but it's also historic because there is another endorsement, despite the american medical association. that's very important to me. the american medical association is not pose an legislation, but rather supports it. and they're supporting it in a way where once to keep working with the senate on issues that concern. he mentions the payment for

but it's also historic because there is another endorsement, despite the american medical association. that's very important to me. the american medical association is not pose an legislation, but rather supports it. and they're supporting it in a way where once to keep working with the senate on issues that concern. he mentions the payment for doctors. dr. wilson also mentioned the medicare commission. that attitude of saying yes, this is good, it's good for the country, but also yes you want to keep working with you if that attitude of working together, trying to find a common solution, which mean so much to me and not found regrettably in the senate for the last several weeks. but you are groups that are not part of the senate, outside who want to do the right thing. this is especially important to your endorsement for doctors. after all, it is doctors to spend more time with patients than any other group. they know what's needed. they know problems of the insurance companies denying payments. they know it's wrong that a person can't get insurance coverage because of a preexisting

i welcome the support of the american medical association. rica's doctors have sized up are broken health care system and their prescription for a cure is to pass the patient protection and affordable care act. i want to emphasize that this bill will enhance the doctor- patient relationship in many ways. for example, by cracking down on health insurance company abuses, we will reduce the opportunities for "corporate bureaucrats to come between the doctor and the patients. this bill will reduce administrative requirements and paperwork, freeing up doctors to practice medicine and focus on their positions rather than on paper work. this bill will significantly increase the number of primary care doctors, especially in rural areas and other underserved communities. we do this by greatly expanding the presence of community health centers and increasing investment in the national health services. we create a rural health care professional pipeline which gives increased training opportunities to help professionals working in rural areas. i cannot em

now maybe it's hard for them, but it's not hard for the american medical association, the ama who was endorsed our bill. it's not hard for the american heart association who have endorsed our bill. it's not hard for the american cancer society action network who have endorsed our bill. the american hospital association who have endorsed our bill, families u.s.a., the business roundtable, the small-business majority. we hear colleagues a small business opposes our bill. the small-business majority organization supports it and how about the aarp who represent our seniors? millions of seniors. that's just a few. they not only defend our bill, they support our bill. madam president, this is a deed an important moment in our nation's history as we approach a final vote on this major health care reform legislation. and i think whenever you're trying to change something, you have to take a look at how things are at the moment. so why is it that we need to change our current system? and there is certain numbers here that i think explain it. the first number is 14,000. madam president, we know

it is also a strike because there is another endorsement by the medical -- american medical associationry important to me that the american medical association is not opposing the legislation. rather, it supports it. and a word wants to keep working with the senate on issues that concern them. they mentioned payment physicians to doctors -- payment to doctors. it is that attitude of saying yes, this is good, this is good for the country, but also we want to keep working with you. is that attitude of working together to try to find a common solution which means so much to me and is not found, regrettably, in the senate in the last several weeks. but here are groups that are not part of the senate and who want to do the right thing. it is especially important to hear endorsement from doctors. how strong, it is doctors to spend more time with patients than any other groups. they know what is needed. they know the problems of insurance companies denying payment. they know it is wrong that a person cannot get insurance coverage because of a pre- existing condition. they also know that it is

he relies on the american medical association, the american medical association that today represents less than 10% of the active practice and doctors in this country. he relies on aarp who has 40 million membership but is the fifth largest revenue receiver from supplemental policies. that is who he relies on. the fact is as he doesn't have the experience of being in the trough of caring for patients. let me tell you what's been to happen to medicare advantage patients. the censure would not yield i have no intention of yielding to him. >> i was ready to deal on your time. >> the center would not healed by will continue my top. >> medicare advantage patience there's no question i've agreed with the chairman of the finance committee the competitive bidding needs to happen. but there's one thing that happened on the way to the bank but there's going to be decrease in benefits, not only decrease in what we pay for their spring to be decreasing benefits. and where will that impact the most importantly felch? notte the ruben areas. it's not when to be felt in the urban areas. it's going to

that's why it's interesting to see that today the american medical association, the nation's doctors, the people who take care of you when you're ill, the ones who follow your progress when you have maybe a debilitating disease or a lifetime health challenge, your doctor, the voice of your doctor, not any members of the senate, the voice of your doctor said this in support of this historic reform. they said -- quote -- "this is a time of great opportunity for the american health care system. we have the chance to substantially expand health insurance coverage, implement insurance market reforms that promote greater choice, affordability and security, improve -- this is the doctor speaking. improve the quality of the care and help americans live longer, healthier, happier and more productive lives. to that end, the doctors of the nation say we urge all senators to support passage of the patient protection and affordable care act as amended. this is the nation's doctors. this is your doctor who's telling the members of the senate vote for it. they're not, they don't believe the line abo

i welcome the support of the american medical association. h care system and their prescription for a cure is to pass the patient protection and affordable care act. specifically with regard to doctors, i want to emphasize that this bill will enhance the doctor patient relationship in many ways. for example, by cracking down on health insurance company abuses, we're goingç to reduce -- reduce the opportunities for corporate bureaucrats to come between the doctors and the doctor's patient. this bill will reduce administrative requirements and paperwork, freeing up doctors to practice medicine and toç focus on their patients rather than on paper work. this bill will significantly increase the number of primary care doctors, especially in underserved communities. we do this by greatly expanding the presence of community health centers and increasing investments in the national health service corps. we also createÑo a rural health professional pipeline. i cannot emphasize enough how revolutionary it is going toç e mto trat system to to help car

that is the american medical association. south arb and the american medical association and others no senior will see a single reduction in their guaranteed medical benefits under this bill, not a single one. i might also say that this bill would reduce premiums that seniors may have otherwise stayed. much of the savings to seniors comes from limiting massive over payments to private insurers as private companies like medicare advantage. small pointier, seniors to the word mccarrick antigen they tend to think it is medicare. it is not. those are private companies. their private companies and they are basically enhanced under the 2003 medicare part d legislation, they are given a lot more money and encouraged to less competition rural areas. it turned out that we gave them way to much additional money and they know it. and this legislation is trying to cut back on the access that they are provided back in your 2003. i would say the cut is about $118 billion over ten years. i don't have with me how much is remaining but at 5% f

questions that need to be -- not only is the oppose significance from the mayo clinic but the american medical associationand the american hospital association have come out steadfastly against. i quote from this editorial. here we are going out for the weekend, and the editorial for "the washington post" says, "presumably, the expanded medicare program would pay medicare rates to providers, raising the question of the spillover effects on a health care system already stressed by a dramatic expansion of medicaid. will providers cut costs or will they shift them to private insurers, driving up premiums? will they stop take medicare patients or go to congress demanding higher rates? once 5-year-olds are in -- once 55-year-olds are in, they're not likely to be kicked out and the pressure will be on to expand the program to make more people eligible. the irony of this late-breaking medicare proposal is that it could be a bigger step toward a single-payer system than the multipublic option plans rejected by senate moderates as too disruptive of the private market." mr. alexander: -- mr. coburn: i would answer

he relies on the american medical association, the american medical association that today represents less than 10% of the active practicing doctors in this country. he relies on aarp who has 40 million in membership but is the fifth largest revenue receiver from supplemental policies. that's who he relies on. the fact is he doesn't have the experience of being in the trough, caring for patients. now, let me tell you what's going to happen to medicare advantage patients. the senator would not yield to me. i have no intention of yielding to him. mr. kerry: no, i was ready to yield on your time. mr. coburn: the senator would not yield. i will continue my talk. medicare advantage patients, there's no question i have agreed with the chairman of the finance committee that competitive bidding needs to happen, but there is one little thing that happened on the way to the bank. is that there is going to be a decrease in benefits. not only a decrease in what we pay for them, but there is going to be a decrease in benefits. and where will that impact be most importantly felt? not in the urban a

the american medical association joined tay in supporting the sene version after refung to back the house bill. meanwhile, rd said talk about a conference w premature. >> we have to pass thibill in the senate first. that is our direction. that is our guidinlight. we'll rry about next steps a later time. >> repter: the next step in the path to passing a bill cometomorrow morning when the senate will ta another procedural vote. >> ifill: we have our n dete on the mer is of the senate bill and what it migh take to get a fil bill to the president's desk. sherd brown is a democrat from ohio and is a memr of thsenate's health committee and lisey graham is a republican from sout carolina. he's a member of the senate' dget committee. gentlemen, we just hea ben nelson, thfamously sought-off senator om nebraska, say this weend that this is not about whether the heth care system gets fixed but the wa you fithe health care syst. so was this, as rry reid put it today, e grand compromise of the senate or w it just back room dealing at its worst? senator brow >> it was a good comomise. i n't like some o

a 2005 survey in the journal of the american medical association found that 93% of physicians reported practicing defensive medicine costing the health care system $200 billion annually. so we clearly need to reform the tort system and not in the form of some sense of the senate, but in the way of something real. it seems to me that the ensign amendment begins that process by saying let's at least allow the injured plaintiffs in these cases to keep more of the award that is granted to them and have less of that go to the lawyers that bring the cases. surely it is an adequate incentive that they receive about $1 million out of a $4 million lawsuit. again i want to thank my colleagues from michigan and new jersey for their courtesy in allowing me to speak. the presiding officer: the senator from new jersey. mr. lautenberg: i rise to speak in support of the amendment that's proposed by senator lincoln from arkansas, and i thank her for an excellent idea. i want to say at the outset that before i came to the united states senate, i was a founder and the c.e.o. of a major new york stock exc

and that's why you're seeing the american medical association, american hospital association come out against this proposal on medicare expansion. that alone with the idea on how on earth would it ever be paid for when the program already is not on a stable financial track. the federation of american hospitals stated this: "the f.a.a. is strongly opposed to this proposal. a medicare buy-in would involve medicare rates, would be controlled by c.m.s. and crowd out older workers with private coverage who may choose early retirement as a result. such a policy will further negatively impact hospitals." my rural state in particular would have a huge negative impact on a number of rural hospitals in my state. mr. president, i yield the floor. the presiding officer: the senator from illinois. mr. durbin: is there a unanimous consent or order of business at the moment? the presiding officer: there is not. mr. durbin: mr. president, i rise to speak as if in morning business. i would like to say at the outset that i respect very much my colleague from the state of kansas. he and i have worked on

the president said, "i want to work with the american medical association so we can scale back the excessive defensive medicine that reinforces our current system and shift to a system where we are providing better care simply rather than simply more treatment. so this is going to be a priority for me." well, if this is a priority for the president of the united states, it's apparently not a priority of those who've authored this bill, because all that's contained in this bill is a nonbinding sense of the sena senate. we've heard that medical liability reform laws like those that have been passed and implemented in texas, if passed nationwide in this health care reform bill could bend the cost durvcostcurve by $54 billion ovn years. and yet all we get is a watered-down sense of the senate that has no binding effect at all. mr. president, if the president was sincere about making those promises to the american people, then this congress ought to be sincere about helping him keep that promise. and the fact of the matter is, time after time after time after time again, this bill breaks the prom

that's why the american medical association supports the bill. this bill will help the medicare population much it strengthens medicare, as i pointed before. that's why the aarp supports it. it will provide annual physicals for our seniors. this bill is important for our business owners an will no longer be discriminated by paying 20% more than the comparable large companies pay for an insurance product. mr. president, this bill is good for marylanders. it's -- it's good for every american. it moves us toward universal coverage. the bill is not perfect. there are things -- i'm disappointed by some of the things that are in the bill, some of the things that didn't make it into the bill. but, mr. president, this bill establishes the framework for universal, afordable quality care for every american. it speaks to the values of our nation. i'm proud to support this legislation and i know that we will look back that the day as being one of the bright moments for america where we said to the people of our nation, that, indeed, we will provide affordabl

president, we had a press conference with the president elect of the american medical association, dr. wilson. and i'm proud of the fact that the american medical association has now endorsed our bill. as i said at the time, i said the doctors of america have examined this bill and they've made the right prescription: pass it. pass the health reform bill. but dr. wilson in his statements made particular note of the wellness and prevention programs that we have in in bill. he didn't say this, but i was thinking when he was talking that it made sense. i mean, doctors want to keep people healthy. they don't want to see people go to the hospital. they'd rather be working with their patients one on one. how can they structure a patient's profile so the patient stays healthy, doesn't get sick so often? that's what dr. wilson was talking about. he's letting doctors practice medicine in a way that focuses on a person's health and keeping them healthy. as president obama said in his speech to congress earlier this year -- and i quote -- "it's time to make the largest investment ever in prevent

now, that was published in the journal of the american medical association june 1, 2005. in addition, a 2002 nationwide survey of 300 physicians, nationwide, this is the interactive fear of litigation study found that 79% of physicians ordered more tests than are necessary. think about that. if they're ordering -- 79% are ordering more than are necessary, you can imagine the multibillion dollars in unnecessary defensive medicine that comes from that. but that's not the end of that fear of litigation study. 74% of physicians referred patients to specialists that in their judgment did not need any such referral. think about it referring people to specialists that they knew they didn't need. think of the cost, the billions of dollars in cost. 52% of physicians suggested unnecessary invasive procedures. that word invase i've an important word. 52%. why? because they're trying to protect themselves by making sure that everything could possibly be done. 41% of physicians prescribed unnecessary medications. now, this is a nationwide survey of 300 physicians. apparently they obvio

according to a letter from the american medical association today, the a.m.a. policy specifically opposes any provision that would empower an independent commission to mandate payment cuts or physicians. further, the provision does not apply equally to all health care providers, and for the first four years, significant portions of the medicare program would be walled off for savings. this is an example of another trade association that basically decided to cut a deal with the administration behind closed doors, and they had been prevented from some of these cuts under this medicare commission while physicians have not been accorded similar treatment and they don't think it's fair. they think it's unfair, and i agree with them. this letter goes on to say -- "in addition, medicare spending targets must reflect appropriate increases in volume that may be a result of policy changes, innovations in care, that improve care, create greater longevity and unanticipated spending for such things as influenza pandemics. these are crucial issues with the potential for sign

i know that the american medical association does not represent the majority of physicians and caregivers in the state of arizona. i know that because i know too many of them. so -- but i also know that they have a very large lobbying presence here in our nation's capitol as does the other interested groups that have -- quote -- cut deals with -- that may be at peril now, according to "the washington post." so with that, i would like to obviously mention again that the doctor is in, and would the doctor care to give us some enlightened information before we give our various opinions on this issue? mr. barrasso: thank you very much, because i agree with the senator from arizona. i took -- i looked at another one of his favorite newspapers, "the new york times" today, because we have on this floor -- we have on this floor said that the democrat proposal is cutting medicare, cutting the medicare that the seniors of this country depend upon for their health care, and we pointed out that they have taken $120 billion away from medicare advantage. $11 million seniors use medicare advantage. one

let me mention the american medical association. "we are working to put the scare tactics to bed once and for all and inform the patients will the benefits of health reform." that's the american medical association. they are referring to the scare tactics of the other side. so the aarp and the american medical cal association and others know that no senior will see a single reduction in guaranteed medical benefits under this bill, not a single one. i might also say that this bill would reduce premiums that seniors would have otherwise paid. much of those savings come from limiting massive overpayments to private insurers -- that is, private companies like medicare advantage. seniors hear the word "medicare advantage," they tend to think that's medicare. it's not. it's a private company. those are private companies. and they're basically enhanced under the 2003 medicare part-d legislation. they're give an lot more money to encourage them to have competition in rural areas t turned out that we gave them way too much additional money an

the american medical association, susan b. komen for the cure continue to support mammograms starting at 40, not 50. they never meant to send the message that women should not get breast cancer screenings but women should consult with their personal physicians about the preventatives, risks and limitations on mammography. they admitted at a hearing this message has largely been lost in the media. i therefore again commend the gentlewoman from florida for her resolution today and really her work all year guided by her personal experience to improve education and awareness and the benefits of breast cancer screeling screening. the -- cancer screenings. we recently marked the 25th anniversary of the national breast cancer awareness month which celebrated great strides. we must continue that. the speaker pro tempore: the gentleman's time has expired. mr. engel: and i urge support of the resolution. the speaker pro tempore: the gentleman's time has expired. the gentlewoman from tennessee. mrs. blackburn: thank you, mr. speaker. at t

for instance, recent press reports have described how the american medical association has promised -- was promised a permanent fix to the medicare payment formula for doctors if they agreed to support this bill. or a one-year fix if there was an end to junk lawsuits. under current law, doctors' medicare payments are scheduled to be cut by more than 40% over the next decade. that's already in place. that's not a part of the bill. the cost of fixing this flawed government mandated formula will be more than $250 billion, and we know that because we've debated it on the floor and we decided that we were going to have to pay for that if we were going to do it. let's see, with $464 billion in medicare money that we're using on other things. that's why i keep saying that medicare money only ought to go to medicare benefits. and that $250 billion in fixing the doctors might make it possible for people to see the doctors. now, i can understand why doctors want to fix this flawed government price-control system, and that's what it is. they're telling the doctors what they can charge a customer

according to the american medical association's 2008 national health insurance report card, medicare -- not private health insurance -- but medicare had the highest percentage and the largest number of denied medical claims. in fact, medicare denied ten times more medical claims than private insurers. that's another reason why seniors deserve a choice between medicare and private plans that will offer them better benefits. as i mentioned today, 11 million americans have made that choice of better benefits and better care coordination through the medicare advantage program. the proposed bill, the reid bill will take away those choices and the benefits of those 11 million seniors by cutting about $120 billion from the program. now, many of our friends across the aisle will say we can cut $120 billion out of medicare advantage and it will have no impact on delivery of services, but the congressional budget office disagrees with them, the director does, who said that their benefits, their additional benefits will be cut roughly in half. we need to set the record straight on these so-call

the american medical association has also opposed this proposal. these groups recognize the potential for financial disaster by boosting the number of patients with coverage that pays well below costs. this medicare buy-in proposal would also jeopardize retiree benefits going back to the same aarp analysis that i quoted, they concluded that a medicare buy-in program could further reduce employer-sponsored health benefits. according to the aarp, i quote -- "a buy-in program might displace retiree coverage now available through their employers." still quoting aarp they said -- quote -- "as health care costs tend to drive -- to rise with age, employers might have the incentive to find ways to avoid offering private coverage for early retirees." end quote. so with fewer patients, with higher paying private coverage, there is less opportunity for providers to cost shift to makeup for low medicare payments. because everybody recognizes the federal government does not pay 100% of costs. this would make it even harder for providers to treat medicare benefic

and in fact getting all these provider groups -- the american hospital association, the american medicalssociation -- engaged in this debate because they see what a train wreck it would be for them. and, frankly, what that means is you'd have a lot of providers who wouldn't be able to make ends meet. they would have to shut their doors and go out of business because many of them are very dependent upon medicare patients. and i say that in my state of south dakota, most of your hospitals, especially in rural areas, are heavily dependent, 70% or thereabouts between medicare and medicaid. if they are not a critical access hospital and they're still getting reimbursed under the traditional medicare program, they're going to have a very, very hard time making ends meet because right now what they do is what all hospitals do. and that is they shift costs over to the private payers. here's what the a.m.a. said about that proposal. they have a long-standing policy opposing the expansion of medicare given the financial projections for the future. that's what the doctors group has said. the americ

questions that need to be -- not only is the oppose significance from the mayo clinic but the american medical association and the american hospital association have come out steadfastly against. i quote from this editorial. here we are going out for the weekend, and the editorial for "the washington post" says, "presumably, the expanded medicare program would pay medicare rates to providers, medicare rates to providers, "washington post" says presumably the expanded medicare program would pay medicare rates to providers, raising the question of the spillover effect on health care system already stressed by a dramatic expansion of medicaid. will provider's cost or shift them to private insurers driving up premiums? will they stop taking medicare patient or go to congress standing higher rates? wants 55-year-olds are in they are not likely to be kicked out and the pressure will be on to expand the program to make more people eligible. the irony of this late breaking medicare proposal is that it could be a bigger step toward a single payer system than the public option plans rejected by senate moderates as

there questions that not only is the opposition from the mayo clinic but the american hospital association and the american medical association have come out steadfast against. can i ask my colleague from oklahoma, and i quote from this editorial come here we are supposedly going out for the weekend and the editorial from the "washington post" says presumably the expanded medicare program would pay medicare rates to providers raising the question of this spillover effect on health care system already stressed by dramatic expansion of medicaid. will provider's cost or will they shift them to private insurers driving up premiums. will they stop taking medicare patients or go to congress demanding higher rates. once 55-year-olds are in the or are likely to be kicked out and the pressure will be on to expand the program to make more people eligible. the irony of this late breaking medicare proposal is that it could be a bigger step toward a single payer system than the multi public option plans rejected by senate moderates as too disruptive of the private market. >> i would answer my colleague as somebody practiced me

the big ones we all know, the afl-cio, the chamber of commerce, the national association of manufacturers, the american medicaliation, of course, the american political science association. all of those and more. and if you are a smart businessman or woman, you probably belong to the national independent federation of small business -- i forget the exact title, but that is roughly it. so what happens then? maybe you run a small hardware store, you know, a barbershop, with four or five employees. to whatever the dues may be for you in that bracket, maybe $25, $50, maybe you get some literature explaining to you what is happening on the hill with respect to small business. maybe they send you some information about an annual conference in las vegas, maybe. that is the association. then you have a lot of boutique lobbying shops around. you have a lot of former members, former hill staffers, former executive officials who have specialized knowledge, or interest in a certain area. they form their small shop with a limited number of employees. but for example, if i was a staff director -- a former staff director of

now maybe it is hard for them but it is not hard for the american medical association, the ama who levin torstar bill. it is not hard for the american heart association who have endorsed our bill. is not hard for the american cancer society action network to have endorsed our bill. the american hospital association 11 torstar erbil. families usa, the business roundtable, the small business majority. be here colleagues say small business opposes our bill. the small business organization supports it and how about the aarp who represent our seniors? millions of seniors. that is just a few. they not only defend our bill, they support our bill. madam president this is indeed an important moment in our nation's history as we approach a final vote on this major health care reform legislation and i think whenever you were trying to change something, you have to take a look at how things are at the moment so why is it that we need to change our current system? and their are certain numbers here that i think explain it. the first number is 14,000. madam president, we know that every single day, 14

our bill, the health care reform bill, has been endorsed by the american medical association, the doctors, the largest physicians organization in this country. it's been endorsed by the american hospital association, the largest organization representing our hospitals. it's been endorsed by the american association of retired persons, the largest senior citizens organization which focuses intensely on the future of medicare. but today we received the endorsement of what is regarded by most as the most highly respected medical profession in america. if you ask most americans who do you respect the most, it's the nurses. and you know why. because when you're in a hospital with someone you love or in the care of a doctor, it's the nurse who's with you those moments that make a lifetime. and the nurses today have issued their formal endorsement of this health care reform bill. rose gonzalez, who's director of government affairs for the american nurses association writes, "nurses across the country have waited decades for this historic moment and the time is at hand. once again the need for fu

i know that aarp and the american medical association are trying to tell seniors that these cuts will actually be good for the medicare program, and the program won't be harmed, but let's be honest. when you think about it, does it really make any sense? congress is going to cut cut $465 billion from a program that is already facing bankruptcy, and it will somehow make it stronger? if you believe that, i have some oceanfront property to sell you in arizona. under this bill, hospitals will be cut, nursing homes will be cut, health home agencies will be cut, hospices will be cut, and medicare advantage programs will be cut. by cutting the reimbursement rate for providers, they are making it harder for seniors to find medical providers to treat them, plain and simple. seniors will have -- will have the same benefit, but if they cannot find anyone to treat them, then their benefits don't do them any good, does it? i have to tell you that there isn't one medical provider who walks in my office each year who is happy with their reimbursement rate under medicare. i cannot think of one. hospi

coburn: the senator would probably be interested to know, the american medical association now represents less than 10% of the actively practicing physicians in this country. the physicians as a whole in this country are adamantly, adamantly opposed to this bill. and the reason they're opposed to this bill is because you are inserting the government between them and their patient. that's why they're opposed to this bill. so you have the endorsement of the a.m.a., which represents less than 10% of the practicing doctors, actively practicing doctors in this country because not only will it increase payments, but the c.p.t. code revenue's protected. that's the revenue the a.m.a. gathers from the payment system that continues to be fostered in this bill, which is their main source of revenue. mr. mccain: could i ask my colleague's indulgence for just a moment? as you know, the majority leader seems to appear more and more frantic as he perhaps is reading the same polls that we are that more and more americans, when they figure out this legislation, are becoming more and more opposed to it. so

roberts and crapo in introducing the patients act which, by the way, is supported by the american medical association. and it creates this fire wall to prevent the use of research for rationing. we filed it as an amendment, but of course we're not going to be able to vote on it now that cloture has been invoked. this is the third time this year we've tried to institute this pro-patient fire wall, but obviously we're not going to be able to vote on it, as i said. mr. president, from the very beginning of the health care reform debate, i believed that any bill should be rooted in a simple yet fundamental principle, that every american should be able to choose the doctor, hospital, and health plan of his or her choice. no washington bureaucrat should interfere with that right or substitute the government's judgment for that of a physician. there's nothing more important to americans other than maybe their freedom than the health of their family. and that does, by the way, include an element of freedom obviously. the freedom to do what you think is best for your family. we'd all do anything we could to h

i will begin with the american medical association. that's the major doctors association that support this legislation. in fact, the incoming president, president-elect of the a.m.a. in a press conference here yesterday made that statement very clear. in addition, the american heart association supports the legislation. it believes that many patient-centered provisions are a significant step forwards toward meaningful health care. the american hospital association supports passage of this legislation. the american cancer society network supports this legislation. the federation of american hospitals also support it. national puerto rican coalition supports this legislation. i might say, mr. president, it would be unfair for me to say these are all total hundred% endorsements, but rather these are statements of support from these organizations. some totally support it. some say there are very, very good features. so far as i know, none of these groups oppose this legislation. in fact, they favor it. some would like to see some changes, b

now the american hospital association, the american medical association, and the federation of american hospitals are finally taking the -- finally taking notice of the advice they're receiving from the state and local hospital associations and doctors and they finally have seen light and come out in opposition to this deal at least. i urge my friends across the aisle to resist this latest misguided attempt at deal making. the consequences are just too dangerous. you know, there's an awful lot of kactus in this -- cactus in this health care world, i just don't think that we have to sit on each and every one of them. before i yield back my time, i truly want to thank the distinguished senator from connecticut and thank him for his comity in allowing me to make these debate comments and also thank the acting presiding officer in his effort to be bipartisan. and i think we will have a sad day in this body if one side or the other gets into a situation where we do not even allow people to make remarks on not only the pending bills, but on the general issue of health care. thank you, sir. a

coburn: the senator would probably be interested to know, the american medical association now represents less than 10% of the actively practicing physicians in this country. the physicians as a whole in this country are adamantly, adamantly opposed to this bill. and the reason they're opposed to this bill is because you are inserting the government between them and their patient. that's why they're opposed to this bill. so you have the endorsement of the a.m.a., which represents less than 10% of the practicing doctors, actively practicing doctors in this country because not only will it increase payments, but the c.p.t. code revenue's protected. that's the revenue the a.m.a. gathers from the payment system that continues to be fostered in this bill, which is their main source of revenue. mr. mccain: could i ask my colleague's indulgence for just a moment? as you know, the majority leader seems to appear more and more frantic as he perhaps is reading the same polls that we are that more and more americans, when they figure out this legislation, are becoming more and more opposed to it. so

the associations that i already mentioned. in terms of the telephone directory. big ones we all know, afl-cio, chamber of commerce, national association of manufacturers, american medicalssociation, the american political scientists association. all of those and more. and if you are a small businessman or woman, you probably belong to the national independent federation of small business. i forget the exact title, but that's roughly it. what happens then? maybe you are running a small hardware store or barber shop, four, five employees and whatever the do's may be for you in that racket. what do you get? maybe some lit tur explaining what is happening on the hill and maybe they'll send you some information owe a convention in las vegas. and then we have a lot of boutique lobbying shops around and a lot of former members, former hill staffers who have specialized knowledge or interest in a certain area so they form their own small shop with a limited number of employees. if i was a former staff director of the house transportation and infrastructure committee, maybe i would decide i want to go out and start my boutique lobbying shop. what am i go go to do, i worked with

conference of mayors, the american medical students association, the afl-cio the national association for the advancement of colored people, the national association of letter carriers, the national education association the united church of christ, the uaw, international association of machinery united steelworkers, and the older american league. ..resident unanimous consent that i can submit a list to the desk of all of the organization representing millions and millions of americans who are sick and tired of the current system and want to move to a medicare for all single payer system. the presiding officer: without objection. mr. sanders: thank you. madam president there is something significant support in the house of representatives for a single-payer system. together h.r. 6676 and h.r. 1200 two different single payer programs have 94 cosponsors. let me say a word about state legislators who have moved to let me say a word about state legislatures that have progressively taught a finger payer system. in california, our largest state, the state legislature dared on two occasions

that when the aarp, the american association of retired persons set up and says this is a good ill for the seniors and americans for medicare and social security and for their families. when medical, doctors, and medical professional stand up and say this is a good bill that we have to kind of support that we need to save the american people, this is an important step forward in health care protection in america. it is time for us to make history and pass this bill. let's do it and do it in time for members to enjoy christmas with their families. not a president, i yield the floor and suggest the absence of a quorum. >> he was not imposing figure. he was not a giant of his time. and yet he emerged as the nominee at a time when the party was populated by big fears. >> his mark in history includes manifest destiny and in his new biography of james k. polk, a country of vast design, robert ehrlich said the life and times of our 11th president sunday on c-span q&a. sports executives and broadcasters told a house panel that the piracy of live sports broadcasts over the internet is a rapidly growing problem. during this two-hour hearing, the house judiciary committee heard from officia

change their positions in the future and there's no guarantee that mammograms will continue to be covered. this is on trare to positions take bin the medical association, the american college of obstetric and gynecology and the national institutes of health. i have some publications here and i'll read from them. but right now i'm hopeful that women ignore this task force's recommendation. it is for their health and for their safety and it's also for the health and the safety of their family. i would also hope that we as debate this health care bill -- that as we debate this health care bill, we ensure that we do not look at costs and then look at treatment and decide that cost outweigh treatment. yes there's a limited amount of money out there but nobody's health should be put on the line because of the dollars that are involved. and so i hope that women continue to listen to their doctors, not the government, not the insurance companies, and certainly not this task force, and make the right decisions for all of their health care. there simply is no room for a government bureaucrat and a woman's decision to screen for breast cancer and right now i have my good frie

we care about and what we stand for and when you look at aarp's endorsed it, american medical association's endorsed it, the catholic bishop had nothing but good things to say about it, and even the business round table, the top c.e.o.'s in the country said that the health care reform bill in 2019 will save them $3,000 an employee, $3,000. now you can argue with me, you can argue and call people liberal and socialist and pull out all the names that our friends on the other side have been using for the last 60 years or 70 years in their rebutals to policy initiatives by the democratic party but you can't argue with the business round table saying that the going to save them $3,000 per employee. and aren't we tired of getting calls from small business people telling us about all of the increases, all of the rate increases, and i just call a call the other day from a health care provider talking about this issue and another from a health care business person who said he just got in the mail a 50% increase for his business. that's one person out of a couple hundred gets sick, push the number up, next thing you

over again and the medical profession and medical experts, we just need to keep moving more and more towards the evidence-based medicine. the statement from the american heart association and the american stroke association goes on to say we are concerned that senator murkowski's preventative health services amendment takes a step backwards by substituting the judgment of the independent service task force to the judgment of private health insurance companies. that is a point i would very much agree with an. i don't think we want the judgment of private health insurance companies making these decisions and i would like now to recognize, appropriate the sponsor of the main amendment to finish up and she is doing a very good job. >> i would yield the final amendment to the center of wyoming. >> without objection. >> mr. president. >> the senator from wyoming. >> thank you mr. president. mr. president my wife was diagnosed with breast cancer by screening mammogram in her 40's who. it is that screening mammogram that is saved her life. by the time of the mammogram the tumor had spread and she is had three operations, to full bouts of chemotherapy. i do not want a governmen

the u.l. 2034 is an american national standards institute or a.n.s.i. standard that requires input from medical experts, approval bodies, government agencies like the cpsc, the national fire protection association each based on years of field test data intended to progressively strengthen the standard. kidde supports the standard because it tests the design for electrical safety, mechanical robustness and the accuracy of c.o. production over time and in different environmental conditions. u.l. 2034 is continually reviewed by a standards nick call panel to keep pace with technology advances and past lessons learned. this process has lead to the creation of c.o.-sensing technology that's more advanced, stable and reliable than past generations. to date, 23 states have enacted laws requiring alarms in residential dwellings and while most mandate the alarm as meet ul-2034 there is no uniform requirement. more states will likely adopt similar regulation. in order to avoid confusion state lawmakers need a consistent standard to define what constitutes an approved alarm. without such a reference conflicting regulations arise, the counter one of the cpsc's main objectives which is to develop uniform sa

again in the medical profession and medical experts, that we just need to keep moving more and more and more toward evidence-based medicine. this statement from the american heart association, the american stroke association goes to say, "in addition, we are concerned that senator murkowski's preventive health services amendment would take a step backwards by substituting the judgment of the independent u.s. preventive services task force with the judgment of private health insurance companies." that's a frank -- frankly, that's a point i very much agree with. i don't think we want the judgment of private health insurance companies making these decisions. and i'd like now to -- to defer -- to recognize -- i don't need to recognize, i just think it's appropriate the sponsor of the main amendment finish up. she's doing a very good job. a senator: mr. president, i'd yield our final minute to the senator from wyoming. the presiding officer: without objection. mr. barrasso: mr. president? the presiding officer: the senator from wyoming. mr. barrasso: thank you, mr. president. mr. president, my wife, bobbie, was diagnosed with breast cancer by a screening mammogram in her 40's.

the tough choices associated with bringing down the rising costs of medical care. it brings us to the basic question, why is cost containment so hard? first, consider the mixed incentives that drive americanalthcare. our system rewards doing more. more tests, more medicine, more specialists. whether or not it improves a patient's outcome or improves the result. our system is further driven and burdened by a malpractice liability system that threatens to punish a clinician for failing to do everything imaginable versus what he or she believes is the right thing. then there are these related factors. there's no systemic process to identify and remove ineffective or dangerous practices from our system. there's no systemic process to reward best practices and consensus on what constitutes best practice. and then we pay 50 to 60% more in unit costs than every other industrialized nation for medicines, for technology, and for professional services. these problems are part of a culture of healthcare delivery that's been building up for decades. changing it will require more than just adjusting incentives. it will require setting tangible goals that we can manage and we can measure. today, i'd li

not underestimate the stunning success of the american trial lawyers association who have made sure there is no provision in this bill that has to do with medical malpractice reform. by the way, if there is an example it is called the state of texas. the state of texas enacted meaningful and yet not draconian medical malpractice reform. premiums have gone down. doctors are flooding back into the state of texas. it has worked. they are making demonstration projects. the demonstration project is the state of texas. so instead of a reform which could save we are going to get hospitals, nursing homes, hospices. the list goes on and on up to half a trillion dollars. my motion will send it back to the finance committee and tell them to remove these unnecessary and needed harmful cuts in the medicare system which will not allow us to fulfill our obligation to the senior citizens of this country. buried in this partisan legislation as i mentioned, ten years of tax increases and medicare cuts the total over a trillion dollars. this stack of partisan legislation cost 2.5 trillion dollars over its ten year implementation. let me put this in different term

the u.l. 2034 is an american national standards institute or a.n.s.i. standard that requires input from medical experts, approval bodies, government agencies like the cpsc, the national fire protection association, users and manufacturers in order to create a robust standard of performance. first published in 1992, ul-2034 has gone through several revisions, each based on years of field test data intended to progressively strengthen the standard. kidde supports the standard because it tests the design for electrical safety, mechanical robustness and the accuracy of c.o. production over time and in different environmental conditions. u.l. 2034 is continually reviewed by a standards nick call panel to keep pace with technology advances and past lessons learned. this process has lead to the creation of c.o.-sensing technology that's more advanced, stable and reliable than past generations. to date, 23 states have enacted laws requiring alarms in residential dwellings and while most mandate the alarm as meet ul-2034 there is no uniform requirement. more states will likely adopt similar regulation. in order to avoid confusion state lawmakers need a consistent standard to define what constitutes an a