medicare. unfortunately, that's not the case with the reid bill that we are currently considering. to be clear, the reid bill cuts medicare by $465 billion to fund a new government program. unfortunately, our seniors and the disabled will be the ones who suffer the consequences as a result of these reductions. now, throughout my senate service i have fought to strengthen, preserve, and protect medicare. i think most republicans have. in spite of what my colleagues say on the other side. unless we're blowing money down the drain, they don't think we're doing anything. medicare is already in trouble today. the program faces challenges in the very future. the medicare trust fund will be insolvent in the year 2017 and the program vs over th 37 million in unfunded liability. the reid bill will make this situation much worse. look at the cuts to medicare. hospitals -- $134.7 billion. in this bill! where are they going to get that money? how are we going to keep our hospitals going? hospices -- $7.7 b

all medicare plans, whether traditional medicare or private, must, must offer all required medicare benefits. now, here's the kicker. if, in fact, there are some cuts made in medicare advantage, then these private plans, these private companies that are making $12 billion is their slush fund. maybe rather than cutting the benefits, maybe they will decide to cut their c.e.o. salaries from $12 million a year to to $10 million a year. maybe they will decide instead of three or four corporate jets, they only need one corporate jet. maybe they'll start reducing some of the profits that they're making, huge profits that they're making off of the taxpayers and off of medicare payees right now. so, again, if you cut the medicare advantage programs, i guess my friend on the other side say well, number one, they can continue to pay their c.e.o.'s $12 million a year salaries, they can continue the corporate jets, they can continue to have all their fancy buildings, they can continue to have all these outrageous profits, but they're going to have to cut medicare. that's what the other side is saying. wh

medicare money for medicare. medicare funds should be used to fix medicare's problems, such as this flawed payment formula that keeps doctors from taking seniors. taking hundreds of billions of dollars out of a medicare program now will only guarantee that it will be much harder to permanently fix the doctor payment issue in the future. i can understand why the a.m.a. continues to support -- i cannot understand why the a.m.a. continues to support this terrible deal for doctors. if you can't see a doctor, your benefits, your guaranteed benefits have been cut. apparently, the members of the a.m.a. don't like the deal either. at a recent convention, up to 40% of the current membership of the a.m.a. voted to reject this deal. i know that's not a majority, but most associations survive by consensus agreements. that means that almost all of their membership agrees with the tack that they're taking. not just slightly more than half. now their membership is less than 20% of all doctors. it's a dwindling association. let'

to medicare. and there were many on the floor here who are concerned about costs today -- at least they say so in their speeches -- who were very anxious to add that legislation to medicare, adding another $500 billion -- that was estimated by the c.b.o. at that time -- another $500 billion over a ten-year period to the cost that medicare was married. the efforts to bring the costs down in medicare is essential if we're going to keep medicare solvent in the future and part of the solvency problem medicare has in the future frankly is related to what we did in subpart-d. mr. president, i see my time is up. and there are other waiting to speak. let me just conclude and ask unanimous consent that the balance of my statement be included in the record. the presiding officer: without objection. the senator from montana. but how much time remains undere time of the majority? the presiding officer: 24 minutes. mr. baucus: i yield ten minutes to the senator from massachusetts. a senator: thank you. mr. bau

medicare. and the trustees tell us it will be insolvent by 2017. two years earlier than forecast just last year. so those who say you don't have to do anything, just steady as she goes, status quo is fine, are detatched from any financial reality. but the bill before us has significant medicare savings. provisions that lower cost growth without harming beneficiaries. let me just give some examples. in the legislation before us we reduced overpayments to private medicare advantage plans. we reform the health care delivery system. and, by the way, this is the provision that most experts say is the single most important component of this legislation and it's gotten almost no attention in this debate. got almost no attention from the media. reforming the delivery system so instead of paying for procedures, we pay for quality outcomes. and we incentivize those integrated systems, like the mayo clinic, cliec th like the t have much lower costs an highest quality outcomes. we're going to provide major

basic medicare. these companies promise us that when they got involved, they'd show us how to run a health insurance plan. they'd show us how to provide medicare benefited and save us money. some have. but by and large, if i am not mistaken, isn't the jury in -- 14% increase in cost for medicare benefits under this medicare advantage? mr. dodd: in some states it reaches 50% more. mr. durbin: when we talk about saving billions of dollars in the medicare program over the next several years, part of it is by saying to those companies who are overcharging medicare recipients, the party is over. we're going to make sure that every american who qualifies for medicare gets the basic benefits, but we will not allow these private health insurance companies to get a subsidy from the federal government at the expense of medicare and its recipients? mr. dodd: and in charge the other 78 -- and they're charging the other 78% to ge of medicare beneficiaries to get a premium. it is neither medicare nor an advantage.

medicare. the -- 8 tax on this bill and -- attacks on this bill and my amendment has nothing to do with those facts. the sad part is there are ideas on every side of this debate worth considering. i think we should be debating those ideas rather than claiming something that's not true about this bill. these washington tactics of trying to ship health care reform back to some committee to language is exactly why nothing ever gets done around here. the almost unbelievable part of this is the opponents of my amendment say that the health care bill hurts seniors. yet the bill and the amendment is supported by the aarp, alliance for retired americans, center for medicare rights, and the national committee to preserve social security and medicare. what are the opponents of my amendment actually saying that the aarp and other senior advocates don't know what they're doing, mr. president? they know what they're doing and they also know what's in the bill. the aarp has seniors' best interest in mind and

as senator dodd said so frequently on the floor medicare advantage is neither medicare nor an advantage. what i believe and most agree with is it's time for this party to end. these private health insurance companies didn't keep their word and didn't keep their promise. and because of that we're in a situation and predicament where we are asking other people covered by medicare to subsidize the profits of these private health insurance companies. what does it cost every medicare recipient in america to provide this subsidy and profits to these private health insurance companies under medicare advantage? $90 a year on average. so those who are defending the medicare advantage program as we currently know it and don't support the reforms of this bill are also supporting a $90 annual tax on medicare recipients. my fiscally conservative republican friends here who run against taxes every chance they have should reflect on the fact that they are protecting a tax on medicare recipients. that, to me, is indefensible. i'd be happy to yield to the senator from rhode island first. mr. whitehouse:

yes, there are savings in medicare. yes, medicare is going broke. use the savings for medicare. it seems pretty simple to me. one of the things that they're complaining about is the doc fix that we have. we're not paying doctors adequately to be willing to take medicare patients. of course we're not paying them adequately to take medicaid patients either. but we're not paying them right and it would cost $250 billion to fix that. well, if we're talking abou about $464 billion worth of savings in medicare, why not use that $250 billion to fix that problem so we have doctors? i don't care what kind of insurance you've got. i don't care how much you pay for the insurance. if you can't see a doctor, you really don't have insurance. and that's what seniors are being faced with. that's what medicaid people are being faced with. medicaid, well, that's another piece that ought to be maybe a step. because 40% of the doctors won't take medicaid patients because they're not being paid adequately for it. and if you're not paid adequately, you go broke. they're small businesses much they're

, it cuts medicare, cuts medicare. that's what they say. what they don't say is that it does not cut medicare-guaranteed benefits. it doesn't cut benefits. it does reduce the rate of growth that hospitals would otherwise receive. it does reduce the rate of growth that medical device manufacturers might receive. all that is true. so it is true that it is cutting the rate of growth of medicare providers. it is not true that this legislation cuts medicare benefits. that is not true. the other side would like you to believe that's true by using the words they choose, by saying cutting medicare. they want you to believe that's cutting medicare benefits, but it's not cutting medicare benefits. rather, it's -- the underlying bill reduces the rate of growth of government spending on providers, on hospitals, home health, hospice, lots of other providers. that's really what's going on here. don't let anybody fool you, this bill does not cut medicare benefits. it does not. it does reduce the rate of growth of providers. now, why

that medicare money be used for medicare. and that medicare money not be used to fund extraneous things, medicare cuts. then you have to vote for the amendment. will the senator yield for a question? >> i'd be happy to. >> it strikes me to the senator amendment is very straightforward, very simple, and very clear. and that is that any savings that come out of the medicare program cannot be used to fund a new entitlement program. in other words, -- >> if it's not related to seniors. >> correct. to me it seems at least your amendment gets at what some on the other side have argued through their amendments. could the senator from new hampshire describe now the effect, the legal effect, of his amendment differs from say, for example, where it was 101 vote on the amendment, which the impact on the senator from new hampshire's amendment would be relative to the some of the previous votes that we've had. it appears to me they were completely meaningless. short of cover votes to try to get people on the other side the opportunity to

if you are on medicare advantage and their 176,000 medicare beneficiaries on medicare advantage in my state, if this bill is signed under law they will not be able to keep what they have come so there's just no question but what the president can't keep that promise and does not intend to keep the promise. secondly he said on the ninth of september of this year that he will protect medicare, so don't pay any attention to those scary stories about how your benefits will be cut, especially since some of the same folks spreading these tall tales have supported the budget that would essentially turn medicare into a privatized voucher program. i am not going to delineate all of the cuts in medicare. we have been talking about that on the floor for the last several days and i won't repeat what we said but folks, they are going to pay for this bill, they have got to cut medicare. there's just no other way around it and lastly, i want to say on the 15th of june of this year, the president talked about medical liability reform, stating i want to work with the ama so we can scale back the exces

saved medicare. doesn't it seem like an enormous step backwards when we talk about reform, when really what we're doing is cutting a program that serves people so much in need and yet saves money in our medicare program. home health agencies in nebraska have been very successful in doing exactly what we want, keeping people at home and out of the hospital and nursing home. of special interest are patients with congestive heart failure. one nebraska woman turned to home health after facing a big stack of hospital bills for rehab. since then, she has been able to remain at home safely at a fraction of the cost. this home health agency can see a person for 60 days at a cost of about $2,500. 60 days. one hospital admission, by comparison, would cost medicare conservatively $20,000 to treat a patient with chronic health failure -- or chronic heart failure. so, again, home health care costs a fraction of hospital care, about ten times less. there are so many stories from patients who are alive today who lo

i think he understands these medicare savings go into medicare. we're extending the solvency of the medicare trust fund. i see my friend from south dakota. i think he understands. he's sitting there and grinning at me now. i think he understands those savings go back into medicare and extend the solvency of the trust funds. let's make that very clear. second, we're using some of the money to reduce part-b premiums. that helps seniors. if part-b premiums are reduced that helps seniors. by how much? $30 million over ten years. that will reduce seniors' part-b premiums. we're helping seniors, giving more dollars to seniors in this legislation. in addition, there are additional benefits for seniors in this legislation. we're starting to close the doughnut hole. that's really something seniors talk about in prescription drug benefits. they want that doughnut hole closed. after that, we are -- other benefits here, new preventive benefits under medicare. mammograms, preventive screening, colonoscopies, annual wellness visits, all new benefits. so i want

so no longer do we have a medicare tax for the medicare trust fund. we have a medicare tax that funds the medicare trust fund plus other programs. i would say to my colleagues, i think we want a lot of the same things. how we go about it, the senator from montana recognized the fact that we're going to increase payments to primary care physicians. ask yourself the question why only one in 50 doctors last year who graduated from medical school is going into primary care? why do you think that is? could it be that the government who is setting the payment rates created a maldistribution in remuneration to primary care physicians? therefore, they choose to go where they can make 200% more over their lifetime by spending one additional year in residency rather than doing primary care. and what this bill does and what the senator from arizona is trying to do by sending this bill back is to refocus it on the fact that medicare money ought to be used for medicare. and if in fact we're going to slow the growth of medicare, can we do that without cutting benef

expand medicaid, and if the medicare reports are true, expanding medicare as well. so the end result is to harm medicare patients as we expand medicaid. now, alaska is a little bit unique. we are one of two states where medicaid is actually a better payer or better in terms of the reimbursements than medicare, but even still the economists that we have at the university of alaska, the institute for social and economic research, the economists have said that medicare patients will lose access, and as they have suggested kind of go to the back of the bus if we expand medicare. and i -- i want to -- i want to use their language specifically. this is from the -- the analysts at iser. he has stated that we can continue to be concerned that the newly enrolled through the medicaid expansion and the new exchange will create a big surge in demand that could easily create a traffic jam in the health care system and send the medicare beneficiaries to the back of the line in alaska due to medicare's low briewrmt rate -- low reimbursement rate. so expanding medicaid is bad for a

so no longer do we have a medicare tax for the medicare trust fund, we have a medicare tax that funds medicare trust fund plus other programs. i would say to my colleagues, i think we want a lot of the same things. how we go about it, the senator from montana recognized the fact that we are going to increase payments to primary care physicians. ask yourself the question why only one in 50 doctors last year who graduated from medical school is going into primary care. why do you think that is lax could it be that the government who is setting the payment rates created a maldistribution in butyrate into primary care physicians. therefore, they choose to go where they can make 200% more over their lifetime by spending one additional year and residency rather than doing primary care. and what this bill does, and what the senator from arizona is trying to do by sending this bill back is to refocus it on the fact that medicare money out to be used for medicare. and if in fact we're going to slow the growth of medicare, can we do that without cutting benefits? and to slow the growth in this

if you look at the law there's medicare-a, medicare-b, medicare-c, medicare-d. they're all a law.t is guaranteed under the law is that if you want medicare advantage, srubg it. what's going to change is we're going to take away that guarantee. we're going to modify medicare part-c, which is medicare advantage. so we have this confusing state to say we're not taking away any of your guaranteed benefits, but medicare advantage is guaranteed to anybody who wants to sign up for it. it is duplicitous to say we're not cutting your benefits when in fact we are. i'll yield to my colleague, an orthopedic surgeon from wyoming. what is good about medicare advantage? we hear it's a money pot to pay for a new program for other people. here's what's good about it: as we get coordinated care for poor medicare folks, medicare advantage coordinates the care. and when you coordinate care, what you do is you decrease the number of tests. you prevent hospitalizations. you get better outcomes. and consequently, you have healthier seniors. so when it's really looked at, medicare advantage doesn't cost

medicare advantage is medicare part-c. we've had a kind of a differential made that it wasn't really medicare. it is medicare. and 20% of the people in this country that are on medicare are on medicare part-c, medicare advantage, and they like it. and why do they like it? because most of them don't have enough money to buy a supplemental medicare policy to cover the costs that are associated with deductibles and co-pays and outliars. and so -- and outliars. so as we -- i agree with the chairman. i agree that medicare advantage is overpaid. i disagree with the way you're going about getting there. but i also disagree taking any of the money that is now being spent on medicare part-c and creating another program. i think all that money ought to be put back into the longevity of medicare. and in case you don't understand how impactful that is, we -- we now owe just in the next 75 years -- actually, we don't owe it. none of the senators sitting here will be around. our kids are going to pay back back $44 trillion in money for

said it cut long materil costs in medicare, said it saved medicare. said it saved a trillion dollars over the first ten years for states, and the early estimate -- because we couldn't get the commitment that was made to us by the chairman of the "help" committee that he would score the bill -- the bill didn't ever get scored by c.b.o. but outside score says it saves at least $10 billion the first year and covered more people than this bill, saves personal choice. doesn't put somebody between you and your doctor. i heard the senator from rhode island say we were lying about that happening. ist hang today both from insurance companies and medicare and medicaid. so if we really wanted to reform health care, weefd be attacking that. -- we'd be attacking that. and instead we're going to make it worse and let me tell you how we're going to make it worse. we're going to use cost comparative analysis, which is exactly what the u.s. task force on prevention services did. they used cost comparative effectiveness, and when they looked at breast cancer, they said

medicare program. but this bill also imposes $500 billion in new tacks. these are -- in new taxes. these are taxes that hit every american and virtually every business and health care-related businesses. these taxes will discourage investment and hiring. we are in one of the worst economic downturns in the history of our country. we don't need to tell anybody that. we're all feeling it. we know people who are really suffering right now. i look at what has been done in the past when we've had economic downturns, and i look at president kennedy, president reagan, president bush. they lowered taxes. and what happened? the economy was spurred. lower taxes are proven to spur the economy. and yet, in this bill we see $500 billion in new taxes on families and small businesses. let's walk through some of these taxes. employer taxes, $28 billion in new taxes is imposed on businesses that don't provide health insurance to their employees. and to avoid the tax, an employer has to provide the right kind of insuran

we extend the life of medicare. so here we are in a situation where many women are delaying going to the doctor, getting their preventive services. and the mikulski amendment addresses this critical issue. it requires that all health plans covers comprehensive women's preventive care and screenings and cover these at little or no cost. now, the reason this is so important that, first of all, in the "help" committee, under senator dodd's and senator kennedy's leadership, we knew that this piece of the package was in the bill because senator mikulski and others pushed so hard to get it placed into the bill. and i'd ask my friend in maryland, i would ask senator mikulski if i could complete my remarks and then give the floor over to her. thank you. i'm so proud to work with senator mikulski. i wanted to say, senator, that we worked on this over the years. i just asked my staff to go back and look at the first time we teamed up to ensure that women get mammograms at age 40, and that was in 1994. and then again over the

but more importantly, if you look at the law, there's medicare a, medicare b, medicare c, medicare d. all law. they're all law. and what is guaranteed under the law today is that if you want medicare advantage, you can have it. and what's going to change is we're going to take away that guarantee. we're going to, we're going to modify medicare part c which is medicare advantage. so we have this confusing state to say we're not taking away any of your guaranteed benefits, but in fact under the current law today medicare advantage is guaranteed to anybody who wants to sign up for it. so it's due due policous at best. let me just speak to my experience is what is good about medicare advantage? we hear it's a money pot to pay for a new program for other people, here's what's good about it. we get coordinated care for poor medicare folks. medicare advantage coordinates the care, and when you coordinate care, what you do is you decrease the number of tests, you prevent hospitalizations, you get better outcomes, and consequently you have healthier seniors. so when it's really looked at, medi

pressure on medicare. that is somewhat true but the congressional budget office did a study six or eight months ago that showed it is about 70% of the additional cost of medicare trust fund is due to cost increases, not due to more baby boomers retiring when they reach the age of 65. now, what are some of the groups that say about this legislation? let me say what aarp says. they have a chart here which indicates what the american association of retired people says about the underlying bill. now, they were cutting medicare like the other side says you think they would not like this bill. you would think they would have problems with it. aarp has not totally endorse this bill but they don't have problems with that because they know we are doing the right thing but what did they say? proponents of health care reform will not rest. they are using misinformation to distort the truth and wrongly suggesting medicare be harmed after a lifetime of hard work, don't seniors deserve better? that is what are says, ref

medicare reform for not medicare services. but that's exactly what we're doing. now to my democratic colleagues, there will come a day when republicans and democrats will have to sit down and seriously deal with the underfunding of medicare, with the impending bankruptcy of medicare. everything that we're doing in this bill may make sense to save medicare from bankruptcy. it doesn't make sense to pay for another government-run health care program outside of medicare. it makes no sense to take the savings that we're trying to find in medicare and not use them to save medicare from what i think is going to be a budget disaster. so let it be said that this attempt to pay for health care, to make it revenue neutral, will require the congress to do something with medicare that has never been done before and it's not going to do in the future. so the whole concept is going to fall like a house of cards. the way we tried to pay for this bill has got so many gimmicks in it, it would make an enron accountant blush. now, as to tort refo

i'd rather have a medicare-type plan. and i think poll after poll suctsuggests that the american people want that public option much so that's point number one. freedom of choice. people should have that choice. if they don't want it, that's fine. point number two may be even more important. if we're going to get a handle on exploding health care costs, somebody is going to have to rein in the private insurance companies whose only function in life is to make as much money as they possibly can. we need a nonprofit government-run public plan to do that. and if we do not have that in this bill, i am not sure how you're going to get any handle on cost containment. so i will fight to make sure that we have a strong -- as strong a public option as we possibly can. as i have said publicly many times, my vote for this legislation is not at all certain. i have a lot of problems with this bill. and we've got to have at least, among other things, a strong public option. let me tell you something else that i think we have got to add

medicare benefits and protect access to medicare providers. we voted 100-0 on a bipartisan fashion to make sure that we protect the medicare program. that's the way it should be and that's the way the senate voted. the presiding officer: under the previous order, the leadership time is reserved. under the previous order, the senate will resume consideration of h.r. 3590 which the clerk will report. the clerk: h.r. 3590, an act to amend the internal revenue code of 1986 to modify the first-time home buyers credit in cases of the members of the armed forces and certain other federal employees and for other purposes. the presiding officer: under the previous order, the time until 3:15 p.m. will be for debate with respect to amendment numbered 2905 offered by the senator from arkansas, mrs. lincoln, and the amendment offered by the senator from nevada, mr. ensign, with the time divided with 10 minutes each, with the majority controlling the first 60 minutes and the republicans controlling the next 60 minutes. mr. nelson: mr. president? the presidi

the money for medicare has to go to medicare. but we're going to take money from medicare.d i say if we've got that money that we can take from medicare, we ought to put it to medicare, and only to medicare until we have the medicare problem solved. our seniors are relying on that. so don't be caught up by the little words in do-nothing amendments that say the money for medicare is going to go to medicare. what we want to see is that the money from medicare goes only to medicare. it's a very important part. mr. baucus: will the senator yield on that point? mr. enzi: i'm on my time limit here. mr. baucus: how much time remains on our side, mr. president? the presiding officer: there are 12 minutes remaining on the majority side and 14 minutes remaining on the republican side. mr. baucus: i'll take two minutes, our side, to ask a question. the presiding officer: does the senator from wyoming wish to yield time for a question? mr. enzi: it's my understanding that the senator from montana is willing to take his time for the question. mr. baucus: correct. the presiding officer:

and how that was ruining medicare, well, we're faced now with $464 billion out of medicare, and so we think that they've talked out of both sides of their mouth in the sense that four years ago medicare would be hurt if $10 billion was taken out. well, surely if $464 billion is taken out, it's hurting medicare. i rise not to take on the senate whip -- majority whip at this point, but i rise because we keep hearing from the other side about how premiums are going to go down and i've referred in previous remarks in this past week to a letter sent to senator bayh that provides a very comprehensive analysis of what health insurance premiums look like as a result of this reid bill now before us. and that reminds me of one other thing that the senate majority whip just said; that we want to delay action on this bill. well, what we would really like to have is have 99 senators have the time to consider what's in this 2,074-page bill when you got to remember that the -- in the secrecy of the senate leader's office, senator reid's office, from october 2 until about the saturday before thanksgi

implemented, it cuts over a trillion dollars out of medicare. in the first ten years, years, $135 billion out of hospitals. $120 billion as i said earlier out of medicare advantage.

medicare.none of the people that will get this benefit have paid into the hospital truffs -- trust fund which is what funds medicare. i -- if there are going to be reductions in medicare, shouldn't it be to make medicare more solvent? >> one would think so. there are two doctors in the united states senate. there are lots of lawyers. there are two doctors. both have had hands-on experience. i don't know if doctor brasso has seen "the new york times", another one of my favorite sources of news and entertainment. on the front page this morm morning, home health care worries over proposed cuts. the purpose of reform, i understand by the other side, is to reduce health care costs. is there a way to reduce health care costs better than treating people at home than instead of in a hospital. i'm curious about your experience. >> as the senator from arizona knows, i've treated patients in wyoming for 25 years, and the story in the "the new york times" was a wonderful picture of bertha milliard, a 94-ye

it doesn't just apply to medicare and medicaid. it applies to your choice of your private insurance. the government's going to ration your care. and we know that's true because they wouldn't allow an amendment to prohibit rationing and they all voted against the amendments in committees when we offered amendments to limit rationing. so we know the intention is to ration care. and if that's what -- if that's how we're going to control costs, then bernie sanders is right, just go to a single-payer, government-run system. bernie sanders' system is far better than this one. far better than this one. if that's what we're going to do, if we're going to ration care to control costs, let's let everybody know upfront. let's be absolutely honest about it. if you're 75 years of age and you need a hip replacement but the quality of your life is not all that great, we're going to say you can't have it. that's what we're going to do because that's exactly what they do in england. they have the national institute of comparative effectiveness and

medicare dsh. section 1886(r)(2)(b) of the social security act, as added by section 3133, is amended- (1) in clause (i)- (a) in the matter preceding subclause (i), by striking "(divided by 100)"; (b) in subclause (i), by striking "2012" and inserting "2013"; (c) in subclause (ii), by striking the period at the end and inserting a comma; and (d) by adding at the end the following flush matter: "minus 1.5 percentage points.". (2) in clause (ii)- (a) in the matter preceding subclause (i), by striking "(divided by 100)"; (b) in subclause (i), by striking "2012" and inserting "2013"; (c) in subclause (ii), by striking the period at the end and inserting a comma; and (d) by adding at the end the following flush matter: "and, for each of 2018 and 2019, minus 1.5 percentage points.". sec. 10317. revisions to extension of section 508 hospital provisions. section 3137(a) is amended to read as follows: "(a) extension.- "(1) in general.-subsection (a) of section 106 of division b of the tax relief and health c

walls not a medicare program -- that medicare advantage was not a medicare program. well, that's apparently news to the department of health and -- well, that's apparently news to the department of health and human services that states on its web site in words as plain as the alphabet -- quote: "medicare advantage plans are part of the medicare program." according to the department of health and human services, medicare advantage's plan are part of the medicare program. and it's news to the millions of american seniors who depend on this popular program for their care. at the moment, medicare advantage has nearly 11 million enrollees. looking at it another way, that is one-fourth of all medicare beneficiaries. one-fourth of medicare beneficiaries are on medicare advantage. and in recent years this program has proven to be particularly popular with seniors in rural areas who would otherwise have limbed access to care -- limited access to care. seniors have shown that they want this plan. they like it. and i dare say that if you had asked seniors earlier this year what

medicare was created. it wasn't the medicare we know today. it didn't reach the disabled. it didn't provide some of the basic services that many seniors now desperately need, and it didn't cover prescription drugs, but it was a start. it was a critical decision made to move forward. the same republican party that objected to the creation of medicare has been critical of the program ever since. they have argued that it is wasteful, that it's doomed, that it should be allowed to wither on the vine -- that was actually a quote from a leading republican not that long ago -- and they suggested there was a better way. let's privatize medicare. they love the notion of privatizing -- get government out of the picture. and they came up with this theory with the health insurance industry of something called medicare advantage. this was where those flinty-eyed entrepreneurs would teach government a lesson. they would offer the benefits of medicare and show how to do it at a lower cost. we accepted their challenge and gave them their opportunity and what we found was they failed. oh,

third, medicare cuts. we have been talking a lot about medicare cuts, and my colleagues on the other side say well, we -- we really don't think that the medicare cuts the -- cuts are the way you describe them. seniors are still going to have access to doctors and so on. this report is devastating and blowing a hole in that argument. let me just quote a couple of the things that they say. providers for whom medicare constitutes a substantive portion of their business can find it difficult to remain profitable, and absent legislative intervention might end their participation in the program, possibly jeopardizing access to care for beneficiaries. now, this is what we have been predicting. if you -- if you impose extra costs and mandates on the people who are providing the care, whether it be the hospitals, the physicians, home health care, if you're taxing something like medical devices, all of those impose costs on the people who are providing these medical benefits. and what the c.m.s. actuary is saying he

of medicare. it's going to give free physicals, once-a-year checkups and colonoscopies and mammograms for people in medicare and it's going to close the doughnut hole so more -- so fewer people will have to pay so much out of pocket. last letter, mr. president, raymond from delaware county, my wife and i had to drop our coverage because it costs $30,000 a year. the country needs reform that bars insurance companies from denying coverage or charging higher premiums on the basis of preexisting conditions. health reform is the right solution for the people of ohio. raymond from central ohio. okay, thank you, mr. president. a senator: mr. president? the presiding officer: the senator from wyoming. mr. barrasso: mr. president, i just heard my colleague, the senator from ohio, said "i wish some of my colleagues on the other side of the aisle would understand families that don't have insurance." mr. president, i practiced medicine for 25 years taking care of families in the state of wyoming. mr. presiden

model for improving medicare. are you impressed by what they are talking about? >> i am not sure what you are referring to. we don't know what they're doing. i try to get details and the democratic folks said we can't give you any details. we don't know either. there is some discussion about the fact that there is a trigger which would take us to public plan very soon after re-enactment of the bill. one report was unknown and there is an article in the newspaper quoting harry reid as saying that is not true. we are not for something like that. i have no idea what the proposed action will do. i will take a look at it. >> this is reminiscent of the health education labor and pension committee. republicans had no input whatsoever to go over a period of two weeks thrust on us to do amendment. they wrote it so fast we had to do technical corrections. we proof read the bill. there were some amendments that were good. until we had finished voting on it and they went to print the bill and talking to a single senator and t

to shore up medicare. it's financially not sustainable. we all know that, so what are we doing? we're putting nearly nearly $500 billion out of a program that does not have sufficient funds to deal with the influx of the baby boom generation, much less with the costs that it is now incurring. it is fiscally irresponsible to raid medicare to pay for a new entitlement program. i would be happy to yield. a senator: i have heard some of our colleagues say that these draconian medicare cuts will actually lead to the closure of some rural hospitals. mr. mcconnell: i'm wondering if the senator from maine thinks that may even be possible given the magnitude of these medicare cuts that we're hearing complaints about all across america? ms. collins: mr. president, the minority leader brings up a very good point. the republican leader i know is familiar with the analysis that was done by medicare's own actuary that says that one out of five hospitals -- and these are likely to be the small rural hospitals that are so

do with medicare. yet, they start a new commission to figure out where to make additional medicare cuts in order to keep the system going. doesn't that seem counterproductive? after limiting where the cuts can come from because of hidden deals to get support for the bill. whatever we do has to reduce costs for all individuals and be deficit-neutral. it has to truly be paid for. why does it have to be paid for? because america is going broke. we've maxed out the credit cards. now we're driving down the value of our money. we have to use honest costs, not gimmicks like the doc fix delay or collecting revenues before the benefits kick in and showing years of revenue for a shorter-time benefit. what ways can the government pay for anything? unfortunately, they can cut benefits, cut payments to doctors and other providers, increase taxes or cut waste, fraud and abuse. which government seldom does and even more seldom does effectively or more honestly allow a checkoff for donations to other people's insuranc

in 1965 we passed medicare, medicaid came afterwards. they opposed it. they opposed medicare. one of the most important programs in thawing united states of america that lifted countless numbers of seniors out of poverty. they said no to read the insurance industry survived, medicare and medicaid. they are doing very well. according to cbo, the gross cost the manager's amendment is over the next ten years $871 billion less than the trillion dollars we started with in our committee, but it buys a lot. and i will talk at some time perhaps tomorrow or afterwards about what this bill provides an addition, but i think it is critical for people to follow the truth here, to look for the facts and measure the reality of the positive ways which this legislation will change -- will provide additional help to seniors, reduce premiums for many americans, help people for coverage who don't have it today, spread risk throughout the system more effectively, will prove care and delivery within the hospitals, prevent people from being denied insurance if they have a pre-existing condition, pre

the senator just mentioned medicare advantage. that's called medicare part c. of the senator well knows. that's part of the medicare system and there are arguments that are made that are enormous savings over time because the seniors who have this program have it violated any law who have chosen it are more well and have better health over time thereby in the long run saving significant -- making significant savings in the health care system, which is what this is supposed to be all about. and so i just ask in response, how would the world to take a medicare system which according to the trustees is going broke and then expand it to people between age 55 and 64. the math doesn't work i say to the senator from illinois. it doesn't work under the present system which is going broke to add onto it on the witch and a medical expert will tell you results in adverse selection and therefore increases in health care costs. >> if i could respond first. why is medicare facing insolvency? why is it going broke? where the other systems facing the increased cost of health c

it strengthens medicare. it provides tax incentives to small business so they can begin to cover their employees. most small businesses want to do that. i think this legislation is important when you look at the insurance reform. immediately going into effect next year when the president signs it is no longer allowing a child to be... a child with a pre-existing condition to lose the insurance for the family. i mean we're going to prohibit that. no more discrimination between where women pay more for the same policy as a man has. no more lifetime limits where someone gets sick and their health care costs are so high that the insurance company cuts them off. and in terms of medicare we're going to be giving annual check-ups, close the donut hole so seniors won't pay so much out of pocket for prescription drugs and this for the first time unlike the 2003 drug company insurance company bill that president bush pushed through, this bill actually lengthens the life expectancy of medicare. the deals notwithstanding

and then you had people on medicare asking how the cuts in medicare would affect their treatment and their care. and then you had small business people who are scared to death of having more burdens, more taxes, more mandates on small business when they're almost screaming into the phone. but don't people realize how hard it is to make ends meet right now for small business? don't -- don't you all realize that we are trying to stay afloat while we are in one of the worst recessions of our lifetimes? and, of course, i assured them that i do understand that. that's why i am trying to amend this bill, trying to change it, trying to encourage my colleagues on the other side of the aisle that we really should start over, that we should start over and try to have a health care reform bill that does three basic things. we want a health care reform bill that actually lowers the cost of health care. right now, the bill before us will increase the cost of health care. the -- the cost of the bill that is before us today, if you start when the bill takes effect, eff, which is 2014 and you go ten

back in the 1997 period there were changes made in medicare reimbursements for medicare advantage thattually ensured there would be no access to medicare advantage here in michigan. in 2000 a bipartisan group of members stepped up and put more resources back into the program. and indeed, the floor in michigan is higher than it is in 100%. substantially higher because it is a relatively low medicare payment rate. so when you hear stories and discussions about medicare payments, medicare advantage payments being at a fairly high level, michigan is one of those states because of the legislation that resources were put back to recognize the underfunding that occurs in medicare. and michigan is one of the states that stands to lose medicare as and hedge participation because of the draconian nature of the cutbacks that are proposed both in the house and the senate. so we offered in terms of offering a very aggressive path but sustainable path to make sure we were taking responsibility to participate in the cost containment discussions but not so much that would take choices a week. so i'm g

how do we improve medicare? this creates some incentives to move forward on some innovation within our medicare system. when you look at the small business end of it, the package improves -- improvements include starting the health insurance tax credit in 2010. almost $40 billion of tax credits and tax savings to small business will be available. transparency. new requirements will ensure that insurers and health care providers report on their performance, empowering patients to make the best possible choice. this one -- the next issue, multistate options. this is actually something during my campaign i talked a lot about. a program that we all have here in congress and so do almost four million federal employees have. when you include their dependents on, say, a million. how do we replicate that to give a benefit to the taxpayers of this country so if they wanted to access something similar? now we have the multistate option. health insurance carriers will offer plans under the supervision of the office of pers

medicare isn't the way to do it.as a matter of fact, i heard our colleagues talk, we've had eight votes since last saturday. we're ready to vote. this is a 2,074-page vote. i've got 15 amendments in the queue. i want to vote on them. they don't want to vote because they don't want the american people to hear all of the bad things about what's going to happen to their health care if this bill passes. and if we do medicare, what's going to happen is medicare costs are going to skyrocket but access to going to go down. mr. mccain: parntsly, i'd ask my colleague from tennessee, we don't know what we'd be voting on, because there's been a whole rewrite of this health care reform here after a year and we don't even know what the provisions of that bill are, except what has been leaked and apparently my colleagues on the other side of the aisle, with the exception of the majority leader, don't know what it is either. mr. coburn: but the senator, if he would yield, there are some things we could vote on. president obama outl

we've cut $465 billion out of medicare or moved it out of medicare to create a new program, and we're going to add 34 million new americans to it in a plan tha*s that has already mortgaged the few -- faln -- a mortgaged the few -- faln -- a >> the other thing that the chairman said is that costs and health care will go down. and that premiums will go down. well, there is 11 out of 12 people who have studied the plan that says premiums will rise. and what cbo says is that if you're in the individual market, your premiums are going to go up anywhere from 10 to 13%. and in fact, they're not sure whether premiums will decline. they say it's on the other groups from a 1% increase to a 2% decrease over what they already would have increased. so our problem with health care is cost. that's the thing that stops access to health care in this country. and the plan, whether it's the new plan which nobody has gotten to see the details of, or the plan that we have seen the details of, the 2074 pages, and that we have seen the details of, raises costs of health care in this country. but none of tha

within medicare, cutting medicare, saves money. it puts more money in the pot, but it's part of the medicare trust fund pot. that savings, it is said, well, we will just spend it over here and pay for this new health care program that just was voted on earlier today. so we're going to take this saving and increased revenue to medicare and we're going to spend it over here. and this is a chart i just put together to try to show that. so here's medicare. you raise medicare incomes and you -- you cut their costs and you create an extra surplus. we've got some surplus still in medicare. if we don't do something about it, medicare will be in deficit in 2017, eight years. so this transfer of money then goes to the united states treasury, and we have got extra money. let's spend it on a new health care reform, never before been passed, creating benefits for people who never received this kind of benefits before because we want to be helpful to those people and create more insured people in america. but as the c.b.o. said, you can't count

there are seniors who depend upon medicare and medicare advantage, and the reason they call it medicareadvantage is because there are advantages to being in it. it coordinates care, it helps with preventative care, which isn't part of the routine, the regular medicare program. i just heard my colleague from arizona say that there are those who want to shut down medicare advantage, aarp, he said, because they are the ones to benefit and profit if, in fact, medicare advantage is lost to the seniors of this country. 11 million americans depend on medicare advantage, and yet they are losing that as a vote that this body took. this body voted to strip strip $120 billion away from our folks who depend upon medicare advantage. and i know the senator from arizona has another important point he wants to make. mr. mccain: the point i want to make, i -- this -- this has turned -- this process has turned into something, again, like i have never seen before. i was just handed this fox news just reported breaking news that harkin said -- i guess referring to the senator from iowa, senator harkin said