the house does not have a right to go into the homes of the people of my state of wyoming or anywhere around the country and say to them, you must buy a product. you must purchase something. if the government can tell people they have to buy health insurance, where does it stop? and that's why i'm encouraged. as are americans all across the country when they saw the ruling coming out of florida. people inherently understand that this is unconstitutional. the health care law even fails to meet the president's own promise. in wyoming, we have the code of the west. it says if you give your word, keep it. the president promised that this health care law would actually bring down the cost of care. he said by $2,500 a family. what are we seeing with insurance costs? the costs continue to go up and up and up. the president said if you like

what you have, you can keep it. that hasn't been true either. in terms of insurance people have. they are losing what they have if they like it, and even though the several pages of the health care law may have implied that, when the secretary of health and human services came out with over 100 pages of regulations, it was clear that if you get your insurance through work, big company, small company, a majority of americans will not be able to keep the health insurance that they have and that they like. today, a recent poll -- a poll today that was released said 58% of americans would like to have this health care law repealed. the interesting thing about this, mr. president, was that it went further, recent polling went further to say when you poll people who have actually talked to a nurse or talked to a doctor or talked to a physician assistant or e.m.t. or people

involved in the health care area, then those people who have talked to somebody, a care provider, even more of them want this health care law repealed. as nancy pelosi said, first you have to pass it to find out what's in it. as more and more people become aware of what's in it, more and more people want this health care law repealed. the mandates are excessive and they are expensive, and states with governors of both parties are being impacted by these huge expenses. you know, it's interesting, mr. president, there was an article in saturday's "new york times", "for governors of both parties, medicaid looks ripe to slash." well, what's medicaid? they're going to slash medicaid. the headline, "hamstrung by federal prohibitions against lowering medicaid eligibility. governors from both parties are exercising their remaining

options in proposing cuts to the program." well, mr. president, i've just heard other colleagues on the senate floor talk about this huge expansion of medicaid. that's the solution. that's the president's solution. that's the democrats' solution. cram more people onto medicaid, a program initially designed for the poor with low reimbursement rates. where over half of the doctors in the country won't see medicaid patients, and that's the solution. i listened to my colleagues on the other side of the aisle talk about coverage and talk about care and use the words interchangeably, and, mr. president, that is misleading to the american people. you can get a medicaid card, but it doesn't mean you can get in to see a doctor in the way that you might think. half of the doctors don't want to see patients. why? because the reimbursement is so low.

so "the new york times" article from saturday goes on, "as u.s. aid runs dry, states propose medicaid cuts," the first governor's picture up there is jerry brown of california, democrat. under him, andrew cuomo, democrat of new york. what does it say? it says, "the shrinking of medicaid state programs if approved by the state legislatures would come at a tenuous moment for the obama administration." that's because, it says, starting in 2014, the health care act calls for an enormous expansion of medicaid eligibility that is expected to add 16 million beneficiaries by 2019. the health care law puts in a proposal and a program that will hire i.r.s. agents to make sure people buy health insurance, but it doesn't pay to train the doctors and the nurses needing to take care of those -- needed to take care of those patients. and as the article goes on, it says states have already cut payments to health care

providers and scaled back benefits over the last few years so these new proposed cuts are much more painful. i will tell you, mr. president, for the people of wyoming, the people of wyoming -- i will in a second talk about an article. the people of wyoming want this law repealed. the chairman of our health committee and our state senate -- and i served under him for five years when i was a member of the wyoming state senate is named charles scott. he has been in the state senate for over two decades, studies this extensively. he had an article in the "casper star tribune" on january 30. mr. chairman, i ask unanimous consent to include this in the congressional record. the presiding officer: without objection. mr. barrasso: the headline is "repeal of obamacare would help wyoming." just a few excerpts. he says -- "the obamacare law is a disaster for our country, a disaster for our country and especially for wyoming."

he says our american health care system costs too much, there are too many uninsured. obama reform makes these problems worse. makes these problems worse. he goes on, the centerpiece of the obama effort to insure the uninsured is to expand the medicaid program, the existing program for poor people. this, he says, is the most expensive way available to insure the uninsured, the most expensive way to insure the uninsured. this is someone who studied this for 20 years. the medicaid program is designed to be a high-cost program. the federal government has required a set of medicaid benefits that are richer than any insurance the rest of us can buy. the feds forbid most of the effective cost controls the rest of us face. he goes on, one consequence is that medicaid clients are free to use the hospital emergency room for things most of us take care of at home. the health care costs, the health care costs for an adult in medicaid are one and a half

times larger than for a comparable adult insurance by our largest private insurer, and a child on medicaid costs two and a half times as much. those are the things that we're dealing with. that's the solution that the democrats have presented to the country. that is what has been passed. this solution is not a solution. what we need to do is repeal and replace this health care law. and i will tell you, mr. president, the american people notice when month after month the secretary of health and human service rolls out more -- more waivers for people under this health care law. last week, she granted 500 new waivers. we now have 2.2 million americans who this law does not apply to. they have gotten their waivers, doesn't apply to them. well, say who are these people?

well, they are people with friends in high places. 166 of these are union benefit funds. 166 covering 860,000 americans. these are the same union members who many of them lobbied congress, contributed in ways to say we need this health care law, and yet they say oh, once we have looked at it, once we have followed nancy pelosi's idea and actually read the bill to find out what was in it after it got passed, we don't want it to apply to us. 40% of all of the waivers have gone to unions even though union workers only account for 8% -- for 7% of the private work force in this country. well, if this health care law is so great for the country, why should companies and unions need waivers and why can't the rest of america receive a waiver and get the same treatment? and that's why i come to the floor today, mr. president, and tell you this health care law is bad for patients, it's bad for providers, the nurses and the

doctors who take care of those patients, and it's bad for the taxpayers. and by voting to repeal this health care law, we will give these waivers to every american and give them the opportunity and the freedom that they request and the flexibility that they need to get the health care that work best for them, not a one-size-fits-all approach that comes out of a -- that comes out of washington loaded with washington wasteful spending. thank you, mr. president, and i yield the floor. a senator: mr. president? the presiding officer: the senator from south dakota. mr. thune: mr. president, i wish to add to the comments that were made by my colleague from wyoming who in his former life being a physician understands this issue probably better than any of us here in the chamber, and i think he -- he very

eloquently pointed out why this amendment that we're hopefully going to be voting on that will repeal the health care law is so important. you know, obviously, there is a -- a big debate that has been raging in the country over the past year about this legislation as it was being considered here in the congress, and i think the one thing that is clear about the public's view of this is they think it was a bad idea, and that hasn't changed. that was true a year ago, that was true six months ago, and that's still true today. i think that the administration had tried to argue that they had merely done a poor job of communicating to the american people how great this health care reform idea was, but that excuse misses the point entirely. the american people, mr. president, are not clueless. they know a bad idea when they see one and they understand that the democrat health care plan was a bad idea, and despite the administration's full-court p.r.

press in trying to reverse the public opinion about this, the health spending law remains unpopular in polls. in fact, as was quoted by my colleague from wyoming, there was a poll that came out today where 58% of likely voters in a recent rasmussen poll favored repealing it. in fact, if you drill down a little further into that survey, it says 47% strongly favor repeal, 38% oppose repeal, 29% strongly oppose repeal. but you have got a decisive majority in this country, 58% of our -- of the population saying they would like to see this repealed, and nearly half strongly committed to that position. so notwithstanding efforts by the administration to reverse the public's view of this, the american people still get it. i think that the -- the administration had hoped that this would get behind them, that people would start once they were educated about the benefits of this come to a different conclusion, but i think they see clearly now that that hasn't

happened, hasn't been the case. so this -- this whole health care law has failed the test of being something that the american people think is important, something that they want to see done. now, i don't doubt for a minute that they will want to see the issue of health care addressed in this country, health care reform. unfortunately, this particular proposal didn't do anything to reform health care. it expanded health care dramatically. it expanded the costs that most people are going to bear when it comes to paying for their health insurance premiums. and so it failed the -- the test of public support, of the people in this country who have been following this debate very carefully because it affects them in a very personal and profound way. health care is something that every american understands, it's something they get, and regrettably they have turned a -- i shouldn't say regrettably. it's regrettable that we passed it. i think the american people have turned a thumbs down on it, and that should speak to the importance of this amendment and

us trying to go back and do this the right way. the other test that it failed, which everybody here talks about and there is a great deal of lip service and a great deal of rhetoric paid to the issue of jobs. honestly, i think if there was a message coming out of november's election, it was this: the american people want us focused on three things: they want us focused on jobs, they want us focused on spending, and they want us focused on debt. now, on the issue of jobs, this also fails the test. why? because it raises taxes so dramatically. if you look at the tax increases in the bill, $569 billion in taxes on virtually every sector of the american economy. for instance, the measure penalizes employers for hiring for workers by raising the medicare payroll tax by by $210 billion. leaving new taxes on many small businesses that will serve as the engine of economic growth and job creation.

if we want to get this economy recovering again and creating jobs, one thing you don't want to do is impose new mandates, new burdens, new taxes, new regulations on the economic engine, the job creators in america today, and that's our small businesses. and so the issue of jobs, if we're serious about jobs, this certainly didn't do anything to create jobs, and i think the american people made it very plain and very clear, we want you focused on jobs. we want you exclusively focused on getting this economy back on track, creating jobs, getting the american people back to work. so it failed on that test. how about on the test of spending? well, you know, if the american people, i think, understand a very sort of basic sort of adage, if you want to call it that, and that is when you're in a hole, you don't keep digging. and what we have done is we have dramatically expanded the size of government at a time when we're running year over year trillion dollar deficits. so what did this do? well, when it's fully implemented, it will increase spending by $2.6 trillion.

that's the ten-year score between 2014 and 2023. it's a massive expansion, the most dramatic expansion that we have seen of government literally since the 1960's. and so it's not -- it doesn't do anything to address the issue that the american people spoke loudly about, and that is getting washington spending under control. now, arguably, as i said before, i think they care deeply about the issue of health care and getting health care costs under control, as i'll get to in a minute. this doesn't do little, if anything, to address their health care costs, but it certainly increases federal spending and increases the role and the size of government at a time when most americans are saying we want the government reined in, we want less government, we want the government to start living within its means. instead, we have increased and expanded the size of government dramatically. now, how about the issue of debt? a lot's been made by our colleagues on the other side if we were to repeal this, it's going to add to the deficit.

well, let's go back to the -- to the reason why they can make that argument, mr. president, and the reason they can make that argument is because of all the gimmicks, all the phony accounting that was included when this bill was passed in the first place. we've all referenced and talked about the double counting of medicare savings, to the tune of about $400 billion. new payroll taxes, savings that are supposed to be achieved by reductions in medicare spending double counted, counted both as a pay-for, an offset to pay for the new health care entitlement program and as a credit to the medicare trust fund. you can't double count. you can't score these things in a way that dips into the same revenues twice, mr. president. and that was one of the great i think ironies of this legislation when it was being debated here that that issue did not become more fully discussed, the way that this thing was accounted for and the way in which the trust funds were

credited with saving or extending the life span of medicare at the same time that the same dollars were being used to pay for this new health care entitlement. you can't spend the same money twice. and that's exactly what happened. and the american people get that. i cannot feature any other place in america where you could get away with what happened here during the health care debate. so you had the $400 billion, $398 billion, to be act, that was double counted on medicare. you also had $29 billion in social security revenues that were double counted as well. the social security trust fund was credited with $29 billion at the same time the revenue that was coming in from higher social security payroll taxes because of some changes that were made in the -- in the legislation was counted to pay for the new health care entitlement. so you had social security and medicare payroll taxes that were double counted, they were essentially scored twice to credit the social security trust fund, the medicare trust fund, at the same time they were being

used to finance the new health care entitlement. add in the $70 billion that was listed as revenues to pay for this from a yet new entitlement program called the class act, which is the long-term care entitlement program and is -- was described by my colleague from wyoming, even the senate budget committee chairman, the senator from north dakota, described the class act as a ponzi scheme of the highest order, something that bernie madoff would be proud of. and yet $70 billion was scored as being used -- as a -- as a revenue raise to her pay for the new -- raiser to pay for the new health care entitlement program knowing full well that at some point in the future, the people who paid premiums into this new program were going to demand some sort of -- when it came time to -- to -- to stake a claim against that -- against that trust fund, that those benefits were going to have to be paid out. so in the out-years, it dramatically expands and explodes the deficit even though

in the near term it was counted as revenues that were used to shield the true cost of the health care bill. well, if you add in the cost of implementation, which turned out to be about $115 billion, something that wasn't discussed or included in the debate nor was it included in the initial c.b.o. score, you have about $208 billion cost to do the doctors' fix, to take care of the physician fee issue which will be coming to us and which was left out of this bill so as to understate the true cost of the bill and to put it into balance. my point very simple, mr. president -- my point very simply, mr. president, is by any objective measure, if you look at the games that were played, the gimmicks that were used, the phony accounting that was used to -- to claim that somehow this was going to be a positive impact on the deficit, it just doesn't pass the smell test. no rational american would look at this and say this makes any sense at all. now, in fact, if you add up everything i just said, if you take all these -- all these

accounting gimmicks, all the phony accounting that was used here and you offset that against what is claimed as a -- a budget savings in this, you actually get not a $143 billion savings, you get about a $700 billion deficit. that's what we'd be looking at over the ten years. now, remember also that you also had the six years of -- of spending in this bill in the first ten-year window, which is what the c.b.o. used to score this, and about ten years of revenues. so the tax increases start right away, the revenues are -- are counted immediately; the spending doesn't come until later. you front load the revenue, you back-end load the spending in that decade and try and claim that somehow this thing balances out. again, the american people see through this. they get it, which is why they have taken the position they have on the health care bill in the first place. so on the test of -- of debt, on the test of how does this impact the deficit, how does this impact america's long-term

fiscal standing, this bill is -- is a failure. one other point i'd like to make because, again, i wanted to come back to it earlier. i think a lot of americans were hoping that when congress took on this issue of health care, that it actually would be with an eye toward reducing the cost of health insurance premiums for most americans. what we're seeing is the contrary. actually, what we -- we predicted would happen is coming true. many of us who were involved in that debate said at the time that this thing was going to lead to higher health care costs for most americans and it's actually true. and actually, the c.b.o. said the same thing. they said that the individual health insurance premiums would increase by about $2,100 per family as a result of the new law and that some consumers would face total premium increases of more than 20%. well, that's -- those are things that we're seeing come to fruition now. a lot of people are seeing their health insurance premiums go up. that's just a fact. it's a reality.

it's a complete contradiction of what was promised when this bill was being debated. but you have not only higher taxes on small businesses that are costing us jobs, that are destroying jobs, you have this massive expansion of spending, you have the -- the debt and the deficit, which in the out-years is going to explode because of all these accounting gimmicks, and then when it's all said and done, you still haven't done anything that lowers health care costs for most americans. and i believe that most americans, that's what they wanted to see come out of the health care debate in the congress. they wanted to see reforms passed that put downward procedure health care costs to them and their families rather than increasing it. and, in fact, what we've seen is the opposite. it hasn't decreased costs, it has increased costs, and i think you're going to continue to see costs go up. because as these tax increases start to kick in, a lot of these businesses around the country obviously are going to pass these costs on to the american consumer. and so it fails the test of -- of doing anything really to -- to lower costs for most

americans. finally, mr. president, it also i think now is failing the legality test as you're seeing now, these courts are coming out and determining that this whole exercise was unconstitutional. and so that triggers a whole nother debate in this country, a debate that i think we're going to watch probably for awhile but i hope as this thing moves through the courts that it does engage the american public about what is the role of the government and how intrusive should it be and what kind of mandates can it impose on the american people. it was a very well-reasoned decision that came out of the florida court yesterday which says that this legislation is unconstitutional. again, that makes the argument that many of us were making as this was being debated last year. but the bottom line is, we are in a positioned to something about it. this isn't the end -- this shouldn't be the end of the debate. we should look at this as an opportunity f. th. if the amendment that was offered by the senator from

kentucky, senator mcconnell, actually were to pass and we were to repeal this, we could start over, we could go about this in a way that actually does reform health care in this country in a way that lowers costs rather than raises costs for most americans. and i think that would be a welcome thing for the american people. now, the other side's going to argue we don't need to do this, we don't need to repeal this, we just need to -- quote -- "repair it," we can make these little modifications to it. but the fundamental fact, mr. president, is this was a mistake in the first place and we should acknowledge it. and i think, again, the fact that it passed last year on a total party-line vote, a total partisan vote -- there wasn't a single republican here in the united states senate that voted for this -- and usually when you're doing big, bold things, if you look historically in this country, it's done in a bipartisan way. it's done in a way that incorporates the -- the best thoughts, the best ideas, the best input from both sides and you generally get a bipartisan vote in support of something like that. this was passed party-line vote.

it's now facing a challenge and i think a very direct challenge in the courts which is going to play out in the course of the next several months. but we near the united states senate -- but we here in the united states senate could do something bi repealing this law and -- by repealing this law and starting over and going become b this the right way. and that isn't to say for a moment that there aren't issues that need to be addressed with regard to health care in this country and many of them have been touched upon by speakers who've come down here before me. but there is a better way to do it. there is a way to do this that doesn't dramatically increase the size and expansion of our federal government, that doesn't add an explode to the debt -- or explode explode the debt in the out-years, that doesn't raise taxes on our small businesses when we're asking them to create jobs, that actually does lower the cost of insurance, health care insurance, for most people in this country rather than increasing it, and is done in a way that's consistent with what our framers intended in terms of ofthe -- of the basic parameters that are allowed by our constitution. and so i would hope, mr. president, that the

mcconnell amendment will get voted on. i think it's important for all of us, obviously, to be on the record on this but i would hope that my colleagues on the other side might reconsider the position that they took when this was voted on last year and conclude with many of us that this was a failure and that starting over is the very best solution for the american people if we're serious about giving them a health care system in this country that is affordable, that delivers the high quality that they expect and enables them to have the maximum a. amot of choice and decision making authority when it comes to something that is so personal and so important to them and that's their health. mr. president, with that, i -- i yield the balance of my time. a senator: mr. president? the presiding officer: the senator from maryland. mr. cardin: mr. president, i listened to my friend from south dakota and i was thinking back about how long we have been debating health care reform and if we were to repeal the bill that we enacted last year how long it would be before we would be able to get back to serious

health care changes. it took us a year to debate and pass the bill that was ultimately signed by the president, but it took us 30 years to get to the subject. and several administrations, both democrat and republican, that offered proposals where we could bring down the cost of health care and make it more available to the people of this country. we -- we brag, and rightly so, that we have the highest call, most technologically advanced health care in the world in the united states. i look at my own state of maryland and i know that people come from all over the world to get their health care needs met and get their doctors trained, whether it's at johns hopkins university or university of maryland medical center, what's happening at n.i.h. i know the president can tell us about the great institutions in the state of pennsylvania. and that's true. but the problem is that it's out of the reach for too many americans. it's too expensive. we don't have access to care in

too many communities here in america. and the congress last year did something about that. we took major steps forward to help the people of our nation. i've gotten hundreds of letters and phone calls from people in maryland who told me their stories about fighting health insurance companies or their story about trying to get access to -- to preventive health care and how they were denied under our current system. i've talked to the seniors of maryland and i know how expensive health care is to them. yeah, seniors are very fortunate in that they have medicare, but seniors as an age group have the highest out-of-pocket cost of any group of americans. if you -- there's too many gaps in the system. we have to improve the system. and the problem i have with senator mcconnell's amendment is that if we repeal what we did last year, we've got to understand what consequences that will mean, because we're not sure when congress will be

able to deal with this subject again. it might be 30 years from now. and if we just repeal the bill, as suggested by senator mcconnell, the consequences of that action i think will be very damaging to the seniors in maryland and around the nation. and let me tell you why. the bill that we enacted last year started to deal with the gap in coverage for prescription drugs. seniors last year received $250. this gap, when you spend a couple thousand dollars on prescription medicines, you then have to pay 100% of the costs of your prescription medicines under current law. until you spend another couple thousand. for many seniors, they can't afford that. it means either doing without prescriptions or cutting pills in half, compromising their own health care. i've gotten many letters from people in maryland telling me, from seniors who've said, look, i've had to leave a prescription on the counter because i couldn't afford it.

and i got medicare and i got coverage under medicare-d but i couldn't afford it because i fell within the coverage gap. do something about it. it's not fair. taking medicines keep me healthier. and i should be able to get that coverage here in the wealthiest nation in the world. well, we did something about it last year and the repeal would eliminate that protection. we're going to close totally that coverage gap, that so-called doughnut hole.and thie benefits are going to be worth about $500 to the seniors who fall within that coverage gap. that would be lost if the mcconnell amendment were adopted and became law. we can't let that happen. i'm going toll you, next year it'll be an even better benefit, gets up to $2,400 of benefits to our seniors. that would be lost in we do not -- if we were to repeal the

bill. but it goes beyond that. we now are providing a wellness exam every year to our seniors. they'll be able to get covered for their preventive health care. they don't have that today. we expand their benefits. we guarantee that their benefits will be provided. but we go beyond that. we eliminate a lot of the co-payments on preventive health care. we make the program stronger, increasing the benefits for our seniors. and at the same time we do something which is extremely important: we make the program safer for tomorrow. we extend the solvency of the medicare trust fund for a decade. that's what we did last year. if we repeal the bill, if the mcconnell amendment became law, the medicare system would be on much weaker ground. making it much more vulnerable through the types -- to the types of of attack that some of my republican colleagues have been talking about, much more likely that that would become reality. that's what this bill means for the seniors of married or the

seniors of west virginia or the seniors of pennsylvania. that's what it means. that's what we did. we strengthened the frame program. that will be lost, lost, if the mcconnell amendment were to become law. but it goes beyond our seniors. it goes to all families across this nation. i can't tell you how many families i have run into who have said to me, senator cardin, we want to cover our children, but under the old law, once they became 21 or 22, they lost coverage. even though they still needed insurance coverage. so we changed that to 26 under this law. you're allowed to be on your parents' policy now until age 26. that's the loft land right now. the mcconnell amendment will repeal that. will tell these young people who perhaps have graduated from college, who may be in their first job but they don't have insurance available to them, that they will not have an

affordable option for health coverage. it can't on -- they can't be on their parents'pologies. do we really want to do that? that doesn't help american families. that moves us in the wrong direction. we've told the private insurance marketplace that your premium that you pay, whether you do it through your work and your employer in your own contributions, the premium that you pay, most that have should go for health benefits. it shouldn't go for bonuses for executives it shouldn't go for nonmedical expenses. most of it should go for benefits. the bill we passed last year says that now 80-to 85% of the premium that you pay for your health insurance must go for benefits. and if it doesn't, we'll get a rebate. the money will actually come back to you in your pocket. that's taking on the private insurance companies. telling them that they have to work within at least acceptable

ranges. that's going to provide real benefits, improved coverage for the people of this nation. if the mcconnell amendment were to become law, that would be lost. you truly would be at the mehrive your private insurance companies. -- at the mercy of your private insurance companies. how many constituents have we heard from who told us examples of the insurance companies using preexisting conditions to block their coverage? i could tell you about a family in montgomery county, maryland, a husband and wife and two children had to take out two insurance policies because the insurance company said that one of their children had a preexisting condition. they had to take out two insurance plans, paying two premiums, two deductibles. that's outrageous. we have done away with preexisting conditions for our children. and we're going to do away with preexisting conditions for all americans, as we should. if you buy insurance that protection you -- i was really surprised to learn

of how many americans, if they tried to buy snrurns today without -- to buy insurance today without government protection would run into an insurance company that would tell them that they have a preefnlt if you have high blood pressure, even if it is under control, a preexisting condition. god forbid you should need to see a cardiologist -- not covered. if you have high cholesterol, take a pill, it is under control, you think you're in good shape because you can eat whatever you want, your cholesterol numbers are still good. not for your insurance company. that has been considered a preexisting condition. you are a victim of domestic violence. that's considered a preexisting condition. quite frankly, i think some insurance companies considered women to be a preexisting condition, the way they wrote their policies. but we doway with that. and if the mcconnell amendment were to become law, all of that protection that was done last year, iters a gone. and if you think we'll be ail to pass it again quickly in this congress, come down here and

watch the way congress works. 30 years it took us to bring this bill up and to get it passed. these are protections that are critically important to families in this nation, and we need to make sure that these are protected. caps -- you buy an insurance plan and you find out you have annual caps and lifetime caps. what you thought you were buying, protection against cat strove iraq, it is not there. we have done away with the caps. protecting american families -- that would be gone, if the mcconnell amendment were to become law. i have heard a lot of discussion about small businesses. i tell you, one of the reasons i worked so hard for the passage of the affordable care act is to help small businesses in our community. they are discriminated against. it costs a small business owner more for the same coverage, the same coverage for its employees as a large company. on average it is about 20% higher for smaller companies to ensure their -- to insure their employees. that's just wrong.

we take steps to correct that immediately by giving small businesses a credit. we help them make it more affordable for them to cover their employees. now, i heard my colleagues complain the premiums are going up. yes, premiums are going up because of the current system, the one that we have changed, are in the process of changing. it is going to take some time for us to get full implementation of that law. that's understandable. it's wrong. i wish we could do more to bring it down quicker. but for this bill, the premiums would be even higher. we know that. this bill helps us to start to get a handle on helping small businesses have affordable coverage for their employees. and, once again, if the mcconnell amendment were adopted and became larks that protection, that help for small businesses would be lost. let me talk about taxpayers for one moment. there's a lot of us discussion on both sides of the aisle -- and i hope we are able to reach

an agreement to bring down the deficit in this country; we need to do that for the casket our economy, for our children and grandchildren. it is wrong for us to pass on our debt to future generations. we need to be serious about deficit reduction. and i hope we do come up with a game plan in order to bring that about. but you don't do that by repealing the health reform tbhail our own congressional budget office, our independent evaluator, tells us that by peeling that bill will add about -- repealing this bill will add about $1.5 trillion over to the national deficit over the next 20 years. now, i know that people are listening to me and may not believe what i say. i understand that. i understand there's been a lot of misinformation that's been given out there. and my colleagues on both sides of the io aisle have tried to oversell this. but let me tell you something. the congressional budget office is our independent evaluator.

i remember when senator rockefeller was working on this bill. we thought we had a pretty good understanding of how to bring the bill out. but, unfortunately, the congressional budget office said we can't give you all the savings that you think you're going to get by keeping people healthier. senator rockefeller and the finance committee had to go back and find some additional savings in order to meet congressional budget office's requirement. so that we made sure that we didn't add to the deficit of the country. in fact, we reduced deficit of the country with this bill. so what do my republicans in the house do, my colleagues, do? they say, the congressional budget office does do anything? if we do that with every bill we pass here, mr. president, we will never attack the deficit of this country. we have to have objective rules about what we do that impacts the deficit. one thing is clear by the objective scorekeepers. the mcconnell amendment will

add $1.5 trillion to the national debt, because of what we were able to do in the affordable care act. now, we could argue this from many different sides. i am always amazed at my frefnedzs on the other side of the aisle who say, look, this is what the american people wanted us to do. i've looked at all these polls that go back and forth and the americans are divide on this issue. but most americans want us to move forward. they want us to deal with job creation and job growth and that's exactly what the bill that my friend from west virginia has brought forward in the if a bill -- and i am going to talk about that at a different time, mr. chairman. it is a very important bill for the american peevment it is going to make our air traffic safer. it is also going to create more jobs in our community, the exact type of bill that we should be bringing foompletd we should be working today to create more jobs and keep more jobs. that's what this underlying bill does. not h the mcconnell amendment.

thal that won't create jobs. that will add to the deficit. make it harder to keep afford baling hefnlg i do invite my republican friends. we should be working together on this bill. we should be working on ways to improve health care in america. we never said we completed our work last year. we know there's ways to improve health care in this country. let's work today to do that. but let's not go backwards. let's move forward. let's create the jobs that we need for our economy. let's continue to make health care access to believe more and more americans and afford to believe more and more americans let's provide the quality care that's befitting this great nation to all of our citizens. in my own state of maryland we have a person who we will never forget, a 12-year-old who lived in prince georges county maryland, the wealthiest nation in the world.

in 2007, he needed to see a dentist but had no health insurance. so his mom tried to get thoim a dentist. no dentist would treat him because he had no money. so he went to a social worker, the parents went to a social worker, his mom took him there. made a lot of calls. no -- no one would treat him. his condition got worse, and he went to an emergency room, which is what happens with a lot of people who have no health insurance. you talk about ways of saving money, one of the ways is to bring people out of the emergency rooms into preventive care, into our clinics and get them the health care they need. monty driver went to an emergency room months after he should have seen a dentist because his tooth had become abscessed and had gone into his brain and he had severe headaches. he went to the emergency room because of his headaches. and they found that the only way that he had chance to save his life is through emergency surgery. two surgeries later, a quufort a million dollars spent, where it

would have cost $80 to take care of his need, devment amonte driver lost his life in 2007 in the wealthiest nation in the world. i understand health care is personal to every person in this nation. and that everyone looks to how they're going to be taken care of in this health care bill, and that's the way you should. we think the overwhelming majority of americans benefit by the bill that we passed last year. but i would hope every american wants to make sure we have no more deamonte drivers, that every person has access to affordable, quality care. and that was the signature accomplishment in the last congress. we did it in a way that helped our seniors, that helped our families, that helped small business, that helped our taxpayers, and helped america to become at long last a nation that said, health care is a right, into the privilege. all that's lost if the

mcconnell amendment were to become law. i urge my colleagues to think before they vote on this amendment. as to whether you want to be on the right side of an issue that i think has helped define the nation that we are. i urge my colleagues to reject the mcconnell amendment and with that, mr. president, i would yield the floor. mr. rockefeller: mr. president? officer the senior senator from west virginia. mr. rockefeller: that was a magic any of sent speech given by our colleague -- that was a magnificent speech given by our colleagues. there will be no roll call votes this evening. i will continue to work with my ranking, senator hutchison, and the leadership on both sides of the aisle on an agreement to dispose of the pending amendments tomorrow. actually, it is on the f.a.a. bill. remember that? we sort of started out the day

doing that. a very important bill, as the senator from maryland pointed owvment i ask unanimous consent that there be debate only on the f.a.a. authorization bill for the remainder of the evening. the presiding officer: without objection. mr. rockefeller: i believe i note the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call: quorum call:

a senator: mr. president? the presiding officer: the senator from oklahoma. mr. coburn: thank you, mr. president. i would ask that the quorum call be dispensed with. the presiding officer: without objection. mr. coburn: i've come to the floor today to talk about the amendment that senator mcconnell brought forward in terms of repealing the health care bill. i'm probably going to approach this different than a lot of my colleagues have. i don't doubt that the intent of what was passed a year ago last december was well intentioned, with the thought of really solving the health care problems in this country. my experience as 25 years as a

physician and the ten years before that as a manufacturer in the medical device field gives me a little bit different take on what the consequences are associated with this bill. and during that hearty debate that we all had, i made some claims that people doubted in this chamber which have become absolutely apparent and true. costs are going through the roof faster than what we thought. plans -- portions of people can't tolerate the plans, so we're giving them exemptions because it won't work in the business model to keep people covered. but most importantly, what is getting ready to happen is really what happens between a patient and their access and their care and their provider.

and as well-meaning as the bill was, the destruction of that aspect of health care will cause us to rue the day that we put into motion what we're putting into motion. let me explain it. most of the doctors in this country became very interested in this health care bill, and rightly so. they are the ones that are going to be impacted along with their patients because they are the ones delivering the care. and when you pull those doctors, what do you find? now that they actually know what this bill is going to do. well, some pretty significant statistics have come out, one by thompson reuters where two-thirds of the doctors in this country absolutely believe that the care of their patients is going to suffer as a

consequence of this legislation. now think for a minute if you're an individual needy to access care and we're at 2014, 2015 and the advisory payment board to medicare is intact and we know what the board said. the payment under medicare will be less than the reimbursement for medicaid, less than the reimbursement for medicaid. so all of a sudden what was your family physician or who was your surgeon is no longer there. you see, this really is, this bill really is about whether you can walk in and have the attention and care of somebody

dedicated to you who has your best interest at heart in terms of your health. and what we're moving to is somebody who's going to have their best interest of survival at heart and your interest second. and that's the real tragedy of what's happening with this bill. and the implementation of it. not only are we going to have payments reduced on medicare -- that's the only way the bill works, by the way. it's the only way we can ever get out of the jam until we address really fixing medicare. but 55% of the specialists in this country today won't see medicaid patients at the reimbursement rate that we have, and we're going to have a reimbursement rate for medicare lower than medicaid.

let me give you another example. what we know on medicaid is that if you have no insurance and go to an emergency room with a significant illness, and you have medicaid and go to the emergency room with the same illness, the outcome for you with no insurance is better than the outcome with you with medicaid. and that's been repeated in four different studies now. and we're putting 18 million people into a system that are not going to have access to the best doctors because the payment is so low that there's a loss every time you see a patient. so describe to yourself for a minute what happens to the mother who has three young children and has their four-year-old all of a sudden sick with a fever and there's no primary care doctor available under the 18 million new people

that are going into medicaid, and this child doesn't get seen for 72 hours. the mother thinks, well, i'll wait the fever out. i don't have a doctor i can call. i'll wait the fever out. and when the child gets to the emergency room because there wasn't a primary care doctor for that medicaid patient to call, what do they find? they find a four-year-old not with otitis media any longer, but with the early stages of meningitis. and what was a simple, treatable disease because access, even though guaranteed was denied because there's not the available resources to care for that child, the child ends up with a very complicated hospital stay and potentially the loss of hearing or brain damage. those are the real consequences

of what we're talking about as we put 18 million people into the medicaid system. we've had several senators today talk about the cost and the gimmicks. i'm not going to do that. but i want to talk about the real issues. and the one place that we failed in health care is we didn't fix the real problem. the real problem is everybody's health care costs too much. and we didn't ask the right question. how do you drive costs down? and even when you go through all the numbers that have been given by c.b.o., medicare trustees, medicaid trustees and outside studies, what we know is what we didn't do is we didn't drive any costs down. in fact, in short term we've actually driven costs up. so how do we do that? the way we do that is put some responsibility on both the physician and the purchaser of

health care for the cost. and it's human nature. if i gave you an insurance card for your groceries, and once your deductible was met all you had to pay was 20% of that from then on out, your diet would significantly improve in terms of the quality and price of the products that you buy. that's all in our human nature. and what we fail to do is address the real cost drivers. and that cost driver is there's no connection with my purchasing of health care with actual payment of health care. now, how do we know if we connected, it works? go to any place in the country that has amish folks. they don't have health insurance. none of them. they don't buy health insurance. but what do they do? they're grand consumers and very

discretionary consumers of health care because they come forward and they want to know what they're getting and what it costs before they buy it. every time. i've delivered over 500 amish babies and there was not one time that i wasn't asked at the time that the patient came to see me, what's the price for this? will you take a cash payment up front to where i can buy it for cheaper? are there places where i can get the test done? there were questions on whether or not they absolutely need to have the test. they were discretionary purchasers and very sharp in their discretion on how they bought health care. consequently their cost for the same thing was 40% less than somebody who kawc walked in with insurance. and so we totally missed this connection of market forces allocating scrace resources by making discerning consumers out of the purchasers of health

care. we've gone exactly the other way. we've taken people who are 133% of poverty and said you're going into medicaid. you can't buy a private insurance even if you want to, you have to be on medicaid, a far substandard health care system. all the studies show the outcomes are poor even after you equate for social disparities. we've put -- we're going to put 18 million into that program and we're going to have a shortage of over 100,000 primary care doctors in this country in the next 10 years? so who's going to see them? let me give you another example. it happened this weekend. a patient, 90 years of age, severely bent over from scoliosis, bad aging and scolisosi is running a fever. she goes to the e.r. saw a physician on friday, had a

chest x-ray, and no pneumonia showed. she goes to the emergency, and has a pulse of 93%, they put her on oxygen, change her anti-biotics and sent her home. well, what happened? had we not interceded -- i certainly as a physician make a call to another physician, she'd be dead by now. because what she had was a full-blown raging pneumonia and restrictive lung disease, but she was sent home from the e.r. because a physician -- not a doctor, a physician did not see her. so consequently she goes back to the e.r. the same night and is admitted to the hospital. they take a chest x ray and they see the full blown. she had all the symptoms. the person in the e.r. didn't have the experience to make the judgment. is that really what we want? we want substandard care so

somebody can go home and die versus come into the hospital. today she's 200% better. she's eating her pulse ox now on room air is 91%, we actually saved her life because a real physician put hands on a patient and made the right diagnosis. but we're going to put people into a system where that doesn't happen because we're going to use physician extenders. and that doesn't mean they're bad, they just don't have the same experience. and people die when they don't have the same experience. but we're going to inflate the utilization of less than a physician to care for the vast majority of these people that are going to go into medicaid. these are real examples of what the consequences are of what we've done. as i started out, i said, i don't doubt the intent of my colleagues in terms of what they were trying to get to. but the biggest disease washington has is fixing the wrong problem. we have expanded under this

health care bill access, but access doesn't mean you're going to get care. and when you add 18 million people to the medicaid roll, let alone what's going to happen to the states ultimately with a cost on the maintenance of effort where they have a medicaid now and we're going to go to 133%, what you've done is put the states in a pinch. and they're in a pinch already. and my question to my colleagues is, where are the things that drive the costs down? where's the discerning consumerism that allocates scrace resources in the most effective way in this bill? it's not there. it's no -- nowhere is it there. now what is there? what is there is a tremendous amount of new taxes.

$52 billion over 10 years on employers who fail to comply with the insurance mandate. 40% excised tax on high-cost health plans, $32 billion. ban on drugs over someone's health savings accounts $5 billion. increased tax on small business. and a surtax on investment income, that's $210 billion. increase from 10% of income after which you can make a medical deduction. 2,500 annual cap on your flexible spending account contributions. i'll go through this and through this. the point is we're increasing by $2.6 trillion after this thing is fully in place spending on health care. and it has been discussed on the floor the gimmickry in terms of the accounting, the problems associated with that.

the other things that are ther there -- one of the things that's there that concerns me as a physician getting back to talking about patients is cost comparative effectiveness. it was really cheap to send that 90-year-old person home. there was an e.r. visit, a little bit of oxygen, a change in antibiotics, that was really cheap. comparative effectiveness would have said, that's okay, except she would have been dead in 24 hours. so every physician who is maintaining their license or their speciality certification,

studies of comparative effectiveness every day. they read it in the journals, they do it to get recertified. they know the comparative effectiveness. what they don't know is what we're going to mandate what they will do. what is the cheapest? not what is the best. what is the cheapest. well,ly tell you if you look at heart disease in our country, if you look at cancer cure rates in our country, if you look at recovery rates from massively serious illnesses in our country from both trauma and otherwise, what you'll see is the highest rate in the world of recovery. we have the highest five-year survival rate on almost every cancer by 20% or 30% over every other system in the world. do we really want to put that away? in 2003, i was diagnosed with colon cancer. had mat static colon cancer.

i'm so thankful for the health care system that we had that generated new devices, that incentivized great care, and after a major surgery where half of my colon was taken out and a radical lymphectomy was taken out and six months of chemotherapy, i stand here today seven years after that alive. and i want to tell you, had i been in england or canada, my cure rate would have been about 35%. you know what it is in this country for somebody -- metastatic colon cancer, it's nearly 70%. now, what created that? what gave us the technology to do that? it's because we looked at the best clinical effectiveness, not the best price. we said how do we best and most effectively get an outcome of

cure? this bill goes the other way. this bill's going to mandate from washington what your doctor can do for you. it's going to -- and it's also going to mandate from washington what price your doctor will be paid. and -- and there's no question that according to the trustees for medicare, for us to maintain what has been put in this bill, medicare reimbursement rates will fall below medicaid rates. do we really want that to happen? and i would tell you, for those in my condition, those people who are diagnosed today with colon cancer, you don't want that to happen. now, how do we -- how do we get the costs down? there's no question there's tons of waste in our health care field and we've not attacked in the way we should attack.

and i can speak as a practicing physician that i wasted money caring for people because i didn't concentrate on that individual because that individual wasn't paying the bill. some nebulous insurance company was paying the bill. some government program was paying the bill. but when somebody like an an amh patient looks now the face and you know that what you spend of their hard-earned money is going to come directly out of their pocket, all of a sudden the other obligation of a physician jumps up: how do i do this in the most efficient and effective way that still gives the best outcome? and we've totally, totally missed that. the most personal of all interchanges between humans besides those within a family are between patients and their physicians. and we're going to interrupt

that. we're going to undermine it. and we're going to undermine it because somebody from washington's going to be looki looking -- "did do you it the way we said to do it accident, doctor?" -- now, what is the doctor's oath, is it to do what medicare says or is it to do what's in the best interest of the patient? and that's the rub. that's where we're going with this program. and so what we're going to have is, first of all we're going to have tens of thousands of physicians retire over age 55, our best, most experienced physicians, they're leaving. they're not going to play this game. and then we're going to give physician extenders the role as primary care. very good in what their limited knowledge will give them but not anywhere in comparison to eight years of full medical training, including residency. they have two years. two years.

and then we're going to treat all those? what do you think the cost of that's going to be in terms of lost lives, in terms of delayed diagnosis? delayed care is denied care. what goo is it if i have medicaid and i -- what good is it if i have medicaid and i can't see a doctor? so the problems are very real with this bill, and i don't say that as a fiscal hawk. i want to fix health care and i want to drive the costs down, and we can drive the costs down $300 billion or $400 billion a year. thompson-reuters did a study. i talked about it in our debate last year. the fact is, is we know that over $580 billion a year is blown in health care. that's enough to cut everybody's health care costs 20% in this country. but we didn't address any of those issues.

not one of the issues that thompson-reuters has brought up that said here's what's wrong, here's why health care's more expensive -- we didn't address those in the health care bill that was passed, and yet we wonder why we're out here wanting to change this bill. it's not so we can say "did you it wrong, ha-ha-ha." it's because we really care, like you do, that we've got fix the real problem, and this bill didn't fix the real problem. and so i hope my colleagues will take in the spirit that it's intended that we don't believe that we've done anything except expand coverage under a very broken system that's highly inefficient, that tells people they're going to have care but they're not going to have care. and those that have a doctor are going to be told by the federal government what kind of care they're going to have. it's exactly the opposite of what we should have done and we did it in haste. we know there's 1,600 new sets

of rules coming, of which about a hundred are through. we've got another 1,500 to go. and c.b.o. says that that's $100 billion in costs just to implement all this, which was never even considered in the cost of this bill. and that doesn't consider the cost of complying with all the new rules and regulations. so my time is up. i'll be back to talk on this again, but my hope is that now we have three physicians in the senate, we have all seen the same thing. i'm a primary care o.b. one is an ophthalmologist and one is an orthopedist. we have pretty well got it covered. what we have done is not going to work. we're going to be sorry we did it. but you know who is going to be the most unfortunate receivers of this? the people who think they have care who don't.

the people who get seen by less than qualified individuals for the care that they need, and we're going to pay twice what it should cost. i yield the floor. a senator: mr. president? the presiding officer: the senator from alabama. mr. shelby: mr. president, i ask unanimous consent that i may proceed as if in morning business for ten minutes. the presiding officer: without objection. mr. shelby: mr. president, i rise today to introduce a piece of legislation that i have introduced in every congress since 1987. a proposed constitutional amendment requiring congress to balance our nation's budget. this bill has bipartisan support and will allow us to finally begin, mr. president, to get our fiscal house in order. a balanced budget amendment to the constitution i believe is the only certain mechanism that will break the cycle of deficit

spending. i believe, mr. president, that we must ensure that the government does not continue to saddle our children and our grandchildren with the current generation's debt. essentially, this amendment that i propose requires that the united states not spend more money than it receives in revenue, except in times of war or when suspended by a vote of three-fifths of both houses of congress. mr. president, this bill that we proposal will provide financial stability to our nation. bailouts, stimulus programs, government takeovers of private industry and costly new programs have consumed and have overwhelmed the federal budget. over the past 30 years, annual deficits have become routine, and the federal government has incurred massive debt, nearly

nearly $14 trillion and rising quickly. for a moment, just let me share this chart with you. it says, "the case for a balanced budget amendment to the constitution." if we go back to 1980, just 30 years ago, we owed as a nation nation $909 billion, not yet yet $1 trillion. this was after nearly 200 years of government, including the first world war debt, the depression, the second world war, the korean war, the vietnamese war and many deficits. but from 1980-1990, this jumped to $3 trillion, and from 1990-2000, a ten-year span, it jumped from $3 trillion to to $5.6 trillion, and that was pretty bad. but, mr. president, from the year 2000-2010, which just ended

a few weeks ago, it went from from $5 trillion to $13 trillion in ten years. it's slated now by -- in the next 11 years to go to to $25 trillion. that is unsustainable. in fact, mr. president, just for the record, the united states has only had two years in its entire history where it's been debt free. look back a while. it was 1834 and 1835. i repeat, only two years free from debt. it seems to me, mr. president, that the most powerful nation in the world has had its weaknesses exposed. foreign markets cannot stand on our wobbly financial legs. mr. president, the reverberations of our fiscal ineptitude have not only cost american jobs, which we badly

need, but have weakened how other nations perceive us. something must be done. unfortunately, we do not have to look back far in history to see an example of a once-great empire sitting on the curb with its hand held out. greece's excessive public spending coupled with a massive borrowing campaign has put its fiscal insolvency woes on the entire european union. greece's bond rating was downgraded to junk by s&p in april. bondholders were warned that they could recover as little as 30% of their initial investment. the euro weakened and the european stock market plunged. mr. president, the question is will the dollar soon be seen as junk to the rest of the world? i hope not. american taxpayers are rightly infuriated by the federal government's disregard for the

same, mr. president, economic principles that govern every household and business budget. until the federal government is required to spend only the amount of money that it takes in, i fear that we will continue to write checks that the treasury cannot cash. in the year 2010, the total interest alone on the treasury debt securities was was $413 billion. i believe this money could be better spent on improving education, supporting our law enforcement, or even better, by returning it to the people who earned it, the taxpayers. mr. president, we hear on a daily basis the rhetoric about tough choices, sacrifice and austerity. what we need to hear more about, i think, is basic mathematics when we're talking about the

budget. a balanced budget amendment to the constitution is the solution, i believe, to a perpetual problem that we do not have the political will to fix. it will finally put our nation on a path to paying off our national debt. the adoption of an amendment that would require the federal government to do what every american already has to do, balance its checkbook, is exactly what this country needs to prove that washington is serious about accomplishing this feat. a balanced budget amendment is simply a promise to the american people that the government will spend their hard-earned tax dollars responsibly. some opponents of a balanced budget amendment state it's a drastic measure, not necessary at this time. they are also correct that it is both, but i believe it is also necessary. i have introduced this legislation, as i said, in every congress since 1987, but if not

now, mr. president, when? i yield the floor. the presiding officer: the senator from colorado. mr. udall: mr. president, i'm proud to join my colleague, the senior senator from alabama, to abusive legislation today that would amend the united states institution to require a balanced budget. the idea of requiring a balanced federal budget seems like common sense to most americans. americans have to balance their checkbooks. nuclear weapon these hard times, they are wondering why the federal government doesn't have to do the same. in fact, the united states has only balanced its budget five times in the last 50 years. we heard the senator from alabama point out that the federal government has operated at an even balance only twice in our history. mr. president, the budgets of nations are not the same as family budgets, and since the great depression of the 1930's, we have known that national emergencies sometimes require deficit spending, but we are

fast approaching a tipping point where our debt threatens this economic orthodoxy. we're approaching a tipping point where an unprecedented level of debt in our -- and our institutional failure to address it risks our national security. we need to take action now to turn around our fiscal situation. by restoring responsible spending through a reasonable balanced budget amendment, we can begin climbing out of our economic hole. perhaps just as importantly, this amendment would send a strong signal to the financial markets, u.s. businesses and the american people that we are serious about stabilizing our economy for the long term. that is a signal, i believe, that we need to send now. now, before going further, i want to recognize the obvious, that there are a wide range of strong opinions about the wisdom of adding a balanced budget amendment to our u.s. constitution. tinkering with the constitution is not something that any of us takes lightly, and this

amendment is certainly no exception. i myself have had doubts in the past about similar legislation. during the clinton years, our government ran a surplus and there was no pressing need for such a requirement. when we start running deficits again, part of me hoped we could use other tools at our disposal to get our nation back on a financially sound path. additionally, members of my party raised and continue to raise credible arguments about why a budget -- balanced budget amendment could actually hurt our economy in some circumstances. some of them believe that it's nothing more than a rhetorical tool designed only to make a political statement and move us inevitably towards smaller government. i would say, mr. president, the recent history of the balanced budget amendment is a partisan one. of the five different proposals that were introduced last congress, none had a democratic cosponsor, largely because of, in my opinion, extraneous provisions that manipulated the budget in one way or another to perfect favored tax breaks or certain kinds of spending.

however, if you take a longer view into the past, it was actually progressive democratic senator paul simon who i think the senator from alabama served with along with our own senator hatch of utah who led the balanced budget amendment effort that came closest to passage in 1995. they knew that if we balanced our federal budget, we would be better able to make more intelligent choices about our spending rather than spending billions on debt service, and we would actually see family incomes rise. today the dilemma we face as a result of our debt is even more extreme, and that is why i am cosponsoring this resolution. our government debt, as senator shelby pointed out, is now over over $14 trillion. that's $45,300 for every person in this country. if we don't put limits on how we spend money, the question we face isn't whether we can make intelligent choices. it's whether we will be able to afford any of the programs we

value at all. programs that we need to help propel the middle class and small businesses over the longer term. and what's at stake isn't just family income. it's our nation's ability to continue to lead in the global economic race. the cochairman of president bush's bipartisan commission on reducing the debt called our debt a cancer that's eating away at our economic health. that's a point i wish president bush -- president obama had made in his state of the union address last week when he talked about some of the investments americans need to spur education and economic growth, education and infrastructure, to name a few. he is right that without targeted investments to help hard-working americans and businesses, the united states will be relegated to second-class status. we won't be able to compete with countries around the world. we won't be able to grow jobs here in america. we won't be able to unleash our innovative spirit. and we won't be able to give our children and grandchildren their

shot at the american dream. mr. president, i've also come to the conclusion that unless we also put constraints on spending, congress simply lacks the political will to make the extremely difficult decisions that will lead us out of the dire fiscal situation in which we find our nation. i have been fighting for many years for smart budgeting tools. i know the presiding officer has as well, including pay as you go budgeting, a line-item veto and a ban on earmarks. i am also working with a group of bipartisan senators trying to make sure the recommendations by the president's fiscal commission can get an up-or-down vote here in congress. a balanced budget amendment is one more important tool that we need. let me just say a few words about the legislation itself. senator shelby, to his credit, first introduced this legislation, and i think i can say that, when he was a democrat, some 25 years ago, and he has continued to reintroduce it every congress since he

became a republican. i want to thank him and acknowledge his leadership on this. the shelby-udall balanced budget amendment would create a requirement that federal spending cannot exceed revenue and that total expenditures of the government cannot exceed 20% of the previous year's gross national product. as senator shelby pointed out, this requirement wouldn't apply when the united states is at war and it can be suspended by a supermajority or three-fifths vote of each house of congress in the event certain spending is necessary to address a national emergency. mr. president, thus to my friends who worry that this balanced budget amendment puts our economy in an inflexible straitjacket, i say it's not true. it allows commonsense safety valves to be used for exceptional circumstances to give the flexibility that's needed in situations that can't be predicted or planned for. all in all, i'm confident that our proposed amendment provides a responsible approach to putting us on a path towards a

balanced budget. we have talked a lot last week during and after the state of the union address about the need to work together to address our biggest challenges, not just sitting together. and today i hope i'm putting my money where my mouth is by joining my good friend from alabama. i hope our partnership will send a signal that collaboration can help us address our most pressing national issues. the american people are demanding that of us. as usual, they are a few steps ahead of us. now it's time for us to catch up. so i would ask my colleagues of both parties and both chambers to work with senator shelby and me on this idea. we may not have it perfect. nothing is ever perfect, but it's a really good start. let's at least have an honest and spirited dialogue about this legislation and about the ways to dig ourselves out of our economic hole. our children's future depends on it. mr. president, thank you for your attention, and i yield the floor.

the presiding officer: the senator from missouri. a senator: mr. president, today i have the opportunity to speak on the floor of the senate for the first time as part of the work of the senate. mr. blunt: i'm pleased to be here on a day when the senate is addressing a topic of health care because clearly it was a major topic on the mind of missourians and all americans last year, and i support the amendment that the gentleman from kentucky has offered that would repeal the health care bill and make us start again looking at how we make the health care system work better. but, mr. president, this is my first speech on the senate, so let me say a couple of things about that. one is as i look in the desk drawer, i understand the tradition of the senate that people who have used this desk, the desk that i get to use on the senate floor, and coming from the house where nobody had a desk, it's quite an accomplishment just to get a desk, but the desk i use on the

senate floor has names carved in it by other missourins who have used that desk before. senator truman, senator eagleton, senator danforth and senator bond. i'm honored and humbled to get to sit at the same desk that those individuals used as they served our state, and they all served our state in a dedicated way. in fact, the collective service of those -- of those senators in various jobs working for missourians probably totals about two centuries of collective service where they worked hard for missourians and worked hard to advance the views that they believed were so important. senator bond whose place i am taking on the senate floor this year for 24 years in the senate i think showed an unmatched understanding of our state, and in recent years, a real -- a real understanding of the national security issues we face

and what was necessary to protect the country. he was a great competitor on the senate floor and in all other ways, a great friend of mine, and certainly my wife abby and i value the friendship we have had with senator bond and his wife linda. in fact, as i campaigned last year all over our state at 931 events, i never had a single person tell me they thought i would be a better united states senator than kit bond, and for good reason. but i'm here today thinking about those events all over our state last year. at first, i was surprised having campaigned in missouri before, i was surprised at the level of engagement on the domestic issues that the country was facing. i truthfully had never seen anything like it, where people were ready to talk about the specifics of the issues the country was talking about, and as i thought more and more about it it occurred to me, we will,

why wouldn't they be engaged? this is not like we're trying to decide what your position is going to be on the missile defense system. this is not like we're trying to decide your family's position about foreign policy toward the middle east. this is about -- this was an election about jobs and health care and taxes and in oir state whether your utility bill might double in 10 years. why wouldn't people be edg be ge id with a -- be engaged in ways that were extraordinary, and they were. they said they wanted the government move over and allow them to get the economy back on the right track. they understood that government jobs, while vom necessary, and i'm glad to have one don't, pay the bill. government jobs really are the bill. and we need to be focused on private-sector jobs and how to create those jobs. the questions really were, why is the federal government

spending so much more money than it's ever spent before and where are the private-sector jobs, and frankly i would have thought that would be the overriding topic of the first speech i had a chance to give on the senate floor. but as you think about those two questions, i don't know that anything is a bigger issue in this health care discussion than the impact that the health care bill has had on private-sector job creation and on our estimates of future government spending. the biggest single deterrent to job creation is uncertainty, and we've certainly done great things in the last few years to create a sense of uncertainty. if you don't know what your tax liability is going to look like, if you don't know what your utility bill will be, if you don't know what your health care expenses are going to be, you're less likely to take that risk that anybody takes when they

create a private-sector job than you would be if you had a greater sense of those questions. and in health care, for every job that they'd create or every job they'd think about a job -- a job creator would think about continuing, this was a time when they'd have to wonder, can -- once the -- what's the obligation going to be? what's the cost going to be? i was with a group of small business people in northwest missouri one day last year, right after the health care bill passed, about 30 days after the health care bill passed. i was at rockport, missouri, and somebody there at that meeting said, look, i have 47 employees. and i've looked at the health care bill. and my accountants have looked at the health care bill, and i need four or five more people right now. but i'm not going to hire them because i am neat going to get one employee closer -- because i'm not going to get one employee closer to 50 than i am

now because 50 created new obligations that 49 or 48 or 47 -- aim just not going to hire those people. scwhee am i going to do snim going to pay overtime in the short term, but in the long term i'm going to to look at what i'm doing that's not making much money and quit doing that. now, there's somebody telling me a handful of jobs, ready to be created, that he believed he needed to create are not going to happen because he doesn't want to get any closer to this health care moment. he doesn't want to get any comploaser where the government comes in and say, we're going to make you do things that you don't have to do if you don't create these jobs, or people i talked to in columbia, missouri, in the middle of the state in the fast-food industry said, we're just going to try to figure out how not to have full-time employees. wheandz said washings the person who gives you your breakfast sandwich in the morning may be the same person that across the

street gives you your fast-food lunch because we're not going to have that person as a full-time employee, if we can figure out how not to have that obligation. reecialtion sustainable, private-sector job creation doesn't happen in an environment of uncertainty. we need to be focused on jobs that are family-supporting. we need to be focused on economic growth that includes letting american families keep more of what they earn, includes economic incentives for small businesses and employers, and encourages the government to get out of the way so that employers of all sizes can create self-sustaining, stable, private-sector jobs. we need a government that meets the requirements of the constitution and rarely, mr. president, do we've we have a chance to revisit a misguided decision. and in fact this decision and

this bill was the result of a set of circumstances that nobody we've anticipated whvment this bill passed -- that nobody would have anticipated. when this bill passed with the 60 votes that was required at the moment, nobody thought that this bill would be the final product. not a single person who voted for that bill said that was the bill thald that will go to the president's defnlg everybody that voted nor that bill thought that this will be a bill that gets the senate to conference with the other part fft -- part of the congress and we'll work out all the things in the conference that need to be worked out between the two. but what happened was that suddenly the 60 votes that passed that bill weren't there anymore. so that becomes the only thing that can become law. and, you know, the plan that the leader -- that the republican leerksd the minority leader advances, let's us go back and

revisit this decision and do this the right way. two federal courts have already ruled that the law, one said, was all, that didn't meet the constitutional standard and couldn't go forward. why was that? that was because the way the bill was put together. put together in a way that didn't have the normal legislative language that would allow severability, that would allow if somebody is unconstitutional, nobody thought this was going to be the bill, mr. president. the american people are the victims of having to rush forward with a bill that wasn't ready to become law. another federal judge has said that part of the law is unconstitutional that makes people buy a commercially available product. and i, along with a lot of other people, have thought from day one that that -- there's nothing in the constitution that allows that to be a requirement.

voters in the state of missouri, my state, at the primary election day, the second-biggest election we have, had hundreds of thousands of people vote, were faced with a question the legislature put on the ballot that essentially said, do you want to be part of this process? do you want to be part of the mandatory obligation to buy insurance? do you want to be part of the health care bill? over 70% voaforts that voted that day said "no" -- over 70% of the voters that voted that day said "no." they were the first voters that day that had chance to go to the polling place and had chance to say at the ballot box how they felt about this law that would go forward. and they said, mr. president, they didn't want to be part of it. they understood -- those voters understood that this is a misguided plan that. it puts government between people and their doctors. in ways that dr. coburn talked about earlier today, in a meaningful way that he and other doctors that join us as members

of this body would understand. it puts government between people and their doctors. it implodes the current health care system. i believe the current health care system will not survive this bill, and not that the current health care system is perfect. but it certainly produces great results for people who come here from all over the world. this is a bill that cuts medicare to pay the bill. i heard it over and over again at the ballot box. they said they didn't wasn't to be part of it, i thought for three cycles -- three election opportunities -- 2004, 2006, 2008 -- that health care would become the biggest domestic issue. and just may be too complicated, too difficult to deal with, may be too difficult for people to

engage. this law gives us the opportunity to go back and get it right. weengdzed to deal with health care for a long time. when i worked in this building in the -- on the other side of of the building, we sent medical liability reform to the senate seven times in ten years. we sent plans a half a dozen times where people could join together in what we were tale calling associate $health plans and get their insurance that way. and become part of however big a group they could figure out how to associate with. it wasn't like anybody was doing anything. and this bill very likely creates the pressure that we need to go back and loo look for better solutions. this idea of associated health plans where you can join other groups, other individuals that are somehow like you or other small businesses like your small business. medical liability reform saves the most money of anything that can be done for taxpayers but it

also saves money for taxpayers who are paying for their own health care because it takes a lot of expense out of the whole system. certainly we want people to have access to insurance coverage that had preexisting conditions. and in fact i proposed in the past and will propose this year along with others ways to expand risk pools so that people can have access to coverage but not coverage they wait for until they're in the ambulance and need it; coverage that they get because they want it and they get -- what we need to empower families-- you know, one size -- one of the reasons why government-designed anything doesn't work very we will is the one-size-fits-all concept doesn't very we will. in fact, the so-called one-size-fits-all almost never fits anybody, and that's what i think this bill does for the health care that means so much to american families.

somebody toaldz me one time that when everybody in your family is we will, you've got lots of problems. and when somebody in your family is sick, you've got one problem. we will, this discussion of health care -- well, this discussion of health care focused missourians and americans on one problem: how do we have access to health care that's the best health care that we can have and also is the health care -- is health care that's affordable? there's no real competition in this system. so i'm for buying across state lines. you're not going to see anybody on television tonight advertising health care insurance, but it's pretty hard to watch television for a couple of hours in the evening and not see people competing for your business in every other area of insurance thr-fplt's no little -- there's no little green lizard for health care. there's all kinds of other people competing to get your other insurance business, but this hasn't really had a

marketplace. it hasn't been transparent, it hasn't been competitive. we can achieve all those things. we need to achieve all those things. choice plus competition equals quality and price. in health care, we haven't had enough choice or competition, so we haven't seen that reflected in quality and price. i don't believe that government has the authority to penalize citizens for refuse to go buy private health insurance. i don't believe taxpayers will benefit from this bill that's built on too many false premises. the idea that we're going to cut compensation to doctors back to levels of a decade ago just, it's not going to happen. and it's a quarter of a trillion dollars of the so-called pay-fors in this bill. it's not going to happen. it's almost equally unlikely that $500 billion of medicare costs are not going to happen.

if we can find savings in medicare, mr. president, we should find them and we should use them to save medicare. only in washington, d.c. would you say look we've got one program that's about to get in really big trouble in a handful of years, so let's cut that program to start another program. i don't think those pay-fors are going to happen either, mr. president. when employers are telling us they're not hiring because of the uncertainty create bid this new lawmakers when courts are ruling the law unconstitutional, when voters are overwhelmingly rejecting it, we need to understand why. americans deserve a country where the people are bigger than the government. this health care bill opens the door to a future where the government is bigger than the people, mr. president, and i think we should reject the law, repeal it now, move forward with more competition, more transparency and better health care. better health care at a lower cost is achievable if we do the

right things. i believe that this bill does the wrong things, and the more the american people look at it, the more they're convinced that it leads us to a future that is not the health care future they want. mr. president, i'm pleased to be able to speak on the senate floor. i'm pleased to be able to represent missourians here, and i yield back. the presiding officer: the republican leader. mr. mcconnell: if i may, mr. president, i believe this is the first opportunity the new senator from missouri has had to address the senate and his colleagues, and he's certainly chosen the most important topic to begin his career in the senate. i want to just express my admiration not only for the comments that he just made on what many of us believe is right near the top of the list of america's priorities, but also his extraordinary service in the house of representatives over the last 14 years, and welcome

the senator from missouri to the senate. as i indicated, he certainly picked an appropriate topic to make his maiden speech to the united states senate. mr. president, i yield the floor. mr. brown: mr. president? the presiding officer: the senator from ohio. mr. brown: i appreciate senator blunt's maiden speech too and having the honor of listening to it. of course i disagree with his comments. i've heard all this before, mr. president. i've heard republicans say this is a bad law that we've got to deal with all these issues. i hear that over and over. but i also notice by even a cursory observation or look back in our nation's recent history that when president bush was in office, when republicans controlled the house of representatives, republicans controlled the senate, the only

thing they did on anything relating to health care or pensions was try to privatize social security. they didn't really do anything to try to provide health insurance for people that don't have it. they pass no real consumer protections in terms of eliminating preexisting condition. they did minor things, but in terms of eliminating preexisting conditions, they did nothing for 23-year olds to stay on their parents' health care plan. they did -- they were woefully inadequate in their efforts to assist small business in providing health insurance for their employees. mr. president, it really is the same kind of empty rhetoric that we've heard from republicans for years. they don't like it -- they don't like doing it this way. they will to repeal, then they want to fix it. but they don't reefly want to fix it because they have offered nothing to fix it particularly when they had the ability to pass something through both houses and get it signed by the president. because they don't ever stand up

to the insurance interests. the republican party receives huge contributions from the insurance industry, from the pharmaceutical industry, the medical device industry. they really have shown little interest in providing for the kind of people whose letters i'm about to share, mr. president. now we hear republicans say, we'll provide insurance by selling across state lines and enacting malpractice reform. that hardly, even the most optimistic estimates is that might insure two million or three million more people and cut costs in health care by minuscule -- i don't know even know if it's 1%. nothing substantive that matters in people's lives. not to mention it takes away people's ability to get redress when they have been injured by a negligent hospital or provider. mostly empty rhetoric, mr. president, from republicans in this whole debate. i want to bring it back and put a hugh fan face on it.

the law of the land today -- and put a human face on it. the law of the land today is that much of what we passed a year ago will affect people's lives. that's now the law of the land. i'm particularly troubled when i hear people stand on the house and senate floor or people in attorneys offices in columbus in my state or around the country say bring a suit against this health care bill. when i think about that, i think about conservative politicians who have been the beneficiaries -- they and their families have been the beneficiaries of taxpayer-financed health insurance for their whole careers. now they want to take benefits away from voters and citizens and families in my state. they want to take benefits from seniors, some of their medicare benefits. they want to take benefits from families. it just strikes me as rank hypocrisy. let me illustrate much better than i can -- by reading these letters than i can just by

talking. megan from summit county is a college student. megan lives in the akron area. as a 22-year-old college student it can be demanding trying to keep a successful schedule going to maintain health care under my parents. as for my brother who does not attend college health care is nearly impossible because of costs. this new law will allow both of us to remain under our parents for awhile longer while we get our feet planted. megan knows even when she graduates how difficult it is to find a good job with health insurance, with good-quality health insurance. so she knows that she has the option, because of this law, to stay on her parents' health insurance until her 27th birthday. when republicans talk about repealing this health insurance law, what are they going to tell megan? what are they going to promise megan in return? i assume nothing. rose from cuyahoga county is a small business owner. as a small business owner i do not want the new health care bill to be repealed. we're excited the small business

tax credit for health care and the new plans being rolled out that will give more choices. this bill will help us to continue to offer health care to our employees. rose, if she has fewer than 50 employees, she's not required to buy them health insurance. but she will have available to them, to a 35% tax credit beginning now, beginning last fall, that she can use to insure her employs, which -- insure her employees. by 2015 rose will benefit with a 50% tax credit. richard from huron county, i've been reading where mitch mcconnell wants to force a vote in the senate on the repeal of the health care law enforcement if he does them -- health care law. when he does this, would you ask the all republicans request they'll give up their federal health care since they're so opposed to the bill. ask them if they're willing to keep the insurance provided by

the government and at the same time take away the health care for seniors. or ask them to tell all the families that their sons or daughters aren't covered. richard understands this. a bunch of conservative politicians say they don't believe in any government benefits are all enjoying, they and their families are enjoying their government insurance, their taxpayer-financed insurance. yet they're willing to take medicare benefits away from seniors. they're willing to take benefits away from families that they've earned. tonya from warren county in southwest ohio, north of cincinnati. please fight the repeal of the health care law. don't let them take away pap smears and ma'am tkpwraps from being part -- mammograms from being part of preventive health. there's a lot of good in this bill that will be erase fundamental it's repealed. craig from cuyahoga county writes a number of years ago my 23-year-old daughter was in a bad car accident. she had no health insurance

because her employer -- she was working but her employer did not offer it. since she did not have good access to good health care, she received substandard care and she continues to suffer. my 21-year-old son is taking a year off to earn money to return to school. craig says contrast my 21-year-old son with my 23-year-old daughter's situation. we cannot afford his tuition and living expenses as he pursues a double major in physics and economics. in the past he would be uncovered by insurance unless he could afford his own. in case of an accident, his prognosis would be not much better than his sister's. now he's covered under my insurance until he gets a job that provides benefits or turns 26. actually 27. my point with all of this is is to beg you to keep the health care bill intact. sue from franklin county, the center of the state, the capital, please do not let the

republicans take away my daughter's health insurance. my husband and i are retired civil servants on a fixed income. i was overjoyed when my health insurance company informed me my daughter could remain on my policy until she's 26. under the old regime she would have been dropped from my policy in april 2011 when she turns 22. this may not seem like a big deal to you but my daughter has a preexisting condition that requires her to take three prescriptions a day not to mention doctor appointments and blood work. i paid for private insurance for my older daughter for three years until her husband's employer covered her. by the end of the three years i was paying almost $200 a month for my daughter's policy and she was a healthy 25-year-old without preexisting conditions. mr. president, we know the kinds of hardships that repeal of this health care bill would inflict on all kinds of americans. the college student, the recent graduate, the child with the preexisting condition, the senior who wants to be able to have access to mammograms and a

checkup and osteoporosis screening. we know the small business person who really needs this tax credit so she can cover her five or ten employees, because she wants to. not because the law tells her to but because she wants to. mr. president, all of these reasons underscore to me how outrageous it is that a bunch of people dressed like this, that get elected to offices like this, who enjoy government insurance, whose families, where they and their families have benefited from taxpayer-funded insurance are willing to continue to take their insurance, continue to enjoy those benefits but take them away from so many seniors, so many families, so many small business people, so many people that are working hard and playing by the rules and trying to live the american dream. and in many cases this stops them cold in their tracks. mr. president, i yield the floor. i suggest the absence of a quorum. the presiding officer: the clerk will call the roll.

quorum call:

a senator: mr. president? the presiding officer: the senator from south carolina is recognized. a senator: i ask unanimous consent to terminate the quorum call. the presiding officer: without objection. mr. graham: i'd like to have a few minutes to talk about the health care bill. the presiding officer: without objection. mr. graham: thank you. thank you very much.kj mr. press debating a lot of issues. we've passed the health care bill last year. now there's an effort in the house to repeal and replace it. i join my house colleagues with the idea that we should start over and come up with some product that was truly bipartisan, that will lower costs. and all the information we've received about this bill since it was passed showing it's going in the wrong direction. in may 2010, c.b.o. director doug elmendorf stated that rising health care costs will put tremendous pressure on the

federal budget during the next few decades. in c.b.o.'s judgment, the health legislation enacted earlier this year does not substantially diminish that pressure. we're getting more and more input about the next bill has on costs because there's over 700 waives now in terms of the mandates. 40% of all the waivers given are to union health care plans and union work force is 7% of the total work force. so the idea that more and more people are asking for waivers indicates that the cost component of this bill is a real problem for the country. and the whole goal of health care reform is lower cost costs, improved quality. and what i'm afraid we've done with the health care bill is we've increased costs, consolidated power under the federal government. medicaid and medicare already are unsustainable when it comes to federal financial obligatio obligations, and the obama health care bill, if fully enacted by 2014, would extend medicaid coverage in the state

of south carolina to 29%. 29% of south carolinians would be covered by medicaid. that's a substantial increase over the number of people on medicaid today. that would require my state to come up with $1 billion more in the next seven years of state matching money to get the federal government medicaid dollars. the second largest expense in south carolina today is the state's matching requirement to get existing medicaid dollars from the federal government. if you expanded medicaid, you're going to bankrupt south carolina and i think there's a better way to deliver health care to low-income americans. i was on a bipartisan bill with senator wyden and bennett that did cover everyone but it allowed people to buy health care in the private sector with tack credits. it took deductions away from employers. that's a lot of money. and it took that pool of money and allowed individuals to buy their own health care in a more competitive environment.

so at the end of the day, it looks like we're going to be taking a vote here soon in the senate i hope to repeal and replace the health care law that was passed last year. if it is repealed, it should be replaced and the way you replace something this complicated, that affects one-fifth of the economy, is you do is deliberately, you do it in a bipartisan manner. and let's remember how this bill became law. it got exactly 60 votes, a party-line vote in the senate. it was passed on christmas eve a couple of years ago, and at the end of the day, the process i thought was not befitting of the united states senate. there was a lot of provisions given to senators in particular states like in florida. medicare advantage participants had a lot -- a lot more medicare advantage availability than

other states. ohio, michigan, some health care companies in those states got special deals. at the end of the day, it was done in a back -- back of a room in a partisan fashion, not transparent, not negotiated before c-span, as president obama promised. it really reinforced the worst of politics. and it's no surprise to me that something that came out of that process is not going down well. and what i did today with senator barrasso, a physician senator from wyoming, was allow states to opt out if they chose. if this is really such a good deal, let the state legislatures throughout the country decide whether or not they want to be covered by the individual mandate, the employer mandate or medicaid expansion. i know the answer in south carolina. my governor, my legislators want to opt out of expanded medicaid because it will bankrupt the state. they don't want any part of the employer mandates. so i would challenge the congress, if repeal and replace doesn't work, let the individual

states have a say about whether or not they want to be in the system. i do hope we can repeal it and replace it and that vote's coming up soon. but the amount of tax increases in this bill, $17 billion in individual penalties, $52 billion in employer penalties, $500 billion taken out of medicare to help pay for the uninsured. at the end of the day, the formula, the construct of this bill i think is going to grow the size and scope of the federal government when it comes to health care at a time we need more private-sector competition in medicine. it's going to increase taxes on businesses at a time when we should lower their taxes. and it's going to make it very hard in the future for senior citizens to find doctors to take medicare because at the end of the day, the more you consolidate power in the federal government, the more obligations the federal government has when it comes to health care, the less we can pay because we're so broke.

so i hope that this vote will happen soon, and to my colleagues who want to keep this bill, i respectfully disagree but that's what debate's all about. we can have a civil debate about the future of health care. i think the congress would be wise to start over and come up with a new product, and it does put pressure on republicans if we do repeal this bill, to replace it with something that makes sense. and what makes sense to me is to lower costs and make sure that people have access to health care and that the uninsured are taken care of but one size does not fit all. so i look forward to casting my vote to repeal and replace, and if that doesn't work, i look forward to having my amendment, along with senator barrasso, on the floor of the senate allowing states to opt out if they choose. my guess will be that a majority of the states would opt out of the individual mandate, the employer mandate and medicaid expansion and some democratic governors are going to be talking to the members of this body about how their states will

be devastated by medicaid expansion. i think you're going to have some big states that are in the hands of democratic governors that are going to feel the impact of this medicaid expansion. they're going to petition the congress to do something about it. and i hope we listen to them. so this vote should happen soon. we're in a new congress. there are new people here with new ideas and now is the time to allow the american people to participate, because most of this bill was passed in secret, without a whole lot of bipartisan give-and-take. now is the time to start over. take -- take the idea of health care reform, blank sheet of paper and see what we can come up with in a bipartisan incremental fashion, and the only way we can do that is to replace the bill we have before us. so i look forward to this debate. i look forward to the vote. and this issue is not going away. between now and 2012, we're going to have a very serious debate about the future of health care in america and i would argue that anybody running for governor between now and

2012 should be asked the question, "if you could, would you opt your state out of provisions i just described, the individual mandate, the employer mandate, and medicaid expansion?" and those are good questions to ask and answer. and maybe they'll have a good answer why they would say "no." but everybody running for the statehouse throughout the country should have a genuine debate about whether or not their state should be included in obama health care. and that's why i hope that if we don't repeal and replace the bill with the current amendment that will be offered by senator mcconnell, that we not abandon this debate. debating policy in a civil way is the essence of democracy. and at the end of the day, i do believe there is a better way to come up with health care reform than that chosen by our democratic colleagues in the last couple years. having said that, the status quo is unacceptable. i am very much for eliminating the preexisting illness

exclusion that denies americans the ability to buy health care when they get sick. i'm very much more shopping around and buying a plan that is best for you and your family, and if you're a low-income person, helping you make that purchase. but i don't want to consolidate any more power in the federal government when it comes to health care because the health care obligations of the federal government, medicare and medicaid alone in 20 years are going to cost as much as the entire federal government does today. this is an unsustainable course. entitlement reform has to be embraced. but until we get to that day, i would like to restart the deba debate, have a new dialogue with new members of congress who heard loud and clear in the last election the displeasure the american people have with the process, a bill that was passed in the dead of night on christmas eve, with a lot of chicanery, replace it with a new process that leads to a better bill and that puts us all on the hook to try to find middle

ground. there was no middle ground found last time. quite frankly, i don't think a lot of people looked for middle ground. those days are behind us. there's a new congress. and if this election said anything to us up here in washington, it ought to be that the country doesn't like what we're doing, republican or democrat, and the health care bill, the way it was passed, is the worst of washington, not the best. and i look for better days. and i know the senate president tonight has genuinely tried to reform this institution and make it more reflective of the american people's hopes and dreams. the health care bill was passed in a way that none of us, quite frankly, should be proud of, and if we start over, the obligation exists for all of us to find some middle ground to move the debate forward. so the vote will be soon. it will probably be less than 60 but that doesn't mean the debate ends. there are other ways to address

this issue. so i can assure the people in south carolina that this fight will continue, that i will do the best i can as a senator from south carolina to make sure that the obama health care bill, president obama's plan that was passed by the democratic congress, is dramatically changed and altered before it takes hold and becomes irreversible. we've got a chance in the next year or so to fix this before it gets out of control. i hope we'll take advantage of it. i look forward to the debate. i look forward to offering solutions. i look forward to more than just saying "no," but i do look forward to a genuine debate where i do have a say and hopefully people on the other side will listen. with that, i yield and i thank you very much for the time. mr. casey: mr. president? the presiding officer: the senator from pennsylvania is recognized. mr. casey: mr. president, i would ask to speak as if in morning business, ask consent to do that. the presiding officer: without

objection. mr. casey: thank you, mr. president. i rise tonight to speak about the conflict in afghanistan from really one perspective, that is of those who have given their lives in the service of our country. and i -- i do so knowing that we have a lot of work to do this year, to debate and discuss and spend a good deal of time this year talking about the policy, what's happening in afghanistan, whether it's our policy as it relates to security or governance or development. but tonight i just want to focus on those who gave, as lincoln said, the last full measure of devotion to their country. and i guess at times like this, we have to ask maybe one threshold question and it's -- for me this it's question: how do we adequately pay tribute to our fighting men and women serving in afghanistan or

anywhere around the world? mr. casey: and i guess the other part of that question is, how do we adequately express our gratitude for those who are serving, those who served and came back with no injury, or -- or -- and were able to get back to some semblance of a normal life, those who served and came back but are suffering grievously from an injury, and, finally, how do we adequately express our gratitude to those who were killed in action in their -- and express gratitude to their families as well? the answer to all of those questions i think is we cannot adequately express our gratitu gratitude. but even though it's inadequate, even though it falls short of what we hope it could be, we still have to thank them, we still have to and should express our gratitude. so i do so tonight with a

healthy dose of humility in recognition that it's very difficult to adequately express our -- our gratitude. we're a nation at war, and as we pay tribute to the troops who are fighting for us, we should also never forget the sacrifices of their families, the families that support those fighting men and women and, of course, by extension, support all of us. an enormous sacrifice when a loved one goes overseas. even if, as i said before, even if they serve and come back and they're okay at the end of that -- end of that service. just the time away, the things they miss in their family's life month after month, year after year, they miss family celebrations, birthdays and weddings and literally the birth of a child is sometimes missed because of their deployment. and that's in nowhere near an exhaustive list. so we do want to pay tribute in a very personal way to the families as well.

sometimes when we talk about our troops and i talk about our country, we search for language and stories and meaning. we -- we look to the scriptures, we, as i've often done, quote abraham lincoln. we can also look to -- to some of our more modern and current artists, and there are plenty of them we could cite. i'm thinking a lot about the words from the great recording artist bruce spring steen. springsteen. he wrote a series of songs that were connected to -- or i should say inspired by the horrific events of 9/11, and most of that, most of the songs on that what we used to call an album,, the rising" were connected to 9/11. but he wrote one song i think that has -- the words and the direct theme of the song i think has direct application to folks

who are serving our country and who are, in fact, missing from their families. there is a repetition of some lines in that song where he says, quurgs a missing." and one thin point the song goe, you're missing, when i shut out the lights. when i close my ierksz you're missing. and he fine lame says, when you see the sunrise, you're missing. and always thought that made a lot of stones me in terms of trying -- a lot of sense to me in terms of trying to best understand what our families are going through when a loved one is deployed. that that family is missing that service -- that family member when they're serving in iraq or afghanistan or anywhere around the world. of course it is especially meaningful and poignant and sad and moving when it minors a missing because you've been

killed in action. and every day they're miss pg when someone is turning out the lights at night, when they're sleeping, and when they see the sun rise in the morning. so we think of those words and the fact that there are a lot of people missing today from their family because of their deployment or because of their death. i've read the names of those who were killed in action in iraq over -- over time in 2507, 28, and 2009, and we got through that list of those who had lost hear lives in iraq. in that conflict to date, 197 pennsylvanians lost their lives. and as we remember those who were killed in action from -- in this case i'll be referring to the pennsylvanians, we also must remember the wounded warriors

who have returned from the battlefield. in pennsylvania, that's to date 398 brave men and women have been wounded in this war, the war in afghanistan. last week i met two courageous young men%, army corporal rus sevment ll, pennsylvania. and marine corporal david noblet of the herndon, pennsylvania. that's in the missile defense our state. they had just returned from afghanistan. both wounded. and just remark imply strong -- and just remarkably strong and capable soldiers. fighting for us, not a word -- the presiding officer knows from the soldiers he's spoken to, not a word of complaint about bhapped to them, into the word of complaint about their care, and they're getting great, great care at walter reed.

and i salute obviously their bravery and their valor because we also of course salute the sacrifice of their families at this time. and commend the efforts of the staff at walter reed who take care of them. racialg -- almost miraculous -- care and treatment of our soasmtion they work every day to make sure that those soldiers not only are cared for and that they're progressing but that in fact, because of that care, because of that dedicated care, that so many facilities -- at so many facilities whether it is walter reed or veterans hospitals aor whatever across the country, one of the reasons they do that is to ensure that the future choices much these young service members are not determined by an i.e.d. blast or by the bullet from a sniper this

a. that because of the rehabilitation, because of the healing and hope that comes from that work, that that soldier's future is determined and will be determined by that soldier and not by the enemy. the rehabilitation work done at walter reed is just remarkable, and we are reminded when we see these soldiers in that care of their strength. we're reminded of their skills, the dignity that comes as a result of that care and treatment over time, and that in fact they will determine their own future because of that care. so what i'll do now, just for the next couple of moments -- the next couple of minutes sill a read the names of pennsylvanians who have been killed in action in afghanistan in "operation enduring freedom" and i'll do so in alphabetical

order and read their hometown, but the alphabetical order of course will be based upon the last name of the soldier. so i'll start with someone actually from my home county, sergeant jan argonish of scranton, pennsylvania, sergeant first class scott ball of carlisle, pennsylvania. lieutenant colonel richard baratini of wilcox, pennsylvania. capital david boriss of pot potsville, pennsylvania. private matthew brown of zelionople, pennsylvania. sergeant joseph caskey of pittsburgh, pennsylvania. first lieutenant jeffrey deprimo of pitston, pennsylvania. private first class james dillon

jfer grove city, pavment private first class michael dinterman of little torn, pennsylvania, staff sergeant troy i disevment rnak of lancaster, pennsylvania. lance corporal fabrey of glitson, pennsylvania. sergeant louis fastuka of westchester, pennsylvania. sergeant first class robert fyke of conianville, pennsylvania. sean flannery. sergeant james fordheis petty officer john fraylish. michael freeman of fayetteville, pennsylvania. airman first class austin gates

benson of pevment llartown, pennsylvania. sergeant christopher geiger of north hampton, pennsylvania. second lieutenant michael gor.iordano. corporal joshua harton, of bethlehem. michael heed jr. of delta, pennsylvania. sergeant brett hershey. specialist derek holland. sergeant first class brian hoover of west elizabeth, pennsylvania. lance corporal abram howard of williams port, pavment staff sergeant matthew ink ham of altoona, pennsylvania. private first class david jefferson of philadelphia, pennsylvania. lance corporal larry johnson of scronton, pennsylvania.

sergeant nathan kennedy of cla classville, pavment corporal jared king of eerie, pavment specialist dale k rhode island idlow. private first class sevment rg e krapow. staff sergeant patrick kuchboch -- staff sergeant patrick kuchboch of mckeesport, pavment sergeant ryan lane with pittsburgh, pavment master sergeant arthur lily of smithtown -- smithfield, pavment capital ronald luce jr. of wayne, pavment specialist jonathan lusher of scranton, pennsylvania. master sergeant thomas mohallack

of bradford, pennsylvania. jonathan mcculley of gettysburg, pavment sergeant andrew mcconnell of carlisle, pennsylvania. first sergeant christopher raftery of brownsville, pavment first sergeant christopher raverty of brownsville, pennsylvania. specialist jesse reed of orfield, pavment sergeant joshua rhymer of rochester, pennsylvania. begunry sergeant justin schmolsteg of pittsburgh, pavment sergeant first class michael shannon of canadensis. chief warrant officer iv michael slobidick of gibsonville,

pavment staff sergeant glenn stiveson of blaresville, pavment corporal sasha strewingal of, pennsylvania. private first class stire of l.a.n. scafter, pavment paul sweenie of lakeville, pavment staff sergeant richard teman of waynes bore row, pavment corporal eric tour rod jfer l.a.n. ceafort rts pavment lance corporal joshua twig of indiana, pennsylvania. specialist anthony vargas of redding, pavment staff sergeant william vyle of philadelphia, pavment sergeant david walls iii of sharmsville, pavment sergeant

john on this walls. staff sergeant david bygle of philadelphia, pavment capital brian willard of pavment finally, copper rat anthony williams of oxford, pavment those are the names of those pennsylvanians who have been killed in action in afghanistan. we now have a total of 64 brave service members from the commonwealth of pennsylvania, who as i said before, quoting lincoln, gave the last full measure of devotion to their country. 27 of these young men came from towns with less than 5,000 people. you notice that that list, some came from big cities like pittsburgh and philadelphia and other big cities like erie and

allen towfnlt but 27 of the 64 came from very small communities where the death of one soldier in a town of 5,000 or less has a seismic impact on that town, a searing impact first and foremost on that soldier's family and on their relatives and loved ones but obviously even on the community itself. so all we can do at times like this, when it comes to paying tribute, is to do our best, to convey a sense of grat feud, a sense of -- a sense of gratitude, a sense of respect and also to commit ourselves not only to helping the living, to help those who have been -- who come after them, who have been wounded, their family and others. lincoln also talked about him who has borne the battle. he talked about those who have been wounded and their feassments but all we can do for

those who have been killed is to do as best we can to help their families and to pay tribute to their service and their memory. but also to make sure we're doing everything possible to get this policy right, to make sure that their sacrifice is -- or that our policy, i should say, is commensurate with their sacrifice. so in one sense we, as my father said a long time ago in reference to the gulf war of 1991, he said, "we pray for them who have served. we pray for theme and we pray for ourselves is that we may be worthy of their valor." so tonight we do that only for those who have serve died in acn but those who have lost their lives from states across the country, including the state of colorado that our presiding officer represents.

with that, mr. president, i would yield the floor. i 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 senator from pennsylvania is recognized. mr. casey: i would ask that the quorum call be vitiated. the presiding officer: without objection. mr. casey: mr. president, first i ask unanimous consent the senate proceed to a period of morning business with senators permitted to speak for up to ten minutes each. the presiding officer: without objection. mr. casey: i ask unanimous consent that the committee on environment and public works be discharged from further consideration of s. 188 and the senate proceed to its immediate consideration. the presiding officer: the clerk will report.

the clerk: s. 188, a bill to designate the united states courthouse under construction at 98 west first street, yuma, arizona, as the john m. roll united states courthouse. the presiding officer: without objection, the senate will proceed to the measure. mr. casey: i ask unanimous consent that the bill be read a third time and passed, the motion to reconsider be laid on the table, and any statements relating to the measure appear at the appropriate place in the record as if read. the presiding officer: without objection. mr. casey: mr. president, i ask unanimous consent that the appointments at the desk appear separately in the record as if made by the chair. the presiding officer: without objection. mr. casey: mr. president, i ask unanimous consent that when the senate completes its business today it adjourn until 10:00 a.m. on wednesday, february 2, that following the

prayer and the pledge, the journal of proceedings be approved to date, the morning hour be deemed expired, the time for the two leaders be reserved for their use later in the day and following any leader remarks senator paul be recognized in morning business for up to 20 minutes in order to deliver his maiden speech to the senate. i finally ask that following his remarks the senate resume consideration of calendar number 5, s. 223, the federal aviation administration authorization bill. the presiding officer: without objection. mr. casey: mr. president, tomorrow the managers of the bill will continue to work with the leadership on an agreement to dispose of the pending amendments. senators will be notified when any votes are scheduled. if there is no further business to come before the senate, i ask that it adjourn under the previous order. the presiding officer: the >> "washington journal"

continues.gton journal" >> host: economic issues on the table now. deputy assistant secretary of state for the first president bush. your testifying today before the senate budget committee. what are you doing to tell them? >> guest: i'm going to tell them that the deficit is big and

the national debt is going up rapidly. we have to have a limit on the debt to gdp ratio. that's one way to compare countries around the world and see how much trouble they're in. a second thing i'll talk about is the short maturity of the national debt. you know, the amount of debt matters, but it also matters if you have to roll it over in emergencies, and if you have a short maturity for the national debt, is makes it dangerous. i know that sounds complicated, but people understand it in terms of their mortgage. do you want to have a three year or a five year mortgage that might mature when you are in trouble, when you don't have a job. the u.s. is putting itself at i think a grave risk by having suture debt and having it so short term. >> host: our guest will testify at 10 a.m. this morning before the budget senate committee, an event live here on c-span looking at the u.s. economy. other witnesses is the managing

director at morgan stanley and someone from the school of management at mit. he is now president of what company? >> guest: isema global. it comes out of my work frombear sterns. i'm part of grow pack which is set up to try to have smaller government. we've taken on specific issues. i wrote a letter to chairman bernanke and there was 30 people who signed on and asked him to stop buying up the national debt. one of my worries is that the fed buys that national debt, is gives them a conflict of interest as they set interest rates. they are on both sides of that transaction because there's such a gigantic owner of the debt.

it's hard to set the interest rates in an objective way. >> host: phone numbers on the screen for our guests. we're talking about spending and proposals to cut federal spending if you want to be specific, speak up. we have lines for republicans, democrats, and independents. our guest has this piece in the "washington times" today. truth or dare? obama bets on the world overlending. tell us more. >> guest: we're going to be spending -- right now it's $8.trillion in the estimates. we are going up and these are large numbers and the debt compounds on top of that. you know, there's two ways to evaluate debt. one is the marketable debt, meaning how many treasury bonds does treasury sell to the public, and there's the statutory debt that includes the bonds that go automatically into

the social security trust fund. people get confused on the two numbers. they are both so large that you can't really comprehend them. on a marketable debt basis now, we're at $9 trillion, and the statutory debt is at $14 trillion, so they are boat going to skyrocket in the next few years. that's got to cause a grave concern around the world and also it slows growth in the u.s.. once you're struggling under that heavy a burden, it makes it hard for businesses to want to invest in that environment. >> host: our guest ran for u.s. senate last year up in new york. had you been elected to the senate, what would be your chief argument specifically on what should be cut out of the budget? where would you go? >> guest: i think what you should do is like with a diet. start today. cut the cake out for tonight,

and so in our budget, we have this giant set of spending for example for ethanol that is just a huge burden, and everyone knows why it's there. iowa is the first presidential primary. we have logic there. if you think about the money that flows through the foreign aide programs and that going on in africa now where they are not effectively spent. i think billions can be cut there. as you think about the broad spending programs, i was disappointed they extended the unemployment insurance as long as they did. in december, they gave a full other year for unemployment benefits. that's a huge expense of transferring money from people who work to those who are not. that undercuts the job creation environment in the u.s.. >> host: what do you make of

cut and grow, spend and grow versus cut and grow? it's called economic nonsense. what's your take in >> guest: it's not nonsense at all. the private sector looks at the government spending as being or coming from their pockets, so each time the private sector sees washington spend another billion dollars, it thinks, well, that's money i can't spend. i think that we've gotten to such a high level of debt, the debt to gdp ratio is 60%, and it's heading to 100% debt to gdp ratio which we know is unsustainable. if you're the private sector looking at that, you reduce your spending when the government increases. millton freeman wrote about that, and i don't think that, you know, people have been criticizing it because they want the government to spend more, and i don't think that's the right economics. it's pretty clear. we have a clear example. president bush, 43, in may of

2008, gave everyone a rebate check, remember? it was supposed to cause people to spend money. there was no economic juice out of that in the second quarter of 2008, no boost in growth because the public looked at it and said, great, the government gave me a little portion of my money back, and they're probably taking a cut, a little percentage in washington, so the actually spending didn't go up even though the government gave everybody a bunch of min. >> host: our guest is chief economiest and taking first call from rick on the line for democrats. hey, there. >> caller: hi. i'd like to say working class republicans are the biggest chumps on earth. how has reaganonmics worked? for give me for calling you a socialist.

>> guest: there was a huge amount of growth in the 80s and 1990s. in my testimony this morning to the senate budget committee, i include a graph of the median incomes during that period of time. it came from a big surge in private sector jobs. it extended not only in the reagan administration, but into the clinton administration. remember, by the time we were at the end of the clinton administration, unemployment was at 3.8%, the best thing that can happen to people at the low end of the income scale. >> host: arizona, tony, republican, your thoughts. >> caller: yes, good morning. a couple quick questions. number one, do you feel that the american public really understands the severity of the problem our country is in financially, and then number two, my personal recommendation for the size of our government is to remove the politics out of it and cut the size of our federal government.

pick a number, cut the size of the federal government 10% straight across the board. take all the politics out of the request and say all the programs are in place. we agree they are proper and fine, but they all need to be reduced by this figure. >> host: 10% across the board, everything? >> caller: correct. >> host: got it. what do you think? >> guest: thing we would afford the 10% cut. i think really we're paying people in the washington to make decisions, to make the hard decisions on where to go heavier on that cut and where to go less. you're saying it's politics. i agree with that. i think the president, i think omb, you know, hundreds of people are working on the budget, and it is possible for them to make reasoned reductions. reductions in the commerce department, for example. ronald reagan who i worked for recommended and tried to get big cuts in the federal department

of education on the idea that education should be a local matter, a county, city, state matter, and not have the federal government as involved. those are cuts that we haven't been able to make, and so my challenge to the members is do your jobs. you're paid to make specific cuts within a budget. the problem we have now is that there really is no budget. it's an unlimited credit card they are running up. the severity of the problem for the public, i agree with the sense of the caller that people probably don't get how deep a trouble we're in. that's what i'm testifying on this morning. by the way, i have my testimony is posted on my website. >> host: you can watch the hearing at ten o'clock live on c-span. ron, independent, good morning. >> caller: good morning. i have a couple quick ones. one, i'm really disgusted at

this point that democrats and republicans cannot when they are asked a question, what specific cuts would you take, none of them are willing to list, you know, hardly anything tangible in the cuts. one at a time and stop or -- >> host: go ahead with this one and we'll come back for another one. >> guest: i do think that the executive branch should be, you know, should be responsible for having a smaller budget. president obama will get a crack at this in february when he produces his budget because the congress operates by having been presented an idea, and then they modify the idea on the edges. the best thing we could have is if omb came up with deep chosen spending cuts where they really reasoned it through. in the defense budget, foreign aide budget, all across the

board. >> caller: i think they did a good job, but i guess what bothers me is senator john mccain is taking $70,000 between social security and his navy pension when his wife makes $6 million a year. how can these people expect us to want to sacrifice the people when they are not willing to sacrifice themselves. a 5% on the operate budget is not enough to show that they really mean they are serious about cutting. >> guest: yeah, i think it would be good for congress to focus on washington. you know, we've got the problem in the country, and it makes people mad around the country that washington is in utter boom. it's building all over here. i'm here in washington today, and it's the hottest spot in the country in this area, and so some of the cuts, many of -- the first round of cuts i think need to be consciously and an effort

to stop government from growing in washington, and they could do that. they just need to go deeper. it's again their nature. >> host: some of the headlines from the white house. "wall street journal," obama proposals tax relief for small businesses asking congress to permanently eliminate capital gains taxes on small businesses as part of the budget plan submitted this month. >> guest: i don't like the capital gains tax, and it is good to have that proposal, but the president is really taking republican rhetoric and twisting it some. you know, the original idea of growth is that the private sector keeps its money. it doesn't funnel it through washington, and my concern with this huge build-up that they do in the small business programs, you know, it's not just the small business administration, but now it's the department of energy. it's multiple departments within the federal government who are having the authority to lend money, and that's just a very

bad direction. i would like to see them leaving the money with the businesses in the first place because if i'm a small business, and i see this guy from washington coming with money to hand out, i'm worried because that means he got the money from me in the first place. >> host: the president spoke about infrastructure spending as part of the state of the union a week ago today. here's a quick look. >> our infrastructure used to be the best, but our lead has slipped. south korean homes have greater internet access than we do. countries in europe and russia invest more in roads and railways than we do. china's building faster trains and newer airports. meanwhile, when our own engineers created our nation's infrastructure, they gave us a d. we have to do better. america is a nation that built the transcontinental railroad, ran electricity to rural communities, construct the the interstate highway system. the jobs created by these

projects didn't just come from laying down track or pavement, but they came from towns that opened a new train station or a new off ramp. over the last two years, we've began rebuilding for the 21st century, a project that means thousands of good jobs for the hard hit construction industry. i'm proposing we redouble those efforts. [applause] we'll put more americans to work repairing crumbling roads and bridges. we'll make sure this is fully paid for, attracts private investment, and pick projects based on what's best for the economy, not politicians. within 25 years, our goal is to give 80% of the americans access to high speed rail. >> host: what did you hear there, david, and what does it

mean to you? >> guest: you know this message is compelling. we live in a wonderful country and we want better infrastructure, but i can't imagine that the american public really wants washington, which can't really do anything quite right, to be entrusted with the hundreds of billions of dollars that he laid out right there. we are already spending $3.8 trillion. what are you getting for it? are the people actually getting much through? we already did this in the massive stimulus bill in the spring of 2009. the president said that was going to be shovel-ready jobs that were going to help the country, and then you saw it disappear in the morass of washington. the president should be shifting his rhetoric to propose cuts that make sense to him and retrain -- put the country on a diet, and that's going to help in businesses creating jobs.

>> host: jane on the line from illinois, republican, go ahead, jane. >> caller: good morning. sorry you lost your election, and i hope you will try again. i was listening to the radio, and there was a discussion about georgia being one the better fiscally responsible states, and that they have their own state bank, and would that be a way to resolve some of the problems for the state's to develop their own banks and the other thing is nebraska has governments since 1937 and i've been reading on it, and it sounds good to me. curious if you have any thoughts. >> guest: i think states can't be good at their own banks, but i think the federal government absolutely should not be in that business, but if states want to experiment, the founding fathers said, you know, they are each sovereigns, and they can try things, and other states look at it to see if it works.

i don't think a bank run by a state will actually help because it's going to come from taxpayer's money. as far as governments, across the country there's a huge amount of wastes in state and local governments, and so i think each state should experiment with ways to make that more streamlined, make it better. new york city state has a -- new york state has a fiscal deficit of $10 billion. that's part of the government entities so there can be streamlining. one of the things that i think should be done is washington should stop enabling wasteful spending at the state and local level. one thing that washington does is not urge accurate accounting by the states, and so the unfunded pension funds in the state are growing rapidly without washington reviewing or without washington giving an honest assessment of the unfunded liabilities, and, in

fact, washington gives oftentimes an implicit guarantee to pension funds that are going out around the country, implicit guarantee i'd say, and that really could be reduced out of washington to get the states and local governments to be more fiscally responsible. >> host: from north carolina, independent. good morning. >> caller: good morning. how are you? i noticed that republicans and democrats you guys complain what is is good for the democrats is bad for republicans, whatever is good for republicans is bad for the democrats. you mentioned the cut and grow. can you explain that better for me? i mean, if i'm -- my household, if i cut my spending, if i don't invest in my education, if i don't invest in my kids' education, how do i grow? can you explain that concept better? you talked about the business choosing to spend because of what washington is doing. okay, that may be true, but then the business community is

depending on trillions of dollars and not doing anything at the moment. it gets down to the part about doing the reagan era. i remember that. i was young, i was in high school. unemployment was out through the roof. okay. it was out through the roof. reagan came in, there was a lot 6 economics. 40 years later, or 35 years later, we have not yet to see anything about this economics working. okay. one more last question. one more last point. you made a statement about unemployment being extended which made to claim about the tax cuts for the extremely rich. i take exceptions to that. >> host: there's a lot there for you. >> guest: there's a ton. well, the point that he is making is a good one. families educate and are responsible for their own budgets, and he was suggesting why can't the federal government invest as well. that really was what the founding fathers thought about in the institution, and they

decided clearly that the federal government should not be doing that, should be done at the community level, at the family level, maybe at the state level, but not at the federal level. i really don't think you can draw that analogy that just because people invest in themselves, therefore the government should invest, the federal government. as far as reagan, remember the hard times, i remember them well. in 1981 when he was inaugurated, the inflation rate was through the roof. the dollar had collapsed. we had gasoline lines, and i think it's not fair to say reagan had high unemployment rate of his causing. when he came in, he changedded the economic -- changed the economic system, and when he left. unemployment was lower, and laid the ground work for private sector growth into the 1990s, and bill clinton as he evolved his own economic views with the

welfare reform and other reforms and capital gains tax cut in 1995, we saw the unemployment rate continue to stay down. i think that really underscores the value of having a limited role for federal government. >> host: what do you make of the debate whether to lift the debt ceiling? big thing folks are writing about what do you think should happen? >> i'm a fiscal conservative, but they have to lift that particular debt ceiling. it's the statutory debt that goes up automatically with the inflation rate, the growth of the country, and also with the trust funds for social security, and so it's -- i don't think we should have a limit on statutory debt. what i would like to see is a limit on marketable debt relative to the size of the economy. imagine back when they wrote the constitution, they had no idea we'd ever have a government that could borrow 20% of gdp much less the 60 mcwe're the at now

and heading towards 100%. if they realized there were fancy financial markets, they would have put a limit in the constitution on that. we need that now, a get to gdp limit, 50% marketable debt to gdp, and then have escalating penalties starts with washington if you're above that. if you're in an environment at 60% debt to gdp like now, that means no raises for senators, congressman, for staff, and even the senior executive service, get the people who are paid to balance the budget to get up and do it. that would help a lot. >> host: a few more calls, north carolina, republican, you're up next, alex. >> caller: good morning. really, when you have a guest on like this, you need to have someone on there to rebut him. i'm an attorney who studied the constitution, and there's

nothing there that supports what you guys just said about the federal government not spending money, so that's ridiculous, and then the other issue is the comment of we had a big brawl in the constitutional times about having a central bank. jefferson was against it. hamilton was for it, and then we have the fed put in around 1913. that would speak to the debt. my first comment was when reagan came into office, we were the largest credder nation -- creditor nation on the planet. when he left office, we owed people money. how does that speak to fiscal conservatives if this gentlemen was behind it? additionally, look at sterns, where's the track record here? weren't they bankrupt? >> host: before we go to the guest, another viewpoint is coming up in o couple minutes. stay tuned, and