percentage of g.d.p. from 70% last year to 84% this year. now, we have not seen this kind of debt-to-g.d.p. since the end of the second world war. we have amassed a staggering $70 trillion in unfunded obligations over the next 75 years or an estimated $600,000 per american household. our medicare program is already on shaky footing with $37 trillion in unfunded future medicare costs, and the medicare trust fund is expected to be insolvent by 2017. frankly, this is why i'm disappointed the senate failed to support senator gregg's amendment we considered earlier in this debate to ensure that the savings achieved by medicare cuts would be used to ensure the viability of 9 program and not

hue entitlements. and so i ask my colleagues can our nation take on new programs and costs when we can't pay for what we're doing right now? our nation's fiscal pike tour is not -- picture is not pretty. our obligations to our entitlement programs are exploding. if kwaoep going the way we are, our debt will double in five years and triple in ten. last year we borrowed $1.4 trillion and 50% of our debt is in the hands of foreign countries. the american people get it. they already know the federal government is the worst credit card abuser in the world, and we are putting everything on the tab of our children and grandchildren. and they're not the only ones. internationally our creditors

are concerned. chinese premier wen jiabao said we're concerned about the security of our assets. to be honest, i'm a little bit worried. that's why here i would like to urge the u.s. to keep its commitment and promise to ensure safety in chinese assets. end of quote. that's what he said to the president and anybody that goes to china. they're worried about the fact that they lent us a lot of money and might not get it back. while the international community understands our crisis, somehow congress doesn't get it. here we are considering a bill when fully implemented spends more than $2 trillion over ten years to restructure our health care system. i respect my friends on the other side of the aisle, but the assumptions that they make are optimistic about the cuts in this bill especially when you consider this body's propensity for acting in a fiscally irresponsible manner. frankly, our history on the

so-called doc fix is illustrative. we continue to kick the can down the road, and medicare payments for physicians instead of dealing with its more than $200 billion cost. the bill before us doesn't even have the one-year fix, the one-year fix that the original bill had included. my friends on the other side of the aisle decided to put it off and deal with it in a separate measure because it would make this bill even more expensive. as congressional observers have noted, we continue to put off the difficult choices. the fact of the matter is congress is not willing to take short-term pain for long-term gain. this is my 11th year, and it's the same old story year after year after year. this brings me back to the health care bill. i've heard all the arguments of why health care reform is needed, and you know something? i agree with most of them.

frankly, there are a number of incremental things we could do today to make real improvements in our system in a bipartisan way. in fact, i encourage my colleagues to take a look at some of the proposals contained in the alternatives offered by my colleagues, including senators wyden and bennett. these and other legislative proposals include things we can do on an incremental basis to improve our system like making it easier for small businesses to group together to reduce their health care costs, passing medical liability reform, which we have more tests being taken because doctors are afraid of being sued. increasing flexibility in the private market so people have more options and can choose insurance products that best meet their needs, implementing policies that encourage wellness and prevention, eliminating the fraud and abuse it has and will continue to plague our health care programs, eliminating the

ability of insurance companies to deny people insurance coverage because of preexisting conditions or eliminating the caps that insurance companies put once an individual reaches a certain amount. instead we're going to pass a massive new spending bill that does little to fix our problems in the long run. with too many of my colleagues don't understand is there are limits to what government can do. there are limits on what government can do. when i was mayor of the city of cleveland, governor of ohio, people would come to me with ideas to expand programs and services. often even though i saw the merit of these proposals, just like i see the merit of a lot of the suggestions that we need to have in terms of health care, i knew we didn't have the money to pay for these proposals, especially because we had to balance our budgets. in those situations, i had to be honest and say no.

and it's the same thing here. i'm sure the president has people coming into his office every day saying, "i want you to help with this worthy cause." i sit, i listen patiently, and i say to them, "if what you're asking me to do means that we're going to have to borrow money and it's going to be paid for by our children and grandchildren, what do you have to say?" and nine times out of ten they said, no. thank you very much, senator. and they go out the door. they get it. they understand that. unfortunately, congress doesn't get it. and it isn't just my colleagues on the other side of the aisle, folks. no one's hands are completely clean. that's the way it is. we just keep on going the way we are, keep going down the road. here we are in the worst

recession since the great depression. millions of americans are out of work. others lucky enough to have a job are wondering if they will be next to be laid off or fired. in my state of ohio, the unemployment rate is 10.6%. yet, we're talking about health care reform, cap-and-trade, which will put unsustainable burdens on doing business in this country and make it more difficult to get this economy going again. what people in this country want is they want to go back to work and have some assurance that their jobs are safe. and the best way to give them security and access to health insurance is get them back to work. we shouldn't be asking our nation's businesses to take on new tax burdens in the current recession. yet, this bill before us would impose $28 billion in new taxes on employers. $28 billion. furthermore, the legislation creates a new medicare payroll tax that will likely hit

approximately one-third of the small businesses in this country which employ some 30 million americans. these new taxes are likely to significantly hinder these engines of job growth. another troubling tax that will impact businesses in my state is the tax on device manufacturers. i've heard from one of our ohio companies that this tax could force it to move its operations overseas to keep its doors open. in fact, this is unbelievable, in fact according to the company's own calculations, the new device tax will exceed 100% of its domestic earnings and research and development budget. it's got nothing do with their profit a*plt. they say -- profitability. they say you're this business, you've got a percentage of it and we're going to lay this tax on your back. ohio can't afford to lose these jobs to another country at any time but certainly not right now in the struggling economy.

this is just the beginning for businesses large and small. the bill will add a whole new never seen before layer of bureaucracies on our businesses. when i think about that, small, even large businesses are already overwhelmed with management and paperwork demands as a result of government mandates. many of them have to hire multiple tax attorneys, accountants to help them navigate the federal laws and their tax obligation. i can't help but wonder how many businesses both large and small will have to hire new benefit managers. there's an area that will create new jobs, we're going to hire benefit tphaoerpbgz help them keep track of the new requirements, ensure that they are offering the appropriate benefits or paying the appropriate fine. what a nightmare. and no one has mentioned the thousands of additional federal workers. nobody's talked about it. when we did part-d of medicare -- of medicare, they had to hire over 500 people in c.m.s. and so we'll have to hire all

kinds of people, including -- listen to this -- including the internal revenue service. i bet you'd have a hard time finding an american that thinks it is a good idea to get the i.r.s. involved in delivering our nation's health care. and the worst thing we can do is borrow another $2.3 trillion, create additional federal programs and put a bigger burden on the engine of job creation. i find this especially troublesome after hearing the centers for medicare and medicaid, their chief actuary. last week, under the original reid health care bill, they said costs will go up, not down. in fact, according to his analysis, the federal government will spend $234 billion more on health care if this legislation became law than without it. $234 billion more with this legislation than what we're

spending right now. and it's not just the federal government, as i discussed in some detail last week, most states will have new fiscal obligations of about $26 billion under this bill. if you're not lucky enough to be from one of the states like the corn husker state or another state that got a special deal in this legislation to get the democratic leadership's 60 votes, your governor is going to be hit with a portion of the cost of expanding the medicaid program to cover all individuals up to 133% of the federal poverty level. in the state of ohio, we've had 154,000 more people come on medicaid just with the current extent of poverty, and to go to 133%, it's going to be incredible. as a former governor of ohio, former chairman of the national governors association and past chairman of the national league of cities, i'm very familiar with what unfunded mandates can do to state and local governments. by the way, there's a point of

order that lies against this bill as an unfunded mandate in terms of local and state government and also business. the american people should understand that the new state obligations under the medicare expansion will mean less funding, less funding for primary and secondary education. higher education programs, roads and bridges, county and local government projects and safety service programs run by their states. in fact, i used to call medicaid the pac man that gobbled up our state budget dollars. let's look at this. you take the silo over here, medicaid. then what you do, you've got to expand that. it's going to be more expensive. then you look around and say we've got great needs with the secondary, primary education. the kids are complaining about the fact that tuition's going up for our institutions of higher education. our local government officials are complaining because the state and local government funds that are going to them are not available to them because all this money is flowing in this

direction. in other words, under the reid bill, we will put more stress and further unfunded mandates on the states, making our health care fiscal picture even worse than it would be without doing anything at all. and this doesn't make any sense. i've often said -- in fact, when i was governor i said gone are the days when public officials will be judged by how much they spend on a problem. the new realities dictate that we work harder and smarter and more with less. in fact, i remember giving my state of the union address or state of the state addresses in ohio, and they used to take a poll about how many times i would say harder and harder, more with less. harder and harder and more with less. and that's what our states are doing, but not the federal government. not the federal government. oh, no. states are raising taxes and cutting, but not the federal government. we're just in there borrowing and borrowing and borrowing, like there's not going to be any

tomorrow. the costs incurred by our children and grandchildren as a result of this bill will be a crushing blow to their futures, a future that is already ominous because of this body. in other words, what we're saying to them is we're putting the costs on your credit card. you're in a new world where the competition is going to be keener than ever. we've got all kinds of competitors that bedidn't have when i was growing up. so they're going to have to work harder. and then we're going to say to them, by the way, your taxes are going to go up. we're going to put a burden on your back because we weren't willing to pay for or do without during the time that we were in a position of responsibility. another legacy that i'm upset about leaving for our children and grandchildren is the public funding of abortion. you know, the other day i explained to an individual that since roe vs. wade, we have had 40 -- over 40 million abortions.

40 million abortions. and yet, i have friends of mine that are wanting children, that are going to china, they're going to russia, they're going to other places to find those children. and here in the united states, over 40 million abortions. unfortunately, the language that was inserted in the manager's amendment does not protect taxpayer dollars from being used to fund abortion. in fact, the u.s. conference of catholic bishops and the national the right to life has said the language and, thus, the bill is unacceptable and should not move forward. turning back to the fiscal arguments against this bill, one of my colleagues yesterday said that those of us on this side of the aisle who argue we cannot afford this bill are being disingenuous and we're engaging in scare tactics, even asking when the -- quote -- "lying time

" "the lying time from this side of the aisle of the aisle will stop." well, mr. president, we will see. we will see. i'm not going to br of the united states senate in 2012, but if god gives me the health and the energy, i will certainly be around to remind people who was telling the truth and was not. mr. president, i yield the floor. mr. demint: mr. president? the presiding officer: the senator from south carolina. mr. demint: mr. president, i ask unanimous consent that i be allowed to speak for ten minutes. the presiding officer: without objection. mr. demint: parliamentary inquiry, mr. president. does rule 22 of the standing rules of the senate provide that on a measure or motion to amend the senate rules, the necessary

affirmative vote shall be two-thirds of the senators present and voting? the presiding officer: it does. mr. demint: further parliamentary inquiry. is it also the case that on numerous occasions, the senate has required a two-thirds cloture vote on bills that combine amendments to senate rules with other legislative provisions that do not amend the rules? the presiding officer: that would require a two-thirds vote. mr. demint: i have numerous examples here. we did it twice this year on senate bill 2349 and i could read those but i'll spare the chair all of these. i'm just trying to get at a concern we have here. am i correct that with respect to these bills, there was a combination of legislative provision and rules changes and the chair ruled that because they were -- and i'm referring,

mr. chairman, to the -- earlier this year, those he referred to where we required the two-thirds cloture. am i correct on these previous bills that with respect to the bills, there was a combination of legislative provisions and rules changes and the chair ruled that because there were rules changes, a two-thirds vote was required? the presiding officer: if there were changes to the standing rules of the senate, a two-thirds vote would have been required to invoke cloture. mr. demint: i thank the chair. mr. president, am i also correct that the senate has required a two-thirds cloture on amendments to bills where the amendments combine legislative provisions and rules changes?

mr. demint: i have a number of references on bills that this was done if there's any question, and i have given them to the parliamentarian for consideration. is there an answer? i mean, i know that there have been amendments to bills that we required two-thirds because they include rule changes. i just wanted to get a confirmation from our parliamentarian. is that, in fact, the case, where two-thirds cloture on amendments to bills have been required to have a two-thirds vote because there were rules changes included in them? the presiding officer: the chair would like to check that for a

future answer. mr. demint: okay. i believe the parliamentarian does have some of the references of times this has been done. we're quite certain it has. but, mr. president, as the chair has confirmed, rule 22, paragraph 2, of the standing rules of the senate, states that on a measure or motion to amend the senate rules, the necessary affirmative vote shall be two-thirds of the senators present and voting. let me go to the bill before us, because buried deep within the over 2,000 pages of this bill, we find a rather substantial change to the standing rules of the senate. it is section 3403 and it begins on page 1,000 of the reid substitute. these provisions not only amend certain rules, they waive certain rules and create entirely new rules out of whole cloth. again, i'll skip over some examples but let me read a few

of these provisions that amend the senate rules which are contained in section 3403 of the reid substitute. it's section d, titled referral. the legislation introduced under this paragraph shall be referred to the presiding officers of the prospective houses, to the committee on finance in the senate, and to the committee on energy and commerce, and the committee on ways and means in the house of representatives. the bill creates out of whole cloth a new rule that this specific bill must be referred to the senate finance committee. another example under section c, titled "committee jurisdiction." and it references rule here. "notwithstanding rule 15 of the standing rules of the senate, a committee amendment described in subparagraph a may include matter not within the jurisdiction of the committee on finance if that matter is relevant to a proposal contained

in the bill submitted under subsection c-3. clearly a rule change. so there's no pretense that this bill is being referred under the rules of the committee of jurisdiction. and now it is allowing the finance committee to add whatever matter it wants to the bill, regardless of any rules regarding committee jurisdiction. and of good measure, the bill even specifically states that it is amending rule 15. let me just skip over a number of other examples referring to rules just to try to get to th the -- the point here. because it goes on and on, and i've got pages here. but there's one provision that i found particularly troubling and it's under section c, titled "limitations on changes to this subsection." and i quote -- "it shall not be in order in the senate or the house of representatives to consider any bill, resolution,

amendment, or conference report that would repeal or otherwise change this subsection." this is not legislation. it's not law. this is a rule change. it's a pretty big deal. we will be passing a new law and at the same time creating a senate rule that makes it out of order to amend or even repeal the law. i'm not even sure that it's constitutional, but if it is, it most certainly is a senate rule. i don't see why the majority party wouldn't put this in every bill. if you like your law, you most certainly would want it to have force for future senates. i mean, we want to bind future congresses. this goes to the fundamental purpose of senate rules: to prevent a tyrannical majority from trampling the rights of the minority or of future congress congresses. mr. president, therefore, i would like to propound a parliamentary inquiry to the chair. does section 3403 of this bill propose amendments to the

standing rules of the standing rules of the senate? and further parliamentary inquiry. does the inclusion of these proposed amendments to the senate rules mean that the bill requires two-thirds present and voting to invoke cloture? the presiding officer: the section of the proposed legislation addressed by the senator is not -- does not amend the standing rules. the standing rules of the senate. mr. demint: okay. mr. president -- the presiding officer: and, therefore, its inclusion does not affect the number of votes required to invoke cloture. mr. demint: mr. president, is the chair aware of any precedent where the senate created a new law and in doing so created a new rule -- and i'm quoting from our bill -- "it shall not be in order in the senate or the house of representatives to consider any bill, resolution, amendment or conference report that would repeal or otherwise change the

law." is the chair aware that we have ever put this type of binding legislation on future congresses in a bill? the presiding officer: it is quite common to do that. mr. demint: i would ask the chair to get those references, if the parliamentarian would, to us. mr. president, another parliamentary inquiry. if this new law will operate as a senate rule, making it out of order for senators to propose amendments to repeal or amend it -- i've been in congress 11 years. i have not ever heard of an amendment being called out of order because it changes something that was done before. you know, how is that different from the types of senate rule making for which our predecessors in their wisdom provided a two-thirds cloture vote? this seems to be a redefinition of words in my mind. mr. president, it's clear that the parliamentarian is -- is going to redefine words, as i'm afraid he has done as part of

this process before, but this is truly historic, that we have included rules changes in legislation. we have included rules changes in this legislation yet we're ignoring a rule that requires a two-thirds cloture vote to pass it. i believe that it's unconstitutional. it subverts the principles that -- i believe it subverts the principles that we've operated under and it's very obvious to everyone that it does change a rule. mr. president, it's clear that our rules mean nothing if we can redefine the words that we use in them. and i yield the floor. the presiding officer: the chair will note that it is quite common to include provisions affecting senate procedure in

legislation. mr. demint: is there a difference between senate procedures and rules? the presiding officer: yes. mr. demint: and so the language you see in this bill that specifically refers to a change in a rule is not a rule change, it's a procedure change? the presiding officer: that is correct. mr. demint: then i guess our rules mean nothing, do they, if they can red define them. thank you. and i do yield back. the presiding officer: the senate stands adjourned until 7:00 a.m. tomorrow.

>> c-span, christmas day a look ahead to 2010 politics including republican congressman eric cantor and nbc's david gregory. buzz aldrin and fellow astronauts on the legacy of apollo 11, a discussion on the role of muslims in america and the world. later, a former cia intelligence officer on u.s. strategy against al qaeda and afghanistan. and start at 8:00 p.m. eastern membered lives of william f. junior and senator ted kennedy.

>> we now continue our coverage at the health care debate. next come the senate democratic leaders are joined by the president of the american medical association. the ama has endorsed the senate health legislation. this news conference is just under 25 minutes. >> dr., don't be bashful. we stand closer than ever to making it possible for every american to afford to live a healthy life. never have we been so close to reforming america's broken health insurance system. we're not over the finish line, but we would never have gotten this far without the support of doctors, nurses, medical professionals. we know we did action, not

excuses anymore. excuses are not going to work. this legislation is not about politics or partisanship or some poll that appears in a newspaper somewhere around the country. the legislation is really about people. our guest today, dr. cecil wilson, president-elect of the american medical association knows this as well as anyone. he sees patients, patients coming to him are there to find out if there's things he can do to help them. he feels that every day. to be part of this great organization must have a distinguished service record and he does. we appreciate his support, not only on a doctor of medicine, but his contributions to the

military where he was a flight surgeon. for us to get the support of the american medical association is really important and really makes those who've worked on this so long had a little bit of humility. in fact, a lot of humility. in the last several days, we've also received support from other organizations. the heart association, the american diabetes association, american hospital association, federation of hospitals, aarp, notice i pronounced it right today. each of these organizations know the cost and actions to hide that our bill will bring needed relief to millions and millions of americans who wake up every day without health insurance or

waking up every day afraid they're going to lose their health insurance. like those in the medical field, our responsibility as legislators is to care for people, not just those that are fortunate. that's what this historic reform fixes. it starts to break down the wall between a class of americans who can afford to stay healthy and those who cannot. americans are dying from diseases we know how to treat. living in pain because it's too expensive to ease. you hear us talk about this a lot and have a lot lately heard us talk about this, but every day, doctors like dr. wilson see it and talk about it. we know the bill will soon be sent to the president that will save lives, save money, extend medicare for ten years and basically save medicare.

dr.? >> well, thank you senator reid and thank you all for joining us today. i'm cecil wilson that you've heard on the president-elect of the american medical association and an internist in one of our florida. i flew into washington snowstorm somerset of the century because the message i have to communicate with you today is of critical importance to the nation's physicians and to the patients we dedicate our lives to caring for. after i close and careful review of the ama is pleased to report its passage of the amended health system reform bill. the senate bill includes a number of key benefits were

meaningful reform. it will include improvements in choice and access to affordable health insurance coverage and eliminate denials based on preexisting conditions. it will improve -- it will get rid of lifetime amendments on health care coverage as well as higher premiums based on medical conditions or agenda. these are imported benefits for those who have insurance now and for those who want it, but have been unable to get it. america has the best health care in the world if you can get it. but for far too many people, access to care is out of reach because they lack insurance and this is just not acceptable to physicians who provide high-quality care and are often fragmented system that doesn't work for them or their patients.

this bill will increase coverage for preventive and wellness care that can lead to better disease management and prevention. it will further the development of research that can help patients and physicians provide treatment and make better informed medical decisions. it authorizes grants to test alternative medical liability reform and show promise in benefiting patients and reducing the impact of advancing medicine. over the past few weeks, the ama communicated closely with members of the senate about support and items of concern in the senate bill. we are pleased that the manager's amendment addresses several issues. for example, the bill increases payments to primary care physicians and general surgeons and underserved areas while no longer cutting payments to other positions. it eliminates the tax on physician services for cosmetic

surgery and drops the proposed position enrollment fee for medicare. passage of the patient protection and care act by the senate will bring us close to the finish line on health system reform. there is still work to do and the ama will continue to stay actively engaged throughout the conference process to further improve the final bill for patients and physicians. we will work to resolve issues of concerns to physicians are just the creation of the medicare payment board, quality improvement, and medicare data relief initiatives. in addition, physicians and advocates for baby boomers, seniors, and military families have also engaged in efforts to fix the broken medicare physician payment formula that threatens access to care. we commend senators reid and pockets for keeping the focus on a solution for this early next

year and we will continue to work closely with them to get the solution. the ama is committed to health system reform and improves the system for patients and the physicians who take care of them. and we're pleased to be able to support passage of the amended senate health system reform bill. thank you. >> senator baucus. >> thank you senator reid and dr. wilson. this is an historic moment not only because the legislation is about to be passed in the senate, but also because of the statement we just heard. there are many organizations who are endorsing this legislation because they know it's the right thing to do for america. hospitals know that, hospice, home health, pharmaceutical industry, they all know this is good for our country. but it's also historic because

there is another endorsement, despite the american medical association. that's very important to me. the american medical association is not pose an legislation, but rather supports it. and they're supporting it in a way where once to keep working with the senate on issues that concern. he mentions the payment for doctors. dr. wilson also mentioned the medicare commission. that attitude of saying yes, this is good, it's good for the country, but also yes you want to keep working with you if that attitude of working together, trying to find a common solution, which mean so much to me and not found regrettably in the senate for the last several weeks. but you are groups that are not part of the senate, outside who want to do the right thing.

this is especially important to your endorsement for doctors. after all, it is doctors to spend more time with patients than any other group. they know what's needed. they know problems of the insurance companies denying payments. they know it's wrong that a person can't get insurance coverage because of a preexisting condition. and they also know that it's wrong for an insurance company to rescind a policy based on a minor health condition. dr. wilson also mentioned the importance of eliminating annual limits and lifetime limits of benefits. doctors know, doctors see patients, they work with patients. and dr. wilson statement also put all the reasons why many of us have given in the past, almost a year now, explaining why health care reform is so

finally important. it's important because the american medical association is taking a positive statement, which i find comforting because it's positive. a second comforting because it is honest in saying yes their issues we're working with but its attitude that we want to work with, which is i find encouraging. so i thank you dr. wilson very much. thank you. >> thank you, leader. images underscore the points made by leaders reid and max baucus and dr. wilson. i suspected you can only have one organization and the group of people that important to the bill, but choice to make is the one you're hearing today. but it's important to have other organizations be supportive. there's nothing more fundamental when you get right down to it than the relationship between a patient and their doctor. not that the most fundamental

level whether or not you have access to that doctor or the resources to be able to accommodate the doctor for his or her services. and so all the organizations and individual groups that supported this bill, i rate this one of the most important because it speaks to the relationship of patients and doctors. their number of of provisions in the spell some of them articulated already by leaders reid and max baucus. one that tom harkin and i worked on by senator kennedy cared deeply about was making it possible for young men and women who have desired to become physicians in our country to be a lot to do so by reducing the tremendous cost. and so, the scholarships, grants, loans and this bill make it possible for us to increase the workforce. some estimates are more than 16,000 primary care physicians are needed with the expansion of 31 million people who now will have health care. and so as we expand the number of people who have that kind of coverage and demand on the providers, particularly physicians will grow. and so the ability of young men

and women who have a strong ambition to be a health care provider needs to be more accessible and less costly. in one of the major provisions coming out of the health committee was in fact designed to do just that. so on behalf of my colleagues on the health committee, particularly senator harkin, senator mikulski, senator murray, senator bingaman, particularly those who worked on the organizations, this is a very ported moment. we're grateful to the ama. this'll make a a huge difference in our country. >> well, dr. wilson, thank you very much for being here and for your huge endorsement of this bill. some of you may know i was a naval back in the 60's and we always had need for flight surgeons that took good care of us. and i found out that dr. wilson is a former navy flight surgeon. in fact, we serve in the same area of operations in the 1960's.

we didn't know each other, but were the same area. as soon as we found that i knew we were in good hands. well, no one knows america's health care system better than doctors. they know the predicament of tens of millions of americans without health insurance is injuries and diseases go without proper treatment. they know the predicament of patients who have coverage, but their health insurance company refuses to pay for procedures or they canceled the policy after they get sick. they know the lives and money that could be saved if we invest in more generously and wellness and disease prevention and i thank you dr. wilson for pointing that out. so i welcome the support of the american medical association, america's doctors have sized up our broken health care system and their prescriptions for a care is to pass the patient protection and affordable care act. specifically, with regard to doctors i want to emphasize that this bill will enhance the doctor patient relationship in many ways. for example, by cracking down on

health insurance company abuses, we are going to the opportunities for corporate bureaucrats to come between the doctors and the doctors patient. this bill will reduce administrative requirements and paperwork, again for enough doctors to practice medicine and focus on their patients rather than on paperwork. this bill will significantly increase the number of primary care doctors, especially in rural areas and other underserved communities. we do this by greatly expanding the presence of community health centers and increasing investment for the national health service corps. we also create a pipeline which give increased training opportunities to help professionals working in rural areas. and i can't emphasize enough how revolutionary it is going to be to transition from our current sick care system to a true health care system. one that focuses on preventing chronic disease and keeping people out of the hospital in the first place.

that's what doctors want to do. help people stay healthy. and now these preventative services will be paid for. so again, i welcome the ama's support, america's doctors have made the right diagnosis and they've offered the right prescription to pass the health care reform bill. >> thank you. questions? >> you cited a bunch of how the ama's backing her decision. ..