vote:

the presiding officer: are there any senators who wish to vote or to change their vote? well, then on this vote, the yeas are 40 and the nays are 55. three-fifths of the senators duly chosen and sworn not having voted in the affirmative, the motion is not agreed to. the point of order is sustained, and the amendment falls.

the presiding officer: the senator from louisiana. mr. vitter: mr. president, i ask to call up amendment number 3668 and ask for its immediate consideration. the presiding officer: the clerk will report. the clerk: the senator from louisiana, mr. vitter, proposes an amendment numbered 3668. mr. vitter: i ask unanimous consent to waive reading of the whole. the presiding officer: without objection. mr. vitter: mr. president, a short time ago, the distinguished majority leader urged there to be amendments to improve the bill, not to do any harm to the broader obama-care bill. this is exactly such an amendment. this amendment would pass my mobile momgraphy act, s. 2051, which would allow -- mobile mammography act, s. 2051, which would allow -- the presiding officer: sorry. please, order. thank you. mr. baucus: mr. president, mr. president?

mr. president? at the risk of doing something a little untoward, i honestly do think it's better this conversation, which is trying to resolve all this, be not right down in the well when the senator from louisiana is trying to explain his amendment. i just suggest that conversation be at a more appropriate place. the presiding officer: the senator from louisiana can take a little bit more time. mr. vitter: thank you, mr. president. mr. president, this amendment would allow mobile mammography units to purchase fuel without the federal excise tax. that's exactly similar to an existing exemption for blood centers. these units are very important to give access to women for breast cancer screening and this only scores $1 million so there's no significant budget impact. this does improve the bill. this does nothing to the underlying obama-care bill. this reconciliation bill is already going back to the house,

so i urge a bipartisan vote in support of this good idea, and i reserve the balance of my time. the presiding officer: the senator's time has expired. the senator from montana. mr. baucus: mr. president, i strongly support, every member in this chamber does, prevention and treatment of breast cancer and women's health generally, and the bill the president signed tuesday moves to that end. limit make it denial of coverage based on preexisting conditions, services available to everyone in the exchange. and the health reform bill ensures that women have access to services they need like wellness exams. and this amendment further drains dollars from the highway trust fund. we don't want to go in that direction. i, therefore, mr. president, suggest -- i move to table the amendment and i ask for the yeas and nays. the presiding officer: is there a sufficient second? there appears to be.

the clerk will call the roll on the motion to waive -- on the motion to table the vitter amendment. vote:

vote:

officer are there any senators in the chamber wishing to vote or change their vote? well, i guess not. so the vote is 56 ayes and 39 noes. and the motion to table is agreed to. without objection. mr. reid: mr.resint?

the presiding officer: the majority leader. mr. reid: it goes without saying that we all appreciate everyone's cooperation in having the senate work so well. yesterday and today. i, therefore, after having had long discussions with my friend, the distinguished senator from kentucky, ask unanimous consent that we agree to adjourn in just a few minutes and we will convene at 9:45 a.m. this morning, resume the bill, consider amendments up to 2:00 p.m. we will dispose of points of order that have been determined and one is still under review by 2:00 p.m. there will be no further amendments after 2:00 p.m. the third reading will occur after amendments and points of order have been posted by 2:00 p.m. i ask that in the form of a unanimous consent agreement. the presiding officer: is there objection? without objection, so ordered.

i guess we're eadjourned. i say that we're not adjourned.

mr. whitehouse: mr. president? the presiding officer: the senator from rhode island. mr. whitehouse: mr. president, i suggest the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call:

i mr. whitehouse: mr. president?

the presiding officer: the senator from rhode island. mr. whitehouse: i ask unanimous consent that the senate proceed to a period -- the presiding officer: it is a quorum call. mr. whitehouse: may i ask that the quorum call be terminated. the presiding officer: without objection. mr. whitehouse: may i ask unanimous consent that the senate proceed it a period of morning business with senators permitted to speak for up to 10 minutes each. the presiding officer: without objection. mr. whitehouse: mr. president, i ask unanimous consent that when the senate completes its business today, it adjourn until 9:45 a.m. today.

thursday, march 25. that following the prayer and pledge, the journal of proceedings be approved to date, the morning hour be deemed expired, the time for the two leaders be reserved for their use later in the day, and the senate resume consideration of h.r. 4872, as provided for under the previous order. the presiding officer: without objection, so ordered. mr. whitehouse: mr. president, senators should expect a series of roll call votes in relation to amendments and motions to the reconciliation bill at approximately 9:45 a.m. under the agreement reached tonight, we expect to complete action on the bill around 2:00 p.m. tomorrow. there are other matters that need to be considered during tomorrow's session. therefore, senators should be prepared for additional votes upon disposition of the bill. if there's no further business to come before the senate, i ask that we adjourn under the previous order.

the presiding officer: the senate now stands adjourned until 9:45 a.m.

ask to dispense with the reading of the amendment. the presiding officer: without objection. mr. lemieux: mr. president, i rise in support of the amendment that i'm filing today. i want to thank my colleague from virginia who asked us to think about the practical aspects of this health care reform. i just listened to my freshmen colleagues on the democratic side talk about all of the good things in their opinion that this bill is going to do. and, you know, there's one i didn't hear them speak about. i didn't hear them speak about the fact that half of the new people who are going to be

covered by health care in this country, some 16 million of the 30-some million who have the opportunity for health care under this law are going into medicaid. and the practical impact that my friend from virginia asked us to think about is that our states right now are finding themselves in bankruptcy, realistically, because of the obligations of medicaid. our states, unlike the federal government, have to balance the budget. medicaid is a program that the states pay some 50% of. and they can't make it work. we're finding out in florida right now that this program -- this new law will cost florida $1 billion in the text 10 years. and because they balanced their budget and because they can't print money, that means the dollars will go away from teachers, away from students and away from police. but the point i want to make sheer and the amendment that i'm offering is this, several times, mr. president, as i've been on

the floor, and heard from my democratic colleagues, they have made this point: why shouldn't the american people have the same health care that we in the congress enjoy? why shouldn't they, like all federal employees, be able to pick from a comprehensive and rich plan of benefits in order to take care of their health and the health of their family? well, mr. president, that's a good point. but what's going to happen to these 16 million new americans? they're going to go on medicaid. that's not the plan we have. that is not the rich benefits that the members of congress enjoy. medicaid, health care for the poor, which will now have some 50 million americans in it after these 16 million join it, is a program in crisis. it's a program that is failing. and let me give you some real-world examples. right now we know that patients

on medicaid can't find doctors who will treat them. we know in california, for example, 49% of family physicians do not participate in medicaid. i entered this document into the record last year, "the seattle times" on march 17th reports, that walgreens will no longer take new medicaid patients in the state of seattle. "the new york times," on march 15th, reports about mrs. volet, she's in flint, michigan, she has cancer. for two years she's been receiving treatment, but now her doctor is dropping her from medicaid. he says, after a while you realize that we're really losing money on seeing these patients. not even breaking even. we're starting to lose more and more money month after month. all across america health care providers are dumping medicaid. and we're about to put

16 million new people. so i'm going to take a page from my friends on the other side. because they say the american people should have the same rich benefits that we should have. what i'm proposing today in this amendment is that 535 members of congress should have the same benefits as these 16 million new people and these 50 million americans. mr. president, under this amendment the members of congress will go into medicaid. if it's good enough for 50 million americans, it should be good enough for us. so i've offered amendment 3586, it will require that the benefits that are paid for health care by the federal government for the 535 members of congress go to the state medicaid agencies. and then we all can enjoy this program that 50 million people in america are struggling with. if it's good enough for 50 million americans, it's good enough for the members of congress. and i'd like to call upon my

distinguished colleague from arizona, who i know wants to speak on this issue as well. mr. mccain: mr. president, i ask unanimous consent in engaging in a colloquy with the senator from oklahoma, the senator from florida, an myself. the presiding officer: without objection. mr. mccain: mr. president, i strongly support the amendment. let me also, just for a moment, point out where we are here. where are we now that all of the champagne has been drunk and all of the celebration has gone on on the inside the beltway entitlement and the adoring need aiment we have a deficit o of $1.4 trillion. we have a 9.7% unemployment. we've got beginning right away half a trillion dollars worth of medicare cuts will take place over the next 10 years. a half a trillion dollars beginning right away. a half a trillion dollars worth of tax increases over the next 10 years. beginning in four years years, $2.5 trillion in new health care entitlement spending begin.

the plan still puts government in control, it still mandates that every american must purchase a government-designed and approved health policy, it still mandates that employers have to provide health insurance or pay a fee. and 330,000 medicare advantage members in my state are going to be exposed to drastic cuts. fortunately, we took out one of the sweetheart deals that now a least the 800,000 that were carved out before in florida will be subject to the same cuts. and no one -- no one -- no one believes that the so-called doc fix, that there will be a 21% cut in physicians' payment for treatment of medicare patients is going to happen. this is a -- you can put lipstick on a pig, mr. president, but this is still a pig. and the fact is i noticed the senator from illinois came to the floor this morning and said well, how great this is and how

there's going to be really reductions in the deficit as a result of this legislation. i wonder what he is responded to one of the biggest corporations in the state of illinois, caterpillar, who sent him a letter saying -- quote --"in our fragile economy we can ill afford increases that place us at a disadvantage v. global competitors that are not similarly burdened. and they state elements of the legislation would drive up caterpillar's health care costs by more than 20%, ove over $100 million." the senator from illinois is sponsoring legislation that increases costs for one of the largest manufacturers and exporters in america that's going to increase their cost by $100 million. i wonder when he's going to go out and visit headquarters out there in peoria. i hope it's soon. the fact is that there are things in this legislation that are wrong and there are things that are left out of this

legislation that are wrong. including $100 billion a year that could be saved by medical malpractice reform. is there anything in those 2,733 pages that have anything to do with medical malpractice reform? that's the little dirty secret here. the dirty little secret is that the trial lawyers control the agenda certainly as far as this legislation is concerned. we have the state of texas that has reduced costs, reduced premiums, increased the number of people who have been able to lawsuit filings are down, defensive medicine increases, annual costs by 10%. physician recruitment is up. the largest malpractice insurance company in state has slashed its premiums by 35%. saving doctors some $217 million in four kwraoefrs in the state -- years in the state of texas. i would like to ask my friend from oklahoma why in the world we would not enact medical

malpractice reform if we're truly interested in reducing costs of health care in america. and he -- and our other doctor, barrasso, from wyoming, can testify because of their experience to practice defensive medicine which could be as much as $100 billion a year. here we are looking at dramatic increases in costs -- and, by the way, we need to discuss more. the president's going around the country saying that insurance premiums will go down. individual premiums will go up between 10% and 13%. facts are stubborn things. i'd ask my friend from oklahoma if he might talk a little bit not only about what's in this bill, but what's not in this bill. and medical malpractice reform is certainly something that anyone would logically assume would be part of any real reform if you're interested in reducing costs.

now, if you're interested in increasing government bureaucracy -- and i hear that this could mean the employment or hiring of 16,500 i.r.s., new i.r.s. agents. we're trying to track down the facts behind that. then we are now embarked on one of the greatest expansions of government in the history of this country. coburn i thank the senator -- mr. coburn: i thank the senator for his question. if you look at thompson roeurts, the estimate -- reuters, the estimate for defensive medicine costs are $200 billion a year. it's not just that we order tests that protect us from frivolous lawsuits, those tests have consequences. some of those tests actually hurt patients or expose them to radiation or in fact limit our ability to do what's best for the patient because we're more interested in protecting

ourselves. but -- mr. mccain: could i ask the opinion of the senator from oklahoma. why do you think there is no address of medical malpractice reform whatsoever in this legislation that has the lightest impact on reducing -- the slightest impact on reducing health care costs? mr. coburn: two reasons. the doctors' only defense is to order tests that they need that the patient doesn't necessarily need. the second is because they couldn't get, or wouldn't put it in the bill because they knew it would pass and the american people would agree with it. it's beyond me. let me go to the point of this current amendment because i think a lot of people -- i delivered almost 4,000, somewhere over 4,000 babies. 2,000 of those were medicaid babies. over half the babies i've delivered in my life i've cared

for through medicaid. the state of oklahoma in march or april -- february, i mean, cut medicaid reimbursements 3%. they're going to cut it another 8%. 40% of the primary care doctors don't see medicaid patients because the price that is paid for the coverage doesn't cover the costs, let alone any margin, doesn't cover the costs of the nurses, the rent, the malpractice. the second point is of the specialists that are available, 65% of the specialists in this country won't see. when i'm taking care of medicaid patients, i have trouble finding better than me in a specialized area to care for my patient. what's the the other thing we know about medicaid? even if you normalize for social factors, their outcomes are worse. the cost in terms of number procedures, failure of therapeutics, all are worse. so why is this a good idea?

it's not just a political stunt. if members of congress are enrolled in medicaid, the first thing that's going to happen is medicaid reimbursements are going to go up, so that the availability of the finest and the best and the brightest in this country are available to members in this congress. so it's not just a stunt to say we put our membership in medicaid. it is a very important you willr motive to improve medicaid. think about if you're one of the 16 million people that are going to get medicaid supposedly under this bill, and i doubt that seriously because we're going to see a marked decrease to 50% or 60% of the doctors won't see them, think about what's going to happen. they're not going to be able to find a doctor. you've got coverage, but up can't get anybody to care for you. now, is that coverage? is that care? is that prevention?

is that management of chronic disease? no, none of that will happen. so the whole idea between placing us in a leadership position into a medicaid program is so that we'll lead and fix it and make it what it should be. there's only one health care system worse in america than medicaid and that's indian health care service. there's only one worse. everything else outside of those two programs is better. so why would we consign 16 million americans to a health care program that's failing today? and so the way to fix that is to put us into it. and i guarantee you the self-interest of the members of congress will fix medicaid and make it what it should be. with that, i yield back to the original author of the amendment. mr. lemieux: i thank my friend and colleague from oklahoma. how could anyone in this body not vote for this amendment? why should we have better health care than the 16 million people that we're going to put into

medicaid and now will be 50 million americans? why should we have it better? why should we have a gold-plated premium health care plan? look, i've got a family of five. we're going to have a baby any day -- could be today -- and have a family of six. i pay $400 a month on the government program. $5,000 a year. could i get that in the marketplace? of course i could. there is a doctor right here in the capitol, whole staff of them. any time i want to see a doctor, i get fantastic health care as a member of congress. why shouldn't we have the same health care that we're subjecting 16 million new americans to and 50 million americans in total? like my friend from oklahoma says, certainly won't that make the point to us that this health care is failing? what's going to happen when a member of congress tries to find a doctor and can't find a doctor that will take him? what's going to happen when they try to find a specialist and no specialist will take him? you don't hear our friends on the other side talking about the

fact that half of the people who are going to get coverage under this legislation are going into a failing system. that's not one of their talking points. but it's the truth. so i challenge my friends who say that they should walk among the least of us to vote for this amendment. and i just want to turn again to my colleague from arizona. he and i have expressed our distress about this bill for one -- for lots of reasons, but a specific reason is we both represent states with lots of seniors. we have this medicare advantage program that's going to get $200 billion cut out of it. it's going to really affect our two states. i wonder and would ask my colleague, the distinguished senator from arizona, to speak on that issue. how is this going to affect seniors in arizona when we're raiding medicare to start this new program? mr. mccain: i thank my opinion friend from florida. the fact is that medicare advantage is a program that provides seniors with choices. that's one of the reasons why it's a major target for the other side because it doesn't

fit in with the government mandates that this whole bill embodies. and so i'm worried about 11 million americans who have the medicare advantage program. i'd just like to refer my colleagues to a article -- i know the senator from utah is waiting. if he'd just give me another minute or so here. today in the "wall street journal" entitled "now can we have health care reform." i quote from the part of it that says "health insurers and indeed corporate america as a whole are like monkeys, cut by staking a glass jar to the ground. they won't let go so they can't get their hands out of the jar. the trinket in the jar is the ruinous $250 billion tax benefit for employer-provided insurance." that's the elephant in the room. corporate america isn't brave enough to argue against a direct subsidy to an employment cost no

matter how perversities impact of insulating consumers from the true cost of health care choices. insurers aren't brave enough to say give us a tax code that lets us go back to being insurers rather than a tax laundromat for the middle class' health care spending. almost any bill that would have been worth having that fundamentally fixed this tax distortion regardless of its other elements. we say this because any bill, including the one signed by the president yesterday, will be revisited many times in the future. millions of pages of rules will be written by regulators before we see how it really works. congress itself will return in predictable ways. it will reverse the proposed medicare cuts that created obama care's illusion of fiscal probity. it will tighten the mandate that requires insurers to cover the sick at favorable prices. it will not tighten the requirement that the young and healthy buy insurance at prices

that subsidize the old and unhealthy. more and more tax money will have to be found to keep the jalopy on the road. more and more administrative controls on medicine will attempt family from keeping the jalopy. under the law insurers have more incentive to lavish on their high-end employees. mr. president, i ask unanimous consent that the entire piece be included in the record. the presiding officer: without objection. mr. mccain: mr. president, i thank -- i thank my friend from utah for his indulgence. going around the country right now telling the american people things that simply are not correct. including the fact that these budget projections we know are patently false not because c.b.o. gave these false numbers but because assumptions were wrong.

one of the biggest assumptions is the so-called doc fix. is there anyone who believes that we're going to have a 21% cut in medicare physician payments this fall? i would ask my friend, the senator from utah, who is very familiar with this issue. i know he has an amendment. this is one of the reasons why americans are so angry. they know they're not going to cut doctors tpraeuplts medicare by 21 -- payments from medicare by 21%. it's a sham perpetrated on the american people. so, i'd say to my friend from florida and my friend from utah, we'll be back on the floor probably this fall sometime or littler next year and we'll be talking about the fact that this doc fix was obviously, that the doctors payments for provision of health care for medicare enrollees was not cut 21%, as the other side is telling the american people that it would

be. it's not fair to the american people i'd say to my friend from utah. mr. hatch: i agree with my friend. mr. president? the presiding officer: the senator from utah. mr. hatch: i ask unanimous consent to set aside the pending motion to offer a to maryland. the presiding officer: the senator from maryland. ms. mikulski: mr. president, this is, indeed, a great day because we're passing real health care reform for american families, for american workers, for american small business, for seniors, and our communities. health care reform will save lives. no longer will dreams and lives be endangered because people lost their health care insurance when they either got sick, lost a job, or had an accident. now, mr. president, i listened to the other side, who says that they listen to the people. well, you know, you heard the old saying, "men are from mars,

women are from venus"? i think that party is from mars and we're from planet earth. i think they've been out in our orbit. the planet earth that i'm on tells me to pass health insurance. one of the reasons i'm voting for this bill is all, and the main reason i'm voting for this bill is the story of the lives that i heard from my constituents in maryland. round-tables, town halls, hearings, lots of letters, phone calls, e-mails. they told me about the situation in their lives where they were terrified that one big health care incident could lead them into bankruptcy. they were terrified that if they changed a job in one of our new high-tech communities that could have offered great opportunity for them, they didn't take it because they weren't going to have health insurance. when i listened to people, i think about the lady in

cumberland who works full time but her employer doesn't provide health insurance and she's terrified that she's one sickness away from a catastrophic situation. or from karen in kensington, whose father had to quit work because he had crohn's disease. when he was making payment on his insurance, he was two pennies short and they canceled his insurance, and it took him six months to try to get it ba back. he lost his coverage and he was only 59 years old when he passed away. and then there were the breast cancer survivors, the wonderful women and the nanny they loved who are -- women -- the wonderful women and the men that they loved who are out there racing for the cure. but even in a prosperous community like annapolis, a woman told me how she lost her job and with it, her family's health insurance, and when her insurance ran out, she was terrified if she would lose her cancer treatment. walking around the diners -- and

i love diner -- i see myself as a diner democrat -- in every diner, it's usually multigenerational people. and what do they tell me? "barb, don't forget the old people." senator barb, no matter what, keep medicare stable. if you're 50 years old, you're terrified that your parents could lose their medicare and it's going to fall on you. the sandwiches they're eating also affected the sandwich generation. right about the old-timer's health care, worried about keeping their own and then trying to figure out how they were going to pay for college. medicare has multigenerational implications. this is why in this bill i'm so proud of the fact that we're going to stabilize medicare for another ten years and do very important reforms in medicare. i'm also very pleased to respond to the people who said, no

matter what, make health care available and affordable. for every parent who's ever worried about covering a child with a chronic illness, whether it's autism or cerebral palsy or juvenile diabetes, they will always be able to get health insurance. for the small business owner, like my own father who once had a grocery store, or my grandmother, who had the best baker shop, worried about how they were going to provide health care for themselves. well, this generation, they won't be able to worry about that. i think this bill is really an exceptional one. we save and strengthen medicare, expand the solvency for anothe another -- nearly a decade, we end the punitive practices of insurance companies, we expand universal access, and we pay for it with an emphasis on wellness and quality, saying goodbye to quantity medicine and emphasizing quality medicine.

goodbye to volume medicine and getting value for our dollar. for our seniors -- for our seniors, one of the most important things we'll do is close that doughnut hole. the doughnut hole has been hard to swallow ever since this bill was passed, and we're going to provide a $250 rebate to seniors who hit the gap in the prescription drug benefit and also offer a better discount on prescription drugs. but where i'm also very excited and honored is because the role that i played in making sure that we ended the punitive practices of insurance companies towards women. for too long, in too many ways, they treated simply being a woman as a preexisting condition. so, first of all, they charged

us 30% to 40% more just simply to be able to get insurance. then they would have the punitive practices of denying us health insurance for a preexisting condition. in eight states, domestic violence was viewed as a preexisting condition. you talk about being abused, you were abused by your husband, then you were abused by your insurance company. well, we're not going to be battered any more by these companies. we've ended that in this. and then there was the hearing that shocked and chilled me, when a hearing on gender discrimination in insurance, a woman told a compelling story -- peggy from colorado -- that after she had had a c-section and a premature baby, the costs were high and lost her health insurance. and when she went to apply, they told her, in order to get health

insurance, because she had a premature baby, because she had a c-section, they would not give her health insurance unless she was sterilized. i couldn't believe it. that's what fascist countries do. that's what authoritarian regimes would be. it wasn't the taliban in afghanistan. it was an insurance company in colorado. well, we took that fight and we end those abusive practices in this bill. never again will a woman be able to deny -- be denied health insurance because of any preexisting condition. we end the gender discrimination in charging women more. but then, as the debate went forward, they wanted to take our mammograms away from us and they didn't want to put mammogram and preventive services for women in the bill. they said it cost too much mon money. well, i didn't want to hear th that, and i asked the women to

suit up and come to the floor and we offered an amendment. the good men of the senate also joined us. many remember we wore pink that day, and today we're in the pink as well. and we offered our amendment to ensure preventive services for women so that if you -- if your doctor says you need a mammogram, you're going to get one. if you need screening for cervical cancer or a pap smear, you're going to get one and you're not going to have to pay a co-pay and a deductible. but we, like the old song "bread and roses," we fight not only for women but we fight for men too, because it is for us, it's not about gender, it is about the agenda. and the biggest agenda is to make sure we provide health care to as many americans we can in the most affordable way, with value, quality and prevention as our underpinnings. so we were able to make significant changes in this bi

bill. but affordability is an issue, and i believe that we did that by emphasizing quality. at senator kennedy's request, i led the quality task force, and because of prudent ways that we're going to be able to offer these initiatives, we are going to be able to increase the affordability of this bill. to make people healthier, we want to prevent disease an manage chronic disease. by the emphasis on the management of chronic disease, we're going to save lives an save money. first of all, we're getting more value for the dollar. yes, we will be looking at comparative effectiveness. so when you go for a treatment or you buy a drug, you know that we're getting value for the dollar. the other is that we're going to emphasize reduction of medical errors and also medical infections in hospitals by

introducing quality initiatives that reward hospitals for being able to do that. but you know i also listen to the providers. i represent iconic institutions, johns hopkins medical institution an the university of -- and the the university of maryland. and i listened to my primary care physicians as well, and they said, senator barb, please, reduce the hassle factor, too much paperwork and not enough time to be with patients, too many contradictory rules from yish companies and not -- from insurance companies and not enough after clear path on how to help people. we made sure that we're going to save money by reducing the hassle factor. by simplifying administrative costs by emphasizing medical health technology. we're going to promote the medicine through this

comparative effectiveness research and we're going to also reward following the recommendations of the finance committee the -- really the encouragement of medical homes in order to be able to manage chronic disease. these are the many reforms that are in this bill and that i'm very, very proud of them. and i'm also, as the daughter of a small business, really excited about how we're going to be able to help small business be able to provide health care to their employees. the fact that we're going to offer tax breaks for small business and be able to have health exchanges that they can buy those health care bills at a better cost are, indeed, important. so, again, the other party might be mars, but i'm glad that my feet were planted in planet earth by listening to the people that i represent, by listening to their concerns, and then listening to the excellent ideas

that came from both the people themselves and, i must say, the people who are the providers that could help us lead the way. mr. president, i'm going to vote for this bill, and i know there's much to reform it in the years ahead. but this is more than a beginning. this is a leap into the future. and it's a leap that we can take with confidence that when this bill passes with reconciliation, we will have done a major historic advance for the american people. our job is about creating opportunity, an opportunity to have health care is one of the greatest opp there objection? without objection, so ordered. mr. baucus: mr. president, i'd just like to take a couple of moments to speak on two amendments. one offered by -- i think it's senator -- senator hatch with respect to medicare advantage.

off the topic, it's important to remember that health care reform will reduce excessive overpayments to medicare advantage plans while at the same time rewarding high-quality efficient plans for providing care to seniors. medicare advantage plans that achieve high-quality rankings under this legislation that save -- for regular checkouts for blood pressure, diabetes, will receive increase in payments. that's very important. because today medicare advantage plans are paid the same amount regard less of the quality of care they provide. so for the first time under this legislation payments to plans would be based on performance. something that all seniors would prefer. that makes this medicare advantage plan more fair, more reasonable. it will enable plans to participate everywhere in the country both urban and rural while eliminating overplaiments that plans -- overpayments that

plans receive today. according to medpac, it is a bipartisan commission that advises congress on medicare payments. that organization says that medicare plans are paid 13% more than traditional payments. they strongly recommend that we reduce that overpayment because it causes a great inefficiencies. i might also say that today because of the overpayment all seniors on medicare -- i'm talking now especially about seniors who -- who take a fee-for-service. all seniors on medicare pay for these overpayments. even if they're not on medicare advantage plans. how? basically because every senior pays $3 more per month on part-b premiums. what so seniors paying paying for the overpayment for medicare advantage plans. medicare advantage overpayments

drain resources from the medicare trust fund. if they're overpaid, that means they're draining excessive resources from the medicare trust fund. in fact, the -- the -- the government estimates that medicare advantage overpayments speed up insolvency of the medicare trust fund by 18 months. after that, there's no evidence that overpayments to medicare advantage plans -- don't forget these are private insurance plans, even though they say medicare, they're private insurance plans, there's no evidence that overpayments to them lead to better quality to medicare beneficiaries. in fact seniors can spend more out-of-pocket dollars under medicare advantage plans than under traditional medicare even if they have certain conditions. the bill eliminates these overpayments by decreasing the statutory rates on rates today and giving quality performance increases to high-ranking plans.

we're paying more than we do today to high-ranking plans. no senior in medicare advantage will lose access to any of their medicare benefits under this proposal. there are all of these false claims across the aisle that these cuts which cause more efficiency, prevent waste, prevent overpayments are going to cut beneficiaries, medicare advantage beneficiaries payments. that's not true. it's misleading. plans will not be allowed to lower or drop their basic medicare benefits that seniors are entitled to under medicare program. so there's no cut in basic medicare benefits. in fact, they're guaranteed. the reforms in this bill will ensure that the dollars for medicare trust fund go toward improving the quality of care for seniors rather than to support the operations of private insurers. i think that's something the vast majority of seniors would prefer. i want to make that clear. because some of the statements made on the other side of the aisle i find quite misleading. which leads me to another point,

mr. president. americans probably are a little concerned about what's in the health care reform. they hear all kinds of claims, both sides. now the health care reform has passed. the president signed the bill yesterday. this is just sort of a help, fixer upper around the edges a little bit. now americans can look for themselves as to who's telling the truth. they can -- they will want to look more closely than they have in the past because now it's law. now it affects people. so people are going to ask: gee, how's it going to affect me? i better find out. when people start to find out, they're going to learn, i say this somewhat presumptuously -- but they will find out that those claiming all the bad things that will happen, all the bad things about this bill are basically not true. and they're also going to start to realize that all of the good things in this bill that a lot of the proponents have been mentioning from the president on down, the good things are true. once people are thinking closely

and separate it, they'll realize not only are the medicare charges are not -- are false and some of the other charges are also false and i say, again, somewhat presumptuously, i think the provisions are good and help seniors are basically accurate. the senator from florida offered an amendment basically requiring all members of congress to enroll in medicaid. now, i ask you, mr. president, i clear -- that clearly is not a serious amendment. medicaid's a very vital program for vulnerable americans. it should be treated very seriously and should not be used for political games. mr. president, i now yield the balance of our time in thisfifie senator from oklahoma is recognized. mr. coburn: thank you, mr. president. as i contemplate what's happening at 62 years of age and

looking back through my life, this is undoubtedly the greatest assault on liberty this country has ever had. and it's not direct, it's indirect, but it's what the senator from new hampshire talked about. it's, we're going to decide for you what you get. what the american people still don't understand in this bill is there's three areas in this bill that in the next five years will put the government in charge of everybody's health care: what you can have, what you can't have and who can give it to you. that's what's coming in this bill. so if you're a caregiver out there or you're a patient, you might think long and hard about the three provisions in this bill that are going to do that: the medicare advisory commissi commission, the cost-effectiveness, comparative effectiveness panel, and the u.s. preventive task force panel. all of those are going to carry the force of law, and it's not just going to apply to

government-run plans. if you have private insurance with your employer today, you're going to be told what treatments you can have, because some group of bureaucracies in washington are going to decide that. that's what's in this bill. the senator from new hampshire mentioned several of the claims that have been made. i won't address them again. but i would ask unanimous consent to temporarily set aside the pending motions and -- and amendments so that i may offer an amendment which is at the desk number 3556. the presiding officer: is there objection? without objection, so ordered. e crk will report. the clerk: the senator from oklahoma, mr. coburn, proposes an amendment numbered 3556. mr. coburn: i ask unanimous consent that the amendment be considered as read. the presiding ficer: without objection, so ordered. mr. coburn: this is a constructive amendment that saves millions and millions and millions of dollars in medicaid. the fraud in medicaid prescriptions is out of this world. it can be fixed.

this amendment will prohibit prescriptions for recreational drugs for rapists and child molesters. nobody can disagree with that. it's not in the bill. it's the current state. but if this bill goes through without this amendment, your tax dollars are going to be paying for viagra for child molesters. that's what's going to happen. there is a executive order that this will override. the bill overrides the executive order. so there's no prohibition in the bill for this at this time. a government accountability audit of medicaid found 65,000 instances of improper prescriptions costing $65 million over the last two years. thousands of prescriptions written for dead patients by people prescribing and posing as

doctors. they focus on ten types of frequently abused prescription drugs in just five states, which means this audit, which is just over five states, multiply it by at least ten, and you got $650 million worth of fraudulent prescriptions in medicaid alone. we're not going to address that. 65 doctors or pharmacists were banned from medicaid for writing or filling prescriptions for illegally selling drugs. just in those five states. 1,800 prescriptions were written for dead patients and 1,200 prescriptions were written by dead doctors. just in those five states. the amendment would direct the centers for medicare and medicaid services to enact a g.a.o. recommendation to prevent and eliminate fraudulent prescriptions. it would direct c.m.s. to establish a fraud prevention system for medicaid program and issue guidance for states to prevent the process in claims for prescription providers and pharmacies debarred or excluded from the medicare or medicaid

program. ensure that utilization of drugs and review of that and restrictive recipient programs adequately identify and prevent doctor shopping and other abuses of controlled sst to identify duplicate or death of medicaid beneficiaries and approval fraudulent claims. for years the the federal government has required states to provide prescriptions for viagra and other impotent drugs to medicaid patients, including convicted sex offenders, child molesters and rapists. states have providedhe coverage based on a 1998 letter from the clinton administration. as a result of that, an executive order was issued in 2005 which this bill, if unamended, will reverse. 800 convicted sex offenders in 14 states receive medicaid-funded prescription drugs for erectile dysfunction. that's according to the 2005

survey. the predators of these victims have been as young as two years old. so we've got convicted sex offenders, rapists and child molesters that were taking federal tax dollars and buying them drugs so they can act again. florida, 218 case. new york, 198 cases. texas, 191 cases. and it goes down the list. this amendment would prohibit new health care exchanges from providing coverage for e.d. drugs to convicted child molesters and convicted rapists. it's pretty simple. the claims that are made on this bill are outlandish. as somebody who's practiced medicine for 27 years, 50% of my

patients were medicaid patients. what are you going to do if you don't fix some of the things in this bill? is destroy the best doctor-patient relationships in the world. that's what you're going to do. you're going to put 16 million people into a failing medicaid system that the states can't afford. almost every state is cutting medicaid reimbursement at the time only 40% of the doctors in the specialties will see medicaid patients. it's going to go to 20%. so we're going to put 16 million people in a system, and then they're not going to be able to find a doctor because the costs in my own state, we're going to have an 11% net reduction in medicaid reimbursement which is already only 75% of medicare. what do you think is going to happen in all the states in the

country when the medicaid reimbursement goes down and we add 16 million new people to medicaid? you're going to call it care. you're going to rub your shoulders, rub that medal on your shoulder and say we fixed health care. you're going to promise them that they're going to have care, but they're not going to have care. they're going to have a card, but they're going to have no care. we're going to have indian health service-type care in medicaid because nobody's going to be there to care for them. the claims under this bill keep me sleepless at night not because of washington. because of those 10,000 medicaid patients that i've taken care of through my career, that i know you're going to destroy what care's left for them. you can claim otherwise, but the facts are going to prove you wrong. and we're seeing it in every state in the country right now.

the cuts to medicaid reimbursements. so at least you ought to help save $650 million a year by getting rid of fraudulent prescriptions, eliminating prescriptions for convicted child molesters for erectile tkeus function and disdysfunction and recreational use for a drug such as viagra. and to vote against this amendment to, not fix something that's very obvious is criminal. it's not just not right. it's an active aid to help those who would hurt our c