own lives in some way and not just expect everything that has. in our society, we're not crazy about channeling the system. we like basically the structure the way it is. that theme, that american theme that, you know, an average person can do whatever they want to do and may be change their lives in the process is very powerful for the country. it's one the reasons why i've enjoyed being in the business for so long. what we do changes people's lives here and around the world. >> what's next for you? >> you know, i'm not quite sure. although i spent so many years in the nonprofit world and the public service world. and my interest relate to national issues, i've been involved in international and food issues. i guess i want to see if i can save the world as the last part of my occupational live.

we'll see what happens. >> let me ask you about another fcc matter which is network neutrality which with is heating up on the midst of the rulemaking and ensuring that the networks cannot discriminate against the content. the npaa has been opposed to these kind of nondiscrimination rules as they are known. do you find any room on the common ground? you seem to be locked in the content companies like google and skype that are worried about them losing the access that they with the consumer and having to go through the toll lane? >> i think it's wrong to say we are permanently opposed to these folks. that's not true. second of all, we've been working very closely with the chairman and other commissioners and finding common ground to

work on these issues. and i think we can get that.name. i would say that our biggest concern has to do with unlawful material online. how we separate lawful and unlawful and how we can make the ability to properly manage these networks on which people's information and content and entertainment go up and doe down to make sure that we can remove the unlawful material. and it could be pirated material, other forms of unlawful, pornography, other kinds of things. at the same time, protect our ability to get our product online as well. these are not absolute perspectives and principals. my hope and my belief is we're going to be able to work out with the fcc, a way to deal with our issues and still be supportive of them. the process is still

undergoing. this one is given a straight access. we talk through the problems. i'm confident we can work through them. >> >> i'd like to get your take on the proposal on the providers discriminating against the content to make the better delivery to consumers at the other end. that should be allowed. there would not be let's say comcast walking indult mall video service that may compete. do you see this as a way forward? >> i don't want to comment on the particular proposal. i haven't studied in depth. we do know that the internet, the web is kind of like the railroads, the highways and the mail system, it's changed the total course of the world. and it's democratized the

process. obviously, you want to preserve the fair and sensible and reasonable access. we'll look at all sorts of proposals like that. i go back to the point because our industry is so worried about ewe ewe -- ubiquitous product. >> and finally, mr. glickman, president obama has appointed victoria to be the new intellectual property czar. from your perspective, you're worked both sides of pennsylvania avenue, what do you think of the appointment of czars? and what do you think the effectiveness of i.p. czar? >> i don't think she's going to be the czar. you have statutory authority given to certain agencies.

he's -- she's not going to have the independent ability. what she will be able to do is help coordinate and manage the issues, elevate the concept into every single agency of government. they all believe this is high priority, and work with the congress on ways to make our enforcement in dealing with intellectual property more effective and more positive. she'll also probably coordinate all of the public comment, public discussion of this kind of thing within the government. the congress is very good at passing it. i think it shows they believe this is a priority issue to our national economy. it needs to be addressed at the highest level. yesterday at the meeting, she was there, the vice president referred to her as the federal

agencies. that's something i found that i was working to the government. one agency and other agency may not always see eye to eye or turf is a big battle. i used to say that the dirtiest four-letter word was turf. i saw that a lot when i worked in the government and executive branch. >> if the federal government can better coordinate its enforcement and does not make any other legal changes to the content that it's been supporting at home and abored, would this be enough for the content industry simply to be able to better act and protect the copyrights to the extent they can now? >> it certainly will be helpful. i think we have to look at the legislative arena to see anything there. a roll of what's happening here is affected by what's happening in the rest of the world. we need to sea what other countries are doing and work with them. >> dan glickman is with motion

picture association of america and greg piper is with the washington internet daily. this has been the communicators.

>> democratic senate leaders today said they are more likely to pass overhaul by christmas. they passed the test vote when 60 lawmakers agreed to limit debate, setting up the next procedural votes tomorrow morning. later remarks from president obama on the senate legislation. >> mr. president, for weeks we have been debating legislation

that will dramatically and permanently reform the health care. it will impact the life of every american, and it will add to our growing national debt. on saturday, the majority leader filed an amendment, increasing the size of this bill. early this morning at 1:00 a.m. we had a vote to it proceed to the reviced bill that makes really a mockery of transparency and public policy. yet, even though the majority took the opportunity to amend the bill, it is clear that the concerns of the american people were not heard by my friends on the other side of the aisle. i was astounded to see that this reviced bill still contains half a trillion dollars in new taxes, half a trillion in medicare cuts, and mandates and penalty on businesses and individuals throughout our country in a time when businesses struggling,

unemployment is up, and families are trying to make ends meet. i want to talk about the taxes. the reviced bill has an additional 25-billion in taxes than the bill as introduced. we have been hearing for weeks about families that are struggling to pay their mortgage, struggling to find the job, struggling to pay the utility bills, yet, what do we find in the bill? more taxes and more mandates. the american people overwhelmingly oppose this bill. just when we thought the final product couldn't get any worse, it does. under the reviced bill, the taxes collected from individuals that cannot afford health insurance has been raised from $8 billion to $15 billion, almost double. why? because the penalty for not purchasing insurance has become

more severe. now if you cannot afford insurance, the tax is either $750 or 2% of your taxable income. which ever is higher. there are still taxes that begin next month, less than two weeks from now. less than two weeks from now in this bill, $60 billion in taxes on insurance companies will start, accept for companies in two particular states. now that doesn't seem fair. fortunately, the constitutions equal protection clause may have something to say about this gross situation. this will not stand a test of the constitution. i hope, because the deals that have been made to get votes from specific states senates cannot

be considered equal protection under the law. and if it does stand up, and the taxes start next, two weeks from now, the people who have insurance are going to pay higher premiums, even higher than what has been projected already. in 2011, then we see the taxes on prescription drug manufacturers and medical device manufacturers. so the public can expect to see higher prices for medicine and devices, therm not tears, cocaines, walkers, the things that people need to stay healthy. that's another $40 billion in taxes. $149 billion on taxes in high-benefit plan. a 40% excise tax on the amount

on which premiums exceed $80 billion and $23,000 for teams. $87 billion collected from a medicare payroll tax. this tax is actually $33 billion higher than in the prior bill. individuals earning more than $200,000 and couples earning more than $250,000 are now assessed at a tax rate of $ -- 2.35% more than 1.45. if you were a couple earning $125,000 each, you have another tax increase. in addition to possibly a tax on not having insurance or a high benefit plan. $15 billion will be raised by raising the threat threshold for the medical reduction.

to receive the medical reduction, you must now spend 10% of your income rather than 7.5%. this tax will impact those who have high medical cost or are suffering from a catastrophic or chronic illness. this bill taxes those who have insurance, and those who don't. all of these taxes are collective. all of the taxes that i have mentioned will be collected before there would be the option that is the purpose of this bill. whatever the option becomes, it takes effect on 2014. all of the taxes that i have mentioned start before 2014. senator thune and i had a motion that would have sent this bill back to the committee and required that everything in this bill start at the same time.

so if the program starts in 2014, the taxes would start in 2014. under our motion, not one time in taxes would be paid before americans are offered the insurance option in the bill. the motion was to feed it. now the democratted had adviced the bill, the democrats are higher than the previous bill. but don't forget the penalties to business. business that can't afford to offer insurance to it their agrees. a tax is assessed. this is a time when unemployment has reached double digits. we should be encouraging employers to high more workers. yet this bill imposing $28 billion in new taxes on employers.

what will the taxes do to small business which create 70% of the new jobs in our country? in a letter sent to the majority leader yesterday, the small business coalition for affordable health care stated, with its new taxes, mandates, growth in government programs, and overall price tag, the patient protection and affordable care act, the bill that we are discussing, cost too much and delivers too little. any potential savings are more than outweighed by the new taxes, new mandates, and expensive new government programs included in this bill. that letter is signed in edition to the small business coalition by association such as the farm bureau, associated builders and contracts, associated general contracts of america, the national association of home builders, the national association of manufacturers,

the national automobile dealers association, the national retail federation, and more. the national federation of independent business, which is the voice of small business sent a letter expressing their strong concerns over this bill. it says, the current bill does not do enough to reduce cost for small business owners and their employees. despite the inclusion of insurance market reforms into small group and individual marketplaces, the savings that may materialize are too small for too few. and the increase in premium cost are too great for too many. that's the tax situation. how about the half a trillion in medicare cuts? they are still there. they were in the first bill. and they are there now. $120 billion in cuts to medicare advantage. which we know reduces choices

for seniors. in my state of texas over $500,000 currently enrolled enjoy the benefits of medicare advantage. that's just in my state alone. millions across the country like medicare advantage. but many seniors without a doubt are going to lose this option. now oddly enough, once again, one the points in the new bill is that there were opt out for certain states on medicare advantages cut. so some states are going to have the medicare advantage cuts, while other states will not. the individual fixes for certain states presumably to get the votes for certain senators, really, mr. president, does not pass the test of transparency. if you put it in the nicest

way. it just doesn't pass the test for fairness or due process and equal treatment under the law. and it certainly doesn't pass the the test for what is the right way for us to pass comprehensive reform legislation. the other health care cuts in medicare would be $186 billion in cuts to nursing home, home health care, and house piece providers. and then there are the cut to hospitals. approximately $135 billion in cuts to hospitals. the texas hospital association has estimated that hospitals in my state will suffer almost $10 billion in reduced payments. i have a letter from texas hospital association that outlined their concerns with the cut and this bill. and they are very concerned.

here's one the quotes from their letter. the texas hospital association says with a significant reduction in payment, hospitals may be forced to reduce medical services. hospitals may be forced to close or merge with another hospital or severely reduce the services they provide to their communities. essential service such as paternity care, medical services or wellness program may be reduced or eliminated entirely. mr. president, i don't know so many -- i've talked to so many hospital administrators and people in hospital boards. and they are very concerned about the cuts in this bill. because they are on very thin margin. most of them -- they are struggling. and especially in our rural areas, and they are very worried that there are going to be shutdowns of hospitals

throughout our state and certainly our country. but our aging population is growing. so cutting pavement to providers who treat those, doesn't seem to be a way to reform medicare. cuts in medicare and especially the pavement for treating low-income seniors will disproportionally impact rural hospitals which are the safety net of the health care outside the metropolitan area. the texas association which represents 150 rural hospitals, we fear the medicare cuts could hurt rural hospitals which are the health care safety net for more than two million rural

texans. because of lower financial margin and higher percentage, rural hospitals will be impacted more than urban hospitals. it will have a devastated effect, and the closure of some of these hospitals in texas is a real possibility. how would could anybody support a reform bill have been to drive 90 miles and more. care that was accessible in their community before the bill took effect. mr. president, what we have here is a bill, heavy with tax cuts -- tax hikes, medicare cults and government inclusion. this bill is being forced

through congress because everyone knows this is not the perform that americans want. we all know that polls can have margin of errors. maybe they are not completely accurate. but the trend is the polls is clear. it has gone from people thinking the health care reform is a good thing to going down now to the point where the trend is clear. the american people now do not snort bill. they would rather have nothing according to the latest polls, and have congress start all over and do what they hoped it would do. and that is bring down the cost of health care. not have the big government increase in debt, cuts to medicare, and increases on taxes to small business and families, especially at this time.

my republicans and i have tried to offer alternatives. allowing business to pool together. if you have the exchain with the pools that are increased, it would be fine unless you have so many mandates like we see in this bill that are going to cause the prices to stay up. and even get bigger because of the companies that are providing the health care. creating the online marketplace from government interference would be a republican proposal. something that i think would be a point at which we can start having health care reform that

would be truly effective for america. if you didn't have the mandates that would drive up the cost. offering tax credits to individuals and families that purchased insurance on their own. that's a bill that we have put forward. $5,000 per family would cut the cost and make it affordable without any government intervention that would be necessary. and of course medical malpractice reform could take $100 billion out of the cost of health care by stopping the frivolous lawsuit or at least limiting them. republicans are not at the table. the bill was written in a room. no transparency, no c-span cameras, and no republicans. we did not have input into this bill.

that's why it is the bipartisan bill. that's why the vote at 1:00 a.m. was completely 100% partisan. because why would a republican vote for a bill that goes against every principal that we have. higher taxes, higher fan -- mandates, and cuts in medicare. we had one agreement passed. there were hundreds of amendments left on the table that we were closed out of offering because of the rush to pass the bill before christmas. mr. president, americans ask for reform. they deserve it. this bill is not the reform that americans hoped to get from a congress that would have acted responsibly but it not. thank you, mr. president, and i yield the floor.

>> mr. president, the senator from texas. >> mr. president, like my colleagues on this side of the aisle, i voted against the reid health care bill last night, because it cuts $470 from medicare to create the entitlement program that will cost $2.5 trillion over the next ten years. a price we cannot afford. it increases proceed yums from american families that currently have health insurance and who are struggling to make ends meet during tough times. and it increases taxes on small businesses and individuals which is a terrible idea, particularly at a time when our economy is struggling, and our job creates were struggling to be able to keep people on the payroll and expand and hire people back and bring down the unemployment rate. but i want to talk about the way

this bill came to pass at least the vote this morning at 1:00 a.m. i want to talk about the process. i recall that when senator obama was running for president of the united states, we talked about wanting to change the politics as usual in washington, d.c. but i have to tell you, the majority of this administration have in many ways confirm people's worse suspiciouses about washington politics as usual. and they have taken it to a new level. and that's not a higher level. it's a lower level. as a matter of fact, the bartered, the sweetheart deals with drug industries. with senators in order to get the 60 votes is nothing more, nothing worse than confirming the worst fears that the american people have about the way washington works.

we know the bill is a direct result of many special deals with interest groups in their lobbyist. we heard the president say when he ran that he wanted to have the transparent process. that would take place in front of c-span, so people can see who's making arguments on behalf of the drug companies and the insurance companies. but that rhetoric conflicts with with the drug companies and the insurance companies and others were negotiating behind close the doors for sweetheart deals for ultimately ending up getting 60 votes. legislation, does completely the opposite. this is tragic, in my view, mr. president. the american people want to believe in their government. they want to believe in their elected leaders who are trying to do their best on behalf of

the american people, but this process confirms their worst suspicions. no wonder public opinion of congress is in the toilet. rather than listening to the american people, the creators of this bill started cutting deals with special interest groups first and cut those deals early. the white house struck a deal with the pharmaceutical industry, as you know, which produced in part, as "the new produced in part, as "the new the white house struck a deal with the pharmaceutical industry as you know, which produced in part as "new york times" reported about $150 million in television advertising, supporting this bill. and this deal got 24 democrat when we were debating the issue of drug reimportation to switch their vote from their previous position against drug reimportation earlier this month. we know the insurance industry

notwithstanding all the rhetoric about insurance companies that basically this is a sweetheart deal with insurance companies because insurance companies will get $476 billion of your tax dollars and my tax dollars to pay for the subsidies in the insurance is provided in this bill. the hospital industry cut a special deal that provided them an exemption from the payment advisory board and then there were groups like aarp that purport to serve seniors as they interest but we know primarily pockets money as a result to sale of insurance policies. ensures policies that will be necessary because of cuts in medicare advantage for 11 million seniors, just to name one example. this bill was the result of backroom deals with specific senators, persuading them to vote for cloture, what has caused some people to call on

the blogs and on the internet cash for cloture. in order to get 60 votes for cloture we know one of the first examples of that was a so-called louisiana purchase. charles krauthammer said it well. he said after watching louisiana get a hundred million dollars was not called the louisiana purchase she ought to ask for $500 million instead. and that's because obama said he would end business as usual in washington. so it's a new kind of business as usual. in other words, i guess the price has gone up. but one business leader points out that notwithstanding the special sweetheart deal for the state of louisiana directing $300 million to the state that the medicare at engine alone here results in the tax payers and the payers of louisiana being a net loser. we know that in order to get 60 votes the majority had to cut a deal with the senator from nebraska.

the senior senator from her brow scott in order to get the vote for cloture. it's been widely reported that that meeting with the senior senator of nebraska to place for 13 hours behind closed doors after which they negotiated some language, which purportedly no longer allowed the use of tax dollars to pay for abortions, but which according to the conference of catholic ships and other pro-life groups is completely ineffectual and which restores are actually produces a taxpayer paid for abortions for the first time in three decades. what else did the senior senator from nebraska debt? well, the state of nebraska purportedly got a free ride from washington's new unfunded medical mandates on the states. but of course we know that every other state is a paying for that sweetheart deal that the senior senator gotten for nebraska. what do nebraskans think about

it? well, just as the governor, governor dave hyde amendment said yesterday he had nothing to do with that deal and called the overhaul bill that is for nebraska and bad news for america. governor heinemann said he did not ask for a deal just a fair deal. we know that in order to get 60 votes to majority leader had to cut a special deal with the senator from vermont, one senator from vermont threatened to vote against the bill but then low and behold the managers package included $600 billion benefiting only that one state. the senator threatened to vote no decided to vote yes after that special deal was concluded. "the new york times" list several other sweetheart deal to produce this monstrosity piece of legislation. the intended beneficiaries though in many institute were identified and a vague and sort of cryptic way.

individuals exposed to environmental health hazards recognizes health emergency in a declaration issued by the federal government. in june the 17th. while there's only one state that would qualify for that, notwithstanding the sort of vague description designed to hide the ball and -underscore what was happening to another sweetheart deal as part of this bill. another item in the package would increase medicare payments to doctors and hospitals in many states were at least 50% of the counties are quote, frontier counties, to find those who have a population density of less than six people per square mile. and then we know that there was another hundred million dollars sweetheart deal for an unnamed health care facility affiliated with an academic health center in a stage where there's only one public medical and dental school. "the associated press" reports that the state not qualified for

that special deal is the state of connecticut, where the senior senator currently is in a tough reelection fight. now mr. axelrod, who is the architect of the campaign strategy for this administration to bring change to washington when asked about the special deals in the managers amendment his his response was pretty telling. he said, that's the way it has been, that's the way it will always be. well, maybe in chicago, but not in my state and not in the heartland and the vast expansion of this great country where the american people want us to come in to represent our constituents and vote for what is right in terms of policy, no account of sweetheart deals we can eke out at the expense of the rest of the american people. the very thing that's happening with this health care bill demonstrates why washington takeovers are such a terrible idea. because instead of health care

decisions being made between patients and doctors, health care decisions are overcome through a political process where a elected official winners and losers. politics has become a dirty word outside of the beltway and certainly we can understand why this process is only reconfirmed in the minds of many people that what we are doing here is not the peoples business, but protecting special interests and special sweetheart deals. rather than making decisions about what's best for the american people, this deal has been driven by deals with special interest groups and lobbyists and rather than listen to constituents individual senators have decided that they are both should be traded for tax dollars and other sweetheart benefits that go to their states. but make no doubt about it, this bill takes the power from individual americans to make

their own health care decisions and transfers back to washington d.c. and this new low level of politics as usual. mr. president, according to a recent poll that occurred today where was reported today for one state that went to mention by name where only 30% of the respondents of this bull favor this health care bill and 64% are opposed. the senators from those states voted for the bill were only 30% of their constituents reportedly support the bill and that's not the only example. and you can only ask yourself, why in the world would senators vote for a bill when two thirds of their constituents are opposed to it? who must they be listening to? are they listening to the people that represent and send them here to washington to represent them or are they listening to the special interest or have

they decided on how that they've become oracular sleep smarter than their constituents? and they know what's better for their constituents than what their constituents know themselves. mr. president, this debate is not over. there's la champ to vote against this bill. the senator mcconnell said last night, any single senator on the other side of the aisle can stop this bill. or everyone who votes for will own it. i yield the floor. >> mr. president. >> senator from nebraska. >> mr. president, let me start my comments today i complementing the gentleman from texas. i thought she did an excellent job by shining the light on some name that is now gathering a lot of intention because the manager's amendment is out and we can read the words and we can

start to understand the special deals that were cut to get the votes, to make this happen. so i applaud you for standing here so courageously. mr. president, my state, the great state of nebraska has been pulled into this debate and i want to start out today by saying here on the senate floor that night and enormously proud of my state, probably like all united states senators in reference to their states. i'm enormously proud of the people of nebraska. i've gotten to know them well. i was their governor and on a more localized basis, i was also the mayor of lincoln and i date my time in public service back to the time when i was lancaster county commissioner and a city council member in lincoln.

these are good, decent, honorable people who are always looking to try to figure out the right way of doing things and i stand here today to acknowledge that and to tell all nebraskans how proud i am to be here today. mr. president, i rise to share with my colleagues the reaction of nebraskans to the special deal that got cut for nebraska that came to light over the weekend as the manager's amendment was released and analyzed. less than 24 hours after the announcement of the special carveouts for nebraska, with virtually no warning, no preparation to speak of 2000 people gathered in omaha nebraska, nebraskans to win one voice cry.

nebraskans are frustrated and angry that our beloved state has been thrust into the same pot with all the other special deals that got cut here. in fact, mr. president, they are outraged that a backroom deal for our state might have been what is this bill across the finish line. you see mr. president, i fundamentally believe that if this health care bill is so good it should stand on its own merits. there should be no special deals, no carveouts for anyone in this health care bill. not for states, not for states, not for insurance companies and not for individual senators. you know, i stand here today and i find it just enormously ironic that advocates for this bill who

worked overtime to vilify insurance companies in the last hours of putting this bill together struck a special deal with two insurance companies in omaha, nebraska that they would be carved out of their responsibility in this bill to pay taxes. i found -- find it painful to even make knowledge that that's happened. i said at the beginning of this debate that changes of this magnitude affect the one sixth of our economy must be fair and they must be believed to be fair by the law. the special deal for nevada was wrong. i said that. in fact one of the six reformed principles i publicly outlined and took out two town hall meetings, i stand by today. and it just simply said no

special deals. the special deal for nevada was wrong as is the carveouts for louisiana and the same applies for the backroom deal that was struck for my state, the great state of nebraska. all of the special deals should be removed from this legislation. if this bill cannot pass without the carveouts, the special deals, what further evidence could we possibly need to draw the conclusion that this is just enormously bad policy? if you literally have to sit down in the last hours of negotiations and strike a special deal, do we need any other argument about how bad the policy of this bill is for my state and the citizen of nebraska? our governor said it well, nebraskans don't want a special deal. you see, i went around and stay

for months doing town halls and listening to nebraskans. they don't want a special deal. no nebraska and came up to me and said mike, get me a special deal. you see, their request is simple. they want to be able to see the doctor of their choice and to keep the current plan that they have. they want our job creators, our small businesses to get our economy moving and create jobs in our communities from large to small, free of the half trillion dollars in taxes and fees that this bill will keep on our employers. the manager's amendment does nothing to change the core problems with this bill. the nearly $500 billion in medicare cuts will be devastating to nebraska and no

special deal with an insurance company is going to make nebraskans feel better about that. no special deal to make the state budget book better is going to make nebraskans feel any better about the medicare cuts and the impacts on our hospitals, our nursing homes, our home health care industry, our hospice industry. nationally governors, republicans and democrats, have stepped forward to say that they can't afford the unfunded mandate that come from washington and drive their budgets into the red. the special deal struck on abortion is enormously tragic and insufficient. it breaks my heart. this is a far cry from the 30 years of policy by this united states government. you see, when this is done and over, what we will be reporting

to our citizens is that taxpayer funds will fund abortions if this bill passes. you see, no watered-down accounting gimmick will convince the pro-life community and my state or otherwise. in fact, they have publicly said they feel betrayed. i'll wrap up with this. this bad deal is not sealed. there is time for a truly pro-life senators to stand tall and say now. there is still time for senators to reject the carveouts and to cast aside the bad backroom deals. there is still time for senators to listen to the people and reject reckless federal policy. fair treatment isn't too much to ask of washington. i know when my state that's what they're asking for. i will firmly stand behind any senator who has the courage to

stop this train wreck. i'll be the first to lead the applause and i'm confident this standing ovation for that courageous senator will extend all the way back to nebraska and it will be deafening. thank you, mr. president. i yield the floor. >> mr. president? >> 2.5 minutes. >> i would think one of the things we would have seen from the majority at this point is a list of what the last two senators were talking about. all the earmarks that are in this bill because -- i ask for

parliamentary inquiry yesterday. i'm not going to ask for that again. as we said yesterday, rule 44 was adopted as part of a major ethics and reform legislation adopted in 2007. it was part of the honest leadership and open government act. the democratic leadership made the first bill to be introduced when they took a majority in 2007, taking control of congress for the first time for a long period of time. and this -- bill passed by unanimous consent when -- when rule 44 was passed the theory behind it was that we ought to have total transparency on earmarks.

that applies to four amendments like the pending read bill, it requires the sponsor of the amendment to provide a list of earmarks in that amendment, earmarks are provisions that provide limited tax benefits and those are words limited tax benefits words out of the rule and another substitute language for limited tax benefits congressionally direct its spending items or earmarks as they are generally referred to by the public at large given what a priority of the new rule passed in 2007 was given and the importance of it. one would expect that the majority leader would be making every effort to comply with it. one would think that he would be wanting to set a good example in

complying with the rule and disclose these earmarks in order to ensure transparency of these very narrow provision like what the senator johanns just referred to to get the votes of specific members of the majority party that probably would not have voted for this bill. you would link that that ought to be made public. that's what rule 44 is about. and of course that burden under that rule is on the sponsor to provide the list. so once again, i'm going to ask the democratic leadership to comply with the honest leadership and open government act. >> the senator from california. >> madam president, you just heard our republican, a republican friend say that it's very hard to defend our bill. now maybe it's hard for them,

but it's not hard for the american medical association, the ama who was endorsed our bill. it's not hard for the american heart association who have endorsed our bill. it's not hard for the american cancer society action network who have endorsed our bill. the american hospital association who have endorsed our bill, families u.s.a., the business roundtable, the small-business majority. we hear colleagues a small business opposes our bill. the small-business majority organization supports it and how about the aarp who represent our seniors? millions of seniors. that's just a few. they not only defend our bill, they support our bill. madam president, this is a deed an important moment in our nation's history as we approach a final vote on this major health care reform legislation.

and i think whenever you're trying to change something, you have to take a look at how things are at the moment. so why is it that we need to change our current system? and there is certain numbers here that i think explain it. the first number is 14,000. madam president, we know that every single day 14,000 of our neighbors lose their health insurance through no fault of their own. they either lose their job, they can't afford to keep up health insurance, or they have a condition in the insurance company walks away from them. or they just are priced out of the market. 14,000 a day. that is cruel and we need to change it. 62% of bankruptcies are linked to health care crisis. now, where the only nation in the world where people go broke because they get sick.

if we do nothing, 45% of an average family's income will go for premiums in 2016. i ask everyone to think about it. paid 45% of your income for premiums. it's not sustainable. what about food? what about clothing lacks what about shelter? can't do it. we are 29th in the world on infant mortality. we come in behind cuba. we come in behind singapore. we come in behind south korea. twenty-ninth in the world on infant mortality because people don't have good insurance or they don't have any insurance. 52% of women, 52% of women don't think the health care they need. they either put it off or they never get it because they may not be insured or they're afraid of the co-pays, they're afraid of what it would cost. it may have limits on their

policies and we need to change it. and the u.s. spends twice as much on health care than most other industrialized nations. so what message here? we spend a huge amount, we're not doing very well in outcomes. by the way, i think were 24th in life expectancy in the world. twenty-fourth, we must do better. i want to share with my colleagues some of the letters and e-mails that have been sent to me from californians that personalize the statistics i just showed you. mr. william robinson wrote, i'm about to be laid off from the job i've had for 19 years. my biggest fear is not being employed, but being able to find and get affordable health care. i'm 60 years old. i have a preexisting condition that will for certain make it impossible for me to buy health insurance.

mr. and mrs. gilbert de la cruz quote, we're at the point of losing our home because we've spent our savings on medical and prescription drugs. i'm 67, retired and my wife is 62. because of the medicare gap and prescription drug coverage, we have to pay $600 a month on prescription drugs. it's a huge portion of our monthly income. we will be selling our home shortly because -- and perhaps moving in with one of our children because there doesn't seem to be any option. well, i want to say to mr. de la cruz, help is on the way. if we get the 60 votes, we are forced to get, not 50 when the majority, but 60 votes because of the republican filibuster. we get those 60 votes each time, there's hope for you because we are going to fix that entire

problem. mr. ronald kim, he says i'm in the construction industry and my work is very slow. he says he is in the design industry. i'm in danger of becoming financially ill and i'm looking for ways to stay healthy. and one way may be to eliminate my medical insurance. it is a significant part of my budget. this may, heaven forbid, lead me to financial ruin if i get sick. this is my situation. i want to say to mr. kim, help is on the way. this is not a lead foot rubs companies are all californians, my constituents. i recently turned 25 and lost my health coverage. i attempted to get health care under blue cross plans created for young people my age but because i had taken medication i was denied. i applied again for another plan, was offered a plan with a

3000-dollar.apple deductible and was $300 a month on top of that. as a young person working in a restaurant, repaying student loans and trying to make it on my own, this is a huge financial burden. i cannot afford an insurance that charges me so much and won't be any benefit for me and so i shelled out a huge portion of my income. to madeleine, i say help is on the way if we can break the republican filibuster. mr. john higdon wrote, as a self-employed person i have a pacemaker implanted. the cost was borne entirely by me at prices much higher than any insurance company would've had to pay. that was a wake-up call to get health insurance. i'm told by every health insurance company i've contact did that no one, no one will offer me health insurance at any price with a quote, preexisting heart condition.

and i want to say to mr. higdon, help is on the way. dr. robert meagher, a turk, a pediatrician for over 30 years. you know what he wrote and told me? that he has to fake, he's pressured to fake a diagnosis because when a parent comes in with a young child with asthma, they bade him not to write down as not the breakdown bronchitis because if he writes down asthma that child will have a preexisting condition and when she turns 21 she won't be able to get insurance. imagine an america a position dean pressured to lie on a form because of a health care system that is so cruel. so dr. meagher, we are going to change things here if we can break this filibuster.

mr. douglas inglesby wrote, i am a small business i employ 11 people. i've been in business in california since 1972. he says, i used to provide health care for all my employees and all the members of their families and if i want to remain profitable enough to stay in business now he says he can't do it anymore. you can only cover the employees, not their families. he feels terrible about it and he says he may have to cut off his employees as prices keep going up. and i want to say to this fine small business owner, douglas, help is on the way. and mrs. linda schumacher wrote and this is the one i'll close with and this is a series of stories. i am a republican. to me repeat what she writes. i am a republican and my husband and i are small business owners. the senators and congressmen of both arteries who are against president obama's plan have their own insurance.

and it is my understanding, she writes, that it does not cost what we pay. they do not understand what a huge expense this is. leaflets into the middle class who are in our position or who no longer have insurance. it keeps me up at night worrying. this time the republicans have the wrong and they need to know. please push a health plan. the insurance companies only care about the bottom line, not people. and i want to say to mrs. schumacher, thank you for putting aside party politics because this isn't about republicans and it isn't about democrats. it isn't about independence. it's about all of us together. so what happens now is you are hearing the polls, the polls show americans don't want us to act. and i understand why.

there is spend so much misinformation. senator durbin and i are assistant majority leader talking about the misinformation on the other side day in and day out. and i believe much of it if i might say is purposeful. if you listen to my republican colleagues over the past few days and weeks, they have trashed this bill and they've trashed the process. over the weekend, the republican leaders that health reform is a legislative train rack of historic proportions. at the direct quote. earlier this month senator coburn used more inflammatory language when he said to seniors, i'm quoting senator coburn. i have a message for you. you are going to die soon, unquote. well, if you want to know what fear mongering is, that's the best example i can give you. so, you know, i decided to go back and look at the past

congressional records and i thought, have republican spoken like this over the years every time we tried to do some health care? every time we try to make life better for people such as social security. and i'll let you be the judge. in 1935, on the floor of the house of representatives, during the debate on social security, republican congressman jenkins of ohio said a social security bill. remember it hadn't passed. quote, this is compulsion of the righteous kind. don't be misled by the title. the title says quote, old-age benefits, unquote. shame on you he said for putting such a misleading and unfair title on such a nefarious bill. old-age benefits? gigabit ethernet. zero what a travesty. mr. chairman, what's the hurry? no one will get a dime out of this until night and 32.

and if you listen to some of my colleagues, you will hear the same thing. what's the rest? as a matter of fact i have four or five amendments. senator to committee, what's the rush? the rashes that 14,000 people are losing their health care every day. the rush is that 62% of bankruptcies are linked to a health care crisis and in 2016 our people will be paying almost half of their income for premium. yeah, we've got to do this and we started it seven months ago. in 100 years ago teddy roosevelt, a republican president, but in his platform. what's the rush? what's the rush? i want to tell you about another republican, congressman j. william did her of pennsylvania. this is what he said. he said security for the individual whether worker or agent will be a mockery and a

sham. this is what he said about social security. and it will a lot to our people the role of puppet in a socialistic state. that's what he said back then. and i tell you, if you ask republicans who are getting social security, democrats who are getting social security, independents who are getting social security, they'll all tell you the same thing. keep your hands off it. it works, it goes, it's fair. it's insurance, it's what we did way back then. in 1965, when medicare passed that was health care for those 65 and up. senator -- republican senator carl curtis decided socialism. it moves the country in a direction which is not good for anyone. and years later, we know newt gingrich when he was speaker of the house said he wanted to see medicare wither on the vine, his

words. and in 1995 while seeking the republican nomination for president, senator bob dole, he said quote, i would say are in 1965 fighting the fight, voting against medicare because we knew it wouldn't work in 1965. so when you hear our republican friends say my goodness, they're making a lot of savings in medicare, this is bad for the seniors. please, please, which party has good for protect dean our seniors? it's not a matter of being bipartisan. it's just a fact. so the echoes of the past fill this chamber, but i'm convinced now in 2009 that hope and reason and determination and good policy will triumph over fear and obstruction and the status quo. let's look at the immediate and near-term changes for the better that people are going to have because our colleagues say we

are raising revenues but there's no benefits right away. let's talk about what the benefits are. and i don't have time to go into them. i have them in a statement which will be placed into the record. there'll be a $5 billion high-risk pool immediately for people with preexisting conditions who can't find insurance. they'll be re-insurance for retirees so if you're retired and you're getting your health care benefits and something happens to your company, there'll be re-insurance so you can still get your benefit. we close that doughnut hole for the medicare recipients who fall into it and suddenly they can't afford their prescription drugs. there will be billions of tax credits, billions, up to 50% tax credits for small business. that's why we have the support of snow when a small business is. and for new policies, no discrimination against children with preexisting conditions and children can stay on their

family policy until they're 26 years of age. what else are the immediate and near-term changes for the better? before new policies, no lifetime limits, no more precision they can't walk away from you when you get sick. they're required to cover essential preventative health benefits like mammograms, prohibits discrimination by employers based on salary of their employees. so an employer can't say well if you earn over $250,000 you get these great benefits, but if you earn under $50,000 you get a worse array. a 2011, standards for insurance overhead costs go into place. and if your insurance company spends too much on overhead and too much on executive pay, let me tell you what happens. they have to rebate to you the policy holder.

we also see increased funding for community health care senators. this is going to make a huge difference. there'll be a national website to shop for an affordable insurance. there'll be a long-term care program that is voluntary that you can buy into. insurance companies with unreasonable premium increases can be barred from the exchanges that will be set up in 2014 so they'll be making sure they don't increase your premiums beyond a reasonable amount. this bill will benefit the insured. and one way, i don't think people understand this, by 2014, 62% of families will no longer face unsustainable premium cost. if you are a family of four and make less than $88,000 a year, you will never have to pay more than 9.8% of your income on health insurance premiums. could we have some order please?

>> the senate will be in order. >> so, this is an amazing thing that most people don't focus on. i just explained that the nonpartisan studies show and this is important that will be paying an average -- the average family 45% of their income for health care. in 2014, people in this country will not have to pay more than 9.8% of their income on health insurance, otherwise they'll get tax credits. and that is very, very important. now this bill is going to benefit our seniors. that's why it's endorsed by the aarp. we eliminate the prescription drug coverage gap. that's the doughnut hole. we extend the life of the medicare trust fund by nine years. we reduce waste and fraud in medicare and we provide for free

yearly wellness visits for seniors. this bill saves medicare. this bill makes our seniors stronger. they will have more benefits and they can never lose their guarantee benefits. small businesses will be able to reduce their cost again by getting immediate tax credit. and in 2014 they will be able to access the exchange as well self-employed people and they will have the power of big business behind them, as they go into those exchanges. i want to talk about public-interest provisions. i wanted a public option, but me be clear. because i thought it would keep the insurance companies honest. but let me tell you what we have in here that our public definitely public-interest provisions. we expand medicaid, that's a public lan, to cover an additional 14 million people.

and that starts in 2014 and that's 1.5 million californians. and the federal government in my state will pay the full fare for those avid people for three years. and after that, far more than we get paid now. hhs will set the initial rules for the state exchanges. for those getting into the exchanges have to be fair. the opm plan, that's the plan that will be part of the exchange will be set up by the government, the office of personnel management. and again community health centers and a basic plan can be created by the states which i think is very important and i want to thank her re-cantwell for working so hard on not. so if people tell you, we don't have anything to do with public options, they're really not right. you have to look carefully at this bill. now, i want to talk about the deficit. we reduced the deficit between 2010 and 2019 by $132 billion

between 2020 and 2029% to a $1.3 trillion deficit reduction, according to the congressional budget office. that is a nonpartisan office. this bill reduces the deficit. i'm going to say one more time. this bill reduces the deficit and the reason is we invest in prevention and that pays off. we finally will be able to save the insurance companies gouging and that pays off. and we do have competition here now because we will have that special plan won by opm, the state option that maria cantwell put in there. this is why we see the reduction including taking the fraud and the ways out of medicare. we don't need fraud and waste. so here's how i want to close. health care coverage for all

americans has been such an elusive goal for nearly a century. if you look at republican president and democratic presidents and republican congress is in congresses, we've tried it over and over. and the status quo has always prevailed. our beloved friend, senator ted kennedy, whom we missed so much particularly during a time like this spot for health care right here on the floor from the moment he became a senator in 1962 to the moment he died. in an odd bad in the "washington post" this past friday, ted kennedy's wife vicki wrote, ted often said we can't let the perfect the enemy of the good. and i want to say to vicki, she's exactly right. each of us could write this bill our way. believe me, if i wrote a bill to me it would be perfect. but to my friend in the chair, she'd say well, you know i could

make it better. and all of us could. this is the legislative process. this is a good bill. vicki goes on to say, the bill before the senate while in perfect could achieve many of the bolts had 54 during the 40 year cgi-bin access to quality affordability for all. he is not your two are just, not to let this chance slip through our fingers. and she says i humbly ask his colleagues to finish the work of his life, the work of generations to allow the vote to go forward and to pass health care reform now. as ted opry said, when it's finally done, the people will wonder what took so long. i want to thank vicky not only for writing that wonderful editorial, but also for actually being in the chamber when we took that first vote to break down the filibuster. colleagues, i am so proud that

today we are moving closer to fulfilling the promise of health care for all americans, including the 40 million californians that i am so privileged to represent. i thank you. i think my colleagues for other work they they put into this bill. i spent a lot of time on it myself and this moment is very poignant and i hope we pass it. i thank you and i yield the floor. [inaudible conversations] >> the senator from massachusetts. >> i think the chair. madam president, let me begin by commending the senator from california, the really outstanding presentation regarding this legislation. i was listening to her before i came over here in my office.

i listened to her over here and she's really laid out a very careful and delivered it in a thoughtful way. the realities about this legislation before us, i really want to thank her or that terrific presentation. and i want to sort of pick up a little bit where she is left off. but let me just in choir so i understand where we are here. can i ask, shall we have remaining on the majority side? >> the majority side has 34.5 minutes remaining. >> i thank the chair. let me begin by -- let me begin by saying that i listen also to our colleagues on the other side of the aisle, particularly the senator from south dakota just a little while ago. and i was really struck by the chart that they put up showing medicare going up and up and up. and then they talk to americans,

basically scaring them, trying to say well, if you pass this bill is not going to do anything to reduce the crisis of medicare down the road. and the reality isthat that's all they present, is a scary picture of the future, which they're not even describing accurately. now they've had a year and a house, a year and a half that we've been working on this legislation since it was announced in the finance committee, which i serve on and we heard and we held a daylong, a think a two day conference where we began the work laid the groundwork and foundation for a new president we end for the work that is going on this year. many of their members took heart and not. and so there is no secret as to

where we are. this is a debate that's gone on in the united states of america since harry truman was president of the united states and before. we all know that president teddy roosevelt, a republican, but before the country the notion that every american should be able to have their sickness still with. and nobody has ever contemplated that you ought to go bankrupt in order to be able to have health care. but as we know, we have more bankruptcies in america, health care bankruptcies, every year than any other nation on the planet. i think we're the only nation that really knows health care bankruptcy. and the stories that we've heard, countless stories, you know, earlier this morning when we were here at 1:00 in the morning, we heard the majority leader talk about those very

poignant movie in situations of individuals in nevada. we heard the senator from california. there are stories from every senator, from every state. and yet, it is only that this dividing line right here down the center of this chamber. it is only the senator's of this side of the dividing line who seem to be prepared to try to address this issue. the fact is that the managers package, which is now the pending business before the senate, brings us close, even closer to being able to address many of the major concerns that we have. now, senator after senator has come to the floor and describe the way in which this bill doesn't do everything we wanted to do. i've been a passionate supporter, as was ted kennedy and a lot of other of our colleagues of a public component of this plan. why? he does i believe that's the

best way to create the kind of competitive pressure that will retain a group of insurance companies that have shown no predeliction to restraining themselves over these past years. if you are for the status quo, then 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 are breaking the back of businesses. they are a huge albatross surrounding the mac of american competitiveness. many of our companies have a harder time competing because there is a health care premium tax, if you will, for the uneven distribution of being sick in america. incidentally, obviously, if you are sick in america you get care at some point in time. it maybelle we bet that point in time is in your deathbed or when

you're so sick that you finally go into the hospital or emergency room in 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 why somebody who has a health care plan gets, which may be a or a pap smear or a psa test for 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 learned that they had a type of

diabetes that might've 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 and its probably more it ought to. and we often refer to something as being historic or otherwise 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 are living here now. when i think of what we try to do in 1993 and 94, when president clinton was there, we tried to pass health care and we got beaten back by false lover thyssen, harry and louise eratosthenes and i might add a plan that didn't quite pull the pieces together as effectively as we have. and we learned a lot of lessons since then. and we've had many fits and

starts. children's health care, trying to deal with certain gender discrimination or other discrimination for the systems eared we've gotten little pieces done, but all the time the basics of the system of band without the reform necessary to bring down costs and make health care more accessible to more americans. so i've 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 pass 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 quality of care that people love, the premiums and 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 reason we can't provide it late in massachusetts because there's certain things we do in massachusetts that the other side were some folks have prevented us from doing here. the fact is that -- let me sort of lay out a couple 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 going to be able to save money in the legislation that we are 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 cbo, the congressional budget office. they don't measure many of the things that we are going to do in this legislation that in fact

will reduce, all of us now, as a matter of common sense. many of the measures in this legislation are going to reduce the cost of health care. and one of the reasons is that cbo 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 cbo found only night teen billion dollars in government savings from transitioning towards postacute bundled payments and medicare. but recent research in the "new england journal of medicine" suggests that bundled payments, bundled payments for somebody listening that doesn't understand, when you take all the payments that come to a hospital or to the providers are provide the care and the payments are all put together for the various services 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 they take care of this patient and all of your various parts have to fit into a hole today. 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 redundant. it's noncommunicative and that's one of the reasons why in america we don't get the same outcomes are less money that people get in europe or in some other countries. so what we've learned is that the "new england journal of medicine," which is highly respect it medical journal suggests that the bundled payments for chronic diseases and for elective surgeries could

reduce health care spending by as much as 5.4% from 2010 to 2019. are we don't get credit for that savings. they don't talk about it. but common sense tells us because we seem to where they've done these bundled payments, they're going to reduce the cost. in addition, even if some savings only applied to half of the spending in health care back there or the result would be more than $900 billion in savings over the next ten years teared his bundled payments get expanded beyond the postacute care and even half of the potential savings from bundled payments were realized in the medicare pro-program during the upcoming decade, these savings would translate to an additional .2% of savings per year or a 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 formerly presented to the american people as part of this process because the bureaucratic technical rules about what the budget applies to. everybody on the other side of this file knows as a matter of common sense that if you look at the experience the way authority proven in the marketplace and if you just apply your thinking to this, we are 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. 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 some money, it's about a penny

insurance paperwork if you go to the atm machine and pull out money, it is about a penny or half a penny per who transaction. if you go to a hospital where they don't have technology managing director and people are doing it, it is about $2,425 per what transaction to pull the records in the age of information technology. it doesn't make sense when. and all of us who know that but we also know because we are putting the money on that he will and incentives in place to help do that we are trying to be able to get additional savings. all of the savings are on top of the trillion dollar savings high already talked about none of which gets measured when our colleagues come to the floor and ceiling a terrible bill this is. cielo has also underestimated savings in the past and i am not picking on cbo. they've done an incredible hard job and they've done an incredible job they completely overworked any number of efforts week asking them up for the

models and analysis. but it's automatic and a process. according to the generic pharmaceutical association in 1984, it was predicted we would save our country 1 billion in the first decade. now generic medicines save more than that every three days to read every three days we do what was predicted to happen in savings every ten years. in the mid nineties the congressional budget office released analysis showing in 1994 the tenth anniversary of the hatch-waxman savings had reached approximately $8 million. the new data released showed by 1999, 15 years after the hatch-waxman became law, a generics were generating 49 million of annual savings. and in the last decade alone,

generics have saved consumers, businesses, state and federal governments $734 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 we can do to prevent preventable disease and take actions and our life, life styles, our doggett and any other number of things we can bring the costs of health care down in america. now, let me just say there's nothing -- we keep hearing about the secrecy, how this legislation has been hidden from folks for a long period of time. again, that is just not true. there's nothing in this legislation that we haven't been working on or talking about or bristling 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 during news conferences denouncing what they hadn't really analyzed, they would have a better sense that they might have been able to read the manager's amendment on the internet for over a month -- excuse me, the manager's 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 to read 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 foss. in all the time we were in the finance committee trying to market we never had people coming to us as i often have here in the 25 years i've been here when religious leading -- legislating and people say if you include this or work is of

little or tweak this, i think i could support this bill. there is just a fundamental political divide, the fundamental, philosophical divide. we are looking at a party for whom opposition the health care for americans is not new. my colleague from california talked about it a few minutes ago. 1935 if 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 they argue now -- could i ask how much time we have? >> the center has consumed 25 minutes to beat >> , time do i have? >> the majority has 15 minutes remaining. >> and is that predesignated? is the 15 minutes that is remaining predesignated, madame chair?

>> not by order. [inaudible conversations] madame president, in fairness i wasn't aware. i felt i had the full amount of time, but i don't want to -- i won the senator from connecticut to share thoughts also, so let me just say that, and i will wrap up here, that the insurance industry -- the insurance industry 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 thawing united states of america that lifted countless numbers of seniors out of poverty. they said no to read the insurance industry survived, medicare and medicaid. they are doing very well. according to cbo, the gross cost the manager's amendment is over

the next ten 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 an addition, but i think it is critical for people to follow the truth here, to look for the facts and measure the reality of the positive ways which this legislation will change -- will provide additional help to seniors, reduce premiums for many americans, help people for coverage who don't have it today, spread risk throughout the system more effectively, will prove care and delivery within the hospitals, prevent people from being denied insurance if they have a pre-existing condition, prevent them from being kicked off insurance they paid for and thought they had when they get sick and 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 -- alladi yield the floor and ask unanimous consent that some portion of the statement be placed in the record as if read and i will decide without will be and thank the chair. >> without objection. >> madame president? >> the center of connecticut. >> i thank the president and my friend of massachusetts. 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 it 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 increase is in the cost of health care that a burden every individual, family, business, our government and our economy. second, we have wanted to regulate insurance companies to provide better protection for consumers and patience. and third, we have wanted to find a way to make it easier for millions of americans who cannot afford health insurance today to deal to buy it tomorrow. i believe this bill makes it

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 100 -- by $130 billion over the first ten years according to the independent congressional budget office. that figure could multiplied 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 eight 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 the patients received rather than the quantity of care. and i am proud to have worked with members on both sides of the ogle to include amendments that would do just that. for instance, senator collins and i introduced an amendment parts of which were included in the managers package that will enhance transparency for consumers so they can make more informed decisions in choosing their health care providers and and terse. in fact our amendment will create physician compare to a new web site where physician quality measures that exist now but are not known by the rest of us will be posted for everyone to see and use in the choice of

physicians. this will also create incentives we believe for doctors to provide high-quality, more efficient care. i also co-sponsor 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 d to offer management services to beneficiaries so they can better in here to their prescription treatments. all of that is progress on the first goal that all i and most others have which is to reduce the cost of health care without compromising, in fact improving, it's quality. the second goal, if this bill

passes, insurance companies, senator speed said, will not only not be able to deny coverage if an individual has a pre-existing condition, and they will not be able 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 other than on administrative costs and profits. that's real progress on the second goal i mentioned. as for the third goal, the fact is tested by the cms actuary and cbo 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 six and goes to the hospital to be treated. that is real progress on the third fundamental of health care reform that i mentioned. now, is their anything in the bill that worries me? will of course there is, and i would say most of all i worry that we and future congresses will not have the discipline to keep many of the promises we made in this bill to control costs by transforming the way health care is delivered because some of these reforms are controversial and are going to be opposed by some health care providers and health care

beneficiaries. so without the kind of discipline i've 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 content of the bill, this bill will cut health care costs, and will reduce our national debt. in my opinion, our exploding national debt is the biggest domestic right to our country's future. that is why i've said this bill must reduce that debt, not increase it to the accumulated debt is currently over $12 trillion with our budget office estimating that an additional 9 trillion will be added 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 in peril. when we will have to raise interest rates so high that it will construct our economy and send us back into a recession worse than the one that we are coming out of now. madam president, we cannot bring the fiscal books of the government back into balance buy only making the health care system more cost-efficient, but we will never control our national debt without doing so. medicare is in a particular perilous condition today. without reform, the medicare trust fund will be broken 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 a little the for medicare to 55 years. the 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 cost the federal government, that is federal tax payers, 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 and future liabilities and further jeopardize the solvency of medicare. because of the insurance market reform in this bill, the creation, and other measures, the creation of new system of tax credits and subsidies for

people making up to 400% of property, 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 or expansion of medicare. yet both proposals would in my opinion lead to higher premiums or the 180 million people who have insurance today and are struggling to afford the health insurance they have now. according to studies by the cbo and new government-run insurance program, public option would actually likely to 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 this and that disappointed and angered many members of the senate and house and why no and please 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, "and additional step we can take." an additional step, he said, but not an essential one, and then he added and i quote again, "the public often is only a means to that and." and concluded we should remain, and i quote again, "open to other ideas that accomplish the ultimate goal." i'm confident, madame president,

that this bill accomplishes the goals the president and most of us set out to achieve without the creation of a brand new government and insurance company or the further weakening of medicare. this bill, as it appears, it will emerge from the senate is delicately balanced. i understand that the normal inclination in a 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 votes and a 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 senator's time has expired. >> madame 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 to moments to complete my remarks. >> without objection. >> i thank my friends. each member of the senate, i repeat, will have to decide 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. significant changes are made to the senate bill and conference it will be difficult to hold the 60 votes we now have. i have to priorities that 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 reassert 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 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 see it's naive. i hope 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 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 supportive members of both parties. i thank the chair and yield the floor.

president obama praised the senate for moving forward on health care legislation. democratic leaders secured the last votes needed for a test vote early monday morning. this means a final vote on the measure could come later this week. the president's comments came at the event highlighting efforts to save the because find savings in the services. this about ten minutes. >> good morning, everybody good morning. before i begin, i want to say a brief word about the historic vote which took place earlier this morning. the united states senate knocked down a filibuster aimed at blocking a final vote on health care reform and scored a big victory for american people. bye standing up to the special interests who prevented reform for decades and were furiously lobbying against it now, the senate has moved closer to a reform that makes a tremendous difference for families, seniors, businesses and for the

country as a whole. for those who have insurance, reform will mean greater security and stability. no longer will people with pre-existing conditions be excluded from coverage. no longer will people who are seriously ill be dropped from coverage and no longer will families be allowed to go broke because they're forced to pay exorbitant of pocket expenses. many people recall the enormous fights are now the patient bill of rights that never got done. well, you know what? the patient bill of rights is imbedded in this health care bill and it makes sure all americans who have insurance right now are getting a fair deal from their insurance companies. small businesses, and those who don't get insurance through their employer will finally be able to get insurance at a price they can afford with tax credits to help. and medicare will be stronger in its solvency extended by nearly a decade. seniors will get more

assistance, with prescription drug costs than they are getting now. and finally, these reforms will help the inexorable and unsustainable rise of health care costs that are overwhelming families, businesses and the federal budget. the congressional budget office now reports that this bill will reduce our deficit by $132 billion over the first decade and by as much as $1.3 trillion in the decade after that. so i just want to be clear for all of those who are continually carping about how somehow this is a big spending government bill, this cut our deficit by $132 billion the first ten years and by over a trillion in the second. that argument that opponents are making against this bill does not hold water. now, increasing this kind of responsibility in washington is also brings us here today.

i am pleased to be joined this morning by my secretary of veterans affairs, ric shinseki, my budget director, peter orszag, and our special guest, last but not least, the winner of the first annual save award, and that's nancy fichtner of loma, colorado. having met with nancy a few minutes ago i can tell you nancy means business. she's a single working mom, she's a clerk with the va. she's an artist, she's and outdoorswoman, and she is an avid hunter. in fact somewhere in the western united states, there is an elk that is breathing a sigh of relief because nancy is here instead of where she would have been, hunting with her kids. and i believe her children are here. where are nancies kids? there they are right there. it's great to see you guys. nancy's daughter skins and guts

her elkus. don't mess with her either. [laughter] we are here for a reason. at a time we face not only fiscal crisis but also host of difficult challenges as a nation. business as usual in washington just won't cut it. we need a government that is more efficient, that is more effective and far more fiscally responsible. when my administration walked through the door, the country faced a growing economic downturn as well as deepening fiscal. washington passed a massive tax cuts for the wealthy and expensive new entitlement program without paying for any of it. health care costs continue to rise year after year and little effort was made to cut wasteful spending. as a result over the previous eight years, the national debt doubled, doubled. in january, the deficit stood at $1.3 trillion. and we had to make the difficult

decision to add to the deficit in the short term to prevent the potential collapse of our economy but as i have said in the long run, we cannot continue to spend as of deficits don't have consequences. as if waste doesn't matter. as if the hard-earned tax dollars of the american people can be treated like monopoly money. that's what we've seen time and time again. washington has become more concerned of the next election than the next generation. it's put off hour choices and the spending bill after spending bill budget after bloated budget. the government contracting is a perfect example. between 2002 and 2008, the amount spent on government contracts more than doubled. the amount spent on no-bid, non-competitve contracts jumped by 129%. this is an inexcusable waste of money. and that is why back in march and ordered federal departments and agencies to come up with plans to save up to $40 billion

a year in contracting by 2011. and over the past six months, agencies have been making cuts by looking for better deals, buy ending contracts and doing work in house and opening of no big contracts to competitive been bidding. because of these i'm proud to announce today we are on track to meet our goals, 24 departments have identified more than $19 billion in savings for this year alone. and this is only the latest example. my very first cabinet meeting i directed every secretary to join us in scouring the budget line by line to find ways to make government more efficient and less wasteful. together, we identified more than 100 programs to scale back or incompletely as well as other ways to cut cost, to $17 billion in savings so far. we are also going after roughly $100 billion wasted on the improper payments to contractors, organizations and individuals. to put this in perspective,

these mistakes and in some cases of abuses cost the taxpayers more each year than the budgets for the education and homeland security departments combined. we have done what some said was impossible, preventing wasteful spending on outdated weapons systems that even the pentagon says it doesn't need. and i have insisted from the beginning that health care reform will not add one dime to our deficit, and as i just noted, not only is it not adding to our deficit, it is actually reducing it. finally, i issued a challenge to every man, woman and child who works for the federal government. if you see a way government can do its job better or to the same job for less money, i want to know about it. and that is why we started the save award, to draw on those who know the government best to improve how the government works. we asked of all employees to submit reform proposals based on their experiences and in a testament to the seriousness with which these folks are taking their jobs we've received

more than 38,000 proposals in just three weeks. from these submissions, four finalists were selected and put to an online vote. nancy is here because she won. her idea stems from her experience at the va center where she works. she noticed that whenever patience left the hospital, left over medications like eyedrops or inhalers were just thrown away. and often veterans would have to go right back to the pharmacy to refill it was discarded. so the va is paying twice. as waste, plan and simple, and thanks to nancy and to secretary shinseki and the folks at the veterans affairs we are putting a stop to it. the changes already under way. of course nancy's proposal was one of many great ideas that came to us. we've already begun to implement a host of suggestions made through the state's contest and while promoting the electronic pay stubs or scheduling social security appointments online or three purposing on used government supplies may not be the most glamorous reforms in

history, when taken together these small changes add up. they add up to the transformation of how the government works. and that's why we are going to turn the save award into an annual event. that's why we are holding a forum at the white house next month to seek more ideas from the private sector, specifically about how we can better use technology to reform our government for the 21st century. after years of irresponsibility, we are once again taking responsibility for every dollar we spend the same way families do. it's true that what i've described today will not be enough to get us out of our fiscal mess by itself. we face a deficit that will take some tough decisions in the next year's budget and in years to come to get under control. but these changes will save the american people billions of dollars. and they will help put in place a government that is more efficient and effective, that wastes less money on new bid contracts, cutting bureaucracy and harnessing technology.

it is more fiscally responsible and that better serve the american taxpayer. that is a government we need, that's the government on the intend to implement, that's the kind of government that the american people deserve. and that's the kind of government that people like nancy are helping to build each and every day. so nancy, congratulations. we are proud of you. thank you so much. thank you. we are very proud of your mom. [laughter] that's great. thank you, everyone. [inaudible conversations] [inaudible conversations] we now continue our coverage

of the health care debate. next senate democratic leaders are joined by the president of the american medical since the nation. the ama has endorsed the senate health legislation. this news conference is just under 25 minutes. >> don't be bashful, come in here. tom give us balance with someone over here >> we stand closer than ever to make 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 are not over the finish line, but we would never have gotten this far without the support of doctors, nurses, medical professionals who know we need action, not excuses anymore. excuses are not going to work.

you know, this legislation is not about politics or partisanship were a poll that appears in the newspapers in place of the country. the legislation is 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 come to him or they are there to find out if there are things he can do to help them. he feels it every day. dr. wilson, to be president of this great organization, must have a distinguished service record and he does. we appreciate his support, not only as 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 us who have worked on this so long have 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, american diabetes association, american hospital association, federation of american hospitals, american cancer society, aarp, notice i pronounced it right today. each of these organizations know the cost of inaction is too high. our bill will bring the needed relief to millions of americans who wake up every day without health insurance or waking up every day afraid they are going to lose their health insurance.

like those in the medical field, our responsibility as legislators is a cure for all people, not just those that are fortunate. that is what this historic reform texas. it starts the breakdown of the wall between the class of americans who can afford to stay healthy and others that cannot. americans are dying from diseases we know how to treat, living in pain because it is too expensive to ease. you hear us talk about this a lot and have heard us briefly talk about this, but everyday doctors, like dr. wilson see this that don't talk about it. he sees it. he knows the bill will soon be sent to the president that will save lives, save money, extend medicare for ten years and basically save medicare. doctor?

>> well, thank you, senator reid, and thank you all for joining today. i'm cecil willson as you heard the president-elect of the american medical association, and internist in florida. i flew into washington snowstorm some have said 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 a close and careful review, the ama is pleased to announce its support for passage of the amended health system reform bill. the senate bill includes a number of key benefits for meaningful reform. it will include improvements and

choice and access to affordable health insurance coverage and eliminate the denial based on pre-existing conditions. it will improve -- it will get rid of a lifetime limits on health care coverage as well as higher premiums based on medical conditions agenda. these are important benefits for those who have insurance now and for those who want it but have been on able 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 have had high quality care and often fragmented system that doesn't work for them or the patience -- patients.

this will include better disease management and prevention. it will further the development of research that can help patients and physicians compare treatments and make better informed medical decisions. it authorizes grants to test alternative medical liability reforms that show promise and benefitting patients and reducing the impact of the defensive medicine. over the past few weeks, the ama communicated closely with members of the senate about items we 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 will no longer cutting payments to other physicians. it eliminates the tax on physician services of surgery and drops the proposed physician enrollment fee for medicare.

passage of the patients protection and affordable care act by the senate will bring us close to the finish line on the 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 concern to physicians such as the creation of a medicare payment board, quality improvement and medicare data release initiatives. in addition, physicians and advocates for the baby boomers, seniors and military families have also been engaged in efforts to fix the broken medicare physician payment formula that threatens access to care. we'll come and senators reid and bachus for keeping the focus on a solution to this problem early next year, and we will continue to work closely with them to get

that solution. the ama is committed to help the system reform that improves the system for patients and the physicians to take care of them. and we are pleased to be able to support passage of the amended senate health system reform bill. thank you. >> senator baucus. >> thank you, leader reid and dr. willson. this is a historic moment, not only because of the legislation that is about to be passed in the samet, but also because of the statement we just heard. there are many organizations endorsing this legislation is essentially 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 here's another endorsement, this

by the american medical association. that's a very important to me that the american medical association is not opposing this legislation, but rather supports it. and in supporting it in a way it wants to keep working with the samet on issues that concern them. mengin the payment provisions for doctors, dr. wilson also mentioned the medicare commission, and it is that attitude saying yes this is good, it is good for the country. but also yes, we want to keep working with you. it's that attitude of working together to try to find a common solution, which means so much to me and which is not found, regrettably, in the senate in the last several weeks. but here or groups who were not part of the senate who want to do the right thing. it is especially important to your endorsements from doctors

after all, it is doctors who spend more time with patients than any other group. they know what's needed. they know the problems insurance companies deny payment. they know that it's wrong person cannot get insurance coverage because of a pre-existing condition, and they also know that it is wrong for an insurance company to rescind a policy based on some minor for less health condition. dr. wilson also mentioned the importance of eliminating the annual limits, lifetime limits on benefits, and doctors know. dr. c. patients, the work with patients and dr. wilson's statement also included the reasons many of us have given in the past, ghosh, a year now explaining why health care reform is so important. so it is historic because the

legislation but also because the medical association is historically taking a very positive statement, which i think -- which i find comforting because it is positive and second it is comforting because it is honest and singing yes but it's the attitude of wanting to work with us, which i find very encouraging. thank you, doctor, very much. where is dr. wilson? thank you, dr. wilson, very much. >> senator dodd. >> thank you, leader. let me underscore the points made by leader reid and max baucus and dr. wilson. i suspect if you could only have one organization of a group of people to support this bill, the choice we would probably make is the one you're hearing today. while it's important that other organizations be supportive, there's nothing more fundamental when you get right down to this than the relationship between a patient and their doctor. that is it the most fundamental level whether or not you have access to that doctor, whether you have the resources to be put

to compensate that doctor for his or her services. and so, of all of the organizations and individuals and groups that have supported this bill, i read this one as most important because it speaks to that relationships to the eckert relationship between doctors and patients. you heard some articulation already by leader reid and max baucus and dr. wilson. one provision senator tom harkin and i worked on senator kennedy cared deeply about was making it possible for young men and women who would desire to become physicians in the country to be able to do so by reducing the tremendous cost. and so the scholarships, the grants, loans in this bill make it possible for us to increase the work force. some estimates are more than 16,000 primary-care physicians are needed with expansion of 31 million people that now will have health care. so as we expand the number of people who have that kind of coverage, the demand on the providers particularly physicians will grow. and so the ability of young men and women who have the strong ambition to be a health care

provider needs to be more accessible and less costly. and one of the major provisions coming out of the help committee was in fact designed to do just that. so on behalf of my colleagues on the help committee, particularly senator harkin and senator mikulski, senator murray, senator bingaman, particularly those who worked on the work force issues this is a very and put a moment, and we are grateful to the ama, particularly you, dr. wilson, for your supporting this effort. this is we to make a huge difference in our effort. >> dr. wilson, thank you very much for being here and for your great endorsement of this bill. some of you may know i was a naval aviator back in the 60's, and we always had naval flight surgeons that took good care of us. and i found out dr. wilson is a former navy flight surgeon. in fact, we served in the same area of operations in the 60's. we didn't know each other but preserved in the same area. as soon as i found that out, i

knew we were in good hands. [laughter] no one knows america's health care system better than doctors treated the know the predicament of tens of millions of americans without insurance whose injuries and diseases go without proper treatment. the end of the predicament of patient who have coverage but their health insurance company refuses to pay for the procedures or they cancel the policy after they get sick to read the note the lives and the money that could be saved if we invested more generously and wellness and disease prevention, and thank you, dr. wilson, for pointing that out. so i welcome the support of the american medical association. america's doctors have size of our broken health care system, and their prescription for a cure 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. we are going to reduce the

opportunities for corporate bureaucrats to come before the doctor and the doctor patient. this bill will reduce administrative requirements and people work. again, freeing up the doctors to practice medicine and focus on their patience rather than on paper work. this bill will significantly increase the number of primary care doctors, especially in the rural areas and other underserved communities. we do this by greatly expanded the presence of community health centers and increasing investment in the national health service corps. we also create a health care professional pipeline which gives increase training opportunities to help professionals working in four 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 health care system. one that flucas is on preventing chronic disease and keeping people out of the hospital then the first place. that is what doctors want to do. help people stay healthy.

and now these preventive services will be paid for. so again, i welcome the ama support. america's doctors have made the right diagnosis, and they've offered the right prescription, to pass the health care reform. >> we will take a few questions. >> leader reid, you cite a bunch of associations, ama as backing your legislation. republicans say, however, you don't have the support of the public. a few hours ago, michael steele accused democrats and i'm quoting him, flooding the bird at the american people -- flipping the bird at the american people. >> i'm more worried about an example set by a party leader with something so obscene. i think that's something people should be worried about. if you look at the warning polls today there's some that show just as a result of our passing this, the support of this bill is about 10% just over 90. the american people, once the

have the information, will be totally supportive of this bill. think that the examples i gave on the floor last. one boy and nevada was [inaudible] the insurance company will not give him prosthetics. that is what this is about, it's about physicians like dr. wilson being able to take care of people like kaleb. i'm disappointed that someone with a title like mr. steele would be so crass and said such a terrible example for the youth of this country. >> could you address concerns that the bill is chock full of hid projects for even some of you standing up there that would designed to benefit your states and also perhaps to secure the

votes of the wavering democrats, and senator dodd -- >> i'm happy to respond -- >> [inaudible] >> i'm happy to respond to this. we just completed a bill, $600 billion to the defense of this country. you all know how difficult it was to pass that. one way we were able to do that is a legislation is we had to do a number of different compromises. as you know, that dealt with extending the safety net, food stamps. we were not able to put the child tax credit in there because senators didn't want that. that's what legislation is all about, the art of compromise. in this great country of ours, nevada has many different problems than it does new hampshire. michigan has many different problems than those georgia. we have a wide range of

different needs throughout regions of this country. some of those are basic health care delivery problems. others are because of the unemployment situation. so, this legislation is no different than the defense bill we just spent. we just spent $600 billion on. it is no different than other pieces of legislation that are large pieces and small pieces of legislation. we work to compromise. there is 100 senators here, and i don't know if there is a senator that it doesn't have something in this bill that was important to them. and if they don't have something in this important to them, than is not speaking well of them. that is what this legislation is about, the art of compromise. chris? >> just very briefly, talking about the grant program for construction. there are roughly 14 states to qualify for that program, connecticut being one, along with negative told 13 other states. it is a grant to be determined by the secretary of health and

human services. it's not an earmarks. it will be competitive as to states -- if they decide to compete for those grants will get them to be its competitive to read it doesn't dustin of my state, although my state is very interested in the proposal for reconstructing what is the john dempsey medical center at the university of connecticut, and so i crafted the language and wrote it in such a way that would include four more than just my state and make sure it was competitive to be determined by the secretary who makes those decisions on the competitive basis. >> one more question. >> center, can you talk a bit about the situation heading into the conference with house now that this does seem likely headed for passage? >> first of all, let me say this: we have to pass this bill in the senate first, and that is our direction, that is our guiding light. and we will worry about the next steps at a later time. we are going to finish this bill before christmas. we are committed to doing that. and we will worry about the next

steps at a later time. right now we are focused on what we are going to do this week. >> just to follow up on a previous question, can you explain why is it fair for nebraska in particular to get the expanded coverage on the medicaid costs paid for by federal government, especially when other states like -- >> let me just say this -- let me just say this: medicaid is a difficult issue, and you will see in this bill different treatments of medicaid. why? the same reason i said earlier. nevada has some -- we probably have the lowest health insurance stayed in the country. we have some means other places don't have we have primary-care physicians, we have problems with medicaid because the low

contribution rate we have. so we could -- we could go through this bill and talk about individual things for individual senators. we have a bill -- we are happy with the bill we have. >> don't forget, medicaid is a block grant program. it is up to the states to design their own program. different states have different designations. different states cover some populations. other states don't cover. some states the inaccurate do good states in the federal minimums so each state is a lot different in the interest of fairness and balance in the equity it does make sense in this legislation to kind of even out some of the inequities that have occurred over time. >> thanks everyone. [inaudible conversations]

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