and i say that is morally wrong. [applause] >> i think the british people know it's wrote this. -- wrong. and i think even some conservatives know it's wrong. so i say this election choice is becoming clearer. someone say it's between new and old. someone to say it's between substance and style. but i say it's between fairness and unfairness. it's between justice and injustice. it's between doing what's right for our country and doing what's wrong. now, let me give one final distance. -- instance. what did we hear from mr. cameron on friday? they have already marked out the margins to be hit and hardest by conservative cuts. northern ireland was singled out and then the northeast of england was singled out. more singled out as first places

for the ax to fall. they have and what become of the towns and cities of the northeast will not end there but will set the blueprint for their attacks on jobs and investment, not just in the northeast but in the northwest and in the midlands, in yorkshire coming towards london, too. but it doesn't need to be like that. britain deserves better. and britain will get better if we can persuade enough people to vote for fairness on may the 6th. you know when i was at school with my brother, i was so determined to campaign for justice that we ran an organization to help raise money for the freedom from hunger campaign. and when i was at university i was so determined that low paid workers in the university should be properly paid that we run a campaign that was successful to get the university cleaners to pay a decent minimum wage.

and when i was at university also, south africa and apartheid was the issue and we campaigned successfully to disinvest that the shares our universities had in mining companies. i was an idealist then and i'm an idealist now. i believe politics can change the world and our labour party is the greatest force for fairness our country has ever seen. because our country has been moving forward these last few years. the cancer guarantee, the fox hunting ban, smoke-free public places, devolution, neighborhood precinct, the minimum wage, the social chapter, the sure chart, the new deal for young people, free nursery places, free museum entry, the shortest waiting time since records began, civil partnerships, maternity leave, freedom of information, peace in northern ireland, the climate change act, the cluster bombs act, reform of the house of

lourdes, the disability discrimination act, reinvestment and these are just a few of the changes we've made. [applause] >> you know, we've -- we've come so far in our short lives. now it's up to you to ensure the country goes forward and not backwards. if you want a fairer britain, you have to vote for it. and you have to vote labour. if you want to be sure the recovery will happen, you have to vote for us and vote labour. if you want to protect jobs and public services, our precincts and our schools and hospitals, you have to vote for it and vote labour. if you want to stop the immoral unfair, unjust, unpressure inheritance tax cuts for the richest in our country, you have to vote for it and you have to vote labour. if you want to stop the cuts to

the northeast and the northwest and then to every region of britain and nation in our land, you have to vote to stop them. and that means voting labour. if you believe in fairness, you need to fight for it. because a fairer future never happens by chance. so get out there and fight for labour's cancer guarantee, fight for our sure start guarantee and tax cuts for working families, fight for the child trust funds for young people. get out and fight to protect investment in our schools and in our neighborhood policing. get out there and fight for 1 million new skilled jobs, for universal broadband, for high-speed rail. get out and fight for a national care service and to beat cancer in this generation. get out and fight and fight and fight again. not for our party's future but fight for our country's future. it's when you see the tory proposals that you realize fairness is in our dna. it's in the british people's dna.

fairness is at the core of the british people's dna. and we are fighting an election on the recovery and not putting that at risk. we're fighting an election on building britain's economy for the future and not putting that at risk. we're fighting an election on defending our schools. we are fighting an election for the british people. let's fight it. and let's win it. thank you very much. [applause] ♪ >> i worked for the bbc 24-hour new teams. i'm on the labour party team so i'm following gordon brown for the entire campaign. that means we hit the ground running the day he came out and said to the nation it's may the 6th we hit the ground running and we have another team with the conservative party with david cameron and then a third

team with the liberal democrats with nick clegg and we follow them every single day wherever they go in the country deciding to campaign that day. we follow them and we try to analyze the policies as best we can. we try very much as well to talk to some of the people that they meet on the way. because i think it's important to hear from people particularly undecided voters who understood know which way they're going to vote on may 6th. you want to know their opinions and what they think their policies and which way the campaign is going. if i can say that's the criticism you may have picked up on the british press all the labour party campaign thus far they say gordon brown in particular is not meeting enough real people. and so it can be hard to try to interview people who are not already affiliated to the party in one way. i think it's not probably stretching a point to say things are pretty stage managed. now i have spent my whole campaign with labour. i can only try to compare that with the main opposition party,

the conservative party. from talking to my friends who are running with the conservative team, i think there's probably some similars. there's got to be the green stage management. you're deal with the prime minister so there are security issues that the other two main parties don't have to the same degree. it's fairly staged, managed. we would have a vote in the labour campaign say he always go to morrison which is a big supermarket campaign in the u.k. there's a few others and ah tuesday it must be morrisons. he has quite a lot of campaigns where he shakes a lot of hands. goes through talks through the aisles and always goes and talks to the staff. we've done quite a lot of events like that. the one thing we have picked up in particular is he's very keen on talking to apprentices. so these are sort of junior members of staff who have taken on in whatever capacity it could be. the supermarket, it could be with an engineering company and

plummers and electricians and we have a slightly running joke. it's wednesday he must be be talking to the apprentices and it ties in with their manifesto and their economy. it's about saying the economy is in a bad way in this country but we've made things better and stick with us because we will continue to make things better. if you stick with the conservatives it will get worse. it's securing the recovery and this is why they're always talking to younger members of staff, younger people like we see at this event here in west london and talking to apprentices. [applause] >> it doesn't need polling that the debate -- we hen't had like you have in the states. that suggest that has got young people more gaenled in the process and more interested. and if that is true then i think i think that can only be a good thing. whether labour specifically has

been engaging with young people in the audience, what's slightly strange is you would think they would pack the audience with first time voters, people who are 18, 19, voting for the first time on may the 6th. and what's quite interesting is a lot of the young people are 15, 16 so they're not nearly old enough to vote. i suppose, they're working on the basis of converting them young so that by the time we get to the next general election they will hopefully vote for labour. i think that there's still a bit of polling to be done as to which way young people will vote in this election. >> i think it's a breath of fresh air. it's not like the conservatives who are very rigid and fixed.

labour just gives a chance for people to be themselves. we have our own opinions. and like, you know, labour is just the best. >> is your family political? >> yes. not like m.p.s or not. they vote for labour as well. >> and what issues are most important to you? >> well, currently i have a friend that died recently around my area and the key issue for us right now for youths in london is knife and gun crimes. and those issues right now. and it's getting too much. i hope that when they do come in to control that they will change it. they'll change the situation right now. >> i think this event is really good. and when i first heard it, i felt really excited.

i think the ideas that gordon brown has is really good. and we'll be able to vote when we're 16. because we have a lot of ideas to share with other people. and it helps us out if we contribute our ideas. and to the society. >> how old do you have to be now to vote? >> you have to be 18 to vote. and if you vote for labor, then you get to vote when you're 16. they're trying to change the law into 16. and that's really good. for all of us. >> what issues do you think are most important in this election? >> the issues that are most important is the fact -- education, that we should have more variety of schools around. and children should get the chance to get educated. and they should have the chance

for other people to see their talents. i think that gordon brown is offering all those chances. >> i believe in every word he says in fairness. so like i said he just brings young people to politics. and just makes them believe. and has this trust by everyone that he's actually doing what he says. unlike others. >> what are the particular issues that you think is really important to your selection? >> yes, i believe what i heard today about the nursery. that they should be charged that i found really, really appalling. to be honest, kids just born, he

or she needs education to start them off and get them ready before primary school. so for them to be charged that's not fair. and family is what we take into consideration. >> between gordon brown and david cameron and democrat nick clegg i think the debate that was going on was quite intense. you could tell they were all very passionate in what they believe in. but then when you weigh out the disadvantages and advantages of each of the leaders, labour has more like advantages. and it doesn't appeal to like the rich people like the conservatives do. they reach out to a wide span of people. people like me and my family who are middle class. who aren't rich. >> and what about nick clegg.

we've heard a lot about him and the liberal democrat party. are you curious at all about that? >> to be honest, i'm not really into the democrats. they're quite new. they really don't have as much experience as the labour party do. so not many people are going to vote for them. that's what i think anyway. >> and do you have any opinion about america's political system? did you watch the u.s. presidential debate? what did you think? >> it's kind of hard because i actually don't live in america. i think it's like -- it's just like here. you know, you get your chance to vote. you have your own say. like barack obama, he's a democrat like the labour party.

and what was his name, the republican, john mccain, it's like the conservatives. so it's very similar.

>> chairman and chief executive of medco health solutions, dave snow announced his company will benefit from the new u.s. health care bill this year. during his speech to the detroit economic club. medco is the largest u.s. pharmacy benefit manager and operates the largest u.s. mail order pharmacy. this is about 45 minutes. >> back in that period of time i was there like many of you and you felt that. and you experienced that. and not only on the east side of detroit but both my degrees coming from wayne state university, it all sort of touches. it's interesting, you know, when you look at the detroit economic club, it helps set the agenda when you look at that film of bringing the foremost leaders to the podium to address many topics, the period between '60

and '84 were no exception. those who addressed the detroit economic club moved the needle through the most important parts of the day. the american generation were articulated and shaped from civil rights to social issues to foreign policy and political ideology, the struggles of dedemocracy and communism and the dialog in america's place in the global economic realm when you looked at the film delta is flying us to japan and china 15 or 16 times a day and how foreign that was when you think about it back just 25 or 30 years ago is quite amazing. the detroit economic club served as an essential speaking venue,

not only for candidates in waiting like jimmy carter and george bush but for sitting presidents like richard nixon. it was clear to speak at the economic club was to gain audience with the nation in the world. today that detroit economic club tradition continues. in the wake of last month's historic passage of the patient protection and affordable care act, that title is almost as long as the bill. [laughter] >> our topic centers on the next crucial steps towards health care reform. we're all impacted by health care reform. we all have a significant amount of skin in the game. we all have the questions and concerns about what happens next. but i can tell you that blue cross blue shield of michigan has dedicated employees to put it together right away. a way that delivers on the promises of accessibility,

affordibility and quality health care for all americans. it's now my pleasure to introduce the man who leads an organization that's playing a major role in delivering on the promises of health care reform. david snow is the chairman and ceo of medco health solutions. medco is a $60 billion a year enterprise currently ranked 35th on the fortune 500 list. it operates the world's most advanced mail service pharmacies on the leading edge of health care innovation. medco manages pharmacy benefits for 65 million americans across all sectors and from every walk of life. its customers include general motors, delphi, and the ford motor company. and partners with several health care companies including blue cross-blue shield of michigan. working with dave's teams the they have created a better approach to manage health care spending for some of our largest customers.

we have partnered to ensure the uaw medical benefits trust retained its pharmacy administration through a michigan-based company. our partnership has helped blue cross blue shield of michigan to maintain a strong company with a michigan conference. through this partnership blue's customers save hundreds of millions of dollars a year and it's created new jobs in michigan to handle mail order pharmacy customer service. those kinds of outcomes are a big reason medco has been named one of the world's most innovative, and admired trustworthy companies as defined by publications like forbes and "fortune" magazine. much of the credit of those honors is attributed to dave's leadership. he has proved himself to be a health care innovator. he's managed hospitals. he's run health plans. and, in fact, is a veteran in the blue system. and today he leads an organization of 23,000 employees

on the leading edge of clinical innovation. medco is forging the future of pharmacy, improving outcomes for patients and reducing costs for payors so we can afford to extend access of quality quality health care to all. isn't that really the true essence of health care reform? not surprisingly, dave was recently named one of the best performing ceos by harvard business review. he's a true champion of health care reform and i had the opportunity to spend some time with dave today and i think you'll really enjoy his insights. so why don't you join me in welcoming david snow. david? [applause] >> thank you, dan. and thank you, beth. i'm really pleased to be here. and i'm going to warn you right up front that i am extremely passionate about health care reform.

i rarely pull my punches. i'm very direct. i've been trying to reform health care for 32 years now. and it's getting very frustrating so i have to be more and more direct as i get older. all of you know that health care reform is fundamentally important in our country. and there are some really solid reasons for it. we all know that 40 million-plus people are uninsured in this country. but we also know the burden of cost related to health care is astronomical and unsustainable. we have now got in our hands a reform bill, a health care reform bill. and many people ask me, is this a good reform bill? does this get the job done? the way i describe health care reform is it's really a three-legged stool. the three legs of the stool are access, cost and quality. the reform fill we have today is almost entirely about access.

there's very little in the bill that get at cost and quality. if we don't get at cost and quality, the stool is going to fall over. and it's going to fall over fairly quickly. the entitlement that we've created today in the current health care reform bill is actually highly inflationary to the system. the majority of the bill is financed through taxes. industries as well as individuals. most of those taxes are going to be passed on to literally everybody in our country. it will not stick to the companies who are being taxed. you know, those taxes become legitimate costs of doing business and they will be passed through. now, i'm not being negative on what we have because at least we have one leg of the stool. access is important. but cost and quality is really important because the truth is, cost and quality creates an

equation that gets to value for every dollar we spend in our health care system. and the truth is that i estimate and i'm going to show you exactly where and how -- i estimate that of the $2.4 trillion we spend on health care today, a trillion of it is pure waste. pure waste. a year. so we as a country can easily handle a new entitlement tied to the uninsured. and also reduce the burden upon corporations in our country and individuals in our country relative to their health insurance premiums. as soon as i make that statement there are people in the room who will say he must be talking about rationing. he must be talking about cuts. i'm talking about none of the above. when dan talked about my background in want some of you in the audience i also grew up in a family of physicians. and i understand what it's like to practice medicine and what it used to be like and how it's changed. how much more difficult it is

today and how much less rewarding it is today. i believe for the right solutions we can get at these cost issues and actually create a mechanism for physicians to enjoy practicing medicine again. so i only have a half hour. and there's been a lot of stuff so i'm going to try to get it through as much as i can with some granularity because the truth is we all know what the problems are. what we don't really understand is what are the solutions? so let's start with the fact there's a trillion dollars of waste in our current system on a $2.4 trillion budget currently and inflating incredibly. how do we get to a real systemic solution that solves our problem in a rational way? we need to build those solutions block by block. so if i were doing this, i would start with addressing the issues around chronic and complex disease. underneath that by the way is a wired health care system.

a wired health care system is a great enabler that will allow us to solve these problems. and you'll see how wired health care fits in when i finish this talk. so chronic and complex disease in this country affects 50% of the population. when i was giving this speech five years ago it was 45% of the population. the reason the numbers changed at the aging of america. and it's going to keep going up because america is going to continue to age. relative to the total population. so we're at 50% of the population as chronic and complex disease. that 50% -- and i'm sure dan ran his numbers. he would see that with his own group here in michigan. of the 50% -- that 50% of the population spends 96% of the drug money and 75% of the medical money. right? so if you do the math on 2.4 trillion you're talking about 1.9 trillion is spent on people with chronic and complex disease.

and it's estimated right now today that for that 1.9 trillion we spend, we waste about $350 billion a year. tied to the poor management of chronic and complex disease. so you might say well, how is it wasted? there are two key ways. number one, patients stop doing what the doctor tells them to do in less than a year. so if a doctor says i'm sorry, mrs. jones, you have diabetes, here is what you need to do to stay stable and healthy, here are the meds you need to do and here's what you need to do with your blood sugars and so forth, in less than a year they stop doing what they're supposed to do. they end up unstable. they end up in the american room. they end up in the emergency room. it helps in every time complex disease.

carnegie did a study that with all the complex diseases 65% of patients stop doing what the doctor told them to do. in less than a year. c. everett coupe says drugs stop working when people stop taking them. well, if we really want to do something about complex disease we need to manage compliance on the part of the patient. the other piece, which is more surprising to people is that when you're managing chronic and complex disease, 33% of physicians are not practicing to current evidence-based protocols. the knowledge domains in medicine are getting so deep so fast they can't keep up. they just cannot keep up. right now today from the time landmark evidence is produced in medicine, it takes 17 years before it comes -- becomes standard of practice.

and so medco is actually playing a role here. the one part of the health care system that's wired today is pharmacy. all of our 66 million members no matter where they go to get their drugs, whether it's our pharmacies or retail pharmacies, we know what they're taking. and we know whether they're compliant and whether the physician is prescribing what the evidence protocol is saying what to prescribe. we're wired -- our specialist pharmacists are looking at the gaps in care around those patients. it's important to point out, drugs are the first line of defense for 88% of all chronic and complex diseases. so if you actually manage a patient properly on the drugs, the ability to avoid the unstable events, the big heartache tied to bad outcomes as well as the cost is enormous. so what medco is doing is medco is using a wired system, watching compliance, looking what a patient is doing against the evidence-based protocol.

the specially trained pharmacist at the disease level and closing the gaps in care and there's a direct correlation, cost per person per year going down as compliance goes up. it's a very direct effect. both on the omission side on the part of the physician as well as the compliance side on the part of the patient. medco is able to close 76% of all gaps in care on the part of the patient in 90 days. when we measure these gaps called to patients close those problems. on the physician side it's a lot harder. physicians don't like to get the phone call from a pharmacist saying did you know there's a more current evidence out there? ..

>> our pharmacists see this. we are also pushing those the same gaps in care to all the retail pharmacies we are wired to. this year we are now starting to do some demonstration projects. with medical homes and accountable care organizations, because physicians also would benefit from seeing this information. if they knew mrs. jones wasn't doing a single thing the doctor told that patient to do, wouldn't that be helpful if you want a patient to become accountable for an outcome? when i used to run health plans

a while ago, for 20 years i ran them, but i was an executive at u.s. health care. we used to capitated rate care doctors. that's an early precursor to a medical home. you prepaid a physician to be a terrible for an outcome. for a patient and an outcome. it ultimately didn't work and the main reason was, the doctor did the right thing, diagnose the problem, told the patient what to do, the patient went off, didn't do a single thing they were supposed to do. the next time they saw the patient was in the hospital. the doctor was welcome to the bill. so you can't ask, you can't go pay for performance until you give this ability to that person you're asking to be what's going on in the patient in between office visits. you have to make a wired system such that they can see what's going on, and you can measure what they are doing and hold them accountable. that's the power that medco has built now that we're not going to push to position. we need to do, once you have

physicians with that ability, you have to change the way you pay them. so let's imagine you're an endocrinologist and you have a panel of 500 patients with diabetes. let's say we're telling you that after 500 patients, 65% of them have one or most serious gaps in care. if you're a practicing physician today, could you afford to have yourself or your nurse or your nurse practitioner calling all your patients to close those gaps in care? today, the system will not pay you a time for that effort. they won't pay you for the vocal. they won't pay for the gap in care. they can't measure what you're doing. you are not going to really be motivated or able, the economics of your practice you would not be able to close those gaps. so what we intend to do, tied to the wiring of the system, working with companies is to come up with mechanisms for pay for performance where we can

recognize the need for that time with patients and that intervention to keep the patient stable and out of hospital. which is where the big dollars are spent in the system. so these things all come together to get at $350 billion away from this country. by the way medco is also pioneering in a space called personalized medicine. so what we're doing is on top of this new approach to managing care, we are bring in a new science and we're doing research in the sides where we actually, once we know your unique genetics and your inability to metabolize a drug, we are able to actually move the system away from shotgun medicine to processing medicine. and i can give you an example of that. we just recently did a landmark study with the mayo clinic around the drug coumadin. i don't know how many of you know the drill committed but it is the most dangerous drugs we dispense that it is a very, very

powerful blood thinner. it has the same chemical composition as rat poison. the mechanism to kill a rat is to thin the blood until the plea. the way we take that drug in, we metabolize it with one enzyme manufactured in our liver. and we all produce different amount of that enzyme. so if you produce a lot of that in zion, you're going to flush the drug out of your system so quickly that you're still at risk of clotting. if you're in under metabolize from the drug it will stay in your system longer and you over the new blood and you will bleed out. today, the truth is 22% of all patients who are put on coumadin, within six months in up in hospital with a serious claude or bleed because the drug wasn't does probably. so what medco is now doing in its protocol on first articulated we're genetic testing the patient. why? we did a study with the mayo clinic and we found that by

genetically testing a patient before there does on coumadin, we could start them on the right does. in fact, when we genetically tested patient 66% of the time we start them on a different dose than it otherwise would have been started on. we reduce hospitalization rates by over 30%. by simply having that powerful information before you were dosed. the study also said that has the physician done the genetic testing before the surgery that required the need for the drug, because often what we did is we saw the first dose of the coumadin, then chase a physician and had the physician, support of the test and we analyzed it and gave them the result. the patient is often 30 or 45 days and. if the physicians would genetically test prior to the surgery we could get the reduction and hospitalization rates of over 50%. that's the power of pharmacogenomics. this goes across the avenues of

different drugs as you look out the, 70% of all drugs are tied to five key enzymes. that are needed to metabolize and activate those drugs. lots of opportunity there. one other quick point. when we started this joint venture with the mayo clinic, the fda had already put a warning label on the coumadin bottle saying do a genetic test before you does a patient. it was a big deal. it was in the "new york times." it was in the new england journal of medicine. it was in job and the walter gilbert everyone read about it in august of 2007. we started this study with mail in march of 2008. the first thousand doctors we call to order the genetic tests on these first our coumadin only three have ever heard of the test out of a thousand. and i can tidy you that there is a lot of examples of this were, in fact, the truth is it will be 17 years before this becomes

standard of practice, despite the telling of his. by the way, the fda if they black box warning on the drug now because of the study. there is a lot we can do just to get care a round chronically complex disease right, following protocols, using a wired system, closing those gaps in care, having accountability. so that's 350 billion a year. then where would we go to reform health care? the next that i would take is medical malpractice reform. fixing the problem around medical liability and defensive medicine. and here's the way i would do it. frankly, if you have a protocol, and you can see a physicians practice to protocol, they are eminently defensible on a court of law. immensely defensible. the truth is today when you look at the data, and you look at the standard of practice and you look at the deviations to that

standard, it's very easy for a malpractice attorney to have a field day. we spend $200 billion a year in this country around defensive medicine and medical malpractice. we can take a huge amount of money out of that equation, once we move to this wired system with protocols, and, in fact, protect the physicians. so let me give you an example of how that might work. today, we all know that, and we have known this for 10 years actually, that 10% of all women cannot metabolize the drug tamoxifen tamoxifen is the number one drug used to prevent the recurrence of breast cancer was you been diagnosed with the first time. and if you're not on a drug watcher that breast cancer, your odds of getting a second time in a metastatic way within two years are extremely high, compared to if you were on a drug.

so tamoxifen is that drug. it is the first choice. but 10% of women can't metabolize the drug, and the drug is not active and less it is metabolize. seven years ago the genetic test was produced so we can tell which of you are that 10% who can't metabolize the drug. seven years ago. remember, there are lots of other choices if tamoxifen isn't the drug for you. this is a life or death decision. today, seven years later, all the first star from tamoxifen, and in him is number, out of 100 doctors today, how many do you think are doing that genetic test first? out of 100 doctors, how many are doing a genetic test? one. one. so think about from a malpractice attorney's point of view. they know that tamoxifen is not the right drug if, in fact, you

can't metabolize it because you can't activate it you can be taking him and instead have the same effect. right? they know this. so a woman comes to that attorney insist i just had a recurrence of breast cancer, the first thing he can do now is a what's the drug you're put on when you had it the first time? all, tamoxifen. let's do a genetic test. and if you in fact are one of those women that can't metabolize the drug, just pay me, let's let him go to court. just pay me. it's over. because the science is there. and just so you know, the knowledge domains are getting so deep so fast physicians can't possibly keep up. just as pharma genomics and genetic states as we on raveled the human genome is growing and an explosive rate. in 2000 we knew about one disease tied to one gene. by 2007 we knew about 19 diseases, and about 76 different genes. by the end of 2008, we added

fortitude new diseases and 364 more genes, all of the genetic test associate with it. you know, human cognitive capacity is five facts per decision. just sides alone delivering so many facts we can't possibly do it without a wired system and some kind of decision-making support using technology. so if you get as a malpractice reform, tied to protocol, getting it right, you're not going to be sued. if you are, in fact, doing everything we as human beings, no. if you are doing the best we know, there are still going to be outcomes, but if you're doing the best we as human beings know, you will never lose a case in court. but if you're protocol is 17 years old, the odds of you getting it wrong are extremely high, and the odds of you getting sued are very high. so where are we now? we are at 350 billion, plus 200 billion. we are $550 billion of waste.

where do we go from there? well, in medicare, we currently ways a third of the medicare budget on the last year of life. these are not, and these are not these great areas where you're pulling the plug on grandma. these are, i ran hospitals. i saw this all the time were in fact we took enormous money on crazy things that sometimes are unrelated to the reason the patient is dying. just because the family wants you to do it and the doctor doesn't want to get sued, and there are no protocols, upon which to act. and i've give you an example of personal to me. my grandmother, 96 years old, this happens all the time. i'm going to say this again. grandmother, 96 years old, vital, has a stroke, goes into a coma, gets stabilize in the hospital. sent to a nursing home. and that nursing home, she was

in a coma, unconscious for a year. my father who i told you was a physician told the attending, i'm going on vacation for a week. do not do anything heroic. the family doesn't want it. he was about it. most families aren't. crystal clear. these are peers, because they're both physicians. they work in the same hospital. and my father goes off to hawaii, wouldn't you know, my grandmother gets pneumonia, which i'm told is a pleasant way to go. i haven't tried it yet, but i'm told it's pleasant. [laughter] >> and my father gave clear, tentative only. but what did the physician do? he sent her to the intensive care unit of the hospital. whether pumped her full of i.v. antibiotics, got rid of pneumonia, shipped her back to the nursing home and a coma where she laid for another year. but doctor, everybody knows when these things are just a waste, but we do this in medicare

across the country. it's $130 billion we flush away. medicare is approaching bankruptcy yet we continue to do this and were not willing to say let's get smart about this. so i'm not saying make it a big deal politically. it's very hard to make it a big deal. but i am saying if you have solutions to protocols, so that physicians can say these are the protocols and this is what, you know, mandated, and you can also basically deal with the issues around -- i forgot what i was going to say. let me see, there were two points. oh, we have the protocols and then have the tort reform. you have the protocols and you have toward reform. when those two things are there together you're going to solve a lot of the $130 billion of

waste. so now you're up to $700 billion a year in this country that we ways. each and every year. not over 10 a year. so there's 300 billion more. and it's something i don't think the private sector is going to solve. i believe this is something the government has to solve. and it's all around wellness. we spend about $300 billion a year tied to lifestyle choices in this country. the key bill in right now is obesity, followed by substance abuse, smoking. over $320 billion a year associated with those, the outcomes of those lifestyle choices. and my view there is the government has to get much more aggressive with advertising and getting to our youngest generation. i remember when i was young, the public service ads around later. there was a huge problem when i was a kid. and they started running public service ads with a native american indian.

remember that, i goes by, trash rules of the native american indians the. they can at the indian. the tears are coming down, and they played it all time. that tells you i washtenaw television at the time. [laughter] >> and really affected me. and i would feel guilty if i put a gun wrapper on the ground that it really affected me. for my daughters, crash dummies and seatbelts but i can't so the go without my daughter reminded me to put my seatbelt. it is very effective when you get to the youngest generation. i think we need to start doing that much more aggressively. i am seeing more now, and i'm talking graphics. graphics. such you want to talk about smoking and cancer, make a graphic. if you want to talk about what obesity does to the body and what the long-term effects aren't to your well being, get a graphic. be willing to go at it and really make people, even used to guilt, it's fine to use the

kill. i don't know if you saw this in a paper two years ago, but japan decided obesity was their number one problem. and other than the sumo wrestlers i never thought of japan as the place. but they see it as driving the cost, number one thing. so what japan did, and i'm not recommending this, but what japan did is draconian. what they did is they really made people feel guilty. they said all men will have a 33-inch waist. all women, or better, all women will have a 34-inch waist. or better. and i guess that includes pregnancy. i'm not sure. [laughter] >> but they put the onus of the measurement of the ways on the employers, and the employers were penalized, find if, in fact, everyone within six months of measurement wasn't at the government required waistline. now, that's a homogeneous population. maybe you can get away with it. we could never get away with that here.

i would look horrendous with a 33-inch waist. [laughter] >> that tell you other countries are going at it. i just think we're too far to the, i couldn't possibly, i might insult want to talk about the problems around obesity. but he tries $300 billion of cost in a system. so we are up to a trillion dollars that we're up to a trillion dollars that i ask you to look at our health care reform bill today. it creates that leg of the stool around access. what does it do around that constant quality equation to get at that, get at the trillion dollars we could use to pay for this new entitlement, and also been to the curve downward, which was a original goal when we talk about health care reform. been deemed occur down for everyone, not just the government program. the truth is we have the ability to do this in a system today. we have the technology, we have the providers, who really actually would like to practice medicine in a different way and

be paid for what they do. but we are putting the pieces together in an effective way. we can do it all at once, by the way. this will take 15 years to get everything into place the right way, to get everyone comfortable with a system that is managed this way. the danger is, if we don't start down this path now, in washington, i'm all racing this. everybody is saying, you know what? this health care reform was really hard, thank god we're done. you know, we are done. no, we're not. if we think we're done now, we're going to sea employers giving up sooner relative to their ability to carry the burden. we're going to find out cost are so phenomenal we will be left with little choice other than to go to a single-payer socialized system. which, frankly, isn't efficient that make you is been a lot done over in europe right now because europe is traditionally used price-fixing as their way to

manage costs. that game is over. they're rates of inflation over in europe are faster than ours here right now. they have none of the other tools or techniques. they have no innovation going on. so it is not their bond over there. we have the ability to continue to be the best medical system in the country. we have the ability do it in a very fiscal responsible way if we get smart about how we approach this and build it piece by piece, and a way that is fair and it's the right thing to do. so one last point i want to make is everybody asks me, well, where you done in washington this past year, why didn't congress do any of these things? i will take, yeah, i was down there way too much for me. way, way too much. i'm not a politician. and talk to, i was invited to the white house six different times. and by the way, there were other very smart people about health care in the white house meetings. and people were all saying the

same thing. unit, it didn't matter if it was cleveland clinic or mayo clinic or the health plans that were there. very consistent feedback about where the money is wasted in a system and what we need to do. you may ask why didn't the bill have anything specific in it? there are provisions for innovation, cmf center of innovation, demonstrations, but it's a little vague. it really is that it's vague. why wasn't there something specific? here's a fundamental problem. everything that you put into public policy has to go the congressional budget office to score. the things i just talked about to you, have never been done at scale. so therefore cbo cannot score them. and so that is why people often say government cannot innovate. the best they can do is create guardrails on highway so the private sector can do what they do well which is innovate and operate. so many members of congress love

this concept, tried to get him into the bill through cbo, cbo what's going. hell, they only scored wiring health care worth $12 billion over 10 years. it is the great enabler to get at a trillion dollars a year. are at least 700 billion of it. it's the great enabler yet it is scored 12 billion over 10. the others they could barely score. the private sector is needed more than ever to make real health care reform happen. we need 10% of this bill is around cost and quality, compared effectiveness studies, accountable care organizations studies, wired health care studies. by the way, there are $20 billion in the stimulus bill to wider health care. we don't have a blueprint to do it. my biggest fear is we will spend and put a pc in the doctors office so that that doctor can put his medical records into the computer. that's not wiring health care. has nothing to do with wiring health care. we have the building blocks. we know what to do but it will

take the private sector to do something big enough of scale that it proves this works so you can score it. once you can score it, you will see these changes put into effect a public policy for medicare and medicaid and drive the system in the right direction. that's what we need to do. today, we are not there. without i'm going to close, and i'm available for questions. [applause] >> we've got time for a couple of questions, so one, as an employer, what are the one or two things i should be doing? >> the employers are in a position where they need the people they hire to been to those caused. clearly, benefit design is something we have all done and it has run its course. the things i just talked about that are really rude cause

problems are not going to be solved to benefit design. and you don't want to go to rationing. what i would help employers would do is search out those health plans, or those pbm's, on those combinations that are really getting at the root cause drivers of their costs. by the way, if you close these gaps in care, you are absolutely going to try to medical loss ratio down. if you're self-insured that major going to really contain your total health care cost. medco has about 50% of the fortune 500 employers as customers today. they get this stuff. medco has won $21 billion worth of business in the last 36 months because they understand the power of closing gaps in care to get patients with chronic and complex diseases stable. they also love the promise of pharmacogenomics or personalized medicine. so i think is really about holding the people you hire to

manage your health care for your employees accountable for moving this needle when you do best in finals, when you do rfps, make sure they are moving the needle, they are not just sitting in place writing this atrocity. and i think that that will push the industry, both my industry and dance industry, to innovate and do some of the things under this remark that can balance our school so it won't fall over. i really think that is where the onus lies. health plans, and pbm's, people and health care who deliver care need to do it a different way that works for the people are paying the bill. >> the last question, there's about four and will and the subject matter. as individuals should we be demanding our family doctors look at performing genetic testing as part of our annual physical? >> you know, here's the problem. that's a really tough one. i mean, you know, i can

guarantee you if my wife was diagnosed with breast cancer i would demand she gets genetically test before she was dealt with tamoxifen. absolutely. you can expect the lay public to notice, number one. number two, you wouldn't believe how hard the conversations are when we're talking to even special is about these signs to tell them about why they should do this testing. it's really hard. and honestly, it's very complicated. so i do believe ultimately a protocol that will tie all of these test, all of their applications together is fundamental so it is in front of the physician as he is trying to decide on a treatment path. i don't think the individual -- i think the individual consumer can be empowered with information as well and take it to their doctor. we are doing that today. we have the coumadin information. we have other information on genetic interaction. we have a lot of this and a

layperson's language so they can talk to the talked about it. but the lay person will have a tough time telling the doctor because the doc doesn't understand the size or isn't up on. it's a difficult thing for our specialty trained pharmacists to educate. so i think we need a systems approach that can help the patient get the right thing done. i really do. >> thank you. >> thank you. [applause] >> david snow, thank you so much. i think the right to guess in the room i think during certain times that i think we all learned some really important things. and mr. snow and his team have been nice enough ,-comcome if you would like more information, that is digestible by people like me who are not health care professionals, we've got a booklet as you walk out the door if you would like to take a. that is, to medco. so thank you very much. dan, always terrific to have you with us. thank you for the terrific job

as presiding officer. and as i said earlier, we know you all have a lot of demands on your time. thank you for investing it with us today. this meeting is adjourned. have a great day. thanks. [applause] [inaudible conversations] [inaudible conversations] and [inaudible conversations] [inaudible conversations] [inaudible conversations] >> the u.s. senate is about to gavel in. senators began the day with about an hour of general speeches before returning to debate on whether to begin work on financial regulation.

a vote to bring the bill to the floor failed yesterday. democratic senator ben nelson joined 41 republicans in voting against the bill. senate democratic leader harry we may call for a revote today. he is likely to discuss that short. live coverage now of the u.s. senate on c-span2. them to mount up on eagle's wings, soaring high for your glory. help them to be devoted, confident, and obedient laborers for you. lord, fill them with your grace so that their lives will be like fountains of living water. we pray in your great name.

amen. the presiding officer: please join me in reciting the pledge of allegiance to the flag. i pledge allegiance to the flag of the united states of america and to the republic for which it stands, one nation under god, indivisible, with liberty and justice for all. the presiding officer: the clerk will read a communication to the senate. the clerk: washington d.c., april 27, 2010. to the senate: under the provisions of rule 1, paragraph 3, of the standing rules of the senate, i hereby appoint the honorable mark pryor, a senator from the state of arkansas, to perform the duties of the chair. signed: robert c. byrd, presidet pro tempore. mr. reid: mr. president? the presiding officer: the majority leader. mr. reid: 60 miles outside las vegas is a rural community called perump. it was originally, it had a

series of artesian wells. it had lots and lots of water and for many years they farmed cotton. it has now become a retirement business community. i think a golf course is there. it's a beautiful community, less than an hour from las vegas. last night a man who had just returned from afghanistan, his name was ian deutsch, his second day on the job as a police officer when he was murdered by a man who had had a domestic dispute with a woman, and he was proceeding to go into a place of business with lots and lots of people in it when he shot officer deutch. the officer who was with him, thomas klensar, killed the

gunman, saving untold lives. this is a tragic story. the slain man had a teenage child, a seven-year-old, and just returned, as i've indicated, from afghanistan and our military. the second day on the job. not killed in sparks not wounded -- not killed in afghanistan, not wounded in afghanistan, killed in nevada. this is the way that police officers find themselves all over america every day, protecting us from these criminals and crazed people. i express my condolences to the entire sheriffs department and especially anthony demayo and the family of officer deutch.

mr. president, today following leader remarks, there will be a period of morning business for one hour, with senators being allowed to speak for ten minutes each during that time. the first 30 minutes will be controlled by the majority. the republicans will control the final 30 minutes. following morning business we'll resume consideration of the motion to proceed to the wall street reform legislation. mr. president, part of our required reading, as i was going through college was to read george orwell's book, "1984," which was looking into the future. of course looking at 1984 now is looking in the rear-view mirror. but when i was in school, we looked at 1984. it was george orwell's classic book. and the main focus in the book

is how societies would be in the years to come: 1984. and he, k appears, was fairly prophetic because one of the things that georgeorwell talked about was that there would come a time when people would stand and talk and whatever they said, the direct opposite was true. that's what we have going on from my friends on the republican side of the aisle as it deals with wall street reform, as it deals with what we've been doing here legislatively. mr. president, we have a situation where i think people sometimes forget where we were. let's talk about where we were for just a short time. during the eight years of the clinton administration, 24 million new jobs were created. during that period of time we were paying down national debt.

we were being criticized for paying it down too fast, too quickly. now comes eight years of george bush. let's remember where we were. privatization of social security was the cry of the bush administration. then we had a war of choice. and, by the way, there's a new book out written by evan thomas of "newsweek" who talks about the rush to war. that war was a war of choice. we're all glad to be rid of saddam hussein, but in the process, we know the toll of our national treasury and our men and women. and that doesn't take into consideration what's happened to the iraqi people. hundreds of thousands of them killed during this war. all that war was unpaid for. tax cuts to the wealthy, unpaid

for. no longer was there any concern about paying down the debt too quickly. the bush administration turned that on its head. in fact, they got rid of all the rules that allowed us to do that, including paygo. so, mr. president, let's just understand a little bit where we were. in the last two months of the bush administration, 1.5 million jobs lost. obama came into presidency with this huge hole having been dug. and i mean it was a hole that was a sight to behold. and we have worked out of that hole. we still have a long ways to go, but we've dug a long ways out of that hole. we know that we have stopped a worldwide depression with a stimulus bill, a recovery bill. now that's little consolation for people who have lost their

homes or are afraid they're going to lose their home or lost their jobs or are afraid they're going to lose their jobs. but we've stopped the bleeding. now we have to get back to a vibrant economy, and we can do that. we're not there yet. mr. president, we've been able to accomplish a lot. we have been able to stop that worldwide depression. we're able to pass the most significant environmental legislation in more than a quarter of a century, create more than 2 million acres of wilderness, 1,000 miles of wild and scenic rivers, hundreds of miles of trails and many other things in that bill. we passed the lilly ledbetter legislation, the more equal rights pay for men and women. we passed legislation to stop mortgage fraud. we passed legislation to stop children from being addicted by tobacco companies. for the first time in the history of this country, the f.d.a. now controls tobacco, stopping people from being addicted as all my family was

when they were teenagers. credit card legislation, we were able to move forward on that and stop many of the abuses of credit card companies. national insurance legislation, something that senator kennedy wanted for 30 years; we were able to pass that. and many other things, mr. president, in spite of the republicans fighting every step of the way. dozens of filibusters. certainly establish themselves as the "party of no." and, of course, we passed health care legislation, one of the most important things ever done in the history of this country. four million small businesses across america, 24,000 of them in nevada, are now eligible for health care. they'll be able to get a 35% subsidy for their health insurance premium, 4 million of them, 25,000 in nevada.

children with preexisting disabilities can no longer be denied insurance. we put $5 billion in that program to work with states for people who have preexisting disabilities. mr. president, we also raised the age for young men and women who are not getting married as early as they used to. they can now be on their parents' health insurance policy until they're 26 years old. we filled the doughnut hold create during the bush administration. so that health care legislation is extremely important and good legislation, an important law in this country. each day that goes by, part of the 4 million people are going to have insurance -- 4 million businesses will be able to have

insurance for their employees they never had before. people will no longer suffer as a result of the doughnut hole. people can stay on their insurance policy until they're 26. preexisting disability will not be the problem it was. we've done other things. mr. president, we're now moving to wall street reform, and here's where george orwelcomes into the picture -- george orwell comes into the picture. everything republicans have said about what we're trying to do with wall street reform is just the opposite. whatever they say is just the opposite. i talked to one republican senator last night. i said, "we should get on the bill, be and then you can offer all the amendments you think are appropriate." and that senator said, no, we want all the problems worked out before we get on the bill. and i said, you know, that's not really the way the senate was set up to work. the senate is to be a body where we proceed to legislation and

then offer amendments and then debate takes place. but the republicans have a new standard, and that is they have -- they want to negotiate -- negotiate. that's the new banner. i wonder when the end of negotiation takes place. the ranking member and chairman of the committee negotiated for months on this legislation. then when that fell through, one of the junior members of the committee stepped forward and negotiated for a month, and that fell through. now, mr. president, there comes a time when we have to start legislating and stop negotiating. we have a bill that's on the floor. it received all democratic votes except one, and none of the republican votes. it's not as if we're asking anyone to approve the legislation. we're simply asking to be able to get on the legislation.

but the republicans said no. we know from looking at the newspapers and all the accounts on electronic media that the american people support the legislation that is now being asked to be debated. they believe being too big to fail should be in the legislation as we have it. they believe that having a feel-safe method to make sure when -- a fail-safe method to make sure when these big companies have a funeral that they pay for it themselves. mr. president, i can't understand why we can't go to the bill, have amendments offered. the end of negotiations should terminate some time. i was a trial lawyer by profession, and of course it's good to negotiate. but there comes a time when you say, okay, we've had enough of this. let the jury decide. that's basically what we've done here. the jury is the american people. they decided they want us to

move forward. the american people undeniably demand we protect them from wall street which has run wild. two-thirds of the american people support us cracking down on big bankers reckless risk taking. i direct everyone within the sound of my voice to read the book, the best certainly called "the big short." this book written by the same man that wrote "the blind side" talks about what happened in wall street. i'm from a state that's famous for gambling. mr. president, the people come to las vegas to gamble, gamble with their own money. wall street gallon pwepld and -- gambled and caused this problem with our money. they're gambling now with our money. the rules are the same today as they were when this debacle occurred. the majority of american people support us asking banks to pay for their own funerals. that's the fund financed by the big financial firms to cover the cost of their liquidation. not to bail out banks that

threaten this economy, but to shut them down for good. the american people also demand their leaders discuss those details and approve on those ideas. we have two simple requests. this is the american people, mr. president. one, that their leaders look out for their economic security. and, two, that the legislators, legislate. in other words, they want to us protect their jobs. they want us to do our own jobs. right now senate democrats are refuse to go do either. yesterday they stood together en bloc to block us from moving this bill to the floor. they didn't even want the senate to talk about legislation as part of the normal legislative process. more than two years after the financial collapse that sparked a worldwide recession, senate republicans are claiming we're moving too fast -- too fast. they're claiming that only a fully negotiated and agreed-upon bill can come up for debate. that is absurd, stunning,

unheard of. they want all the details to be worked out beforehand behind closed doors, not in view of the public. that's unprecedented in the more than 200 years we've been a senate. as we all learned in civics class, that's not how the legislative process should work. wwe ought to bring our bill to the floor so we can discuss it, amendment it. we ought to do it in the open. if we're not debating, what are we doing here? it's very interesting, mr. president, that the republican senators are willing to talk about financial reform with press conferences and other media events. why weren't they willing to talk about it here on the floor? what purpose does the senate serve? why do we have rules for debate and the opportunity to offer amendments? president kennedy once said --

quote -- "let us not be afraid of debate or discussion. let us encourage it." that's what he said. so i ask my republican colleagues, why are you afraid? what are you afraid of? all we want to do is move to the bill. now, mr. president, if something untoward happens after the bill gets to the floor, they still have their 60 votes -- they can stop us from getting 60 votes. there's 41 of them. why in the world can't we go to the floor and debate this bill? they have that protection. the right response to this is not dismissal but discussion. for far too long there's been too much secrecy and no transparency on wall street. the american people demand we fix what's broken. as long as republicans insist on secrecy and resist transparency here in the senate and if they don't let us address the problems we were set hurricane t

here to solve, we will never fix this. why aren't we here, mr. president, debating the issue? because the republicans want more negotiations. they refuse to legislate 678. the presiding officer: the majority leader. mr. reid: i'm sorry that i didn't have th a chance to telle republican leader, but i think he understands that we have an opportunity to have a vote today. i think we'll have it at 4:30 today. mr. mcconnell: yes. mr. reid: so i ask consent that today when the senate

resumes the motion to proceed to is $3217, that all time between 2:15 and 4:30 be equally divided and controlled by the leaders or their designees. the time from 2:15 to 4:30 be divided by senator dodd and senator shelby. at 4:30, the motion to reconsider be agreed to, the senate then move to vote on the mexico to invoke cloture on s. 3217. the presiding officer: is there objection? without objection, so ordered. mr. mcconnell: madam president? the presiding officer: the republican leader. mr. mcconnell: madam president, last night the democratic majority forced a vote on a bill that wasn't ready for prime time. we know because every day it seems another one of its flaws comes to light. and it's not noteworthy that the was bipartisan objection to going forward with the bill last night in its current form. you've got every single member

in my conference from one end the party spectrum to the other united in calling for more bipartisan talks. we've heard from a couple of democrats who think we should make some improvements as well. you've got the national federation of independent business yesterday saying the bill hurts america's small business job creators. we heard from the organization that represents military officers yesterday expressing their concerns about the impact this bill will have on nearly 400,000 active duty, retired, and former service members, their families, and survivors. community bankers from across the country say this bill, as currently written, hurts main street. "the new york times" this morning reported that the maker of m&m's and snickers is concerned about the bill's impact on the cost of sugar and

chocolate. harley davidson is word about the effect it's going to have on business. ebay is worried about the consequences for its business. clearly, this bill isn't ready. it falls short of our constituents' demands to prevent future bailouts, and it's expected to hurt america's job creators at a time when we need jobs most. i mean, does anyone really believe that the people who make harley davidsons and snickers bars is podge for the financial crisis? does anyone think that? then why would we want to punish them in our effort to hold wall street accountable? these are just the kinds of unintended consequences you get from rushing legislation. if we're aware of them, why wouldn't we want to address them? in many cases all it would take is a simple fix. the military officers association says all it would take is a simple tweak in the language to address their concerns. in other places we just need to close a loophole.

unfortunately, the democratic majority seems interested in fixing -- seems less interested in fixing this bill than in some political win they think they're scoring by not fixing the bill. it's a total waste of the people's time. americans don't understand why we vote on a bill that doesn't meet the basic test of reform. he they don't see the point -- they don't see the point. in what other line of work is it acceptable to show up at a meeting with an unfinished product? don't we have an obles to make sure the bill we -- don't we have an obligation to make sure the bill we vote on is in good shape before we vote on it? this bill isn't ready yet. it needs work. that's what last night's vote was b this morning i saw the junior senator from virginia, a democrat and a man who knows what it's like to create jobs, is acknowledging what republicans have been saying all along. "there are parts that need to be

tightened." that's certainly true. so let's stop the show part -- e show par partisanship. let's back to proving to the american people that the days of wall street bailouts are indeed over. madam presint, i yield the floor. the presiding officer: under the previous order, the leadership time is reserved. under the previous order, there will now be a period of morning business for one hour with senators permitted to speak therein for up to 10 minutes each and with the time equally divided and controlled between the two leaders or their designees with the majority controlling the first half and the republicans controlling the final half. ms. stabenow: madam president? the presiding officer: the snoer from michigan. ms. stabenow: thank you, madam president. i rise today to urge republican colleagues, to urge the republican leader to drop their filibuster of the wall street

reform bill. i wish i could say, madam president, that this is the first time we have seen efforts to block moving forward to even debate a critical issue before the senate. but, as you know, the party of "no" has now 171 different times either filibustered or threatened to filibuster critical legislation that's important for moving america forward. historic -- 171 times. never heard of before. and with all due respect, the idea that the bill has to be perfect before we begin to debate it makes absolutely no sense. there have been numerous times, because of the importance of a piece of legislation, that i have supported and everyone on this floor has supported moving forward to proceed to a bill, knowing that they would need to have changes before they would support the final outcome of the

bill. we do that all the time. personally, there are changes that i want to see and will work hard for in the legislation that is before us. there are provisions, there are amendments that i will support in order to make sure that this does not have unintended consequences. and i would guess that the majority of us are in that situation. but to simply sa sayings "no, we won't proceed to the bill," this is not a vote on whether for final passage. changing the unintended regulated -- unaccountable practices on wall street isn't worth even bringing up to get to the floor to debate. that's what this does. that's what is so shocking to me, and i have to say, on behalf of the people of michigan who have been hit so hard by the gambling and unregulated

processes%, i am extremely concerned that we're seeing another filibuster and we'll have opportunity to change that today, tomorrow, the next day. i hope colleagues will decide that rather than just blocking the ability for us to fix this problem, they will join with us and many of us will join together in amendments that will make sure that this bill is the right kind of bill moving forward. but we have seen what happened when wall street did not have accountability and oversight, and i can tell you, the people of michigan can't afford to go through that again, madam president. 8 million americans, many of them -- too many of them in my great state of michigan -- have lost their jobs, through no fault of their own because of the secret, unregulated deals on wall street. we've seen small business owners who've worked hard to build their part of the american dream

for their families forced to close their doors because they didn't have access to capital. this has got to stop. families around my state have watched their money an -- their money in their pension funds and 401(k)s vanish before their eyes because other people are gambling with their money. the most heart-wrenching time for us in michigan was g.m. and chrysler being forced into brawps because of the -- bankruptcy because of the wreckless unless of wall street. i'm shocked and deeply concerned that my colleagues on the other side of the aisle would choose to filibuster this bill, which puts in place commonsense regulations and puts consumers back in control of their finances. and i'm deeply concerned for our community bankers who've also been victims of this crisis, who need help so that they can get credit flowing again back to our

small businesses and our manufacturers to create jobs. but, mostly, i am deeply concerned for the hard-working men and women in my state who work hard every day, who play by the rules, and who were hurt by the reckless behavior on wall street and who want to know that this will not happen again. the bill we have will hold the big banks accountable and put consumers back in control. it's time to stop the unregulated gam ling on wall street of -- gambling on wall street of other people's money. i would strongly urge colleagues to stand up to the special interests and the lobbyists, to dropple the filibuster of this -- to drop the filibuster of this bill, to work with us, to make sure that it's done right. but, most of all, to make sure that we put in place rules and accountability for our families,

our small businesses, and our manufacturers so that they can have the capital they need and the accountability and the trust in the system they need to move forward and create jobs and create investment in this country. again, madam president, 171 times -- unprecedented, more than any other time in our history we have seen efforts to block and to filibuster. it's got to stop. too much is at stake, and certainly the people in my state have gone through too much to allow this to continue. i yield the floor. ms. cantwell: madam president? the presiding officer: the senator from washington. ms. cantwell: i appreciate my colleague from michigan being out here, as she has repeatedly, to talk about how our process oftentimes breaks down and what the consequences are because there's probably no bigger consequence than what's happened to the state of michigan.

and she fights every day to make sure that we're aware of what will help our economy and help main street, and so i thank her for that and i thank her for being out here to urge us to get off of a filibuster and on to important legislation that i think will help our country. i'm here also to talk about something that i want to make sure as we enter this floor debate that people aren't confused about. that is that we've made choices in the past that really have helped accentuate the situation we're in. and if we're going to get out of this situation, we have to be honest with ourselves that this is a time when we need to do our job and make sure that we understand the opportunity to make sure consumers are protected. i want to start, madam president, by talking about the commodities exchange act because there's been a lot of debate here about what various committees have oversight and what the important issues are here. and, for me, there's no more important issue than making sure the commodities future trading

commission which has oversight of financial indexes has the authority to regulate what are called derivative markets. the reason i say this is so important is because it really is the fact that we allowed legislation to pass here in 2000, the commodities futures modernization act that legally deregulated these tkreufrgts. we had a commodities future trading commission chair, a woman named brooksleybourne who saw what was taking place and tried to do something about it. she tried to do something about it because the commodities exchange act oversight is to deter and prevent price manipulation or any other disruptions in the market, to ensure financial integrity of all transactions and avoid systemic risk and protect participants from fraudulent or

abusive practices. now that's what their charge was. and when she saw in the marketplace that there were these products that were being used that didn't, that basically thwarted this act, she proposed regulating derivatives. so that is in the 1998 time frame. so this problem has been around for a long time. she said, as we saw the demise of long-term capital management incurred a financial crisis at that time, she said let's make sure we are regulating these products. and what happened is that she was basically run out of town for her views. she was the chair of the commission at the time, and a bunch of people basically influenced by wall street came down to washington, d.c. and said, you know, that's the wrong idea. we don't need to do this. this problem isn't going to be an issue for us. and so not only was she prohibited as the chair of the

commodities future trading commission to fulfill this act, to make sure that we regulated this market, not only that, legislation was passed here by the congress prohibiting us from regulating these derivatives. now imagine that. you actually had a chair of the commission doing their job; you actually had her calling out a problem in the market on her responsibilities on oversight. and not only was she told no that she couldn't regulate those; congress prohibited her from doing that in the commodities future modernization act. how did we get to that situation before? you know, i get it because i had to live through the enron crisis in our state, and a lot of people cooked up off-book accounting. and people at first said it is a bunch of environmentalists not allowing us to have energy supply. that's why we have an energy crisis. then people said, oh, well, we're having an energy crisis because we don't have enough refineries. we found out that it was people

manipulating supply and demand with various schemes called dust star, get shorty, a variety of things that all came down to this: off-book accounting. how could you fool the accountants into believing that your scheme was really legitimate? so it should be no surprise that in 19 -- i think it's 1994 that in a little, you know, retreat effort -- you know, some of us go on retreats and talk about our policy issues. well, here some of the titans of wall street went down to boca raton, about 80 j.p. morgan bankers and started to wonder if there was a way to create derivatives that could bet on whether bonds or loans would default. okay, that's what they did. they were down in boca raton saying basically how can we do off-book accounting to figure out ways in which we can bet on these things. so that's what happened. and that was the start of this

and brooksley bourne called them out on it, let's stop it and basically was prohibited from doing it. so what happened when we prohibited -- when we prohibited the derivatives from being regulated? well, one of the cftc persons said all the fundamental templates that are learned from the great depression that are needed to have markets function smoothly were gone. these are things we put in place after the last fiscal crisis. we put them in place because we knew we had to protect things. the other side of the aisle led the charge on that deregulation, led the charge on the deregulation of derivatives and said let's keep our hands offer. thraoft four times -- at least four times we have had votes on derivative measures and those on the other side of the aisle said no, let's don't deregulate them.

this is an important issue, and let me explain why. because when you look at capital markets, you have to have transparency. if you don't have transparency, people don't know what's going on and products can be manipulated. after the 2000 commodities future modernization act, basically on derivatives you had no transparency, no capital requirements, no prohibition on fraud, no prohibition on manipulation and no regulation of the intermediaries. why are we surprised that we ended up in this situation? because if we basically took what had been the fundamentals of the last fiscal crisis and put them in place in a law and then basically were warned and we deregulated them, why are we surprised that we ended up in this situation? because after deregulation, what it meant, if you were doing trading, at least on these derivatives. on other products, you had

certainty and you had predictability. but on these products, let me be more specific, you had what were called dark markets. and that meant because you couldn't see into these dark markets, you didn't really understand what was being done. i know that our colleague, senator levin is holding a hearing today, and he's going to get to the bottom of exactly what was going on in those dark markets and who was trying to manipulate them. but the fact that they were dark and not traded meant that you couldn't see the price that somebody was paying and thereby understanding what was going on in the market. so you had no transparency. and you also had, you know, no requirements to keep records, no large trader reporting, which would have been things that the cftc would have said i can look at that and see whether manipulation is happening. you had no speculation limits. another thing that happens on the stock markets or on trades that happen now -- i mean we

hear about it all the time -- is that if somebody thinks that somebody is messing around with the market, you can have limits. you can come in and, on an exchange or an agency can come in and say we're going to stop that kind of trading because we have concerns about what's going on. and we also know that there was no capital behind these bets as well, which, you know, is very alarming to a lot of people that, you know, the synthetic c.d.o.'s were cooked up and had no capital behind them. and i know my colleague, senator dorgan, has been out on the floor and talking about legislation, an amendment he's going to be offering on the senate floor to make sure that we close that. but what it created was just a high risk for fraud and manipulation and excessive speculation. that's what happened. that's what happened. so, when you deregulate the derivatives market, what happened? it should be no surprise again to find out that when we

deregulated it, the market exploded. here's where we were in 1999. there were some derivative products. but now look at it. it peaked a $700 trillion. it somewhere leveled off at $600 trillion. a $600 trillion market in derivatives drew because we created a dark market opportunity in which people couldn't really, not everybody could really understand what was going on. and certainly the regulators who used to have a day job of overseeing this, were prohibited from doing their day job. and i should add, madam president, not only were the regulators prohibited from doing their day job, in that commodities future modernization act of 2000, we also had a provision in there that said states aren't able to use their authority to look into these markets and market activities as well. we did two things.

we prevented federal regulators from doing anything. and we prevented the state regulators from doing something as well. and now we have this unbelievable, unbelievable, unbelievable market of activity. so my colleagues on the other side of the aisle like to talk about innovation. well, i know a little bit about innovation. i worked for a company that was a start-up company. and when i look at that, yes, you have to have financial markets on wall street that help those companies get financing through their very early stages. that's what's so important about our financial markets operating effectively. but you can see from this chart -- or maybe you can't. maybe you can't see from this chart because it's so hard to see. but at the very bottom here is a little yellow line, and that yellow line represents the assets, the assets that people -- the loans that these banks are making, the amount of money that's in loans, in

capital going to businesses that are the true ideas of innovation. now, there's a lot of innovation here in derivatives. now we know what it is. dark market be derivatives that cooked up things like c.d.o. and synthetic instruments to basically bet against bonds because somebody had securitized loans to banks that were risky bank loans anyway and then tried to make somebody believe that that was a great way to cover them financially. so all of it was just a risky game. and that's what we're doing. so we're not helping the american economy in investing in detroit or investing in software. not the way we used to. we're basically investing, and people are making a ton of money in dark market derivatives. so that's why it's so important that we get out here and we fix this legislation. and just to give you an idea of

where people are making the money, because i know some people like to say, well, you know, let's, you know, get out here and make sure we do something for small business, which i think is it's incredibly important that we do that. but you're not going to get the big banks to make a bunch of loans to small businesses, as that last chart just showed you, when they can make money in dark market derivatives. this chart here shows the increased profits that they have had since 2008. so you've actually had a decrease in lending. you've actually had a decrease in the amount of capital going out to the tune of something like $547 billion, and you've actually had an increase in trading profits. so we know where the money is going. wall street's not putting money into main street. wall street's putting money into wall street dark markets. and we have to get on this legislation to fix that. so what would we do in this

legislation? well, if my colleague from the agriculture committee's mark is put into this legislation, as i believe the leader is going to do, then you have a choice of having an unregulated market, or with this legislation, a truly regulated market with exchange trading. people say, what does that mean, exchange trading? i don't understand. what is that going to solve for us? just as i said how dark the market was and no one knew what was going on, when you have a product that is traded on an exchange, you actually have transparent pricing so people can see what the pricing is. just like the situation being described right now in the senate oversight committee about people didn't know what was going on or who was paying what or who was behind what bets. you have transparent pricing and you have realtime trade monitoring. you know because someone is monitoring those trades, you know exactly what's happening in the market and who's moving what

and how they're moving it. and you have a transparent valuation. if you go back and you have time and read this latest book out by michael lewis, "the big short," he talks about how people didn't know exactly what was going on on the valuation of this because it was being hidden from them. and so they had no way of understanding exactly what the value of these products were. that's why this scheme was able to be perpetrated on people because they didn't know what the true valuation is. if you have exchange trading, you actually have speculation limits and you have public transparency. so when we're out here debating this -- and i hope my colleagues on the other side of the aisle will support exchange trading. i heard one of our colleagues on the other side of the aisle say i don't think that's the solution. well, by my book, it's absolutely the solution. it's absolutely the solution. just as it is for the stock

market, who would buy stock on the stock market if you didn't have oversight of the exchange, if you didn't have these kinds of things: transparency, realtime monitoring, speculation limits? who would go buy stock on the stock market if that was the case? so why do we think the deriff alternatives can operate in the dark -- the derivatives can operate in the dark? they can't. the other thing we will be talking about here on the floor is that unregulated trading doesn't have any capital behind the trades. if you had a clearinghouse involved, exchange trading and a clearinghouse, you actually have capital behind these trades and people know that somebody has the ability to deal with this transaction that they are betting on. so, madam president, these are the things that we need to do. these are the things that are critical to the type of reform that we need to get done. i am concerned that we're not going to get to this

legislation, that dark market is going to continue to operate that way, or that people are going to propose loopholes to basically water this legislation down. and, you know, we've had a lot of conversation about loopholes, and one of them is the end user loophole, and basically any kind of loophole in this legislation, it's -- you know, it's kind of like water. the money is going to flow where it can. if it's a dark market, that's where the money is going to flow. we had a hearing of the commerce committee in 2008, you know, six or seven months before the big bubble burst and george sorrows came to testify and -- and george soros came to testify and said we're inside a bubble and it is going to cause great concern. he knew then because he knew what kind of activity was going on.

and he talked in his testimony how important it is what if you applied regulation, you had to apply them both to the regulated and unregulate $market, because if you don't afly to the unregulated market, all the money moves over to the unregulated area. so i appreciated this "new york times" editorial that basically said, if end users are exempted, then trillions of dollars' worth of transactions could avoid the exposure and stability that comes with exchange trading. so that's what we're going to be trading out here, about whether you're going to have the kind of oversight and you're going to make sure that we end up putting the kinds of regulations in place that we need. derivatives, as another "new york times" editorial said, "strong derivatives reform is a matter of putting taxpayers first -- ahead of big banks and corporate america that are fighting hard

for a return to the risky business as usual." we don't need rickey business as usual, madam president -- we don't need risky business as usual, madam president. we need to reform these markets. let's get capital flowing again to innovation, service, in important areas of our economy, and know that a fundamental rule to markets and capitalism is to have transparency and that the legislation we're considering about do just that. hopefully the republicans will say what true reforms they are for and realize that, in the past, they have been against some of the derivatives reforms that would have stopped us from having this crisis. so i thank the president, and i yield the floor. i suggest the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call:

mr. barrasso: madam president? the presiding officer: the senator from wyoming. mr. barrasso: thank you, madam president. i ask that the quorum call be vitiated. the presiding officer: without objection. mr. barrasso: thank you, madam president. madam president, i come to the floor today as someone who's practiced medicine in casper, wyoming, for 25 years. as an orthopedic surgeon for the people of the great of wyoming as well as the medical director for a program that has outreached all across the cowboy state with low-cost health care screenings, all aimed at giving people an opportunity to take more responsibility for their

own health and essentially keep down the costs and get down the costs of their medical care. so today i come to the floor with a second opinion on what this senate has passed, what the house has passed, and what has been signed into law by the president. and i come today because i continue to believe that what is now the law of the land in health care reform is going to be bad for patients, bade bad for providers -- the nurses and the doctors, those who take care of your patients, and bad for payers, bad for the american people hoandz up paying the bill for -- who end up paying the bill for health care in this narks people who care for their own care, because i believe fundamentally as this bill has been passed into law that it's going to result in higher costs for patients as well as for taxpayers, less access to care for people all across america,

and unsustainable spending at a time when we're running record deficits. and that's not just my opinion. if you ask what the public believes in the polling across the country, the american people have overwhelmingly rejected this bill that is now signed into law by the president, rejected it because they believe that the cost of their own personal care is going to go up, the quality of their own personal care is going to go down, and that fundamentally they believe that this bill was not passed for them but was passed for someone else. and the reason i come to the floor today to talk about it is because the has just come out by the centers for -- the report has just come out by the centers for medicare and medicaid services actuary. the report has come out to go through methodically and page by page what's actually in the health care bill.

you'll remember that when the bill was in front of the house, the speaker of the house, nancy pelosi, said that you'll have to pats bill before you get to find outer what's in it. and in a rush by this body to pass a bill that to me was irresponsible, they've missed the things that now the actuary for the centers for medicare and medicaid services has outlined in a very thorough report to the american people. i want to go through that with you. because fundamentally, this says that health care costs are going to be higher, access to care is going to go down, the spending is unsustainable, and it's fascinating because this is in light of the speech by president obama in june of 2509 when he -- in june of 2009 when he said that if any bill arrives from congress to his deck that is not controlling cost -- to his desk that is not controlling costs,

that is not a bill that i can support, he said. he said, it is going to have to control costs. well, the actuary tells us that the bill now signed into law by the president, as well as the additional bill -- because there are actually two new laws; one the initial bill then the fix-it bill -- they will increase costs, raise federal spending, threaten access to care for seniors, and will result in higher insurance premiums. that's not a republican senator saying that. that's the chief actuary for the united states in charge of medicare and medicaid in a well-documented report that is out april 22, 2010. well, what's actually in the report? let's go through it page by page. first thing is it says this is going to bend the spending curve, the rate at which we're spending money on health care in the country. you know, the president said we want to get the cost curve down this. says just the opposite,

mr. president. the cost curve is going to go up. that's on page 2. turn to page 4 of the romplet we'll go through this page by page. what about overall national spending on health care over the next 10 years. between 2010 rand 2019, the national spending on health care is going to go up by $311 billion. the president said he want add bill that was actually going to get the cost of care down and the spending on health care down. let's turn to page 7. the president said that he wants to make sure that if you have -- that if you have care that you like, you can keep it. you can keep the care that you like. we all heard that. we heard it time and time again. but yet page 7 of this report by the president's agency says, about 14 million people will lose their employer coverage by

2019. the president of the united states says if you have what you like, you can keep it. his actuary, who actually had to do the numbers of the bill, said, sorry, 14 million people are going to lose their employer coverage by 2019. let's turn to page 8. an estimated 23 million people will remain uninsured by 2019. this is at a time when the president said he wanted to provide coverage for all of these people, but even 10 years out, 23 million people will still remain uninsured. in the united states. many of them are going to have to pay a penalty because of that. they will be fined because that's how the rule and that's how the law has been written. i talked to a lot of seniors. i was home, madam president, this past weekend in wyoming visiting with a number of seniors around the state. was in torrington, wyoming and

caspar and talked to a lot of folks and they're concerned about medicare. what does it say about medicare? turn to page 9. unsustainable. the cuts that we're looking at are going to become unsustainable even within the next ten years. yet the cuts to medicare of over $500 billion, you would think at a time when we're looking at more and more seniors coming of age to be on medicare, that we would have used that money, used that specific medicare money and keep it in medicare, use it to save medicare, not to start an entirely new government program. so as you work your way through it, you say what does it mean for these seniors on medicare? and that gets to page 9 and page 10 of the national report, the centers for medicare and medicaid services. these are the people that know. they looked into the numbers. they basically said they didn't have time to do it while the senate and house were rushing to pass a bill. said, you know, we should have given some more time and more thought to this.

but what happens when they actually look at what's been signed into law? they talk about the cuts to providers, to the people that take care of the patients on medicare. they're expecting many providers, medical professionals it says to -- quote -- "end their participation in the program." this is going to jeopardize access to patient care. the report says 15% of all the hospitals in this country, all of the nursing homes in this country and similar providers -- we're talking about home health care agencies that link, that lifeline to people that are at home needing care, to hospice to people who are in the final days of their life, about 15% of all of them as a result of the way that this bill has been put together are likely to be operating at a loss, at a financial loss by 2019. and then are they going to be able to stay open? are they going to be able to provide care for people?

absolutely not. are they going to close down? very likely. is that going to impact a lot of rural communities across this country? absolutely. as we go through this actuary report, it really brings to light when nancy pelosi says you're going to have to pass the bill before you get to find out what's in it, what a shame that is that the american people, while they sense they knew what was in it really had to wait till this point so that they can then continue to express their concerns to those who voted in favor of it. well, let's take a look at some other provisions. those who supported this bill said there are other medicare savings provisions in the bill that will help save money and that will help control future health care growth. no, the report page 13, they said those things that people in this chamber said will help

actually control future health care costs, now it said negligible financial impact over the next ten years. negligible financial impact over the next ten years, even though members of this senate stood up on the other side of the aisle and absolutely swore that this is going to improve care as well as get down the cost of care. now let's turn to page 15 of the report, the class act. that's the long-term care insurance program that so many in this chamber thought was going to be a wonderful thing and those on my side of the aisle said this can't work. the numbers are not going to work for our country. they're not going to work for this bill. who are you trying to kid? well, the democrats who supported the class act weren't able to kid the people at health and human services division of medicare and medicaid. oh, no, they saw right through it. but of course the report came out after the bill had been signed into law by the president. what the report says is that the

class act faces -- quote -- "a significant risk of failure. a significant risk of failure." it says there is a very serious risk. the class act program will be unsustainable. people on this side of the aisle said that, who said it before the vote. we heard from the other side of the aisle, oh, no, you have it all wrong. people who looked at it and know -- these are the president's own people -- they said unsustainable. now, what about premiums for insurance? the president last year said he expects to lower the health care premiums for the average family in this country by $2,500. an incredibly admirable goal, something i think all americans would support because, after all, the president early on said my goal is to get down the cost of care. clearly something he abandoned

early on. because what this says on page 17 of the report from the actuary is that the new laws, fees and excise taxes, higher drug prices, device prices, this is all going to result in higher insurance premiums for american families. the exact opposite of what the president promised. now let's go to page 16 because we talk about funds allocated for the new high-risk insurance pools. i think it's important to have these pools. they work well in various states. a number of states have these pools. it's a commitment by the state. we want to involve the federal government in that. but what the c.m.s. report says is that what this body has done is insufficient. it says that the amount of money they decided to put in this program is going to be exhausted by the year 2012. exhausted by the year 2012.

once again this body that said they knew better than the folks who really studied the bill, those who said we just have to pass it to get something done, i think it created a monster, and the american people are going to be paying the price for a long, long time. let's look now to page 20, because so many of the people that are going to be covered under this program, how are they going to be cover? the president said i want to cover all these people. what he's decided to do and what this body has decided to do is to cram another 18 million people on to medicaid arcs program that we know right now is fundamentally flawed. it is broken. half the doctors in the country don't want to see patients on medicaid because the reimbursement to them is so low. hospitals tell you that they lose money when those patients are in the hospital. doctors will say they can't keep their offices even open if they take more and more medicaid

patients, and the only way they're allowed to see them is by charging other patients more. the cost shifting that happens in health care in america. what does this say about medicare? 18 million more people are going to be pud on to medicaid by the year -- to be put on to medicaid by the year 2019. is that going to be care? the president talks about coverage but he doesn't talk about care. these people are very unlikely to get care. this is what the report says, page 20, "a significant portion of the increased demand for medicaid services, because there's always a*ul these millions and millions more people on medicaid. increased demand for medicaid services are going to be difficult to meet. all these people are going to be put on there and they're not going to be able to get care. i would say, mr. president, it's hardly fair and it's misleading to the american people. everybody in canada has coverage. they have coverage, but they can't get care.

33,000 canadians came to the united states last year to pay for their own health care because even though they had coverage in canada, they can't get care there. so they come to the united states and pay for care. and this medicaid program, you know, about a year ago when the president of the united states was talking about health care, he always held up the mayo clinic as the model for excellent care in america. it is the model for excellent care. the mayo clinic said we don't want more medicaid patients because they lose too much money by taking care of those people and they want to keep their doors open for fulfilling their mission. here you have, mr. president, the actuary who is looking at this page by page, be and this is somebody, obviously the center for medicaid and medicare services knows what they're talking about, looked at the numbers and item after item, page after page said this isn't working. now, one of the things we talked about at the health care summit was the issue of medicare fraud.

and i sat at the table and discussed the issue with the president. now, this law does almost nothing -- almost nothing -- to limit actual fraud and abuse. last year medicare paid $47 billion in claims that are suspect. $47 billion. we know that in florida, drug dealers have been moving from dealing in drugs to medicare fraud. you say why? why would they do that? they're doing it for a couple of reasons. one, it's more profitable. two, it's less likely they'll get caught. and third is if they do get caught, the penalty is less. so they're saying more profit, less chance of getting caught, less punishment. i think i should go into medicare fraud, and that's what they're doing. what does the actuary say when they look at the new bill? the estimate that the fraud

provision in the law will save only about 2% -- only $1 out of every $50 of medicare fraud. when you look at this, it's no surprise that the american people want a second opinion about this bill. it is no surprise that the american people are saying it's time to repeal and replace the bill. that's why i come to the floor today of the senate, mr. president, with my second opinion from 25 years of practicing medicine. and, you know, on the way over i picked up "usa today," and it's so interesting, big story in the paper today: "next phase in the health care war: applying the law." the subheadline is "cabinet" -- we're talking about the president's cabinet, the cabinet of the united states. "cabinet braces for lobbying blitz by industry advocates. cabinet is bracing for a

lobbying blitz." i thought the president of the united states said he didn't want lobbyists, didn't want lobbyists in the white house, didn't want lobbyists impacting on his cabinet. but they're weighing right in. absolutely. the president did have them in the white house obviously behind closed doors, cutting the deals. that is the way, mr. president, that we ended up with a health care bill that is bad for patients, bad for providers and bad for payers, the american payers, the taxpayers of this country and the people that are paying for their health care. and that's why, mr. president, i come to the floor to say it is time to repeal this piece of legislation and replace it, replace it with legislation that is actually patient centered, that gives more responsibility and opportunities for individual patients. the thing i tried to do through the wyoming health fair so they can get more information so they can use that information to get their cholesterol down, find out if they're diabetic, give incentives to individuals to stay healthy and keep down the

cost of their care. we need a patient-centered health care bill. we sure don't have one. we need a health care bill that allows people to buy insurance across state lines. that increased competition will drive down the cost of care. mr. president, the university of minnesota did a study. 12 million more americans would have insurance today without this bill -- without this bill -- if all we did was allow americans to buy insurance across state lines. and allows small groups to join together to have better opportunities to buy insurance to keep the cost down. then dealing with the abusive lawsuits which exist in this country which drive up the cost of care for patients because of the tests that the doctors routinely order not to help the patient get better, but to make sure the doctor doesn't miss something. so that's why i come here today, to tell you, mr. president, there are things that will work to get down the cost of care. there are things that will work to provide additional treatment for more people in america, more patients, better care. but they're not in this health

care bill that passed the house, passed the senate, signed into law by the president. and that's why today i offer you my second opinion and the opinion that it is time to repeal this bill and replace it with things that will work. thank you, mr. president. i yield the floor and note the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call:

quorum call:

mr. casey: mr. president? the presiding officer: the president -- the senator from pennsylvania is recognized. mr. casey: mr. president, i'd ask that the quorum call be vitiated. the presiding officer: without objection, so ordered. morning business is closed. under the previous order, the senate will resume consideration of the motion to proceed to s. 3 3217, which the clerk will report. the clerk: motion to proceed to the consideration of s. 3217, an original bill to promote the

financial stability of the united states and so forth and fo oth purposes. the presiding officer: under the previous order, all time until 12:30 p.m. and from 2:15 to 4:30 p.m. will be equally divided and controlled between the two leaders or their designees. the senator from pennsylvania is recognized. mr. casey: mr. president, thank you very much. i rise today to talk about the business we have in front of us here in the united states senate, the financial reform and regulatory reform, but i did want to note that we -- we meet in an hour of real economic trauma for so many families across america and across the commonwealth of pennsylvania. i know that the presiding officer sees this as well in his home state of new mexico. we have lots of people out of work and although there's no question in my mind that our economist has begun to recover and has recovered substantially, we still have aways to go. so even as we debate financial

reform and the intricacies of that, it's important that we remember that there are still a lot of people out of work. the latest numbers nationally are 15 million people without work across america, and in pennsylvania, it's 582,000 people. i was looking at the numbers. these are for the month of march. region by region in pennsylvania, we've got 14 labor markets that are -- whose numbers are charted on a monthly basis, and looking at the areas of the state where it's above our unemployment rate, we've got several parts of pennsylvania where it's -- if it's not 10%, it's very close to that. erie, pennsylvania, way up in northwestern pennsylvania, 10 percentage point unemployment. i realize for some states they've been in double figures awhile, but for places like erie, where it's 10%, the lehigh

value in the eastern part of our state is getting to 10%. it's 9.8%. my home area of northeastern pennsylvania is at 9.8%. johnstown, an area in southwestern pennsylvania, which has always had higher numbers of unemployment, their numbers are getting close to 10%. so throughout our state, the numbers are very high. and when people in any state see those high numbers, they see joblessness, they see people have lost their homes or their jobs or both, and really by definition many people lost their hopes and their dreams in the process. and they see all that around them, either in their own lives or in the lives of their families or their neighbors, and they look to washington and say, what are you doing about it? how are you going to respond to this? how can you take action to help us? i think we have in some measure, but this wall street reform is going to be part of it as well. we've passed the recovery bill. that's having an impact. we passed the higher act a

couple of months ago. that's having an impact and will have more impact as time goes by. so there have been a series of jobs bill that will help and have helped substantially. but one of the most urgent priorities for the american people is a very basic question: who's on our side? who's going to be on our side? who's going to fight for us? when it comes to whether or not we're going to have -- empower local communities to create jobs and to have some security or whether we're going to continue to empower wall street and the deal makers, the scam artists who have ripped people off to make a profit. and not just a profit of what we used to think was a lot of money -- a million dollars -- we're talking about profits that we can't even begin to comprehend. a very small number of americans, a very small number of institutions, like these megabanks getting these profits purely out of greed and purely

out of a willingness to cast aside people's lives and their futures, to not worry about whether the actions they take on wall street causes people to lose their jobs. so that's what people are -- across the country who are not on wall street are asking us to consider. and, of course, part of that is what's happening here in this debate. i think it's become more apparent to the american people on this question of whose side are you on, that there's one side, this side of the aisle, that's been trying not to just get a bill -- the policy right and get a bill prepared, but we're trying to move that bill forward. and one of the ways that you move the bill forward is have a debate. why shouldn't the united states senate be having a debate? unless, unless there's a question about are you on one side or the other. so i think our friends on the other side are going to have to ask themselves if they're really on the side of the people, if

they're really on the side of communities and small businesses who are telling us, get something done about these wall street problems we've got that caused 15 million people to lose their jobs and in pennsylvania we've lost -- we have 582,000, as i said before -- people are wondering, whose side are on you? and if you're not on the side of debate and getting the bill passed, then you're on the side of wall street. it is very simple. this part of it -- i know some of the policy gets complicated, but this isn't -- this isn't complicated at all. so if you're on the side of the megabanks on wall street, here's what you're on the side of. you're on the side of continuing what has happened over a generation now, where our usual and -- and more familiar banking system has been altered in a way that's almost -- it's become almost unrecognizable to people

who used to walk down the street, figuratively but almost literally, or walk or drive not too very far in their community and go to a bank. they knew the institution, they knew the people that worked there, they knew the -- who was in charge, they dealt with a banker in a very personal way, and a lot of that is gone. and i think if we do the right thing here, we can bring some of that sense back but at a minimum, put the brakes on, put rules in place to govern what the scam artists on wall street do every day of the week to make a profit, to rip people off and to destroy our economy and to cause record high unemployment. in that scenario i talked aboutt people did know their bankers, and they knew that each party was invested in the other. the banker wanted to make a good loan obviously. that was part of his or her business. but he knew or she knew that

making that loan had to be on good terms in a way that that borrower could pay it back. and obviously the borrower, going to a local bank is a local business, people that they knew, they were invested in their success as well. the borrower wanted the bank to do well. it's part of their community. but now we have this system where you enter into a mortgage transaction, and that goes, that flies off into the -- flies off to wall street, and then wall street they slice and dice it, so a lot of wealthy people make record profits, and they laugh and laugh all the way to the bank, not worrying about whose life was destroyed back in that community. so these mega banks have prospered in ways that we can't even begin to describe or appreciate. and we continue, so to speak, back at home grappling with the results of that, the aftermath of that: high unemployment,

record high numbers, a ballooning deficit. why are we even having a debate or trying to have a debate, i should say, if our friends get to the point of allowing us to have a debate, why are we even having this debate is because wall street put the american people into this position. so we need to reinvent this mega bank model, change it substantially and move it towards a system of smaller banks and more competition. i thought that's what our friends were for. i thought they were in favor of competition. many people know community bankers. the american -- i should say the independent community bankers of america have almost, say they're almost 8,000 community banks operating across the country. those 8,000 community banks are still, even with this problem we have with mega banks on wall street, still 97% of our banks. that's the good news that that number is high.

these institutions, as we know, have boards of directors made up of people in the community, as it should be, who are invested in the community and the success of those borrowers. and there are also, there are also institutions that are a lot smaller in terms of size. in terms of asset size, 91% of community banks have assets of less than $1 billion. less than $1 billion. nother where near a big bank and nowhere near obviously a mega bank. the largest of our mega banks is bank of america, which by september of 2009 -- and i'm sure the number is much higher today, but as of september of 2009, had assets of $2.3 trillion. it's hard to describe that, but that's most of the federal budget. we have a federal budget that's several trillion. so that's a big share, if you equate it to the entire federal budget, not the full budget but

certainly a big share. $2.3 trillion. consumers don't reap huge benefits from these banks. we know that. if anything, they're harmed by the unchecked power of these banks. as i said last week, three of our largest mega banks have cut participation in a key small business administration lending program by between 85% and 90% from one year to the next. just at a time we have a bad economy that they caused in large measure, and just at a time we need help for small businesses, these same big banks who got the benefit of all of that, all of that wealth and all of that scam artistry and fraud in some cases, they're not helping us create jobs in small business. to say that that is perverted and disturbing doesn't even begin to capture the sentiment. but i won't dwell on that.

then we get to the question of fees, bank fees. we've heard a lot about these. we all have experienced it. fees for checking accounts and other services are lower in community banks than at the mega banks, the big institutions. according to research by the federal reserve bank of dallas, in one quarter last year, the four largest mega banks received fees related to deposits by an average of 8%. in this same period, community banks lowered their fees by an average of 12%. so in one quarter last year, the four big banks raised their fees by an average of 8% and the smaller community banks are lowering those same fees. another reason why community banks make a lot more sense for most americans. the reason for the big difference in fees charged by the smaller community banks versus the big mega wall street banks is not just that they want

to try to be consumer, or customer friendly, it's because there's competition in the midst, or injected, i should say, into the system of community banks. the economist simon johnson said -- and i quote -- "with low interest rates, the big banks could raise money from deposit tors virtually for free. they could borrow cheaply from one another. they could borrow cheaply at the fed's discount window. they could swap their asset-backed securities for cash with the fed. they could sell their mortgages at fannie and freddie, and so on." it's kind of like dot, dot, dot. we all heard about this. their plate was full. i'm a big mega bank and i need a little extra help here to make some more millions for this guy or that guy or to make billions for the bank or for individual

bankers. i need a little help, so i'll go to the fed discount. that was one option. i'll just charge a little more over here. they had all these options to make more money; okay. because of the generosity, i should say, of the federal government, by the way, in large measure. the federal government helps a lot of institutions every day of the week, including banks. the same folks who complain about government want bankers to get all the help in the world from government. the big bankers had all these options at their disposal if they got into a period where they needed a little extra help. what about the borrower who got into a bad mortgage because some local scam artist, or maybe a scam artist on wall street put them into a mortgage they couldn't afford? what happens when they can't pay their mortgage? what happens when they lose their job and then can't pay the

mortgage and lose health care? do they have a menu, a list or a full plate or a full table of options? no. they got very few options. and for a lot of americans who lost their job because of wall street or who lost their house because of what wall street was doing or lost their livelihood because of some fraud on wall street or some scam artist on wall street, they have no -- very few options. but the bank, big banks have lots of options. so this is about not just about what's fair and what's right and making sure we have competition in our banking system. it's also more than that. it's about a gross disparity of power residing on wall street and injuring the ability of people just to make ends meet, just to have a job or just to be able to borrow money in a way that will allow them to purchase a house or do something else in their lives.

so what this means is despite offering better and cheaper consumer products, our consumer -- or our community banks at the local level are struggling to get by. so while their big brothers, their mega bank brothers are on wall street making more money than we can even compute or comprehend, the community banks, which used to be the foundation of our system and the place where people could go to borrow, they're having trouble and they're struggling to get by. so one of the ways to confront this is not just to pass a bill that sounds good here and there and looks like it's reform, but to have a final product after debate -- again, i hope our friends will get to the point of debating this. it kind of makes sense if it's something that's real important and the american people say do something about it, that you ought to debate and pass it. just a little advice for the

other side. but we have to do more than just pass something. we have to pass something that works. we have to pass something that will be meaningful in the lives of real people. and if we allow these mega banks to retain their power and their influence and their wealth to the detriment of working families, small businesses and our economy in general, if we allow them to have that power, it would be nice to pass a bill, but we won't be getting to the root cause, or one of the root causes of our problems. so that's why i and others -- senator kaufman, senator brown and others -- are supporting the safe banking act. i want to thank those two senators for their work on this over a long period of time. this will be an amendment to the act that we're working on, the restoring financial stability act of 2010. this part of it or this new, what will be a new element to it if we can get the amendment passed -- i think we can -- the safe banking act, here's what it will do. basically four things.

i'll go through them quickly. first of all, impose a 10% cap on any bank share of the total deposits of government-backed depository juices. placing a cap -- depository institutions. placing a 2% g.d.p. limit on all nondeposit liabilities. limiting and circumscribing what these mega banks can do. third, place a 3% of g.d.p. limit on all nondeposit liabilities, including any off-balance sheet provisions as well as any systemically significant nonbank financial institution. fourth, we would put into law a 6% leverage limit for bank holding companies and selected nonbank financial institutions. so instead of leaving size limitations in the hands of the regulators -- and i know regulators work hard and i know they always try to do the right

thing in almost every instance -- this amendment would at long last put some clearly defined rules in place about the size and the leverage of financial institutions. we can't just say, okay, mega bank, you can do whatever you want. you can get bigger and do whatever you want. and after the fact we'll have some regulators try to mitigate the damage you're causing or try to pull, rein you in a little bit. sometimes that works. but our recent history tells us that it's not going to work in the way that it should. so we need some clearly defined rules that apply to these mega banks and would only impact a hand full of institutions, a very small number of institutions, these large mega banks that are he heart of the problem. now, the alternative to placing these limitations on the big banks, on their size and the leverage that they have is a

continuation of the system we have right now, the so-called too-big-to-fail system. a bank gets so big and has so many tentacles out into our economy and across the world that we say, gosh, if they're in trouble, we can't let them -- you know, we can't let them go. they're too big. you have too much of an impact to fail. so we've got to help them. in addition to passing a law that ends bailouts, we also have to end this too big to fail. it's kind of a straitjacket our system's been in. it doesn't allow us much freedom, but it gives a soft landing to a lot of these mega banks who really should be cut down in size. we know we need to change that. so i commend the efforts to increase the ability of regulators to oversee and enforce discipline. but candidly, and i think our

history shows this, it's not enough. it's not enough to just give regulators more power or more resources. we need to begin to pull apart or deconstruct in some measure these mega banks because they are too big, too powerful and they've caused too much damage. and having a regulatory system in place will not be enough. that's why we need the safe banking act. and we also make -- need to take other steps to address this root cause as well as other root causes. we know that community banks are banks that are better for families and for small businesses. the two parts of our society, the two parts of our economy are families and our small businesses, are saying to us do something that's real. do something that makes, not only makes sense in terms of policy, but will help at the local level in terms of improving our economy.

more banks mean more competition. they also mean more customer-friendly products. it also means more customers for businesses. it means a retail banking system that more closely resembles our nation's community banks than the wall street model that has indeed failed us. and that's an understatement. it has failed us significantly. that is why i encourage my colleagues on both sides of the aisle to support the "safe" act amendment to our financial reform legislation. it's about time that we took a step that has real meaning and real impact on one of the biggest problems we have in america, where you have megabanks that are doing quite well, and if we allow them to do well, they will have a few individuals in a few institutions across america who will benefit from that. but most of the rest of us, most

people, especially those out of work, most small businesses won't benefit from those megabanks. we need to change this, and we need to do it in the course of this debate. and i would once again say to my colleagues, if we debate, it'll tell us very clearly whose side we're on. if you continue to hold up debate, i think the american people know whose side you're on and it's not their side. mr. president, i would yield the floor. i would withdraw that -- not yield the floor. i would ask first unanimous consent that any time spent in a quorum call on the motion to proceed to s. 3217 during today's session be divided equally between both sides. the presiding officer: without objection. mr mr. president. i suggest the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call: