we must begin to make politically difficult decisions to reduce our debt, and that means saying no. some groups and some ideas, including some we would otherwise support because we simply can't afford them anymore. a final hope about the

conference report. perhaps some will say it's naive. i hope that the conferees will find a way to produce a report that can be supported by some republican members of the senate and house. it is a sad commentary on this moment in our political history, that so major a reform will be adopted with no bipartisan support. hopefully, the conference will find a way, difficult as i know it might be, to conclude this long legislative journey with a bill that is not only worth supporting, as i believe the senate bill now surely is, but also engages the support of members of both parties. i thank the chair, and i yield the floor. a senator: madam president, i would ask unanimous consent that our time be extended in the same amount as their time was extended. the presiding officer: without objection. mr. enzi: and i would yield myself 15 minutes. the presiding officer: the senator from wyoming. mr. enzi: thank you, madam president. the majority has voted to cut off further amendments to this bill. senator reid has used a

procedural tool that prevents republicans from offering amendments. several of my democrat colleagues have come to the floor to argue the republicans don't have any ideas on how to improve this bill. nothing could be further from the truth. republicans have filed over 200 separate amendments to this bill, yet the majority is refusing to allow us to vote on any of them. on a bill that will affect the health care of every american and 1/6 of our nation's economy, the majority has not allowed us to have more than ten votes to try to improve this bill. this bill needs to be fixed. we know this bill currently will cut medicare, raise taxes, and increase insurance premiums. if we had the chance to offer amendments, i believe we could make changes to fix those problems. i have filed nine amendments this bill, but i have not been allowed to offer any of them. i believe that any reform should reflect the following core principles -- reducing health care costs so that all americans get quality, affordable care they need. ending discrimination based on pre-existing conditions,

ensuring everyone has access to at least catastrophic care. preserving the right of patients to choose the doctors and health insurance plan that meet their needs. eliminating junk lawsuits and reforming our medical liability system. reducing health care costs for all americans and improving patient safety. encouraging incentives for healthy behaviors by allowing insurers to charge low premiums to people who eat healthily, exercise regularly and abstain from tobacco use. protecting medicare for seniors by ensuring that any savings found in medicare, a program that's going broke, are used to strengthen that program, not to create new entitlements. and helping all americans afford health care coverage by fixing the flawed tax code so that all americans can get tax benefits for purchasing health insurance. unfortunately, the bill fails to do these things. i think most members in the chamber agree on those principles for reform.

the hard parts is always making the principles come to life by translating them into bill language. i did that four years ago when i introduced ten steps to transform health care in america. once the bill was introduced, i went on a tour of wyoming in march of 2008 and hosted town meetings to talk about health care to my constituents. some of the ideas i included in my ten steps plan i also filed as amendments to senator reid's bill. madam president, i think we need to end discrimination based on pre-existing conditions. no one that has at least catastrophic coverage should be denied coverage for a pre-existing condition. everyone should have catastrophic coverage, but no one should be forced to buy anything. if someone doesn't at least have have -- if someone doesn't at least have catastrophic coverage, then they should have to pay more if they want coverage in the future. everyone should get the choices for health care that senators get. senators get to choose between competing private plans. so should all americans. senators get the same choices as

any other federal employee, no more, no less. the janitor in the building, the mailman, the forest ranger, we all get the same choices. all the choices are from private insurance. the federal government does not have its own plan. like other employers, the federal government does pay part of our health care, but not all of it. our choices allow us to pick a plan with a higher premium and a lower deductible or a plan with lower premium and a higher deductible. everyone should have these same choices, but they would have to work for a company willing to make a contribution to be personally willing to make that contribution and pay the remaining premium and deductible. no matter how the health care reform bill comes out, there will not be free insurance. everyone will have to pay something. everyone should pay something. and the amount we pay should have a relationship to the choices we make. the insurance costs will only come down if we are encouraged to make the best choices. speaking of -- speaking of

choices s there is no reason shopping for health insurance should be any more complicated than purchasing an airline ticket. everyone should be able to fire up their computer and look up health insurance options like they will look up airline flights. each state should set up a website or an exchange where consumers can find the listing of all the health insurance plans sold in their state. the public should be able to pick their health insurance using the information on the website. each health plan would list what's covered, the premium, the deductible, and the co-pay. not what washington says they have to put on there. every insurance company should be allowed to list their plan on any exchange and the state could certify whether the plans meet the minimum requirements and whether the subsidies could be used for those plans. there could also be ratings for how well the company provides for its insurance customers, but people could buy from any

company having been warned. everyone could use the transparency of the exchange to find the insurance that best suits them. transparency would also bring the cost down. another thing that will bring down costs is changing our system from one that provides sick care to one that health care providers -- one that provides health care. one way to do this is to focus more on preventing preventable diseases. we know that incentives to encourage changes in behavior can result in lower costs for patients and employers. we know this because 70% of all health care costs are driven by behaviors. if you provide incentives to change those behaviors, you have the potential decreases of costs of 70% of all of the health care costs for an organization. companies like safeway have designed plans that focus on personal responsibility and provide targeted incentives that lead to behavior changes that can reduce the risk of developing four of the most costly chronic conditions.

safeway's model focused on four chronic conditions that can be contributed to 75% of all health care costs. that would be cardiovascular diseases which are 80% preventable. cancers, some types are 60% preventable. type two diabetes which is 80% preventable, and obesity. as a result, safeway has seen their health care costs remain flat over the past four years while other employers experience annual cost increases as high as 6.3%. this is a huge accomplishment for safeway and its employees, and the employee satisfaction is fantastic. senator harkin and i had an amendment that would do that. it was inserted into the health bill and then pulled out without talking to us at all before it was printed in september. never heard of that being done to senators before. health care reform legislation should include the necessary provisions to ensure that

companies can continue to provide successful prevention programs that lead to better health and lower costs. we should encourage these programs and allow people to reap the benefits of better health outcomes and lower health costs. additionally, people who smoke should have to pay more. people who don't smoke should pay less. people should be encouraged to quit smoking, start exercising, and eat healthily. allow folks who follow healthy practices to pay less for their health insurance. people should be able to buy insurance across state lines. companies should be able to sell insurance anywhere in the united states. policies should be listed on the state exchanges with the disclaimer stating the policy is an out of state policy. the exchange could also say whether the policy meets minimum credible standards according to your government in washington and the state.

insurance commissioners in both the insurance company state and consumer state each get their usual amount for the sale. originators because they have to handle complaints. now, we need to help small businesses. i've been working on health care reform for some time. small business owners are seeing their insurance premiums go up and up every year. they need real help. what they don't need is for the federal government to make their insurance even more expensive. c.b.o. says the reid bill will drive up insurance costs for small businesses. i proposed a bill that c.b.o. scored as saving small businesses money by lowering their health insurance premiums by up to 6%. small business health plans allow businesses to join together through their trade association across state lines, even nationwide so they can form big enough purchasing pools to effectively negotiate with the insurance companies and providers. ohio has enough people that are able to do this within their

state. it's very effective. it brought down the cost of health care. they were able to save 23% just on administrative costs. they were sure if i could get my bill through that they would save even more by going across state borders. that's one that's been in the lab. it's been proven to work. not in the bill. small business health plans, which was s. 1955, drafted by myself and senator nelson of nebraska, former governor and insurance commissioner, was voted out of the "help" committee in march of 2006. on may of 2006, cloture on the bill was not allowed on the senate by a vote of 55-43. i know how tough health care reform is to pass. i had a majority of votes but not enough to begin the debate. at the same time, senator snowe was poised to do a single amendment that would have solved the objection for 80% of those who voted against it. without cloture, that amendment could not be offered. the snowe amendment would have solved the question of what health mandates would be required. the desire for mandate

clarification was the objection that had the disease groups working against the bill. the insurance companies worked against the bill and successfully defeated other versions called associated health plans for over a decade. i was able to neutralize much of the insurance lobby by creating small business health plans, we can put small business owners in the driver's seat instead of the federal government or insurance companies. through their association, small business owners will have the kind of clout in the marketplace needed to negotiate high-value and high-quality health insurance for their members on a regional or even national basis. additionally, throughout the health care debate, we've heard democrats say we need a public option in order to keep insurers honest and to have more choices for americans. however, the only place where we don't currently have competition is for the millions of americans who are currently trapped in the medicaid program. democrats believe that it's okay to lock 54 million poor american people into medicaid and have

them languish in a system that's broken and they're unwilling to fix, and their solution is to keep adding more americans to their broken system. a 2007 "wall street journal" article stated that medicare -- medicaid beneficiaries have poorer health than their peers with private insurance. a study published in the "journal of american college of cardiology" found that medicaid patients were almost 50% more likely to die after coronary artery bypass surgery than patients with private coverage. m merit hawkins found that in cities like washington, d.c. medicaid acceptance was below 50%. a 2002 medpac report stated 40% of the physicians -- let me repeat that. 40% of physicians won't treat medicaid patients because of concerns about reimbursement and time and added cost of completing the billing paperwork. the office of the actuary at the center for medicare and medicaid services state that had providers will accept more

patients with private insurance than government-run health care due to the more attractive private physician rates. if you can't see a doctor, you don't have insurance. as we increase dramatically the number of people eligible we should find a way to offer them regular insurance. they should be able to choose between the usual medicaid and a private policy with subsidy. the reid bill expands medicaid, and the reason is because it's cheap. according to the congressional budget office, it costs 20% more to cover the purchase of an exchange funded by federal dollars than through medicaid which is shared between federal and state governments. one of my amendments would change all of this. senators and their staffs have the ability to choose between competing private plans. and i believe we should give the same kind of choice to low-income marines instead of trapping -- low-income americans. my amendment would provide individuals who would otherwise be enrolled in medicaid through the expansion of this bill the

right to choose to be covered by medicaid or a qualified private health plan offered through the state exchange. every american should be able to choose to enroll in private insurance, and my amendment would provide real choice access to the network of physicians and fix this problem. it would also assure them that they'd have coverage for an entire year, not just while their income fluctuates. on the topic of expanding government programs, i'd like to mention if you save money in medicare, it should only be used to medicare because it's already going broke. the current bill takes money from medicare and uses it for other government programs. this bill takes $466 billion from medicare and uses it to start new entitlements that have nothing to do with medicare. yet, they start a new commission to figure out where to make additional medicare cuts in order to keep the system going. doesn't that seem counterproductive? after limiting where the cuts can come from because of hidden deals to get support for the

bill. whatever we do has to reduce costs for all individuals and be deficit-neutral. it has to truly be paid for. why does it have to be paid for? because america is going broke. we've maxed out the credit cards. now we're driving down the value of our money. we have to use honest costs, not gimmicks like the doc fix delay or collecting revenues before the benefits kick in and showing years of revenue for a shorter-time benefit. what ways can the government pay for anything? unfortunately, they can cut benefits, cut payments to doctors and other providers, increase taxes or cut waste, fraud and abuse. which government seldom does and even more seldom does effectively or more honestly allow a checkoff for donations to other people's insurance, perhaps even a tax-free donation so people who want a bigger role in seeing everybody has insurance can directly participate. people who argue it's imperative that we extend health benefits to everyone should put their money where their mouth is. people should have an

opportunity on their income taxes to make an instantly deductible gift to health care of others. if the deductible size of the gift is a refund, then they don't have to include a check. on the subject of taxes, taxes have to be fair to everyone. right now big companies write off the health care they provide employees, so those employers are getting health care with zero income tax. individuals who buy insurance pay income tax on all the money they use to buy insurance. that's just not fair. i've covered just a few of the ideas that i have. i have several more pages here that i've been talking about time and time again, none of which show up in the bill. these meet the promises that were made. the bill doesn't meet the promises that were made. i would ask unanimous consent to include the rest of my statement in the bill. i'd also -- the presiding officer: without objection. mr. enzi: i'd also ask unanimous consent that an editorial by david broder, one is the loneliest number for

president obama, be included in the record. the presiding officer: without objection. mr. enzi: it mentions some of the editorials and key points of editorials that i put in in my speech last night. and i would also ask that the, unanimous consent that the editorial by george will from "the washington post" the indispensable dispenser opens up be included in the record after my speech. the presiding officer: without objection. mr. enzi: it shows how medicare is left up in the air after the reid bill. i yield the floor and reserve the balance of our time. a senator: madam president? the presiding officer: the senator from south carolina. mr. demint: thank you, madam president. we've heard a lot about the unsustainable mountain of government debt, bureaucracy and spending the democrat majority intends to create in rushing through their health care bill through this chamber. we've also heard a lot about how much of this they inherited. we need to remember that this congress, both houses of congress have been controlled by the democrat party for three years now. the president doesn't write legislation or spend money.

the congress does. the only thing the democrat majority has inherited is its own irresponsible spending. saturday's release of the final democrat bill only increases americans' concern with this congress, the shadow negotiations and our growing debt. early this morning all 60 democrats voted to force all the taxpayers of this country to pay for bailouts and special favors for several states. rather than actually taking the time to put forth real health care reform proposals that would increase americans' ability to buy and own health care plans that they could really afford, this plan forces over 15 million americans on to yet another bankrupt entitlement program: medicaid. while medicaid is a state and federal shared program, the democrat majority saw fit for the federal government to pay 100% of the medicaid program in

the state of nebraska under this legislation at the expense of taxpayers in the other 49 states who will now be forced not only to deal with the loss of their freedom under this huge government takeover, but to pay for special favors in other states. this state bailout is not only one of the down sides of the majority's health care proposal, there's a laundry list that we could go through. just a few are the working american taxpayers and their employers will be taxed $500 billion over the next ten years, and the congressional budget office has confirmed that nothing in this bill decreases the premiums for main street americans. seniors will see their medicare benefits changed as a result of the $500 billion in medicare cuts included in this bill, not to mention that this bill turns a blind eye to the physician payment system that is woefully

underfunded and vitally necessary to maintain the medicare program and physician access for seniors. it doesn't matter how good the insurance is we give our seniors if they can't find a doctor who will see them. another alarming part of in bill is it will for the first time in decades force every american taxpayer to pay for abortion services. frankly, after reading this bill, it seems the only americans who aren't going to be affected by the bill are members of congress, pharmaceutical companies and insurance companies. madam president, for all the mind-boggling numbers and devastating facts we've heard about the majority's government takeover of health care, this debate is about much more than health care. it's about how we find ourselves in a situation where we are debating the best way to give the government control over another big part of our lives and our economy.

in the children's story of hansel and gretel, the children drop a trail of bread crumbs as they walk through the forest so they will be able to find their way out of the woods. but when the birds eat the bread crumbs, the children find that they're lost in a dark and frightening woods. well, lost in the woods is exactly where we find ourselves as a country right now. we know we're in trouble, but there's no clearly marked path tpo get us back where we were. and it's plenty frightening. in the past year alone, this federal government has taken over two of our largest automakers, our largest insurance companies, the largest mortgage company and hundreds of banks. it's bailed out wall street and attempted to stimulate the economy by taking $1 trillion out of the private sector and spending it on wasteful government programs. it has thrown taxpayer money at people to encourage them to buy new cars and houses. and it's looking at imposing massive new job-killing taxes on

businesses in the name of reducing global warming, all in the middle of a snowstorm. when we see a problem, one of the problems we have now in this country is instead of asking if we should solve it, we're asking how should we solve it? it's now considered a sign of admirable restraint to occasionally ask here in this senate and this congress how much should we spend? and somehow we've started thinking that anything less than $1 trillion is a good deal. there is not a pothole in america that most members of this congress do not believe should be filled with an earmark from the federal government. there's not a bridge to nowhere, a flat tire, a skinned knee, there's nothing off limits for this congress today. this matter's not just because of our unsustainable debt and the huge amounts of money we waste. it matters because every time we give a job to the government, we take away some control that people have over their own

lives. and we take away a little bit more of thaoeur freedom. in return for let -- more of their freedom in return for letting government try its hand in solving a problem, we as citizens cede our ability to try for ourselves to find a better way. it's awkward to admit it, but my colleagues in congress have led this country into the woods despite our oath of office. we swore to protect and defend the constitution of the united states and to bear true and faithful allegiance to it. the constitution prescribes a very limited role of the federal government. there is not a word in our oath or in the constitution about most of what we do. as we've wandered off the path of liberty, there are few crumbs left of the constitution in the halls of congress to lead us out of the woods. there's not a word in the constitution about the government deciding what medical test private health insurers should pay, nothing about the government deciding how much

executives on wall street should earn or what kind of light bulbs or cars we should buy. there's nothing about the thousands of parochial earmarks that fund local bridges to nowhere, golf courses, bike paths, sewer paths and teapot museums. there's nothing about these or many other things in the constitution because they have nothing to do with the proper role of the federal government in a free society. but these are exactly the kinds of things our government spends its time and money on, and we don't even question anymore why that is. instead, it's gotten to the point where if we oppose the government doing anything, we are accused of being opposed to getting it done. that's patently absurd. if you really want to get something done and get it done right, the government is absolutely the last place we should turn. the tea parties, town halls and rallies affirm the american people are rethinking the appropriate role of the

government in a free society. hopefully their discontent will be demonstrated in the 2010 elections. only the american people can hold our elected federal representatives accountable for fulfilling their oath of office. in the health care debate, this means deciding exactly what role the government should play to help people in the private sector find solutions. instead of creating a monstrous new bureaucracy that puts the government in charge of every decision. but this debate is about much more than health care. it's a battle for the heart and soul of america. it is a struggle between freedom and socialism, between free markets and a centrally planned economy and between we, the people, and entrenched class of elite politicians. the current debate over health care reform is a symptom of a bigger problem in washington. but it can be the catalyst for a wider debate about the proper role of government in our lives. the same debate can lead us to a

moment when americans finally take a stand to return government to its proper place. and we can all start finding our way out of the woods. madam president, i yield the floor. the presiding officer: the senator from north carolina. mr. burr: madam president, i'm going to be joined by a number of my colleagues, so i would ask unanimous consent that we carry a colloquy on for the balance of our time. the presiding officer: without objection. mr. burr: madam president, i think many members have to ask why are we here? we're here because at 1:00 a.m. this morning there was a motion to proceed, the consideration of the reid substitute amendment. and i think it's important that we discuss what that means. it means that there are going to be no more amendments, no opportunity for any senator in any state to propose a change to the bill. at some point we will have a up-or-down vote on exactly what senator reid has presented to

us. but here's what we do know. we're going to steal $466 billion from medicare. we're going to take that $466 billion away from hospitals, from hospice, from nursing homes, from home care, and, yeah, a popular target up here, the insurance product that many americans have chosen 20% of the seniors, medicare advantage. we're going to eliminate that option. this is one case that if you like your health care, you're going to lose it. the bill that would be considered and voted on later this week raises $519 billion in new taxes and fees. $519 billion in new taxes. and i might add for my colleagues, we tax tanning salons at 10%. now what in the hell does that have to do with health care? well, the reason it's in there

is because we dropped taxing botox. hollywood saw this wasn't advantageous to have botox tax, so when they dropped that they had to find something else. and poor tanning salons, small communities across the country, we're going to tax the majority of americans the president said he wouldn't tax, those under $200,000. the ones that don't have a beach house, they're going to pay a 10% tax when they go to get a tan. if we do that, how far are we from fining parents because we don't put high enough s.p.f. on our children? or are we going to start charging when we go to the beach because we get exposure to the sun? that's what happens when the government becomes a more dominant role in health care. and i might add no doctor fix, something many of us have highlighted. in the bill there was a one-year fix. doctors are going to be faced

with a 21% cut in their reimbursments after this next two months. there was a one-year fix to it, didn't do away with the problem, didn't fix the whole problem. but now there's no one-year fix. we've said in 60 days doctors will be on their own. yeah, there was some special deals. the corn husker kickback, the windfall for nebraska. and i've got to admit that i was proud of my colleague, senator johanns, who came to the floor and said let me assure you, people in nebraska have never asked for something different than everybody else. they're willing to their fair share. it will cost my constituents in north carolina and it will cost the constituents in nevada and -- excuse me, it won't in nevada. i think maybe there's even a deal that affects them to some

degree. but let me just say, is it fair? no. it's not fair. and the fact that it wasn't fair was called that's compromise. that's not compromise. we're here under an obligation to make this fair to all the american people, but in this case it's not. and, yeah, there are 31 million americans that are going to have health insurance, 15 million of which are delegated into medicaid, the most dysfunctional delivery system that exists in the health care delivery system. and, yes, there exists an unfunded mandate to states. because after five years, except for those who got these special deals, the states are going to be responsible for some portion, an average of 10%. let me tell what you the governor of building in income d early. "the absolute deal breaker for me as governor is a federal plan that shifts costs to the

states." well, we're shifting costs to the states and she's nowhere to be found now. but the people in north carolina, the taxpayers of north carolina are going to continue to be charged for this expansion of medicaid when that's the most inefficient place for us to have put these 15 million americans that were promised health care. and while we do all this, according to the chief actuary at the centers for medicare and medicaid services, c.m.s., 20% of our hospitals and nursing homes are going to go bankrupt, they're going to go out of business, because, as the chief actuary said -- and i quote -- "they would be unprofitable within the next ten years as a result of these cuts." hospitals, nursing homes at a time that our senior population is getting ready to explode as the baby boomers hit it. we're cutting $466 billion from medicare and we're starving the infrastructure of hospitals and nursing homes and hospice and

home care. well, providers, what's going to happen to them? c.b.o. said -- or, excuse me, the chief actuary again said if we go through and pass this pl plan, the result is providers will be unwilling to see medicare and medicaid patients. well, today, 40% of providers don't see medicaid. does that mean it's going to be 50% or 60% or 70%? we're ballooning a system that today's having a hard time finding providers. to most of us that doesn't make sense, but that's what the united states senate's going to do. and i might also add that the attempt here was to expand coverage. and, yeah, in sheer numbers we're expanding coverage. but if passed, the congressional

budget office says 8 million to 9 million individuals who currently have employer-based health care will lose that health care. 8 million to 9 million who currently have their health care will lose their health care with the passage of this bill. the net-net here isn't real pretty, and when you look at the $2.3 trillion of health care costs, you have to ask yourself: where's the beef, wherary the value in this? -- where's the value in this? as hospitals close, as nursing homes close, as provider don't see medicare and medicaid, ask yourself: have we really done something good? and chances are you'll find out that if we do nothing -- if we do nothing -- we'll actually save money on the health care system. the last fact. chief actuary of medicare said, if you pass this bill, the costs

of health care will be a quarter of a trillion dollars more than if we did nothing. the president talked about bending the cost curve down. we're bending that cost curve up in this bill. we're bankrupting hospitals and nursing homes. we're chasing providers from seeing medicare and medicaid patients. there are not too many things that we can point to that are great about this bill. that's every reason why we should start over. but i know that my colleagues are here to join in and to offer some perspectives, and i would ask them to chime in. mr. ensign: well, let me just summarize a few problems that i see in the bill and maybe even offer a few suggestions what i think we could do in a bipartisan fashion, kind of this step-by-step approach many of us have been talking about instead of this massive government takeover of our health care system. i've lost track now. i don't -- somewhere around

2,700-page bill, incredibly complex legal language. in the 400-page amendment that was offered the other day, when i was sitting there listening to the reading of it, i can't tell you how many times i was listening to this and i thought, when the regulations are written to that particular small part of the amendment it could be incredibly complex with all types of unintended consequences. and i thought about the burdens on small business and the record keeping that small businesses are going to have in this bill. and i think what's also going to happen with small business, there's going to be a great incentive. if you're a small business owner, the complexities are so much and you can get yourself in so much trouble, do you know what? i'm just going to pay the fine, i'll give -- i'll write a -- i'll write a check to each one of my employees but i'm getting out of the health care business. i'm going to just let them go

out and find their own health care, whether through the government exchanges or whatever it is, but i'm getting out of it. and that's one of those unintended consequences that a lot of people haven't focused on. we've talked a lot about that this $500 billion-plus cut in medicare. you -- my colleague from north carolina mentioned that. and some of the biggest places, i had two grandmothers that were in hospice. hospice care is some of the most compassionate care that we have today. and when you're going to cut hospice care, that actually there's some -- it puts dignity back into dying, that's just unconscionable. and the dprecial budget office says that -- and the congressional budget office that says these cuts actually will be cuts in services because you can't just take money out of a system, okay? unless you make it more efficient. and these cuts don't make th the -- don't make the system more efficient. they just take money out of the system. whether that's out of the hospice or nursing home or the home care -- out of the medicare cuts, we also know there's

$120 billion in cuts to medicare advantage. congressional budget office again said by 2016, 64% of the extra benefits, whether those are prescription drugs or dental coverage or vision coverage, the seniors get under med care of advantage -- get under medicare advantage are going to be cut 64% because of this legislation. we also know there's around $500 billion in new taxes, and this is a complete violation of the president's promise during the campaign, where he said not one dime in new taxes will be raised on those individuals making less than $200,000 or families making less than $250,000, and yet in this bill, of the $500 billion, 84% are paid by those people who the president said wouldn't have their taxes raised by one dime. we also know -- the senator from north carolina talked about this -- this massive medicaid expansion. i think it was the democratic

governor from tennessee who said it was the mother of all unfunded mandates. well, we have to look at this one way. if the sweetheart deal that was made by the senator from nebraska -- and by the way, i agree with you. senator johanns that came to the floor, that takes a lot of courage to say, do you know what? it isn't about just helping my state. it's about thinking about the whole country as well. he isn't asking for something which most senators do around here, ask for something just special for the state that the rest of the states have to pay for, but he stood up with courage and i think he deserves a lot of credit for that. but if all the other states now come back and say, do you know what? we want the federal government to pay for our states and medicaid, this bill's going to do one thing. it's either going to be a massive unfunded mandate on our states or this bill is going to massively balloon the federal deficit and debt. a senatormr. coburn: i have a qn

for both the senator from north carolina and the senator from nevada. can the state of nevada or the state of north carolina or the state of nebraska or the state of oklahoma be healthy if our country as a whole isn't healthy? so no matter what we do for our own states, if, in fact, we're not thinking about the country as a whole, the best, right thing for the country as a who whole, none of our states can flourish? mr. ensign: i think the senator from oklahoma has made a wonderful point. right now, my state is suffering terribly, not because of anything individually, like that we didn't get our fair share of something. my state is suffering because the whole economy is in the doldrums and because we're such a tourist economy, construction oriented, the housing industry, all of those things in the general economy went down, my state's suffering. so you're exactly right. we should be looking at what's best for the entire country,

because this is one of those things, as john f. kennedy said, a rising tide raises all boats. well, if the whole country's doing better, whether it's on health care or whatever it is, instead of looking for something individual for our states, you're exactly right, inc. the whole country -- i think the whole country -- our individual states do better if the whole country does well. mr. coburn: madam president, i would like to ask unanimous consent to place in the record an article that appeared today and it's a quotation from the founder from the "daily coast" web site. and i will give it to the clerk in a moment. but i -- i wanted to read a quote from it. "i don't think this is a reform bill. i mean, i think it's very clear this is not insurance or health care reform. what it is, is allowing more people, 30 million people, to buy into an existing broken system. it's very important to keep in mind that health insurance is

not the same as health care. if you go up to massachusetts, they have a mandate as well