unlikely to be sustainable on a permanent basis. gets to what dr. coburn said. by design, maybe this could work. but there's not a will because there's not reform. we've spent a lot of money, and at the end of the day it looks like the only thing that we've done is tried to address waste, fraud and abuse. for $2.3 trillion, it seems like you could bring more bacon to the table. it seems like there would be a little more meat. it seems like there would be some substance there that we could look at it and say look at the improvements that our health care system makes on this. i know the doctor, that dr. coburn has said many times if we do this wrong, what we do is we chase innovation out of this country, out of our system. the breakthroughs that go from

maintenance to cure, the research on a bench that finds us new ways to address diabetes where amputation and blindness aren't in somebody's future. if we go backwards, if we chase that innovation out, we lock ourselves into not only the most costly health care, but health care that achieves the least amount of quality for our future generations. mr. ensign: i would like to ask senator coburn in our last couple of minutes here to address, because you've spoken so he eloquently about debt. the congressional budget office said this thing helps the deficit by $100 some billion dollars. talk about how the taxes go into effect right away but the spending doesn't go into effect and how that kind of smoke and mirrors happens all the time around here, how they try to hide various expenses and what

this thing is really going to do to our debt. mr. coburn: the dispointing theupl, -- the disappointing thing is we're not honest with the american people about how we account for things, and this bill is another example of it. let me give you the quantify indications. if you go read the c.b.o. report on this bill, they talk about it's highly unlikely we'll ever make the medicare cuts because they've never seen it done. every time we said it in the past, we haven't done it. likely sustainable growth rate formula budget act of 1997. if you match up revenues and expenses, what you see is a $1 trillion tax increase, a $1 trillion cut in medicare, and an increasing cost to the economy. but because there's not a sustainable growth rate to the

doctor fix in the bill, that's $247 billion that's not accounted for in this, and that's if you keep physician wages frozen over the next ten years. so that's $247 billion. it's probably closer to $00 -- $300 billion. so that's $300 billion. the fact is, we know that taxes are going to be collected, people are going to pull down the costs, which is one of their hopes and they're going to pay for it out of their pocket. so we're going to see the insurance plans not reach the cadillac level, and we're counting on revenues from that in terms of billions and billions and billions of dollars. but what they'll do is change the deductibles on individuals. and that's a hidden tax. because if your deductible goes up to keep your insurance from coming too high, your tax goes up, the actual expenditures, so your ability to invest and to create additional jobs. you know, it cascades. the honest accounting for this

is that there's no way that this saves any money, it will cost money. and the final point i'll make is that won't put forward the cuts in medicare that they're claiming in this bill, because they know if they truly do put forward the cuts and patients feel it,, they won't be back here so it won't happen. so i'll go back to what senator burr started this out with. if you start tomorrow and fix health care what would you do? you'd attack costs. why are things so costly? one is because there's no transparency in markets. there's no real connectedness to your pocket. number three, there's no incentivization for prevention of chronic disease or the management of it. in other words, we don't pay people to have less expensive

outcomes. we won't incentivize better care in that way. we won't incentivize prevention. we -- we've done a lot of this on medicare, but -- and i'll talk about it tomorrow -- but they -- they have three different agencies within this bill that are going to ration care, that are going to make decisions for you. not just on medicare and medicaid -- everybody needs to understand that. it doesn't just apply to medicare and medicaid. it applies to your choice of your private insurance. the government's going to ration your care. and we know that's true because they wouldn't allow an amendment to prohibit rationing and they all voted against the amendments in committees when we offered amendments to limit rationing. so we know the intention is to ration care. and if that's what -- if that's how we're going to control costs, then bernie sanders is right, just go to a single-payer, government-run system. bernie sanders' system is far

better than this one. far better than this one. if that's what we're going to do, if we're going to ration care to control costs, let's let everybody know upfront. let's be absolutely honest about it. if you're 75 years of age and you need a hip replacement but the quality of your life is not all that great, we're going to say you can't have it. that's what we're going to do because that's exactly what they do in england. they have the national institute of comparative effectiveness and makes an evaluation of what your worth is. and no matter what your history is, no matter what your family situation is, no matter what your income, you can't have it. now, canada's getting around that because they've said, you get the right to buy what you want. their supreme court ruled 2 1/2 years ago. and so what we're seeing is a two-tier system now developing in canada which ultimately will happen in this country worse than what we have today. mr. ensign: if the senator would yield, though, if america does this with our health care system, where were the can made it -- where will the canadians come for health care when they need it? you know, when they get it

rationed up there, they usually come to the united states. mr. coburn: they'll go to thailand or india. mr. ensign: i was going to say that. but where will americans go? mr. coburn: i thank the senators for holding this colloquy. make one final point before i stop. i don't doubt the motivations of our colleagues on the other side of the aisle. they want us to fix this probl problem. the problem in health care. but the problem's cost. and if you don't fix cost and you just expand the same broken system, you haven't fixed anything, you've just added to the cost. mr. burr: i thank the good doctor and thank the president and yield the floor. mr. menendez: madam president? the presiding officer: the senator from new jersey. mr. menendez: madam president, i rise to speak to the great debate we're having on historic

health care reform, and i'm reminded of the words of a great republican, president abraham lincoln. he said -- quote -- "we cannot escape history, the fiery trial through which we pass will light us down in honor or dishonor of the latest generation. the occasion is piled high with difficulty and we must rise with the occasion. that's what abraham lincoln said. madam president, it's time to rise to the occasion. because our friends on the other side of the aisle have chosen to sit on their hands and do nothing. they have no plan. they have chosen to delay and obfuscate. you know, if you look back in history, during the great debates on social security in 1935 and medicare in 1965, our

friends across the aisle were on the wrong side of history. but in the end, there was a minority who chose to stand up for historic social legislation and vote their conscience. they were not driven by the far right wing of their party or by radio talk-show hosts who demand ideological purity and seek any attempt to support -- see any attempt to support health care reform as an abandonment of principle. each of us is rarely called to act on such significant legislation, and when we are, it is our solemn duty to put aside our ideology, to turn off rush limbaugh and leave politics in the cloakroom. our vote on this groundbreaking legislation, comparable to social security and medicare, will be one of the most significant votes in american

histories. it should not be driven by the hope of failure that the other side prays for, rather by the will to succeed for the american people. this congress will be remembered for this vote for generations to come, and our friends across the aisle will once again be on the wrong side of history. madam president, we've heard the same, tired arguments over and over again. we heard those arguments in 1935 against social security, we heard them again in 1965 against medicare, the same arguments we hear today. history has a way of repeating itself. if past is prologue, historic health care reform legislation will be signed into law despite the naysayers, the fearmongers, the panderers to those who see

any attempt at compromise as defeat to. our friends on the other side, this is no longer about legislating, it is simply about obstructing. it is no longer about doing what's right for the american people but about stopping us from doing anything. it is not about finding common ground but drawing lines in the sand. my friends on the other side have set up an army of strawmen, as they did on social security and medicare, manipulating the facts to create the illusion of refuting the false claims they created in an attempt to score political points. they send up the socialist strawmen, call it a government takeover of health care and make americans fear. well, we say let's make sure the bernie madoffs of the world and people like him are not selling health insurance. they wave a flag, stand up the un-american strawman, saying the

bill is against old-fashioned american values and denounce it. we say, don't you dare question our patriotism. do not dare question our commitment to doing what is right for the american people. they stand up the death panel strawman, claim the legislation would kill grandma and denounce it as inhumane. we say stop the outrageous misinformation and tell the truth to the american people. they stand up the tax strawman and say, health care reform will increase taxes. we say we're making health care entities, like insurance companies, pay their fair share. they set up the spending strawman and say the bill will indebt the next generation despite congressional budget office estimates to the contra contrary. we say, you can't pick and choose when to believe the congressional budget office and

stand by their numbers only when it's convenient to your cause. for instance, my friend, senator gregg, the ranking member on the budget committee,tout, touts c.. numbers even on his specific bill. when they benefit his arguments, for example, on malpractice provisions. but now my friends on the other side conveniently dismiss the congressional budget numbers, showing our health care plan reduces our -- the deficit. so you can't have it both waysment they bring along their partisan strawman, accusing us of drafting a bill or having votes in the middle of the nig night. we say, how quickly you forget the four months that we waited for republicans in the bipartisan gang of six -- three members, democratic members, three republican members -- working supposedly in an effort to achieve a bipartisan effort

in health care reform. four months. four months we waited to work with us in a constructive way, and then they all walked away. so don't come back now and say you had no input in the process when you choose that course. and by the way, these votes, they take place at the times that they take place because the republicans insist on stopping the process and delaying it and drawing it out, so under the procedures, once we start the process to finish that delay, it ends up at certain hours, 30 hours each time, from the moment that we file the motion to say, you know, that's enough of the delay, let's move forward. and whenever those 30 hours ends, that's when we have to have the vote. but they could consent to have that vote in the fullness of the day and

light, but, no, they want to have the vote as late as possible, hoping that 60 members who want to see progress on this reform don't come to the chamber and, therefore, cannot stop the filibuster. and so they want failure. and then they clamor about look at the time that these votes take place. straw men after straw men, they have done nothing but block this legislation as they have throughout the year other legislation. and they will do anything, say anything to delay, deny and defeat health care reform. they are on the wrong side of history now as they were in 1935 and 1965. but the difference between 1935 and social security and 1965 and medicare and today is that when the debates ended in 1935 and 1965, when the legislation was weighed on its merits, there

were those few republicans who voted their conscience, those who did not march in lock step to the demands of right-wing talk show hosts or in fear of tea party anarchists. in 1935 and 1965 there were a few on the other side -- a few -- who voted for social security and medicare because they knew it was right for america. but in 2009, it appears that there will be no votes for health care reform. not one. not a single vote from the other side of the aisle. madam president, the ideological differences were as intense then as they are now, but pure obstinate ideology did not prevail then as it will in this chamber when we vote. you know, before social security was debated, president roosevelt laid out the changes in society and the reasons why we needed social security legislation

before the congress. he said that -- and i quote -- "security was obtained in the early days through the interdependence of members of families upon each others and of the families within a small community upon each other. the complexities, he went on to say, of great communities and of organized industry make less real these simple means of security. therefore, we are compelled to employ the active interests of the nation as a whole through government in order to encourage a greater security for each individual who composes it. that's what he said about social security. that's why we needed social security and why we realize today that without social security, more than half of our seniors in this country would be living in poverty. more than half if the voices then in opposition would have

succeeded. and then the debate began. there is no mention of death panels, but there were those republicans who raised similar straw men to the voices we hear today. a member of the new york delegation, a republican, daniel reid, said -- quote -- "the last of the dictator will be felt when 25 million americans for the first time submit themselves to a fingerprint test." others said the bill invites the evidence into the political field of a power so vast, so powerful as to threaten the integrity of our institutions and pull the pillars of the temple down upon the heads of our descendents. john tabor, another member of the new york delegation, republican, raised the antibusiness straw men saying -- quote -- "never in the history of the world has any measure been brought here so insid with

usually designed -- incidously designed." in this chamber, senator daniel hastings, a republican raised the death of the nation's straw men saying social security would -- quote -- "end the progress of a great country." in this debate, we have seen the same army of straw men standing against us. they have claimed that health care reform is a government takeover that will threaten the integrity of our institutions when in fact we create an exchange of private insurance companies that people will be able to pursue. they say that it will pull down the pillars of the temple and our descendants and leave them in debt, that it will drive private health insurers out of business and put a bureaucrat between doctors and patients. we already have bureaucrats between doctors and patients. there are health insurance

companies between doctors and patients. the difference is when the debate ended on social security in 1935 with the shouts of socialism and un-americanism had faded, a few, a minority on the other side had the political courage to cross the line and vote "yes." there will not be a single vote from the republicans in favor of this bill. thought a single vote -- not a single vote. our colleagues on the other side want nothing more than to stop this bill, period, pure and simple. it is their intention to stand enbloc for insurance companies and against any health reform that would protect american families from losing everything if they get sick. their plan is just to say no, and once again they will squarely be on the wrong side of history. when president kennedy and later lyndon johnson fought for medicare, those on the other side raised the same army of

straw men. they raised 30 years earlier. they played the same game that they are playing again now. senator curtis of nebraska at that time voiced opposition in this chamber saying medicare -- quote -- "is not needed." he was a republican senator of the time, senator curtis of nebraska said medicare is not needed. it is socialism. it moves the country in a direction which is not good for anyone, whether they be young or old. it charts a course for tpr* which there will be no -- a course from which there will be no turning back. it is not only socialism. it is brazen socialism. in the other body, congressman hall of missouri called it an ill-conceived adventure in government medicine. those were the republican voices of the past on medicare. what senior in this country today, which one of our parents

or grandparents believe those words of the past as it relates to their health care today? more straw men, more fear, more nay saying. all of it wrong then, all of it wrong now. they said bureaucrats would come between doctor and patients. well, they're wrong. they're wrong. that's why it's interesting to see that today the american medical association, the nation's doctors, the people who take care of you when you're ill, the ones who follow your progress when you have maybe a debilitating disease or a lifetime health challenge, your doctor, the voice of your doctor, not any members of the senate, the voice of your doctor said this in support of this

historic reform. they said -- quote -- "this is a time of great opportunity for the american health care system. we have the chance to substantially expand health insurance coverage, implement insurance market reforms that promote greater choice, affordability and security, improve -- this is the doctor speaking. improve the quality of the care and help americans live longer, healthier, happier and more productive lives. to that end, the doctors of the nation say we urge all senators to support passage of the patient protection and affordable care act as amended. this is the nation's doctors. this is your doctor who's telling the members of the senate vote for it. they're not, they don't believe the line about that bureaucrats are going to come between doctor and thaeurbt.

they call medicare unpatriotic and un-american. they were wrong again. they said it would mean the rationing of health care. they were wrong. they made the same arguments they have been making for 74 years, and they are still wrong. in 1965, the champion of my conservative friends, ronald reagan, issued a 19-minute long, l.p. -- for those of us who still remember that, a long-playing vinyl recording at the time. it's passed on. they're like antiques now. it was entitled "ronald reagan speaks out against socialized medicine." it featured an impassioned 2,000-word speech intended to get people to write to their congressman against the idea of medicare that was beginning to make its way through the congress. that was 1965. it was referred to as operation coffee cup, something of a precursor to today's tea

parties. in his recorded message against medicare, ronald reagan said -- quote -- "one of the traditional methods of imposing socialism on people has been by way of medicine. sound familiar? sound familiar in the year 2009, in the debates we've heard here on the floor? when he became president, one of the pillars of his health policy was cutting benefits, in particular, to increase cost sharing from medicare and medicaid recipients. he was wrong then just as our conservative friends on the other side are wrong now. madam president, in the face of yet another landmark piece of legislation, is it possible that there is not one of my friends on the other side who does not in their heart believe we need to pass this legislation for the good of the american people regardless of ideology? is there not one of my friends on the other side who will vote "yes" to help americans who have

lost their jobs and their health care and stand to lose everything if they are or a member of their family becomes ill? my friends, saying no to accessible, affordable health care for the american people is too big a price to pay for ideological period. when i think of what this legislation will do, i cannot believe that there will not be one vote on the other side to provide competition and affordable choices for every american, as this bill does. not one vote for greater accountability for health insurance companies, not a vote for more choice in competition for consumers for programs that will rein in health costs and make policies more affordable. now, is this bill perfect? no. but it is a great and historic foundation of reform. and yet, there will not be one vote on the other side to improve access to quality care

for children, as this bill provides for and the most vulnerable among us, which the bill does, not a single vote for tougher accountability policies for health insurance companies that are included in this legislation. not one vote to require insurers to spend more of the premium revenues on health care rather than on administrative costs, executive compensation and boosting the bottom line. not a vote to hold health insurers accountable for excessive rate increases, not a single vote on the other side from immediately banning insurance companies from denying children, from denying children coverage for a preexisting condition. not one vote for expanding eligibility for tax credits for small businesses and starting the health insurance tax credit next year. that's why it's interesting to note that among the many, many

supporters of this, the business round table, they are quoted as saying the proposed legislation is a step towards our shared goal of providing high-quality affordable health care for all americans. it's why the small business majority says the manager's amendments, senator reid's manager's amendment includes new provisions essential for small business protection and survival. that's the voice of business. not one vote for a bill that promotes competition among insurers and choice for workers or to test alternatives to civil tort that emif a sao*eus size resolution -- emphasize resolution of disputes. not one vote. not one vote. or for people in my home state of new jersey and every state who will see direct and immediate benefits from this legislation. not a vote for every uninsured

new jerseyan who has a praoebg condition and has been unable to find affordable health insurance on the marketplace. the health of our families is not a commodity. it is not a privilege for the wealthy. it is something everyone should be able to be protected from without going broke. under this legislation, 1.3 million seniors in my home state will be eligible for free preventive care for recommended services. seniors will also be eligible for free annual wellness visits to their doctors and will be provided with a personalized prevention plan so that they can stay healthy. panned when this legislation -- and when this legislation is signed we will have lived up to our promise to fill the doughnut hole, that gap under medicare part-d to provide affordable prescription drugs to over 227,000 seniors in new jersey and millions across the country, so that they will no longer have to choose between paying their bills and taking the medication. when this legislation i