sponsor readiness an ongoing compliance assessment, investigating complaints against agents involving violations of regulations and monitoring and evaluating sponsors compliance plans and the effectiveness of those plants. i just want to read a few compliments we have had to date we handled 10,000 calls via the toll-free hotline. we handle over 10,300 complaints from beneficiaries. we initiated over 1,100 investigations. we referred over 120 instances of fraud and abuse to the zero ig and other law-enforcement agencies. fulfilled 300 requests of information such as part d data from law-enforcement agencies and referred over 170 agents brokered misconduct cases to insurance commissioners.

these accomplishments resulted from developing a collaborative a constructive relationship with cms and all organizational levels which we continue to foster through weekly meetings ad hoc meetings and conference calls. thank you mr. chairman for the honor of speaking to you today and i would be happy to answer any questions that you are members of the system committee may have. >> thanks for your testimony. i will ask you to suspend for just a moment. i am getting a phonecall that i need to take and we will recess for two minutes. >> [inaudible conversations] [inaudible conversations] [inaudible conversations]

>> thank you very much, senator carper peerk specifically, i am dr. christian jensen and i'm the ceo of quality health strategies, or qhsr which is a nonprofit corporation peerk specifically, health integrity is one of qhsr's subsidiaries and has a manic or medicare drug integrity contract peerk specifically, i written test money contains many more details on our experience with medicare program and integrity contracts, but i wanted to note that we are also the holder of the zone program and integrity contract for region for which includes southwest, and for task orders one in five of the audit, medicaid and integrity contract the history of these contracts has been well covered by mr. apple, and cms as the

program has evolved has taken some important steps to try to improve the integrity of medicare and medicaid peerk there are two some unique differences between deeper service and medicare managed care programs and medicare part d, and that was alluded to by mr. blum, the complexity of medicare part d., the data systems and the data itself are much less mature with medicare part d., and the risk model is much more complex, it includes cost-sharing, risksharing and coverage gaps and so forth period and there has been as already have been alluded to we were not able to get position and pharmacy records for most of

the time of our existence i like to share with you the oig report represented a picture of the medics as of the end of calendar year 2008, and during 2009, many of the challenges and the difficulties that have encountered in bringing this program to successful maturation, were overcome, i cited you, medicare part b. data access was obtained in late 2008 during 2009, and that's what these numbers over to about 2500 call center complaints were received and processed, 138

request word processed, 121 frog referrals were made to law-enforcement peerk 157 referrals were made to state insurance commissioners, 47 proactive analyses were completed, 662 investigations from all sources are now open, and 267 investigations resulted from proactive analyses. with a 28 percent of all our investigations during 2009, resulting from proactive analyses. 12 referrals have resulted from a proactive analyses, and we have 203 investigations from proactive analysis, which are still underway. also during 2009, health integrity focused great efforts on trying to ensure that the law

enforcement community and the plans were fully educated, concerning the differences and the subtleties, and the financial impact of part d fraud. and as a result, we have seen three part d indictments in 2009 and 2010. we've had a great deal of success and collaborating with plan sponsors. we've established part c and part d plan working groups. they have an orderly. they include law-enforcement. they include the see pics. they include the plan sponsors and for example, the referrals that we have received from plan sponsors went up from 90 and 2007, to 396 and 2009, and we've already had 244 in the first two months of 2010. health integrity has only been a

national benefit and integrity medic sent october 2009, 5 months. but already this national experience has strengthened our ability to identify new and emerging regional fraud schemes, to identify existing national scope issues. and to focus on fraud and its prevention through vulnerability reporting, fraud alerts and other measures. and i would like to thank senator carper and the subcommittee for this opportunity for my comments and i'm pleased to answer any questions. >> thanks, dr. jensen. in your statement you mentioned, i will paraphrase, but i think you said you had a great deal of success and i think coordinating was the word, coordinating with plan sponsors. and the question i would ask of both of you is, how do you measure success in the work that you do?

you talked about in your statement, you talked about referrals and investigations a gun. how do you measure success the? i think -- >> sometimes in our schools we measure success not by where the kids make progress from the beginning to the end of the school year, we judge success whether they show up or whether there's lack of disciplinary problems. but how do you measure success? >> well, one measure of success, although it is perhaps a progress or a process measured, rather than an outcome measure, because we're not at the outcome stage yet with many of these investigations, is by the number of referrals and their dramatic increase from the plans. somebody's getting the message there at the plans that the medics are here and that they can handle these complaints or referrals that they receive about fraud. and that there is a responsibility on the part of

the plans to make those referrals. >> mr. apple, how do you measure success? thank you. >> there are two ways of measuring success. you can look at quantity and say we referred this many cases. but what i look at more and what my team looks at more from metrics are the quality of, the quality of our work. so for example, if in one year we referred 10 cases to law-enforcement, and five of them ended up not being accepted because they didn't believe the quality of the work was that good is a benchmark. if the next year we find 100 percent of our cases were accepted because of quality, that's one benchmark to me of success. and at sgs, we truly, the monitor is not quantity.

we want quantity but the mozzarella is quality of work. when we refer cases to law enforcement, for request for information, if we got a letter back from law enforcement saying that was very helpful, that saved us tons of hours of work to get this case through, that to me as a measure of success. >> is there some way that we are measuring success in the work that you all do, where we actually quantify dollars that we prevent from being defrauded from the program? or dollars we have recovered that were fraudulent diverted? is that part of the measurement of success? >> that is, and of course there is the return on investment issue. what they put into funding, its contractors, what are they getting back and what are the taxpayers getting back for that.

and that's a difficult thing to measure sometimes when you have a lot of variables. >> let me interrupt if i can. i mentioned earlier the program that we are providing and running in three states, recovery audit contractors, last year about $700 million. that's be easy to say this program is working and they get as a percentage of their efforts. but we can say, well, and three states, six, $700 million. that's a printed way to measure success. it's nice to know out of what. but what am looking for is a way to quantify your efforts and the efforts that you describe here, in ways that are relevant to us as the six or $700 million figure is relevant. i'm sorry, go ahead. >> well, i was going to say sgs does more than just medic work. we're also a zpic. we are a contractor in several

states. and let me just digress a little bit from the medic, if i may. any other programs as a zpic and a safeguard contract, we are prohibited by cms from looking, formation success by return on investment, and the reason being, is we don't want to be perceived as bounty hunters. so in other words, you don't want to just say we referred 50 cases to law enforcement and not really look at the quality of our work. but we do -- in the zpic and contract we know how much we recover. there's a mechanism for us to know how much was recovered, and that's one way of knowing that the return is far greater than the expense of running our programs. i have behind me my program director, and doug i believe, you have told me we have no way

of really getting the records to know how much was recovered on the medic part b to may i ask -- >> feel free to come to the table and identify yourself for the record. 's portraiture up if you will. >> for the record my name is doug. on the program director -- >> what is your last name? >> quave. we used to be medic nor does mr. apple referred to. the problem is because of the intricacies and the ways that the part b and part c programs are paid in a capitated weight it's difficult to quantify the loss to the government. it's not as easy. it's not like part a and b. where somebody submits a claim and gets paid so much proclaimed. instead they get paid a monthly rate per member to administer the plan.

and then they did the sponsors bid a certain amount and say this is how much we think we can quantify, we can provide this plan for the beneficiaries. so it's very difficult to quantify the loss. that's what it's difficult for us to turn around and show the return of investment on investment am a by referral. at this point, we have been referring to law enforcement to cms for assistance in trying to quantify that amount. >> and let me just add onto that, when i was saying was under the part a and part d program program, there are different mechanisms to see your metrics. number one you could stop payments from going out the door. you can put prepayment edits and. you can make recovery of payments. that is more definitive way of knowing what was recovered and what your return was. you do not have that in the medic program. >> all right. somebody else? dr. jensen? >> there are anecdotal or

isolated reports. so for example, we conducted an investigation into allegations about a pharmacist in a southern state was submitting high claims, false claims for high-cost hiv and antipsychotic drugs. 28 part d. plans sponsors. the investigation prevailed that that particular pharmacist had submitted $200,000 worth of prescriptions to medicare part d which were never provided to the beneficiaries or prescribed by the physicians. that pharmacist was taken out of practice. that perhaps is one example of a saving. another, also took place and a prominent southern state, where a florida pharmacy billed medicare as part b for medications that were never rendered the beneficiary or

prescribed by physicians which totaled over $1 million. between federal fourth, 2008, and june 26, 2009. and the owner of the pharmacy was indicted in the southern district of that state on charges that he owes to pharmacies which build care for proximate 20 million received 6 million in payments. he was sentenced to 112 months incarceration. but, senator, there are other values to this program which cannot be measured in dollars. i point out also an investigation of a physician and a nurse practitioner who were overprescribing controlled substance, narcotic analgesic drugs. no drug traffickers were seen going into the office.

and as a result of his prescribing, 10 patients died of overdoses of prescription drugs. that doctor was indicted on october 2008 on 14 counts that alleged her action, led to the death of three patients. in 2006, her trial is set for next month. and the director of an assisted living facility, who stole controlled substance will chronically ill patients for her own personal use. she was indicted on 11 counts of false statements relating to healthcare matter. and those things are important, perhaps, but it is difficult to measure them in money. >> okay, thank you. a question really for both dr. jensen and mr. apple. maybe a couple of questions. your comments and your testimony

have suggested some improvements on several fronts, identified by the inspector general. medics, i believe was supposed to ensure that the sponsors anti-fraud complaints plans were in order in being implemented correctly. yet the center for medicare and medicaid prevented you from actually starting the audits, at least that's what i'm told. would you say that the progress on the auditing of the compliance plans started what you're giving the the authority to audit the anti-fraud plans sponsors? second, why would you not given the authority before 2008? and finally, are their current tasks or auditing that you're awaiting permission to begin? >> well, i can start with that. quite frankly, we do not know why we were not given the authority. we were just told we were not able to conduct audits until i

believe it was october 1 of 2008. and again, this is a customer telling us this, and we follow what the task order required of us. we believe that -- we believe that as we do more audits -- let me just interrupt you. my last question, just go to my last question. there are current task or audited you're awaiting for permission to begin, either of you? >> we are, as i speaker today, we're conducting an on site audit, under the new program, and expanded audit. and we are told that many more are being planned. >> then my question was are the audits that you are awaiting permission to begin? that's my question. >> no, because we do not request permission from cms. they tell us what audits they want them to do. this is directed by cms. >> dr. jensen? >> we did what we have yet authority to do 10 audits, which were desk audits.

and i would say that we, too, were prepared to do many more audits. the medics were ready to carry out that responsibility, but the orders didn't come. and of the 10 desk audits we did, we did find some areas, weakness, but the desk audits are subject to the criticisms that have been made already here this afternoon. >> let me interrupt you again if i may. describe for us in terms that everybody can understand what a desk audit is. describe for us in terms that everybody can understand the kind of audits that you ought to be conducting. >> the desk audit itself was essentially, you ask for information from the sponsored -- >> you being -- >> sgs would ask -- >> that stands for --

>> safeguard services. that's my copy, safeguard services. and i request would be made of the sponsors, the plans to provide us the data to prove that they were meeting the seven elements required to be a sponsor. the difference between that and what sgs is doing now, is now we are going on site and we're looking at the effectiveness of their programs, of the compliance programs. and this would be the best example, senator. on a desktop audit, sgs might receive information that had proved that trainings, sessions, were provided on the following dates, abc, d. or e. when you go on site you can get extra records like attendance records, how many people actually attended, let me see the curriculum that you provided

the attendees to make sure it's relevant to the work you are doing. so you really can delve into the effectiveness, not just the fact that they checked the box and had compliance. >> dr. jensen, same question. just compare force a desk audit and the kind of audit that you think you ought to be doing. >> in my view, and on site audit has many advantages over the desk audit. the opportunity to verify on site directly what has been, what has been stated in the document. >> okay. do you feel you now have the ability to go on site and conduct the kind of on site audit that is more appropriate? >> mr. chairman, the audits we're doing now are much more effective. and my team believes that these audits will be very effective. >> dr. jensen?

>> the division of labor between the two maddux leaves that responsibility now with mr. apple's organizations. >> okay. one of the questions i asked of the first out, i asked him to tell us what we need to be doing in terms of legislation that would enable them to do a better job, especially at cms. and they gave us a couple of ideas and we export some other ideas during the course of their testimony. but in terms of what you need to have in order to be unleashed, to be fully effective, what do you need in terms of change in attitude, change in direction, change in regulation, change in legislation? what do you need to unleash a sin not me like the fact and assaulting the fraud that is occurring in this program? >> mr. chairman, i come from a background of law enforcement that i very long history of law enforcement, and you made a reference to willie sutton of robbing a bank because that's

where the money is. medicare fraud is a little bit different, and that fraud many times is paper driven. and i want to do anytime you have medicare fraud, if you have specific data you will find that fraud proactively work we actively. and with that as a basis, my comments would be, the more data that can be available to the medics, the better off the medics will be. additionally, if the medics were a loud to obtaining medical records directly rather than going through the sponsors, i believe that would be beneficial. and third, something that was not addressed, is while the medics are able to look at the a and b. data, the fact is that zpic that do the a and b. are not allowed to look at the d-day. and i believe the more people, the more investigators i can wrap their hands around ada and

crime problems, you will get a better picture and more productive results. >> we're going to write you and ask you to reiterate that, maybe if you would. >> dr. jensen? >> i go with what mr. apple said. particularly with respect to did that one of the reasons we are here and some of the criticisms which have been made of the program have been made, are because of the lack of data in a timely way. the larger the database, the greater the potential for identifying fraud. and that's what i am enthusiastic about. anything that the legislative branch can do to facilitate that would be greatly appreciated. >> okay. i think those are the my

question. anything either of you want to add or take away from what's been said? also, not just for this conversation we've had with you on this panel, but looking back to a conversation with a our first three guests. just reflect on that, anything that you would like to underline, underscore and bring to our attention, especially noteworthy and? >> i think hearings like this are so essential. it makes us all better, and i appreciate the ability to be a participant in this hearing. thank you, mr. chairman. >> is there any point? >> no, i think everyone of their points were online. i don't think i could add to anything that they said already without being redundant. >> in a city like this, that's good. we're talking about billions of dollars. were trying to capture. >> one thing that mr. vito he

mentioned is what i said is to give more data to the plans, and also to require that sponsors to report fraud, waste, and abuse and not make it voluntary. >> okay. >> and in retrospect, considering the testimony from the previous panel, it is important to remember that that was a snapshot in time. that was at the end of 2008. and here we are, a good year past that, and senator carper, there's been a lot of progress and a lot of upward movement, and a lot of successes since then. >> what you say we still have some distance to go? >> absolutely. in your own words, anything can be improved on. >> i agree. i agree. it is not enough to be good. you have to be great and continue to get better.

>> okay. all right, we appreciate you being here today. thanks for your preparation. thanks for your responses to our questions. thank you for coming out of the audience. appreciate the witness table. and some of our colleagues are unable to join us today but we will be submitting an questions in writing. i will probably be submitting a couple of question in writing as will. members have two weeks to submit their questions following the conclusion of today's hearing. i would ask when you receive those questions, if you would respond to is probably. and again, thank you. we look forward to improved further on the work that is being done. thanks very much. with that, this hearing is adjourned. [inaudible conversations] [inaudible conversations]

[inaudible conversations] >> the next journal must be one open to blogs and e-mails that are hammering like this on the door to be let into the conversation. to add new information, to raise new questions, to suggest new context. >> winners of this years national press foundation awards talk about the role of journalism in a changing society. saturday night at eight eastern on c-span.

>> the senate is about to gavel and to continue work on $138 billion bill to continue several expiring tax breaks and federal programs. it includes unemployment insurance, cobra health insurance, medicare payment to doctors. and even a continuation of a satellite tv law. senators are working on amendments to the bill. several will be brought up-to-date. votes are possible. work on the bill could continue into next week. meanwhile, the house comes in at half an hour to take up changes to the senate passed jobs bill. live coverage of the house at 10 on c-span. live coverage of the senate have on c-span2 ll lead the senate in prayer. the presiding officer: the senate will come to order. the chaplain dr. barry black will lead the senate in prayer. the chaplain: let us pray. god of all grace, in the darkness of our limited

knowledge, we turn to you for light. illuminate the path of our senators, so that they may glorify you. teach them to test all things by their conscience and always strive to do what is right. in these challenging times, strengthen their weakness, bring courage for cowardice and invincible faith for doubts. may they so live that their actions can withstand the scrutiny and judgment of posterity.

we pray in your great name. amen. the presiding officer: please join me in reciting the pledge of allegiance to the flag. i pledge allegiance to the flag of the united states of america, and to the republic for which it stands, one nation under god, indivisible, with liberty and justice for all. the presiding officer: the clerk will read a communication to the senate. the clerk: washington, d.c., march 4, 2010. to the senate: under the provisions of rule 1, paragraph 3, of the standing rules of the senate, i hereby appoint the honorable kirsten e. gillibrand, a senator from the state of new york, to perform te duties of the chair. signed: robert c. byrd, presidet pro tempore. mr. reid: madam president? the presiding officer: the leader. mr. reid: following leader

remarks, the senate will resume consideration of the tax extenders legislation. today we'll continue work through the remaining amendments to the bill. senators will be notified when votes are scheduled. there should be some this morning. mr. mcconnell: madam president? the presiding officer: the republican leader. mr. mcconnell: madam president, the american people are asking us to start over on health care. they are asking us to scrap the massive bills democrats have been trying to force on them. they want us to focus on cost instead. that has been their clear message now for over a year. but yesterday, democrats in washington said they know better. the president and his allies in congress made up their minds to turn aside any pretense of

bipartisanship and plow ahead on a partisan bill. a partisan bill, by the way, that americans don't want. in a last-ditch effort to get their way, they stake themselves to a flawed vision of reform over the wishes of the public. and what is that vision? it's a vision of health care whereby the federal government would become more involved in health care decisions of every man, woman, and child in america. where small businesses get hit with new job-killing taxes, where medicare is slashed for millions of seniors, insurance premiums go up and federal taxpayers are required for the first time ever to cover the cost of abortions. the administration and its allies in congress have tried repeatedly to jam this vision of

health care through congress without success. now they are doubling down. they have got one more tool in their arsenal. they have got one more tool in their arsenal, and they are deploying it. meanwhile, the american people are watching all this in utter disbelief. the american people are watching all of this in utter disbelief. americans do want reform, but they don't want this, and they are fed up because the longer democrats cling to their flawed vision of reform, the longer americans have to wait for the reforms they really want. and the longer they will have to wait for us to focus on jobs and the economy. the president did a very good job of laying out the problem yesterday, but the heart of the problem, as he himself described it, is the high cost of care. and the simple fact is the bill

he wants doesn't lower costs. on the contrary, the administration's own experts say the democratic plan increases costs. this alone should be reason enough to start over, start all over and put together a list of commonsense, step-by-step reforms that will actually lower costs. now, the good news is we already have the list. at last week's health care summit at the white house, both parties acknowledged a handful of reforms that all of us could agree on. that's where we should start, on the things that we agree on. unfortunately, even before the summit began, democrats were already intent on pushing the same old vision, the same old version they were pushing before the summit by any means possible. they couldn't get the old

version over the finish line, even with all the back room deals, the kickbacks, the buyoffs, so sometime after the massachusetts election, they hatched a plan to win over wavering democrats in the house by promising to use some legislative sleight of hand that will only require a slim partisan majority in the senate. this is outrageous on two counts. first, because the method they are proposing has never been used on such a sweeping piece of legislation. and second, because americans have already told us loud and clear that they don't want this partisan approach. what about public opinion do our friends in the majority not understand? the american people are saying loud and clear they don't want us to do this. what's worse, many of the same democrats who are now pushing this party-line vote are on

record as being four square against it for major legislation like this. here's what one senior democratic senator had to say about party-line votes on major legislation just a few years ago. "i have never passed a single bill worth talking about that didn't have a -- as a lead cosponsor a republican," he said ." and i don't know of a single piece of legislation that has ever been adopted here that didn't have a republican and a democrat in the lead. that's because we need to sit down and work with each other. the rules of this institution have required that. that's why we exist." i couldn't agree more. americans expect big bills to command big majorities. americans expect big bills to command big majorities. and that's why this isn't a fight between democrats and republicans.

it's a fight between democrats inside the beltway and their constituents beyond it. this is a fight between democrats inside the beltway and their constituents beyond it. there is a better way. there is a better path to reform that none of us will regret. it's time to listen to the american people. it's time to work together on the kind of step-by-step reforms they're asking for. americans aren't stupid. they know the option they are being presented with. the option of some massive bill or nothing? that's a false choice. so let's drop the partisan plan. let's drop this unsalvageable bill and let's start over.

madam president, i yield the floor. the presiding officer: under the previous order, the leadership me is reserved. under the previous order, the senate will resume consideration of h.r. 4213, which the clerk will report. the clerk: h.r. 4213, an act to amend the internal revenue code of 1986 to extend certain expiring provisions, and for other purposes.

the presiding officer: the senator from illinois. the clerk will call the roll. quorum call:

quorum call:

a senator: mr. president? the presiding officer: the senator from montana. . baucus: i ask further proceedings on the quorum call be dispensed with. the presiding officer: without objection. mr. baucus: we are now on our fourth day of consideration of this important legislation to create jobs on the safety net of tax provisions. this legislation would prevent millions of americans from falling through the safety net. it would extend vital programs that were extended on a short-term basis earlier this year. it would put cash in the hands of americans who had spent it quickly, boosting economic demand, and it would extend critical programs and tax incentives to create jobs. s thissed lusts that the holt of ever ever ever of eve--this is t will help half a million americans pay for cobravment this is the legislation that will help nearly 40 million medicare beneficiaries, nearly 9 million tricare beneficiaries to

keep access to their doctors. and this is the legislation that will help 400,000 americans get unemployment insurance benefits. this is urgent legislation. we must enact it soon. we've had a productive day. yesterday we disposed of six amendments and rejected a point of order against the bill. ace count it, there are about 10 amendments pending. those amendments are the underlying substitute amendment, senator sessions' amendment to impose discretionary spending caps, senator landrieu's amendment on the go zones, senator murray's amendment on summer employment for youth, senator coburn's amendment on transparency, senator webb's amendment on executive bonuses, senator stabenow's amendment on a.m.t. credits, a feingold-coburn amendment to rescind unused transportation earmarks, an amendment by senator brown of massachusetts on a payroll tax holiday, and

senator burr's amendment on a sales tax holiday. before senators offer additional amendments, we need to start processing the pending amendments. i have been advised that there will be objection to setting aside the pending amendments for senators to offer additional amendments until we have addressed some of the pending amendments. now some of the amendments appear to me to be the sort of thing that we could adopt by voice vote, and we are exploring that possibility in connection with at least two of them. on amendments that require roll call vote, i'm hopeful that we can schedule a number of votes at 2:00 p.m. this afternoon to dispose of several amendments, and then we'll continue to process the pending amendments throughout the day. and i thank all senators for their cooperation. madam president, i ask unanimous consent the senate proceed to the immediate consideration of calendar number 274, senate resolution 404. the presiding officer: the

clerk will report. the clerk: calendar number 274, s. res. 404, a resolution supporting full implementation of the comprehensive peace agreement and other efforts to promote peace and stability in sudan and for other purposes. the presiding officer: is there an objection to proceeding to the measure? without objection, the senate will proceed. mr. baucus: madam president, i ask unanimous consent that the resolution be agreed to, the preamble be agreed to, the motions to reconsider be laid on the table, with no intervening action or debate, and anyies related to the -- and any statements related to the resolution be place the in the record at the appropriate place. the presiding officer: wowsmghts. mr. baucus: i ask that the senate proceed to calendar number 275, s. res. 414. the presiding officer: the clerk will report. the clerk: calendar number 275, s. res. 414, a resolution expressing the sense of the senate on the recovery, rehabilitation, and rebuilding of haiti following the humanitarian crisis caused by

the january 12, 2010, earthquake in haiti. the presiding officer: is there objection to proceeding to the measure? without objection. mr. baucus: madam president, i further ask that the resolution be agreed to, the preamble be agreed to, the motion to reconsider be laid on the table, with no intervening action for debate, and any statements relate together measure be printed in the record at the appropriate place. the presiding officer: without objection. mr. baucus: madam president, i ask unanimous consent that the foreign relations committee be discharged from further consideration of s. res. 422 and the senate proceed to its immediate consideration. the presiding officer: the clerk will report. the clerk: s. res. 422, resolution recognizing the important progress made by the people of ukraine in the establishment of democratic institutions following the presidential runup -- runoff election on february 7, 2010. the presiding officer: is there objection to proceeding? without objection, the committee

is discharged and the senate will proceed. mr. baucus: madam president, i ask unanimous consent the resolution be agreed to, the preamble be agreed to, the motions to be reconsidered be laid upon the table with no intervening action or debate and the statements relating to the resolution be placed at the appropriate place in the record as if read. the presiding officer: without objection. mr. baucus: i ask unanimous consent the judiciary committee be discharged from further consideration of s. res. 426 and the senate proceed to its immediate consideration. the presiding officer: the clerk will report. the clerk: s. res. 426, resolution designating the week of february 28 through march 7, 2010, as school social workweek. the presiding officer: is there objection to proceeding to the measure? without objection, the committee will be discharged and the senate will proceed. mr. baucus: madam president, i ask unanimous consent the resolution be agreed to, the preamble be agreed to, the motion to reconsider be laid upon the table, and any

statements to the resolution be placed in the record at the appropriate place as if read. the presiding officer: without objection. mr. baucus: madam president, i ask unanimous consent that the senate now proceed to the en bloc consideration of the following senate resolutions. s. res. 434, s. res. 435, s. res. 436, s. res. 437, and s. res. 438. the presiding officer: without objection. the senate will proceed to the measures en bloc. mr. baucus: madam president, i ask unanimous consent that the resolutions be agreed to, the preambles be agreed to and the motions to reconsider be laid upon the table en bloc. the presiding officer: without objection. mr. baucus: madam president, i yield the floor. the presiding officer: the clerk will call the roll. the senator from mississippi.

mr. wicker: i ask that further proceedings underhe the quorum call be dispensed with. the presiding officer: without objection. mr. wicker: i ask unanimous consent that senator barrasso and others and i be allowed to enter into a colloquy for the next 30 minutes. the presiding officer: without objection. mr. wicker: thank you, madam president. i come from a background of earlier having been in the state senate and after that the united states house of representatives, and sometimes when i was a state legislator and it looked like we were making a hash of legislation on the senate side, someone would say well, let's pass the bill anyway, we'll clean it up in conference. it was always tempting to just send it on to conference and hope that cooler heads would prevail and we would get a better work product. sometimes that happened and worked out well, and sometimes it turned out that we didn't clean it up in conference. and i'm reminded of that when i hear about what is being discussed and what now seems to be the clear plan for this democratic majority and president obama in moving forward with health care legislation. the house has passed a flawed

bill, with one half trillion dollars in cuts to medicare, with huge mandates to the states, with tax increases. the largest increase, really, in entitle, big government in my memory, and the senate has passed its flawed version. not only those flaws that i just mentioned with the house commercial, but also special deals, a special deal for nebraska, a special deal for florida and louisiana and on and on and on. and that's where we are now. the plan now seems to be that that mistaken bill, that flawed bill that the senate has passed on christmas eve is now at the desk at the house of representatives and leadership over there is tempted to take that flawed product, pass it without any changes whatsoever, and send it to the president for his signature.

the plan there is not the old legislative trick of we'll clean it up in conference. the plan is we'll clean it up in reconciliation. well, as i mentioned, madam president, sometimes that works and sometimes it doesn't. the problem with cleaning it up in reconciliation is that if this democratic scheme goes forward and we do that, we will have not only not just a bill in conference to be worked out, where if a mistake is made we can vote against it in the end. we'll have a statute. the plan is for the president to sign this flawed senate product. with all the taxes, with all the mandates, with all the special deals and purchases. sign it into law and then hope that the senate can correct all of those miss takes in

reconciliation. if that scheme fails, we will be stuck with a very bad product, and it will be the law of the land and up to some future congress to deal with. certainly, it will be the key, the top paramount election issue for the next several months. if the plan works, if the democratic scheme works, we'll still have this. maybe the louisiana purchase will be taken out, the cornhusker kickback, the gatorade, -- the gator aid, all of the special deals. then we'll have the president's additional taxes, additional federal regulation that he has recently proposed. when it's all said and done, even at their best, most optimistic predictions, we'll have massive funding mandates to

the states. we'll have a one half trillion dollar cut to medicare, we'll have huge tax increases and a large new entitlement program. the people don't want this. i heard a democratic member of the house of representatives very articulately stating this on television just this morning. he said the people must be out of their minds. this is wrong, according to this member of the house of representatives, a democrat who says he has voted against it before and he's not going to be one of those that is willing to change his mind. so i -- i don't want to spend the rest of this year with this flawed legislation as the only campaign issue. it may be our only choice, but i can assure everyone within the sound of my voice of this -- if this scheme goes through, if the flawed senate version is signed into law and we have this

reconciliation debate, this will be the number one issue if not the only issue, and there will be devastation for my friends on the other side of the aisle if they persist in thumbing their noses at the american people and defying the clear will of the american people in this issue. i'm glad to be joined by my friend, senator barrasso, a legislator in his own right with considerable experience and a physician, so i would be happy to hear the comments of my colleague from wyoming. mr. barrasso: thank you very much, senator. i -- you know, i agree with exactly what you said because my experience has been very similar. i served five years in the state senate in wyoming, and before that was a physician practicing in wyoming, taking care of so many families and just this monday was at the wyoming medical center, the largest hospital in our state. it is a hospital where i have previously been chief of staff.

and what i heard from the people of wyoming is i'm sure what you have heard from the people at home in mississippi. they say why don't you just stop and start over? it's not just the people from our states. in a cnn recent poll, 50% of all americans say it is time to stop and start over. we do need health care reform but we don't need this 2,700-page bill with all of the unintended consequences that may come with it, all of the new government boards and commissions, a program that cuts cuts $500 billion from our seniors who depend upon medicare for their health care and raises taxes by another $500 billion. the american people are saying stop and start over. they know that we have good ideas. they have listened to that summit last week that i was able to attend at the white house, and they have heard that republicans say let people buy

insurance across state lines. that will help 12 million more people get insurance today. they say let's deal with lawsuit abuse. that will help cut down the cost of these unnecessary tests which are done as defensive medicine. they understand the american people, the value of allowing small businesses to join together to help more effectively get down the costs of care, and that's why half of all americans say stop and start over. one in four just say stop. only one in four americans say yes, pass the bill. so three in four do not want what the president seems to be wanting to shove through congress and shove down the throats of the american people. the american people are incensed, and that's what i heard in wyoming this weekend, and i'm sure from my colleague who is here from mississippi that's what he has heard as well. so the president made his speech yesterday which seemed to be a new sales pitch, but it's for

the same bill. it's why so many folks have said stop, start over, focus on ideas that we know will work, give individuals, as patients, as citizens rights to make more choices that affect their own life. give them those opportunities. we don't need a government bureaucrat standing between a doctor and a patient. don't need a government bureaucrat, don't need an insurance bureaucrat. i see my colleague, senator coburn, is on the floor. another physician who has, as have i, fought against government bureaucrats and insurance company bureaucrats all for our patients because we need a patient-centered health care program and we need health care reform but we do not need this massive bill. and now i see my colleague from florida has joined, and he knows we have positive ideas that will make a difference because we need to be focused on the cost of care. people like the quality of care that they are getting. they like the fact that it is

available, but the cost is what is affecting us. that's why warren buffet just on monday has said we need to focus on cost. they need to take thousand pages of the nonsense out of the bill, focus on getting the costs under control, and so many of the ideas that the republicans have brought forth are focused specifically on that. so i would ask my colleague from florida are there things that you have heard as you have visited with your constituents and the people in your state that you might want to add to this discussion right now? mr. lemieux: i appreciate my colleague, dr. barrasso, for referring this question to me. certainly the people of florida are concerned about this bill. they want the costs to go down. they thought the whole reason why we were doing this health care bill was to address the skyrocketing costs of health care. up 130% on average over the past ten years. but what we find out with this bill is not only does it lower the cost of health insurance for

americans, some americans are going to have to pay more. so why would we undertake this huge enterprise of creating a trillion dollar new program, multitrillion over time, a program that cuts a half of a trillion dollars out of health care for seniors, raises taxes by half a trillion dollars, why would we undertake all of that if we weren't going to reduce the cost of health insurance for most americans? that's what they think we're doing here. they don't think that we're creating some brand-new entitlement program. they don't want us to do that. they want us to lower the costs. so republicans have put forward proposals. and some of them my colleague just mentioned. allowing insurance companies to sell across state lines. trying to get rid of junk lawsuits. my wife mikki is pregnant with our fourth child. she goes to see her doctor in tallahassee, florida. not a big town. he is paying $120,000 a year in medical malpractice insurance.

that affects not only the cost of care, but it also creates this defensive medicine which runs up costs. we have got some real concrete, step-by-step solutions on our side of the aisle that will make things better and reduce the cost of health care. one thing that i have had the privilege of working on with dr. coburn is this idea of going after waste, fraud and abuse. in the medicare system, we know that there is $60 billion a year, $60 billion in waste, fraud and abuse. my state, florida, unfortunately, is the capital of this health care fraud. i'll give you one statistic, madam president, that really i think says it all. in miami-dade county, we have 7% of the country's aids population, yet reimbursements for health care for aids patients in miami-dade county constitutes 83% of what's spent in the entire country. now, why is that?

it's because folks are committing fraud on the system. health care providers in warehouses and strip shopping centers or nonexistent offices at all -- and they're not providers. they are just scam artists, running the codes, running these medical codes and submitting them to medicare and medicaid. and billions of dollars are being lost. why shouldn't the first thing we do is fix the system we have, stop this bleeding of billions of dollars and put it back into medicare and medicaid which are programs that are going broke. the president is right. there is a health care emergency in this country, and the number-one emergency is medicare and medicaid. not creating a new program. we should make sure that medicare for seniors is viable. we should stop the waste, fraud, and abuse, and get the money back in medicare. and then we should do the same thing for medicaid.

and once we've got those programs more solvent and we meet the commitments we've already made, then we could take the step-by-step approach an trying to -- on trying to provide lower-cost health insurance for people who have it and more access for people who don't. so we have offered solutions, but as we understand it, what's going to happen is they're going to take the senate bill that was passed on a party-line vote here in december on christmas eve, send it over to the house, and then try to convince the house democrats that they're going to have a makeup bill that's going to fix their problems and try to send that over here and make us vote on that on a simple majority, which is not what was intended by the rules. so i'm new here to the united states senate, so i want to defer to my colleagues, and perhaps the senator from oklahoma could speak to this and whether or not that's the appropriate thing to do, and also speak to the good step-by-step measures that we have to combat the problems with health care.

mr. coburn: well, i thank my colleague from florida. i, along with senator barrasso, attended the summit with the president. and, if i recall his words, we were going to take four to six weeks to see if we couldn't work out some compromises to get a bill that would -- the american people would accept but we also would accept. and i would tell you, today marks a week since we had that, and we had an announcement yesterday that it's time to quit tawrks it's time to quit negotiating, and they're going to ram a bill through. and i think there's a bill contrast -- i appreciate what my colleagues have said. the problem in health care in america is -- it's cost. and if we don't attack the cost, whatever we do is going to expand the amount of dollars we spend on health care if we add people to it. but if you attack the cost, what you can do is add more people with no increase in cost. and the thing that denies somebody access to health care

is not not having an insurance policy; it's having a cost of the system that is unaffordable. whether you have insurance or not. and so when you look at it -- malcolm sparrow from harvard says he believes 20% of all the billings in medicare are fraudulent. that's over $100 billion a year. that's $100 billion just in medicare. we have good indications there's $15 billion in fraud in new york city alone in medicaid, just in one city. so why would we not go after the fraud, which is the second-largest component of wasted dollars in health care? well, some of it the president has accepted. but the number-one cost that does not benefit anybody in this country is defensive medicine. and defensive medicine costs up to $250 billion a year. and let me tell you why it is so bad and it's terrible for us to ignore that. it's not just that we spend

money doing tests on patients. when we do tests on patients, we put them at risk. and let me give you an example. if you go to any emergency room in this country this summer on a weekend, you'll see a kid in there that has gotten hit with a baseball. and what the standard is now, because of the legal system in this country, is that child is going to get exposed to radiation for a c.t. scan. not because they need it but because the e.r. doctor needs it. and the th standard of care shod be, if you have reliable adults around that child and the child has no neurologic damage and neurologic signs is watching to see if some signs occur. but the legal system has entrapped us where we do hundreds of thousands of c.t. scans on children because they

get hit with a baseball -- no none of them really need. there's billions of dollars just in one summertime event that gets chewed up that's not there to take care of somebody at a level at which they can afford because we've added that onto the cost, not because a patient needs it, but because the system demands it, because doctors have to protect themselves against untoward extortion lawsuits. so to ignore that as a part of this bill says you're not going to go where the money is to cut the costs. so i'll summarize just very shortly. we've said the president doesn'e have that the republicans don't have any plans. we haven't said that. the president has. i have a plan, senator enzi has a plan, senator demint has a plan. they cover millions more

americans, but they do it by not raising taxes, by not stealing money from medicare which mass a $37 trillion liability over the near-term, but we do that without increasing the cost. so we get a true expansion of coverage without an increase in cost. so what we would actually think would be the right thing to do would be center health care on patients, not the government. this plan has 88 new government plans. it has 1,695 times where the secretary of h.h.s. will write new regulations for health care, new regulations. what do you think the consequence of complying with those regulations is going to be in terms of cost? so we're adding more costs into the system that doesn't go to help anybody get well, but it becomes compliance costs. so we believe in patient-centered, not government-centered. we believe in expanding the options available to patients -- patients, not expanding government. we believe in increasing access, knot increasing taxes on people.

we believe in reducing, not quality. and the bill we're going to have before you no matter what the shenanigans they're going to have, doesn't attack the underlying problem -- and that's cost. until we look at cost, we'll never get out of the problem with comairks and we'll never -- with medicare, and we'll never truly improve access for americans. i yield to my colleague. a senator: senator lemieux and i both agree on this. we owe a great debt of gratitude to our colleagues, to our two physicians, for making it clear on national television over the course of seven and a half hours last week that republicans have positive ideas, ideas that will work and frankly ideas that the american people believe in. mr. wicker: and so i am astonished really that after we had such a clear demonstration of ideas, not only that are popular but ideas that need to

be given a chance to work, that the whole thrust of that seven and a half hour discussion has been cast aside and we're back at this proposal of passing the flawed bill with all of the mistakes that people on the other side of the aisle agree that we have made. and signing it into law before we do anything else. now, i have some comments i want to make about what senator coburn called "shenanigans." the reconciliation process. now, let me just say this: never intended for this purpose, an outrage, a nonstarter, i will not accept it, ill-advised, a real mistake, not appropriate,

undesirable. those are all comments of democratic members of the united states senate about the concept of cramming this bill through in this procedure that i've described and then coming back with reconciliation. it's not simply a republican objection. it's an objection where we have our democratic colleagues on record. i hope they will recall their words. i hope there's not some pressure that is going to be issued against my colleagues in the house and in the senate to do something they don't believe in, simply because someone really wants it in the white house and is exerting pressure. the comments that i have read were all made by democrats. i happen to agree with that. we have never, under reconciliation, attempted something of this magnitude and this substance.

and it would forever change the legislative process in the house and senate of the united states. if we begin with health care. and i'd be happy to -- mr. barrasso: if i may -- one of the phrases you didn't use was "hijacking." hijacking the system, hijacking the way that this works. and that specific word was used by then-senator barack obama bhefs when he was a senator. very much opposed to this approach. one of the other things he has said when we talk about the billions of dollars cut from seniors on comairks he talks about a program called medicare advantage. well, that's only a part of the area that's being involved. and for people on medicare advantage -- and there are about 10 manufacture of them -- they know they're on it, and they like the program and there are some advantages. one thing is it actually helps to coordinate care.

it works with preventive care. so those are things that are very important. but there are also cuts to medicare for nursing homes, for payments to doctors, for home health care, which is a lifeline for people, and for hospice care, for care at the end of someone's life. that is all going to get cut under these $500 billion of medicare cuts. mr. coburn: will the gentleman yield? mr. barrasso: of course. mr. coburn: the problem is that it's highly unlikely congress will ever effectuate those cuts. if that's true, then that means there's $5 billion in costs that aren't accounted for. so, one, iter a going to undermine the trust fund and actually lessen the available funds for seniors today, or you're not and you're just using a ruse to say we're going to

charge this to our children and grandchildren. having been in this body nor over five years, this body ot's: we recognize there are difficulties in health care. we recognize that the number-one difficulty -- keeping somebody from getting care -- is the cost of care. this bill does nothing for that, and i would go back and worry that when the president said we'lloo to six weeks and now we're less than a week later and he's ramming it through, what is it the american people want us to do? do they want us to create another entitlement system when every entitlement system we have today is bankrupt, and in creating that steal from the bankrupt entitlement systems we have today, or do they want a commonsense approach that goes after cost that will lessen the cost for everybody in america?

because we will never solve the problem with medicare until we address the cost. i see the senior senator from arizona is here. mr. mccain: thank you. now that my two favorite doctors are on the floor, i would like to refer to statements by both of them about a statement the president just said. "i believe it's time to give the american people more control over their own health insurance. i don't believe we can afford to leave life-and-death decisions about health care to the discretion of insurance company executives alone. i believe that doctors and nurses, like the ones in this room, should be free to decide what's best for their patients." by the way, i hope that our doctors will be wearing white coats on the floor. it would be really impressive to me. but that's neither here nor there. but, isn't it true that on page

982 that the -- is created add new board of federal bureaucrats, the independent payment advisory board, it's called, required to make binding recommendations to reduce the costs of the medicare program? how does that work, if the president is say, give the american people more control and there's an independent payment advisory board that's making binding recommendations? i'd ask my doctor friends. mr. coburn: there's three very worrisome provisions in this bill. one is the medicare advisory board that you just talked about that will decide what gets paid for and when doesn't. and congress will either have to agree to it or agree to some other cuts. the second is the cost comparative effectiveness panel which says, we don't care what's best for you; this is cheapest, so, therefore, this is what you're going to get, which ignores the doctor-patient relationship in tesms what's best for you as an individual patient and then finally the task force on preventive services which we saw during the

debate in december had recommended women under 50 not get mammograms because it wasn't "quote effective. "quhtion you look mind the data, it is one to 480 versus 60 years and above versus 50 years -- 40 to 50. so what happens is you now have three government agencies that are going to step between the doctor and the patient when it comes to medicare and medicaid in this country. and actually, it will fall over and they will mandate it on your own private coverage. so very, very inconsistent in terms of saying you want doctors to be in control of health care, but you have a bill that has three organizations in it that are designed to allow bureaucrats to make the decision on what your care is going to be. mr. mccain: and i would ask dr. barrasso, if these provisions were operative at this time, how would that have affected your practice? mr. barrasso: well, it would have affected me in several ways. it would have affected -- it would have affected my life in

that my -- my wife bobbi is a breast cancer survivor. she had a screening mammogram when she was in her 40's. something that this task force on preventative services said was unnecessary. if it hadn't been for that screening mammogram, her cancer would not have been detected. and by having a screening mammogram, which the american cancer society and others recommend for women in this country, by her following the guidelines of the cancer society as opposed to this new government mandated guidelines, her cancer was detected. she has had three operations, several bouts of chemotherapy and is alive today, a breast cancer survivor six years later because she did what scientists, what those who know what's best for patients recommended as opposed to what a government panel might have recommended

trying to focus on their cost-effectiveness. mr. mccain: a patient comes to you with a certain orthopedic requirement that requires a certain level of treatment, what does that do to you as a physician as well as the patient? mr. barrasso: well, it puts -- it puts the government between you and your patient, which is what you never want to have happen. as dr. coburn said, that is the wrong approach. it's not the way medicine has ever been practiced in america, it's not the way patients want it, it's not the way doctors want it. we don't want bureaucrats, whether government or insurance company bureaucrats between doctors and patients. as we saw it at the health care summit on thursday of last week, the president kept talking about covering people, health coverage. he wants to put 15 million more people on medicaid, a program where we know half of the doctors don't see them because the government pays so little. a program where the mayo clinic which the president has held up

as a model for health care in america, we can't continue to see medicaid patients from a number of states because we lose too much money. and now they have said the same with medicare. when they are talking about about $500 billion of cuts to medicare, the mayo clinic january 1 said we can't handle additional medicare patients because last year we lost, they said, $800 million by taking care of medicare patients because the government pays so little. mr. mccain: the issue of coming between the doctor and the patient, this legislation, the 2,733 pages, has 159 new boards, bureaucracies and programs created. 159. and when the president says that you will be able to choose your health care, how in the world does that in any way comport with the fact that it requires

every american to buy health insurance, whether they want to or not? which to me raises a fundamental question, a constitutional question. where in the constitution does it say that we require every american to have a health insurance policy? and finally, i would ask my friend, you know, there were very -- there were a lot of impressive statements made, i thought, during the blair house meeting. i thought, frankly, dr. barrasso gave one of the most impressive ones that i have heard. and the perspective from practicing physicians is something that has all too often been absent from this debate. but i would also ask my friend, did he -- i know he paid attention when congressman paul ryan gave his statement as far as the budgetary implications and the costs to americans. it's been reprinted in "the

wall street journal" this morning. he in -- what? i'd say five or six minutes encapsulated really what this legislation does is laying in his view a true ten-year cost of of $2.3 trillion, and he points out the gimmickry, and one of them, of course, the elephant in the room is that you have ten years of tax increases for -- of half a trillion dollars and ten years of cuts and half a trillion dollars to pay for six years of spending. now, where in the world would you have a program that you pay for ten years in taxes and cuts and benefits and have six years of benefits? so the true cost, the true cost over ten years without the budget gimmickry is is $2.3 trillion.

things like $72 billion in claims, money from the class act, the list goes on and on. and what i would ask dr. barrasso, that we all trust the congressional budget office. there is no doubt that these people, we all trust them and their estimates, but their estimates are only as good as the -- as what they are given as far as what the proposal is. and i might add -- again, i request dr. barrasso's comments on this that the president's proposal that was online was really an 11-page statement and the congressional budget office said they could not give a cost estimate because they didn't have sufficient information, and it's very clear when you delay revenues to the year 2016, that obviously that has budgetary impacts.

and finally, i would ask, again, dr. barrasso to talk about the so-called doc fix which has been counted in the budget and is reducing costs, and everybody knows we are not going to cut physician payments for treatment of medicare patients. i think that would be an important one for dr. barrasso to discuss because i think it really encapsulates the kind of budget gimmickry that's gone on in the formulation of this legislation. mr. barrasso: madam president, i ask unanimous consent to continue for an additional five minutes. the presiding officer: without objection. mr. barrasso: thank you, madam president. if i could, several things. it is a wonderful paul ryan op-ed in today's "wall street journal." i would recommend it to anyone to look at that because he specifically points out that the president's own chief medicare actuary says that the senate and house bills are bending the cost

curve up, making the costs go up, which is what happens if you go to a town meeting in arizona or wyoming and you ask people if this passes, will the cost of your own care go up? and the hands go up, too. you say how about the quality? will the quality of your care go down? and again, the hands go up. so that is a continual concern of people all across america, which is why three quarters of americans have told cnn that it is time to either just completely stop or stop and start over. only one quarter of americans support this proposal because they realize this is going to do that. you mentioned -- it was interesting we mentioned the 11 pages from the president. the gimmicks are still there. they may have taken out one of the gimmicks, but the -- the spending gimmicks are there, but plus the louisiana purchase, the special carveout for 800,000 people in florida who are on medicare advantage, they are

expected -- protected, but there are another 10 million americans who will lose their medicare advantage. and then the next thing that came up is what's called the doc fix. the way the numbers are moved around -- mr. mccain: for the benefit of our colleagues, could you explain exactly what the doc fix is, how we got to it? mr. barrasso: the -- right now -- and we just passed an extension, a one-month extension the other night -- medicare is supposed to cut the fees for all doctors across the country by 21%. now, seniors know that medicare underpays right now, and as one of my colleagues in the state senate in wyoming used to say, government is the biggest dead beat payer because they don't even pay enough to cover the cost of care that's delivered in our hospitals. with ambulances, they don't cover enough to pay for the gas to fill up the ambulances to go the long distances in arizona or in wyoming. but right now, to deal with some

promises that were made years ago, the fees for physicians should be cut 21% according to medicare. a number of years ago, they were supposed to cut it by 1% or 2%. they said we will not cut it. next year we'll cut it by 4%. then 8%, 10%. now they have continued to kick the can down the road enough that this year they are supposed to cut fees for physicians 21%. mr. mccain: could not happen. mr. barrasso: and they are supposed to keep them, according to the president's budget numbers, the way that this bill is part of the financial gimmickry is they want to cut physicians' fees for medicare 21% and keep them frozen there then for the next ten years. so it's cut and freeze for ten years, and they use that as one of the additional financial gimmicks. well, you do that to the doctors of the country who are already reluctant to see medicare

patients because the payment is so low. mayo clinic said we're not going to see new medicare patients because the reimbursement at today's rates are so low. to drop them 21% additionally at a time when the congressional budget office says 1/5 of the hospitals and 1/5 of the doctors' offices in this country will be unable to continue to be solvent ten years from now if this bill goes into place, we know without a question that we cannot allow this to happen. congress knows that, the doctors know that, the american people know it. everybody knows it except the people on the health care bill that say oh, this is actually going to save money in the long run when the people that look at it in an honest way know that this is going to drive up the cost of care and make the quality of care for our american citizens go down. mr. mccain: finally, i would ask -- madam president, i would ask unanimous consent that congressman paul ryan's piece in

the "wall street journal" may be made part of the record. the presiding officer: without objection. mr. mccain: and finally, it is incredibly cynical to say -- tell the american people that the cost of this reform is going to be $371 billion, i believe, less than we all know it actually will be, and if those cuts were ever enacted, what's the prospect of any -- of the overwhelming majority of doctors just saying i'm not going to treat medicare patients? mr. barrasso: we are going to see that. we will see that across the board. i was at our hospital in wyoming on monday, talking to physicians who take care of everyone. great concerns because they say at that rate, they can't afford to keep the doors open if the medicare cuts go through that the president says will have to go through if, in fact, he wants to hold up the numbers that he continues to talk about. mr. mccain: i hope that we

will continue to be on the floor. again, we need to talk about -- the president talked during the mccain about many things, but including i saw this morning on fox news that you shouldn't govern with 50-plus-one votes, that he was in opposition to that. i'm sorry he is not in -- remains in opposition. i thank dr. barrasso. i thank the president. i yield the floor. the presiding officer: the senator from montana. mr. baucus: madam president, we are now on a bill to extend tax cuts to extend certain payments for unemployment insurance, cobra subsidies and so forth. it is a jobs bill. this is a safety net extenders bill. this is not a health care bill. four senators just spoke -- i

think there were four -- there were six of them all together. basically very critical of the health care reform bill that passed the senate, very critical of the president's efforts to pass health care reform. i think some of the misstatements made deserve a response. the senator from mississippi called it -- the senate health care bill a massive tax increase simply the senator is mistaken. that's not correct. the health care reform is, in fact, a major tax cut. not a tax increase, but a major tax cut. the senate-passed health care bill provided more than than $400 billion in tax cuts for americans to buy health insurance. $400 billion in tax cuts. those are credits, tax credits given to americans to buy health insurance. it sounds like a tax cut to me. this is the largest tax cut for individuals since the record tax cuts of 2001. the junior senator from wyoming

said that we need to stop and start all over again. anyone who has paid any attention to the debate on health care reform for any amount of time knows that the opportunity to pass health care reform comes around about once in a generation. it doesn't happen all the time. in fact, i think with teddy roosevelt, the first attempt to pass health care reform has been 60, 70 years. we are on the cusp of passing major health care reform now. madam president, we all know that health care reform must pass. why? to address the draconian cost increases that families, companies, and budgets are facing to reform the health insurance industry, and if we don't do it now, don't reform health care now, believe me, this country is going to be digging itself into a pretty deep hole. this comes along once in a lifetime. so a call to stop and start all over again is, in reality, a

call to kill health care reform. that's what that is. whenever you hear somebody say, let's stop and start all over again, really what they want to do is kill health care reform. that's the whole point of it is. stopping and starting all over again sounds to me like nobody is paying attention to where we are. most senators don't like to be partisan, but the fact is, the other side of the aisle never presented a comprehensive health care reform proposal. there was never an alternative. in my judgment, it was a disservice to the american people that the other side did not present anything that could be called comprehensive health care reform so that we could debate it. the proposal offered by the finance committee and offered by the "help" committee merged together, that was one of the that was basically a democratic version. there could be an taunt to

debate that as well as the one offered by the other sievmentd except they never offered one. what did they do? they just picked and tried to find holes and crit siessments it is easy, easy, easy to criticize. anything can be criticized. and if you're halfway intelligent, you can make something that's inaccurate sound pretty good. very little good-faith effort to fry to find a common sliewsmghts there was an effort a while ago when senator grossly, myself, senator enzi, senator conrad, senator snowe worked hard to try to find a solution. we met or months and days, but frankly, to be totally ca candid about it, the other side decided it was better to play politics than to find a solution. that's why we had to withdraw. they withdrew because of so much

political pressure on them from their leadership to kilt bill. senator snowe stayed with us for a while, but even -- i don't want to put words in senator snowe's mouth or decide what they wants to speak for her, but even she became under tremendous pressure not to find a solution. so any effort to start all over again is really a very thinly veiled attempt to kill health care reform. the senate passing health care reform, the senator from wyoming said that he want add series of ideas. well, one idea talked about is allow people to buy health insurance across state lines. now, i'm sure he didn't mean this. but if he thinks that's a sole solution, i think most americans who are denied coverage because of preexisting conditions, who face all kinds of problems from the health insurance industry couldn't agree with that. but nevertheless i might say, madam president, the bill that

passed the senate does allow insurance to be sold across state lines. maybe not quite as freely as the opponentopponents on the other f the aisle would prefer, but we do allow insurance to be sold across state lines. why? because we want competition. we want people to choose. people should have the ability to choose what health insurance plan they want. there's very little competition now. in many states, there may be one or two companies that dominate. very little competition. that's not right. and allowing insurance companies to sell across state lines will allow better competition, allow better choice. but it should be done in a way that's fair, fair to the american public. what's one of the big problems here if companies are allowed to just willy-nilly stem cell across state lines without protections? i'll tell wheys going to happen. it is going to be race to the bottom. the insurance companies will race to find the state that has the lowest standards. that's where they'll set up.

then they'll sell across the country. that means that somebody who resides? a state that has pretty high standards but finds that the only policies being sold are those sold by a company that's registered in a state with lower standards is going to have very low-quality insurance. what we want here is fairness, even-handedness, some balance here so that insurance people are able to buy insurance freely and to buy -- have the choice to buy insurance. which is to say, madam president, the basic approach that the majority has taken in health insurance reform is to basically maintain the current system. today we spend about $2.4 trillion, $2.5 trillion in health care. that's a total figure. but half public, half private. half public is medicaid, medicare, children's health insurance -- that's about half. the other half is private.

it's commercial insurance. that's the way it should be. that's our american way. we're not canada. we're not great britain. we're not sweden. we're not japan. we're america. in america we have a system which is basically 50/50. half public, h., half private. this legislation that's before us today maintains that allocation. maintains that ability for people to din to buy private insurance -- to continue to buy private insurance. maintains the ability for people to have more choices, more competition, more availability to buy insurance, especially when the exchanges are set up. and i just don't -- so i say to my good friend from wyoming, i say, gee, mere's an idea. why not allow people to buy insurance across state lines? we do that. wree allow companies to sell across state lines. but that's after we have a level playing field, to make sure it is quality insurance. we want to make sure that

insurance sold across state lines is quality insurance, not insurance of very, very low quality. and we also allow in the legislation -- major legislation allow snrurns to be sold across state lines when the exchange is set up. the senator from wyoming and oklahoma have talked about something else. they've talked about tort reform. i must say, when the senator from oklahoma talks about tort reform speaks, he -- first of all, he says that our bill ignores lawsuit reform. that, true, madam president, is not true. our legislation does not ignore tort reform. frankly, we begin with a series of steps. the bill begins with state-by-state programs to try out some of the best idea to address lawsuit reform. we basically -- basically states

have the ability to try different measures. they can try courts, health coforts, or they can try something similar to work mn's comp. or they can set up systems similar to tort reform 0 or lawsuit reform in the state of michigan. it is called sorry, it works. if the patient goes to the hospital and they say, sorry, it it didn't work f they reach an agreement, that's great. if they don't, then the statements used by the physician -- if there is a subsequent suit, cannot be used. so we do begin to go down the road of lawsuit reform in the major bill. now, the senator from wyoming also talked about people joining together to buy insurance in associations. i might say again, madam president, our bill allows that. it alloys that and much more.

-- it allows that and much more. when you hear people talk about the bill they join together in association health plans, it's important to also point out to people, that's quite restrictive. first of all, it's restrictive in the sense it's only available to members of that association. it's not available to other people. i think we would want to make sure we set up pooling arrangements that all americans have the availability of pooling arrangements. in addition, who joins associations? well, the companies join them. what about the employees? the employees might -- the companies might have members of association, pooling, but it might not be what -- in the best interest -- or what the employees want. it really cuts out the employees. so the pooling that we allow in our underlying bill is real pooling. it's honest-to-goodness pooling and frankly real pooling will occur when the exchange is set

up because then -- where companies will be able to sell across state lines in the insurance exchange and a lot more people will be involved, which will enable us to have the same benefits of pooling. i might also say a point about the exchange. right now, madam president, you get on your computer. if you want to find the lowest airline ticket, what do you do? you go to or by the, you go to exspeeds -- you go to orbitz, you go to exspeedsia. you go to these various outfits. i like these outfits. you can shop online. that's basically what we are taking about with the insurance exchange. just like orbitz, just like expedia. get online, you can shop, find the right fares. it is going to be easier because we're requiring insurance forms to be standardized, which will simplify so people can

understand the choice that they're pursuing. make the choice that they want to. so i just want to make sure that the senate knows that when the senator from wyoming talks about associations, he's really talking about pooling. our underlying bill has pooling, and i think even better pooling. the senator from oklahoma, mississippi, and wyoming expressed shock at the prospect of health care being addressed in the budget reconciliation process. the senator from oklahoma said the reconciliation process means -- quote -- "ramming it through." well, what my colleagues fail to remember is that this body has used budget reconciliation 22 times. this is nothing new. 17 of those times the republican party controlled either the congress or the white house. when reconciliation was used. and it in most of the times when we had reconciliation bills,

they included measures on health care. health care is no stranger to the reconciliation process. i'll make that clear. health care is no stranger to the reconciliation process. i will not talking about mierng -- i am not talking about minor provisions in health care reform. reconciliation was a process by which the republican senate passed the cobra health insurance bill. the republican senate passed the cobra health insurance bill under reconciliation when they were in charge. cay bra stands for consolidated omnibus reconciliation act of 1976. congress used re1keu reconciliao create the children's health insurance program in 1997. health care is no stranger to this reconciliation process. it's actually an exception when congress has done health reform outside of reconciliation. that's the real truth. the senator from arizona questioned the constitutionality

of people to buy insurance. my colleagues actually -- i want to say that -- they want health care to be thrown out if these charges are true. the fact of the matter is that the vast majority of scholars have considered the matter and have said that the commerce clause and the revenue clause in the constitution give the congress ample authority to address the responsibility of people to buy insurance. this has been addressed many, many, many times. certainly, someone can trot out a law professor or somebody who can make a contrary claim. but, madam president, our committee, the finance committee, looked that the issue very, very thoroughly. we searched out lots of law professors. we want to find out, is this constitutional or is it not? and the weight, the far weight of constitutional scholarship, is that in fact this is constitutional and so when

senators stand up here and say it is not constitutional, they're entitled to their own opinions; that's fair. that's why we debate. but i might say that when one studies literature and question constitutional law professors, the vast, vast opinion is that this is constitutional. i might also add that most states require people to buy auto insurance right now. is that unconstitutional? is it unconstitutional for a state to require the purchase of liability insurance if you want to operate a car? i don't think so. now, the senators from wyoming said that our bill would bend the cost curve. he said the bill would raise health care costs. that's not true, madam president. flatly, simply, categorically, positively not true. the nonpartisan congressional budget office says that the underlying bill would reduce

federal government commitment to health care in the second ten years, reduce -- reduce. that doesn't sound like costs going up. the budget office says, it'll reduce it. our bill, according to the congressional budget office, would also cut costs for the taxpayer. first of all, the budget -- the c.b.o. said that the legislation, the health care legislation reduced the deficit by $132 billion in the first ten years and between $631 billion and $1.3 trillion in the second ten years. that's cut, cut deficits. now, let me just make a point there. we have large budget deficits, as basically the world knows. they have got to be reduced. health care reform is a step toward reducing our fiscal deficits. it's a very significant step and as peter orzag said, the head of

congressional budget office, the head of office of management and budget, the path to iewg our fiscal deficit situation is through health care reform. we need health care reform to get our -- get budgets, family, company and governments under control. just to repeat, our bill according to c.b.o. would cut costs for taxpayers, reduce budget deficits up to to $10 billion and a trillion the next ten. to summarize, our bill provides real cost control. that's what's needed, real cost control. our bill reforms incentives under the tax code to encourage smarter shopping for health insurance. i might say, madam president, if this side over here wants us to stop and start over again,

what's going to happen? it's going to mean all those people today -- and there are millions of them -- who are denying -- who are denied quality health insurance because of a pre-existing condition will be unable to get good health insurance. basically, those who say stop and start over are saying we want you, you who can't get health insurance because of a pre-existing condition to continue not to get good health insurance because of a pre-existing condition. that's basically what they are saying. that's not right. that's not right at all. it reminds me, too, a fellow in my home state of montana, a few years ago, i was talking to him. he just said max, he said it's just awful. i have a small construction firm. i have six or seven people in my firm. there is one person who has been with me for 20 or 30 years. the insurance company informed me that my premiums are now going to go up 40%. why i asked? one of your employees, long-time

employees has a pre-existing condition, and you have got to either let him go -- and then your rates will only go up 20%, or if you keep him, your rate will go up 40%. that put this fella, the owner of the firm, the guy i was talking to, in a an untenable position. so what did he do? he shopped around, he looked and looked and looked to try to find another insurance company that wouldn't raise premiums quite so much. he finally found one. his rates went up, but not a full 40%. i forgot how much they went up by. he was wrong to be in that position. he was not going to fire that person who was such a good person who has been with him for such a long period of time. so our bill would begin reforming the way the government pays for health care. right now, the government pays for the number of services performed. our bill would begin to have the government pay for quality. very important point, madam president. i think this is a real game changer. this is what's going to really make a difference over time is how we pay for health care.

about four, five, six seven years from -- six, seven years from now when these provisions kick in, we'll be very, very happy we took the first step because that's what's going to make the big difference here. so i say, madam president, that my colleagues on the other side of the aisle threw a whole lot of criticisms at our bill just now, but just because you say something doesn't mean it's true. frankly, -- and that is why i felt it important to stand up and set the record straight. what they are saying just is not true. madam president, i yield the floor. i suggest the absence of a quorum. quorum call:

quorum call:

mr. durbin: madam president? i ask consent theuorum call be suspended. the presiding officer: the senator from illinois, without objection. mr. durbin: madam president, we have before us a number of issues on the floor today is a jobs bill. it is a critically important bill because so many americans are out of work and we are trying to find ways to keep the families together while they're unemployed, but also to provide health care, which is one of the first casualties of losing your job. this bill also tries to help several states facing disasters by providing assistance on an emergency basis. it extends tax relief to individuals in businesses, and

it helps workers to plan for their futures by helping businesses afford their pensions. it is a good bill. it should pass. yesterday we had a series of amendments -- five or eight different amendments. there are others that will be pending conge, but i really hope that this particular bill will not be filibustered by the republican side of the aisle. there ought to be at least a bipartisan agreement that if we allow amendments on both sides and everybody gets their chance, that at the end of the day we actually vote for the bill. i am a afraid, though, that we're facing another filibuster, like the bunning filibuster on unemployment. what it does is just drag this out additional days, additional weeks, and while the people of this country are impatient, if not angry, with congress, unfortunately, these filibusters from the other side of the aisle just adds to the frustration. i hope that the republican leadership will join us now in a bipartisan effort to help create jobs in this country.

we need to have help for small businesses. most of us understand that that is the engine that will help bring us out of this recession. the small businesses, if they can stay in business and add an employee, can make a significant difference in terms of whether this recession is long or short. i hope the republicans will decide to work with us in good faith on this jobs bill. it really is in the best interest of all americans, regardless of their party. and if we're tabooing get our country -- and if we're going to get our country moving again and we get moving again, we've got to stop these filibusters, like the one that tied us up for five or six days over the weekend and literally cut off the unemployment checks for thousands of americans who are oust work through no fault of their own. we also have to look at the issue which is perhaps one of the major challenges facing us between now and the next few

weeks, and that's the issue of health care. yesterday the president of the united states came forward, after his health care summit, and said to republican leaders, we will accept four of your major provisions that you brought up at the health care summit in a goodfaith effort to bring you into this conversation, so that we can have a bipartisan bill, a good dialogue, and a bipartisan vote. unfortunately, the president's gesture did not lead to this kind of republican cooperation. it's never too late, and i hope that some will still consider joining us. i think that they should understand that the president believes, as i do, that there are good ideas coming from the other side of the aisle, and that the sooner we can bring them into one bill for the good of the country, the better. just this morning, madam president, i received an e-mail from a member of my family. she told me about a situation in texas where one of the workers

at an office where she knows some people was diagnosed with serious cancer and is now facing an extraordinary efforts to save her life -- chemotherapy and radiation are going to be her lot in life for sometime now, as she struggles with this dreaded disease which has affected the lives of so many of us and our families. it's going to cost about $5,000 a week for the therapy, which she needs to save her life. she was notified not only of this diagnosis and the need for this extraordinary care, but she was also notified that her health insurance had been canceled. it's a situation which sadly faces too many people, people who paid their health insurance premiums for a lifetime find out when they need this health insurance the most, it is canceled for a variety of reasons. one of the most common is the

argument of the insurance company that you have a preexisting condition. which you failed to disclose. i saw a list recently of preens, and i -- i saw a list recently of preexisting conditions. and i can tell thank you a very long list. it includes things that most people would be surprised to read. did over acne as a teenager? is there an adoptive child in your household? things like this are used by insurance companies to deny coverage to people. the health care reform bill that we are working on wantdz wants to put an end to these practices by health insurance companies. it mak -- it makes it clear to deny coverage for preexisting condition is going to become a thing of the past. i would say that any and all of us should take heart in knowing that that protection will be there for us when we need it. it also will stop health insurance companies from putting limits on the a. money that they'll pay out. we know what happens when you

pay $5,000 a week for cancer therapy. it runs into large amounts of money. some insurance companies, at some point walk away from you. we also try to expand the coverage of young people under health insurance. my wife and i raised three children, and when they reached the age of 24, our health insurance, family health insurance no longer covered them. we want to extend that to age 26. that will mean that many young people who are coming out of college, out of work and looking for a job will at least have the health insurance protection of their family while they're looking for their first job and their own health insurance protection. i think that's reasonable. when some argue, as we've heard from the other side of the aisle, that we're really going too far and too fast when it comes to health insurance, i would say that these basic facts that i have given you are the realities that face americans. and if we don't deal with these

health insurance injustices, if we don't deal with this unfairness, then, frankly, we'll continue to pay huge amounts for health insurance, and it won't be there when you need it. this week the mayor of a downstate city in illinois, kankokee told me this city of 200,000 people and annual budget of $20 million, 10% of which goes to health insurance for employees, was rocked to learn they're not only facing a recession, but they face an 83% increase in their health insurance premiums next year. they're going to try to negotiate with the insurance company, increase the co-pays and deductibles that individuals have to pay, cut the coverage. and that's the only way out of this terrible situation. but they're not alone. bluecross blueshield in

california recently announced they were going to increase annual premiums by 39%. another friend of our family was notified yesterday, her insurance premiums are going up 35% next kwraoefrplt how long can families and businesses deal with this? the answer is not long at all. the larger question is: what are we going to do about these health insurance companies? virtually all companies in america are bound by antitrust laws. what it means is that if you make an automobile or provide a service that you are bound by laws in terms of fair competition. there are two exceptions. one exception is organized baseball. don't ask me why, but it is. and the second one: insurance companies. it started back in the 1970's when insurance companies said we're not national companies. we are regulated and chartered by states. we do business in states.

therefore, national antitrust laws should not apphraoeufplt then in the 1940's someone took note of the fact that insurance companies were now doing business across state lines and, therefore, involved in interstate commerce and should be subject to antitrust laws. a law was passed called mccarran ferguson which exempted insurance companies from antitrust law. what it means is that insurance companies, like no other company in america, can colewd and conspire on the premiums they charge. they can legally sit down and decide how much they'll charge for life insurance, casualty insurance, medical malpractice insurance. it's legal because of this mccarran-ferguson exception. they can also parcel out territory. insurance company "a" is going to take over los angeles. insurance company "b" will do new york.

insurance company "c" will focus on chicago. i'm really heartened by a vote that took place just a week or so ago in the house of representatives where the vote to repeal the mccarran-ferguson act received more than 400 votes out of 435, a strong bipartisan voice. i spoke to senator patrick leahy of vermont, the chairman of our senate judiciary committee, this morning and said i hope you'll call this bill soon in the senate. we need to repeal this exemption for health insurance companies and medical malpractice carriers to stop this collusion when it comes to pricing and this allocation of markets, which we don't allow for any other businesses. i think if we do that, it's going to create a more competitive atmosphere so that insurance companies will compete with one another and consumers win if there's real competition. currently now it is perfectly

legal to stifle competition in insurance, to limit the availability of insurance and to dictate prices by industry, not by company. that has to come to an end. i hope that we can either include it in health care reform or pass it separately. we need to do that. another element that we need to do is to focus on these increased costs. how do we start to bring down the costs of health insurance? for those who suggest that premiums are going to drop presup tuesdayly in the passage -- precipitously in the passage of this bill, they're wrong. the steep climb in prices, we want to try to flatten it out. there are many reasons to do it. we know as a government that we can't deal with our deficit as a nation as long as health care costs are skyrocketing for medicare and medicaid and veterans administration care and so many other areas where we provide health care. we also understand that states face the same budgetary

pressures, and the increasing costs make it difficult for them as well as local governments. not to mention the impact on businesses and families. we now estimate some 50 million americans have no health insurance. they are not the poorest of the poor. those people are covered many times by medicaid. and they're not the fortunate ones like members of congress, who have the best health insurance in america. many times they are people who get up and go to work every single day, and their small business can't afford to pay the premiums. and, of course, their children at home who may be denied coverage just because the parent works at a place where health insurance is not available. there are things we can do about this, and should do. and this health care reform bill, when it is signed by the president, will say immediately that there will be a tax credit available for all businesses with fewer than 50 employees that offer health insurance to their employees.

we understand that a lot of people work for these small businesses. and if the owners of the businesses are really trying to provide basic coverage for their employees, we want to help them. we want the tax code to help them. the same thing is true for individuals. if the amount of health insurance premiums that you need to pay exceed a certain percentage of your income, you'll be eligible for a tax credit. critics of this bill talk about how much it will cost. it is an expensive undertaking. but more than half of the money that is raised for this bill is used in tax breaks and tax cuts for businesses and individuals to help pay for their health insurance. trying to get people through this difficult time so that they have coverage and can afford to pay for that coverage, that is an essential part of what we're trying to do with this health care reform bill. we also create insurance exchanges, and the idea behind an exchange is to bring together

private insurance companies, private companies that will compete with one another for your business. we know how this works in congress, because those of us who are members of congress are under the federal employees health benefit program. for over 40 years this program has offered to federal employees and members of congress the offer of health insurance bought on an exchange. i think we're the luckiest people in america when it comes to health insurance. as federal employees and members of congress, each year we have open enrollment. my wife and i take a look at the private plans available through the state of illinois and choose what we think fits us best. we have nine different choices of private health insurance companies, companies that are competing for our business. and if we don't like the way we were treated last year by our insurance carrier, come september we'll change. and we can pick another carrier and see if the coverage is better. now, this is something every member of congress currently has. but when we went to the health

senate, some on the other side of the aisle argued that the creation of these exchanges was too much government. well, if it's not too much government for their health insurance and my health insurance, why is it too much government when it comes to the people of this country? they're entitled to competition and choice from private insurance companies, just as we are as senators and members of the house of representatives. one other criticism said you know what's wrong with this bill, this bill will not allow to us buy insurance across state lines. that's a way we can save some money. that doesn't tell the story. this bill does allow the purchase of insurance across state lines: multistate compacts and multistate efforts to buy insurance. but with one important element. we establish in this bill the minimum standards for coverage. incidentally, that's exactly what we do with the federal employees health benefit program. if you want to be one of the companies competing for the

business of senators, you have to offer certain minimum protection. some of it's based on state law, some by national standard. why do we do that? because many people can't sit down and carefully go through every line and every page of insurance policy and try to imagine whether the coverage is adequate. i recall years ago when i was an attorney working in the state senate in springfield, illinois, a case came to my attention where health insurance was being sold to expectant mothers, family health insurance, but it excluded coverage for newborn infants for the first 30 days. think about that for a second. if you and your wife has a baby and the baby has an immediate costly health problem, this health insurance plan excluded you. we said as a matter of law in illinois, if you're going to cover mother and child, you cover that baby from the moment of birth.

that's part of the law. maybe you can buy a health insurance plan somewhere in america that doesn't have that coverage. but what's going to happen when you have that sick baby and huge medical costs? you may end up in bankruptcy court. you may end up on a government health insurance plan. we try to establish basic minimum standards for health insurance offered across america, and i think that is the only right way to deal with this issue that challenges us. we also expand the coverage to provide for more coverage for uninsured people in america. 50 million uninsured people and we would provide coverage for over 30 of those 50 million. these are people who literally have no health insurance at aufplt what happens when they -- at all. what happens when they get sick? they go to the hospital or the doctor, and they're treated. who pays for it? the cost is shifted. the hospital can't collect from them because they can't pay for it. so the hospital increases the cost for those who are paying,

those who have health insurance. we estimate the average family pays $1,000 a year in extra premiums, almost 100 dollars a month to cover the uninsured. if we bring more people into insurance coverage, fewer charity cases will be at the hospital. fewer dollars in cost will be transferred to the policies of the rest of us who have health insurance. it's a good thing to bring more and more people under this tent of coverage. the republican proposal takes a look at 50 million uninsured americans, and instead of covering 30 million as we do, they cover 3 million. that's a far cry from 30 million. if our bill passes, it will mean that the largest percentage of americans will have health insurance in our history. that's a good thing for our nation. it's a good thing for our medical system. we also, in our bill, try to move forward to encourage new, innovative and productive

medical practices. one of them is wellness. we've met with companies that have come to us and said when we incentivize our employees to be mindful of their weight, the food they eat, their cholesterol, their blood sugar, their blood pressure, and to stop smoking, it makes a dramatic difference. they feel healthier, they live longer, and they need less medical attention. so we are creating incentives for wellness. for example, one of the things we do is provide, under medicare, a free annual exam for every senior citizen. so that they'll be able to come in and be checked out, that little problems won't become big problems. i think that that's just sensible and responsible. we've got to move toward more primary care. across america we have community health clinics, and these clinics are primary care clinics in cities and small towns across america. and for many people they are the

only source of primary medical care. this bill that we will pass -- i hope we will pass -- will double the number of those clinics and increase the people working there. is it a good idea? well, it certainly sounds good, but it's also economically smart. where do sick people go today if they have no health insurance and they don't have a regular doctor and their child has a severe of 106-degrees? you know where they go. they go to the emergency room. they wait in the cue and get treatment and it costs a fortune. dramatically more than it would cost if they went to a local clinic or primary care physician. we're trying to afford good care. i think that's a move in the right direction. same thing's true when it comes to medicare. some of our critics on the other side of the aisle said, you know, they're going to cut

hundreds of millions of dollars out of medicare. and the simple answer is, yes. because we believe there is money there that can be saved without compromising in any way the basic benefits of the medicare program. this program for seniors and the disabled across america has been a godsend for over 45 years. people live longer and they're healthier and they're more independent because medicare's there. social security and medicare have given to this modern retired generation things that others just dreamed of. there was a time, and i can remember it in my own family, when your grandparents, after they quit working, either because of retirement or because of physical health problems, they ran out of money. and what did they do? they moved in with the family. it was not unusual. it happened in our family and others. along came social security and said, we're going to have a check for you -- a monthly check. you won't get rich on it, bulb able to get by on it in most

cases and you can live in your own place independent, the way you want to be. medicare said, and we're going to help pay for your health care bills as part of this. right now if we do nothing to medicare in a matter of nine years, it goes broke. it starts running in the red. doing nothing is not an option. but our bill, the health care reform bill, which we passed in the senate, and which the president supports, will add another 10 years of solvency to medicare. that is essential. how do we achieve this by making savings within medicare? well, one of the ways is to look at how care is provided. i took a look at the average medicare cost per recipient in some of the major cities in america. my hometown of springfield, illinois, two great hospitals and great doctors, it's abou about $7,060 a year for every medicare recipient. go up to chicago, it's $9,600 a year. over in rochester, minnesota, at

it's $7,600 a year but you go down to miami, florida and the average is $17,000 a year for each medicare resip yefnlt i'll concede miami may be a little bit more expensive than the other cities i mentioned, but twice the cost? i don't think so. there are savings we can find in the medicare system and still find quality care that the seniors need and are entitled to. we've got to find twice do that. and if we don't enter into this conversation in very short order, we are going to see the medicare system basically facing insolvency. that is one of the real realities that we face. how are we going to reach this goal politically? that is a major item of discussion much the president made it clear yesterday that he feels after the super majority vote in the senate for health care reform, that we need to move this to conclusion and have

an up or down vote. let me translate what that means. it means if the house enacts the senate health care reform bill, they can also turn to something called reconciliation. reconciliation is a process that is used in both the house and the senate to deal with budgetary questions. we have not invented it. it's been around for decades. and it's been used some 22 different times. that, to me, is an indication that reconciliation is an accepted practice and procedure in the modern congress. we have seen, as well, that the republicans have used it more than half of those times for issues that are important to them. issues important to many of us. children's health insurance was enacted through reconciliation. the cobra program for health insurance for the unemployed, enacted through reconciliation. president bush's tax cuts, enacted through reconciliation.

in addition, newt gingrich's contract with america, parts of it enacted through reconciliation. so we know that it's been used. some of the people on the other side have argued that it's unfair to use it to modify any basic health care reform. it's interesting that the critics of reconciliation process have voted for it many times. out of the 17 opportunities to vote for reconciliation since he's been in the united states senate, the republican leader, senator mcconnell, has voted 13 times out of 17 for reconciliation. senator grassley has had 20 occasions to vote for or against reconciliation. he has voted for it 18 times. senator mccain, 13 votes on reconciliation. he voted for nine of them. senator kyl, 11 opportunities to vote for reconciliation, he voted for them every time. so these republican senators who are now saying that there's

something flawed or wrong or sneaky about this process have used it over and over again to achieve legislative goals. i've voted for it myself. we had some provisions relating to reform of student loans, for example, that i thought were good for families and students across america and reconciliation -- in reconciliation, and i voted for it. there was nothing sincister about it. it was right there. what it means is this: under reconciliation, you can bring a bill to the floor and it cannot be filibustered. we know what a filibuster is. senator bunning put a hold on a bill and held us for five days where we couldn't vote for unemployment benefits for people across this country. eventually the senator agreed to a vote and we moved forward on it. but that kind of procedure is allowed in the senate and it take days, if not weeks, to work through the deadlines and schedule to get to a final vote.

reconciliation say that's we're going to set the delay tactics and object struksz aside. we're going to have a majority vote. we bring the issue to the floor. 20 hours of debate equally divided and then any senator can offer an amendment for a vote. that can be abused too. i hope it isn't if we move to reconciliation. at the end of date, there's a majority vote, up or down. 51 votes will be necessary, i believe, to have this pass. and then we will see if we will move forward on health care reform in this country. i hope that we do move forward. i hope if we can't get the cooperation on the republican side of the aisle to tell us that we won't use -- that they won't use delays and filibusters, we do it through the regular process. in my home state of illinois, this is an issue, health care reform, which is top ral. a recent press release, illinois consumers to pay up to 60% more

on individual health insurance policies. individual health insurance policies soaring in the state of illinois. it says that the consumers in illinois who lose their jobs and have no other option but to buy their own health insurance, will get socked this year with 60% increase. that has been growing since more uninsured americans are looking for ways to protect themselves and their families. now illinois consumers will get a glimpse into just how wide ranging rate increases among individual health plans can be. the data obtained by the "chicago tribune" provides a window of the overall increases for the lawrnlg and -- large and small employers. for the consumers, and we're a state of 12 million, base rates will go up from 8.5% to more than 60% according to state data. base rates don't take into consideration health status,

gender, age, all factors that could increase the premiums even more. the individual insurance market is relatively small compared with consumers who get their insurance through their employers, but it's one of the fastest growing groups in our economy. i might add that that's going to happen as fewer and fewer businesses offer health insurance. people are on their own. people who might have their own medical history or history in the family that precludes an opportunity for this health insurance protection. the director of insurance, mike mcgraph, said this is important because the individual market is where an increasing number of people fall when they lose their jobs and become unemployed. individuals need insurance more and more and they're struggling to hang on to it now more than ever. fewer employers are offering health insurance, we would expect to see increased applications for individual health insurance. when we hear from the other side of the aisle that we need to start over on this debate, it

basically means to put an end to it. we're not going to start over. we've been at this for 15 months. we've had the most lengthy committee hearings in our history. the senate committee, health, education, labor and pension, accepted 150 amendments from the republican side of the aisle. 150 of them. and, yet, not a single republican senator would vote for the bill when it came out of committee. we have tried our best not only to have open and transparent hearings an an amendment -- and an amendment process, but to engage the other side of the aisle to put them together into a package that really does address the needs in america. for those who say start over, end it, put it behind us, how do you ignore the obvious? the cost of health insurance is going through the roof. people know it, businesses know it, families know it, and we know it as a government. and if we don't address this issue, address it openly and

honestly, it will just get worse. that is something that families understand and i think we all understand. we've talked about jobs as being the bill before us on the floor today. i happen to think that health insurance is an important part of this conversation. when i met with some unemployed people in chicago a couple of months ago, i asked each one of them, and they were struggling to continue the health insurance for their family. i remember one mother who said, my problem is this: if i lose the health insurance that i had when i went to work, if i can't make these cobra payments to keep up this health insurance and i'm dropped, i don't think they're ever going to insurance my -- insure my diabetic son. that's what they face. that reality needs to be addressed and we can address it. i sincerely hope many of my republican colleagues will accept president obama's invitation to join us in this effort. we can do this together and we

should. if we do it together, it will be a stronger bill and a better bill. but we can only invite our colleagues to the prom so many times and be turned down until we stop asking. this invitation was sincere yesterday. the president brought up four major elements the republicans have asked for and said we will include all of them in our health care reform bill. i hope that they will join us in this effort. if they do not, we owe it to the american people to move forward to make sure that we are ending discrimination against people because of preexisting conditions. to make sure that we bring down costs and increase choice an competition for small businesses and individuals. to bring into the coverage and protection of health insurance 30 million more americans than we have today. to give medicare another 10 years of longevity. to bring down the deficit in the process as health care costs start to come down. all of these positive things argue that we need to get this

job done. madam president, i look forward to working toward that goal and getting it done in a matter of weeks and not months, and i yield the floor. a senator: madam president? the presiding officer: the senator from hawaii. mr. inouye: i have 12 unanimous consent requests for committees to meet during today's session of the senate. they have the approval of the majority and minority leaders. therefore, i ask unanimous consent that these requests be agreed to and that these requests be printed in the record. the presiding officer: without objection. mr. inouye: madam president, so often when members come to the floor to offer simple amendments and describe their noble objectives, it sounds too good to be true. madam president in my years in the senate i found that when things are too good to be true, they usually are. madam president, the amendment

from the senator from alabama seeks to constrain discretionary spending at levels agreed to in last year's budget resolution. he says that it his -- that his intent is to cap spending for the next four years. now we all understand that discretionary spending is likely to be frozen this year as the president has proposed. but, madam president, this proposal goes way beyond what the president of the united states has recommended. the president has proposed a modified spending freeze which caps nonsecurity-related spending. forexample, the president allows growth in homeland