of the aisle? as the distinguished assistant majority leader showed us, all kinds of amendments -- first of all, they have nothing to do with health care, nothing to do with this bill, that are all about games. and so i would ask colleagues on the other side of the aisle don't play games with americans' health care. don't play games with the lives of americans right now who are counting on us to finish the job, to pass the bill in front of us, to make a good bill better, to be able to save money for americans and to be able to get this job done. we don't need more political games. i think the american people have seen enough, and frankly, i don't blame them for being frustrated about what has happened and all that we have gone through in the last year. i share that frustration. they expect us to get things done. frankly, they're not caring what

configuration gets that done in terms of the votes. they want us to get things done. so i would ask colleagues to drop the games. you know, we're going to get a lot of different kinds of amendments that are designed to embarrass, designed to hold things up. i would ask colleagues to, please, stop the games. don't play games with americans' health care. and in conclusion, mr. president, i would simply say again, health insurance reform is about a family doctor for every family. isn't that what we want? the ability to know that when you tuck the kids in tonight, if one of them gets sick, you're going to be able to call the doctor, you're going to be able to care for your children, you're going to be able to get insurance for them, you're going to be able to know that your children are going to get the care they need because you have

a family doctor. that's what this is about fundamentally, it's about a set of values that start from the premise that everybody in america, every family should have a family doctor. this bill in front of us completes that task and sets us on the road to fulfill that vision, and i would urge colleagues to vote for this bi bill, put aside the games, and let us get on with the business of our country. thank you. mr. baucus: mr. president? the presiding officer: the senator from montana. mr. baucus: mr. president, i yield ten minutes to the senator from california, senator boxer. off the bill. the presiding officer: the senator from california. mrs. boxer: mr. president, in 1912, a republican president named teddy roosevelt ran for the presidency on a platform that promised national health care reform. today, i had the privilege of

watching president per ram obama sign -- president barack obama sign a landmark bill that is being perfected today in the legislation now before the senate. it was quite a moment. the senate health care reform bill that the president signed today gives small businesses tax credits to help them purchase insurance for themselves and their employees. and in my state of california, mr. president, that's 400,000 businesses that will have access to tax credits. the new law is very important to those early retirees because it will ensure lower insurance rates, and we will see a high-risk pool so that in my state and all states, adults who can't get insurance because of a preexisting condition will be able to do so. the bill the president signed

prohibits preexisting condition exclusions for children, so if you have insurance but your child has asthma or diabetes or something else and they can't get covered, that discrimination is over. it ended today. the new law will cover preventive services, such as mammograms and vaccinations, at little or no cost. this bill is so important. i should say this law because it's now the law, is so important for our people. it will create new community health care centers throughout our states and we will see primary care doctors serving in those community health care centers and nurses. it will require 80% of premium income to be spent on our health care, not on outrageous bonuses for the c.e.o.'s.

they cannot say that overall they've spent 50% on us, the policyholders, and 50% on themselves. that is called medical loss ratio and we have fixed it in this law. medicare -- seniors on medicare will get free preventive care, and we have a new voluntary long-term care insurance program that people can buy into starting in 2011. in 2014,, even more things are added to this extremely important list of benefits. health insurance exchanges will open so that there's a marketplace for businesses to go and families and individuals. it's going to help us make better choices and have more choices. it provides tax credits to help individuals and families with incomes below $88,000 to

purchase insurance through the exchange. so this has a lot of benefits for our working families and our middle-class families. and $88,000, we go up to $8,000 for a family -- $88,000 for a family of four. it expands medicaid for families earning up to $49,000. now it's a much lower level. so these are very good things, and the bill before the senate now, this is our unfinished business, mr. president. we need to make a good bill better, and that's what we're doing today. how do we do it? the bill before us entirely closes the gap in medicare drug coverage. it starts with the $250 rebate to those senior citizens who are in that doughnut hole, that payment gap. in my state, it's about 800,000

senior citizens -- imagine, 800,000 senior citizens in my state, when we pass this bill will, get $250, each one of them, if they have fallen into the coverage gap. it allows young people to stay on their parents' insurance until they're 26. and that happens this year. mr. president, how many stories have we heard about young people who may have -- i use asthma as an example -- who get off their parents' health care -- they have to -- an insurance company says we're not going to insure you, and they are in deep, deep trouble. and the bill before us today says to an insurance company, no more rescissions, no more -- that's a cancellation of a policy. you cannot do that anymore. and no more lifetime limits on your plans, because a lot of times people get sick, they didn't read the fine print, they find out they're up against the limit if they have a serious

condition, such as cancer, they may reach that limit. and what happens is, they have to in many cases sell their homes, sell their possessions and they declare bankruptcy. no more. insurance companies can't do that once we pass this bill tonight. and once it is signed. so there are many good things in the bill that the president signed today, things that are very important to our families and very good things to make that bill better in the bill before us. and i hope we're not going to see the kind of tactics that some on the other side have said they're going to use by offering amendments that have really nothing to do with anything except killing this very important bill. now, i want to say, there's so many improvements in this bill. for example, medicaid. my state will be able to put millions of people on to

medicaid. 1.7, to be act, 1.7 million people. and -- 1.7, to be exact, 1.7 million people. and my state will get 100% reimbursement for that in the years 2014, 2015, and 2016. and we're going to see 32 million more people in our nation have access to health insurance, and the medicare trust fund will be extended by nine years. my state benefits greatly. there are many ways that i've already discussed. but i want to just lay this out. by 2014, up to 7 million californians will finally have health insurance, and it will reverse a horrible trend year after year people not able to do it. now, i want to spend a moment to address republican concerns that

the process was partisan. i think it's important to note over and over again that the bill that was signed by the president today that's going to help so many of our people contains 147 republican amendments. let me repeat that. the bill the president signed today contains 147 amendments. for example, an amendment by a republican colleague that all members of congress and their staff have to enroll in the exchanges. that's in the law. an amendment by another republican senator to allow premium rates to vary by tobacco use. that was accepted and is now law. and an amendment to ensure that the voluntary long-term insurance program, the "class act" remains solvent over 75 years. we have taken those amendments. they are now law. now my republican friends saying they want to repeal the bill.

this is going out all across the airwaves, they want to repeal the bill. and they say that if a lot of us lose and they get more votes here, they're going to repeal the bill. so i wanted to ask a few rhetorical questions. which of the protections in the bill do they want to repeal? do they want repeal the end of gender rating, where women have to pay much more than men? do they want to repeal the protections for our children, who will now have coverage even if they have a preexisting condition? do they want to repeal free prevention services, such as vaccinations or mammograms? do they want to repeal the prohibition on lifetime caps on insurance policies? or maybe they want to repeal the $250 rebate for prescription drug costs to seniors. well, do they want to repeal other things? you know, there's a law now that

says you can't get kicked out of your insurance plan when you get sick. that's the one i described before -- no rescissions. do they want to repeal that? or maybe they want to repeal generous tax credits for small businesses? i guess they want to repeal all of these things, because, mr. president, they said they want to repeal the entire law. but i would urge them to stand up and tell their constituents exactly which of these provisions they want to repeal. and i just want to put it on the record that i look forward to that battle, because i can tell you that the letters to my office are saying please, please protect us. we feel vulnerable. so i would like to state at this time that this bill reduces the deficit in addition to doing all these other things. and i think, in closing -- and

i'd ask how much time i have? the presiding officer: 30 seconds. mrs. boxer: okay. i would just say in closing that a lot of fear has been injected into this debate and you're going to get a barrel of it coming up. there is one thing to fear and that's doing nothing. it's unsustainable. 100 -- how many people lose their health insurance every day? 14,000 people lose their health insurance every day. 1,400 in my state. 66% of bankruptcies linked to a health care crisis. 45,000 americans die every year because they have no health insurance. the presiding officer: the senator's time has expired. mrs. withou boxer: so let's do something, let's do this, let's finish the job. and i yield the floor. a senator: mr. president? the presiding officer: the senator from wyoming. mr. barrasso: thank you, mr. president. i ask unanimous consent to proceed in a colloquy with a number of my colleagues. the presiding officer: against which block of time will this be charged? mr. barrasso: the next 30 minutes for the republicans. the presiding officer: off the

bill? mr. barrasso: yes. the presiding officer: without objection. mr. barrasso: thank you, mr. president. mr. president, i come to discuss an amendment that has to do with the fact that, as i read this bill, as i talk to my colleagues who are physicians, as i talk to other senators, i believe that this amendment, that this bill, the signed into law as well as the reconciliation bill that is before this body right now is going to significantly increase the cost of health insurance premiums paid by american citizens. and i'm bringing an amendment tonight that says that if the department of health and human services certifies that premiums will rise faster under this democratic health care bill signed into law and the reconciliation bill, then it would, under current law, then the provisions of the bill will sunset. because we have been promised, the american people have been promised that by passing this

law, what would happen is that the cost of their own health insurance premiums would go do down. the president of the united states promised t. the president of the united states -- the president of the united states promised it. the president of the united states while campaigning talked about that, made that promise, and then early in his term said that he would actually lower the premiums for families by an average of $2,500 per family for the cost of their health care insurance. that's what the president said. so then the bill is written behind closed doors, people had very little input and that bill came out, and then senator richard durbin, democrat from illinois, majority whip, comes to the floor on the 10th of this month, the 10th of march, and says, "anyone who would stand before you and say, 'well, if you pass health care reform, next year's health care premiums are going down,'" -- which is what the president has said --

"'anyone who says that i don't think is telling the truth.'." he went on to say, "i think it is likely they would go up" -- they would go up. "what we're trying to do," he said, is "slow the rate of increase." only two days before senator durbin said that on this floor, the president was in pennsylvania and he said, our cost-cutting measures mirror most of the proposals in the current senate bill which reduces, he said, reduces most people's premiums. mr. mccain: you know, could i ask my colleague, he recalls that over at blair house when our colleague from tennessee began the discussion with the president and our democratic colleagues, he said at that time that the congressional budget office said premiums would increase from 10% to 13% for individuals purchasing health insurance. that comes out to $2,100 more for a typical family. the president challenged that,

as you may recall, and said, well, we're going to settle this before the end of this -- what later turned out to be over seven hours of fun. but -- so what was the answer to that, i would ask, dr. barrasso? what was the answer? was senator alexander correct when he quoted the congressional budget office that premiums would increase by 10% to 13% for individuals purchasing health insurance? or was the president correct by saying that that was not true? mr. barrasso: well, and senator ensee who's joined us on the floor, was also sitting with us on that day-on-at blair house. and my recollection and from doing the research afterward, the press reported that senator alexander was correct, that premiums on individuals buying health insurance in the individual market would see their health insurance premiums go up by 10% to 13% if this bill becomes law and the president signed it into law today. so the american public needs to know that their health insurance premiums are going to go up as a

result of what the president signed today. and i'm bringing an amendment opposed to that. mr. mccain: that's exactly what -- mr. enzi: that's exactly what was concluded at that blair house meeting, which was supposed to be a listening meeting. nothing appears to have been listened to. there were multiple suggestions that the republicans had there. and on that 10% to 13% that this premium is going to increase, there's a very important addition to that. it's 10% to 13% more than if we did nothing. the president keeps talking about how we need to do this bill because health care costs are escalating dramatically, and they are. but they're going to escalate even faster. 10% to 13% more than if we did nothing. mr. mccain: could i ask senator enzi then, what was the president referring to. in fairness to the president, what was he referring to when he challenged the senator from tennessee's assertion that

individual premiums would go up by some 10% to 13%? mr. enzi: i am neat exactly sure what he was referring to. he has used that in a number of speeches, just as they keep using the number that this bill will reduce the deficit by $138 billion. again, you got to read the rest of the sentence and find out nays we don't take care of all of the things that we normally take care of like the doc fix, which is going to cost $300 billion, which more than uses up that money. mr. mccain: so it seems to me pretty legitimate to hold the president and the sponsors of this legislation to their word. and that is, if it doesn't increase the premiums, then they're true to their words. but if it does increase, then the american people have not been told the truth. so, therefore, this legislation should be scrapped and we start all over. and by the way, could i just add one point. i've grown a little weary -- a

lot weary when they say, to do nothing will do x, y, and z. we're not talking about doing nothing. we're talking about medical malpractice reform. how does anybody excuse the fact that there's not medical malpractice reform in this legislation? there's only one answer: it's the trial lawyers control this legislation, and that's disgraceful. mr. gregg: if the senator would yield, i think it's important to understand why the premiums go up, so that the argument that they don't go up can be pointed out as being really transparently inaccurate on its face. the reason the premiums go up is because under this bill americans who have health insurance will be forced to buy more expensive health insurance. they are real estate going to be forced to buy health insurance -- they're going to be forced to buy health insurance which is at a much higher level of coverage for a lot of things that americans simply don't need and therefore they don't buy it today. they're going to be required to buy that higher health insurance and that's going to force the premiums up.

this is a classic top-down "you do what the government says relative to what type of health insurance you're going to be able to buy" with respect to that plan. it has an immediate impact on the cost of their health insurance and that c.b.o. says has said, that both senators from wyoming have accurately pointed out that c.b.o. has scored this as increasing the premiums for individuals. because of that -- is that not correct? mr. barrasso: that is absolutely correct. and the nonpartisan congressional budget office says it is going to go up. the joint committee on taxation says people will have to end up paying more in health care premiums than if there was no bill at all. the chief actuariry for the medicare and medicaid services said the same as do eight additional private-sector agencies, that the health care bill signed into law today will drive insurance costs up greater than if there was no bill at all signed into law, and there are

mandates and we're putting this on the young people who are going to be forced -- many of whom are going to be forced to buy insurance, forced by this law, all of they will are going to be forced to buy insurance that many of them don't need, many of them don't want, and many of them can't afford. because they're going to have to buy levels that are far in excess of what they might want, and it's going to be very expensive, as many of them are going to be subsidizing others because of what's called the community rating and the way this whole program has been set up. mr. mccain: could i ask the senator from new hampshire just a personal point: suppose we had decided to do away with the tax benefit for employer-provided health insurance and given every american family ads 5,000 refundable tax credit. would we have then been able to give the ability to acquire insurance? mr. gregg: i think the senator

is right. and the type of insurance they would have gotten would have been the type they wanted. if you're not buying insurance today, it's not because you can't afford it. of the uninsured population, of the 47 million uninsured, approximately 20 million have incomes over $70,000. they just simply decide they're not going to buy it. if you gave them this refundable tax credit, what they could buy is a catastrophic plan so they could insure themselves against a catastrophic disease that might wipe themselves out financially. it would have been better tailored to their needs as opposed to what some bureaucrat here in washington has decided they should have. mr. lemieux: we realize that really it is a bait-and-switch. during the campaign, president obama said this was about lowering the cost of health insurance. we know that health insurance has gone up 130% in the past ten years. the bait was, don't you want

your health insurance to be lower? the american people said, sure, yes, of course they d th they d. the switch is that what this is all about is about putting more people in medicaid, 15 million more people in a program that's failing, a program where walgreen's in washington state is no longer taking medicaid, a program where doctors no longer taking comid. it is not health care reform if the dpr is not in. but for the rest of the americans shall the 159 million people who have health insurance, their costs aren't going to go down. in fact, they are costs are going to go up. i'd ask my friend, the senator from arizona, you know, who comes from a state where we have a population, just like florida with a lot of seniors. what do we say to our seniors -- our seniors who are not going to have a cut in medicare of $500-plus billion to finance this big expansion in medicaid -- how do we justify this to

them? mr. mccain: and the program that i'm sure senator enzi and dr. barrasso would grearks the one program that's going to be cut the most called medicare advantage where seniors do have some relative choice as to what type of care they wish to receive. and the fortunate -- fortunately, the 800,000 enrollee carve-out has been removed because of the national attention that it got. but i'd ask dr. bar real estate so if -- mr. barrasso: there is an advantage to medicare advantage. that's why people sign up to it, as 11 million americans v the advantage, it worked with cordsh coordinated care, prevention of disease. that's why people want to be in that program but now the president is eliminating it. my colleague from florida talked about the 15 million people dumped onto medicaid. and "the new york times" reports, "as medicaid payments

shrink, patients and doctors drop out. patients and doctors drop out." the president not only is dumping 15 million on with the health care bill, with the bill we're discussing right now, the reconciliation bill, it adds another million people onto those rolls dumped into medicaid. mr. mccain: so prance the -- sos the worst fraud that's being perpetrated is the doc fix. no one, no one, who is an expert on health care believes that we're going to cut physicians' payments for treatment of medicare enrollees by 21%. no one. and yet that is calculated so that there can be this phony actual reduction in the deficit in the calculation. mr. barrasso: and for the ginned up ness numbers that we have been -- and for the ginned up numbers that we have been presented to for the deficit to work, in the next couple of months they would have to cut

doctors' fees for all of the medicare patients they take care of by 21%, and then keep those fees frozen at that low level for the next ten years. now, is that going to happen? but if it doesn't happen -- and i ask the accountant from wyoming, as opposed to the surgeon from wyoming -- from an accounting standpoint, can you do that? mr. enzi: um, the senator from wyoming, not only is correct that we're going to have a huge problem, but something that's new in the singles bill -- besides this 21% that of course we're going to have to fix and that's going to cost us $300 billion. and all the proposals so far have not paid for that proposal. they slipped in a little cliff for medicaid. and in two years we're going to drop off a cliff with medicaid just as for medicare.

that's going to drive up the deficits, too. wasn't everybody promised catastrophic care as one of the presidential promises? it kind of fascinates me that medicare doesn't have catastrophic care -- unless -- unless you buy medicare advantage. and then you can have the catastrophic care. but we're trying to get rid of medicare advantage now and force all those people into a different kind of insurance. and i appreciate the senator from new hampshire mentioning mandates. yes, they're going to require you to have a lot more different kinds of insurance than you might want to have. we're going to say, the federal government knows best, and this is the minimum insurance that you can have, and you're going to have to buy it or we're going to put a mandate on you, another mandate. now, there's the mandates for what you have to get in health care. but there's also going to be a mandate that says every single person has to buy insurance. and there are a lot of people right now that make a good living, that are healthy, that don't think they need insurance,

and won't buy it. they'll pay the penalty up until the time that they have a preexisting condition, and then they'll jump into the market. and that'll drive up the price for everybody else. so there are a whole lot of accounting finagling that's going on in this to make certain statements possible. but it is going to dive up the premiums, it is going to cause people to get more insurance than they want to get and it's going to cause everybody to get insurance whether they want to or novment in the history of the united states, we've never had the federal government tell anybody that they had to buy something. we've set up safety measures in their purchasing to protect them, but we haven't said, you got to buy it. in this case, we're going to say, you got to buy it and there are a whole bunches of people that say that's unconstitutional. mr. lemieux: if the gentleman would yield. isn't it amazing that the federal government is going to penalize you, send an i.r.s. agent to tax you, if you don't buy health insurance?

if you fail to take an act? has the federal government ever in the history of our country ever penalized a person for failing to act? and that's why we have these folks around the country who are experts in the constitution, folks like my attorney general in florida bill mccollum who is going to bring a lawsuit against this bill, because the commerce clause has never been interpreted to that you'r that e to do something is within the realm of congress. if you can say that your failure to purchase health insurance is within the role of the federal government, why can't you federal government say -- why can't the federal government say you got to go to the gym or you got to eat your broccoli? what account federal government not do, mr. president, if it can do this? it is beyond the framers' intentions. it is beyond any of the supreme court law. and it really, whñ -- when you think about the relationship to our government, we are supposed to have the

rights. our declaration of independence says that we have the rights and we give them up to the government. the government is with the consent of the governed. but in this situation, it seems that the democrats believe that the government knows best. i just want to make one other point about this cost issue. 130% in the past ten years, health care insurance has gone up. the reason why this bill will not control the cost of health care is because it takes the consumer and keeps the consumer out of the equation. the consumer has no motivation to reduce the cost of health care. we didn't do the tax credit idea that the gentleman from wyoming mentioned which would put the consumer back in the game, make the consumer conscious of prices and make a competitive environment that would actually reduce health care costs. and i wonder if my colleague and friend from wyoming might speak to that point because i know that he was very much involved and the author of this idea of giving us tax credits. mr. enzi: and i appreciated the senator from arizona bringing that up because when he

mentioned tax credits in his campaign, he was chastised by now-president obama as saying that just can't happen, that is that's terrible. but you will find it slipped into the bill anyway. now, so far it just catches the top insurance people. they're going to be taxed -- no, they're not going to be taxed because it's shoved in as a hidden tax so it doesn't expose that they are actually doing what the senator from arizona was suggesting. it's going to be a hidden tax that the company is going to have to pay but the company is going to take it out on the employee. so it's another way that they are going to tax and taxes raise prices and lower benefits. the prices on insurance are going to go up because right now the insurance companies are trying to protect themselves. and on the one hand, they have been protected a lot by this bill, and you would think that we're accused of being -- of

helping out the insurance companies. but take a look at some of the stuff that really helps out the insurance companies, and this with the individual mandates, the employer mandates and those things. but at the same time, they are being threatened that they are going to be price fixing. i was in the shoe business with my wife, and when we first went into the shoe business, nixon was talking about fixing prices. in response, the companies immediately raised the price of shoes 50%. and then every time that they were allowed to raise the price again, they did. within one year, shoes cost twice as much as before. that's what happens he had government interferes. this is government interference. it's going to cause premiums to go up, and it's going to cause prices to go up. now, the other side says don't worry about it because there are subsidies. where are the subsidies coming from? oh, yeah, we're going to take half a trillion dollars for medicare and we're going to put it into these new programs which are subsidies. and besides that, we're going to come up with half a trillion dollars in taxes, and that's going to go for the new subsidies. does anybody in america believe

that you can put in new programs at a cost of a trillion dollars and that isn't going to cost any of us a dime? of course not. and the seniors know it. the people that are going to be paying premiums are going to know it. and the companies are all going to know it. and who are they going to be mad at? they're not going to be mad at republicans because not a one of us voted for it. on this reconciliation bill, i don't think they're going to be mad at us on this one either, but they can see what's happening. premiums are going to go up. just as the other senator from wyoming mentioned. mr. barrasso: if i may interject, that's why i have an at the desk that deals with this specific aspect that says that it will cause premiums to go up higher, in my opinion, if nothing were done at all. i think that actually happens because the democrats and the democrats have promised something differently, that we ought to sunset the entire bill. with that, i would like to call up the amendment that is at the

desk. the presiding officer: is there objection? mr. baucus: mr. president. the presiding officer: the senator from montana. mr. baucus: mr. president, i ask contessa that once -- i ask consent that once the time on the barrasso amendment expires, that the amendment be set aside. the presiding officer: the senator from montana does not have the floor. mr. baucus: well, can the senator from montana ask for the floor? the presiding officer: the senator from wyoming has the floor. would the senator from wyoming -- there is a unanimous consent request pending to offer an amendment. is there objection? mr. baucus: mr. president, reserving the right to object. would the senator agree to modify as follows -- that once the time on the amendment -- your amendment expires, the amendment be set aside until a time to be determined by the leaders. the presiding officer: does the senator still modify his request?

mr. barrasso: yes. the presiding officer: is there objection? mr. baucus: no objection. the presiding officer: without objection, so report. the clerk: the senator from wyoming, mr. barrasso, proposes an amendment numbered 3582, at the end of sub title b of title 2, insert the following -- mr. barrasso: mr. president, i ask the reading be dispensed with. the presiding officer: without objection. mr. barrasso: how much time do we have remaining? the presiding officer: 7 1/2 minutes. mr. barrasso: thank you. we have a number of colleagues on the floor, and we believe this amendment is absolutely critical because it goes specifically to the heart of the promises that have been made to the people of our home states and the people of the country. and the promises made to the 8 5% of americans that have coverage that they like is that their costs would actually go down. but yet as i travel around my state and around the country, i see people who are very worried

that this bill that cuts medicare for our seniors, raises taxes on all of us, is loaded with sweetheart deals is going to cause their people's health insurance premiums to go up at a time when they believe that the quality of their care will go down. a senator: would the senator yield? mr. barrasso: yes. mr. gregg: i want to make one point i hope is obvious to everyone. this amendment simply says that if the -- if the premiums rise faster than what they would rise under current law, then the bill won't go into effect. isn't that what it says? mr. barrasso: it is exactly what it says. the presidingmr. gregg: it's bay reinforcing what the other side of the aisle says. why shouldn't there be any claim to something which basically puts in place the language which enforces what the president claims he is doing and what the other side of the aisle is claiming he is doing. can you think of why there should be opposition to this?

mr. barrasso: this should be unanimously accepted, all sides agreeing. this is what the promise is to the american people when this bill is brought forth and when the president first addressed this to the nation. when he said he wants to get the cost curve down, wants to get the cost of insurance down by by $2,500 per american family. we just want to hold folks to the promises that have been made to the american people. the american people have spoken overwhelmingly and loudly in opposition to the bill that has come out from behind closed doors, for them to finally see and try to understand all of the machinations and maneuvers, and they ultimately looked at it and in overwhelming numbers said we don't want this for ourselves, for our families, for our neighbors or for our country. and yet, it was crammed down the throats of the american people, and i bring this amendment tonight to say that i want to hold those who voted for this bill to the promises that they made to the american people.

and if, in fact, insurance premiums go up faster because this bill has become law, then they would have gone up without this bill, then the law is no longer in effect. and as i look to my colleagues from other states, i imagine this is the sort of thing that you hear in florida when you head home for the weekend and they say, you know, what have we been promised, what are we going to get, how are we going to hold people to the promises made? mr. lemieux: i thank my friend and colleague, the good doctor, for bringing that point up. my constituents in florida say we care about the rising cost of health insurance so i think your amendment is exactly on point. if this bill makes the situation worse, it should not go into effect. why would anyone, why would any of the 100 of us not support your amendment if we're not going to control the cost of health insurance? that's what we are supposed to be about. that was supposed to be the number one goal. so i think it's a great

amendment. i certainly will support it. i hope that all of our colleagues do. and i think the challenge to our colleagues on the other side of the aisle is i know they don't want to take any of our amendments. i know they just want to cram this through and get it done so it doesn't gak to the house of representatives. but the duty of our friends on the other side of the aisle is as always as it is our duty to enact good laws and make things better. so if there is an amendment like this one that is good for the american people, it is their duty, i would respectfully suggest, to vote in favor of it even if it has to be sent back to the house of representatives because when we go home to our constituents, they are going to ask us did you lower the cost of health insurance? i'm going to have to go home to more than 300 floridians who are on medicare who continue to question me and say why are they taking half a trillion dollars out of our medicare? why is there now $200 billion coming out of medicare advantage? over the next 12, 24, 36 months,

i'm not going to enjoy the conversations with my constituents even after my time in the senate is through, who come to me and say why can't i go to medicare advantage anymore, why did they shut that program down? why can't i keep the health insurance the president told me i could keep? why did my employer drop me? you know, the estimate is that 33% of folks on medicare advantage by 2015 -- this is rick foster -- says are going to lose it? we have more than a million people on medicare advantage in florida, more than a million. so these are going to be tough questions to answer, but i applaud my colleague, the good doctor, for bringing this forward. it's exactly the right thing to do. i hope that our colleagues on the other side of the aisle will have the courage to accept these amendments that are in the best interests of the people of the country. mr. president, how much time do we have remaining? the presiding officer: two minutes. mr. barrasso: mr. president, we

continue here tonight to bring forth to the american people our concerns about a bill that i believe from my years of practice of medicine, taking care of families in wyoming, and now as a united states senator for the last several years, is going to be bad for patients, it's going to be bad for providers, the nurses and the physicians who take care of those patients, and it's going to be bad for payers, people that pay for their health insurance, people that pay taxes in this country, the taxpayers of this country as a bill continues down the road which is going to contribute to the debt, contribute to the deficit, and as i hear week after week at home and on telephone town hall meetings, the debt is the threat. our spending at this point is unsustainable, it is irreversible, and it -- it really is -- it is irresponsible. and i bring this to say we

cannot pass bills in the united states senate and have them signed into law which promise one thing, do something very different, promise to help people, end up hurting our nation, hurting our economy, hurting our jobs, hurting the opportunity to hire more people with mandates, hurt young people who are trying to buy insurance because their rates are going to go up. this is a bill that is going to cost all of america in ways in the decades to come from a financial standpoint as well as a health standpoint are going to be detrimental to our nation. so, mr. president, i would say with my colleagues here on the floor, i would say please take a very serious and close look at this amendment because the american people should not be promised one thing during a campaign and during a bill that is being written and then when it comes into law they are going to see something very differently which is going to be detrimental to them, much more

expensive for them, for their families and impact on the kind of care that they want for themselves and their families, and that's why when i have town hall meetings in wyoming, or in other states, people raised their hand, they think the cost of their own care is going to go up, the quality of the care is going to go down. the presiding officer: the minority's time has expired mr. barrasso: thank you, mr. president. i yield the floor. mr. baucus: mr. president? the presiding officer: the senator from montana. mr. baucus: i ask we have additional time, a half-hour on each side, as is the customary practice. the presiding officer: is there objection? without objection, so ordered. mr. baucus: i yield ten minutes to the senator from washington, mr. murray, off the bill. the presiding officer: the senator from washington. mrs. murray: thank you, mr. president. throughout this debate, i have come out here to share the stories of families and small business owners from my home state of washington who were suffering under our broken health care system. i talked about washington state

small business owners from ken he wick, good -- from kenewick, good people who wanted to cover their employees but could not afford to pay the skyrocketing premiums. i spoke about mothers and fathers in seattle and spokane, grandmothers and grandfathers east of the cascades and west. men and women from every part of my state. some barely holding onto their health insurance and some with no coverage at all. i told the stories of so many people from so many different backgrounds, but each one of them shared a common thread -- the health care system we have today didn't work for them. it failed our families one way or another over and over again. mr. president, i have received well over 10,000 letters from washington state residents and too many of them share that theme. stories of coverage dropped when they needed it most, premiums going up at rates of 20% or 30% or 40%, seniors struggling after falling into the doughnut hole,

terrible stories. stories of loved ones who are lost, of children and parents, brothers and sisters, stories about what they had to go through before they passed away. battling insurance companies, losing their coverage, fighting for their care, never giving up but fighting against powers too great for them to bear. mr. president, that is why i fought so hard to reform our broken health insurance system. to fight for our families who need help to level the playing field for people who just need a little support. for families with real struggles and real problems that we can work together to help solve. and that's why i am so proud to stand here today and say to those families and so many others that although we have not fixed everything that's wrong with our health care system overnight, we have taken a real step forward for people across my home state of washington and across america. today, when president obama

signed health insurance into l law, a number of significant improvements kicked in and some of the worst practices of those insurance companies were tossed into the dust bin of history. great changes went into effect immediately for families and small business owners, for children and seniors in washington state and across the country. now that this bill is signed into law, if you ever worried about losing your coverage when you or a family member got sick, you don't have to worry anymore. it's no longer allowed. now that this bill is signed into law, no family ever has to worry about the unreasonable and unfair lifetime caps on coverage that we have seen from insurance companies in the past. and now that this bill has been signed into law, never again will families have to fight for the preventive services that they paid for and they deserve. families like the labrums from port orchard, washington. now, joseph labrum sent me a

better about his wife, who went to a doctor complaining about a pain in her breast. a mammogram failed to show anything was wrong but she wasn't personally convinced. she knew something wasn't right and she knew that there was a history of breast cancer in her family. so she asked for an m.r.i. but her doctor told her, her insurance company wouldn't pay for it, and she just couldn't pay for it on her own. after three years of fighting with her insurance company, three years of pain and uncertainty, she was finally able to convince them to take that test. mr. president, by that time, her cancer had grown to eight centimeters and required a full mastectomy, chemotherapy, and eight weeks of radiation. joseph told me that he's convinced that if his wife's care had been up to her doctor and not her insurance company, she would have been cured with a minor lumpectomy and wouldn't have had to go through so much pain and suffering. the bill president obama signed

into law today makes sure that starting today, insurance companies will be required to cover preventive services with little or no cost on the part of washington state patients. starting today, washington state families will have access to new streamlined assistance to help them appeal services that have been denied or not covered adequately by their insurance companies. this is going to help anyone who's ever bel felt buried undea blizzard of forms and denials, and it's going to start helping our families right away. mr. president, if you're a small business owner, starting today, the health insurance market will begin working better for you. starting today, people like mark peters, who's the owner of a small technology company in porttownsend, washington, will be -- port townsend, washington, will be better able to afford care for his employees. a month ago mark wrote me to tell me he offers health insurance to his employees. he does the right thing.

but last year he got a letter from his insurance company raising his rates by 25%. mark told me that his small business can't sustain increases like that. no business can. but in our current health insurance system, small businesses are often at the mercy of the shurps companies -- of the insurance companies. they lack the leverage, they lack the negotiating power of the larger employers, and they can't afford to hire a human resources department to spend the day haggling for better rates. but that ends today. thanks to the bill president obama signed, small business owners like mark will immediately qualify for the first phase of a tax credit program to help them purchase insurance for their families and for their employees. that credit will kick in immediately, is up to 35% of the employer's contribution to coverage, which is going to make a huge difference for almost 100,000 small business owners in my state of washington right away. and, mr. president, starting today, if you're a young person or a senior citizen, you will

also be helped immediately. over 159,000 washington state seniors who fall into that doughnut hole are going to have their brand-name prescription drug costs cut in half starting right away. the law that begins to close this destructive coverage gap and the bill we are considering today finishes the job and closes that doughnut hole once and for all. and starting today, insurance companies are going to be required to permit young people to stay on family policies until the age of 26, which is especially, i must say, important now when so many of our young people are having trouble finding that first job. again, real help for real people right away. mr. president, that's why i supported this law and that's why i fought so hard to get it. because, mr. president, we've been talking about reforming the health insurance system for a long time. many leaders in this country have tried to fix this broken system. each of them has failed. but today, thanks to the bill, president obama -- thanks to the

bill president obama signed, we begin the move towards real reform. reform that's going to help families like the labrums, small business owners like mark pete peters, seniors and young people in washington state and across the entire country. reform that will help people immediately, starting today, and that will move our families one step closer to lower premiums, more choices, and at long last the health care security and stability americans deserve. mr. president, starting today, things are starting to look brighter for millions of americans who've waited far too long for the help they need and deserve. thank you, mr. president. i yield the floor. predent? the presiding officer: the senator from montana. mr. baucus: mr. president, i yield ten minutes to the senator from new jersey, senator menendez. the presiding officer: the senator from new jersey. mr. menendez: thank you, mr. president. let me thank the distinguished chairman of the finance committee for his work on this

bill and the bill the president signed earlier today. mr. president, the time has co come. historic health care reform has passed this congress. the president has signed it into law. and the american people will live healthier, safer, more secure lives because of it. now we come to the floor again, called upon once more to finalize this historic legislation and make it even better. and once again i ask my colleagues on the other side of the aisle to take their place on the right side of history and end the obstructionism, stop the fearmongering, the apocalyptic predictions and think about what you're about to do through the long lens of history. think of the legacy you want to leave. think of your grandchildren. think of all of those who will look back a generation from now, maybe two generations, like we did with social security and medicare, the civil rights act, the voting rights act, and ask,

how did you vote. think of what you'll say then and think of what you'll tell your children and your grandchildren. will you look them in the eye and say you stood up for our families against the big insurance companies in voting for one -- and voted for one of the greatest pieces of reform legislation in history? that's exactly, mr. president, what this bill will do, will change the lives of millions of americans just as social security and medicare changed the lives of americans, and thank god they did. those two pieces of legislation defined who we are as a people and the strength of the american people, each of us working for the betterment of all of us. it's our obligation. it's our duty. it is our call to history to leave a legacy of hope and health security for every american family. now, there are those who stood steadfast against social security at a time when millions of seniors were facing ruin in this country.

when old women were selling apples on street corners ands? who had played by the rules -- and seniors who had played by the rules all their lives found themselves with nothing and no health care at a time in life when they needed it the most. the concept of social security and medicare, as we know, was a long time coming but it was the right thing to do. it was a democratic proposal derided by those who used the same arguments then that they are using today against this legislation. where, a government takeover, socialism, the insurers will do the right thing. well, they have not. the difference between us then and the difference now is that our friends on the other side of the aisle believe the business of government is to protect big insurance companies. but we believe the business of government is about our people, their lives, their hopes, their dreams for a better, safer, healthier, more secure life for

themselves and their families. this is the debate on the floor today, just as it was when we debated social security and medicare and every other major piece of historic legislation that benefited people over big business. the health care needs of our families must prevail over what we see on the floor still today: the delay, the obstructionism, the almost irrational fervor to stand in the way of change that is being driven by talk shows and tea partiers and unacceptable outbursts of demeaning language and behavior like we saw on the steps of the capitol this past weekend against an american hero like john lewis, which will be judged harshly by history. let's be clear. republicans have said "no" for a century, and once again we hear a resounding "no" to changing a broken system. i want to say "yes" -- i want to say "yes" to the people of new jersey and let that be our

legacy to those who we represent. i want to tell the 1.5 million people of new jersey who are uninsured and the 326,000 who have individual market insurance that you will now have access to affordable health care coverage. i want to say to the 854,000 new jerseyans, you will now qualify for tax credits to purchase the health coverage you need and deserve. i want to say "yes" to the preventive services for 1.3 million seniors in new jersey who don't have those services today. i want to say "yes" to the 227,000 seniors in my state who will finally have their drug costs under the medicare part-d doughnut hole covered over time. i want to say "yes" to the tax credits for 107,000 new jersey small businesses that will be eligible for tax credits to offset their premium costs. i want to say "yes" to $14 billion in tax credits and

cost-sharing tax credits for new jerseyans to purchase private health insurance, many for the first time. i want to say "yes" to an estimated $9 billion more for medicaid that new jersey would receive in this reconciliation bill, which is $580 million more than even the original senate-passed version. i want to stand and say "yes" to basic commonsense protections that stop insurance companies from making health care about the bottom line and not the lives of people. i want to say "yes" to stopping insurers from denying coverage for preexisting conditions, something that you have no control over, something that happened to you in your health and now stops you from getting health insurance. i want to say "yes" to stopping companies from canceling policies when people get sick "g lifetime limits on coverage. i want to say "yes" to all of that and leave a legacy of hope to all the families who would benefit from this legislation.

and yet it seems the only answer we get from those who have been against this legislation from the beginning is "let's start over." but we're not starting over. it's the law of the land now, and not only do they want say "no" to it, well, they want to repeal it, they want to repeal all of those things, they want to take away those rights that now exist for all americans as a result of the president's signature, they want to take that away from you. the fact is, hard as it may be for some to realize or accept, americans voted for change in their lives, change so that they would not have all of these obstacles to the health care of their families and themselves. and that is the change that's being delivered. mr. president, affordable, accessible health care is now the law of the land, and this reconciliation bill makes it even fairer and more affordable for middle-class families. it helps seniors.

it protects consumers. it eliminates waste and fraud. and it further reduces our national deficit. this bill will eliminate special deals, no matter how many times, no matter how many times we hear bumper-sticker slogans shouted from those who see health care reform in terms of their own political future rather than what is right for america. it makes health care insurance accessible to low- and moderate-income families who never thought they'd be able to afford health care for themselves and their children. it extends the prohibition on dropping people when they get sick and they need it the most and the requirement to provide coverage for nondependent children up to their 26th birthday starting six months after enactment. it attacks waste and fraud in medicare and medicaid by cracking down on abusive billing practices for hospitalization services, and it strengthens medicare prepayment reviews to reduce abuses in the system and,

thereforings help build the system. so, mr. president, the time has come once again to be counted. the time has come to take an historic vote once again, take our place before the lens of history, as our predecessors did on social security and medicare and think of what we will tell our grandchildren. history will judge whose side were you on and the legacy we will live. voting "yes" gives young people like 24-year-old christopher joyce of old bridge, new jersey, who had no insurance from work and suffered a massive stroke in january that left him paralyzed, barely able to speak. he'd be on his family's policy instead of league his family on the verge of losing their home. vote "yes" and never again will a mother or father in america wake up in the middle of the night with a sick child and look at each other knowing they can't afford the medical care their child needs.

vote "yes" and never again will a man, woman, our child in america be discriminated against because they are sick or once had something an insurance executive decided was a disqualifying preexisting condition. vote "yes" and never again will an insurance executive be able to make medical discussions instead of a doctor to manage risk for shareholders and hold the bottom line other people. vote "yes" and christopher joyce would have the health insurance he needed to save his family's shoafamily'shome. vote "yes" and we'll make things better for every american family. that's what this bill is about, about a legacy of hope and security and health security and that's why i'll be casting a "yes" vote on singles. with that, mr. president, i yield back the balance of any time i have and yield the floor. mr. baucus: mr. president? the presiding officer: the senator montana. mr. baucus: i'll yield five minutes to the senator maryland. the presiding officer: the senator maryland.

mr. cardin: first, let me thank senator baucus for his incredible leadership in our successful completion of health insurance reform and health care reform. this was a special day. to be with the president of the united states when he signed into law the law that the united states will finally join every other industrial nation in the world in providing universal health insurance coverage, universal access to health care. the best news, mr. president, we can improve it. we can improve that legislation with the bill that is currently before us. with this bill and the bill that the president signed, 32 million americans who currently don't have health insurance will be insured. 95% of americans under the age of 65 will have health insurance. and the good news is that we do this by reducing the federal budget deficit. we all know we need to do that. $1 billion ove$150 billion overn

years. it provides immediate help to small businesses and individuals so that people can get insured immediately. for small businesses, if you are under 25 employees, you can get help. 10 or under, you can get a tax credit this year, up to 35% of the premiums for covering your employees. and then when the health exchanges come into effect, small companies can get credits up to 50% of the premiums that they pay. it provides immediate help for our seniors. i can't tell you how many seniors have talked to me about the dilemma of filling their prptioprescriptions or paying tr food bills or cutting pills in havment well, this year, with the bill the president signed, with the improvements that we make with the underlying bill here today, seniors will receive a $250 check to help cover the prescription drug costs that they fall within the doughnut

hole. and under the bills, we completely eliminate over time the so-called doughnut hole where seniors fall into and have to pay 100% of their drug costs. that'll be gone. under this legislation, there will be immediate help for individuals who have preexisting conditions to go into a community-based risk pool, so they can get affordable health care now as a result of the passage of these bills. under this legislation, we take on the abusive practices of private insurance companies. effective within six months of enactment, no further discrimination against children with preexisting conditions. extending coverage for young people up to the aifnlg their 26th birthday. ending the rescission of the healt--of a health insurance poy because a person gets sick. banning lifetime limits on your insurance protection and starting down the path of restricting, eliminating annual

liltlimits that are unreasonabl. all that is included in the legislation we're talking about providing immediate help to american families to find affordable health care. then we have also the access to affordable health care. i thank the chairman, these dragses to extend this to emergency -- i thank the chair, these are additions to extend this to emergency care. a physician can't deny you coverage for going to an emergency room where you had the symptoms where a person should go to the emergency room, where you can pick your own primary care physician, where you can take an independent appeal from a decision of an insurance company that's contrary to what you believe is right. and then, mr. president, starting in 2011, we start telling insurance companies that there's a limit as to how much they can take from your insurance premiums and use for their bureaucratic administrative costs or profits. that they have to put the money back into benefits for you.

between 80% and 85%. if they don't, you get a refund, a rebate from your insurance company because they've taken too much premiums from you. that's all in this legislation. we build upon the community health centers. i particularly want to thank senator sanders for his leadership on that. community health insurance are critical to access to care. that's in this bill, and it takes effect immediately. these are important changes. i'm also very pleased about the provisions that were added to the bill, an amendment that i offered for minority health that will set up within the department of health and at n.i.h. a division for minority health, so that we can start to deal with the disparity in health care in america in a more aggressive way, in a more continuous way. so that we can truly provide equal access to health care for all americans. mr. president, the bill the president signed was great. this bill improves upon that, and i just urge my colleagues:

let's take pride in what we were able to do collectively, let's improve it with the bill that's before us. it will help our seniors with prescription drugs. it will reduce the deficit further, make health insurance more affordable, and it will help our states in the payment of medicaid. i urge my colleagues to support legislation, and with that, mr. president, i would yield the floor. the presiding officer: the senior senator from delaware is recognized. mr. carper: how much time do we have on our side? the presiding officer: six minutes and five seconds. mr. carper: i'd like to take a few minutes and talk before my republican colleagues return to the floor, just talk about some provisions in the legislation that the president signed today that are not very well-understood, but i think could be of real help in reining in the growth of health care costs. and i've said all along, a number of my completion have heard me say this before, it's all well and good that we want to extend coverage to people that don't have it.

there's plenty of people -- way too many people that don't have it. but if all we do is extend coverage without reining in costs, we're not going to do that for very long. one, if a person turns 65 years old, let's say, next month and they become eligible for medicare, they are offered under current law -- at least before today, signing the bill -- but they are offered the opportunity to get a once-in-a-lifetime deal, an annual physical. and under the law of the land until today, that was it. under medicare, if they lived to be 105, they wouldn't get another physical paid for by medicare. for those of us who -- i've been getting annual physicals for the last 27 years in all. i've had a lot of annual physicals. and i think one of the reasons i'm fairly healthy guy is because of that and the feedback from an annual physical.

we have lot who never get an annual physical. one of the reasons why, it's just not part of their health insurance coverage. under the legislation the president signed today, a person turns 65, becomes part of comairks they get an annual physical. the next year another one, the year after that if they live to 75, 85, 95, or god bless them, 105, they'll get a lot of annual physicals. we don't do a very good job in primary care. part of pr primary care is annul physicals. another provision in the legislation is the idea of what can we do to incentivize people to take better care of themselves? it's all well and good that we want doctors and hospitals and nurses to go after the insurance companies. but what are we doing to incentivize themselves? one of the reasons why is they

take better care of themselves. something that's always fascinated me is how do we figure out how to harness the market force forces for the dely of health care? how do we harness incentives to drive good public policy behavior? if we want people -- we know it is not good for people to be overweight, how can we encourage them to lose weight? one of the things that's in the underlying bill is a provision that says, i think starting yeks year, we're going to have menu labeling. what do we mean by menu laiblg? if we happen to be in a restaurant with more than 20 or more restaurants durve a restaurant company and you have restaurants in 20 more sites around the country, you got to start next year putting on the menu board in the restaurant how many calories are on the items that they serve. they have a men united states, you got to put it on the menu -- they have a menu, you got to put it on the menu how many calori calories. people are going to start thinking about t it'll be a

reminder. another provision in the legislation i think that's especially noteworthy is to build on something already in the current law but to make it stronger. we all know people who need to lose weight. they go ton a diet and they join a gym. but they stop. they exercise for a while, go on a diet for a while rption then they kind of fall off the wagon. we know people who try to stop smoking and they do it for a while and then they start stealing cigarettes from other people. they're back smoking full-time. and what we're trying to do with our legislation is to say, look, if companies that have employees that they want -- they know they're overweight, they want to encourage them to lose weight, we'll let them offer a premium discount n legislation the president signed today, employers can offer premium discounts of as much as 30% to their employees if they will lose weight, if they're overweight. lose weight and keep it off. if they are smoking and then they'll stop smoking and

continue to stop smoking. if they have high cholesterol or high blood pressure and they'll continue those and continue to control though, they can get premium discounts of as much as 30%. everybody in this chamber today, we all know people that have tried to lose weight, thriewz for a while, and then go back the other way. we know people who have fried to stop smoking. do it for a while and then -- what this legislation does says look, we want to put more money in the pockets of people who do what is the right thing for them to do for their own personal hell. by doing those things, they actually bring down the health care costs of their group, the place where they work. i think those are ideas that make pretty good sense. how much time left on our side, mr. president? the presiding officer: the senator delaware has 50 seconds. mr. carper: 50 seconds. the last thing i want to mention is our presidin presiding officm ohio. he's been to cleveland many times. but i've spent some time in ohio as well. one of my return visits last

year in ohio was to go back to the cleveland clinic and see how are they able to provide better helt health care for a lot less money? it's because they focus on really the same kind of model, a better focus on primary care, focus on prevention. all their patients have electronic health records. all the docs are salaried. they don't get more if they run more tests. this is a much better model. what we did with the legislation signed by the president today is we incentive a lost other folks to use the same model. with that, my time has expired. thank you, sir. the presiding officer: the senator from delaware's time has expired. the senior senator from iowa is recognized. mr. grassley: thank you, mr. president. i ask that the pending amendment be set aside. if that's necessary. mr. carper: reserving the right to object -- the presiding officer: is there objection? the senator from delaware, is there an objection? mr. carper: we'd just request,

could we see a copy of the amendment, please. grass grails a discuss the -- mr. grassley: i'll discuss the amendment while that's going on, mr. president. the presiding officer: the senator is recognized. mr. grassley: first of all, if the amendment can be called up, it's 3564, and i would like to have senator roberts added as a cosponsor. the presiding officer: without objection, so ordered. mr. grassley: mr. grassley: mr. president, i worked for six years to pass what's called the congressional accountability act which was signed into law by president clinton in 1995. i worked so hard to get that bill passed because i strongly believe that congress should live underher -- under the same laws it passes for the rest of the country. if you remember, prior to 1995, congress had exempted itself from 12 different pease --

pieces of legislation, starting with the fair labor standards act of 1938. and now, of course, we in congress as employers have to live by the same laws as the a.b.c. company of des moines, iowa, as an example. so the same principle applies to some parts of this bill. that's why i offered an amendment during finance committee markup to require that members of congress and congressional staff get their employer-based health insurance through the same exchanges as our constituents. and part of that original amendment that i got adopted back then is in the bill that the president signed today. but -- and that amendment was adopted without objection, let me say, so it had pretty

consensus support. i'm hoping the majority will support a similar amendment to make sure that the president, the vice president, senior white house staff, political appointees from cabinet and sub cabinet but of course not civil servants within the executive branch of government. also, my amendment would close a loophole that was added behind closed doors, meaning the closed doors of the majority leader's office. senator reid during the time that he was merging the finance and "help" committee bills. and that loophole would exempt staff from committee and leadership offices from being required to use exchanges even though individual offices of individual senators and their staffs and the senators would still be covered. now, that takes a lot of chutzpah behind closed doors to say well, it's okay for the members' offices and for the member staff and the individual

senator, but it's not okay for committee staff, it's not okay for leadership staff. somehow they are a heck of a lot better than the rest of us. so it would also then bring that back to a level playing field for everybody here on capitol hill, because, you know, most of our constituents would find it pretty unbelievable that the president, his closest advisors and some staff remain untouched by the reforms that they push for the rest of the country. to put it simply, president obama's health care reform won't apply to president obama or other people, political appointees within the executive branch. the message the white house then is sending to the grassroots of america is that it's good enough for all of everybody else but not for us political appointees in the executive branch of government. so is it really any wonder then why most americans oppose this

effort? last december, i tried to correct the inequity that i talked about of leadership staff and committee staff, but the effort to apply any new law to the administration was objected by senate majority leader at that particular time. in other words, i didn't get a chance to get a vote on it. but there is no justification for such a double standard that's blatantly wrong. it's only fair and logical that top administration officials who fought so hard for passage of this overhaul of the america's health care system experience it themselves. if it's good as promised, they will know firsthand that it is good as promised. if there are problems, they will be able to really understand those problems, as they should. just as the congressional accountability act teaches each

of us senators who have to live under the same laws as the rest of the country has to, that somehow, that somehow we have to experience them, then we know what it takes for small business to live by the civil rights laws, the wage and hour laws, the -- well, i can't think of all 12 laws that we exempted ourselves from that we're not exempted from. but we need to understand grassroots america. you know, what's wrong with washington, it's an island surrounded by reality. we have to bring some of the common sense of the rest of the country to inside here where we work all the time, because, you know, the only business in washington is government, and everybody in government is in the wagon. everybody outside of washington is pulling that wagon. we have got to make sure that the people in the wagon at least understand the problems of those pulling the wagon. and i think this will be one way

to do it. now, could i please propose my unanimous consent that the -- that the pending amendment be set aside so that i can offer the amendment that i listed as number 3564, the amendment i just talked about? the presiding officer: is there objection? mr. carper: mr. president, reserving the right to object. would the senator from iowa modify his unanimous consent request to provide that once all time has been used on this grassley amendment, that the amendment be set aside until a time designated by the leaders? the presiding officer: does the senator from iowa so modify his request? mr. grassley: i'm fine with that. the presiding officer: without objection, so ordered. the clerk will report. the clerk: the senator from iowa, mr. grassley, proposes an amendment numbered 3564, at the end of sub title a --

mr. grassley: stop reading. the presiding officer: without objection, so orded. the senator from delaware. mr. carper: one of the things that senator grassley and i have endeavored to do in working on this legislation in the finance committee is to try to figure out what works to rein in the growth of health care costs and improve outcomes. i think we will agree one of the best ideas that is in our bill is the idea of large purchasing pools, really modeled after the federal employee health benefit plan. we as members and our staff have to be part of the exchange. the idea is to create large purchasing pools in all of our states and even regional purchasing pools as well. mr. grassley: without a doubt. mr. carper: i'm glad that provision has survived at least this far. aye hope is it will go on. i just wish we could implement it a little sooner. thank you for yielding. mr. grassley: i yield the floor. ms. murkowski: mr. president? the presiding officer: the senior senator from alaska is

recognized. ms. murkowski: thank you, mr. president. i rise this evening in support of the grassley amendment, and i appreciate that my colleague has brought this forward. we had an opportunity to discuss this months ago in the "help" committee. the fact of the matter is that the health care bill that is now law creates the state exchanges where all non-medicaid and medicare individuals will go to purchase their health insurance, and included in the exchange are members of congress and their personal staffs who are required to join these exchanges in order to obtain their health care benefits. but as the senator from iowa has mentioned in the rules that apply here, the rule that came to my mind when we were discussing this is this rule that we were all taught as young children, do unto others as you would do unto yourself. and unfortunately, i think what we see with this new health care

law, it fails to adhere to this rule. so what you're going to have under this new law is every american will have to be part of this new health care exchange, but who is going to be left out? who is going to be excluded? well, the -- the law itself here is pretty clear in terms of the definitions. it says members of congress, congressional staff. congressional staff means all full time and part time employees employed by the official office of a member of congress, whether in washington, d.c., or outside of washington, d.c. but -- but let's think about who it does not include. it does not include the president, it does not include cabinet members, it doesn't include members of the white house senior staff. it doesn't include committee staff that we may have as the -- as the ranking member on the energy committee, i have

committee staff for that. as the vice chair of the -- of the conference, i have leadership staff. my committee staff nor my leadership staff would be covered under this new law. in other words, many of -- of the chief architects of this health care law were apparently very conveniently omitted from any requirement of being within the health exchange. so again, whether it's the cabinet members, the white house senior staff, the committee members, the leadership staff. so you have got to ask the question why -- why have they been left out of this? why is there a double standard? and -- and if you're not asking that question, is it just glaring omission or is there something else? is this yet further evidence of what we are seeing that was done in the -- in the back rooms, the outcome of the late night, the

back room deals that certain staffers who might perhaps work for the -- the majority leader or certain staffers who work for the white house get to be treated differently than every other american out there? i don't think that's what we intended here. as i mentioned, during the "help" committee markup that we had, i supported an amendment that was offered by senator coburn that most democrats on the committee did not support, but it would have required members of congress and their staffs to be included in the health care exchange, and the conversation that was had at the committee at that point in time certainly by members on the republican side was hey, if it's good enough for my constituents, if it's good enough for the people of the state of alaska, then it ought to be good enough for me, it ought to be good enough for the president. but what we see is the president, the house and the senate leadership offices who have -- have pulled this bill

together, have conveniently left themselves out from being subjected to this provision. so i appreciate senator grassley bringing this issue up, pointing it out, pointing out that there are omissions, there are perhaps convenient omissions. i'm not one to say whether it's been convenient or not, but it does raise the question so what else has been left out? what else is contained within this bill that might be viewed by others as a -- as a special deal. earlier on the floor, senator mccain came and along with many of our colleagues kind of outlined some of those special deals that i know the people in alaska are quite concerned about. wait a minute, if you're going to -- if you're going to move health care reform in the manner that you have, make sure that it's even, make sure that it is

equal, make sure that people are treated fairly and -- and in a manner that we think and we recognize is consistent. so i think we need to ask ourselves certain questions about what's in and what is out. we know that there is certainly more spending. more spending in terms of the -- the proposal. we know that we have gone from from $200 billion in spending to now $2.6 trillion in spending. we know that there is more entitlements. we see that repeated and repeated. $115 billion in new entitlement spending, bringing the combined new spending in the proposal to to $1.2 trillion. we know that there is more taxes. we know that there is more medicare cuts. we know that there are more

gimmicks. these -- these are -- are what the folks back home are saying wait a minute, if these are the types of things that -- that you have promised us, and now you're telling us that there are some good provisions in this bill. you're going to like -- you're going to like this bill once you get to know it. now, some of my colleagues will tell you that medicare patients will now see free preventative services, and i admit that that sounds great. i'm all for making sure that we have screenings, whether they be mammograms or preventative services, but i have to ask the question in a state like alaska where we face such an incredible crisis when it comes to access to care, to primary providers, knowing that we now have this bill before us, this new law of the land, how many of the few

primary care doctors in my state are going to be accepting these new medicare patients to provide them these wonderful preventative services, these free preventative services. according to -- according to the experts, not only in alaska but in many parts of rural america, medicare patients are going to -- they're not going to have a provider who would be willing to take them on. we have our think tank in the state, the institute of socio and economic research has said that seniors in medicare states are going to be forced in line. what they have said is independently of the doc fix, in alaska, the seniors are at risk of long lines of seeing a medicare doctor and overflowing to community health centers and hospital emergency rooms where

existing capacity is highly likely to be quickly overwhelmed and long wait times become increasingly common. they go on to say that existing patients are going to hurt the existing medicare beneficiaries again, because of the access issue. so, mr. president, what we will have done is we will have been able to issue that card, we will be able to say yes, this is now available to you, but if you still can't get in to see the provider, then what have we provided for these seniors other than the card? that's not access. my -- my mom used to tell us, if it sounds too good to be true, it's probably too good to be true. so i think we're going to be spending a fair amount of time in these next few days, in these next many hours going through so many aspects of this

reconciliation bill, trying to understand what is in it, what is not in it, who it applies to and how it applies. i'm hopeful tomorrow that i'll have an opportunity to talk a little bit more about not necessarily the health care side of this reconciliation bill but one way in which the health care reforms are going to be paid for and that's on the back of our students. our students who have taken out loans, who, as we eliminate the federal family education loan program, the ffel program, essentially, mr. president, we're going to be helping to pay these young people, these some 19 million young people who take out student loans, are going to be paying for the cost of -- of the health care provisions that are contained within this bill. is that right? is that fair?

there's so much, there is so much, mr. president, that -- that needs to be discussed, that needs to be uncovered. because what we have before us within this reconciliation bill is -- is more of the same in terms of the bad provision that passed this senate on the 24th of december, more taxes, more cuts to medicare, more hits t to -- to our seniors and our small business people. it's not -- it wasn't good in the senate bill, it's made worse in the reconciliation provision, and our job tonight and in these intervening hours is to make sure that the american public fully understands that. and with that, mr. chairman, i -- i yield back to my colleague from iowa. the presiding officer: the senior senator from iowa is recognized. mr. grassley: please tell me how much time is left on this side.

the presiding officer: the senator from iowa has 19 minutes remaining. -- excuse me, the senator from iowa has 15 minutes remaining. mr. grassley: 15? the presiding officer: 15, 1-5, remaining. mr. grassley: thank you. i know that many folks look at this week's debate as the end of the process. i know some people look at the conclusion of this week with relief. i look at it with regret. regret for the opportunity squandered and regret for problems that we must now address. our health care system is in need of reform. our health care system spends too much, leaves too many people without coverage, and doesn't provide quality care that it should. we had an opportunity to do something about it the right way. we could have passed a bill with

broad support in congress and amongst the american people. that opportunity was lost. this process started in a bipartisan fashion. in 2008, the finance committee held a health care summit. the committee brought in experts from all over the country and all over the health care spectrum. we heard numerous hearings. in 2009, the finance committee put together bipartisan round-tables and walkthroughs of the critical issues in creating this health care legislation. throughout the summer of 2009, six of us worked together in a bipartisan fashion to try to reach an agreement that could achieve broad-based support because we felt that's traditional of social change in america, to be bipartisan, and this was a restructuring of one-sixth of the economy and doing that ought to be done not

on a partisan basis, not on a slight bipartisan basis but on the basis of a broad consensus. somewhere along the line, thou though, getting it done quickly became more important than getting it done right. was it when the help committee produced a partisan draft that would have cost more than $2 trillion? was it when the house slammed the bills that were outright government takeover through committee? every year i hold 99 town hall meetings, one for each county in iowa. when i went home last july and august, i found anger back home in my state. people were mad, people were fearful. they saw a government that took over general motors, they took over banks, spent us into mind-boggling debt.

my people were worried about the direction of this country. nothing has happened since august that has improved that situation. while americans get up every morning worried that the struggling economy may cost them their jobs, congress has been hyperfocused on health care reform. this hyperfocus has led congress to abandon bipartisanship and make some very conventional deals in the name of just getting it done. congress had an opportunity to enact something the american people could support, but congressional democrats and the white house seemed so focus on making history -- so focused on making history, they stopped actually listening to the american people. all the backroom deals, the budget gimmicks and broken promises made it clear they're

willing to go to any length to pass any bill, just any bill. health care reform will raise taxes by a half a trillion dollars. it will cut medicare by more than a half a trillion dollars and not strengthen medicare. but to do it -- but in doing it solely to create a new and unsustainable entitlement program. and, of course, it will cause health insurance premiums to go up even more than they're already going up. rather than bring the country together around some commonsense reform, it has driven the country further apart. at a very time that we need to come together, and health care reform legislation should have been done with

broad-based support. now, of course, this excessive bill is law. an opportunity has been lost. this legislation will raise taxes by a trillion dollars and, in the end -- you know, this is not the enow the process of clep the mess begins. hopefully we can get some of these changes started this week in this very bill before the senate, because congress will be back to fix challenges created by this bill. the medicare physician payment problem for one is still out there. it will cost more than $300 billion to fix. neither the bill the house passed sunday nor this reconciliation bill addresses that very major problem.

congress will have to come back and. problem: medicare is still going bankrupt. hundreds of billions of dollars were taken out of the medicare program and were not used to improve the solvency of that program. even the president has now acknowledged that you can't count the savings to pay for the new entitlement and to improve medicare solvency. something i tried to tell body many a time. now the president says it. i hope people that avoided this last time are listening to the president. congress will have to come back and fix it. there are billions of dollars of cuts to medicare providers in the health care reform bill that are totally unsustainable. providers won't be able to survive if these cuts go into effect. a cynical person might suggest

some providers supported the bill knowing that there would be an influx of dollars to pay for new coveragehey' off the corresponding payment cuts. so, as i've said before, congress will have to come back to this 2,700-page law that the president just signed and fix it. the bill gets half -- the bill gets half of the new coverage through the medicaid program. now, everybody knows that medicaid is thread bare to begin with. adding 16 million people to medicaid with tens of billions of dollars of unfunded liability for states is not going to improve that program. the reconciliation bill has a

farcical payment for medicaid that ends, how? with a 50% cliff. no one has yet explained to me how that's supposed to improve the program. congress will have to come back and fix t. th -- and fix it. the bill includes health plans -- bars health plans from not covering kids with prin -- preexisting conditions 16 months after enactment. positive, right? but in a rush to get things done, the majority failed to notice that prohibiting preexisting condition exclusions but allowing insurance companies to still deny kids entirely will just end up in more kids being denied coverage. a long-term entitlement -- aong-term care entitlement called by the acronym the "class a act" is a l

disaster waiting to happen. when it starts to run out of money, when the insurance death spiral hits the program, the taxpayers will be on the hook to fix it. congress will have to come back and fix it. congress will have hundreds and hundreds of billions of dollars of problems to come back and fix. i yield the floor. mr. gregg: mr. president? the presiding officer: the senior senator from new hampshire is recognized. mr. gregg: mr. president, i ask unanimous consent to call up and modify my amendment which is pending at the desk. the presiding officer: is there objection? without objection, so ordered. mr. gregg: ils appreciation to e senator from montana for allowing me to do this at this time. i understand we're going to have some agreement here; is that correct? is that what the plan is for the rest of the night? mr. baucus: senator franken

wanted to speak for 12 minutes. the presiding officer: the senator from minnesota is recognized. mr. baucus: mr. president, i yield 12 minutes off the bill to the senator from minnesota. the presiding officer: the senator from minnesota is recognized. mr. franken: thank you, mr. president. mr. president, today we took an historic step forward toward a healthier america. i'm proud that the senate is debating the reconciliation bill this evening, fulfilling our pledge to make some crucial adjustments to the senate bill dat we passed in the reconciliation bill before us will make the newly minted health reform b it will provide stronger subsidies for low- and middle-income working families so that they can afford

insurance. and that means fewer people getting primary care in emergency rooms. it families affected by the excise tax on high-cost plans and address the geographic disparities in and it will finally close the medicare prescription drug doughnut hole so that so many of our seniors no longer will have to choose between eating or taking medicine. but let's be honest. even with these changes, it still isn't perfect, and we'll continue to improve it because there's always things that we can't foresee. look, we're still making adjustments to medicare 40ears later. and when medicare passed, there were -- there was also ample opposition not dissimilar to what we're hearing about this bill. opponents said that medicare would be a government takeover

of health care. but today, you won't find a senior -- a single senior in minnesota who wants to give up his or her medicare. in f -- in fact, just in these past few months, i'm so pleased that so many of my colleagues on the other side of the aisle sproan out in favor of medicare and of strong benefits for seniors, and i'm confident that, like medicare, support for health reform, which is already strong, will continue to grow with time as people understand just how helpful it will be to working families. unfortunately, many people have been scared by the misinformation that's been used to try to eportmp, t point thatt in the overblown and apocalyptic rhetoric these past few mon this bill is not a government

takeover of health care. in fact, it's an expansion of private coverage, with millions more americans covered by private insurance companies. so let me say this again. the patient protection and affordable care act expands private insurance, and since we're giving these companies a huge influx of new business, we have to hold them accountable. and we do that by improving regulation of these companies by making sure that they keep patients as their highest priority. our bill epr no more lifetime and annual caps. mental health services will be covered. and companies won't be able to kick people off their plans when they get sick. the truth is that my state -- there are a lot of good things happening in health care already, but even in minnesota, erageed

rising costs and a huge state budget deficit -- i support this bill because itsota in all the twhais we need right now. incentives to advance state innovation, an instant relief to cover low-income minnesotans in medicaid. this is really helpful at a time when the state legislature is struggling to make ends meet. and for minnesota's small business owners who are stretched but want to cover their workers, they will have access to tax credits this year, in 2010. i'm also very pleased that this bill will begin to fix one of the most flawed elements of our current system: medicare reimbursements. our system pis high-quality mina providers like the mayo clinic

by paying them less because they provide efficient, low-cost care. the senate bill includes provisions that i fought for with my colleagues senator klobr and now, thanks to my colleague, representative mccollum of minnesota, we have a commitment from secretary sebelius to continue to expand these efforts to hospitals and to nursing homes. i'm proud to represent minnesota at this historic time and to have contributed to improving the health of this country for future generations. our new law, improved by the singles bill, will be a -- our new law, improved by the reconciliation bill, will be a major victory for minnesota families. but if this reconciliation bill passes, we'll also be scoring a double victory for working families. in addition to expanding access

to health care, this bill will make it less expensive for working families to send their kids to college. by cutting out the middle man from the student lending system, we're able to increase funding for pell grants to make it easier for college graduates to repay their loans. not only are these measures fully paid for, but they'll also reduce the deficit. under the current federatioal ffae -el -- the federal governmt pays families subsidies. then on top of that the government guarantees the loans so that there's virtually no risk to the banks, just taxpayer-subsidized profits. this is not a private enterprise program,s the banks would like you to believe.

it's corporate welfare, masquerading as private enterprise. the good news is that there is a better way to run the government loan program than keeping banks on the dole. lenng. and it slashes $61 billion in costs by putting out the middle man and lending to students directly. this idea is hardl new. in the early 1990's, senator david durenberger of minnesota, a republican, joined with senator paul simon of illinois, a democrat, in a bipartisan effort to end the wasteful practices of the bank lending program. they were able to give colleges the option of switching to direct lending, but the bank lobbyists thwarted their efforts to eliminate the bank subsidy program altogether. today i'm proud to be continuing

senator durenberger's fight to eliminate wasteful bank subsidies. i'm also proud that the university of minnesota is leading the way. the u of m was one of the first universities in the nion to switch to direct lending. i recently met with students and administrators at several campuses, and they told me that the direct-lending program is working very, very well. not only does it provide students with the same benefits as the bank subsidy program at a we administrative headaches of financial aid officers by decreasing the number of entities that they have to deal with. to be blunt, our choice here is simple. we can continue to waste billions to line the pockets of banks or we can

i certainly don't want to go home to minnesota next week and explain to my constituents that the senate decided to keep forking over their hard-earned tax dollars to banks rather than helping their kids go to college. and for many families, it really is the opportunity to send their kids to college that's at stake here. most of the money that would be saved from switching to direct lending would be used to strengthen the pell grant. pell grants give over 8 million low-income and middle-income students the ability to retain a college education. pell in my ty give -- gave my wife and her family. when franie was 17 months old,

her father died in a car accide, leaving frannie's mom widowed at age 29 with five kids. my brother-in-law neil went into the coast guard and became an electrical engineer. but all four girls went to college, and they were able to do it with a combination of scholarships and pell grants. unfortunately, since then, the purchasing power of the pell grant has declined dramatically. 30 years ago the maximum pell grant covered 77% -- 77% of the cost attending the average four-year public college. these days, it only covers 35%. and this economy has made a bad situation worse. many of the students and families that i've met in minnesota are struggling with high tuition and a tough economy. the average minnesota student graduates from college with a

$25,000 debt. job losses and cutbacks have left many middle-class families barely hanging on that. means that more students who depend on pell grants have to spend more hours at work and away from their studies to help pay for their education. unfortunately, the economic crisis has also increased the demand for pell grants, as more families have fallen on tough times.e increase in demand has t with us a $19 billion shortfall in the pell grant program. if we don't fix this shortfall, nearly 600,000 students could lose their hell grants entirely. another 8 million students could have their grants cut by almost 60%. this would be catastrophic. -- catastrophic for those students and their families. and this economy would be an unforgivable failure for

congress to allow pell grants to be cut in half. it would also be shortsighted since we of all new jobs will require a college education. a national switch to direct lending is simply the right ning to do for our students, for our. so i want to urge my colleagues to stand up for what's right and support this reconciliation package tfusz of banks, and reduce -- in front of banks, and reducing the federal deficit. thank you, mr. president. and i yield the floor. the presiding officer: the senator's time has expired. mr. whitehouse: mr. president, on behalf of senator baucus, i yield myself up to 20 minutes. and that senator brown be recognized for up to 10 minutes and that the time be charged against the bill. the presiding offic: is there objection?

so ordered. mr. whitehouse: mr. president, on this historic day, i rise to speak, as i have many times before, about our historic opportunity to turn away from the path of physica fiscal toshetoward the difficult and vl work of bringing down the cost of health care. after the wild and unsustainable borrowing of bush era, we now face an era of limited resources in which every last dollar is needed to spur economic recovery, create jobs, and restore economic security for all. economists agree with virtual unanimity that the needless and excessive cost of health care is the heaviest weight dragging down america's economic growth.

in 1955, the year i was born, the nation spent $12 billion annually on health care. last year we spent $2.5 trillio. $134 billion more than the previous year, the largest in history, we spent the year i was born. that spending constitutes a stunging 17.3% of our nation's entire gross domestic product, also the highest level in our history. the cost of our republican colleagues' desire to do nothing would have been impossibly high. in my home state of rhode island, a family of four would have faced more than $26,000 in

premiums for family health insurance in 2016. last year premiums fr -- last yr premiums for medicare advantage nationally jumped 14.2% in one year. indeed, this escalation is unsustainable. but it is not, mr. president, inevitable. a great deal of health care cost is nothing more than waste. waste resulting from a status quo that is irrational, disorganized and often downrigt greedy and mean. the only good news is that we know where to look for savings. and in the reform bill signed by president obama today, we deploy every tool at our disposal to reap those savings.

this health care debate has been enveloped, indeed sometimes blindedliard of numbers. c.b.o. reports, actuarial analyses, projections upon estimates upon projections. too often my colleagues on the other side pluck out only those figures that serve their purpose. their purpose to delay and ultimately dt their insurance company friends. however, i believe that a fair view of the evidence demonstrates that this reform bill will do more to lower health care costs, reduce the deficit and free up precious resources in the p has ever done before. let me start with the budget deficit. in its most recent report, c.b.o. projects that the bill, combined with a package of improvements that are now before the senate, will reduce the deficit by $138 billion over the

next decade. economists from the commonwealth fund have estimated that the bill will reduce the deficit even more dramatically, by by $409 billion over the next ten years. and in the second decade, c.b.o. projects that the combined bills will reduce the deficit by a broad range around .5% of g.d.p. mr. president, .5% of g.d.p. is is $1.3 trillion over ten years. a significant achievement in deficit reduction. let's look at another number that critics too frequently ignore. savings in medicare and medicaid spending from innovative reforms in the delivery of health services. particularly increased efficiencies, improved quality and the elimination of wasteful spending. both c.b.o. and the c.m.a. actuary estimate those savings

at roughly $490 billion, nearly half a trillion dollars, over the next ten years. and the economists at the commonwealth fund pegged that number over half a trillion $57. examples of this are found in c.b.o.'s forecast that an independent, nonpartisan commission of experts with authority to determine payment rates under medicare will save the treasury $13.3 billion over a ten-year period. c.b.o. also credits medicare payment refor that seek to limit hospital readmissions and hospital-acquired infections with that encourage physicians to group together in cost-saving organizations with with $4.9 billion in savings. we know these things work because places like the mayo clinic in minnesota are out

there doing that right bill prot the medicare ust fund and preserve medicare benefits, it also reduces spending growth in the out years. the savings i have been talking about are not just a one off proposition and then back on the spending growth ratchet. this bill reshapes the delivery system so that federal health care costs should never grow at this outrageous rate again. c.b.o. and commonwealth economists find that the bill reduces medicare rate of growth by 2%. president obama's council of ecom e bill will reduce the annl growth rate of federal spending by a percentage point in the upcoming decade and by an even greater amount in the subsequent decade. which would increase national savings and improve the long run performance of the u.s.co their. widening the focus from public

programs to the economy as a whole, the challenge posed by wasteful health care costs expands. the president's council of economic advisor recently released an updated report in which they concluded that annual waste and inefficiency in the health care status quo approaches 5% of g.d.p. $700 billion. billion with a b, $700 billion every year in waste and inefficiency. set aside for a moment duplicative tests, lost medical records, unnecessary treatments and uncoordinated care for chronic patients and look just, just at the administrative overhead of the private insurance market. asare run about 3% to 5%. overhead for private insurers is

an astounding 20% to 27%. a commonwealth fund report indicates that private insurer administrative costsncreased toe than doubled in just six years. and you can just imagine the mischievous purposes to which all that bureaucracies is being put. the mckenzie global institute estimates that americans spend roughly $128 billion annually just on excess administrative overhead of private insurance companies. $128 billion every year. and then, of course, there are those duplicative tests, lost medical recordseaents and uncood care for patients. because of all that waste in the

system, the council of economic advisors concludes that it should be possible to cut total% without worthenning outcomes. which would again suggest that savings on the order of 5% is is $700 billion a year. and they're not alone. othepengland health care institute reports that as much as $850 billion in annual excess costs, and i quote, can be eliminated without reducing the quality of care. former treasury secretary o'neill has written recently that the excess cost is is $1 trillion a year. and the often cited by my colleue the ot finds that we bn up over

over $1 trillion a year throughs broken health care delivery it's $700 billion a year or $1 trillion a year, it is a big savings target. to ache potential savings are in this bill. analysts stripes agree that thisill than any previous measure to relieve the economy of this dead weight of waste and excess health care costs. the commonwealth fund has projected that our bill will reduce the annual growth of national health expenditures. apeually. amounat every year b6 $683 billi tthe council of econs

writes the total slowing of private sector cost growth will be approximately one percentage point per year. why does this happen? this happens because the bill begins to streamline and modernize our disorganized and illogic will gd health care outcomes, procedure. it funds comparative effectiveness research sung worksr not before you pay for it. it creates financial incentives for low quality but high cost providers to improve their performanc and for transparency so you will know who they are and you can avoid them. it makes investments in wellness and prevention, to reduce costs by keeping you healthy in it improves the cin for chronic.

anyone with aamily mr. that -- member in that situationo organize their care d pilot projects in medicare to createciencies i that will spreo the privateector.fe keystone prn which reduced infections, respiratory complications and other medical errors in michigan's the intensive care units. just in the participating intensive care units, it saved more than 1,800 over 140,000 days that patients otherwise would have spent in the 140,000 saved patient days. d, of course, over 271 million health care dollars. saving lives and saving dollars. in my home state, the rhode

island quality institute has taken t statewide, with every one of our hospitals participating. an hospital-acquiredsec mortality and a statewide mortality rate almost 21% lower than the national average. saving the oveh ll so far. big savings opportunity, and many agree that we're taking the right apph it, but they also agree that thean n why? why is tools are in the bill to achve the ise administing and applying these toolsill beken aim at this targ. we have never launched such a battery of innovative reforms, even though experts have been

advoca t casesecad. success will depend on the quality of executive management, how dynamic we are in bringing these innovative tools toe im they can do. c.b.o. director doug he will man doctor of -- elm quote -- "chaes in government policy have inonaled poly should move. many of the specific changes that might ultimately prove most important cannot be over time th sounds an awful lot likeing..at

the exampled dr. atul georgia juan did i --di, who analogized health the agricultural sector. he wrote about the agricultural thor count agriculture, but the government didn't leave itlone eithehape af experiments and learning and encouragement for farmers across the experiments andea totiduced on no more land than was devoted to a century ago and works because united states agencies were allowed to proceed by trial and error. continually adjusting policies b

pick up the senate health car bill, he continues, yes,2,4 pagd almost half i dedicated to programs that would test ways to curb costs and increase concluda hodgepodge, and it should he wr. "we crave sweeping transformations. however, a tot programs, a battery of experiments. the strategy of this suggests otherwise." davi cutler is a widy respected st journal" rtlst year of debate, d ideas have been offered for ct

curve. the democrats' propod of them."incorporates o professor cutler gives the bill full credit on six of the cost control ideas and partial credit on three, including ideas regularly championed by my colleagues on the other side like combating fraud and abuse in the medicare system and reform of the medical malpractice liability system. the one area, the only area tho credit is in its failure to include a public option. it is hard for our colleagues on the other side to criticize us for that since it is the thing they fought the hardest toet. and as codrafter with the distinguished presiding officer, senator brown of deeply regret that tha provision was excluded. perhaps on another occasion,

we'll have the chance to revisit that issue. but nine hisilc option our colleagues opposed. david is on the table is the mos medil spending ever proposed in the united the uncertainty described by c.b.o. director elmendorf, cutler estimates that the reforms will save, and i quote -- "nearly $600 billion over the next decade and even more in the ssequent one. nobel laureate paul krugman agrees that there's no reason to believe that c.b.o.'s estimates are too pessimistic. there are many cost-saving estimates in the proposed reform, he says, bny well one oe efforts will work. and as a result, he continues, "official estimates don't give the plan much credit for any of them. realistically, though, health

reform is likely to do much better at controlling costs than any of the official projections suggest." recently, three more respected health economists -- len nichols of george mason, ken thorpe of emory, and ben gore of stanford -- called the price controls vital, a significant improvement on the status quo. as professor thorpe neatly described it, "under the do-nothing scenario, everything gets worse." and m.i.t. professor jonathan gruber, one of our leading health economist, said of this bill's cost-control measures, "i can't think of a thing to try that they didn't try." may i ask consent for an additional minute. the presiding officer: is there objection? so ordered. mr. whitehouse: i can't think of a thi to try that they didn't try. they really make the best effort anyone has ever made. everything is in here. you couldn't have done better than they are doing. so when the do-thing crowd on the other side argues that this

bill is a cost disaster, that it has no master plan, i urge that american ingenuity, through experimentation and learning, can overcome the toughest challenges, not through command-and-control but through a flexible, dynamic and persistent exercise and experimentation, learning and encouragement. i'll close by urging president obama to specify a savings target for his administration to achieve. i have before recommended setting the target at $200 billion in annual savings by 2014. that should be conservative and easy to achieve. but a clear and specific goal tf federal bureaucracy more rapidly towards the comprehensive change we need. mr. president, when president kennedy announced in september of strive to put a man on the moon, he set a specific target. he didn't say he was going to bend the curve of space

exploration. he said he would put a man on the moon. and what this: "we choose to doh things not because they are easy but because they are hard. because that goal will serve to organize and measure the best of our energies and skills. because that challenge is one that we are willing to accept, one we are unwilling to postpoe intend to win." mr. president, health care cost is a challenge we are, indeed, willing to accept. it is one we cannot afford to postpone. and it is one in which we can and must and will win. i thank the presiding officer for his courtesy, and i yield the floor.

mr. brown con. mr. president? the presiding officer: the senator from ohio. mr. brown: thank you, mr. president. i, first of all, thank you for the work that -- that you did on this bill that the president signed today to bring costs under control in our health care system, to do what we need to do to ensure 31 million -- 32 million people, to provide these consumer protections that this bill offered, to give the these -- these tax breaks immediately to america's small businesses. one of the most important components of that is the work that you did and others in this chamber did to -- to bring costs down in this health care system. the costs that afflict taxpaye taxpayers, the costs that afflict small businesses, the costs that afflict our -- in

effect, our ability to compete around the world, and the costs that come directly out of people's pockets, those who have health insurance and those who don't. and the huge, burdensome costs. and we're finally on track to do the right thing here, so i thank the presiding officer -- the presiding officer, the senator from rhode island, senator whitehouse. mr. president, i'll just speak for just a few minutes. i've come to this floor since july, as we voted the health care bill initially out of the health, education, labor, pension committee, i've come to this floor night after night for -- off and off mostly for -- on and off mostly for the last seven months to share letters from ohioans with my colleagues. and there's a couple of things that these letters have in common. in most cases, these letters, written by people who've had significant problems, generally have lost their insurance or are paying so much that it's hardly

insurance. these letters typically come from people who a year or two ago would have told you they were satisfied with their insurance. they thought that it covered what they needed. then something happened. they either lost their job and lost their insurance or they had a child born with preexisting condition and couldn't get insurance for her or him. or they got very sick and their care was very expensive and the insurance company cut them off. or they -- the insurance company realized that they were going to be expensive, they were, perhaps, had had a preexisting condition and they were getting more expensive, they were getting older and the insurance company found a way by charging them so much for -- because they couldn't cancel the insurance, that they thought perhaps they could force the -- the -- the letter writer, the insurer, to cancel insurance. so these letters tend to have that in common. the other thing they had in common so often was so many letter writers are 60, 61, 62 years old and they said, i can't wait until i get on medicare

because i know i can trust medicare, i know medicare's stable, i know medicare will be there for me. a strong government program, not socialism. government is simply the insurer. but the government has made such a difference in the lives of so many senior citizens because the medicare program has worked. and it's interesting, as the presiding officer knows -- just a little history of this institution and this bill -- the same arguments that were used this year against this health care bill were used against medicare in 1965: socialism, government takeover. back then it was the john birch society. today it's the tea parties. the same kind of opposition. they said things like bureaucrat -- a government bureaucrat will get between a doctor and me. well, that really wasn't true about medicare and it's not really true now. and the public clearly sees through that. that's why this congress has passed this bill and that's why the president today and -- and one of the most important things professionally and in my lifetime by a long shot, maybe "the" most important thing, watched the president of the united states today sign this

legislation. but let me share just three or four letters, mr. president, just three letters from ohioans, going to give you an idea of what this bill means to people who -- who it affects. and you know, we are on this floor all the debate and all the partisanship and all the -- we see the obstructionism from the other side and who's going to win, the republicans or democrats the reason we're doing this bill is these letters. that's why it matters. and you will see this. david from northern ohio writes, "my best friend's husband is a hemophiliac. he's had a pretty scary life and could be one bleed away from death or financial ruin. they, she and her husband, are about to hit their cap for their employer-provided insurance and they have very few choices to seek out other insurance because of his preexisting condition. they've done everything that people should do. they've worked hard, they've put money aside for retirement. they only use their insurance when it was absolutely necessary. i cannot imagine," she writes about her friend, "i cannot

imagine the fear they must constantly feel. please stand firm. remember those whose voices are small individually but are standing strong together. health reform will help families like david's friend's family t. will get rid of lifetime limits and arbitrary annual caps on benefits. so in this case of this -- this man who has hemophilia and his wife, they know if their health insurance -- their health care gets too expensive under the present system, or at least the system before today, before the president signed the bill today, they know that they could lose their insurance if it gets too expensive. they won't have any coverage then. under this bill, an insurance company simply, mr. president, can no longer do that. diane from cuyahoga county writes, "we have a small business that's been in the family for many years, but after doing well, our situation is precarious because of the high cost of health insurance. in the last few years, we've continually downgraded our health insurance coverage. we're struggling to pay our health care bills and, of course, have no dental or eye

coverage. putting children through college paying health insurance, trying to keep the business afloat makes life difficult." that's what's happened with so many small businesses. they've struggled to ensure themselves and their families. in one small business, a small business has ten employees. one person gets really sick. it's very expensive, cancer or something else, that company so often has to cancel their insurance simply because they can't afford it and their employees, even those that weren't very sick, lose out. and in so many cases, as diane points out, the insurance that people do have has more and more holes in it. she says, we continually downgraded our health insurance. this bill, starting today, starting tomorrow -- the president signed it today -- will help by offering small businesses tax credits so employers can offer coverage to their employees. this is the first -- the first major impact this bill will have. this bill will take awhile because we want to implement it

correctly and quickly enough to help people but not so quickly that we'll make significant mistakes. the first thing this bill does is provide tax -- tax incentives to small businesses like diane so they can actually write good insurance policies for themselves, if they're self-employed, and for themselves if they have a business with their -- and with their employees. the last letter i'll share, mr. president, cynthia from hocking county, logan, ohio, southeast of columbus, writes -- "my son-in-law's 40 with a serious medical condition that makes it extremely difficult to get around. my daughter's 42 and on disability. neither of them can work and make supplemental income. they have to spend so much on medication they're not able to pay their house payments and may have to file for bankruptcy. they have a 16-year-old son to support. who doesn't want to send their child to college and help him have a better life, but where will that money come from if they can't pay the bills now? please continue to fight for the middle and lower middle-class families who insist that we be treated fairly and with dignity.

we just want good insurance like lawmakers in washington have." this plan with the insurance exchange was based on the federal employee plan that most senators and congressmen have, that most federal employees have. this bill will provide for those who are lower income than we a are, significantly lower income than we are, for people who are making $10,000 or $20,000 or $30,000 or $50,000 a year, or an a little more than that, will provide them with health -- with subsidies so they can afford health insurance. we want everybody to be insured. we know right now that every american who has insurance pays about a thousand dollars extra, a tax, for all intents and purposes, pays a thousand dollars extra to pay for the care of people who don't have insurance and go to the hospital and somebody has to pay for that. it ends up being spread around to everybody who has insurance. that extra thousand dollars will no longer happen to any significant degree because, as everybody in this country, or almost everybody, gets

insurance, people will be paying for themselves. they'll get subsidies if they're low income. if they have a little more money than that, they'll pay everything themselves. that's why this legislation made so much sense. -- or makes so much sense. mr. president, today we saw the president of the united states move this country forward. tax breaks for small businesses, no more -- no more preexisting condition for a child to keep a family from getting -- no more exclusions for that to keep a family from getting insurance f. you're a 22 -- if your 22-year-old son or daughter comes home from college and can't get a job with insurance, they can stay -- that daughter or son can stay on the insurance plan of their parents until they're 26. there are a whole lot of very important things. senior citizens will, starting next year, be able to get a physical every year without a co-pay, making sure that our senior population stays healthier longer. we begin to close the doughnut hole so that seniors with that bill that was passed a few years ago that gave the drug companies

a whole lot more money than it helped seniors but at least we're fixing that bill so that seniors will see that doughnut hole closed. all of those things are part of this legislation in the next year or so as it takes effect. this is the right thing for our country. it's a -- it's an honor and a privilege to represent ohio and have the opportunity to vote for this legislation and to push it and to work for -- for public health. it's a -- you look back. we waited, president truman -- president truman when he spoke to the congress in 1946, spoke about the importance of health care. now, 65 years later and ten presidents later, it's happened. it's a good day for our country and we celebrate that. most importantly, it gives people like cynthia from hocking county, diane, the business owner in cleveland, and david from northern ohio, it gives them the opportunity to get on with their lives in a much -- much more workable, practical, happier way. i -- mr. president, i yield the

floor. the presiding officer: the setorhio. mr. brown: i ask unanimous consent the senate proceed to a period of morning business with senators permitted to speak for up to 10 minutes each. the presiding officer: without objection. mr. brown: mr. president, i ask unanimous consent the senate proceed to the immediate consideration of s. res. 467 submitted earlier today. the presiding officer: the clerk will report. the clerk: to authorize representation by the senate legal counsel in the case of sallers v. reid et al. the presiding oicer: without objection, the senate will pod to the measure.

-- will proceed to the measure. mr. brown: 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 being a or debate, and any statements related to the resolution be placed in the record at the appropriate place as if read. the presiding officer: without objection. mr. brown: i understand there is a bill at the desk. i ask for its first reading. the presiding officer: the clerk will read the title for the first time. the clerk: is $3158, a bill to require congress to lead by example and freeze its own pay and fully offset the cost of the extension of unemployment benefits and other federal aid. mr. brown: i now ask for its second reading in order to place the bill on the calendar under the provisions of rule 14, i object to my own request. the presiding officer: objection is heard. the bill will be read for the second time on the next legislative day. mr. brown: i ask unanimous consent that when the senate completes its business today it adjourn until 9:00 a.m. on wednesday, march 24. follow the following the prayer

and pledge, the journal of proceedings be approved to date, the time for the two leaders be reserved for their use later in the day and the senate resume consideration of h.r. 4872. the presiding officer: without objection. mr. brown: mr. president, tomorrow the senate will resume consideration of the health care and education resilliation act. senators should expect a long day with votes occurring dilute the day. if there is -- with votes occurring throughout the day. if there is no further business to come before the senate, i ask that it adjourn under the previous order. the presiding officer: the senate stands adjourned until 9:00 a.m. tomorrow,

>> now education secretary arne duncan who is our guest on this morning's "washington journal". this interview took place at the national archives with an audience of local high school students. it is just under an hour. >> host: and good morning from the national archives. we are situated between constitution and pennsylvania avenue just adjacent to the national mall, a building that first opened back in 1935 and holds three main documents that serve as the foundation for our

country: the declaration of independence, the u.s. constitution, and the bill of rights. you'll also find a copy of the magna carta, the emancipation proclamation, and census data. we are inside the archives with high-school students from ten states. all part of the close-up program for my conversation. let me begin with a newsweek cover story. we must fire the bad teachers. how do you do that? >> guest: that is a little simplistic answer. we support great teachers and do a much better job of that. the overall majority of teachers around the country to end a store near a job and go far beyond the duty. we don't begin to do enough to recognize them, reward them, anchorage and. we have some teachers at the bottom. our students have one chance to

get a great education. if every school had a great principal i would have a very easy job. >> host: we will get to questions in just a moment. generally what is the role of the department of education when it comes to students in elementary, middle, and high school. >> guest: we want to raise the bar. expectations have been far too low. we want college and career-ready standards. now what is best for these guys. we want to raise the bar. we want to recognize and see where we have schools improving. you want to make sure students around the country have a well-rounded curriculum. one of the things i have heard from teachers, parents, and students, nail the curriculum. under no child left behind that is a real problem. we want to make sure our

children have access to an array of subjects. so high bar for everybody. really rewarding excellence. we want to become an engine of innovation. we have been this large and compliance driven bureaucracy. what the invest in the achievement for all students. >> host: and a department that dates back to the carter administration. >> guest: small percent, between eight and 2%. the vast majority of funding. always the local level. the state and community level. we want to drive dramatic change. we are seeing a remarkable change around the country that is very, very encouraging. we want to drive the dramatic change and reform that our country needs. we have measures in which we have to get better. the president wants us to lead the world by 2020. we used to lead the world.

other countries have passed a spy. we are paying the price for that. we also have a dropout rate, a dropout rate in this country of 2.7%. we lose 1.2 million students each year from our schools to the streets. that is economically unsustainable and morally unacceptable. we have to educate our way to a better economy. we are not looking to get incrementally better. we have to get dramatically better. our students are as smart and capable and committed as any student in the world. we have to level the playing field. if we do that they will do phenomenal. if not we put a real limit on success. >> host: we will take your phone calls. the number is on the bottom of the screen. for all of you here by a show of hands, first-time visitors to washington, d.c., how many.

welcome. >> guest: welcome. >> host: first question. >> i want to know how your new education policy differs from the no child left behind >> guest: how many of you love no child left behind? not a lot. i'll tell you what i think no child left behind did right and wrong. the differences in outcomes. when that there are a number of things no child left behind got wrong. fifty ways to fail. a few ways to succeed. very descriptive. what local schools had to do to get better. it actually lowered the bar. many states, due to political pressure, many states actually dumbing down standards, which i think as you guys a great disservice and lead to a narrowing of the curriculum, which is not good. we want to flip all of that on

its head. we want a high bar. whether it is it for year universities, community colleges, vocational training, whenever it might be, some form of education beyond high school has to be the goal. we want to reward success and growth. lots of great teachers and school districts improving. want to continue to see them grow and flourish and shine a spotlight on them. want to make sure you guys have a well-rounded curriculum. >> host: a question right over here. >> how do we solve budget cuts around american schools? >> guest: a huge challenge. we have been lucky with the president asking for the largest ever increase in our budget which is $3.5 billion increase. at a time when he has leveled funding we are putting unprecedented resources. as he said, or ask me, our budget is only 10 percent of most school districts budgets. 90 percent of the money comes

from the state and local level. right now states and districts are in a horrendous financial position. we are arguing for more time. some schools going to four-day weeks, which i don't think is the right thing to do. times are very, very tough. what we have to do as a country is we have to think as education not as an expense, but an investment. even when times are tough i don't see how we can keep cutting back on spending for education. it is hard. again, brutal budget times for state and local levels. i understand that. if we don't invest it's never going to get better. we are trying to put our money where our mouth is. i can think of anything better or more important for states to be investing in the near future. >> host: question in the back. >> yes, under no child left behind teachers who are under

par can be dismissed. do you believe that under the obama administration merit-based pay should be a part of salary? >> guest: i do. the program that has been set up that pits teachers against each other, i don't think that is good. what you want to do in education is have the folks working together. when i ran chicago public schools be put in place performance based plans. 25,000 teachers put together by 25 of the best teachers in the system. the union works closely. we did a couple things. rewarded not just individual teachers, but entire schools. we did not just reward teachers, but everybody in that school. teachers, principals, custodians, security guards, you guys know when you go to a high performing school it is every adult in that building creating a culture of high expectations. it is absolutely right to reward excellence in education beat you have to be thoughtful about how

you do it and engage teachers and send out programs. we had enough funding in chicago to find 20 schools, and we only went to schools where 75 percent or more of teachers wanted us. we had 120 schools show interest. >> host: he pointed out we were the leader in education. when you compare us right to end or below. when did we began to see this drop-off and why? >> guest: it started a couple decades ago. we have just lost our way. to an back decades ago we lead the world. it is not that we have dropped. we have flat land. for in ten of our 24 to 35 year olds have a college degree. other countries are far below us. they have eclipsed as. so i think we got of the complacent and lost our way. we have to educate our way to a better economy. it is the most important thing we can do. we have to do this together we

want to do it in a bipartisan way. all of the political fighting, that is not good for you guys. in education we can break through. education has to rise above politics and ideology. republicans, democrats, house, senate. so far there has been that spirit around education. what has been most encouraging to me, everyone shares a sense of urgency. no one is saying we are in a good in a position now. everyone knows we have to get better and do it as fast as we can. so far i have been very encouraged by the outpouring of support. >> host: here in washington, d.c. michele reed blames, in part, the teachers' union. >> guest: well, i think all of us have to get better. teachers' unions have to move. so do principals. first i think it is very easy to point fingers. we have been this large

compliance driven bureaucracy. we have not given the kind of change our country needs. we will push everyone outside their comfort zone. all of us have to apply an answer. we have to lead by example. we have to drive the kind of change and reform that we need. as hard as we push everyone else everybody loves to point fingers and pulling each other. when you do that high-school teachers blame elementary teachers. in early childhood blames parents. urologist pointing fingers. we are going to call these, we have to work together. >> host: signed into law under the carter administration. how many people work for the department of education and what is your budget? >> guest: $50 billion and 4,000 employees.

>> wilmington, north carolina. why do you think in the past education was one of the first things to be cut in the budget? >> guest: you know why? people don't vote. if every 10-year-old or 8-year-old or 12-year-old could vote education would be a lot better funded in our country. that is my battle to fight for students. i think having students stepped up will be part of the solution to have your voice heard. i think we have dramatically under invested in education. we don't invest enough. teachers should be paid more. you guys should have a richer array of not just programs and glasses, but after school programming, extracurricular are easily important. as a country we have not valued or invested enough in education. having a student voice speak up is hugely important. you have a real leadership role

to play. >> host: this is an obvious role question. >> guest: parents are always going to be most important teachers. that is never going to change. my wife and i have two young into the net tom. we make sure not watching any tv. i think we have to educationally challenge parents to be part of the solution. when they are not involved good things don't happen for children. when parents are a full and equal partner great things happen. so parental responsibility is hugely important. parental accountability. interesting, an auditorium full of teenagers. one of the things i did when i ran the chicago post was we used to survey our high school students. it's fascinating. one of the most important things, they were asking for more time, activities for their parents. their is a perception that things want to be free.

our students were the truly saying that one of the most important things we want is more time with their parents. choice we are thinking about the five and four and six year olds. equally important that the high-school level. >> host: a question on this side of the room. >> christie from nebraska. i was wondering what your stance is on government-funded extracurricular and music programs in schools. do you feel it is necessary for providing the overall quality of education, or do you feel students should focus more on raising the standard of study? >> host: extracurriculars are hugely important. whether it is band or drama or art or chorus or sports teams or academic decathlon or chess or debate those extracurriculars cannot be more important. we tried to ana, in our department, we use to do lots and lots of different things and

narrow our focus and become world class. we have six large areas we will find. one is what we are calling a well-rounded education. we are putting $100 million into that. we take that pool of money up to a billion dollars to invest in states and districts that of thinking about how you provide every child with the chance to get a very well-rounded education. we are serious about reducing the dropout rate and having more students be successful, not just graduating, but going on to some form of higher education. extracurricular is are a huge part of the answer. >> howdy. nolan sullivan. the most heavily-funded public high school right here in d.c. spends about $14,000 per student to send them to school. yet they retain some of the lowest scores on average. how do you feel about this, and what, if anything, does it say about the notion that many

people have that government funding equates to kick quality education? >> guest: is money the only answer? of course not. we under invest in education. were you have schools going to 40 weeks, that is that the right thing for students or our country. we have to invest more education. we have to make sure every dollar we are spending is being well spent. we are not getting results and perpetuating academic failure we have to have the courage to challenge that. >> host: good morning. this is a special edition of the "washington journal." as we come to you from this auditorium in a conversation with about 200 students from ten states, all part of the close-up program and our conversation with the education secretary arnie duncan who for eight years headed up the chicago school system and the secretary of the

department of education. margaret is joining us. we welcome your call. go ahead, margaret. margaret, are you with us? we will try beth in maryland if you're with us. good morning to beth. and if neither is with us we will get a question over here. stand up. >> i know that most -- from washington, nebraska. most teenagers in high school will say that being called homosexual or transsexual is the worst insult possible. the average public high school student will your 26 derogatory gay slurs during the school day. what are your feelings on this, and how do you plan on stopping gay bashing and hate crimes in high school? >> guest: i abhor any kind of discrimination, any sense of intolerance. i think so much of what we have to do is to teach young children, not just teenagers, but young children to have

respect for diversity. we will work as hard as we can to make sure we are creating climates in schools where students feel safe, emotionally, physically safe, where students are respected. where you have those kinds of insults and bullying, it is very hard for students to be successful academically. we have to create a climate of emotional and psychological safety so that students can concentrate on schoolwork and be successful. wherever we are seeing that kind of intolerance or discrimination or eight we need to work hard to challenge that clement in a very significant way. >> host: howdy do you do that? >> guest: i think you have programs like close-up. since seventh chance to talk about talk about their differences. diversity. real clear forms. students are providing a huge amount of the hard work to make

sure that there are positive cultures in schools. i think student leadership and voice is huge. we don't value enough how much are your people have to contribute. this negative peer pressure, positive peer pressure, i think students can do so much to create a climate of positive peer pressure. reinforce the behavior. if we continue to strive to get better i think you guys are a huge part of the answer. we need to do a better job of tapping into your skill. >> host: margaret is still waiting on the line to review will go to her question next. morning. >> caller: good morning. >> host: good morning. >> caller: with the no child left behind so many of our teachers had to teach to test to the children, not the basics of education. will this new bill allow our teachers to go back and be able to teach and not the teaching of the test? >> guest: thank you, ma'am, so

much for your question. that is a constant complaint i heard in 37 states from teachers, parents, and students. i can't emphasize enough one of our six basic tenets is how we have a well-rounded education. yes, reading and math are very important. we want to go well beyond that. science, social studies, history, p.e., art, music, drama, all of those things that give us a chance to be successful. the other big thing that, two other changes we want to make to really support teachers. we're going to invest almost $4 billion. we need better professionals, better mentoring programs, teachers with more time to work together, more time to collaborate. making a historic investment there. the other big thing that always bothered me about no child left behind, if you were a sixth grade teacher and i came to you as a third grader, three grade levels behind if i left your classroom reading one grade

level behind, under no child left behind you were level the failure. not only are you not a failure you are a great teacher. in one year of school i improved two grade levels. that is extraordinary progress. we should not label that teacher a failure. we should be recognizing and reporting that. we should find out why the kid came to the class three levels behind as well. we want to look at growth, classrooms, schools, districts gaining and making progress towards higher goals. so a well-rounded education. this idea of really rewarding growth and gain. how much our students improving. i heard that constantly. teachers are not scared of accountability. they want to be fair. this is a fair way to evaluate. >> host: on that issue when a school board is faced with

budget cuts often music programs. >> guest: all the time. i don't have any easy answer. all i can say is i have been in that seat. you have to do everything. when budgets are tight have to set priorities. when we don't value those extracurricular is i think our students pay a real price. if you want to raise your math scores music has a huge correlation to improvement in math. just out of your own self interest those cuts are the raw one. >> host: again, by a show of hands. an unscientific survey. how many of you participate in outside extracurricular activities through your school? and by a show of hands how many of you have seen cuts in the programs in your schools or school districts? >> guest: that scares me. i love the participation. this is a highly motivated and successful group of students. part of the reason why is they have had those types of

opportunities. you take them away and narrow that piece of the curriculum. that is a big problem. >> host: question right over here. the lead. >> in the north carolina, south carolina, and texas they have been talking about changing their history books. i was wondering why and what is wrong with them. i was also wondering if it is going to become a national issue. >> host: direct loan curriculuml always be interested at the local level. what we are working on, the is not coming from us. forty-eight governors, 48 state school chiefs including north carolina, south carolina, working together around higher standards. so if you have a high bar then you can at the local level beacon have folks working together and figure out who is doing a good job of that to be the will never have a national curriculum. that is not what we should be doing. education will always be done at the local level.

i think we will see improvements in curriculum along the way. >> nick rodriguez. high school in the southwest wind through a great ordeal because parents found out that about 90% of the students enrolled were illegal immigrants. how do you feel about allowing illegal immigrants to attend public school? >> guest: we absolutely have to educate every child in this country. any form of discrimination, not letting children attend school because of their parents' status, i don't agree with that. if we want children to be successful, if you want them to have a chance to be a productive citizen and get a good job and help our nation's economy and help our country we have to give every single child a great education. >> host: good morning to you. go ahead with your question. >> caller: good morning. innovation has always helped this country to be great. the cost teachers, buses,

buildings, etc., why haven't we taken advantage of the internet as a bigger part of our education? >> guest: a great question. you're seeing a flurry of new ideas using the internet and technology. we want to invest heavily in innovation. we have an investment in innovation funds, $600 million that we will cut out to states. at every level, whether it is early childhood, high school, cutting edge technology, not just in the school day, but 24/7. how many of you guys have cell phones? how many of you guys spend a little time every day on those cell phones? >> host: there are off now. . >> guest: we should be delivering content. why do we think about educating during the six hours? there is so much we can do better using technology. you're seeing pretty interesting breakthroughs. we want to make an unprecedented investment in places that are using technology to better teach

students. >> host: jacqueline from tempe, arizona. your next. good morning. >> caller: good morning. traditionally native americans since the been the most performing. i would like to know how you