[Congressional Record Volume 155, Number 158 (Wednesday, October 28, 2009)]
[Senate]
[Pages S10800-S10805]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           HEALTH CARE REFORM

  Mr. GREGG. Mr. President, one of the first rules in health care that 
doctors learn and health care providers learn is to do no harm. So, as 
we move down the road of this health reform effort, I think we ought to 
have that as our watchword also. The health reform effort which we 
pursue should do no harm to a lot of the elements of our health care 
system which are doing pretty well.
  For example, there are a large number of Americans who get health 
insurance from the private sector--about 170 or 180 million--who are 
quite happy with their health care. They may have concerns with their 
insurance companies, legitimately, but they think their health care is 
pretty good. In fact, American health care is excellent.
  As we move down this road toward health reform, we should not harm 
those folks. We should not push them into a public plan by creating a 
system which basically disincentivizes their employers to give them 
health care, incentivizes employers to pay a penalty rather than pay a 
health care premium, and moves people over to what are called health 
exchanges in a public plan. But that is exactly what the bill did as it 
left the HELP Committee, and who knows what it is going to do when it 
comes out of the secret room where it is being written right now, but I 
wouldn't be surprised if that is exactly what it does when it returns 
from this secret room. That will be harmful--harmful to all Americans 
who have health insurance and like what they have. They like the 
doctors they see, and they don't want to have the Federal Government 
basically supplying their health care and putting them

[[Page S10801]]

under a bureaucracy where the Federal Government stands between them 
and their doctors.
  There are also a lot of senior citizens in this country today who are 
on something called Medicare Advantage. They find this to be an 
excellent Medicare Program. It gives them a lot of options they don't 
have under traditional Medicare, and they like it.
  Under the Finance Committee plan, Medicare Advantage would have been 
eviscerated. Most Americans who get Medicare Advantage would lose it--
that simple--because the Finance Committee is anticipating a $400 
billion reduction in Medicare spending, with the vast majority of 
that--or the majority of that coming out of the Medicare Advantage 
program, essentially eliminating Medicare Advantage as an option. 
People who are on Medicare Advantage would be pushed back into 
traditional Medicare. I don't think they are going to be very happy 
with that. That does them harm. That should not happen.
  As part of the ``do no harm'' we should be pursuing in health care, 
we should not cut Medicare in order to fund a brandnew entitlement for 
people who are younger and who are not on Medicare, for the most part--
who obviously are not on Medicare--and cause people who are on Medicare 
and who are quite comfortable with what they are getting under 
Medicare, specifically Medicare Advantage, to lose that option in order 
to fund a brandnew entitlement with $400 billion in Medicare cuts.
  In the new ``do no harm'' issue, there is the issue of innovation. 
Innovation is one of the great advantages our health care system has. 
You do not see innovation in England, of any significance, where they 
have a nationalized system. You do not see innovation in Canada, where 
they have a nationalized system, because innovation takes investment. 
To bring a new drug to the market requires 12 years and almost $1 
billion. Someone has to put up that billion dollars. Somebody has to be 
willing to take a risk with their money, that they are willing to 
invest in this very chancy undertaking of trying to bring a new drug to 
the market, a new drug which will help millions of Americans, 
potentially.
  But it takes money and it takes a willingness to invest in that type 
of research. Money follows return. If you set up a government-run 
program--which, inevitably, in order to reduce costs has to control 
prices--you reduce returns. It is absolutely guaranteed that if this 
country moves to a single-payer, government-run system, the innovation 
that is occurring in the area of pharmaceuticals and biologics, in the 
area of devices, will be dramatically chilled because there is not 
going to be the investment capital to pursue that type of innovation.
  Granted, the government can try to do it through government research. 
But we know government research can never replace the creativity of the 
private sector and the risk-taking of a broader market that involves 
billions of dollars of investment.
  But we also know investment follows return. If you use a government 
plan, which essentially can only save money by controlling prices and, 
thus, reduces returns significantly or reduces the number of years 
companies have control over the drug they produce, as is being proposed 
by the majority under the biologics-generic proposal down to 4 or 5 
years, then you will not get the initial investment. Those dollars will 
go somewhere else. They will go into software, they will go into some 
other technology or some other activity where the return will be 
something they think is better.
  So innovation will be chilled, significantly chilled. That does harm. 
That will do significant harm because one of the great things about our 
system, as I mentioned earlier, is that we are bringing these new drugs 
to the market, these new pharmaceuticals, these new biologics, these 
new devices which are saving lives and making people's lives better.
  No other country is doing that at the rate we are doing it because 
our country has a system which encourages that sort of entrepreneurship 
and innovation. But that will be dramatically affected if we go down 
the road as proposed, at least by the bill that was produced by the 
HELP Committee, which the majority leader said he endorses, a bill that 
has a public plan in it.
  In the ``do no harm'' category, who are the people we want to have 
take care of us? I know when I was in high school and in college, the 
best and brightest people I ran into wanted to be doctors. I liked that 
because I knew those folks, who were a lot smarter than I was, were 
going to be taking care of myself and my family if I went to see a 
doctor.
  Almost universally we know the best and brightest people in our 
society, for the most part, go into medicine. They become doctors. That 
has been our culture for a long time. But that culture will change, 
change fundamentally, when every doctor in this country is working for 
the government, when basically the doctors become bureaucrats. What 
sort of incentive is there going to be for the best and brightest to 
move into medicine then? I think we do significant harm if we undermine 
that character of our culture.
  Lastly--and this is the point I wished to talk about mostly--doing no 
harm, in a financial sense, means not creating programs which we cannot 
afford, for which we end up passing the bill on to our children. We 
know the proposal, as passed by the Finance Committee, costs between $1 
and $2 trillion.
  They will tell you: Oh, it only costs $800 billion. But that is 
because they used ``Bernie Madoff'' accounting. They said: We have a 
10-year bill. We are going to spend 5 years on the program. We are 
going to pay for 5 years of the program, but we are going to have 10 
years of income to pay for it. We are going to score as if it is a real 
bill over 10 years.
  That is absurd. You would go to jail if you did that in the private 
sector, which Bernie Madoff did. But he has been released. He is on 
work release, I think, down here working with the Democratic majority 
on how to score this bill.
  But as a practical matter, you have to match the full 10 years of 
expenditures with the full 10 years of what is alleged to be income. So 
if you have this plan fully phased in over 10 years, the cost, by our 
estimate, the Budget Committee staff estimate on the Republican side--
and it is a reasonable cost estimate--is about $1.8 trillion. The 
income alleged to occur under this bill--remember, it is coming from 
Medicare reductions and from taxes and fees--is alleged to be about 
$900 billion.
  If you give them the benefit of the doubt, if they get all the income 
they claim they are going to get, you are still about $1 trillion off. 
Well, who pays for that? That goes on the debt. Our kids pay for that.
  By the way, we skipped over one little item, which costs $250 
billion, called the doctors fix. That is not even scored in this 
exercise, but we know we have to do it--more sleight of hand on the 
accounting side, a little bit more Bernie Madoffism. The real price of 
this bill is somewhere between $1 and $1.5 trillion, unpaid for. The 
total bills' real cost is somewhere over $2 trillion. We are talking 
10-year figures here.
  So you are going to grow the government by $2 trillion because you 
are going to create this brandnew entitlement, and you are going to 
take $400 billion from the Medicare recipients and use that to pay for 
it. Then you are going to take $500 billion in fees and taxes and you 
are going to use that to pay for it.
  Well, you are about $1.2 trillion short. So who pays for that? Our 
kids. More debt. The problem we have today is, we have too much debt. 
We have too much debt. The debt is the threat to this country.
  I ask for an additional 2 minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. GREGG. We are facing a situation where our national debt is 
rising so fast because we are running deficits of over $1 trillion a 
year for the next 10 years. That is what is projected in the 
President's budget. We are essentially going to put ourselves in a 
position where we are going to be similar to a dog chasing its tail. We 
can never catch up with the amount of debt we are putting on the books.
  Now we are talking about putting a $2 trillion expansion of the 
government on top of a government that already has a projected debt of 
80 percent of gross domestic national product, which means our kids are 
going to inherit a

[[Page S10802]]

country they cannot afford to live in because their standard of living 
will be reduced in order to try to meet the obligations we are putting 
on their backs. It is not fair. It is not right.
  Clearly, if we are going to do health reform, it should be done in a 
fiscally responsible way. It is not fiscally responsible to grow this 
government by $2 trillion, take money from Medicare to pay for it, and 
pass the majority of the cost of that bill on to our kids with more 
debt. It is not a responsible thing to do.
  So in the arena of ``do no harm,'' what is presently proposed around 
here is going to do a lot of harm. That is unfortunate.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Arizona.
  Mr. KYL. Mr. President, I ask to be informed when I have spoken for 9 
minutes.
  The PRESIDING OFFICER. The Senator will be informed.
  Mr. KYL. Let me say, the Senator from New Hampshire has it right on 
target. I asked a bunch of my constituents how many believe, if we 
create a new $1 trillion health care program, it is not going to run up 
the public debt. Not one hand went up.
  I think the American people realize what the Senator from New 
Hampshire said is absolutely right. You cannot create this kind of a 
new government takeover of health care in this country and health 
insurance and not have it cost a lot of money, No. 1, and not have it 
run up the debt, No. 2.
  In fact, one of two things is true. You know, half of this is paid 
for allegedly by cutting Medicare $500 billion, although we do not know 
what the final bill will be. Maybe it is $450 billion, but let's say 
$\1/2\ trillion to round it off. One of two things is true: Either 
Congress will end up not making all the cuts in Medicare because we 
have never had the ability to do that in the past because we know it 
will cut benefits for seniors, in which case we are going to run up 
another $500 billion debt--the American people know that--or, for the 
first time, we are going to make the cuts and seniors are going to see 
their Medicare benefits cut.
  One of those two things is true. Yet our friends on the other side 
say: Oh, no, no, no. We are not going to have any new debt. Besides 
that, we are not going to lose any benefits. Well, one of those two 
things is going to happen. Either we are going to be more in debt or we 
are going to lose a lot of benefits for seniors.
  This week, of course, all the talk is about a new government-run 
insurance plan. It has lots of different names. It is called opt-out or 
opt-in or trigger or co-op or consumer or public option.
  The Speaker of the House this morning was talking about this. She 
said: I do not think we should call it public option. I think we should 
call it consumer option.
  Well, let's dwell on this for a second. Is this being paid for or run 
by consumers? No. It is being run by the U.S. Government here in 
Washington. Is it being run by the public? No, it is not being run by 
the public. It is being run by the government here in Washington. This 
is government-run insurance. That is what it is. It is a government 
insurance company that they want to compete with the private companies.
  The supporters of this are very honest about this. They say they want 
them to compete. After all, why shouldn't the private insurance 
companies have some competition from a government-run insurance 
company? So let's stop the phony characterization of it in some way 
that sounds a little better, that sounds like it is not government-run 
insurance. It is government-run insurance. Let's call it by what it is.
  Strangely, when it comes to Medicare, these same people who are all 
for competition suddenly go silent. They are not so much for 
competition in Medicare. That is what we created with a program called 
Medicare Advantage. We have the government-run part of Medicare, and 
you can have that if you want it or you can buy one of these private 
insurance plans called Medicare Advantage. Well, people on the other 
side of the aisle do not like Medicare Advantage because it is private. 
It is a private insurance company. Usually, they are health maintenance 
organizations or HMOs. They provide a lot of extra benefits to their 
enrollees and the enrollees love it.
  I get all kinds of letters from Arizonians who are on Medicare 
Advantage and they do not want us to eliminate it. Of course, that is 
what is going to happen under this legislation. They cut $120 billion 
out of Medicare Advantage because they do not want the private 
insurance companies that provide Medicare Advantage to be competing 
with Medicare, the government-run entity.
  So we are all for competition in the private sector today. We need to 
have a new government insurance company competing. But we are not for 
competition when it comes to Medicare, we want to keep that government 
run. The bottom line is this: The left, in this body and in the other 
body and in the country at large, wants a single-payer government 
system. They know they cannot get there in one jump. So they are going 
to do it in two jumps.
  First will be with all the government involvement in this bill, 
including a government-run insurance company. Then, when everybody gets 
covered under that, they can move to a single-payer system and, voila, 
you no longer have a viable private sector.
  This is not just me talking. The Lewin Group, probably the most 
respected health care consulting firm, had a study earlier this year in 
which they said 119 million Americans would be signed up within, I 
believe it is, 2 or 3 years, under this legislation, with the 
government-run insurance company.
  But here is the interesting figure: 88 million of those people 
already have insurance. They do not need a new government-run program. 
They have insurance provided by their employer. The dirty little secret 
is, when the President and others say: If you like your insurance, you 
get to keep it, that is not right. Because all the incentive is for 
your employer to shift you to the government-run plan. That is a lot 
cheaper for the employer to do that. So you may like your plan, you may 
want to keep it, but you do not get to keep it if your employer says: 
Sorry, it is cheaper for me to put you on the government plan. I am not 
going to offer you coverage anymore.
  Lewin says that will happen to 88 million Americans. This is not a 
small matter. Of course, it is also true on Medicare Advantage. If you 
like your Medicare Advantage plan, as my constituents do, Arizona has 
one of the highest percentages of seniors signed up with Medicare 
Advantage, well, that is tough.
  We are going to cut $120 billion out of Medicare Advantage and the 
value of that plan is going to be cut by about--from roughly $140-
something in value down to roughly $40-some dollars in value, meaning 
you are going to be losing just under $100 in actuarial value off your 
Medicare Advantage plan because of what we are doing here.
  All this because those on the left do not like the private sector 
providing insurance and want it eventually to go all government. The 
first step to that is this government-run insurance.
  On Monday, the majority leader announced a new tweak on this, a new 
variation. In order to try to placate some who do not like the 
government-run concept, he will say: Well, we will let the States opt 
out. What exactly does that mean? Nobody knows. Somebody has written a 
bill or at least has written a concept. Nobody that I know of has seen 
it. Certainly Republicans have not seen it. This was cooked up in the 
majority leader's office with people from the administration and some 
other Democratic Senators, and they came up with the idea that maybe it 
would not sound so bad if they let States opt out.
  What exactly does that mean? Well, first of all, I do not know. But 
does it mean everybody has to pay for it, but if you do not want to 
accept the benefits, you can opt out of the benefits? How many States 
are going to go for that? Who knows what it means?
  Somebody said: Well, how about an opt-in? I said: Well, you ought to 
ask the Democrats that. It would seem to make more sense than an opt-
out if you are going to have the program. Of course, you should not 
have it in the first place, but at least, if you have it, shouldn't you 
give people the option of deciding whether they want it and whether 
they have to pay for it? If they do not want to pay for it and do not 
want the benefits, well, maybe then it is a little different 
proposition. But that is not a good idea either, because you are still 
creating the basic government-run insurance company, and that

[[Page S10803]]

is also what is wrong with the so-called trigger.
  The idea of the trigger is, well, if the Secretary of Health and 
Human Services decides in her opinion that not enough people can get 
insurance at the right cost, then we are going to have the government-
run insurance company take over. National, paid for by the Federal 
Government, created by the Federal Government--this is government-run 
insurance.
  A co-op. That idea seems to have pretty well fallen off.
  But all of these ideas--whether it is a co-op or consumer or public 
or opt-in or opt-out, it all amounts to the same thing: It is 
government-run insurance. We do not need it. It is bad. It is a 
problem--or a solution looking for a problem.
  There are times where there is not that much competition. Why? 
Because they are generally small States without very much population. 
The last thing they need is one more insurance company coming in 
splitting up the pie. They need a large risk pool to provide the basis 
for them to be able to write insurance. And you split the risk pool up 
even more with yet another insurer, and you are not solving any kind of 
a problem.
  The final thing they said: Well, we need the government-run insurance 
to keep the insurance companies honest. That is what the State 
insurance commissioners are for. We have several former State insurance 
commissioners--the Senator from Maine, Ms. Collins; the Senator from 
Nebraska, Mr. Nelson; the other Senator Nelson--all former insurance 
commissioners, and they know their job was to keep the insurance 
companies honest. I have not heard anybody say the insurance companies 
are not honest. I heard them say: Well, they make way too much money. 
Well, obviously, that to some extent can be controlled by the 
individual States. But it is also the case----
  The PRESIDING OFFICER. The Senator has consumed 9 minutes.
  Mr. KYL. I appreciate that, Mr. President. I will conclude with this 
point: A study that came out in the papers earlier this week 
demonstrated that insurance companies ranked 35th on the list of the 
most profitable companies, making a profit of something like 2 percent. 
So the bottom line is, people say: Well, we either want to punish the 
insurance companies or give them more competition or keep them honest. 
All of these are excuses for offering government-run insurance that, at 
the end of the day, is simply a step toward a single-payer system in 
this country. That is not the kind of reform Americans want.
  The PRESIDING OFFICER. The Senator from South Dakota.
  Mr. THUNE. Mr. President, I appreciate the comments of my colleague 
from Arizona and before him my colleague from New Hampshire in pointing 
out what happens when you deal with a Federal Government insurance 
company. If you want to call it Federal Government, Inc., whatever you 
want to call it, what you are essentially talking about when the 
Federal Government takes greater control of any part of our economy but 
certainly one-sixth of our economy with health care, which is what 
health care represents--$1 in every $6 of our economy is spent on 
health care in this country--what you typically get is fewer choices 
and higher costs. That is certainly the case here because you are going 
to see fewer choices.
  I think most Americans realize that if the Federal Government has 
more control, more intervention, more involvement in health care in 
this country, it is going to ratchet down the availability of choice 
and there will be fewer freedoms for people in this country because the 
Federal Government is going to start saying what has to be in a certain 
health care policy. It is going to start getting in the way of that 
fundamental relationship between physicians and their patients. You are 
going to have more and more governmental intervention, and that 
ultimately is something I think most Americans have great reservations 
and great apprehension about.
  In fact, if you look at the bills, the various bills that are before 
the Congress today--and there are three that have been reported out in 
the House, two now in the Senate--they vary a little bit in terms of 
particulars, but they are consistent in terms of their overall themes. 
They are all going to raise taxes. They are going to raise taxes not 
just on the rich, not just on people with high incomes, they are going 
to raise taxes on ordinary Americans. All the studies bear that out. 
The Congressional Budget Office says that. The Joint Tax Committee says 
that. They are going to cut Medicare for seniors, particularly those 
who have Medicare Advantage. So Medicare benefits are going to be 
slashed if this bill becomes law. And they are going to all lead to 
higher premiums. That is the remarkable thing about this legislation. 
All these bills that are before Congress right now, which propose to 
control costs and to lower costs for people in this country, all lead 
to the same result; that is, higher costs for health care in the form 
of higher premiums.
  I want to point out something in the bill the Finance Committee 
produced.
  By the way, they are still merging these bills behind closed doors. 
There are a handful of people who are writing this bill. Contrary to 
the assertions of the President last year when he was campaigning that 
this was going to be on C-SPAN, it was going to be a wide-open process, 
and the American public was going to be able to participate and engage 
in this, this is all occurring behind closed doors. The specifics of 
this legislation are being written right now and probably will end up 
being hundreds of pages, perhaps even thousands of pages. But they all 
come back to the basic characteristics I mentioned earlier: higher 
taxes, Medicare cuts, and higher premiums for Americans.
  What is interesting about this chart I have in the Chamber is there 
are Americans who will be put into an exchange who would be able to get 
some subsidies to help purchase insurance. Obviously, there are a lot 
of people in this country who do not have access to insurance today, 
and that is what we all--Members on both sides in the Senate--want to 
address: How do we provide more Americans access to affordable health 
care in this country? So there are some who get subsidies and who would 
be able to buy insurance through an exchange. That is about 18 million 
Americans. But if you are among the 185 million Americans who currently 
have health insurance, you will pay higher taxes and your premiums will 
end up going up.
  What is ironic about this is 18 million Americans will get subsidies 
through these exchanges, but there are still 25 million Americans under 
the Finance Committee bill who will not have insurance when this is all 
said and done. So you actually have more people without insurance than 
would actually get subsidies under this plan that is being proposed by 
the Finance Committee, financed by the 185 million people who are going 
to pay higher taxes and also who are going to see their premiums go up. 
Now, I am not saying that. That is what the Congressional Budget Office 
and the Joint Tax Committee have said. That is what every independent 
study that has looked at this has said.
  By the way, last week there was an analysis that came out, done by 
the Actuary at the Department of Health and Human Services here in 
Washington, DC, that said overall spending on health care under this 
proposal--and when I say ``this,'' I am talking about the House 
proposal. Again, they are very similar in their characteristics, and in 
some of the particulars they differ. But in the House proposal, it 
would go up by 2.1 percent. If you remember, today we spend about $1 in 
every $6 in our economy on health care. At the end of the 10-year 
period, according to the Actuary at the Department of Health and Human 
Services, we are going to be spending more than $1 in every $5. So 21.3 
percent of every $1 in our economy is going to go to health care 
because under these proposals, health care costs are going to go up 
over and above the rate of inflation. In other words, if we do nothing 
today, you are going to have normal inflationary health care costs, 
which are going to increase the cost of health care. Enacting this 
legislation would increase the cost of health care 2.1 percent above 
that, or $750 billion over 10 years. That is what the Actuary at the 
Health and Human Services Department said--$750 billion in spending on 
health care above and beyond what would be normal if we did nothing 
with health care inflation in this country. So it would add 2.1 percent 
to the

[[Page S10804]]

amount we spend as a percentage of our GDP, to where 21.3 percent of 
our entire economy would be spent on health care.

  So you have health care costs going up, you have taxes going up, 
according to the Congressional Budget Office and the Joint Tax 
Committee, on people who are making less than $200,000 a year. And even 
half of the tax burden, over 50 percent, according to the Joint 
Committee on Taxation, would be borne by those who make less than 
$100,000 a year.
  The amazing thing about this, from the analysis that has been done, 
is that someone who is making 150 percent of the poverty level, which 
is $32,200 a year, because of the way the provisions in this bill would 
interact, would actually end up with an effective marginal tax rate of 
59 percent--a 59-percent tax rate--because they would lose subsidies as 
they make more money. So the incentive for someone in a lower income 
category to make more money is going to go away because with every 
dollar they make, their effective marginal tax rate is going to go up. 
It would be 59 percent for someone making $32,200 in this country 
today. That is for people whose income is 150 percent of the poverty 
level.
  So to suggest for a minute these tax increases and these tax policies 
and the way this bill is financed are not going to impact average 
Americans, working-class Americans, is absolutely wrong. It is false. 
That is what the Joint Tax Committee and the Congressional Budget 
Office have said.
  But probably the worst thing: If you are one of these 185 million 
Americans, as shown right here, who are paying the burden in the form 
of higher taxes, you are going to see, at the end of all this, that 
after all the promises that we are going to get costs under control, 
your health care costs are going to go up and your taxes are going to 
go up. If you are a senior citizen, your Medicare benefits go down. And 
guess what. Your health care costs, your insurance premiums are going 
to go up. That is what has been said consistently.
  Doug Elmendorf, the Director of the Congressional Budget Office, 
said:

       Our judgment is that piece of the legislation would raise 
     insurance premiums.

  He goes on to say:

       Those projected premium amounts include the effect of the 
     fees that would be imposed under the proposal on 
     manufacturers and importers of brand name drugs and medical 
     devices, on health insurance providers, and on clinical 
     laboratories. Those fees would increase costs for the 
     affected firms, which would be passed on to purchasers and 
     ultimately would raise insurance fees by a corresponding 
     amount.

  That is a direct quote from the Congressional Budget Officer 
Director, Doug Elmendorf.
  He also said, when asked the question about, Would these taxes be 
passed on in the form of higher premium, that roughly dollar for dollar 
they would be passed on in the form of higher premiums.
  Some of the independent studies that have been done out there suggest 
that if you are buying in the individual market as an individual, you 
are going to see up to a 73-percent increase in your health insurance 
premiums; if you are a small business, up to a 20-percent increase. The 
studies vary. I have looked at my State. They break it down, some of 
these analyses, State by State. In my State of South Dakota, if you are 
buying in the individual marketplace as an individual, you would see a 
49-percent increase. If you are buying in the individual marketplace as 
a family, you would see a 50-percent increase. If you are someone who 
is in a small group market, you would see smaller increases but still 
double-digit increases--14 percent, 15 percent above the normal rate of 
inflation. In other words, if we do nothing, if we do absolutely 
nothing, you are going to have normal inflationary increases in health 
care costs, which I think are hurting a lot of small businesses. But if 
we do what is being proposed here, it is going to be way worse because 
the overall cost of health care, according to the Actuary at the 
Department of Health and Human Services, the overall cost of health 
care above and beyond the rate of inflation is going to be $750 billion 
over 10 years or a 2.1-percent increase in overall health care costs. 
It translates, as I said earlier, into individuals, small businesses, 
and families paying higher health insurance premiums, higher costs for 
their health care, higher taxes.
  If you are among the 185 million Americans, again, who are not in the 
exchange, who do not get subsidies, you are going to pay higher taxes 
and you are going to see your health insurance premiums go up.
  There are a lot of people--a total of 282 million people--who are not 
going to be in the exchange. There are a lot of people who derive their 
health care through the government: Medicare and Medicaid. So there are 
a total of about 282 million people in this country who are not going 
to get subsidies and 18 million who will.
  By the way, again, 25 million Americans will still not be covered. 
There will be more not covered than would be able to get subsidies 
through these exchanges to buy insurance.
  The Democrats are saying: Trust us. They said that on the stimulus. 
They said unemployment would not go above 8 percent.
  The PRESIDING OFFICER. The Senator's time is expired.
  Mr. THUNE. I will wrap up with this, Mr. President. ``Trust us'' is 
not enough for the American people. The American people need real, 
meaningful health care reform that will drive costs down, not up. These 
proposals drive it up.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Arizona is recognized.
  Mr. McCAIN. Mr. President, I wish to say that the presentation by the 
Senator from South Dakota, Mr. Thune, is a strong one and a compelling 
one. I am also very impressed with his knowledge of the facts and his 
in-depth analysis of what we are apparently facing. I say 
``apparently'' because so far, as has unfortunately been the case, the 
majority leader has not shared with at least this side of the aisle or 
anyone I know of on this side of the aisle any of the specifics of the 
latest proposal. That is very unfortunate.
  As the Senator from South Dakota mentioned, the President of the 
United States, when campaigning, stated categorically that there would 
be C-SPAN cameras, that there would be Republicans, there would be an 
open process, and he was specifically addressing the issue of health 
care reform.
  Americans grow cynical from time to time about the things we say 
during political campaigns. I can only conclude that the statement made 
by the President during the campaign contributes mightily to not only 
the issue of health care reform but also the cynicism about real change 
in Washington. Change has not taken place; the majority rules.
  I certainly agree those abuses were committed when Republicans were 
in the majority in this body, and I saw it, and I fought against it. 
But it was stated just a little over a year ago that when health care 
reform came to its period of consideration by the Senate, when the 
negotiations went on, C-SPAN cameras and Republicans would be present 
so the American people would be able to see, in the President's words, 
``who is there representing the pharmaceutical companies and who is 
representing the American people.''
  Well, if we open it up now, if we opened the doors not far from here, 
we would see that already a deal has been cut with the pharmaceutical 
companies. It is an $80 billion deal done in return for $100 million or 
so in positive ads and in return for punishment to average American 
citizens because the administration agreed to a prohibition of 
importation of prescription drugs from Canada that could sometimes save 
as much as 60 percent on lifesaving pharmaceutical drugs; as well as 
the elimination of or opposition to competition amongst drug companies 
to provide prescription drugs to Medicare recipients.
  So what they have done by buying off the pharmaceutical companies--by 
the way, according to the latest reports I read this morning, the head 
of the pharmaceutical lobby makes over $2 million a year--we have now 
penalized the American people by preventing them from having choice, as 
well as seeing the influence of special interests in this country and 
in our deliberations. It is very unfortunate.
  There is a great deal of cynicism out there amongst the American 
people. It is manifest through tea parties and in other ways. Polling 
data shows the great dissatisfaction the American people have about the 
way we do business.

[[Page S10805]]

That cynicism has been authenticated by the process we are going 
through.
  I would again urge the majority leader to invite us in to sit down. 
We have some constructive ideas. We have some thoughts as to how we can 
reform health care in America. We know there needs to be reform. We 
have people such as my colleagues, two doctors--Dr. Coburn and Dr. 
Barrasso--on our side of the aisle, who have extensive hands-on 
experience with these issues. Why can't we at least at some point--
which we should have done a long time ago--be allowed to have input 
into the behind-closed-doors process that is taking place as we speak?


                           H1N1 Preparedness

  Mr. President, I wish to also say a few words this morning about an 
issue that is of great concern to me and is of greater concern 
throughout the country; that is, the availability of vaccines in order 
to combat swine flu, known as H1N1. There are long lines around the 
country. There is scarcity. There is great concern amongst the American 
people about this problem. Unfortunately, just last week, in a hearing 
before the Homeland Security Committee, the Secretary of Health and 
Human Services assured us that it was no problem and that there would 
be plenty of supplies on hand.
  The previous administration conducted the initial analysis, as we 
know, and worked with the World Health Organization to estimate the 
magnitude of this worldwide pandemic. A plan was put in place and 
stakeholders began executing their roles in protecting the public 
health.
  In the fall of 2005, in response to the government's lessons from 
combating avian flu, Congress provided $6.1 billion in the 2006 
supplemental appropriations for pandemic planning across several 
Federal departments and agencies. Since then, annual funding has been 
provided to the Centers for Disease Control and the FDA and activities 
in Health and Human Services to continue work on vaccine development, 
stockpiling of countermeasures, and assistance to States.
  In late April of this year, Margaret Chan, the World Health 
Organization's Director General, declared ``a public health emergency 
of international concern'' when the first cases of the H1N1 virus were 
reported in the United States. National and State plans were in place 
and orders for vaccines were processed. Among other actions, officials 
released antiviral drugs from the national stockpile, developed and 
released diagnostic tests for the H1N1 virus, and developed guidance 
for the clinical management of patients and the management of community 
and school outbreaks. The administration requested $9 billion in 
emergency supplemental appropriations to address the situation.
  On June 26 the President signed an appropriations bill which provided 
$1.9 billion immediately and an additional $5.8 billion contingent upon 
a Presidential request documenting the need for and proposed use of the 
additional funds. In total, from 2004 through 2009, Health and Human 
Services alone has received almost $9 billion for pandemic flu 
preparedness. Again, this doesn't account for the other billions to 
other agencies.
  However, for the $9 billion and counting the government has spent on 
preparing for pandemic outbreaks, Americans have only experienced 
frustration at vaccine shortages and the long lines for the limited 
supply of H1N1 vaccines that are available. This should make all 
Americans extremely nervous about the government possibly taking 
control of our health care system.
  Three months ago we were told--this is important. Three months ago we 
were told the CDC expected 120 million to 160 million doses by the end 
of October. Two months ago the administration's estimate of vaccine 
availability dropped to 40 million by mid October, with 20 million 
additional doses rolling out every week. Last week, the estimate 
dropped again. Now only about 28 million doses are expected to be 
available by the end of October. Yet the CDC estimates there are at 
least 45 million high-risk Americans, including pregnant women and 
children, in need of the vaccine. So according to my math, we are about 
20 million doses short.
  Unfortunately, the outbreak of the flu is widespread and deaths are 
accumulating. The Washington Post reported yesterday:

       As of October 17, 46 States were reporting ``widespread'' 
     influenza activity and many doctors' offices have been 
     swamped with swine flu patients . . . The U.S. Government has 
     ordered enough vaccine to make up to 251 million doses if 
     needed, but production has been slower than originally 
     anticipated. A total of 11.3 million doses of vaccine have 
     been shipped to U.S. doctors and hospitals and clinics as of 
     Wednesday, according to the CDC, out of a total of 14.1 
     million doses that manufacturers had shipped to warehouses by 
     that time. By Friday, 16.1 million doses of vaccine had been 
     shipped to warehouses.

  In Arizona, State officials estimated a need of 900,000 to 1 million 
vaccines for my State's 6.5 million residents.
  The PRESIDING OFFICER. The Senator's time has expired.
  Mr. McCAIN. I ask unanimous consent for 2 additional minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. McCAIN. However, Arizona has only received 263,000 vaccines as of 
yesterday. According to the Arizona Republic, the swine flu vaccine was 
only available at 35 of the 113 planned clinics in Maricopa County. The 
article quoted the county's director of public health as stating:

       It's a very frustrating situation where we are just not 
     getting what we need. Right now, it is completely out of 
     everyone's control.

  On October 24, the Arizona Republic reported:

       The lines were long, but the desire intense Saturday as 
     hundreds, possibly thousands, of people waited up to three 
     hours to get in one of today's rarest experiences: a swine-
     flu shot.

  The doses available represented a little more than 1 percent of 
Maricopa County's population. People were turned away if they did not 
fall into the high-risk group.
  Congress needs to know more information. Obviously, the hearing we 
had in the Homeland Security Committee last week was, at best, 
misleading as to the magnitude of this problem. We need more 
information from the government, and we need to act now and find out 
how we are going to get enough swine flu vaccine to take care of the 
citizens of this country. We have already invested $9 billion. I don't 
think we have a lot to show for it.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Oklahoma.
  Mr. COBURN. Mr. President, I will be recognized for the remainder of 
our time. Would the Chair tell me when I have 1 minute left, please?
  The PRESIDING OFFICER. The Senator will be informed.

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